December 2009 by San Diego Physician

understanding a knowing smile helping

your fellow

man

passion

their faces light up

December 2009

official publication of the san diego county medical society

serving our community

a grateful patient superb thanked us the staff

blend of art and science

saving lives

wealth of experiences an anguished cry

g r e at s t o r i e s

moments of validation a glow radiates interiorly

her no insurance of being cancer denials a doctor was a knowing smile gone understanding “ P HYSICIANS UNITED FOR A HEA L THY SAN DIEGO ”

We reward loyalty. We applaud dedication. We believe doctors deserve more than a little gratitude. We do what no other insurer does. We proudly present the Tribute® Plan. We honor years spent practicing good medicine. We salute a great career. We give a standing ovation. We are your biggest fans. Richard E. Anderson, MD, FACP Chairman and CEO, The Doctors Company

We are The Doctors Company.

You deserve more than a little gratitude for a career spent practicing good medicine. That’s why The Doctors Company created the Tribute Plan. This one-of-a-kind benefit provides our long-term members with a significant financial reward when they leave medicine. How significant? Think “new car.” Or maybe “vacation home.” Now that’s a fitting tribute. The San Diego County Medical Society has exclusively endorsed our medical professional liability program since 2005. To learn more about our program for SDCMS members, including the Tribute Plan, call us at (800) 328-8831, extension 4390, or visit www.thedoctors.com/tribute.

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december 2009 SAN DIEGO PHYSICIAN . o rg

thismonth Volume 96, Number 12

features 26 the joy of being a doctor 28 Saving Sight in Tecate by William L. Basuk, MD 29 Call Me an Idealist by William T. Chapman, MD 30 Mr. Gonzalez’s Story Reminds Me How Lucky I Am to Be a Doctor by Van L. Cheng, MD 31 We Are Not Just Clinicians Making Diagnoses and Treating Patients by Jeannette Del Valle, MD

32 Sometimes, When All Hope Is Gone by Lawrence D. Eisenhauer, MD 34 “Does Your Daughter Plan to Be a Doctor Like You?” by Rebecca L. Ferrini, MD 35 Surgery in the Desert by Edgar A. Gamboa, MD

joy26

The

SAN DIE GO PHY SIC IAN

.Or G dec emb

er 2009

36 Neurology as a Spiritual Journey by James S. Grisolía, MD 36 Joy Often Comes Unexpectedly, and Often Serendipitously by Steve H. Koh, MD, MPH, MBA 38 He Was Careful, Thorough, Wise, and Deeply Caring by William A. Norcross, MD

of Being a Do ctor

38 Why She Came in That Day by Robert B. Pendleton MD, PhD 40 It’s Just the Doctor Helping and Bonding With the Patient by Thomas R. Vecchione, MD

departments

Physicians cho medicine and ose their profession way, that pas for caring for patien because of the passio n ts. that the car sion gets beaten dow But too often, somew they have for e n. their commu they give their patien In an effort to remind here along the ts December nities is little short of and the service the physicians y render to 2009 issue, magical, SD to CM In the follow “The Joy of S devotes thi s, our County ph ing pages you will find Being a Doctor.” ysi joy we exp cians and one Imper submissions from 11 erie ial Shakespeare nce when, as physi County physician tha San Diego cia t wr ns, tes ote tify we care for in a sonnet to the in mind, we other hu that that our col hope you take deligh “joy delights in joy,” and man beings. t in lea you to all of gues have graciousl reading about the exp with that y cho our submitte erie profession. rs for remind sen to share with us. nces ing us of wh Th y we chose ank this noble

4 Contributors This Issue’s Contributing Writers 6 From Your Executive Director 8 SDCMS Seminars/webinars/Events

dec emb

er 2009 SAN DIE GO PHY SIC IAN

27 12 Community Healthcare Calendar .Or G

14 Briefly Noted Ask Your Office Manager Advocate and More … 18 healthcare abroad It’s Saturday Night in Pago Pago 22 humor in Healthcare reform AMA in Wonderland

44 2

SAN DIEGO PHYSICIAN. or g dec em b e r 2009

24 SDCMS’ 2009 Outstanding Office Manager Winner! 37 SDCMS Endorsed partner benefits Potential Value: $10,000–$17,000 42 Physician Marketplace Classifieds 44 Physician leadership Dr. Richard Butcher Receives CMA Award

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contributors William L. Basuk, MD

James S. Grisolía, MD

Dr. Basuk, SDCMS and CMA member since 1999, is chief of ophthalmology at Scripps Memorial Hospital in La Jolla and at Palomar Medical Center in Escondido, is a director of the San Diego Eye Bank, and is a clinical instructor at UC San Diego. He has taught and performed eye surgery in 25 countries with international organizations such as ORBIS and with local groups like the Flying Samaritans, which supports the Tecate Eye Clinic.

Dr. Grisolía, SDCMS and CMA member since 1983, is a neurologist in solo practice and has previously served as editor of San Diego Physician and as a CMA trustee.

William T. Chapman, MD Dr. Chapman, SDCMS and CMA member since 1980, is a National City, boardcertified neurologist whose hobbies include African-American studies and genealogy.

Van L Cheng, MD Dr. Cheng, SDCMS and CMA member since 2006, is currently clinical instructor of surgery at UCSD, specializing in treating all vein problems without surgery.

Jeannette Del Valle, MD Dr. Del Valle, SDCMS and CMA member since 2009, is board-certified in internal medicine and practices in Chula Vista.

Lawrence D. Eisenhauer, MD Dr. Eisenhauer, SDCMS and CMA member since 1979, is board-certified in obstetrics and gynecology and practices in Encinitas.

Rebecca L. Ferrini, MD Dr. Ferrini, SDCMS and CMA member since 2005, is medical director at Edgemoor Hospital in Santee and was honored as the “Medical Director of the Year” for 2009–10 by the American Medical Directors Association.

Edgar A. Gamboa, MD Dr. Gamboa is a board member of the Imperial County Medical Society. Board-certified in general surgery and a fellow of the American College of Surgeons, Dr. Gamboa serves as chief of surgery at El Centro Regional Medical Center. He is the author of Virtuous Healers: Models of Faith in Medicine (St. Anthony Messenger Press, 2008).

TOM GEHRING Mr. Gehring is executive director and CEO of the San Diego County Medical Society.

SAN DIEGO PHYSICIAN. or g dec em b e r 2009

Linda Halderman, MD Dr. Halderman works in the department of general surgery at LBJ Tropical Medical Center in Pago Pago, American Samoa.

Steve H. Koh, MD, MPH, MBA Dr. Koh, SDCMS and CMA member since 2009, is chief resident at the San Diego VA Hospital.

John A. LaFata, MD Dr. LaFata, SDCMS and CMA member since 1981, is board-certified in internal medicine and practices in Vista.

William A. Norcross, MD Dr. Norcross, SDCMS and CMA member since 1999, is board-certified in family medicine and geriatric medicine.

Robert B. Pendleton MD, PhD Dr. Pendleton, SDCMS and CMA member since 2003, is an ophthalmologist in private practice since 1994. He was raised in La Jolla and heads to the ocean whenever possible for fun and relaxation. His new Oceanside office, the Pendleton Eye Center, features salt-water aquariums and gallery space for displaying the works of local artists.

Thomas R. Vecchione, MD Dr. Vecchione, SDCMS and CMA member since 1974 and associate clinical professor of plastic surgery at UC San Diego (voluntary), is a San Diego plastic surgeon who performs cosmetic as well as reconstructive repair to congenital anomalies and traumatic deformities. Dr. Vecchione is one of the founding members of the Mercy Outreach Surgical Team.

Managing Editor Kyle Lewis Editorial Board Van Le Cheng, MD, Adam F. Dorin, MD, Kimberly M. Lovett, MD, Theodore M. Mazer, MD, Robert E. Peters, MD, PhD, David M. Priver, MD, Roderick C. Rapier, MD Marketing & Production Manager Jennifer Rohr Sales Director Dari Pebdani Project Designer Lisa Williams Copy Editor Adam Elder SDCMS Board of Directors Officers President Lisa S. Miller, MD Immediate Past President Stuart A. Cohen, MD, MPH President-elect Susan Kaweski, MD Treasurer Robert E. Wailes, MD Secretary Sherry L. Franklin, MD geographic and geographic alternate Directors East County William T. Tseng, MD, Heywood “Woody” Zeidman, MD (Alternate: Venu Prabaker, MD) Hillcrest Thomas V. McAfee, MD (Alternate: Eric C. Yu, MD) Kearny Mesa Adam F. Dorin, MD, John G. Lane, MD (Alternate: Jason P. Lujan, MD) La Jolla J. Steven Poceta, MD, Wayne Sun, MD (Alternate: Matt H. Hom, MD) North County Arthur “Tony” Blain, MD, Douglas Fenton, MD, James H. Schultz, MD (Alternate: Steven A. Green, MD) South Bay Vimal I. Nanavati, MD (Alternate: Asha V. Devereaux, MD) At-large Directors John W. Allen, MD, David E.M. Bazzo, MD, V. Paul Kater, MD, Jeffrey O. Leach, MD, Mihir Parikh, MD, Robert E. Peters, MD, PhD, David M. Priver, MD At-large alternate Directors James E. Bush, MD, Richard O. Butcher, MD, Ben Medina, MD, Jerome A. Robinson, MD, Alan A. Schoengold, MD, Edward L. Singer, MD, Carol L. Young, MD Communications Chair Theodore M. Mazer, MD Young Physician Director Kimberly Lovett, MD Young Physician alternate Director Van Le Cheng, MD Resident Physician Director Katherine M. Whipple, MD Resident Physician Alternate Director Steve H. Koh, MD Retired Physician Director Glenn Kellogg, MD Retired Physician alternate Director John A. Bishop, MD Medical Student Director Jane Bugea Medical Student alternate Director Iain J. Macewan CMA Speaker of the House James T. Hay, MD CMA Past Presidents Robert E. Hertzka, MD, Ralph R. Ocampo, MD CMA Trustees Catherine D. Moore, MD, Theodore M. Mazer, MD, Albert Ray, MD, Diana Shiba, MD, Robert E. Wailes, MD AMA Delegates James T. Hay, MD, Robert E. Hertzka, MD AMA Alternate Delegates Lisa S. Miller, MD, Albert Ray, MD

Lauren Wendler Ms. Wendler is your SDCMS office manager advocate. She can be reached at (858) 3002782 or at LWendler@SDCMS.org with any questions your office manager may have.

Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org. All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

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Sdecember A N D I E2009 G O SAN DIEGO PHYSICIAN P H Y S I C I A N . o r .go rg 5

fromyourexecutivedirector By Tom Gehring

s I got to thinking about the “Joy in Medicine,” I realized that’s a physician-centric perspective — that your chosen profession should be joyful, should be rewarding, and should be a force for good in your lives. Allow me to suggest that there is also a patient-centric perspective about what you do — a perspective often obliterated by the caustic and ceaseless arguments about reimbursements and insurance and co-pays and a million other detractors … My plea to physicians is that you never lose sight of the realization that to us patients, what you do is magic. Yes, yes, I know: It’s scientific, it’s evidence-based, and yes, we got rid of the leeches centuries ago! That’s not what I mean by magic. Allow me to posit the “magic” in a different way — perhaps what I would like every San Diego County physician to feel is both “joy” in what you do and recognition that what you do is not just a job, a routine skill, something that you just get up every morning and do — to us patients, it’s “magic.” Almost five years ago I wrote the following piece for San Diego Physician. I hope it helps you keep the joy and magic of what you do always in mind.

The Joy of Being a Doctor

To Us Patients, It’s “Magic”

SAN DIEGO PHYSICIAN. or g dec em b e r 2009

Three weeks ago, I became a patient. I’ve been in excellent health all my life, so I never spent a minute in a hospital. In the last six months, I finally decided that the cataract in my right eye had to be surgically repaired. I want to share some of my observations as a patient with you. First, physicians lose sight of the routine miracles they perform. I’m still flabbergasted that an SDCMS young physician, Dr. Mike Couris, was able to cut into my eyeball, remove my failed lens through a tiny aperture, insert a new lens through that same tiny aperture, and have me up and walking — with 20/20 vision in my right eye — four hours after I’d walked into the hospital. Physicians forget the magic of what they do on a routine basis. Second, being a patient is a fearful exercise. Stepping into the unknown — with the possibility of a less-than-perfect outcome on something as important as vision — makes one nervous, to say the least. Confidence in your physician — trusting your physician — is what allows patients to step into the

unknown with faith. Third, it’s a team effort. The number of people who laid their hands on me during a very short outpatient surgery was amazing. Fourth, the technology is everywhere and awesome. As an engineer — albeit an older one — I’m still amazed at the tools and materials used for that “simple,” 15-minute surgery.

What I would like every San Diego County physician to feel is both “joy” in what you do and recognition that what you do is not just a job … to us patients, it’s “magic.” Fifth, medicine is not cheap. My family is fortunate to have excellent insurance that was able to mitigate the cost of the surgery, but I cannot imagine the moral dilemma of someone who needs the surgery but is underinsured or functionally underinsured. Sixth, and finally, a warm blanket really does make a difference. As I was being put under anesthesia, the Scripps Mercy team had a heated blanket to put over me. Those are the details that are kind.

(About the Author} Mr. Gehring is CEO and executive director of the San Diego County Medical Society.

Send your letters to the editor to Editor@SDCMS.org

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december 2009 SAN DIEGO PHYSICIAN . o rg

sdcmsseminars/webinars/events

Free to Member Physicians and Their Office Staff! Don’t See What You Need? Let Us Know!

For further information, visit SDCMS.org or contact Lauren Wendler, your SDCMS office manager advocate, at (858) 300-2782 or at LWendler@SDCMS.org.

SDCMS 2010 Seminars / Webinars / Events Date Time

Topic

Presenter

S W E

Jan 7

11:30am–1:00pm

Collections

Catherine Sherman, TSC Accounts Receivable Solutions

Jan 9

8:00am–11:00am

Advocacy Training

Tom Gehring, SDCMS

Jan 13

11:30am–12:30pm

e-Town Hall (T)

Tom Gehring, SDCMS

Jan 20

6:30pm–7:30pm

Risk Management (“Scope of Practice of Allied Health Professionals”)

The Doctors Company

Jan 21

11:30am–12:30pm

Risk Management (“Scope of Practice of Allied Health Professionals”)

The Doctors Company

Jan 22

6:00pm–9:00pm

Young Physician Winter Social

SDCMS

continued ››

SAN DIEGO PHYSICIAN. or g dec em b e r 2009

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Sdecember A N D I E2009 G O SAN DIEGO PHYSICIAN P H Y S I C I A N . o r .go rg 9

sdcmsseminars/webinars/events SDCMS 2010 Seminars / Webinars / Events Date Time

Topic

Presenter

S W E

JAN 27

11:30am–1:00pm

Human Resources Law

(TBD)

FEB 4

11:30am–1:00pm

Practice Management (“Treating Patients Right”)

Judy Bee, Practice Performance Group

FEB 18

11:30am–1:00pm

Palmetto / Medicare

Michele Kelly, California Medical Association

FEB 20

9:00am–2:00pm

Retirement (“End-game Planning”)

Jeffrey Denning, Practice Performance Group

FEB 25

9:00am–7:00pm

EMR/EHR Trunk Show

Maxwell IT, Multiple Exhibitors

Certified Medical Office Manager Course

Practice Management Institute

MAR 5–26 9:00am–4:00pm

MAR 18

11:30am–1:00pm

Contract Management

Kim Fenton, Coastal Healthcare Consulting Group

MAR 24

9:00am–12:00pm

Billing and Collections Procedures (“Back to Basics”)

California Medical Association

APR 2

6:00pm–9:00pm

New Member Social (T)

SDCMS

APR 17

8:30am–3:30pm

Resident Physician Workshop (“Preparing to Practice”)

Multiple Presenters

APR 21

6:30pm–7:30pm

Risk Management (“eHealth: Telemedicine and Telehealth”)

The Doctors Company

APR 22

11:30am–12:30pm

Risk Management (“eHealth: Telemedicine and Telehealth”)

The Doctors Company

APR 28

11:30am–1:00pm

Medi-Cal

(TBD)

MAY 6

11:30am–1:00pm

Ofer Shimrat, SOUNDOFF Computing Corporation

MAY 12

11:30am–12:30pm

e-Town Hall (T)

Tom Gehring, SDCMS

MAY 20

11:30am–1:00pm

Workers’ Compensation Billing

CHMB Solutions

MAY 21

6:00pm–9:00pm

Young Physician Spring Social (T)

SDCMS

JUN 5

6:00pm–11:00pm

SDCMS Inaugural

SDCMS

Leader’s Toolbox

Tom Gehring, SDCMS

x x

JUN 18–19 8:00am–4:00pm

x x

JUN 24

11:30am–1:00pm

Sexual Harassment

Alliant Insurance Services

JUL 21

6:30pm–7:30pm

Risk Management (“The Employee’s Role in Decreasing Liability Risks in the Physician Office”)

The Doctors Company

JUL 22

11:30am–12:30pm

Risk Management (“The Employee’s Role in Decreasing Liability Risks in the Physician Office”)

The Doctors Company

AUG 18

11:30am–1:00pm

OSHA Updates

Tom Gehring, SDCMS

AUG 25

11:30am–1:00pm

HIPAA Updates

David Ginsberg, PrivaPlan

SEP 11

4:00pm–7:00pm

Young Physician Summer Social

SDCMS

SEP 15

11:30am–12:30pm

e-Town Hall (T)

Tom Gehring, SDCMS

SEP 16

11:30am–1:00pm

Palmetto / Medicare

Michele Kelly, California Medical Association

SEP 18

9:00am–12:00pm

Media Training

Tom Gehring, SDCMS

Certified Medical Coder Course

Practice Management Institute

OCT 1–29 8:00am–4:00pm

x x x

OCT 7

11:30am–1:00 pm

Economic Survivial

AKT CPAs

OCT 27

11:30am–1:00pm

Legal Issues (“Scope/Allied Health Professionals”)

California Medical Association

NOV 4

11:30am–1:00pm

Legal Issues (“Expert Witness, Medical Board Interactions”)

Alexander & Alexander, Attorneys At Law

NOV 12

6:00pm–9:00pm

New Member Social (T)

SDCMS

NOV 17

6:30pm–7:30pm

Risk Management (“Emerging Patient Safety Issues Impacting Office Practices”)

The Doctors Company

NOV 18

11:30am–12:30pm

Risk Management (“Emerging Patient Safety Issues Impacting Office Practices”)

The Doctors Company

SAN DIEGO PHYSICIAN . or g de c em b e r 2009

Happy Holidays! Happy Holidays From Your SDCMS and SDCMSF Support Teams! Back Row (L–R): Kyle Lewis, Tana Lorah, Alisha Mann, Kitty Bailey, and Marisol Gonzalez. Middle Row (L–R): Jennipher Ohmstede, Janet Lockett, Lauren Radano, Betty Matthews, Barbara Rodriguez, Karen Dotson, and Brenda Salcedo. Front Row (L–R): James Beaubeaux, Lauren Wendler, and Tom Gehring

Join

SDCMS

online today!

ww.SDCMS.org www.SDCMS.org www.SDCMS.org www.SDCMS.org www.SDCMS.org december 2009 SAN DIEGO PHYSICIAN . o rg

communityhealthcarecalendar

To submit a community healthcare event for possible publication, email KLewis@SDCMS.org. All events should be physician-focused and should take place in San Diego County. Anesthesiology Update Conference 2010

Jan. 13–16 • Kona Kai Spa Resort and Spa, San Diego • cme.ucsd.edu

10th Annual San Diego Heart Failure and Hypertension Symposium for Primary Care and Internal Medicine Jan. 16 • Estancia La Jolla Hotel and Spa • cme.ucsd.edu

Melanoma 2010: 20th Annual Cutaneous Malignancy Update

Jan. 16–17 • Hilton San Diego Resort and Spa • scripps.org/conferenceservices

7th Annual Natural Supplements: An Evidence-based Update

Jan. 21–24 • Paradise Point Resort and Spa • scripps.org/conferenceservices

Minimally Invasive Robotics Association 5th International Congress Jan. 27–30 • Manchester Grand Hyatt, San Diego • cme.ucsd.edu

29th Annual Advanced Nephrology: Nephrology for the Consultant Feb. 4–6 • Estancia La Jolla Hotel and Spa • cme.ucsd.edu

Scripps Cancer Center’s 30th Annual Conference: Clinical Hematology and Oncology

Feb. 13–16 • Omni San Diego Hotel • scripps. org/conferenceservices

33rd Annual San Diego Postgraduate Assembly in Surgery

Feb. 18–20 • Omni San Diego Hotel • cme.ucsd.edu

Headaches: Easing the Pain (15-Minute Evaluation Tools for the Busy Primary Care Physician) Feb. 27 • The Dana on Mission Bay • scripps. org/conferenceservices

Topics and Advances in Internal Medicine

Mar. 4–10 • Hilton San Diego Resort and Spa • cme.ucsd.edu

The Future of Genomic Medicine III

SAN DIEGO PHYSICIAN . or g de c em b e r 2009

Mar. 26–27 • The Schaetzel Center, Scripps Memorial Hospital, La Jolla • scripps.org/ conferenceservices

25th Annual New Treatments in Chronic Liver Disease

Mar. 27–28 • Hilton La Jolla Torrey Pines • scripps.org/conferenceservices

15th Annual Primary Care in Paradise Mar. 29–Apr. 1 • Marriott Kauai Resort, Kauai, Hawaii • scripps.org/conferenceservices

Mar. 5–6 • The Neurosciences Institute Auditorium, San Diego • scripps.org/conferenceservices

23rd Annual Review of Vascular and Interventional Radiology

Topics and Advances in Pulmonary and Critical Care Medicine

30th Annual Residents’ Radiology Review Course

Mar. 11–12 • Hilton San Diego Resort and Spa • cme.ucsd.edu

3rd Annual UCSD Urology Postgraduate Course

Mar. 13–15 • Hilton La Jolla Torrey Pines • cme. ucsd.edu

20th Annual Nelson Butters’ West Coast Neuropsychology Conference

Mar. 25–28 • Hilton San Diego Resort and Spa • cme.ucsd.edu

6th Annual San Diego Health Policy Conference Mar. 26 • The Hilton Harbor Island Hotel • prt@cwsl.edu

5th Annual Brain Injury Rehabilitation Conference

Apr. 3 • Hotel del Coronado • cme.ucsd.edu

Apr. 4–9 • Hotel del Coronado • cme.ucsd.edu

Research Summit

Apr. 9 • The Schaetzel Center, Scripps Memorial Hospital, La Jolla • scripps.org/conferenceservices

3rd Annual Sudden Cardiac Arrest: From Awareness to Prevention

Apr. 17–18 • Hyatt Regency La Jolla • scripps. org/conferenceservices

Trauma First Response 2010

Spring 2010 • California Center for the Arts, Escondido • scripps.org/conferenceservices

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brieflynoted our office is taking to prevent the spread of H1N1? The Centers for Disease Control and Prevention (CDC) has a section on infection control measures that may be implemented at the first point of contact with a potentially infected person. Visual alerts (in appropriate languages) instruct patients and persons who accompany them (e.g., family, friends) to inform healthcare personnel of symptoms of a respiratory infection when they first register for care and to practice respiratory hygiene/cough etiquette. The posters may be found at www.cdc.gov/flu/ professionals/infectioncontrol/resphygiene. htm. Visit SDCMS.org for additional H1N1 resources.

Your Office Manager Advocate Has the Answers! By Lauren Wendler

Q A

Where can we order the seasonal influenza vaccine? All of the distributors we normally order from are out of stock. The National Influenza Vaccine Summit-sponsored website “Prevent Influenza Now” has an influenza vaccine availability tracking system (IVAST) available at www.PreventInfluenza.org/ivats that has been developed to address difficulties

healthcare providers may experience when trying to determine which wholesale distributors or manufacturers have seasonal influenza vaccine in stock for sale or on order. The table is updated to reflect which manufacturers have the immunization available.

›› Seasonal Influenza Vaccine ›› H1N1 Precautions ›› Billing for Mid-level Providers 14

SAN DIEGO PHYSICIAN . or g de c em b e r 2009

Where can we find template signs to advise patients of the precautions

How do we bill for mid-level providers (nurse practitioners, physician assistants) when they work under a physician? Are there any specific modifiers that need to be used? If the mid-level provider is providing services “incident to” the physician’s professional services, then no additional codes are needed. The NPI number on the claim form will reflect which provider was providing the service. For example, the nurse practitioner’s NPI number should be listed under the physician’s NPI when the NP is providing “incident to” services. There are no additional modifiers or codes needed when billing. For further information on the definition of “incident to” services, consult CMA’s ON-CALL document #0245, “Allied Heath Professional Relationships: Business Issues,” available free to SDCMS-CMA members at www.cmanet.org. Note: Answer provided by SDCMS endorsed partner CHMB Solutions. CHMB provides free coding assistance for SDCMS members. Email your coding question(s) to SDCMS at Coding@SDCMS.org.

{About the Author}

Ms. Wendler is your SDCMS office manager advocate. She can be reached at (858) 3002782 or at LWendler@SDCMS.org with any questions your office manager may have.

›› december

quote:

“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”

-Theodore Roosevelt, 26th President of the United States

Excerpted From His “Citizenship in a Republic” Speech, Delivered at the Sorbonne in Paris, April 23, 1910

Physicians

Reducing Risks in Telephone Triage

Get Noticed! Wish Your Legislators a Happy Birthday!

Birthday: december 7 U.S. Representative Duncan D. Hunter Washington, DC, Office: United States Congress 1429 Longworth House Office Building Washington, DC 20515 T: (202) 225-5672 F: (202) 225-0235 El Cajon Office: 1870 Cordell Court, Suite 206, El Cajon, CA 92020 T: (619) 448-5201 F: (619) 449-2251 E: www.hunter.house.gov Birthday: january 12 California State Senator Dennis Hollingsworth Sacramento Office: California State Senate P.O. Box 942848 Sacramento, CA 94248-0036 T: (916) 651-4036 F: (916) 447-9008 El Cajon Office: 1870 Cordell Court, #107, El Cajon, CA 92020 T: (619) 596-3136 F: (619) 596-3140 E: senator.hollingsworth@sen.ca.gov Birthday: january 28 U.S. Representative Brian Bilbray Washington, DC, Office: United States Congress 2348 Rayburn House Office Building Washington, DC 20515 T: (202) 225-0508 F: (202) 225-2558 E: www.house.gov/bilbray Solana Beach Office: 462 Stevens Avenue, Suite 107 Solana Beach, CA 92075 T: (858) 350-1150 F: (858) 350-0750 E: www.house.gov/bilbray

{risk tip}

By The Doctors Company

he phone is a key area of responsibility for physicians, and it is critical to make certain that protocols for this important point of contact with patients are set, reviewed, and followed; otherwise, the practice is at risk. While at one time it was merely a scheduling tool, phone interactions have become an integral part of practice. Phone triage is a critical tool in managing care delivery. It is frequently the first interaction with a patient and the care team, and can help determine the patient experience. The caller’s health problems are assessed regarding urgency, and education and advice is given. All of this, however, is done without the benefit of seeing the caller who is speaking. Without proper training and supervision, telephone triage can result in improper diagnosis and management, as well as legal liability. Consider the following recommendations regarding the telephone triage system in your practice to reduce potential risk: • Outline in written protocols the questions to ask the caller, the recommended responses for minor problems, and which calls should be referred immediately to a doctor or scheduled for an office appointment. • Recognize top-priority calls and instruct the patient to dial 911 for emergency situations that involve, but are not limited to, allergic reactions, chest pain, eye injuries, burns, or shortness of breath/wheezing. • Only physicians or qualified staff such as RNs, NPs, and PAs should provide telephone triage. • Document all calls and the triage decision in the medical chart indicating advice provided. As much as possible, use the caller’s own words to describe the reason for the call. Many practices use specific forms — either paper forms or notes in the electronic records — to memorialize telephone calls. These forms then become part of the patient record and are available for other members of the healthcare team to review. • Review all telephone triage decisions for appropriateness of actions taken.

For more risk management tips, articles, and information, please visit www.thedoctors.com/ knowledgecenter. december 2009 SAN DIEGO PHYSICIAN . o rg

brieflynoted pl e a s e

w e l c o m e

Our New and Rejoining Members Welcome New SDCMS-CMA Members! Sonal Agrawal, MD Pediatrics San Diego Vitali Aizin, MD Cardiovascular Disease Chula Vista (619) 427-8646 Harry R. Albers, MD Internal Medicine San Diego (858) 764-9000 Fariba Amiri, MD Internal Medicine San Diego (619) 229-5055 Elena Y. Atchikova, MD Internal Medicine San Diego Shereen Binno, MD Obstetrics and Gynecology San Diego (858) 292-7200 Marcella R. Bothwell, MD Otolaryngology San Diego (858) 309-7701 Catherine A. Buerchner, MD Obstetrics and Gynecology San Diego (858) 764-3280 Nisha J. Bunke, MD Family Medicine La Jolla (858) 550-0330 Andrew J. Busby, MD Internal Medicine San Diego

Shannon K. Cheffet, DO Pediatrics Alpine (619) 445-6200

Mayyas S. Isho, MD Colon and Rectal Surgery San Diego (619) 686-4011

Brent E. Rathbun, MD Pediatrics San Diego (858) 499-2600

Houman Dahi, MD Sleep Medicine San Diego (619) 299-2570

Desmond A. Jolly, MD Pediatrics Chula Vista (619) 426-7910

Rene O. Sanchez-Mejia, MD Neurological Surgery La Jolla (858) 554-8920

Niloufer S. Dennis, MD Obstetrics and Gynecology San Diego (858) 268-0300

Michio Kajitani, MD Thoracic Surgery Chula Vista (619) 421-1111

Gary S. Firestein, MD Rheumatology La Jolla (619) 543-2359

Regina M. Mangine, MD Pediatrics La Mesa (619) 464-6434

Wade D. Schwendemann, MD Obstetrics and Gynecology San Diego (858) 939-6880

Janet E. Fischer, MD Psychiatry Cardiff

Ritvik P. Mehta, MD Otolaryngology La Jolla (858) 909-0770

Michelle Gonzales, MD Family Medicine Oceanside (760) 639-1204 Anshu K. Gupta, MD Surgery La Jolla (858) 909-0660 Chelsea S. Hardin, MD Surgery La Mesa (619) 462-8100 Rachelle M. Hippen, MD Family Medicine Escondido (760) 745-5832 Mark W. Huang, MD Thoracic Surgery Chula Vista (619) 421-1111 Joseph A. Hughes, MD Anatomic Pathology and Clinical Pathology San Diego

SANâ&#x20AC;&#x2C6;DIEGOâ&#x20AC;&#x2C6;PHYSICIAN . or g de c em b e r 2009

Horst-Helmut Meissner, MD Pulmonary Disease Chula Vista (619) 934-4566 Ahmad S. Mohammad, MD Neurology La Mesa (619) 460-5850 Christopher Morache, MD Psychiatry San Diego (619) 688-5855 Irene J. Oh, MD Neurology Oceanside Alexandra E. Page, MD Orthopedic Surgery San Diego Athena Philis-Tsimikas, MD Endocrinology, Diabetes and Metabolism La Jolla (858) 626-5628

Christopher C. Sullivan, MD Pediatrics Poway (858) 673-3340 Renjit A. Sundharadas, MD Pain Medicine La Jolla (858) 554-7988 Paul-Thomas Tremoulet, MD Emergency Medicine San Diego Jay I. Varughese, MD Internal Medicine San Diego (619) 471-9198 Brian H. Weeks, MD Otolaryngology San Diego (619) 229-4902

Welcome Rejoining SDCMS-CMA Members! Rafael E. Cuellar, MD Gastroenterology Encinitas (760) 632-5222 Jeannette Del Valle, MD Internal Medicine Chula Vista (619) 421-3313 Rosalind R. Dockweiler, MD Pediatrics Encinitas (760) 753-7143 Aireen L. Gutierrez, MD Geriatric Medicine San Diego (619) 677-3800 Paul E. Kim, MD Anesthesiology San Diego (619) 543-0144 Frank L. Mannix, MD Emergency Medicine Oceanside (760) 439-1963 Arturo E. Mendoza, MD Anatomic Pathology and Clinical Pathology San Diego (858) 939-3660 Manorama Reddy, MD Internal Medicine San Diego (619) 583-8700

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Get in

Touch

Your SDCMS and SDCMSF Support Teams Are Here to Help! SDCMS Contact Information

Address 5575 Ruffin Road, Suite 250, San Diego, CA 92123 Telephone (858) 565-8888 Fax (858) 569-1334 Email SDCMS@SDCMS.org Website SDCMS.org • SanDiegoPhysician.org CEO/Executive Director Tom Gehring at (858) 565-8597 or at Gehring@SDCMS.org COO/CFO James Beaubeaux at (858) 300-2788 or at Beaubeaux@SDCMS.org Director of Membership DevelopmenT Janet Lockett at (858) 300-2778 or at JLockett@SDCMS.org Director of Membership Operations and Physician Advocate Marisol Gonzalez at (858) 300-2783 or at MGonzalez@SDCMS.org Office Manager Advocate Lauren Wendler at (858) 300-2782 or at LWendler@SDCMS.org Director of Engagement Jennipher Ohmstede at (858) 300-2781 or at JOhmstede@SDCMS.org Director of Communications and Marketing Kyle Lewis at (858) 300-2784 or at KLewis@SDCMS.org Specialty Society Advocate Karen Dotson at (858) 300-2787 or at KDotson@SDCMS.org administrative assistant Betty Matthews at (858) 565-8888 or at BMatthews@SDCMS.org Letters to the Editor Editor@SDCMS.org General Suggestions SuggestionBox@SDCMS.org

SDCMSF Contact Information Address 5575 Ruffin Rd., Ste. 250, San Diego, CA 92123 Fax (858) 560-0179 Executive Director Kitty Bailey at (858) 300-2780 or KBailey@SDCMS.org Associate Executive Director Tana Lorah at (858) 300-2779 or at TLorah@SDCMS.org Patient Care Manager Barbara Rodriguez at (858) 300-2785 or at BRodriguez@SDCMS.org Patient Care Manager Brenda Salcedo at (858) 565-8161 or at BSalcedo@SDCMS.org Program Manager, Surgery Days Alisha Mann at (858) 565-8156 or at AMann@SDCMS.org Healthcare Access Manager Lauren Radano at (858) 565-7930 or at LRadano@SDCMS.org

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december 2009 SAN DIEGO PHYSICIAN . o rg

healthcareabroad By Linda Halderman, MD

It’s Saturday A Night in Pago Pago

On a Tiny Tropical Island in the Middle of the Pacific Ocean 18

SAN DIEGO PHYSICIAN . or g de c em b e r 2009

s I write this from a little tropical hospital in the middle of the Pacific Ocean on a tiny island called American Samoa, I’m trying hard to make sense of the last 72 hours. I remember sleeping at one point, eating some ramen noodles yesterday, and wondering often — but without much interest — if it was light or dark outside. I can’t wrap my brain around what has happened, so I’ll just report it and let you make your own assessment. For almost 10 days, I watched my 5-yearold patient as he healed from dengue fever and a set of superimposed infections (heart, both lungs, entire abdomen, blood, and urine), any one of which could have taken his life. But he had so many medical victories.

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december 2009 SAN DIEGO PHYSICIAN . o rg

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healthcareabroad Three days ago, I sat with him on the regular pediatric ward and watched him play with his brothers and eat Bongos (a Samoan version of Cheetos … yuck) and smile at me. He breathed the same air I did, needing no extra oxygen or any of the dozens of treatments he had required when I first arrived on the island. I had drained infected fluid from around his heart three hours into my assignment at the LBJ Tropical Medical Center. And he was getting better! No tubes, no ICU, no beeping machines. Just a little boy recovering nicely, surrounded by parents and siblings who spoiled him. For the past three days, I have watched my 5-year-old patient try to die. Three days ago, I walked by his bed on the pediatric ward and was stunned. He was short of breath and miserable. The muscles between his ribs were visibly moving in and out, trying to keep his lungs full of air. By four o’clock in the morning, he was on a

ventilator in the intensive care unit. The rest of that day and most of the next, his team of pediatricians and I struggled to stabilize him. There were X-rays and ultrasounds and blood tests and microbiology cultures. I put in chest tubes and placed intravenous lines that went directly to the blood vessels near his heart. There were four powerful antibiotics and a pharmacy’s worth of drugs. The ancient ventilator we have for children gave us few options, but we tried all of them. I put my head together with my colleague, Dr. John DePasquale, a pediatrician from New York who came to us from the CDC in Atlanta. John spent so many hours in the ICU with this patient that nurses brought him sandwiches when he forgot to eat. We were losing the war and could not even identify the enemy. Tuberculosis? Bacteria? Fungus? A novel virus or a vicious strain of a known one? We had no answers.

I didn’t have the luxury of indulging my emotions while caring for a child for whom death was a much greater likelihood than survival. Every time I met with his helpless parents, they thanked me. I thought to myself, “For what?” I could not help this child. When it became clear that this remote facility had no more resources to make a difference in the outcome of a 5-year-old

Above: American Samoa coastline from mountainside, 2009. Right: U.S. Congressman Eni Faleomavaega (American Samoa) and lbj surgeon Linda Halderman

SAN DIEGO PHYSICIAN . or g de c em b e r 2009

who had been happily munching on artificially colored orange snacks 24 hours earlier, my colleagues and I struggled to get the closest hospitals, those on Hawaii, to consider accepting the boy in transfer. We were unsuccessful. I don’t really know which of the two dozen phone calls was the one I placed to Dr. Bill Dominic, a burn surgeon/mentor of mine from Fresno. But after I described to him what was in front of me, he offered to make some calls himself. A few minutes later, Dr. Kathleen Murphy, a pediatric intensivist with the Children’s Hospital of Central California, called me. “We’d be happy to take care of him.” She was unfazed when I explained that although the child was a U.S. national, the care would be charity. There were no family or island resources for the kind of care he needed. “It’s what we’re here for,” she said. Then the logistical nightmare began. There was no transportation to California for this child. He was far too sick for commercial travel even if he could survive the four days until the next flight left American Samoa. An air ambulance was essential. But such a trip would carry an astronomical cost and require at least an overnight stay with a medical team on the way to the mainland. That presupposed he could survive 11 to 15 hours in transit. I left a desperate message for U.S. Congressman Jim Costa of California’s Central Valley. He called me back. I explained the situation in what must have sounded like an incoherent medical rant against bugs and bureaucracy and one doctor’s frustration at having the child’s only hope of survival destroyed by 7,000 miles of ocean. Congressman Costa told me to keep doing what I did as a doctor and let him deal with the rest. The next call I received was from David with the office of Congressman Eni Faleomavenga of American Samoa. And then there was a really friendly call from Costa’s chief of staff in Washington, DC, Lisa Williams. (She and I have the same streak of relentlessness. We

recognize that it’s occasionally useful but mostly just irritating to those around us.) Then there was somebody from the State Department and then Homeland Security, and of course the “Theater Patient Movement Requirement Center” (!) because they are the United States military medical transport people in the Pacific region. There were at least five of those guys and a cool, highranking lady named Captain Ellenberg. I don’t want to forget the U.S. Coast Guard’s Chief Petty Officer Smedley or Lt. Max Sada. Both intervened to help the sick boy, investing hours trying to cut red tape for a child they’d never met at the request of a surgeon who they’d never heard of. And then there was a call from the military doctor with the pediatric ICU at Tripler Army Medical Center in Hawaii. She said that the facility would be happy to care for the child if logistics were overcome. She also gave us some good suggestions for his care, which we instituted. Between all of these calls and a series of late-night and 5 a.m. conferences with Dr. Jim Marone, head of pediatrics at LBJ Tropical Medical Center, we spent our time in the ICU with our critically ill patient. Dr. DePasquale had a full load of pediatric patients to care for in addition. I depended heavily on LBJ surgery chief Dr. Kamlesh Kumar and the seriously overworked doctors of LBJ’s emergency department to cover cases and shifts while I worked in the ICU and fought cell-phone battles. They are buried under the workload but never complain. I hope reinforcements come soon to relieve them. My favorite call was from Major Matthew Nims, MD, United States Air Force anesthesiologist, Medical Transport team leader and all-around superhero. It was his commitment to care for a dying 5-year-old child en route to Tripler that made the impossible possible. At 2:30 p.m., a United States Air Force C-17 (a sort of flying intensive care unit) landed at the Tafuna International Airport in American Samoa. In addition to the pilots, there were two physicians, two pediatric ICU nurses, and a respiratory therapist. Did I mention that these people had volunteered for this mission? For four hours the Army/Air Force team and the LBJ Hospital team worked together to stabilize the boy. At some point — don’t ask me how, medically — the child began to show noticeable improvement. The LBJ in-

Left: LBJ Tropical Medical Center, American Samoa. Below: LBJ general surgery team, American Samoa, October 2009

tensive care unit nurses worked as hard as the visitors, and they had been doing it for three days straight. The little boy’s parents expressed their gratitude to everyone who entered the ICU doors. They gave the same grateful recognition to the Xray technician as they did to Congressman Faleomavenga. Transporting a critically ill 5-year-old with every available monitor, tube, and life-support device is no simple task. I rode in the ambulance with the boy and three other team members to the airport and was awed by how easy these men and women made the effort seem. The sight of the C-17 waiting for us on the runway had me repeating, “Holy Cow!” I couldn’t find any other words to describe the impossibly massive jet, nicknamed The Globemaster. It is the only aircraft in the world with a self-contained onboard oxygen system. After the little boy was safely delivered to the warehouse-size interior of the jet, I hugged Major Nims and his colleagues and walked down the ramp to find Ele (“ELLeh”), the LBJ social worker who had conquered limitless paperwork hurdles in the past three days. I looked back from a distance at the giant plane. When I saw the words “United States Air Force” on the nose, I choked up. “She’s ours,” was the thought I had. During the ride back to LBJ, all of the exhaustion and hopes and fears and frustrations and victories and grief of the past 72 hours hit me. I didn’t have the luxury of indulging my emotions while caring for a child for whom death was a much greater likelihood than survival. I don’t know if my patient will survive. I don’t know if the beautiful long dark eyelashes I looked at in the ambulance ride to

the airport will open again. But I do know that if he has a chance, it is inside the C-17 that left American Samoa tonight, in the pediatric ICU of a Hawaiian military hospital, and in the greatness of a nation that can aim its military might at saving the life of a little boy on a tiny tropical island in the middle of the Pacific Ocean. P.S. There were at least 40 other people I know of — and many more I don’t — who participated in this effort, and I don’t diminish their kindness or commitment to this work by not naming them individually. I did make one critical omission though: U.S. Representative Laura Richardson intervened with Homeland Security as a member of the Energy and Transportation Committee to cut a huge spool of red tape. She deserves credit, though neither she nor her staff asked for any. Note: For an update on the extraordinary efforts of the United States Air Force to save the life of a 5-year-old on a remote Pacific American outpost, please go to SDCMS.org/ publications.

{about the Author}

Dr. Halderman works in the department of general surgery at LBJ Tropical Medical Center in Pago Pago, American Samoa.

december 2009 SAN DIEGO PHYSICIAN . o rg

humorinhealthcarereform By Melvyn L. Sterling, MD

AMA in Wonderland With Apologies to Lewis Carroll

{About the Author}

Dr. Sterling, clinical professor of medicine at the University of California, Irvine, penned this riff on November 7, 2009, while attending AMA’s interim meeting in Houston, Texas.

SAN DIEGO PHYSICIAN . or g de c em b e r 2009

The time has come the Senator said, to talk of many things, Talk not of cabbages, talk not of kings. It’s time to talk of SGRs and fee constraints and money from the PACs, It’s time to talk of all the things you say our healthcare lacks, And how we can abuse you with our bounty hunting RACs. Come talk with us, and make a stand, We can work together, collaboration’s grand, All we need from the AMA is to give Congress a hand. We’ll repeal the SGR, have no concern, We are the Congress, we have money to burn. Reforming healthcare is our goal, we’re working night and day, Creating legislation, we’ll surely earn our pay. O doctors, come and talk with us! The Senator did beseech. A pleasant walk, a pleasant talk, Along the Grassley Mall Just give us your support, and we will do our all To do away with the SGR and not cut your fees a bit Until next year or two years hence and then you’ll surely grieve, You’ll learn that what the Congress says is not to be believed.

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sdcmsmemberbenefits

Congratulations to Anne Billeter

SDCMS’ “Outstanding Medical Office Manager” for 2009!

WANTED

Outstanding office administrator/manager for a large internal medicine practice of eight MDs, with separate practices, sharing overhead, one NP, 32 employees, and an inhouse, complex laboratory. Hours Monday through Sunday, 6 a.m. – 5 p.m. (60-hour work week). Experience required. Oh, and also need to administer profit-sharing plan, and two other, separate, related business entities: NCIM Aesthetics (with five employees) and Progressive Clinical Research (with four employees). Sixteen years experience would be nice. Good working knowledge of California employee laws, workers’ compensation, and safety requirements is required. Additionally, must supervise in-house billing and electronic medical record system. Prefer someone who doesn’t complain or ask for frequent raises.

Note: The following nomination was submitted by John A. LaFata, MD, SDCMS and CMA member since 1981, in support of his office manager’s — Anne Billeter — candidacy for SDCMS’ 2009 “Outstanding Medical Office Manager” contest. Congratulations to Ms. Billeter and to all of our member physician office managers and support staff for all that they do, day in and day out, for San Diego County’s physicians and patients!

oes it sound too good to be true? Yes, but we have just the person, in Anne Billeter, who has been a dedicated and loyal manager/administrator, friend, and counselor for 16 years. If anything, the above description is understated, as each MD has his/her own business practice, which requires separate bookkeeping, billing, and collections, as well as Medicare, state, etc., licensure and business registration. Additionally, it has been no easy task to keep each of our demanding and detailoriented, perfectionist internists satisfied with the balance of their own needs versus those of the group setting. All would agree to the complexity of challenges presented by Medicare, HMO, PPO, and the wide gamut of healthcare payers. Anne has been able to keep abreast of changing requirements, fee schedules, and payments of each payer, and analyze our ability to continue to partic-

Above: Lauren Wendler at right, SDCMS’ office manager advocate, congratulating Anne for her win. Right (L-R): John LaFata, MD, Anne Billeter, and Jon Lelevier, MD.

SAN DIEGO PHYSICIAN . or g de c em b e r 2009

ipate in these plans. Through her diligence, our collections have always exceeded 90 percent, and our AR/R ratio less than 2. HMO collections as a percentage of Medicare fees has been carefully monitored. She has stayed abreast of billing changes in order to maximize appropriate reimbursements for our services. Anne presents a kind but firm hand in managing employer-employee issues and preserves great morale. She adeptly manages workers’ compensation, disability, OSHA, personnel records, recruitment, and dismissal without unnecessary employer risk exposure. She also manages the accounting needs and recordkeeping obligations of our profit-sharing plan, cafeteria plans, and health insurance. Overhead continues to be a major challenge for all well-run medical facilities, and ours is no exception. However, employees’ hours — and certainly overtime — are carefully monitored with the goal to minimize this major overhead contributor. Supply orders, including vaccines and laboratory supplies, are regularly placed out to bid for our best ongoing price.

Congratulations go out as well to Karen Page, office manager for Steven R. Drosman, MD, SDCMS and CMA member since 2003, and Cassie Lewis, office manager for R. Christopher Searles, MD, SDCMS and CMA member since 2007 — both runners-up in our 2009 “Outstanding Medical Office Manager” contest!

Anne Billeter has been a dedicated and loyal manager/ administrator, friend, and counselor for 16 years. Addressing and satisfying the individual practice needs of each of our eight physicians is a continual challenge, especially with the need to balance these individual needs in a group-practice setting where we share overhead. To promote morale, Anne personally and silently accepts the pressure of various group practice inefficiencies, which ultimately lay with unrealistic demands of individual physicians. Our decision to adopt an EMR system required considerable research, and Anne appropriately led this effort as it applied to front-office records, reporting, and in-house billing.

When several of our physicians branched out into separate but in-house aesthetics as well as clinical research businesses, Anne was eager to assist in the personnel management, billing, and collections of these entities in an attempt to save us overhead. The “24/7” reference in the ad on the previous page is an exaggeration. We hold her vacation time at her New Hampshire cottage sacrosanct — after all, there is no cell phone service in those woods! The bottom line: Anne Billeter is the best practice administrator/manager we know, and we would hate to be in this business without her!

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december 2009 SAN DIEGO PHYSICIAN . o rg

The

joy

SAN DIEGO PHYSICIAN . or g de c em b e r 2009

of Being a Doctor Physicians choose their profession because of the passion they have for medicine and for caring for patients. But too often, somewhere along the way, that passion gets beaten down. In an effort to remind physicians that the care they give their patients and the service they render to their communities is little short of magical, SDCMS devotes this, our December 2009 issue, to “The Joy of Being a Doctor.” In the following pages you will find submissions from 11 San Diego County physicians and one Imperial County physician that testify to the joy we experience when, as physicians, we care for others. Shakespeare wrote in a sonnet that “joy delights in joy,” and with that in mind, we hope you take delight in reading about the experiences that our colleagues have graciously chosen to share with us. Thank you to all of our submitters for reminding us of why we chose this noble profession.

december 2009 SAN DIEGO PHYSICIAN . o rg

The

joy

of Being a Doctor

Saving Sight in Tecate By William L. Basuk, MD

’ve had the fortunate opportunity over the past 15 years to work regularly just across the border in a small charity eye clinic in Tecate, Baja California, Mexico. One Saturday each month, a group of San Diego-based ophthalmologists, optometrists, technicians, and support staff, in conjunction with local Mexican authorities, operates a clinic devoted to restoring

Joy can only be real if people look upon their life as a service, and have a definite object in life outside themselves and their personal happiness. — Leo Tolstoy sight. San Diego’s unique proximity to our southern border makes outreach trips such as these sustainable and repeatable. Though we may be divided by a line on a map, to a certain degree we are one community, in which access to care and the resulting degree of pathology varies markedly. Our primary procedure is cataract surgery. Our patients do not merely have blurry vision. Almost all are blind. A typical patient is screened with a brief penlight eye exam. Examination of the retina, an important part of the work-up here at

suk, MD William L. Ba

William T. Ch apman, MD

SAN DIEGO PHYSICIAN . or g de c em b e r 2009

“Joy lies in the fight, in the attempt, in the suffering involved, not in the victory itself.” — Mahatma Gandhi

home, is usually impossible as most of these severely cataractous lenses are opaque. Visual acuity is measured, antibiotic and dilating eyedrops are applied, and a brief history is taken. The patient lies down, and a local anesthetic is given. A simple, cost-effective cataract surgery is then performed, using modern lens implants. The entire process from beginning to end takes minutes — certainly less than an hour. When one patient leaves the OR, the next one enters, and the process repeats. There is no ream of intake sheets, demographic data, and authorizations. No insurance denials, 24-hour H&P updates, medication reconciliation forms, or dictations. Not even an IV. The “chart” for each patient is four lines on a sheet of paper. The next morning the patch is removed and the patient can see. The world is clearer. Reading, cooking, and other work not previously possible can now be done. Independence is regained. A grandchild is seen for the first time. The joy of medicine comes from the feeling one gets by making someone’s life better. The feeling we had that first time we removed a patch from a post-op patient’s eye as a resident, and saw a knowing smile. Or the first time a grateful patient thanked us for a job well done. In our little clinic in Tecate, the rewards may be more emotional than financial, but they are no less real. To me, this is medicine in its purest sense.

{About the Author}

Dr. Basuk, SDCMS and CMA member since 1999, is chief of ophthalmology at Scripps Memorial Hospital in La Jolla, a director of the San Diego Eye Bank, and clinical instructor at UC San Diego. He has taught and performed eye surgery in 25 countries with international organizations such as ORBIS and local groups like the Flying Samaritans, which supports the Tecate Eye Clinic.

Call Me an Idealist By William T. Chapman, MD

hen I entered medical school, my ambition, like a few other classmates, was to serve the underserved, to bring quality care to the poor. This resulted in me establishing my practice in neurology in National City. By doing so I could serve a mixed population while living in an area with a beautiful climate. After more than 20 years of practice, has it been worth it? Yes. After all, I have been serving my target population, and although I have not made much money doing so, I in turn have a wealth of experiences that I will never forget. Learning about cultures and values of my patients has been an occupational necessity. They are from Mexico, Philippines, Laos, Vietnam, Ethiopia, Eritrea, Somalia, Samoa, Iraq, Iran, and many other countries. Their faces light up, and sometimes they laugh if I speak of one of their traditions or say a sentence in their native tongue. I have learned to be more patient and value the family when they bring four or more concerned family members during their visit. I have advocated for my patients, obtaining services for some that they might not normally have received. I have argued for my patients before county committees. When our community hospital was changing ownership, I argued for continued nonprofit status. However, since coming under private ownership, the administration has streamlined services, hopefully ensuring the hospital’s continued existence. What I encourage colleagues to consider is that it’s not all about reimbursement. Consider what footprint you are going to leave behind. By the way, I was able to send four children to college on my meager salary, so it can be done.

Congratulates These Outstanding Physicians Who Have Been Recognized By Their Peers For Providing Exceptional Care Robert Michael Adamson, MD Thoracic Surgery William E. Bowman, MD Orthopaedic Surgery Lynne Michelle Champagne, MD Internal Medicine Raymond Chinn, MD Infectious Disease Sherry Lynn Franklin, MD Pediatric Endocrinology James W. Lyon, MD Vascular and Interventional Radiology Ada Maria Marin, MD Family Medicine Lorraine M. Stanco, MD Obstetrics/Pregnancy Specialist Martin T. Stein, MD Pediatrics

Physicians Medical center, 7910 Frost st, san diego 92123 Cambridge Healthcare Properties extends its appreciation to all physicians and health practitioners at the Physicians Medical Center for their gift of service and dedication to their patients.

{About the Author} Dr. Chapman, SDCMS and CMA member since 1980, is a National City board-certified neurologist whose hobbies include African-American studies and genealogy.

Physician Recognition: The San Diego Medical Society (SDCMS), working collaboratively with San Diego Magazine, has sponsored the annual Top Doctor recognition awards for six years. SDCMS member physicians vote for those board-certified doctors who practice within San Diego County to whom they would refer their patients and family members.

december 2009 SAN DIEGO PHYSICIAN . o rg

The

joy

of Being a Doctor

Mr. Gonzalez’s Story Reminds Me How Lucky I Am to Be a Doctor By Van L. Cheng, MD

, MD Van L. Cheng

Jeannette D el Valle,

r. Gonzalez hobbles into my office, a son and a daughter flanking him on either side. I soon realize that he has an infected ulcer stemming from horribly dilated and nonfunctioning varicose veins. It was obvious he was not my typical patient. Mr. Gonzalez was applying a “medicinal” powder he got from Tijuana to his ulcer daily, to no avail. With his children translating, I learn that he is a dishwasher who stands all day and, despite his pain, continues to work very long hours. Mr. Gonzalez’s story reminds me how lucky I am to be a doctor here in the United States. My father was a dishwasher when he first immigrated to this country without a penny to his name. He worked long hours to make sure my mother, siblings, and I could come over. When I passed the Statue

Sometimes your joy is the source of your smile, but sometimes your smile can be the source of your joy. — Thich Nhat Hanh of Liberty more than two decades ago, I knew one thing: This country would always give me an opportunity if I tried my hardest. As long as her torch remains glowing, I can reach my goal of being a medical doctor. After writing an antibiotic prescription and educating Mr. Gonzalez on the care of his ulcer, I reassure him that I will treat him. I tell him he reminds me a lot of my own father’s story. I tell him it is my way of paying it forward. I tell him this is part of the joy of being a doctor.

{About the Author}

Dr. Cheng, SDCMS and CMA member since 2006, is currently clinical instructor of surgery at UCSD, specializing in treating all vein problems without surgery.

SAN DIEGO PHYSICIAN . or g de c em b e r 2009

“Joy is a net of love by which you can catch souls.” — Mother Teresa of Calcutta

We Are Not Just Clinicians Making Diagnoses and Treating Patients By Jeannette Del Valle, MD

very morning before the sun rises, I wake up and thank God for everything I have, the ability to wake up, see the light, get up, walk, talk, move, eat, and all the things many people take for granted. I feel fortunate to have the opportunity to help other people be able to wake up in the morning to the same sunrise, and thank God. As a doctor I enjoy teaching my patients to care for their health, the most precious treasure. I believe in motivating patients to exercise regularly, to follow a healthy diet, and to modify their lifestyle. I urge my pa-

tients to carry with them a list of their allergies and their medications. I encourage them to play an active role in their medical care and to be organized with their medications so they will not get confused. As a doctor we are not just clinicians making diagnoses and treating patients. We are psychologists, teachers, and motivators. Many diseases are aggravated or precipitated by patients not understanding their illnesses — like diabetes, hypertension, and dyslipidemia — and many patients succumb to renal failure, severe peripheral vascular disease, or coronary artery disease. As doctors, we must use empathy, understanding, and real listening. We must take the extra time to discuss patients’ concerns and answer any questions they may have. This is what patients are grateful for. Let’s make medicine not just a science but an art where patients are not numbers but human beings who have trusted us with their

physical well-being. They want to be treated the same way we would want to be treated, the way we want our families to be treated: with respect and care. We enjoy what we do every day, and we make a difference in people’s lives all the time. The joy of being a doctor is the gratification of doing good every day for people, and serving our community with passion.

{About the Author}

Dr. Del Valle, SDCMS and CMA member since 2009, is board-certified in internal medicine and practices in Chula Vista.

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The

joy

of Being a Doctor

Sometimes, When All Hope Is Gone By Lawrence D. Eisenhauer, MD

met her as a psychology doctorate student. Her name was Patricia, and after 30 years, my care of her is like yesterday. I will never forget several things I learned from her: 1. 23-year-olds can have 12-cm ovarian cancers surprise a young gynecologist. “Complete debulking” in 1979 would be grossly inadequate today.

Her husband left her during the post-operative period, and Patricia refused chemotherapy. She took her horse and returned to Colorado where she had vacationed as a child, to die. She continued to have CA125 levels done, and, with rising numbers, when asked, her oncologist said, “She is going to die.” She returned regularly for follow-up, and we talked about the enlarging abdomen, etc. However, one visit she related the following series of events: Patricia was riding her horse through a mountain meadow in Colorado and had what she described as a “blinding light” ex-

“Who is the happiest of men? He who values the merits of others, and in their pleasure takes joy, even as though t’were his own.” — Johann Wolfgang von Goethe 2. Rational people can refuse rational treatment; she had one alkeran dose and left therapy. 3. Some things are not explainable in our lives and practices — read on …

Lawrence D. Eisenhauer

perience. When she awoke from her unconsciousness, she knew that her cancer was gone. In fact, her exam returned to normal as did her CA125s. I had no clue what had happened. Her oncologist said it was the one tablet of alkeran months before; another wanted to know where the meadow was; another, what water she was drinking. As a scientist, however, I had no plausible explanation. I knew I had witnessed a true, large miracle. I followed her for many years, then lost track of her. She taught me the joy of always having hope despite the statistics of pessimism. She also taught me to look for the miracles that are happening daily — those that we either miss or take personal credit for. There is a joy in knowing that I do not have control over the outcomes of my patients’ treatment. Though I cannot count on miracles, they can happen … sometimes when all hope is gone.

{About the Author}

Dr. Eisenhauer, SDCMS and CMA member since 1979, is board-certified in obstetrics and gynecology and practices in Encinitas.

SAN DIEGO PHYSICIAN . or g de c em b e r 2009

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The

joy

of Being a Doctor

“Does Your Daughter Plan to Be a Doctor Like You?” By Rebecca L. Ferrini, MD

n the flurry of college application essays and life decisions, I pause and reflect: Do I want my daughter (or one of my sons) to be a doctor like I am? The deep exhaustion, insecurity, and poverty of medical training has passed and is replaced by a professional identity, confidence, and passion for daily attacking and solving problems, sharing the intimacies of people’s lives, leading teams, and nudging patients towards health. What other profession is a blend of art and science, heart and hands, purely intellectual pursuits and constant interaction with others, doing daily good and establishing a lifetime identity that is recognizable to all? And what other profession has such great stories?

I remember J, an illiterate immigrant who suffered a catastrophic auto accident and was left a quadriplegic. Years of anger and withdrawal followed, but persistent contact with professionals opened his mind to possibilities. He completed a GED then entered college and began mouth painting. He said his accident was the “best thing that ever happened to him,” and I learned that nothing prevents pressure ulcers and infections and chronic pain like a vision for the future and happiness. I remember A, a patient with Huntington’s Disease who required a nurse 24/7 to keep him from crashing into things and harming himself, but who nevertheless eked out daily pleasure: food, a good BM, or a visit from his wife. The only thing that quieted his incessant movements was death, which is considerately timed to best coincide with the schedules of his family. I remember L, who lost years of life to psychosis and alcoholism, but who came back after the involuntary administration

Participate joyfully in the sorrows of the world. We cannot cure the world of sorrows, but we can choose to live in joy.

errini, MD Rebecca L. F

— Joseph Campbell of depo-Haldol wondering who she was and what happened, and struggling daily to reconcile what she saw around her with what her mind said was true. My daughter has many options, and I am trying hard not to push her in any one direction, but I quietly hope that she sees the passion and satisfaction and joy I have from my profession and chooses to follow a similar path.

{About the Author}

Edgar A. Gamboa, MD

SAN DIEGO PHYSICIAN . or g de c em b e r 2009

Dr. Ferrini, SDCMS and CMA member since 2005, is medical director at Edgemoor Hospital in Santee and was honored as the Medical Director of the Year for 2009–10 by the American Medical Directors Association.

You shall have joy, or you shall have power, said God; you shall not have both.” — Ralph Waldo Emerson

Surgery in the Desert

By Edgar A. Gamboa, MD

he little girl, with a Glasgow of 9, had been in a rollover on Interstate 8. The trauma team resuscitated her in the ER. In the OR, we packed her liver, ligated one renal artery, and repaired a ruptured hemidiaphragm. The anesthesiologist reversed hypothermia and blood loss, the circulating nurses rushed the argon beam and autotransfusion units in, and the surgical techs were zipping. As we closed her chest and abdomen and put in the last stitch, there was a collective sigh of relief. Behind the mask, I smiled at my co-surgeon, thanked everyone, picked up the chart, and dictated the case. One minor misstep would have lost her. Had paramedics not rescued her quickly, had the ER

staff not kept up with her pressure, had we missed a bleeder, she would not have survived. “A glow radiates interiorly when you find yourself in such a situation,” Dr. Tom Dooley once said. I imagine it is the same delight that my colleagues in obstetrics experience when a newborn cries out after a difficult delivery, when pediatricians watch their asthmatics breathe easier, when internists reverse overwhelming sepsis, when ER physicians get a heart beating once more … Then we forget about ICDs and CPTs, authorizations, denials, malpractice, healthcare reform, and such vicissitudes. The essence of medicine is, after all, treating the sick and saving lives. I went out to the waiting room. The grateful smiles of caring relatives and friends made me happy that I am still practicing medicine. For, as Mother Teresa of Calcutta said, “Yours is a consecrated life. Yours is not

only a profession but a vocation, the vocation to be God’s love, God’s compassion. Being a doctor means going out and touching God in each of the suffering, whether rich or poor, for sickness strikes all.”

{About the Author} Dr. Gamboa is a board member of the Imperial County Medical Society. Board-certified in general surgery and a fellow of the American College of Surgeons, Dr. Gamboa serves as chief of surgery at El Centro Regional Medical Center. He is the author of Virtuous Healers: Models of Faith in Medicine (St. Anthony Messenger Press, 2008).

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december 2009 SAN DIEGO PHYSICIAN . o rg

The

joy

of Being a Doctor

Neurology as a Spiritual Journey By James S. Grisolía, MD

fter a miscarriage, a young woman mysteriously began continuous, shaking seizures, with no prior history of epilepsy. When I first saw her in the hospital, she was already heavily medicated, too groggy to interview.

We choose our joys and sorrows long before we experience them. — Kahlil gibran

solía, MD James S. Gri

Steve Koh, MD , MPH, MBA

SAN DIEGO PHYSICIAN . or g de c em b e r 2009

Overnight, she had more attacks, so I came in early the next morning. Despite frequent seizure movements, her EEG showed only normal brain activity. Finding her awake, I congratulated her that her “seizures” were not epilepsy. I suggested that her miscarriage must have been stressful, and she agreed. After a moment, she added, “Interesting that you say these are ‘stress seizures.’ As I went into each attack, I felt just like when I was little, and I always used to ‘go away’ mentally when my mother beat me.” After more questions, I suggested she might be trying to repair the abusive, broken relationship with her mother by raising her own child as she wished she had been raised. Losing her pregnancy brought an anguished cry from the deeps of her own childhood unconscious. She said, “Doctor, that sounds right to me.” She never had another attack, as I learned years later when she returned for a different problem. Like everyone, I began my specialty on a steep learning curve, reading about each patient’s illness through residency and the first years of practice. Now, I’ve shifted to online searches for rare conditions, but each patient’s shining inner self continues to offer new depths and layers and marvels. Increasingly, I find the physical illness lies embedded in a web of stresses and dislocations.

Now, listening comes after diagnosis: Helping people identify lifestyle and spiritual factors underpinning their migraines, seizures, or dizzy spells creates tiny, exciting discoveries each day, while helping another soul move toward the spiritual reorganization they need for lasting relief creates joy daily. Even in brokenness, pain, or illness, the brain continues to fascinate as the physical anchor for the human spirit, the focus of so much tribulation, yet so much hope.

{About the Author}

Dr. Grisolía, SDCMS and CMA member since 1983, is a neurologist in solo practice and has previously served as editor of San Diego Physician and as a CMA trustee.

Joy Often Comes Unexpectedly, and Often Serendipitously By Steve W. Koh, MD, MPH, MBA

t seems to me that “the joy of being a doctor” comes unexpectedly and often serendipitously. Unexpected because being a doctor and taking care of patients becomes a habit, day in and day out. Serendipitous because the moments that give us joy happen almost by chance and therefore are appreciated more so because of it. During call one night, I saw a young, intoxicated veteran who recently arrived from Iraq. In psychiatry, such cases are not uncommon these days. However, we are trained to look for the unusual and make sense of the seemingly benign yet oddly atypical presentations. This reliance on training, at times, makes for longer case formulations but allows one to function with discipline. Even though I was habitually screening for symptoms of PTSD (sadly, much too common) and for his pattern of alcohol use (often to self-medicate), I remember thinking that his speech was not quite right. One of his eyes did not seem to move the same as the other. His attention seemed to fluctuate and become progressively more confused. Almost on a whim and with some convincing to radiology, I got a head CT and off he went to surgery for an acute bleed. I remember talking to his mother, who

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december 2009 SAN DIEGO PHYSICIAN . o rg

The

joy

of Being a Doctor

orcross, MD William A. N

seemed confused that a psychiatrist was talking to her about a head bleed. It turns out he did have PTSD and was indeed using alcohol to self-medicate. She expected a talk about medication compliance, the need for her son to stop drinking, and getting into PTSD treatment. Seeing the patient’s improvement after surgery, I felt rewarded from such a successful outcome. How fortunate it was to discover and manage such an acute issue. As a young doctor, these are the moments of validation that I take with me to each patient encounter. To always look for the unexpected and to recognize them for what they may or may not represent. To feel that my years of training led to such a serendipitous moment to care for him was a joy for me.

{About the Author}

Dr. Koh, SDCMS and CMA member since 2009, is chief resident at the San Diego VA Hospital.

He Was Careful, Thorough, Wise, and Deeply Caring By William A. Norcross, MD

Robert B. Pen dleton MD, P hD

SAN DIEGO PHYSICIAN . or g de c em b e r 2009

hen I reflect on what is good and right and noble about our profession, I think of my mentor, friend, and role model, Dr. Sam Smith, of the Lemon Grove Medical Group. When I first came to UCSD in June of 1974 as an intern in that first family medicine residency class, we did not have our own clinic on the university hospital campus. For that first year our clinics took place at the Linda Vista Community Clinic. More than 35 years have come and gone since then, but I can still easily recall with warmth and gratitude the superb staff and wonderful patients who made us feel at home. The internship year is a challenge for all physicians, but my weekly family medicine clinic was a joy and a window on what a career as a family physician could be. Sam spent every Thursday afternoon as my personal mentor, teacher, and preceptor. He freely and happily devoted a halfday every week, year-round to me and to

the care of my patients. He made certain he supervised me carefully on each and every patient, yet had the magical talent that great clinical mentors seem to have, of giving the student sufficient freedom to become a physician. He was careful, thorough, wise, and deeply caring. He was the consummate professional. He taught me through personal example that by developing my clinical acumen I would not only deliver better quality care, but would order fewer tests as well. He was always happy and upbeat, even when I knew that both of us were bone tired. I can think of only one way to repay his profound generosity: to work every day to be worthy of his example, to experience daily the joy of medicine.

{About the Author}

Dr. Norcross, SDCMS and CMA member since 1999, is board-certified in family medicine and geriatric medicine.

Why She Came in That Day

By Robert B. Pendleton MD, PhD

t was an afternoon resident’s clinic at our children’s hospital. I was calling my first patient when a 5-year-old Hispanic girl with Coke-bottle glasses bounded toward me. Big black curls flew around her head as she crashed into my leg, giving me a big hug with all her heart. Then she scampered away. I watched her briefly, trying to remember her, but drew a blank. Hours later the little girl was politely perched in my exam chair. She didn’t know her letters, so I used pictures to measure her vision with glasses: normal. I turned on Pinocchio on a monitor across the room, and she watched it alertly. Aside from high myopia, the exam was normal. I flipped the chart note to her previous visit only two weeks prior. She had seen the attending and his findings were the same; he wrote, “follow-up, six months.” “Why did she come in today?” I asked her mother. My knowledge of Spanish was limited. Not hearing anything relating to the eyes, I nodded my head. I then flipped the chart note to her first

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The

joy

of Being a Doctor

visit — four months prior — and was surprised to recognize my handwriting. In a wave it came to me, and I remembered a hyperactive, illiterate, uncooperative little girl, squirming around and unable to concentrate. Mother was just out of drug rehab, and she was just out of foster care. I remembered uncertainty about my diagnosis of extreme myopia. Then I remembered pinning trial glasses onto her and how they instantly had transformed her behavior. With glasses, she slowly gazed around the room. She stared at Pinocchio and giggled, and I remembered thinking that she actually was seeing the world around her for the first time.

me, the pure joy of being a doctor is in my participation in the Mercy Outreach Surgical Team (MOST). Our group has been undertaking missions to Mexico for 25 years. Each year MOST completes two weeklong mission trips deep into Mexico as well as three or four weekend trips to Tijuana, resulting in our team’s helping about 800 children and adults live a better and happier life every year. The joy of this team effort is palpable during each of these trips. This is particularly powerful when the mother sees her child come back from surgery and into the recovery area. She sees that the cleft lip and palate

Grief can take care of itself, but to get the full value of a joy you must have somebody to divide it with. — Mark Twain

hione, Thomas R. Vecc

We scheduled a follow-up at the reception desk, and they walked away hand in hand. “Why did she come in today?” I asked the Hispanic receptionist, not really expecting an answer. “The little girl wanted to thank you. She said that you changed her life.”

By Thomas R. Vecchione, MD

have been repaired or the crossed eyes are straightened or the facial tumor has been removed. This one scenario is the reason that the members of our team keep coming back year after year. This is the real joy of being a doctor. Today’s medicine, with all of the external forces, can result in a slow erosion and dissolution of the joy of taking care of our patients. But the simple, unencumbered relationship of that one patient and that one doctor is so important in the preservation of the spirit of our medical practice. Any medical community outreach project can erase many of these barriers. It’s just the doctor helping and bonding with the patient. This happens without regard for insurance companies or government authorizations or troublesome regulations. This is the real joy of being a doctor in its purest form … this is the goal toward which I think all of us strive. It’s why we all became doctors.

When all the smoke of healthcare politics has been blown away, what remains is the pure joy of being a doctor, of helping your fellow man. That is the one thing that all of us realize as we practice medicine today. For

Dr. Vecchione, SDCMS and CMA member since 1974, is a plastic surgeon and one of the founding members of the Mercy Outreach Surgical Team.

{About the Author}

Dr. Pendleton, SDCMS and CMA member since 2003, grew up in La Jolla, trained in Chicago, and has been practicing fee-for-service ophthalmology in Oceanside since 1997. He learned from his travels to try to see the world each day through the eyes of a traveler in a foreign land.

It’s Just the Doctor Helping and Bonding With the Patient

SAN DIEGO PHYSICIAN . or g de c em b e r 2009

{About the Author}

Project Access

San Diego

Volunteerism Made Easy The heart of the program is to link low-income, uninsured adults in San Diego County with specialist volunteers who agree to see a limited number of patients per year in their office for free. • Physician Volunteer Flexibility: Physicians set their own volunteer commitment (ideal is one patient per month). Project Access patients are seen in the private office setting so you do not have to travel far to provide care for the medically underserved. • Enrolling Patients Based on Need: Patients are referred to us exclusively from the community clinics in the area and do not qualify for any type of public health insurance program. Specialty care is a significant challenge for the clinics, and many patients endure wait times of up to six months to see a volunteer specialist at their clinic. • Making Appropriate Referrals: Project Access publishes referral guidelines for community clinic

use. Our Chief Medical Officer also reviews each case individually so that specialists see only the most appropriate referrals. • Providing Enabling Services: We provide services such as transportation and translation so that you don’t have to wonder if a patient is going to miss an appointment or if there will be a language barrier. • Providing Case Management Services: We work with each patient one-on-one to coordinate followthrough on all medical needs. • Providing All Needed Services: Through our partnerships, we ensure that a full scope of services is available to all of our patients, from hospital and ancillary services to a defined pharmacy benefit.

Join over 75 specialists as a Project Access volunteer! Project Access is actively recruiting physicians, hospitals, and ancillary service providers to participate in our program. Together we can ensure that our vulnerable populations have access to needed healthcare services. Your commitment to Project Access is needed for our success! Please visit our website at SDCMSF.org to learn more and to sign up.

Sign up NOW at SDCMSF.org We need your volunteer commitment to help even one patient. Our Medical Community Liaison, Rosemarie Marshall Johnson, MD, can answer your questions. Dr. Johnson can be paged at 619.290.5351. You may also contact Lauren Radano, Healthcare Access Manager, at 858.565.7930.

classifieds CLINICAL STUDIES CLINICAL STUDY: Dr. Timothy Bailey, board-certified endocrinologist and ACRP-certified physician investigator, invites you to participate in a research study to determine if treating obstructive sleep apnea (OSA) may lead to improvements in diabetes control and other health benefits for people with type 2 diabetes. Tests results obtained from wearing a sleep-screening device in your home overnight may indicate whether or not you have OSA. If positive, you will be scheduled for an overnight visit to a sleep clinic and then assigned to sleep apnea therapy and lifestyle counseling or you will receive lifestyle counseling with sleep apnea therapy occurring upon completion of the study, if you would like treatment. If you are interested in this study or would like more information, please call (877) 567-2627 or email us at info@amcrinstitute.com. [731] OFFICE SPACE OFFICE SPACE AVAILABLE FOR A DERMATOLOGIST LOOKING TO EXPAND OR START A PRACTICE: The successful RiverView MD medicaldental spa is entering its second year of service to the public and is looking for the right fit with a physician with a cosmetic practice. To enquire, contact our office manager, Nancy, our dentist-owner, Shirin Dorin, DDS, or our medical director-owner, Adam Dorin, MD, MBA. The facility number is (619) 4564555. [753]

Leasing, Renewals & Sales: Call the Healthcare Real Estate Specialists at Colliers International for a complete inventory of all available medical office space for lease or for sale in your area, or for valuable vacancy and absorption information. Use our knowledge and expertise to help you negotiate a new lease, renewal, or purchase to assure you obtain the best possible terms. There is no charge for our consulting services. Contact Chris Ross at 858.677.5329 email chris.ross@colliers.com TURNKEY MULTI-MILLION OFFICE MEDICAL SUITE: Spectacular design with a history of successful medical practices in this suite. We have a multi-million dollar practice out of this 1,700ft2 facility. We have outgrown our space, and we are moving to a larger suite in the same building. Over 150K in tenant improvements have been made. Furniture is also included at this turnkey suite. Up to four exam rooms, small procedure room, doctor’s office, elective procedure consultation room, and two waiting rooms. Office is for sale for a very reasonable rate — much less than a build-out. Rent is extremely reasonable. Furniture and improvements also included. Be ready to practice nearly instantly! Located in Mission Valley in a prime location. Contact Dr. Tony at tpinvestor@yahoo.com or cell phone (858) 3352266. [770]

PROFESSIONAL OFFICE SPACE TO SHARE OR LEASE: Part time, full time, flexible terms and incentives. Up to 1,400ft2 in a medical complex. Near Alvarado Hospital, SDSU college area. Ample parking. High visibility street location. Ideal for any specialty or allied medical professionals. Call (858) 243-2425. [733]

NEW MEDICAL BUILDING ALONG I-15: Pinnacle Medical Plaza is a new 80,000 SF building recently completed off Scripps Poway Parkway. The location is perfect for serving patients along the I-15 from Mira Mesa to Rancho Bernardo and reaches west with easy access to Highway 56. Suites are available from 1,000—11,000 SF and will be improved to meet exact requirements. FREE RENT INCENTIVES and a generous improvement allowance is provided. For information, contact Ed Muna at 619-702-5655, ed@lankfordsd.com www.pinnaclemedicalplaza.com MISSION VALLEY HEIGHTS-AREA MEDICAL OFFICE SPACE AVAILABLE TO SHARE: Medical office space available to share in existing 2,700ft2 orthopedic office in Mission Valley Heights area. Newer building with excellent part-time tenant, but may consider daily or half-day rental arrangements. Willing to rent space only or can provide full-service, turnkey environment. Contact Roger Freeman at (858) 277-9000. [768]

CARMEL VALLEY OFFICE SPACE TO SHARE: Sublease and share extra space in 4,600-sf cosmetic surgeons’ office. Surgery center and X-ray on site. Beautiful space in very attractive, welllocated building on El Camino Real in the heart of Carmel Valley. Ideal for a surgeon, satellite office, or solo physician not needing space full time. Potential for sharing staff / overhead. Contact Chris Ross at 858.677.5329 email chris.ross@colliers.com

MULTI-SPECIALTY MEDICAL OFFICE SPACE AVAILABLE IN BANKER’S HILL AREA: Large office with view of San Diego harbor, eight fully equipped exam rooms, lab on site, and underground parking. Please contact Chris Bobritchi at (619) 2334044 or at hivdocs@yahoo.com. [767] BEAUTIFUL 2,000FT2 MEDICAL SUITE IN PRIME LOCATION AVAILABLE FOR SUBLEASE: Women’s healthcare office located next to Sharp Hospital in Chula Vista is available for sublease on Mondays, Wednesdays, and Thursdays beginning June 1. For more information please contact Jessica at (619) 397-2950, ext. 200. [766]

SPACE AVAILABLE FOR SINGLE DOCTOR PRACTICE: Office located in the Alvarado Hospital area, near San Diego State College. Space includes a physician office and two exam rooms. Please email cnc_case@cox.net. [765] CORONADO OFFICE SPACE AVAILABLE: New, gorgeous building with 1,100ft2 left. “Build to suit” tall ceilings, excellent location, and onsite parking. Contact Dr. Glenn Cook at (619) 742-9300 or at drcook@glenncookmd.com. [764]

NEW MEDICAL OFFICE BUILDING: Now leasing! Gateway Chula Vista is a new 230,000 SF SMART complex with COX Fiber broadband equipped. Conveniently located near I-5 & I-805 Freeways in Downtown Chula Vista, across and adjacent to Scripps Mercy Hospital & Sharp Rees-Stealy Urgent Care. Suites available from 950 – 20,000 SF and include generous Tenant Improvement Allowances provided. Free onsite & ample parking (Over 4 per 1000 SF). For additional information please contact James Pieri, Jr., (619) 422.8400, jamesd@mountainwest.com www.mountainwest.com OFFICE SPACE IN CORONADO FOR LEASE: Beautifully built-out space with all the extras, grandiose reception area, granite counter tops, extravagant lighting and artwork. One exam room still available for lease per half day, per full day, etc. Contact Dr. Glenn Cook at (619) 742-9300 or at drcook@ glenncookmd.com. [763] UTC / LA JOLLA MEDICAL SPACE AVAILABLE: Medical suites available at UTC La Jolla. For available suites, floor plans, and leasing information, contact Kelly Tang at (858) 622-1240. [761] LOOKING TO RENT OFFICE SPACE IN GREATER SAN DIEGO AREA: I am a physician specializing in pain medicine. I am currently looking to rent office space from a family/general medicine doctor in the greater San Diego area, approximately once a week. I am pretty flexible in setting up the arrangement. Please contact me at guptaa3@hotmail.com or call me at (760) 285-8866. [762] LA JOLLA OFFICE SPACE AVAILABLE AT XIMED MEDICAL BUILDING: Brand new, renovated office space available, preferably to a primary care MD to share. This is a rare opportunity to have a presence at the prestigious XiMed Medical Building right next to Scripps Memorial Hospital and to reduce your overhead by sharing space. Currently, the office is being used by a single physician part of the time. Flexible to any arrangement proposed. Call (858) 837-1540 or email melkurtulus@hotmail.com. [664]

To submit a classified ad, email Kyle Lewis at KLewis@SDCMS.org. SDCMS members place classified ads free of charge (excepting “Services Offered” ads). Nonmembers pay $150 (100-word limit) per ad per month of insertion.

SAN DIEGO PHYSICIAN . or g de c em b e r 2009

DOWNTOWN OFFICE SPACE AVAILABLE: Family practice physician in downtown San Diego has office space available. If interested, please call (858) 2707633. [735] SCRIPPS ENCINITAS CONSULTATION ROOM/ EXAM ROOMS: Available consultation room with two examination rooms on the campus of Scripps Encinitas. Will be available a total of eight half days per week. Receptionist help provided if needed. Contact Stephanie at (760) 753-8413. [703] NORTH COUNTY INLAND OFFICE SPACE TO SHARE: We have a busy, long-established family practice that is centrally located near I-15 and Poway Road in the North County Inland area of San Diego in the attractive Sabre Springs neighborhood, and we have office space and exam rooms available. Traditional medical practice preferred, please no esthetics, etc. Contact Dr. Wickes at awickes@sbcglobal.net. [751] ENCINITAS OFFICE SPACE SUBLEASE: Beautiful, top-floor office on the Scripps Encinitas Hospital campus has available space to sublet part time or full time. Set up well for any specialty. Available at competitive rates. If interested please contact us at (760) 753-1104, ext. 1107. [745] LA MESA OFFICE SPACE TO SHARE: Over 6,000ft2 OB/GYN office of three doctors, with space available immediately. Ideal for a medical practice or clinical studies and is located on Grossmont Hospital campus. Contact La Mesa OB/GYN at (619) 463-7775 or fax letter of interest to (619) 463-4181. [648] PHYSICIAN POSITIONS AVAILABLE SEEKING PART-TIME INTERNIST, FAMILY PRACTITIONER, OR MEDICAL GENERALIST: San Diego County Psychiatric Hospital is seeking part-time service of an internist, family practitioner, or medical generalist to conduct histories and physicals and provide primary care medical attention for its 45 psychiatrically hospitalized patients. This doctor will be joining a growing medical staff at our hospital, thereby augmenting services rather than practicing alone. Flexible hours. If interested, please call Michael S. Krelstein, MD, medical director, at (619) 692-8258. [769] PHYSICIANS NEEDED: Full-time, part-time, and per-diem opportunities available for family medicine, pediatric, and OB/GYN physicians. Vista Community Clinic is a private, nonprofit outpatient clinic serving the communities of North San Diego County. Must have current CA and DEA licenses. Malpractice coverage provided. Bilingual: English/Spanish preferred. Forward resume to hr@vistacommunityclinic.org or fax to (760) 414-3702. Visit our website at http:// www.vistacommunityclinic.org. EOE/M/F/D/V [760] FAMILY MEDICINE / HIV PHYSICIAN: Sharp Rees-Stealy Medical Group, a 400+ physician multispecialty group in San Diego, is seeking a half-time job share BC/BE family medicine physician with HIV management experience to join our staff. We offer a first-year competitive compensation guarantee and an excellent benefits package. Please send CV to SRSMG, Physician Services, 2001 Fourth Avenue, San Diego, CA 92101. Fax: (619) 233-4730. Email: Lori.Miller@sharp.com. [752]

FAMILY PRACTICE DOCTORS NEEDED: Full time and part time. Days, nights, weekends available. Fax CV to La Costa Urgent Care at (760) 603-7719. [750] PHYSICIAN EMPLOYMENT OPPORTUNITIES: Part-time and full-time openings for primary care physicians. Board-certified family practice or internal medicine physicians wanted to join our successful, prominent East County private medical group. Located on the Grossmont Hospital campus, our primary care group practices full spectrum family medicine, including hospital care. Sharp Community Medical Group providers. Ownership opportunities available. Interested applicants please send CV to eva.leonard@gfmg.net. For further information, visit us at www.gfmg.net. [747] OB/GYN PHYSICIAN SITE DIRECTOR: Founded in 1972 and located in North San Diego County. We provide the highest quality services in five different locations throughout Vista and Oceanside. Vista Community Clinic is a private, non-profit medical, dental, and social services center, including advocacy and education programs. We serve people who experience social, culture, or economic barriers to healthcare in a comprehensive, high-quality setting. We are currently looking for a director of our OB/ GYN department. This individual will be responsible for oversight of all obstetrics and gynecological services by directing and providing care for clinic and hospital patients. Providing clinical and administrative leadership for OB/GYN multi-provider clinic and multi-physician hospital group. Cover a minimum of one 24-hour per week panel shift and two clinic shifts per week. Oversee panel scheduling. Participate in clinical alliances. Must hold current CA license, DEA license, CPR certification, and be board certified in obstetrics and gynecology. Five years post-graduate clinic experience. A minimum of four years administrative experience. Bilingual English/Spanish is helpful. Malpractice coverage is provided by the clinic. May apply for state/federal loan repayment programs. Forward resume to hr@ vistacommunityclinic.org or fax to (760) 414-3702. Visit our website at www.vistacommunityclinic.org. EOE/M/F/D/V [748] PRIMARY CARE JOB OPPORTUNITY: Home Physicians is a fast growing group of doctors who make house calls. Great pay ($60–$100+/hour), flexible hours, choose your own days (full or part time). No weekends, no call, transportation and personal assistant provided. Call Chris Hunt, MD, at (858) 2791212. [711] PHYSICIAN POSITIONs WANTED OPHTHALMOLOGIST: Retired, early, given current events. Board certified. Spent entire ophthalmology career in San Diego. Seeks part-time office association. Very flexible. Impeccable local references. Email MJB6520@sbcglobal.net or call cell (858) 382-0552. [715]

MD Seeks PT/FT Position Skilled physician with extensive experience including: Radiology, Primary Care, research and teaching. Board certified in addiction medicine. Available immediately. Very flexible with terms and location. Please contact 412-606-1681 medical staffs as well as the financial functions of the practice. The practice administrator must understand the business model of a cosmetic practice and be able to motivate staff to achieve revenue goals. This candidate will be responsible to develop and implement current and long-range policies, procedures, and programs as well as any required comprehensive compliance plans. Must develop, manage, and monitor the financial and fiscal aspects of the practice, including budget preparation, and will demonstrate a proven financial track record. Other duties include management of the equipment maintenance, personnel, payroll, creation of a quality improvement plan and follow through, accounts payable (QuickBooks experience), accounts receivable process, including creation of measurable results and ensuring accountability, front and back office, payer contracts, regular staff meetings, product sales, and marketing and business development. The practice administrator will maintain relationships with referring physicians, vendors, and the healthcare community, as well as perform other duties as requested. Please fax resumes to (615) 6943611. [771] NURSE PRACTITIONERS NEEDED: Part-time and per-diem opportunities available for family medicine, pediatric, and OB/GYN nurse practitioners. Vista Community Clinic is a private, nonprofit outpatient clinic serving the communities of North San Diego County. Must have current CA license. Malpractice coverage provided. Bilingual: English/ Spanish preferred. Forward resume to hr@vistacommunityclinic.org or fax to (760) 414-3702. Visit our website at http://www.vistacommunityclinic.org. EOE/M/F/D/V [759] BILLER WANTED: Looking for biller with ambulatory billing experience. If interested, call Mira at (619) 464-9876 or email your resume to mirap@pacbell. net. [749] EXPERIENCED MEDICAL BILLER NEEDED: Experienced medical biller needed immediately. Four to five years experience required. Full-time position, M–F. Benefits include health insurance and pension. Must be organized, reliable, detail oriented, and work independently. Please call (858) 292-7527 or email resume to sdddc5@yahoo.com. [744] MEDICAL EQUIPMENT/OFFICE FURNITURE

NONPHYSICIAN POSITIONS AVAILABLE PRACTICE ADMINISTRATOR NEEDED FOR BUSY NORTH COUNTY MEDICAL OFFICE: Must have a minimum of 5–7 years of medical management experience with cosmetic/sales/customer service experience a plus. The practice administrator will direct the daily operations of the administrative and

HOLOGIC BONE DENSITOMETER: Full-size hip and spine. Originally $42,000, reduced to $17,000. Telephone (760) 703-0691. [755] OFFICE FURNITURE FOR SALE: Chairs $10.00 each, desk $50.00, exam stools $10.00, and two exam tables. Call (619) 585-0476. [746]

december 2009 SAN DIEGO PHYSICIAN . o rg

physicianleadership

Richard Butcher, MD, Receives CMA’s Gary F. Krieger Speaker’s Recognition Award For His Many Years of Leadership for his or her fellow physicians to CMA. Dr. Butcher was recognized for his continuing leadership in advancing the cause of key healthcare issues such as access to care, quality of care, and physician training.

for the uninsured patients in his community. He is a community activist, who, along with his wife, an Alliance leader and activist herself, has been one of the most respected leaders for community improvement. “I’m honored to receive this very prestigious recognition,” said Dr. Butcher. “I’m very heartened to be a recipient and among such company.”

uring the 138th Annual Session of the California Medical Association’s recent House of Delegates, CMA honored Richard Butcher, MD, SDCMS and CMA member since 1970 and SDCMS president in 1988, with its Gary F. Krieger Speaker’s Recognition Award. The award was established in 2002 in honor of Gary Krieger, MD, a physician who was a passionate advocate for Medi-Cal and for patient care. The award is given to one physician each year who provides outstanding leadership

SAN DIEGO PHYSICIAN . or g de c em b e r 2009

“Dr. Butcher is a fellow family physician who has taught me and others that it really is true that one person who has the intelligence, the perseverance, and the integrity to lead others can make a difference. I was honored to select him as this year’s award recipient,” said James T. Hay, MD, CMA Speaker of the House and SDCMS and CMA member since 1985. Dr. Butcher has served as president of the Golden State Medical Association and the National Medical Association. He is an active member of his specialty society. He was one of the founders of a nonprofit corporation to provide discounted and free services

During more than 30 years of practice, Dr. Gary Krieger had been a vigorous advocate of Medi-Cal. He worked hard to ensure patient access and physician interest in the program. He felt strongly that we, as a society, must provide decent healthcare coverage to all. He gave many hours of his time advocating for the uninsured. Congratulations Dr. Butcher!

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