Summer 2012: Volume 23, Number 3 by Michigan Osteopathic Association

TRIAD, Summer 2012

We reward loyalty. We applaud dedication. We believe doctors deserve more than a little gratitude. We do what no other insurer does. We proudly present the Tribute® Plan. We honor years spent practicing good medicine. We salute a great career. We give a standing ovation. We are your biggest fans. We are The Doctors Company. Richard E. Anderson, MD, FACP Chairman and CEO, The Doctors Company

You deserve more than a little gratitude for a career spent practicing good medicine. That’s why The Doctors Company created the Tribute Plan. This one-of-a-kind benefit provides our long-term members with a significant financial reward when they leave medicine. How significant? Think “new car.” Or maybe “vacation home.” Now that’s a fitting tribute. 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/tribute.

Michigan Osteopathic Association

www.thedoctors.com

2 TRIAD, Summer Tribute Plan projections are2012 not a forecast of future events or a guarantee of future balance amounts. For additional details, see www.thedoctors.com/tribute.

TRIAD Staff Bruce A. Wolf, D.O. & John Sealey, D.O., Editors-in-Chief Kevin M. McFatridge, 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 Marc A. Staley, Manager of Finance Carl Mischka, Advertising Representative Millbrook Printing, Layout and Cover Design

contents features 10

Core Grant 2011–2012 Recipients: Recognizing Commitment to Primary Care and Prevention by Tessa Albright

One Doctor’s Quest to Tip the Scales of Childhood Obesity

Respite Ranch Cares for Caregivers

Alternative Spring Break Teaches Empathy, Awareness

A Tragic Lesson in Drug Safety by David M. Traxel, MD

Patient Protection Affordable Health Care Act Update by Michael G. Buck

2012–2013 Board of Trustees President Edward J. Canﬁeld, D.O. President-Elect Michael D. Weiss, D.O. Immediate Past President Kurt C. Anderson, D.O. Secretary/Treasurer Myral R. Robbins, D.O., FAAFP, FACOFP Past President George T. Sawabini, D.O., FACOFP, D.Ph Trustees Insurance Department Lawrence J. Abramson, D.O., MPH & Bruce A. Wolf, D.O. Membership Department Gregory Harris, D.O. & Lawrence L. Prokop, DO Continuing Education Department Robert G.G. Piccinini, D.O., dFACN & Jeffrey Stevens, D.O. Public Affairs Department Leo E. Reap III & John W. Sealey, D.O.

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 quarterly by the Michigan Osteopathic Association, 2445 Woodlake Circle, Okemos, MI 48864. Periodical postage paid at Okemos, MI 48864 and other post offices. Subscription rate: $50 per year for nonmembers. 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. Email: moa@mi-osteopathic.org.

departments 5

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

President’s Page by Edward J. Canfield, D.O.

AMOA News by Dana Borenitsch

D.O. Spotlight on Christopher Pohlod, D.O.

Student Spotlight on Leo Reap

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

Legislative Update by Kevin McKinney

Intern-Resident Perspective by Gregory Harris, D.O.

Practice Manager’s Column by Stacey Kammer

Inside the AOA by John B. Crosby, JD

The Last Word by Walker Foland

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TRIAD, Summer 2012

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editor’s notebook by Bruce A. Wolf, D.O.

imply defined, community outreach is the practice of conducting local public awareness activities through targeted community interaction. As an osteopathic physician working in partnership with our patients, we consider the impact that lifestyle and community have on the health of each individual, and we work to break down barriers to good health. The articles that follow are a mere example of how Michigan osteopathic physicians interact with many different communities. From Dr. Erhmann’s work in childhood obesity to Nancy DeKatch’s Joseph DeKatch Caregiver Foundation to the Michigan State University College of Osteopathic Medicine’s alternative spring break, this issue of TRIAD is sure to open your eyes to the outreach our member physicians do each and every day. Community outreach begins in our lives early. As medical students, we begin to learn of our communities through different events our neighbors may participate. As interns and residents, we assist our teaching faculty with school health screenings and free clinics. As a practicing physician, we work within our hospitals to put on programs that educate our local communities about available services. Then as adults, we coach little league teams for our children. In fact, there are many osteopathic physicians who serve as the physician for high schools, colleges and professional sports teams. There are many members of the Michigan Osteopathic Association who participate in community outreach programs that we could fill an entire issue of TRIAD with the list of names and activities. The majority are done without fanfare. I applaud each and every one of you for your service in giving back, and encourage those who have yet to do so, to find a willing cause. This is one of the basic tenets we are taught.

Bruce A. Wolf, D.O., is TRIAD co-editor-in-chief and a member of the MOA Board of Trustees. He can be reached at BWolf@dmc.org. TRIAD, Summer 2012

president’s page by Edward J. Canﬁeld, D.O.

MOA President Edward J. Canfield, D.O. is a family physician in Sebewaing, MI. He may be reached at ejcanfield.do@gmail.com. 6

TRIAD, Summer 2012

t is my great honor and privilege to serve as your 114th President of the Michigan Osteopathic Association (MOA). Albert Schweitzer said, and I quote: “I don’t know what your destiny will be, but one thing I do know: the only ones among you who will be really happy are those who have sought and found how to serve.” I believe that Service is one of man’s greatest callings. When I teach medical students and residents I ensure that they realize that as physicians we are to serve our patients. As your President of the MOA, my job is to serve the interest of Osteopathic Physicians and our patients. With your help, I fully intend to do so. Osteopathic Physicians are great servants! In this issue of TRIAD, you will discover: • Dr. Paul Ehrmann’s quest to tip the scales of childhood obesity. Dr. Ehrmann helped to launch a school-based outreach program called Children’s Health Initiative Program, or CHIP, nearly a decade ago. Ehrmann and his team visited different schools to create a five week, 90-minute program that would encourage fourth to sixth graders and their families to make healthy choices and educate them on the importance of physical fitness. • Twelve Michigan State University College of Osteopathic Medicine students who chose an alternative to the traditional spring break and served food in a D.C. soup kitchen, organized health fairs for a homeless shelter and rehab facility and provided health screenings to some of our nation’s capital’s most in-need citizens. • Nancy DeKatch and Robert Chatfield, D.O., M.P.H., M.H.A. who, together, founded the Respite Ranch for Caregivers. Think of Respite Ranch as a professional development retreat meets group therapy meets spa for caregivers. “It’s a total wellness stay.” When I first considered joining the MOA Board of Trustees I struggled with the decision. There were many issues which I felt needed to be addressed. I was trying to define them to get some action. I spoke to MOA Past President Dr. John Everett, who told me the biggest reason to serve on the Board, was, “If you are not at the table you cannot affect change. Being on the MOA Board puts us at the table.” Medicine has some serious issues that must be addressed! • Cost of Health Insurance: It is estimated the average cost of a families’ health insurance plan by the year 2019 will be more than $30,000 per year. By the year 2010, the average Michigan family earnings will be $45,000 per year. We must anticipate that a serious change to what health insurance is, and what it will pay, is going to occur within the next few years. • Michigan Medicaid: Reduce the number of Medicaid HMO’s from 14 to, ideally one or at least fewer; A single drug formulary for all Michigan Medicaid; press for administrative consistencies in the programs; and continue to work on tort reform. • Affordable Health Care Act: The Medicaid roles in Michigan are expected to swell by more than one million additional lives… the plan touts a partial solution for the first few years; it is to pay at least primary care physicians at Medicare rates. That should help if you believe the Federal Government will address the Sustainable Growth Rate. • Military Service People: Are you aware that many doctors and hospitals do not accept TRICARE Prime, one of the insurances provided by the federal government to our retired, disabled and active duty service men and women and their families living in remote areas? One local hospital could not afford to see these patients, as TRICARE Prime for many services, reimburse at less than Michigan Medicaid rates! It is important that we are not only at the table on these issues, but driving the conversation. Let us work together. If you have a problem, you can bet that other physicians have a problem also. The MOA is here to serve, but we need to hear from you.

amoa news by Dana Borenitsch

s a first term president of the Advocates for the Michigan Osteopathic Association (AMOA), I would like to introduce myself. I have been the proud, supportive wife of an osteopathic physician for 36 years. I am also the survivor of my husband’s TWO residencies; one in Pediatrics and one in E.N.T., and managed his two offices for more than 25 years. I am no stranger to the world of health care, also being the proud mom of a chiropractor, a neonatal nurse practitioner and a proud mother-in-law of an optometrist. It is truly exciting to be part of an organization that is as important and multifaceted as the AMOA. Just some of our venues include the Michigan Osteopathic College Foundation annual Ball, participation at D.O. Day on the Hill, support of our MSUCOM students and the Student Advocate Association. In addition, we have promoted such worthy endeavors as the Yellow Ribbon Program to provide emotional support to young people who may be contemplating suicide. My most fervent wish is for active participation and involvement of all those individuals who are affiliated with someone in the osteopathic profession. With more than 8,000 D.O.’s in Michigan, we will work together as a vital and viable part of our state health care community. With fundraising being crucial to our purpose, there are multiple modalities of generating income. These include membership fees, raffle tickets at our state convention, the sale of gift cards through ScripPro, ink cartridge recycling, and the Tree of Peace ornaments. Another important function is the dissemination of information through our current website www. mi-advocates.org which will be updated monthly. There, you will find dates and times of upcoming events and activities. My Motto for the year is by Charles Allen:

“Remember that you are needed. There is at least one important work to be done that will not get done unless you do it.”

Dana Borenitsch is the president of Advocates for the Michigan Osteopathic Association. She can be reached at michadvocates@yahoo.com.

I would like to emphasize how much each and every one of you is needed! Everyone has a talent to contribute to the body of our membership. Above all, by participation and strengthening our relationships, we can all truly make our purpose fun while helping to provide support for our spouses and children. I would like to personally extend an invitation to attend any board meeting (dates are on the website) and also, bring a friend! Check us out and become involved; be a part of our creative planning. Your ideas and our friendships are eagerly anticipated. I am looking forward to the year ahead, meeting as many of you as possible, and doing new things to beneﬁt the Osteopathic member of your family.

TRIAD, Summer 2012

d.o. spotlight on Christopher Pohlod, D.O. by Kate Tykocki, APR

Christopher Pohlod, D.O. is an assistant professor of Pediatrics for MSUCOM and the Associate Chief Medical Information Officer for MSU Health Team. He can be reached at pohlodch@msu.edu. 8

TRIAD, Summer 2012

hen Christopher Pohlod, D.O. transitioned from Michigan State University College of Osteopathic Medicine (MSUCOM) to a Pediatric Residency at Sparrow Health System, it was the start of a robust partnership and career path. His passion for pediatrics started with a research project at Michigan State University teaching physicians to be researchers. Pohlod chose pediatric obesity as his research topic and interviewed dieticians in the area that had been treating obese children. “I got to know the disease itself and how to make it better. It gels with my internal sense of what osteopathic medicine is all about. A lot of people focus on manual medicine as what defines us as D.O.s, but I see it that we use inherent mechanisms to help us heal that don’t always use drugs or surgery. We can deal with obesity using a multidiscipline approach to get people back to healthy.” Pohlod uses that multidiscipline approach as an Assistant Professor of Pediatrics at MSUCOM. He’s also the Associate Chief Medical Information Officer for MSU Health Team and is part of group trying to establish a multidisciplinary weight management team with MSU and Sparrow. Pohlod is a proponent of motivational interviewing as a technique to help children and families struggling with obesity, and recognizes change often starts with the parents. “If we just realize that through developing strong relationships with families, you’re able to start to help the healing process begin is a very osteopathic concept.” It’s no surprise this osteopathic manipulative medical fellow uses osteopathic manipulative therapy frequently in his practice. “I’ve had a couple of asthmatic patients that have done much better in terms of less chronic symptoms with their asthma when families wanted to do OMT. With musculoskeletal pain, not only does it help a large number of kids, I think it also decreases need for follow-up. With exercise prescription and stretching and some other things we come up with, we’re able to manage musculotherapy problems much quicker than with a physical therapist. Often times with colic and reflux with families, not only do you get to do the manipulation, but you spend time with the families to see how the disease is affecting them and it helps to be able to see how it affects families to better be able to counsel them.” Pohlod is also doing work in HIT and EMR to improve electronic records and the way physicians and their practices interact with software. Despite being a techie, though, he still believes in traditional osteopathy. “I think a lot of us feel kind of lost in the current world on what is actually a D.O. and if you return to the thought that osteopathy is using the body’s inherent mechanisms to encourage health and happiness there is a bunch of evidence-based interventions that do fit that profile that I think we could be embracing as we go through our lives in our practices.”

student spotlight on Leo Reap by Kate Tykocki, APR

Leo Reap is a second-year medical student at MSUCOM and the student board member for the MOA. He can be reached at reapleo@msu.edu.

hen Leo Reap started his college career as a Biology major at Kalamazoo College, the extent of his knowledge of osteopathic medicine was that everyone in his hometown loved the local D.O. When he shadowed a general surgeon during his undergraduate career and had the opportunity to partner on a research project, he found his passion. “I discovered that I really loved medicine.” Now a second-year medical student at Michigan State University’s College of Osteopathic Medicine (MSUCOM), Reap knew the osteopathic philosophy resonated with him. “I looked into the philosophy and it really agreed with what I wanted to be as a physician,” said Reap. Reap dove right into the MSUCOM program, joining the Student American Academy of Osteopathy (SAAO) and attending Convocation. “It gives me a different perspective because you get to see the big picture,” said Reap. “When you’re swamped with studying it’s easier to get distracted from the overarching perspective of what we’re studying to be and through SAAO I get to keep that perspective.” That perspective has also been broadened by Reap’s service as SAAO president and his new position as the student board member for the Michigan Osteopathic Association (MOA). Reap’s MSUCOM “Big Sib” was Jesse Park, the previous student board member. Park introduced Reap to MOA and its Board of Trustees, and Reap knew it was a great fit to pursue one of his other passions in life -- politics. “I’ve always been interested in politics and I was looking for something greater,” said Reap. “It’s hard to keep informed around what’s going on in all of medicine and it’s going to affect how we practice.” As a student board member, Reap wants to see students better understand MOA’s mission, and the effects of policy decisions on students’ future careers. “I really promote what the MOA does for the students. It’s so easy to forget what’s going on when we’re at school, and this is an organization that’s there to serve them in their practices and as students. Part of my job is to promote how the MOA will be there for them and also help them understand how it will affect them as physicians.” Even with medical school, SAAO and his Board of Trustees seat, Reap still finds time to stay physically active. He’s a long distance runner who competed in the Traverse City Marathon and Tough Mudder race, an obstacle course designed by British Special Forces. “What I love about running is it’s a time for me to think and get away from everything. Running has been a really great outlet for me and trying to figure out myself and not think about school and just to de-stress.” He’s also an avid golfer and always looking for a new partner on the course. “Let the other D.O.s know that if they ever need a golf partner, I’m up for it.” TRIAD, Summer 2012

Core Grant 2011–2012 Recipients

Recognizing Commitment to Primary Care and Prevention by Tessa Albright

ach year, the Michigan Osteopathic Association (MOA) awards three Core Grants of $1,000 to support primary care and prevention initiatives which illustrate an outstanding commitment to the principal tenets of osteopathic medicine. In 2007, Core Grants were established by MOA’s Michigan Council of Osteopathic Promotion (MCOP) as a means to promote primary care and prevention initiatives which exemplify the core values of osteopathic medicine. A panel comprised of members of the MOA MCOP selects the Core Grant recipients based on their project’s level of need, feasibility, impact, and embodiment of the osteopathic cornerstone of preventive health. This year, the panel awarded three grants to the following projects: • Pontiac Osteopathic Hospital (POH) Dermatology Residency Program for its Melanoma and Skin Cancer Prevention Initiative. Jonathan Richey, D.O., MHA submitted the project entitled, Melanoma/Skin Cancer Detection and Prevention Event. Dr. Richey’s project centered on raising public awareness of the grave dangers of melanoma and skin cancer, particularly in Oakland County. An alarmingly high number of Americans will be aﬀected by skin cancer in their 10

TRIAD, Summer 2012

lifetimes. Moreover, melanoma claims thousands of lives every year but if detected early, it has an exceedingly high cure rate. The POH Dermatology Residency Program held a free skin cancer screening event during May, the Melanoma/Skin Cancer Detection and Prevention Month, in hopes of reaching, teaching, and screening as many people in Oakland County as possible. Additionally, the Core Grant funds will be utilized to create radio and television advertisements, mailers to area physicians and community groups, as well as educational materials to teach the public the critical importance of skin cancer early detection and prevention. • Shane R. Sergent and Travis Gordon, students of the Michigan State University College of Osteopathic Medicine (MSUCOM), received a Core Grant for their project entitled, Sustainable Medicine: the International Osteopathic Approach. For the past three years, Sergent and Gordon, along with Melissa Hart, Michael Burla, and Hailey Wouters, have led international research and clinical medical teams composed of Michigan physicians, medical students, as well as undergraduates on medical mission trips to Peru. Sergent and Gordon’s award-winning project focused on providing sustainable medicine to Peruvian communities in the absence

of these medical mission trips. To promote the central osteopathic tenet of preventative medicine, Sergent and Gordon proposed implementing an Osteopathic Principals and Practices Interactive Workshop in Lima, Peru. The workshop will target Peruvian physicians, medical students, non-governmental organizations, and health policy leaders. MSUCOM physicians and students will present on topics such as the History of Osteopathic Medicine, Osteopathic Principles/Philosophy, the Anatomy and Physiology behind Osteopathic Manipulative Medicine (OMM), Soft Tissue Techniques, and Sports Medicine/ Extremity Techniques. The interactive workshop will serve as a catalyst to enhance the quality of care for Peruvian patients through the employment of sustainable, preventative healthcare techniques while simultaneously raising public awareness and advancing the osteopathic profession internationally. Core Grant funding will be utilized primarily to generate advertisements to raise awareness of the interactive workshop as well as to purchase and transport workshop materials. • Naomie Warner, D.O. of the Michigan State University (MSU) — Hillsdale Campus for her project entitled, Michigan State UniversityHillsdale Campus Ophthalmology Free Clinic at St. Pete’s. Throughout

the year, Ophthalmology residents of the MSU-Hillsdale Campus hold free ophthalmology clinics. The free ophthalmology clinic was recently established as a branch of a community charity clinic dedicated to providing primary and preventative care to the uninsured population of Hillsdale County. When asked what inspired her to pursue this project, Dr. Warner explains that she and other ophthalmology residents are thankful to have the opportunity to serve the Hillsdale community and want to “give back to the community.” Dr. Warner, along with Hillsdale Ophthalmology residents, Matthew Lowrence, D.O. and Erin Benjamin, D.O., aim to expand the services and enhance the quality of care the clinic oﬀers through the purchase of proper ophthalmologic instruments. The clinic lacks a number of tools necessary to complete a comprehensive ophthalmic exam. Various preventable diseases manifest in the eye, but with comprehensive ophthalmic exams, diseases can be detected early on and further complications such as blindness can be averted. With the use of proper equipment, the MSU- Hillsdale Campus Ophthalmology Free Clinic will be able to signiﬁcantly increase early detection and prevention of diseases among patients. Dr. Warner said that the Core Grant has advanced the project by allowing the clinic to “buy more equipment to provide better exams.” According to Dr. Warner, the Core Grant funds have been utilized to purchase vital ophthalmologic tools such as penlights and eye charts. Additionally, funding will contribute to the purchase of equipment for pediatric exams in the future. MOA commends and congratulates

Jonathan Richey, D.O., MHA of the POH Dermatology Residency Program, Shane R. Sergent and Travis Gordon of MSUCOM, and Naomie Warner, D.O. of the MSU- Hillsdale Campus on demonstrating an exceptional commitment to the core osteopathic value of preventative medicine. The

Core Grant winners’ initiatives possess the potential to considerably raise public awareness of the osteopathic profession, to signiﬁcantly improve patient care, and ultimately, to save many lives. Tessa Albright is an Intern for Michigan Osteopathic Association. She may be reached at talbright@mi-osteopathic.org.

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by Kate Tykocki, APR

TRIAD, Summer 2012

Tipping the Scales of >CDG?CJJ? Obesity Childhood obesity has more than tripled in the past 30 years, according to the Centers for Disease Control. In 2008, more than one third of children and adolescents were overweight or obese. Here in Michigan, the Trust for America’s Health issued a report naming Michigan as the 10th fattest state in the nation. But one Royal Oak D.O. is committed to tipping the scales for the better for Michigan’s children and families. “It’s a pandemic,” said Paul Ehrmann, D.O. of the Family Health Care Center in Royal Oak, Michigan. “But you have to work with the adults to get to the kids. You can do the math and figure out what an enormous problem it is. If you only impact five percent you’re going to save a lot of money and help a lot of people and be able to reallocate those dollars elsewhere.” A LABOR OF LOVE It’s clear solving the obesity problem in American isn’t just about the dollars and cents for Ehrmann. The physician graduated from Michigan State University College of Osteopathic Medicine and has been in practice for more than three decades. He helped to launch a school-based outreach program called Children’s Health Initiative Program, or CHIP, nearly a decade ago and in 2008 published a book memorializing the effort. “We had this team together just doing it out of a labor of love. We went to different schools to create a five week 90 minute program for elementary schools and families.” Together with a dietician, physical therapist, exercise physiologist, psychologist and gourmet cook, Ehrmann and his team would encourage fourth to sixth graders and their families to make healthy choices and educate them on the importance of physical fitness. LITTLE CHANGES MAKE A BIG IMPACT FOR D.O.S Ehrmann believes a physician’s own practice is one of the most powerful places D.O.s can impact childhood obesity. “It’s really a family issue,” he said. “There isn’t anything that I know of that we do on a preventative side that is going to impact

our children and families more that having them maintain a healthy weight and healthy lifestyle.” Ehrmann works BMI, weight, cholesterol, blood pressure and fitness into his normal physical exam inventory and asks patients to grade their nutrition and fitness levels. “I don’t like to use the words diet and exercise,” Ehrmann said. “A lot of it’s how you present it to people and not make them feel threatened. A lot of times kids will be in for other reasons. You try to gently impact obesity when they have something else going on. The parents are the key.” And parents may not have a realistic perception of what’s going on with their kids. A 2010 study by the Department of Pediatrics, University of Rochester School of Medicine and Dentistry and the Children’s Hospital at Strong, USA found 31 percent of parents underestimated their child’s weight status. Erhmann sees this disconnect frequently in his practice. “If the parents don’t get involved, if they’re not engaged, it is not going to happen.” SIMPLE TOOLS YIELD BIG RESULTS Ehrmann suggests his patients take simple steps like keeping a diet diary, and points them to free resources like My Fitness Pal, a food journaling website and mobile app. He also frequently directs patients to the American Heart Association and Mediterranean style of eating for practical tips they can implement with their families. Ehrmann recommends screening both children and adults for anxiety and depression so D.O.s can treat the root causes of overeating. For Ehrmann’s patients, month one of a fitness program is typically focused on nutrition. “It’s a little bit too much to ask to do the exercise right away. We want to give them confidence they can do it.” He continues to work with his patients on exercise and monitoring their health indicators to show successes and progress. “I think at the end of the day it really takes an effort from the primary care grassroots community to get the word out and impact the kids in diet and fitness,” he said. “Just because it takes a lot of time and it’s hard doesn’t mean that we shouldn’t try. I want to be able to say that I did all that I could for our kids.” TRIAD, Summer 2012

TRIAD, Summer 2012

CARING FOR CAREGIVERS by Kate Tykocki, APR

Imagine feeling trapped in your own home. Your husband or wife is unable to care for him or herself and needs you by his or her side 24/7. You’re afraid to leave the house in case something happens, but you can’t afford the type of care your loved one needs. Your kids are off at college or caring for families of their own. You can’t work. You’re struggling to make ends meet. You feel alone, and tired, and frustrated, and immensely sad. This is the startling reality for nearly 120 million adult Americans who are providing unpaid care to an adult family member or friend, or who have provided care in the past, according to Strength for Caring, an initiative of the Johnson & Johnson Caregiver Institute. And that was the overwhelming reality for Nancy DeKatch when the love of her life Joseph was told he had three weeks to live. Those three weeks turned to years of battling cardiac disease, liver cancer and infections with DeKatch as the primary caregiver. “I had to go through all this agony taking care of him. I lost everything,” she said. When she felt she was at her lowest point, she was introduced to Robert Chatfield, D.O., M.P.H., M.H.A. “He became my personal living guardian angel.” Chatfield gave Nancy a place to stay after losing her home and job. “During that time of recovery is when I realized if this act of kindness could work for me, just think what it could do for other people.” Together, they founded the Respite Ranch for Caregivers, www.respiteranch.com. “We offer caregiver awareness and burnout prevention to caregivers,” explained DeKatch. “Our goal is to help them, to educate them, about what kind of resources they have available to them — financial, legal, what their rights are, programs, veterans’ benefits — all kinds of things,” said Chatfield. “If we don’t have the answers, we’ll find them.” Think of the Respite Ranch as a professional development retreat meets group therapy meets spa for caregivers. “It’s a total wellness stay,” explained Chatfield. The Michigan State University College of Osteopathic Medicine graduate worked for the Flint Osteopathic Hospital for two decades before

moving to Port Huron Mercy Hospital and now works in urology offices. “As a D.O., I’m very much involved in wellness and wellbeing,” said Chatfield. “We’re trying to give our caregivers information so that it’s not just a place where they come — it’s not a vacation. We try to give them something they can take home with them, things they can do to help their lives out when they get back so they can be better caregivers. It not only helps the caregiver but it helps the recipient.” The ranch itself is Chatfield’s 60+ acre transformed residence in the Grand Blanc area. The goal is to offer “scholarships” for low-income caregivers to be able to attend the ranch for three days of training. DeKatch and Chatfield have been meeting with foundations and others around the state to help educate on the challenges caregivers face and to be able to provide the chance for respite at the ranch. TRIAD, Summer 2012

The funds granted to ranch guests will help to pay for in-home care for their loved ones so the caregiver can get away, learn ways to cope and make life easier, and be pampered a bit while developing a support network with other caregivers. “We don’t want them to feel alone. We want them to know they’re not alone, and there’s a place that we can go,” said DeKatch. In fact, at any given time there are nearly 50 million Americans providing unpaid care for a loved one, according to the Opinion Research Corporation. In addition to a curriculum of health and wellness, budgeting, legal and insurance challenges, resources for caregivers and basic care, caregivers at the ranch will be treated to a little “me” time with massages, manicures and pedicures. “We try to give our caregivers an opportunity to understand they are going to experience burnout,” said DeKatch. “Now they can come to a place where they get a little

TRIAD, Summer 2012

short break and we’re going to help them along the way. We help them build a blueprint so they’re going to survive.” “Caregivers really need rest, information. They’re stressed,” said Chatﬁeld. “As a D.O. I’m into whole body. That’s was I was taught almost 40 years ago in medical school and that includes physical, mental, emotional, spiritual. It’s a total osteopathic concept.” Chatﬁeld would like to see the Respite Ranch concept catch on and provide opportunities for caregivers around the state and nation to improve their lives. “We try to keep the caregivers healthy so they’re better caregivers — they’re happier, so it helps the care recipient.” He’s also pleased to welcome DeKatch and other caregivers into the Respite Ranch. “It’s been my home and I’m thrilled to be able to share it with other people. It’s my chance to give back after having a nice medical career. It’s great. It’s a noble cause and I’m all for it.”

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TRIAD, Summer 2012

Alternative Spring Break Teaches Empathy, Awareness by Kate Tykocki, APR

pring break for most college students is synonymous with Cancun, Daytona Beach or anywhere sunny with plenty of libations. But 12 Michigan State University College of Osteopathic Medicine (MSUCOM) students chose an alternative to the traditional spring break. While other college students were blowing oﬀ steam, this dedicated dozen was serving food in a D.C. soup kitchen, organizing health fairs for a homeless shelter and rehab facility and providing health screenings to some of our nation’s capital’s most in-need citizens. CREATING AN ALTERNATIVE TO SPRING BREAK Tiﬀany Chritz was heavily involved in Michigan State University’s Alternative Spring Break program during undergrad and traveled to Kansas City, Staten Island and Washington D.C. When she was admitted to MSUCOM, she

TRIAD, Summer 2012

didn’t want the experience to end. “I wanted to set up a trip that was more health focused for us,” said Chritz. Together with another former Alternative Spring Break participant, Tiﬀany worked to coordinate a week’s worth of service activities in D.C. “It’s such a unique experience being in the nation’s capital and still seeing a lot of poverty. It’s not a side of D.C. a lot people experience.” MAKING AN IMPACT Margaret Aguwa, D.O., M.P.H., F.A.C.O.F.P., associate dean for community outreach and clinical research, professor of family and community medicine and director of the OsteoCHAMPS program at MSUCOM agreed to supervise the group and is a proponent of its impact. “One of the reasons is that it puts them into unfamiliar territory,” said Aguwa. “Basically it extends their wings into areas they are not always familiar with geographically as well as

experientially. It also helps to promote the college in a variety of ways including our students practicing and getting involved in clinical aspects as well as humanitarian services.” For Chritz, the impact was a little closer to home. “Something I’ve learned from all of my involvement, there’s just so much need in the U.S. that goes unnoticed that it’s such a unique experience for students to be able to see that and recognize it and know that there are things we can do to help,” said Chritz. “A week isn’t that much time to make a diﬀerence, but it’s a step. When you come back to East Lansing we want you to go out into the community and start helping here.” STARTING A NEW MSUCOM TRADITION That motivation and new-found awareness is one of the reasons Aguwa hopes to be able to continue to provide MSUCOM speciﬁc alternative spring break options.

“Students develop relationships with others particularly those who are in disadvantaged positions and those who cannot take care of themselves, those who have substance abuse issues and homelessness,” said Aguwa. “There’s more empathy, there’s more interest in being of help and going beyond what they themselves can do. It helps them to have a more global picture of the needs of diverse populations and provides them a template for recognizing their own strengths and being able to be better physicians, more caring physicians, listening more to their patients, being more attentive and being less critical of an individual’s life situation.” Aguwa and Chritz are already looking toward the 20122013 school year to identify student leaders to coordinate another trip. Whether it’s half-way around the globe or right here in Michigan, MSUCOM students will be spending their spring break making a diﬀerence.

TRIAD, Summer 2012

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TRIAD, Summer 2012

dean’s column by William Strampel, D.O.

f there ever were a time in human history in which the concept of community is being stretched, it is now. Since the click of the millennium only 12 years ago, technology has changed the entire global-social landscape, with cell phones, Facebook, Twitter and YouTube literally revolutionizing human interaction. Tele-referral, distance learning, conferencing, and web-based instruction are changing the face of medicine. Though the word “community” still often evokes an image of peaceful, small-town Americana, it’s important for us osteopathic physicians, as servants of the community, to realize that we each live in a Venn diagram of overlapping social circles.

“There can be no vulnerability without risk; there can be no community without vulnerability; there can be no peace, and ultimately no life, without community.” — Dr. M. Scott Peck

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.

Families, friends near and far, colleagues, organizations, interest groups, faith circles, sports teams, political parties – all of these are bubbles in our lives, some which intersect and some which remain discrete. All of these constitute our individual “communities,” with far more precision than the borders of our townships, towns and cities or our zip codes. So, for an osteopathic physician today, how do we best practice “community-integrated” medicine? I see three ways. • We act as advocates for health in all of our personal communities, striving to be good examples of moderation. We also inspire others to seek good health not as an end in itself, but as a vehicle for human joy and effectiveness. • For our patients, we help them assess their communities to determine both negative health factors (violence, poor nutrition, overwork, life stresses, etc.) and positive assets for health (strong family support, access to healthy food, financial security, etc.). • For our traditional community, the area surrounding our homes and workplaces, we act as leaders, targeting unhealthy aspects of the environment, healthcare disparities, inherent dangers, and mobilizing available forces for good to address these issues (public health, voluntarism, health professions colleagues, etc.). For all the encroaching constraints on the practice of medicine, this ability as physicians to define our community is one area that is liberating. Look at the circles of your relationships, decide where you might have the positive impact, and focus your attention there. It’s a classically osteopathic thing to do!

TRIAD, Summer 2012

legislative update by Kevin McKinney

Kevin McKinney handles the MOA’s Governmental Affairs and may be reached at kevin@ mckinneyandassociates.net 22

or the second consecutive year, the Governor and the legislature have successfully finished work on the upcoming fiscal year state budget (Fiscal Year 2012-13) by June 1st. The Governor is expected to sign the omnibus budget bills in mid June which leaves adequate time for local units of government, colleges and universities and K-12 schools time to adjust their budgets with the anticipated state revenue before their fiscal years start on July 1. While the initial executive budget recommendation for the Michigan Department of Community Health (MDCH) protected Medicaid reimbursement rates from further reductions and did contain a recommendation to use $281 million of federal funding to support primary care physician rate increases to Medicare rates, MOA was concerned about the proposed cuts to graduate medical education (GME). The initial recommendation was to cut $17.1 million (gross) for the new fiscal year which was in addition to a $14.7million (gross) cut to GME made in FY 2012 (although all but $5.8 million was restored in a supplemental appropriations by the legislature). The final agreement restores the GME funding level to FY 2012 levels; uses $281 million in federal funds to increase primary care reimbursement rates and adds almost $12 million (gross) to increase Medicaid rates by 20 percent for OB/GYN physicians. Additionally, the Michigan Care Improvement Registry (MCIR – formerly the Michigan Child Immunization Registry) funding was restored from earlier proposed elimination and will be funded at $2.1 million. Finally, the conference committee did not include the Senate language that would have prohibited MDCH from using funds to enforce the public smoking ban for certain charitable organizations. With the Legislature on its extended summer recess due to the upcoming November elections, several key policy initiatives will be pushed off until this September or into the lame duck session (after the November election). Over the last several months, MOA has been very busy working on a number of legislative proposals. In early June, the House passed HB 5604 which would repeal the Michigan Osteopathic Medicine Advisory Board (MOMAB). The elimination was part of a larger set of recommendations by the Office of Regulatory Reinvention to reduce numerous outdated, non functioning or duplicative state boards and agencies. After consultation with MSU and MSUCOM, MOA took a position of support for the elimination of MOMAB since its advisory function to MSUCOM and to the MSU Board of Trustees can be accomplished in alternative ways. The bill will likely see action in the Senate this fall. Both the House and Senate have introduced sports concussion bills aimed at better education and public awareness of sports concussions for student athletes especially in the youth and recreational leagues. SB 1122 recently passed the Senate and HB 5967 is expected to get a hearing in the House Health Policy Committee this September. MOA is working with a number of stakeholders on this issue including the NFL, the Detroit Lions and the Brain Injury Association – MI on its passage. The Senate Insurance Committee concluded a number of hearings on the med/mal reform package (SBs 1115-1118). As expected, passionate testimony from both sides of the issue has dominated the hearings. While it was initially expected that the legislature would move swiftly to complete this package of bills which were introduced in both the House and Senate, it appears more likely to be pushed back into the fall before the bills are ready to move. The Senate Health Policy Committee held an initial hearing on SB 481 (Advance Nurse Practitioner)

TRIAD, Summer 2012

scope of practice bill. MOA opposes the bill as currently written and will likely get the opportunity to present to the committee along with other physician groups in the fall when the issue is taken back up. The House Insurance Committee continues to take up auto no fault bills that would significantly impact the auto no fault system and deny benefits to injured drivers and cost shift coverage from the insurers to the taxpayers and increasing uncompensated care to the provider. The most recent package of bills reported out of committee - (HB 4993, 5587-89) would disqualify drivers from receiving their lifetime medical benefits - if the driver was using the car during the commission of a felony, if the driver was operating the vehicle while intoxicated, impaired or with a blood chemistry that would include commonly prescribed medications, an unlawful taking of a vehicle or if the driver was an undocumented immigrant. While all of these proposals have some surface appeal, the political pandering of these bills compounds the deeply flawed policy contained within them. None of the bills require the conviction of a crime or driving under the influence. Disqualifying undocumented immigrants, no matter the status in seeking citizenship regardless if they have a current insurance coverage is very problematic. MOA continues to work with CPAN to convey its strong reservations about such policies and the consequences to the injured parties, providers and the taxpayers. The House of Representatives are up for re-election this November and are eager to get on the campaign trail. MOA will continue to work aggressively on policy issues over the next several months with the anticipation of an active lame duck session in November.

MOA will also be providing MOPAC information on key issues and votes to assist in its contribution strategies to House candidates. Additionally, there are three Michigan Supreme Court races up in November. Two current incumbent Justices – Stephen Markman and Brian Zahra are seeking another term on the bench and there is an open race due to Justice Marilyn

Kelly being age limited from seeking re-election. MOA will continue to share information on these top judicial races as the campaigns heat up this fall. MOA and MOPAC encourages all members to remain engaged and informed on the candidates and issues this election cycle. If you have any questions, please do not hesitate to contact me at: kevin@ mckinneyandassociates.net.

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TRIAD, Summer 2012

A Tragic Lesson in Drug Safety by David B. Troxel, MD, Medical Director, Board of Governors

four-year-old female with a history of asthma presented with her mother to our insured pediatrician for treatment of a barky cough (croup). The pediatrician prescribed Tussionex, one-half teaspoon once a day. The following day at 6:30 PM, the oﬃce nurse telephoned the residence and spoke with the mother, who reported the child was much better and was running around. The next day, the mother found the child unresponsive and summoned the emergency squad. They administered CPR and transported the child to the hospital, where she was pronounced dead. An autopsy revealed the child had toxic blood levels of hydrocodone and chlorpheniramine (components of Tussionex) and diphenhydramine (an active ingredient of Benadryl). It was alleged the insured pediatrician failed to heed the warnings and recommendations of the manufacturer of Tussionex, including explicit warnings against its administration to children under the age of six; that he failed to heed the warnings of the Food and Drug Administration (FDA) and the American Academy of Pediatrics against prescribing Tussionex to children under the age of six; and that he prescribed an excessive dose of Tussionex based on the child’s age and weight. DEFENSE EXPERTS A pediatrician expert stated he had no issue with the insured prescribing Tussionex to a child this age. He said the 24

TRIAD, Summer 2012

FDA Alert regarding Tussionex was released just a week before this event occurred, and he felt it was understandable that the insured was not aware of it. He also did not believe the standard of care required the insured to be aware of the FDA press release on Tussionex (released three months before this event) or the notice posted on the FDA Web site. However, he believed the insured was responsible for knowing the contents of the FDA “Dear Provider” letter that had been sent within a week of this prescribing event. He also questioned whether a physician is responsible for reviewing each medication he prescribes when a new edition of the Physicians’ Desk Reference (PDR) is released. A toxicology expert stated that both the Benadryl and the antihistamine in the hydrocodone are inhibitors of metabolism of hydrocodone. The toxicologist concluded the amount of hydrocodone found in the blood meant that the child had 3.4 doses in her body at the time of death, which is more than would be expected based on the dosage prescribed. He made similar calculations with regard to chlorpheniramine and concluded there were approximately 4.8 doses at death. Chlorpheniramine has a longer half-life than hydrocodone, which could account for the difference. A pediatric neonatologist felt it was a breach of the standard of care to prescribe Tussionex to this child. He said slow-release narcotics can accumulate in the system and lead to respiratory depression, which is aggravated by the child’s age, by other drugs in the mixture, and by Benadryl. There is no safe amount to prescribe. The specific drug for croup (when it is very bad) is a corticosteroid; otherwise a vaporizer and observation are the standard of care. The pharmacy that filled the prescription was a codefendant. Its pharmacist received an electronic Drug Utilization Review (DUR) Alert requiring him to contact the physician regarding the safety of the prescription. He entered “prescriber contacted, prescribe as is” to override the Alert and filled the prescription without calling the insured. PLAINTIFF’S EXPERTS A forensic pathologist and a toxicologist from the coroner’s office believed there were toxic-to-lethal blood levels of the components of Tussionex, which caused the child’s death. A pediatrician opined that the insured should never have prescribed Tussionex to this child, adding that this drug should never be considered for any child under six years of age. He could not say if the proper dose was one-quarter teaspoon rather than one-half teaspoon, but he opined that the insured prescribed twice as much as he should have based on the child’s weight. He added that it was not appropriate to

recommend using Benadryl as a sleeping aid in a child. (Our insured did not remember ever making this recommendation, while the parents alleged that he did.) SHOULD THIS CASE BE TRIED? The death of a four-year-old child is tragic and would be viewed as such by a jury. While there was one expert to support the insured’s lack of knowledge of the multiple warnings against using Tussionex in children, the plaintiﬀ’s counsel had multiple experts to state the contrary. Furthermore, the PDR in the insured’s oﬃce contained the warning, and a jury would likely expect a physician to be fully knowledgeable about medications being prescribed and the dangers contained therein. The insured would be susceptible to the question, “Doctor, who is responsible for knowing about a medication that is prescribed to a patient?” Clearly, the correct answer is the physician who is prescribing it. With the insured’s consent, the case was settled. DISCUSSION Each year, almost 25 percent of drugs have clinically relevant changes made to their FDA-approved labels. FDAapproved labeling is often the standard to which physicians

are held in claims involving medication errors. An analysis of all claims closed at The Doctors Company in 2010 revealed that 6.1 percent contained medication errors. The most prevalent claims in this category included giving the wrong medication (18 percent), failing to follow guidelines or protocols (16 percent), giving the wrong dosage (13 percent), errors in drug administration (12 percent), and ordering errors (5 percent). It is likely that some of these errors could have been prevented by keeping current on FDA-approved drug labeling. IMPLICATIONS FOR E-PRESCRIBING LIABILITY The pharmacist overrode the DUR Alert and ﬁlled the prescription without calling the insured. This may be a harbinger of electronic health record e-prescribing liability risk, because there is a danger that doctors may suﬀer “alert fatigue”—and ignore, override, or disable alerts, warnings, reminders, and clinical decision support guidelines. If following an alert or guideline would have prevented an adverse patient event, the physician may be found liable for ignoring it. Contributed by The Doctors Company. For more information, please visit www.thedoctors.com.

TRIAD, Summer 2012

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Patient Protection Affordable Health Care Act Update by Michael G.Buck, President, Association Benefits WOMEN’S PREVENTIVE BENEFITS Effective for plan years August 1st, 2012 and beyond, plans are required to cover the following services as part of preventive benefits with no cost sharing when rendered by a participating provider: • Well woman visits • Screening for gestational diabetes • Human papillomavirus (HPV) testing • Counseling for sexually transmitted infections • Counseling and screening for human immune deficiency virus (HIV) • Contraceptive methods and counseling – certain religious employers are exempt • Breast feeding support, supplies and counseling • Screening/counseling for interpersonal and domestic violence

STATE-BASED EXCHANGES SB693, passed by the Senate awaiting approval from the House, is proposed legislation to create the MI Health Marketplace. It would establish a nonprofit corporation where Michigan individuals and small businesses can shop for health insurance. The state-based Exchanges are scheduled to be operational in 2014. The Marketplace would contract with the Office of Financial and Insurance Regulation to ensure that plans offered in the Exchanges are in compliance with applicable state and federal laws.

This tax is expected to raise $27 billion in the first 10 years following the passage of the Affordable Care Act (ACA). • Increase to Medicare Tax for High Income Earners – Individuals earning more than $200,000 and married couples filing jointly with earnings more than $250,000 ($125,000 for married filing separately), will be subject to a 2.35% tax above the threshold amount. Employers are not required to increase their contribution to the Medicare payroll tax. The tax is expected to raise $86.8 billion through fiscal year 2019. • Unearned Income Medicare Contribution – This tax applies to individuals with modified adjusted gross income that exceeds $250,000 for married filing jointly, $125,000 for married filing separately, and $200,000 for individuals and will be applicable for tax years beginning on or after January 1st, 2013. This tax is expected to raise $123 billion through fiscal year 2019. • Comparative Effectiveness Fee – For insured coverage, the health insurance issuer pays the fee. For self funded coverage, the plan sponsor, usually the employer, pays the fee. The fee begins at $1 per covered life for policy years ending in fiscal year 2013 and increases to $2 per covered life for 2014 to 2019. This fee is expected to raise $2.6 billion. • Insurer Market Share Tax – This tax will be paid by all health insurance companies and will be proportional to each insurer’s share of the national market based on fully insured net premium revenue. There will be no fee on the first $25 million of net premiums and the net premium used for the calculation is reduced by 50% for federally tax exempt organizations. This tax is expected to raise $60 billion through fiscal year 2019. • High Cost Health Insurance Tax “Cadillac Tax” – A 40% excise tax will be assessed on the value of employer provided health benefits that exceed certain thresholds. It is applicable to health insurance companies for fully insured benefits and the plan administrator, usually the employer, for self insured business. Plans are subject to the tax if the total premium exceeds $10,000 for single coverage and $27,500 for family coverage. These numbers will be indexed beginning in 2019. The “Cadillac tax” is expected to raise $32 billion in fiscal year 2018 through 2019.

FINANCING NATIONAL HEALTH CARE REFORM - NEW TAXES AND FEES • Branded Drug Market Share Tax – Certain manufacturers and importers of brand name pharmaceuticals will be taxed based on the total amount of their drug sales compared to overall national drug sales. This tax is projected to equate to approximately 1% of total branded drug sales.

Association Benefits Company has provided MOA members and their staff benefits consulting services for more than 20 years. As a licensed independent agency, we provide employers with benefit solutions including life, health, dental, long term care and disability. We can provide clients with competitive quotes from a variety of carriers. For additional information or if you have questions about Health Care Reform, contact the Association Benefits dedicated MOA representative, Julie Watson at 1.800.782.0712 extension 167 or direct at 248.359.6489

AUTOMATIC ENROLLMENT & WAITING PERIODS Provisions of the PPACA for automatic enrollment of full-time employees are designed to expand access to health coverage. Regulations were recently released regarding automatic enrollment, employer shared responsibility, and the 90 day limitation on waiting periods. Group health plans may not impose a waiting period exceeding 90 days for plan years beginning on or after January 1st, 2014. Future guidance is likely to place a limit on the maximum number of hours permitted.

TRIAD, Summer 2012

intern-resident perspective by Gregory Harris, D.O.

s the future of the medical profession, Michigan is fortunate to have the largest number of osteopathic postdoctoral trainees in our nation. Additionally, doctors of osteopathic medicine are the fastest growing segment of health care professionals, both in Michigan and our nation. As residents, we are fortuitous to have such skilled and dedicated professionals and mentors as a part of the osteopathic profession. In addition to becoming medical experts, residents are trained in management skills, health advocacy, research methodology and professionalism. We look to these professionals and mentors to help us become future leaders, advocates for patients, and, for some, become state, national and world leaders in health research. To that end, I hope that all residents in Michigan become involved in the Michigan Osteopathic Association (MOA); and, namely on the MOA’s Intern and Resident (I-R) Committee. This year is going to be particularly exciting due to the upcoming presidential election. Topics like health care reform and the Accreditation Council for Graduate Medical Education (ACGME) training crisis will be top items on our agenda. The I-R Committee will keep you fully informed on these issues and many more. The MOA I-R Committee is a free-standing committee of interns and residents who participate in MOA activities and functions. As the incoming Chair of the I-R Committee, I would like to see greater involvement within the committee meetings and the committee’s activities in the year ahead. Upcoming events include the American Osteopathic Association House of Delegates in Chicago July 19 - 22, 2012. One resident will represent the MOA as a delegate and four alternate delegates will represent the interests of osteopathic postdoctoral trainees in Michigan. Below are the 2012-2013 meeting dates for the I-R Committee. Please mark your calendars and join us! • September 13, 2012 • November 8, 2012 • March 7, 2013 • June 6, 2013 If you are interested in serving on this committee and helping to shape health care within our state, please contact Shelly Madden, SMadden@mi-osteopathic.org.

Gregory Harris, D.O. is the MOA’s Intern-Resident Trustee and a second-year internal medicine resident at Genesys Regional Medical Center. He may be reached at drgregoryharrisdo@gmail.com TRIAD, Summer 2012

practice manager’s column by Stacey Kammer Great Ideas Buy a few mini clipboards at the dollar store. After checking in, slide a piece of colorful paper or a page from the comics section. They’ll feel so BIG and important carrying their own ‘medical information.’ The newest trend: fish tanksBut it’s not what you think. If you’ve had a fish tank, you know it can be messy and probably not the most germ friendly. Instead, if your office has a TV in the waiting room, purchase a DVD or cassette (for newer TV models, a flash drive) with a continuous playing fish tank scene. It creates the perception that your office is located in an underwater sea world, and is also fun and relaxing for both kids and adults. (To find out more, simply go to Amazon. com and enter in keywords: Aquarium DVD)

Practice Hot Topic: Making Your Office ‘Kid Approved‘ Whether your office currently serves pediatric patients, or you’re looking to diversify your service lines by bringing a pediatrician on board, making your office ‘kid friendly’ is vital to attracting and keeping families with children long term. FIRST IMPRESSION: THE WAITING ROOM AND FRONT DESK They may be small, but little patients matter in a big way. The waiting room and reception area is the best place to make the best first impression. The presentation of your office can set the tone for a happy trip to the doctor’s office. Both areas can easily and inexpensively be transformed to fit your needs. If your practice is a mixed specialty (for example; you have a mix of pediatrics, family practice, internal medicine patients) you may have found it challenging to create a shared waiting and registration space suitable for the young, old, and everything in between. Rest assured you have many options that will be sure to amuse and comfort patients of all ages. Your tiny guest most likely will be filled with fear upon arriving at your office. Fearful memories of painful shots, prodding and poking are sure to fill their minds, making it all the more difficult for you to insure their satisfaction (and yes, their satisfaction does matter!) To ease the fear, we have a few tips that go a long way in a big world. THE GREAT WALL OF CHINA: YOUR FRONT DESK At the reception counter, add a few safety stools they can stand up on. Seeing the person behind the desk gives an apprehensive child the chance to feel important and make contact with your receptionist. TICK TOCK: THE WAITING GAME For all you office managers slash parents, you know that the area in your practice called The Waiting Room is merely another name for the area that your child is most likely to cause the biggest scene in. To counter their intelligence, attention grabbing distractions can be easily added to make the waiting room attractive for wandering minds. A few extra touches, smaller tables and chairs, low level drinking fountains, child friendly magazines and bright paint colors are a nice touch that creates a child friendly environment. TO INFINITY AND BEYOND: THE BACK OFFICE Keep in mind that although we adults like our fresco paintings and abstract art, our smaller guests think they stink. Instead, engage their imaginations by investing in some 3 dimensional decorations like pop-out zoo animals, wall train tracks, wood dinosaurs and a ceiling painted to resemble the solar system. I found www.sassafrasrooms.com a few months back, which offers a great selection of wall decor that’s very reasonably priced. Carry your playful theme back into your pediatric exam rooms. Try adding a youth exam tables in a few rooms you use most for child exams. Not only are they more safe for tiny bodies, (they are more stable and are lower to the ground) but they are also fun and again, offer a distraction from the care being delivered. You’ll find nearly every major medical supplier offers pediatric tables that range from spotted hippos, pink princess carriages, racecars, and giant lily pads.

Stacey Kammer is the Enterprise Manager at Metro Health in Allendale, MI. She can be reached at Stacey.Kammer@metrogr.org. 28

LAST TIPS Don’t forget those stickers and suckers…safety pops, of course :)

TRIAD, Summer 2012

inside the aoa by John B. Crosby, JD AOA Response to ACGME Crisis

John B. Crosby, JD, is the Executive Director of the American Osteopathic Association (AOA) and may be reached at jcrosby@osteopathic.org.

The osteopathic medical profession has endured challenges and crises since our inception. Some states did not recognize the DO degree for the purpose of the unlimited scope of medical practice until the 1970s. There were hospitals throughout the country that did not allow DOs to apply for positions on their medical staﬀs. And, in the not too distant past, the State of California converted an osteopathic medical school in Irvine into an MD school and allowed graduates of the old osteopathic school to convert their DO degrees into MDs. Last summer, a new challenge emerged. The AOA began hearing reports about Residency Review Committees not allowing DOs to serve as core faculty. Then, in October 2011, the Accreditation Council for Graduate Medical Education (ACGME) announced two proposed Common Program Requirements that would restrict transfer of DOs into ACGME-accredited training programs. The proposed restrictions mandate that all prerequisite clinical education for entry into ACGME-accredited residency and fellowship programs must be accomplished in ACGME-accredited programs. This crisis, as you no doubt agree, poses serious threats to the future of graduate medical education for all osteopathic postdoctoral trainees. But the AOA and our family of advocates have rallied to address this crisis. During the ACGME’s public comment period in November 2011, AOA President Martin S. Levine, DO, our Council on Postdoctoral Training, AACOM, osteopathic specialty colleges, and several allopathic organizations wrote letters to the ACGME objecting to the proposed Requirements due to their adverse impact on osteopathic graduates, allopathic training programs, and the quality of care provided at the institutions. We are advised that over 400 comments were submitted, all but a few of which supported our position. After months of receiving no response to written comments, the AOA was able to secure an inperson meeting with ACGME leadership this past January. At the meeting, we were advised that the proposals will remain under discussion throughout a year-long review process. The ACGME Council on Requirements is meeting this September to hear public comment on the proposals—including the AOA’s—and formulate recommendations to the ACGME Board. Their Board will then act at that meeting on the proposed Common Program Requirements and decide whether to approve them asis, amend them, or withdraw them entirely—the latter being the AOA’s preferred option. The aforementioned January meeting opened up a new opportunity for the AOA to work with the ACGME to address a mutual crisis—ensuring the future of the physician workforce as well as the quality of GME, which faces pressure in Washington, D.C., to show value for the billions in Medicare and other funds being spent on postdoctoral training each year. The ACGME invited us to form a Joint Task Force to formulate common goals on how to ensure quality in GME and residents. This Task Force, which met on March 27 and again on May 25, is currently developing several scenarios to establish common pathways and indicators that can be used to assess GME program and trainee quality. We hope these discussions will have a positive impact on our comments regarding the proposed Program requirements. Let there be no doubt, however, that our number one priority is to get the Common Program Requirements withdrawn or amended. If the proposed rule is not withdrawn, the AOA is prepared to aggressively pursue other options to protect our postdoctoral trainees’ rights, responsibilities, and access to all GME training. We can DO it! TRIAD, Summer 2012

last word by Walker Foland

Family in Residency The term “resident” has changed faces over the years. When the term was first coined to describe doctors in training, it was quite literal. Residents were required to live in the hospital they trained. They were required to be single men without children and they were only allowed to leave for no more than a day or two per month. Nowadays, being a resident means much more freedom. We are allowed lives outside of the hospital walls and pursue relationships and family. With that added freedom, we are all allowed to choose what we do with our time away from work. Many choose marriage, some choose the single life and fewer choose to have a family. It is simple to understand why residents are inclined to not have a family during their residency training. We are pounded by our responsibilities at work and are put under massive amounts of stress that few outside of our profession understand. Despite all of that, I chose to have a family. My life changed when we had our daughter. I was a fourth year medical student and for the first time, I truly felt the weight of responsibility on my shoulders. No matter how much I prepared during my wife’s pregnancy, it didn’t seem real until I looked into my daughter’s eyes. Being an intern with a brand new child was not easy, but I think in many ways, I had an edge over my fellow interns. I felt that every day I went to work mattered. I was no longer just looking out for my career as a doctor or making sure I wasn’t going to hurt my patients. I was working for the future of my child. At home, my spare moments were few and far between, requiring me to read medical literature while holding my sleeping daughter. Long nights and long days blurred the delineation of time, but I got through just fine. We had our son my second year of training. Once again, reality didn’t strike until I saw him, and once again, things changed. My spare time lessened again. I now read medical literature while my son kicks me and my daughter runs circles around the dog trying to injure herself and send us all running to the emergency room for stitches. Balance between work and home is hard. So, I have put a few rules in motion: 1). Make sure you and your family are happy at home. Nothing makes me happier than my family being happy. 2). Use every spare moment possible to get work done. That counts for house work or homework. 3). Take care of yourself. Eat right and exercise if possible, even if it is just walking the dog. Nothing is more worthwhile in my life than having a family. I work for them and I am happy to do it. They have given me motivation to achieve far beyond what I would attempt if I was alone and they make me a better doctor. Walker Foland, D.O. works in Emergency Medicine at Genesys Regional Medical Center at may be reached at folandwa@gmail.com. 30

TRIAD, Summer 2012

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TRIAD, Summer 2012