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July/August 1999

Doctors MetroDoctors THE BULLETIN OF THE HENNEPIN AND RAMSEY MEDICAL SOCIETIES

metrodoctors.com The premiere source of information on physicians

Doctors MetroDoctors THE BULLETIN OF THE HENNEPIN AND RAMSEY MEDICAL SOCIETIES

MetroDoctors (ISSN 1079-4808) is published bimonthly by the Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761.

To promote their objectives and services, the Hennepin and Ramsey Medical Societies print information in MetroDoctors regarding activities and interests of the societies. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reflect the official position of HMS or RMS. Send letters and other materials for consideration to MetroDoctors, Hennepin and Ramsey Medical Societies, 3433 Broadway Street NE, Broadway Place East, Suite 325, Minneapolis, MN 554131761. E-mail: nbauer@mnmed.org.

For advertising rates and space reservations, contact Dustin J. Rossow, 4200 Parklawn Ave., #103, Edina, MN 55435; phone: (612) 8313280; fax: (612) 831-3260; e-mail: djrossow@aol.com.

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

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

CONTENTS VOLUME 1, NO. 2

2

LETTERS

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FEATURE

J U LY / A U G U S T 1 9 9 9

metrodoctors.com: Hennepin and Ramsey Medical Societies’ Joint Web Site to Serve as the Premiere Source of Information on Physicians

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Glossary of Internet Terms

8

Tips on Purchasing Computer Hardware

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www.metrodoctors.com A Step by Step Tour of the Web Site

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COLLEAGUE INTERVIEW

Mark Jacobson, M.D.

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Image Network Improves Efficiency and Accuracy

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PERSONAL FINANCE

The Dangers of Online Investing

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NOTEWORTHY

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HMS/RMS Annual Joint Board Meeting

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HMS and RMS Submit Resolutions to MMA

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HMS and RMS Jointly Sponsor Community Internship Program RAMSEY MEDICAL SOCIETY

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President’s Message RMS News RMS Alliance July/August 1999

Physician Advisor Thomas B. Dunkel, M.D. Physician Advisor Richard J. Morris, M.D. Editor Nancy K. Bauer Assistant Editor Doreen Hines HMS CEO Jack G. Davis RMS CEO Roger K. Johnson Managing Editor Sheila A. Hatcher Advertising Manager Dustin J. Rossow Cover Design by Susan Reed

Doctors MetroDoctors THE BULLETIN OF THE HENNEPIN AND RAMSEY MEDICAL SOCIETIES

HENNEPIN MEDICAL SOCIETY

29 30 32

HMS in Action HMS News

metrodoctors.com The premiere source of information on physicians

HMS Alliance

On the cover: metrodoctors.com, the joint web site of the Hennepin and Ramsey Medical Societies, serves as the premiere source of information on physicians. See related articles beginning on page 4.

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

July/August 1999

1

LETTERS Dear Dr. Swenson:

Dear Dr. Swenson: I appreciated Dr. Ringsred’s interview in the January/February 1999 Ramsey Medical Society Bulletin. While I am encouraged by her enthusiasm to analyze healthcare in Minnesota, several of her assumptions are at variance with my logic.

• Her premise that HealthPartners’ actions is driven by “the bottom line” and that we physicians are strictly influenced by providing “quality” care is too simple.

HealthPartners would not be in business long if they ignored patient’s wants and the patient’s quality of care. Physicians also have multiple concerns which influence their response to the regulation in which we are seeing inherent in today’s managed care.

• HealthPartners has been on the forefront of presenting healthcare data to their patients, though it is still elementary as Dr. Ringsred points out. It seems to be the best effort yet in our metro area.

• Rather than drawing a line in the sand, emphasizing differences between physicians

MetroDoctors welcomes letters to the editor. Send yours to: Nancy K. Bauer, Editor MetroDoctors Hennepin & Ramsey Medical Societies Broadway Place East, Suite 325 3433 Broadway St. NE Minneapolis, MN 55413-1761 Fax: (612) 623-2888

and the administration at HealthPartners and Regions Hospital, I believe that it is to our mutual interest to work together to solve our immense healthcare problems.

(The enemy is disease not each other.)

• Regions Hospital is the “safety net” for all of us in the East Metro area for trauma and burn therapy as well as the primary hospital for a significant portion of the people in this East Metro area. Regions supplies $15 million of uncompensated or free care each year. Five million of uncompensated care is provided by Ramsey Clinic and HealthPartners physicians as well. This is at least 10 times greater than provided by any other hospital system in either St. Paul or Minneapolis.

The physicians and hospital at Regions are committed to taking care of those patients who need care. I am proud to be a physician in St. Paul because the care that all the hospitals and physicians provide our patients is very high quality.

• The administrative bureaucracy at HealthPartners can be frustrating to us physicians working within and with the system. HealthPartners as well as Blue Cross, HealthEast and PreferredOne all can try our patience as well. We have to work with these organizations to achieve better patient care, which is our primary objective.

In closing, none of the hospital plans approach perfection, nor do I. We physicians must realize that change, though painful, has potential to help offer our patients more consistent care. This will be high quality care which emphasizes the similarity in care for similar patients. We can only achieve this goal by applying the resources of physicians, hospital and insurance plans together. We must continue to try to work together as difficult as it may be at times.

Sincerely, Walter L. Bailey, M.D.

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MetroDoctors

I am writing to express my disappointment and concern about the article in the RMS Journal entitled “Colleague Interview: Employer/Employee Physician Relations” by Karen Ringsred, M.D. The majority of this article does not deal with the employer/ employee physician relations at all, but on Dr. Ringsred’s disgruntlement with her former employer, HealthPartners. In my opinion, Dr. Ringsred has painted a very biased, one-sided perspective. Taken out of context, many of the statements made are very misleading. Dr. Ringsred is not a member of the HealthPartners Medical Group (HPMG), yet she seems to think she is qualified to speak for this group. She apparently also feels that she has the right to speak for former Ramsey Clinic Associates physicians. She has conveniently omitted a great deal of information. Of greater concern is that the RMS Journal editor has allowed her to do this, without giving anyone representing HealthPartners or HPMG an opportunity to rebut or clarify the issues.

As you know, I am an HPMG member, as are many of your former colleagues at Ramsey. I am also a member of the RMS. As a practicing physician and administrator, I have chosen to work within the system as an advocate for patients and physicians in a positive and substantive manner. I thought the RMS had a similar approach.

You indicated on page three of the same journal that “...the Medical Society is constantly adjusting and adapting to a changing medical environment” and that you want RMS to “…become a valuable source of information to all our members and the community.” I am a member of RMS because I believe you are right and I applaud your plans and efforts. However, I implore you to be sure that you are indeed adjusting to change, and that you are disseminating accurate and fair information, in which differing opinions are given equal time and space.

Sincerely yours, Susan L. Freeman, M.D., MS, CPE Section of Endocrinology Vice President of Medical Affairs, Regions Hospital The Bulletin of the Hennepin and Ramsey Medical Societies

“USOPNET” US Office Pick up from May/June Page 5 214163 TABLE

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July/August 1999

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FEATURE STORY Hennepin and Ramsey Medical Societies’ joint Web site

metrodoctors.com to serve as the premiere source of information on physicians

The new site should prove popular. Its forerunner, ramseymed.org, registered more than 100,000 hits in one year.

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Anne Queenan would seem to be the perfect candidate to use an Internet database of Twin Cities’ physicians. The forty-something video producer recently moved to St. Paul from Chicago, and hasn’t had time to find a doctor. She’s a computer-savvy professional who views the Web as a source of news and a research tool.

But it’s never dawned on her to use this new technology as an easy way to discover a doctor, or locate more information on a health concern. She’s leaned on friends and family for physician referrals and doctors themselves for the inside scoop on ailments.

When Hennepin Medical Society (HMS) and Ramsey Medical Society (RMS) complete construction of their joint Web site, metrodoctors.com, cyber-linked consumers such as Queenan might be forced to reconsider their expectations of what the Internet has to offer.

“Our aim is to be the premiere source of information on physicians,” says Jack Davis, HMS chief executive officer.

The new site will serve both consumers and HMS and RMS member physicians.

After entering a password, member physicians will be able to peruse the doctors-only section of metrodoctors.com, where they can find out about upcoming meetings of the societies, explore legislative issues, and read an on-line version of this magazine.

On the consumer side, metrodoctors.com promises convenience and access to easyto-understand physician information. A site-specific search engine allows consumers to look for a physician by name, specialty, clinic or geographic area (Minneapolis, Southwest Minneapolis, St. Paul, North St. Paul, etc.). All physicians — whether medical society members or not — will be listed.

“Search by location and you’ll see the total universe of practicing doctors in that area,” says Roger Johnson, RMS chief executive officer. “It won’t be just the three that you might find in the phone book, but 203.”

The new site should prove popular. Its forerunner, ramseymed .org, registered more than 100,000 hits in one year. That site was launched as a trial balloon in an attempt to discover Webcrawlers’ willingness to access medical facts online.

“People truly want to find doctor and health information on the Internet,” says Jim Ullyot, Creative Communications Inc., president. “RMS’s experiment proved that.”

Ullyot’s firm designed both ramseymed.org and metrodoctors.com.

Individual doctor listings on metrodoctors.com will note the following information: specialty, medical school attended, year of graduation, board certification, office hours and locations, languages spoken in office, insurance accepted, hospital affiliation, and if appropriate, a link to the physician’s own Web site for still more details.

Metrodoctors.com could prove especially helpful to residents of Greater Minnesota and Wisconsin, many of whom are referred to doctors in the metro area for specialty care.

It might also ease the way for closer physician-patient relationships.

“We’re the champion of direct interaction between doctors and patients,” Johnson

BY TODD MELBY

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July/August 1999

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The Bulletin of the Hennepin and Ramsey Medical Societies

says. “We believe patients still want to have a close relationship with physicians. This service will help facilitate that interaction.”

In this respect, metrodoctors.com can be seen as an outgrowth of the “First A Physician” promotional campaign that featured ads highlighting six doctors in a testimoniallike format. The ads appeared in local newspapers and magazines.

Many practitioners are already online, including Dr. Kenneth W. Crabb, a St. Paul obstetrician and gynecologist. For nearly three years, Crabb’s clinic, Advanced Specialty Care for Women, P.A., has had a presence on the Internet (www.advancedcare.com).

Has the site landed him more patients?

“It goes in streaks,” Crabb says. “But I’d say I average one or two new patients every month. It definitely pays for itself.”

A firm specializing in Web site design created the Advanced Specialty Care site, which has 11 categories of information, ranging from the philosophy behind the clinic’s name to curriculum vitaes (for Crabb and Kathleen C. Flynn, registered nurse and nurse practitioner), map to the clinic, listing of Twin Cities happenings, and related links on OB/GYN-related diseases.

The links take advancedcare.com visitors to sites specializing in abnormal pap smears, endometriosis, and urinary incontinence. According to Crabb, these links not only provide information to current patients but give clues to prospective clients about his practice.

“I specialize in treating women with pelvic pain,” Crabb says. “And endometriosis is the leading cause.”

Producing an accurate Web site — or detailed information at metrodoctors.com — that emphasizes a practice’s specialty makes sense, says Dr. Leighton Siegel, an ear, nose and throat specialist, and Internet enthusiast.

“As physicians, we tend to focus on things we are good at. If you spend a lot of time treating patients with head and neck cancer, you’re probably quite good at it. And that’s what you should be telling consumers,” Siegel says. “If you don’t care about doing it, don’t say anything about it.”

Siegel hasn’t shied away from technology. As a practicing physician at United Hospital in St. Paul, he helped design a computerized patient tracking system for the institution.

That led to the creation of NaviCare Systems Inc., a for-profit company specializing in selling similar software nationwide. And just recently, Siegel’s adult son needed someone to update a Web site dedicated to the youth’s travels in southeast Asia.

“Let me give it a try,” he remembers saying.

After purchasing a do-it-yourself Web design software product, Siegel was soon successfully installing photos of his son backpacking to base camp at Mount Everest, riding a camel in western India, and scuba diving in Thailand. With that experience under his belt, he undertook the task of revising the Web site for Ear, Nose and Throat Specialty Care of Minnesota, P.A., a clinic composed of 19 physicians metrowide.

“What we had wasn’t adequate,” Siegel says. “So I thought, ‘Now that I can do Web sites, let’s see what I can do for our group.’”

Visitors to the Ear, Nose and Throat Specialty Care of Minnesota site (www.entsc.com) can uncover a list of clinic physicians and qualifications, office hours, location listings, and insurance information. Especially helpful is the straightforward language used to describe typical ailments. Polysyllabic medical terms have been replaced by “nosebleeds, voice and speech disorders, snoring and sleep apnea, cancer, loss of hearing, dizziness, and ringing in the ear,” and other easy-to-understand descriptions on the site.

“Our site isn’t set up to inform other physicians, so we didn’t want to get too technical,” Siegel says. “Our goal was to focus on the patient, and include information that was useful for them.”

The same principle applies to metrodoctors.com. That’s why HMS and RMS will soon begin experimenting with a system that allows consumers to make clinic appoint-

“Producing an accurate Web site — or detailed information at metrodoctors.com — that emphasizes a practice’s specialty makes sense.”

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ments online. Similar technology already exists in the golf industry. TeeMasters, a Twin Cities-based company, has linked reservations systems at golf courses with the Internet. The result: With a few mouse clicks, you’ll know if there’s room at the course for a group of three at 8:00 a.m.

Saturday morning.

“This is a long-term goal for the Web site,” Davis says. “We’re considering a pilot project to see if it has potential.”

Minnesota Oncology/Hematology, P.A., a clinic with seven locations and 27 physicians, plans to launch its own site later this summer. It will include online patient registration, a first step to reducing the paperwork associated with visiting a physician.

“The potential on the Internet is only limited by one’s imagination,” says Bill Thompson, Minnesota Oncology/Hematology clinic manager.

Although metrodoctors.com has been accessible for months, the site is just now nearing completion. Put off completing the Web site census form any longer, and your

information may not be available for viewing when the site is promoted. HMS and RMS plan an extensive advertising campaign to raise awareness. Look for ads this autumn in local newspapers and magazines. ✦ Todd Melby is a freelance writer.

Is Your Practice Y2k Ready?

Some Useful Web Sites www.year2000.com www.y2k.com www.itaa.org www.computerworld.com www.rx2000.org www.state.mn.us www.hcfa.gov/y2k The American Medical Association: www.y2k@ama-assn.org The American Hospital Association: www.aha.org/ y2k The American College of Physicians— American Society of Internal Medicine: www.acponline.org/y2k

“Professional Projects for the Professional” • Clinics • Professional Buildings • Hospitals •

Morcon Construction, Inc. 5905 Golden Valley Road Golden Valley, MN 55442 Phone: 612-546-6066 Bill Jundt Medical Construction Specialist Member MMGMA/Gold Sponsor

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July/August 1999

morcon@isd.net MetroDoctors

Glossary of Internet Terms Following are helpful terms to know. They are highlighted in bold face, with regard to computer hardware, software, and the Internet.

Hardware: PC = Personal Computer, sometimes called PC/Win because it operates with the Microsoft Windows operating system.

Any such computer is also known as “IBM compatible” (whether manufactured by IBM or not), as differentiated from Apple’s Macintosh. The PC dominates in business as well as personal use and has an estimated 85-90% share of the market. Widely used for accessing the Internet.

Mac = Macintosh Computer, including the recent “iMac” model, which has been popular as a personal computer and also with the education and publishing markets. As with PC’s, Mac’s can be used for accessing the Internet, and have even been modified to run certain Windows programs. Although excellent computers, they don’t have as much variety of software or support as the PC because of their relatively smaller market share, about 10-15% worldwide.

Modem = An internal or external device connected to the PC or MAC which enables the computer to connect to a phone line to access the Internet or communicate online with other computers. With ever faster speeds desired for “surfing” the Internet, traditional modems using regular analog phone lines have increased in recent years from 9,600 bps (bytes per second) to 56,000 bps (aka 56 kbps, for kilobytes per second). The more recent ISDN modems may be used with special ISDN (Integrated Services Digital Network) phone lines for speeds of 64 kbps or 128 kbps. U.S. West is also introducing

The Bulletin of the Hennepin and Ramsey Medical Societies

ADSL (Asymmetric Digital Subscriber Line) capability on normal copper phone lines in selected local markets. With a special modem, users can achieve speeds of 512 kbps or more using such ADSL lines.

Software: Web Browser = Software on the PC or Mac that allows you to dial into the Internet (aka World Wide Web) and view any of the thousand of various “Web Sites” worldwide. The most popular software of this type is Netscape Navigator, and a close second is Microsoft’s Internet Explorer (which is built into the Windows software).

E-Mail Software = Software that allows you to send and receive e-mail communications locally and/or worldwide through the Internet. Both Netscape Navigator and Microsoft Internet Explorer have built-in e-mail capabilities, as does America Online software (see below).

Some users often want added capabilities for their use of e-mail, such as having automated responses to certain types of mail or setting up special in-boxes when receiving e-mail from certain specified senders. For those users, e-mail software such as Eudora Pro from Qualcomm offers excellent expanded capabilities.

America Online = This popular service comes with its own special software and functions, including a Web browser and e-mail service. It even provides its own dial-in phone lines for accessing the service and in that sense is an Internet Service Provider as well. Because AOL is primarily oriented toward providing its many proprietary discussion groups and online services, and has its own protocols, it is only secondarily providing access to the Internet. For that reason, AOL users may sometimes find it more difficult to browse the Web and/or to view Web sites than those who use a Web browser and dial directly into the Internet using an access provider, known as ISP (Internet Service Provider).

MetroDoctors

Search Engines = Web sites on the Internet which provide the service of allowing visitors to search for Web sites based on the entry of key words. Examples of search engines are at www.yahoo.com, www.goto.com and www.altavista.com, which will show tens, hundreds, or thousands of Web sites – along with brief descriptions – responding to a search.

For example, a visit to www.yahoo.com recently allowed users to search a Health section; a search for “health information” resulted in a list of over 7,000 Web sites!

The Internet: WWW = World Wide Web, aka “the Web,” synonymous with the Internet. In 1994, the Internet became a virtual “web” of sites that were easily visited online by computer users with browsers such as Netscape Navigator or Microsoft Internet Explorer. The browsers offered technology to take advantage of HTTP (Hypertext Transfer Protocol), the textbased protocol that serves as the official language of the World Wide Web for communicating with Web servers, downloading text, data, graphics files, or other items and then displaying in a browser window. (A web site’s address typically begins with http://… denoting Hypertext Transfer Protocol.)

HTML = Hypertext Markup Language, the software language used to create Web pages.

TCP/IP = Transmission Control Protocol/ Internet Protocol, the transmission protocol that functions as “the glue that binds the Internet” in that it allows disjointed, dissimilar and spatially separated physical networks to be accessed and thus joined together to form one large virtual network, or “Internet.” This protocol is built into Web browsers, and may need to be specified when initially setting up your browser.

The Bulletin of the Hennepin and Ramsey Medical Societies

URL = Uniform Resource Locator, a readable string that identifies the location of a Web site or “page” or file within a Web site. For example, the list of hospitals in metrodoctors.com is at this URL: http:// www.metrodoctors.com/ index.cfm?Action:Hospitals Domain Name = a URL that has been purchased and reserved specifically for a company or organization for the main page, aka home page, of its Web site, as in www.metrodoctors.com.

Home Page = The first page that a visitor sees when linking to a Web site. This is the main page or home page, as it is known, from which the visitor can “navigate” the entire site.

DNS = Domain Name Service, an online database distributed among thousands of name servers throughout the Internet that translates IP (Internet Protocol) addresses into URL’s. Example: 204.220.146.192 is translated into metrodoctors.com.

ISP = Internet Service Provider, a company that provides access to the Internet.

Typically, the company will provide a local phone number which you can dial into using your PC and a modem to establish a connection. Then, or automatically, you can invoke your Web browser to begin visiting Web sites (aka “surfing” the Web).

Links = As a courtesy to visitors, Web sites often list related Web sites. If a visitor is interested in “linking” to any of the Web sites shown, he or she simply clicks on the item, and the browser goes directly to the site which has been chosen. ✦ Computer/Internet terms were compiled by James R. Ullyot, president, Creative Communications, Inc.

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Tips on Purchasing Computer Hardware For Accessing the Internet and www.metrodoctors.com

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When recommending computer hardware, I refer to the PC not only because it is standard fare in our company and is the type of computer I have used for years (though I initially was a Mac user), but it tends to be the computer of choice in the industries we serve. For those who prefer the Mac, dealers can recommend rough equivalents. The user I have in mind has a computer for home or office, uses it for word processing, spreadsheets, and perhaps database management or visual presentations, and uses it to surf the Web — with a view toward enjoying the increasing amount of multimedia (video and audio) on Web sites.

At the time of this article, the widely sold Pentium II PC’s, with speeds typically 350, 400 or 450 MHz (megahertz), are fast enough and would be recommended because they can help to cut down the wait time on the World Wide Web experienced by earlier versions of the PC. Because these machines will typically come with Windows 95, 98 or NT Workstation, I would recommend a minimum of 64 MB (Megabytes) of RAM (random access memory), not the 16 or 32 MB that are often sold or recommended. The video card is important because of the need for speed and display of graphics, and I would recommend an 8 MB video card.

Important, too, is the audio or sound card, my recommendation being a 128 bit sound card. The computer should have a floppy drive (for the 1.44 mb diskette) and a 24X (or higher) CD (compact disc) drive. A standard hard drive these days is typically in the range of 3 gb (gigabytes), which is probably more than needed, though not worth trying to swap for a smaller drive.

As for a modem, I would strongly recommend an external modem (as opposed to an internal modem), a 56 kbps V.90 model, such as the US Robotics Faxmodem. The reason for an external model is that it is easier to flip off and on in order to “re-set” the modem, an unfortunate requirement quite often. An external modem is also easier to replace — you don’t have to open up the computer; also, an external modem has visible lights which make it easier to see what’s going on and trouble shoot. Further, many computer users (including myself) believe that external modems tend to outperform internal modems of the same speed and rating.

The monitor is important, with a resolution of 640 x 480 (pixels) being standard, but you should also be satisfied with its performance at 800 x 600 or 1024 x 768. (Higher resolutions, though available, may not be that important.) If you order a 14 or 15 inch monitor, you shouldn’t worry about performance; if, on the other hand, you want a larger moniB Y J A M E S R . U L LY O T Creative Communications, Inc.

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tor, such as 17 or 19 inch, try to get .26 dpi and take note of “refresh rates” — the higher, the better. For example, a refresh rate of 85 Hz (hertz) provides much crisper and cleaner screens than 60 Hz. An HP laser printer, such as the 1100 or 2200, or equivalent, provides good black and white printing. If you prefer color printing, and can wait longer for the pages to be printed, you may want to get a low cost but acceptable color ink jet printer made by HP or Epson (or others). Remember that with ink jet printers, the paper matters, and you should use paper specifically produced for ink jets. The much faster color laser printer is coming down in price, currently in the range of $2,000. I personally think it would be worth waiting for a while before buying one at what will be much lower prices.

The software that comes with such a PC can include the suite of useful Microsoft products (including Word, Excel, Access) that comes with Office 95 or 97. Office 2000 is just being released, but I would tend to stay with an earlier version until the new product is tested and proven in the marketplace.

Finally, I have long preferred Netscape Navigator for browsing the Web, but also acknowledge and accept that a browser can simply be a matter of personal preference. Microsoft’s Internet Explorer is good, but perhaps not as universal in dealing with different types of Web server software and presentations. (AOL’s browser is even more limited.) There is other software that you will want for the Web, such as Real Player (by Real Networks) that you can download and install from the Internet and integrate into your browser (for viewing various multimedia presentations).

To wrap up, the current speed and capabilities of PC hardware (and software) are impressive, and many off-the-shelf PC models are quite acceptable, though I would heed the advice above regarding certain aspects or add-ons to PC’s. You can spend more money (for example, for PC’s with Pentium III processors), but such “power” systems don’t seem necessary or worth the extra cost at this time for the user and/or applications referred to above. Remember, too, that many manufacturers, such as Dell, Gateway and Micron, will build to your specifications — as do many “generic” PC builders located in the Twin Cities area (one example of which is Genesis Computers at 612/884-5009, ask for Scott Kimball).

The system I outlined above is now quite affordable, in the range of $2,000 (more or less, depending on the peripherals and specific features you order). Learning to back up your system, not saving excessive amounts of files and programs that you end up not using, and performing frequent “de-fragmentation” routines on the hard drive, will help to maximize the performance of your PC, too. ✦ MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

www.metrodoctors.com A Step by Step Tour of the Web Site of becoming “the” Yellow Pages via a digital access to doctors and medical information for the greater Twin Cities metropolitan area.

An advantage of this free site over others is that it is a neutral source and includes all doctors in our area, and not just the doctors affiliated Brought to you by the Hennepin & Ramsey Medical Societies. Above: Minneapolis and St. Paul skylines.

MetroDoctors.com is a comprehensive guide to with a particular HMO or group. Also, the site Doctors & health information, in the St. Paul allows for a “mini” Web page for each doctor, Minneapolis metropolitan area. It is designed to help you find the right doctor or clinic for your needs, and thus physicians are urged to cooperate with and to help you find useful health information for both RMS and HMS in providing information you and your family. on themselves, their specialties and practices, so that they – as well as the public – can benefit from detailed, useful information. Samples appear later in this article.

The “Find a Doctor” selection on the main page of the Web site has a pulsating animation Visitors to the www.metrodoctors.com site are greeted by the home page, which can’t be shown above, but is noteworthy in that it draws attention which appears above. It explains to the public that the site offers “a to the service. When anybody clicks on this selection, they go to the page comprehensive guide to Doctors & health information in the St. Paulshown below: Minneapolis metropolitan area.” A different picture appears randomly on this page with each new log-on to give the site added variety and interest.

Whereas the menu selections at left enable visitors to the site to find the names, addresses and phone numbers of hospitals, and to access health information, you will note that there are also links to “HMS” (www.hmsdoctors.com) and “RMS” (www.rmsdoctors.com). These last Brought to you by the Hennepin & Ramsey Medical Societies. Above: Minneapolis and St. Paul skylines. two are the separate Web sites of the Medical Societies, presented primarily for the benefit of doctors. Each site includes a private section for Please bookmark this page for future reference when seeking a doctor. members only to get up-to-date information on their Society’s news, events and services.

Find a Doctor For purposes of this article, we will focus on the item shown on the Search by region and/or specialty: All Regions home page, “Find a Doctor.” This is expected to be one of the most used All Specialties parts of the site and a significant service to the community. The experiSubmit Search ence of Ramsey Medical Society’s Web site over the past two years has Search by name of Doctor or Practice shown that people are eager to know more about the doctors, clinics and practices, and medical services available. Doctors have even commented that they are receiving inquiries and patients are coming to their office as You will note that the search enables users to find a doctor by region a result of the Web site. and/or by specialty. At the bottom of the page an additional search is An important goal for the www.metrodoctors.com Web site is that offered, to search by name of Doctor or Practice (on a separate page).

If you click on the selection which says “All Regions,” you will see these selections: All Regions; Minneapolis; Minneapolis North; Minne-

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apolis South; Minneapolis West; St. Paul; St. Paul East; St. Paul North; and St. Paul South.

If you click on the selection which says “Specialties,” you will see a wide variety of selections.

It is noteworthy that a visitor to the site doesn’t have to know the technical medical term for the doctor’s specialty to conduct a search. For example, he or she could search for a “skin” doctor in north Minneapolis without knowing the terms dermatology or dermatologist.

For the sake of this article, we searched for Dr. Lyle Swenson, current President of RMS. Because a search for cardiologists in St. Paul yielded far too many to be practical to show, we instead searched for “Swenson” and came up with the following. It shows how a group of doctors are shown after a search has been executed:

If you were to click on St. Paul Cardiology (which is underlined and thus shows there is a link to another web page), you see the following:

Brought to you by the Hennepin & Ramsey Medical Societies. Above: Minneapolis and St. Paul skylines.

Friday, June 25, 1999

Practice Detail

St. Paul Cardiology 17 W Exchange St #710 St. Paul, MN 55102 651-232-4340 Fax: 651-232-4198 Click to view map.

Erhard, Mark W. Cardiology (Heart) * Internal Medicine *

Forgosh, Les B. Cardiology (Heart) *

Johannsen, Ronald A. Loria, Kim M. Cardiology (Heart) *

Mir, Sajad H. Cardiology (Heart) *

Cardiology (Heart) *

Seidlitz, Mary B. Cardiology (Heart) * Critical Care Medicine *

Swenson, Lyle J. Cardiology (Heart) * Internal Medicine *

Brought to you by the Hennepin & Ramsey Medical Societies. Above: Minneapolis and St. Paul skylines.

Membership Search Results 3598 Members Found SWENSON, Donald B. Mound, MN - 612-472-2848 Internal Medicine * -Critical Care Medicine

SWENSON, Helmer E. Northeast Urology Clinic, PA, Coon Rapids, MN - (612) 422-4665 Surgery, Urological -Critical Care Medicine

SWENSON, Lyle J. St Paul Cardiology, St. Paul, MN - 651-232-4340

This shows detail on Dr. Swenson’s practice, and his partners. If you click on “Map,” you will be shown a map of the practice’s location. (You could also click on “View Directions” for specific written directions on how to drive to the doctor’s office from your current location.) The map is shown below:

Cardiology (Heart) * -Internal Medicine *

SWENSON, Stephen S. Waverly, MN - 612-540-0005 Yahoo! -Maps -Yellow Pages -Help

The information concerning individual physicians and their qualifications in this website has been supplied by those physicians and has not been verified by the Hennepin & Ramsey Medical Societies, therefore, the Hennepin & Ramsey Medical Societies does not guarantee that the information is accurate or complete.

Click Here!

Note how a small camera appears after Dr. Swenson’s name. It indicates that there is a picture of him along with his information. In turn, when we clicked on “SWENSON, Lyle J.,” we were taken to “member detail” as shown below, with his picture and the indication of two specialties (Cardiology and Internal Medicine):

17 W Exchange St #710, St Paul, MN

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17 W Exchange St #710, St Paul, MN 55102 Zoom Out

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Brought to you by the Hennepin & Ramsey Medical Societies. Above: Minneapolis and St. Paul skylines.

Member Detail (RMS)

Friday, June 25, 1999

Lyle J. Swenson, M.D. Cardiology (Heart) * Internal Medicine * St Paul Cardiology 17 W Exchange #710 St. Paul, MN 55102 651-232-4340

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17 W Exchange St #710

The information concerning individual physicians and their qualifications in this website has been supplied by those physicians and has not been verified by the Hennepin & Ramsey Medical Societies, therefore, the Hennepin & Ramsey Medical Societies does not guarantee that the information is accurate or complete.

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July/August 1999

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

All doctors — and patients seeking them out — will benefit from this kind of information. Soon, you will be asked to fill out and return a census form for additional information on your locations, office hours, phone numbers, e-mail address, etc. Such information will be used to provide a larger type of Web page for each doctor than the one shown above for Dr. Swenson. To show an example of the type of Web page that will be available to you, we have selected that of Dr. Jon V. Thomas of Ear, Nose & Throat Specialty Care in St. Paul. He has provided additional information for an expanded Web page that appears as follows: Jon V. Thomas, M.D. Otolaryngology (Ear, Nose & Throat) Board Certified Ear, Nose & Throat Specialty Care 310 N Smith Ave #120 St. Paul, MN 55102 651-227-0821 Fax: 651-297-6597

Email

A member in good standing of the Ramsey Medical Society

Practice Description:

Our group provides a variety of otolaryngological services. I specialize in sinus disease and head & neck tumors. I work with patients of all ages, but particularly enjoy working with children.

Office Locations: Ear, Nose & Throat Specialty Care 310 N Smith Ave #120 St. Paul, MN 55102

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651-227-0821

Monday - Friday 9:00 am - 5:00pm

or marketers that try to get email addresses from Web sites for junk mail (aka “spam”) purposes. Also, note that there is an elongated box and a key at the bottom right of Dr. Thomas’ Web page. He can enter a password and then modify his information. He can also change the color and appearance of the Web page. In that manner, he can remotely manage his own Web page, which is an exciting part of this new service. The good news is that there is no charge for having such information and/or expanded Web page on www.metrodoctors.com — it is a benefit of your membership in RMS or HMS. At the end of this article is a sample of the census form that will be mailed to members in the near future. Physicians will be asked to fill out the form and submit it to RMS or HMS. In turn, as a convenience, your information will be entered for you on your own Web page on www.metrodoctors.com. Later, you will be shown how to modify the information online, simply by using a Web browser. Or if you prefer to complete the form online, it’s available at www.metrodoctors.com/census.

We are excited about www.metrodoctors.com, and again, urge your cooperation in filling out and returning the census form (along with a picture, if we don’t already have one). The www.metrodoctors.com Web site promises to be a great benefit to members and most important, a valuable and useful service for citizens and families throughout the greater Twin Cities metropolitan community. ✦ James R. Ullyot is president of Creative Communications, Inc. in Bloomington. CCI provides Web site design, development and hosting services, and manages www.metrodoctors.com.

Medical School: Mayo Medical School 88

Hospital Affiliations: ●

Methodist Hospital

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Fairview Ridges HospitalFairview-University Medical Center

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Fairview Ridges HospitalFairview Southdale Hospital

Insurances: ●

Medica Preferred One

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Blue Cross/Blue Shield

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HealthPartners

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Achievements: ●

Assistant Professor (1993-), University of Minnesota Department of Family Practice

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Vice President (1997), Ear, Nose & Throat SpecialtyCare of Minnesota

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Chair (1997), Ramsey Medical Society Communications Council Member, Minnesota Academy of Otolaryngology Head & Neck Surgery Council

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Hobby/Interests:

I enjoy working with computers and surfing the internet.

The information concerning individual physicians and their qualifications in this website has been supplied by those physicians and has not been verified by the Hennepin & Ramsey Medical Societies, therefore, the Hennepin & Ramsey Medical Societies does not guarantee that the information is accurate or complete.

The advantages of this expanded Web page are obvious: it provides reassuring additional information on Dr. Thomas’ credentials, training and accomplishments. It also provides hospital affiliations and insurances which are helpful to potential patients. Note that he has “Email” highlighted, which means that he can be reached by email. If you were to click on that option, you would be sent to a screen where you could send email to Dr. Thomas. But at no time would you be shown his specific email address. This is to protect doctors from being subject to Web site spiders MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

July/August 1999

11

COLLEAGUE INTERVIEW

Mark Jacobson, M.D. Medical Superintendent Selian Lutheran Hospital, Tanzania

“Colleague Interview” provides HMS and RMS members with an opportunity to ask questions of their colleagues who are in unique roles.

In this issue, interview questions were asked by Drs. Peter Bornstein, Gary Kravitz, Edward A.L. Spenny, and Rebecca Thoman. In keeping with the computer/internet theme of this issue of MetroDoctors, this interview was conducted via e-mail with Dr. Jacobson in Tanzania.

Background: As I begin to read and answer the questions that you have sent me for the “Colleague Interview,” I find myself needing to give something of an overview of what it is that I am involved with here in Tanzania.

My title, as a medical missionary working for the Evangelical Lutheran Church in Tanzania is “Medical Superintendent” for the Selian Lutheran Hospital. This constitutes a hybrid position of the responsibilities of Chief of Staff and the Hospital Administrator which one would recognize in the United States.

Selian Lutheran Hospital is a 120 bed unit serving both a rural and an urban community in the Arusha area. The vision of the hospital is to serve the poor with wholistic care in body, mind, and spirit.

The “poor” however, in this environment, is quite a relative term.

Annual per capita income is less than $150. Government expenditure on health is less than $2 per capita per year. Life expectancy is about 50.

Infant mortality rates are estimated at 100 per 1,000 live births. This hospital is a fee-for-service hospital in which patient fees pay only 60% of actual costs. The remainder is covered through donor subsidies from throughout the international community.

As the Medical Superintendent, I have overall responsibility for directing the hospital. Communally, our greatest challenge is how to serve the poor with such limited resources. Personally, my responsibilities cover a great breadth of roles: quality of care; continuing education; fund raising; setting the vision for the hospital; exploring new services; staff development; and long term sustainability are among the challenges before me.

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Q A

What are the challenges in your job related to the different cultural values of Tanzanian health care versus American health care, especially in the area of reproductive health?

Cultural values present in two very large swaths within my work in Tanzania. One focuses around medical anthropology and how patients and staff alike perceive and understand illness. The second, and perhaps more profound, is how cultural differences surround and impact on attitudes about work.

Illness is spiritual in this community. Illness results from broken relationships — with others, with the physical world, or with God. While patients may understand and accept a physical explanation of an infection or disorder and readily comply with my treatment, they are ultimately more interested in answering the question, “Yes, I understand how I got sick, but I need to know the answer to why?” “Why me, why now, and why not somebody else?” Healing is perceived primarily as restoration of broken relationships. The healer is reconciler. The healer is seen as priest, as a go-between between the broken person and God. So all of my care of patients must have this perception and understanding of disease and healing as a background for my western medical therapies.

The cultural challenge surrounding work or employment is one of lacking a sense of call or vocation. This is captured in a common faux pas of Americans learning Swahili. As the American begins to develop some conversational ability, the talk quickly turns to asking about one’s work.

“What is your work?” and an answer is forthcoming. The American then naturally asks, “Do you like your work?” to which he or she receives only a confused look and the answer: “Work is work.”

The implications are that if nursing a seriously ill patient is truly the same as hoeing in the garden, it is extremely challenging to encourage the MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

nurse to provide loving, supportive, quality care to that patient on the bed. It means that one of my biggest challenges is building a common vision and commitment to excellence. One of our guiding goals is to provide “Compassionate and Competent Care.” It sounds a modest goal, yet when work is simply an interchangeable role with little variance in meaning or import, then even the modest goal becomes a challenge and if successful, becomes a trumpeting summons to people in need.

Reproductive health has a great cultural overlay. One begins with a culture in which women are largely valued for and thus perceive their own worth primarily for their reproductive capability. Women produce workers for the family survival and produce the children who will be the social security for the aging parents. Thus, infertility becomes a greater curse and concern than excess fertility. Contraception is viewed suspiciously by both men and women. The traditional culture sees a continuum of spiritual life from existence prior to conception through human life and on to spiritual life in an afterlife. Contraception can be viewed as preventing the yet to be from coming into the human world. In such perceptions, it raises profound questions about who but God can decide when a spirit should be born.

Interestingly, as population pressure grows, our Family Planning clinic has grown dramatically. Contraception gains approval as families can no longer subdivide their land among sons nor pay the minimal school fees for their children. Depo Provera is our most popular contraceptive in large part because its use is entirely independent from knowledge or assent of the husband.

Female circumcision is still widely practiced in this community and consists of a partial clitorectomy. Although immediate post circumcision hemorrhage is sometimes a problem, there is little impact of circumcision on future complications of labor and delivery.

More common in a poor community is the problem of women with prolonged obstructed labor without access to medical care. We see a small yet significant group of women suffering from vesico vaginal fistulas as a result of obstructed labor. Of course these are poor women who in the miserable complication of their labor not only lose their baby but go on to become unhygienic outcasts from their families. My most rewarding effort of late has been to begin the first dedicated fistula surgical care in all of Tanzania.

What lessons learned from managed care experience in the United States apply to the development of the first HMO in Tanzania?

Why develop an HMO in Tanzania, considering limited data on their efficacy in “developed” nations?

Let me try to respond to these two questions together. The health system in Tanzania has gone through a very great upheaval over the past five years. In the years following independence in 1961, the government claimed for itself the responsibility of providing free health care to all its citizens.

The reality on the ground at that time was that various church institutions were providing over half of the medical care in the country. This was reluctantly recognized and most church hospitals were allowed to continue while some others were nationalized by the government.

The health system settled into something of a routine relationship between government and church. The government provided free care to patients in its facilities and the churches were allowed to charge patient fees (though controlled) in their facilities. Private medical practice was expressly illegal. The church hospitals, even with their mandates to serve the poor, were found by many to be providing better care than government facilities. Thus, church hospitals had a group of patients who had the means to pay their bills and were not unhappy to do so. Church hospitals depended on these paying clients to help subsidize the care to the poorest of the poor.

In 1994, in response to World Bank economic reforms, health care was taken from the socialist model and subjected to the market economy.

Private practice was legalized and almost overnight, thousands of new health care delivery points sprung up throughout the country. Unfortunately, there was little regulation or monitoring of these new facilities.

They entered into direct competition with existing institutions like Selian (Continued on page 14)

What is the focus of health work of the Evangelical Lutheran Church?

The Evangelical Lutheran Church in Tanzania has a vision of wholistic ministry to a people who also view their lives wholistically. In this culture, health and disease are spiritual, food production and animal husbandry are spiritual, life and death are spiritual. Into this milieu, the church shares the good news that wholeness and reconciliation are a gift of God through Jesus Christ.

So health work is very much perceived within the general context of wholistic development. The focus is on prevention and education and yet, offers curative care to those in need. The Lutheran Church provides over 10% of all the health care in the country and has led the way in developing community health and preventive efforts.

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

July/August 1999

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(Continued from page 13)

but had none of the overhead which quality care demands. Many were bogus and deceptive. I believe that most communities do not have the sophistication to evaluate quality of care. In our community, speed of service, price, and getting more medicines (especially injections) are perceived as better care. Since most patients in any setting recover, it is difficult for the community to use mortality as a measure of quality for an individual clinic or dispensary.

Almost overnight, there were four new clinics just outside the gates of our hospital. People had to walk by these four clinics to get to Selian.

And then once they came to Selian, they actually had to wait the half hour that a “real” malaria smear takes and then they would walk out with only one or two medicines. The result, our Outpatient flow dropped by 30% in one year! Suddenly, we found ourselves competing for the patient population with the ability to pay while realizing that there was no similar competition for serving the poor.

This represented a time when the survivability of church related hospitals came into question. In the face of essentially unfair competition and with a decrease in donor support, hospitals committed to quality care for the poor were in jeopardy. The leadership of Selian began to seek ways in which to assure itself of a loyal patient base. Simultaneously, employers in the community were seeking a service through which they could provide quality health care for their employees at a predictable and affordable cost. The solution was to offer a hospital sponsored pre-paid insurance program.

This is an area that my personal background as an American physician was very useful. The medical community in Tanzania has little exposure to or experience with the competitive and marketing aspects of an open medical economy. Both socialism and the subsidized church hospital system caused medical staff to practice in a manner of some indifference to patients. Patient satisfaction was not a necessary priority for survival as the patient load was consistently high.

Certainly, the idea of marketing, at least in the sense of getting information into the public arena in order to provide more informed choice, was an idea that was unknown. Marketing continues to be suspect and the Medical Licensing Board in Tanzania holds an extremely conservative view of what is ethically and legally permissible in providing the community with information about health care services. Though my own experience was not great, I at least began with a higher comfort level of the issues involved.

We began both a pre-paid and an indemnity insurance program in 1996. This is administered by the hospital and reflects biases of the hospital. However, the cost is so much below the private practice rates that employers are very pleased to participate. This program has grown by 50% a year since and now accounts for nearly a third of our total patient income. It has provided us with a firmly committed patient base and also has much carry over to extended families and acquaintances who learn of Selian’s services from satisfied patients.

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What aspects in your medical training best prepared you for the challenges you found in Tanzania? What were the most deficient?

Very clearly the opportunities I had to work and study overseas as part of my medical training was the best preparation. I was allowed multiple overseas experiences in both the MD program and in my Internal Medicine training program. These in turn gave rise to my connecting with others in the University of Minnesota system with similar interest. Working at what was then Ramsey Hospital at the height of the influx of Hmong people of Laos gave me ample opportunity to continue to explore cross cultural medicine and tropical medicine even in what was quite a homogenous metropolitan community at that time.

My only wish in many years of service in Tanzania is that my training had provided me with some basic surgical skills. As an internist, I was not only able to but expected to focus on medicine from as early as the third year of medical school. Yet even this “deficiency” may in many ways be a blessing in disguise as it has caused me to be much more of a team builder than a lone ranger in our work at Selian.

What makes Tanzania’s health care system more effective than many other African countries?

This is a difficult question. It is difficult because Tanzania has a reputation for more effective health care than many other countries and yet, I am not at all sure that it remains as a true description of the situation today. The reputation developed out of a serious effort to peripheralize health care services. Both preventive and curative services were pushed into the rural periphery until Tanzania had the best ratio of access to medical care in all of Africa.

Unfortunately, physical access to a clinic and quality of service did not go together. The peripheral units could not be adequately supervised, supported, supplied, or monitored. With the per capita health expenditure falling annually the peripheral units became moribund and many died. Drugs were often only available one week in a month and then were sold rather than prescribed. Salaries went unpaid for months and staff opted to begin “private practice” under the guise of the government dispensary.

The failing economy led to a near collapse of the government health sector in the eighties when lack of supplies, corruption, and shrinking budgets came together with the challenge of AIDS to demoralize and subdue the health care system.

Recent moves to revitalize the health care system through support from international debt relief have potential. Cost sharing has been introduced by the government at its facilities and community health is being decentralized to smaller communities. There is some hope again but the past ten to 15 years have been terribly bleak for health care in Tanzania.

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

Can an American hospital Medical Staff “adopt” an international hospital with frequent interchange of personnel? How can this be done?

Absolutely. Every international hospital that I know of in Africa would be eager for and interested in such a relationship. The potential for support and supplies is tremendous. For the American hospital, the creation of good will and a greatly expanded vision of what is medical care is uplifting and produces a better practice of medicine back in the United States.

Such an exchange is not always an easy dance to orchestrate. Differing visions and goals, unless clearly stated and agreed to at the beginning, can lead to conflict and discomfort. Africa must not be perceived as a vacuum into which any gift or donation is appropriate. Exchanges must be seen as mutual learning and sharing. Much is being done and learned here that would be useful to the practice of medicine back in the United States. Our hospital relates closely to Global Health Ministries located in Minneapolis for coordination of supplies, support staff, and project development.

What value is there for an American doctor to practice in a third world setting — for the hospital served? For the doctor visiting? What is the minimum or ideal time required to make such a visit worthwhile?

We regularly have U.S. doctors and medical students visiting and serving in our hospital. Universally they have been thrilled and excited about their service. For the doctor, it is many times an opportunity to return to the idealism which led them into medicine. It is the simplicity of matching skills to the needs of people and rejoicing in a positive outcome without the headaches of paperwork, malpractice, review panels, or productivity monitoring. One plastic surgeon who operated with us for a week was heard to say after just the first day “What’s so refreshing is that I’ve just seen 20 patients and plan to operate on 11 and not a single one has asked me how many of these operations I’ve done before!”

As a hospital, we are greatly appreciative of volunteer service. Surgical subspecialties are especially useful as, at least on one level, an ophthalmologist or an orthopedic surgeon can come for a short period of time and accomplish much without needing to learn the language or yet truly begin to understand the culture. Visiting doctors challenge our staff and challenge us to improve our services. It represents the classic “win – win” situation.

In an era of rapid air travel, how responsible should Americans be for better health care in third world countries generally and specifically to prevent spread of infectious diseases?

for a total cost of $350,000 per year. One simply has to pause and ask the ethical and moral questions of how our society in America and how our health care culture in particular uses or misuses resources.

I am among the first to agree that the money we are discussing is not mutually available for an either/or decision making process. Money not used in the U.S. is not in any sense necessarily available for health care in Tanzania. I raise again the question of the value of our increased spending for reduced gain in life expectancy. Thirteen dollars fully immunizes a child in Tanzania while not covering the cost of a well baby visit in an American clinic.

Tanzania is seeking debt reduction through the World Bank and the International Monetary Fund. If relief is granted from these crippling debt repayments, fifty million dollars annually become available and are committed to health care and education — exclusively. Can and should health care providers in the U.S. be supporting this effort? Most definitely.

Do you feel your additional education (MPH) contributed to your practice of medicine?

Incredibly so! I received my MPH from the International Health Department at Johns Hopkins so I was focused on health and disease in tropical countries from before I moved to Africa. Most important was the development of my own belief in prevention, a development of a sense of management in medical care, and rigorous assessment of assumptions about what makes sense in health care. I have used my public health training as the foundation upon which my curative medicine background could build a structure to stand against the winds of the politics, economics, and culture in Tanzania. ✦

Ill health in third world countries is related to poverty. Ill health in the more economically developed world is related to affluence. What then is the responsibility of the American health care provider on a global scale?

This is truly an ethical conundrum. Numbers clarify the dilemma for us.

We receive 40,000 patient visits annually at Selian and run the hospital

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

July/August 1999

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Image Network Improves Efficiency and Accuracy

A

As a radiologist, I have seen first-hand the impact that computerization has brought to radiology. The Center for Diagnostic Imaging’s (CDI’s) computer network has grown substantially since the installation of our first CT and MR systems many years ago. The network is integral to our operations and has enabled us to streamline our processes to provide cost-effective image interpretation services. And, it has profoundly influenced the way I personally practice.

CDI’s Image Network MR and CT images are acquired by and stored on the scanner computers. Each exam has scores of images. For example, an MR examination of the knee contains 150 separate images with over 75 megabytes of data. By networking the scanner computers, images can be electronically transmitted to other computers in the network for image interpretation and archival. The transmitted images are identical to the original images and have 12-bit pixel depth allowing full window and level capabilities.

CDI has one of the largest networks in the country designed for radiological image transmission. CDI’s image network of more than 80 nodes is comprised primarily of scanners, display workstations, and routers. We have high network utilization; for example, our Minneapolis office receives and/or transmits over 10,000 images a day.

With clinics across the country, we make use of a wide variety of telecommunication services ranging from ISDN to fractional T1 to

B Y K E N N E T H B . H E I T O F F, M . D .

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full T1 bandwidths. Our radiologists also have ISDN lines for their homes allowing our subspecialty experts to consult on cases throughout the system in real-time, day or night, seven days a week.

We are basically as filmless as we can be — practically the only MR and CT films we produce are those that are sent to referring physicians. We archive all our cases to DAT tape to allow timely retrieval of cases when needed again in the future.

Image Display and Interpretation We use a very efficient and functional Windowsbased software program for viewing our CT and MR images. The software allows very rapid viewing of multiple images, and the split screen capability allows comparison of multiple sagittal, axial, or coronal series, or comparison with a previous study. The images are full 12-bit images which permit full window and level functionality (i.e., varying the contrast of the image to highlight specific information on the scan (i.e. bone, soft tissue, fluid, etc.). There is no degradation of the images. In fact, our radiologists feel that the ability to sequentially view and simultaneously window and level the images to better study areas of abnormality results in more accurate interpretation than film, which contains a fixed image. The efficiency of imaging is also enhanced, as it is easier to view the hundreds of MRI images on multiple sequences on a computer with our software than to view multiple sheets of films on view boxes or rolloscopes.

Improved archival and retrieval of images as well as eradication of film loss problems are also positive attributes of the system.

MetroDoctors

Advantages We believe the use of image transmission improves patient care in several ways. First, it allows the images to be interpreted by a subspecialist radiologist with expertise in that anatomical area. For example, an MR examination of the knee acquired in Indianapolis can be transmitted to a radiologist in Minneapolis who specializes in knee imaging and who has experience with thousands of similar examinations each year. By focusing on a certain subspecialty, radiologists improve their accuracy and become extremely proficient in their subspecialty area. Patient care is improved by more accurate, timely diagnosis of subtle injuries that can be easily missed or misinterpreted.

Secondly, electronic transmission of images allows for timely response of the radiologist to the referring physician. An entire MR case can be transmitted from anywhere in our network to any radiologist in our network in under three minutes. CDI’s network allows the radiologist to be involved in patient care as the scan occurs even though the radiologist may be in a different location than the patient. At times, the radiologist may request that additional images be acquired. Patients benefit from the decreased time for interpretation of their images since it allows the referring physicians to more rapidly manage the care of their patients.

The network also allows for consultations between radiologists on difficult cases.

Subspecialized radiologists at two different

The Bulletin of the Hennepin and Ramsey Medical Societies

locations can review the same case minutes after the scan and discuss it via phone.

For me personally, as Medical Director and practicing radiologist, teleradiology has been a godsend. With a multitude of meetings both in and out of the clinics, the flexibility to read from multiple locations throughout the early morning, day and evening has made scheduling much more manageable. Now, instead of being late for a 5:30 PM meeting because I had to finish reading all the scans before I left the clinic, I can flip the switch to send the images home, make the meeting on time, finish reading in the evening or early morning, and start the next day with a clean slate.

It allows me to stay in touch with our physicians in all of our markets on a daily basis to monitor image quality and interact with our technologists and radiologists, as well as our referring physicians. We also use the image network in our radiologist peer review program in which 5% of each radiologists’ cases are reviewed on an ongoing basis. I can monitor

examinations while they are being performed in any of our centers in the country in real-time.

This improves our efficiency, service and accuracy of diagnosis, as the subspecialty expert

“For me personally, as Medical Director and practicing radiologist, teleradiology has been a godsend.” responsible for the interpretation is also guiding the examination to ensure that all of the information necessary for the diagnosis is obtained on the initial examination.

As our physicians cover more clinics, teleradiology makes it possible to easily consult with each other on difficult cases in real time, again, improving our ability to achieve a better, more thorough consultation.

From a teaching and training standpoint, the system is a wonderful adjunct to our program. As new radiologists are added to our various subspecialty practices in various centers throughout the country, extensive training is required. With teleradiology, our senior radiologists can review images and reports with their new colleagues each day prior to the report being released. This process is continued until the learning radiologist has reached the level of accuracy of a senior radiologist. Teleradiology makes this a very complete and thorough program with constant monitoring and feedback. ✦ Kenneth B. Heitoff, M.D. is Chairman and Medical Director for the Center for Diagnostic Imaging.

MN Med Foundation 1/2 Page Camera-Ready Ad Provided

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

July/August 1999

17

PERSONAL FINANCE complaints have spiked to record levels, with duplication of trades, unfilled orders and buy orders executed at higher-than-anticipated prices among the chief concerns.3 Another troubling issue: Online traders may have trouble resisting the urge to invest on impulse rather than adhering to a coherent plan.

In fact, some economists and mental-health professionals have characterized the rising tide of online investing as “gambling,” and Securities and Exchange Commission Chairman Arthur Levitt even called the new medium a “kind of narcotic” for some traders.

Online investing has given the individual investor a huge degree of freedom, but may also pose clear and present dangers. Before you become a “cybertrader,” consider understanding these risks and weighing them carefully. ✦

The Dangers of Online Investing

A

At first glance, the concept of online investing seems positively utopian. The Internet offers a powerful medium for researching the vast universe of investments as well as the means to buy and sell stocks with a single mouse click.

It’s no wonder, then, that the popularity of online trading is soaring: Trades placed over the Internet jumped 34% in the last three months of 1998 alone.l But underneath the hype and

BY JERALD M. PROSTROLLO Midwest Capital Management, Inc.

excitement surrounding online investing lie some potential dangers.

For starters, online investing may encourage more frequent trading. Yet a recent study found that investors who made the most trades suffered lower returns than those who followed a “buy-and-hold” philosophy. Households that traded infrequently earned 18.7%, while the households with the highest number of trades earned just 11.4% — a dropoff of nearly 40%.2 The new stock-trading medium has also been plagued by growing pains. The National Association of Securities Dealers reports that

1)

Newsday, February 3, 1999 “The Common Stock Investment Performance of Individual Investors,” Barber and Odean, University of California at Davis, January 1999, for the period February 1991 through January 1997. Past performance is no guarantee of future results. Taxes were not considered in this analysis.

3) The New York Times. January 28, 1999 4) The Wall Street Journal, February 1, 1999 2)

RMS Membership Advantages for Physicians and their Practices ➢ Office Supplies – US Office Products • 651-639-4700 25-40% discount on a full-range of office supplies and office furniture. Free delivery. www.gop.usop.com

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July/August 1999

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

NOTEWORTHY Medical Education and Research Advisory Committee has Openings

AMA Data Shows Physician Income Down Again

Pharmacy Practice Act Changes Authorized

For the second time in four years, median physician income fell slightly between 1996 and 1997, according to the most recent edition of the AMA’s Socioeconomic Monitoring System physician survey.

In 1997, the most recent year for which complete data were available, the median net income for a U.S. physician was $164,000, down 1.2% from $166,000 in 1996.

The annual survey polls a representative sample of approximately 4,000 doctors. Since 1988, survey data show that physicians income, adjusted for inflation, has been essentially flat. Between 1993 and 1997, median net income adjusted for inflation fell at a rate of 1.4% per year.

The survey also found that as of last year, 62.3% of the nation’s physicians were selfemployed, with 36.1% identifying themselves as employees and 1.6% listing themselves as independent contractors. Physicians worked an average of 55 hours a week; self-employed doctors averaged 57-hour weeks, while employed doctors averaged 51.

In April, Governor Jesse Ventura signed into law changes to the Pharmacy Practice Act. The new law takes effect August 1, 1999.

Under the new law, pharmacists will be allowed to modify drug therapies, but only under a specific protocol between a patient’s individual pharmacist and his or her treating physician.

The bills originally called for authorizing pharmacists to independently administer immunizations and would have allowed pharmacists to modify a patient’s treatment regimen. The independent immunization provision was removed from the bills.

The Minnesota Department of Health recently announced that there are 28 positions available on the Medical Education and Research Advisory Committee.

The purpose of the committee is to provide advice and oversight on the distribution of the Medical Education and Research Trust Fund grants. These grants are distributed to clinical medical education programs to help offset lost patient care revenue for teaching institutions affected by increased competition in the home health care marketplace.

Meetings will be held quarterly, or more often as needed, for three hours at the Minnesota Department of Health in St. Paul.

The committee expires June 30, 2001.

For more information, contact the Minnesota Department of Health at (651) 282-5601. ✦

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

HCFA Drops Fines for Using Bed Side Rails According to American Medical News Highlights, The Health Care Financing Administration is rescinding fines against nine of 14 Minnesota nursing homes accused of improperly using bed side rails, a commonly used patient restraint.

Fines totaling more than $700,000 were levied by the state health department last year after it cracked down on homes it said violated federal regulations aimed at minimizing restraint use. While the request to drop the fines was initiated by the health department, patient safety concerns and family opposition may also have been factors.

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

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July/August 1999

19

HMS/RMS Annual Joint Board Meeting

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The Hennepin Medical Society and Ramsey Medical Society held their annual joint Board of Directors meeting on May 13 at the St. Paul Town & Country Club. The meeting was called to order by Lyle Swenson, M.D., RMS president. A demonstration of the new HMS/RMS Website, metrodoctors.com, was available for Board members to visit.

David Renner, Director of State and Federal Legislation at the Minnesota Medical Association, was invited to provide an update on the legislative activities occurring at the capitol and the status of bills still under consideration.

(Editor’s note: As the legislative session concluded after this meeting, a complete summary of the actions taken is available through the Physician’s Center for Advocacy at the MMA).

Jan Malcolm, Commissioner, Minnesota Department of Health, was the featured speaker.

Commissioner Malcolm opened her comments citing that the mission of the Minnesota Department of Health is to maintain and protect the health of all Minnesotans. In this regard, she stated that links to the public health sector and the medical community must be maximized.

Education is a first priority for fiscal responsibility on the Governor’s agenda, and although health is not on the short list, Commissioner Malcolm is certain it will most likely come around. She encouraged an ongoing dialogue with the medical community both in issue identification and solutions.

Commissioner Malcolm referenced the following challenges: • Disparity in health status among the population (age, cultural, minorities, uninsured, etc.)

• Escalating Costs — the need to educate the public about what is causing the rise in health care costs; there is no societal consensus as to what the vision of health care is or should be.

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July/August 1999

• Changing demographics (belief sets, communication, aging population, etc.)

• Fragmentation of the payment systems (how should MinnesotaCare be financed? Replace provider tax with what? How to finance the uninsured, graduate education, state-wide poison control system, safety net issues?)

Solutions: • The Governor has a talent for reducing issues to public language and placing value to them.

• Need to get back to a more encompassing discussion of where we will go with public health financing. A recommitment that quality returns to the front and center with objective, science-based debates on what has maximum impact on health.

• Prevention — failure to prevent is a moral failure.

• Research and evaluation — scientific discussions about how health care dollars are spent.

• Disparity — work with immigrant populations, beliefs and practices.

In closing, Commissioner Malcolm envisioned that we could knit public health and the medical model together by clarifying the roles and responsibilities and stop the fragmentation and reinvention. We need to partner to address changes to improve the quality and sustainability of the health care system.

Questions were asked of Commissioner Malcolm regarding the role of the state Health Department in HCFA’s guidelines for patient dumping; is MDH aware of the hospital bed capacity issue and who should regulate the HMOs — the Health Department or Department of Commerce.

According to Commissioner Malcolm, the Minnesota Department of Health is contracted to enforce HCFA guidelines. However, MDH can also serve as an effective advocate back to MetroDoctors

Commissioner Jan Malcolm, Minnesota Department of Health

HCFA when guidelines are not workable. She further noted that the Governor is interested in being an activist for challenging rules and responsibilities.

MDH has not been asked to investigate the issue of hospital bed capacity, however, they would be open to a collaborative task force to discuss the problem.

Both MDH and the Department of Commerce bring a set of competencies and strengths in regulating HMOs. The challenge is to look at ways in which the regulations can be consistently regulated based on quality and solvency.

In other business, a motion was approved to provide up to $5,000 from the medical societies to the Senior Federation for funding of an initiative designed to evaluate the possibility of building a class action lawsuit against the Federal Government for unfair Medicare reimbursement. Additional funding will be considered if a suit is undertaken.

The tentative slate of candidates for MMA officers was presented and a discussion about possible AMA Delegate and Alternate Delegate vacancies was held. Members interested in being considered for any of these openings should contact their medical society leadership as soon as possible.

Edward A. L. Spenny, M.D., HMS chair, adjourned the meeting. ✦

The Bulletin of the Hennepin and Ramsey Medical Societies

6. Emergency Preparedness William M. Rupp, M.D.

HMS and RMS Submit Resolutions to MMA The following resolutions were submitted to the Minnesota Medical Association for consideration by the House of Delegates at their annual meeting slated for Sept. 26-28.

Hennepin Medical Society

11. MMA Sponsorship of the Minnesota Smoke-Free Coalition A. Stuart Hanson, M.D.

8. Revision of Minnesota and Federal MSA Statutes Robert W. Geist, M.D.

12. Increasing Government Programs Rates Richard K. Simmons, M.D.

9. Exclusive Contracts for Drugs and Devices William M. Rupp, M.D.

1. Educating Physicians about Sexual Abuse David G. McCollum, M.D.

13. Improving Health Care Access Richard K. Simmons, M.D.

2. AAP Guidelines for Circumcision David G. McCollum, M.D.

14. Health Care Standards in U.S. Jails and Prisons Karen K. Dickson, M.D.

3. Implement a Hassle Factor Project Modeled After Existing Programs in Colorado and Texas Rebecca J. Thoman, M.D. 4. Mandate Legislative Protection for Health Care Providers in Health Plan Contracting Practices Rebecca J. Thoman, M.D. 5. Medica Choice Health Plan Radiology Reimbursement Policy Richard M. Gebhart, M.D. 6. Pharmaceutical Costs Richard M. Gebhart, M.D. 7. Revision of Federal and MN State Medical Savings Account (MSA) Statutes Rebecca J. Thoman, M.D. 8. Sponsorship of Forum for Enhancing the Training of Medical Students and Residents in Violence and Abuse Issues David G. McCollum, M.D. 9. Legislation for Increasing the Severity of Charges for Domestic Violence in the Presence of a Child David G. McCollum, M.D. 10. Prominent Ears Drs. Richard K. Simmons and David L. Estrin

MetroDoctors

7. FDA Regulation of Dietary Supplements Donald S. Asp, M.D., Ila Harris, Ph.D., and Jamie D. Santilli, M.D.

15. Medicare Funding Equity Richard K. Simmons, M.D. 16. Options for Physicians and Patients When Doctors Terminate Managed Care Contracts Lee H. Beecher, M.D. 17. Tort Liability Richard K. Simmons, M.D.

Ramsey Medical Society 1. Ethnic Data Reporting for Clinical Trials Kenneth W. Crabb, M.D. 2. Appropriate Evaluation and Treatment of Patients with Mental Health Conditions James J. Jordan, M.D. 3. Liability for the Substitution of Physician Orders for In-patients William M. Rupp, M.D. 4. Cash Basis Managed Care Contracts William M. Rupp, M.D. 5. Minnesota Medical Association Conference on Kids, Guns and Media Violence Kent S. Wilson, M.D.

The Bulletin of the Hennepin and Ramsey Medical Societies

10. Reporting of Hospital Bed Capacity to the Minnesota Department of Health William M. Rupp, M.D. 11. MMA Study of the History of the Treatments of Persons with Developmental Disabilities Who Have Been Involuntarily Committed to State Institutions Peter F. Bornstein, M.D. âœŚ

9th Annual Minnesota Medical Foundation Golf Classic

August 30, 1999 Minneapolis Golf Club The event is a double shotgun start played in a scramble format, followed by an evening dinner and program.

(For the first time this year, a limited number of spaces will be available during the morning round for players with a handicap of 20 or better to play the course individually in lieu of the scramble format.)

For more information, or to register, call (612) 626-0619.

July/August 1999

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HMS and RMS Jointly Sponsor Community Internship Program

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“What was life like before coding?”

This question was posed by Bill Cammack, president, C & H Chemical, St. Paul, one of nine interns participating in the recent Hennepin Medical Society/Ramsey Medical Society Joint Community Internship Program.

He cited his interest in how physicians balance time, quality of care, and insurance requirements when agreeing to spend the two days shadowing physicians. His question and many others along this same line dominated the discussion at the concluding reception of the program.

Karen Padley, Health Care Business Writer, St. Paul Pioneer Press, stated that she is “amazed at the pace decisions and diagnoses are made.”

And Peter Dick, a principal operational research analyst within the Economics and Operational Research Division of the National Health Service in Leeds, England, stated matter-of-factly that the introduction of new technology and drugs is the root of the rising costs in the United States. He compared the consequences of inappropriate utilization in the U.S. as rising costs, versus the UK where there is a denial of care for

Dr. Brenda Abraham and Community Intern Bill Cammack.

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July/August 1999

MetroDoctors

others when the total/limited budget is reached.

Mr. Dick is currently a Fulbright Fellow at the Humphrey Institute.

Three of the interns, Mr. Dick, Moira Gaidzanwa, and Duchess Harris are currently completing policy fellowships at the Humphrey Institute. “I thought by participating in the Community Internship all the answers to my questions about managed care would be crystal clear. Now I’m only more confused!” exclaimed Duchess Harris, Ph.D., an assistant professor in Political Science at Macalaster College. She will be teaching health care policy in the spring of 2000.

Other interns included: Tony Anastasia, account executive, HealthEast Care, Inc.; Steve Heimel, health care consultant, Larson, Allen, Weishar and Co., LLP; Mary Jeanne Lee, director of sales and marketing, HealthEast Care, Inc.; and Laura Putnam, director, business development for Blue Cross and Blue Shield.

Initially established by the Ramsey MediThe Bulletin of the Hennepin and Ramsey Medical Societies

cal Society, HMS and RMS have been offering the opportunity for business leaders, purchasers, and other decision-makers to experience the practice of medicine first-hand for over a decade.

“The Community Intern Program is an excellent program that provides physicians with the opportunity to show community leaders how quality medical care is provided to the patients in our community,”according to Dr. Lyle Swenson, RMS president. “It is also an excellent opportunity to enter into discussions of key health care issues with the community leaders who participate as interns. It is a rewarding educational experience for both the interns and the physicians.” ✦

Peter Dick and Dr. Douglas Hotvedt.

Thank you to the following physicians for participating in the Community Internship Program.

Brenda Abraham, M.D. Kimberly Anderson, M.D. Ivan Brodsky, M.D. M. Nicholas Burke, M.D. John Canfield, M.D. Raul Cifuentes, M.D. Gary Coon, M.D. Paul Crowe, M.D. Peter Daly, M.D. Thomas Dunkel, M.D. Sandra Engwall, M.D. David Estrin, M.D. T. Bruce Ferrara, M.D. Michael Gonzalez-Campoy, M.D. Jorge Granja, M.D. Jim Hart, M.D. Douglas Hotvedt, M.D. James Jordan, M.D. Peter Kelly, M.D. Brian Lew, M.D. Patrick Lilja, M.D. Paul McCormick, M.D. C. Phifer Nicholson, M.D. Robert Plouff, M.D. Manuel Ramon, M.D. Jon Thomas, M.D. Peter Wilton, M.D. Patrick Wright, M.D.

MetroDoctors

Dr. Paul Crowe and Steven Heimel.

Community Internship Program participants included Karen Padley, Peter Dick, Duchess Harris, Ph.D., Moira Gaidzanwa, Mary Jean Lee, Tony Anastasia, and Bill Cammack. Not pictured: Steven Heimel and Laura Putnam.

The Bulletin of the Hennepin and Ramsey Medical Societies

July/August 1999

23

P R E S I D E N T ’ S M E S SA G E LYLE J. SWENSON, M.D.

RMS-Officers

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

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

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

Roger K. Johnson, CAE, Chief Executive Officer

T

There has been a curious discordance within health care in this country over the past few years. Following the failure of the Clinton administration to enact any legislation after the tremendous investment of time and energy put into the Clinton Health Plan, there has been very little effort on a national level to re-shape health care delivery or financing. Current efforts have not sought any fundamental change, but have made small legislative and regulatory changes to the present unstructured, uncoordinated collection of different delivery and financing systems. Some of these efforts have been directed at improving the recognized negative aspects of the “market-driven” or “competitive” part of health care delivery in the form of “patient protection” legislation. It is truly ironic that health care in the most affluent country in the world is perceived to need continual legislative revision to protect individuals seeking health care, to guarantee that care, and to ensure it does not harm the individual. Legislation has been proposed that would let individuals see the physician they wish, that would guarantee coverage for visits to an emergency room for commonly accepted emergencies, and that would hold managed care entities accountable for decisions that affect the health care of a covered individual.

These rights may seem obvious and logical, but now, apparently, we need legislation to protect these rights. These legislative efforts on a national and state level signal an acceptance of current health care delivery and financing, and an evolving era of increasing attempts to modify and regulate in relatively minor ways.

On the other hand, there are now increasingly frequent calls for truly fundamental change in health care. There have been proponents of dramatic change in the past, of course, but calls for sweeping change largely died after failure of the Clinton Health Plan. The more recent calls for change have been quiet, not because their proponents have not been vocal, but because their voice has been through the medical literature and in specialty publications, not the mass media. A prime example: Jerome Kassirer and

24 July/August MetroDoctors The1999 Bulletin of the Hennepin and Ramsey Medical Societies

MetroDoctors

Marcia Angell, the Editor-in-Chief and the Executive Editor, respectively, of the New England Journal of Medicine, stated in the December 24, 1998 issue of the Journal that “The fundamental problem is our fragmented, price-competitive health care system…Perhaps it will soon be possible to reconsider a more overarching reform that will eliminate both the incentive and the ability to shift costs. It makes no sense to have a health care system in which the name of the game is to avoid caring for sick people.” There have been numerous other pleas for fundamental change, but I have seen no sincere effort to design a fundamentally new system that could be seriously debated. One senses that no one is willing to make this effort, probably suspecting that no matter how diligent the effort, it would be doomed to failure as was the Clinton Health Plan.

Health care in the United States of America mirrors our culture. It recognizes the independence, and self reliance, of the individual. It fiercely supports a free enterprise approach — health care in many ways has become a business, with many participants making large profits with the blessing of the populace and of the government. We are a consumer society, consuming large amounts of resources with attendant hype, redundancy, waste, and inefficiency. The disadvantaged and poor are left to fend for themselves as best they can by the majority, but are helped by bureaucratic government organizations and the altruism and dedication of a relatively few, mostly independent, charitable organizations and individuals.

What is the future of health care in our state and in our country? A quote attributed to Winston Churchill comes to mind: “Americans will always do the right thing — after they have tried everything else.” Any fundamental change in health care delivery and financing will require 24

The Bulletin of the Hennepin andJuly/August Ramsey Medical 1999Societies

ety, their state medical association, and the American Medical Association.

With increasing power of large health care corporate entities, the continued independent spirit of many physicians, and loss of membership in broad-membership organized physician groups, the physician’s role and power in influencing health care policy in the country and in Minnesota has declined. If many physicians feel disheartened and powerless in regards to formation of state and national health care policy, it is not without some justification.

Recognizing the limitations of the present delivery and financing of health care, the AMA has proposed three changes to the way health insurance is provided in our country: 1) replacing the current tax exclusion of employer-provided health insurance with a tax credit for individuals; 2) changing ERISA laws and state mandates so that individuals may either purchase affordable coverage or join risk pooling cooperatives; and 3) broaden the concept of employer-provided health benefits to give favor-

able tax treatment to individuals purchasing health insurance on their own. These proposals would not lead to any fundamental change in delivery, but could lead to changes in financing of employer-based health insurance.

What should you do as a physician? I urge all physicians to be active and involved on whatever level makes sense for them. Talk to your neighbors about what is important to physicians and to health care in your community, your state, and in our country. Speak out at medical staff meetings. Get to know your elected government officials. Call and write them when an issue needs attention. Involve yourselves with other groups of physicians in whatever way you see value, be it a staff organization of a health care institution, a specialty society, local society, state society, or national society. And remember your commitment to the practice of medicine. If you want health care delivery and financing to improve, you need to be active and involved. âœŚ

RMS Family Night St. Paul Saints Camera-ready Ad provided 1/2 Page

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

July/August 1999

25

Ramsey Medical Society

cultural change. Cultural change will probably occur slowly, and therefore, changes in health care will most likely come slowly and incrementally.

What should be the physician’s role? Physicians generally have embraced their ability to practice independently, and have staunchly supported fee-for-service financing. This has changed significantly with the advent of managed care and a market-driven, business oriented style of health care delivery, with large corporate entities controlling large patient populations and delivery systems. More and more physicians are employed by these large health care corporate entities. It is estimated that nearly half of all Twin Cities physicians are employed and do not practice independently. Employed physicians have certain responsibilities and loyalties to their employer, which have changed the traditional physician-patient relationship and their relationship with their profession. One other consequence has been that they are much less apt to be a member of their local medical soci-

RMS NEWS Resident Todd A. Capistrant, D.O. University of Osteopathic Med., Iowa Family Practice Bethesda University Family Practice Clinic Victor Lazaron, M.D. University of Massachusetts General Surgery U of MN - Dept. of Surgery

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

Active Daniel Berndt, M.D. University of Utah Emergency Medicine St. Joseph’s Hospital - ER J. David Brown, M.D. University of Minnesota Ophthalmology/Internal Medicine HealthPartners-Ardenwood Spec. Center Steven S. Eisenberg, M.D. SUNY-DOWN Medical School Family Practice Blue Cross Blue Shield of Minnesota

Randall T. Loder, M.D. Washington University Orthopaedic Surgery/ Pediatric Orthopaedic Surgery Shriners Hospital for Children

Julie A. Scheff, M.D. University of Minnesota Family Practice University Family Physicians Alexander S. Tretinyak, M.D. University of Minnesota General Surgery University of Minnesota

Scott M. Yarosh, M.D. University of Minnesota Family Practice Highland Family Physicians

Transfer into RMS (Active) Keith E. Folkert, M.D. University of Iowa Administration/Geriatrics/Internal Medicine Blue Cross Blue Shield of Minnesota

Active Retired Brian Campion, M.D. University of Minnesota Cardiology/Internal Medicine Professor, University of St. Thomas

John R. Hotchkiss, Jr., M.D. University of Chicago Internal Medicine/Nephrology/ Critical Care Medicine Regions Hospital

Correction We regret that in the May/June issue of MetroDoctors we inadvertenly listed Dr. Kohli’s specialty incorrectly. It should have been listed as Neurology, not Neurological Surgery.

Jagdeep Kohli, M.D. University of Calgary Neurology Neurological Associates of St. Paul

Oppenheimer 1/3 Page

In Memoriam HOMER D. VENTERS, M.D., died in

June. He was 74. He graduated from Emory University. Dr. Venters was the former chief of pediatrics at St. Paul-Ramsey Medical Center (Regions Hospital), and a professor of pediatrics at the University of Minnesota Medical School. He was a strong advocate for children who were handicapped, mentally retarded, or victims of emotional, sexual and physical abuse. ✦ 26

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The Bulletin of the Hennepin and Ramsey Medical Societies

RMS ALLIANCE NEWS DUCHESS HARRIS, Ph.D.

Home of Fergus Falls. She is also the Wilkin County Commissioner. Because of her expertise with the Veterans Home, Audrey would tackle long-term care.

Peter Dick is an analyst and facilitator with the National Health Service (NHS) Executive, part of the Department of Health in the United Kingdom. He came to the United States for the 1998-99 academic year to be the U.K. Fulbright-Humphrey Fellow. He is undertaking research into strategic management and leadership of decentralized organizations with the aim of improving the Health Service in the U.K. Peter took on Medicare and Medicaid.

Then there’s me, I’m not a nurse. I’ve never even played one on T.V. So when the doctor in my house comes home and tells me what a difficult day he’s had, I usually nod and continue doing whatever is holding my attention at the time. (As of late it’s been a much younger man — about five months old — who actually reminds me of my husband.) Anyway, I digress. My sympathy, or lack there of, for Jon’s professional stressors quickly diminished when I participated in the joint Hennepin/Ramsey Medical Society’s Internship program.

White lab coat in hand I sought out Marcus Welby or Trapper John and prayed to shadow anyone who might resemble George Clooney.

O.K. so I was a little disappointed.

What I did find were competent physicians who blended bedside manner and competence with ease.

The first day of my internship began with me “assisting” an orthopaedic surgeon. That afternoon I went to the United Hospital Emergency Room. The next morning was spent in the operating room observing a tonsillectomy. I ended my “rotation” at HealthPartners with an Internist.

Dr. Tom Valente presents Duchess Harris, Ph.D. with a Community Internship Certificate of Participation.

MetroDoctors

The Bulletin of the Hennepin and Ramsey Medical Societies

When I was observing one of these physicians I saw the best example of HMO interference with patient care. This situation dealt with a diabetic woman’s swollen feet. The physician had written her a prescription for custom made orthopaedic diabetic shoes. Her insurance company refused to pay for the shoe and told her that a custom insert would be satisfactory. When she removed these improperly fitting shoes her feet were deformed and she was experiencing pain. The insurance company did not inform the doctor, and she did not know that she could call him and express concern. Her healthcare provider re-wrote her a prescription and had one of his staff members call the insurance company.

After observing this metro doctor, it brought me back to a conversation I had in Washington, DC. “We don’t have managed care…I haven’t seen it.” This is a quote from a meeting that my three colleagues and I had with Secretary of Health and Human Services, Donna Shalala in March of 1999. I use this quote as a point of departure to underscore the complexities of managed care in the United States. I attended the public hearing on the Patients’ Bill of Rights and was encouraged to see bi-partisan support of a health care bill in a climate that has seen polarization during the Clinton Administration. I was discouraged however, that the insurance companies were able to keep the bill tabled. I hope that there can be some resolution that satisfies all three constituencies and I realize that physician families need to organize to ensure that our interests are represented both locally and nationally.

As the 1999-2000 co-president of the Alliance I have decided that my mantra will be, “It Can’t Wait: Legislate.” Of course, in my home it will be followed by, “Tough day at the office?” Not bad for a spouse who didn’t live through residency. ✦ July/August 1999

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Ramsey Medical Society

A

As the spouse of a physician and a Policy Fellow at the Humphrey School of Public Affairs, I was interested in having a “day in the life” experience of a physician. My assignment in order to get my fellowship in Policy, was to study health care with three of my colleagues. We decided that the most pertinent issues were long-term care, the uninsured, Medicare/Medicaid, and managed care.

My colleague Moira Gaidzanwa is a research analyst and coordinator of a Trust Fund for Medical Education and Research Cost for the Health Economics Program at the Minnesota Department of Health. She specializes in the funding of graduate medical education and workforce planning. She conducts research studies on issues related to health care, its affordability, and uncompensated care. Her assignment: the uninsured.

Audrey Krebs is the Coordinator of Voluntary Services for the Minnesota Veterans

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July/August 1999

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The Bulletin of the Hennepin and Ramsey Medical Societies

HMS IN ACTION JACK G. DAVIS, CEO

HMS-Officers

HMS-Board Members

Michael Belzer, M.D. Steven Bennett, M.D. Carl E. Burkland, M.D. Penny Chally, Alliance Co-President William Conroy, M.D. Rebecca Finne, Alliance Co-President Daniel F. Greeley, M.D. Raymond A. Hackett, M.D. Michael King, M.D. James P. LaRoy, M.D. Edward C. McElfresh, M.D. William D. Payne, M.D. Joseph F. Rinowski, M.D. R. Douglas Thorsen, M.D. Clark Tungseth, M.D. Joan Williams, M.D. Bret Yonke, Medical Student

HMS in Action highlights activities that your leadership and executive office staff have participated in, or responded to, between MetroDoctors issues. We solicit your input on these activities and encourage your calls regarding issues in which you would like our involvement.

Adolescent Health Care Coalition,

The Success By 6® Healthy Babies Collaborative is exploring a pilot project with Dr. Charles Rogers to increase the number of children receiving Child and Teen Checkups in the Phillips/Powderhorn communities.

Drs. David Estrin, Timothy Komoto and Dawn Martin are again serving as physician co-champions for the Minneapolis Public Schools “No Shots. No School” campaign.

A. Stuart Hanson, M.D. and Deborah Anderson, consultant, Respond 2, Inc., gave two presentations on “Abuse and Violence-Free Work Places” to union workers at Hennepin County Medical Center.

The Minnesota AFSCME Council 14 sponsored these programs.

HMS-Ex-Officio Board Members

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

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

Edward Spenny, M.D. and Richard Gebhart, M.D. were sponsors of Visitation Programs at Unity and North Memorial Hospitals at which time several

physician colleagues had an opportunity to share their thoughts and concerns about the practice of medicine with HMS leadership and staff.

Edward Spenny, M.D. and David Estrin, M.D., along with representatives from the Ramsey Medical Society and Minnesota Medical Association, attended the quarterly meeting with Allina Health System leadership.

Jack Davis has been appointed to the Board of Directors of the Center for CrossCultural Health.

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Nancy Bauer and other members of the

The Bulletin of the Hennepin and Ramsey Medical Societies

made a presentation to Hennepin County Commissioner Mary Tambornino, Minneapolis Department of Health Commissioner David Doth, and a representative from the Minnesota Department of Health, calling for a committed state-wide effort to address the health needs of adolescents. David Estrin, M.D. also attended this meeting.

On behalf of the HMS Board, Nancy Bauer made a presentation of a plaque and flowers to Mary Anderson, outgoing HMS Alliance President, in appreciation of her participation on the HMS Board and Foundation.

A meeting of the Hennepin Medical Foundation was held on June 3, 1999. A review of the investment strategies and returns was conducted.

Drs. Michael Ainslie and Karen Dickson served as co-chairs of the HMS Caucus held on June 8. Seventeen resolutions were discussed and will be forwarded to MMA for consideration by the House of Delegates.

Delegates and alternative delegates are still being sought. Please contact HMS if interested in serving in this capacity.

Thomas W. and Mary Kay Hoban Scholarship funds were awarded to Laurel

Krause, M.D. and Michael Tedford, M.D., for participation in the Leadership Development Course offered by the University of St. Thomas.

The HMS medical student board representative for next year is Bret Yonke. ✦ July/August 1999

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

HMS NEWS Randall A. Lewis, M.D. UCLA Orthopaedic Surgery Orthopaedic Consultants

New Members HMS welcomes these new members to the Society as of June 2, 1999. Schools listed indicate the institution where the medical degree was received.

David A. Augustine, M.D. University of Minnesota Psychiatry Private Practice Pablo U. Avendano, M.D. Universidad de Chile Pediatrics South Lake Pediatrics Laura A. Biglow, M.D. University of Minnesota Unspecified Specialty Kenneth R. Britton, D.O. University Osteopathic Medicine and Health Sciences - Des Moines, IA Physical Medicine and Rehabilitation Hennepin Faculty Associates Michelle A. Bussmann, M.D. University of Minnesota Dermatology Dermatology Specialists, P.A. Mari B. Daniels, M.D. University of Minnesota Pediatrics Metropolitan Pediatric Specialists, P.A. Christine M. Duncan, M.D. University of Minnesota Family Practice University Affiliated Family Physicians Samuel B. Emmons, M.D. Northwestern University Medical School Family Practice Creekside Family Practice David C. Fey, M.D. University of Minnesota Orthopaedic Surgery Orthopaedic Consultants, PA 30

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Diana C. Liu, M.D. Albany Medical College-Albany Family Practice Silver Lake Clinic, P.A.

Laxmana M. Godishala, M.D. Kakalinea Medical College, India Internal Medicine Hennepin Faculty Associates

Peter R. Loewenson, M.D. University of Minnesota Pediatrics Hennepin County Medical Center

J. Mark Haugland, M.D. University of Minnesota Cardiology Park Nicollet Heart Center Susan M. Holt, M.D. University of Minnesota Dermatology Southwest Dermatology Specialists, Ltd. Byron C. Holth, M.D. University of Minnesota Family Practice Champlin Medical Center

Flora M. MacCafferty, M.D. University of Glascow, Scotland OB/GYN Associates in Women’s Health, P.A. Stacene R. Maroushek, M.D. University of Minnesota Pediatrics Hennepin County Medical Center Tina A. Martin, M.D. University of Minnesota Internal Medicine Community University Health Care Center

David G. Hurrell, M.D. Mayo Medical School Cardiovascular Diseases Minneapolis Heart Institute

Casey S. Martin, M.D. University of Minnesota Family Practice Silver Lake Clinic, P.A.

Rajan Jhanjee, M.D. University of Minnesota General Surgery University of Minnesota/ Orthopaedic Surgery Julia P. Joseph-Di Caprio, M.D. University of Illinois at Urbana-Champaign Pediatrics Hennepin County Medical Center Brian J. Kobienia, M.D. University of Minnesota Plastic Surgery Brian J. Kobienia, M.D., PA Mark R. LaRose, M.D. St. Louis University School of Medicine OB/GYN Lakeview Clinic, Ltd. Craig J. Leesman, M.D. Wright State University SOM, Dayton, Ohio Pediatrics Mork Clinic

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Bridget A. McGill, M.D. Chicago College of Osteopathic Medicine Emergency Medicine Emergency Physicians Professional Association Daniel S. Murphy, M.D. University of Colorado-Denver Otolaryngology Minnesota Ear, Head & Neck Clinic L. James Nixon, M.D. University of Oklahoma Internal Medicine/Pediatrics University of Minnesota John C. O’Connell, M.D. University of Minnesota Pediatrics Metropolitan Pediatric Specialists, P.A. Sarah D. Pugh, M.D. University of Minnesota Pediatrics Southdale Pediatric Associates, Ltd.

The Bulletin of the Hennepin and Ramsey Medical Societies

Lisa M. Rolstad, M.D. Medical College of Wisconsin Pediatrics Metropolitan Pediatric Specialists, P.A.

Andrew K. Vaaler, M.D. University of Minnesota Internal Medicine Respiratory Consultants, P.A.

Lisa A. Ruohoniemi, M.D. University of Illinois College of Medicine at Urbana/Champaign Pediatrics Partners in Pediatrics, Ltd.

Michael T. Valley, M.D. Vanderbilt OB/GYN Park Nicollet Clinic-Shakopee

Michael T. Schulenberg, M.D. Oregon Health Sciences University, Portland Family Medicine Chanhassen Medical Center

Cherie Y. Zachary, M.D. Howard University Allergy Fairview Oxboro Clinic

Ronald L. Schut, M.D. University of Minnesota Internal Medicine Hennepin County Medical Center

Judith L. Zier, M.D. Washington School of Medicine Pediatrics Children’s Respiratory & Critical Care Specialists, P.A.

Kathleen M. Sluhoski, M.D. University of Minnesota Pediatrics Metropolitan Pediatric Specialists, P.A.

Stevan D. Zimmer, M.D. University of Pittsburgh Cardiology VA Medical Center

Laurie M. Steward, M.D. University of Nevada - Reno, NV Pediatrics Buffalo Clinic, P.A.

In Memoriam

Shelly R. Svoboda, M.D. University of Kansas Neurology Noran Neurological Clinic Stafanie Swanson-Galicich, M.D. University of Minnesota OB/GYN Southdale OB/GYN Consultants, P.A. Traci D. Swink, M.D. St. Louis University School of Medicine Pediatric Neurology MINCEP Epilepsy Care Angela K. Thompson-Busch, M.D. Johns Hopkins University School of Medicine Pediatrics Edina Pediatrics Kenneth F. Trofatter, M.D. Duke University Medical Center OB/GYN UMHC Dept. of OB/GYN MetroDoctors

DENNIS J. KANE, M.D., 79, died April

17 from complications from Alzheimer’s Disease. He received his Ph.D. and M.D. degrees from the University of Minnesota and completed his internship and residency in Internal Medicine at the University Hospital.

Dr. Kane started his private practice in 1966.

He served as vice president and medical director of the North American Life & Casualty Co. until 1984.

HARRY B. HALL, M.D., died on May 19 at the age of 87. He graduated from the University of Minnesota Medical School and then in 1938 earned the first Masters degree in Orthopedic Surgery given out by the University. He started a private orthopedic practice in Minneapolis in 1963. In 1965 he was elected the first Chief of Staff of the new Fairview Southdale Hospital. He retired in 1985.

The Bulletin of the Hennepin and Ramsey Medical Societies

on May 15 at the age of 84. He graduated from the University of Illinois and completed his internship and residency at Swedish Hospital. Dr. Schultz practiced family medicine for over 36 years. He retired in 1981.

Notes VIRGINIA LUPO, M.D. was presented with the President’s Award by the Minnesota Academy of Family Physicians. The President’s Award is given by the MAFP President to someone who has made an outstanding contribution to the MAFP and the specialty of family medicine.

AN HMS MEMBER PHYSICIAN is

sought to serve on the Medical Admissions Committee at the University of Minnesota Medical School. (Position is being vacated by Paul Bowlin, M.D.) The Admissions Committee is a standing committee of the Executive Faculty of the University of Minnesota Medical School. Qualifications include a person who is interested in medical education and who is committed to the future practice of medicine in all its forms; is openminded, a team player, and available to give extended time to committee work. Committee members are responsible for reviewing applicant files, making decisions regarding the merit of individual applications, and attending regularly scheduled committee meetings where those decisions are acted upon. Meetings are held Monday and Wednesday afternoons, 12:30 (lunch) until 3 p.m. The committee is scheduled to meet once in late September, once in October, weekly in November and December, and biweekly between January and April.

THE SENIOR PHYSICIANS ASSOCIATION SUMMER SOCIAL, a luncheon

and tour of the Minneapolis Institute of Arts, is open to all physician members and their spouses. It will be held Wednesday, August 11; social hour begins at 11:00 a.m. Tickets are $28.00. For more information, call (612) 623-2893. ✦

July/August 1999

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Hennepin Medical Society

Andrea M. Saterbak, M.D. Creighton University Orthopaedic Surgery St. Croix Orthopedics

Marie A. Youakim, M.D. University of Minnesota Family Practice Silver Lake Clinic, P.A.

JOHN HAROLD SCHULTZ, M.D. died

HMS ALLIANCE NEWS REBECCA S. FINNE

T

This is a unique year for the Hennepin Medical Society Alliance in that we have two presidents, Penny Chally and myself. We have been busy preparing for the coming year and are excited about the possibilities that may be. We welcome the year 2000 and the celebration of HMSA’s 90th anniversary. This is especially significant in that Hennepin was the very first county Alliance, formed in 1910, when a group of physician’s wives from Minneapolis met in the Dayton’s Tea Room to discuss mutual concerns.

HMSA is a very special organization of dedicated volunteers — the one bond that brings us together is simply that we are spouses of physicians. There is understanding, friendship and sharing that occurs within this group that would be impossible to find anywhere else. As Penny and I have attempted to map out the coming year, our focus has been on the following areas: 1. To be sensitive to changing membership needs.

2. To continue and support our already successful philanthropic endeavors and to be open to new possibilities.

3. To promote opportunities of education for ourselves and others.

This past year membership has been most successful and we obtained 17 new members.

Much of that success should be credited to Judy

Nagel and her tireless efforts as membership treasurer and to Sammi Ugarte and her determination in forming the resident spouse’s group. This young group has taken on a life and momentum of its own and is now an inspiration for us.

Many of our members have volunteered to mentor our newest members and the rewards have been great. We will be offering some evening functions in the coming year and will have child care options available. Membership recruitment and retention still remains one of our greatest challenges; plans are underway for a membership drive later this fall.

Our two major philanthropic efforts, Body Works and the HIV/AIDS education folder have gotten much attention and speak volumes for themselves. We have just completed the 16th annual Body Works health fair and it was as successful this year as ever. We saw 2,400 Minneapolis third grade students during Body Works week and still had to turn away other classrooms. It was a special honor this year to have Mayor Sharon Sayles Belton attend one of the sessions and then to make a proclamation of Body Works Week in Minneapolis. The HIV/ AIDS folder, now completing its third year, has become a tremendous success with requests of over 70,000 folders that were distributed to middle school students across the state this past

Alliance members Ophelia Balcos and Mary Anderson with Mayor Sharon Sayles Belton during Body Works.

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year. Kudos to Diane Gayes, Dianne Fenyk, Julie Fenyk, Nancy Bauer, Eleanor Goodall and Candy Nordland who tenaciously pursued this project until its success became reality. We are most grateful to the Hennepin Medical Society and Hennepin Medical Foundation for their encouragement and financial support of these projects.

The AMA Foundation (formerly AMAERF) and the support of medical school education will always be dear to the heart of this organization. This year we are adding another fund raising opportunity — a garage sale — to raise money for Body Works and other philanthropic endeavors. Opportunities to serve our community abound for us as an organization and personally.

Being active in this organization is an education in itself! Whether working on a community awareness project such as SAVE (Stop America’s Violence Everywhere) or Child Health Month or partaking of an opportunity within the group, there is a learning experience at every corner. HMSA now has its very own Web page (www.hmsa.net) and this, too, should be a new and exciting tool of communication among ourselves and with others.

Our mission statement reads: The Alliance is an educational and charitable volunteer organization, working in partnership with others, to promote the health and well-being of its members and the community through education, advocacy and service. With these goals in mind, we will be working toward this mission statement. The Hennepin Medical Society Alliance, with its diverse and committed members, is a strong and viable presence, poised and ready to work in partnership with our physician spouses. Together we will continue to make a positive difference in our community and world. We look forward to a busy and productive year. ✦ The Bulletin of the Hennepin and Ramsey Medical Societies