July 2014

the physician wellness issue:

M e n t a l H e a lt h

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Sleep

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Va c a t i o n P l a n n i n g

LACMA Welcomes 143rd President

Dr. Pedram Salimpour JULY 2014 l i a

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A N o r c A l G r o u p c o m pA N y

juLY 2014 | TA B LE OF CONT ENT S

Volume 145 Issue 7

6

14 16

physician wellness

6 Early Intervention for Physician Mental Health 8 Why Physicians Don’t Know How Sleepy They Are 12 Sleep Hygiene: What’s Keeping You Awake at Night?

COVER STORY

10

LACMA Welcomes President Pedram Salimpour, MD

More than 375 LACMA members, sponsors, vendors and associates attended the June 19 event that ushered in Dr. Pedram Salimpour’s term as the 143rd president of the Los Angeles County Medical Society.

14 Risk Management in Your Vacation Planning

From Your Association 4

President’s Letter | pedram salimpour, MD

16 CEO’s Letter | Rocky Delgadillo

Physician Magazine (ISSN 1533-9254) is published monthly by LACMA Services Inc. (a subsidiary of the Los Angeles County Medical Association) at 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. Periodicals Postage Paid at Los Angeles, California, and at additional mailing offices. Volume 143, No. 04 Copyright ©2012 by LACMA Services Inc. All rights reserved. Reproduction in whole or in part without written permission is prohibited. POSTMASTER: Send address changes to Physician Magazine, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 9001 7. Advertising rates and information sent upon request.

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cal Association is a professional association representing

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President

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Pedram Salimpour, MD Peter Richman, MD Vito Imbasciani, MD William Averill, MD Marshall Morgan, MD

than 100 years, LACMA has been at the forefront of current medicine, ensuring that its members are represented in the areas of public policy, govern-

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lenges of managing a practice.

LACMA’s Board of Directors consists of a group of 30 dedicated physicians who are working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, Director of Governance, at lisa@lacmanet.org or 213-226-0304.

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PR ES ID ENT ’S LET T ER | ped r am sali mpour , MD

Medicine as the indispensable Profession In regards to doctors and medicine, I have come to have two beliefs: one, that medicine is the indispensable profession and, two, that doctors have to lead.

By any measure, medicine continues to attract the best and the brightest. Doctors are better trained and better prepared to meet their patients’ clinical needs than at any other time in human history or in any other place in the world. Those who argue otherwise — who suggest that doctors are somehow in decline or have seen their position slip away — are talking about something other than doctors. They’re talking about the healthcare system.

And they might be right, because more and more, doctors operate in a volatile, uncertain, complex, and ambiguous business environment. These situations are invitations for inaction— people are perplexed by uncertainty and don’t act or act from a place of fear. But in business, in any business, your competition has a vote. To succeed, you have to act, and your leaders have to lead.

Doctors have already spent decades facing down challenges to their clinical management of patients, challenges that have gone from appearing to be bugs in the system to becoming features of the system.

At least for thirty years, there have been those who warned against the situation we face today. True to those predictions, while the number of physicians has seen a modest percentage increase in the past few decades, the number of administrators in healthcare has gone up twentyfold. And that explosive growth in bureaucracy has become corrosive to the practice of medicine--for doctors, and also for patients. And it has left people asking, who’s in charge? Doctors ask this. Patients ask this. The courts ask this.

To help answer that call, LACMA has grown into a Best Ideas organization: We are a principled group, but no principle trumps every other consideration.

There are ideas and ideals, but there is no ideology, there is no preference to men or women or to any one group. Just look at what’s been built in the past few years alone. We have the Latino Physicians’ Advisory Board, the African American Physicians’ Advisory Board, the Women Physicians’ Advisory Board, and others. This kind of disciplined organization can help be the decisive vote in elections. It creates leadership that is demanding of doctors and sympathetic to our day-to-day struggles. Because having elections and winning them can help to eliminate volatility, uncertainty and ambiguity. Because medicine as the indispensable profession has to find a way to lead.

But perhaps we should take a step back to examine our leadership. Some say that conflicts between 4 PHYSICIAN MA G A Z INE | j uLY 2014

different healthcare entities are not our issues to solve. A different view says that ignoring these disputes not only violates our conscience but also invites an acceleration of interference.

I believe neither view fully speaks to the demands of this moment.

LACMA doesn’t have a solution to every problem.

But we do have an interest in pursuing our ideals. Life and business and politics, the worlds that LACMA occupies, are complex, but our challenges are not insurmountable. We have to act on behalf of all doctors and patients; we just have to be deliberate about our engagements. We are not an impulsive profession.

We are not an impulsive organization. But today, we are postured toward action.

For the immediate future, the most direct question for doctors, nurses, hospitals and our patients remains uncertainty of the new legislative landscape.

But a strategy that involves unilateral confrontation is naïve.

I believe we have to shift our strategy to more effectively partner with organizations who are also affected by these challenges, to forge partnerships that will help us achieve our objectives and theirs.

Many of those organizations joined us at the installation, including Allied Physicians, a powerful and unified force that understands the critical role that legislators play in our lives and on the lives of our patients, and USC’s leadership, an organization with thousands of doctors and now a member of LACMA. There are hundreds of other coalition members in support of MICRA alone, including the California Hospital Association, the Service Employees International Union, the California Medical Association, my friend Dr. Azizzadeh of La Peer Surgery Center and other surgery centers and the California Teachers Association.

Of course, partnerships don’t eliminate the need to take direct action. But it sure is nice to have a coalition. It’s the right investment. It’s the right way for doctors to lead.

In healthcare, doctors have to lead, and today, that’s what LACMA stands for. When bad things are starting to happen, when doctors need help, our fire department, our cops, our ambulance, our 911, is LACMA. I moved to this city when I was 12. As a teenager I remember my then-middle-aged dad redoing his residency at Cedars to once again be able to practice medicine. We came here because my parents wanted a better life for their kids. But I can’t imagine how I can ever be a better doctor than my dad has been to his patients. I am proud to have had the privilege of practicing medicine with him and my brother almost every day of the past eleven years.

The story of doctors is the most beautiful of stories because it is the most human of stories, the most American of stories. Doctors are the people who find new ways to new places, and now we have to find new ways to bring everyone else along. Medicine is the indispensable profession. Doctors have to lead.

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balance | phys i ci an wellness

The Importance of Early Intervention for Physician Mental Health Mary Beth James, MA, LMFT

The need for early intervention in healthcare is ubiquitous. It’s so well researched and un-

derstood that early intervention will aid the success of treatment that it has become obvious, part of the air we breathe. In some cases, patients lack access to care and can’t obtain it until it’s too late. In other circumstances, patients are in denial about their symptoms, or too stubborn to seek help. I imagine that most, if not all, of you reading this have lost a patient (perhaps many) due to delayed care.

Just as in medical care, the same principle holds true for mental health symptoms: Early intervention is best. Unfortunately, many people—including physicians—ignore this reality and put off attending to their mental health needs. Barriers to mental health care for physicians can include lack of time, stigma (both social and internalized as shame) and concerns about confidentiality. While these barriers are real, and cause for concern, the cost of ignoring the problem is often worse: Ruptured family relationships, disciplinary actions at work and substance abuse are frequent results.

Furthermore, patient care is likely to be affected by unaddressed mental health symptoms of their provider (Ruitenburg, Frings-Dresen & Sluiter, 2012). Would you refer a family member to a colleague who has an alcohol problem or angry outbursts?

The demands placed on physicians—and therefore, the need to attend to their own mental health— have never been higher. The bureaucracy of managed care and other administrative challenges have resulted in alarmingly high rates of physician burnout

6 PHYSICIAN MA G A Z INE | j uLY 2014

(Shanafelt, et al., 2012). Multiple studies have also shown compassion fatigue to have a significant negative effect on doctors. Further, the threats of workplace violence and malpractice lawsuits are additional layers of stress. Being a physician is already an incredibly difficult job. In light of these emotional occupational hazards, it is no wonder that anxiety, depression and suicide are risks for physicians (Moutier, et al., 2012).

Some signs that you may need to reach out include: • Consistently struggling to sleep • Having difficulty separating home and work life • Struggling to focus at work • Bringing to mind memories of a traumatizing event frequently or to the point of distraction • Lashing out in anger • Feeling less able to connect to your partner, children or spouse • Not finding joy in activities you typically like • Relying on substances to “unwind” or “decompress”

Barriers to mental health care for physicians can include lack of time, stigma (both social and internalized as shame) and concerns about confidentiality.

Fortunately, there are resources and options to address every type of mental health symptom. Just as there are often different medications for the same disease, there are a variety of strategies that improve emotional well-being. Mental health requires maintenance just as our physical bodies, relationships, homes and cars do!

Consider: • Utilizing or improving self-care. Pick one area to start with, such as increasing your exercise or developing healthy eating habits • Setting aside time at home that you are unavailable (and not checking phone and email during this time) • Improving sleep hygiene • Using accrued vacation time • Increasing face-to-face social engagement with friends, colleagues or family • Attending a wellness program through your facility or in the community • Seeking out a therapist for support • Attending an AA or NA group • Attending a church or synagogue or developing a spiritual practice • Talking to your doctor or psychiatrist • Obtaining literature and educating yourself about your particular concern or symptom • Beginning some type of mindfulness practice (meditation, yoga) • Spending more time outdoors Early intervention can make a big difference to your mental health and overall sense of well-being.

Do yourself, your patients and your loved ones a favor

and attend to your human needs, rather than ignore them.

Mary Beth James, MA, LMFT is a psychotherapist in private practice in Pasadena. Ms. James’ website is www.mftmb. com <http://www.mftmb.com> and her license number is MFC 51983. She can be reached at mftmbjames@gmail.com.

References: Moutier, C., Norcross W., Jong P., Norman M., Kirby B., McGuire T., & Zisook S. (2012). The suicide prevention and depression awareness program at the University of California, San Diego School of Medicine. Academic Medicine, Vol. 87. No. 3. doi: 10.1097/ ACM.0b013e31824451ad.

Ruitenburg, M., Frings-Dresen, M., & Sluiter, J. (2012). The prevalence of common mental disorders among hospital physicians and their association with self-reported work ability: a cross-sectional study. BMC Health Services Research 12:292. doi:10.1186/1472-6963-12-292.

Shanafelt,T., Boone, S.,Tan, L., Dyrbye, L., Sotile,W., Satele, D.,West, C., Sloan, J., & Oreskovich, M. (2012). Burnout and satisfaction with work-life balance among US physicians relative to the general US population. JAMA Internal Medicine 172(18):1377-1385. doi:10.1001/archinternmed.2012.3199.

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j uLY 2014 | w w w. p h y s i c i a n s n e w s n e t w o r k .c o m 7

p h y s ic ian wellnes s | b alan c e

• Realizing that the only thing that defines you is your work • Feeling a sense of “depersonalization,” or not like yourself • Obtaining prescriptions for any psychotropic medication from a colleague, or writing them yourself • Engaging in risky behaviors as an escape

balance | phys i ci an wellness

Sleep-Deprived Physicians at Work:

Why Physicians Don’t Know How Sleepy They Are Liz Ferron, MSW, LICSW

Most physicians wouldn’t dream of coming to work drunk, yet they feel a professional

obligation to report for duty even when seriously sleep-deprived. In a Harvard Business Review article Dr. Charles A. Czeisler, the Baldino Professor of Sleep Medicine at Harvard Medical School, referred to a nonsensical “culture of machismo sleeplessness,” noting that going 24 hours without sleep, or a week of sleeping four or five hours a night, induces an impairment equivalent to a blood alcohol level of .1%—a concentration that qualifies as “too drunk to drive.”1 Given their training, many physicians are convinced they’ve somehow overcome their need for sleep, pointing to the many years they’ve practiced without a problem as proof that they’ve somehow conditioned themselves to operate without sleep.

There’s some evidence that physicians can and do rise to the occasion on very little sleep. A 2013 study demonstrated that surgeons who worked the night before an operation were no less effective and did not have a higher rate of complications in surgery than those who did not work the night before.2 However, one commentator noted that this somewhat surprising result might be due to the fact that surgery isn’t boring.

Research suggests that it’s while performing routine procedures that sleep-deprived physicians may put themselves and their patients at risk: • A 2012 study from Penn State found sleep deprivation didn’t impair surgeons while performing operations in which they were already trained, but they experienced a total subjective increase in mental workload that left them less prepared to deal with unexpected events.3

8 PHYSICIAN MA G A Z INE | j uLY 2014

• A 2013 study found that acute sleep loss due to working long on-call shifts significantly decreased daytime alertness and negatively affected the mood state of junior physicians. 4 Doctors are so conditioned to performing while sleep deprived that they’re not good at recognizing symptoms of, or impairment resulting from, sleep deprivation.

A Baylor University Medical Center study used the Multiple Sleep Latency Test (MSLT) to measure the physiologic sleepiness of anesthesiology residents— both when they were well-rested and had been on call: 5 • The MSLT scores for groups that had been on call in busy units were 4.9 minutes—scores of less than 5 minutes are considered pathologic daytime sleepiness.

• When asked if they’d fallen asleep during the test, only half gave the answer that corresponded to the EEG data.

• Among those who thought they’d stayed awake, 68% were wrong.

Career Longevity and Quality of Life: Medical Error Isn’t the Only Risk

In addition to not being immune from the effects of sleepiness, physicians aren’t immune from the negative health outcomes associated with insufficient sleep and circadian rhythm disruption, including: • • • • • •

Obesity Cardiovascular disease High blood pressure Stroke Reduced sex drive Neurologic and memory impairment

In attempting to dispel the myth that poor sleep quality has nothing to do with health disorders, the Cleveland Clinic’s Sleep Disorders Center notes: “More and more scientific studies are showing correlations between poor quality sleep and/ or insufficient sleep with a variety of diseases. Blood pressure is variable during the sleep cycle. Interrupted sleep, however, can negatively affect the normal variability and may lead to hypertension and cardiovascular problems. Research indicates that insufficient sleep impairs the body’s ability to use insulin, which can lead to the onset of diabetes.

Fragmented sleep can cause a lowered metabolism and increased levels of the hormone cortisol. Increased cortisol levels can result in an increased appetite and a decrease in one’s ability to burn calories.” 6 A new study from Penn Medicine shows disturbing evidence that chronic sleep loss may be more serious than previously thought and may even lead to irreversible physical damage to and loss of brain cells.7 Sleep also takes a toll on emotional health and well-being. When we ask physicians suffering from depression or anxiety about their sleep habits, they often just laugh. They seem to think a good night’s sleep is a crazy pipe dream instead of one of life’s most basic needs.

However, we have found that when overtired physicians are able to get more sleep, they often see an immediate improvement in

mood and anxiety levels. Instead of just saying, “I’ll get more sleep when life improves,” they find, in fact, that life improves when they get more sleep.

Liz Ferron, MSW, LICSW, is vice president of clinical services at Physician Wellness Services in Minneapolis. She has been with the company for over 10 years, and has been in the employee assistance field for over 20 years. She has served three terms as president of the Minnesota Employee Assistance Program Administrators and Counselors (MEAPAC), and is a former adjunct faculty member at the College of St. Benedict. Liz has her MSW degree from the University of Minnesota and is a Licensed Independent Clinical Social Worker.

1 Brownyn Fryer, “Sleep Deficit: The Performance Killer, A Conversation with Charles A. Czeisler,” Harvard Business Review, October 2006 2 Christopher Vinden, MD1,2; Danielle M. Nash, MSc2; Jagadish Rangrej, MSc4; Salimah Z. Shariff, PhD2; Stephanie N. Dixon, PhD2,3; Arsh K. Jain, MD2; Amit X. Garg, MD2,3, “Complications of Daytime Elective Laparoscopic Cholecystectomies Performed by Surgeons Who Operated the Night Before,” JAMA. 2013;310(17):1837-1841. doi:10.1001/jama.2013.280372 3 Jonathan M. Tomasko, Eric M. Pauli, Allen R. Kunselman, Randy S. Haluck “Sleep deprivation increases cognitive workload during simulated surgical tasks,”The American Journal of Surgery,Volume 203, Issue 1 , Pages 37-43, January 2012 4 Wali Siraj O, Qutah Karimah, Abushanab Lujain, Basamh Roa’s«SQ»a, Abushanab Jolanar, Krayem Ayman , “Effect of on-call-related sleep deprivation on physicians’ mood and alertness,” Annals of Thoracic Medicine, Volume 8, Issue Number1, Pages 22-27, 2013 5 Howard SK, Gaba DM, Rosekind MR, Zarcone VP.The risks and implications of excessive daytime sleepiness in resident physicians. Acad Med. 2002;77:1019– 1025.[PubMed] 6 “Myths and facts about sleep,” http://my.clevelandclinic.org/neurological_institute/sleep-disorders-center/patient-education/hic-myths-and-facts-about-sleep.aspx 7 Zhang Jing, Zhu Yan, Zhan Guanxia, Fenik Polina, Panossian Lori, Wang Maxime M, Reid Shayla, Lai David, Davis James G, Baur Joseph A, Veasey Sigrid, “Extended Wakefulness: Compromised Metabolics in and Degeneration of Locus Ceruleus Neurons,” The Journal of Neuroscience, 19 March 2014, 34(12):4418-4431

j uLY 2014 | w w w. p h y s i c i a n s n e w s n e t w o r k .c o m 9

p h y s ic ian wellnes s | b alan c e

Given this data, physicians have to question whether they’re really comfortable that the decisions they make when sleep-deprived have no adverse effects on patient care.

LACMA WELCOMES 143rd President

Dr. Pedram Salimpour

With a call for physician leadership, Pedram Salimpour, MD, ushered in his term as the 143rd president of the Los Angeles County Medical Association (LACMA). More than 375 LACMA members, sponsors, vendors and associates attended the Thursday evening event held at the Riviera Country Club in Pacific Palisades.

Clayton Patchett, MD, and Ralph DiLibereo, MD, led the installation of the 2014-2015 officers, which, in addition to Dr. Salimpour as president, included Peter Richman, MD, as president-elect, Vito Imbasciani, MD, as treasurer and William Averill, MD, as secretary.

In his president’s remarks, Dr. Salimpour emphasized the essential role medicine plays in the lives of all people, calling for physicians to take a leadership role in healthcare, stating that “medicine is the indispensable profession … doctors have to lead,” a theme he repeated throughout his remarks.

Dr. Salimpour noted that medicine continues to attract the best and the brightest and that doctors are better trained to meet their patients’ clinical needs than in any previous time.

Arguing against those who suggest that the medical practice is in decline, Dr. Salimpour observed that physicians practice in a healthcare system that places doctors in an ever more “volatile, uncertain, complex and ambiguous business environment.” The result, Dr. Salimpour noted, is that patients and physicians alike are asking, “Who’s in charge?”

In the face of this uncertain environment, Dr. Salimpour warned of unilateral confrontation by doctors, suggesting instead that physicians should form partnerships with organizations to help achieve the objectives of all partners. Noting that LACMA stands for physician leadership, Dr. Salimpour recognized the number of organizations following LACMA’s leadership in support of the Medical Injury Compensation Reform Act (MICRA).

In closing, Dr. Salimpour noted that “doctors are people who find new ways to new places, and now we have to find new ways to bring everyone else along.”

Rabbi David Wolpe of Sinai Temple in Los Angeles offered the invocation in support of Dr. Salimpour’s leadership of LACMA. Event keynote speaker was Antonio R. Villaraigosa, former mayor of Los Angeles, who spoke on the importance of equal educational opportunities for all people.

Richard Baker, MD, made the welcoming remarks, and Marshall Morgan, MD, outgoing LACMA president, called the evening to order.

Samuel Fink, MD, a former LACMA president, presented the Recognition of Lifetime Achievement award to Patrick Wade, MD, and recognized Dr. Marshall Morgan for his service to LACMA. LACMA CEO Rocky Delgadillo gave brief closing remarks.

1 0 PHYSICIAN MA G A Z INE | j uLY 2014

h os p ital + p h y s ic ian ali g n m en t | f eat u r e Top Left: 143rd LACMA President Dr. Pedram Salimpour with outgoing president, Marshall Morgan, MD. Top Right: Dr. Salimpour being sworn in by Ralph DiLibero, MD and Clayton Patchett, MD. Middle Left: The Salimpour family enjoys the event.

Middle Right: Event sponsors chat with LACMA physicians.

Bottom Right: Event guests enjoy cocktail hour before dinner.

Bottom Left: Friends, family, sponsors and fellow physicians honor Dr. Salimpour at the sold-out event.

j uLY 2014 | w w w. p h y s i c i a n s n e w s n e t w o r k .c o m 11

balance | phys i ci an wellness

Sleep Hygiene: What’s Keeping You Awake at Night?

Liz Ferron, MSW, LICSW

In addition to having insufficient time to sleep, many physicians have difficulty falling to

sleep—for a variety of reasons. Doctors have lifestyle issues that get in the way of good sleep hygiene. They eat on the run, grab what’s available at the hospital—which is generally terrible—and don’t make exercise, play or stress management a priority. It’s all about getting the work done.

In 2010, physicians at a major teaching hospital were surveyed about their personal lifestyle behavior.1 The survey showed: • Both residents and attending physicians reported low levels of fruit and vegetable consumption and low levels of exercise.

• Only 8% of trainees and 12% of attending physicians reported a regular yoga practice— and just 6% of trainees and 10% of attending physicians reported regular meditation.

Not surprisingly, this combination of high stress, poor quality diet and lack of exercise often makes it difficult to fall asleep. Relying on medication or alcohol to quiet the brain can compound the problem when used on a regular basis.

A comprehensive approach to addressing the problem begins long before bedtime and has benefits not just for physicians but for their patients, as well. Research indicates that doctors with healthy lifestyles are more apt to rec1 2 PHYSICIAN MA G A Z INE | j uLY 2014

ommend lifestyle changes to their patients.

A national cross-sectional survey of 500 primary-care physicians2 found that physicians with normal body mass index: • Were more likely to engage their obese patients in weight loss discussions as compared to overweight/obese physicians • Had greater confidence in their ability to provide diet and exercise counseling to their obese patients.

And, a 2012 survey of physicians found that doctors who exercised at least once a week or didn’t smoke were about twice as likely to recommend their patients eat a healthy diet, reduce salt intake, attain or maintain a healthy weight, limit alcohol use and exercise regularly.3

Sleep Hygiene for Physicians: Promoting Healthier Sleep Patterns Create a sleep routine: When lying down

antioxidants and serotonin that research indicates may improve sleep onset, duration and efficiency in adults with self-reported sleep disturbances.5 Bananas contain tryptophan, magnesium and potassium, a nutrient that— according to a 2007 article in the journal Neuroscience—may promote a more restful sleep.6 1 Howe Micheal, Leidel Adam, Krishnan Sangeetha M, Weber Alissa, Rubenfire Melvyn, Jackson Elizabeth A, “Patient-Related Diet and Exercise Counseling: Do Providers’ Own Lifestyle Habits Matter?,” Preventive Cardiology (pages 180–185), August 2010 2 Bleich, S. N., Bennett,W. L., Gudzune, K. A. and Cooper, L. A. (2012), Impact of Physician BMI on Obesity Care and Beliefs. Obesity, 20: 999–1005. doi: 10.1038/oby.2011.402 3 Hung, Olivia Y, et al, “Doctors practicing healthy lifestyles more likely to preach it to patients,” American Heart Association, March 2012 http://newsroom.heart. org/news/doctors-practicing-healthy-lifestyles-230084, retrieved March 23, 2014 4 Greer, SM, “The impact of sleep deprivation on food desire in the human brain,” Nature, August 2012 5 Lin HH, Tsai PS, Fang SC, Liu JF. “Effect of kiwifruit consumption on sleep quality in adults with sleep problems,” Asia Pac J Clin Nutr. 2011;20(2):169-74.

6 Young, Simon M. “How to increase serotonin in the human brain without drugs,” J Psychiatry Neurosci. Nov 2007; 32(6): 394–399.

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p h y s ic ian wellnes s | b alan c e

to go to sleep, do some deep breathing and try to empty your mind instead of going over mistakes you made today or things you need to do tomorrow. With each breath, try to release tension and relax.

Give yourself 20 minutes: If you haven’t fallen asleep in 20 minutes, get up and do something relaxing. Don’t lie in bed worrying about not sleeping.

Single-purpose your bedroom: People who work in bed or watch TV in bed may have trouble sleeping in that room. If you’re having trouble sleeping, consider using your bedroom only for sleep. Equip your bedroom with shades that ensure complete darkness (particularly if you sleep during the day) and keep the temperature on the cool side.

Delineate a nap space at work: Some doctors keep pillows in their desk drawers and can catch “power naps” on whatever flat surface is available. Others need to reserve the call room, make a point of saying “do not disturb”—and leave their cell phones behind.

Permit yourself to “power nap”: A nap of 15-20 minutes can help restore cognitive function. It’s not a replacement for a good night’s sleep but a way to re-energize yourself when working a punishing schedule.

Get good and tired: Exercise creates a tiredness that leads to better sleep. Don’t exercise right before bedtime, but make regular exercise a priority. If you don’t put it on your schedule, it won’t happen.

Pick a better nighttime snack: Research indicates that the less you sleep, the more you crave junk food.4 Instead of giving in to that craving, try a bowl of fresh fruit one to two hours before bedtime. Kiwi fruit is high in

balance | phys i ci an wellness

risk tip

Including Risk Management in Your Vacation Planning Allows You to Relax Because liability never takes a holiday, your vacation plans should include medical cover-

age arrangements for your practice, particularly when you use locum tenens. The following tips will help reduce risks in your practice and promote the safety of your patients as you plan your vacation: • Review managed care contracts for relevant coverage requirements. Some managed care contracts contain very specific language on this topic, and many contain indemnification clauses that could expose you to the liability of the covering physician (as well as breach of contract).

• Whenever possible, make secondary coverage arrangements. Confirm coverage arrangements via email or fax with the locum tenens who are covering your practice in order to avoid misunderstandings, possible uncertainty of dates or time frame, and exposure to abandonment.

• Ensure that the practice coverage arrangements include an understanding about patient billing practices in conjunction with any managed care contracts or plans.

1 4 PHYSICIAN MA G A Z INE | j uLY 2014

• Choose covering physicians who share your medical specialty and have privileges at the same hospitals that you do.

• Determine if covering physicians carry professional liability coverage and the limits of such coverage. While asking these questions could be awkward, you may be required to ask under certain managed care plans, provider agreements, and hospital bylaws.

• Before leaving on vacation, prepare a list of patients who are hospitalized or are in the midst of diagnostic work-up, or who have special medical problems or needs. Give this information to the covering physicians and document any specific advice you provide.

• Inform the attending physicians or hospitalists of any hospitalized patients you are following about your coverage arrangements, and docu-

â&#x20AC;˘ Advise your patients of the coverage arrangements and give them the covering physiciansâ&#x20AC;&#x2122; names.

Confirm coverage arrangements via email or fax with the locum tenens who are covering your practice in order to avoid misunderstandings

â&#x20AC;˘ Make each hospital where you have on-call responsibilities aware of the dates of your unavailability and the identity and phone numbers of the covering physicians. Give similar notice to your answering service and office staff.

Upon returning from vacation, promptly confer with all covering physicians. Document what

you were told by the covering physicians about any significant developments in patientsâ&#x20AC;&#x2122; clinical course or treatment while you were away.

Consider implementing these fundamental loss prevention measures for even brief periods when you are unavailable, such as observance of religious holidays, attending medical conferences, personal illness, or a long weekend. Unfortunately, vulnerability to claims is not diminished on these occasions.

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.

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p h y s ic ian wellnes s | b alan c e

ment the hospital chart to reflect these conversations.

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ceo’s letter

Medical Professional Liability Protection, and more!

800-356-5672 www.CAPphysicians.com

SAN DIEGO ORANGE LOS ANGELES PALO ALTO SACRAMENTO

This July is marked with new beginnings and LACMA’s continued advocacy for patients’ rights.

We welcome our new president, Dr. Pedram Salimpour, who, as the youngest president in LACMA’s history, will tackle new challenges and initiatives with a renewed vigor and energetic drive. We look forward to supporting him in all of his efforts.

I also want to thank Dr. Marshall Morgan, LACMA’s outgoing president, for his tremendous leadership. He has catapulted our organization forward in many ways. His tireless workings on the dual-eligible demonstration project and the protection of MICRA laid much of the groundwork of what’s still ahead for the new leadership.

This summer, LACMA will closely follow new developments by the Department of Veterans Affairs to help ensure that American veterans, who have sacrificed so much for our country, will be given the timely medical care they deserve.

We will keep a close eye on legislative efforts to reform the current VA healthcare system.

According to a recent report released by the Department of Veterans Affairs, the average wait time for new patients with a primary care doctor at the VA’s Greater Los Angeles Healthcare System averages 56 days.

The average wait time for new patients at other VA hospitals in California ranged from about 25 days in Fresno to about 44 days in Loma Linda, which is significantly longer than within the 14-day period the VA guidelines say a veteran should be able to see a primary care doctor.

We are hopeful that new legislation will open the doors for veterans to get the medical care they need and deserve by allowing our veterans to visit with a private primary care doctor.

Dr. Robert Bitonte, who was recently selected by Los Angeles Mayor Eric Garcetti to join the city’s Commission on Disability, will devote his efforts to serve our homeless veterans and advocate on behalf of patients who have been hurt by the current system.

The Board of Commissioners has the primary responsibility of working with the city’s Department on Disability to respond to the needs and concerns of our citizens, in particular, those with disabilities.

Given Dr. Bitonte’s tremendous track record of innovated leadership and dedication to saving and enhancing lives, his guidance as a physician on the Commission on Disability will be a great contribution to the lives of our residents.

This 4th of July, we look forward to the Independence Day festivities in Los Angeles County as we pay tribute to our hometown heroes and military veterans.

A happy 4th also to all of our hardworking LACMA members and their families who dedicate their lives to serving the local community.

Rocky Delgadillo Chief Executive Officer

1 6 PHYSICIAN MA G A Z INE | j uLY 2014

Los Angeles County Medical Association Activate your free membership by visiting www.lacmanet.org/StudentsandResidents Calling all Students, Residents & Fellows!

Shape your future as a physician-in-training.

Students, Residents, and Fellows have the opportunity to shape healthcare policy as they train to become the future leaders of medicine in California.

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Membership is free for the duration of your training program J ULY 2014 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 17

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Responsibilities Provide consultation-liaison services for patients suffering from both psychiatric and medical disorders by focusing on the evaluation and treatment of patients serving adolescents, adult, seniors and their families. Preferably able to serve children as well, but not required.

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CME

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UCLA Intensive Course in Geriatric Medicine and Board Review

City of Hope welcomes internationally acclaimed liver and pancreatic surgeon, researcher and author Yuman Fong, M.D., as the new chair of the Department of Surgery. Come meet Dr. Fong at this special CME event and reception:

Join us for this extraordinary four-day conference designed for healthcare professionals to enhance their ability to care for older adults. With more than thirty case-based presentations, smaller interactive sessions and discussion with faculty on issues in geriatrics, emphasis is on the clinical “how to,” and Board Review preparation for physicians and pharmacists.

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To place a classified ad visit www.physiciansnewsnetwork.com or contact Dari Pebdani at dpebdani@gmail.com or 858-231-1231.

Benefits & Discounts Aimed at meeting both your professional and personal needs, LACMA offers you additional discounts and savings on Auto & Home Insurance, UPS services, Staples office supplies, Financial Planning, HIPAA Compliance Kits, and more!

For Joining LACMA and CMA Working together, the Los Angeles County Medical Association and the California Medical Association are strong advocates for all physicians and for the profession of medicine. Of the many reasons for joining LACMA and CMA, 10 stand out.

FREE CME & Educational Resources CMA develops toolkits, guides, webinars, and resources on all things related to today’s changing healthcare landscape—all FREE with membership.

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FREE Legal Assistance

Legislative Advocacy LACMA and CMA are distinguished by their successes. Dual membership provides for unparalleled legislative advocacy at the local, state, and federal level on behalf of our members.

FREE Reimbursement Assistance Tired of fighting with payors? CMA’s Economic Services experts recovered over $7.8 million for members since 2010.

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Save time and money by consulting with a CMA legal expert before hiring a lawyer. Services include HIPAA Compliance, ACOs, Buying and selling a practice, Upkeep of medical records, and much more!

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State-of-the-Art Communication Information is power. LACMA and CMA produce several publications full of valuable information including the award-winning Physician Magazine, Physicians’ News Network, and CMA Practice Resources, full of tips and tools for your practice.

Access to your Physician Advocate If you come across a challenge and you are not sure what to do, call 213-226-0356 to support your practice and professional needs.

is the best time to join LACMA and CMA For more information on member benefits and resources, visit lacmanet.org/Membership or call (213) 226-0356 Los Angeles County Medical Association o 707 Wilshire Blvd, Suite 3800 o Los Angeles, CA o 90017 o FAX: (213) 226-0353