1mayjune99 by Advocates for Better Health

Doctors MetroDoctors THE BULLETIN OF THE HENNEPIN AND RAMSEY MEDICAL SOCIETIES

Hennepin Medical Society

A NEW COLLABORATION Ramsey Medical Society

Doctors MetroDoctors THE BULLETIN OF THE HENNEPIN AND RAMSEY MEDICAL SOCIETIES

Physician Advisor Thomas B. Dunkel, M.D. Physician Advisor Charles R. Meyer, M.D. Editor Nancy K. Bauer HMS CEO Jack G. Davis RMS CEO Roger K. Johnson Managing Editor Sheila A. Hatcher Advertising Manager Dustin J. Rossow Designer Susan Reed MetroDoctors is published bi-monthly by the Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 55413-1761. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761. To promote their objectives and services, the Hennepin and Ramsey Medical Societies print information in MetroDoctors regarding activities and interests of the societies. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reflect the official position of HMS or RMS. Send letters and other materials for consideration to MetroDoctors, Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761. E-mail: nbauer@mnmed.org. For advertising rates and space reservations, contact Dustin J. Rossow, 4200 Parklawn Ave., #103, Edina, MN 55435; phone: (612) 8313280; fax: (612) 831-3260; e-mail: djrossow@aol.com. MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy.

CONTENTS VOLUME 1, NO. 1

M AY / J U N E 1 9 9 9

FEATURE STORY: COLLABORATION

Hennepin Medical Society and Ramsey Medical Society work together to meet the challenges of the new millenium

COLLEAGUE INTERVIEW

Medical School Faces Great Challenges

COMMUNITY SERVICE

Resident Dr. Lorinda Parks Makes a Difference in North Minneapolis

RISK MANAGEMENT

Avoiding—and Defending—Allegations of Inappropriate Physician Conduct

HEALTH ECONOMICS

Attorney General Hatch Unveiled “The Fairness in Health Care Act”

PERSONAL FINANCE

Mutual Funds: How Many is Too Many? The Correlation of Stocks and Bonds Over Time

Long Term Care Insurance Provides Peace of Mind in Retirement

NOTEWORTHY RAMSEY MEDICAL SOCIETY

21 22 23

President’s Message

RMS Alliance

RMS News Winter Medical Conference Caring Hearts for the Homeless

HENNEPIN MEDICAL SOCIETY Non-members may subscribe to MetroDoctors at a cost of $15 per year or $3 per issue, if extra copies are available.

25 26 27 28

Chairman’s Report HMS News Community Internship HMS Alliance

On the cover: Hennepin Medical Society Chair Edward A.L. Spenny, M.D., and Ramsey Medical Society President Lyle J. Swenson, M.D. (Lake Street Bridge photo courtesy of Richard Johnson, HNTB).

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

May/June 1999

FEATURE STORY Hennepin and Ramsey Medical Societies work together

C O L L A B O R AT I O N to meet the challenges of the new millenium

“The members…are saying that physician’s top issues and concerns are the same on both sides of the Mississippi River.”

May/June 1999

Editor’s note: Throughout 1998 and continuing into 1999 the medical societies’ leadership have met as a joint executive committee and identified many areas for collaboration on physician issues and achieving further economies of scale. MetroDoctors, the new membership publication for both Ramsey and Hennepin Medical Society members, is the first visible sign of this process. This article, coauthored by Past Presidents Thomas Dunkel, M.D., and William Schoenwetter, M.D. provides the background for this undertaking and sets the stage for future activities.

Thomas B. Dunkel, M.D.

PHYSICIANS ARE NOW, MORE THAN EVER, in need of an effective public advocate. The

growing cooperation between the Ramsey and Hennepin Medical Societies is a natural and necessary step toward best serving the needs of physicians in today’s health care industry. For a medical society, serving physicians means first paying attention to what the members are saying. The members of the Hennepin and Ramsey Medical Societies are saying that physician’s top issues and concerns are the same on both sides of the Mississippi River. Metro area physicians share the desire for economic stability, the commitment to high medical standards and practices, and the assurance of adequate working conditions. By pooling the resources of the Ramsey and Hennepin Medical Societies, a larger and more cohesive voice for physicians is formed while better impacting the marketplace. Physicians need an advocate in the area of public opinion. Through the Community Internship Program, started by the Ramsey Medical Society and expanded to the Hennepin Medical Society, business community members engage in hands-on exposure to the delivery of medical care to patients in different situations. These “interns” are able to gain an in-depth understanding of the patient-physician relationship and health care’s important place in our society. The Community Intern Program, and others like it, help promote physicians in a positive light while creating opportunities through social and business networking. Physicians must continue to affirm their place as the medical authority in our society, and the Ramsey and Hennepin Medical Societies can help provide that service through broadened media relations. It seems like all too often, the media goes to HMO presidents with medical questions. Why? Because the HMO is an organized group with a medical platform and a visible leadership. The continued collaboration between the Ramsey and Hennepin Medical Societies can help provide the media with a visible, medically qualified leadership to go to for answers.

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The Bulletin of the Hennepin and Ramsey Medical Societies

Some would say the rise of managed care and the decline in numbers of physicians in private practice have diminished the need for medical professional organizations. Professional medical organizations certainly have suffered consistent declining membership in recent years. In some ways, the internal structure of the large HMOs can seem, and even function like, a professional organization through quality assurance committees and in dealing with other, non-patient care issues. The truth is that employed physicians are in need of an organization that will put their best interests ahead of the bottom line. And, with their combined resources, the Ramsey and Hennepin Medical Societies will function as a clearer more effective platform for the employed physician as they operate within a managed care system. The Societies’ challenge is to better promote the advantages and benefits they can offer physicians of all types. The Ramsey and Hennepin Medical Societies need to be flexible and creative enough to best serve the ever-evolving profile of Twin Cities physicians. Physicians need assistance in keeping up with the changing rules of managed care, the lack of severity indexing, and capitated systems. Also, both employed and independent physicians need an advocate when it comes to contracts with an HMO or any other third-party payer. The Ramsey and Hennepin Medical Societies are on the right track with looking into the idea of providing contract background for our members. The collaboration between the Societies is already providing the membership with educational opportunities through expanded doctor to doctor interaction. The joint Societies’ winter conference will provide additional opportunities to meet metro area colleagues and build personal and professional relationships. Physician’s basic conservatism has traditionally limited their willingness to take the initiative in forming alliances. And, in terms of formal organizational structure between the Societies, it might be a long time in coming. But, the Societies continue to make steady and solid progress in combining their resources to become more effective as a resource and public forum for physicians’ issues. The two societies have established a joint web page and bulletin, and our executive committees now meet together quarterly. Further collaboration between the Ramsey and Hennepin Medical Societies is providing more benefits for members and a more attractive draw for new and future membership.

Thomas B. Dunkel, M.D.

B Y T H O M A S B. D U N K E L , M . D .

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The Bulletin of the Hennepin and Ramsey Medical Societies

May/June 1999

William F. Schoenwetter, M.D.

LOCAL ORGANIZED MEDICINE HAS HAD CHALLENGES in recent years. The Hennepin Medical Society, like many organizations of its kind, has faced a slow, steady erosion of membership. The employment of growing numbers of physicians in large provider organizations has reduced HMS membership for a few different reasons. The results of a physician survey conducted more than a year ago by Allina seem to accurately represent employed physician’s attitudes toward professional organizations.

• 60% of the wide survey sample were not members of either the MMA or a county organization. • The average amount that physicians were willing to commit to a state or local medical society was only $250. • The reason cited for their lack of membership was “lack of value.” The same survey also highlighted the benefits and services that physicians are seeking in a professional organization. The five benefits or services that topped the list were (in descending order of importance) public relations, lobbying, acting as an information source, enabling networking and other professional contacts, and to monitor the actions of the large HMOs. The “wish list” of services and benefits compiled from the Allina survey address the exact same areas on which the HMS has traditionally focused its efforts. And, it is those exact desired services and benefits that will continue to benefit from the HMS’ continuing collaborations with the Ramsey Medical Society. The two societies’ combined resources are already stretching each dollar farther than in the past. The services that the societies have always provided will continue to improve through this economy of scale. There will be more money saved through the continuing reduction of duplicate efforts, and those savings will translate into new functions. The collaboration between the two societies also

William F. Schoenwetter, M.D.

creates an opportunity to more effectively put a metro area focus on physician’s issues. The problems and concerns of HMS and RMS members can often be different than those from outstate areas. The coordinated HMS and RMS can clearly and efficiently function as a unified voice for its unique membership. Medical organizations have not had the best press lately. When the AMA, our nation’s most visible beacon for organized medicine became involved in the Sunbeam and E&M Coding fiascoes, a red flag rose for most physicians. In these two situations, the representation of physician’s best interests was obviously not accomplished. And, closer to home, there was a perception among physicians that the MMA could have done more for physician’s interests concerning MinnesotaCare legislation. When the two leading medical organizations have the appearance of not being terribly effective on several important issues, it’s harder for the little local society to stand up and say “we’re different.” The culture of physicians has changed. The paradox that pits large, growing, and sometimes impersonal provider organizations against shrinking medical societies that exist solely to promote physician’s best interests may continue. It is HMS’ challenge to become even more efficient in getting the message across that physicians need a voice, outside of their employer, that can speak to their best interests. Combining the HMS’ resources with the RMS is a timely, necessary step towards preserving a voice for physician advocacy in the Twin Cities. ✦

B Y W I L L I A M F. S C H O E N W E T T E R , M . D .

May/June 1999

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May/June 1999

COLLEAGUE INTERVIEW

Medical School Faces Great Challenges Alfred F. Michael, M.D. Dean of the Medical School Regents’ Professor of Pediatrics “Colleague Interview” provides HMS and RMS members with an opportunity to ask questions of their colleagues who are in unique roles. In this issue, interview questions were asked by Drs. Lee Beecher, Richard J. Frey, John Gates, William E. Petersen, and Lyle J. Swenson.

Q A

What motivated you to get into administration and accept your position as Dean? Over the years my goal as an academic physician was to establish strong state of the art medical programs by world-class education and research. Administration was never a personal goal in itself, although it is clearly a necessary ingredient. Actually, I was having too much fun dealing with kidney disease in children and leading the Department of Pediatrics. My agreement to become Dean two years ago was based upon my strong commitment to the School as well as the exceptional challenge of the major changes that will be necessary for our future. I view my own career as continuing to paint the academic picture— but with a broader brush.

What is the single largest problem facing the University of Minnesota Medical School? The single largest problem is how we support this School at times of great change. We are in an era in which there have been remarkable achievements in science—a revolution initiated by the Watson and Crick’s description of DNA some 46 years ago and the rapid development of molecular biology during the last decade. In addition, the developments of digital and information technology during the same period will make the 21st century much different than its predecessor. These disciplines will increasingly affect what we teach medical students and residents, how we conduct research, and how we practice medicine. These achievements will ultimately translate to the patients’ bedside but also fuel the medical technology industry in Minnesota.

May/June 1999

A L F R E D F. M I C H A E L , M . D .

Since the Medical School is part of a land-grant University, one of my personal goals is to connect us with all segments of the community. Medical education will continue to involve contributions of community physicians, but will also be carried out in the context of relationships among other health professionals as well as rural health initiatives. Our entire Medical School curriculum and educational systems are undergoing change to be sure that our physicians are prepared for the challenges of an aging population, adolescent medicine, women’s health, and our increasingly diverse population. We are not able to meet the challenges effectively because of the impact of another revolution—the changes in financing of health care. During the last 40 years, our School as well as other medical schools, used resources from clinical sources—hospital and faculty practice—to support the academic mission of education and research. These sources of funds are no longer available to meet the mission of the Medical School. The current deficit for the Medical School is in the range of $25 million per year. A proposal to meet the financial needs of the Medical School has been submitted by the University to the State Legislature. In addition, the balanced budget act of 1997 has resulted in major changes in the financing of graduate medical education from Medicare with an anticipated deficit over the next five years of 100 million dollars. A State Department of Health commission dealing with medical education and research costs (MERC) is addressing this important issue.

How has managed care changed the medical school curriculum and the postgraduate training of medical school graduates? As I mentioned above, changes in the financing of health care have had a profound effect on medical schools and our educational and research programs. In view of the fact that our students and residents will be practicing in a managed care environment, we have introduced discussions on managed care into our curriculum. Further, community and academic physicians within managed care programs play an important role in the education of our students and residents.

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Should the problem “tenure” be addressed in the near future? The tenure debate of several years ago was not a pleasant one for the faculty, the Board of Regents, or the State of Minnesota. In my view, the issue should not be addressed further.

How do we overcome the perception of Fairview-University as now competing with the rest of the metro health systems as opposed to complementing them?

A Center for Spirituality and Healing has been established within the Academic Health Center. Citizens of this nation currently spend billions of dollars on complementary or alternative modalities of care. From a scientific point of view, we know very little about their effectiveness although there is clear evidence that some forms of care result in improvement of the patient. Given the magnitude and pervasiveness of complementary care, it is important that our students know what complementary forms of therapy are all about. Further, demonstrating scientific effectiveness is an appropriate form of inquiry.

As you know, two years ago the University sold its hospital to Fairview Health Systems. The agreement between the University and Fairview was based upon the fact that the University Hospital’s financial status was deteriorating in our highly competitive managed care marketplace. Fairview did not buy the faculty nor are the faculty employed by Fairview; they continue to serve in their roles of education, research and patient care. There is obviously a preferred clinical relationship with Fairview-University Medical Center. However, Fairview must compete in the health care marketplace similar to all hospitals and organizations in the Twin Cities. The Medical School is an integral part of the University of Minnesota and has commitments to the citizens of this State, its health professionals as well as all clinical programs in Minnesota. These commitments and relationships are essential for us to meet our mission for training physicians and to support research.

How can community physicians best work with the medical school to educate residents and medical students?

The University of Minnesota is recruiting a head for the Department of Psychiatry. Please comment on this.

The Medical School has 1,500 clinical faculty practicing within the metropolitan and statewide community. The commitment of our community physician educators has been extraordinary since they play crucial roles in the education of students and residents in office-based and hospital settings. We support increasing involvement and partnerships with full-time faculty. In some Medical School departments the links are strong and in others these relationships are growing.

Our recruitment of a Department of Psychiatry Head has included participation of a broad base of the mental health care community. Specifically, the search committee included representatives from our major teaching hospitals, the practicing medical community, and academic psychologists. In addition, we arranged interviews and receptions with community psychiatrists. My message during the search was clear—that this be an open process with broad participation. The balance between biological/scientific psychiatry and consultation/therapy is crucial to maintain our educational and research program. My sense is that the process worked. The eclectic process for the search will extend beyond the search process to include collaboration with our teaching hospitals, community clinical faculty, and other mental health care practitioners. I am hopeful that a definitive selection will be made in the near future.

Is the faculty actively engaged in discussion and evaluation of alternative/complementary medicine?

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The Bulletin of the Hennepin and Ramsey Medical Societies

May/June 1999

How do you feel we should deal with the application of ever increasingly high technology in a near term environment of limited resources as it relates to demand on our capacity to deliver? An example close to your experience is the resource utilization in the neurologically or otherwise seriously impaired premature neonate? Should we spend one million dollars on one permanently impaired neonate or $100 each on 10,000 needy children—and whom do you want to decide? Resource allocation based upon finite resources and prioritization has been suggested as a way to deal with the current financial pressures in health care. How do we balance the one million dollar cost for a single premature infant with the need to immunize or feed 10,000 children? Science and technology have raised the ante by creating sophisticated equipment and new drugs. The molecular and digital age of the 21st century may add to the cost of health care. On the other hand, scientific advancement may lead to striking reductions in health care costs. For example, the effectiveness of polio, H. influenza, and other vaccines on morbidity and mortality has been remarkable. A physician is not confronted with the dilemma of choosing between care for a single neonate and preventive care for thousands of children. A decision of this magnitude would have to be made by someone, but who? Certainly not the physicians caring for a sick baby. Perhaps someone who controls the purse strings, but surely for such an enormous ethical issue societal consensus or mandate would be required—in my view an unlikely event for the foreseeable future. However, our resources are limited and therefore allocation decisions have been and will continue to be made in less dramatic scenarios: the selection of a cheaper drug over an equivalent more expensive one; the denial of reimbursement for unproven forms of therapy, etc.

May/June 1999

Alfred F. Michael, M.D.

What needs to be done to preserve the tradition of excellence and the important role of the University of Minnesota Medical School? The Medical School and its affiliate hospitals educate the majority of physicians in Minnesota. Its mission therefore is directed to enhancing the health of its citizens through education, new discovery, and clinical programs. The development of new technology in the Medical School is a catalyst for Minnesota’s biotechnology industry. We are poised to meet these challenges. In my view, we will need to do the following: • develop in the broadest context close relationships with the community that we serve—our students, citizens, physicians, other health professionals, and industry; • continue to develop innovative educational programs for students, residents, and physicians that meet the changing world of the 21st century; • increase our scientific research programs to improve the health of our citizens; • develop vigorous interdisciplinary programs and interactions with other health professionals and industry; and • obtain adequate financial resources to fulfill the above goals at a time when clinical and hospital funds can no longer support the mission of the Medical School. Currently a major initiative has been presented to the legislature by the University to provide necessary support for the School. ✦

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May/June 1999

COMMUNITY SERVICE

Resident Dr. Lorinda Parks Makes a Difference in North Minneapolis Editor’s note: Lorinda Parks, M.D., is a first year family practice resident at North Memorial’s Family Practice Clinic and is making changes in her life to improve the lives of families in North Minneapolis.

WHILE NORTH MINNEAPOLIS may not top the list of preferred areas

for Minneapolis physicians to call home, for Dr. Lorinda Parks, the choice was simple. The long path leading Parks to her North Minneapolis neighborhood began while she was a medical student at the University of Minnesota. Fulfilling a desire to work with inner city kids, Parks became involved with the Boy’s and Girl’s Club of South Minneapolis. Her involvement with the Boy’s and Girl’s Club also helped attract some of her fellow medical students to the program, coaching basketball teams and other activities. Over time, Parks and her sister, Aneesa, developed a close relationship with one family in particular. And when this family of seven unexpectedly needed housing during the summer of 1996, they started looking for a solution. Acting on a tip from a friend about an available house on his block in North Minneapolis, Dr. Parks began assembling a plan to get this family into the house. She found 12 families (including her own) willing to invest $5,000 each into the project. By the fall of 1996, the house was purchased outright and refurbished. In January of 1997, Dr. Parks and her sister were spending much of their free time helping out and socializing with the family at their new house when the house across the street was busted by Minneapolis Police. The amount of traffic coming and going from the house had tipped off the neighbors to drug activity several years before the police became involved. Now vacant, the house presented a great opportunity for the Parks sisters. Not only could they be neighbors to some of their closest friends, but the house itself had potential if they looked hard enough. Also, a vacant “crack” house was bound to be affordable. By the time Parks, her sister, and another friend moved into the house in the Fall of 1997, they were already attracting attention from the kids on the block. That summer, along with the neighbor who had attracted them to the area in the first place, they were able to send some of the kids to camp in the Brainerd area. BY DAN BENSMAN

May/June 1999

Soon, kids from the block were playing and doing other activities together at Parks’ home. After school and on the weekends, kids from different cultural backgrounds get tutoring, go on day trips, play board games and organized sports. Last season, Parks was able to procure a grant from the City of Minneapolis to outfit 11 kids in new soccer cleats. A few of the kids also wrestle for a city league team. Recently, Parks borrowed her parent’s van to transport ten kids to Fergus Falls for a wrestling tournament. Parks helped gain permission from the City to use a vacant lot across the street from her house as a community garden. In addition to yielding

The Parks’ sisters were welcomed to the neighborhood by many children and their families. Pictured are a few of the children who come to be safe, tutored, play games and be loved at the Parks’ sister’s home.

a wide variety of fresh vegetables to help feed children and their families on the block, the garden provided an opportunity to break down some of the barriers that exist between the Hmong families and other people on the block. Language and cultural differences that have historically isolated Hmong families on the block became less pronounced when the Hmongs MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

were able to use their superior agricultural know-how, instead of forced and reluctant English, to communicate. It is not just a one-way transaction for Parks. According to her, the time and effort she puts into the kids and her neighborhood is repaid in several ways, not the least of which is helping her become a better doctor. Parks is a first-year resident at North Memorial Health Care. “It has been a really good learning experience. I’ve learned so much about what it is like to live in North Minneapolis from my patients…and when they find out that I live in the neighborhood, it’s always a bonus…patients feel a special connection,” she said. Parks’ efforts at home have not gone unnoticed by her colleagues. According to Dr. Bruce Norback, a University of Minnesota clinical professor of neurology and staff member at North Memorial Health Care, Parks “epitomizes the best caring aspects of physicians.” Norback was “stunned” to learn that Parks was living in North Minneapolis and “not only was she going through her grueling schedule as a first year resident, but also helping these people.” Parks feels that patient care often suffers unnecessarily due to a communication gap between physician and patient. According to Parks, the gaps between care-givers and patients in North Minneapolis can be especially large and are ever-widening. As an example, Parks highlighted one of the biggest complaints made by physicians in her area — inner-city families often use the emergency room for non-emergent care. “The situation has little prospect of being resolved because the care-givers and patients do not understand each other’s goals and motivations.”

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“…and when they find out that I live in the neighborhood, it’s always a bonus…patients feel a special connection.” Another concern is the economic division between physicians and patients. Parks feels strongly enough about this issue to make changes in her personal life to try to reduce this gap. “Patients know that you chose to live here because you care about them…I think that it really does make a difference.” “After a few years, the kids finally believe we’re going to stay awhile” said Aneesa Parks. The kids once asked her why she was planting flowers outside of her house if she was just going to have to dig them up again when she left. It is not easy for kids who grow up in a tough neighborhood to trust people. The Parks sisters’ care is at least one thing these kids can bank on. ✦ Dan Bensman is a freelance writer in South Minneapolis.

May/June 1999

RISK MANAGEMENT

Avoiding—and Defending—Allegations of Inappropriate Physician Conduct

RECENT HEADLINES have highlighted a growing trend in malpractice lawsuits, disciplinary actions, and criminal prosecutions — alleged sexual misconduct by physicians. Sensational publicity, heightened concern about gender issues, and changing medical practices have created a climate in which every physician may be vulnerable to allegations of inappropriate conduct. Healthcare facilities, too, may be subject to lawsuits for the misconduct of their physicians. Cases of Concern

The majority of the cases involve allegations of inappropriate breast, pelvic, or rectal examinations. According to Debra McBride, MMIC Assistant Vice President of Risk Management, several different scenarios are presented by these cases. First are cases in which the examination was for a bona fide diagnostic or treatment purpose and the physician had no inappropriate intentions. However, questions were raised about the propriety of the examination for such reasons as: • The technique of examination was outdated or ineffective; • The type of examination is not usually performed within the physician’s specialty; • Examinations were performed at unnecessarily frequent intervals; • The physician knew, or should have known, that another physician was following the patient’s care in the areas of concern; or

• The examination did not otherwise fall within common practice patterns. Second are cases in which everything about the examination was medically and ethically appropriate, but there was a breakdown in communication leading to a patient misunderstanding of the need for the examination or how it was conducted. A third category involves “predatory” physicians, where the actions and intent of the physicians were, in fact, inappropriate. “Cases involving physicians who deliberately engage in sexual misconduct with patients are rare, but they do occur,” says Ms. McBride. “Our risk management goal for this type of case is to educate healthcare facility administrators about how to identify problems and how to respond if a problem does arise.” A related type of situation in which sexual misconduct may be alleged is that in which physicians overstep professional boundaries and become involved in personal relationships with patients. When the relationship ends, the patient files a malpractice suit or complaint with the medical licensing board. Risk Management for Physicians — Respect; Communication; Documentation; Good Practice

Many risk management lessons in how to minimize the threat of allegations of inappropriate conduct can be learned from past lawsuits. Although they are simple recommendations for avoiding misunderstandings with patients and ensuring that the propriety of examinations is above question, they can be easily overlooked in the midst of a busy schedule.

• Respect the patient’s privacy. - Knock before entering the exam room; - Provide a gown whenever the patient is asked to fully or partially disrobe; - Do not remain in the exam room while the patient is disrobing or re-dressing; - Do not assist the patient in removing clothing. (If a patient is unable to undress him/ herself offer assistance from someone of the same sex as the patient); - Allow the patient to regown or dress before discussing the findings of the examination, course of treatment, next visit, etc. • Communicate fully the purpose of the examination and obtain the patient’s consent before proceeding. This is especially critical if the purpose of the examination is not obvious to the patient from their presenting complaint. Explain what you are doing throughout the examination. • Have an assistant of the same sex as the patient in the room whenever you believe there may be potential for the patient to misunderstand the purpose of an examination. Patients with whom an assistant may be advisable include: - Young patients who may not have previous experience with the type of examination necessary; - New patients with whom no relationship has been established; - Patients expressing particular concern about the examination; - Patients exhibiting any type of seductive behavior; - Patients with a history of sexual abuse; - Patients raising “red flags” of any other sort.

B Y M I D W E S T M E D I C A L I N S U R A N C E C O M P A N Y, RISK MANAGEMENT COMMITTEE

May/June 1999

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The Bulletin of the Hennepin and Ramsey Medical Societies

An assistant should definitely be available for any patient who requests that another person be present in the exam room. • Evaluate your techniques of performing examinations. Do they comply with accepted standards and practice patterns? Do your partners and other colleagues use the same methods? Do the examinations generally fall within your area of specialization? • Document all examinations fully, including the reason for the exam. • Be careful of overly casual comments or questions that may have sexual overtones and be misunderstood by the patient. If questions are medically necessary, explain the reason they are being asked. For example, many patients do not realize that inquiry about birth control or sexual practices may be important for diagnostic or treatment purposes. Without explanation, they may be offended by the questions. • Maintain appropriate professional boundaries with patients. What may be intended as simply a comforting hug by a physician may be perceived as an unwelcome advance by a patient who is unfamiliar with the physician’s practice style.

A significant problem with these cases is that they often receive extensive publicity. Once one patient’s claim of inappropriate conduct by a facility physician hits the headlines, allegations by other patients frequently follow. The potential for facility liability is most significant when there are multiple allegations against a single physician. Therefore, quick response to even a single complaint is vitally important. Prevention, early detection, and damage control are the keys. Administrators and medical directors should: • Establish a written policy stating that inappropriate conduct with patients will not be tolerated, that complaints will be thoroughly investigated, and that appropriate disciplinary action will be imposed if a complaint is found to be valid.

• Develop a facility policy on the use of exam assistants. Some facilities require an assistant to be in the room whenever a physician is examining a patient of the opposite sex. Some require an assistant whenever a breast, pelvic, or rectal exam is performed. Other facilities handle the issue on a case-by-case basis. At a minimum, trained assistants should be available whenever a physician or patient requests one.

• Ensure that the healthcare facility has a formal, effective policy for the handling and resolution of patient complaints. In the case of a complaint alleging sexual misconduct, the policy should require that the complaint be brought immediately to the attention of the administrator.

• Recognize that the interests of the healthcare facility may diverge from those of the physician if an allegation of misconduct is made. Contact legal counsel immediately if any question of physician misconduct arises to ensure that the facility is able to protect all

• Respond promptly to any patient who complains of physician misconduct. Let them know that their complaint is being investigated and that appropriate action will be taken. In most cases, it should not be the physician against whom a complaint is made who responds to the patient.

• Carefully assess the propriety of personal involvement with patients. The AMA and many state medical associations have addressed the issue of when personal relationships with patients are — and are not — ethically appropriate. Risk Management for Healthcare Facilities—Good Policies; Quick Response; Legal Counsel

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In addition to the lawsuits filed against physicians for inappropriate conduct, many malpractice suits also involve allegations against the physician’s healthcare facility for failing to supervise the physician, negligent employment, or failure to respond to patient complaints. These allegations are based on the theory that the facility administration knew, or should have known, that the physician was engaging in inappropriate conduct. MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

May/June 1999

corporate interests and that any reporting requirements are met. • Discuss with legal counsel how to structure an appropriate investigation and, if necessary, disciplinary response to allegations of sexual misconduct. Consider the advisability of restricting, during the investigation, the practice of any physician against whom a complaint of inappropriate conduct has been made (e.g. requiring exam assistants, limiting appointments to established patients only, limiting the type of examinations performed). • Notify your professional liability carrier immediately if a complaint of inappropriate conduct is made against a physician. Such notice is not for punitive purposes; rather, it will allow the company to work with you and your corporate attorney to resolve the complaint and prevent future problems. Although the majority of cases have alleged inappropriate conduct by physicians, lawsuits have also been filed against facilities based on the conduct of allied health professionals. The

result, MMIC will deny such claims against physicians in Minnesota; claims against corporate facilities will be considered on a case-bycase basis. “MMIC policyholders and staff need to work together to eliminate the significant exposures these cases create,” says Mr. Rutz. “It is MMIC’s expectation that—at a minimum— every facility will: 1) establish a firm policy against inappropriate conduct with patients; 2) follow sound risk management principles in handling patient complaints; and 3) report any complaint of inappropriate conduct immediately to the MMIC Risk Management Department. Our goal is to work with our policyholders to prevent isolated allegations from becoming major problems.” For further information, please contact the MMIC Risk Management Department. ✦

same risk management principles should be applied to these cases. What About Coverage?

According to Michael Rutz, vice president of underwriting, there is no simple answer to the question of whether the policy of insurance with MMIC covers allegations of inappropriate conduct. “Certainly, it was never the intent of the policy to cover sexual acts, and our rate structure does not take this exposure into account.” MMIC’s duty to defend or indemnify depends on the specific facts and wording of the allegations in each individual case. At times, coverage has been denied. Generally, however, MMIC has provided a defense to physicians and healthcare facilities under a reservation of rights. By reserving our rights, the company maintains the ability to withdraw from the defense if investigation and evaluation of the case reveal that coverage should not apply. Minnesota claims are affected by a 1998 Minnesota Supreme Court ruling that held general liability coverage, not professional liability, applied to claims of sexual misconduct. As a

Midwest Medical Insurance Company is a physician-owned medical malpractice insurer covering physicians, clinics, and hospitals in Minnesota, Iowa, Nebraska, North Dakota, and South Dakota. For more information call 1-800-328-5532.

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Products and Services Offered to RMS Members by RCMS, Inc. For more information call 612-362-3704. 14

May/June 1999

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The Bulletin of the Hennepin and Ramsey Medical Societies

HEALTH ECONOMICS

Attorney General Hatch Unveiled “The Fairness in Health Care Act” The proposed bill would have created a fairer playing field between patients, doctors and HMOs when treatment decisions are made. Patient Protection Bill Defeated in House Committee Legislation promoted by Attorney General Mike Hatch, which would have adopted health plan liability, proposed a standardized definition of medical necessity, and provided a number of other patient protections, was “laid on the table” in the House Health and Human Services Policy Committee. After nearly three hours of debate, the strong opposition from the health plan industry and the business community, the committee voted to lay the bill on the table.

“The most powerful lobby in the state is the health maintenance lobby and they were successfully able to raise issues, most of which were false. This bill would be a gentle expansion of patient’s rights and wouldn’t increase premiums as opponents contend,” said the bill’s House sponsor, Rep. Ron Abrams, RMinnetonka. (From the Minneapolis Star Tribune, March 26, 1999.) “It’s bad all the way around. The bill would do nothing to increase quality, access or control costs,” said Tom Lehman, lobbyist for Blue Cross and Blue Shield. (From the Minneapolis Star Tribune, March 26, 1999.) The MMA had generally supported this legislation and had been working with both the attorney general and the House and Senate authors to make improvements to the bill. It was predicted that provisions included in these bills would appear as amendments to other bills The Original Proposed Bill Attorney General Mike Hatch, State Representative Ron Abrams (R-Minnetonka), and State MetroDoctors

Senator Don Samueulson (DFL-Brainerd) proposed in February, “The Fairness in Health Care Act,” designed to allow patients and doctors to be more active as participants in making health care treatment decisions. The proposed bill exposes conflicts of interest created by financial incentives between HMOs and physicians, clarifies and provides balanced definitions of “experimental” and “medically necessary” treatment, and strengthens current laws relating to the disclosure of information to patients. The “Fairness in Health Care Act” establishes standards of ordinary care all health insurance carriers in Minnesota must follow in making health care treatment decisions, and holds a health carrier liable for harm to an insured or enrollee caused by its failure to follow those standards. “Health care providers such as HMOs and health insurers make crucial decisions every day regarding whether medical treatment is necessary for the care of patients, yet are held to no standard of care in making those decisions,” Hatch said. “This bill puts the term ‘care’ back into the business of health care. When someone’s life is at stake, a treatment decision should be made by a skilled physician, not an HMO executive who is mainly concerned with the bottom line.” The proposed bill outlaws certain financial incentives which some HMOs impose on physicians. Currently, some HMOs reward or penalize physicians based upon the number of referrals made to outside specialists or the treatment prescribed. Such financial incentives create a direct conflict of interest, measuring health care by financial concerns, rather than what is in the best interest of the patient. Attorney General Hatch noted that “physicians should not

The Bulletin of the Hennepin and Ramsey Medical Societies

be placed in situations in which they are deterred from fully and freely exercising their professional judgment as to the type of care necessary for a particular patient. With financial incentives removed from referrals to specialists, doctors will make decisions and recommendations free from undue influence.” An additional component Hatch proposed involves clarifying the definitions of what is “experimental or investigative treatment” and “medically necessary treatment.” According to Hatch, “The classifications we are proposing today will limit an HMOs ability to deny treatment based on broad definitions and undefined ‘internal standards,’ and will instead tie the term ‘medically necessary’ to the prevailing medical standards as determined by actual practicing physicians.” Hatch’s bill will also strengthen disclosure requirements and protect health consumers by: • Requiring physicians to disclose the reimbursement methodology agreed to between the physician and HMO. • Requiring HMO review physicians to be available to discuss their conclusions not only with a patient’s doctor, but also with the patient or the patient’s representative. • Requiring all health plan companies to provide to potential enrollees upon request a copy of the coverage agreement. • Requiring disclosure of the procedures for obtaining standing referrals to specialists. • Precluding health plan companies which give pre-authorization approval for services or benefits from subsequently denying coverage for those services or benefits. Hatch described his proposed bill as “a first step in leveling a very uneven playing field.” ✦

May/June 1999

PERSONAL FINANCE

Mutual Funds: How Many is Too Many? Ease of Investing Can Lead to Overdiversification

IF A LITTLE DIVERSIFICATION is a good thing, then more is better, right? Not necessarily. The rationale behind owning a diverse group of mutual funds is simple: by investing in a number of funds, you may reduce the risk that a poor-performing fund may disproportionately affect the portfolio’s overall returns.1 In their zeal to diversify, however, some individuals buy more funds rather than adding assets to their existing funds. Given that the average mutual fund holds more than 130 stocks, a person with 20 mutual fund accounts could conceivably own literally thousands of securities.2 And all too often, investors chase the latest hot performers without considering the role of their new fund in their overall investment strategy. “The ‘8-funds-to-buy-now’ approach seen in many personal finance articles encourages investors to collect funds haphazardly, without a road map, and without tying their fund investments back to their financial goals,” said Don Phillips, chief executive officer of Morningstar, Inc., a leading source of performance data and research on mutual funds.

of investing in additional funds all but disappear. Financial publications often lead you to believe that determining how many mutual funds to own is a simple process. And some experts believe that striking the right balance of assets in your portfolio (asset allocation) is more important than the specific funds you choose. “Ultimately, though, each individual has to consider asset allocation in the context of his or

her time horizon and risk tolerance,” said Morningstar’s Phillips. So how many funds should you own? The answer to that question depends on the factors mentioned above, as well as your financial goals. ✦ 1)

Diversification does not guarantee against loss. It is a method used to manage risk. 2, 3) “Are You Overdiversified?” Morningstar, 1997

A CASE OF DIMINISHING RETURNS

Study Shows More Funds Aren’t Necessarily Better

To determine the optimal number of mutual funds an investor should own, Morningstar conducted an in-depth study of past performance. Its research compared the hypothetical returns of various portfolios holding between 1 and 30 randomly selected mutual funds. Morningstar’s study found that a portfolio’s expected range of returns begins to narrow considerably once a portfolio exceeds 5 funds.3 Once a portfolio holds 17 mutual funds, the benefits 16

May/June 1999

Each additional mutual fund you invest in may decrease your portfolio’s expected range of returns. Once you own five funds, however, your expected range of returns may still decrease, but less and less with each additional fund you include in your portfolio. After your portfolio holds 15 mutual funds, the benefits of further diversification may be minimal. The hypothetical portfolios holding between 1 and 20 mutual funds were constructed from all combinations of growth and income funds with at least five years of historical returns using performance data for the fiveyear period ended January 31, 1999, as reported in The Wall Street Journal, February 1, 1999. Past performance is no guarantee of future results.

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The Bulletin of the Hennepin and Ramsey Medical Societies

The Correlation of Stocks and Bonds Over Time

MANY INVESTORS ASK, “Which should I buy — stocks or bonds?” Often the answer is both. Investment experts generally recommend that you diversify your portfolio holdings between stocks and bonds, with some cash reserves for emergencies or to enable you to move quickly should attractive buying opportunities arise. The rationale behind diversification is that stocks have produced higher long-term growth over time, while bonds have offered more stability and current income to offset stock market volatility. But is this really the case? Do bonds perform well when stocks fall, and vice versa? Or do these two asset classes move in some random pattern? Although past performance is no guarantee of future results, historical performance records show that stocks do indeed outperform bonds over the long run. Surprisingly enough, however, bonds have produced gains roughly equivalent to or better than stocks in 4 of the last 15 rolling five-year periods between 1980 and 1988.1 And in 11 of these 15 rolling periods, the returns on both stocks and bonds have exceeded double digits.2 If you’ve rejected owning one asset class or the other out of hand, consider the strong performance of both stocks and bonds since 1984. History teaches us that diversifying your holdings across stocks, bonds and cash may be a sound strategy for pursuing both current income and long-term growth.3 ✦

1,2) CDA Wiesenberger. Stocks are represented by the Standard & Poor’s Composite Index of 500 stocks (with dividends reinvested), which is generally considered representative of the U.S. stock market. Bonds are represented by the Salomon Gov’t./Corp. Bond Index, which is generally considered representative of the U.S. bond market. The performance of any index is not indicative of the performance of any particular investment. Individuals cannot invest directly in any index. Past performance is no guarantee of future results. 3) Diversification does not guarantee against loss. It is a method used to manage risk.

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The Bulletin of the Hennepin and Ramsey Medical Societies

Rolling 1 Year Rates of Return S&P 500

Rolling 1 Year Rates of Return Salomon Gov’t./Corp. Bond

BY JERALD M. PROSTROLLO, M I D W E S T C A P I TA L M A N A G E M E N T, I N C .

May/June 1999

Long Term Care Insurance Provides Peace of Mind in Retirement

CURRENTLY THERE ARE 62,000 PEOPLE in the United States over

chased long term care insurance if the policies were better. Today, policies are much improved and are matching the way care is being delivered. You will also see that 35% of the people would have purchased long term care insurance if the policies were tax deductible. Well, that has also changed. There is now a federal bill that allows for LTC insurance to be treated as a health insurance policy for tax purposes. Minnesota also has a tax credit

the age of 100. By the year 2050 there will be more than 1,000,000 people over the age of 100. For many reasons this is great news; however, for the risk of needing Long Term Care this could be catastrophic not only for the families but also for our state and federal governments and, therefore, ultimately us— the taxpayers. However, this does not mean that we will all end up in a nursing home. In fact, I tell my clients Graph 1 we may never set foot in a nursing home. But, clients Most Important Factors Leading Nonpurchasers could still collect the entire benefit from LTC insurance due to care giving trends moving away from nursto Consider Buying a Policy—1994 and 1990 ing homes. This is very important because, nationally, 17 states now have moratoria on building new nursing homes.* This is driven primarily by Medicaid costs. Medicaid is the primary payment source for current residents of nursing homes (68% nationally, 63% in Minnesota). In 1996, the Medicaid bill for long term care was $51.3 billion! While this process of limiting the number of nursing home beds may appear to control state and federal spending in the short run, it does not make the overall need for this type of care go away. The burden of payment simply shifts to the private sector. So what’s happening? Assisted-living facilities, senior housing with services, adult foster care, adult day care, home health care, congregate care communities and so on are emerging everywhere. Take a look around your comNOTES: Nonpurchasers in 1990 were not asked whether stable rates munity. These places are beautiful. And guess what— would influence their decision to buy long-term care policies. they are primarily private pay! Numbers do not add up to 100% because some respondents cited the Two studies of long term care were conducted in presence of other factors as most important in their decision to 1994. The first consisted of people who purchased long reconsider the nonpurchase decision. term care insurance, and the second consisted of those Source: LifePlans, Inc. survey of 1,245 nonbuyers (1994) and 1,750 who chose not to purchase long term care insurance. nonbuyers (1990). As you can see from the bar chart of the latter study, shown in Graph 1, 20% of those surveyed indicated that they would have purchased long term care insurance if they felt the risks were greater. These risks are greater if we include effective for the tax year 1999. There are Bills in both the Minnesota the need for home health care and care in alternate settings. House and Senate right now to enhance the tax credit to 25% of the The study also indicates that 18% of the people would have purpremium not to exceed $500. The results of the former study, shown in Graph 2, are perhaps even more astonishing. When asked, “What was the most important reason for purchasing LTC insurance?” only 23% responded that they purchased it BY DEBRA C. NEWMAN, CLU CHFC 18

May/June 1999

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The Bulletin of the Hennepin and Ramsey Medical Societies

to protect assets. So, if we are only discussing the finanGraph 2 cial risk we are missing the critical emotional compoMost Important Reason for Purchasing nent integral in comprehensive planning. Let me share a few stories that reflect the motivaLong-Term Care Insurance—1994 and 1990 tions which move people to plan for Long Term Care. One was a client who was in her early 70s and had more that $600,000 in assets. If we had used only a calculator, we would have seen that she probably had plenty of assets to provide quality care in any setting, but instead we asked about her family. She said, “I cared for my mother in my home for six years, and while I would never take back any of that time, I do not want my children to have to care for me.” She bought LTC insurance so that she would never be a burden to her children. Another similar story was related to me by an attorney whose 79-year-old mother had purchased LTC insurance for thousands of dollars. Her mother had $500,000 in assets and again would have been able to pay her way into any facility she desired. Instead, she chose to buy LTC insurance. After she bought Source: LifePlans, Inc. analysis of 2,601 buyers (1994) and 8,363 buyers (1990). the insurance, she began gifting to grandchildren and taking expensive vacations. She finally had the peace of mind to start spending her money. A professional colleague told me a story about a friend of hers with cians, for example, are already topped out on 401k contributions. There $30 million in assets. The friend asked if she could buy LTC insurance. are plans that allow for the insurance to be fully paid for in 10 years or to The agent responded, “Why do you want to buy LTC insurance? You pay to age 65, so it could tie in perfectly with other retirement plans. could buy the nursing home.” Her friend replied, “Let me tell you what As a clinic, or as an individual, this is a good time to evaluate this happens when you have a lot of money. You have a lot of heirs watching important planning tool for yourselves, but perhaps to also understand what you do with your money. If I ever need care and can no longer make what may be motivating your patients to ask about it. decisions for myself, I want to be sure I get the highest quality care availLong Term Care Insurance helps provide peace of mind in retireable without my heirs worrying about how they are spending their inherment and with the tax incentives finally in place it makes economic sense itance on my care.” as well. ✦ When you combine the need for peace of mind in retirement with the logical understanding that we need to personally accept the financial responsibility for Long Term Care, this type of insurance becomes a criti* Joshua M. Wiener & David G. Stevenson, State Policy on Long Term cal planning tool. Care for the Elderly, Health Affairs, May/June 1998, at 81. The tax advantages to a business are tremendous. The premiums of employees and their spouses are 100% deductible to the business, cannot Debra Newman, CLU, ChFC, Newman Financial Services, specializes in be included in employee’s income and are tax free when the benefits are Long Term Care Insurance. received. Additionally, there are no requirements that everyone be covered. This is a great benefit to enhance a retirement plan where the physiMetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

May/June 1999

NOTEWORTHY

Legislation Would Allow Physicians to Bargain In March, Rep. Tom Campbell, R-Calif., and House Judiciary ranking member John Conyers, D-Mich., introduced legislation that would allow physicians and other healthcare providers to form professional associations that would give them greater leverage to bargain with insurers. The legislation would allow providers to collectively negotiate the terms and conditions of their contracts with insurers without violating antitrust laws or joining a labor union. Providers would be entitled to the same treatment under antitrust laws as bargaining units recognized under the National Labor Relations Act, but would not be permitted to collectively stop providing care.

Social Security Administration Needs Medical Experts The Social Security Administration (SSA) Office of Hearings and Appeals is seeking applications from physicians who are interested in establishing blanket purchase agreements with SSA for the provision of medical expert (ME) services. MEs are physicians and mental health professionals who provide impartial expert opinion at the hearing level of the SSA disability claims process. MEs either testify at hearings or provide written responses to interrogations on claims for disability insurance, supplemental security income or health insurance benefits under the Social Security Act.

AUTO LEASING Boulevard Leasing offers many advantages to the physician or group practice. • • • •

May/June 1999

According to the Minnesota Medical Association, legislation to repeal the requirement that licensees of health-related boards (dentistry, medical practice, nursing, and podiatric medicine) receive continuing education on infection control has been signed into law. Gov. Jesse Ventura signed the bill on March 8; it became effective March 9. As of that date, physicians and other health care professionals are no longer required to report continuing education on infection control on applications for relicensure.

According to the Health Care Financing Administration, in 2011, 77 million baby boomers (those born between 1946 and 1964) will begin reaching retirement age and become eligible for Medicare benefits. Estimated enrollment: 1970—20 million 1980—28 million 1990—34 million 2000—40 million 2010—47 million 2020—61 million 2030—76 million 2040—81 million

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To qualify, physicians and doctors of osteopathy must be licensed to practice medicine and be Board Certified. The current reimbursement includes $160 for an appearance at a hearing; $80 for a study of the claimants record and $50 for a written response to the Administrative Law Judge’s (ALJ) questions. Cases are scheduled so that the ME can be called for three to five cases in a day before an ALJ. MEs can limit themselves from one day to many days per month. The following specialties are in greatest need: internal medicine, physical medicine and rehabilitation, orthopedic surgery, neurology, and psychiatry. Interested physicians should apply by forwarding a CV to: Judge TownsendAnderson; SSA: Office of Hearings and Appeals; Towle Building, Suite 650; 330 Second Ave. South; Minneapolis, MN 55401; Phone: 612-348-1230; Fax: 612-348-1255.

Endorsed by Ramsey Medical Society

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The Bulletin of the Hennepin and Ramsey Medical Societies

P R E S I D E N T ’ S M E S SA G E LY L E J . S W E N S O N , M . D .

RMS-Officers

RMS-Board Members

Kimberly A. Anderson, M.D. John R. Balfanz, M.D. James A. Brockberg, M.D. Charles E. Crutchfield, M.D. Peter J. Daly, M.D. Aimee George, Medical Student Michael Gonzalez-Campoy, M.D. James J. Jordan, M.D. F. Donald Kapps, M.D. Charlene E. McEvoy, M.D. Joseph L. Rigatuso, M.D. Thomas E. Rolewicz, M.D. Jamie D. Santilli, M.D. Paul M. Spilseth, M.D. Jon V. Thomas, M.D. Randy S. Twito, M.D. Russell C. Welch, M.D. Phua Xiong, M.D., Resident Physician RMS-Ex-Officio Board Members

Blanton Bessinger, M.D., MMA House of Delegates Speaker Chad Boult, M.D., Council on Professionalsim & Ethics Chair Kenneth W. Crabb, M.D., AMA Alternate Delegate Duchess Harris, Alliance Co-President Neal R. Holtan, M.D., Community Health Council Chair Nicki Hyser, Alliance Co-President Frank J. Indihar, M.D., AMA Delegate William Jacott, M.D., U of MN Representative C. Randall Nelms, M.D., AMA Specialty Delegate Robert W. Reif, M.D., Sr. Physicians Association President William M. Rupp, M.D., Joint Contract Review Program Chair Melanie Sullivan, Clinic Administrator Kent S. Wilson, M.D., MMA Past President RMS-Executive Staff

Roger K. Johnson, CAE, Chief Executive Officer

MetroDoctors

IN THE ERA of business-oriented health care delivery and increasing commercialism of medicine, there are significant threats and challenges to our profession. In the day-to-day practice of medicine, and sometimes when responding directly to these threats and challenges, guidance and support for our convictions can be found in the concept of professionalism. What is professionalism, and what does professionalism mean to a physician? While there may be some differences, I think all physicians would have a similar understanding of what it means to be a physician, and what is unique about our profession. One of the best definitions of professionalism has been provided by the American Board of Internal Medicine. The ABIM defines the core of professionalism as “consisting of those attitudes and behaviors that serve to maintain patient interest about physician self interest. Accordingly, professionalism aspires to altruism, accountability, excellence, duty, service, honor, integrity, and respect for others.” What are the threats and challenges that we face as a profession? Many of these threats and challenges are related to the economics of health care, and attempts to control health care costs. Dealing with costs, and striving to use resources wisely and efficiently, is nothing new to physicians. However, as we see the business community and our government embrace managed care and a market driven health care delivery system, (or non-system), controlling the costs of health care has become a more important determinant of how health care is provided. We have also seen how larger and larger business entities involved with health care relate to patients as “covered lives,” regard patients and physicians as commodities, put physician income at risk to influence their practice, make decisions that affect medical care, and sometimes make decisions to withhold care to favorably affect their bottom line. What will be our response to these and other threats and challenges to our profession? Will we also begin to deal with patients as com-

The Bulletin of the Hennepin and Ramsey Medical Societies

modities? In our continual struggle to use resources wisely and efficiently, will we gradually focus our efforts primarily on costs ahead of what is best for our patients? Will we shift our loyalty from our patients to our employer or the managed care plan that controls the flow of dollars? I think not. Health care is not a business like other businesses. Patients are human beings, not commodities. Physicians have a sacred trust and responsibility to do what is best for each individual they care for. This is fundamental to the physician-patient relationship and fundamental to the medical profession. The individual seeking care does so because of the unique knowledge and skill of the medical professional. They put their trust in their physician, and we, as physicians, hold that trust sacred, and will not let it be eroded by financial considerations, business practices of insurers or managed care plans, or questions of where our loyalty belongs. As health care continues to change and evolve, there will be other threats and new challenges to our profession. Our ability and capacity to overcome these threats and meet new challenges is in large part dependent on our professionalism. We must maintain our patients’ interests above physician self interest; we must aspire to altruism, accountability, excellence, duty, service, honor, integrity, and respect for others. This issue of MetroDoctors signals another change for the physicians in the metropolitan area, and is a natural development in the continuing collaboration between the Hennepin and Ramsey Medical Societies. These collaborative efforts will help us carry out more effectively our primary mission, which is to be an advocate for all physicians in our metropolitan area. In all these efforts, and in carrying out our mission, we will find guidance and support in our professionalism. ✦ May/June 1999

Ramsey Medical Society

President Lyle J. Swenson, M.D. President-Elect John R. Gates, M.D. Past President Thomas B. Dunkel, M.D. Secretary Robert C. Moravec, M.D. Treasurer Peter H. Kelly, M.D.

RMS NEWS

In Memoriam ROBERT W. EMMONS, M.D., died on March 26 at the age of 81. He received his medical degree from Indiana University School of Medicine and completed his internship at the University of Minnesota Hospital. He practiced family medicine in E. St. Paul for over 40 years.

Applicants for Membership We welcome these new applicants for membership to the Ramsey Medical Society.

Active Annika M. Crosby, M.D. University of Minnesota Internal Medicine United Internal Medicine Jagdeep Kohli, M.D. University of Calgary Neurological Surgery Neurological Associates of St. Paul Jeffrey R. Olive, M.D. St. Louis University Internal Medicine Drs. Daly, Corbett, Ogden & Abid Andrea M. Saterbak, M.D. Creighton University School of Medicine Orthopaedic Surgery St. Croix Orthopedics, P.A. Alden R. Tetlie, M.D. University of Minnesota Family Practice Highland Family Physicians Michelle M. Tichey, M.D. University of Minnesota Psychiatry Private Practice

Eric M. Johnson, M.D. University of Minnesota General Surgery University of Minnesota Christa K. Hoiland, M.D. Albert Einstein College of Medicine Family Practice University of Minnesota Marilou P. Johnson, M.D. University of Minnesota Family Practice United Family Medicine Todd A. Leonard, M.D. University of Minnesota Family Practice University of Minnesota - St. Johnâ&#x20AC;&#x2122;s

Chris A. Stuart, M.D. University of Minnesota Family Practice United Family Medicine

died on April 10. He was 92. He earned his medical degree and his masters in ophthalmology from the University of Minnesota Medical School. Dr. Schmidtke had a private ophthalmology practice in St. Paul. When he semi-retired, he was a clinical ophthalmologist at the U of MNâ&#x20AC;&#x2122;s Boynton Health Service. GEORGE TADASHI TANI, M.D., died

Dimitri M. Drekonja

Daniel G. Danahey, M.D. Ohio State University Otolaryngology/Plastic Surgery Regions Hospital

Heather Kay Swanson

May/June 1999

REINHARDT L. SCHMIDTKE, M.D.,

Student (from the University of Minnesota) Seth G. Janus

internist, died February 12 of Parkinsons. He received his medical degree from the University of Minnesota and completed his internship at West Suburban Hospital in Oak Park, Illinois.

March 22 at the age of 83. He graduated from the U of M Medical School and completed an ophthalmology residency at the Mayo Clinic. He served as Clinical Professor in the Department of Ophthalmology at the U of M. He was a past Board Member of the Minnesota Medical Association.

Sigrid A. Nelson, M.D. University of Minnesota Family Practice University of Minnesota

Resident Donald A. Curtis, M.D. University of Minnesota Family Practice Bethesda University Family Practice Clinic

Trent M. Fischer, M.D. University of Wisconsin - Madison Orthopaedic Surgery University of Minnesota

ALAN P. RUSTERHOLZ, M.D., 77, an

Cassie C. Kennedy Muaj C. Lo Darren A. Manthey

UNDER CONSTRUCTION

Tod J. Worner

Transfer into RMS (Active) Gretchen Sandvik Crary, M.D. University of Minnesota Anatomic & Clinical Pathology/Cytopathology Central Regional Pathology Lab.

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The Bulletin of the Hennepin and Ramsey Medical Societies

Winter Medical Conference Receives High Marks and Golf Resort in the Guanacaste region of Costa Rica proved to be an excellent setting for the 1999 RMS Winter Medical Conference. The warm weather, the Robert Trent Jones designed golf course, the sandy beach and extensive pool area, and the numerous excursions to volcanoes and rain forests proved to be very popular with the 21 physicians and the 25 spouses and children who traveled to Costa Rica. The faculty included Dr. John Gates, Minnesota Epilepsy Group in St. Paul; Dr. Donald Kapps, Hospital Pathology Associates in St. Paul; Dr. Thomas McPartlin, Neurologic Consultants of St. Paul; Dr. Lyle Swenson, St. Paul Cardiology; Dr. James Tiede, Affiliated Medical Group in Willmar; Dr. John Toso, Austin Medical Center of Austin; and Dr. Timothy Twito, Park Nicollet Clinic of Burnsville. Sixteen hours of prescribed credit were offered including: Neurological Complications of Infectious Disease; New Drugs for Epilepsy; Perspectives on Managed Care; Hepatitis D (Delta) Virus; Practice Merger, A Case Study; Headache and Migraine Update; Management of Acute

Stroke; Acute Myocardial Infarction; New AntiPlatelet Agents for Coronary Disease; Clinician’s Perspective on Physician Licensing; Update on GI—What’s New?; Diagnosis, Management and Epidemiology of Hepatitis C; Clinical Update for International Travel; Essential Medical Elements of a Travel Clinic; The Diagnosis and Treatment

The education sessions were followed by a fishing trip that was enjoyed by (from left); President Lyle Swenson, M.D.; James Tiede, M.D.; David Zanick, M.D.; Don Kapps, M.D.; Tom Combs, M.D.; and Roger Johnson, RMS staff.

1999 Caring Hearts for the Homeless a Success

SEVENTEEN MEDICAL CLINICS,

churches, HealthEast Hospitals, and many volunteers from the Ramsey Medical Society Alliance, and many other organizations pitched in to collect over $27,600 worth of hygiene and medical supplies for the clinics that care for the homeless. In addition, over $600 in cash contributions were collected. The campaign was conducted from February 14th through the 28th. Carole Nimlos coordinated the activities of the RMS Alliance members who worked hard MetroDoctors

picking up the supplies from the 17 medical clinics. Dr. Tom Dunkel headed the efforts for the Ramsey Medical Society. Thanks to the clinic managers, staff, and physicians of the following clinics that participated: Advanced Specialty Care for Women Central Regional Pathology Labs Dermatology Consultants, P.A. Drs. Lien, Sackett, Huberty & Pohl East Metro Family Practice Fort Road Medical Specialists

The Bulletin of the Hennepin and Ramsey Medical Societies

Gillette Children’s Specialty Health Care Hadley M. Verwest, M.D., P.A. Hamm Clinic HealthEast Care, Inc. NCBS, American Red Cross NorthEast Pediatric Clinic North Suburban Family Physicians, P.A. Phalen Village Clinic Physicians Neck & Back Clinic, P.A. Shoreview Family Physicians Yankee Square Family Practice ✦ May/June 1999

Ramsey Medical Society

THE MELIA PLAYA CONCHAL Beach

of Mood Disorders; and The Diagnosis and Treatment of Anxiety Disorders. Educational grants were received from: Abbott Laboratories; Bristol-Myers Squibb, Co.; Glaxo Wellcome, Inc.; Merck & Co.; Novartis Pharmaceuticals Corp.; Ortho-McNeil Pharmaceuticals; Parke-Davis, a division of WarnerLambert Co.; and TAP Pharmaceuticals, Inc. Planning for the Winter Medical Conference in 2000, which will be a joint effort with the Hennepin Medical Society, is underway. Planners include Dr. John Gates, RMS president elect and chairperson of the RMS Education Resource Council; Dr. Lyle Swenson, RMS president; and Drs. Kenneth Kephart and William Schoenwetter from HMS. ✦

RMS ALLIANCE NEWS DUCHESS HARRIS, Ph.D.

AS I WAS WRITING this presidential ad-

dress I realized that there is someone in Ramsey County who is married to a physician, who is not even a member of the Alliance, who five years from now could become the President of our group. Why did I think this? Because that is what happened to me. First I’ll start off by saying how I became a physician’s spouse. My husband, Jon, is originally from Los Angeles and moved to Minnesota in 1980 to attend Carleton College. He graduated in 1984 as a Chemistry major and went to Mayo Medical School and continued his Otolaryngology Residency there. After nine years in Rochester he came to St. Paul to join Head and Neck Surgeons. This was July 1993. Jon and I had mutual friends, the husband had been a chemist at Mayo and his wife was a doctoral student in American Studies at the University of Minnesota. She was a classmate of mine and decided that Jon and I had to meet. I had never been on a blind date and was apprehensive. “Just go,” my friend said, “No big deal. Sunday brunch—if you don’t like him you’ll be home by 2:00 p.m.” Well, Jon showed up on my doorstep one Sunday afternoon, (October 10, 1993), and most of the fall and winter are a blur now, but by spring the snow melted and so had our hearts. When Jon returned from taking the second part of his boards in Chicago in April he decided to celebrate by asking me to marry him, and I decided that it wasn’t a half bad offer. Thanksgiving weekend 1994 I married Dr. Jon Thomas and before I knew it, as a newlywed, I was at the Holiday Auction at Debbie Rupp’s house. I had entered the world of the Ramsey Medical Society Alliance. I take my new found responsibility as an incoming President of the Alliance seriously because I can attest better than anyone how strong presidential leadership in the Alliance can bring someone out of the shadows. When I think of the impact that the former presidents of the Alliance have had on my participation in this group, I realize that they have truly led by 24

May/June 1999

example. From what I know, membership has always been an important tenet of each administration’s platform, and I am a Crutchfield, Brown, Nimlos, Rupp, Hyser success story. I would not have attended the Holiday Auction at Debbie Rupp’s house if I had not been invited by Pat Crutchfield. In February of 1995 Sally Brown encouraged me to go to a Martin Luther King celebration that the Alliance was having at Model Cities. Carole Nimlos spent most of 1996 trying to get me to become a dues paying member. “Oh I’m really busy.” I would say. “I don’t have time; I’m still in graduate school.” Persistence is everything. In 1997 I got a call from Pat Crutchfield, “I heard you just graduated, come to the annual meeting, they’re inducting Debbie Rupp, remember her from the auction?” Persistence is everything. “Hey Duchess, this is Debbie Rupp, would you like to come to a Board meeting?” “Oh no I couldn’t, you all meet in the day and I work. If you all met during lunch I could make it.” Persistence is everything. “Duchess, we changed the meeting to lunch, wanna come?” What could I say? In 1998 I was the President of the Auxiliary to the Minnesota Association of Black Physicians. We had a Mother’s Day Tea and Nicki Hyser attended. “Wow, this was a wonderful fundraiser. You know the Ramsey Alliance still doesn’t have a president-elect….” Well, you know the rest. As the incoming president, it is now my turn to bring in members and to articulate a vision for the new millennium. My agenda for 1999-2000 is to promote legislative awareness and involvement. My professional background is in policy. I have a Ph.D. in American Studies from the University of Minnesota and did a Policy Fellowship at the Hubert H. Humphrey School of Public Affairs with an emphasis in Health Care. I am an Assistant Professor of Political Science at Macalester College and will teach Health Care Policy in the Spring of 2000. I plan to use my passion for teaching to MetroDoctors

get the Alliance involved with advocating on behalf of medical families. Therefore, when I am officially inducted on May 4, 1999 the keynote speaker at our annual luncheon will be Linda Caroll Shern, the Minnesota Medical Association Lobbyist. I look forward to a year of raising political awareness, fundraising and, last but not least, friendship. I have belonged to numerous organizations since I moved to the Twin Cities in 1991, but it was my fellow Alliance members who brought me food and made me feel part of the Ramsey family when I gave birth to my son, Austin Harris Thomas, in January. The baby shower that the Alliance hosted for Austin and me at the Buckingham Bee in February was a genuine demonstration of how Debbie’s leadership was truly “Hand in Hand and Heart to Heart.” I would be remiss not to publicly thank Patty Schubert, Carole Nimlos and Debbie Rupp for their support. But it is with special thanks that I acknowledge Nicki Hyser for choosing me to be her co-president—a vote of confidence in my leadership, and an extension of a friendship that I am sure will grow. ✦

The Bulletin of the Hennepin and Ramsey Medical Societies

CHAIRMAN’S REPORT E D W A R D A . L . S P E N N Y, M . D .

HMS-Officers

HMS-Board Members

Mary Anderson, Alliance President Michael Belzer, M.D. Steven Bennett, M.D. Carl E. Burkland, M.D. William Conroy, M.D. Daniel F. Greeley, M.D. Raymond A. Hackett, M.D. Michael King, M.D. James P. LaRoy, M.D. Edward C. McElfresh, M.D. William D. Payne, M.D. Joseph F. Rinowski, M.D. Jill Salo, Medical Student R. Douglas Thorsen, M.D. Clark Tungseth, M.D. Joan Williams, M.D. HMS-Ex-Officio Board Members

Lyle French, M.D., Senior Physicians Karen Dickson, M.D., MMA-Trustee John W. Larsen, M.D., MMA-Trustee Robert K. Meiches, M.D., MMA-Trustee Henry T. Smith, M.D., MMA-Trustee Benjamin Whitten, M.D., MMA-Trustee Timothy Signorelli, MMGMA Rep. HMS-Executive Staff

Jack G. Davis, Chief Executive Officer Nancy K. Bauer, Associate Director

MetroDoctors

WELCOME TO THE first issue of

MetroDoctors and the Hennepin Medical Society designated section. We hope you like the new look and the expanded content. As we’ve made you aware over the last few months, the Boards of the Hennepin Medical Society and the Ramsey Medical Society have agreed to collaborate in several areas. The bulletin will probably be the most visible area of collaboration. MetroDoctors will contain more content than you have received in the past, including fourcolor and two-color areas. It will also contain individual sections devoted to the two medical societies and will result in a significant cost savings to each organization. Charles Meyer, M.D. and Thomas Dunkel, M.D. have agreed to be co-editors of the new publication. I know that they are always looking for content to publish and suggestions for improvement. If you have ideas for articles, direct your suggestions to Nancy Bauer (612) 623-2893 or Jack Davis (612) 623-2899. The two Medical Societies have already created an impressive list of areas and programs on which we are collaborating. Several years ago RMS started the Community Internship Program where community leaders and decisionmakers are invited to spend two days with physicians. HMS adopted the program eight years ago and now both Societies work together on the program to make it a richer experience for the participants. Three or four times a year the two societies put on a medical student “Lunch ’n Learn” educational program at the U of M. HMS/RMS invite speakers to present topics as requested by the students. It’s not uncommon for there to be 130 to 150 attendees. The two societies also share space, bookkeeping and publication advertising, conduct a joint Board meeting each May and from time to time hold joint Executive Committee meetings. We also create joint educational offerings, hold joint caucuses at the annual MMA meeting and until recently jointly owned the central credentialing partnership. In the future we expect to take some of

The Bulletin of the Hennepin and Ramsey Medical Societies

Hennepin’s community service programs and broaden them to go metro-wide. Our colleagues at Ramsey have recently offered to add HMS as a co-sponsor and assist in the planning of a joint winter CME trip along the lines of what they have offered over the last few years. The next issue of MetroDoctors will feature the development of a joint web page which will contain public and “members only” features. STAY TUNED! For the last two years, HMS has established an important Hennepin Medical Society Ethics Project. Barbara LeTourneau, M.D. and Burton Schwartz, M.D. have championed this project. At the last Board meeting, the Board approved to move forward to the next stage of the project. To date, with the assistance of Karen Gervais, Ph.D. of the Minnesota Center for Health Care Ethics and a number of HMS members acting as an ad hoc committee, several cases have been reviewed which contained managed care features which challenge the patient-physician relationship. These cases were published in the Bulletin throughout 1998. The next stage will be policy development. By midsummer we anticipate that the committee will create and disseminate educational material applying the HMS ethical framework for the patient-physician relationship. Any HMS member who has an interest in this important project is encouraged to contact Drs. LeTourneau or Schwartz or let Jack Davis (jdavis@mnmed.org) or Nancy Bauer (nbauer@mnmed.org) know of your interest. With the coming of spring, can the Hennepin Medical Society caucus be far behind? The date for this year’s caucus is June 8. For review, the purpose of the caucus is to give individual HMS members an opportunity to meet Continued on page 26… May/June 1999

Hennepin Medical Society

Chair Edward A.L. Spenny, M.D. President David L. Estrin, M.D. President-Elect Virginia R. Lupo, M.D. Secretary Richard M. Gebhart, M.D. Treasurer Michael B. Ainslie, M.D. Immediate Past Chair William F. Schoenwetter, M.D.

HMS NEWS CHAIRMAN’S REPORT (Continued from Page 25)

New Members HMS welcomes these new members to the Society as of April 7, 1999. Schools listed indicate the institution where the medical degree was received.

Christopher A. Armstrong, M.D. Case Western Reserve University Internal Medicine Consultants Internal Medicine Keith C. Burnes, M.D. University of Minnesota Ophthalmology Eye Physicians & Surgeons P.A. Carol M. Carlson, M.D. University of Minnesota Pediatrics Southdale Pediatric Associates Gary H. Cramer, M.D. State University of New York at Buffalo Cardiology Park Nicollet Clinic/HSM Albert J. Enriquez, M.D. University of Minnesota Obstetrics & Gynecology Park Nicollet Clinic/HSM Susan L. Erickson, M.D. University of Minnesota Psychiatry/Child & Adolescent Psychiatry Ridgeview Behavioral Services Casey S. Martin, M.D. University of Minnesota Family Practice Silver Lake Clinic Ronald G. McGown, M.D. University of Wisconsin Family Practice Park Nicollet Clinic/HSM Mary S. McMillan, M.D. Northwestern University Medical School Internal Medicine Isles Medical Group Kirsten R. Nelson, M.D. University of Minnesota Pediatrics South Lake Pediatrics 26

May/June 1999

John T. Olsen, M.D. University of Minnesota Diagnostic Radiology Suburban Radiologic Consultants, Ltd. Frank G. Ondrey, M.D. Rush Medical School Otolaryngology Regions Hospital, Dept. of Otolaryngology Jay J. Schantzen, M.D. University of Minnesota Anesthesiology Twin Cities Anesthesia Associates, P.A. Derek B. Simons, M.D. University of Manitoba Cardiology Metropolitan Cardiology Consultants Marie Youakim, M.D. University of Minnesota Family Practice Silver Lake Clinic

In Memoriam WILLIAM L. JEFFERIES, M.D., 75, died on March 24 of heart disease and liver cancer. He graduated from the University of Arkansas School of Medicine and completed his internship and general surgical residency at St. Mary’s Hospital. He was a charter member of the American Board of Family Practice and Associate Clinical Professor in the Departments of Family Practice and Community Health at the University of Minnesota Medical School. MILTON ORKIN, M.D., 69, world renowned dermatologist and U of M clinical professor died March 5 of a brain tumor. He practiced dermatology in Robbinsdale and downtown Minneapolis for 38 years, and traveled throughout the world teaching other physicians about skin care. He received his medical degree from Tulane Univeristy in New Orleans.

MetroDoctors

and discuss issues that the physicians would like to have the Minnesota Medical Association include in their 1999-2000 agenda. If you have issues that you would like to present to the caucus, now is the time to start thinking about creating a resolution. The resolutions need to be available by mid-May. Jack or Nancy would be glad to assist in the resolution writing. Please volunteer to be a delegate to this year’s MMA annual meeting. Your voice is very important in the development of MMA policy and focus. The MMA annual meeting is scheduled for Saturday, September 26 to Tuesday, September 28, at Madden’s Resort in Brainerd. Again, let Jack or Nancy know of your interest in attending and representing your colleagues. For input and comments, my e-mail address is espenny@worldnetatt.net. I look forward to your comments. In conclusion, several of us from Minnesota, including David Estrin, M.D., HMS president, attended the AMA Leadership Development Conference in Phoenix with physicians from all over the country. Most of us are upset about how managed care and HMOs have interfered with the practice of medicine and how HCFA has set out to pay seniors to report doctors and hospitals for any payment abnormalities they suspect. University teaching centers across the country are financially threatened by new 1997 regulations which reduce reimbursement for teaching medical students and residents. Organized medicine seems to be the only mechanism to combat these challenges. We certainly have little or no power divided. We need to stand and work together with the AMA and MMA to represent the changes to continue to do what is right for our patients and for our doctors in training. ✦

UNDER CONSTRUCTION www.metrodoctors.com

The Bulletin of the Hennepin and Ramsey Medical Societies

Community Internship: A Big Picture in a Few Frames

AS A CPA AND A BUSINESS consultant, I

MetroDoctors

Community Interns from left: Jerry Gallivan, J.D., Arthur Chapman Law Firm; Julie Mafi, Coding Manager, Emergency Physicians, PA; Peggy Liddell, Workers’ Comp. Claim Specialist, St. Paul Fire & Marine; Brian Knapp, V.P., COO, Fairview Ridges Hospital; Joe White, CPA, Prinicipal/ Health Care Services, Larson, Allen, Weishair & Co., LLP; James Sieben, J.D., Metropolitan Anesthesia Network; and Minneapolis City Council Member Joe Biernat.

the payment mechanism was for the service, so I asked. He looked a little puzzled and responded that he didn’t know. It turned out, in fact, that he had been providing the service and had not been compensated for it. I was getting a very real taste of the complexity of our health care system. I finally ended up at Methodist Hospital joining Dr. William Omlie in surgery. Dr. Omlie harvested a vein from the right arm of an 85year-old diabetic and used it in the left leg. I was impressed by the artistry of this work. It was all hands and scalpels — no power tools like in orthopedics. While the surgeon worked on the leg, a physician’s assistant arrived to sew up the arm. It took her two hours for which there would be no reimbursement, since Medicare doesn’t pay for the work of physicians’ assistants. An option, I suppose, is to keep the patient under anesthesia and wait for the surgeon to finish with

The Bulletin of the Hennepin and Ramsey Medical Societies

the leg and then have him return to the arm. But would this additional two hours under the knife really be in the best interest of the patient or the surgeon? As a result of my internship I certainly have a greater appreciation for what health care professionals do and the variety of challenges they face every day. But this experience also raised many questions. In fact, it generated more questions than answers -— the mark of a positive and provocative learning experience. It made me wonder at the complexity of the health care issues that we face as a nation. It suggested to me that no single solution will solve the problems of such a dynamic and complicated industry; no one system will be appropriate for all situations. Addressing the country’s growing health care needs will demand open minds, creative thinking and a commitment to the people in the industry as well as those served by the industry. ✦

BY JOE WHITE, COMMUNITY INTERN

May/June 1999

Hennepin Medical Society

work with physicians on financial matters and am exposed to the changes in the health care industry from an organizational perspective. I was excited by the opportunity to witness the daily pressures that physicians cope with, and to my surprise, I found that observing them raised many questions closely related to my own financial and organizational work with health care organizations. My first visit was with Dr. David Holte, an orthopedic surgeon in Edina, who was doing follow-up visits with several patients who had undergone spine surgery. Immediately I was struck by how easy it was to fall behind. If a patient is just a little bit late, or if the doctor needs to give an in-depth explanation, the minutes add up. Strict time management isn’t easy when you are face-to-face with another human being. My next stop was the Fairview Southdale Hospital where I watched Dr. John Schaffer handle several cases in the emergency room. I liked the emergency room because of the variety of cases I got to see. I was talking with a businessman as Dr. Schaffer sewed up his hand, and I asked him if he would pay $50 extra per month on his health plan to get preferential treatment. “Absolutely,” he said without hesitation. Another issue for me to ponder later on: What are the implications of offering patients an opportunity to pay for preferential treatment? The following morning I spent time with Dr. Steven Heifetz, a cardiologist also at Fairview Southdale. While I was there, a patient undergoing a stress test went into arrhythmia, which required quick action in order to ensure that the condition did not become critical. My own heart was working hard as I watched these professionals in action. At some point in the morning, Dr. Heifetz was reading stress tests that had been sent over from another hospital. I was curious about what

HMS ALLIANCE NEWS MARY ANDERSON

AS I WRITE THIS, May is almost here and

my term as President of the Hennepin Medical Society Alliance is coming to an end. At last year’s annual meeting I used the Oak tree as an analogy in describing the Alliance (the tree standing firm with each branch representing an Alliance member joined at the trunk). As we, the branches, work together in partnership with others to promote the health and well being of our members and community through education, advocacy, and service, the tree grows stronger, its roots grow deeper, and it bears more fruit. This year the Alliance participated in the following projects: Child Health Month, SAVE (Stop America’s Violence Everywhere), Book Buddies, “A Magical Evening of Giving” for the HIV/AIDS folder, and the Legislative Advocacy Summit. We sponsored a Blood Drive in honor of you, our physician spouses, on Doctors’ Day.

May/June 1999

We awarded certificates and books to one senior high and two junior high students, winners of the Twin Cities Regional Science Fair. Their projects were in the field of medical science. The AMA Foundation is an on-going project that for nearly 50 years has helped medical students by providing $75 million in grants, scholarships, and medical assistance. This year we raised over $1,500 through a holiday plant sale, Doctors’ Day sharing cards, silent auctions, and individual donations directed to the AMA Foundation. Body Works was our final project for the year. It was held the week of April 12 at Lutheran Brotherhood. Five full days and around 100 volunteers makes this one of our most challenging endeavors. There will be more about Body Works in the next issue of MetroDoctors.

MetroDoctors

The Alliance membership has increased in the past year thanks to some diligent work in recruiting and retaining members. Our mentoring program for Resident Spouses and Medical Student Partners has been well received. The opening event, meeting with RMS Alliance, Holiday Tea, and Day at the Marsh brought us together for education, enjoyment and relaxation. This is a vital part of any organization. On May 7 we look forward to hearing from Carol Johnson, Superintendent of the Minneapolis Public Schools. She will be the keynote speaker at our annual meeting. It has been a rich and rewarding experience to serve as President of the Hennepin Medical Society Alliance. I appreciate the support of the Hennepin Medical Society through the Board of Directors and the staff. In like manner, I am grateful for the support of the Alliance Board of Directors and the Alliance members. Their diligence and hard work contributed to our success. So you see, this year the Alliance did grow stronger, its roots grew deeper, and we did bear more fruit. My hope is that we will continue to grow and work in partnership to make a difference in the health and well being of our members and our communities. My thanks to all of you. ✦

The Bulletin of the Hennepin and Ramsey Medical Societies