Winter 2012: Volume 23, Issue 1

TRIAD, Winter 2012

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We hate lawsuits. We loathe litigation. We help doctors head off claims at the pass. We track new treatments and analyze medical advances. We are the eyes in the back of your head. We make CME easy, free, and online. We do extra homework. We protect good medicine. We are your guardian angels. We are The Doctors Company.

Richard E. Anderson, MD, FACP Chairman and CEO, The Doctors Company

The Doctors Company is devoted to helping doctors avoid potential lawsuits. For us, this starts with patient safety. In fact, we have the largest Department of Patient Safety/Risk Management of any medical malpractice insurer. And, local physician advisory boards across the country. Why do we go this far? Because sometimes the best way to look out for the doctor is to start with the patient.

The Michigan State Medical Society exclusively endorses our medical professional liability program, and we are a preferred partner of the Michigan Osteopathic Association. To learn more about our program benefits, call our East Lansing office at (800) 748-0465 or visit www.thedoctors.com.

www.thedoctors.com 2

TRIAD, Winter 2012

TRIAD Staff Bruce A. Wolf, D.O. & John Sealey, D.O., Editors-in-Chief Jennifer N. Trayan, Managing Editor John Bodell, D.O.; Vance Powell, D.O. & William Strampel, D.O., Contributing Editors Kris T. Nicholoff, Executive Director Lisa M. Neufer, Director of Administration Kevin M. McFatridge, Manager of Communications Cyndi Earles, Director, MOA Service Corp.

Shelly M. Madden. Manager of Membership Carl Mischka, Advertising Representative Millbrook Printing, Layout and Cover Design

contents features 10

Cholera Treatment in Haiti

by Kyle Denison Martin

2011-2012 Michigan Osteopathic Association

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Board of Trustees President Kurt Anderson, D.O. President-Elect Edward J. Canfield, D.O. Immediate Past President George T. Sawabini, D.O. Secretary-Treasurer Michael D. Weiss, D.O.

International Medicine: The Osteopathic Model

by Shane Sergent

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Medical Missions: A Student’s Perspective

by Joseph Gorz

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OMT Strategies to Boost Your Bottom Line

by Douglas J. Jorgensen, D.O., C.P.C.

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Medication Safety provided by The Doctor’s Company

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New Medical Plan Designs

by Mike Buck with Association Benefits

Trustees Bruce A. Wolf, D.O. & John Sealey, D.O. Department of Continuing Education Lawrence J. Abramson, D.O. & Sonbol A. Shahid-Salles, D.O. Department of Insurance Donna R. Moyer, D.O. Department of Judiciary and Ethics Lawrence L. Prokop, D.O. & Myral R. Robbins, D.O. Department of Membership George T. Sawabini, D.O. Department of Professional Affairs Robert G. Piccinini, D.O. & Jesse A. Park, Student Department of Public Affairs The osteopathic profession in Michigan is made up of osteopathic physicians, osteopathic hospitals and an osteopathic medical school. This TRIAD stands together to serve our patients and one another.

TRIAD, the official journal of the Michigan Osteopathic Association, serves Michigan’s osteopathic community, including its osteopathic physicians, hospitals, medical school and patients.

The Michigan Osteopathic Association will not accept responsibility for statements made or opinions expressed by any contributor or any article or feature published in TRIAD. The views expressed are those of the writer, and not necessarily official positions of MOA. TRIAD reserves the right to accept or reject advertising. The acceptance of an advertisement from another health institution or practitioner does not indicate an endorsement by MOA. TRIAD (ISSN 1046-4948; USPS 301-150) is published under the direction of the MOA Editorial Committee.

The committee develops policies regarding the content, advertising and format of all MOA publications.

TRIAD is published quarterly. Periodical postage paid at Okemos, MI 48864 and other post offices.

Subscription rate: $50 per year for non-members (includes UPDATE newsletter). All correspondence should be addressed to: Communications Department, Michigan Osteopathic Association, 2445 Woodlake Circle, Okemos, MI 48864. Phone: 517/347-1555 Fax: 517/347-1566 Website: www.mi-osteopathic.org E-mail: moa@mi-osteopathic.org POSTMASTER: send address changes to TRIAD, 2445 Woodlake Circle, Okemos, MI 48864. ©2012 Michigan Osteopathic Association

departments 5

Editor’s Notebook by Bruce A. Wolf, D.O.

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President’s Page by Kurt C. Anderson, D.O.

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AMOA News by Pam Kolinski

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D.O. Spotlight on Lawrence L. Prokop. D.O.

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Student Spotlight on Jesse Park

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Michigan State University College of Osteopathic Medicine: Now a Global Force

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Dean’s Column by William Strampel, D.O.

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Legislative Update by Daniel J. Schulte

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A Unified Voice: The Michigan Osteopathic Political Action Committee by Joseph Gorz

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Intern-Resident Perspective by Ryan Hart, D.O.

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Practice Manager’s Column by Stacey Kammer

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Last Word with Reza Nassiri, D. Sc. TRIAD, Winter 2012

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TRIAD, Winter 2012

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editor’s notebook

by Bruce A. Wolf, DO

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Bruce A. Wolf, DO, is TRIAD co-editor-in-chief and a member of the MOA Board of Trustees. He can be reached at BWolf@dmc.org.

he way we practice osteopathic medicine in the United States is continually gaining popularity across the globe. Within the past decade, there has been an increasing need for an alliance between U.S.–trained and internationally-trained doctors of osteopathic medicine. With organizations available such as the Bureau on International Osteopathic Medical Education and Affairs (BIOMEA) and the Osteopathic International Alliance (OIA), our profession is currently in progress of reaching its full potential around the world. With this kind of support for the way we practice medicine, we must look at the bigger picture. How can we impact other states and other nations with osteopathic medicine? What are we doing nationally that can be shared? How does this help the people of the world?

In the Michigan Osteopathic Association, we have many members and students who are dedicating their time, knowledge and resources to growing the osteopathic profession internationally.

This not only puts us heads above other osteopathic associations across the country, but this also ensures that Michigan is making a difference locally and abroad. Advancing the knowledge of health, medicine and the osteopathic way in developing regions helps make a difference in global health standards. Nations such as Peru, Haiti and Mexico have realized the importance of whole body and self reliance that helps the healing process. We should not be surprised that this is catching on elsewhere.

As osteopathic physicians, we are advocates for healthy living.

As I stated before, the MOA is heads above other osteopathic associations across the country. There are many of us who are making trips, organizing fundraisers, applying for grants and encouraging fellow physicians or students to use some of their time to aid other countries. These needs have grown exponentially in the last 10 years, and they’re not going to subside anytime soon. Advancing the osteopathic mission and the way that we practice medicine is something that needs to take precedence in our careers. Whether it is among doctors in our practice or reaching children in under-developed countries, the advancement of osteopathic medicine is something that simply must be done.

In this issue of TRIAD, we focus on how our member physicians are spreading the profession across the globe. Terrie Taylor, D.O. and her work on cerebral malaria in children is world renowned. Lawrence Prokop, D.O. and his work in Mexico is reaching new solutions for how we practice osteopathic medicine.

Shane Sergent and Kyle Denison Martin are two Michigan State University College of Osteopathic Medicine students who are raising the bar with their involvement in Peru and Haiti respectively.

Our featured specialty for this edition is osteopathic manipulative medicine, or OMM, and how it can be used. OMM is something that is unique to the osteopathic profession, and I for one am amazed at its growing popularity.

Not only is osteopathic medicine growing internationally, we are also growing locally. When compared to medical doctors, D.O.s are the fastest growing physician profession in the country. Our membership in the MOA alone has increased from more than 4,000 members in 2003 to more than 8,000 members in 2011. With support from the MOA, you can be rest assured that the D.O. profession will continue to live on in strength for years to come.

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president’s page

by Kurt C. Anderson, DO

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s 2012 unfolds before us, let me take this opportunity to wish all of you the best for the new year.

Since my last communication, there has been a virtual whirlwind of activity at the Michigan Osteopathic Association. At the Board of Trustees meeting in November 2011, an updated brand for the MOA was introduced. That new brand communicates the three concepts of the MOA as a conservative, progressive and approachable organization.

I must admit I was somewhat taken aback by the brashness of the proposed new look — a radically different look from what the MOA has used for decades. While the development continues, it occurs to me that maybe a radical new look is what we need, for what is happening to medicine is nothing short of radical.

What started out as a concept by a renegade allopathic physician in a one-room shack in Missouri has flourished exponentially to exist not only in all 50 states, but across our northern and southern borders, and now internationally.

MOA President Kurt C. Anderson, DO, is a private practice family physician and medical director for sports medicine at Central Michigan University.

He can be reached at kander54@aol.com.

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It is necessary to update our image in order to embrace the ever-expanding field of osteopathic medicine while remaining true to our mission and values. What started out as a concept by a renegade allopathic physician in a one-room shack in Missouri has flourished exponentially to exist not only in all 50 states, but across our northern and southern borders, and now internationally. Osteopathic physicians continue to lead the nation as champions for our patients as well as our profession. Our approach to medicine, while humble in its beginnings, has significant impact on the health of our patients. Through the work of organizations like the MOA and American Osteopathic Association, D.O.s are also shaping the health care system. It is reasonable to foresee that, particularly in countries where access to medical care is extremely limited, the benefits of osteopathic medicine have the opportunity to be as far reaching.

Clearly, this world-wide expansion substantiates the osteopathic model as a superior approach to medicine. Within the AOA, Michigan has long been, and will continue to be, a proven leader.

Whichever brand chosen will communicate to doctors and patients alike our progressive vision and leadership as we move forward in the health care profession.

amoa news

by Pam Kolinski

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Pam Kolinski is president of Advocates for the Michigan Osteopathic Association.

She can be reached at michadvocates@yahoo.com.

s we move into 2012, the Advocates for the Michigan Osteopathic Association (AMOA) would like to thank our members and the Michigan Osteopathic Association’s member physicians for your support. It is our goal to encourage and promote those who are active in osteopathic medicine and those who are affiliated with someone in the osteopathic profession. We are pleased to say that we are doing just that through a variety of venues. Some of those venues include: • The Michigan Osteopathic College Foundation annual ball: The AMOA assists in the sales of raffle tickets for the ball and purchases a full-page ad in their program that is handed out to the attendees of the ball. We also donate money to the MOCF annually, and our president is always in attendance at the MOCF ball.

• The Yellow Ribbon Program: The AMOA assists in promoting the Yellow Ribbon Program, a program that provides young people who are contemplating suicide emotional support, throughout the state of Michigan. In fact, many of our members have been trained to give presentations to junior high and high schools about the importance of this program.

• D.O. Day on the Hill: Not only do we participate in Michigan’s D.O. Day on the Hill, we send at least five members to Washington, D.C. to participate and advocate for Michigan D.O.s in the American Osteopathic Association’s national D.O. Day on Capitol Hill. We do this, because we realize that many of our member physicians are not able to make the journey to Washington, D.C. due to the high demands of the osteopathic profession. We want to make sure that Michigan D.O.s’ voices are heard both statewide and on a national level. Be sure to register for D.O. Day on Capitol Hill on March 8, 2012 by going to: http://cf.osteopathic.org/doday/index.cfm.

• Keeping up with legislation: With recent legislative decisions being made such as the physician’s tax and Auto No Fault, the AMOA calls MOA member physicians reminding them to contact their congressmen in regards to the overall decision. We also staff the computer labs during the Annual Scientific Convention in May to allow member physicians to write letters to their congressmen about legislative issues.

• We support our students: In addition to providing each incoming student at the Michigan State University College of Osteopathic Medicine with a personal flash drive, we also provide the Student Advocate Association with funding to go to the annual AOA convention. We also help the MOA with their annual student welcome barbeque they put on for the incoming MSUCOM students during the summer.

As 2012 progresses, I hope to meet more students and obtain more student involvement with the AMOA. Advocacy for these physicians is so important, and anyone who is affiliated with an osteopathic physician can do it. Be on the lookout for future information from the AMOA about how to join and be a part of supporting our D.O.s in Michigan. Here’s to a great 2012!

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d.o. spotlight on Lawrence L. Prokop, D.O.

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Lawrence L. Prokop, D.O. is an associate professor for the Department of Physical Medicine and Rehabilitation at MSUCOM. He can be reached at Lawrence.Prokop@hc.msu.edu.

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bout a decade ago, Lawrence Prokop, D.O. was approached by Peter LaPine, Ph.D., a Speech and Language Pathologist at Michigan State University. Dr. LaPine inquired if Dr. Prokop would be interested in doing some work in the Yucatan peninsula of Mexico with an organization called Angel Notion. Dr. Prokop was told he would see patients who didn’t have access to health care in the Yucatan.

“I didn’t know if there would be any patients who needed some type of rehab,” said Dr. Prokop.

“That being said, I saw about 100 patients in two days. That was almost a decade ago.”

Since that time, Dr. Prokop has traveled one to two times a year, with Dr. LaPine, to work for about a week at a time in Playa del Carmen at Angel Notion. He teaches the Speech and Language Pathology graduate students the medical side of what they are treating.

“They were helping patients learn to swallow, access language and cognitive skills, speak clearly and things of that nature. I was helping them learn why the patients weren’t able to do those things,” he said.

Dr. Prokop brings a wide variety of medical knowledge to the Yucatan peninsula. He teaches the native doctors everything from osteopathic manipulative medicine (OMM) to spasticity treatment that is not available in Mexico. He would see patients who were burn victims, could not speak, could not swallow and could not walk. One woman, who was burned on the entire right side of her body, only wanted them to treat one area, because she did not want to take too much of the doctors’ time.

“The people appreciated the help, but they didn’t want to ‘put out the doctors from America,’” he said. “Those are their words, not mine.”

Through contacts with the Michigan State University College of Osteopathic Medicine (MSUCOM), Drs. Prokop and LaPine are able to expand their practice to Merida, Mexico. This will be in association with a hospital which is constructing new outpatient facilities in Merida. This will draw patients from all over the Yucatan peninsula. Dr. Prokop and Dr. LaPine plan to be a part of this expansion and work with the doctors on the facility that they agreed to build. They will be able to reach out to a larger area of patients and have a stable group of doctors that he is able to work with in Merida.

Dr. Prokop hopes the expansion into Merida will allow him to take medical students from MSUCOM down to the area so that they can see what it’s like to practice medicine in that environment. There are herbal farms that ship their goods around the world. There are also spiritual healers called shaman. This is what Dr. Prokop and his team must take into consideration when practicing medicine in a foreign country.

“Seeing how the natives integrate western medicine with their own is intriguing in itself,” he said. “If you were to ignore their traditional approaches to medicine, you may lose the patient.”

The overall goal is to develop the Merida clinic as a site for MSUCOM students to go and see the merging of both the western approach and the traditional approaches to medicine. The level of medical care in Mexico is not the same as in Michigan, and Dr. Prokop wants to have students learn both ways.

“This is one of the best things I’ve ever done,” said Dr. Prokop of his work in Mexico. “The students we take always want to come back. The patients we see are so grateful for what we do.”

student spotlight on Jesse Park

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Jesse Park is a second year medical student at MSUCOM and the student board member for the MOA. He can be reached at parkjes3@msu.edu.

esse Park is a second-year student at Michigan State University’s College of Osteopathic Medicine (MSUCOM). After having a friend in the firefighting profession, Park went on after high school to become an Emergency Medical Technician (EMT). “It was my drug,” said Park.

“You have to be calm, sharp and alert. It’s an integrity that you need to bring with you in any job, really.”

Park is a student who doesn’t seem to crack under high-stress situations. After seeing interesting sights as an EMT, Park knew that he was meant for the medical field. With that experience and the help of his personal physician, David Charles, D.O., Park knew that the osteopathic method to medicine was a philosophy he wanted to adopt.

“When Dr. Charles told me about the osteopathic way of medicine, I knew that’s what I wanted to do,” said Park. “He was such an awesome representation of osteopathic medicine and what it’s about. I owe a lot to him, and he is a lot of the reason why I wanted to become an osteopathic physician.”

Park is part of the Health Professions Scholarship Program through the United States Navy. While he will become a Naval physician after graduation, Park still says his biggest passion and interest is emergency medicine. However, he is also passionate about his country and being able to serve the men and women fighting for it.

“It’s such an honor that the Navy would want to invest in me,” said Park. “I look forward to being able to take care of them.”

Park also serves on the Michigan Osteopathic Association (MOA) Board of Trustees as the student board member. Through him, the MOA Board is able to hear the thoughts and opinions of the students at MSUCOM. “Because of the MOA, I learned the importance of having a governing body for what I believe in. There are so many physicians who are passionate about the association, and it’s really awesome to see that,” said Park.

Throughout his time serving on the MOA Board, Park has had opportunities to meet physicians from all over the country. Earlier this year, he was able to go to the House of Delegates at the American Osteopathic Association (AOA) headquarters in Chicago, IL. These opportunities have shown him what osteopathic medicine is about and the importance of its existence. He believes the physicians’ passion for the MOA and its affiliates is shown through the decisions that are made.

As far as MSUCOM students getting involved with the MOA, Park believes that is paramount for students’ time in medical school. “To be a good physician, you need to know what’s going on with your profession,” said Park. “What would the D.O. profession be now, if everyone turned a blind eye?”

Park states that wherever he ends up after his service to the Navy, he will be part of that state’s osteopathic association. However, he also is staying true to Michigan. “Michigan is my home, and it always will be. I will always have a tie here and a connection to the Michigan Osteopathic Association,” Park said.

When he’s not studying or serving on the Board of Trustees, Park can be found playing soccer or serving at his church, Riverview. He has recently taken up cooking and enjoys trying new recipes.

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CHOLERA TREATMENT IN

10 TRIAD, Winter 2012 Photo provided by Kyle Denison Martin

by Kyle Denison Martin

There is a certain look to cholera patients: sunken eyes, pale skin, stick thin.

That was how this man appeared. His home, roughly the size of a college dorm room, housed seven people: three adults and four children. One queen-sized mattress was situated in the corner. He was not on this mattress. Instead, he lay strewn across the concrete floor of his small, dark home.

After situating my headlamp, I knelt down next to him and introduced myself. His pulse was racing. The skin around his belly button stayed perched in the air when I pinched it. His family explained that he had been having constant bouts of diarrhea since the prior afternoon.

Fortunately, I had prepared for the worst.

Within fifteen minutes, there was an IV in his arm delivering the fluids that his body so badly needed. Four hours later, after my shift at the house was over, his energy level had already begun to improve. He was able to talk in short sentences. He thanked me over and over again.

The Cloud Forest Medical Clinic (CFMC) was founded in June 2010. This was our first cholera patient.

Many more would follow (including the wife of the man described in this story). Initially, we hiked to the homes of those who became ill.

Oftentimes this meant traveling miles through the mountains. Almost always, the patients that TRIAD, Winter 2012

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Photo provided by Kyle Denison Martin

we found were severely dehydrated and on the verge of death.

Eventually, with the help of Doctors Without Borders (Médecins Sans Frontières), we were able to build a cholera treatment unit near the CFMC. At this new unit, we were able provide treatment to multiple patients at one time in the same setting. The facility was amazingly organized. MSF even provided us with paid nursing staff to care for patients while

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we met our daily duties at the CFMC. Three months after we saw our initial patient, the flow of cholera patients came to a sudden stop. We had survived the first wave.

In total, we had cared for 12 patients in their homes and 50 at the cholera treatment unit. Two patients had died (one who was already dead when our staff member arrived at his home).

When I first came to Haiti in 1996, I didn’t anticipate that fourteen years later I would be helping to open the doors of a new clinic and devising a strategy to prevent the spread of cholera throughout the mountainous regions of the country’s southeast. Yet here I was doing those exact things. It was rewarding in an extremely terrifying way.

Funded by Humanity First, an international non-profit organization, Clayton Bell, M.D., and I ran the CFMC. Dr. Bell took charge of the clinical side of things while I devoted myself to public health and training a staff of local women to become community health workers. The clinic served several communities near Seguin, a trading hub in the mountains of southeast Haiti. Most estimates place the population of this area at somewhere between 20,000 and 40,000. Many patients walked over seven hours to receive care.

From June 2010 to June 2011, more than 8,000 patients received treatment at the CFMC. The majority of patients suffered from communicable diseases, but there were many who also lived with chronic conditions, particularly hypertension.

By the time that I returned to Michigan to begin my thirdyear rotations, we had hired a Haitian staff including a highlyqualified physician trained in the Dominican Republic, a nurse educator, and a pharmacist.

At that point, the first fully-trained class of community health workers had graduated. These eight women began visiting the homes of patients with hypertension, delivering medications and ensuring that they were being taken appropriately. Each woman also began teaching community

health classes to other women in the community. By June 2012, more than 60 additional women near Seguin will have a basic health education.

In March 2010, a group of students from the Christian Medical Association (CMA) chapter at MSUCOM came to volunteer at the CFMC. These students not only shadowed physicians but also provided OMT to patients.

Each day, three students went out into the community to visit patients in their homes, gathering information regarding who had access to clean water and who did not. The experience left such an impression on the students who came that they are eager to return again.

Osteopathic physicians have a history of providing medical care in the remote areas where few health professionals are willing to go. Where there is no doctor, osteopathic physicians are stepping up to fill the gap.

As the world transitions from distinct nations to a global, interconnected community, osteopathic physicians are stepping up to fill the gaps in places like guatemala, Peru and Malawi. These physicians are spreading the osteopathic philosophy and benefits of osteopathic manipulative treatment across the globe. Not only that, they are excelling in these environments, conducting life-saving research on malaria and other deadly diseases.

The future of osteopathic medicine includes an increase in international involvement. Medical students are traveling beyond the borders of the United States more than ever before. It’s become common for students to have experiences serving abroad.

In reality, my own work is a drop in the bucket. Osteopathic physicians reaching out and changing the world; I’m just proud to be a part of it.

Photo provided by Kyle Den

ison Martin

Kyle Denison Martin is a third-year medical student at MSUCOM based in the Muskegon area. He has a Master’s in Bioethics, Humanities, and Society and a Master’s in Public Health from Michigan State University. He can be reached at marti545@msu.edu.

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Photos provided by Shane Sergent

INTERNATIONAL MEDICINE:THE OSTEOPATHIC MODEL

by Shane Sergent

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he concept of international osteopathic medicine is nothing new. When reflecting on the efforts of early osteopaths during the time of Dr. Andrew Taylor Still, the contributions to international medicine that were made by individuals like Dr. John Martin Littlejohn are appreciated. In 1898 he was the first osteopathic physician to touch European soil and is credited with what is now European osteopathic medicine. Furthermore, other great contributors such as Dr. William Smith, Dr. Robert Lavezzari, and physiotherapist Paul gény, led to the spread of international osteopathic medicine.

International osteopathic medicine is more than just a mere ‘mission trip’ or school elective. It is an opportunity to follow in the footsteps of early osteopathic physicians who saw a shortcoming in a distant community and wanted to share a powerful resource: the art and knowledge of osteopathic medicine. Today, MSU COM has been leading international research and clinical medical teams consisting of Michigan physicians, medical students and undergraduates to countless locations around the world, such as Malawi, Haiti, Peru and Mexico, among others.

My experience with international medicine started with the 2010 mission to Huamachuco, a large rural community high in the Andes mountain of Peru. Under the leadership of gary Willyerd, D.O., medical services were provided to a community that has little to no medical services, including a lack of trained health care providers, lack of medications, lack of transportation to health care, lacking health care options, and is lacking in infrastructure. Their efforts included investigations into the epidemiological causes and clinical correlations to the diseases being observed in the clinic. This investigation works to aid in prevention; the cornerstone of osteopathic medicine. As such, the efforts are focused on sustainable medicine rather than just a two week mission.

Shane Sergent is a third year osteopathic medical student at MSUCOM. He can be reached at sergent2@msu.edu.

Osteopathic medicine is focused on preventive medicine and a “whole person” approach to medicine. Just as each individual is unique, so is each community. With this understanding the 2010 mission is not attempting to transplant our nation’s beliefs and culture, but rather preserve the Peruvian identity while providing a sustainable and stable health system.

Serving as the research coordinator these last few years has granted me the rewarding opportunity to develop a research program which focuses on identifying and undertaking measures geared towards sustainable preventive efforts.

Each year this research team consists of medical students and undergraduate medical students with a strong interest in research. Our synergistic approach explores clinical questions and opportunities which may provide the key to unlocking barriers to medicine in Peru. In addition, a research rotation is provided while in Peru to all students interested in exploring a research experience, which hopefully sparks an interest in clinical research. This experience has changed the way I see medicine. Being an osteopathic physician means more than treating symptoms, it means working to find the source of symptoms and disease and working towards prevention. By taking the time to observe trends and having the ingenuity to find correlations, I am realizing new ways to treat communities.

To date, this research has produced a number of clinical findings. For example, under the efforts of Mary Jo voelpel, D.O., elevated blood lead levels in the pediatric patient population were discovered and investigated. After continued on page 28

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MEDICAL MISSIONS: A STUDENT’S PERSPECTIVE

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by Joe gorz

oing on a medical mission is like looking through a telescope into the past. It allows us to practice medicine in the fashion that Andrew Taylor Still envisioned osteopathic physicians to do so. Rather than relying on imaging and laboratory tests, osteopathic physicians rely on our hands, our voice and our physical exam skills. We are able to make a diagnosis by using the symptoms as clues to the disease.

As a third year medical student and student coordinator of the Peru Medical mission under the guidance of Dr. gary Willyerd, I had the opportunity to work with everyone from interns to physicians practicing medicine for more than 40 years. I was able to have quite a few unique experiences in Peru over the past three years. There is one experience in particular, that stands out in my mind. One afternoon while in Huamachuco, a small town 11,000 feet in the Andes Mountains, a patient presented with lower leg pain and gait disturbance. I spoke with and examined the patient. I performed my osteopathic musculoskeletal exam—everything from seated flexion to straight leg raise tests.

Dumbfounded, I turned to my attending physician and told him we needed to order an MRI. My attending turned to me and said, “Joe, look at the patient. Start at the head, look at his shoulders, are they symmetrical? Look at his hips, does one drop down? Look at his knees; do they bow in or out? Finally, look at his feet. Does one have mud on top and the other does not?

The side he feels weak, is that not the same side with mud all over the top of the boot? Could this be foot drop, caused by common fibular nerve dysfunction which is innervated by L4, L5 and S1? We need to focus our physical exam to these motor and sensory nerve areas.” With this new perspective in mind, I reevaluated the patient and realized that patient had sensory loss in the anterior medial upper thigh and foot

drop. In three minutes my attending physician was to make a diagnosis. I felt as though I was experiencing the teachings of Andrew Taylor Still that he used more than one hundred years ago to reach a diagnosis. Dr. Still incorporated his knowledge of anatomy, physiology and pathology to make his diagnoses. If I was back in the United States, I would have jumped to imaging right away, had him follow up when his tests were finished and read, and probably consulted neurology without even thinking twice.

Where have our physical exam skills gone? I remember learning so many skills from Donald J. Sefcik, D.O., and Kari Hortos, D.O., at the Michigan State University College of Osteopathic Medicine in my clinical skills small group. So why was I not relying on them in the first place and instead jumping to what tests I could order? We have become so dependent on our technological resources that our physical exam has fallen to the wayside. We forget the greatest resource of allour physical exam skills.

I am reminded of a comic strip where the first frame showed a group of doctors and residents around a patient. The year was 1950. The next frame in the comic strip showed a group of doctors gathered around a computer. The year was 2000. It would be valuable for everyone to participate in medical missions, where there are no MRIs, EMgS, CT scans, comprehensive metabolic panels and be forced to work with our first set of skills learned—our physical exam skills.

Serving on medical mission trips is one way to put our osteopathic physical exam skills to use, while at the same time helping those who are really in need.

Photos provided

by Shane Sergent

Joseph Gorz is a third year student at the Michigan State University College of Osteopathic Medicine and is from Clarkston, MI. He can be reached at joegorzusa@gmail.com.

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MSuCOM: Now a global Force Elsewhere in this issue of TRIAD are featured faculty and students from the Michigan State University College of Osteopathic Medicine who serve as a powerful force for good around the globe: University Distinguished Professor Terrie Taylor, who has researched and treated cerebral malaria in children in Malawi for decades; student Shane Sargent, one of the leaders of a recent mission to Peru; and student Kyle Martin, who has been serving the people of Haiti his whole adult life. Our Institute of International Health, housed in MSUCOM and serving the entire university under the leadership of Associate Dean of Osteopathic global Outreach Reza Nassiri, has developed educational, research, and clinical service programs on five continents.

But these are only representative samples. A wide variety of MSUCOM faculty, staff and students are active overseas, sharing their skill, time and expertise to care for and educate others. Our students learn both about new cultures in developing countries, and about themselves in light of those cultures. MSUCOM has been at the forefront of promoting and nurturing the osteopathic profession outside of the United States through its exchanges and advocacy. Some of our faculty are world-recognized for the research they are doing, especially in Africa. Here are a few examples: BuiLDinG THe PROFeSSiOn neXT DOOR In the entire nation of Canada, there are only about 20 osteopathic physicians in practice. In order to build the profession there, MSUCOM has developed a new program to encourage Canadian students to study here and return to their 18

TRIAD, Winter 2012

homeland. In 2011, fourteen such students were part of the entering class, with plans to recruit up to 25 each year for the next several years.

FReeinG PeOPLe WiTH ePiLePSY in ZaMBia MSUCOM’s gretchen Birbeck has gained an international reputation for her research and clinical work with persons suffering from epilepsy in zambia. Her work is notable because she has addressed the issue of epilepsy in that African nation comprehensively – including social shunning of its victims, economic deprivation, lack of antiepileptic drugs, interactions with HIv treatments, and most recently, the relationship of cerebral malaria and epilepsy. aDVOCaCY FOR aMeRiCan OSTeOPaTHiC MeDiCine Every positive interaction overseas

by MSUCOM faculty and students helps to increase the understanding of and appreciation for

osteopathic physicians. For example, Dean William D. Strampel, along with IIH, was honored this summer for “playing an integral role in gaining approval for the U.S. model of osteopathic Medicine in the Mexican state of Yucatan.” Dr. Strampel (far right) is shown with (left to right) Douglas Jackson, president of Project CURE; Miguel Cabrera Jr. of the Yucatan Ministry of Health; Yucatan governor Ivonne Ortega Pacheco; and Martin Levine, president of the American Osteopathic Association.

BOaT-BaSeD HeaLinG On THe aMaZOn

One of the more interesting clinical missions undertaken through IIH occurred in January 2011 when 21 MSU medical students provided care from a traveling hospital boat on the Amazon in Brazil, treating parasitic infections, malnutrition and malaria. The 10-day trip also included rotations in a hospital and community clinics, and lectures from Brazilian physicians and Dr. Nassiri.

ReSTORinG HOPe in HaiTi

northern Haiti in October, taking more than $10,000 worth of medical supplies and treating more than 700 patients in that beleaguered country. The trip was organized by IIH, and made possible by donations from the MSU Caribbean Student Association. Willyerd is a global health veteran who has served with or organized 17 medical missions to Central and South America (including this year’s trip to Peru), encompassing more than 1,000 volunteers and treating more than 25,000 patients.

He said the Haitian people were “the poorest and the most in need of health care services I have personally encountered.”

WE’RE DOING WHAT

WE DO BEST IN THE PLACES WE’RE

Two of MSUCOM’s associate deans, gary Willyerd and William Cunningham, led a clinical delegation to

NEEDED MOST. 4,324 Spartan D.O.s celebrating 40 years as part of Michigan State University

College of Osteopathic Medicine

www.com.msu.edu

TRIAD, Winter 2012

19

OMT Strategies to Boost Your Bottom Line

by Douglas J. Jorgensen, D.O., C.P.C.

K

eeping osteopathic manipulation as part of a busy family practice may at times seem arduous and frustrating. However, the benefits to patients and to your bottom line far outweigh the perceived barriers to making Osteopathic Manipulative Treatment (OMT) part of your daily practice, both in and outpatient.

With key input from Dr. Edward G. Stiles, a small teaching hospital in central Maine helped put osteopathy on the federal map. In 1974, Medicare contacted Dr. Stiles due to the objective lack of repeat admissions and improved outcomes for their patients based on billing patterns that proved these measures.1 In today’s fast-paced practice setting, we often see decreased reimbursement for patient encounters. The solution suggested by both payers and administrators to this problem is to maintain last year’s numbers by seeing more patients.

OMT helps treat a myriad of diseases and complaints, but also allows physicians more quality time with patients so they can have medically relevant discussions about their disease, prognosis, psychosocial issues, and treatment options. As if this were not enough, physicians can be paid for a procedure that is and should be readily reimbursed along with the office visit.

Documentation of OMT Poor documentation, even if the work was done at the patient visit, is the primary issue for penalties imposed by audits. Audits aside, notes are often requested to clarify what actually transpired and this is your only record medico legally as well as to defend your charges billed. While an exhaustive medical student or resident note is impractical, we need to be consistent in our terminology and documentation.3 For vertebral somatic dysfunction, the gold standard should be describing the three planes of motion: • neutral, flexion or extension • side bending • rotation Brevity is best so writing T4-6NRLSR clearly illustrates that 20

TRIAD, Winter 2012

the fourth through sixth thoracic vertebrae were in neutral, rotated left and side bent right. Writing T4-6 with a left convexity essentially conveys the same principle, but is less specific and more open to interpretation. Make your notes unambiguous and write exactly what you mean. The less there is to interpret, the more likely you can validate work done and subsequently obviate reimbursement.

Several texts and our terminology from OP&P and OMM during our DO training speak to how we are to document OMT. A quick review or refresher course might be all that is needed to improve documentation to ensure proper reimbursement.

Summary OMT is a wonderful addition to your treatment options that can provide an added economic boost to your bottom line. Knowing how to document and code correctly as well as what modifiers to use when will allow more consistent, optimal reimbursement.

Spending more quality time with patients, holistically treating their ailments and being paid for it makes this a truly rewarding procedural experience.

This article was provided by ACOFP. To view the full article, please visit: http://www. acofp.org/membership/practice_management/coding/0404_1.html.

Douglas Jorgensen, DO, CPC is a family physician with Manchester Osteopathic Healthcare in Manchester, Maine. He can be contacted via e-mail at drj@ jorgensenconsulting.net.

1 When queried, osteopathic medicine with OMT having a vital role was the answer for those better than average outcomes and thus, federal acceptance of OMT commenced.

References • Letter dated 7/30/74 from David D. Williams, Manager Medicare Benefits and Administration, Medicare, Part B to Edwards G. Stiles, D.O. in Waterville, Maine.

Dr. Stiles is currently at the Pikeville College School of Osteopathic Medicine and serves as Professor of Osteopathic Principles and Practice and Chair, Department of Osteopathic Principles and Practice.

• Personal communication with Dr. Stiles • Jorgensen, DJ; “Consistency Counts for OMT Coding”; Osteopathic Family Physician News; April 2003.Ibid

dean’s column

by William Strampel, D.O.

C

arrying the healing power of osteopathic medicine outside American borders is an opportunity that we must not allow to pass us. Why? Our compassion and expertise are needed. The World Bank estimates that a quarter of the world’s people live on less than $1.25 a day and without infrastructure: basic sanitation, clean water, healthy food, reliable shelter, safety. By teaching simple public health measures, offering the skill of physicians and students, propagating osteopathic manipulative medicine, and helping to educate indigenous health professionals, we can make a difference.

The world is our neighborhood. Infectious diseases, environmental disasters, lifestyle degradation, economic turmoil — what impacts one part of the planet impacts us all.

It’s the right thing to do. Institutions that are arrogant and insular are institutions that will fail.

Through the work of our Institute of International Health, the Michigan State University College of

The world is our neighborhood. Infectious diseases, environmental disasters, lifestyle degradation, economic turmoil — what impacts one part of the planet impacts us all.

William Strampel, D.O., is Dean of the Michigan State University College of Osteopathic Medicine. He can be reached at pat.grauer@hc.msu.edu.

Osteopathic Medicine is among those spearheading the next logical step in the growth of American osteopathic medicine – its application and propagation globally. At present we have programs on five continents. When our faculty collaborate on research, when we host physicians from other continents, when our students provide much-needed care in the depths of a rain forest or attend classes in an Egyptian hospital, when we send medical supplies and texts overseas where they are urgently needed, our college is strengthened.

We have dedicated faculty, such as Terrie Taylor, D.O., in Malawi and Gretchen Birbeck, M.D., in Zambia, living and working in developing countries, who have provided for decades the highest levels of research and clinical care where people need it the most. From Michigan, faculty such as Gary Willyerd, D.O., organize multiple medical missions for students and residents. Many MSUCOM students and faculty have made individual pilgrimages to learn, connect, and provide needed care around the globe.

With this year’s entering class, we are expanding internationally on another level. With fourteen Canadian students admitted in a special program, MSUCOM is teaching more full-practice osteopathic physicians than currently exist in all of Canada’s provinces together. It is our hope that the example and advocacy of these students when they return to their homeland upon graduation will provide both recognition of the value of osteopathic practice and high-quality primary care the Canadians sorely need.

I believe that osteopathic medicine is a natural bridge between Western medicine and the medicine of other cultures. When we start with the patient and add “the science of medicine, the art of caring and the power of touch,” we offer medicine that is hospitable, caring, and transcends location and origin.

TRIAD, Winter 2012

21

legislative update

by Daniel J. Schulte

Q

Daniel J. Schulte is the legal counsel for the Michigan Osteopathic Association. He can be reached at djs@krwlaw.com.

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TRIAD, Winter 2012

Can you explain the changes to Michigan’s Auto-No-Fault law being considered in the Legislature? Would the changes just affect insurance coverages? If not, how would the changes affect physicians?

You are referring to House Bill 4936. If this Bill becomes law it will reduce the amount physicians are reimbursed for services provided to auto accident victims and make it more difficult for these patients exceeding coverage limits to pay for these services. The changes will substantially benefit Michigan’s no fault auto insurers, without requiring them to reduce premiums.

Three fundamental provisions of Michigan’s Auto No Fault that have been in effect for decades are: (1) drivers are required to have an insurance policy applicable to injuries suffered in auto accidents providing lifetime coverage for all medical products, services and accommodations reasonably necessary for the insured driver’s recovery and rehabilitation; (2) fault in an auto accident is usually not an issue—persons injured in auto accidents are not able to sue to recover for their injuries (subject to limited exceptions); and (3) physicians and other providers of medical care paid by for by a patient’s Auto No Fault insurer are required to be paid their reasonable and customary fees for these services (there are no fee schedules). House Bill 4936 would make significant changes to each of these provisions of Michigan’s Auto No Fault law.

First, instead of being required to purchase policies providing for lifetime unlimited coverage for medical products, services and accommodations, House Bill 4936 would allow the sale of coverage for medical care and rehabilitation expenses at levels capped at either $500,000, $1,000,000 or $5,000,000.

Payments for medical care in excess of these amounts would have to come from a driver’s health insurance, Medicaid, Medicare (if coverage is available from these sources) or the patients themselves.

Second, fault would become an issue since patients injured in auto accidents that have exhausted their coverage for medical expenses would be allowed to file a lawsuit against a party at fault in the accident to recover unpaid medical costs.

Third, physician services paid for by a patient’s no fault auto insurer would become subject to Michigan’s worker’s compensation fee schedule. No longer would physicians be free to charge their reasonable and customary fee for these services. This would result in an automatic decrease in physician fees for these services as well as physicians losing the ability to set their fees as they now can in the fee-for-service system provided by Michigan’s Auto No Fault law.

The changes to Michigan’s Auto No Fault law proposed in House Bill 4936 would have nothing but undesirable effects on Michigan’s healthcare system, and would have a directly negative effect on Michigan physicians by reducing amounts paid for services provided to patients suffering injuries in auto accidents and making it difficult to collect these amounts.

political action committee A Unified Voice

by Joseph Gorz

T

aking pride in one’s profession is the foundation for success. For physicians, our goals should be to work hard and serve our patients, and our success should be measured by how many lives we save and people we help. For osteopathic physicians, our greatest asset is that we see people as a whole. In helping our patients we experience their pain and suffering and come to understand them as we look to alleviate whatever is not right in their body, mind and soul. In the past, this was enough. A doctor and his patients were all that was needed. The doctor made decisions based on what was best for the patient.

There has been a paradigm shift in the past two decades. The decision on how to treat a patient is now adjusted to what their insurance company allows or what the government is mandating. In this time of ever changing health care, a unified Michigan Osteopathic voice must be heard. I ask you

The decision on how to treat a patient is now adjusted to what their insurance company allows or what the government is mandating. In this time of ever changing health care, a unified Michigan Osteopathic voice must be heard.

Joseph Gorz is a third year student at the Michigan State University College of Osteopathic Medicine and is from Clarkston, MI. He can be reached at joegorzusa@gmail.com.

today to not see yourself as family practitioners, as sub specialists, as surgeons, as fellows, as residents, as students, but as osteopathic physicians or soon to be physicians practicing in the state of Michigan.

What we must do is speak with one loud unified voice. There is a unified voice, but unfortunately only three percent of the osteopathic physicians in Michigan are aware and active. The large majority of our profession is unaware of our very own political action committee. The Michigan Osteopathic Political Action Committee (MOPAC) has been dedicated to preserving our profession. They have worked hard to stop the physician’s tax. They are currently battling to keep the Auto No Fault insurance proposal.

I ask you to show your support by joining MOPAC and becoming part of our profession’s political voice. For those of you who have already joined and those who plan to, I have a simple proposal to demonstrate our profession’s pride. I want us to come together as one and and wear our MOPAC pins every Friday (which are a gift when you join) in order to show our support and pride for being part of the Osteopathic community. A simple act such as this may be what we need to further connect us and keep us unified as group of present and future physicians.

TRIAD, Winter 2012

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www.thedoctors.com

12/1/11

Medication Safety Provided by The Doctor’s Company

by Susan Shepard, MSN, RN Director, Patient Safety Education Article provided by The Doctor’s Company

M

edication safety is a critical component of safe patient care, whether it is general medication knowledge or a provider’s awareness of all medications that a patient is taking.

The Institute of Medicine studied the prevalence of medication errors and found that they are surprisingly common and costly. When all types of errors are taken into account, a hospital patient can expect on average to be subjected to more than one medication error each day.

These medication errors are undoubtedly costly. In the Medicare group, one study found that the annual cost of treating ADEs was $887 million.1 The Joint Commission’s sentinel event database has over 350 medication errors resulting in death or major injury.2 The most common causes of errors involved medication management and medication reconciliation. A majority of medication reconciliation errors resulted from an improper dose or quantity, followed by omission error and prescribing error.3 APPROPRIATE MEDICATION MANAGEMENT As medications are commonly a part of the patient’s 24

TRIAD, Winter 2012

treatment plan, appropriate management is vital to patient safety. Development of standardized systems to ensure safe retrieval and preparation that address similar medications, or “look-alike/sound-alike” medications, and labeling have shown to decrease error and improve outcomes.5 PATIENT SAFETY RECOMMENDATIONS The following additional recommendations are provided to 4:40 PM improve safe medication use in the outpatient clinic setting: • Obtain a medication history and enter it into the chart.

Include prescription medication, over-the-counter medications, vitamins, herbal products, dietary supplements, alternative medicine, and homeopathic medications.

• Have staff update this list at each patient encounter.

• Provide the patient with an up-to-date list at the end of each encounter.

• When telephoning prescription orders, inform the pharmacy about the patient’s co-morbid conditions, allergies, weight, date of birth, and the indication for use.

• Prepare a prescription label for medication samples for the patient to take home each time a sample is given.

• Provide medication counseling to the patient/caregiver through a medium that he or she can understand.

• Do not store drugs (sample medications or clinic medications) that look alike or sound alike adjacent to each other. Drugs with different concentrations or routes should not be stored adjacent to each other.

• Secure all medications that are in the clinic, whether routine or sample medications, in lockable closets or cabinets to prevent unauthorized access by patients or visitors.

• Controlled substances should be maintained in doublelocked locations and counted daily whenever patients are present to ensure all narcotics are there.

• Review all medications at least monthly for their expiration dates. Dispose of outdated medications properly. Assign a clinical person to review all medications and rotate the task to ensure compliance.

• Document all medications administered to the patient during the clinic visit, including vaccines and sample medications.

Ask the patient about medication allergies or sensitivities to substances at each visit or at least yearly, and document the information on the medication form for easy access.

• Provide education to the patient on the medications he or she is taking and any potential interactions, such as with herbal and nutritional substances. Also include signs and symptoms of untoward reaction with instructions to call the clinic for further care. Involving the patient as an active participant in his or her own medication knowledge is a critical aspect of medication safety.

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References 1. Committee on Identifying and Preventing Medication Errors: Incidence and Cost. In: Aspden P, Wolcott JA, Bootman JL, Cronenwett LR, eds. Preventing Medication Errors: Quality Chasm Series. Washington, DC: The National Academies Press; July 2006:105–142.

2. Sentinel Event Alert: Using Medication Reconciliation to Prevent Errors. Journal on Quality and Patient Safety [serial online]. 2006;32(4):230–232. Available from: Joint Commission Resources, Oakbrook Terrace, IL. Accessed February 15, 2007.

3. Ibid.

5. The Joint Commission. E-edition. Medication Management Standards. https://e-dition.jcrinc.com. Accessed July 6, 2011.

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New Medical Plan Designs

by Mike Buck, Association Benefits THe BLueS OFFeR neW PLan DeSiGnS FOR 2012 As the new year approaches, many employers are looking for cost effective ways to manage employee benefits expenses. Blue Cross® Blue Shield® of Michigan is continuing to address those specific needs of the employer and seek a more competitive position throughout the state of Michigan. The latest effort begins with a host of changes that are effective January 1, 2012. These changes will offer employer groups an opportunity to better manage increasing health care cost trends. neW MeDiCaL PLan DeSiGnS The flexibility of Blue Cross Blue Shield of Michigan’s (BCBSM) new Simply BlueSM PPO, Simply Blue SM HRA, and Simply Blue SM HSA plans available January 1st allow employers to gradually move to new comprehensive benefit designs for increased cost-savings opportunities while maintaining the coverage their employees need.

SiMPLY BLue PPOSM This PPO plan is competitively priced and provides employees with the benefits they want.

• Multiple deductible and copay plan options • Preventive care covered at 100% • 20% in-network coinsurance • 40% out-of-network coinsurance • Cost-sharing feature supports cost-eff ective use of services SiMPLY BLue HRaSM The Simply Blue deductible PPO plan can be paired with a health reimbursement arrangement providing the flexibility to help employees to cover out-of-pocket health expenses.

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SiMPLY BLue HSaSM The Simply Blue PPO plans are IRS-compliant to be paired with a health savings account offering employees a tax advantage and encouraging them to take responsibility of their health care dollars.

BLueHeaLTHCOnneCTiOn® Employees are provided with comprehensive wellness and care management through BlueHealthConnect. This unique program includes an online health assessment and coaching programs, 24/7 nurse line and health improvement programs including quit the Nic, chronic condition management and case management.

VaLuaBLe WeB ReSOuRCeS Employees have the convenience of viewing their account, benefit and claims information online anytime. They also can find and compare the cost and quality of doctors, hospitals and drug treatment options based on the criteria that is important to them with Healthcare Advisor, which is powered

by WebMD. MeMBeR DiSCOunTS Employees can save money on healthy products and services with Healthy Blue XtrasSM and Blue365® savings programs. This includes healthy products and services they use every day from companies across Michigan and the United States.

For additional information call the MOA at (800) 657-1556, or contact the Association Benefi ts dedicated MOA representative, Julie Watson (248) 359-6489 or julie@association-benefits.com.

Mike Buck is the president of Association Benefits. He can be reached at mike@association-benefits.com.

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TRIAD, Winter 2012

intern-resident perspective

by Ryan Hart, D.O.

I

Ryan Hart is a PGY3 Emergency Medical Resident at Sparrow Hospital in Lansing, MI. He can be reached at emergencydo@gmail.com.

believe that we have a grand opportunity before us. As physicians in this age of health care, I believe that our unified voice, should we find it, can change the future. As a profession, we have the influence and the ability to alter the course of not only our careers and the future of health policy, but our economic stability as a nation in the years to come, the health of our poor and the education of our children.

So often we play the ostrich, sticking our collective and individual heads in the sand and protecting ourselves in the short term; not getting involved. Instead I propose that we follow in the footsteps of some of our greatest leaders: Franklin, Churchill, Lincoln, gandhi and King. In our own minds we need to decide what is right, not for us, but for everyone in our community. Then, we need to act on those issues.

As physicians, we face threats against our practice and livelihood from trial lawyers forcing defensive medicine, from CMS dictating “standard of care”, from mid-level and alternative practitioners who want to skip medical school to practice medicine, from legislators who think we are gaming the system and from a public that thinks we are money-hungry, greedy and dishonest. As citizens, we face threats from increasing crime rates, increasing tax rates, decreasing quality of education for our children, instability in the economic sector, and the loss of morality from the general public. As a parent I struggle when my children envy what others have and do. I believe that my children, while still young, need to be taught that nothing will be given to them; they will have to earn every bit. I cringe as my children play with some of their friends who have no respect for their elders, their parents, their siblings, or even themselves.

When I compare my generation with that of my grandparents’, I see the values that forged this country disappearing quickly. My grandparents taught my parents, who in turn taught me, to work hard every day to earn everything you have. If you have truly earned something, then nobody can take it away from you. The number of people of my generation who want to have their cake and eat it too, is astounding. All over the news, the streets, in the government, and even in my own hospital I see people who want the quick fix, the quick buck, the easy answer.

During the one to three minutes after I lay my weary resident head on my pillow and before my two-year-old can jump on my head without waking me up, I worry that I may not be providing my children with the best example of how to conduct oneself. I worry that I work too much, and I don’t place enough emphasis on family. We talk constantly, for the five to ten hours per week that I get to see my children, about what we should be doing and why we should be doing it. But all of you who have children know that it takes much more than that to properly raise a child.

It is your job to decide what is right for you and your family. It is my job to go to bed at night and sleep soundly knowing that I set my best example for my children to follow. I ask that each of you consider, next time you see someone compromise, confronting the offender and pointing out that he or she should be choosing right and not compromising beliefs and values. I’ll bet that the next person you notice compromising is yourself.

As a group, physicians across the country and across the world have the ability and the responsibility to do what is right to improve our patients’ well-being. We can do it one on one in our offices, we can do it one to one hundred in the PTA meeting and we can do it 900,000 to nearly 7,000,000,000 by standing up for what is right for everyone. Winston Churchill was quoted, “You can always count on Americans to do the right thing after they’ve tried everything else.” I would like to prove him wrong. Won’t you join me?

TRIAD, Winter 2012

27

estimates of the overweight and obesity levels range from 26-42.7% of the pediatric population. Additional research investigating multiple environmental focuses on water quality studies and the factors, elevated lead levels in the impact of the overweight and obesity soil was discovered. This was likely levels on cardiorespiratory fitness. secondary to mining run-off. Other The sole mission continues research teams have been investigating to be one of sustainability. Given trends contradicting the historic belief that Peruvians have sought to that overweight and obesity are a understand the principles of the high-income country problem. Using osteopathic profession, there will be anthropometry, significant overweight preventive strategies by educating and obesity levels in the pediatric the communities about osteopathic 11ADX546 Pinkus BW ad 1/2 page_Layout 1 12/20/11 1:58 PM Page 1 population have been found. Current medicine with an Osteopathic Principles “International Medicine” continued from page 15

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TRIAD, Winter 2012

and Practices interactive workshop in Lima, Peru. The objective is two-fold; impart the sustainable preventive philosophy to foster unquestionable health promotion and further the advancement of international osteopathic medicine. Currently, Peru is a country which does not acknowledge DO licensure. While efforts are nowhere close to paralleling those like Dr. John Martin Littlejohn, the desire is reflected to integrate sustainable osteopathic ideals, techniques, and philosophy in the communities served. With this understanding, the Michigan Osteopathic Association has provided the resources through an osteopathic principles and practice initiative to demonstrate how the body is intrinsically able to heal itself and how a preventive approach to medicine prevails to the leaders of these communities. The immense importance that this project has is a direct effect on community integrated preventive healthcare. Through education of osteopathic manipulative therapy (OMT), a hands-on diagnostic and therapeutic technique to correct and prevent disease and injury, which is one of the greatest tools of osteopathic physicians, is offered. Given the resource limited infrastructure of this country, the utilization of manual medicine would provide a lasting reserve to medicine.

If there was anything that reinforced my belief and perceptions of osteopathic medicine, it would have to be the individuals with whom I share this experience. Each year there are countless eager students and physicians who leave the comfort of their homes and forgo vacation time to serve this patient population without the resources available in the United States. These volunteers are subjected to long work days, limited modern comforts, cold showers, and often no electricity, all in an effort to spread osteopathic humanitarianism. One cannot understand the need until one sees the need. While many volunteers assist the underserved communities in the United States; they continue to serve the international community during their off time. Therefore, we will continue to explore sustainable medicine in our absence.

practice manager’s column

by Stacey Kammer

I

Stacey Kammer is the Enterprise Manager at Metro Health in Allendale, MI. She can be reached at Stacey.Kammer@metrogr.org.

t’s that time of year… when gifts come in all shapes and sizes. We are reminded to take a step back from our busy lives and jobs to share in the warmth of others and to selflessly give our time and resources, simply because we care. In this issue you have read about the impact that osteopathic medicine has had across the country and far beyond our borders. As we gather to share the season’s greetings with one another, be reminded of the special gift that you, your staff, and providers give each and every day.

Our jobs are stressful, chaotic, ever-changing and demanding. We often do not take time to reflect on the profound impact our practice and staff has on the most important aspect of any person: Their ability to live, and live well.

The gift of medicine has no borders. Just last year, the country of Haiti faced one of the greatest natural disasters in the last decade. A catastrophic earthquake struck near the heart of the country’s capital, killing more than 316,000, injuring nearly 300,000 and left more than one million people homeless. Just shortly after the holidays in the wake of the disaster, I was inspired to give hope by the generosity and support at my own hospital, Metro Health. One of my physicians, William Cunningham, D.O., helped steer a group of providers, nurses and staff who came together to bring supplies and aid to the country. The employees helped round up extra medical supplies, medicine and other useful items that could be spared for the trip. In all, nine doctors from Michigan, including Dr. Cunningham, made the journey to Haiti and provided care to hundreds of Haitians in need.

Providers at Edmondson, Rouse & Schmid Family Practice in Saranac also know the value of giving back. Steven Edmonson, D.O., has created an amazing non-profit organization called Starfysh, which provides support to La Gonava Island, just 12 miles off the coast of Haiti. The organization has many goals including agricultural development, advancements for clean water, economic and academic growth and health care progression. More than 80% of the population has no access to basic health care. On an island where one of 13 children will die before their fifth birthday, Starfysh’s mission is spreading a message of hope, not only to the people in Haiti, but also for the people Dr. Edmonson works with. The generosity is not only channeled through the mission of the organization, but also by the backing of the practice. Providers and staff give a different kind of gift: support. While Dr. Edmonson is away, coworkers pitch in to cover the work load, which allows him to share his talent with those in need.

Although your resources and ability to give back may not reach across international borders, consider what you and your staff can do locally to help those less fortunate.

After all… it is better to give than receive.

For more information on how you can help, please visit any one of these reputable non-profit organizations: Starfysh.org; Doctorswithoutborders.org; Liveunited.org; Redcross.org.

TRIAD, Winter 2012

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last word with Reza Nassiri, D. Sc.

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Dr. Reza Nassiri is the Associate Dean of Global Health Programs at the Michigan State University College of Osteopathic Medicine. He can be reached at reza.nassiri@hc.msu.edu.

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fter joining Michigan State University’s College of Osteopathic Medicine (MSUCOM) three years ago, Dr. Reza Nassiri has worked to provide medical and health students with opportunities to see how medicine is practiced internationally. Being the Associate Dean of Global Health Programs, the Director of the Institute of International Health (IIH), professor of clinical pharmacology and a lecturer in infectious diseases and tropical medicine, Dr. Nassiri has aided the establishment of multiple teaching sites around the world including Brazil, Mexico, Dominican Republic, India, Italy, Russia, the UK, Uganda and Egypt.

“Our goal is to provide our medical and health students, with global health opportunities, either through clinical electives or global health research with all continents,” says Dr. Nassiri.

One of Dr. Nassiri’s main responsibilities is to develop study-abroad courses for students in the medical field at MSUCOM. Students from not only the osteopathic school of medicine, but those involved in human medicine, public health and nursing, are given the opportunity to travel with Dr. Nassiri and a team to learn about topics ranging from poverty-related diseases to culture of medicine in community health. Dr. Nassiri teaches students to compare and contrast the health care systems and how medicine is practiced between the United States and other nations. These experiences allow the students’ eyes to be opened at the stark differences in medicine and health around the world.

Another duty of Nassiri’s is to promote osteopathic medicine internationally.

“I really want to highlight Dean William D. Strampel, D.O. He is very visionary and a true leader in osteopathic medicine. Because of his vision and leadership, I am now in a position to internationalize the profession of osteopathic medicine with support from the American Osteopathic Association” (AOA).

With the help of Strampel’s vision, MSUCOM gained the approval from Yucatán allowing any osteopathic physician who is trained in the United States to practice in Yucatán. At a ceremony last year, on campus, Dr. Alvaro Quija, the general secretary of Yucatán Department of Health, had a proclamation signed by him, Dean Strampel and John Crosby, the Executive Director of the AOA. The hospital in Merida, Yucatán now has a new five-story structure. One floor has been designated to MSUCOM and helps further Dean Strampel’s vision to establish the first international osteopathic clinic of MSUCOM in Yucatán.

“It is very exciting to be part of this unique college,” said Nassiri. “Being able to see osteopathic medicine advance to other nations is a wonderful opportunity for me. I enjoy working with my colleagues at MSUCOM to promote our profession in other countries.”

As the Director of the IIH, it is Nassiri’s responsibility to foster basic, clinical and translational research for all health and health related faculty members of Michigan State University and to conduct global health research, global health research programming or global health development. The IIH conducts numerous program including ones to do with HIV/AIDS, tuberculosis, environmental health and water quality, point of care molecular diagnostics, nutrition and international osteopathic medicine and outreach programs.

“Currently we are studying how we can extend the mission of international health to other areas such as community health, family practice, child care and maternity care,” said Nassiri.

Nassiri travels on average once a month with the exception of June and July. Because of his extensive traveling, MSUCOM is able to establish these global health opportunities. Dr. Nassiri plays an important role of the expansion of Michigan State University’s global health vision and osteopathic medicine on an international level. With his continued service to MSU, MSUCOM and the osteopathic profession, great strides will continue to be made.

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