2010 July/August by Advocates for Better Health

100% Success Rate. FFor Treatment Of One Rare Heart Condition.

Six-month-old Josue and his mom, Yesenia.

At Children’s Hospitals and Clinics of Minnesota our cardiovascular team consistently produces some of the most successful outcomes in the nation. Meet Josue. Diagnosed with hypoplastic left heart syndrome (HLHS), our cardiac surgeons performed the Norwood surgical procedure when he was four days old. Josue now joins the many others who are part of Children’s three year, 100% survival rate for the ﬁrst stage of the three-part surgery to repair HLHS. To learn more about Children’s cardiovascular program and take a tour of our new cardiovascular center, visit www.heartatchildrens.org.

July/August Index to Advertisers

Doctors MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY

TCMS Officers

President Edward P. Ehlinger, M.D. Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Marvin S. Segal, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer Assistant Editor Katie R. Snow TCMS CEO Sue A. Schettle Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Outside Line Studio MetroDoctors (ISSN 1526-4262) is published bi-monthly by the Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. To promote its objectives and services, the Twin Cities Medical Society prints information in MetroDoctors regarding activities and interests of the society. 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 TCMS. Send letters and other materials for consideration to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: nbauer@metrodoctors.com. For advertising rates and space reservations, contact: Betsy Pierre 2318 Eastwood Circle Monticello, MN 55362 phone: (763) 295-5420 fax: (763) 295-2550 e-mail: betsy@pierreproductions.com 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. For subscription information, contact Katie Snow at (612) 362-3704.

President-elect Thomas D. Siefferman, M.D. Secretary Anthony C. Orecchia, M.D. Treasurer Melody A. Mendiola, M.D. Past President Ronnell A. Hansen, M.D. TCMS Executive Staff

Sue A. Schettle, Chief Executive Officer (612) 362-3799 sschettle@metrodoctors.com Jennifer J. Anderson, Project Director (612) 362-3752 janderson@metrodoctors.com Nancy K. Bauer, Assistant Director, and Managing Editor, MetroDoctors (612) 623-2893 nbauer@metrodoctors.com Kathy R. Dittmer, Executive Assistant (612) 623-2885 kdittmer@metrodoctors.com Katie R. Snow, Administrative Coordinator (612) 362-3704 ksnow@metrodoctors.com For a complete list of TCMS Board of Directors go to www.metrodoctors.com.

July/August 2010

WEBER

LAW OFFICE •TCMS Members• WE NEED YOUR PARTICIPATION to serve as a DELEGATE at the

Minnesota Medical Association’s Annual Meeting

September 15-17, 2010

Focusing on the legal needs of the health professional!

• Licensure • Employment Law • Trial Work • Wills and Estates • Regulatory Compliance

Michael J. Weber, J.D. • Former Attorney for the Board of Medical Practice • Over Six Years as an Assistant Attorney General

(Wednesday evening–Friday afternoon) Breezy Point Resort near Brainerd, MN TCMS is eligible for 119 Delegates. This is your opportunity to make a difference by testifying at the reference committees, acting on the resolutions submitted state-wide and voting for your colleagues willing to serve as your MMA Officers. Contact Kathy Dittmer at kdittmer@metrodoctors.com or (612) 623-2885 to participate.

Acute Care, Inc. .................................................30 Bethesda Hospital ........... Outside Back Cover Billing Buddies ...................................................20 Brainerd Lakes Health .....................................29 Children’s Hospitals and Clinics of MN...... 1 Crutchfield Dermatology................................21 The Davis Group .............. Inside Front Cover Fairview Health Services .................................28 Family HealthServices Minnesota, P.A. ......31 Hamm Clinic......................................................18 Healthcare Billing Resources, Inc. ...............23 HealthEast Care System ..................................29 Lockridge Grindal Nauen P.L.L.P. ...............18 Mankato Clinic ..................................................28 MN Society of Internal Medicine ................23 Minnesota Epilepsy Group, P.A....................21 Minnesota Physician Services, Inc. ..............17 The MMIC Group ................................................ Inside Back Cover Pediatric Home Service ........................................ Inside Back Cover SafeAssure Consultants, Inc...........................25 U.S. Army ............................................................31 Uptown Dermatology & SkinSpa, P.A.......24 Weber Law Office ............................................... 2

612-296-8080 www.weber-law.com “Committed to the Best Legal Outcome Possible Through Diligence and Resourcefulness!”

MetroDoctors

The Journal of the Twin Cities Medical Society

Contents VOLUME 12, NO. 4

Index to Advertisers/Call for Delegates

President’s Message

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

Lifeboats, Torpedoes, and Social Policies By Edward P. Ehlinger, M.D., MSPH

tCMs in aCtion By Sue Schettle, CEO

2010 Legislative Session Wrap Up By Nathaniel Mussell, J.D.

Page 25

Colleague interview

Karen Lawson, M.D.

Military MediCine •

Medical Leadership Through Army Service By Walter B. Franz III, M.D.

•

Serving My Country and My Patients—Humbling Opportunities By 2nd Lt. Dennis J. Gerold, USAF

•

Thoughts and Experiences of a Minnesota Army Doctor By David B. Hale, M.D.

•

The Call of Duty By Lt. Col. William Lundberg, M.D., USAR MC

Achieving Successful Management of EHRs by Mitigating Risks By Elizabeth Schultz, RN

Page 32

New Health Care CEO: David Abelson, M.D., CEO, Park Nicollet Health Services

Disability Insurance for Docs—the Difference is in the Details By Dale Forsythe, CLTC, and Joel Greenwald, M.D., CFP

Page 14

MetroDoctors

Call for Delegates/New Members

East Metro Caucus/East Metro Foundation

West Metro Caucus/Thomas and Mary Kay Hoban Scholarhip Sunsets

West Metro Medical Society Alliance Celebrates 100 Years

West Metro Senior Physicians/Call for Delegates/ Career Opportunities

In Memoriam

luMinary of twin Cities MediCine

Richard M. Magraw, M.D. The Journal of the Twin Cities Medical Society

On the cover: Image represents four Minnesota physicians who express their commitment to medicine and the military. Articles begin on page 11.

July/August 2010

President’s Message

Lifeboats, Torpedoes, and Social Policies EdwArd p. EhLiNGEr, M.d., MSph

ON THE SOUTH COAST OF COUNTY CORK, IRELAND is the sheltered seaport

town of Cobh. The town is best known as the final port of call of the RMS Titanic which sank on April 15, 1912 with a death toll of 1,517. Another maritime disaster that is part of Cobh’s history is the sinking of the RMS Lusitania on May 7, 1915. The Lusitania was torpedoed by a German U-boat 10 miles off the shore of Cobh with a loss of 1,198 lives. Less well known is the fact that for over a hundred years Cobh was the single most important emigration center in Ireland. Between 1845 and 1851 over 1.5 million adults and children emigrated from Ireland. Ultimately, over 6 million Irish people emigrated, with over 2.5 million departing from Cobh. As I walked along the docks of Cobh on a recent vacation, the specter of these three traumatic events was everywhere. Wherever I looked, whatever I read, and with whomever I talked, these historical events which occurred over 95 years ago were still vivid in people’s minds. The more engrossed I became in the stories of Cobh, the more I realized that the unifying lesson was the role of policy decisions in causing these tragedies. Different individual or societal decisions could have prevented or significantly reduced the loss of lives and the human trauma caused by these events. On the Titanic the number of life boats was inadequate for the number of passengers. The ship had been designed for more lifeboats but a decision was made to fit it with a lower number that met the minimum requirements of an outdated law that based lifeboat numbers on tonnage not on number of passengers. Plans were to add more only if the law required them. In early 1915 a policy decision was made by the German military to do whatever was necessary to gain control of the waters of the Atlantic Ocean. This decision led to the torpedoing of the passenger ship Lusitania and the eventual U.S. entry into World War I — a war that killed or injured over 37 million people. The policy decisions that led to the starvation and mass emigration of the Irish were more subtle and indirect but just as lethal as the iceberg and the torpedo that sunk the Titanic and the Lusitania. Decades of state-sponsored discrimination promoted laws that influenced all aspects of Irish life including the restriction of education, the practice of religion, and the use of Gaelic by the Irish people. It also fostered passage of the “penal laws” that affected land ownership, and which led to total dependence on the potato for sustenance. These prejudicial policies inevitably caused the 1.5 million deaths and mass emigration precipitated by the potato famine that plagued Ireland for decades. In each of these situations, conscious policy decisions led to catastrophic results and negatively affected the life and health of large numbers of people. Yet, none of these policy decisions was related to health care. They were policies emanating from consideration of business and political needs or the maintenance of a social and economic order that favored those in power. In March the Twin Cities Medical Society Board affirmed its vision to provide “leadership for the health of our community.” It also made a decision that policy issues would be a priority for the organization. Certainly, “health care policies” must be part of that focus. However, the example of Cobh demonstrates that business, occupational, educational, transportation, economic, and social policies can have an even larger impact on the health of our patients and our communities. As physicians, we have a responsibility to advocate for the health of our patients and our communities and that responsibility goes far beyond just dealing with health care issues. To be true to our vision of leadership, TCMS needs to be actively involved in monitoring all policies that could have a health impact and advocating for decisions that would ultimately benefit the health of all of our patients and our communities. The history of Cobh reminds us that policy decisions make a difference in people’s health. TCMS can help assure that the difference will be a positive one by actively assessing the broad health implications of policy decisions at the local, state and national levels. 4

July/August 2010

MetroDoctors

The Journal of the Twin Cities Medical Society

tCMs in aCtion SUE A. SChETTLE, CEO

THE TWIN CITIES MEDICAL SOCIETY BOARD OF DIRECTORS held its first strategic planning retreat on March 25, 2010. The evening was facilitated by Jerry Spicer, Ph.D., a strategic planning consultant working for Experienced Resources. Board members came prepared to discuss the strategic direction that the newly formed organization should undertake in order to best represent metro-based physicians. A great discussion ensued resulting in a new mission and vision statement as well as five key areas of focus for the next three years. The TCMS board of directors approved the three-year strategic plan at their May 27, 2010 meeting. Vision Statement Providing leadership for the health of our communities. Mission Statement To connect, represent, and engage physicians in improving clinical practice, policy development and public health initiatives. Five Key Areas of Strategic Focus

#1: Public Policy Advocacy Goal: Establish TCMS policy scope and focus • Use TCMS policy committee to develop and recommend priorities • Focus primarily on local and state policy • Monitor policy trends to identify emerging issues Goal: Engage key partners on common issues • Involve physicians and Society members as key stakeholders • Work with MMA and other medical societies • Target local and state Congressional leaders and government Goal: Develop an overall process for public policy advocacy • Board agreement on primary issues that affect the members • Assure that processes and resources are available for pro-active advocacy • Have a rapid-response system for critical, time-sensitive policy issues

#2: Public and Community Health Initiatives Goal: Continue current initiatives • Healthy Eating Minnesota • Honoring Choices Minnesota Goal: Develop relationships with the medical community to broaden our impact • Medical school and residency programs • Society members and physicians • Public health medical directors • State and local public and community health agencies Goal: Actively seek new opportunities • To be developed

#3: Support the Practice of Medicine Goal: Advocate for sustainable medical practices emphasizing the patient-physician relationship MetroDoctors

The Journal of the Twin Cities Medical Society

• •

Including business acumen Helping medical students prepare for managing a successful business • Medical staff governance Goal: Identify and facilitate relevant education and training resources • Medical practice business management • Impact and use of technology • Business impact of legislation and regulation • Innovative reimbursement models • Use experienced physicians as knowledge experts and coaches Goal: Monitor new and emerging issues that impact the practice of medicine • Inform and prepare members for the potential impact • Raise awareness of these issues in the general medical community and with policy-makers

#4: Visibility, Awareness and Benefits of the Society to Members and the Community Goal: Attract and retain members • Monitor member attitudes and satisfaction • Develop marketing tactics to expand membership Goal: Increase awareness of the Twin Cities Medical Society • Complete the launch of our new website • Create a communications plan to reach new audiences Goal: Expand opportunities for collegiality and involvement • Expand our social media and networking for Members • Implement outreach efforts to less active Members

#5: Effectiveness and Management of the Society Goal: Maintain our financial strength • Develop a resources plan to support strategic goals • Monitor and communicate our budget results and fund performance • Seek outside funding for new initiatives Goal: Assure open, effective governance and decision-making • Create board committee structure and responsibilities to support the Society’s strategy • Periodically assess member and board attitudes and satisfaction Membership surveyed Prior to the strategic planning retreat staff surveyed the membership of TCMS asking for feedback on the various activities that TCMS sees as important for our members. The survey results were a great asset to the Board of Directors as they focused their discussion. Additional direction was obtained from the membership survey which will be shared in the next issue of MetroDoctors. Please contact me if you have any questions at (612) 362-3799, or sschettle@metrodoctors.com.

July/August 2010

2010 Legislative Session Wrap Up GOING INTO THE 2010 LEGISLATIvE

session it was clear health care was going to be the lead actor in this supplemental budget year. As it turned out, the discussion over reforming the General Assistance Medical Care program and solving the state’s almost $1 billion short-term budget dominated much of the four month session at the capitol. If those two issues were not enough for state lawmakers to grapple with, mid-April saw the passage of landmark federal health care reform. To cap it off, one week before the end of session, the Minnesota Supreme Court came down with a decision finding Gov. Pawlenty’s 2009 unallotments exceeded his powers under the law. It was the combination of these four issues that ultimately brought legislative leaders and the Governor into the final hours of session, and briefly into a special session, before a balanced budget was agreed to and passed. Although the $1 billion deficit was solved this session, the solutions continue to be balanced largely on the backs of the state’s health care system. The Health and Human Services budget, the second largest portion of the state’s budget, continues to take a disproportionate share of the cuts and health care providers continue to pay a high price. Unfortunately, many fear these cuts will only continue given the projected structural deficit the state is facing. Others fear this downward spiral will ultimately lead to more jobs lost and more businesses going under. One thing was clear once the final gavel was lowered on the 2010 session, there were far more unanswered questions than there were answers. Over the next five months, the state will not only face an election cycle in which health care has now become one of the stratifying issues, but the state will also face the challenges By Nathaniel Mussell, J.d.

July/August 2010

of balancing implementation of federal health reform legislation with finding solutions for a projected $5.8 billion deficit next year. General Assistance Medical Care

The first major issue legislators faced this session was the reform of the General Assistance Medical Care (GAMC) program. In the final weeks of the 2009 legislative session, the combination of the Governor’s line item veto and unallotments left the GAMC program without funding beginning March 1 of this year. Legislative leaders and stakeholders in the health industry and throughout the broader community struggled to craft a solution that was both feasible for the state from a financial perspective and feasible as a health care solution for those 35,000 Minnesotans who relied on this program to meet their health care needs. Legislators were given a brief reprieve in January, when the state found funds to extend the existing program until the end of March. The first solution brought forward by the House and Senate health care policy committees proved unworkable primarily given the efforts to pay for the program. Reliance on an increase in the medical assistance surcharge

hospitals pay on inpatient revenue not only created what many thought was a system of winners and losers, but also did not have the support of the Governor. Although the legislature eventually replaced this surcharge with other shifts originally proposed by the Governor, the first GAMC solution still drew a veto once it reached the Governor’s desk. As the negotiations moved behind closed doors, an agreement finally emerged late in April between the Governor’s office and legislative leaders on a revised GAMC program that utilized the concept of coordinated care delivery systems (CCDS) and an uncompensated care pool. Seventeen hospitals were given the option to participate as a CCDS based on certain revenue thresholds. These hospitals would be required to manage and provide the entire spectrum of medical care for those individuals on the program under a capped payment of less than 30 percent of the previous levels. For those hospitals not designated as a CCDS the only potential for reimbursement for seeing GAMC patients came in the form of a six month $20 million uncompensated care pool in which payments would be made on a first come, first serve basis. Following passage of this compromise, there were far more questions than answers. It wasn’t until after this bill had been signed into law that a new potential solution for this population arose. Under the federal health reform bill Minnesota was one of 12 states given the option to expand our Medicaid program, Medical Assistance, to cover single adults without children up to 75 percent of federal poverty guidelines (FPG). The possibility of moving away from what many people viewed as an unworkable solution to an expansion of the Medical Assistance program set the stage for the discussions on the Health and Human Services budget.

MetroDoctors

The Journal of the Twin Cities Medical Society

Health and Human Services Budget Omnibus Bill

Even though the first hurdle of the session had been cleared in finding a solution to the GAMC problem, the second larger hurdle was figuring how to balance the budget. Early on, it was clear that given the election year, K-12 education, the largest portion of the state’s budget, would not be cut this year, leaving Health and Human Services to take the brunt of the cuts. To make matters worse, the HHS budget discussions, usually spanning the course of at least a month in years past, were pared down into two fast paced weeks of around the clock negotiations. Ultimately the centerpiece of the HHS budget, and the overall budget solution, became whether to expand the current Medical Assistance program and how to pay for the expansion. Hospitals and other providers voiced their support for an expanded MA program given the unwelcome options under the revised GAMC program. Whether or not MA expansion was included in an eventual budget solution, it was still apparent the legislature was intent on balancing large portions of the budget on the backs of health care providers and hospitals. Initially it appeared House Democrats were considering the possibility of increasing the provider tax. This was quickly ruled out as a budget solution when it became apparent there was not enough support for such an approach. Instead, House and Senate leaders reverted back to direct cuts to reimbursement. Physicians again saw their reimbursement cut — this time cutting an additional 7 percent off the Medical Assistance rates for physicians performing non-primary care procedures. This cut comes on top of a 6.5 percent cut in last year’s budget. Many specialists were hit again this year through a provision cutting the reimbursement of certain services under Medical Assistance down to Medicare levels. Hospitals saw a further reduction in their inpatient rates and an additional 24 month delay in rebasing. HMOs saw cuts to their managed care rates — cuts which may ultimately hit physicians and other providers directly if past action is any indicator. While providers and hospitals took the brunt of the cuts in this year’s budget, long term care providers continued to get by without any cuts. It was not until the last few hours of the legislative session that an eventual budget agreement was reached in which these cuts MetroDoctors

and the expansion of MA were the focal point. Complicating matters was the Supreme Court’s decision that the Governor’s actions at the end of the 2009 legislative session exceeded his authority. What was previously a $1 billion deficit turned into $3.7 billion overnight. The final agreement included a ratification of the 2009 unallotments — all of the above cuts in the health and human services budget but no expansion of the Medical Assistance program. In the late hours of session the MA debate quickly changed from a policy debate to a political debate as House Republicans voiced strong opposition to the expansion calling it an endorsement of “Obamacare.” As a result, Governor Pawlenty passed the question of expanding MA onto the next governor, giving them the option to opt into the program by January 15, 2011. If it wasn’t apparent already, the way in which the legislative session ended this year made it clear that federal health care reform will play a significant role in the upcoming fall elections as we move into 2011. Health Care Policy Issues

arisen with the provider peer grouping program passed as part of the 2008 health reform bill. Again, following lengthy discussions with the Minnesota Department of Health, both parties were able to reach an agreement. As passed, the bill delays the implementation of the peer grouping findings until physicians and other providers have a chance to ensure the accuracy and validity of the findings. More importantly, the bill removed a provision from the original 2008 legislation which had the punitive effect of punishing those providers who fall within the bottom 10 percent of the peer grouping rankings. Looking Forward

Going forward, health care issues have the potential to play an even larger role next session as the legislature begins to implement many pieces of the federal health reform legislation. There will be considerable discussion about delivery system reform over the interim months as a new health care task force is convened by the Governor. Given all these factors, in addition to a $5.8 million deficit, the new legislature and Governor will be tasked with decisions that may permanently transform the delivery of health care in Minnesota.

Although the budget and GAMC dominated the majority of the short 2010 session, two important health care policy bills passed this session. The first bill, brought forward by Nathaniel Mussell, J.D. is a lobbyist with Lockthe Minnesota Medical Group Management ridge Grindal Nauen’s government relations group Association (MMGMA) revisited a number of with a focus primarily on health care clients. issues outstanding from the 2006 provider fair contracting bill. An agreement was eventually worked out with the health plans on almost all portions of the original bill. Some of the agreed upon terms include not requiring a termination letter in order to renegotiate a contract, notifying a provider of tiered product methodologies, creating a time limit on claims appeals, limiting the claims adjustment period, and allowing providers to request up front payment for certain services. The second important policy bill this session was brought as an initiative from the Minnesota Medical AsMussell, J.D. (back) summarized actions taken by the sociation to address some Nate Minnesota Legislature at the TCMS Board meeting. Also of the concerns that had pictured (front) is Peter Bornstein, M.D., board member.

The Journal of the Twin Cities Medical Society

July/August 2010

COLLEAGUE INTERVIEW

A Conversation With

Karen Lawson, M.D.

ince 2005, Karen Lawson, M.D. has served on the teaching faculty and is director of Health Coaching, University of Minnesota, Center for Spirituality and Healing, and assistant professor, Family Medicine and Community Health. She also serves on the teaching faculty of Northwestern Academy of Homeopathy and as an associate clinical faculty, Northwestern Health Sciences University. Dr. Lawson received her medical degree from the University of Michigan Medical School, Ann Arbor, MI; completed a residency in family medicine at the University of Wisconsin, Madison, WI; and subsequent studies in Homeopathy, Northwest School of Homeopathy, Minneapolis, and studies in Shamanic Medicine with Christina Pratt, Last Mask Center for Shamanic Medicine, Seattle, WA. She is board certified in family medicine and holistic medicine, and is a founding diplomat of the American Board of Holistic Medicine. Questions were provided by: Gregory A. Plotnikoff, M.D.; James Struve, M.D.; Marvin Segal, M.D. and Lee Beecher, M.D.

What does an average day look like for you at the University of Minnesota’s Center for Spirituality and Healing? My primary role at the Center for Spirituality and Healing (CSH) is an educational one — medical student, graduate student, community outreach, and some faculty development — although I do participate in some outcomes projects relative to that work. On any given day, I may spend a portion of my day doing a lecture for the medical school, teaching Health Coaching for either graduate students or at a corporate consulting site, working on new curriculum development on spirituality or integrative medicine or health coaching, participating in meetings with the Center faculty/staff, writing on a talk or article for community outreach, or meeting one-on-one with any of a wide range of individuals who have interest in our Health Coaching certificate program or other areas of study, or networking with individuals with shared interests. Every day varies, and each day is full and often holds surprises and unexpected calls or events.

Holistic medicine seeks to view the patient and his/her condition in a biopsychosocial context, with attention to specific language, culture, and patient preferences. Can one quantify or evaluate the quality of holistic medicine in medical practices? That is a great question, though with no easy answer. First, it is important to recognize that Holistic medicine is even broader than the 8

July/August 2010

biopsychosocial model that has been well accepted in family medicine (and some other areas) for decades. It really is about mind/body/spirit, as well as family, community and environment. Many non-biomedical systems of care are holistic by nature, and some individuals who have come from biomedical training and roots have evolved into holistic practitioners. New models of research are beginning to look at the impact of entire systems of care, rather than a specific therapy or procedure. I believe these research models are beginning to enable us to explore the impact on clinical outcomes, patient satisfaction and cost but we are early in that process. Right now, I can say I believe the American consumers vote with their feet — and I get many calls from individuals looking for medical doctors who are embracing of more holistic philosophies and approaches to care.

Evidence-based medicine relies on comparing outcomes of specified interventions to controls, with random assignment of subjects to each. Can we similarly study “complementary” or “alternative” health care practices such as homeopathy, naturopathy, and chiropractic? If so, what studies have you looked at and with what findings? This is not a new process. There is a large and rapidly growing body of research literature exploring both complementary and alternative medicine (CAM) practices, as well as entire alternative systems of health care. I could not even begin to review the tens of thousands of articles looking at this area. I think many physicians are very unaware of how MetroDoctors

The Journal of the Twin Cities Medical Society

much actually does exist. There certainly are issues around study design and funding that need to be addressed to expand this area in very necessary ways. There are also issues of publication bias, which leads to some of these studies never making it into the journals most physicians read. There are several good peer-reviewed journals in CAM and integrative medicine, including Alternative Therapies in Health and Medicine, Journal of Alternative and Complementary Medicine, and the Integrative Medicine: A Clinicianâ&#x20AC;&#x2122;s Journal. I would also recommend to those who are interested in reviewing research findings to check out the following resources: General CAM research: National Center for Complementary and Alternative Medicine government website. http://nccam.nih.gov/. Each field, e.g. chiropractic, homeopathic, naturopathic, has their own repository of research. The CSH website can head you to some of those specific sites. http://www.csh.umn.edu/research/home.html.

The power of the placebo effect is based on positive therapeutic patient and physician expectations (along with other factors) in studies of drug, psychotherapy, or surgical efficacy. Can we conceptualize the placebo effect in evaluating complementary or alternative health care practices? If you are asking if there is a placebo effect operating in CAM approaches, yes, of course there is, just as there is in ANY therapeutic approach. Plus, in my opinion, that should always be optimized. If you are asking if CAM can be explained away as exclusively the placebo in operation, then I can say from both research and my personal and professional experience, the answer is definitely, no. In CAM research studies, the issue of placebo is addressed to the best of their ability in study design, just as it is in conventional studies. Some areas, say prayer for example, have much more complicated control challenges than do drug studies.

There has been a large body of peer review articles in the last 20 years predominantly outlining a positive association between faith/religious involvement and personal health. Do you incorporate this literature into your teaching and coaching about spirituality? I lecture the first year medical students early in their training about spirituality and medicine, and we do review this ever growing and changing body of literature. We try to get them to also appreciate the differences between spirituality and religion, and to examine the impact their own beliefs and practices have on their work as future physicians. We are currently involved in a national effort to standardize competencies in spirituality and medicine for medical students, funded by the George Washington Institute for Spirituality and Healthcare (GWISH). UMN is one of eight medical schools involved in this effort and are currently piloting a small curricular study with a selected group of 3rd and 4th year medical students in their clinical training.

Psychiatrist Jerome D. Frank, M.D., Ph.D., author of Persuasion and Healing 1963,1993, eloquently described the power of the shaman in healing rituals. Can principles of shamanism be taught as tools for mainstream medical practice? Examples? Maybe someday, hopefully. This is actually an area of personal interest to me, as I have been a student of shamanic practices for 15 years, and teach a graduate course on cross cultural shamanism, as well as teaching a class in the Minneapolis community at Pathways. I think this will first be an area explored by practicing physicians, like myself, who are ready to expand their perspectives on healing and all of its mysteries. I find a rare medical student, or even resident, who has the time or inclination to explore this area, which feels rather out on the fringe in our current system. That said, those students who have the opportunities to interact with indigenous patients, in the states or abroad, often have shamanic perspectives made very real to them in a clinical situation. Such opportunity changes and expands the sometimes limited scientific understanding of many physicians, in, I believe, a very positive and inclusive way. Some continuing medical education events include opportunities to explore such a question and Iâ&#x20AC;&#x2122;d like to recommend two. The SIMPLE conference, offered by the University of New Mexico every other year in the fall, often will have talks or experiences in shamanic approaches included in their program. At this yearâ&#x20AC;&#x2122;s conference, Oct. 10-13, I will be presenting a breakout session on healing and ritual, and a colleague, Scott Carroll, M.D., will be teaching about shamanism. Scott and I will also be leading a healing ritual in the evening as a special offering for those who elect it. http://hsc.unm.edu/som/cme/2010/SIMPLE/ SIMPLE_PostCard.pdf. Other learning opportunities for interested practitioners would be two classes offered by CSH. Every fall I teach CSH5331 Foundations of Shamanism and Shamanic Healing. It is taught in a form of two weekend intensives. Another option coming up in 2011 (not offered annually) is CSH5332 Global Healing Traditions of the Amazon Rainforest taught by Connie Grauds (author of Jungle Medicine) and assisted by me. It is a three week course in which we take students to Peru to study with the native healers. There is an information session about this course being held on Oct. 18. Both of these classes are open to individuals who are not existing students at UMN (www.csh.umn.edu).

Traditionally, physicians have been patient advocates, teachers and coaches. Does health coaching replace or support these physician roles? When does health coaching best enhance patient care? As a physician, I was trained to diagnose and treat, often to educate, and to encourage when I could, but I was never instructed in the process of coaching, nor was it suggested that it would be an appropriate or timely activity for me in the role of doctor. That said, my own interest in holistic practice and integrative therapies also led me to explore different kinds of roles for providers, and I have educated myself in the (Continued on page 10)

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Colleague Interview (Continued from page 9)

process and practice of coaching. Health coaching is a process, which is relationship-based and client-centered, of partnering with individual clients to facilitate the lifestyle, behavior and belief changes that clients are interested in exploring. I don’t say changes they are ready to make, because much of the change process occurs before action steps, but we don’t understand or support that well in health care today. I believe that is one of the reasons that, despite copious amounts of information telling us how to eat, exercise, rest, and relax, most Americans still persist in lifestyles which do not support optimal health. I believe that every person could benefit from the option of working with a health coach, but given limited resources and opportunities, those who would likely benefit the greatest are those people ready and willing to increase their own autonomy and self-efficacy to initiate change in their lives in ways that impact their health and well-being. That said, we really don’t know if it is more cost effective to put our greatest efforts to those without known illness, from a prevention orientation, or to assist those patients with serious or chronic illnesses that have significant lifestyle components (which pretty much all illnesses do have.) In our existing system of medical care (I hesitate to call it “health” care), it is much more likely to find funding support to bring health coaching to the second population, helping with diet, exercise, smoking-cessation, stress management, weight loss, etc.

What one or two complementary evidence-based therapies will move into practical use and be recommended by the next generation of outpatient primary care physicians? I think the “easiest” of the CAM approaches to readily incorporate into primary care are mind/body practices. They have a growing scientific base for both mechanism, as well as clinical outcomes. They are inexpensive and increase patient self-efficacy. For the most part, they are things that individuals learn, then they can do for themselves, rather than needing to have ongoing specialized visits with a professional. They can be done with group instruction and group support. They impact our ability to manage stress in ways that decreases the negative impact of stress on all aspects of our physiology, or psychology and our relationships. Such approaches as Mindfulness-Based Stress Reduction (MBSR) and yoga have growing bodies of research supporting their use. CSH offers MBSR classes in an on-going basis, and I recommend them for practitioners, as well as individuals who are challenged with illness (www.csh.umn.edu).

What impact do you think complementary therapies will have on the typical patient visit in the primary care clinic of the future? I think one of the greatest impacts CAM has had, and will continue to have, is that of empowering the individual and the family to take back charge of their own health. It increases the concept that they are not passive victims of illness and they can do something to support their own healing. It is not as often about symptom suppression as many 10

July/August 2010

biomedical interventions are aimed to be. I think we have already seen the change in the nature of our usual primary care patient—after all it was the health care consumers of the U.S. whose grass roots efforts led to the development of the National Center for Complementary and Alternative Medicine at NIH. Individuals, more than ever, want to be informed and active participants in making their treatment decisions. Especially as the Baby Boomers have hit the 50-plus years, people want to age differently than did their parents. I think this changes the nature of the doctor (PA, NP)/patient relationship, in a positive way. I really think most physicians welcome engaged and responsible patients, but patients need to be supported and assisted in changing their paradigm from being passive recipients who take their pills (which as we know, many don’t) to individuals with the resources and the beliefs that how they live their life will impact every aspect of their own health. I think that is where health coaches need to be a member of the teams that will provide the primary care of the future.

Most practicing physicians have heard of or actually experienced patients with serious illnesses utilizing certain CAM practices — to the exclusion of more evidence-based mainstream care management treatments — with a resultant detrimental outcome. How do you address that issue so that poor or harmful results can be avoided?” I think the most important thing in answering this question is making sure that we recognize that (unless we are in pediatrics) we are dealing with adults, who have the right to make their own decisions. That said, I take the approach (and teach the approach) of: • Protect patients against dangerous practices* • “Permit” practices that are harmless and may assist in comfort or palliation • Promote and use those practices that are proven safe and effective • Partner with patients by communicating with them about the use of specific CAM therapies and products *This “protection” is an adult, professional effort to provide factual information, as it is known, without judgment or bias. That means we have to be honest about the potential benefits, and risks, of the therapies we offer in conventional medicine. Too many times, I’ve seen physicians being adamant about things like medication (e.g. chemo) where there were many side-effects and mixed potential benefits/risks, and the patient did not want those things. Yet, when we feel as docs that a particular treatment regiment is all we have to offer, we may not recognize our own agenda. We also can be biased and judgmental about practices or therapies that we may not be familiar with or understand. If there truly is a “proven” therapy, in any realm of medicine, then it should be made available to an individual with full disclosure of any potential side-effects. Ultimately, we need to support our patient’s well-informed decisions, and be willing to be part of the healing team that they choose.

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MILITARY MEDICINE

Medical Leadership Through Army Service

fter 31 years in the medical field, I have a hard time separating where I have learned more — Mayo Clinic or the U.S. Army. Luckily, my civilian practice has rich military ties that support my other medical career, or “second life,” in the Army Reserve. As a primary care physician at Mayo Clinic in Rochester, my daily work is deeply rooted in the value of service with the shared tradition of the Mayo brothers, who both served as brigadier generals in the Army during World War I. Charles and William Mayo are part of the long and distinguished tradition of Army medicine. Their medical expertise benefited the Army and the thousands of patients whose lives they touched throughout their careers. Military service is a long-standing tradition in my family, dating back as far as the Civil War. I dabbled with the idea of joining the Army in the early 1980s, but didn’t feel a real pull until watching the build-up to the first Gulf War. In the early 1990s, 13 years into my medical career at Mayo, I decided it was my time to pay it forward, to give back to my country and honor those who served before me. Primary care physicians are often on the front lines of health care in both the civilian world and military medicine. We are required to be experts on a wide array of conditions, diseases and chronic ailments, while at the same time trained to handle acute conditions and trauma situations. Being a family practice physician is certainly not for the faint of heart — especially when caring for Soldiers and civilians in countries torn apart by conflict. Day-to-day, I help my patients with mainly chronic illnesses. As a Reserve officer,

the conditions change as we are charged with providing more acute care to soldiers and their families. I also work in different conditions during humanitarian missions around the world. I joined the Army as a major in 1991 and I feel fortunate to have experienced unique opportunities to expand my skills and medical knowledge through tangible service experiences in missions to Africa and the Middle East as well as my three deployments to Iraq. From assisting the Iraqi health care system in training medics on emergency response, to serving on the board of the American Refugee Committee, it is evident how the field medical skills I have developed during these missions translate to my clinical work at Mayo every day.

Although Mayo is where I was trained as a physician, the Army has taught me how to be a soldier in the best sense — how to lead, and when to follow. I use both educations every day, whether I’m at Mayo or in Iraq. Both of these venerable institutions have significantly enhanced the medical landscape in this country, and around the world. It would be easy to detail the medical breakthroughs both organizations have been responsible for, but equally important, I point to the leadership qualities I and other medical professionals have gained through the years. Dotted on medical staff and hospital rosters around the country (Continued on page 12)

By Col. walter B. Franz iii, M.d.

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Military Medicine (Continued from page 11)

are physicians with military, and Mayo Clinic, credentials — doctors who have a command of medicine and the ability to direct and lead diverse teams of medical personnel. Based on my experiences, I hope that someday soon the military, non-governmental agencies and U.S. medical centers will engage in cohesive partnerships and drive the support and technology needed to train more health care providers. In the meantime, our nation faces critical health care shortages, and the Army is no exception. There is great need for Army and civilian medical professionals alike to join forces against disease and poverty, and pool resources into underserved populations. We must never become isolationists and lose compassion for the suffering of others. This is not to say that

we must solve all of the hurt in the world — we need to solve it at home — but there is intrinsic good in service to others and generosity breeds more of the same. Not unlike civilian health care shortages, the Army needs physicians to fill its ranks and continue serving the greater health of our nation and world. I represent a specialty in need of experienced and skilled physicians — family practice — but the call for more professionals reaches far and wide and does not exclude other areas like surgery, psychiatry and emergency medicine. I also represent a non-traditional and growing group of physicians who join the military mid-career, or later in life — up to the age of 60. Many physicians who may not be interested in active duty military careers don’t realize there are opportunities to stay in their

civilian practice and still contribute to Army medicine via the Reserve for a shorter commitment. Still, some physicians do choose active duty Army service for the chance to practice medicine without the constraints of insurance forms and burden of running a practice — a welcome change from the norm. While there is no question our country faces a shortage of health care providers across the board, I feel fortunate to be doing my part with two outstanding health organizations. Americans send their most precious resources for the good of the nation and world — their family and children. I’m proud to be part of caring for them. Dr. Walter B. Franz III, family practice physician, Mayo Clinic, and Colonel, United States Army Reserve.

Serving My Country and My Patients— Humbling Opportunities

have long desired to serve my country and support the cause of freedom. I made the decision upon graduation from college that regardless of whether or not I was accepted into medical school, I was going to join the military. As I spoke with recruiters from the various branches, it became apparent that the United States Air Force was indeed the best choice. From early on, the U.S. Air Force was a part of my life. My father was stationed at KI Sawyer Air Force Base (AFB), a Strategic Air Command base, in northern Michigan where I was born. Several other close relatives have also served our country as Airmen. Those influences, along with the core values that the Air Force espouses of integrity first, service before self, and excellence in all we do, all combined to solidify my decision to join the U.S. Air Force.

By 2nd Lt. dennis J. Gerold, USAF

July/August 2010

Even though I have been in the Air Force for only a short period of time, it has already provided me with a great deal of invaluable experience. During the summer of 2009, between the first and second years of medical school, I attended Commissioned Officers Training (COT) at Maxwell AFB in Montgomery, Alabama. While there, I had the opportunity to learn and build upon some very important skills that will be immeasurably useful in my career as a physician. The training I received in leadership and teamwork skills was incredible. During the six weeks I spent in the Alabama heat and humidity, I learned much more than can ever be taught in a classroom. I learned how to trust my team members implicitly, how to lead people so that the objective was accomplished with both precision and accuracy, and how to work effectively as part of a team in order for the group to be successful as a whole. While each medical student must possess a MetroDoctors

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basic proficiency in these skills to merely be accepted into medical school, the Air Force took those basic skills and improved upon them to such a significant extent that by the time I graduated from COT, I felt confident in my ability to be an effective Air Force officer capable of leading men and women in the service and defense of this nation. I am very excited for my future career as a military physician. Such a career combines two unique elements of service in that as a military officer I have sworn to support and defend the Constitution and this nation, and as a physician I will swear to treat and care for those in need. The prospect of having the opportunity to help people not only from the United States but also from nations around the world, who are truly in need, is indeed very humbling. In exchange for a minimum of four years

of active duty service after the completion of residency, the Air Force pays the full cost of medical school tuition, required books, and a monthly stipend. A sign-on bonus is also offered as part of the Armed Forces Health Professions Scholarship Program (HPSP). An HPSP medical student is commissioned as a second lieutenant upon entering medical school, and after graduation from medical school, they enter active duty and advance in rank to captain. Upon completion of medical school, students then move onto military residency programs at numerous military teaching hospitals around the United States which for the Air Force includes but is not limited to Wilford Hall Medical Center in Texas, WrightPatterson AFB in Ohio, Elgin AFB in Flordia, Travis AFB in California, and Keesler AFB in Missouri. Similar programs also exist for dental,

veterinary, optometry, and psychology students. The HPSP provides the students with the unique opportunity to serve their country, fighting for and defending the cause of freedom and liberty while also fulfilling their desire to become a physician. I personally can imagine no greater privilege in life than the opportunity to serve my country as a military officer and, in the future, as a physician. 2nd Lt. Dennis J. Gerold, USAF. 3rd year medical student, University of Minnesota Medical School. Please Note: The views expressed in this article are those of the author and do not reflect the official policy or position of the United States Air Force, Department of Defense, or the U.S. Government or the University of Minnesota or the University of Minnesota Medical School.

Thoughts and Experiences of a Minnesota Army Doctor

y the end of World War II, 11 percent of the U.S. population had served in some capacity in the war. This number remained fairly constant with approximately 15 percent serving in the Korean conflict and roughly 13 percent during Vietnam. Today, less than ½ of 1 percent of the U.S. population is a part of the military. Even assuming the same percentage of physicians in the military today as in previous years, it is painfully clear that there is a huge need. Because of this deficit, almost every physician I know has been deployed at least once, if not multiple times. At first, the thought of being deployed multiple times or leaving a growing practice might, on the surface, seem like a huge deterrent. I have heard several doctors express these, as well as multiple other concerns, as to why they do not want to enlist. On the other hand, I would argue that this is exactly the reason to join the U.S. military medical core. If we, as physicians, went into medicine to help those

By Lt. Col. david B. hale, M.d. MetroDoctors

in need, then there is no better group of people to help than those currently serving in the U.S. military. Like just about anyone you talk to, I remember exactly what I was doing on September 11. I was transfixed to the TV and watched in horror first, as people jumped from buildings, and then both collapsed. Like many, I wanted to do something and I made myself a promise, “I would never watch something like that again and be helpless to respond.” It took all of about five seconds to figure out that the best way to do that would be to join the military, and the next day I found a recruiter and signed-up. Since then I can honestly say I have never regretted my decision. So, what is it really like to be a deployed military doctor? Despite what some might think, it isn’t anything like MASH or most any other military show you see where doctors play a role. It can be very routine if you work in an aide station or level II clinic. Most of what you see is pretty straight forward and not very demanding. Yet the reward is tremendous. These are young men and women who

The Journal of the Twin Cities Medical Society

genuinely have nowhere else to turn for care and really cannot afford to “take a day off” if they do not feel well. After all, it isn’t like you can run to the doctor of your choice whenever you want, and if the soldier isn’t able to do the job — well someone has to do it. It was (Continued on page 14)

July/August 2010

Military Medicine (Continued from page 13)

incredibly satisfying to me to treat a soldier and then run into them a couple of days later on the base and have them say thanks. It wasn’t like I had done anything spectacular, but the appreciation was genuine. And it doesn’t just come from the patient but from the rest of their unit because keeping the soldier “mission capable” makes everyone’s life a little easier. On the other hand, if you work in a hospital you will have a completely different experience. During one of my tours I volunteered to work in a Combat Support Hospital (CSH). This was during a part of the war in

Iraq when we had a lot of casualties and it was not uncommon to work well past shift change. I will never forget some of the images I have from this experience or the patients I saw and helped take care of. We didn’t save everyone, but if a casualty made it to our CSH, they had a 90 percent chance of going home alive. I wouldn’t trade this for anything as it was one of the most rewarding experiences of my career. I like to think that I had at least some part in getting some of these wounded home. And I tell myself that if even one person made it home because of what I did, and a mom, dad, finance, brother, sister, or child doesn’t have to get a knock on the door telling them their

loved one isn’t coming home, then it was all worthwhile. I can honestly say that this happened at least a few times. I can think of few things in medicine that give you this feeling of accomplishment. And again, it is for young people that actually volunteered for this. I am sure most didn’t think they would end up on a battlefield — let alone injured. As a physician, I want to do absolutely everything I can to make sure that they come home! Lt. Col. David B. Hale, M.D., Ph.D., Minnesota National Guard. Board Certified in emergency medicine.

The Call of Duty

joined the army reserves STRAP program during my residency. The program was created to obtain medical personnel in critical areas of concentration. Orthopaedics is one of those critical areas of concentration where there is a lot of need and not enough Army personnel. The STRAP program offered me a monthly stipend while I was engaged in my residency training. Having a family of five to support at this time in my life, made this offer appealing to me, especially since the United States was not at war and did not seem to have one in its near future. In return for this monthly stipend, my obligation to the Army would be to be in the reserves for two years to every one year of receiving the stipend. The recruiter said all I had to do when I was finished with residency, was to go to Germany for two weeks in the summer with my family, once a year, for seven years to relieve active duty Army surgeons. The last three years of my obligation would just be on paper. Wow what a deal! However, shortly after I finished my residency, the world became a different place. I finished in July of 2001, became employed in my position with Northwest Orthopaedic Surgeons and worked for only one month when the unthinkable By Lt. Col. william Lundberg, M.d., USAr MC

July/August 2010

happened…9/11. The shock to the country was unfathomable and during the following year the war against Iraq was a whisper that might soon come true. I got notice in February of 2003 that I would be deployed to Germany to serve at the hospital in Landstuhl. This hospital is associated with the Ramstein air force base and I was deployed even before the war started. I was part of a team of surgeons, nurses and anesthetists who were deployed to handle the massive triage of injured soldiers to this hospital during the 2003 Operation Iraqi Freedom invasion. The work was very rewarding and busy, and it was a privilege to serve these brave soldiers — many who were just kids. I have been deployed two other times since that first engagement. I went once again to Germany and my most recent, in 2007, was to the Army base in Tikrit, Iraq. The deployments lasted for 90 days once I reached my destinations. In Tikrit, I was the only orthopaedic surgeon on duty where I took care of not only our troops, but also the Iraqi army, police, and civilians who were injured there. The operating facilities were well equipped and I had everything that was needed to provide adequate care. I will be deployed again this fall to Afghanistan. Each deployment means being away from my practice and family for about 15 weeks. I MetroDoctors

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am lucky to have great partners who take care of my patients when I am gone, and who are also willing to take my share of the call. I think that one of the most difficult things that I must deal with, is to be away from my family, and that my wife has to become a single parent to three kids while Iâ&#x20AC;&#x2122;m away. I am sure most days are harder on her than me. Even with all the hardships, I love being an orthopaedic surgeon and serving our troops is a great honor. I have an obligation to fulfill, but what most of the soldiers sacrifice to serve our country is so much more than what I give up. The soldiers that I have taken care of are amazing and their strength and willingness to serve their fellow soldiers and country is unimaginable. I think that serving in the Army Reserves as an orthopaedic surgeon helps a lot of people. Orthopaedics is one of the areas in the military where the need is greater than the supply. It is a chance to serve a population that gives and sacrifices the most for our country and for our privilege of freedom. Lt. Col. William R. Lundberg, M.D., USAR MC. Twin Cities Orthopedics. Board Certified in orthopaedic surgery.

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Achieving Successful Management of EHRs by Mitigating Risks The Importance of Establishing Policies and Procedures

n an article in the New England Journal of Medicine, authors David W. Bates, M.D. and Gordon D. Schiff, M.D., state: “Clinicians need to take back ownership of the medical record as a tool for improving patient care; such a move could have many benefits, including reducing the frequency of diagnostic errors.” To that end, they suggest physicians get involved when new technologies or upgrades to existing systems are being evaluated and planned. They go on to say that electronic health records (EHRs) are a pivotal tool that can help them better serve their patients. Accessing a patient’s visit notes to review previous diagnoses, tests and treatments before seeing the patient will improve a physician’s knowledge and facilitate diagnosis and treatment plans. EHRs are becoming a necessity in today’s health care environment and they provide an opportunity to improve the quality of care and automate measures in patient safety. Many EHRs are designed to easily manage followup care and monitor patient progress through tasking and reporting features giving physicians and staff better tools to manage care. Preventive care services are likely to increase due to the ability to track, notify and schedule when tests and procedures are due. Most EHRs will alert clinicians of improper dosing and when a medication is contraindicated. The opportunity to interface with lab and radiology systems not only streamlines workflow but also minimizes the risk of transposing or omitting critical data which can impact patient care. The choices of EHR systems and how they are configured are numerous. The key is

to confirm that any system you are considering meets two critical criteria: • It assures and protects continuity of care. • It functions within defined standards by which records are managed. Even if an EHR meets these conditions, managing the new risks associated with electronic systems is imperative to realizing its full benefits. Most risks can be assessed and man-

groups are exposed to greater risk during an eHr implementation when physicians and staff are inconsistent with documentation methods...

aged through policies and procedures that are based on well-designed standards to address the technology and the processes in which the technology is applied in your clinic. The Health Information and Management Systems Society (HIMSS) http://himss.org and the American Health Information Management Association http://www.ahima.org are excellent resources when seeking information about IT and medical record documentation standards. It is important to remember that an EHR implementation is an ongoing process that requires frequent policy review. You will want to ensure standards are being met throughout the entire implementation and the integrity of the medical record remains intact. The Human Touch

By Elizabeth Schultz, rN

July/August 2010

EHR risk management. Electronic systems are designed to better capture and store patient records — but when you add the element of human error to the mix, it is imperative to have policies and procedures in place to make sure everyone who touches the system is well trained. An EHR system is only as good as the data entered by its users. Consider guidelines that address medi-

Meeting IT standards is just one piece of

cal record entries. Determine documentation responsibilities based on staffing qualifications along with EHR procedural instruction (i.e. who, what, when and where). Groups are exposed to greater risk during an EHR implementation when physicians and staff are inconsistent with documentation methods — and some of the risks inherent in EHRs are built into the systems by the developers who strive to make the system easier and more efficient for physician use. For example, templates or “boiler plates” are designed to allow end-users to populate patient records quickly by embedding “typical” symptoms and conditions associated with specific diagnoses. The ease of simply clicking one or two checkboxes to populate a patient record from a list of “normals” on a review

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of systems is often a temptation. While this convenience may speed up documentation, it creates the risk of populating a patient’s record with symptoms and conditions which may or may not be present. This “exploding” data may result in misinformation that potentially can lead to inappropriate treatment, billing and other misguided decisions if clinicians are not reviewing the documentation for accuracy. Cloning in the EHR is another approach used by clinicians to minimize time spent on documentation. The ease of cutting or copying text from an existing entry and pasting it to a subsequent visit has been made simple in EHR systems with a few simple clicks. However, this practice can lead to inaccuracies in the medical record and jeopardize reimbursement and compliance. You can only imagine how the integrity of the medical record is compromised when outdated, duplicated or irrelevant information is brought forward to a new visit. The possibility of losing information or inserting data out of context to the original note, weighs heavily on those responsible for coding and compliance.

More importantly is the risk it brings to patient care and safety if strict guidelines are not followed or set in place. Physicians and staff are stretched for time more than ever before. Improving workflows without misusing the very tool that is set in place to manage and document patient care is fundamental. Training clinicians and staff who are responsible for entering data, accompanied by guidelines to validate accuracy, and setting audits in place will help minimize the new risks associated with these time-saving practices. Risks During Transition

The transitional period from paper to electronic is often a time when practices are exposed to greater risk. A “big bang” approach may shorten the transitional period, but it typically involves a lengthy planning, training and testing period. With a phased-in approach, an EHR rollout is executed in stages, transitioning one provider, location, specialty or EHR function at a time. The phased-in approach allows groups to implement the EHR in manageable segments,

giving practices the opportunity to begin the EHR integration sooner than a big bang approach. The phased-in approach typically is less of a burden on staff, because training and new workflows are spread out over time. While using a phased-in approach may seem more manageable, it also adds a new dimension of risk. By transitioning in stages, practices are forced to manage two sets of medical records. Defining your legal health record and documenting the location of where patient information is stored will help minimize the risk when patients are seen by multiple providers and at different locations. From a patient safety standpoint, it is critical that everyone in the practice understands what is documented in each system until the final transition has been completed. Tapping into Health Information Management (HIM) personnel during an EHR implementation will ensure documentation (Continued on page 18)

Proceeds from MPS help to support the medical society’s operations. Please consider our business partners listed below as you look to reduce your operational costs.

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Management of EHRs (Continued from page 17)

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standards are followed and the medical record remains a trustworthy source for all health care providers accessing and relying on patient information. In today’s environment, the content of the medical record comes from multiple sources, both internal and external, and in various formats (i.e. images, interface transactions, scanned images, audio files, e-mails, etc.). Rapid access to test results, patient reports and shared information among providers ensures timely treatment and promotes continuity of care for the patient. However, importing and exchanging electronic health information poses new risks from security breaches, importing or exporting inaccurate information, filing electronic records to the wrong patient and viewing illegible images. Strong security policies and audits will certainly help in minimizing the risk but just as important is a thorough testing plan when importing and exchanging patient information to validate that proper mapping

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July/August 2010

has occurred and confirming data is accurate and appropriate. Managing Mistakes

Despite all the plans you make and the guidelines you develop, mistakes will happen, even with the best policies, procedures and staff training. That’s why policies must also address the correction process. Correcting mistakes in the paper world was handled simply by drawing a line through the incorrect information. However, in an EHR system, the correction process can be extensive and may require someone who has the system background of the EHR to determine the impact of the error. Often data in the EHR is shared across multiple fields and tables. It is vital to understand how the system processes modifications and to validate corrections have been made system wide along with the appropriate audit trail. Training and Communication

The integrity of your EHR data depends upon everyone knowing your standards and policies inside and out. Before anyone uses the system, they should be trained — and then monitored — to make certain they have mastered the tasks. Learning “on-the-fly” is a risky approach and will, in most cases, lengthen the learning curve and elevate frustration. Committing to and scheduling training time up front will more than likely pay off in the end. When it is time to create your EHR guidelines, think about your current environment. Policies and procedures that are concise, easy to follow and are aligned with the workflow of the clinic will be more willingly embraced by users. Communicating often and engaging employees will increase the commitment level and ongoing support of your new EHR policies and procedures. You will get even more support if you involve individuals who can contribute based on their expertise and expectations. Once your EHR guidelines are in place, success will be dependent upon training, monitoring, revising as appropriate, and recognizing successes and lessons learned. Elizabeth Schultz, RN, implementation manager, MMIC Health IT.

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New Health Care CEO:

David Abelson, M.D., CEO, Park Nicollet Health Services Editor’s note: MetroDoctors continues to highlight newly named health care executives. Each CEO has been asked to outline his/her vision and challenges for their organization as well as offer some personal insights.

I am beginning my service as chief executive officer of Park Nicollet Health Services at a time of great change and tumult. No sooner did health care systems begin emerging from the challenges created by the world-wide economic downturn in 2009, than we were faced with the truly historic and transformational changes that will be played out over the next several years due to passage of federal health care reform. And yet, dealing with change has been a constant theme since I began practicing medicine. Prior to joining Park Nicollet, I was part of a five person internal medicine practice in downtown Minneapolis which I joined after completing my medical residency in 1979. One year later, my colleagues asked me to manage our practice. My early experiences as a practicing physician with management responsibilities continue to shape me to this day. When I joined Park Nicollet Clinic in 1983, it was a new entity created by the recent merger of St. Louis Park Medical Center (SLPMC) and Nicollet Clinic. The next year, Shakopee Medical Center merged with Park Nicollet. In 1995, Methodist Hospital merged with Park Nicollet Clinic to form Health System Minnesota, the organization we know today as Park Nicollet Health Services. Three years after that, I left daily practice to assume executive responsibilities at Park Nicollet, which ultimately led to being named chief clinical officer in 2008, president in June 2009, and CEO this year. As I quickly learned in health care, the ability to adapt to changing circumstances is essential to the success of your organization and the health of your patients and your community. Proponents of federal health care reform cite the advantages that integrated medical practices will have in this new era of health MetroDoctors

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care. Park Nicollet has a long and rich tradition as an integrated multispecialty group practice. Going back to 1920, Nicollet Clinic offered group practice combined with academic appointments. In 1957, Saint Louis Park Medical Center declared in its “Statement of Objectives” that “…group practice offers the best opportunity to promote and maintain the highest standards of medical proficiency… each member shall preserve his [sic] own identity but at the same time share resources and experience with others in the group for the benefit of all who come here for medical care.” At the time, group practice was so revolutionary that many SLPMC physicians were not allowed onto the staffs of hospitals in the Twin Cities area. But as they say “everything old is new again,” and Park Nicollet’s long history as an integrated medical practice puts us today at the forefront of medical systems uniquely poised to take advantage of the opportunities created by federal health care reform. In keeping with the goals of reform, Park Nicollet’s integration provides an environment that delivers an outstanding patient experience with quality outcomes at affordable costs. It also provides an outstanding environment for physicians to practice and do medical research with a stimulating and supportive group of clinical colleagues. And that environment produces results. A recent Star Tribune article (“Choice of hospital in Minnesota can put odds against you,” 4-18-10) cited Park Nicollet’s outstanding outcomes on 30 day measures of mortality and readmissions for congestive heart failure, pneumonia and myocardial infarction. Park Nicollet Methodist Hospital is one of a handful of hospitals to perform better than national averages in all three categories. These outstanding results are achieved in no small part because of the advantages Park Nicollet maintains as an integrated medical system. We are also receiving national attention for our innovative ways of providing care. The New York Times lauded our successful program (Continued on page 21)

July/August 2010

New Health Care CEO (Continued from page 19)

of at-home interventions to improve the outcomes of patients with congestive heart failure and keep them from being readmitted to the hospital (May 9, 2009). Again, the success of this program is largely possible due to the benefits of working within an integrated practice setting. Park Nicollet achieves national rankings for the quality and affordability of care for Medicare patients. The Centers for Medicare and Medicaid Services (CMS) reports mortality and readmission measures for three common inpatient conditions: heart failure, pneumonia and acute MI. Park Nicollet consistently performs statistically “lower than national average” in the mortality and readmission for a majority of these condition measures. In 2009, Park Nicollet became the first health system in Minnesota, and only the second in the nation, to publicly disclose financial relationships between clinicians and the medical industry. This was front page news in the Star Tribune (Jan. 22, 2009) and the Star Tribune again lauded Park Nicollet for its leadership in a recent editorial (April 19, 2010). As we enter this new era of health care reform, Park Nicollet continues to provide exciting innovations in the delivery of health care while also drawing from its rich tradition of innovation and accomplishment as an integrated, multispecialty group practice. And I draw upon my own experiences of dealing with change to help our physician leadership and administrative team provide the vision and management needed to meet these challenges. As it has for decades, Park Nicollet will continue to provide national leadership in the practice of health care. I am honored to be Park Nicollet’s new chief executive officer at a time when the future of health care is being shaped right here in Minnesota.

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July/August 2010

Disability Insurance for Docs— the difference is in the details

s a physician, the importance of disability insurance is pretty clear but the details are confusing. One grey area is group disability coverage versus individual coverage. Most likely, you have disability coverage through your practice and assume that this coverage is adequate; and in some cases it is. But, there are significant differences between group and individual disability coverage that you should know now. Defining the Difference

The first difference between group and individual policies is the definition of “total disability.” Many individual policies have an “own occupation” definition of disability. Some are specific to your medical specialty, but some are not. What is best is a true, specialty-specific definition. Under this definition, if you are disabled and unable to perform the duties required to practice in your specialty, you are considered disabled and collect your monthly benefit. You may still be able to teach, work for a pharmaceutical or insurance company, or even in another medical specialty — and you will still receive your full benefit. Group policies often have different definitions of disability. One common definition is based on a two or five year scenario. For the first two or five years of disability, you are considered disabled if you cannot perform the duties of your occupation. If you are still disabled after two or five years, the definition changes to an “any reasonable occupation” definition, which is very subjective. If your group carrier feels you can perform the duties of an occupation that’s “reasonable” based on your education, training and experience, they can stop paying you. Another common definition in group plans is By dale Forsythe, CLTC, and Joel Greenwald, M.d., CFp

July/August 2010

an “own occupation,” not “working” definition. This version will result in a reduced benefit if you choose to work in another occupation. The Disabled Determination

Another important consideration with any disability policy is who determines if you are disabled. With both group and individual plans you, your physician, and possibly your agent, initiate the claim process. Of course, there is always a medical reason for filing a claim. • Group plans will either have an assigned claims representative or a committee that reviews each claim. • Individuals and carrier policy claims will normally have an assigned representative for you. Generally, the claims process with an individual policy is easier because the definitions and provisions within individual plans are not as restrictive as many group plans. The Changeability Difference

Did you also know that group coverage can change and individual coverage cannot, because it is a contract between you and the insurance company? For example: The senior M.D.s in a small surgery group no longer needed disability coverage and wanted to save money, so they changed the practice’s disability coverage. The change caused a significant decline in the quality of the coverage and the younger, more junior partners, who relied on the group plan in case of disability, had no recourse. The Cost of Living Difference

Another area to look at is cost of living increases. Most group policies do not contain a cost of living provision. If the M.D. in the example above were disabled, and started collecting $15,000/month in benefit, this sum would not change with time. In five or 10 years, if still disabled and collecting benefit,

the $15,000 would not buy as much. With an individual policy, the M.D. can choose whether to have a cost of living feature, and often has a choice of the level of inflation protection. One of the more egregious examples of inadequate group coverage we have seen is a group plan that requires a period of complete disability before they start paying. Let’s say you have a partial disability due to back pain, and you can still practice half a day. But, you have never had a period of complete disability due to your back problem. The group coverage will not pay any benefit even though you have suffered a 50 percent decline in income. An individual policy contains provisions such that if income declines 15 or 20 percent due to a disability, the policy will start paying, even though there has never been a period of complete disability. The Taxability Difference

One major area of difference is the taxability of the disability benefit. In many cases, group disability through a practice is an employee benefit paid for by the employer. In this case, the benefit coming to a disabled physician is taxable income. For example: If you’re earning $300,000/ year, ($25,000/month) and the practice’s disability policy pays a 60 percent benefit, you will receive a monthly benefit of $15,000/month which will be taxable just like your regular income. While $15,000/month of benefit might seem like a lot, if you are used to $25,000/ month, it is often inadequate to fund your families’ needs. You can layer an individual disability policy on top of your existing group coverage by paying the premium out of pocket. This gives you an additional monthly benefit, which you will receive tax-free. Most of you assume your group coverage is enough. Is it? The last thing you want is to

MetroDoctors

The Journal of the Twin Cities Medical Society

suffer a significant disability and be unable to practice and pay your bills. Find out the details on your group disability coverage before it is too late. Review your coverage with an insurance agent who specializes in disability insurance or ask your financial advisor or planner for a disability specialist. You can also find an insurance carrier that specializes in working with physicians. Then, check with their local office for a disability specialist who can help you. Dale Forsythe, CLTC, director of brokerage, Foster Klima & Company, LLC, Guardian Life Insurance Company of America, Minneapolis, MN; dale_forsythe@glic.com.

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East Metro Caucus Puts Forth Resolutions The East Metro Caucus was held on May 12 and the agenda included eight resolutions that will be brought forward to the Minnesota Medical Association’s Annual Meeting this September: 1. 2. 3.

4. 5.

6. 7. 8.

Birth Centers Patient Choice Physician Disparities Between Hospital-based and Office-based Reimbursement for Physician Services Support for the Independent Practice of Medicine Develop and Lobby for Legislation to Prohibit Payments Contingent on Volume of Referrals Oppose Health Insurance Mandates High Deductible Health Plans for Minnesota State Employees Minnesota Board of Medical Practice License Requirements

From left: Ron Hansen, M.D. listens as Richard Baron, M.D. and Thomas Siefferman, M.D. weigh in on a resolution.

NEW

The East Metro Medical Society Foundation (EMMS Foundation) is a physician-led philanthropic organization that strives to improve the health of residents in eastern Dakota, Ramsey and Washington counties. The foundation, established in 1975, has recently added several new board members and is working this summer to develop criteria to guide the grant application process. The work that is being done on current projects has brought renewed energy and is increasing the influence and profile of the foundation. The EMMS Foundation thanks the following individuals and organizations for their contributions in response to the fundraising effort at the end of 2009: Blanton Bessinger, M.D. Barclay Cram, M.D. Thomas Dunkel, M.D. Robert Dunn, M.D. Christopher Jackson, M.D. David A. Lee, M.D. Stanley Leonard, M.D. Midwest Ear, Nose & Throat Foundation Robert Moravec, M.D. MetroDoctors

Leon Nesvacil, M.D. Carole Nimlos Thomas O’Kane, M.D. Donald Piper, M.D. Susan Roe, M.D. and Rene DuCret, M.D. Jonathan Sembrano, M.D. Valley Anesthesiology Consultants, PA Kent Wilson, M.D.

The Journal of the Twin Cities Medical Society

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July/August 2010

West Metro Caucus Deliberates Resolutions

meeting of the West Metro Caucus was called to order by Benjamin Chaska, M.D., chair, on Wednesday, May 19, 2010. The following resolutions were discussed and approved and will be forwarded for consideration at the MMA annual meeting of the House of Delegates on September 16-18: • Health Notes for Proposed Legislation • Hospital Health Care Personnel Influenza Vaccination Requirements • Transparency of Patients’ Medical Care Costs and Internet Shopping • HDHPs for Minnesota State Employees • Improving the MMA Online “Physician Finder” • Access to Out-Of-State Insurance Products and High Risk Pools in Minnesota • Paying for Physicians Doing Medication Prescribing and Reducing Pharmacy Hassles

In addition, Michael B. Ainslie, M.D. was re-elected for his second three-year term as a West Metro District Trustee to the MMA

Board of Trustees and Carl E. Burkland, M.D. was elected to his first three-year term.

Delegates from the west metro area discuss proposed resolutions.

Thomas and Mary Kay Hoban Scholarship Sunsets

s with all things, there is a time and place for beginnings and endings. The Thomas and Mary Kay Hoban Scholarship held its final educational event and recognition of scholars on Wednesday, May 12 at the Edina Country Club. The scholarship was established in honor and recognition of the 25-year career of Thomas Hoban (CEO of the former Hennepin County Medical Society) and his wife, Mary Kay. With the inspiration and leadership of Drs. Frank Johnson and William Petersen, retirement gifts were solicited for the funding of the scholarship. Awards were given to graduate level students pursuing master’s degree programs in either health care administration or nutrition. It was the intention that the scholarship would sunset after 10 years. However, with 26

July/August 2010

wise investment counsel and lots of luck, the website at www.metrodoctors.com for a video funds continued for 15 years with 80 scholarclip from Thomas and Mary Kay Hoban. ships awarded for a total of $193,000. The legacy that the Thomas and Mary Kay Hoban Scholarship has afforded to the scholars will continue to be celebrated as each continues to grow and succeed in their careers. “This program will be missed” concluded Standing from left: Meg Bruening, Carissa Glatt, Paula HalverPaul Hamann, M.D., son, Cassandra Silveira, and Jamie Stolee (2009 Hoban Scholars); Hoban Selection ComDebra Thingstad Boe (2005 Hoban Scholar); and Nicholas Jenmittee Chair. nings (2008 Hoban Scholar). Seated, are Mary Kay and Thomas W. Hoban. Please visit our MetroDoctors

The Journal of the Twin Cities Medical Society

West Metro Medical Society Alliance Celebrates 100 Years

ne hundred years ago, wives of 40 members of the Hennepin County Medical Society met at Dayton’s Tea Room to form an Auxiliary Association to the Medical Society. These forward-thinking women established the FIRST county Medical Auxiliary in the country. Their goal for the organization was “sociability and general helpfulness.” Their philanthropic endeavors began almost immediately. Before the first official meeting, they held a benefit performance at the Schubert Theater and raised $163.56 to purchase garments for 20 patients at Hopewell Hospital. On May 16, 2010 nearly 80 West Metro Medical Society Alliance members and their families gathered at Interlachen Country Club to honor all Auxilians and Alliance members who have done so much to better the health of the people of Minneapolis — indeed all Minnesotans — over the last century. Alliance members representing five decades of membership attended the festivities. They enjoyed a slide show (created by Diane Gayes) of photos and news articles covering 100 years of the Auxiliary/Alliance and video presentations from one of the Alliance’s signature projects, Body Works and the 1970-80s satirical revue group, “The Mad Housewives.” After a brief 100th Annual Business Meeting chaired by Martha Arneson, emcee Eleanor Goodall recognized all members of the organization with an Academy Award theme with such categories as Best Director, Best Screen Play and Best Documentary. The award for Best Picture went to the celebration itself and those in attendance were asked to hold hands with their neighbor and reflect on what the Alliance has accomplished over the years and how much the organization meant to each individual. A glimpse into the resounding effect the Auxiliary/Alliance has had on the community is summed up in chronological highlights:

By dianne Fenyk and diane Gayes MetroDoctors

1920-1930-1940: In 1920, the HCMSA held its first big charity project — a card party which netted $201.50. By 1953, theses card parties were raising several thousand dollars. Glen Lake Sanitorium was a frequent beneficiary of the Auxiliary. In 1924, the group endorsed a “no spitting in public places” policy during the tuberculosis outbreak. In 1932, a student loan fund was started to help the University of Minnesota Medical School. In 1943, members joined with other organizations on War Service Projects. They made dressings by rolling bandages, collected 20 tons of used instruments and surplus medicines and staffed a Bond Booth. In 1944, the sale of bonds and stamps totaled an amazing $101,814! They also initiated a Community Health Day to further health education of high school students and senior citizens. 1950-1960-1970: HCMSA members developed an annual Health Day program that included education on drugs; visiting patients in the Mental Health Center at Hennepin General Hospital; registering young children for vision and hearing screenings; helping to mail Christmas Seals; and working on a pilot project for testing newborn hearing at Fairview Southdale Hospital. They also created an annual fashion show that generated thousands of dollars for health needs in the community such as purchasing equipment for General Hospital’s new mobile intensive care ambulance and sending medical supplies to East Africa. 1970-1980-1990-2000: HCMSA continued to raise funds for nursing scholarships for many Minneapolis hospitals and collaborated with, or donated to, many organizations. One of the Alliance’s most successful and long-running projects, Body Works, began in 1983. This week-long health fair

The Journal of the Twin Cities Medical Society

Alliance members Penny Chally and Ophelia Balcos enjoy lunch and conversation.

reached as many as 3,000 third graders every year for 20 years. In 1996, an HIV/AIDS Education folder was developed for middle school students. This folder is still in production and has reached at least 350,000 students across Minnesota. In 2004-05, Alliance members sent more than 2,000 stethoscopes to needy areas of the world. We are proud to be members of such an important, respected and valuable organization. The Alliance is a valued member of the Family of Medicine and every member is honored to have played a role in the better health of Minnesotans — especially those in Hennepin County — for 100 years.

From left: Diane Gayes, Dianne Fenyk, Trish Vaurio, Marlene Engstrom, and Mary Anderson.

July/August 2010

West Metro Senior Physicians

he Senior Physicians Association (West Metro Medical Foundation) met on April 27 at Broadway Ridge Building in North East Minneapolis. The speaker, Meri Firpo, Ph.D., an assistant professor at the University of Minnesota, shared her expertise on Stem Cell Research. We are in the midst of trying to find a new meeting location as the Zuhrah Shrine Center has become cost prohibitive. For further information, contact Kathy Dittmer at kdittmer@metrodoctors.com or (612) 623-2885.

CAREER OPPORTUNITIES

see additional Career opportunities on page 29.

Fairview Health Services Opportunities to fit your life Fairview Health Services seeks physicians to improve the health of the communities we serve. We have a variety of opportunities that allow you to focus on innovative and quality care. Shape your practice to fit your life as a part of our nationally recognized, patient-centered, evidence-based care team. Whether your focus is work-life balance or participating in clinical quality initiatives, we have an opportunity that is right for you: Cardiology Dermatology Emergency Medicine Family Medicine General Surgery Geriatric Medicine Hospitalist Internal Medicine

Med/Peds Ob/Gyn Pain Palliative Pediatrics Psychiatry Pulmonology/Critical Care Urgent Care

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•TCMS Members• WE NEED YOUR PARTICIPATION to serve as a DELEGATE at the

Minnesota Medical Association’s Annual Meeting

September 15-17, 2010 (Wednesday evening–Friday afternoon) Breezy Point Resort near Brainerd, MN TCMS is eligible for 119 Delegates. This is your opportunity to make a difference by testifying at the reference committees, acting on the resolutions submitted statewide and voting for your colleagues willing to serve as your MMA Officers. Contact Kathy Dittmer at kdittmer@metrodoctors.com or (612) 623-2885 to participate.

July/August 2010

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In Memoriam

CAREER OPPORTUNITIES

see additional Career opportunities on page 30.

EvAN (BUD) ELLISON, M.D. died April 17, 2010. He was 83. He graduated from the University of Minnesota Medical School. Dr. Ellison was an orthopaedic surgeon in Minneapolis for 38 years. ALBERT HOHMANN, M.D. died on April 11, 2010, at the age of 85. Dr. Hohmann obtained his medical degree in Hesse, Germany, in 1953. He specialized in otolaryngology. BYRON “BERNIE” WILLIAM KREMENAK, M.D. passed away on May 11, 2010. He was 58. He graduated from the University of Iowa College of Medicine, Iowa City. Dr. Kremenak was an anesthesiologist at Fairview Ridges Hospital. JOSEPH F. MELANCON, M.D., age 95, died on May 1, 2010. He graduated from the Medical College of Wisconsin, Milwaukee, in 1940 and was a well known and respected OB-GYN physician in St. Paul for more than 40 years. Dr. Melancon practiced at United and St. Joseph’s Hospitals. NIAL C. O’NEILL, M.D., died on April 20, 2010 at 78 years. He was an anesthesiologist who graduated from the National University of Ireland in 1956.

A Journey of Leadership Medical Director - Maplewood Clinic

Visit us at www.metrodoctors.com and

forum.metrodoctors.com To find new career opportunities, past issues of MetroDoctors and information on the latest news, events and legislative issues!

HealthEast® Care System in St. Paul, Minnesota is looking to develop and support a progressive physician leader ready to make a difference in the areas of patient satisfaction, employee engagement, clinical quality and operational efficiency in this multi-specialty Clinic. If you are an Internal Medicine or Family Medicine physician interested in collaborating with an innovative health system recognized for excellence in improving patient outcomes, a rewarding journey awaits you! For more information about physician leadership opportunities, please contact Michael Griffin at: mjgriffin@healtheast.org or call 651-232-2227.

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July/August 2010

Career Opportunities

CAREER OPPORTUNITIES

Please also visit www.metrodoctors.com for Career opportunities.

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July/August 2010

luMinary of Twin Cities Medicine By Marvin S. Segal, M.d.

RICHARD M. MAGRAW, M.D. This last page series is intended to honor esteemed colleagues who have contributed significantly to Twin Cities medicine. Please forward names of physicians you would like considered for this recognition to Nancy Bauer, managing editor, nbauer@metrodoctors.com.

It was nearly 50 years ago when many third year students in the Class of 1962 gathered to learn of a major revision in curriculum that would likely have a profound effect on their clinical education and quite possibly on their burgeoning careers in medicine. Standing tall in his crisp white coat, Richard Magraw, M.D. outlined the relevant aspects of The Comprehensive Clinic Program, the most notable of which was a six month assignment of ½ of the class at a time to the outpatient clinics of the University of Minnesota Hospitals. Change can be difficult and we students knew change was coming and that Dr. Magraw, a highly respected faculty member, was at the forefront of the development and administration of that change. Most of us were aware of his successful and diverse personal medical background, and that — along with his forthright and clearly stated presentation — brought about confidence in him as we embarked upon that programmatic journey. Doctor Magraw had engendered similar confidences in others long before that fall Minnesota day, and he has continued to do so as the years and his many responsibilities and accomplishments have unfolded. Dick Magraw was born in Minneapolis 90 years ago. His 68 year marriage has been blessed with four accomplished children and their progeny. At age 25 he obtained his M.D. degree with honors from the University of Minnesota. His surgically oriented preceptorship and general practice in Two Harbors, Minnesota preceded a psychiatric residency and clinical training in neurology and internal medicine back at the “U of M.” He is board certified in psychiatry and neurology as well as internal medicine. Dr. Magraw later attained full professorships in psychiatry and internal medicine. Other titles at the “U” have included director of Outpatient Clinics, assistant dean of the Medical School and chief of Psychiatry at the Minneapolis V.A. Hospital. Doctor Magraw served his country via military service in 32

July/August 2010

Korea and Japan (50s), as a deputy assistant secretary for health in Washington, D.C. (60s) and as a consultant to the Indian Health Service (70s). He played prominent roles in the initial development of medical colleges in Illinois and Virginia (60s and 70s) while accomplishing those endeavors as the deputy executive dean at the University of Illinois and president of the Eastern Virginia Medical School. Doctor Magraw’s luminous legacy will live on in many ways, not the least of which will be through his numerous contributions to the literature of medicine in the form of journal articles, book chapters and with perhaps the most notable being his 1966 book, Ferment in Medicine, A Study of the Essence of Medical Practice and of Its New Dilemmas. Now, over 40 years later, his wise analysis and uncanny predictions ring very true in today’s complicated medical milieu. For that book, he won not only the prestigious Welch Award for distinguished writing in medical care and economics but also the disbelief of many skeptics and the admiration of countless readers. As rewarding as the above titles, positions and awards — in addition to the 2000 Diehl Award from the “U” Medical School and his long tenure as chair of the AMA Committee on Undergraduate Medical Education — may have been, they were not the most gratifying of his long and distinguished career. In a recent conversation, he shared with us that his most pleasing medical activity was “caring for people during my general practice days on the North Shore. It was, you know, a sort of ‘ministry’ with a technical basis.” Dr. Richard M. Magraw seemed “bigger than life” to that band of medical students some 50 years ago. He still is thought of in that fashion by this former student who had the recent privilege of renewing his acquaintance and learning more about this true “Medical Renaissance Man,” our Luminary of Twin Cities Medicine. MetroDoctors

The Journal of the Twin Cities Medical Society

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All I wanted was to et back in the saddle again. And I did, thanks to Bethesda Hospital, member of HealthEast速 Care System.

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