United For Children.
With one of the busiest pediatric emergency departments in the country, Children’s ® Hospitals and Clinics of Minnesota is proud to partner with UnitedHealthcare to take on trauma - the leading cause of death and disability in children. Thanks to a generous gift from UnitedHealthcare, Children’s - Minneapolis now has a state-of-the-art emergency department designed exclusively for kids, and is working to become a Level I Pediatric Trauma Center. Together we will advance injury prevention and treatment of trauma for the children in our region. Take a virtual tour of our new UnitedHealthcare Pediatric Emergency Department located at Children’s - Minneapolis, by visiting www.childrensmn.org/Services/Trauma.
www.childrensmn.org
Doctors MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY
September/october index to advertisers Acute Care, Inc. .................................................30 Advanced Dermatology Care.........................12 AmeriPride...........................................................22 Bethesda Hospital ........... Outside Back Cover Billing Buddies ...................................................26 Brainerd Lakes Health .....................................28 Children’s Hospitals and Clinics of MN...... 1 Crutchfield Dermatology................................18 The Davis Group .............. Inside Front Cover Fairview Health Services .................................31 Hamm Clinic......................................................14 Healthcare Billing Resources, Inc. ...............24 Hogue Vein Institute ........................................13 Lockridge Grindal Nauen P.L.L.P. ................. 2 Mpls. Society of Internal Medicine .............14 Minnesota Epilepsy Group, P.A....................20 Minnesota Physician Services, Inc. ..............16 The MMIC Group .............Inside Back Cover Pediatric Home Service .....Inside Back Cover SafeAssure Consultants, Inc............................. 9 Stillwater Medical Group................................29 U.S. Army ............................................................31 Uptown Dermatology & SkinSpa, P.A.......10 Weber Law Office ............................................... 7
TCMS Officers
President Edward P. Ehlinger, M.D. President-elect Thomas D. Siefferman, M.D.
Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Marvin S. Segal, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing editor Nancy K. Bauer assistant editor Katie R. Snow TCMS Ceo Sue A. Schettle Production Manager Sheila A. Hatcher advertising representative Betsy Pierre Cover Design by Outside Line Studio MetroDoctors (ISSN 1526-4262) is published bi-monthly by the Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at Minneapolis, Minnesota. Postmaster: Send address changes to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. To promote its objectives and services, the Twin Cities Medical Society prints information in MetroDoctors regarding activities and interests of the society. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reflect the official position of TCMS. Send letters and other materials for consideration to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: nbauer@metrodoctors.com. For advertising rates and space reservations, contact: Betsy Pierre 2318 Eastwood Circle Monticello, MN 55362 phone: (763) 295-5420 fax: (763) 295-2550 e-mail: betsy@pierreproductions.com MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy. Non-members may subscribe to MetroDoctors at a cost of $15 per year or $3 per issue, if extra copies are available. For subscription information, contact Katie Snow at (612) 362-3704.
Secretary Anthony C. Orecchia, M.D. Treasurer Melody A. Mendiola, M.D. Past President Ronnell A. Hansen, M.D. TCMS Executive Staff
Sue a. Schettle, Chief Executive Officer (612) 362-3799 sschettle@metrodoctors.com Jennifer J. anderson, Project Director (612) 362-3752 janderson@metrodoctors.com nancy k. Bauer, Assistant Director, and Managing Editor, MetroDoctors (612) 623-2893 nbauer@metrodoctors.com kathy r. Dittmer, Executive Assistant (612) 623-2885 kdittmer@metrodoctors.com katie r. Snow, Administrative Coordinator (612) 362-3704 ksnow@metrodoctors.com For a complete list of TCMS Board of Directors go to www.metrodoctors.com.
The Lawyers & Lobbyists
That Doctors Trust Lockridge Grindal Nauen helps our health care clients meet the challenges posed by today’s rapidly changing health care environment. The firm’s attorneys and lobbyists provide representation in: •Government relations. •Litigation and administrative law. •Business structuring. •Contracts, sales, mergers, joint ventures. •Employment matters. •Compliance and reimbursement issues.
612-339-6900
From the Courtroom to the Capitol.™
2
September/October 2010
MetroDoctors
The Journal of the Twin Cities Medical Society
CONTENTS VOluMe 12, nO. 5
2
index to advertisers
4
PRESIDENT’S MESSAGE
SepTeMBer/OCTOBer 2010
Soon gonna Be get Mixed up By Edward P. Ehlinger, M.D., MSPH
5
TCMS IN ACTION By Sue Schettle, CEO
Page 23
6
LETTERS By Thomas P. Coleman, M.D., and Karen Lawson, M.D.
TCMS and MMa Co-sponsor aCo Conference
8
east european Medical Society of Minnesota By Elena Lev Polukhin, M.D.
11
Culturally Competent Care Means Safer and improved Care By Mary Beth Dahl
Page 25
14
MMa Helps Clinics and Docs with improving use of interpreters
15
agency Fills Critical Health Community Void
17
Center for Cross-Cultural Health By Sandra Eliason, M.D.
19
People’s Center Health Services By Peggy Metzer, CEO
21
Culturally Competent Medical Care at west Side Community Health Services By K.A. Culhane-Pera, M.D., MA
Page 32
23
new Health Care Ceo: Sara Criger, Ceo, St. Joseph’s Hospital
25
Sharing the experience: Honoring Choices Minnesota® Conference
27
First a Physician award
28
new Members/in Memoriam/Career opportunities
29
west Metro Senior Physicians/Call for Delegates/ Twin Cities Medical Forum
32
LUMINARY OF TWIN CITIES MEDICINE
Arne S. Anderson, M.D.
On the cover: Providing culturally competent care and resources to our diverse communities. Articles begin on page 8.
Page 19
MetroDoctors
The Journal of the Twin Cities Medical Society
September/October 2010
3
President’s Message
“Soon Gonna Be Get Mixed Up” edward p. ehlinger, M.d., MSph
During the intermission of an on-campus Pete Seeger concert that I attended during medical school, one of the leaders of an activist graduate student group took the stage and asked for donations to help pay the legal fees of some of the group’s members who had been arrested during a protest outside the university’s administration building. Several people in the audience vociferously disagreed with the speaker and tried to shout him down. Soon there were shouts and angry words flying back and forth from every corner of the pavilion. Today, I can’t recall the specifics of the protest or why there were such strong disagreements among audience members, but I can vividly remember exactly what happened when Pete Seeger returned to the stage. While deftly picking the melody of the first song of his second set, Pete made an announcement that went something like this, “I don’t agree with what the group is demanding, but I fully support their right to voice those demands. I also believe that there is a need for dissenting voices from all directions to be heard if our democracy and our society are going to thrive. Because of that, I will be donating my fee for tonight’s performance to their efforts. I am confident that they will use it wisely.” Before the stunned audience had a chance to react, Pete began singing a song I had never heard before. The song was simple, lively and catchy. By the second verse, the audience had stopped arguing and shouting and was joining in the singing of the chorus. From that point on there was a sense of community among the crowd that hadn’t been evident before. For the last 39 years I have periodically thought about the events of that night but had forgotten about the song. I had not heard the song again until last year when I purchased a Pete Seeger CD in honor of Pete’s 90th birthday. As soon as I heard the song, I remembered it as the song that calmed the crowd and created a sense of community during a very challenging, chaotic and divisive time. Listening to the words, I realized that the song is just as appropriate in today’s world of conflict and chaos as it was in 1971. Perhaps the message of this simple song can help us get through the struggles of dealing with differing perspectives and conflicting opinions in 2010 as effectively as it did 39 years ago. Here are a few of the verses from the song.
4
September/October 2010
ALL MIXED UP by Pete Seeger You know, this language that we speak Is part German, part Latin, and part Greek, With some Celtic and Arabic and Scandinavian all in the heap, Well amended by the people in the street. Choctaw gave us the word “okay,” “Vamoose” is a word from Mexico way, And all of this is a hint, I suspect, Of what comes next: Chorus: I think that this whole world Soon mama, my whole wide world Soon mama, my whole world, Soon gonna be get mixed up. Oh, this doesn’t mean we will all be the same. We’ll have different faces and different names. Long live many different kinds of races And difference of opinion; that makes horse races. Just remember The Rule About Rules, brother: “What’s right with one is wrong with another.” And take a tip from La Belle France, “Vive la différence.” Chorus As we strive to increase the diversity (broadly defined) of our TCMS membership and improve our cultural competency, I hope we can be appreciative of all differing cultures, voices, views and perspectives even if they contrast markedly with our own. Recognizing and accepting that we’re “All Mixed Up” may be the best and only way to develop the broader sense of community needed to successfully address the complex challenges that face medicine and our society today.
MetroDoctors
The Journal of the Twin Cities Medical Society
TCMS IN ACTION Sue a. SCheTTle, CeO
Membership Survey Results
Next 4 Responses:
The members of the Twin Cities Medical Society responded to an electronic survey sent to them prior to the March 2010 TCMS Board of Directors Strategic Planning Retreat. The results of the survey were very interesting and helped to guide the Board as they worked their way through the development of the three year strategic plan. The response rate to the survey was over 10 percent. Of those responding, 4 percent said they were very active in TCMS; 10 percent somewhat active; 86 percent not very active. 92.3 percent were non-board members or committee members; and 30 percent had recommended joining the Society to another physician; 70 percent had not. When asked to rank the activities of TCMS and how important those activities are to our membership there was a clear and consistent theme. The chart below shows the results. Top 5 Responses: Importance of Activities—Top 5
Scale: 3=important; 2=somewhat important; 1=not important 3 2.5
2.52
2.49
2.46
2.39 2.07
2 1.5 1 0.5 0
State public policy efforts
Community and public health initiatives
Local public policy efforts
Liaison with elected officials
National public policy efforts
The survey showed that there was strong support for work at the local and state level as it relates to policy and that members understood and supported the work associated with public health. There was also strong interest expressed from members related to providing educational opportunities, practice standards and regulations, helping physicians become leaders, developing reimbursement strategies, social and collegial activities and some interest expressed related to particular local and state policy and funding issues (tort reform, GMAC, etc). The survey also provided some insight into our membership journal — MetroDoctors was rated highly in terms of its value to our members. Many felt that the merger of EMMS and WMMS went smoothly.
MetroDoctors
The Journal of the Twin Cities Medical Society
Importance of Activities
Scale: 3=important; 2=somewhat important; 1=not important 2 1.98 1.96 1.94 1.92 1.9 1.88 1.86 1.84
Continuing education
General Membership Communications
Management of Society’s financial resources
Opportunities for collegiality
The survey provided the board of directors with some clear direction as they went into the Strategic Planning retreat in March 2010. The discussions at the retreat as reported in an earlier version of MetroDoctors resulted in five key areas of strategic focus for TCMS. They include: 1. Public policy advocacy 2. Community and public health initiatives 3. Support the practice of medicine 4. Promote the visibility, awareness and benefits of membership 5. Effective management of resources The TCMS executive committee and board of directors recently reviewed the Strategic Implementation Plan which sets the framework for achieving the goals of TCMS over the next three years. Currently TCMS has 5,817 multi-specialty members. Below is a summary of the categories of membership as well as various demographic information relating to gender and average age of our Regular Active members. TCMS Total Membership—5,817
851
992
3,028
Regular Active
Retired Residents Medical Students
946
Of the Regular Active Members: 927—Female 2,051—Male 50—Not Listed Average Age—50
Input from the membership was extremely valuable throughout the strategic planning process as the Board set the future direction of TCMS. Please feel free to contact me if you have any questions. I can be reached at (612) 362-3799 or sschettle@metrodoctors.com. September/October 2010
5
LETTERS
The Dark Side of Shamanism I write these lines in response to a page entitled Alumni Profile: Healing Traditional Medicine, from University of MN Alumni Association, September-October 2007, page 48; and Colleague Interview: A Conversation with Karen Lawson, M.D., MetroDoctors, July/August 2010, page 8. Webster defines Shamanism as “a primitive religion holding that gods, demons, ancestral spirits, etc., work for the good or ill of mankind through the sole medium of the Shamans.” Shaman is defined as a priest of shamanism, a magician. I have had frequent contact with shamans, their practice of “spiritual healing,” and have observed its effect on their subjects. My wife and I spent a total of 13 years on the ground in Ethiopia between 1956 and 1975. After retirement from ORS practice in MN in 1988 we were asked to assist in church hospitals in Cameroon, West
Harold Miller, President and CEO for Regional Healthcare Improvement and Executive Director of Center for Healthcare Quality and Payment Reform,
Africa. The result was 16 yearly trips to Cameroon spending an average of four months there each year. Those months were spent in surgery practice and teaching interns from the medical school in Yaounde. Our last visit to Cameroon was in 2004, after which old age ended our foreign travels. Over the years, bridges of friendship were developed with many shamans who received treatment for themselves and their families. Many remained incognito but some revealed their identity to me. The most powerful shaman of all lived on the south bank of the Blue Nile gorge in the Gendeberet wereda (county) of Ethiopia, an area of about 2,000 square miles, bounded by the Muger and Guder rivers which flow through mile deep canyons to join the Blue Nile. Our friendship started when this man was carried to us for five miles on a horse skin bed severely ill with typhoid fever, which was common in Ethiopia
Event The Role of Physicians in Accountable Care Organizations
PITTSBURGH, PA
When: Wednesday, October 13, 2010 6–8:30 p.m.
Event Partners
Where: Ramada Plaza Minneapolis,
1300 Industrial Blvd, Minneapolis, MN
Cost: $49 MMA/TCMS/MMGMA members $99 non-members
Event Co-Sponsor
RANGE MEDICAL SOCIETY
Hors d’ouvres will be served. Space is limited. Find out more and register now: www.mmaonline.net/ACOevent
The Minnesota Medical Association (MMA) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The MMA designates this educational activity for a maximum of 2.5 AMA PRA Category 1 creditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
6
September/October 2010
at that time and continues to be so now in both countries. This man’s title was Kallu, an Oromo word meaning “Chief Sacrificer.” As he explained it, he was controlled by a demon named Cherega, greatly feared by the Kallu’s subjects. When he traveled on his very tall mule, followed by a bodyguard of 10 well armed men with rifles and well filled cartridge belts, people would fall on their faces and stay prone while he passed. People were often seen crawling on knees to the galma (spirit temple) to obtain favor with Cherega. On one occasion along the trail a screaming woman was seen pounding her head against a house wall. She had been ordered by the Kallu to give her small child to a childless woman who had requested a child from the Kallu. She dared not refuse his order. One man related how when ill with what he called pneumonia, the Kallu said, “Bring six white bulls; we must kill them and pour the blood over you”; which was done. On the roof poles of the veranda running around the spirit temple (galma), a round structure about 50 feet in diameter, were hung the jawbones of cattle and sheep which had been sacrificed to Cherega; evidence that Satan and the demons require heavy dues from those who worship them. The late Karl Eric Knuttson, social anthropologist from Stockholm, published the definitive paper about the Kallu system in 1967. [Authority and Change, a study of the Kallu Institution among the Macha Galla of Ethiopia, published by Göteborg 1967.] Also, on the other side of the African Continent, I encountered other traditional healers in the delightful country of Northwest Province, Cameroon. Cameroon is a favorite location for anthropological studies with its 250 tribes and languages, and animistic religions. It is important to note that my Cameroonian M.D. colleagues who were questioned about shamanism could see no way to integrate their evidence-based medicine with shamanistic practice. They had all suffered in childhood at the hands of shamans. Kumbo, also known as Banso Hospital (http://www.cmda.org/AM/Template.
MetroDoctors
The Journal of the Twin Cities Medical Society
cfm?Section=PAACS&Template=/CM/HTMLDisplay.cfm&ContentID=19380), in the year 2000, had on its staff around 100 traditional healers and 10 M.D.’s — mostly nationals with a few expatriates. An M.D. from Canada contacted 50 traditional healers, visited their shrines, herb gardens, and studied their philosophies of healing. Fifty-four percent had some type of training by older healers and the rest had none. After training by an older healer there would be initiation to the group with incantations and sacrifice of goats and chickens, the blood stained feathers of which were hung in his shrine and kept for their invisible power. Most healers spoke of powers as coming from God. One said, “My powers come from The Almighty. He created herbs and gave knowledge to Lucifer who instructed me in a dream.” He thought of Lucifer as a messenger from God.
Most traditional healers receive remuneration in the form of goats, fowl and palm wine. Some demand cash. A man came to us with chronic osteomyelitis and non-union of fractures of femur and tibia. He showed a photo of a shaman applying a splint made of goat leg bones to the fractures. The patient had paid the equivalent of $120 U.S. for one treatment and $80 U.S. for a second treatment which consisted of applying the goat bone splint for a short time to the fracture areas. Diagnosis of illness must be made usually in the shamans own shrine where his powers reside and where the oracles of diagnosis are scattered on the ground. Shamans do not look for signs and symptoms of diseases but for causes. Spider Divination is a common tool. (Gebaur, Paul 1964 Spider Divination in the Cameroons, Milwaukee Public Museum, Milwaukee.)
Dr. Coleman, I very much hear the sincerity of your response and the intensity of the experiences you had over the years, and am certainly not in anyway suggesting the we bring dark religious practices, or sorcery, into the practice of modern medicine. Your experience, and indeed your very definitions of Shamanism, are not all encompassing, and indeed are not reflective of how this field is currently viewed in the contemporary world. Shamanism, as I teach and experience it, and as defined by current scholars in the field, is not a religion, but a world view and life path. In the Encyclopedia of Shamanism, by Christina Pratt, “Shamanism is not a system of faith, either. Rather, it is a group of common activities and experiences that link shamans and their unique experience of the world. The shaman and the people they serve value shamanism because it works; it meets their needs in practical ways. What shamans experience in their journeys in the spirit world is accepted as real.” John Matthews, in The Celtic Shaman, states: “Because it is not an organized religion as such, but rather a spiritual practice, shamanism cuts across all faiths and creeds, reaching deep levels of ancestral memory. As a primal belief system, which preceded established religion, it has its own universal symbolism and cosmology, inhabited by beings, gods and totems, who display similar characteristics although they appear in various forms, depending on their places of origin.” While the terminology cross-culturally, makes this a very confusing situation, much of what you describe as experiencing in Africa would be considered sorcery, although healers and their practices do vary widely by culture. The common goal for shamanic healers would be the health and well-being of the tribe, the homeland, and the individual. According to Sandra Ingerman, contemporary shamanic scholar, we are seeing a “renaissance of shamanism, because it is a ‘path of direct revelation.’ Shamanism requires no outside authorities, intermediaries, or even beliefs — instead, it provides powerful tools to let you tap into the unseen world for insight and healing.” It is about seeing all things in the world as connected through unseen energies or spirit; a view that is increasingly shared by both physicists and ecologists. It is that philosophy of interconnection that I personally value, and I believe has something useful to offer modern medical practices. What is most important, however, is that we be respectful of the beliefs and practices of the patients and families with whom we work, because it is their beliefs that will impact their own healing.
Another instrument seen was a monkey skull and spine assembled on a pivot. The skull was asked to tell the diagnosis. It spins and where it points when stopped gives the shaman information. Only one example of anything like a physical exam was given by a shaman who asked the patient to breathe into his closed fist. Then he would smell the hand for a diagnosis. The shamans often used cuts on the skin to deliver herbal substances into the body, saying, “Since most illnesses move in blood we cut flesh and rub the medicine into the blood stream.” Kale in British Medical Journal, 1995, described this as a common way for HIV to be transmitted and also as a causative factor in high rates of staphylococcal endocarditis. Experiences during my 88 years of life and 60 year acquaintance with medicine and surgery tell me that we should not integrate a shaman system based on superstition, ignorance and fear of the demonic world with evidence-based medicine and its life-saving and life-preserving advances. Thomas P. Coleman, M.D. University of Minnesota, 1953. Dr. Coleman joined Hennepin County Medical Society in 1967.
WEBER
LAW OFFICE Focusing on the legal needs of the health professional!
• Licensure • Employment Law • Trial Work • Wills and Estates • Regulatory Compliance
Michael J. Weber, J.D. • Former Attorney for the Board of Medical Practice • Over Six Years as an Assistant Attorney General
612-296-8080 www.weber-law.com “Committed to the Best Legal Outcome Possible Through Diligence and Resourcefulness!”
Karen Lawson, M.D.
MetroDoctors
The Journal of the Twin Cities Medical Society
September/October 2010
7
East European Medical Society of Minnesota First Steps and Future plans
S
everal years ago I moved to Minnesota and joined a small private clinic that provided care to East European immigrants — mostly Russian speaking. I was surprised to see how fast my census was growing. In a short time my schedule was full and was booked several weeks in advance. I did not understand why so many Russians came to my clinic. I later learned that Minnesota has one of the largest Eastern European communities in the Midwest. It is one of several American states that welcomed Eastern European religious refugees — Baptists, Pentecostals, Seventh Day Adventists, Catholics, and Russian Orthodox. I also realized this Eastern European community was vibrant, diverse and challenging. The first wave of Slavic people came to Minnesota after World War II; those people were primarily from the Ukraine escaping the horrors of concentration camps and the war. Later on a mass influx of immigrants came from the former Soviet Union following the demise of the USSR at the end of the 1980s, beginning of the 1990s. For the last 20-30 years Minnesota has welcomed Jewish settlers and more recently Fundamental Christians. It is a unique group of religious people who dared to believe in God and not in the Communist Party and its phony socialistic ideas. These people were persecuted in the former Soviet Union; they were not allowed to leave the Russian Empire, and only several years ago this group of people was liberated. Today the number of Eastern European immigrants in Minnesota exceeds 240,000 and represents 15 official nationalities and 230 sub-nationalities
By elena lev polukhin, M.d.
8
September/October 2010
of the former Soviet Union as well as former East European countries1. Any immigrant group, in general, presents with more health related challenges than the host population, and the Minnesota Eastern European community is no exception. Russia has the lowest life expectancy among industrialized countries1, and self-rated health in Russia and other eastern bloc countries is substantially lower compared to western populations2. The concept of mental health and disability did not exist in the former Soviet Union and other Communist countries. Conditions like depression, bipolar disorder, and schizophrenia were not recognized or differently diagnosed. Also, out of fear of reprisals, Russian citizens did not report signs of emotional discomfort to their doctors in their home countries. Even in the United States these new immigrants are underreporting mental health conditions today assuming the medical providers will inform the immigration officials and have them deported. While working with the Eastern European immigrants my colleagues and I quickly realized that our patients were completely lost in the U.S. health care system: they did not understand the
difference between U.S. and their home country medical systems; did not comprehend the great advantages of the U.S. disability and social support system; were unable to utilize community resources; and frequently continued to rely on dangerous folk medicine practices. This is why the group of community leaders and activists in collaboration with the local government decided to organize the East European Medical Society of MN (EEMS). The development of this program was a shared vision of authors: Drs. Leon Frid, Capt. Alex Tolstov, Gedaly Meerovich, David and Alla Vaynberg, Leo Grichener, Elaine and Tony Axelrod, and Alex Chernyaev; and in collaboration and support of local Minnesotans: Karen and Fred Haider, Drs. Ada Mayo, Dennis Dykstra, Constantin Starchook, Donald Jacobs; and international humanitarians like Drs. Anne Dykstra, Mark Young and many others. First steps were done in 2003, and initially the society functioned on personal funds of the president, board of directors and fellow members, supporters and pharmaceutical companies’ grants. In May of 2005 EEMS received the status of a non-profit organization and IRS tax exemption status. The first examples of EEMS activities were monthly educational articles in the Russian paper ZERKALO, community-based educational lectures and published educational booklets prepared in collaboration with American Slavic Institute. This activity of EEMS was well received by the community in Minnesota and abroad. In 2006 we received the invitation to join the national Russian American Medical Association (RAMA) and continue collaboration with many international charity organizations. While having good intentions, none of us had non-profit organization experience. Many mistakes were made, and sometimes we felt that all our attempts were futile, and that we would
MetroDoctors
The Journal of the Twin Cities Medical Society
never be able to help our people and ease their problems. But, gradually, we gained a reputation in the community, people appreciated our drive and dedication, and Minnesota colleagues admired our persistence. I remember one day Leo Grichener called me. Leo was the EEMS Board member responsible for our educational publications in the Russian speaking newspaper ZERKALO. He said, “you know, I was sick and did not write an article for this month’s issue. The next day after the newspaper delivery, I received hundreds of calls inquiring about the missed article. Why was I thinking that nobody reads us? It was one of our happiest days!” We did not know what programs to run and we decided to try several important, in our opinion, topics. I would like to tell you about some of our past, ongoing and future programs. 1. Medical Providers Directory. Our goal was to develop the network of Minnesota medical providers who are able and willing to deliver medical care to East European immigrants, with respect to the patients’ cultural and religious beliefs. Minnesota has very few Russian born physicians and they are definitely unable to help all of the people in need. We were amazed by the enthusiasm of local Minnesota providers who wanted to list their clinics in our directory. Today EEMS has published three editions of the directory that lists physicians, nurses, therapists, hospitals, nursing homes, pharmacies, nursing agencies, home care services, etc. Currently this directory is published in English and Russian, but we intend to broaden our services in Ukrainian, Serbian and Croatian. 2. Chronic Pain Management and rehabilitation Program. Pain is a big issue for Eastern European immigrants, and EEMS developed several clinical care plans: “Healthy Knee Joints” for the treatment and rehabilitation of arthritis and “Healthy Spine for the Healthy Future” for the neck and low back pain treatment (in English and in Russian). Our goal was to develop and implement clinical pathways and educational programs for the Eastern European Community in Minnesota in order to improve patients’ and providers’ understanding of comprehensive chronic pain, osteoarthritis treatment and the role of newer medications in its management. 3. Self-reported general and Mental Health Status and Disability of eastern european MetroDoctors
religious refugees in Minnesota. This research project was accomplished in collaboration with Karolinska Institute in Sweden. EEMS funded this project since we needed the realistic data about general, mental health and disability issues in the Minnesota East European population. It was one of our very first programs. It is completed, and the study results were published in prestigious scientific journals. EEMS is deeply in debt for the endless help, collaboration and friendship of Dr. Kurt Allenberg (Denmark) and Dr. Julia Blomstedt (Sweden), who helped tremendously with this research project. 4. Dystonia program. This is one of our favorite programs since it was developed and implemented by active community leader Vasyl Pelepchuk, Despite his tragic disease and disability (he suffers from dystonia himself) Vasyl continues his active community and church activities, trying to develop a peer support group for Minnesota dystonia patients. 5. Vocational rehabilitation pilot project is still in the planning phase. It is a mutual project in collaboration with the Russian American Business Cultural Association and the Department of Employment and Economic Development (Kimberly Peck, Director of DEED and Stephen Larson, vocational counsel). We want to develop and implement a vocational rehabilitation program focused primarily on disabled immigrants of Eastern European decent. Successful implementation of this program will help our poor and disabled people to preserve the dignity and enhance the quality of life through a caring, stimulating and enjoyable environment. 6. adult Day Center for Therapeutic rehabilitation for disabled and elderly eastern european immigrants (in collaboration with the Director of Slavic Community Center Gedaliy Meerovich). We continue working with several adult day care centers providing educational activities and medical support to our elders. It is interesting that recently EEMS was contacted by the Hmong community asking to help them with a similar program. 7. Fitness program for eastern european disabled and elderly. This program became a reality because of the enthusiasm of Dr. Tony Axelrod and the support of Minnesota
The Journal of the Twin Cities Medical Society
Bodybuilding Association. EEMS wants to develop the fitness program for elderly and disabled immigrants of Eastern European decent and implement it in adult day care centers, residence centers, and assisted living centers. This is a new program and we hope to develop it in the next several years. 8. Humanitarian Missions and international Collaboration. National and International Exchange Program/Visiting Professorship. This is one of our most successful programs. When we started, we published information about our newly born society at the Russian American Medical Association, WHO and UNESCO websites. We were asking for good advice, direction and help in development and implementation of our programs. We got a tremendous response from our fellow colleagues from the U.S. and Europe who are dealing with Eastern European immigrants in other states and countries. People kindly shared their experience with us, supported our efforts and tried to prevent us from most frequent mistakes (that we did anyway). As a result we have a great network (Continued on page 10)
NEW OSHA Required Employee Training Only an $10 ee y o l Emp
View an On-Line DEMO at www.safeassure.com User name: TCMS
Password: SAFE
“Safety Wise We Specialize”
September/October 2010
9
East European Medical Society (Continued from page 9)
of colleagues in Minnesota, other states and internationally. Since then we have continued our relationships including: exchange visits, workshops, and training for foreign medical providers interested in learning U.S. medical management. In 2008 EEMS hosted Dr. Kybanych Takyrbashshev from the Kyrgyz Republic, from Kazakhstan and Belorussia. 9. Medico-legal program. This is one of the most popular programs, and its goal is to educate the Eastern European community about medico-legal issues, social security disability system, no fault and workmen’s compensation, and immigration issues. This program is designed in collaboration and support of the Minnesota Bar Association, under the guidance of a young community lawyer Nadia Polukhin-Pratt, William Mitchell College of Law graduate. 10. Mental Health Program. This is one of our biggest and most promising programs. It is divided into several small projects that include, but are not limited to the following:2:26 PM Uptn. Jaime ad9 3/18/10
•
•
•
Page 3
11. Mutual project with Slavic Community Center and Jewish Family and Children’s Services of Minneapolis (JFCS). This project began in May 2006 and is devoted to development and implementation of a Coordinated Health Services Collaborative program for Russian-speaking immigrants (CHSC). The program is funded by Blue Cross/Blue Shield Foundation as a continuation of existing JFCS programs. This program was successful and is well regarded in the community; we intend to continue our collaboration that is fruitful and beneficial for the community. This is a very short list of the EEMS activities, achievements and plans. We worked very hard to learn how to run a nonprofit organization in Minnesota. Today, five years later, when our East European Medical Society is active and successful, we are thinking that we were blessed to meet people who took time to understand our ideas, support us, and share the passion to help simple people who came from the country where we were born. Today we feel much more confident and truly believe that EEMS can contribute to the East European Community of Minnesota. We are professionals who can bridge all the gaps gracefully and appeal properly to each community, but we need local experience, knowledge and connections. We continue working and learning from the best medical and professional leaders, and we are confident that we must continue running the culturally sensitive community-based programs for new Americans of the Eastern European Bloc.
Support groups for patients and care givers diagnosed with Alzheimer’s disease and other dementia-causing illnesses. These groups offer a unique cultural and linguistic way to understand and equip participants with tools to cope with Alzheimer’s disease and its impact on one’s overall functioning. Support groups for parents of children adopted from Eastern Europe. These groups provide a forum for adoptive parents to discuss the unique challenges they are facing, to provide mutual support and sharing of information, and to have medical/ mental health professionals for support, guidance, consultations and referrals. Support groups for Eastern European women married to American men. These groups provide a safe and linguistically/ culturally appropriate setting for women married through Internet dating services to discuss their concerns, support each other through the challenges of acculturation, to receive brief crisis counseling and referrals to medical, legal, and/or social services.
• All Major Insurance Accepted Jaime Davis, MD Mayo Clinic Educated Board Certified Dermatologist
Healthy Skin, it’s a Beautiful Thing!
1221 W. Lake Street, Suite 208 • Minneapolis, MN 55408 612-455-3200 • www.UptownDermatology.com
10
September/October 2010
Upt. Derm Group ad 4.8125 x4.526
• Openings in 2 to 3 Weeks • Same Day Urgent Referrals
Metro Doctors
Education • Experience Excellence ...with a smile!
REFERENCES: 1. University of MN survey. Department of Human Services and Public Health. 2001. 2. M Bobak, H Pikhart, C Hertzman, R Rose and M Marmot. Socioeconomic factors, perceived control and self-reported health in Russia, A cross-sectional survey. Soc Sci Med 1998; 47(2):269-279. 3. Y Blomstedt, S-E Johansson and J Sundquist. Mental health of immigrants from the former Soviet Bloc: a future problem for primary health care in the enlarged European Union? A cross-sectional study. BMC Public Health 2007; 7(27):1-12. 4. P Carlson. The European health divide: a matter of financial or social capital? Soc Sci Med 2004; 59:19851992. 5. Y Sungurova, S-E Johansson and J Sundquist. East-west health divide and east-west migration: Self-reported health of immigrants from Eastern Europe and the former Soviet Union in Sweden. Scand J Publ Health 2006; 34:217-221.
Elena Polukhin, M.D., president, East European Medical Society (www.eems-us.org). For more information contact Dr. Polukhin at (651) 890-2041, www.elenarehabilitation.com, or elena@hotmail. com.
MetroDoctors
The Journal of the Twin Cities Medical Society
Culturally Competent Care Means Safer and Improved Care
M
edical and non-medical staff members who are aware of cultural differences and demonstrate cultural sensitivity to the diverse values, beliefs and behaviors of their patients provide a welcoming and inclusive health care experience. They also are more likely to understand the cultural clues that can help them provide the safest and best quality care. Cross-cultural medical encounters can be puzzling for physicians who don’t properly intuit the behaviors of their patients. Vietnamese people may not ask providers questions or voice concerns. Not because they lack questions or concerns but because they value politeness and respect for authority. They may smile easily and often, regardless of underlying emotions. If they disagree or do not understand, they may simply listen and answer yes, then not comply with recommendations or return for further care. Understanding a population’s shared history and generalized characteristics can prepare providers to ask questions that lead to greater discovery. Somali refugees often suffer from unexpressed depression, anxiety and post traumatic stress as a result of torture, loss of family members, and separation from family. Providers may have to dig deeper and spend more time with these patients to better understand their cultural characteristics and backgrounds in order to make the correct diagnosis, provide the best treatment, and make sure the patient truly understands the diagnosis and treatment. Non-English speaking patients are more likely to delay seeking care, refuse services, and fail to follow recommended treatment if they don’t understand it. Staff members at a St. Paul clinic were having challenges ensuring that their
By Mary Beth dahl
MetroDoctors
Hmong patients understood their instructions for taking medications. They realized that using family members as interpreters was not working. The clinic decided to think about getting a trained in-person interpreter or telephone interpreter system for clinical encounters. Today, changing demographics in Minnesota and the nation are making it crucial for providers to recognize and address cultural issues. With recent growth in the number of immigrant residents to Minnesota, including many who speak languages other than English, patient populations are changing dramatically. Minnesota now includes the largest Somali and Liberian populations and the second largest Hmong population in the U.S. The largest urban Hmong population in the world resides in St. Paul. Between 2005 and 2035, the Hispanic population in the Twin Cities is projected to nearly triple, while the African American population is projected to double. According to the Minnesota Department of Health Status Report, nonwhite populations in Minnesota represent more than 10 percent of the state’s population. The percent of Minnesota’s population that is nonwhite is projected to rise to 13 percent by 2015 and to 16 percent by 2030. The U.S. Census Bureau predicts that within the next 50 years, nearly one-half of the nation’s population will be from nonwhite cultures. Cultural competence in health care describes systems and policies that create an effective environment to provide the best care to patients with diverse values and beliefs, as well as people with limited English proficiency and low literacy skills. Culture is influenced by many factors: language, age, gender, sexual orientation, place of birth, and length of residency in a country, as well as educational level, income level, disability, and individual experiences.
The Journal of the Twin Cities Medical Society
In many cultures, family dynamics dictate who makes health care decisions. After a Twin Cities physician understood how important family influence was in whether or not a patient would follow his treatment instructions, he realized he could have been doing a better job of communicating with the Hmong and Hispanic patients and families in his practice. People who come to the U.S. from other countries are often unfamiliar with Western medical customs and may distrust American methods of care. Several immigrant populations use home remedies not used in the U.S., such as dermabrasion techniques that leave marks on the skin, which may be misinterpreted by health care providers as signs of physical abuse. Failure to take into consideration a patient’s cultural and linguistic needs can result in miscommunication, inaccurate histories, and failure of the patient to follow medical advice. Lack of cultural understanding can lead to an inaccurate diagnosis with negative or even fatal consequences. Every clinical encounter is cross-cultural. For example, many Russian immigrants are unfamiliar with the cultural etiquette of American medicine and tend to expect more compassion and emotional closeness with their physician. In Russia a patient can confess to a doctor as if speaking with a priest. Also in Russia, hospital gowns are not provided during examinations; nudity is not considered shameful. Problems can arise in the health care setting directly from these cultural differences. Evidence shows that despite improvement in overall health for the majority of Americans, disparity in the quality of care provided continues to affect minority populations disproportionately. In Minnesota, health care statistics for populations of color do not compare favorably (Continued on page 12)
September/October 2010
11
Culturally Competent Care (Continued from page 11)
to those of the white population — even though Minnesota is consistently ranked as one of the healthiest states in the nation. Illustrating this point, a local nurse noticed a recurring theme within her clinic’s African American patient population. Almost every other patient she saw seemed to have hypertension and heart disease. This observation was confirmed by statistics which show that African Americans are affected disproportionately by the leading causes of death in the U.S., including heart disease and hypertension. To address health care disparities and promote cultural competence in Minnesota, Stratis Health, with the support of UCare, is working with approximately 20 adult primary care clinics in a statewide cultural competence initiative. Participating clinics complete a preassessment survey and receive feedback on how well they are doing in relation to the Office of Minority Health’s national Culturally and
ExpEriEncEd, profEssional ExcEllEncE in dErmatology sincE 1993 ALL CONSULTATIONS SEEN WITHIN ONE WEEK SAME DAY APPOINTMENTS FOR URGENT OR ACUTE CARE PER PCP REQUEST UP TO DATE DIAgNOSTIC AND
PrOvEN TrEATMENT MODALITIES OffErED. rOUTINE DErMOSCOPY, BIOLOgICS...
OJ Rustad, Md
BOaRd CeRtified deRMatOlOgist MediCal diReCtOR Mpls/st paul tOp dOC MOhs CeRtified suRgeOn
XTrAC LASEr fOr PSOrIASIS & vITILIgO TrEATMENT
fULL SErvICES Of
MEDICALLY PrOvEN COSMETIC AND LASEr TrEATMENTS
Ruth Rustad Md tRessa esty pa-C heatheR Kill pa-C shelly laRsOn pa-C Wendy tiMMOns pa-C
ADVANCED DERMATOLOGY CARE Medical, Cosmetic and Surgery P.A.
White Bear Lake Stillwater • ForeSt lake
651) 484-2724
www .aDC Derm . Com
MetroDoctors Ad - 20100722a.indd 1 September/October 2010
12
7/22/2010 8:05:40 AM
Linguistically Appropriate Services (CLAS) Standards. Stratis Health then provides the clinics with recommendations for strategic planning and staff training. The clinics also each receive a demographic profile of their service area, onsite consultation, education, and resources. At the end of the program, clinics will complete a post-assessment survey to measure their improvement. A similar project previously led by Stratis Health resulted in statistically significant performance improvement on all 14 CLAS Standards by the 23 participating clinics. Based on projected demographics for Minnesota and the nation, a large number of Minnesota’s future patient population will be people of color. Being deliberate about developing an infrastructure for cultural competence in your health care organization is important. Everyone has a role to play. Knowledge, skills and attitudes are needed to communicate and interact with people of different cultures. To begin, physicians and staff first need to carefully examine their own beliefs about cultural differences. We all need to be aware of personal attitudes, biases and behaviors that can influence care of patients and relationships with colleagues and staff from different racial and ethnic backgrounds. As we challenge our own reactions to people who are different confronting racism, sexism, classism, and other forms of prejudice and discrimination in clinical encounters we better understand and appreciate our commonalities and differences. Hennepin Faculty Associates in Minneapolis conducts mandatory staff education sessions on cultural competence. Faith Dohmen, RN, said, “This has been a great opportunity for us to do our part to reduce disparities in health care; it really is all about providing the best care for all our patients. These sessions have led to interesting discussions about staff ancestors and languages spoken in the homes of our staff members’ families.” Health care leaders need to make cultural competence a priority, leading by example. Improvement is possible. Conduct walkthroughs in the clinic and hospital to see what patients see every day. How friendly and accommodating are staff members? Are non-English speaking patients aware of your language services? What are the wait times for interpreters? Are translated patient education materials available
and translated signage posted? How difficult is it for your patients to get to your facility and navigate your health system? Do your staff, administration and board members reflect the diverse patient populations you serve? Find out if patients fully understand their diagnosis and treatment options. The Annex Teen Clinic in Robbinsdale conducts monthly education sessions for staff and community health educators. Brooke Stelzer, health education director, said, “Staff have watched DVDs on specific populations and have heard Minnesota International Health Volunteers speak, which has provided a great foundation to discuss a diversity of health beliefs and reflect on where we place ourselves on this continuum of beliefs.” Hennepin Faculty Associates is currently educating its staff about the clinic’s existing cultural competence policies and practices, conducting walkthroughs, and updating its training to include information on the CLAS Standards. Plans also are in place to meet with leadership to discuss changes in job descriptions and performance evaluations, and creation of a bilingual complaint process and an advisory committee with members from the diverse communities they serve. It is incumbent on the health care community — physicians, leadership and staff to be intentional in supporting meaningful efforts to meet the cultural and communication needs of their patients in order to provide culturally competent care and ensure the long-term success of health care organizations. Explore the new Culture Care Connection website for providers, www.culturecareconnection.org, to find a variety of resources that can assist you in your efforts to provide culturally competent care. Stratis Health is a nonprofit organization that leads collaboration and innovation in health care quality and serves as a trusted expert in facilitating improvement for people and communities. Stratis Health lends its expertise to hospitals, clinics, nursing homes, home health agencies, health plans, and other organizations across the health care continuum and has served Minnesota in a broad range of capacities since 1971. Mary Beth Dahl is the program manager for Stratis Health’s cultural competence initiative. www.stratishealth.org.
MetroDoctors
The Journal of the Twin Cities Medical Society
TheRegional Leader inVeinCare Using our advanced vein care techniques, we specialize in treating patients with symptomatic varicose veins, chronic venous stasis ulcers, as well as recurrent veins after surgical stripping (REVAS). • Our physicians represent the most credentialed, board certified vein specialists in the region • Over 23,000 laser vein procedures performed (EVLAs) – The most of any vein specialty clinic in Minnesota • Four convenient metro locations in Eden Prairie, Maple Grove, White Bear Lake & Woodbury
8
Regional Locations
8 6 6 . 2 1 9 . 4 6 9 9 • w w w. h o g u e v e i n . c o m
EDEN PRAIRIE • MAPLE GROVE • WHITE BEAR LAKE • WOODBURY • MANKATO • FARGO • SIOUX FALLS • DAKOTA DUNES
MMA Helps Clinics and Docs with Improving Use of Interpreters
Are you considering a mental health assessment for your patient? Hamm Clinic in St. Paul is a leader in psychiatric consultation and psychotherapy treatment. Our services include:
Psychiatric Consultations Individual and group psychotherapy Couples therapy Services in English and Spanish Evening hours
Please call our intake coordinator at 651-224-0614 with any questions you may have or visit us at www.hammclinic.org
THrougH THe work of the MMA Mi-
nority and Cross-Cultural Affairs Committee, the MMA has created an educational presentation on how to work more effectively with interpreters. “This has been an ongoing issue for physicians and clinics, and we thought that the MMA could provide a constructive product to help with this challenge,” said committee chair Dionne Hart, M.D. Since the fall of 2009, four clinics and hospital systems in Mankato, Minneapolis and St. Paul have participated in the one hour presentation and feedback session. “The primary focus is to remind physicians of the basic
components of how to work effectively with a trained interpreter,” said Hart. “We really don’t find that this information is brand new to anyone in the field, but a brush-up is always a good idea.” In addition to completed sessions at ISJMankato, Children’s St. Paul, Smiley’s Clinic and HealthEast Roselawn Clinic, there are three other sessions planned for 2010 in St. Cloud, St. Paul and Minneapolis. To schedule a presentation in your clinic or hospital system, please contact Dennis Gerhardstein at (612) 362-3745 or dgerhardstein@mnmed.org.
Celebrate your Profession!
Join Colleagues from the Whole Internal Medicine Community - Specialists and Generalists Feed your Professional Soul as a Member of the Minneapolis Society of Internal Medicine! The Minneapolis Society of Internal Medicine (MSIM) was founded in 1949 as a forum for internists of the academic and private communities of the Twin Cities to meet to exchange views and to discover new information. Today, MSIM continues to be an organization dedicated to the intellectual development of the profession, fostering discussion among physicians, providing stimulating speakers on current topics in medicine, and educating medical students about internal medicine as a lifelong pursuit.
2010 - 2011 Dinner Events Annual Medical Student Event:
September 15 - Faith Fitzgerald, MD Magical Medical History Tour
January 26 - Henry Emmons, MD
Restoring Resilience: Using Nature and Wisdom to Sustain a Healthy Mood
April 27 - Scott Litin, MD
Management Issues In Venous Thromboembolism
14
September/October 2010
MSIM Is Shaping the Future of the Profession:
• Sponsors Watson Research Award • Hosts Annual Medical Student Event • Sponsors University of MN Internal Medicine Interest Group
Join MSIM Dues are just $150 per year. Members attend three
dinner events annually at the Minikahda Club as a member benefit. 2738 Evergreen Circle St. Paul, MN 55110 ph. 651-407-1873 fax 651-407-1754 www.MSiMonline.org
MSIM Minneapolis Society of Internal Medicine
MetroDoctors
The Journal of the Twin Cities Medical Society
Agency Fills Critical Health Community Void More than 18,000 immigrants and refugees settle in Minnesota annually to join existing family or start new lives. That means 10 percent of the state’s families speak a language other than English, thus raising challenges for mainstream and New Americans alike. Emergency, Community, and Health Outreach (ECHO) works to close communication gaps with limited English proficiency (LEP) populations and by working with agencies to inform families about health, safety, emergency and civic engagement. ECHO’s Beginnings
ECHO was formed in 2004 by local and state public health and safety agencies. Initial grant funding helped develop ECHO’s communication model which supported emergency response activities initiated by local and state public health agencies seeking ways to communicate to LEP audiences during a public health crisis such as a pandemic or terrorist attack. “Our communication model serves to educate during non-emergencies and activate during emergencies serving limited English Proficiency audiences,” says Lillian McDonald, ECHO’s executive director. “We connect organizations trying to reach limited English speaking audiences with key leaders from those communities and together we provide culturally competent programming and outreach,” adds McDonald.
MetroDoctors
ECHO produced health, safety, emergency and civic engagement topics on public television broadcast statewide on Twin Cities Public Television’s Minnesota Channel. Cable stations extend the broadcasts on participating stations. ECHO’s toll free phone line, website and participating community-based radio stations also spread information to Hispanic, African and SE Asian audiences statewide. Information is extended to classrooms, clinics, and libraries through partnering organizations delivering DVD copies of programs or through streaming video housing an online library of topics on www.echominnesota.org. ECHO’s Growth
Interest and use of ECHO’s communication model, materials, and community connections is growing. About a third of ECHO’s funding comes from government agencies working with ECHO to improve emergency response communications. Public and private agencies sponsor culturally appropriate programming on health or civic engagement topics that the agencies alone cannot produce. Individual and organizational fundraising helps cover the remaining third of ECHO’s budget. ECHO's communication model of success has been documented locally and nationally including most recently in research titled Enhancing Public Health Preparedness for Special Needs Populations: A Toolkit for State and Local Planning and Response by the RAND Public Health Initiative. “One of ECHO’s critical successes has been in forging a positive response among a diverse population. It has done this by customizing each topic for each language and featuring native-speaking on-air personalities and expert guests” (RAND Public Health Initiative, 2010, p. 58). ECHO continues to cultivate and
The Journal of the Twin Cities Medical Society
Lillian McDonald, ECHO’s executive director
strengthen relationships within the community by extending partnerships to dozens of local and state governments and non-profit organizations. Last year, use of ECHO’s website doubled and program views have increased by 30 percent. ECHO's Education
Each month, ECHO focuses on a different health, safety, emergency or civic engagement topic and produces a television program and supporting resources are created. So far, 70 different topics have been produced. Partners can play a role in this process as subject matter experts. “I previously worked with ECHO on the STI prevention video for the Hmong community. It was such a huge success and I would love to continue working with you guys,” said (Continued on page 16)
September/October 2010
15
ECHO (Continued from page 15)
ECHO in an Emergency
Laura Vang, Planned Parenthood Minnesota, South Dakota, North Dakota. October’s focus is breast cancer. A grant from the Susan G. Komen Foundation underwrote breast cancer programming in Spanish, Hmong, Somali and Low-Literacy English on TV, radio, phone, web and targeted outreach in English Language Learning (ELL) classrooms. The educational materials titled, “Breast Cancer: Detection, Prevention, and Treatment,” are designed to educate and provide hope and resources to LEP audiences and health providers who may not realize the cultural barriers impeding patients from seeking prevention or treatment when faced with a potentially curable disease with early detection. Appearing in the program are local doctors, cancer experts, and health care organizations, providing culturally competent information and inspiration to members of the Hispanic, African and Hmong community. “English speaking patients will also benefit because the information is current and conversational rather than clinical or technical” says Paul Moore, the show’s producer.
ECHO’s system for quickly communicating critical health information was utilized in April by the Minnesota Department of Agriculture to inform Somali and East African audiences about dried uneviscerated fish at ethnic grocery stores in the Twin Cities contaminated with Clostridium bacteria known to produce potentially deadly botulinum toxin. Within hours, ECHO translated the Department of Agriculture’s news release into Somali and Oromo and circulated it through its partner network to key contacts within the East African community, ethnic media, and was posted on East African websites. “Without ECHO Minnesota’s quick ability to translate and disseminate our messages on this topic, we would not have been able to share this information with those key audiences as quickly or effectively as we did,” said Gene Hugoson, Minnesota Department of Agriculture Commissioner. How to Use ECHO
There is no charge to become an ECHO Partner. People and organizations can choose to be Supporters, Promoters, Alerters, or all three.
Examples of this are doctors and nurses who make guest appearances on ECHO’s programs, and clinics that help distribute ECHO’s DVDs and materials. “I give the Lead DVD (Lead Free Home Equals Lead Free Kids) to each family that I visit. I cannot tell you how important I think it is,” said Stephanie Hartman, PHN, MSN Saint Paul–Ramsey County Department of Public Health. Most importantly, everyone can help promote ECHO’s work or connect ECHO to grants and programming to help sustain ECHO’s resources and activities. “Public Health’s job would be much more difficult without the ECHO presentations! I cannot thank you enough for the services you provide,” said Karen Ampe, PHN, Kandiyohi County Public Health. The Mission of ECHO is to leverage partnerships to develop and deliver vital health, safety, emergency and civic engagement information to help the ever-changing and diverse population integrate and become successful in our communities. Go to www.echominnesota.org to sign up to become a partner or a volunteer, and follow ECHO on Facebook and Twitter.
Proceeds from MPS help to support the medical society’s operations. Please consider our business partners listed below as you look to reduce your operational costs.
Our partners include: • AmeriPride Services (linens and apparel) • SafeAssure Consultants (OSHA compliance) • Berry Coffee (beverages and food) • AED Professionals (AED distributor) • Stanton Group (group/individual insurance) • IC System (debt collection)
T O LEARN MORE C ALL 612-362-3704 OR VISIT : To Learn More Call (612) 362-3704 WWW . METRODOCTORS . COM / SERVICES . CFM
16
September/October 2010
MetroDoctors
The Journal of the Twin Cities Medical Society
Center for Cross-Cultural Health
D
espite improvements in the overall health status of Americans, minorities continue to lag behind whites in health status and access to care. Since the 2002 Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, each national health care disparities report has continued to document disparities related to race, ethnicity and socioeconomic status. These documented disparities in quality, access to care, and multiple types of care, pervade the American health care system. The Center for Cross-Cultural Health (CCCH), has been working to help eliminate health care disparities since its founding in 1997 with its mission to “Advance health equity by addressing the root causes of poor health and supporting equal opportunities for good health.” Since that time, CCCH has developed cultural competency programs and tools, including organizational cultural competency assessments, resources for education and training of health care personnel, and organizational cultural competency consultation. One of the important areas in which CCCH is working currently is toward the disaggregation of race and ethnicity data to better define health disparities. While much work has been done to attempt to define disparities and find ways to reduce them, the effectiveness has been limited by lack of appropriate data about the populations affected. In its Issue Brief Collecting Race, Ethnicity, and Primary Language Data: Tools to Improve Quality of Care and Reduce Health Care Disparities, The Health Research and Educational Trust (HRET) states that collecting accurate data
By Sandra eliason, M.d. director of Medical programs
MetroDoctors
is the basic foundation to eliminating health disparities and improving quality of care. They state that accurate data collected on patient race, ethnicity and language are necessary to address disparities in health care through a quality of care framework. They state that “Efforts to eliminate racial and ethnic disparities in health care must begin with valid and reliable data on race, ethnicity, and language preference.” HRET has developed a uniform framework for collecting and reporting this information in hospitals. HRET’s framework includes standards and recommendations on the appropriate sources of race and ethnicity data, the timing of data collection, and an approach for categorizing race and ethnicity for analytical and reporting purposes. The August 2009 IOM report brief, Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement, called on the Department of Health and Human Services (HHS) to develop nationally standardized lists for ethnicity categories, and spoken and written languages, with rules for aggregating ethnicity categories to the broader race and Hispanic ethnicity categories as defined by the federal Office of Management and Budget (OMB). They asked for categories for locally relevant ethnicity choices. Both The American Recovery and Reinvestment Act of 2009 (ARRA) and The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) reference the comprehensive collection of patient demographic data, including race, ethnicity, primary language and gender information.” Additionally, MIPPA gives the Secretary of HHS the authority to develop approaches for data collection that measure disparities in health care services, implement strategies that address these disparities in a way that both protects patient privacy and
The Journal of the Twin Cities Medical Society
minimizes burdens on the Medicare program, and evaluate the success of these efforts in reducing clinical outcome disparities. Locally, Minnesota Community Measurement is asking Minnesota clinics to implement what is hoped will be an effective and consistent effort to collect race, ethnicity and language data from all clinic patients in Minnesota. The Minnesota Community Measurement early adopters group, who were already collecting race, ethnicity and language data on its patients, discovered that at this time in Minnesota, “no two medical groups were using the same set of data elements,” to collect race, ethnicity and language data. Because of difficulty in deciding on appropriate locally relevant ethnicity categories in the early adopters group, the decision was made for medical groups in Minnesota to collect race/ethnicity categories based on the categories used by the OMB, along with country of origin and primary language. This is an important first step toward increasing cultural competency and decreasing disparities. Effective data collection will first help define where disparities exist, and can then be used to improve quality and effectiveness of care delivery targeted specifically to those patients experiencing disparities in health. For example, while we know that African American women die more often from breast cancer than white women, we do not know specifically within which area to target our efforts within the African American communities. If the incidence of breast cancer within the Somali community is negligible, for example, and high in the West African population, or higher in African American women who have been born in this country, should our resources be more targeted toward specific populations with higher risk? And, although the incidence of diabetes is increasing within the Hmong (Continued on page 18)
September/October 2010
17
Center for Cross-Cultural Health (Continued from page 17)
ethnicity or language rather than aggregated under the large OMB categories. Participatcommunity, measuring rates of diabetes within ing community organizations agreed to work the Asian population as a whole shows diabetes together to address this issue, and to collectively to be of less concern than in White or Latino have a larger voice than any single organization populations. By not measuring the appropriate could have alone. The group took the name level of ethnicity to define Hmong population ARCHé — the Alliance for Racial and Cultural health, targeted efforts to screen for and treat Health Equity. diabetes in a culturally appropriate way are This legislative session, ARCHé helped missed. As clinics collect data on the race, ethmove legislation through the Minnesota House nicity, and language of their populations, they and Senate which asks for an inventory of how will be better able to target quality programs race, ethnicity and language data is being coland increase culturally competent care. lected in all of the programs of the Minnesota Within communities, also, there is a growDepartment of Health and Department of Huing desire for specific health data relevant to man Services, as a first step to understand the data collection in Minnesota. This legislation their community. Communities are aware that was in alignment with work that MDH was they will not be able to define their level of health or understand their own disparities and already doing with a federal grant to inventory how to respond to them without data specific their data collection practices. Sharing of the and relevant to themselves. There is a sense of inventory by MDH and DHS will help the being invisible within the health system when community address the kinds of data that is people cannot be identified by categories with of importance to them, and to define how the which they identify themselves. collection is best practiced. In a survey of over 50 community orgaThe data disaggregation project is one nizations that CCCH carried out, one comof the important areas of work of the Cenmon area for collaboration stood out — the ter for Cross-Cultural Health. At the same Metro Dr. Ad 9/17/08 11:12 AM Page 1 need for health data to be ungrouped by race, time, CCCH is continuing consultation with
Crutchfield Dermatology “Remarkable patient satisfaction from quality, service, convenience and excellent results” “Exceptional care for all skin problems” Charles E. Crutchfield III, M.D. Board Certified Dermatologist
Psoriasis &
Acne Specialist
Your Patients will Look Good & Feel Great with Beautiful Skin www.CrutchfieldDermatology.com
18
September/October 2010
1185 Town Centre Drive Suite 101 Eagan, MN 55123
Appointments 651-209-3600 At your request, we have same day appointments available for your patients with acute skin care needs.
medical groups around culturally competent care, training on cultural competence and cross cultural communication, and convening with community groups to give a broader voice to their concerns. Other areas of work are typical to the following: CCCH is consulting with a clinic that is experiencing frustration with a clinic patient population to try to lessen frustrations among the clinic staff, improve patient relations, and lessen frustration for patients. After an internal assessment of clinic practices and an external assessment of patient experiences, recommendations will be made as to how to improve experiences for staff and patients alike, how to improve culturally competent care, and what training may be needed. That is just one of the types of consultation that CCCH does with clinic groups. CCCH has developed multiple assessment tools to improve culturally competent care in clinics, and continues training in such areas as introduction to cultural competence, cross cultural communication, working with interpreters, and especially, how to begin collecting race, ethnicity and language data in a clinic. This training and consultation is done using both the HRET and the Minnesota community measurement toolkits. It is a hands-on, step-by-step guide on how to begin to collect this data. CCCH has assisted health and human service organizations with putting into place practices and policies that enhance the organizations’ ability to provide culturally appropriate services to their patients and/or clients since 1997. Additionally, CCCH has multiple deep relationships within communities, and works in the space between health care organizations/ institutions and the communities who experience health disparities. Dr. Sandra Eliason, a physician with Fairview Health Services, has worked with the Center for Cross-Cultural Health since 2001, when she received a Bush Medical Fellowship to increase cultural competence in medical organizations. Dr. Eliason was a consultant to the AMA’s Ethical Force Patient Centered Care Initiative, one of three consultants to this program nationwide, and the only physician. If your organization is experiencing difficulties with instituting the collection of race, ethnicity and language data, implementing culturally competent care, or if you have questions about any of these issues, Dr. Eliason can be reached at Sandra.eliason@ crosshealth.org.
MetroDoctors
The Journal of the Twin Cities Medical Society
People’s Center Health Services
N
estled in the heart of the Cedar-Riverside neighborhood, People’s Center Health Services proudly specializes in providing affordable health care to patients of all racial, ethnic and socioeconomic backgrounds — and has for 40 years. As a Federally Qualified Health Center, People’s Center Health Services is able to address financial barriers to quality health care with our sliding fee scale program. Serving disadvantaged communities and helping patients overcome barriers has always been at the heart of our organization. At People’s Center Health Services, no one is denied care due to lack of insurance or employment status. We offer care on a sliding fee scale based on family income and family size to those with no insurance or a very high deductible. We accept most insurance plans, including those that are government-subsidized and if you don’t have insurance, our social service department can assist you in applying for the help you need. People’s Center Health Services always strives to strengthen the cultural competency of our organization in order to best meet the expectations of all our patients, and with 79 percent of patient visits from communities of color and 64 percent of visits from East African patients, this has been a top priority. This means opening our minds and hearts to the community we serve and investing in resources to create a welcoming environment that celebrates diversity. Our quest to best serve our patient base began with our patients...we listened and reached out to them so we could partner and connect around health and wellness concerns.
By peggy Metzer, CeO MetroDoctors
Our next step was to recruit and train personnel from the communities we served. Our goal was to develop a multi-lingual, multi-cultural staff so people from all over the world could relate to them and feel comfortable. As a result, our clinic currently has the in-house capacity to communicate in over 10 languages including Arabic and Farsi. One notable example is Dr. Ahmed Mohamed, who joined People’s Center Health Services in 2008. His vast international medical experience and fluency in Somali, Arabic, Italian and English, makes him a perfect fit for the diverse patient population in Cedar-Riverside and at People’s Center Health Services. Prior to working in the United States, Dr. Mohamed worked as a physician in hospitals and refugee camps in Somalia and Kenya. His passion to help people from all walks of life makes him a natural fit at People’s Center Health Services. Our diverse team is a blessing, but it also means we have to work toward bridging in-house cultural divides among staff as well as between staff and patients. This is why People’s Center Health Services makes diversity training for all staff a priority. These frequent training sessions, with professional facilitators, help build a better understanding of cultural awareness and what “respect” and “unconditional positive regard” means among many different people. Ultimately,
The Journal of the Twin Cities Medical Society
positive staff relations strengthen our awareness as compassionate and respectful care givers to our patients. Because more than 50 percent of our patient visits are Somali immigrants, People’s Center Health Services offers several special programs targeted toward this group. Everyone is eligible to participate, and program participants include people with no Somali heritage. (Continued on page 20)
September/October 2010
19
People’s Center Health Services (Continued from page 19)
Examples are: the Somali Post Traumatic Stress Disorder Program, Somali Diabetes Program, Somali Obesity Program, and Somali Hepatitis Program. In addition, we are developing a Somali Diabetes Education Video. Since the video will target the Somali population, we will use a Somali video production company and will produce three versions: one in Somali, one in Oromo, and one in English. In addition to having a medical clinic that embraces culturally diverse needs, People’s Center Health Services prides itself on its Behavioral Health department. We understand the advantages of helping individuals, couples and families address mental health needs through ongoing therapy with a licensed professional. Many of our patients are recent immigrants from East Africa. They have unique needs. Thus, we have invested extra resources into developing a Post Traumatic Stress Disorder Program to support their health and well-being. Most of our PTSD patients have experienced
torture or exposure to torture as a result of civil war in countries from which they fled. In molding our program to fit these situations, our behavioral health staff has matched our PTSD program with the cultural beliefs and practices of our patient base. Our team is well versed in East African religions and culture and comfortable discussing traditional practices with PTSD clients. As part of this enhanced program, we have developed four major cultural competencies, which have resulted in high demand for PTSD clinic services: • Knowledge of resettlement issues encountered by East African asylum seekers, who have fled civil war. • Cultural competence with traumatized people from East Africa. • Comprehension of personal torture and war trauma, as well as collective trauma experienced by this group. • Complex coordination with interpreters, who provide translation services to PTSD clients. Working with patients who have PTSD
Minnesota Epilepsy Group is the largest and most comprehensive epilepsy program in the Midwest. As a regional referral facility, we are the recognized leader in treating epilepsy and other seizure-related conditions in patients of all ages, from infants to the elderly. We also offer comprehensive neuropsychological assessment for a broad range of acquired or developmental neurological conditions in both adult and pediatric patients. Adult Epileptologists Deanna L. Dickens, MD Julie Hanna, MD El-Hadi Mouderres, MD Patricia E. Penovich, MD Pediatric Epileptologists Jason S. Doescher, MD Michael D. Frost, MD Frank J. Ritter, MD Functional Neuro-Imaging Wenbo Zhang, MD, PhD
Appointments (651) 241-5290
225 Smith Avenue N St. Paul, MN 55102 www.mnepilepsy.org
20
September/October 2010
Neuropsychologists Elizabeth Adams, PhD Robert Doss, PsyD Ann Hempel, PhD Donna Minter, PhD Gail Risse, PhD
is a very individualized process. Each patient meets with a therapist/counselor and develops a care plan to address their unique circumstances to empower them to make small changes that will impact how they can better deal with their symptoms. There is a growing need for innovative approaches that address current gaps in services, increase access, and show promise in reducing the incidence and severity of symptoms in PTSD patients. This is a need People’s Center Health Services continuously works to fill. When it comes time to sit down and review our demographic reports, statistics and financials, we know what the numbers say about our patient population. But it is in the patient stories and interactions that we see the true impact of working toward a better understanding of our culturally diverse patient base. One of our patients, a 67-year-old Somali man who was a successful merchant and businessman back home, made plans to flee Somalia after he lost everything in the war. Every month he meets with our clinical social worker. He sometimes cannot talk about his losses without crying. Instead, he prefers to reminisce about the world he knew before the conflict. Because the People’s Center Health Services clinical social worker lived in Africa during the ’70s, they have many shared memories. Directly after a follow-up PTSD visit, he said to the clinical social worker “I fear I will never again in my lifetime experience the dignity and beauty that once was my Africa, but visiting with you each month helps me remember, and for a short while, I am happy remembering the sweeter times.” Our clinic experiences patient interactions like this on a daily basis and, ultimately, they fuel our passion and drive. Working to best serve our patients is a steady process of evaluation and self-awareness as an organization. It means conducting patient surveys, holding patient-based focus groups, listening to the ideas of our community and staff, and always asking ourselves “How can we do better?” It requires a diverse, agile staff and a set of unique services that reflects the wants and needs of our patients — two key components that make People’s Center Health Services a medical home to thousands of patients.
MetroDoctors
The Journal of the Twin Cities Medical Society
Culturally Competent Medical Care at West Side Community Health Services
C
ulturally Competent Care. Culturally Appropriate Care. Culturally Responsive Care. Cultural Humility. As physicians, we have heard these terms (and others!) through the years, and have seen many changes through the decades as organizations and individuals have tried to deliver better patient-centered care to patients outside the health care mainstream. At West Side Community Health Services (“West Side”), we have always emphasized culturally competent care. West Side is a nonprofit 501(c)(3) community health center (or Federally Qualified Health Center (FQHC), which is also sometimes known as the “nation’s safety net”). We have been serving medically underserved individuals and families for over 41 years. West Side was begun in 1972 by a few volunteers serving the Latino community in a one-room clinic in a local church, who had a vision of a culturally responsive clinic for Spanish speaking people. Now, West Side is the largest FQHC in Minnesota, serving over 32,000 patients a year from multiple ethnic groups including White, Black, Latino, Hmong and Somali patients. In 18 locations across St. Paul, West Side provides primary medical and dental care at three medical clinics, two dental clinics, four homeless clinic locations, and nine schoolbased clinics in St. Paul high schools. We are family physicians, physician assistants, nurse practitioners, midwives and dentists providing outpatient primary and dental care led by an executive director and community board. Our patients are often isolated from traditional medical care due to lack of insurance (49 percent are uninsured), low incomes (83 percent have incomes below 200 percent of the federal poverty level), race or ethnicity (84 percent By K.a. Culhane-pera, M.d., Ma associate Medical director
MetroDoctors
are from communities of color), the language they speak (44 percent do not speak English as a first language), or their complex health care and social needs. Throughout the years, we have considered it our goal, our responsibility, and our strength to deliver culturally competent services to a wide variety of people. For us, culturally competent care means having many facets of care, such as the following: 1. Sixty percent of West Side employees are bilingual-bicultural professionals, including receptionists, medical assistants, lab technicians, phone operators, medical records personnel, nurses, midwives, nurse practitioners, physician assistants, and doctors who provide primary care. 2. Bilingual-bicultural interpreters are available during all clinic hours. 3. Signs, information and health educational materials are written in Hmong, Spanish and English at a fifth grade reading level. 4. Pharmacology doctors provide education about medicines and diseases as well as provide low-cost medicines for people without insurance. 5. Social workers, psychological therapists and behavioral health professionals address patients’ social and emotional needs that can promote mental and physical health. 6. Patient advocates assist patients with registration, insurance questions, co-pays and West Side’s Discount Program. 7. The Discount Program allows patients without insurance to receive medical care at an affordable price. The Discount Program is a sliding-fee scale program based on household income and federal poverty guidelines. We turn no one away for inability to pay. 8. A myriad of special programs provide support and medical care, including diabetes
The Journal of the Twin Cities Medical Society
education, an HIV clinic, SAGE cervical and breast cancer screening, Healthy Start prenatal care, antenatal classes, and car seat education. 9. Most importantly, West Side staff respect patients’ autonomy to make medical decisions in the context of their cultural milieu. We are committed to working with patients and families to support their need to be understood and to understand. Providing such multi-faceted, individualized care is challenging, of course. Providers and staff must be motivated to serve the under-served, and must be well-trained, beyond medical expertise, in working with patients from diverse backgrounds and cultures. Finding and retaining culturally responsive staff can be difficult, especially in the context of today’s limited primary care workforce. And providing care for the uninsured in tight financial times is an enormous challenge. Like all community health centers, our budget is supplemented by grants from the federal government (Section 330 of the Public Health Service Act) as long as we comply with its multiple regulations. We also rely on and our workload is reduced (Continued on page 22) September/October 2010
21
10-049_HealthStyle_Msg_tall.qxd:Layout 1 7/22/10
You will be surprised how little it costs to: • Promote Your Professional Image • Build Patient Confidence • Reduce Employee Turnover • Increase Office Efficiency
AmeriPride’s HealthStyle full-service programs include lab coats, scrubs, warmups, fluid-resistant coats, patient gowns and more. Partner with a company that will enable you to meet or exceed CDC and OSHA requirements for handling your health care laundry needs. AmeriPride’s HealthStyle service provides your employees with a professionally laundered and quality finished garment to wear every day. You can be confident your complete healthcare service will be delivered by the People You Can Count On for only pennies a day.
To schedule a consultation, please contact Eric Garten, HealthStyle Services Consultant, at 612-362-0353 or email at eric.garten@ameripride.com
22
September/October 2010
West Side Community Health Services (Continued from page 21)
by medical volunteers at the clinic and hospitalists at Regions Hospital who admit our non-obstetrical patients. At West Side and other community health centers, such challenges are part of our everyday work. But they also lead us to our greatest impact. The following vignettes highlight how we deliver culturally competent care and the difference it makes for patients: • A 67-year-old Hmong woman arrived at the clinic, embarrassed to explain that for several months she had vaginal bleeding. Although she had never had a pap smear, she allowed the Hmong-speaking female doctor to perform a pelvic exam and even smiled at the end of the visit, feeling relieved that her problem was going to be addressed. Later she returned for the results, heard the diagnosis of cervical cancer, and accepted her referrals for complete evaluation and multiple treatments. • A 26-year-old pregnant Latino woman was diagnosed with gestational diabetes. Having watched her grandmother die of gangrenous limbs from diabetes in Mexico, she was fearful about what diabetes would mean to her pregnancy, her baby and her future. She met with her provider and a Spanish-speaking diabetes educator every two weeks. She learned a lot about diabetes, and she channeled her fear into action: walking 30 minutes every day, eating small amounts of refried beans and tortillas, measuring her sugar four times a day, and ultimately taking four shots of insulin every day. After delivering a normal-sized infant, she continued her diet and her exercise, determined to create a different future for herself and her children. • A 57-year-old Latino man with diabetes, hypertension and obesity, became homeless last winter and experienced frostbite to three fingers on his left hand. Afraid no one would help him, he sought care at a homeless clinic. To his relief, he found people who cared for him who spoke Spanish, accompanied him to the ER and accompanied him to the hand surgeon, so that ultimately his fingers healed and he was able to avoid an amputation. • A 56-year-old Hmong man was diagnosed with cirrhosis from Hepatitis B. He came
to us after his initial hospitalization and diagnosis. Fearful of spreading Hepatitis B through the family, he had started eating and sleeping by himself, and had stopped hugging his wife, children and grandchildren. With the help of his Hmong physician, Hmong community health worker, and Hmong social worker, he learned more about the disease, and was better able to cope with the poor prognosis. • A 42-year-old Latino woman was concerned about a breast lump because her aunt had died from breast cancer in Mexico. Without insurance, we were able to obtain a breast exam, a mammogram, and a biopsy for her under the SAGE program, ultimately giving her the reassuring diagnosis of fibroadenoma. • A 23-year-old Latino pregnant woman understood her baby had a cleft lip, but when he was born, she was horrified at the sight, and could not stop feeling guilty, responsible and repulsed. With assistance from her Spanish-speaking midwife and family doctor, and with support from the social worker, she was able to keep all surgical appointments and within nine months, was happy with the cosmetic results. • A 62-year-old unemployed and uninsured white man was not able to afford prescription medicines for hypertension, and was overusing alcohol to cope with his depression. He came to the clinic feeling ashamed about his situation, but after receiving medical care, he applied for the Discount Program, obtained low-cost medicines, and had discussions with a social worker about alcohol and started attending Alcoholics Anonymous. • A 58-year-old Hmong man with weight loss, fatigue, and polydipsia/polyuria was depressed when his provider diagnosed him with diabetes mellitus. Fearful of being disabled for the rest of his life, he was reassured to find education and lively role models when he joined the Hmong diabetes support group. He became an active member, as well as an active partner in managing his diabetes with his family physician, diabetes educator, social worker, and community health worker. For more information about West Side Community Health Services, please visit our website at www.westsidechs.org.
MetroDoctors
The Journal of the Twin Cities Medical Society
New Health Care CEO:
Sara Criger, CEO, St. Joseph’s Hospital Editor’s note: MetroDoctors continues to highlight newly named health care executives. Each CEO has been asked to outline his/her vision and challenges for their organization as well as offer some personal insights. Sara Criger became Ceo of St. Joseph’s Hospital in 2007. She’d been president of Fairview ridges Hospital in Burnsville for five years before that, capping nearly 16 years of leadership roles in the Fairview system. She recently discussed her leadership at St. Joseph’s with MetroDoctors. It is common to ask CEOs to identify their biggest challenges and opportunities. To start with something different, what was your biggest surprise when you came to St. Joseph’s Hospital? I distinctly remember my realization of the incredible things happening at this 250-bed hospital! St. Joseph’s wasn’t really on my radar before then; in fact I only previously knew it as the big parking ramp on 35E in downtown St. Paul. But I quickly realized it was a very humble Catholic Hospital with several “best in class” programs. With that said, what are your biggest challenges and opportunities? In my mind the biggest challenges often provide for the greatest opportunities and health care reform has to be right up there. We’re going to see changes in the coming years that are unparalleled and, realistically, we are heading into some uncharted territory. We know there will be financial implications. In the immediate term, St. Joseph’s is slated to see a cut in government funding for many of the neediest patients, just like most other hospitals. And as a CEO, I am concerned about that. Additionally, health care reform is likely to continue taking patients out of the hospitals for their care — delivery models will be more focused on home care and non-hospital settings for certain procedures. And while it is the right thing to do, this will have additional financial implications on hospitals — especially in the short term while the new reimbursement models are being designed and implemented. But we also are on the cusp of tremendous opportunity. The federal reform legislation sets us on a clearer path toward reimbursements for outcomes and improved health. The accountability spelled out in the reform doesn’t call for anything more from health care providers than we ought to be demanding from ourselves. And we are well positioned to keep moving forward at St. Joseph’s. I’m proud of our outcomes on CMS measures and the infrastructure we’ve created to keep improving clinical outcomes, as well as our accomplishments in reducing — even eliminating — complications. MetroDoctors
The Journal of the Twin Cities Medical Society
I have to say one more thing about reform. The rancor and incivility of the debate were disappointing — and, to be honest, nothing frustrated me more than the stated position that we are better off financially as a community if we “cut health care coverage” for those insured by GAMC. Let’s be real, our hospitals and health care systems aren’t going to stop providing care just because the State of Minnesota stops paying us. But we are going to create a wider chasm between the haves and have-nots for the right kind of care. I feel very strongly about that and, as CEO of a hospital in the urban core, I see the results every single day. The uninsured include — though certainly not exclusively — the addicted and mentally ill. Our Emergency Department is often their lifeline, though I don’t know anyone who thinks that is a good way to deliver care. These, and many other patients, are living crisis to crisis. There’s no such thing as a medical home for them. Health care reform, I hope, will help us improve these inequities very soon. What attracted you to St. Joseph’s? That’s a long list, but one particularly appealing feature is the durable and very rich mission. We’re the oldest hospital in Minnesota, founded by the Sisters of St. Joseph of Carondelet in 1853. The Sisters remain a strong presence and their ideals have created a platform for remaining true to our community — both the haves and the have-nots — with a commitment to the very best care. Those principles create a framework through which programs of distinction grow and flourish at St. Joseph’s. A good example is our National Brain Aneurysm Center (NABC). It started less than a decade ago and is now one of the top five centers for aneurysm treatment in the United States. The physicians in NBAC and St. Joseph’s not only meet established national clinical benchmarks in care, but they often are (Continued on page 24)
September/October 2010
23
New Health Care CEO (Continued from page 23)
How does St. Joseph’s surprise people?
creating new evidence and benchmarks in outcomes for stroke, neurovascular surgery and intervention, and neurointensive care for patients. The same can be said about our Heart Care Institute. We’re early, and safe, adapters and advancers in heart care, interventions and surgery. Another reflection of our culture and the commitment to care. Tell us more about physicians and their role in St. Joseph’s programs like the National Brain Aneurysm Center. The key to that program, and others, is the physician champions who drive us toward a higher goal. One of the common threads among them is their tenacity, a near-obsession for excellence in care for patients; they also share St. Joseph’s vision. That’s a good alignment. It’s not always about the high-end technology, either. One of the programs I’m proudest of is the HealthEast Mental Health and Addiction Medicine program at St. Joseph’s, where about 50 percent of our patients have a dual diagnosis of addiction and mental health disorders. There are only a couple other programs in Minnesota that treat dual diagnosis patients — the challenges are significant with this complex patient population. But we have very dynamic physician leadership of our interdisciplinary program and we’re showing that treatment can bring hope into the lives that a lot of others dismissed as hopeless. We’ve carved out a unique identity at St. Joseph’s. We’re not all things to all people but what we do, we do very well. And that often ends up surprising people.
♦ Insurance/Patient Billing and Collection ♦ Accounts Receivable Management ♦ Accounts Payable/General Ledger ♦ Payroll/Fringe Benefit Management ♦ Experienced in over 30 Medical Specialties ♦ Qualified and Experienced Staff ♦ Owned and Managed by Experienced Healthcare Practice Management Professionals Healthcare Billing Resources, Inc. 2854 Highway 55 Suite 130 Eagan, MN 55121
Contact: Rita Kieffer 651-224-4930 Rita@HMR.Net
24
September/October 2010
Let me tell you about our Maternity Care program. At St. Joseph’s, we have the lowest Cesarean section rate in the country — about 10 percent. We’ve held steady, while the rate keeps climbing elsewhere; it’s 32 percent nationally and 26 percent in Minnesota. Our partnership with HealthEast’s midwifery program is essential to that accomplishment but it takes more and — to be honest — I think we’ve achieved something that eludes most hospitals. We’ve created an environment where the relationship between the hospital staff, the obstetricians and family practice physicians, and the midwives is based on mutual respect, a commitment to a unique approach to care together, and a steadfast commitment to safety. Our culture doesn’t just permit that, but it encourages that kind of vision and collaboration. The result is that we are providing a unique care experience in the Twin Cities with very high patient satisfaction to moms, babies and families. Some are from different cultures, and they are looking for an experience that fits most closely with their heritage and beliefs. Other mothers from all walks of life — they have done their research and are coming to us from throughout the metro area and see us as a “birth destination.” They know our partnership between midwives and physicians is going to help them deliver on their own terms, and safely. Our mantra in Maternity Care is “our turf, your birth.” What keeps you going?
Rounding, whenever I can. Being on the floors and in the places where the patients are and where their families are… where care is happening. There’s nothing like it. A CEO is going to spend a lot of time in meetings, but the more time I can spend rounding, the more my decisions as a leader are informed. I love to spend time with physicians and nurses and everyone else who is part of St. Joseph’s. The listening and understanding are essential. We may not always hear what we want to from each other, but you have to listen to each other in order to understand. Rounding keeps me connected to the team and to patients. I meet people whose lives have been turned upside down by a brain hemorThe outsourced rhage. That keeps me focused on being the business office solution best for the patient and the family. And I meet for your the market-savvy moms-to-be with plenty of options or the middle-aged gentleman with medical practice schizophrenia and a drug problem with very few options outside of St. Joseph’s. Their presence at St. Joseph’s keeps it real for me — we have to be the best for everyone. Everyone plays a critical role at St. Joseph’s. Ultimately, mine is to make sure the physicians and staff have what they need so we can be the best for our patients. It’s not always easy, but it is actually that simple.
Healthcare Billing Resources, Inc.
MetroDoctors
The Journal of the Twin Cities Medical Society
Sharing the Experience: Honoring Choices Minnesota速 Conference Honoring CHoiCeS MinneSoTa速 (HCM) is a collaborative, community-wide
initiative to promote discussions and systems for advance care planning. From January through June of this year, seven locations in the Twin Cities area served as the initial pilot sites to test and refine the Honoring Choices Minnesota program. On Tuesday, July 20, 2010, a conference was held to present the outcomes and learnings of the HCM pilots. Reports were given by each site to summarize their work during the past six months. Allina and Park Nicollet, who are both actively involved with Honoring Choices Minnesota, also provided updates on their respective implementation of systemwide advance care planning standards. These PowerPoint presentations can be viewed on our website at www.metrodoctors.com. Advance care planning expert, Bud Hammes, Ph.D., from Respecting Choices速 at Gundersen Lutheran Health System, shared national and global advance care planning news and offered feedback to the pilot teams on Bud Hammes, Ph.D., (left) and Kent Wilson, M.D. after their work. the conference. Kent Wilson, M.D., the medical director of Honoring Choices Minnesota, discussed next steps, which includes a revision of the HCM health care directive, development of patient education materials, a second round of pilot sites beginning in January 2011, and Kent Wilson, M.D. and Bill Hanley of Twin Cities Public Televia civic engagement comsion are filmed for a brief spot on TPT regarding Honoring ponent with partners Twin Choices Minnesota. Cities Public Television and Anne Gilmore, LICSW presented the work of Hennepin County Medical Center. the Citizens League.
Sylvia Bobbitt, of Fairview Oxboro Clinic, discusses the efforts of their pilot.
MetroDoctors
The Journal of the Twin Cities Medical Society
The seven pilot sites were: Fairview Ridges Hospital HealthEast Fairview Oxboro Clinic HealthPartners Fairview Red Wing Medical Center Hennepin County Medical Center Fairview Eagan and Rosemount Clinics
September/October 2010
25
Established in 2007, this award recognizes an unsung hero of the Twin Cities Medical Society who, through his/her dedicated and untiring service to the profession of medicine, has made an outstanding contribution to community service; worked on public policy issues; played a significant role in the governance and success of the Twin Cities Medical Society; or other noteworthy (local) volunteer medical service. NOMINATION FORM
Nominee: Name: Home Address: Home Phone: I believe he/she is deserving of this recognition and meets the qualifications of this award because
Supporting documentation would be greatly appreciated. Nomination submitted by: Name: Address: Phone Number: E-Mail Address: Entries can be submitted: By Mail:
First a Physician Award Twin Cities Medical Society 1300 Godward Street NE Suite 2000 Minneapolis, MN 55413
By E-Mail:
kdittmer@metrodoctors.com
By Fax:
612-623-2888
Entries must be postmarked by Oct. 15, 2010
If you have any questions, contact Kathy Dittmer at 612-623-2885. MetroDoctors
The Journal of the Twin Cities Medical Society
September/October 2010
27
New Members
CAREER OPPORTUNITIES
See Additional Career Opportunities on page 29.
Lisa O. Erhard, M.D. Oakdale OB/GYN, P.A. Obstetrics/Gynecology David R. Hilden, M.D. Hennepin Faculty Associates Internal Medicine Andrea L. Lampland, M.D. Associates in Newborn Medicine, P.A. Pediatrics Michael P. Leehy, M.D. Bethesda Hospital Internal Medicine Kathleen R. Michalk, D.O. Western OB/GYN, Ltd. Obstetrics/Gynecology Stacy L. Noyes, M.D. Oakdale OB/GYN, P.A. Obstetrics/Gynecology Jason B. Olinger, M.D. Metropolitan Anesthesia Network, LLP Anesthesiology Daniel M. Ries, M.D. Regions Hospital Pediatrics, Hospitalist
In Memoriam THeoDore “TeDDY” BerMan, M.D., passed away July 19, 2010 at the age of 61. He graduated from the University of Minnesota Medical School. He specialized in pulmonary disease. Dr. Berman practiced with the Minnesota Lung Center and the Minnesota Sleep Institute. roBerT geraLD “gerrY” CarLSon, M.D., 80, passed away July 17, 2010. He graduated from the University of Minnesota in 1954. He practiced general surgery in Willmar, MN. Starting in 1965, Dr. Carlson began his life-long training, study and practice of cardio-vascular surgery. He trained with Dr. C. Walton Lillehei. Dr. Carlson helped pioneer revascularization surgery, which included the use of the membrane oxygenator and implementation of the current technique of direct coronary artery connection that is now used world wide. As assistant professor of surgery at Cornell University Medical School, he participated in the first heart transplant
28
September/October 2010
in New York City in 1969. He finished his career teaching chest surgery at Texas A and M University Medical School. Dr. Carlson served his country as a captain in the Air Force from 1956-1958. JoSePH P. ConnoLLY, M.D., age 86, died on June 23, 2010. He graduated from the St. Louis University School of Medicine in 1952 and practiced family medicine. PauL LewiS Joern, M.D. died at age 43 after a two year courageous battle with malignant melanoma. He graduated from the University of Minnesota, and was a board certified anesthesiologist in Buffalo, MN. During the last two months of his life, Dr. Joern and his family worked to establish a foundation to help people who struggle with melanoma — half for research and half for families who struggle financially with this cancer. CHarLeS e. “CHuCk” LinDeMann, M.D., age 86, passed away peacefully at his cabin
on Clearwater Lake in Deerwood, MN, on May 29, 2010. He received his M.D. degree from the University of Minnesota in 1946. After serving as a doctor in the U.S. Army, he specialized in internal medicine at Southwest Internists, P.A., in Minneapolis. A natural leader, he was elected president of the Hennepin County Medical Society, vice-president of the Minnesota Medical Association, president of the Minnesota Chapter of the American Society of Internal Medicine, and chief of staff at St. Mary’s Hospital. In recent years he served as chair of the health care committee at Friendship Village in Bloomington, where he was a resident. JoHn B. MaunDer, M.D. passed away July 20, 2010 at the age of 89. He graduated from the University of Minnesota. He served as a captain in the United States Air Force. Dr. Connolly specialized in obstetrics and gynecology.
MetroDoctors
The Journal of the Twin Cities Medical Society
Twin Cities Medical Society Presents
West Metro Senior Physicians
T
he TCMS West Metro Senior Physicians Association met at the Black Forest Inn for its June 8 meeting. We had a grand turnout for the presentation by Bette Hammel and Karen Melvin on their new coffee table book, Legendary Homes on Lake Minnetonka. The slide show and detailed description of the homes was enjoyed by all. The next meeting will be held on Tuesday, September 21, 11:30 at the Broadway Ridge Building, 3001 Broadway St., NE, Minneapolis, MN. Brenda Paul, MS MA, State Quality Measurement Program Development Project Manager, will be our guest speaker. For more information about the September 21 meeting or about joining this association, contact Kathy Dittmer at (612) 623-2885, kdittmer@metrodoctors.com or visit our website at www.metrodoctors.com. Go to the Foundations tab, West Metro Medical Foundation, and then Senior Physicians Association.
•TCMS Members• WE NEED YOUR PARTICIPATION to serve as a DELEGATE at the
Minnesota Medical Association’s Annual Meeting
September 15-17, 2010 (Wednesday evening–Friday afternoon) Breezy Point Resort near Brainerd, MN TCMS is eligible for 119 Delegates. This is your opportunity to make a difference by testifying at the reference committees, acting on the resolutions submitted statewide and voting for your colleagues willing to serve as your MMA Officers.
NEW! Twin Cities Medical Forum Speaker: Stephen T. Parente, Ph.D., Carlson School of Management
Friday, November 19, 2010 7:30 a.m. – 8:30 a.m. United Hospital John Nasseff Medical Center, 333 North Smith Ave. St. Paul, MN – Miller/St. Luke’s Conference Rooms
Watch TCMS website for additional information, www.metrodoctors.com
CAREER OPPORTUNITIES
See Additional Career Opportunities on page 30.
Current Opportunities in:
Family Medicine Gastroenterology OB/GYN Stillwater Medical Group is an 85 Physician multi-specialty group practice affiliated with Lakeview Hospital. For more than 50 years we have been providing comprehensive healthcare services in the beautiful St. Croix River Valley in Stillwater, MN. The historic town of Stillwater is located just east of the Twin Cities metro area and offers excellent recreation as well as a small town feel. For further information, please contact:
Patti Lewis, Director Human Resources Stillwater Medical Group | 1500 Curve Crest Boulevard | Stillwater MN 55082 (651) 275-3304 | plewis@lakeview.org | www.stillwatermedicalgroup.com
Bringing the best to you
Contact Kathy Dittmer at kdittmer@metrodoctors.com or (612) 623-2885 to participate.
MetroDoctors
The Journal of the Twin Cities Medical Society
September/October 2010
29
Career Opportunities
CAREER OPPORTUNITIES
Please also visit www.metrodoctors.com for Career Opportunities.
Introducing the “Career Opportunities” section of MetroDoctors!
A great avenue for professionals to learn about job opportunities AND a perfect place for recruiters to promote openings! Recruiters, call for our special recruitment rate.
THE STRENGTH TO HEAL and get
back to what I love about family medicine. Do you remember why you became a family physician? When you practice in the Army or Army Reserve, you can focus on caring for our Soldiers and their Families. You’ll practice in an environment without concerns about your patients’ ability to pay or overhead expenses. Moreover, you’ll see your efforts making a difference. To learn more about the U.S. Army Health Care Team, call SFC Daniel Ebbers at 952-854-8489, email daniel.ebbers@usarec.army.mil, or visit healthcare.goarmy.com/info/e928.
Betsy Pierre, ad sales 763-295-5420
©2009. Paid for by the United States Army. All rights reserved.
betsy@pierreproductions.com
Visit TCMS at www.metrodoctors.com
Fairview Health Services Opportunities to fit your life Fairview Health Services seeks physicians to improve the health of the communities we serve. We have a variety of opportunities that allow you to focus on innovative and quality care. Shape your practice to fit your life as a part of our nationally recognized, patient-centered, evidence-based care team. Whether your focus is work-life balance or participating in clinical quality initiatives, we have an opportunity that is right for you:
with just one click you will find information on the latest TCMS news, events and legislative issues; Board and committee actions; past issues of MetroDoctors;
Cardiology Dermatology Emergency Medicine Family Medicine General Surgery Geriatric Medicine Hospitalist Internal Medicine
Med/Peds Ob/Gyn Pain Palliative Pediatrics Psychiatry Pulmonology/Critical Care Urgent Care
Visit fairview.org/physicians to explore our current opportunities, then apply online, call 800-842-6469 or e-mail recruit1@fairview.org. Sorry, no J1 opportunities.
and new career opportunities! fairview.org/physicians TTY 612-672-7300 EEO/AA Employer
MetroDoctors
The Journal of the Twin Cities Medical Society
September/October 2010
31
LUMINARY of Twin Cities Medicine By Marvin S. Segal, M.d.
ArNE S. ANDErSoN, M.D. This last page series is intended to honor esteemed colleagues who have contributed significantly to Twin Cities medicine. Please forward names of physicians you would like considered for this recognition to Nancy Bauer, managing editor, nbauer@metrodoctors.com.
Arne Anderson, M.D. has modestly served our Twin Cities community — perhaps as no other, before him or since — for well over a half century. He has been and remains a visionary, a pathfinder, a founder, a pioneer … and a darned nice chap. Dr. Anderson was Minnesota educated during the great depression, having obtained his B.A. at St. Olaf College and his M.D. at the University of Minnesota — both institutions having since honored him with Distinguished Alumnus Awards. His Pediatric Fellowship at the Mayo Clinic was followed by the attainment of an M.S. degree in pediatrics and pathology after returning to the U of M. His mid-1940s U.S. Army service was performed domestically and in Europe, and other volunteer foreign service activities later led him to sites in Africa, India, Thailand and Brazil. In addition to the dedicated family life he has enjoyed with his wife, Rusk Dalton Anderson, and their 10 children, his most profound commitments have been with two major community institutions, Children’s Hospital (CH) and the Saint Louis Park Medical Center (SLPMC). He was a founder of the original Minneapolis CH, a driving force in its early development and a benevolent facilitator in its more recent successful merger with Saint Paul Children’s Hospital. He served CH in many capacities — medical director, trustee, president/ CEO and senior consultant. Dr. Alan Goldbloom, current president/ CEO of Children’s Hospital and Clinics of Minnesota, spoke of Dr. Anderson in glowing terms: “ … a visionary who was bound and determined to create a children’s hospital, despite most of the other community hospitals being opposed to it. It wasn’t just a building he was after; rather the creation of a unique, family-centered environment that would ensure that all children, regardless of socioeconomic status, had access to the highest of quality care.” At Children’s, he cared for kids (a Master Clinician), instituted a firm and continuing collaboration with the U of M Pediatric Department (an Educator), studied the efficiencies and effectiveness of care 32
July/august 2010
delivery (a Researcher) and — perhaps most importantly — inspired his colleagues, staff, patients and their families. In 1949, Arne Anderson was one of the 10 original founders of the SLPMC, a predecessor to Park Nicollet Health Services (PN). Dr. David Abelson, present CEO/president of PN, nicely summarized Dr. Anderson’s long standing association with that successful multifaceted organization: “ … his influence as a role model continues to shape PN … committed to serving the community both in and out of the exam room … his remarkable vision enabled him to understand what needed to change while preserving and enhancing the essence of physicians’ work.” Among the many positions he held at the SLPMC were president of Trustee Board, founder/director of the Research and Education Foundation and chief of staff. Dr. Anderson worked with Senator Hubert Humphrey to enact a supplemental food program for women and children — just one of an array of remarkable activities which ranged far beyond CH and PN. The American Academy of Pediatrics, the Minneapolis and Edina School Boards, the Viking Boy Scout Council, our Minnesota Medical Association and Southern Minnesota Medical Society, Fairview Hospital, Mount Sinai Hospital and Mount Olivet Church are but a few of the entities that have benefitted from his wise counsel. His countless accolades and honors included two very special ones related to our local medical societies — the prestigious Charles Bolles Bolles-Rogers and Shotwell Awards. At the dedication of a Children’s Hospital Education Center named in his honor, he was described as a superb, competent and compassionate professional who fought a personal war against misfortunes that befall children — ill health, poverty and racial discrimination. As he has for many years, Arne Anderson continues to “walk the halls” of Children’s and Park Nicollet. Perhaps his shock of flowing reddish hair has become silver, but his enlightening involvement and vision are constant reminders of core values in medicine as he engages us in conversation steeped in experience and wisdom. We are proud to honor him as a Luminary in Twin Cities Medicine.
MetroDoctors
The Journal of the Twin Cities Medical Society
They were told:
“
Take him home. Hold him.
“
We told them:
“
“
He’ll starve to death in a few weeks.
You’re always there for them.
Take him home.
We’re always here for you. We have defended and supported the individual needs of health professionals for more than 30 years. And nobody is more personally committed to protecting you from the risks you face every day. That was seven years ago. And although Tyler only has six centimeters of short colon, we work with his family and physicians to help
To learn more, call 800-328-5532 or visit MMICGroup.com
him thrive at home. Meet the miracle at tylerthrives.com
visit www.pediatrichomeservice.com click
Protecting Your Peace of Mind.
And thanks to HealthEast® Concussion Clinic at Bethesda Hospital, I could play it safe. The HealthEast Concussion Clinic offers a threelegged approach integrating neuropsychology, physical therapy and medical care to manage concussions. We utilize tools such as ImPACT™ cognitive testing and take advantage of our team’s extensive experience and expertise including neuropsychology specialists who fine-tune treatments for each unique, individual concussion. So patients like Simone can return to their daily lives and favorite activities, safely and successfully. For more information about the HealthEast Concussion Clinic at Bethesda Hospital located in St. Paul, please visit bethesdahospital.org or call 651-326-4323.