September/October 2016 Women in Medicine

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Doctors Metro MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY

Women in Medicine

In This Issue: t $POUSJCVUJPOT UP .FEJDJOF CZ 4JY 0VUTUBOEJOH 'FNBMF 1IZTJDJBOT t $IBOHJOH %FNPHSBQIJDT BU 6./ .FEJDBM 4DIPPM t UI "OOVBM 4IBSJOH UIF &YQFSJFODF )FME t %PFT ZPVS $PNNVOJUZ 3FTUSJDU *OEPPS & DJHBSFUUF 6TF t -VNJOBSZ PG 5XJO $JUJFT .FEJDJOF

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CONTENTS VOLUME 18, NO.5 SEPTEMBER/OCTOBER 2016

3

IN THIS ISSUE

A Refreshing Evolution of Progress

By Marvin S. Segal, M.D.

4

PRESIDENT’S MESSAGE

Really—I am the Doctor

By Carolyn A. McClain, M.D.

5

TCMS IN ACTION

By Sue Schettle, CEO WOMEN IN MEDICINE

6

•

Gender Matters at the University of Minnesota Medical School

By Michael H. Kim, M.D. and Kathleen V. Watson, M.D.

8

•

Colleague Interview: A Conversation with Margit L. Bretzke, M.D.; Deborah L. Day, M.D.; Tamera J. Lillemoe, M.D.; and Beverly A. Trombley, M.D.

13

•

Kealy Ham, M.D. Pulmonary and Critical Care Medicine

15

•

Jennifer Hsia, M.D. Otolaryngology, Sleep Medicine

18

•

Erica Sanders 3rd Year Medical Student

20

•

SPONSORED CONTENT:

Page 32

Page 28

22

•

Jennifer Tessmer-Tuck, M.D. OB/GYN Hospitalist

24

•

Meghan Walsh, M.D., MPH Chief Academic OfďŹ cer, Hennepin Health System

26

Sharing the Experience 2016

By Karen Peterson

28

Summer of Zika Forum

Page 29

Half of Minnesotans Breathing Easier Under Indoor E-cigarette Restrictions

29

In Memoriam Senior Physicians Association Career Opportunities

32

Janette Hansen Strathy, M.D.

Page 26

MetroDoctors

LUMINARY OF TWIN CITIES MEDICINE

The Journal of the Twin Cities Medical Society

4FQUFNCFS 0DUPCFS

Reections on a Life in Medicine

By Sara J. Shumway, M.D.

Doctors Metro MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY

Women in Medicine

In This Issue: t $POUSJCVUJPOT UP .FEJDJOF CZ 4JY 0VUTUBOEJOH 'FNBMF 1IZTJDJBOT t $IBOHJOH %FNPHSBQIJDT BU 6./ .FEJDBM 4DIPPM t UI "OOVBM 4IBSJOH UIF &YQFSJFODF )FME t %PFT ZPVS $PNNVOJUZ 3FTUSJDU *OEPPS & DJHBSFUUF 6TF t -VNJOBSZ PG 5XJO $JUJFT .FEJDJOF

Featured Women in Medicine on the Cover: Top from left: Erica Sanders, MS3; Jennifer Hsia, M.D.; Kealey Ham, M.D. Bottom from left: Jennifer Tessmer-Tuck, M.D.; Sara Schumway, M.D.; Meghan Walsh, M.D.

September/October 2016

1

Doctors MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY

Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Robert R. Neal, Jr., M.D. Physician Co-editor Marvin S. Segal, M.D. Physician Co-editor Stephanie Misono, M.D. Physician Co-editor Richard R. Sturgeon, M.D. Physician Co-editor Charles G. Terzian, M.D. Medical Student Co-editor Mac Garrett Managing Editor Nancy K. Bauer TCMS CEO Sue A. Schettle Production Manager Sheila A. Hatcher Advertising Representative Erica Nelson Cover Design by Emily Larsen 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 St. Paul, 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.

September/October Index to Advertisers

TCMS Officers

President: Carolyn A. McClain, M.D. President-elect: Matthew A. Hunt, M.D. Secretary: Thomas E. Kottke, M.D. Treasurer: Nicholas J. Meyer, M.D. Past President: Kenneth N. Kephart, M.D.

Audiology Concepts .........................................11 Coldwell Banker Burnet..................................12

TCMS Executive Staff

Crutchfield Dermatology.....................................

Inside Front Cover

Sue A. Schettle, Chief Executive Officer (612) 362-3799; sschettle@metrodoctors.com

Entira Family Clinics .......................................29

Nancy K. Bauer, Associate Director, and Managing Editor, MetroDoctors (612) 623-2893; nbauer@metrodoctors.com

Fairview Health Services .................................31

Karen Peterson, BSN Executive Director, Honoring Choices Minnesota (612) 362-3704; kpeterson@metrodoctors.com

Healthcare Billing Resources, Inc. ...............14

Lynn Betzold, Program Coordinator, Honoring Choices Minnesota (612) 362-3703; lbetzold@metrodoctors.com

M Health .............................................................17

Annie Krapek, Assistant Project Coordinator Physician Advocacy Network (612) 362-3715; akrapek@metrodoctors.com

Saint Therese.......................................................16

Emily Larsen, Marketing & Communications Coord.

(612) 623-2885; elarsen@metrodoctors.com Helen Nelson, Administrative Assistant, Honoring Choices Minnesota (612) 362-3705; hnelson@metrodoctors.com

Greenwald Wealth Management ..................12 Lakeview Clinic .................................................31 MMIC ................................ Outside Back Cover Senior LinkAge Line.........................................19 St. Cloud VA Medical Center .......................30 St. David Center .................................................. 2 Uptown Dermatology & SkinSpa................25 U.S. Army ..............................Inside Back Cover

Ellie Parker, Project Coordinator Physician Advocacy Network (612) 362-3706; eparker@metrodoctors.com

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: Erica Nelson 4084 Jana Ave. NE St. Michael, MN 55376 phone: (763) 497-1778 fax: (763) 497-8810 e-mail: erica@pierreproductions.com MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy. Advertisements published in MetroDoctors do not imply endorsement or sponsorship by TCMS. 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 Andrea Farina at (612) 623-2885.

I

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September/October 2016

MetroDoctors

The Journal of the Twin Cities Medical Society

IN THIS ISSUE...

A Refreshing Evolution of Progress IT IS WELL WITHIN THE MEMORY of many of us that medical school admissions for future women physicians hovered in the 10-15% range only a short two or three decades ago. Some of us have questioned just why so many well qualified females with a scientific inclination and a partiality for the healing arts chose, or were chosen into, professions other than the practice of medicine. Numerous intelligent young women then elected nursing, physical therapy, medical technology, etc. — admittedly noble and engaging pursuits themselves — as their life work.

The reasons for this propensity were multiple, though central among them was undoubtedly the widespread and erroneous expectation that a physician should be a man. Thankfully, those notions are briskly changing as our profession is now benefitting from a transition that finds bright and industrious women assuming their rightful numerical position next to their male counterparts in the fields of medicine.

This issue of MetroDoctors is devoted to Women in Medicine. Its articles display an array of successful and dedicated Twin Cities women who provide us with meaningful insight into the “Refreshing Evolution of Progress” that we are witnessing first hand — including the thoughts supporting it, the reasons behind it, and some of the tribulations encountered along the way.

• Drs. Kim and Watson lead off with experiences at our U of M Medical School, factual demographic information and speculation regarding ongoing future improvements of the status of women in medicine.

• The Colleague Interview departs from our usual format by featuring telling answers — almost in a conversational tone — by four (not one) physicians who played prominent collaborative roles in the creation, development and continuing management of an important community medical resource. The Piper Breast Center was brilliantly conceived and should prove to be around a long time providing multispecialty care for this common malignancy.

• Profiled through the next several pages are six female physicians engaged in leadership and/or extraordinary

By Marvin S. Segal, M.D. Member, MetroDoctors Editorial Board

MetroDoctors

The Journal of the Twin Cities Medical Society

•

clinical work in their fields of interest. A colleague at their respective institutions recommended each of these physicians to our editorial Board. *Dr. Kealy Ham, a Pulmonary and Critical Care clinician at Regions Hospital, weaves her personal experiences through an account of modern cutting-edge care provision. *Dr. Jennifer Hsia, a U of M otolaryngologist, utilizes an athletic metaphor with the hard work required for medical training and its later application to the important condition of obstructive sleep apnea. *Erica Sanders, a third year medical student, describes her varied preparation pathway for a career in medicine, and imparts mature words of wisdom suggesting an approach that takes advantage of a golden opportunity. *Dr. Sara Shumway, a U of M cardiovascular surgeon, crisply recounts her educational background, early clinical experiences and the wise counsel of her gifted physician father as her meaningful clinical accomplishments continue to grow. *Dr. Jennifer Tessmer-Tuck, a North Memorial OB/GYN Hospitalist, transparently describes her transformation into the new field of obstetrical in-patient care (Laborist), and recounts both positives and negatives of that burgeoning specialty. *Dr. Meghan Walsh, a general internist, unabashedly describes her dedication to medical education as she applies it in her role as Chief Academic Officer for the Hennepin Health System.

Lastly, you’ll not want to miss the fascinating story of this issue’s Luminary, Dr. Janette Strathy — a very special physician.

Enjoy this issue of MetroDoctors — it’s a good read!

September/October 2016

3

President’s Message

Really—I am the Doctor CAROLYN A. McCLAIN, M.D.

I HAD JUST FINISHED EXPLAINING A COMPLICATED CHEST PAIN DISCHARGE TO

a patient and her family with a number of medication changes and follow-up appointments.

Prior to leaving the room I asked my usual question, “Do you have any other questions for me?” One of the family members sheepishly asked, “So... we aren’t going to see a doctor tonight?” Deep breath. I was wearing my white coat with my name embroidered on my chest. My ID tag hung on my front pocket, facing the right direction for a change. My name was on the white board in front of the family and this was my third time in the room sitting down with them explaining the plan and course of their emergency department visit. Each time, I reintroduced myself as Dr. McClain. Despite the multiple introductions and the uniform, as a woman, I did not meet their expectations of what a doctor should look like. Thankfully, I have a spiel for this situation; this is not the first time this has happened, nor was it the first time this had happened that shift. I walked back over to the chair and sat down and started my patient experience recovery, “I am the doctor.”

For most women in medicine, this will be a familiar story. It likely happens more in a hospital setting where patients are not familiar with their caregivers and are forced to revert to stereotypes. But the truth is, despite Grey’s Anatomy, the stereotype of a doctor, although changing, is still predominantly male. Unfortunately, people in stressful situations not only trust but need stereotypes. For example, if your house caught on fire, and a woman in Lululemon yoga pants and a flowery T-shirt hooked up the fire hose and started spraying your house, even if she said she was the fire chief, you would have some reservations. Every day, despite the uniform of scrubs, a white coat, and the obligatory stethoscope, there is an undercurrent of disbelief. Because first and foremost, I am a woman, and women historically weren’t doctors. It isn’t a personal criticism, it is just an outdated expectation. Most patients are easily won over and can quickly put aside their initial impressions but as women, we often have to put in extra effort.

Within medicine, however, that stereotype is quickly changing. Today, almost half of the medical school graduates are women, meaning that within the rank and file of practicing physicians, there is less of an expectation that the physicians one works with will be male. In fact in some specialties, like OB-GYN the expectation by both patients and referring physicians is that the doctor will be female. I am forever thankful for the women that began practicing medicine 100 years ago and paved the way for me to work in a career where my biggest complaint is that sometimes people didn’t expect a female physician. In 150 years we have gone from Elizabeth Blackwell, a lone beleaguered female physician in New York, to the rare male OB-GYN. Women have embraced medicine as a career and the women of the millenial generation are transforming the culture. The new residency graduates have embraced the power of social media and there are a number of social media outlets that women use to help support each others career choices. I recommend the Physician Moms Group on Facebook. It was started by a young physician in 2014. Today there are 56,000 members and the postings range from negotiating contracts to challenging cases to coping with a lawsuit to managing nanny issues. This morning, a surgeon posted a picture of her child’s rash and in 10 minutes four dermatologists had weighed in on the diagnosis.

For emergency medicine, there is a blog called Feminem. Women physicians from the U.S., Canada and Australia have offered recommendations on negotiating maternity leave, average salaries, and how to homeschool your kids while working full time. Social media has allowed women to find role models outside of our local hospitals and get real time advice from other women facing the same challenges.

One of the recently started medical blogs for women is called #I look like a surgeon. It has a series of pictures of women who are, not surprisingly, surgeons. My guess, is that the woman that started this blog had her share of (Continued on page 5)

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September/October 2016

MetroDoctors

The Journal of the Twin Cities Medical Society

TCMS IN ACTION SUE A. SCHETTLE, CEO

TCMS President Meets With Commissioner Piper

Carolyn McClain, M.D., TCMS president, recently met with the Commissioner of Human Services Emily Johnson Piper and discussed issues around the mental health needs she experiences in her work as an emergency medicine physician. She also spoke about the Honoring Choices MN appropriation.

achieve health equity in maternal and child health.

Summer of Zika Event Held

All of the metro area hospitals participated in supporting the Summer of Zika educational event held on July 26. Over 100 people registered for the event which was held at Moos Tower at the University of Minnesota. Speakers included Peter Bornstein, M.D., Frank Rhame, M.D., and David Neitzel, MS, and Elizabeth Schiffman, MA, MPH, both from the MN Department of Health. (See related story on page 28.)

TCMS Public Health Programs Spotlighted at National Conference

TCMS President Carolyn McClain, M.D., with Commissioner of Human Services Emily Johnson Piper.

TCMS Meets With Congresswoman McCollum’s Staff

Sue Schettle and TCMS past president Lisa Mattson, M.D. met with Congresswoman Betty McCollum’s staff in July to talk about concerns that the Congresswoman has about inadequate access to quality maternal and child health services in multicultural communities.

Dr. Mattson shared her experience as an OB/GYN and provided insights to

The American Association of Medical Society Executives recently opened the door for TCMS staff to share insight into the public health programs that we have built over the past decade.

More than 300 people attended the national conference in Baltimore, MD in July. Ellie Parker, MPH talked about the work TCMS has done in tobacco control, and Sue Schettle spoke about the Honoring Choices Minnesota effort.

There is strong interest from all over the country to replicate our public health programs that are oftentimes accompanied by non-dues revenue opportunities for county and state medical societies.

Sue Schettle and TCMS past president Lisa Mattson, M.D. met with Congresswoman Betty McCollum’s staff.

MetroDoctors

The Journal of the Twin Cities Medical Society

Sharing the Experience Conference

The 7th annual Honoring Choices Sharing the Experience Conference was held on July 21. Over 100 people were registered for the event which was kicked off by MN Hospital Association’s Rahul Koranne, M.D. with an inspiring message for all participants. Senator Amy Klobuchar also had a video-taped message for the audience. (See related article on page 26.)

MMA and AMA Elections

Three Past-Presidents of TCMS are running for Minnesota Medical Association elected positions. Robert Moravec, M.D. is a candidate for President-elect; Lisa Mattson, M.D. and Michael Tedford, M.D. are seeking MMA Trustee seats.

In addition, two TCMS members are running for re-election for AMA Delegation appointments: David Estrin, M.D. is seeking his 2nd term as an AMA Delegate and William Nicholson, M.D. is running for his 2nd term as AMA Alternate Delegate. The MMA Annual Conference and House of Delegates will be held Sept. 23-24, 2016.

PRESIDENT’S MESSAGE (Continued from Page 4)

“But, am I going to see a doctor?” We have come a long way from Elizabeth Blackwell but we still have a ways to go. We have made a recent breakthrough — there are now physician emojis that are both men and women. We have to celebrate our small victories. In 20 years, half of the practicing physicians will be women and each day we go to work we break down the stereotypes a little more. Things are changing.

If my daughter grows up to be a doctor, I have little doubt that when she walks in the room and introduces herself as the doctor, she will be heard. But for now, I will continue to wear my white coat, keep my name tag in a prominent position and reintroduce myself each time I walk in the room.

September/October 2016

5

Women in Medicine

Gender Matters at the University of Minnesota Medical School

T

he University of Minnesota Medical School, through its undergraduate and residency programs, has helped train nearly 70% of the physician workforce in Minnesota1 including both of us. One of us (MHK) had the privilege to matriculate in 1991 with the first class in our school to have an equal number of women and men. Since then the proportion of female matriculates has remained near 50%, however despite 25 years of gender balance the number of women in practice and in academic medicine is still well below that of men. Recently there have been some changes. Women are starting to enter some specialties that traditionally have been dominated by men and more women physicians are beginning to fill the ranks of junior faculty. Major differences still exist: most specialties of medicine are predominantly male; significant sex differences in salary exist; and leadership roles in academic medicine are held primarily by men.

Advances in Gender Equity

A recent review of state licensure data shows that 33% of physicians practicing in Minnesota are female which mirrors the national average.2 This is a big increase from 1970 when across the country only 7.6% of physicians were female; and by 2000 that number had risen to 24%.3 It takes time for the impact of gender equity in medical education to be evident in the workforce. Minnesota Board of Medical Practice data shows that 42% of physicians in Minnesota who were licensed for less than 16 years were women, while 22% of

By Michael H. Kim, M.D. and Kathleen V. Watson, M.D.

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September/October 2016

physicians who were licensed for more than 30 years were female.4 Data from the past three years shows that some female students at the University of Minnesota Medical School are shifting their preferences Michael H. Kim, M.D. Kathleen V. Watson, M.D. towards residency programs in specialties previously preferred by men. When of Associate Professors and 17% of Full compared to the percent of women curProfessors are women.6 Women are also rently practicing in each specialty, a higher less likely to occupy top leadership roles in percentage of women graduates from our academic medicine: only 15% of Departmedical school matched into residency ment Chairs and only 16% of Deans are programs in Anesthesia, Emergency women.7 In a study of the faculty at one Medicine, General Surgery and Psychiatry academic medical center, women were less (Figure 1). Some specialties such as Obstetlikely to be chosen to be chairs of section rics-Gynecology and Pediatrics still attract or divisions.8 mostly women trainees, while the surgical The salaries of women physicians still subspecialties of Orthopedics, Otolarynare not on par with those of their male gology, Neurosurgery, and Urology are counterparts. It was recently reported drawing mostly male graduates from the that for faculty at 24 U.S. public mediUniversity of Minnesota Medical School. cal schools, significant sex differences in The reasons for these shifts in spesalary exist even after accounting for age, cialty choice are unclear. One factor may experience, specialty, faculty rank, and be that residency programs in all specialties measures of research productivity and are working energetically to foster a supclinical revenue. The absolute difference portive, collaborative and healthy cliniwas $19,878 which represented an average 5 cal learning environment which may be of 8% decrease in annual salary.9 Finally, influencing career choices. academic medicine does not appear to be adequately supportive of women physiDefining the Gaps cians. Women have reported that unclear There are still a number of barriers to expectations, the lack of opportunities, achieving physician gender equity. Alinsufficient mentoring, and a working enthough women comprise 44% of junior vironment that lacks diversity are barriers faculty in academic medicine, only 30% to advancing in academic medicine.7 MetroDoctors

The Journal of the Twin Cities Medical Society

Responding to the Challenge

As a public medical school and university it is our responsibility to provide the opportunities and the environment for all trainees and physicians. Like residency programs, we and other medical schools are actively cultivating a respectful and inclusive learning environment and creating more curricular opportunities for collaborative learning, interprofessional teamwork, and reflective practice.

One example has been the greater awareness of the factors that lead to burnout and depression.10 Partnering with the University of Minnesota Center for Spirituality and Healing we are providing experiences for students to learn mindfulness-based stress reduction and to support wellbeing.

There is also a greater appreciation of diversity and the opportunities it creates.

By broadly supporting a diverse workforce our health systems can develop into more innovative and high-performing organizations.11 New Issues on the Horizon

As we make greater strides in promoting diversity and inclusion within our student body and our faculty we have uncovered new challenges. As we attract more open LGBT students the lines between male and female blur. In addition, increasing numbers of students identify themselves as gender nonconforming. Knowing that these populations have some of the largest health disparities it will be critical to provide them with a welcoming environment to improve the health of our communities.

Conclusion

Today we celebrate the achievements

Figure 1. Percent of Female Students at the University of Minnesota Medical ^ĐŚŽŽů DĂƚĐŚŝŶŐ ƚŽ ^ƉĞĐŝĂůƟĞƐ ŽŵƉĂƌĞĚ ƚŽ ĐƟǀĞ WŚLJƐŝĐŝĂŶƐ ŝŶ ƚŚŽƐĞ ^ƉĞĐŝĂůƟĞƐ Percent Female Matching 2014-20161

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Anesthesiology

51.9

24.3

Dermatology

55.6

44.7

40

25.5

Family Medicine

51.5

36.9

General Surgery

45

17.6

Internal Medicine

44.4

35.8

Medicine-Pediatrics

60.7

50.9

Neurological Surgery

16.7

7.3

Neurology

27.3

26.9

Specialty

Emergency Medicine

Obstetrics-Gynecology

94.6

51.8

Ophthalmology

37.5

22.4

Orthopedic Surgery

19.4

4.6

Otolaryngology

28.6

14.5

Pathology

45.5

35.6

Pediatrics

71.8

60.4

Phys Medicine & Rehab

50

34.7

Psychiatry

63

36.9

26.3

23.8

0

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1. University of Minnesota Match Data.

2. 2014 Physician Specialty Data Book. ƐƐŽĐŝĂƟŽŶ ŽĨ ŵĞƌŝĐĂŶ DĞĚŝĐĂů ŽůůĞŐĞƐ.

2014 MetroDoctors

The Journal of the Twin Cities Medical Society

toward equity for women learners and physicians while striving for continued improvement. We will continue to focus on understanding the barriers and opportunities in order to fulfill our commitment to educate physicians to meet the health care needs of all Minnesotans.

Bibliography 1.

Governor’s Blue Ribbon Commission on the University of Minnesota Medical School. Minnesota Office of Higher Education. 2015.

2.

Distribution of Physicians by Gender. Kaiser Family Foundation. Available at: http://kff.org/ other/state-indicator/physicians-by-gender/.

April 2016.

3.

Feedman, J. Women in Medicine: Are We “There” Yet? Medscape News & Perspective.

2010. Available at: http://www.medscape.com/ viewarticle/732197_1.

4.

Overview of Minnesota’s Physician Workforce, 2013-2014. Minnesota Department of Health.

2015.

5.

Weiss, KB, Bagian, JP, Nasca, TJ. The Clinical Learning Environment. The Foundation of Graduate Medical Education. JAMA. 2013:309:1687-1688.

6.

Jena, AB et al. Sex Differences in Academic Rank in US Medical Schools in 2014. JAMA 2015:314:1149-1158.

7.

Lautenberger, DM, Dandar, VM, Raezer, CL, Sloane, RA. The State of Women in Academic Medicine. American Association of Medical Colleges. Washington DC. 2014.

8.

Wright, AL, et al. Gender Differences in Academic Advancement: Patterns, Causes, and Potential Solutions in One U.S. College of Medicine. Acad Med. 2003:78:500-508.

9.

Jena, AB, Olenski, AB, Blumenthal, DM. Sex Differences in Physician Salary in US Public Medical Schools. JAMA Intern Med. Published online ahead of print on July 11, 2016.

10. Dyrbye, LN, et al. Burnout Among U.S. Medical Students, Residents, and Early Career Physicians Relative to the General U.S. Population.

Acad Med. 2014:89:443-451.

11. Nivet, MA. Diversity 3.0: A Necessary Systems Upgrade. Acad Med. 2011:86:1487-1489.

Michael H. Kim, M.D. is the Assistant Dean for Student Affairs at the University of Minnesota Medical School. He is an Internal Medicine-Pediatric Hospitalist at the University of Minnesota Medical Center joining the faculty in 2006.

Kathleen V. Watson, M.D. is a Professor of Medicine in the Division of General Internal Medicine at the University of Minnesota Medical School. Until this past year she was the Senior Associate Dean for Undergraduate Medical Education. She trained in Internal Medicine with a fellowship in Hematology and currently practices as a primary care physician at the Clinics and Surgery Center for M-Health. She joined the faculty in 1985.

September/October 2016

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Women in Medicine

Colleague Interview

E

ditor’s Note: In the early 1990s, a committee of medical oncologists, surgeons, radiologists, nurses, and pathologists came together at Abbott Northwestern Hospital to explore a unique breast imaging center concept where breast imaging and clinical services would be housed in one location. The Piper Breast Center (PBC), now known as the Virginia Piper Cancer Institute, was conceived and opened in 1995. Four women physicians were among those instrumental in this vision and the Center’s continued success today. Their stories are told below in this issue’s Colleague Interview.

Margit L. Bretzke, M.D. (MB)

Deborah L. Day, M.D. (DD)

What is the inspiration behind the Piper Breast Center (PBC)?

DD – The mission of the Piper Breast Center was to offer timely, state-of-the-art, multidisciplinary care under one roof for women with breast disease.

TL – Twenty plus years ago, breast care was very fragmented in Minnesota, and specialists didn’t connect with each other about a patient’s care. We realized that the care for our patients could be dramatically improved by working together across the specialties, researching the literature to identify the best medical approaches for treating various types of breast conditions, creating practice protocols for the workup of disease entities, and having all physicians involved follow the highest standards available for treating benign and malignant breast concerns. A group of us, including surgeon Dr. Dan Dunn, began working together by meeting weekly to create this vision of a multidisciplinary breast center with the generous support of the Piper family.

MB – Taking care of a patient with breast cancer before the PBC was very difficult. There were very few physicians that actually 8

September/October 2016

Tamera J. Lillemoe, M.D. (TL)

Beverly A. Trombley, M.D. (BT)

embraced breast cancer care. At that same time, the science behind breast cancer care was changing rapidly. It only made sense to put the providers that were really interested in the same room at the same time. It made us all better physicians and it accomplished giving women the most up-to-date and efficient care possible. It also made us better address the emotional needs of newly diagnosed patients, driven by the patients themselves.

BT – Mammography in particular was rapidly changing, allowing for better resolution with lower doses of radiation. An especially important development in the early 1990s was our ability to do image guided needle biopsies for breast lesions. It was the cooperation between radiologists and surgeons in developing stereotactic breast biopsies at Abbott Northwestern Hospital that led to discussions to consider starting a breast center.

What planning surprises or unique contributions arose from your lay women focus groups?

DD – The lay women focus groups did not contribute surprises as much as validate our goals of offering patient-centered, individualized, current, compassionate, efficient breast care.

MetroDoctors

The Journal of the Twin Cities Medical Society

TL – The night we were to meet with the lay women turned into a big snowstorm in the Twin Cities. I couldn’t believe the number of survivors who came to the Piper Building on that cold snowy night to tell their stories, despite the difficult weather. I was riveted by their bravery, their compelling stories of what they had been through, and by their passion, determination and commitment to try to make the journey better for the many women who would follow them.

MB – The patients with breast cancer are a vocal and very active group. Even today we get feedback on what we can do better. The George Institute for Health and Healing started largely because of a patient-driven group. And it continues to evolve today.

BT – I think we were helped in so many ways by listening to these patients. They told us not only what they wanted in a breast center but also things we should avoid. Breast centers were rare around the country at that time so we learned at least as much listening to these lay women as we did learning about other centers.

A large variety of specialties were necessary to create and operationalize the PBC. Please discuss some of the more meaningful collaborative activities of this group.

DD – The most important collaborative activity of the various specialty groups was the well-attended weekly breast cancer treatment conference. Pathologists, radiologists, surgeons, plastic surgeons, physiatrists, oncologists, radiation oncologists, genetic counselors, radiology technologists and oncology nurses discussed cases. We all learned from each other.

Diagnostic and treatment protocols spanning many specialties, such as radiology, pathology, and surgery, were developed collaboratively. For example, image-guided noninvasive biopsies are performed by the radiologists; the biopsy specimens are evaluated by the pathologist in collaboration with the radiologist the next working day; the report is called to the referring physician and/or patient the working day following the biopsy.

Another example of collaboration between several specialties was the clinical/surgical treatment recommendation of a specific cancer precursor or risk factor, sometimes found on needle breast biopsy. Detailed follow-up of 316 cases with this finding in a study by our patholgoists, radiologists and surgeons showed that imaging follow-up rather than immediate re-excision could be safely recommended for many of these patients. This saved many women from the stress and time commitment of a re-excision as well as thousands of dollars for these “unnecessary” procedures (Surgical Outcomes of Lobular Neoplasia Diagnosed in Core Biopsy; Prospective Study of 316 cases; Clinical Breast Cancer (in press)).

MB – I would add that the clinical research arm of the PBC is very active and something to be proud of.

TL – Our program has now evolved through our clinical research arm to where we are able to identify the best approaches for a particular disease entity by looking at the data from the large volume of cases we have seen over the years, performing studies and analyses to look at various outcomes, and identify better ways of taking care of our patients.

BT – Also, I think patients definitely benefit because the PBC doctors, nurses, geneticists, etc. work so well together and talk to each other often. The communication about best practices and about patients allows us to treat each patient optimally, but just as importantly, as an individual we care about.

Could you have succeeded without the philanthropic gifts? Did this allow you to proceed without administrative needs for return on investment?

MB – We did have the buy in of the Abbott Northwestern Hospital administration to go forward with the plans for the breast center but it could not have happened without the philanthropic community starting with the Piper family. The Abbott Northwestern foundation has always supported programs that set the hospital and its clinics apart from others. The Piper Breast Center was and is one of its most visible and successful programs. I would love to publicly name all the families that contributed but the list is long. I have very personal memories of our donors — they have meant a lot to our ongoing success.

TL – The philanthropic gifts from so many were crucial to our breast center, in allowing us to create our breast center. This vision began with the incredible support of the Piper family in memory of Virginia Piper. These people believed in us and in what we hoped to do, and their support provided the financial assistance necessary to create a much better experience for those with breast disease. Many new advances in our breast center were the result of the philanthropic support from many other donors. One example is the sentinel lymph node program for breast cancer surgery: we were the first in our state to perform this procedure, and this has now become the standard of care. A generous donor gave us the money to begin a study to prove this was a safe and appropriate procedure for our patients. Once we were able to prove the safety and scientific rigor of this procedure, she also gave us money to educate patients about this technique.

Another example was starting the nurse navigator program in the Piper Breast Center with philanthropic dollars. This program enables a nurse to help “navigate” our patients through their breast cancer journey. The nurse navigator program was so successful for our patients at PBC that this program is now incorporated across the Allina system for cancer patients.

A family in the community has been incredibly supportive of donating money for breast cancer research at PBC. And as a result, we now have a very active research program, we are actively (Continued on page 10)

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Women in Medicine Colleague Interview (Continued from page 9)

presenting abstracts and papers at national meetings, and we are publishing our work in scientific journals.

Many donors have contributed to our PBC Emergency Assistance Fund, which provides various types of financial assistance to newly diagnosed breast cancer patients who have significant financial stress such as paying for groceries, child care, rent, etc., due to breast cancer treatments. When a woman is overwhelmed with her new cancer diagnosis and cannot see how she can provide basic necessities at that difficult moment, our social worker and nurses can step in and connect her to this program.

Another very important program is donating time to assist other women. We have incredible volunteers in our Piper Breast Centers at Abbott Northwestern and West Health, many of whom are our survivors. These women volunteer their valuable time to assist other patients each day in our breast centers. These are many examples of how our survivors and our donors continue to help us succeed in so many ways with their philanthropic gifts, time, and talents, and we are incredibly thankful for their support.

Describe early obstacles or barriers.

DD – Early obstacles in the development of the PBC included buy-in from the private practice groups to allow full coverage of the breast center while growing the patient census; physicians at Abbott Northwestern that resisted following the collaboratively established practice guidelines; educating the primary care physicians that the PBC physicians and staff could and would be total breast care consultants and actively communicate with the patients and physicians.

MB – I would agree with Deb. In addition, once the word was out as to how we functioned, we grew very fast. At times we outstripped our physical space and the availability of our clinicians.

As this occurred however, we as a group would band together to make needed adjustments.

Please discuss the contributions of Carol Bergen and other nursing personnel in the development and ongoing operation of the PBC. DD – Carol Bergen and the nursing staff made the PBC efficient, caring, and compassionate. They epitomized the human aspect of breast care. They were a big reason why the PBC was unique.

MB – Carol Bergen and all the nursing staff were absolutely the most professional and caring group I have ever worked with. All took their jobs very seriously, helping start the whole nurse navigator role before it was labeled as such. If we started new programs they were at the table with planning and development. Each and

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every one has gotten additional education that puts them ahead of their cohorts. The nursing staff has worked collaboratively over the years to better their end of the multidisciplinary care model.

What would you do differently if you were to do this again?

TL – I cannot think of anything I would want done differently.

I think one of the most amazing things about starting the PBC was the incredible cooperation of all of the physicians, nurses, techs, and volunteers. We have had the good fortune of having people who are really passionate about helping patients with breast disease work well together.

What do you see as future areas of diagnosis, evaluation and treatment that the Virginia Piper Cancer Institute might become involved in?

MB – The world of genetics is the future of cancer care. It impacts risk, prognosis, treatment options and prevention. It is in its infancy. Ultimately this will lead to more individualized care of the cancer patient.

TL – Genetics also applies to the DNA changes in the tumor cells (the chromosomal changes in tumor cells that sporadically occur, and are often not inherited). Understanding the biology of the tumor cells is where cancer diagnoses is heading, and this knowledge will lead to more tailored treatments for our patients.

Currently, my role as a pathologist is to try to classify the tumor cells under the microscope. But, in the future these tumors will be far better classified and categorized based on sequencing of the genes in the tumor cells rather than classifying them using a microscope. And, once we know and understand the changes in the DNA of the tumor, this will ultimately lead to better treatments.

BT – Breast imaging is continuously changing and we are able to find cancers earlier because of this. Because we see more questionable findings with these modalities we need more studies to help determine which things seen on imaging can be ignored, which can be followed and which need biopsy. Currently, we biopsy suspicious lesions but as we now know many biopsies show very early cancers (DCIS); some of these will go on to become potentially deadly cancers and others will cause no harm.

How is ongoing staff educational activities handled to take best advantage of the many new developments in breast cancer diagnosis and treatment? Regular meetings versus as needed?

DD – Monthly staff, leadership, and radiology meeting are ongoing to educate personnel and promote cohesiveness and efficiency.

An educational breast care update conference sponsored jointly

by PBC and Consulting Radiologists, Ltd. is presented annually.

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The Journal of the Twin Cities Medical Society

MB – We started a monthly journal club for providers with presentations by all the specialties. In addition we have had quarterly nursing educational meetings supported by all the medical specialties. Regular meetings are essential to ensure we are all functioning cohesively and understand each other’s challenges and viewpoints.

Margit L. Bretzke, M.D. earned her medical degree from the University of Minnesota Medical School and completed a General Surgery residency at Hennepin County Medical Center. She is board certified in Surgery and was in private practice for nearly 30 years with Surgical Specialists of Minnesota. She currently practices part time at United Breast Center.

What challenges do you anticipate in this shifting healthcare environment, and how will you approach them?

Deborah L. Day, M.D. received her medical degree from University of Iowa College of Medicine. She completed a Diagnostic Radiology Residency at the University of Rochester, Rochester, NY followed by a Pediatric Radiology Fellowship at the University of Minnesota.

She is board certified in Diagnostic Radiology. Dr. Day served as the Medical Director of the Piper Breast Center from 2000-2013 and was a partner at Consulting Radiology, Ltd. (retired).

BT – I think multidisciplinary care is the best way to diagnose and treat patients. It is efficient and cost effective if done correctly. It uses best practices which are determined by each physician keeping up with current literature and conferences in their specialty and discussing these with the physicians in other specialties (and others such as geneticists). Places such as PBC are set up to have patient outcomes measured and to adapt to make the patient experience, as well as outcomes, better. They also allow for individualized care for those patients who don’t fit into the standard care model. These decisions are not just one doctor deciding on their own, however, since everyone works together and cases are discussed often. I can’t see into the future, but I know breast centers are now common all over the country and I think they are so because of these reasons. I think this is so even in a shifting healthcare environment.

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Tamera J. Lillemoe, M.D. graduated from medical school at the University of Minnesota, where she also completed a Pathology residency, including a fellowship in Surgical Pathology. She has worked at Abbott Northwestern Hospital (Hospital Pathologist Associates) since 1991 and oversees breast pathology for the Allina hospitals.

Dr. Lillemoe is board certified in Anatomic and Clinical Pathology.

Beverly A. Trombley, M.D. attended medical school at the University of Minnesota and completed a Radiology residency at Harbor – UCLA in Los Angeles. She is board certified in Diagnostic Radiology. Dr. Trombley currently is retired after a 25 year career with Consulting Radiologists, Ltd.

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September/October 2016

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Women in Medicine

Editor’s Note: Profiled throughout the next several pages are six female colleagues engaged in leadership and/or extraordinary clinical work in their field. Each physician was recommended to the editorial board by a colleague at their institution.

Kealy Ham, M.D. Pulmonary and Critical Care Medicine

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here is endless beeping in various tones with flashing lights and multiple voices, and a consistent humming in the background. Near chaos is palpable — there is high energy, more than the sum of the individuals surrounding the patient’s bed — my bed. I can hear it before I can see it. It just feels better to keep my eyes closed. The smell reminds me of burnt toast. I’m so thirsty. The tube invading my throat extends my insides to the machine that is breathing for me. My own lungs have failed. “Filled up with fluid” I hear them telling my parents. “Pulmonary edema” is what I translate in my head. I want to reassure my mom as she stands at the end of the bed. I am trying to gesture for her to go home, that she should get some rest. I am not afraid. I know everyone around me will do everything they can to help me through this.

Acute respiratory distress syndrome (ARDS) as a complication of a blood transfusion during my open heart surgery and valve repair provided me the opportunity to be “bed 7,” “the heart valve,” “the medical resident” patient in the cardiovascular ICU. Interestingly, I had decided to go into pulmonary and critical care medicine prior to my firsthand experience. In part because of this experience, I better understand we are caring, not just for the patient, but also for their family. And, that it is not a physician who provides the care, but rather it is an entire care team. In this lies the humility and the awe.

In medicine and the art of healing, you can never know it all. I finished engineering school with the goal of becoming MetroDoctors

a physician in mind. I see the human body as one of the most graceful examples of applied engineering; our bodies simultaneous converting chemical and electric energy into elaborate systems of mechanical contractility, signal processing, thermoregulation, humidification, coupling, and reprocessing…and that is in just a single breath. How amazing is that? What’s even more amazing is that most often, we don’t even have to think about it. Each breath we don’t have to think about is a blessing.

Each of our organ systems performs millions of perfectly orchestrated tasks every day — most of the time.

In critical care and pulmonary medicine, the organ systems have tipped from their precarious balance of order into dysfunction. Sometimes it is a single organ, but most often, it is multiple organs that are failing. The intellectual challenge of filtering pieces of the available history, laboratory tests and radiologic findings, to explain our patient’s current pathophysiology is still one of the most rewarding parts of my job. I am acutely aware that behind every waveform and diagnosis lies a fellow human being with a story, a family, fears and doubts. I am certain that no matter the country of origin or primary language, the shades of browns and pinks in our skin, and the background from which we come, all of us are more similar than different.

We each want and deserve to be well, to be safe, and to be heard. Being a part of the care team, responsible for providing the best care possible to someone in our world community, someone’s daughter, sister, wife, best friend, is an extraordinary

The Journal of the Twin Cities Medical Society

privilege and at times, a staggering obligation. Always, it is humbling. There is a limit to what the technologies and medicines can provide a critically ill patient.

There are times when it comes down to the body’s ability to “rally and fight.” This requires immeasurable entities: emotional support, love, spirit and grit that we have accumulated to this critical point. I choose to believe that this immeasurable power of energy lies in our joint humanity.

Recently one of our patients, a middle-aged woman, came into the ICU because of the same type of lung failure that I had, ARDS. She had previously survived a transplant and some autoimmune (Continued on page 14)

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Women in Medicine Kealy Ham (Continued from page 13)

problems. She was on chronic blood thinners to minimize her risk of developing inappropriate clots to her veins, her lungs, or her brain. Unfortunately, she had a blood vessel in her head spontaneously start bleeding. And, as a result of this, her whole body reacted with inflammation, some of which was causing her lungs to fail.

She was in a coma on the ventilator, for weeks. Her husband and son were near constants at her bedside. When they would allow themselves to rest, it was her sister or a dear friend being the vocal cheerleader for her healing. The hospital care team provided the necessary nutrition, breathing support, skin protection cares, fluids and kidney support. Each member performed their key role: daily cleaning of her room, calculating her exact caloric needs, moving her limbs while she was unable to move them on her own, suctioning her breathing

tube, adjusting her medication dosing and timing to avoid too much or too little of the chemicals her body needed to maintain its delicate equilibrium and heal.

As the days turned into weeks, the transformation was spectacular. It was not sudden. She did not wake up one day and ask where she was with music playing in the background. It was more subtle and intricate than that. She started with a few facial expressions — a grimace, the hint of a smile. Her recovery continued to include weak but purposeful attempts of moving her arms and legs. Both her perseverance and impatience coaxed her body back toward health. She took part in our early mobility program and got out of bed with more lines and tubes than limbs. With her life support in tow, she walked down the hall. With each step, she, her team, and her family share the same broad smile of accomplishment.

I am continually amazed by our bodies being far more able than we think. I do not always have the right words, but I

can feel the energy we share as we experience these moments. These patients and their families energize me — wanting me to push our system of medicine and the art of healing to the peak of perfection.

As health care providers and families supporting each other, the best we can do is to do our best, every day, for every patient. I teach and try to live by my gold standard, treating each patient like they are my family. Every day is a gift and we never know what tomorrow has in store for us.

This is the reality time and again with each patient’s ordeal in the ICU. The patients and their families deserve the best care that each of us and our complex system of medicine can provide. I want that for my family. Don’t you?

Because of my family and my support at work, I am able to commit myself physically, emotionally, and intellectually to doing what I love doing, this career in medicine. I wish everyone could have a vocation or a recreation that brings them this same joy and fulfillment. If I am inquisitive enough, I will learn something new every day. If I am mindful enough, I will teach something every day. And, if I am selfless enough, I will help ease suffering, every day.

I am grateful for the privilege of being a physician, teacher, and lifelong student; for being the mother of a curious, delightful, and rambunctious six-year-old, and the wife of an amazing, compassionate partner. I realize that if it were not for both my family of origin and my chosen family, I would never be where I am today. I don’t know what tomorrow brings. I know for certain that I am grateful for today. This is my hope for you too.

Kealy Ham, M.D., Department Chair of Critical Care Medicine – HealthPartners Medical Group, Section Head of Critical Care – Regions Hospital, Director of the Medical Intensive Care Unit – Regions Hospital, and Assistant Professor – University of Minnesota Medical School in Pulmonary and Critical Care Medicine.

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The Journal of the Twin Cities Medical Society

Jennifer Hsia, M.D. Otolaryngology, Sleep Medicine

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ompetitive athletics have always played an important part in my life. I think what motivates me to compete is the same drive that pushes me in my profession to learn more and provide the best care that I can.

Both of my parents played sports as children. Not surprisingly, growing up my brother and I played several sports — soccer, basketball, etc. But the sport that I exceled at the most was tennis. Both of my parents are passionate tennis fans and passed that love onto me.

At first we played together recreationally as a family. But then I decided that I wanted to try to make the jump to playing competitive tennis at a national level.

In addition to a love of sports, my parents also impressed upon me the value and importance of an education.

My father is a mathematics professor at the University of Alabama. Ironically, math was one of my worst subjects in school; I was more drawn toward the science subjects. In high school, I took an introduction to anatomy and physiology.

It was during this class that my interest in medicine was piqued. During a class field trip to the local medical school, I was in awe of one of the speakers who was a surgeon. I knew at that moment I wanted to become a doctor.

Learning to balance school with playing tennis taught me how to prioritize tasks. Practice was six days a week, 2-3 hours a day. There were countless hours of practice — running the same MetroDoctors

drills over and over, early morning workouts, evening conditioning sessions, weekends travelling to tournaments.

There were no off-seasons. If I wanted to play tennis, I was expected to keep up my grades. I’m proud to say that the hard work paid off, as I was able to earn a full athletic scholarship to play tennis at Indiana University.

After college, I attended medical school at the University of Alabama — Birmingham. I’m proud to say that our class was one of the first classes to have an equal number of female and male students. I’ve had the good fortune to be surrounded by strong, independent, and smart women since college — from my tennis teammates to the women in my medical class. This trend continued

The Journal of the Twin Cities Medical Society

into my surgical residency. As a result, I don’t think of myself as a woman in medicine. We are all striving to be the best physician we can be.

I completed my otolaryngology residency at the University of Washington in Seattle. It was during my residency that my curiosity about obstructive sleep apnea developed. Obstructive sleep apnea is a disease that affects millions of Americans. It is characterized by a repetitive collapse of the upper airway during sleep. This repetitive collapse of the airway leads to several consequences, including disruptive and non-refreshing sleep, daytime sleepiness, as well as an adverse impact on the cardiovascular system. Untreated obstructive sleep apnea is associated with a higher risk of hypertension, myocardial infarctions, and early death. This disease has a profound impact not only on medical health but also on quality of life. It can leave people so sleepy that a simple task such a reading a book can be impossible.

After my residency, I decided to further build on my understanding of this complex condition, and I completed a sleep surgery fellowship at Stanford University. At Stanford, I learned not only about surgical treatments for sleep apnea but also gained a better understanding about the disease process and the medical treatments for sleep apnea.

There are several approaches for

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Women in Medicine Jennifer Hsia (Continued from page 15)

managing obstructive sleep apnea. First line therapy typically consists of continuous positive airway pressure (CPAP). Alternatives to CPAP include mandibular advancement appliances and surgery. As I often tell my patients, there is not one perfect management option for obstructive sleep apnea. Each strategy has risks and beneďŹ ts, and one of my goals is to help patients ďŹ nd a management strategy that works best for them.

In the past, surgical treatments for sleep apnea consisted of procedures that altered the conďŹ guration of the upper airway, with the goal being to create a wider airway dimension as well as help the tissues resist collapsing during sleep.

Recently, a new surgical treatment has been developed. Instead of operating

directly on the tissues of the airway, we are now able to control collapse of the airway through nerve stimulation. This therapy, called Inspire, is a nerve stimulation device that directly stimulates the hypoglossal nerve. The hypoglossal nerve controls the movement of the tongue, which is the largest muscle of the airway.

This implant provides a gentle stimulation to the nerve, which then moves the tongue forward and keeps the airway open during sleep. Patients turn the device on with a remote control before they go to bed and off when they awaken.

This therapy marks a new surgical direction for management of obstructive sleep apnea, and it is an exciting time in managing this difďŹ cult disease. Although this therapy is still new, we are seeing improvements in clinical outcomes for our patients.

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is also important to providing good outcomes for these patients. One of my goals in coming to the University of Minnesota was to help create a comprehensive program to treat obstructive sleep apnea. A comprehensive program should include sleep medicine providers, sleep dentists, and sleep surgeons. I am fortunate to be able to work with some of the leaders in their respective ďŹ elds of sleep medicine and dentistry.

Although I’m immersed in my work at the University and care for my patients, I do believe that it is important to try to ďŹ nd that elusive “work-lifeâ€? balance. My current life-hobby revolves around athletics but is in a totally new direction. I now compete as a masters athlete in Olympic weightlifting. Olympic weightlifting consists of two disciplines — the snatch and clean and jerk.

The objective is to lift the most amount of weight possible overhead in only six attempts. It is an exciting mix of both skill and strength. This new sport has shown me that I can push beyond my limits and accomplish things that I never thought were possible for myself.

I believe it is this same competitive spirit that drives me to accomplish more and to provide the best care that I can for my patients. My goal is to work with each patient to try to ďŹ nd the best treatment for them, whether that is surgery or another option.

Jennifer Hsia, M.D. is an Assistant Professor in the Department of Otolaryngology at the University of Minnesota. She attended medical school at the University of Alabama-Birmingham; completed an Otolaryngology residency at the University of Washington and a Sleep Surgery fellowship at Stanford University. Her clinical and research interests are in the ďŹ eld of Obstructive Sleep Apnea.

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is for Cardiology.

University of Minnesota Health Heart Care specialists have a deep understanding of academic medicine and clinical research. Leaders in heart-care interventions for over a generation, we make innovative care our mission.

This expert knowledge translates into advanced clinical care tailored for each patient. Through our clinic trials, our patients are at the forefront of groundbreaking care and treatment options.

We’ve transformed lives with major breakthroughs in valve replacements, transplants, cardiac resuscitation and other pioneering techniques to treat heart disease.

With multiple centers and clinic locations throughout the region, some of the best heart care providers are just a heartbeat away.

Learn more about our expert, innovative care at mhealth.org/heartcare The University of Minnesota Health brand represents a collaboration between University of Minnesota Physicians and University of Minnesota Medical Center. Š 2016 University of Minnesota Physicians and University of Minnesota Medical Center

Women in Medicine

Erica Sanders 3rd Year Medical Student

I

n yogic tradition, the teacher, or guru, embodies numerous roles: scholar, teacher, healer, and student.

The teacher studies and imparts wisdom to his or her pupils, but also learns from each individual student and from the world in which we live. The teacher heals by leading the student through a series of poses or breathing exercises, but also by listening, understanding, and introducing new ways to approach life’s challenges. I am no guru — I am currently a third year medical student at the University of Minnesota Medical School — but I hope to someday become a physician that embodies these principles of healing.

I grew up in Moraga, California, a small town east of San Francisco. My mom is a teacher and my father an engineer. I like to think I am combining their two careers into one — in many ways physicians are engineers of the human body as well as educators of health and wellness. From 2007–2011, I completed my undergraduate degree at Stanford University, where I studied psychology, competed on the Equestrian Team, ran a half marathon, and learned to think critically about everything from organic chemistry to religion. After college I spent two years conducting clinical trials studying the treatment and pathophysiology of pediatric bipolar disorder and one year at a startup called Neurotrack, working on a project to validate a prognostic eye-tracking test for Alzheimer’s disease. During this time 18

September/October 2016

I also completed a yoga teacher training, acquired a dog, climbed Mt. Meru and Machu Picchu, and met my fiancé.

These premedical experiences fueled my determination to become a doctor and exposed me to the academic research and med tech aspects of the medical field.

Today I am incredibly excited to be learning to practice medicine alongside inspiring classmates and dedicated teachers. Since applying to medical school a few years ago, I have been passionate about the prospect of improving healthcare — on an individual doctorpatient level as well as through research, teaching, and administration. I love the science of medicine and understanding how the human body works. But I also love the opportunity to connect with patients in an incredibly personal and vulnerable way. Today I spent an hour

with a patient recently diagnosed with neuromyelitis optica — an inflammatory demyelinating disease of the optic nerves and spinal cord. We talked about the medical underpinnings of her disease, the injustice of an immune system designed to protect her that is now attacking her, and the frightening adverse effects of immune modulating therapy.

The medical system can be a frustrating place for patients who often receive unsatisfying answers to their questions.

I definitely didn’t have the answers to all of her questions, but by actively listening and sharing what I did know I was able to ease some of her concerns and encourage her to take a more active role in the management of her condition.

As the yoga teacher studies ancient texts and guides students to greater levels of strength, flexibility, and self-awareness, physicians spend years amassing knowledge of disease and can use that knowledge to empower their patients and communities. Whether in the clinic, the classroom, the research lab, or my senator’s office, I believe that I have the ability and the responsibility to translate my knowledge into digestible information that can help others make wiser health-related decisions. In medical school I have found health policy to be the best arena to explore this concept of empowerment. As the Vice Chair of the Minnesota Medical Association Medical Student Section, I co-lead a team of passionate medical students in a variety of public health efforts, from resolution

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writing, to educating our senators and representatives on important health issues, to initiating advocacy campaigns.

It has been an incredible opportunity to exercise my leadership skills, to better understand organized medicine, politics, and to find my voice.

This issue of MetroDoctors is in celebration of Women in Medicine, and I would like to close with a message to all of the young women who are considering a career in medicine and to my fellow female medical students.

A career in medicine is not easy, and women in particular face societal pressures to place pregnancy and motherhood above our career interests. I don’t yet have experience balancing children and work, but I do know that becoming a doctor has been one of the most exciting and rewarding decisions I have made. I wake up every day excited to go

to the hospital, excited to learn about a new disease, excited to explore the life of another patient. Becoming a doctor is a gift; it is something we get to do, not something we have to do. I have at times been bogged down by anxietyprovoking exams and the fear of not being good enough for the residency program I someday hope to attend. But I urge you to put anxieties and fears aside and instead throw yourself, mind, body, and soul into the present. Learn from everything that you do, explore different activities until you find the ones you love, and study hard. Take on challenges that you aren’t quite sure you can handle and don’t be afraid to fail. Forgive easily. And most importantly, don’t let anyone tell you that you are not good enough. I’ve found each phase of this career (undergraduate, premedical, and medical school) to be a source of great

self discovery and I look forward to continuing to uncover the possibilities that a career in medicine has to offer.

Erica Sanders is a 3rd Year Medical Student at the University of Minnesota.

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Reflections on a Life in Medicine Contributed by Sara J. Shumway, M.D.

I was in the 9th grade when my father, Norman Shumway, completed the first successful adult heart transplant in the U.S. I remember people asking me if I was going to be a doctor. Of course I said no. I changed my mind down the road, though it took me awhile to end up in cardiothoracic surgery. I was 15 when he performed the first heart transplant.

I was 35 when I performed my first.

My junior year of high school, I took an AP Biology course, which really solidified an interest in science. I considered three options: teacher, doctor, or lawyer. Two of those careers were crossed off the list quickly. I was afraid of public speaking, and I didn’t really enjoy dressing as fancy as most lawyers do. A career in scrubs appealed to me.

Of course, there was more to it.

Looking back, a medical career made sense. I always enjoyed working with my hands. I liked sports and playing instruments. An active, engaging career like surgery just fit. And it was not just my father who introduced me to the medical field. My mother had been a nurse. Her mother was a nurse and her father a general practice physician.

I think what really inspired me the most, however, was not watching my dad perform operations but an experience backpacking with friends. It was the summer after my junior year, and one of my friends became quite ill from altitude sickness. As I was caring for her, I realized I wanted to care for people.

Early Career

I studied biology at Stanford for my undergraduate degree, but I wanted to forge 20

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my own path, separate from my father’s career, so I headed east, to Nashville, for medical school at Vanderbilt University.

I did not set out to specialize in cardiothoracic surgery. Initially I considered pediatric surgery, and I worked in cancer and diabetes research.

However, the cardiovascular system won in the end. At one point during my general surgery training I spent six out of eight months doing cardiothoracic surgery, and after that I could consider nothing else.

During my general surgery residency, I took a year to complete an immunology fellowship in London, studying under Peter Medawar. Dr. Medawar was instrumental in the transplant field, particularly for his work on graft rejection and his work on tolerance in transplantation.

He championed the idea that patients could develop tolerance so they would not need continued immunosuppressant treatment.

To this day, we still have not reached a point or method that allows complete immunological tolerance, but we grow closer and closer. His vision inspired my work in transplantation and continues to be a spark for new ideas today.

People often ask what challenges or barriers I faced as a woman in medicine, and as a woman in cardiothoracic surgery at that. Yes, I was a minority, but the real challenge was cardiothoracic surgery itself. The job is very demanding from a mental, emotional and physical vantage point. It requires a very focused, driven and dedicated individual.

In a way, my father prepared me for that. I had a head start. I saw my father’s career advance up close and personal. I saw what that career required, and I saw the rewards he experienced. It helped me to persevere.

I had nine years in surgical residency, broken up into five years as general surgery and three years specializing in cardiothoracic surgery, plus one year of research. Today, surgery fellows and students are limited to 88 hours working a week, but in my time, there was no limit.

At that stage of your career, you have a finite period of time to learn, so you take advantage of every opportunity you can to absorb the information, the techniques, the procedures.

Research

My current research focuses primarily on improving heart and lung transplant

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Integrative Care for Low Back Pain (Continued from page 21)

outcomes, studying new medical devices, and new approaches to managing organ rejection.

Right now, I am working on a clinical trial testing a new LVAD device, which supports a failing heart. The LVAD can support patients until they are ready for transplantation, or it can be placed permanently until it needs to be replaced.

We are also studying approaches to treating pump thrombosis and leading clinical trials to test new heart valves, ventricular assist devices, pediatric heart devices and new immunosuppressant techniques.

University of Minnesota Health has a long history of excellence in medical devices and in heart care. We performed the first successful open-heart surgery.

We implanted the first pacemaker and the first LVAD. We performed the first heart transplant and lung transplant in the state of Minnesota. We also performed the first breathing-lung transplant in the Midwest.

That carries over into the research and clinical care our team provides today.

Eighty percent of our heart transplant patients survive five years or more, which is above the national average.

University of Minnesota Health is a leader in organ transplant overall. Earlier this spring, we had our 100th altruistic kidney donation, the most for any one center in the nation, and we have developed a successful and prestigious living liver donation program. Our endocrinology specialists are pioneering the first islet cell transplants for people with type 1 diabetes.

Surgery is a team effort. I am surrounded by a very inspiring, talented group of cardiologists, cardiothoracic surgeons, nurses, transplant surgeons,

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researchers and primary care physicians who all support one another.

The University is charged with a spirit of discovery and collaboration, which first attracted me as a newly certified cardiothoracic surgeon and has kept me here 28 years.

Finding My Place at University of Minnesota

Over the course of my career, I have climbed the academic ladder, received grants and at different times, acted as surgical director for both heart and lung transplantation at the University. I have been a member of more than 15 professional organizations, published over 140 papers, given lectures, and I co-wrote a textbook with my father.

The most meaningful part of my career, however, has always been my patients and my trainees. Helping patients is very rewarding. It is a wonderful opportunity to perform a challenging

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operation and help the patient recover smoothly. I recently attended a Second Chance for Life meeting, and two patients came up to me. One was a gentleman who is 25 year post-heart transplant and another was a woman who is 20 years out from her transplant. Long-term follow-up is very inspiring, especially when you consider that in 1968 the first patient lived for only 15 days.

I am grateful for my father’s example and I hope my patients are grateful for my efforts.

I love what I do.

Sara J. Shumway, M.D., is a University of Minnesota Health cardiovascular surgeon and Vice Chief, Division of Cardiothoracic Surgery at University of Minnesota Medical School. She has been on study sections for the American Heart Association for almost 20 years and has been recognized by the Mpls. St. Paul Magazine as a top doctor in cardiac surgery for the past six years.

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Women in Medicine

Jennifer Tessmer-Tuck, M.D. OB/GYN Hospitalist

I

t was late 2009. I was 38 years old, working full time in my 5th year of practice as an Obstetrician-Gynecologist in what was, essentially, a solo practice in a town of 18,000 people. My three boys, ages 6, 3 and 7 months were home with my husband enjoying a sunny Saturday afternoon while I was at the hospital attending my fifth laboring woman in four days. I sat grumpily at the nurses station lamenting that I had worked every day for the last seven weeks (either in the clinic or the hospital) without a single 24-hour period free of patient care responsibilities, calculating when I might be able to break free from my laboring patient to use my breast pump, and contemplating the meaning of life and my future as a physician.

“Is this really IT?” I was thinking.

There was no doubt I provided a great service to the women in my small community and felt loved and appreciated for that work. My office was a shrine of baby announcements, annual family Christmas cards and keepsake gifts. My sister frequently refused to go to the local Target with me because, inevitably, we would run into a woman I knew who would break into a discussion that would include intimate obstetric or gynecologic details.

That day (while staring into space listening to the hum and hiss of my breast pump), I imagined what people would say about me at my retirement and realized that, somehow, I was veering the wrong way on my professional path.

Like many aspiring medical students, I am quite sure I told the medical school interview committee that I “wanted to help change people’s lives.” Though I could 22

September/October 2016

see change happening woman-by-woman and family-by-family (A healthy baby after an emergency C-section! No more pelvic pain!), when I pictured those retirement speeches, it seemed to fall flat. I yearned to do something bigger and bolder that would impact many women’s lives and women’s health on a broader scale.

I entered the University of Minnesota School of Public Health to work on my Master’s Degree in Maternal and Child Health. I was thrilled with this “big picture” view of women’s health and energized by the potential impact that I could have on a scale that went beyond my individual patients. Meanwhile, I recognized that I could not keep up the clinical hours I was working — I missed my husband and my young kids. At my imaginary retirement party, I envisioned my grown children recalling the events that I left urgently to

deliver a baby or could not attend at all because I was managing a surgical emergency. Everyone would chuckle and reminisce about these events while I would be smiling, but crying on the inside. I was searching for a job where I could find that rarest of ideals for the physician: “work-life balance.”

As luck would have it, a new job for OB/GYN physicians started appearing in the literature and in the job market — the “Laborist” or “OB/GYN Hospitalist.” In 2010, I gave up my outpatient practice and devoted myself to the practice of inpatient obstetrics and gynecology as an OB/GYN Hospitalist. My family, friends and colleagues were near horrified and did not hesitate to eagerly share their concerns.

“Won’t you miss doing GYN surgery?”

“What will happen if you hate it and decide to go back to general practice — you won’t be able to get credentialed!”

The development and growth of the OB/GYN hospitalist model of care arose from several forces, including rising liability costs, an increasing emphasis on quality and safety in obstetrics and gynecology, the need for physician leadership on labor and delivery units and the changing demographics of the OB/GYN workforce.

These workforce issues are quite significant for my specialty and reflected what I was feeling myself as a young, woman physician and mother.

In 2008, 43% of practicing OB/ GYNs were women compared to 28.3% of practicing physicians overall and 19% of practicing surgeons. The specialty is currently seeing a dramatic increase in this proportion. Between 1975 and 2010, there was a 65% increase in the percentage of

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female 1st year OB/GYN residents and by 2010, almost 80% of OB/GYN residents were women. This compares to 46% women within all residency programs and 38.1% in surgical subspecialty residencies.

It is uncommon these days to see ANY male residents in an intern OB/GYN class.

The information we have on women physicians is compelling: we are more likely to be in dual career households; more often are the primary caregiver for our children; more frequently struggle with work/home conflicts; and consequently, prefer to work less hours, work part-time schedules and have more control over our schedules. Work as an OB/GYN Hospitalist held appeal for me as it met my needs for a controllable lifestyle. Although any one OB/GYN hospitalist program must cover the hospital 24 hours a day, 7 days a week, the number of physicians used to provide this coverage, the number of hours each individual physician works and the days and times each individual physician covers are highly variable. Hours worked and schedules can also be adaptable over an OB/GYN hospitalist career based on each person’s individual needs and life stage. (Here’s where I give a nod to my near-retirement age male partners and recognize that, yes, male physicians also want work-life balance.)

My clinical practice as an OB/GYN Hospitalist and my public health interests unexpectedly coalesced into a career dedicated to improving the quality and safety of healthcare for women. I was tasked with prioritizing and resourcing clinical improvement initiatives for women and children in our health system of 16 clinics and two hospitals. It was important to leverage the expertise and best practices of our physician partners, seek out evidence-based best practice guidelines, and (as needed) develop our own guidelines and algorithms from the published literature in order to improve performance and drive healthcare excellence. It was not difficult to identify a place to start.

Between 2003 and 2013, the U.S. was one of only eight countries in the world where maternal mortality increased (including Afghanistan and South Sudan).

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The number of pregnancy-related deaths in the U.S. more than doubled between 1987 and 2011 from 7.2 to 17.8 per 100,000 live births. Shockingly, many of these deaths were preventable, including those attributed to one of the leading causes of maternal death — postpartum hemorrhage. Almost 18,000 women a year in the U.S. suffer a life-threatening postpartum hemorrhage and the incidence of postpartum hemorrhage increased by 26% between 1994 and 2006.

I currently lead a team of providers including OB/GYN and Family Medicine physicians as well as Certified Nurse Midwives, which meets monthly and has at least one representative in attendance from every provider group who admits obstetric patients to the hospital. We developed an evidence-based best practice protocol for the management of postpartum hemorrhage that focused on system readiness, early recognition, a standardized multi-disciplinary team response to hemorrhage and a robust review and reporting process — key pieces we know reduce maternal morbidity and mortality from postpartum hemorrhage.

Our team is supported by data analysts and quality improvement specialists who help us track variation in care and short- and long-term patient outcomes. I present data on postpartum hemorrhage rates, protocol variation(s) and patient outcomes to physicians, midwives and frontline nursing staff on a regular basis. This data includes physician-specific measures, so each individual physician can see where he or she performs on postpartum hemorrhage management in relation to his/her partners and the other physicians at the hospital. This is not an easy task.

There are times I am met with outright hostility before a physician audience, though this usually mellows out to incredulity, disagreements about the validity of the data, arguments about why the protocol should not apply to Dr. X and, eventually, understanding. I recently saw a slide that described the “Physician Stages of Measurement” using the Kubler-Ross stages of grief and it is an apt description — denial, anger, bargaining,

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depression and acceptance. Over the last 18 months, though, I am pleased to say that our postpartum hemorrhage rates, transfusion rates, total number of blood products transfused, massive transfusion events and Intensive Care Unit admissions are all down.

Working as a physician leader and change agent is neither an easier job nor a job where I work fewer hours than I did in 2009 when I started on this journey. I am still challenged daily to find the right mix of work and family life. I have more control of my schedule now, and arrange my hospitalist shifts around kid events and school vacations or my husband’s work schedule. There is always too much to do and never enough time. I bring far too much work home, plugging away on my laptop at the kitchen table after tuckins and bedtime stories. It is also a role that demands a tremendous amount of resilience and support from a team that is just as committed as I am to making change and improving patient care.

Although physicians do not generally like being told what to do and when and how to do it, I genuinely believe that most of us want the best outcomes for our patients and will do what we need to do to achieve those outcomes.

I am always quite moved by the Margaret Mead quote “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever has.” I have not thought of my retirement for a while and what people would say, but I feel like I am on the right path. I am truly driven by just one thing: to improve the quality and safety of health care for women. I would be honored if anyone at my retirement credited me for doing that.

Jennifer Tessmer-Tuck, M.D. is the Medical Director, North Memorial Laborist Associates; Medical Director, Women and Children’s Services, North Memorial Medical Center; and Clinical Program Director, Women and Children’s Guidance Team.

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Women in Medicine

Meghan Walsh, M.D., MPH Chief Academic Officer, Hennepin Health System

S

ix days after graduating from college in Wisconsin, I took my first trip out of the country to become a Peace Corps Volunteer in Malawi, East Africa. In a small village straddling the border between Malawi, Tanzania and Zambia, I became a Chemistry and Biology teacher to high school juniors and seniors. Equipped with a chalk and a chalkboard, but no textbooks, computers or internet, I began to teach and I loved it.

I became the Chief Academic Officer (CAO) at Hennepin Health System (HHS) in 2012 but my medical career really began as an academic hospitalist on our inpatient cardiology service in 2005. This was a unique time and a great opportunity. I served as the general internist and co-led the team with the attending cardiologist. Together we cared for patients, taught, and engaged our team of fellows, residents and students.

Not only was I given the opportunity to develop as a supervising physician, but I learned to teach from an inspiring group of teachers. Teaching faculty seldom, if ever, have the opportunity to observe one another teach or provide and receive feedback — both are necessary for continuous improvement. I was fortunate to observe different styles and adopt effective traits to hone my own skills as an educator during that formative time.

As the CAO, I oversee all of the undergraduate, graduate, and continuing medical education programs within the Center for Learning Integration at HHS. 24

September/October 2016

As a primary affiliate site for the University of Minnesota medical students, residents and fellows, in addition to our own, there are hundreds of learners that pass through these walls each year.

Because I love to teach, this position has become a terrific platform by which to develop common curriculum for all trainees. Utilizing adult learning principles, technology and our state-of-theart simulation center, we are developing novel curriculum to build competencies critical for a future in medicine.

Healthcare is changing rapidly and physicians must possess the necessary skills to succeed in this environment.

As a result, we are creating inter-professional curriculum to develop skills and competencies not historically taught in residency or medical school. Modern medicine requires teamwork, thus team training is essential. We are bringing together different specialties, who historically have trained within their own programs, to learn alongside nurses, interpreters, pharmacists, and patients. We are moving out of the classroom and into our simulation center for essential skills development such as communication, disclosing medical errors, de-escalation training, and narrative medicine/reflection. Residents and fellows are receiving standard curriculum around continuous quality improvement, allowing them to progress from learning about quality improvement to learning how to improve quality. Nearly 100% of our residents are involved in quality improvement initiatives that align with our Annual Strategic

Plan; these are a complex set of skills and processes that weren’t taught and didn’t exist when their faculty were in medical school or residency. Our programs are emphasizing value in medicine, and this newly engaged and aligned workforce is helping to advance our institution’s quality as well.

Despite these tremendous advances, we have more work to do in medical education. Work-related burnout in medicine is worsening across all specialties. The 2015 Medscape Physician’s Lifestyle Survey reveals a 46% burnout rate among respondents, 16% higher than the same survey done in 2013.

Nearly all specialties noted higher rates

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of burnout for women as compared to men.

Although women and men enter medicine at relatively equal rates (AAMC 2014-15 data for gender distribution in GME residencies: 46% female, 54% male) the gender distribution begins to skew dramatically beyond residency — in both academic medicine and healthcare leadership positions. AAMC national data reveals a disparity across academia with women occupying only 38% of full-time faculty positions, 21% of full professors, 24% of division chiefs and 15% of department chiefs. Academic advancement largely rests on early mentorship in medical school, residency and in the first few years of practice. Without it, traditional forms of scholarship are challenging to pursue and academic promotion falters.

Healthcare leadership positions also highlight a similar pattern. A 2015 Rock Health State of Women in Healthcare Study highlights these differences. Although women make up 78% of the healthcare workforce, only 34% of the executives at Top 100 hospitals are women. Even in 2016 there remains a compensation gap (2016 Medscape Compensation Report) — with men overall earning 24% more than women, although there is less of a pay gap among primary care physicians (15%) than in specialties (25%). A myriad of etiologies for these disparities exist, but most often point to a lack of mentorship and advocacy (including a female mentor/ role model), confidence, and challenges of balancing life and work.

I have been fortunate to have both mentors and advocates to help me reach this position. I was promoted to the CAO position by our former Chief Medical Officer, Dr. Michael Belzer.

He began to mentor me while I was a Program Director, and over the years developed me for this role. He has been a fierce advocate for women in leadership and advocated for me even before I was convinced I could do this job. Equally MetroDoctors

vital to my own success has been my mentor, Dr. Valerie Ulstad. She began as the model teacher — a patient-centered cardiologist who could create a safe place for learning while simultaneously encouraging individual empowerment and confidence. As I moved from student to teacher to executive leader, she has continued to develop me, support me and encourage me to be better and to strive for more.

True work-life balance is probably not achievable nor should it be the goal.

Balancing an academic role, leadership, a clinical practice and a family is challenging, if not impossible. My husband and family are truly the only reason I can pursue any of these roles, in addition to the practice of medicine, and who support me completely today. I have found that as I invest more in one of these aspects, another has to be pushed to the side for a period. I have learned that constantly adjusting these roles is

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critical, and my goal is fulfillment, not balance.

My desire to lead doesn’t stem from a craving for authority or the need to be in charge. I want to shape the way we teach and learn. I want to continue to innovate and foster curiosity. My role as the Chief Academic Officer allows me the platform to advocate for medical education, train the next generation and continuously improve the environment around me. If it takes a village to raise a family, it takes a village to support, develop, and grow physician leaders. Just as I learned more than I taught from my African students, I have become a better educator because of my patients, students, residents and mentors.

Meghan Walsh M.D. MPH is an Associate Professor of Medicine at the University of Minnesota and the Chief Academic Officer at Hennepin Health System.

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Sharing the Experience 2016

Over 100 physicians, nurses, social workers, chaplains and volunteers joined Honoring Choices on Thursday July 21 for the seventh annual Sharing the Experience Advance Care Planning Conference.

Attendees, while mainly Minnesotans, came from as far as Idaho and for nearly half, this was their first Honoring Choices conference.

Rahul Koranne, M.D., Richard Shank, M.D., emceed the CMO Minnesota Hospital 2016 conference.

Association, was the opening keynote speaker and set the tone for an energetic and inspiring day. Through his presentation, Dr. Koranne challenged attendees to take ACP to a true statewide level — to work to grow ACP awareness and availability in their own communities but also to be cognizant of the larger picture and how important it is for all health care systems and sites to have consistent practices and messages. Sharing stories from his work as a geriatrician and his experiences throughout the state, his message was one of excitement and potential for all Minnesotans to have conversations about their future health care choices.

Five concurrent presentations offered conference attendees the opportunity to learn more about a specific area of interest related to ACP. Vic Sandler, M.D., shared the latest news on the Minnesota POLST program. After giving a brief summary of the history of POLST and a national overview, he shared the Minnesota form which is currently under revision.

He explained the reasoning behind proposed changes and took questions on the best use of the form.

By Karen Peterson

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September/October 2016

The role of Agent is one that is often overlooked, and Deborah Laxson led a powerful session explaining the short-sightedness of not helping Agents understand the depth and scope of their role. She shared examples of ways the health care team can assist Agents (as well as others involved in care) to better understand what is happening to their loved one, to gain confidence Deborah Laxson shares the complexity of the role of that decisions being made are the Agent. one the patient him- or herself would make.

Elderly LGBT clients often have hidden needs that can be missed or ignored by health care teams at the end of life. Marsha Berry of Training to Serve explained the frequently-experienced trauma and stress LGBT patients have gone through and how that impacts their perception of the care they receive. Concerns shared were sometimes surprising to attendees, which made the impact of this presentation all the stronger.

How to carry out ACP with patients with dementia was the focus of Honoring Choices’ Executive Director Karen Peterson’s session. There is very little research on this topic and yet, with the growing number of patients experiencing a form of dementia, it is in the forefront of many people’s interest. Gaps were discussed and attendees invited to share stories, resources and suggestions for working with this vulnerable population and their loved ones.

Vic Sandler, M.D., explaining POLST.

Marsha Berry talking about LGBT patints.

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ACP is monitored by both state and national groups, and there are many rules and regulations hospitals and other care centers need to be aware of and compliant with to meet the requirements. Staying abreast of the current standards and knowing how best to meet them was the topic of Fairview Health’s Sheila Johnson, RN. Understanding which rules apply to which situations is critical for successful surveys, and attendees left the session with a grid outlining the regulations.

Closing the day, Deborah Laxson shared her personal story of being Agent for her husband who had cancer and died in 2009.

Her powerful and sometimes emotional narrative had the audience recognizing in new ways how affective end-of-life situations are for loved ones. One audience member, a palliative care social worker, shared “never again will I understate the importance of the role of Agent.”

Sheila Johnson, RN, outlines state and federal ACP regulations.

Rahul Koranne, M.D., inspires the audience.

When asked what they found most valuable about the conference, attendees had this to say: • Synthesis of so many ideas, attitudes and realities of the core problem.

• Bringing together all sorts of people with a variety of perspective, knowledge, and experience, making for a great learning experience and opportunities for making useful connections.

• Coming together to see the progress we have been making and learning from each other.

• This conference best responds to the complexity of ACP in a health care system environment that wants to oversimplify it.

• As always, meeting new people and collaborating on a shared passion and goal is so energizing! I love hearing about the challenges and successes of other systems. I always come away with many new ideas. Thank you for another great conference!

The staff and Advisory Council of Honoring Choices Minnesota thanks all who attended, assisted with, and advised on this year’s conference. A special note of appreciation to the speakers and volunteers who made the day run smoothly.

Karen Peterson, BSN, is the Executive Director of Honoring Choices Minnesota. Planning for the 2017 Sharing the Experience Advance Care Planning Conference is already underway. To learn more or help with the planning efforts, please contact Karen at 612362-3704 or kpeterson@ metrodoctors.com.

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Summer of Zika Forum On July 26, 2016 the Twin Cities Medical Society held an educational forum at the University of Minnesota called the “Summer of Zika.” Moderated by Peter Bornstein, M.D., MBA, the event’s goal was to help educate healthcare providers and professionals on talking with patients about the Zika virus. TCMS board member Frank Rhame, M.D. spoke about the clinical aspects of Zika infection and early epidemiology. David Neitzel, MS from the Minnesota Department of Health Acute Disease Investigation & Control, talked about Zika virus vectors. Elizabeth Schiffman, MA, MPH from the Department of Health provided an update on the current Zika epidemiology, sexual and blood borne transmission, recommendations and guidelines.

To learn more about events like this and other ways to get involved, please visit www.metrodoctors.com.

From left: Peter Bornstein, M.D., MBA, Moderator. Seated: Frank Rhame, M.D.; Elizabeth Schieffman, MA, MPH; and David Neitzle, MS.

Frank Rhame, M.D., Infectious Disease Specialist, Allina Health.

Elizabeth Schiffman, MA, MPH, Minnesota Department of Health.

David Neitzel, MS, Minnesota Department of Health.

Half of Minnesotans Breathing Easier Under Indoor E-cigarette Restrictions Minnesota has reached a significant public health milestone. As of early July, half of Minnesotans live in communities that have added e-cigarettes to their clean indoor air laws. This exciting news means that workers and patrons in communities that have restricted e-cigarette use in indoor public places can enjoy activities in their community without exposure to secondhand e-cigarette aerosol, which contains heavy metals and carcinogens. It also prevents creating a norm of recreational

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September/October 2016

tobacco use to kids. Just as physicians played an important role in passing Minnesota’s Freedom to Breathe Clean Indoor Air Act in 2007, physicians throughout the state have been working tirelessly to protect their community’s clean indoor air from e-cigarette aerosol.

Now it’s time to make sure all Minnesotans are protected. The Physician Advocacy Network, a statewide project of the Twin Cities Medical Society, has been working closely with physicians to encourage local municipalities to prohibit e-cigarette use wherever smoking is already

prohibited and urge state leaders to add e-cigarettes to the Freedom to Breathe Act. You can defend clean indoor air and protect your patients from the harms of e-cigarettes by signing up to be an advocate with the Physician Advocacy Network or hosting a free, evidence-based educational presentation on e-cigarettes at your clinic.

For more information, visit www.panmn. org or contact Ellie Parker, Project Coordinator, at eparker@metrodoctors.com.

We have reached the tipping point.

Let’s make sure that we keep moving forward until all Minnesotans are protected.

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In Memoriam DONALD J. DOUGHMAN, M.D., an ophthalmologist, passed away on May 2, 2016. He joined the medical society in 2006.

F. BRUCE LEWIS, M.D., internal medicine, hematology and oncology, and a passionate musician, passed away on July 19, 2016. Dr. Lewis became a member of the medical society in 1968.

ARNOLD O. RHOLL, M.D., a radiologist, passed away on June 5, 2016. Dr. Rholl joined the medical society in 1957.

EDWARD W. RUTLEDGE, M.D., orthopedic surgeon, passed away on June 29, 2016, at the age of 65. He joined the medical society in 2005.

CAREER OPPORTUNITIES

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Senior Physicians Association On July 12, 2016 the Twin Cities Medical Society Senior Physicians held their annual summer outing at the Science Museum of Minnesota. The group enjoyed a presentation by David Hilden, M.D., MPH, FACP on “Medicine in the Media.� Dr. Hilden talked about how not only is media changing the way people view medicine, but also changing the way people consume it. After the presentation the group was invited to explore the museums many exhibits and/ or check out a show at the Omni Theater.

The next Senior Physicians luncheon will be held on September 27, 2016, with speaker Brooks Jackson, M.D., Dean of the University of Minnesota Medical School. He will be providing a University of Minnesota Medical School update.

To register or learn more about the Senior Physicians Association please visit www.metrodoctors.com

Guest speaker David Hilden, M.D. was introduced by Senior Physician Association President Marilyn Joseph, M.D.

See Additional Career Opportunities on page 30.

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CAREER OPPORTUNITIES

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BEYOND TREATING, THERE’S CARING

Visit TCMS at www.metrodoctors.com

W E L L A N D B E YO N D Fairview Health Services seeks physicians with an unwavering focus on delivering the bestt clinical care and a passion for providing outstanding patientt experience.

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; and new career opportunities!

Be partt off a collaborative team thatt puts patients att the center and is transforming health care for todayy and tomorrow.

We currently have opportunities in the following areas: • • • • • • •

Dermatology Emergencyy Medicine Endocrinology Familyy Medicine General Surgery Geriatric Services Hospitalist

The Journal of the Twin Cities Medical Society

Internal Medicine Med/Peds Neurology OB/GYN Orthopedic Surgery Otolaryngology Pain Medicine

• • • • • •

Palliative Care Pediatrics Psychiatry Pulmonaryy Medicine Urology Vascular Medicine

To learn more, visit fairview.org/physicians, s call 800-842-6469 orr email recruit1@ fairview.org fairview.org/physicians TTY 612- 672-7300 EEO/AA Employer Sorry,

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September/October 2016

31

LUMINARY of Twin Cities Medicine

By Marvin S. Segal, M.D.

JANETTE HANSEN STRATHY, M.D.

Could a young woman from a small town in northern Minnesota find success one day as an accomplished and honored physician? Let’s just see . . .

Janette Strathy was raised in Lutsen, MN, graduated from Cook County High School and was a Phi Beta Kappa graduate of Hamline University before attending the Mayo Medical School. Her OB/GYN residency, also at Mayo, preceded her embarking upon a 31 year career at Park Nicollet Clinic (PN) and Methodist Hospital.

Her choices of medicine as a career and OB/GYN as a specialty were determined early on when a classmate’s youthful pregnancy resulted in that best friend leaving high school and her pregnancy being complicated by serious pre-eclampsia. Janette believes that the conception and birth of that child, Baby Jason, were instrumental to what would follow for the future Dr. Strathy — a career profoundly involved in the prevention of teen pregnancy and ministering to the myriad needs of expectant mothers and their unborn children.

Professional pursuits, beyond expected practice activities, serving to highlight the uniqueness of this devoted clinician include countless hours in leadership positions in her specialty, her clinic, her hospital and her community. Jan was the MN chairperson for the American College of Obstetrics and Gynecology (ACOG). She also chaired the Clinical Board of Governors of PN and during that long tenure achieved national recognition for meaningful activities in the area of Health Care Equality. Though Jan was the driving force in those endeavors, she modestly credits her PN clinical colleagues for most of those positive outcomes.

She’s been a Health Care Advisor to a U.S. Congressperson, worked in the fields of adolescent health care, midwifery, and maternal mortality, as a major publication’s Editorial Consultant, and as our Hennepin Medical Society Board member.

Effective PN teamwork structure plus the supportive cooperation of her practice colleagues, physician husband and son are credited for being able to so effectively carry out her professional endeavors while fulfilling the pleasant responsibilities of a daughter, wife and mother. She won first prize for her basic science paper on estrogen receptors, repeatedly was awarded “Top Doctor” designations and was the recipient of 32

September/October 2016

the prestigious Earl Young Physician of Excellence award.

As a Clinical Professor at the U of M Medical School, she played an important mentoring role for many of our community’s OB/GYN specialists — an activity for which she is extremely proud.

Dr. Strathy’s recent retirement was brought about by the discovery of a serious gynecological condition. She has faced that troublesome situation on her own terms with the same strength and resolve as she has marshaled on many past occasions for others during her sterling medical career. Her initial treatment has been effective and she states that her focus going forward is “staying healthy” — a most achievable goal. There’ll certainly be a lot of her favorite leisure pursuits — skiing, camping, canoeing, fishing and flying (a licensed instrument rated pilot) — ahead for which to look forward.

Direct patient care involvement has been the most gratifying of Janette’s many diverse career activities, with her “frosting on the cake” being her ACOG leadership accomplishments.

Those who know her best describe her as tireless, dedicated, brilliant, enthusiastic, strong, efficient, sensitive and caring.

She is undoubtedly all of that . . . and more. . . . and, oh yes — the answer to our initial question about that young woman from northern MNtby all means, she found many, many successes and we are proud to honor her as our Luminary.

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.

MetroDoctors

The Journal of the Twin Cities Medical Society

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