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From the Exec. Director
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Celebrating
In Memoriam
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60 Years
Marketplace
Volume 61
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Number 4
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- 015 1955 2
MCMS Board Meeting Minutes Page 33 Page 34
April 2015
round-up Providing news and information for the medical community since 1955.
MEMBER PROFILE: Dr. Christine Harter’s dedication to patient empowerment and community outreach. Page 26 PRESIDENT’S PAGE: Empowering patients through open dialogue, providing patient-specific information and helping them assimilate the information to make an informed decision is a fascinating experience and just as uplifting to a physician as much as it might be to the patient. Page 12 PUBLIC HEALTH: See Me Smoke-Free — The first multi-behavioral smart phone app designed to empower women to quit smoking. Page 16
FEATURE ARTICLE: A number of medical schools are adding coursework on clinical empathy into the curriculum. With the growing trend of hospitals incorporating patient satisfaction in their determination of physician compensation, clinical empathy looks to be a vital resource for better connecting with patients and improving the doctor-patient relationship. Page 18 A MEDICAL STUDENT’S PERSPECTIVE: A.T. Still University and University of Arizona College of Medicine – Phoenix medical students share their thoughts on how they plan on helping their patients feel empowered. Pages 22 & 24
You’re invited! “Philanthropy in Medicine” May 7, 2015, 6-8:30 pm at the Maricopa County Medical Society. Event sponsored by Arizona Central Credit Union.
Details on Page 13
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from the executive director
What’s Inside? April 2015: Patient Empowerment By Jay Conyers, PhD
This month, we take a look at patient empowerment. Undeniably, empowered patients have the potential to live healthier, longer lives. Empowered patients lessen the burden on the healthcare system through reduced hospital readmissions, improved drug compliance, and better control of chronic diseases such as diabetes and COPD, among others.
Jay Conyers, PhD MCMS, Executive Director Contact Information: E: jconyers@mcmsonline.com P: 602-251-2361
As the old saying goes, “Give a man a fish and he’ll eat for day. Teach a man to fish and he’ll eat for a lifetime.” Perhaps this applies to the doctor-patient relationship as well. Not all agree, however, that patient empowerment is a good thing. Many physicians, nurses, and other care providers feel that too much medical information in the hands of patients can be dangerous. The availability of medical information on the web has created a scenario where many patients often attempt to self diagnose and self treat, further exacerbating illness and/or disease. The end result is a society in which patients claim to ‘know’ everything about their health, but truly ‘understand’ very little about it.
4 • Round-up • April 2015 • A monthly publication of the MCMS
from the executive director
Another example of how empowering patients could be problematic is through self-refer lab testing. Just last month, the Arizona legislature passed a bill that will allow patients to decide which lab tests they need. HB2645, sponsored by Rep. Heather Carter (R-Cave Creek), was aggressively lobbied by Theranos founder Elizabeth Holmes and will afford Arizona residents the ability to pay for lab tests without a doctor’s note. Currently, the Theranos platform is available at 40 Walgreens nationwide, with plans to be available in thousands more. Once they move into Arizona, residents will be able to walk in and pay for tests with no referral from a physician. Many physicians I’ve spoken with worry about the burden this will have on their practices as patients come in demanding treatment for something revealed through one of these tests. Will the physician have a duty to treat without retesting the patient? It truly opens a Pandora’s box.
Our public health article this month highlights research out of the University of Arizona College of Medicine, where a team led by Judith Gordon, PhD has developed an innovative smartphone app designed to empower women to quit smoking. We also have two wonderful student perspectives this month on patient empowerment. We’re quickly learning that the talented students at the University of Arizona, A.T. Still University, Midwestern University, and Creighton University are all excited to provide their perspective on Roundup topics, and we plan on making it a regular part of the monthly magazine. For May, we’re moving onto the business of medicine; a topic all too familiar these days. There is much talk about how medical students and residents can — and should — be exposed to more business education. Physicians these days have no choice but to understand how to read a balance sheet, evaluate financing terms for capital investments, and understand the financial implications of the Affordable Care Act. The role of social media is booming in medicine, as is telemedicine, and both will undoubtedly have a dramatic impact on how business and medicine intersect. We’re planning a special issue for the ever-important topic, and will be distributing the issue to all practicing physicians (MD/DO) within Maricopa County.
But not all patient empowerment is bad. Just ask this month’s profile physician, Christine Harter, MD. Dr. Harter goes to extensive measures to educate her patients who are seeking treatment for chronic headaches. She walks them through various lifestyle changes, dietary considerations, and natural therapy options before prescribing medication. She goes one step further and volunteers time in the community, through her church, and speaks often with patients from lower socioecoUntil then, enjoy this issue on patient empowerment, nomic groups, educating them on how they can better and write to us if you have a different perspective on play an active role in their health. We hope you enjoy the topic. For another spin on the topic, consider what reading about Dr. Harter as much as we enjoyed writing Ben Carson, MD, retired neurosurgeon and rumored about her. 2016 presidential candidate, said when asked about the Also this month, we have an article that addresses doctor-patient relationship and the status of our nation’s clinical empathy, and how a number of medical schools healthcare system. According to Carson, “The key is to are adding coursework on this topic into the curriculum. cut out the middleman and empower both doctor and With the growing trend of hospitals incorporating pa- patient about what things cost.” tient satisfaction in their determination of physician Perhaps empowerment doesn’t just apply to patients, compensation, clinical empathy looks to be a vital rebut to physicians alike. Let me know what you think. source for better connecting with patients and improvEmail me to jconyers@mcmsonline.com or call direct ing the doctor-patient relationship. to 602-251-2361. ru
A monthly publication of the MCMS • April 2015 • Round-up • 5
round-up
april 2015
Providing news and information for physicians and the healthcare community since 1955. Published by the Maricopa County Medical Society.
4 what’s inside president’s page 12 Positive Steps Forward in Patient Empowerment Through EHRs
22
a medical student’s perspective Helping Patients Find Their Good Health
24
a medical student’s perspective A Student’s Dream of Responsible Patient Empowerment through Education and Assessment: A Functional Solution to a Conflict Problem
26
member profile Patient Empowerment Has No Down-Side. Meet MCMS Member: Christine Harter, MD
health 16 public See Me Smoke-Free: The First MultiBehavioral Smart Phone App Designed to Empower Women to Quit Smoking article 18 feature Efforts to Instill Empathy Among Doctors Are Paying Dividends
Board Meeting Minutes: 33 MCMS February 17, 2015
In every issue In Memoriam ....................................................................................................................................................................8 Marketplace ....................................................................................................................................................................34
Cover photo: Denny Collins Photography • www.dennycollins.com • 602-448-2437
6 • Round-up • April 2015 • A monthly publication of the MCMS
Round-up Staff
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Round-up is a publication of the Maricopa County Medical Society (MCMS). Submissions, including advertisements, are welcome for review and approval by our editorial staff at roundup@mcmsonline.com. All solicited and unsolicited written materials and photos submitted to Round-up will be treated as unconditionally and irrevocably assigned to and the property of MCMS and may be used at MCMS’ sole discretion for publication and copyright purposes and use in any publication, website or brochure. MCMS accepts no responsibility for the loss of or damage to material submitted, including photographs or artwork. Submissions will not be returned. The opinions expressed in Round-up are those of the individual authors and not necessarily of MCMS. Round-up reserves the right to refuse certain submissions and advertising and is not liable for the authors’ or advertisers’ claims and/or errors. Roundup considers its sources reliable and verifies as much data as possible, but is not responsible for inaccuracies or content. Readers rely on this information at their own risk and are advised to seek independent legal, financial or other independent advice regarding the content of any submission. No part of this magazine may be reproduced or transmitted in any form or by any means without written permission by the publisher. All rights are reserved.
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Editor: Ryan R. Stratford, MD, MBA rstratford@mcmsonline.com Managing Editor: Jay Conyers, PhD jconyers@mcmsonline.com
A monthly publication of the MCMS • April 2015 • Round-up • 7
in memoriam
Honoring those we lost...you will be missed.
Members of the Maricopa County Medical Society, past and present, are the organizations’ greatest assest — an assemblage of the finest physicians and healthcare providers. On pages 8-10 we pay homage to current and past members who are no longer with us on this earth.
Otto Stronach Shill, Jr., MD MCMS Member since 1969 Dr. and and Mrs. Shill served a mission for the Church of Jesus Christ of Latter-day Saints in Jacksonville, Florida from 1995 to 1998. He is preceded in death by his parents Otto and Marguerite Shill; sisters Elizabeth Shill, Beverly Shill, Jean Shill Fuller, and Maxine Shill Johnson; brother Talmage Shill, and son Sterling Shill. He is survived by his wife Betty and four Dr. Shill was born in his parof their children: Otto S. Shill, III (JoAnna), Kimball ent’s home in Lehi (now Mesa), C. Shill (Amber), Susan Shill Nelson (Glen), Kristen Arizona on December 16, 1929. Shill Anderson (Ron); 28 grandchildren, 6 great-grandHe married Betty Louise Robbins in 1950, and pracchildren and sisters Fern Shill Ellsworth and Lois Shill ticed medicine as an ear, nose and throat surgeon in Jennings. ru Mesa, Arizona for over 35 years. Dr. Otto Shill, Jr., 85, of Mesa, AZ passed away on March 11, 2015 following a brief illness and after completing a life full of service, with a special dedication to his family.
8 • Round-up • April 2015 • A monthly publication of the MCMS
in memoriam
Robert E. Flynn, MD
Robert P. Rivera, MD
MCMS Member since 1955
MCMS Member 2008-2012
Dr. Flynn, 94, of Phoenix, AZ passed away April 7, 2015. Born in Fond du Lac, WI on December 26, 1920, he is the second son of William A. and Bess Mahoney Flynn. His formative years were spent in Albia, Iowa where he enjoyed the freedom of small town living.
Dr. Robert P. Rivera, 58, passed away peacefully, surrounded by his loving family on Wednesday, April 1, 2015 after a six month battle with cancer.
Dr. Rivera was born in Silver City, NM to Lupe P. Rivera and was raised by his mother, his grandmother Manuela Peralta, He received his premed degree from the College of and his sister Norma. the Holy Cross. In 1940 he volunteered in the U.S. He graduated from Lordsburg High School as valeArmy Reserve and continued his pursuit of a medical dictorian in 1974. Dr. Rivera became very interested in degree at Saint Louis University, School of Medicine. religion at the age of 16 and studied every religion he Following internship at Milwaukee General Hospital could. Eventually, he joined the Church of Jesus Christ and a tour of duty with the Army Medical Corps where of Latter-day Saints when he was 18 years old and later he served at Fitzsimons General Hospital and the station served a two year LDS mission in Guadalajara, Mexico. hospital of Camp Carson and later at Fort Riley, he He spent his freshman year at Brigham Young Univerbegan a residency in Radiology at the University of sity, where he met his first wife. They had three children Iowa, College of Medicine, rising to the rank of Assistogether. He then transferred back to New Mexico State tant Professor in the Radiology Department. University and completed his bachelor’s degree. He atAfter another tour of duty with the Army Medical tended the University of Utah School of Medicine and Corps, this time with the 121st Station Hospital in Dae- finished his residency in eye surgery at the Mayo Clinic jeon, Korea, he and his wife moved to Phoenix in 1953. in Rochester, MN. He settled in Flagstaff, AZ where he His entire civilian medical career was devoted to the met and married the love of his life, Suzanne with Radiology Department of St. Joseph’s Hospital and whom he raised three children. Medical Center. There he may be remembered for havPassionate about his children, he filled their lives ing pioneered the Nuclear Medicine Section and later with joy and humor and led his family to love and serve after a fellowship in Neuroradiology at the New York the Lord. His example of faith in the Lord and His plan, Neurological Institute of Columbia University, for deespecially as he faced a cruel illness, will linger with all veloping the Neuroradiology section of the BNI which those who knew him. His compassion and service will he chaired for many years. He was the first Neuroradibe missed. He was loved and respected as a friend, colologist in Arizona. league, and mentor. His way with words, both in writing He was preceded in death by his wife of 55 years, and speaking, will be remembered at home and around Marion Kelleher, their daughter, Ellen and their son the world. Stephen. Surviving are their sons, Peter and David, Dr. Rivera is survived by his wife, Suzanne M. daughters Lisa F. Rohrer and Kathryn F. Stinson, six Rivera, and his six children: M. Andrew Rivera, Marisa grand children and a sister, Ms. Donna Knowles of R. Rivera, Daniel J. Rivera, Eliana M. Rivera, Samuel Omaha, NB. ru A. Rivera and Anya S. Rivera, as well as many more cousins, nieces, nephews and other relatives. ru A monthly publication of the MCMS • April 2015 • Round-up • 9
in memoriam
Robert Roy McCarver, Jr., MD MCMS Member since 1962 Robert R. McCarver, Jr., MD, Dr. McCarver loved God and his family. He was an age 86, passed away Wednesday, Oklahoma Sooner football fan through and through. He April 8, 2015 at Arbor Rose Sen- also enjoyed hunting, skiing, golfing, traveling and ice ior Care in Mesa, AZ. cream. Dr. McCarver was born on March 26, 1929 in Wister, Oklahoma to Robert R. McCarver, Sr. who was the postmaster in Wister, OK and to Mary Lee Williams McCarver. He grew up in Wister, OK and before graduating from high school he moved to Tahlequah, OK to begin college courses at Northeastern State University. He then went on to the University of Oklahoma in Norman, OK, graduating with a BA degree in Zoology. He continued his education at University of Oklahoma Health Sciences Center in Oklahoma City, OK and graduated with an MD degree in 1954. His Internship was in Kansas City, Kansas at Kansas City General. After his internship he was drafted into the Army as a Captain in the Medical Corp and served his duty mainly in Sendai, Japan. He returned from Japan to the States and started a Radiology residency in Denver at Fitzsimons Army Hospital, graduating in 1961. He was immediately hired in Phoenix, AZ and started practice in August 1961. In 1962 he became a board certified Radiologist. In 1975 Dr. McCarver started TMC Radiology Consultants, Ltd. and Professional Radiology Consultants, Ltd. in Scottsdale, Tempe, Mesa, and Chandler and also had a practice in San Francisco, CA. In 1986 in Baltimore, Maryland, he received the honor of FACR (Fellow of the American College of Radiology) one of the highest honors the ACR can bestow on a radiologist.
He loved being a Radiologist and would still be working today if not for health concerns. He worked until he was 79 years old. He so loved his staff at TMC Radiology and they so loved him in return. He will be missed very much by his family. Dr. McCarver is survived by his beloved wife Joy M. Baker of Mesa, son Robert R. McCarver, III, MD and wife Lauren of Chandler, daughter Deborah L. Stenberg and husband William of Kodiak, AK; his brother Charles L. McCarver, MD and wife Leslie of Phoenix, his sister’s-in-law Maxine Ryan, of West Hills, CA, Barbara McNemar, Walker, LA, Sister Nancy McNemar, SSND of Chatawa, MS, Mary Jane Fabre and husband Tim of Pride, LA. He is also survived by his granddaughter’s Ashleigh Neilson and husband Andrew of Narrows, West Virginia, Courteney K. Stenberg of Dallas, TX and grandson’s Jensen Stenberg, of Norman, Oklahoma, Parker Stenberg, of Dallas, TX, Jeremy McCarver and fiancé McKenna Brown, and Dustin McCarver of Chandler, Arizona. His stepchildren David Baker and partner Kandice Gray, of Mesa, AZ and Joe Baker and wife Jamie Guinn of Portland, OR and grandson’s, Lexton, Landon, Lathan, and Lowen Baker of Mesa, AZ and granddaughter’s Odella and Azalia of Portland, OR. He was preceded in death by his parents, his former wife Betty L. McCarver, of Scottsdale, AZ and Tahlequah, OK, his mother-in-law Gracie McNemar who just recently died on January 6, 2015 and brother-in-law Ralph McNemar, Jr. both of Baton Rouge, LA. ru
10 • Round-up • April 2015 • A monthly publication of the MCMS
president’s page
Positive Steps Forward in Patient Empowerment Through EHRs By Ryan R. Stratford, MD, MBA
P
atient empowerment is the focus of this month’s Round-up. Like most of you, I strongly believe that empowering patients is beneficial and rewarding as a physician. Despite all of the things I am not grateful for in the evolution of healthcare reform, I have seen the benefits of increased patient empowerment brought about through Meaningful Use Requirements.
MCMS President 2015 Ryan R. Stratford, MD, MBA Dr. Stratford specializes in Urogynecology/Pelvic Reconstructive Surgery. He joined MCMS in 2005. Contact Information: The Woman's Center for Advanced Pelvic Surgery 4344 E. Presidio Street www.TheWomansCenter.com P: 480-834-5111 E: rstratford@mcmsonline.com
Among those requirements are three that I see as positive steps forward in patient empowerment: 1. Provide patients the ability to view, download, and transmit their health information online within four business days of the availability to the patient’s provider. 2. Deliver clinical summaries for patients for each office visit – more than 50% of all office visits within three days. 3. Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient if appropriate. Like many of you, I have had to scramble at times to make sure I am meeting Meaningful Use Requirements. Setting up systems that automatically fulfill the requirements has made the process much more manageable. However, in doing so, I have witnessed changes in my interactions with patients.
12 • Round-up • April 2015 • A monthly publication of the MCMS
president’s page
I work with medical residents full time in my practice. They frequently write the clinical notes on the patients we see together as I see the value in training them on how to efficiently and accurately document using an EHR. However, letting them document has allowed some interesting issues to surface.
honest documentation, and, more importantly, the importance of empowering patients. Some physicians might perceive the patients’ ability to review their notes as intrusive but I think it is very valuable, especially since my patients are often trying to drink from a fire hydrant during their consultation.
Medical residents, who are usually very adept at managing new technology, quickly learn shortcuts in documentation such as using templates to quicken their entry. Although I review each note at the end of the clinical day, I have missed details in the discussion section of some clinical notes, leaving in misinformation about what was discussed with the patient. Because the EHR immediately delivers the note to the patient the day of the encounter, I have had some patients email and/or call my office the next day stating that they do not recall discussing all of the items listed in the clinical note. They are anxious to return to discuss the items mentioned or at least be given an explanation for why they were not discussed.
In addition to providing clinical notes to patients, we are required to provide patient-specific education. As it turns out, to treat many disorders of the bladder, education and understanding of the physiologic mechanisms causing their bladder problems is actually therapeutic and needed to effect a good long-term outcome. We hand out a lot of health educational materials to patients when they leave our office. Interestingly, studies that have reviewed the patient handouts in my subspecialty show that although the recommendation is to write the handouts at an 8th grade reading level, most are written at the 12th grade reading level.
With the advent of smartphones and improved technology, I find that more and more patients are using the Whereas these experiences are somewhat embar- internet and my practice website to obtain valuable parassing, they have provided a great teaching tool in tient-specific education. I encourage patients to do so, helping residents learn the importance of accurate and but warn of the misinformation often found on the in-
you’re invited!
Thursday, May 7, 2015 • 6-8:30 pm
to the Maricopa County Medical Society’s Forum on
“Philanthropy in Medicine” To register, call 602-252-2015.
Maricopa County Medical Society 326 E. Coronado Rd., Phoenix, AZ 85004
Drs. David Beyda, Randal Christensen, and Candace Lew have donated many hours and resources providing care to the most vulnerable populations in Arizona and abroad. Join us for a presentation and panel discussion on how physicians can collaborate and speak with a unified voice to advocate for public health. Event sponsor and MCMS Preferred Business Partner:
A monthly publication of the MCMS • April 2015 • Round-up • 13
president’s page
ternet and try to direct patients to reputable sources. Creating content on a website that offers patient information and effectively directs patients to reputable sources is a key to patient empowerment in my practice. Perhaps the most important way I believe I can empower my patients is through good communication, one-on-one. As a fellow, I was amazed at the capacity of my mentor to speak to patients, “in their own language.” He seemed to quickly understand the best way to communicate to each patient based on their capacity to understand, which I assume he gathered from the way they articulated their health concerns, their educational background and the questions they asked. Helping patients to make their own decisions on treatment was not only empowering, but created tremendous buyin from the patient. Although it is much more difficult to help a patient make their own decision than it is to decide for them, the time I invest helping them form their own decisions pays off in huge dividends both in my ability to treat the condition and to avoid pitfalls, such as litigation.
“Learning the art of helping people formulate and make their own decision is what I believe distinguishes good doctors from great doctors. Those who are great seem to be really good at not only speaking the patient’s language, but also artfully helping them navigate the complex information and make decisions.” — Ryan Stratford, MD
of cure, such as in the case of cancer, patients consistently will opt for treatment. If expectations for cure using a new chemotherapeutic agent are only 6%, you would think that only 6% of patients would try the drug. Instead, well over 80% of patients opt for treatment. This seems irrational, but it does make sense when considering the alternatives are not so good either.
Learning the art of helping people formulate and make their own decision is what I believe distinguishes good doctors from great doctors. Those who are great seem to be really good at not only speaking the patient’s language, but also artfully helping them navigate the complex information and make decisions. They do it well because they seem to understand what the patient is thinking. In the words of Atticus from To Kill a Mockingbird, they are, “walking around in [the patient’s] shoes for a little while.”
Irrational decision-making also occurs among physicians who are ingrained with the scientific method and could be expected to always be rational. Physicians routinely negate the impact of incidence when performing screening tests. For example, the risk of a true positive infection in someone with a positive HIV test who comes from a low risk population is extremely low, yet physicians routinely will react and perform a more specific test when the likelihood of a true positive is extremely unlikely. Moving forward with additional testing creates undesired angst to the patient and the physician.
Guiding patients in making decisions about their own health is complicated by the fact that sometimes people are not rational. One of my favorite classes in business school was taught by a behavioral economist who performed studies showing how people consistently make irrational choices. I found the class very intriguing given that the premise of a free market system is that everyone acts in their own self-interest by making rational choices. Some of the greatest irrational behaviors occurred in healthcare decision making. As an example, when offered treatments with low probability
The fact that people consistently do not act rationally, to me, is the beauty of patient empowerment. Helping my patients sort through the complexity of medical decision-making by giving them access to my thought process and clinical notes, giving them patientspecific information and helping them assimilate the information to make a decision is a fascinating experience and empowering to me as much as it might be to my patient. Besides, in the alternative, it would be presumptuous for me to think that I always know what is best for my patient when I am just as irrational. ru
14 • Round-up • April 2015 • A monthly publication of the MCMS
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Cologuard is intended for the qualitative detection of colorectal neoplasia associated DNA markers and for the presence of occult hemoglobin in human stool. A positive result may indicate the presence of colorectal cancer (CRC) or advanced adenoma (AA) and should be followed by diagnostic colonoscopy. Cologuard is indicated to screen adults of either sex, 50 years or older, who are at typical average-risk for CRC. Cologuard is not a replacement for diagnostic colonoscopy or surveillance colonoscopy in high risk individuals. Rx only. 1. Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med. 2014;370(4):1987-97.
Cologuard is a registered trademark of Exact Sciences Corporation. ©2015 Exact Sciences Corporation. All rights reserved. CG-00192-01-February 2015
public health
See Me Smoke-Free The First Multi-Behavioral Smart Phone App Designed to Empower Women to Quit Smoking By Jane Erickson
Y
ou have counseled the patient several times about quitting smoking. She says she understands the dangers and wants to quit, but she hasn’t yet. She confessed she’s afraid of putting on weight if she quits – an outcome that to her is a bigger threat than the other diseases smoking can cause. But now, there’s an app to help with that.
Jane Erickson Jane Erikson wrote about medicine and healthcare policy for the Arizona Daily Star in Tucson for nearly 20 years. She dabbled in non-profit communications and fund-raising for three years, then settled in with the University of Arizona College of Medicine, where she writes about a variety of health-related programs. She can be reached at jerikson@email.arizona.edu
With funding from the National Cancer Institute, University of Arizona researchers have created and launched the first multi-behavioral mobile health (mHealth) app designed to empower women to quit smoking, adopt healthy eating habits and become more physically active. The guided-imagery app, called See Me Smoke-Free, was released on March 30. See Me Smoke-Free, developed for Android phones, can be downloaded at https://play.google.com/store/apps/details?id=edu. arizona.guidedimagery The goal of See Me Smoke-Free is to provide women with an overall sense of well-being and self-efficacy, said Judith S. Gordon, PhD, Associate Professor and Associate Head for Research in the Department of Family and Community Medicine at the University of Arizona College of Medicine – Tucson.
16 • Round-up • April 2015 • A monthly publication of the MCMS
public health
“We want women to recognize that they are strong, they are beautiful, they are powerful and they’re in control of their lives, and that they can use the app to engage in a more healthy lifestyle,” Dr. Gordon says. “And that includes being smoke-free.”
“The reason we developed this as an android app is two-fold,” Dr. Gordon says. “First, Android currently has the largest market share of smartphone operating systems. Second, we know that people with lower incomes are more likely to use Androids, and they are more likely to smoke.”
The app is designed specifically for women, with input from women smokers, because studies have shown that women experience particular challenges when they quit smoking, like gaining weight, which may make quitting harder for them than for men. But men can use the app too, Dr. Gordon says.
See Me Smoke-Free was developed as part of a two-phase study. Participants are needed for the second phase of the study, which will evaluate the app. Additional information about the app and the research study is available at the website: www.seemesmokefree.org
The main component of the app is a guided imagery program, which consists of several audio files. Guided imagery is an enhanced visualization technique that encourages users to imagine themselves smoke-free and capable of dealing with cravings. In addition to sight imagery, the app prompts women to use all their senses for a fully immersive experience. For example, users are asked to visualize a farmers’ market where they imagine seeing, smelling and tasting their favorite fruit or vegetable. Users are prompted to use the guided imagery files daily. The app also allows users to access additional information and resources on quitting, eating well and being physically active. It lets them record achievement of their daily goals, display how many days they have gone without smoking, how often they experience cravings for cigarettes, and how much money they have saved. Users will receive daily motivational messages and tips for living a healthy lifestyle, and will get virtual awards for meeting their goals and engaging with the app.
“A multi-behavioral intervention such as ours requires experts from a variety of fields,” Dr. Gordon says. The study team includes Melanie Hingle, PhD, MPH, RD, Assistant Professor, Department of Nutritional Sciences, UA College of Agriculture and Life Sciences, and the Canyon Ranch Center for Prevention and Health Promotion at the UA Mel and Enid Zuckerman College of Public Health; Thienne Johnson, PhD, Research Associate, Department of Electrical and Computer Engineering, UA College of Engineering, and the Department of Computer Science, UA College of Science; and Peter Giacobbi, PhD, Associate Professor, the College of Physical Activity and Sport Sciences and the School of Public Health at West Virginia University in Morgantown. Jim Cunningham, PhD, an epidemiologist with the UA Department of Family and Community Medicine, is the study’s methodologist and statistician. See Me Smoke-Free is funded by a two-year, $366,400 National Cancer Institute grant, 1R21CA174639. ru
A monthly publication of the MCMS • April 2015 • Round-up • 17
feature article
Efforts To Instill Empathy Among Doctors Are Paying Dividends By Sandra G. Boodman, Kaiser Health News
T
he patient was dying and she knew it. In her mid-50s, she had been battling breast cancer for years, but it had spread to her bones, causing unrelenting pain that required hospitalization. Jeremy Force, a first-year oncology fellow at Duke University Medical Center who had never met the woman, was assigned to stop by her room last November to discuss her decision to enter hospice.
Sandra G. Boodman Ms. Boodman is a reporter for the Washington Post and a regular contributor to Kaiser Health News. She can be reached by email to sandra.boodman@washpost.com Reprinted with permission from Kaiser Health News (KHN). Kaiser Health News (KHN) is a nonprofit national health policy news service.
Employing the skills he had just learned in a day-long course, Force sat at the end of her bed and listened intently. The woman wept, telling him she was exhausted and worried about the impact her death would have on her two daughters. “I acknowledged how hard what she was going through was,” Force said of their 15-minute conversation, “and told her I had two children, too,” and that hospice was designed to provide her additional support. A few days later, he ran into the woman in the hall. “You’re the best physician I’ve ever worked with,” Force remembers her telling him. “I was blown away,” he says. “It was such an honor.” Force credits “Oncotalk,” a course required of Duke’s oncology fellows, for the unexpected accolade. Developed by medical faculty at Duke, the University of Pittsburgh and several other medical schools, “Oncotalk” is part of a burgeoning effort to teach doctors an essential but often overlooked skill: clinical empathy. Unlike sympathy, which is defined as feeling sorry for another person, clinical empathy is the ability to stand in a patient’s shoes and to convey an understanding of the patient’s situation as well as the desire to help.
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Clinical empathy was once dismissively known as “good bedside manner” and traditionally regarded as far less important than technical acumen. But a spate of studies in the past decade has found that it is no mere frill. Increasingly, empathy is considered essential to establishing trust; the foundation of a good doctor-patient relationship.
are less willing to tolerate doctors they consider arrogant or unapproachable,” added Tulsky, director of the Duke Center for Palliative Care. A 2011 study he headed found that doctors who took the course inspired greater trust in their patients than those who did not.
While empathy courses are rarely required in medical training, interest in them is growing, experts say, Studies have linked empathy to greater patient sat- and programs are underway at Jefferson Medical Colisfaction, better outcomes, decreased physician burnout lege and at Columbia University School of Medicine. and a lower risk of malpractice suits and errors. Begin- Columbia has pioneered a program in narrative medining this year, the Medical College Admission Test will cine, which emphasizes the importance of understandcontain questions involving human behavior and psy- ing patients’ life stories in providing compassionate chology, a recognition that being a good doctor “re- care. quires an understanding of people,” not just science, While the curricula differ, most focus on self-moniaccording to the American Association of Medical Coltoring by doctors to reduce defensiveness, improve lisleges. Patient satisfaction scores are now being used to tening skills (one study found that, on average, doctors calculate Medicare reimbursement under the Affordable interrupt patients within 18 seconds) and decode facial Care Act. And more than 70 percent of hospitals and expressions and body language. Some programs use achealth networks are using patient satisfaction scores in tors as simulated patients and provide feedback to inphysician compensation decisions. dividual doctors. While some people are naturally better at being emToo Busy For Empathy pathic, said Mohammadreza Hojat, a research professor of psychiatry at Jefferson Medical College in “In the 1980s, when I trained, the emphasis was on Philadelphia, empathy can be taught. “Empathy is a medical knowledge and technical skills,” said Debra cognitive attribute, not a personality trait,” said Hojat, Weinstein, vice president for graduate medical educawho developed the Jefferson Scale of Empathy, a tool tion at Partners HealthCare, the largest provider of medused by researchers to measure it. ical services in Massachusetts. “But in the past decade, the profession has been more attuned to patient satis“The pressure is really on,” said psychiatrist Helen faction and the connection between satisfaction and outRiess. The director of the empathy and relational scicomes and incentives.” ence program at Massachusetts General Hospital, she designed “Empathetics,” a series of online courses for Partners, which includes Mass General and other physicians. “The ACA and accountability for health im- Harvard teaching hospitals, is requiring that its 2,000 provement is really heightening the importance of a re- residents take “Empathetics.” In a 2012 study involving lationship” between patients and their doctors when it 100 residents, researchers found that doctors randomly comes to boosting adherence to treatment and improv- assigned to take the course were judged by patients as ing health outcomes. significantly better at understanding their concerns and making them feel at ease than residents who had not “Demographics and economics are driving this,” undergone the training. said James A. Tulsky, one of the developers of “Oncotalk.” (The original course for oncologists has been Riess said that while some doctors have told her they adapted for other specialties under the aegis of Vital don’t have the time to be empathic, the skill has proved Talk.) “Baby boomers have higher expectations and to be a timesaver rather than a time sink. It can help A monthly publication of the MCMS • April 2015 • Round-up • 19
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doctors zero in on the real source of a patient’s concern, others, he said, do recognize distress but fear unleashing short-circuiting repeated visits or those “doorknob mo- a flood of emotion in the patient, and sometimes in ments” doctors dread, when the patient says “Oh, by themselves. the way . . . ” and raises the primary concern as the doc“Doctors are explainaholics,” Tulsky said. “Our antor is headed out of the room. swer to distress is more information, that if a patient just Because a lack of empathy and poor communication understood it better, they would come around.” In realdrive many malpractice cases, a large malpractice in- ity, bombarding a patient with information does little to surer, MMIC, is urging doctors it insures to take the alleviate the underlying worry. “Empathetics” course. Another benefit: Empathy trainThe “Empathetics” program teaches doctors “how ing appears to combat physician burnout. to show up, not what to say,” said Riess. “We do a lot “Empathy training is naturally self-rewarding,” said of training in emotional recognition and self-monitorLaurie Drill-Mellum, a former emergency room doc- ing.” That includes learning to identify seven universal tor who is chief medical officer of the Minneapolis- facial expressions — using research pioneered by psybased insurer. “It gives [doctors] the love back,” she chologist Paul Ekman — and to take stock of one’s said, referring to the positive feedback empathic doctors own emotional responses to patients or situations. receive from their patients. Some of the course is explicitly prescriptive: Make eye contact with the patient, not the computer. Don’t ‘Doctors Are Explainaholics’ stand over a hospitalized patient, pull up a chair. Don’t Both Riess and Tulsky say their interest in empathy conduct a monologue in off-putting medicalese. Pay atwas sparked by personal experience. In Riess’ case, it tention to tone of voice, which can be more important was the flood of patients in her psychiatric practice a than what is said. When delivering bad news, schedule decade ago who spent their time in therapy discussing the patient for the end of the day and do not allow indevastating interactions with doctors. “These are not terruptions. Find out what the patient is most concerned just innocuous effects,” she said, “but often experiences about and figure out how best to address that. that were profound and deeply affected people’s lives.” Tulsky said that his father, an obstetrician-gynecologist in a solo practice, routinely talked about his patients at dinner. “His stories were about their lives, so I got this idea that medicine was about more than the illness,” he recalled. In medical school, Tulsky said, “I was very drawn to challenging moments in patients’ lives and volunteered to give bad news,” particularly when he believed other doctors would botch it.
One Doctor’s Experience Andy Lipman has taken the Duke course twice: first as an oncology fellow in 2004 and last year as a practicing oncologist in Naples, Fla., when he felt in need of a “booster shot.” Oncology, he said, “is a fullcontact” specialty with a high burnout rate.
Among the most important lessons Lipman said he learned during both sessions was to let go of “my own “I saw a lot that disturbed me,” Tulsky said. One medical agenda, the desire to fix something or make memorable incident involved his chief resident loudly something happen in that visit.” He learned to pace berating a frightened, impoverished and very sick old himself, monitor his reactions and talk less. man, saying, “If you don’t have this operation, you’ll Every day, he said, he thinks about what he was told die. Don’t you understand?” in 2004: “Never answer a feeling with a fact.” That Tulsky said that researchers have found that some means responding to a patient in a six-month remission doctors don’t respond with empathy because they are from cancer who reports having a sore elbow by saying, clueless when it comes to reading other people. Many “Tell me more about your elbow. This is probably scary 20 • Round-up • April 2015 • A monthly publication of the MCMS
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stuff,” and not “Your scans show no evidence of disease.”
began weeping loudly as she told Lipman how alone she felt.
One technique Lipman routinely employs is taking “I engaged, I expected the emotional response and I 15 seconds before entering an exam room to ask him- hung in there,” he said of the meeting, which lasted 45 self, “What is needed here?” minutes. “It felt good to me,” Lipman said, and he hoped it gave his patient some comfort. ru On the day he was interviewed, Lipman said, he used what he has learned with a patient with end-stage cancer. She was scheduled for a brief appointment but
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A monthly publication of the MCMS • April 2015 • Round-up • 21
a student perspective
Helping Patients Find Their Good Health Germaine Rival, MPH
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s a medical student, I have often been asked why I wanted to go into medicine. Like many students, I would answer, “I want to help take care of people.” It wasn’t until I worked in a hospital that it dawned on me how I failed to recognize what patient care truly entailed — it extends beyond their medical visit. Throughout the course of my first year in medical school, I learned the many ways a physician can help care for their patients, a few of which include patient empowerment and health education. I learned to advocate for my patients and their health.
Germaine Rival, MPH Germaine Rival, MPH, MS is a first year osteopathic medical student at A.T. Still University School of Osteopathic Medicine in Arizona. She obtained her Masters in Public Health at the University of Southern California and later worked in an Immunology lab at Drexel University College of Medicine. She can be reached at grival@atsu.edu.
For me, patient advocacy can be defined in various ways. First, patient advocacy can simply mean utilizing a translator when speaking to a patient with a language barrier. By using a translator, the physician ensures that her patient understands what is going on and what their medical care involves. Secondly, it is important for a physician to exercise patient-centeredness; patients should be included in medical decision-making regarding their care. For example, if a patient were to be seen and treated for high cholesterol, it is important for the physician to discuss the risk factors for high cholesterol, ways in which to lower cholesterol, and the risks and benefits of starting cholesterol medications. By discussing these topics, the patient feels empowered that they are able to make prudent decisions regarding their health. Health education is another way in which a physician can advocate for their patient. Going back to the patient with high cholesterol, it is important for the physician to educate her patient regarding their conditions. By educating them on what they can do to lower their cholesterol as well as help plan their treatment, the patient again feels empowered to make an informed decision that can significantly affect their health. Patients who are fully informed and aware of their medical condition are more likely remain compliant with their treatment
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a student perspective
plan compared to those who do not understand the reasons behind their care1. As a first year osteopathic medical student, I soon learned the importance of establishing good rapport with patients, as this relationship will influence how much my patient will trust me to share their medical information. This, in turn, provides me with direction on developing a diagnosis and how to address their problem. With increasing healthcare demands, physicians can easily find themselves rushing to see patients to get them out as quickly as possible in order to see the next patient. However, I learned that by taking the time to speak with my patient, I can learn more about them and help ascertain the cause of their illness. In addition, “social determinants of health” has become an important part of our history-taking during our patient encounters. Social determinants of health, as emphasized by our directors, help us determine if there are any factors outside of the patient’s health that can influence their healthcare. If a patient were uninsured and could not afford any medications, it would be futile to prescribe them medications to help treat their illness
if they cannot afford them. As a result, we need to find an alternative treatment for our patient. This is what contributes to patient advocacy – which we, as physicians, can do to ensure that our patients are able to receive appropriate medical services beyond the walls of our offices. Furthermore, these social determinants of health will help us paint a better picture of our patients’ lives rather than identify them with a particular disease. As a future physician, I wish to incorporate health education and patient-centeredness in my practice. The values and lessons instilled in me during my first year have been invaluable. I hope to continue learning ways on how to improve the quality of life of my future patients. A physician mentor has always reminded our class that our goal as physicians is not to find disease, but to help our patients find health. I intend to do just that. ru Reference: Schultz, A.B. et al. (2012). “The burden and management of dyslipidemia: practical issues.” Population Health Management, 15(5), p 302 – 308. DOI: 10.1089/pop.2011.0081
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public health — a student perspective
A Student’s Dream of Responsible Patient Empowerment through Education and Assessment: A Functional Solution to a Conflict Problem By Jordan Roberts
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hen I think about patient empowerment, the first associations that come to my mind are: influence, decisions, and power. I think about the patient’s power to influence their doctor’s decisions. While recognizing the potential conflict that may arise between physician and patient perspectives, we must seek a functional transfer of medical decision-making power to our patients as they become informed of the options if we truly wish to empower them.
Jordan Roberts Jordan Roberts is a fourth year medical student at the University of Arizona College of Medicine – Phoenix who matched into the family medicine residency program at St. Mark’s Hospital in Salt Lake City. He is a native of the White Mountains of Arizona, married with two children, and hopes to return to rural, northern Arizona as a primary care physician. Contact him by email to: jrroberts@email.arizona.edu
As a medical student I have observed the apprehension of my clinical preceptors regarding their patients making decisions while lacking appropriate knowledge of their condition or when motivated by a desire to receive special treatment. While these situations often highlighted the underlying tensions between the hopes of the doctor and the patient, the responses I found to be the most helpful were those given when the physician assumed a teaching role and pursued that challenging and elusive goal of gaining real “informed consent.” As medical students, we are taught that education is the best tool for patient empowerment, but in the “real world,” we often lack the time to educate all our patients who truly need it, relying instead on their trust in our authority. Perhaps too often, we discourage the
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public health — a student perspective
patient’s own unguided, independent investigation. (“Don’t trust everything you read on the internet!”) We gather information about our patients, information that is inaccessible to them in varying degrees, in order to make our decisions based upon guidelines and algorithms that would be too time-consuming to routinely explain to each patient. That being said, I have seen first-hand patient cases where my preceptor took the time, and those cases were the most rewarding for me. As a medical student I spent many bedside hours teaching after rounds, writing down my patients’ questions and being their advocate. These were the most satisfying moments of medical school for me. If knowledge is power, then the power gap between the doctor and patient can be very wide indeed, and we would all be better served if it were spread out more evenly.
“...If knowledge is power, then the power gap between the doctor and patient can be very wide indeed, and we would all be better served if it were spread out more evenly.” — Jordan Roberts
I often daydream of my future practice. I imagine a system where my patients’ knowledge of their states of health and their prescribed preventive services and treatment plans would be regularly assessed. These assessments would be used to measure their insight and values, to identify gaps in their understanding and agreement with the plan, and glimpse changes in these metrics. I would then discuss the results of these assessments with them as I would the results of laboratory tests, educate them with the help of my staff, and offer additional resources and media for their study. My hope in doing this is that with time my patients and I would share the power to make medical decisions more completely, eventually reducing the burden on me and empowering them responsibly. I understand such a system may not be desirable for all doctors, specialties or patients. In the earliest itera-
tions, it may be terribly inefficient and even create new tensions between the doctor and patient, who are now also teacher and student; however, the model is inherently dynamic compared to the historical paternalism of medicine and attractive in the age of the internet and within a cultural zeitgeist which values autonomy, egalitarianism and transparency. I don’t pretend to know how I would get paid for this, or how it would affect the overall cost of healthcare. It is only a dream, after all. I am grateful to my many mentors who have shaped my dream with their examples, and I hope to emulate them at their best even more fully. With the courage to fail often and succeed sooner, I hope to begin right away, in my first year of residency. In the words of Maimonides, “Now I turn unto my calling.” ru
A monthly publication of the MCMS • April 2015 • Round-up • 25
member profile
Patient Empowerment Has No Down-Side. Meet MCMS Member:
Christine Harter, MD Article photos: Denny Collins Photography www.dennycollins.com 602-448-2437
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r. Christine Harter is one of Arizona’s first headache specialists, and has spent much of her time and efforts seeking to educate her patients about their options, and encouraging them to invest in their health by exploring diet and lifestyle changes before pursuing medication to improve their conditions. As we focus on patient empowerment in this month’s issue, Round-up took the opportunity to sit down with Dr. Harter and discuss her experience with patient education and empowerment, especially in a world where technology is providing more and more resources and information for patients. Because patients are more likely to follow health plans they are invested in, physicians can take the time to listen to patient concerns and guide them to the right decisions for a better treatment experience, and result.
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member profile
A Priority of Empowerment
It was these experiences in pain management that would ultimately lead her to Arizona, where she developed a special interest in chronic headaches. Harter herself suffers from chronic migraines, so it was an easy and natural interest.
Christine Harter grew up in St Louis and completed her undergraduate studies at Vanderbilt University in Tennessee. It was here she met her husband, Robert. After completing her undergraduate degree, Harter travWhen she found herself looking for a change, (and elled to Baltimore to attend medical school at Johns Hopkins University. She stayed in Baltimore to com- some warmer weather) she moved to Arizona and took plete her residency in primary care and internal medicine the opportunity to work in pain management as well as internal medicine. at Johns Hopkins Bayview Medical Center. After completing her residency Harter initially decided to stay in primary care. “I liked the variety and I had great mentors, Randy Barker and Dave Kern who wrote the textbook Principles of Ambulatory Medicine,” she said. She chose to further specialize in internal medicine so that she could work primarily with adults. “I had grown up thinking I would be a college professor if I were going to be a teacher,” she said. “I guess I am a teacher of sorts. I take patient education seriously.”
In addition to the appeal of the sunshine, Harter was very appreciative of Arizona’s parent-friendly homeschooling laws. “We homeschooled our two children all the way through their education,” she said. “They are graduating next month, our daughter with a master’s in linguistics from University of Florida and our son with a bachelor’s in business administration from Grand Canyon University.”
While working in pain management, Harter worked This passion for patient empowerment was greatly hard to develop herself as a headache specialist. She influenced by her experience working at the community took many Continuing Medical Education courses on health center in inner-city Baltimore, where she saw the subject through the American Headache Society, first-hand the difference that could be made in patients which she quite enjoyed. lives if they were inspired to lead their own healthcare “I highly recommend it—Scottsdale Headache Symexperience, instead of frequent clinic visits with little or posium is at Camelback Inn every November,” she said. no patient follow-through. Finally, through a special practice track and by taking “If the health agenda is just the doctor’s agenda, then a grueling specialty test, Harter became one of the first the patient obviously won’t do it,” she said. She saw this in her experience working in Baltimore’s inner city. She noticed that when she ordered physical therapy for back pain many patients never went more than once, if they went at all. Naturally they didn’t get better very quickly. Frequently, inner-city issues of pain-management were also tied together with issues of addiction, and Harter did not shy away from confronting that. “This needed to be teased out and negotiated like a landmine field,” she said.
Dr. Harter discussing care options with a patient.
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member profile
Demonstrating treatment for headaches.
certified headache specialists in Arizona in 2006. The subspecialty is recognized through the United Council on Neurologic Subspecialties and has come a long way since her pioneering days, now requiring a headache fellowship. The Art of Patient Education
On the Personal Side 1. Describe yourself in one word. I try to be kind. It is up to others to decide if I succeed. 2. What is your favorite food, and favorite restaurant in the Valley? I don’t really have a favorite food or restaurant. I like variety. We have enjoyed The Grill at TPC, and the Persian Room, and True Food. 3. What career would you be doing if you weren’t a physician? College English professor. 4. What’s a hidden talent that you have that most wouldn’t know about you (play the guitar, sing, etc.)? Play violin 5. Best movie you’ve seen in the past ten years? Serenity 6. Favorite Arizona sports team (college or pro)? I don’t follow Arizona teams. Of all sports, I like watching football, it is an interesting game. So I guess I would have to say Vanderbilt Commodores football… Sorry! 7. Favorite activity outside of medicine? I like cooking but don’t have a lot of time for it nowadays. I do spend a lot of time mentoring younger people in our church and other community outreach activities with New Valley Church-Downtown.
28 • Round-up • April 2015 • A monthly publication of the MCMS
Moving deeper into the topic of patient empowerment, Harter illustrated that empowerment and education go hand in hand. In her practice she makes several efforts to help educate her patients on all possible treatments, and encourage them to commit to their own decisions. Her headache patients all receive an educational packet that includes information on diet and various migraine treatments and medications. There is also a dietitian who comes in every week to meet with those who have Diabetes. Harter wishes more of her patients followed up on this opportunity. “I think this is one reason why doctors get discouraged with patient education, ‘you can lead a horse to water but you can’t make him drink,’” she said. “But I am an eternal optimist so I keep doing it for the sake of the small percentage who take me up on it.” In fact, Harter said the percentage who take her up on the headache diet plan is pretty high. “Pain will do that to you; it is an effective diet!” she said. Harter follows this advice herself, easing the burden of her migraines by following strict diet, avoiding headache-
member profile
triggers, and drinking plenty of water. Harter said the biggest advantage of patient education and empowerment is better patient investment and commitment, which naturally results in better health. While patient empowerment may come slowly, especially among lower socioeconomic populations, she believes it definitely will come. Sometimes it takes extra time to listen to the patient’s concerns, and then steer the discussion in the right direction. “It’s an art,” Harter said.
A caring touch and sympathetic ear...
Harter also believes very strongly in the link between patient health empowerment and spiritual empowerment. “Which is why I have always spent most of my non-working time involved with my urban church work, both in Baltimore and here in Phoenix,” she said. Harter has been involved with New Valley Church in Downtown Phoenix for many years. Harter doesn’t think there is a down-side to patient empowerment. The more educated the patient and the more they are invested in their own health, the better. These days there is so much information available to patients through computers and smartphones that it seems technology will certainly have an impact (indeed, is already having an impact) on patient empowerment. So far, Harter has not seen her patients relying too heavily on the internet for their answers.
Private Practice and Activism
“It is hard work running my own practice, but I enjoy the business side of the practice, too,” she said.
In addition to patient empowerment, Harter is also an advocate of Harter feels one of the most imphysician empowerment, and much portant groups she has joined reprefers running her own practice. cently is Scottsdale Health Partners When working with the commu(SHP): a physician-led Clinical Innity health center in Baltimore, Hartegration Network and Accountable ter said, “I saw what happened when Care Organization. non-physicals ‘rule the roost,’ and it Harter has been impressed with isn’t good. I wanted to have control the organization’s ability to bring over my own destiny. A monthly publication of the MCMS • April 2015 • Round-up • 29
member profile
small private practices together to combine forces in a way that allows them to maintain their independence while also negotiating contracts and other economies of scale. “They seem to have stuck a great middle ground,” she said.
“Everybody always blames everything on ACA. I think a lot of the “problems” in medicine actually predated ACA and actually can be “blamed” in Medicare itself and just overall government involvement and regulation in medicine.”
This association between fellow physicians, especially those in private practice, is something Harter would like to see more in other organizations as well.
“The emphasis on ‘physician-led’ has helped me ne— Christine Harter, MD gotiate various contracts for my practice and has just overall provided mentoring and camaraderie with an emphasis on small private practice in a world where hospitals seem to be buying up practices left and right, But even that, she feels, predates the ACA. Although which saddens me to no end.” she certainly feels there were affects. In addition to her involvement with SHP, Harter has “I think it did raise insurance rates, and caused these been a member of the American College of Physicians terribly high deductibles, worst of which is the de(an Internal Medicine Specialty Society) since 1988. ductibles for pharmaceuticals,” she said. She also served on the MCMS board, where she has been a member since 2008. Her participation in ArMA began at much the same time, and she has taken the opportunity to attend and participate in a number of meetings there.
Another big topic is bill HB 2645 which is aimed at making lab tests more accessible to patients by allowing them to bypass physicians and order the tests themselves. The company, Theranos, is pushing this bill to open up the consumer-lab market here in Arizona.
“Those are very important meetings that shape state legislation that affects doctors and medical practice.”
While this may seem like a powerful patient tool on the surface, Harter does not think it will help the patient in the long run.
One area that gets a lot of discussion for its affect on the medical community is, of course, the Affordable “I don’t think patients should order tests themselves. Care Act. However, Harter thinks that many of these is- They need a physician, NP or PA to help them interpret sues run much deeper. the results,” she said. “Everybody always blames everything on ACA. I think a lot of the ‘problems’ in medicine actually predated ACA and actually can be ‘blamed’ in Medicare itself and just overall government involvement and regulation in medicine,” she said.
What often happens is that patients will order tests that do not provide the necessary helpful results. The patients then come into speak with her confused and concerned about results from a test that likely should not have been performed in the first place.
Harter said the worst part of these affects is the “inHarter said that the best thing to encourage patient terminable” documentation now required of physicians. empowerment in this matter is for physicians to leave “It’s a shame that we have to be worrying about the enough time in their visits for patients to mention tests nuances of coding rather than the nuances of diagnosing they are interested in, and to listen carefully to their patient’s true concerns so that the best guidance and care their disease,” she said. are provided. ru 30 • Round-up • April 2015 • A monthly publication of the MCMS
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The Maricopa County Medical Society & Medical Society Business Services
Board of Directors Meeting Minutes – February 17, 2015 BOARD MEMBERS
committed to continue reaching out to membership to fill committee slots. Jay agreed to summarize the comDrs. Ryan Stratford, John Couvaras, Adam Brodsky, mittee assignments, structures, and charges and distribKelly Hsu, Mark Wallace, Shane Daley, Ross Goldberg, ute to the Board. Tanja Gunsberger, Lee Ann Kelley, Marc Lato, Anthony Lee, May Mohty, and Anita Murcko were pres- MEMBERSHIP CATEGORIES ent. MCMS staff present was Jay Conyers. The Board discussed the existing membership cateCALL TO MEETING gories for the Society. Discussion was focused on the need for well-defined membership categories, and apDr. Stratford called the meeting to order at 6:05 pm. propriate dues amounts for each. It was agreed that only He reminded the Board about confidentiality and propfour primary categories are needed: Active, Associate, erly disclosing conflicts of interest. Affiliate, and Education, with sub-categories for some. OLD BUSINESS The Board discussed the various healthcare profesJay updated the Board on the status of the Arizona sions that complement physicians in the care paradigm, Medical Board project and the contract opportunity and whether or not membership was appropriate for with the State’s Comprehensive Medical and Dental each. The pros and cons of expanding membership to Program. He provided an overview of the building sta- be more inclusive of specific allied health professionals tus and potential tenants, and reminded the Board about was considered, and subsequently tabled for further analysis by the Membership Committee. the March 12th Open House at the Society. Jay also clarified the duties of the 401(k) trustees and notified the Board about the designation of Alex Miles and Lois Heller as signers and the removal of Donna Reynolds on the National Bank of Arizona accounts, as confirmed on January 20th when the Corporate Resolution was signed by Dr. Stratford.
NEW BUSINESS
Dr. Hsu briefed the Board on the concept of organizing a “Medical Philanthropy” forum with several speakers that provide care in third world countries. The Board discussed the benefits of also including individuals that provide medical philanthropy here in Arizona, and agreed that a mixed panel would be more impactful. CONSENT AGENDA A mid-May target date was discussed for confirming A motion was made to approve the consent agenda, availability with potential panelists. comprising January 2014 board minutes, the January Jay updated the Board on some new contract oppor2014 membership report, and the November 2015 financials for the Society and the Business Services. The tunities for GACCP that came out of the work being done for the Arizona Medical Board, and agreed to keep motion carried. the Board apprised of any progress on contract negotiCOMMITTEE ASSIGNMENTS ations. Dr. Stratford reviewed each of the committees, going ADJOURNMENT over committee structures, charges from the Board, and The meeting was adjourned at 7:34 pm. ru current members. Each chair or liaison reported back any recruits they had made for their committees, and A monthly publication of the MCMS • April 2015 • Round-up • 33
marketplace LOCUM TENENS, SHORT AND LONG TERM EMPLOYMENT Physician and Advanced Practitioner Recruitment and Placement Locum tenens short and long-term coverage for: CME, medical leave, vacations, sabbaticals, and retirement. It’s more than just filling vacancies. It’s about matching lifestyles, personalities and practice philosophies. Call: 602-331-1655 or 800-657-0354 • www.catalinarecruiters.com
UROLOGISTS
www.prostatecheckup.org • 480-964-3013
LOOKING FOR PART-TIME WORK? Prostate On-Site-Projects needs a part time, Board Certified Urologist to provide prostate cancer screenings on their mobile screening unit. No surgery, or treatment and minimal paperwork. Contact Marla Zimmerman at 480-964-3013 or marla@prostatecheckup.com
MED. EQUIPMENT
FULL OR PART TIME MEDICAL OR OSTEOPATHIC PHYSICIAN needed for physical medicine, physical therapy, neuropathy and chiropractic clinic in SW Phoenix. Responsibilities include primary care, neuropathy treatment and evaluating patients for various physical medicine treatments. Neuropathy and physical medicine experience not necessary. Current medical doctor retiring so position is available immediately. Fun, energetic place to work. Patients are cooperative, appreciative and staff is bilingual, well trained, motivated, professional and sincere. Please contact us with any questions or provide resume to drmaher@arizonahealthpros.com P/T PHYSICIAN NEEDED FOR PRIMARY CARE PRACTICE Internal/Geriatric Medicine physicianneeded part-time for established Sun City West practice. Contact Carl Carlson, MD at 623-546-5897.
AFFORDABLE MEDICAL EQUIPMENT Low priced, high quality new & used equipment for: PHYSICIAN OFFICES, HOSPITAL RADIOLOGY We buy, sell, consign, service, and fInance your CAPITAL MEDICAL EQUIPMENT NEEDS. Global Medical Solutions • Contact: Don Creedon TEL. (480) 874-0333 • www.igogms.com Member AIUM.
PHYSICIANS - FT & PT Occ Med clinics in Phx & Tucson. Excellent hours, CME, salary, benefits. Fax CV to Heather @ 602-773-0287 or e-mail h.wahl@mbiaz.com.
Round-up Marketplace provides local classifieds for full-time or part-time jobs, office space for sale or lease, services, community events, and much more! To advertise your product or service, contact Candice Scheibel at cscheibel@mcmsonline.com or call 602-251-2363.
LOCUM TENUM DOCTOR NEEDED Weekend shift for an urgent care, 8 am to 4 pm, $90/hr. Please call 480-792-1025 or fax your resume to 480-792-1026.
34 • Round-up • April 2015 • A monthly publication of the MCMS
marketplace EDUCATION OPPORTUNITY
RESIDENTIAL LOT FOR SALE
Dr. Satyendra Jain, General Medicine Practitioner with 30 plus years’ primary preventive medicine experience, invites actively practicing physicians, NP’s and PA’s to visit his clinic and observe his best practices in the different modalities of his practice. The doctor is available two days a week and the office is closed on Wednesdays. To set up a time to visit or for more information contact Celeste Jain by calling 602-353-9531 or email celsatjain@cox.net.
HOUSE FOR RENT PINEWOOD HOME FOR RENT Log cabin home only two hours from Phoenix and 20 minutes from Flagstaff in the heart of scenic Arizona.
MEDICAL WASTE SERVICES
For information please call toll-free
Your dream home is waiting to be built in Pinetop! Attractive wooded residential lot for sale in Pinetop. On cul-de-sac, easy access main road, near 2 country clubs. Architect’s prelim schematics for 2 car garage, 3-5 bdrm, 2,495-2,567 SF design available. 0.31/AC. $109,500
1-866-846-HMWS (4697) or email us hmws@cgmailbox.com. • Flexible Service Schedule Including On-Call Service • Trained Service Technicians • Tracking and Documentation • Regulatory Compliance • Approved Packaging Supplies
Call Jan Mullins, Spill Realty 928-369-4300
TRAVEL CLINIC/IMMUNIZATIONS
Four bedroom (2 masters), 3 1/2 bath home with formal living, dining and family rooms. Five decks give you a view of a ponderosa pine yard. Completely furnished with 4 TVs and pool table. Available in August - October weekly to monthly rental. Country Club limited facilities available. For information call Dorothy Westfall at 602-821-2523. Photos of cabin available.
A monthly publication of the MCMS • April 2015 • Round-up • 35
marketplace
OFFICE SPACE FOR LEASE PLUG & PLAY MEDICAL OFFICE ANTHEM, AZ 4,216 RSF built for family practice/urgent care. Great family oriented community. Freeway visibility, aggressive rental rates and concessions. Need for additional medical services in community. Contact Margaret Lloyd, Plaza Companies, 623-344-4558.
East Valley Professional Plaza — 1220 S. Higley Rd. Medical space available in this building on the campus of Phoenix Children’s Specialty and Urgent Care East Valley Center. Over 300 Pediatric Patients visit daily. Immediate access from US-60. Contact Marina Hammersmith, CCIM, Ensemble Real Estate Solutions, 602-954-8414.
SHARED OFFICE SPACE FOR LEASE AT ARROWHEAD CORPORATE CENTER Established Endocrinologist office close to 101 and Bell Road. Beautifully furnished, large waiting area. Four unfurnished exam rooms and three providers’ offices available. Two (2) year agreement preferred. Perfect for satellite office or primary practice. Email matthias15396@hotmail.com or call Jodene Rainford at 623-241-9028, ext. 103 Monday-Thursday, 9 am – 5 pm.
CUSTOM DESIGN YOUR SUITE AT 301 SOUTH POWER ROAD and join Southwest Kidney in this first class project. Directly across from Banner Heart Hospital and Banner Baywood Medical Center. Enjoy Power Road frontage and easy access from Loop 202 and US 60. Call Marina, Tracy or Autumn at Ensemble Real Estate Solutions, 602-277-8558.
MEDICAL OFFICE SUITE TEMPE-MESA AREA For lease in beautiful garden office complex. Includes covered doctor parking. Excellent location with easy access to 101 & 60 freeways and close to Desert Samaritan & Tempe St. Luke’s Hospitals. Contact 602-625-6298.
APACHE JUNCTION MEDICAL PLAZA Second generation PT and Oncology spaces available in this beautifully landscaped medical plaza. Join urgent care, general dentistry, lab and federally funded healthcare clinic in medically underserved Pinal County. Excellent visibility and signage. Adjacent to Banner Goldfield Medical Center. Contact Marina Hammersmith, CCIM, Ensemble Real Estate Solutions, 602-954-8414.
4,800 SF MEDICAL OR OFFICE 101 & THUNDERBIRD PEORIA, AZ Open floor plan vanilla shell. Second floor with lots of windows and views. Turnkey TI’s. Aggressive rental rates. Strong mix of medical including imaging and lab. Contact Margaret Lloyd Plaza Companies, 623-344-4558
2,055 RSF MEDICAL SPEC SUITE SR51 & BELL ROAD Class A Bldg. located on the Paradise Valley Hospital campus. Flexibility to customize flooring and paint. Six exam rooms, 2 RR’s. MA station and large waiting area. Move-in ready. Contact Margaret Lloyd, Plaza Companies, 623-344-4558.
MEDICAL OFFICE SPACE 6638 E. BASELINE RD., #101, MESA, AZ Are you looking for space to start a medical practice, but don’t want the overhead costs associated with opening an office? I have an office with 4 exam rooms available, Mon., Tues. & Wed. Will supply front desk and back office staff. Just come in and see your patients. We have billing and coding available on site. Office is convenient for Banner Gateway, Banner Baywood and Gilbert Hospital at Power and Baseline Roads. Short-term or long-term lease available. You decide how many rooms you need as well as number of days a week. Will allow 1/2 day usage.
36 • Round-up • March 2015 • A monthly publication of the MCMS
Please call or text Kevin 480-200-4590.
platinum
Arizona Central Credit Union
Medical Professional Liability Insurance for Arizona, Colorado, Nevada and Utah
Your personal and business banking partner.
www.mica-insurance.com
www.azcentralcu.org
MICA is a mutual insurance company that is owned by its members. As such, when financial conditions warrant, MICA returns dividends to its members. In fact, over the past ten years, MICA has distributed $337 million in policyholder dividends.**
MCMS members receive $200* when they join Arizona Central Credit Union.
gold
Unique. Exclusive. Preferred. The Maricopa County Medical Society has been a valuable partner to the medical community since 1892. Now we are teaming up with Your favorite companies to bring you even more value!
Premier Southwest Planning Group Let’s start a conversation.
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Bringing you:
MCMS members receive a 15% discount on Individual Disability insurance through Ohio National. Initial consultations are free of charge.
• • • •
silver Ensemble Real Estate Solutions www.ensemblere.com
Healthcare Medical Waste Services hmws@cgmailbox.com
MCMS members receive free initial consultation and complimentary a follow-up market survey (valued at $250).
MCMS members enjoy a 2% discount.
Superior services Personal recommendations Exclusive discounts Incredible value
Discover how you can be preferred! www.mcmsonline.com/partner 602-252-2015 mcms@mcmsonline.com
Plaza Companies www.the plazaco.com
Global Financial Leasing Services www.gfrservices.com
MCMS members receive a complimentary leasing market research.
MCMS members receive a free credit review and consultation with application.
* Visit joinus.azcentralcu.org **Past performance does not guarantee future dividends.
S I N C E M I C A’ S F O U N D I N G , O U R M E M B E R S H AV E R E C E I V E D OVER $ MILLION IN DIVIDENDS
As a mutual company, MICA distributes dividends to its members when financial conditions warrant. With the announcement of a $27 million dividend for the 2014 policy year, MICA’s total dividends distributed to members totals more than half a billion dollars.
MEDICAL PROFESSIONAL LIABILITY INSURANCE (602) 956-5276, (800) 352-0402 www.mica-insurance.com Dividends declared for a given policy year reflect the Company’s financial performance during that year. Past performance does not guarantee future dividends.