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July/August 2001

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Adventure Travel and Hobbies

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Doctors MetroDoctors THE JOURNAL OF THE HENNEPIN AND RAMSEY MEDICAL SOCIETIES

Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Richard J. Morris, M.D. Managing Editor Nancy K. Bauer Assistant Editor Doreen M. Hines HMS CEO Jack G. Davis RMS CEO Roger K. Johnson Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Susan Reed MetroDoctors (ISSN 1526-4262) is published bimonthly by the Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761. 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.

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MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy.

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

CONTENTS VOLUME 3, NO. 4

2

J U LY / A U G U S T 2 0 0 1

PHYSICIAN’S SOAP BO X

Economic Sanctions Affect Health of Iraqi People

4

600 Days — HIPAA Compliance Challenges

6

COLLEAGUE INTERVIEW

Stuart Lane Arey, M.D.

8

FEATURE

Race Across America: Team Heart One Year Later

11

Aeromodeling Celebrates All Aspects of Flight

12

Farming “Hobby” Continues to Grow

14

Antartica — This Fragile Environment Remains Relatively Untouched

16

Interest in Model Boat Building Continues

17

Climbing Wyoming’s Devil’s Tower

19 20

Nepal Provides Unforgettable Experience

21

MN PERSPECTIVE

Apple Trees and Wood Sculptures Get Those Shots Before You Go

22

Highlights of the Code of Medical Ethics of the AMA

28

Community Internship — Another Success

RAMSEY MEDICAL SOCIETY

24 25

President’s Message

26 27

Applicants for Membership/In Memoriam/Don Linder

Resolutions to MMA House of Delegates/ Congresswoman Betty McCollum RMS Alliance HENNEPIN MEDICAL SOCIETY

29 30 31 32

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Chair’s Report New Members/In Memoriam Hoban Scholars/Shotwell Awards HMS Alliance

The Journal of the Hennepin and Ramsey Medical Societies

On the cover: This issue focuses on adventurous travel and hobbies.

Pictured is William Goodall, M.D. enjoying his flock. Articles begin on page 8.

July/August 2001

1

PHYSICIAN'S SOAP BOX

Economic Sanctions Affect Health of Iraqi People

I

IN 1997 LEON EISENBERG, in an article in the N.E.J.M., concerning the effects of our economic sanctions against Iraq, stated, “Economic sanctions are, at their core, a war against public health. Our professional ethic demands the defense of public health. Thus, as physicians, we have a moral imperative to call for the end of sanctions.”

Through reading and listening, I became increasingly aware of many public health issues in Iraq. Being reported, as direct outcomes of these sanctions, was malnutrition, increasing infant mortality, outbreaks of preventable diseases, and lack of clean water. This was occurring in spite of a U.N. Oil for Food program that had been implemented to Dr. Eugene Ott (center) meets with university students in Baghdad. provide humanitarian aid.

In January 2000 my wife, Mary Lou, and I left for New York to infections. Supplies were limited: IV fluids, antibiotics, syringes all join a delegation traveling to Iraq to bring medicines to the people and inadequate. The doctors talked of how lack of medicines and equipgive us the opportunity to see for ourselves how the economic sanctions ment makes adequately treating diseases like dehydration, pneumonia were inflicting the Iraqi people. etc. impossible and causes the death of many children. Leukemia, a Our trip was arranged by the Iraqi Sanctions Challenge and led by treatable disease in the U.S., has 100 percent mortality. Surgical Ramsey Clark, the former U.S. Attorney General. After a day of procedures are scheduled but frequently cancelled at the last minute due orientation, we flew to Amman Jordan. There, we met members of our to being notified of a lack of expected supplies, medicines, or equipdelegation from other countries, boarded buses, and along with a truck ment. This is a teaching hospital, yet journals and textbooks are not load of medicines and supplies, began the long 20 hour ride to available now because of the sanctions. The same is true for medical Baghdad. After being greeted by our hosts, The Association of Friendinformation via the computer. The only way I could describe the ship, Peace and Solidarity, we left for our first site visit, a painful hospital environment is, everything we take for granted in a hospital introduction to the reality of this war. Al Ameriyah, a neighborhood setting, is not readily available, starting with a switch to turn on the recreation building turned Bomb Shelter, was targeted by our “smart” lights. bombs and in a matter of seconds 1,200 people died in the building.

Following our visit to the hospital, we met Dr. Omeed Medhet, Only 14 escaped alive. A woman, who lost her husband and all seven of the Minister of Health. It was my pleasure to give him 12 c.d.’s her children, lives just outside the building. She gives tours to visitors containing updated medical information that had been donated by the like ourselves, taking us through the experience of that terrifying night.

Family Medical Clinic at HCMC. Dr. Medhet gave us an overview of The next morning we visited the Saddam Center for Children. how health status indicators have deteriorated over the 10 years since There, physicians and staff met us for a tour of the outpatient clinics sanctions had been imposed. Under age five mortality has doubled from and hospital wards. The clinics were lined with beds occupied by 50 to 131 deaths per 1,000 live births, and infant mortality from 47 to children accompanied by mothers and grandmothers. The children 108 deaths per 1,000 live births. Twenty-five percent of children under were malnourished, suffering from diarrhea, fever, and upper respiratory age five suffer from chronic malnutrition. When these findings are contrasted with what had been accomplished in the 10 to 15 years preceding the Gulf War, it is estimated that over 500,000 Iraqi children have died because of the sanctions. UNICEF describes these statistics as a “Humanitarian Emergency.”

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Our day ended with a tour of Babylon and the Hanging Gardens.

This historic site dates back to 6000 BC and our guide, an archeologist, provided us a most informative tour.

The next day we visited the university in Baghdad and met with students who were friendly and eager to talk with us, and were asking why we came. When we asked about their concerns and hopes they spoke of a lack of books, materials, computer equipment, as well as news and information of the outside world. We had similar experiences everywhere we visited. Labor unions, food distribution centers, a center for special needs children, a water treatment plant, clinics, and the markets. The people were very receptive and directed no anger or hostility toward us personally.

On our last day we traveled to the northern town of Mosel and saw the Temple of Jonah in Ninevah. We met with the town council and visited a school that had recently been damaged when a missile, one of ours, landed near them—a direct consequence of our “No Fly Zone” policy. The school was lacking adequate chairs and desks as well as supplies such as pencils, papers, books, and chalk; all blocked by the sanctions since they are called “non-essential.” The children were eager to talk with us and had many questions. One young girl, who had been injured in the bombing, asked me, “Why are you bombing us?” I didn’t have an answer for her.

On our trip home, the delegation spent time sharing thoughts about what might be done to help the people of Iraq. Our first objective was to tell others what we saw and experienced. I’ve had the opportunity to give presentations to many groups including one at the “Global Health Forum 2000.” As part of these presentations I noted the ACP

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Position Paper, Annals of Int. Med., 18 Jan. 2000, K. Morin, LLM, and S.H. Miles MD. The College supports the following: 1. Exclude from sanctions humanitarian goods, such as food- and health- related materials or medical supplies, that are deemed likely to reduce the morbidity or mortality of civilians; 2. Empowering qualified and neutral agencies to allow humanitarian needs for exemptions, to conduct and disseminate analyses of the health effects and to monitor and report this on an ongoing basis; 3. Provide medical and health-related supplies and services to offset any increased morbidity caused by sanctions; and 4. Monitor and report the effective delivery of medical and healthrelated materials. ✦

A memorial to those who died in the Bomb Shelter Al Ameriyah.

July/August 2001

3

600 Days — HIPAA Compliance Challenges

I

“I AM TIRED OF THE insurance games. Our

office is inundated with paper work, and I barely have time to see all of my patients. I haven’t had time to think about it,” sighs the exasperated physician. “We are struggling with obtaining and retaining sufficient staffing and dealing with reimbursement challenges and rising costs.

When do I have time to read, let alone understand and do anything about it?” protests the medical group administrator.

What “It” are they referring to? The Health Insurance Portability and Accountability Act, now known as HIPAA, replete with its mind numbing plethora of acronyms such as PHI, AS, CE, ANSIx12, EDI, NRI, NPS. Numerous journals, publications and professional association newsletters have published articles over the last few months regarding HIPAA. Some include hyperbolic descriptions (such as comparing it to the Y2K bug, which of course, at times evoked a bit of hyperbole as well) while others focus on the anesthetizing technicalities of the final rules. With this focus of attention, are the medical groups in our community at an appropriate stage of readiness for compliance? Are physicians aware of and avidly pursuing the various requirements and compliance issues raised by the new rules?

These are some of the questions posed to a number of Twin City medical groups, all of which have sophisticated management infrastructure and leadership. Before getting into how some medical groups view HIPAA, let’s review some basics.

The Basics of HIPAA The Health Insurance Portability and Accountability Act was passed and signed into law

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in 1997. While the essence of this legislation focused on lowering the uninsured population by providing employees the opportunity to retain health insurance when leaving employment, another part of the legislation focused on administrative simplification and privacy. The initial focus (portability) has already been incorporated throughout the economy, while the latter focus on administrative simplification and privacy, awaited a rule-making process that was completed this year. And with that rule-making process complete, the clock begins ticking for implementation compliance.

HIPAA includes provision for patient privacy, security, medical records, electronic transactions and unique identifiers for every health plan, employer and (eventually) individual.

The entities covered by the rules are health plans, health care clearinghouses, and those health care providers who conduct certain financial and administrative transactions electronically. Information protected and covered by the final regulation includes all medical records and other individually identifiable health information held or disclosed by a covered entity in any form, whether communicated electronically, on paper, or orally.

The date for compliance is April 14, 2003.

Simply put, by this date, every health care delivery facility in the nation will need to follow one procedure for the electronic transfer of certain specific administrative and financial health care records. Highly punitive measures (fines and jail time) are put in place for non-compliance with these rules.

In addition, other administrative steps are specified such as physician practices must designate a privacy official responsible for developing and implementing privacy policies and procedures and designate a contact person to receive complaints about the organization’s privacy MetroDoctors

practices. All members of the workforce must be trained on privacy policies and procedures.

The practice must institute administrative, technical and physical safeguards to protect against use or disclosure of PHI in violation of the regulations and apply appropriate sanctions for failure to comply with privacy policies or regulations.1 So how does medical group leadership approach compliance in light of the challenge of day-to-day concerns? Most medical groups surveyed are still in the early stages with 82 percent indicating they have obtained the regulations, reviewed them and begun discussing how to address. However, 94 percent rank issues such as payor contracting and reimbursement, operations performance and staffing, budget and financial controls as a more immediate and higher priority than HIPAA compliance.

This is very understandable. The rules are complex and extensive. To address the compliance requirements adequately (upgrading systems, modifying and documenting policies, training staff ) involves spending time and money — both of which are under pressure with the existing payor reimbursement challenges and rising operating costs. Finally, 20 months till April 2003 can seem like a long time when viewed in the context of more immediate concerns of meeting patient demand, staffing adequately and trying to maximize reimbursement and collections.

In light of this, what approach can a medical group use to move more earnestly in bringing the delivery system into compliance? One place to start is the mindset used in moving forward.

Most view it as onerous, and to be sure, there is a lot of rethinking of how the clinic operates that is required in order to comply sufficiently so as to protect the organization from liability. However, another view focuses on the opportunities The Journal of the Hennepin and Ramsey Medical Societies

that are imbedded in the compliance process.

One of the more onerous aspects of medical group practice is complying with differing sets of rules, requirements and procedures for payment by fiscal intermediaries for care delivered to patients. HIPAA, for the first time, puts us at the point of standardizing and simplifying these transactions. HHS estimates the savings from administrative simplification and standardization at 29.9 billion dollars. HHS also projects 17.6 billion dollars in costs relative to the privacy compliance for a net savings of $12.3 billion.2 But even beyond the administrative opportunity is the physician-patient relationship. Physicians have a special covenant with their patients. In order for an effective physician-patient relationship, there must be a bond of trust rooted in patient confidence. Confidence both in the physicians’ expertise and belief that the information I (the patient) give will be used to help me, will remain private and held in the strictest confidence. Most physicians feel passionate about the sanctity of that trust relationship (witness the umbrage at managed care incursions which are perceived as intruding on that relationship). The public has demonstrated, through recent polls, that privacy is of higher concern than crime, taxes, gun control, the economy, or global warming.3 While the economic and efficiency gains on the administrative simplification are real and should be motivators for groups to ready themselves, privacy has the highest level of attention and exposure for medical groups. Tommy G. Thompson, Secretary, Department of Health and Human Services made the following comments regarding the patient privacy rule on April 12, 2001: “President Bush wants strong patient privacy protections put in place now. Therefore we will immediately begin the process of implementing the patient privacy rule that will give patients greater access to their own medical records and more control over how their personal information is used. We have laws in this country to protect the personal information contained in bank, credit card and other financial records. Our citizens must not wait any longer for protection of the most personal of all information — their health records…we are giving patients peace of mind in knowing that their medical records are indeed confidential and MetroDoctors

their privacy is not vulnerable to intrusion.”

However, in the press of organizational requirements to get the job done, some of the systems and procedures designed to support and augment the care process may inadvertently compromise that ideal. HIPAA provides a motivating rationale to work at greater constancy between clinic systems policies and procedures and the ideal.

Approaching Compliance Many of the medical groups surveyed recognize these opportunities and this is where the approach begins. After establishing a positive mindset by focusing on the opportunities, here is a suggested template to achieving benefits from compliance.

First, Prepare by doing the following: • Obtain regulations and read; • Obtain recent articles; • Put together a HIPAA resource book for the practice; • Raise awareness among physicians and administrative leadership; • Put together a project team consisting of at least one physician and key operations personnel; and • Ask the project team to provide a plan identifying all compliance actions needed.

Next, the project team should conduct preliminary assessment and design a conformance plan that includes information on what actions are needed, who will take actions, by when, and the resources required.

The assessment begins with a current situation analysis that documents and assesses current practices, processes and flow, and current IT standards. Then, the project team describes a future desired state for the organization that includes defining HIPAA compliant practices and processes and IT standards.

The project team is then ready to look for variances (gap analysis) and plan improvement, which will include: • Identify where gaps exist and what needs to change in order to achieve the future desired state; • Develop measures for key conformance variables; • Develop budget for implementation/improvement including training and development activities; • Assign resources; and

The Journal of the Hennepin and Ramsey Medical Societies

• Sign off on communications within practice.

With this foundation, the practice is now ready to begin making the changes necessary to meet the compliance challenges. As the project team implements changes, measures will need to be monitored and evaluated in order to adjust as necessary for workable solutions.

With the plethora of public information available, coupled with attentive, diligent and timely design and implementation of a compliance plan, medical groups should be able to conform to HIPAA standards on health data transmission and privacy with existing resources and capabilities.

If additional assistance is needed, medical groups might look to logical business partners with whom clinic compliance might be a shared goal. For example, the professional liability company the physician uses may have resources available to making sure client risk is low. For example, in this community, MMIC has outstanding legal and regulatory resources well versed on HIPAA and may be a source of help.

Professional associations such as the Minnesota Medical Association, AMA and the various specialty associations are a resource. The Minnesota Health Data Institute is an excellent source of information on HIPAA compliance, especially with respect to data and administrative simplification. Other potential partners where compliance is a shared goal are the health plans and information system vendors.

Obviously, should a medical group need to acquire outside expertise and advice, there are excellent consulting, management, law, and accounting firms in this community that will readily fill that need.

Regardless of how physicians choose to proceed, the time is now to put plans into motion, to avert significant vulnerability 600 days from now. ✦ 1. Lincoln JD, Elizabeth S.: HIPAA Minnesota Physician February 2001 2. Department of Health and Human Services: Protecting the Privacy of Patients’ Health Information 4/23/01 3. Ingenix: HIPAA and Security 2001

Timothy F. Signorelli is President of METRIA Management LLC, which is dedicated to providing leadership, enterprise, and market alignment solutions to medical and health care organizations.

July/August 2001

5

COLLEAGUE INTERVIEW

Stuart Lane Arey, M.D. Editor’s Note: “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. Paul Bowlin, Peggy Craig, E. Duane Engstrom, A. Stuart Hanson, and James C. Mankey.

Stuart Lane Arey was born in 1908, graduated from the University of Minnesota Medical School in 1932, and completed internships at Minneapolis General Hospital and Children’s Memorial Hospital, Chicago, Illinois. Dr. Arey assumed the medical practice of his father in 1934 following his untimely death. Nine years later, Dr. Arey opened a pediatrics clinic in Minneapolis with Drs. F. C. Rodda, E. F. Robb and R. L. Wilder.

In addition to his outstanding career as a pediatrician, Dr. Arey was the recipient of the Harold Diehl Award of the Minnesota Medical Association, the Gold Headed Cane Award from the Department of Pediatrics, University of Minnesota, and received a Citation from the City of Minneapolis for Community Service in 1984. In addition, he is the founder of the Hennepin Medical Society Senior Physician Association and served as its first president.

This issue of MetroDoctors is featuring physicians who have enjoyed adventurous travel and/or unique hobbies. Dr. Arey was chosen as our Colleague Interview because of his stellar career and uniqueness as an individual. He continues to actively enjoy life and all it has to offer, noting he “retired” from winter skiing just this year.

Q A

What led you to contribute so much of your time to teaching other physicians while you were in active practice?

Basically, it goes back to the last letter that I had from my hero, Dr. Joseph Brennamen. He said, “I would recommend that you spend time out of your practice in teaching and continue that even though it might be at the expense of some of your income. You will thereby be able to keep up with things; you cannot fool the young students.” I have continued to do that and really it’s anointed in self-interest. The people I’ve tried to teach have taught me so much, have kept me current, and have kept me in contact with young people.

What has been your incentive or underlying values that motivated you to give so much of your time to volunteer activities in our community?

First of all, the example of my father who managed to do volunteer work in the midst of a very demanding private practice. He took care of the Boy Scout’s, did the physical exams at the Boy Scout Camp and things like 6

July/August 2001

that. Also, the things I learned in church. It was part of a guilt complex. I realized that I had been blessed with many advantages simply by the accident of my birth and a loving family who gave me a good education, home, and opportunities. I want to repay some of it.

What advice could you give to physicians at or near retirement age to assist them in planning for retirement years full of enjoyment, intellectual stimulation, and fulfillment?

There is no one route that’s perfect, so the first advice I would have is to be yourself. Keep yourself involved in organizations that will keep you active such as the YMCA, Meals on Wheels, garden clubs, book clubs, and so forth. There are many of them. You have to cultivate new friends with varied interests. One of my favorite mottos came from Lazarus Long, he said: everything in excess, to enjoy the flavor of life take big bites, moderation is for monks, especiallization for insects. I had a talk I gave on “It’s better after 60,” and I had eight “Be- attitudes” if you will, and these are the advice I can give people: Be yourself; Be lucky; Be challenged; Be venturesome; Be helpful; Be curious; Believe; and Beyond…look forward to something each day. Perhaps the most succinct advice I ever got was from one of my friends when I was about to retire, and he said “for heavens sakes, when you retire, don’t let your day revolve around getting your haircut.”

Do you think that we should provide health insurance for all children (0-18yrs) in our society? If so, how should we do this?

Yes I do, but I’m not wise enough to have a great idea. I think that everyone should be covered and it should be paid depending on people’s in-

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The Journal of the Hennepin and Ramsey Medical Societies

come. That is, the lower income should pay nothing, the higher incomes would have to pay larger and larger co-payments. How you’re going to finance this, I don’t know. Could we get the lottery or some such money as that? I don’t know how we can do it.

Tell us your experiences in piloting airplanes and what motivated you to seek a pilot’s license.

older, and I learned better how to handle people. I was always able to get along with children, but sometimes I was gruff and had the reputation of being difficult. However, I am proud of the fact that most of my patients still think the world of me. I wasn’t perfect, but I hoped that I did a good job with them.

Is there a “life after medicine” and how did (do) you live it?

I took up flying because at the climax of a bad round of golf when I four putted four greens, I quit the game of golf in frustration and went to take flying lessons. Actually, I had been enamored with aviation since my first flight in an OX5 powered Curtis flying boat in the early 20s. When I started flying my children were through college and I figured it wasn’t a foolish risk. I loved flying. The two places on earth where you are nearest God — one is on a pair of skis by yourself, and the second is a little airplane boring holes in the sky all by yourself. One of the great thrills was landing at the old Kansas City airport when they held a DC4 until my 172 was cleared to land. I once flew to Jackson Hole for a meeting; coming in over the Tetons and looking down on the Snake River was thrilling.

Flying became too expensive, so I quit after 300 hours. Incidentally, I didn’t quit golf permanently.

Definitely there is a life after medicine. I’ve been busy. I’ve been on lots of committees. I’ve continued to be active in organizations in my church, the Rotary Club, Minnesota Medical Foundation, and I’ve made a lot of young friends outside of medicine. I’ve enjoyed playing a lot of golf, and I’ve skied a lot. But you cannot have your life rotate just around golf — it gets boring.

We would like to know when bow ties entered the pediatric specialists uniform of the day?

No, I don’t think the children are a bit different, but the environment they live in is very much different and the temptations that they are faced with are very different than 50 years ago.

I wear a bow tie because my father always wore one. In looking at the old pictures, I don’t think bow ties were as popular in the 30s and 40s as they are now on most pediatricians.

Do you have any suggestions as to how to unravel the Third Party intrusion into the patient/doctor relationship?

Again, I don’t have the wisdom of Solomon, but, I think that you have to realize that there can be no medical care unless there are doctors, and the doctors have to show their authority and stand up to the HMOs and the people from the insurance companies, and make sure that the patient/ doctor relationship is taken care of — that we are physicians and not health care providers.

What do you consider your greatest gift to future generations of physicians?

I don’t think that I made any huge gift to future generations of physicians; however, if one of the young men I tried to teach someday thinks, “well this is how Lane Arey did it,” or “I remember what Lane Arey said,” then I think I have been a success.

What is your next career going to be?

I hope to learn more about my computer.

Do you think today’s children are any different than 40 or 50 years ago?

How do you feel about the influence of the media on childhood development?

I think there is nothing wrong with the media; it’s the content of the media. There are some wonderful television programs for children; however, they are faced with some poor role models in many of the television programs. I think the greatest problem is that the children spend too many hours passively watching the television when they should be out playing ball or doing some other activities.

What opportunities have you found for volunteer medical work for emeritus physicians?

Actually, I did very little because when I retired there was no malpractice insurance coverage, so I didn’t do any volunteering. However, I have continued to do programs where I talk to lay groups about advances in medicine, and about problems with medicine, etc. I think that has been my greatest chance to do volunteer medical work. ✦

What was the greatest difficulty in maintaining a successful practice?

I think my interpersonal relationship with parents. Unfortunately, I wasn’t always the greatest in interpersonal relationships. It got better as I got MetroDoctors

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7

FEATURE STORY

Race Across America (RAAM) 2000:

Race Across America Team Heart One Year Later

I

Team Heart at the starting line. From left: Drs. Dan Dunn, Phil Murray, Bob Mackie, and Tom Pettus.

IT IS JUNE 21, 2000, two o’clock in the afternoon on a bright, sunny day in Portland, Oregon. Four aging 50-year old Minnesota physicians straddle their LeMond bicycles, ready for the greatest physical challenge of their lives. The starting official lines up the five teams and begins the countdown. Ten, nine, eight – “Phil, can you believe it? We’re really here!” Eight months of training, dieting, trying to stay in the good graces of our wives, and fundraising, seems trivial to what is ahead of us for the next seven days. Seven, six, five – “Can we make it? Will anyone get hurt?” Four, three, two – “Nervous, Dan? You’ve got to stay with these guys by yourself for the first 15 miles.”

Bob said, “Yeah, but they’re going through town, so I think I can hang on.” One – Team Heart is off on the Race Across America, a three thousand mile, non-stop race from Portland, Oregon to Pensacola, Florida. As luck would have it, we’re not the only over 50-year-old four man team in the race. Team Alaska is a team of finely tuned endurance athletes who have all competed previously in significant long distance events. We think they’re over trained. Team Heart has to finish within 24 hours of the winning team in our division or we will not get an official time for the race. This is a real race!

In November 1999, eight short months before the race, we decided to throw our hats into the ring. Phil Murray, Bob Mackie, Tom Pettus and I (Dan Dunn) had been biking together for about 10 years. We had done some long distance rides, but nothing approaching the Race Across America. We recruited Dan Zeman, an exercise physiologist who had experience helping train Greg LeMond during the years he competed in the Tour de France. Dan customized our exercise programs. Without his help we couldn’t have made it over Mt. Hood. Shortly after we started training, I sustained a lumbar disc and developed a foot drop that lasted six weeks. Phil had had chronic atrial fibrillation, and an oblation procedure performed two years before and he was having some problems with arrhythmias, but it didn’t seem to affect his training. Bob was nursing a chronic back problem, but he never seemed to complain. Tom, being the youngest at just 50, clearly had youth on his side.

We needed a sponsor and we wanted a cause. Four average 50-year old physicians peddling their bikes across the country—there has to be a message! Exercise is important—Age shouldn’t keep you from exercising. The Minneapolis Health Institute Foundation agreed that this was an important message. Team Heart was born!

The logistics of the race were formidable. Tom, an Abbott-Northwestern Hospital inter-

BY DANIEL H. DUNN, M.D.

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nist, was in charge of transportation. He decided we needed four vehicles. Two vans were used as chase vehicles to follow the riders at all times as we leap-frogged across the country. Two Winnebagos were needed for sleeping, eating, showering (oh, sure!), relaxing and socializing for the 14-crew members, as well as the riders. As it turned out, a fifth vehicle came in handy for emergencies such as taking Meagan, one of our crew, to an ER in Colorado in the middle of the night when she fell in one of the vans and broke her wrist. Other than a Winnebago breaking down in Utah and a replacement substituted in Salt Lake City, we had virtually no vehicle problems.

The race was made possible through the combined efforts of a very committed and enthusiastic crew numbering 14 at any one time with a four-person exchange in Steamboat Springs.

Crew members were largely family and friends of the four riders along with three AbbottNorthwestern physicians appropriately chosen for their specialties. Mark Fallen, urologist and team physician; Jim Larson, orthopedist, and Frazier Eales, cardiac surgeon, were thankfully there at critical times.

Bob, a gastroenterologist and a gourmet cook himself, took care of the food. After much research, he concluded that there were as many regimens for food and fluids as there were teams. We thought we might have an advantage over the other teams, since we were all experts in human physiology. (Yeah, right!) So, what did we do? We ate everything we could get our hands on—fried chicken, hamburgers, soups, peanut butter and jelly sandwiches, and tons of cookies, bananas, and candy bars. Not exactly a scientific approach to the caloric requirements of long distance bicycling, but it worked, for the most part. Fluids were the same. We each had our favorites. I drank nothing but XLR-8, a high carbohydrate concoction that is easy to digest.

My goal was to urinate before I got on the bike each and every time. Sometimes, that was every 20 minutes. We all found out two things—you can’t eat too much and you can’t drink too much! Phil, an interventional radiologist and the only proven long distance athlete, discovered that principle and the true meaning of the word “Bonk.”

Phil pushed himself too hard, too early, and too long with not enough food or fluids. By the second day, he was feeling terrible. Phil, at one point, couldn’t get his heart rate below 90 when he was resting or above 100 when he was out on the bike. He was nauseated, so he couldn’t eat, and he had to force himself to drink. About 60 hours into the race, Phil was in trouble. Mark Fallen, plugged an IV into Phil and gave him 2 liters of Ringer’s lactate. He was rejuvenated— for a while. A Bonk is a Bonk and, unless you’ve been there, it is hard to explain the feeling. Phil was totally depleted of energy. The difficult part of getting past this point is that recovery takes days or longer. Phil struggled the rest of the race but gave it everything he had and never quit.

He was the strongest rider coming into the race and he proved that spirit and determination sometimes count for more than physical conditioning.

The toughest part of the race was climbing the Rockies. There was over 100,000 feet of climbing in the race, 80 percent of which came in the first half. The Tennessee Pass at 10,000plus feet on the way to Leadville had grades of 7 percent to 10 percent. We climbed this section in half-mile stretches. It was all downhill, though, from Leadville. We were very lucky with the weather. The wind was at our backs for the first part of the race, which put us in Steamboat Springs (1,200 miles) in less than three days. The mountain stretch slowed us down some and

Two members of Team Heart prepare to make the relay switch.

(Continued on page 10)

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

July/August 2001

9

Race Across America (Continued from page 9)

southern Colorado and New Mexico were pretty hot. Oklahoma has got to be the widest and flattest state in the union, other than Texas. We had a difficult crosswind across most of Oklahoma. After Oklahoma, it was pretty hot and muggy through Arkansas, Mississippi, and Alabama, and our average speed began to slow.

We really wanted to finish in Florida on the 28th of June. Our goal from our earliest planning sessions was to finish in seven and one-half days. We rode into Pensacola at 15 minutes before midnight on June 28—seven days, nine hours, 45 minutes—14 hours behind Team Alaska and good enough to be official finishers of the Race Across America.

At the award ceremony the next night, Team Heart received the award for the most inspi-

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rational effort of the race. We had made it in one piece, exhausted, seriously sleep deprived, everyone healthy, no serious mishaps, and still friends!

It took Phil a couple of weeks to get back to his usual self. I developed a significant median nerve palsy in my right hand, which kept me from some operations for several weeks. Bob had to have his bicycle seat surgically removed from his derriere. Tom suffered no ill effects other than the brain damage that caused him to decide to do the race all over again on a two-man team with Ben Popp, our crew chief, as an entry in RAAM 2001. Best of luck to them!

A very important part of this event for Team Heart was the partnership with the Minneapolis Heart Institute Foundation and Abbott-Northwestern Hospital. Team Heart’s participation in the Race Across America was a major fund raising effort for the Minneapolis Heart Institute Foundation. Ford Bell and his colleagues at the Minneapolis Heart Institute, the Abbott-Northwestern Hospital and medical staff enthusiastically supported this effort. We raised over $120,000 of which $65,000 was donated to the Minnesota Department of Health Council on Physical Fitness and Sports. This seed money has helped develop a new program—Be Active Minnesota, which has as its primary goal, to increase public awareness of the importance of physical activity in our daily lives. That was the message of Team Heart.

The Be Active Minnesota Program is modeled in part on a very successful statewide program already in place in Michigan and North Carolina. What is unique about Be Active Minnesota is that physicians will take a more active leadership role in promoting physical activity.

So what has happened in the year since we finished RAAM 2000? People ask us if we’re still riding. Yes, but not quite as much (except for Tom). We all remain in the good graces of our wives and families. Tom has trained non-stop since RAAM 2000 to compete again this year. Good Luck to Tom and Ben! Was it a good experience? Incredible! Will the rest of us do it again? Never!

So what’s next? Paris-Brest-Paris 2003.

Stay tuned! ✦ The Journal of the Hennepin and Ramsey Medical Societies

Aeromodeling Celebrates All Aspects of Flight

F

FLIGHT HAS ALWAYS fascinated me. As a child I was usually building something that was supposed to fly. I still build and fly radio controlled model airplanes. I recently completed an electric powered model airplane fashioned after the Bleriot XI. The original Bleriot aircraft, with Louis Bleriot at the controls, made the first powered flight from France to England on July 25, 1909. This was only six years after the Wright brother’s first powered flight on December 17, 1903.

Even during the years when I was not actively building model airplanes (career, family, etc.) I kept pace with the hobby. I would periodically pay a visit to my favorite hobby shop where I could bring myself up-to-date on the latest kit offerings and modeling trends. Although I was usually just looking, the visits were always satisfying. I also maintained my membership in the Academy of Model Aeronautics (AMA). This non-profit organization promotes model aviation and is a source of leadership within the modeling community. Their official publication, Model Aviation, is an elegant monthly tour of the hobby.

Model aviation encompasses an incredible variety of enthusiasms. There are models that replicate, in stunning detail, full-scale aircraft.

Other models are unique miniature aircraft designed just for the pleasure of flying. The models are powered by everything from a vigorous toss into the air (hand launched gliders) to kerosene fueled jet turbine engines. Made out of everything from cardboard to carbon fiber, these models all have one thing in common: they fly.

I was drawn back to building airplanes by my fascination with electric powered flight. Although electric powered flight remains challeng-

BY PAUL GLEICH, M.D.

MetroDoctors

ing (heavy batteries and abbreviated flight times) it is a practical method of propulsion and a rapidly expanding part of the hobby. Virtually any type of airplane, even jets, can be powered with an electric motor. The jets are propelled by the thrust of a powerful electric turbine fan.

In addition to being practical, electric powered flight can be fairly quiet. I’m able to fly my electric airplane in the calm air of early morning without denying anyone their sleep. Electric power also lends itself to the replication of historic aircraft. Fragile aircraft, from the beginning of aviation history, adapt well to the minimal vibration and exhaust-free power of electric motors. The electric motors can even be concealed within a replica of the original aircraft’s engine.

Building and flying model airplanes has become a much more accessible hobby in the last few years. Radio control airplanes range in size from several ounces to a maximum permissible takeoff weight (AMA safety code) of 55 pounds.

Reliable radio control systems are available for airplanes of all sizes. The large airplanes need powerful servo motors to convey the pilot’s transmitted control signals to the airplane’s flight control surfaces. These servos weigh five to six ounces and deliver 10 or more pounds of torque.

Small airplanes, weighing as little as a few ounces, use servos weighing only several grams.

These tiny servos are still able to deliver several ounces of torque. There is a similar spectrum of propulsion systems. Piston engine displacement ranges from three cubic mm to 10 cubic inches.

Electric motors propel airplanes ranging in size from four ounce miniatures to 1/4 scale (1/4 the size of the original) giants. Turbine jets (turbo-props are on the way) produce many pounds of thrust to propel some very impressive looking jets.

The Journal of the Hennepin and Ramsey Medical Societies

There are many varieties of model airplanes available. Classic airplanes, both civilian and military, are the most common modeling subjects but virtually any airplane ever built is available either as a kit or a plan. An increasingly large selection of model airplane kits require only a modicum of assembly before the airplane is ready to fly. These are known as “almost ready to fly” (ARF) models. Other kits demand a substantial commitment of time and effort. If an airplane is not available in kit form, a set of construction drawings may be available. This diversity of available models strengthens the hobby. There is something for everyone.

Aeromodeling is a fascinating hobby that celebrates all aspects of flight from gliders to spacecraft. The models are capable of bringing both joy and wonder to anyone who has an opportunity to see them fly. Visit the model flying field of a local aeromodeling club and see them in action. The AMA web site www.modelaircraft.org provides a list of links to AMA chartered flying clubs. These club web sites usually provide directions and even maps to their flying fields. A hobby shop is also an excellent resource for directions to local clubs. While you’re in the hobby shop take a look around. You might see something that interests you. ✦

July/August 2001

11

Farming “Hobby” Continues to Grow

I

INITIALLY I WAS MILDLY AMUSED and

perhaps flattered by the request to write about my hobbies, but as I began thinking about these “hobbies,” it became clearer to me just how important and valuable they are to my family and to me.

Our hobbies include small time farming – sheep, chickens, bees, and more recently, the beginnings of a tree farm – and last but not least, woodworking.

My wife, Eleanor, and I are city-bred and other than building projects and maintenance at summer cottages as adolescents, we had no agricultural experience. Our interest began, I think, when we moved to rural North Dakota to begin my medical practice. We both grew up in Winnipeg, Manitoba and upon completing my training, in search of warmer weather, we immigrated to North Dakota. We didn’t find warmer weather, but we did find ourselves in an agricultural community. We raised our family in this environment and that led to horses, a few livestock, and bees!

By the time we moved to the Twin Cities area 12 years ago, we decided that we wanted to live in a rural area and focus on one home, rather than living in the city and heading for “the lake” on weekends. The result was that we bought approximately 100 acres of land just north of Anoka.

Over the past decade this has evolved into a farming project that now includes a flock of around 40 Columbia sheep, 11 beehives, which yield over 800 pounds of honey a year, a small poultry operation, outbuildings, farm equipment, and my pride and joy, a state of the art woodworking shop.

Running this operation requires most of our free time and a lot of hard work – but the

BY WILLIAM M. GOODALL, M.D.

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rewards for us are enormous! We have three daughters, all with families, and to date, a total of six grandchildren. To our delight, they have all become involved in our project, one way or another. Three years ago, our eldest daughter and son-in-law purchased additional land adjacent to ours, built a home and moved to the “farm.” We now jointly own approximately 130 acres and have really begun to move the operation forward! Let me walk you through a year of our “hobby” as it stands today.

Spring Spring is a particularly busy time for us. Early in March the sheep need to be sheared, wormed and have their hooves trimmed. The actual shearing takes about five minutes per sheep – but it takes a few days to set up pens and prepare a shearing floor. The whole family participates in this event – some of us herding, some trimming the fleece, and some trimming the hooves. We hire a shearer who makes the job look easy. On our farm, the shearer is a woman who weighs about 115 pounds and handles 150 pound ewes as if they were weightless: great fun to watch!

Next come the bees: the hives that wintered are fed sugar water and new colonies are hived. All the bees are treated with antibiotics because of common problems with mites, bacteria, and fungi. My grandchildren are always interested in whether I got stung and how many times – usually only a few.

By the end of March we’re lambing; the catch this year was 20 lambs including one set of triplets. We pen the ewes and their lambs in separate stalls or jugs for the first few days so that they bond and we can be sure that the mother is nursing her lambs. This is the time when we ear tag the lambs, dock the tails and castrate the males. Again, everyone helps and MetroDoctors

my grandchildren protest loudly on behalf of the lambs.

In mid-March we receive 115 day-old chicks and turkeys, 100 for broilers and 15 for egg production. They initially reside in brood chambers to keep them warm. The broilers are ready for market in 12 weeks and turkeys are kept until fall.

This year on May 9, our golden retriever, Dulce, delivered a litter of 11 pups who are quite spectacular. All of the family were up by 6:00 a.m. to watch and occasionally help her with delivery – one breech and one pup which required resuscitation; all now doing well. Eleanor and I removed their dewclaws on the third day with the help of our 8-year-old grandson.

Finally, we have all been busy planting and watering trees. We are starting a tree nursery and this year planted approximately 400 birch, linden, maple and dogwood.

Summer The pace slows a little during the summer months, but there’s still much to do. Livestock largely look after themselves, but need to be checked daily to make sure they have adequate water and pasture. The beehives are examined on alternate weeks and supers are added as necessary for honey production. The new trees all need regular irrigation; we are currently installing another well, trying to automate this work.

This year we are building a new poultry barn that will allow us to increase production and will reduce manual labor. We have finished the rough-in and are now working on plumbing and electrical supply; the project should be The Journal of the Hennepin and Ramsey Medical Societies

finished by mid-summer. If there is any spare time we will spend it on fencing and increasing the length of our woodland walking trails.

Fall Harvest time! This year we will extract about 1,000 pounds of honey. All our children and grandchildren will be home for this process – a very busy and sticky event, but one we all like.

Eleanor sells much of the honey in bulk form, but saves some for family and charitable events.

The poultry need to be processed and we have this done in Little Falls. Sobanias Poultry takes the birds and returns them to us cleaned, shrink-wrapped and ready for the freezer. We sell some of these free-range birds and the family uses the rest.

In late fall the lambs are butchered and sold. We process and tan the hides; we salt the hides and dry them on racks – when completely dry we send them to a tanner and then sell the sheepskins. We also send the sheared spring wool to a small mill in Wisconsin where it is washed, carded and spun. We all have “Irish” sweaters from our own wool.

Finally, in November, we turn the ram in with the ewes and the cycle starts again. The gestation period for sheep is 150 days, so we will be lambing again in March/April.

Winter With the exception of feeding stock, the outdoor work is done. This is the time of year when we repair equipment and my son-in-law and I spend a good deal of our time in the woodworking shop. We have been buying and seasoning cherry, walnut, and maple hardwoods and are now building furniture. Our projects have included bedroom and dining room suites as well as various tables, chairs and assorted furniture that Eleanor and my daughters want built. Of late, I am pleased to report, my grandchildren are beginning to build things with me in the shop.

Having written this description, I’m not sure if what we’re doing qualifies as a “hobby” or not, but I do know that it provides Eleanor and me with a great sense of satisfaction. It also allows both of us to unwind from the sometimes stressful business of emergency medicine and administrative responsibilities. I also know that working with the animals and in the shop is a wonderful experience for my children and grandchildren and brings us all closer together. ✦

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

July/August 2001

13

Antartica– This Fragile Environment Remains Relatively Untouched The ice was here, the ice was there, The ice was all around: It cracked and growled and roared and howled, Like noises in a swound!

Coleridge

G

GOING TO ANTARCTICA brings to mind visions of great heroes, fighting against an exotic, intolerably cold, windswept and frozen wasteland, deserted by all except a few brave explorers. The continent, however, is not only the cold icy spot of our stories, but at its fringes is a place of great beauty, seasonally full of mysterious and fascinating animal species. Except for a few research stations, it remains unpopulated and, until recently, unvisited.

About 25 years ago, the pioneer tour group, led by Sven Lindblad and his small tour ship “Polaris,” began tours to the area. Since then, the fascination and beauty of the Antarctic have continued to attract us, and currently, a dozen or so tour groups have ships visiting and enjoying the area during the brief Austral summer, generally from mid-November to mid-March.

Part of the mystery of the area is its remoteness. On the Pacific side, the Antarctic continent lies about two thousand miles from New Zealand, the nearest land. South of Chili and Argentina, however, the Antarctic Peninsula, really a southern extension of the Andes chain, provides continental seashore available to ships only a couple of days sail from civilization accessible by air. Most tours fly to either the tip of Patagonia and take a ship from there, or fly to Chili and thence to the Falkland Islands to start their voyage. Several stops along the way are valuable—South Georgia Island has enormous mountains close to the sea, fascinating bird

nesting, with penguins, huge albatross, and a slew of others, literally at your feet. In addition, South Georgia is the place to which Shackelton led his rescue team, and he is buried there. His story, and the traditional pouring of brandy over his grave, add a bit of romantic history to the tour.

The South Orkneys also are great birding sites, but despite our ship’s bulling its way through pack ice we couldn’t reach them. To get to the Antarctic mainland, ships must cross the Antarctic Convergence, a wild circumpolar wind and current system that made all of us thankful for scopolamine patches and meclizine. We, as do most groups, went ashore a couple of times a day, in little rubber “Zodiac” rafts, each carrying a dozen or so passengers. Wading ashore from these through seawater and ice chunks in rubber boots definitely adds to the ambience of the area.

Antarctica is a fragile environment, and visitors to the area agree to a rigid set of standards limiting their impact on the physical and biological structure of the sea and shore. Ships, for example, schedule things so that nobody sees anybody else, only small groups go ashore at any one time or place, and nobody leaves anything there nor (hopefully) upsets the various critters swimming, flying, or living on the shore.

Our tour never saw another ship or tourist. We visited one 16-person research station that hadn’t

BY RICHARD C. WOELLNER, M.D.

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MetroDoctors

Photo by Meg Woellner

seen anybody since the previous March. I don’t know if they were happier to see us or the fresh veggies that we gave them. We always spread out our shore visits so that no more than one or two zodiacs went into any one spot.

The most obvious part of the Antarctic region is, of course, its geography. The extent of the glaciers, shoreline cliffs, and towering snowcovered mountains is really indescribable—the waters are deep and our ship and zodiacs could easily wander next to cliffs and glaciers and among ice chunks, ice floes, and multistoried icebergs. Some narrow channels among the islands pass close under cliffs and glaciers towering high above the masts. We transited the LeMaire channel, one of the more famous, at about 1:00 a.m., in fairly bright daylight, with huge cliffs close by either side.

For most of the year, even the Antarctic Peninsula is glaciers, snow rocky cliffs, and ice.

As the weather warms (our highs were in the mid-30s) and the days lengthen, (20+ hours of daylight), the beaches thaw and seagoing birds, seals, and a few hardy plants occupy the shorelines and nearby valleys. The animals all feed on the extraordinary volume of fish and plankThe Journal of the Hennepin and Ramsey Medical Societies

ton in the Antarctic waters.

Some of the snow leaves the cliffs and rock outcroppings, and sea birds by the thousands mate and raise their young near the feeding grounds, providing both avid birders and occasional bird watchers, like me, with great viewing. Flying, nesting, and feeding birds of all sorts are constantly around, and penguin colonies harboring thousands of birds abound in the low areas.

Sailing south from the South Georgia Islands down the Antarctic peninsula reveals a variety of species of penguins in various phases of their courting (very noisy), nesting (very acquisitive) and chick-raising (very parental). An hour or two spent sitting on a cold rock in the snow watching penguin behavior is time well spent.

It’s easy to humanize these entertaining animals as they strut about. One of my shipmates and I sat on adjoining rocks watching birds squabble over nest building. We watched one particularly acquisitive male gather pebbles (and steal some from his neighbors) for building his nest. He looked like a little Warren Buffet in a tuxedo, and ended up with a huge pebble nest and, presumably, a happy mate. My shipmate commented that if her daughter were a penguin, that’s the one she’d want her to marry.

Penguins never had land predators, and so went about their business totally ignoring us except for an occasional curious stare or, if we didn’t move, and occasional hopeful peck at our boots seeking nesting material. We tried to keep 20 or 30 feet away from any wildlife, but the naturally curious penguins can’t read the rules, and we avoided them much more than they avoided us. I have a great memory of my wife peering through one end of a long telephoto lens and fiddling with her camera while a penguin waddled up and put a curious eye to the other end. Each species of penguin, as well as individual within the species, has its own personality—the dignified King penguins, clowning Gentoos, and industrious Chinstraps all go about their business differently, but all raise their young as couples, with evident parental concern about their chicks.

The other summer critters filling the beaches are seals of various breeds, generally MetroDoctors

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ashore to mate or loudly enjoy each other’s company. The largest, most vocal, and weird were the elephant seals, named for their huge noses.

The males, weighing a thousand or two pounds, rigidly defended their territory and harems with loud honks, sounding like an industrial-sized digestive disturbance. As they were surprisingly fast on land for an animal with no legs, we kept a very respectful distance, often necessitating a long detour around their territory through mud, rocks, ice, and snow. Leopard seals mostly stay out on the ice, and are the Antarctic version of an eating machine, consuming their share of penguins and little seals. In our zodiac, we putted past one on an ice floe who looked at us hungrily. I was glad to be away from him, despite our naturalist’s reassurance that they never ate zodiacs and rarely ate humans.

Even with an increase in tourism, the Antarctic remains relatively untouched and is a rewarding trip. Most ships going there are small, with less than a hundred or so passengers, and have several naturalists aboard. We had four, plus three German-speaking ones, all of whom gave frequent excellent lectures and were with us in the zodiacs, ashore, and aboard the ship. Our tour group sent us an excellent reading list, and visiting the land of Amundson, Scott, and Shackelton was really enhanced by studying beforehand. (Most of the books were readily available from the county library systems.)

If you plan to go, the ships and groups give good clothing advice, and ours issued each of us a big red parka. High rubber boots and multiple layers of clothes are adequate to keep everybody warm, dry, and comfortable. We had a great time, and I’d love to go again. ✦

The Journal of the Hennepin and Ramsey Medical Societies

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July/August 2001

15

Interest in Model Boat Building Continues

M

MY EARLY MODELING attempts consisted primarily of balsa and tissue paper airplane kits.

At that time (pre WW II) the kits that were available were primarily WW I airplanes such as the Spad, Fokker, Neuport, and Jenny. I remember that the kits were either a dime or a quarter. The quarter kits had a wingspan of about a foot, and were great for flying from the upstairs bedroom window.

My interest in model building waxed and

B Y C H A R L E S W. F RY E , M . D .

waned through the years but was always present. When my own sons were growing up, I revived my interest in modeling as an activity that we could do together.

Predictably, their interest ran to airplanes. Radio control had improved to the point that it was very good and added much to the ability to make realistic scale models. Unfortunately, model airplanes have a tendency to crash, so

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my own interest runs to boats that have a longer life span. I am especially interested in working boats such as tugboats, as opposed to yacht type models.

The pictures are of MISTER DARBY, a scale model of an ocean going tug, which I built several years ago. The Jackson Marine Corp. of New Orleans built the original boat for work in the Indonesian offshore oil fields. I built my model from a kit consisting of a fiberglass hull, a few die cut parts, various types and sizes of wood, and a set of detailed plans. The finished model is four feet long, weighs 65 pounds and is battery powered. It has twin four bladed props and is capable of about 20 knots (scale). It is also equipped with a horn and a diesel sound generator whose speed is matched to the propeller speed. Overall, I spent about a year in completing the model. We have had the fun of operating the boat in several local lakes, including Lake Minnetonka. It never fails to attract attention. ✦

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The Journal of the Hennepin and Ramsey Medical Societies

Climbing Wyoming’s Devil’s Tower

M

MY INTEREST IN TECHNICAL rock climbing began with a visit to Wyoming’s Devil’s Tower in the early 1990s. I visited with my family—a quick stop before continuing a crosscountry driving trip to Yellowstone. We were amazed to see teams of climbers scaling the vertical columns that surrounded the 800-foot volcanic remnant. My daughter, Ingrid, and I decided that we would learn to rock climb and target climbing Devil’s Tower as our goal.

It turns out that for about $200 you can find a guide to virtually drag you to the top of the Tower, but we had the dangerous illusion that we would spend a couple of years learning the technique and climb it ourselves without guided assistance. Boy, were we mistaken!

We enrolled in basic climbing lessons that winter at Vertical Endeavors, an indoor climbing gym in the East Saint Paul warehouse district. The gym festooned with synthetic rocks screwed into forty-foot walls to simulate rock face climbing. We usually climbed Saturday afternoons when the gym was heavily infested with elementary school children on wall-climbing birthday parties. It was an ego booster for me to know that I could climb better than 8year-old children almost all of the time.

We first learned simple belaying and top rope climbing. Top roping uses a single safety rope that is attached to the climber, running over two carabiners attached to the ceiling and then down to the belayer.

We graduated to real rock that summer, learning to set up top ropes at Taylors Falls from the lead instructor at Vertical Endeavors, Pat Mackin. We would buzz out to the Saint Croix early Saturday morning to stake out our claim on a route, and usually poop out by noon.

BY DAVID L. SWANSON, M.D.

MetroDoctors

By the end of the summer, we were feeling pretty strong, so we decided to advance ourselves to lead climbing. Lead climbing is when a climber carries the top end of the rope up the wall as he ascends, clipping into placed protection such as chocks, carabiners, and cams along the way. There is an opportunity for serious injury in lead climbing if you don’t perform it properly, so lead climbing privileges at Vertical Endeavors are not granted easily. It took a number of technique lessons and lots of practice before we felt comfortable.

Our assault on the Tower finally occurred in summer 1998. We still suffered under the delusion that we could climb the tower unguided, but at the last minute we chickened out and hired Pat to guide us. We drove to the Black Hills to spend two days warming up with two-pitch climbs in the Needles area behind the Rushmore monument. Finally, we drove a hundred miles to the Tower to camp overnight

The Journal of the Hennepin and Ramsey Medical Societies

before the climb. I didn’t sleep well. At 5:00 a.m. Pat woke us up and said it looked like a “go” for the climb, weather-wise. I popped two Lomotil. We dressed and slipped on headlamps to help us scramble to the base of the Tower.

We climbed the classic Durrance route, rated a modest 5.7, meaning that an experienced 9-year-old Vertical Endeavors birthday partier could probably climb with ease if not for the terror. Fortunately for us, I was the only member of our party nearly paralyzed with fear.

I kept it to myself as we started the first pitch, “Leaning column.” It was only 80 feet high, nothing worse than typical indoor gym height.

Climbing the next pitch, the “Durrance crack,” was the hardest thing I have ever done.

The pitch is essentially a 72-foot tube open to one side. In retrospect, I think there is an easier way to climb it; I did it by jamming my back to one side, scrunching one arm and leg to the other side, and inching my way up (literally— one-inch at a time). When I finished the pitch, pulling myself over the narrow ledge that became the next belay station, I could do little more than lie on my back gasping for breath.

The next three pitches, “Cussing crack, Flake crack and Chockstone crack,” were easier, but now we were experiencing some serious height exposure. Heights give me the creeps, even now after a few years of climbing. My daughter kept offering, “Dad, look down! Isn’t this cool?” I couldn’t pull my eyes away from the rock face—in fact, I pressed my whole tethered body against the rock away from the abyss.

I marveled that I could ever have considered trying this adventure unguided.

The sixth pitch is called the “Jump traverse.” It is a 6-foot open space between two ledges, with a 400-foot shear drop between.

Jumping is not recommended. In fact, a Nor(Continued on page 18)

July/August 2001

17

Climbing (Continued from page 17)

wegian nineteen-year-old tried jumping it the year before without protection and fell to his death. Pat rigged up a piece of webbing to a carabiner that allowed us to swing like Tarzan across the void. From that point, the rest was an uneventful 200-foot scramble around boulders to the top. The trip down was an exhilarating three-pitch rappel.

Ingrid has now gone off to college, so most of my climbing these days is done at the gym or with strangers that I have met on some other guided climbing trips, but she and I still think of each other as climbing partners. This summer, we are doing Devil’s Tower again, concentrating on technique. For me, the climb will be all about the Tau of the moment rather than the Outward Bound-like focus to achieve a goal and conquer fear. We will be guided again with Pat Mackin, of course.

Photos from our first Devil’s Tower trip and another climb I made near Las Vegas can be seen on our websites: www.angelfire.com/ mn2/ingadingo/ingrid/tower.htm; and www.angelfire.com/mn2/ingadingo/davidsr/ redrock.htm. ✦

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18

July/August 2001

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Nepal Provides Unforgettable Experience

N

NEPAL IS A COUNTRY LOCATED between Tibet and India, about 500 miles wide and 150 miles in the north-south direction. The northern most region, of course, includes the Himalayan range, which has eight of the 10 highest mountains in the world. The lowest portion of the country is more or less jungle with elephants, rhinoceroses, and a dwindling number of tigers.

The population is over 18 million. The government is more or less a Hindu monarchy with democratic leanings.

Most of the population is Hindu in religious background, especially in the capitol of Kathmandu, which is an interesting city to visit.

The Thamel area, especially, is reminiscent of the way the city presented itself to tourists 30 or 40 years ago. Narrow, irregular streets, are

Thamserku Mountain.

B Y J A M E S D . F O L E Y, M . D .

MetroDoctors

filled with locals selling everything from different types of grains to exotic carved masks and Tibetan rugs to used camping and hiking equipment. The largest stupa, or Buddhist monument, that I have ever encountered is in the city of Kathmandu and must not be missed. There is also a Hindu hospice for the dying next to the river at which Ghats are located where the recently dead are placed for their funeral pyres, and from which their ashes are swept into the river. If you can handle it, this is a most interesting place to visit and gives you a greater depth of feeling about the Hindu culture.

The best part for me, though, is trekking or flying up into the foothills of the Himalayas where the Sherpa people live.

This is, essentially, a Tibetan populace who are all Buddhists in philosophy and they are the most peaceful people I have ever encountered. Where most of the Sherpas live at the 9,000-10,000 foot level, the mountainsides are covered with Rhododendron plants and in the spring of the year there are seen white, pink and red flowering plants carpeting the slopes. The two favorite directions for trekking are west out of Pokhara into the Annapurna and Dhaulagiri mountains, which my friends all say are wonderful destinations. My preference, however, is taking a plane flight up to the Khumba region in the east, landing at the 9,000-foot village of Lukla. Treks begin from there up into the Everest region and most people spend at least a day or two in Namche Bazaar, which is the capitol of the Sherpa territory. Nearby is the famous Tibetan Buddhist monastery at Tengboche where I have spent a couple of nights camping and from which I saw Everest on my 50th birthday. I do plan on returning in a few years to hike to a

The Journal of the Hennepin and Ramsey Medical Societies

A Buddhist Stupa.

mountain pass at 18,500 feet, which is much closer to Everest, from which the entire south face can be seen.

The best time to trek in Nepal is either in the spring when the Rhododendrons are out or in the fall after the monsoon season is over in mid to late October up until mid November.

In addition, for those of you interested in less strenuous but still exotic travel, Tiger Tops in southern Nepal can deliver a good jungle experience and even an occasional viewing of a tiger in the evening. One last thing, for anyone interested in going that far I would recommend getting an around-the-world ticket as they are usually less expensive than round trip tickets.

Coming back by way of Paris is always a great way to finish a wonderful trip. âœŚ July/August 2001

19

Apple Trees and Wood Sculptures

G

GROWING UP ON A FARM near Centuria, Wisconsin, my parents tended a dozen or so apple trees and, every fall, sold apples to their friends and neighbors. From that experience, I developed an abiding interest in raising apples and discovering new varieties from self-seeded apple trees or with scion grafts from “wild” trees.

In 1975 I purchased an 80-acre farm just south of Centuria, and began raising apples for family, friends, and roadside customers. What began as a family project now totals 1,200 trees and includes 12 different varieties of standard

BY DANIEL R. BAKER, M.D.

apples (Macintosh, Haralson, Fireside, Honey Crisp, etc.) as well as several “discovered” varieties (Big Ben, Peachy, Southern Bell). My second oldest, John, has been an enthusiastic partner in this project for a number of years. The other family members and friends have pitched in to help from time to time, particularly during harvest season.

I look at the “Baker Orchard” as a great way to spend my free time, spend time outdoors, and try a different kind of science apart from my surgical practice. My greatest satisfaction in the orchard business is producing the “perfect” apples. During the harvest season (late August

Dr. Daniel Baker (right) with his son, John.

to early November) the orchard is open every weekend and is very busy. The orchard is also a natural center for the gathering of family and friends.

Among my other interests is that of creating wood sculptures and crafts from the pine and hardwood that I harvest from my Wisconsin property. Shown here is a rocking horse that I designed, carved, and constructed for my grandson.

My busy practice and orchard schedule have put my wood sculpting at a minimum for the past several years; however, when, and if, I do retire, I have plenty of raw materials stacked in my pole barn. ✦

Dr. Daniel Baker with crafted rocking horse.

The piece is of solid oak. All of the joints are glued without nails, screws, or dowels.

20

July/August 2001

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

MN PERSPECTIVE

Get Those Shots Before You Go

T

TRAVEL OPENS OUR MINDS and gives us a

new perspective on life. But with more and more travelers going to exotic destinations today, many people are exposing their bodies to deadly diseases that are just not present here in Minnesota.

Good preventive therapy, including immunizations, preserves health and saves lives. That’s why a visit to the doctor before the trip is so important.

Malaria is probably the biggest risk faced by travelers to exotic locales. We have seen a significant increase in malaria cases reported in Minnesota. Some of that increase is due to immigrants returning home to visit their families.

The remainder, though, is due both to increasing numbers of travelers and increased levels of malaria in the endemic countries. Malaria can be a rapidly evolving and fatal disease — the greatest risk of complications and death is with the first attack. So people born in the U.S., including the children of immigrants, need good preventive therapy.

Travelers need to begin prophylaxis onetwo weeks before entering a malaria endemic area. For most, this means starting prior to leaving the U.S. Travelers must also understand that malaria prophylaxis must continue for a month after leaving a malaria endemic country. With the rapid spread of drug resistance throughout the world, the prophylactic regimen must be tailored to the countries that will be visited. Consultation on which drugs are appropriate for a particular locale is best handled through either one of many local travel clinics or the Centers for Disease Control.

A broad variety of vaccines are available to protect the health of the traveler. The regimen prescribed should be tailored to the locale visited, the duration of the trip, and the anticipated activities of the traveler.

B Y H A R R Y F. H U L L , M . D .

MetroDoctors

A consultation for vaccination for travel begins with an assessment of the routine vaccination status. Children over two years and teenagers should be fully vaccinated with MMR, Polio, DTaP, Hib, Hepatitis B and Varicella.

Under two’s should also receive their pneumococcal vaccination. Acceleration of the immunization schedule may be appropriate for under two’s traveling to developing countries where the risk of exposure to disease is high. Teenagers and adults should have had a tetanus-diphtheria booster in the last 10 years. A second dose of MMR should be given to persons born after 1956. Adults who have received at least three doses of polio vaccine (either IPV or OPV) and who are traveling to developing countries should be given a booster dose of inactivated polio vaccine. Adults over age 65 as well as children and adults with high-risk conditions should receive influenza and pneumococcal vaccines consistent with the current recommendations of MDH. Pregnant women are at increased risk of complications of influenza and should also be vaccinated.

Additional vaccines are specifically recommended for travelers. Yellow fever vaccine is recommended if traveling to certain parts of Africa and South America. Hepatitis B vaccine should be considered for those who will live six months or more in areas where there are high rates of hepatitis B (Southeast Asia, Africa [Southern, Central, East, West, and North], the Middle East, the islands of the South and Western Pacific, and the Amazon region of South America), and who will have frequent close contact with the local population. The potential for sexual exposure to hepatitis B during travel is a strong indication for hepatitis B vaccination. In general, hepatitis A vaccine and/or immune globulin (IG) is recommended for travelers to all areas EXCEPT Japan, Australia, New Zealand, Northern and Western Europe and

The Journal of the Hennepin and Ramsey Medical Societies

North America (excluding Mexico). A combined Hepatitis A and Hepatitis B vaccine is now available. Typhoid vaccine is recommended for travelers spending time in areas where food and water sanitation is less than optimal (especially developing countries). Meningococcal vaccine is recommended for travelers to subSaharan Africa during the dry season, which is from December through June, and especially if close contact with the local population is anticipated. Japanese encephalitis or tick-borne encephalitis vaccines should be considered for long-term travelers to areas of risk. There is no cholera vaccine currently available in the U.S. Immune globulin (IG) may be simultaneously administered at different body locations with an inactivated vaccine such as DTaP, IPV, Hib, and hepatitis A and B vaccines. However, IG diminishes the effectiveness of live-virus MMR and varicella vaccines if IG is given simultaneously. IG does not interfere with yellow fever vaccine when given simultaneously.

With so many diseases, so many countries, and so many reasons for travel, providing the right protection for each traveler is a complex business. The Minnesota Department of Health and other physicians with expertise in travel medicine are available to help you meet the needs of your patients.

A list of travel clinics in Minnesota and additional information on travel vaccination can be found on the Minnesota Department of Health website: www.health.state.mn.us/immunize. A pamphlet “Tips on advising patients about shots for international travel” is available by calling the MDH travel resources hotline at 612/676-5588. ✦ Harry F. Hull, M.D.is the State Epidemiologist and the Director of the Division of Infectious Disease Prevention and Control for the Minnesota Department of Health.

July/August 2001

21

Highlights of the Code of Medical Ethics of the American Medical Association Editor’s Note: In the previous issue of MetroDoctors, the current seven Principles of Medical Ethics and proposed amendments to them were published.

In this month’s issue, we turn to the first of 10 sections of the AMA’s Code of Medical Ethics.

The brevity of this first section, which includes only two Opinions, allows us to provide some background on the overall structure of the Code, and its historical evolution, before discussing in more depth Opinions 1.01, “Terminology” and 1.02, “The Relation of Law and Ethics.”

SECTION E-1.00: INTRODUCTION Historical evolution of the structure of the AMA’s Code of Medical Ethics The first and possibly most important – although often under-appreciated – fact about this document is its historical origin. At the time of the foundation of the American Medical Association in 1847, there were two principle items of business: the establishment of minimum requirements for medical education and the adoption of a code of conduct.

The impetus behind both actions, at least in part, was a response to an environment where medical services were rendered by both medically-trained physicians and a multitude of irregular practitioners. Physicians who had undergone formal training wanted due recognition for their skills. Establishing uniform training requirements would help in this regard, but a public commitment to high standards of con-

duct also would help gain the esteem and trust of the public.

The original Code of Ethics, as it was known, expressed the physician’s commitment to uphold certain ethical duties toward their patients, toward each other and the profession at large, and toward the public. Therefore, the Code was organized according to three chapters, each including several provisions.

More than a century later, in 1957, the entire document — now referred to as the Principles of Medical Ethics — underwent a profound transformation. From all of the provisions were extracted 10 basic statements, which retained the name “Principles of Medical Ethics,” and which were accompanied by a preface. All other pronouncements were now considered an interpretation of these basic ethical principles and became known as Opinions. The Code was now organized in 11 parts, and specific provisions fell under the preamble and each of the 10 Principles.

The 1977 edition of the Code brought yet another change. It was found that an Opinion did not always correspond closely with the particular Principle under which it was listed or that it embraced more than one Principle. So, the structure of the Code became based on six broad subject matters, which included “Hospital Relations,” “Office Practices,” “Patient Relations and Medical Responsibilities,” and “Public Responsibilities.” There are now 10 sections, the newest being the one devoted to Opinions that focus on the patient-physician relationship.

Generally, to reflect that an Opinion flows from an interpretation of the Principles, it is followed by one or more roman numerals in brack-

B Y H E R B E R T R A K A T A N S K Y, M . D .

AND KARINE MORIN, L.L.M.

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MetroDoctors

ets to reflect the Principle(s) from which it is derived.

The Code’s Introduction The two Opinions that appear in this section, Opinions 1.01, “Terminology” and 1.02, “The Relation of Law and Ethics” are central to the role and function of the AMA’s Code of Medical Ethics, yet often overlooked.

Opinion 1.01 speaks of the very terms “ethical” and “unethical” and makes clear that a physician, as a member of the medical profession, engages in a moral activity. Moreover, the duties and obligations are, at least in part, determined by the profession itself and a violation of these may result in disciplinary action.

Self-regulation according to standards established in a code of conduct is at the heart of the definition of a profession.

It is worth noting that the Council on Ethical and Judicial Affairs (CEJA), which develops ethics policies that constitute the Code of Medical Ethics, also serves in a judicial capacity. Upon notice that an applicant to the AMA has a disciplinary record or that an AMA member has engaged in conduct that resulted in a disciplinary action by a medical society or a licensing board, CEJA will review the matter to determine whether these actions are indication of conduct that violated the Code.

The other Opinion addresses the complex relationship between a profession’s self-regulatory function and the primacy of law in our society. It is stated that ethical obligations “typically exceed legal duties.” Thus, in the practice of medicine, when laws are found to be unjust, physicians should work to change such laws. In some exceptional circumstances, legal disobedience may even be necessary. A clearer call for civil activism could be found only in a political manifesto. It is also made explicit that conduct The Journal of the Hennepin and Ramsey Medical Societies

that is not illegal may still be unethical.

Executions illustrate this interaction between law and medical ethics. The criminal system has sanctioned executions as an appropriate sentence for certain crimes. Execution by lethal injection makes this act one that requires pharmacological knowledge or other skills that physicians may possess. Therefore, physicians have been considered by the state as appropriate participants in executions. However, the participation of a physician fundamentally violates medicine’s commitment to preserve life and to serve the best interests of patients. Therefore, a physician’s participation is prohibited by the Code (Opinion 2.06, “Capital Punishment.”)

Similar reasoning applies to the prohibition against participation in torture (Opinion 2.07, “Torture”) or against the performance of certain court-mandated treatments (Opinion 2.065, “Court-Initiated Medical Treatments in Criminal Cases”).

Together, the two Opinions found in this section echo language found in the Preamble to the Principles of Medical Ethics, where it is stated the principles are not laws but standards of conduct, “which define the essentials of honorable behavior for the physician.”

That being said, the Code of Medical Ethics does play a part in the judicial adjudication of physicians’ conduct. This is made evident in the annotated edition of the Code, which for each Opinion lists court cases that have made reference to the Opinion. This is not to say that each time a court takes notice of an Opinion, it necessarily relies on it to determine whether a conduct was illegal or below a set standard. It is simply one element of evidence that courts may consider among others.

The more important relation between the Code and regulatory authorities exists at the level of licensing boards. Their oversight of licensure does include ensuring that physicians behave in a manner that is consistent with professionalism. States’ Medical Practice Act generally define unprofessional or dishonorable conduct in broad terms, some listing a non-exclusive set of behaviors that represent grounds for disciplinary actions. In this context, some licensing boards have statutorily incorporated the Principles of Medical Ethics, and a handful of states have incorporated the entire Code.

The relationship between ethics and law, self-regulation and judicial oversight, are dyMetroDoctors

namic ones that continue to evolve. The medical profession’s conversation with the law will benefit from a commitment to high standards of conduct and a commitment to promote and protect patients’ health and welfare. Many of these matters will be visited in more details when we turn to our review of the Opinions related to social policy issues in the next installment of this series.

The content of the entire AMA’s Code of Medical Ethics is accessible online at www.amaassn.org/ceja. ✦ Herbert Rakatansky, M.D. is Chair, Council on Ethical and Judicial Affairs. Karine Morin, L.L.M. serves as Secretary, Council on Ethical and Judicial Affairs.

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The Journal of the Hennepin and Ramsey Medical Societies

July/August 2001

23

PRESIDENT’S MESS AGE ROBERT C. MORAVEC, M.D.

From Where I Sit… “Let’s Talk” RMS-Officers

President Robert C. Moravec, M.D. President-Elect Peter H. Kelly, M.D. Past President John R. Gates, M.D. Secretary Jamie D. Santilli, M.D. Treasurer Peter J. Daly, M.D. RMS-Board Members

Kimberly A. Anderson, M.D., Specialty Director Victor S. Cox, M.D., Specialty Director Charles E. Crutchfield, III, M.D., At-Large Director Kelley C. du Ford, Medical Student Thomas B. Dunkel, M.D., MMA Trustee Michael Gonzalez-Campoy, M.D., At-Large Director James J. Jordan, M.D., Specialty Director Kathryn M. Klingberg, M.D., Resident Physician Charlene E. McEvoy, M.D., At-Large Director Ragnvald Mjanger, M.D., Specialty Director Kenneth E. Nollet, M.D., Ph.D., At-Large Director Thomas F. Rolewicz, M.D., Specialty Director Paul M. Spilseth, M.D., At-Large Director Lyle J. Swenson, M.D., MMA Trustee Charles G. Terzian, M.D., Specialty Director Jon V. Thomas, M.D., At-Large Director David C. Thorson, M.D., Specialty Director Russell C. Welch, M.D., At-Large Director RMS-Ex-Officio Board Members & Council Chairs

Brent R. Asplin, M.D., AMA Young Physician Section Blanton Bessinger, M.D., MMA President Kenneth W. Crabb, M.D., AMA Alternate Delegate Paul J. Dyrdal, M.D., Sr. Physicians Assoc. President Stephen P. England, M.D., Community Health Council Chair *Michael Gonzalez-Campoy, M.D., Education Resource Council Chair Eleanor Goodall, Alliance President Frank J. Indihar, M.D., AMA Delegate William E. Jacott, M.D., U of MN Representative Matthew D. Layman, M.D., AMA Delegate for American Society of Anesthesiologists Melanie Sullivan, Clinic Administrator *Lyle J. Swenson, M.D., Public Policy Council Chair *Russell C. Welch, M.D., Communications Council Chair *Also elected RMS Board Member RMS-Executive Staff

Roger K. Johnson, CAE, Chief Executive Officer Doreen M. Hines, Membership & Web Site Coordinator Sue Schettle, Director of Marketing & Member Services

24

July/August 2001

R

RARELY HAVE I attended such an important conference as the one held in St. Paul May 1618, entitled “Let’s Talk – Communicating Risk and Safety in Health Care.”

The focus of this national conference was to bring experts in communication and patient safety to help achieve high quality in safe patient care in the United States. Although most health care in the United States is delivered safely, a small number of patients are seriously harmed in the course of their care. Even though individual clinicians might account for some of the mistakes, most of the harm is the result of complex interactions among individuals, products, technology, and organizational systems.

The key to improvement in patient safety is to better understand the complex mix and organizational factors and to make enhancements to staff-to-staff and staff-to-patient communications.

I walked away from the conference with a number of significant learnings. Drs. Hickson and Prichert have identified that the most significant factor associated with the disproportionate share of malpractice claims is the physician’s degree of difficulty in “connecting” with patients. Their study showed that good physician/ patient communication was a key factor for reducing risk of malpractice claims. They were able to show that practicing in a high-risk specialty, attracting a medically high-risk patient population, or technical incompetence are not all that important factors in the number of malpractice suits a physician will experience.1 They then were able to develop a “report card” for a group of physicians based on a complaint index from various sources and assist those physicians with a high complaint index in reducing their risk through increased awareness, peer-to-peer discussion, and promotion of accountability.

While single complaints delivered one at a time provide no comparative feedback and may be easily dismissed, a compilation of patient complaints can offer a rich and important dataset about a group or medical center and a valid means to reduce risk and improve deliv-

MetroDoctors

ery of care and satisfaction with caregivers.

I was also struck by the presentation by Dr. Don Berwick from the Institute for HealthCare Improvement. Dr. Berwick discussed the need to change the focus of our efforts from a reduction of “errors”— based interventions to a basis of “prevention of harm.”

Dr. Berwick said, “If we frame the patient safety effort on errors, we will lose. Error has the wrong focus on people and hindsight bias. The real question is how can we keep people from being harmed?”

He also went on to note that, as much effort needs to be made in what happens after patients get hurt as preventing the hurt in the first place. We all need to focus on the healing that results from harm. We need to communicate and converse about it rather than applying more technology or tighter rules. In fact, Dr. Berwick noted that it may be rule violation and adapted behavior (“migration” from rules) that can account for the next level of improvement.

And finally, he noted that while much comparison has been made between medical care and the airline industry in the need to improve safety, we are not the airline industry!! We have our own issues and traditions, we lack integration between the various components and we value (perhaps over-value) our guild-like autonomy, probably to the detriment of care.

And remember, we all do eventually die.

Other industries do not need to accept death as an outcome, or have a process to make death as comfortable as possible one minute and apply maximum effort to stave off death the next.

All in all, the work product of this conference will continue to be evaluated and the sponsors of the conference will discuss a format for distribution. Keep your eyes and ears peeled for follow-up to this important event in patient safety. ✦ 1

Hickson, et al “Obstetricians’ Prior Malpractice Experience and Patients’ Satisfaction With Care;” JAMA, November 23/30, 1994-Vol 272, No., 20.

The Journal of the Hennepin and Ramsey Medical Societies

RMS to Sponsor Eight Resolutions in MMA House of Delegates East Metro area will be carrying eight resolutions to the MMA House of Delegates September 19, 20, and 21 in St. Cloud. The resolutions cover a wide variety of medical issues ranging from Global Risk Sharing Contracts and Reimbursement for the Treatment of Obesity to Appropriate Mental Health Evaluation of Children and Health Screening of Minnesota Offenders.

The subjects of the resolutions are as follows: • Global Risk Sharing Contracts Between Health Plans and Physicians;

•

• • •

• • •

MMA to Co-sponsor a Community Conference to Discuss the Next Generation of Health Care Delivery and Financing Systems; Reimbursement for Treatment of Obesity; Uniform Bar Coding of Pharmaceuticals; Standards to Protect the Quality and Privacy of Patient Care in Contracts Between Health Plans and Physicians; Health Screening of Minnesota Offenders; Task Force to Study Appropriate Mental Health Evaluation of Children; and AMA Federation Unity Project.

These resolutions, and many others, from county medical societies, specialty societies, and MMA committees will be considered by the 233 MMA Delegates meeting as the MMA House of Delegates in St. Cloud in September. Dr. John Gates, RMS Past President, will chair the RMS delegation. Dr. Blanton Bessinger will conclude his term as MMA President at this year’s meeting. Dr. Michael Gonzalez-Campoy, RMS Board member, will be a candidate for election to the position of MMA Vice Speaker. ✦

Congresswoman Betty McCollum in Surgery

O

ON APRIL 17 newly elected Fourth District Congresswoman Betty McCollum observed the surgical skills of Dr. Thomas Von Rueden, Cardiac Surgical Associates, and the surgical team at the John Nassef Heart Hospital at United Hospital in St. Paul. Joining Representative McCollum was her Administrative Assistant, Bill Harper. Opportunities for Members of Congress and for other elected state and local officials to personally observe the delivery of medical care are important educational experiences for government leaders who make health care policy decisions. The joint HMS/RMS Community Intern Program is another excellent program that provides a two-day exposure to medical care delivery. ✦ MetroDoctors

Representative Betty McCollum (right) with Administrative Assistant Bill Harper (left) and OR Supervising Nurse Sue Pitman (center) are scrubbed and ready to head into surgery.

The Journal of the Hennepin and Ramsey Medical Societies

July/August 2001

25

Ramsey Medical Society

T

THE 28 RMS DELEGATES representing the

RMS UPD ATE Medical Student

Elisabeth A. Slattery, M.D. University of Minnesota Internal Medicine/Geriatrics HealthEast Downtown St. Paul

(University of Minnesota)

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

Active AnneMarie McMorrow Tuohy, M.D. Medical College of Georgia Pediatrics PACE Associate Paul V. Shapiro, M.D. Sackler School of Medicine Family Practice Minnesota Institute of Neurology

In Memoriam DWIGHT L. MARTIN, M.D. died June 6 at the age of 89. He graduated from the University of Minnesota Medical School and completed his internship and residency at Ancker Hospital. Dr. Martin specialized in internal medicine. He joined RMS in 1942, and served as its President in 1972. Dr. Martin served on the RMS Constitution and Bylaws Committee and the Ethics Committee. He also served as the RMS representative on the Distribution Committee of the St. Paul Foundation. Dr. Martin retired in 1985.

DONALD M. “TONY” PETERSON, M.D., a radiologist, died in May. He was 87. He graduated from the University of Minnesota Medical School, completed an internship at Bethesda Hospital, and his residency at the University of Minnesota. Dr. Peterson joined RMS in 1949. ✦ 26

July/August 2001

Peter Aas Jennifer E. Dick David A. Kaisaki Becky L. Koshnick Nathan D. McParlan Gail M. Nichols Theresa A. Person David P. Pond Beau G. Reiner Katie L. Vogt Norma T. Walks

Transfer into RMS — 1st Year Practice Melissa A. Schimnowski, M.D. University of Minnesota Family Practice Stillwater Medical Group

Transfer into RMS — Active Richard G. Karlen, M.D. University of Minnesota Otolaryngology Otolaryngology & Head and Neck Surgery, P.A. Heather L. Rocheford, M.D. University of Minnesota Plastic Surgery/Hand Surgery St. Croix Orthopaedics, P.A.

Transfer into RMS — Resident Robyn M. Casey, M.D. University of Minnesota Family Practice St. Joseph’s Hospital A. Nadine F. Maurer, M.D. University of Wisconsin Physical Medicine & Rehabilitation Park Nicollet Clinic Transfer into RMS — Emeritus Patrick F. Hergott, M.D. University of Minnesota Family Practice Physicians Neck & Back Clinic ✦

Memorials for Don Linder MANY OF YOU RECALL Sue Linder who was the Executive Director of the Ramsey County Medical Society from 1968-1985.

Many of you also had the privilege of knowing Sue’s husband, Don Linder. Don was an executive with the Minnesota Medical Association for many years.

On April 23 Don passed away in Mesa, Arizona. A memorial service was held at Salem Covenant Church in New Brighton on May 2.

Sue requested memorials to the Ramsey Medical Society Foundation and expresses her appreciation to the Ramsey Medical Society for their donations to the Foundation. She remembers well getting the Foundation started and is so pleased that it is viable.

MetroDoctors

Thank you to the following members for their memorium gifts: Dr. Richard and Darlene Carroll Dr. Barclay Cram Dr. Robert S. and Ruth Flom Dr. Robert W. and Rosemary Geist Dr. William and Eleanor Goodall Dr. Barnard Hall Doreen Hines, RMS staff Roger Johnson, RMS staff Dr. James Jordan Dr. Roger and Ellen Lillemoen Dr. Thomas W. O’Kane Dr. Kent S. and Missy Wilson Anyone wishing to make a donation can still do so. Please send to: Ramsey Medical Society Foundation, P.O. Box 131690, St. Paul, MN 55113. Note that it is for the Don Linder Memorial. ✦

The Journal of the Hennepin and Ramsey Medical Societies

RMS ALLIANCE NEWS

A

AS BRENDA ANDREWSON AND I begin our

SAVE THE DATE The Annual RMS/HMS 2002 Winter Medical Conference Saturday, March 9 — Saturday, March 15, 2002

Royal Caribbean Cruise Line Explorer of the Seas

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

Jean London Co-President

members. Overwhelmingly, they commented about the caring of the staff and about how despite the fast pace of the units, that the physician was most appreciated because he/she cared so clearly about the patients and their families.

Recently, I met a woman whose son had died at age nine after waging a lengthy battle with leukemia. She recounted in arduous detail his bone marrow transplants, chemotherapy, lengthy hospitalizations and extensive support from family, school, church, and friends. She told me how touched she was when his classmates all shaved their heads in an effort to offer him support. And how she had breathed a sigh of relief that she could relax her vigilance, finally writing a thank you that was printed in the local newspaper. Two weeks later, he relapsed, requiring a second transplant and subsequently died.

What struck this mother so profoundly was the caring she received from the healthcare team.

She marveled at the power of the compassion shown them and the capacity that the physicians had to care for her dying son and his family. She felt that despite her son’s death, she would be eternally grateful to those who traveled this painful road with her and truly cared so much for them all.

“The capacity to care is the quality that gives life its deepest meaning and significance.”

(Author unknown) I stand in awe of the power and responsibility to care for patients that is inherent in the role of the physician. As co-president of the Ramsey Medical Society Alliance, I hope to continue to work with this very dedicated organization of volunteers to “promote educational and charitable endeavors which improve health and quality of life within our community.” It will be an honor to aid in this system of compassion and caring. ✦ July/August 2001

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Ramsey Medical Society

year as co-presidents of the Ramsey Medical Society Alliance, I feel compelled to reflect on the significance of our leadership role. What do I bring to the role that will perhaps enhance the Alliance? And when that question proves too daunting and I feel overwhelmed by its implications, I fall back on my professional role of the past 30 years as keen observer of the changes within the healthcare scene as a clinical social worker mainly in three newborn intensive care units. I have had the good fortune of working alongside physicians, nurses, chaplains and social workers, for whom I have the deepest respect.

And, unfortunately, on a more personal level, as a family member aiding loved ones as they grapple with the final stages of terminal illness.

I have, therefore, emerged as someone deeply respectful of the demands made on physicians: the increase in the numbers of patients seen; the continued assimilation of the ever-in-

creasing knowledge base; and the importance of the doctor-patient relationship — the essential trust that the doctor cares for and about the patient.

In Jane Brody’s article on May 15, she recounted a story told by a colleague about a physician who failed to diagnose his father’s cancer.

The father subsequently died and the physician attended the funeral/memorial service and in speaking to the family members expressed his profound regret and sadness over the missed diagnosis. He relates to the family that after knowing that the patient had cancer he reviewed the X-rays and still could not detect it on the film. “The family was relieved and grateful, both for the doctor’s visit and for the assurance that nothing more could have been done. The doctor’s conversation helped them resolve their grief.”

In my professional capacity, I was privy to hearing unexpurgated comments by family

Community Internship — Another Success

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ANOTHER SUCCESSFUL Community In-

ternship Program, jointly sponsored by HMS and RMS, was held May 14-17. Each of the nine “interns” observed four unique medical/ surgical experiences throughout the program, and shared experiences ranging from seeing an actual bullet on an X-ray to the care and compassion exhibited when decisions about life and death are made. They also noted the vast differences in the way medicine can be practiced from serving the uninsured/underinsured to the highest level of technology and specialized care.

The enthusiasm for the program is captured in the following letter received from one of the participants following her experience: “I can’t thank you enough for the opportunity I have had over the past few days. The variety and scope of the medical procedures I witnessed was wonderful, and the experience is one that I will long remember.

First and foremost, I was blown away by the efforts the physicians made to accommodate me, to involve me and to explain everything to me in detail. They are all so busy and their responsibilities are so enormous, yet they took the time to make my experience an unforgettable one, talking me through

every X-ray, CAT scan Back row: David Dvorak, M.D., Y. Ralph Chu, M.D., Carol and surgical procedure Bender, Thomas Major, Diane Marty, David Johnson, James step-by-step.

Hart, M.D., and Peter Bornstein, M.D. Front row: Karl Chun, M.D., Sue Schettle, Diane Rydrych, Nancy Cusick, Julie Crews I was also glad Barger, and Richard Nicholson. you reminded us to take the time to absorb to report that I did not pass out in surgery — not more than just the actual patient treatment. It was even a cold sweat or lightheadedness. : ) I had been enlightening to observe the teamwork that goes into a little nervous about it, but found that I was abpatient treatment, and it was heartening to see the solutely engrossed in examining every tissue, orcare and respect each physician showed each pagan, incision and suture. It’s truly fascinating work. tient (and their colleagues, from tech to nurse to The Community Internship Program is ofsecretary to PA). Even one physician who was quite fered three times per year to members of the cynical about the state of medicine in the physician’s community who direct, affect, and/or purchase lounge was still a very caring physician when facehealth care. Policy analysts, members of the meto-face with a patient and was absolutely dedidia, legislators, clergy, and others are also incated to doing everything he could for his patients. vited. Physician faculty are always being sought.

Also interesting was the time needed and the methIf you are interested in participating in the upods used for documentation — dictating patient coming program, November 12-15, and/or have charts into a voice mailbox and recording supplies names of potential candidates to serve as interns, used on a computer for billing purposes. please contact Nancy Bauer at HMS (612) 623I don’t have time to go into more detail at the 2893 nbauer@mnmed.org or Doreen Hines at moment, but please know that this is one of the RMS (612) 362-3705 dhines@mnmed.org. ✦ most stimulating experiences I’ve had in a long time and that I am most grateful for it.

— Julie Interns Included: P.S. On a side-note, I am happy Julie Crews Barger – Director of Alumni Relations and Special

Thanks to the following physicians for their participation: Peter Alden, M.D. Steven Anderson, M.D. R. M. Bolman, M.D. Peter Bornstein, M.D. Kenneth Casey, M.D. Y. Ralph Chu, M.D. Karl Chun, M.D. Raul Cifuentes, M.D. Kenneth Crabb, M.D. Peter Daly, M.D. William S. David, M.D. Lyn dosSantos, M.D.

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July/August 2001

David Dvorak, M.D. Michael England, M.D. Sandra Engwall, M.D. J. T. Finnell, M.D. Kevin Graham, M.D. James Hart, M.D. Richard Lamon, M.D. Bonnie Landrum, M.D. Theodore Lillehei, M.D. Catherine McKegney, M.D. Phillip Murray, M.D. Kathy Neacy, M.D.

William Remington, M.D. Frank Rhame, M.D. David Schmeling, M.D. William Simonet, M.D. Steven Sterner, M.D. David Swanson, M.D. Charles Terzian, M.D. Brett Teten, M.D. Steven Tredal, M.D. Stephen Wagner, M.D. Peter Wilton, M.D. Robert J. Wood, M.D.

Events, Minnesota Medical Foundation Carol Bender – Deputy Director for Constituent Advocacy for Senator Paul Wellstone Nancy Cusick – Information Technology Specialist, Health Technology Advisory Committee David W. Johnson – Vice President of Programs, Minnesota Medical Foundation Thomas B. Major – Public Program and Policy Supervisor, Minnesota Department of Health, Health Economics Program Diane M. Marty – State Program Administrator, State of Minnesota Health Economics Program Richard H. Nicholson – Portfolio Manager, Nicholson Family Foundation Diane Rydrych – Health Policy Analyst, Minnesota Department of Health Sue Schettle – Director of Marketing and Member Services, Ramsey Medical Society

MetroDoctors

The Journal of the Hennepin and Ramsey Medical Societies

CHAIR’S REPORT VIRGINIA R. LUPO, M.D.

HMS-Officers

HMS-Board Members

Ben Baechler, Medical Student Michael Belzer, M.D. Carl E. Burkland, M.D. Jeffrey Christensen, M.D. William Conroy, M.D. Dianne Fenyk, Alliance Co-President Paul A. Kettler, M.D. James P. LaRoy, M.D. Ronald D. Osborn, D.O. Joseph F. Rinowski, M.D. David F. Ruebeck, M.D. Richard D. Schmidt, M.D. Marc F. Swiontkowski M.D. D. Clark Tungseth, M.D. Trish Vaurio, Alliance Co-President Joan M. Williams, M.D. HMS-Ex-Officio Board Members

Barbara H. Subak M.D., Senior Physicians Association Lee H. Beecher, M.D., MMA-Trustee Karen K. 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 David W. Allen, Jr., MMGMA Rep. HMS-Executive Staff

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

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I

I RECENTLY HAD THE unexpected good

fortune of hearing one of my literary heroes speak.

During my recent year-long sabbatical, I was exposed to the author/poet David Whyte by the Bush Foundation. I encountered him in his book The Heart Aroused, a reflection on finding meaning in one’s work, whether corporate or academic or medical. To my great surprise, I found that he was the dinner speaker at this year’s Allina Annual Board Meeting, which I was scheduled to attend. The Shotwell Award was being presented to both Gordon Sprenger and Paul Quie, M.D. A committee of the Hennepin Medical Society determined the annual winners, and several HMS board and staff members were present at the meeting for the award presentation.

Whyte was just as inspirational in person as he is in print. He suggested that each of us identify a “place of revelation in our lives” that we can visit daily. Much of our daily lives is not revelation, but frustration. Often I feel that one of the best survival skills a physician can have today is an adult attention deficit disorder, since concentrating too long in any one area, or regarding any one patient or problem, is detrimental to keeping a hectic office schedule moving. Every surgeon knows that the act of scrubbing in can offer an escape from the frantic pace of a day and provide a chance to concentrate and complete something. And we all know there’s often not much to show for all our sitting at the end of a beeper and a telephone and putting out fires, not of our own making.

Whyte also suggested that we need to “have a place in our lives where we can hear another voice.” I sometimes reflect upon the differences between medical students and residents. I think that internship is the watershed time, and that people who have completed it have crossed some divide that they can’t go back across. We are hard-wired by our internship and are rarely the same as before we started. Whether we stop us-

The Journal of the Hennepin and Ramsey Medical Societies

ing a part of our brains and start to de-learn other ways of thinking or other voices to hear, we’re different people. Whyte would urge us to keep in touch with whatever motivated us initially to go into medicine, to find where our passion lies, and to try to weave that into our daily lives at work, or at least touch base with it on some kind of a regular basis.

I sometimes think about what my relation to medicine will be after I’ve retired. Some physicians leave their office, finish signing every medical record their hospitals’ incomplete rooms can find, sign off on their malpractice tail, never renew their journal subscriptions and society memberships and leave the profession behind.

Some physicians don’t retire. When I look at the advances in my field in the 20+ years since I began residency, I’d argue that large parts of current obstetrics are unrecognizable from when I began, and that I’d be reportable to the Board of Medical Practice within about 15 minutes if I spent a morning practicing ob/gyn that way. I can’t help but think that the field will continue to change at least at a comparable rate, and that sometime when I’m about 84, there will be tremendous advances in my field and I’ll envy practicing physicians who have tools I could only dream of.

I also wonder about what’s to come after we stop practicing, remembering that HIV and crack addiction didn’t exist when many of us were in medical school, and looking at how they have both dramatically changed the way we work every day.

So, reflect on what it is we do each day, and try to find what anchors or centers us and track towards that when you can. Pick up Whyte’s book before your next plane trip for a thoughtful read and some help from another voice to help you do this. ✦ July/August 2001

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Hennepin Medical Society

Chair Virginia R. Lupo, M.D. President David L. Swanson, M.D. President-Elect T. Michael Tedford, M.D. Secretary Richard M. Gebhart, M.D. Treasurer Michael B. Ainslie, M.D. Immediate Past Chair David L. Estrin, M.D.

HMS NEWS

New Members HMS welcomes these new members to the Society. Schools listed indicate the institution where the medical degree was received.

Active David A. Asinger, M.D. University of Minnesota Medical School, Duluth Diagnostic Radiology Suburban Radiologic Krasimir Georges Bojanov, M.D. Varna Higher Institute of Medicine, Varna Anesthesiology Twin Cities Anesthesia Associates, P.A. Terrence D. Brayboy, M.D. University of North Carolina School of Medicine Emergency Medicine Unity Hospital Evan D. Friese, M.D. University of South Dakota School of Medicine Obstetrics & Gynecology Coon Rapid’s Women’s Health Sean S. Gupton, M.D. University of Manitoba Faculty of Medicine Emergency Medicine Eric G. Heegaard, M.D. University of Washington School of Medicine Obstetrics & Gynecology Associates in Women’s Health

Alejandro Mendez M.D. Universidade Catolica de Chile, Faculdade de Medicina y Ciencias Biologicas, Santiago Neurological Surgery University of Minnesota Physicians

Residents Michael D. Alter, M.D. Medical College of Ohio at Toledo Pulmonary Disease Minnesota Lung Center

Owen R. O’Neill M.D. Mayo Medical School Orthopedic Surgery Minnesota Orthopaedic Spec., P.A.

Eric J. Anderson, M.D. University of Minnesota Medical School Pediatrics Fairview-University Medical Center

Michael T. Philbin, M.D. University of Wisconsin Medical School Plastic Surgery Edina Plastic Surgery, Ltd.

Gary D. Cravens, M.D. Indiana University School of Medicine General Surgery Ingenix Health Intelligence

Suzanne Ruth Proudfoot, D.O. UDMHS-Des Moines Phy. Medicine & Rehabilitation Fairview Pain Management

Students (University of Minnesota)

Manuel Roman, M.D. University of Wisconsin Medical School Emergency Medicine J. Richard Sheely, M.D. University of Tennesee Center for Health Sciences Family Practice Quello Clinic, Ltd., Mall of America Kevin David Sipprell, M.D. University of Minnesota Medical School Emergency Medicine Ridgeview Medical Center Julie Ann Switzer, M.D. Stanford University Orthopedic Surgery Orthopaedic Consultants, P.A.-Administrative Office

Mark A. Heller M.D. University of Minnesota Medical School Orthopedic Surgery Minnesota Orthopaedic Spec., P.A.

Mallikarjun R Thatipelli, M.D. Kakatiya Medical College, Osmania University, Warangal, Andhra Pradesh Family Practice Southern Metro Medical Center

Concepcion A. Laqui M.D. Faculty of Medicine and Surgery University of Santo Tomas, Manila Anesthesiology Hennepin County Medical Center

Peter J. Thill M.D. University of Michigan Medical School Pediatric Critical Care Children’s Respiratory & Critical Care Specialists, P.A.

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July/August 2001

MetroDoctors

Sharone Kamran Askari Elias P Bazakos Michelle A. Bochert Jonathan B. Gully Monica C. Koplas Joshua R. Kovach Jennifer C. Koziol Nicholas W. Krawezyk Michael M. Lukoma Rosemarie B. Ramirez Michael Jay Remucal Kelly L. Rood Mara B. Rosenthal Tseganesh Selameab Thao P. Tran Rochus K. Voeller ✦

In Memoriam EVERETT C. PERLMAN, M.D. died in June at the age of 95. He graduated from the University of Minnesota Medical School. Dr. Perlman, a pediatrician, retired at the age of 80. He joined HMS in 1994.

JAMES ROBERT SHANKS, M.D., died April 25. He was 60. He graduated from the University of Minnesota Medical School. An endocrinologist, Dr. Shanks practiced at Abbott Northwestern for many years. He joined HMS in 1995. ✦

The Journal of the Hennepin and Ramsey Medical Societies

Two Shotwell Awards Presented The second recipient, Paul Quie, M.D., was recognized by Judith Shank, M.D. Dr. Quie, a University of Minnesota pediatrician with specialization in infectious diseases, has achieved great fame in areas of research, both locally as

well as nationally. His other interests include international medical education, and improving the lives of refugees. He is described as humble, yet very accomplished, warm, kind, a true gentleman, and an extraordinary role model. ✦

Robert Van Tassel, M.D. with Gordon Sprenger.

Judith Shank, M.D. presents award to Paul Quie, M.D.

Hoban Scholars Present Educational Research Projects

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THOMAS AND MARY KAY Hoban were the

guests of honor as five “Hoban Scholars” delivered presentations on their educational research projects. Topics such as “Characteristics of Unionized Minnesota Nursing Homes: An Analysis At the Nursing Assistant Level;” “Six Sigma;” “Factors Contributing to Abstaining or Engaging in Sexual Intercourse Among Minnesota Adolescents;” “Technological Initiatives;” and “Open Access” were made by the scholars. In addition, Tim Signorelli, President of METRIA Management, LLC, shared his insight on “Physicians and Administrators as Partners.” The highlight, however, was the opportunity for Thomas and Mary Kay Hoban to meet in person the scholarship recipients and Tom’s recollection of his successful partnership with physicians as the CEO of the Hennepin Medical Society for 25 years.

MetroDoctors

Members of the Scholarship Selection Committee include: Roger Becklund, M.D., Paul Bowlin, M.D., Peggy Craig, M.D., Paul

Hamann, M.D., Richard Frey, M.D., William Petersen, M.D., and Bonnie Sauerer. Dr. H. Thomas Blum chairs the Committee. ✦

Back row: John Jendro, Eric Nielsen, H. Thomas Blum, M.D., Brian Cooper, Jon Rauen. Front row: Thomas & Mary Kay Hoban, Janiece Gray, Jessica Levine.

The Journal of the Hennepin and Ramsey Medical Societies

July/August 2001

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Hennepin Medical Society

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THE MINNEAPOLIS CLUB was the venue for the Allina Annual Meeting and the annual presentation of the Shotwell Award. This year two awards were given out to noteworthy recipients for their exceptional contributions in health care.

The award was established in 1971 by (the former) Metropolitan Medical Center in recognition of the support and dedication of the Shotwell Family. The Hennepin Medical Society has served as the repository for this award with funding provided by the Allina Foundation since 1991.

Robert Van Tassel, M.D. presented the first award to Gordon Sprenger, former CEO of Abbott-Northwestern Hospital, and currently the CEO of Allina. Among his many accomplishments, Mr. Sprenger was recognized for his 35 years as a leader in health care, both locally and nationally, and for his inspirational leadership, superior integrity and communication skills.

HMS ALLIANCE NEWS

President’s Note: As the recently installed president of the HMSA for 2001-2002, it is my pleasure to introduce fellow member, Peggy Johnson, as our guest columnist for this edition. She and her family have had the stimulating experiences of world-wide travel.

Kathy Larson, HMSA President

I

IN 1996, OUR DAUGHTER, Lara, traveled to

Tanzania, East Africa, to study abroad for a semester. The experience included a home stay with a Masaii family where she worked with the family on several projects such as general health care and disease prevention utilizing simple measures such as water sanitation and solar energy.

During her stay, Lara noticed the declining health of one of the young daughters. Although Nema was quite sick, she was allowed to help with family chores and attend school, as she felt able. Her ailment had never been diagnosed or treated and her condition was simply accepted, even as her health steadily deteriorated and simple tasks became increasingly difficult.

Several months later, after Lara returned home, we received a letter from Nema’s father, Zablon, informing us that Nema had become weaker, developed shortness of breath, and was now unable to attend school. An American phy-

sician in Arusha, Tanzania had diagnosed Nema with Tetralogy of Fallot, a congenital heart problem, and advised corrective heart surgery. At this time no heart surgery was performed in Tanzania. Remembering that Lara’s father was a physician, Zablon was now seeking our help.

Coincidentally, just a few days after receiving the letter, a medical team from Nairobi, Kenya, was planning a trip to Minneapolis for training in diagnostic procedures and treatment of cardiac patients. The group was sponsored

by Children’s Heartlink, an international medical charity dedicated to the treatment and prevention of heart disease in needy children in developing countries. Our family had volunteered with Children’s Heartlink over the years, and a few of the physicians and nurses were staying with us during this visit. We presented Nema’s problem to the team at a welcome reception. They agreed to see the patient.

Nema’s family was astonished when the Kenyan team notified them that Nema could be brought to Kenya for a cardiac workup and surgery. The family was apprehensive and fearful at first, having been approached by a foreign medical team with promises of helping their daughter get well. They did make the six hour bus ride to Nairobi and met with several physi-

Nema’s father, Zablon, Dr. Bruce Johnson, and Nema’s mother with Nema as she recovers from surgery.

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MetroDoctors

Peggy Johnson

cians. After seeking several opinions, the family’s confusion increased once again as the promises of Western medicine clashed with those of the more traditional local medicine men. We received another letter from Nema’s family explaining their anxiety and hesitations regarding the surgery.

Eventually, my husband, Dr. Bruce Johnson, a cardiologist with Cardiovascular Consultants, located at North Memorial Medical Center, had an opportunity to journey to Nairobi as a member of Children’s Heartlink volunteer medical team. The Minneapolis team would work alongside the Kenyan physicians, assisting their international counterparts with several cardiac cases, teaching new techniques, while learning a bit about traditional medicine as well. Once again we contacted the family, but received no reply. A few days after the team’s arrival, Nema and her family unexpectedly arrived at Nairobi Hospital. They were ready to go ahead with the surgery. During the team’s stay, the necessary pre-op was completed; Nema had surgery and was recovering by the time they left. The experience marked an emotional and rewarding week for these two fathers from different cultures.

Our family has maintained our connection to Nema’s father and Africa. A year later our family visited Nema and her family in their Tanzanian village. Nema gave our family a tour of her school and introduced us to her new baby brother. She has completely recovered and can enjoy all the activities of her siblings and friends.

Today, Lara lives in Tarangire National Park in Tanzania where she and her husband, Charles Foley, head an elephant research and conservation project. This September, our second daughter, Anthea, leaves for a semester abroad in South Africa. ✦

The Journal of the Hennepin and Ramsey Medical Societies