April 2017 | San Mateo County Physician

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Telemonitoring Saves Lives and Improves Care

The Effects of

Implicit Bias

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EDITOR

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APRIL 2017 - VOLUME 6, ISSUE 4

www.PhysiciansNewsNetwork.com EDITORIAL COMMITTEE

Russ Granich, MD , Chair | Judy Chang, MD | Uli Chettipally, MD Sharon Clark, MD | Carri Allen Jones, MD | Gurpreet Padam, MD Sue U. Malone | Executive Director SMCMA LEADERSHIP

Russ Granich, MD | President Alexander Ding, MD | President-Elect Sara Whitehead, MD | Secretary- Treasurer Michael Norris, MD | Immediate Past President Janet Chaikind, MD Uli Chettipally, MD Mamatha Chivukula, MD Paul Jemelian, MD Alex Lakowsky, MD Richard Moore, MD Joshua Parker, MD Xiushui (Mike) Ren, MD Brian Tang, MD Dirk Baumann, MD | AMA Alternate Delgate Scott A. Morrow, MD | Health Officer, County of San Mateo www.SMCMA.org facebook.com/smcma | twitter.com/SMCMedAssoc.

On The Inside 2................President’s Letter | Russ Granich, MD Preparing for a Healthcare Crisis 4................Telemonitoring Saves Lives and Improves Care 8................Healthy Financial Planning | RETIREMENT 12..............The Effects of Implicit Bias

EDITORIAL

San Mateo County Physician is published ten times per year by Physicians News Network (PNN) and the San Mateo County Medical Association. Opinions expressed by authors are their own and not necessarily those of PNN or SMCMA. San Mateo County Physician reserves the right to edit contributions for clarity and length, as well as to reject any material submitted.

Acceptance and publication of advertising does not constitute approval or endorsement by the San Mateo County Medical Association of products or services advertised.

© 2016 San Mateo County Medical Association

Cover photo by: Chris White, LittleBlueMarbleGallery.com

A P R I L 2017 | S A N M AT E O C O U N T Y P H Y S I C I A N 1

PRESIDENT’S MESSAGE

Preparing for a Healthcare Crisis — SMCMA TO THE RESCUE

BY RUSS GRANICH, MD

President Trump and the Republicans are trying to repeal the ACA (Affordable Care Act, aka “Obamacare”) with the AHCA (American Health Care Act, aka “Trumpcare”).

Although at this point there seems to be no consensus, we just don’t know what will happen if the Republicans manage to unite and pass a bill. As we have seen, when there is a shift in political power, unless there is something bipartisan, we will have another change in direction. That’s what happened to the ACA, a primarily Democratsponsored reform that the Republicans are trying to change. One would hope that any changes would be a bipartisan effort (Don’t hold your breath – Editor).

Let’s look at the impact. In California, we have nearly 5 million people enrolled under the ACA. The uninsured rate has dropped from 17% in 2013 to 7.1% in 2016.

The Berkeley Labor Center estimates that we would have a net loss of 209,000 jobs PHOTO BY SCOTT BUSCHMAN plus the undetermined ripple effect that would be felt in industries supporting those newly unemployed. Despite all the talk of the ACA being a disaster, it has been successful (with some growing pains) in California, and it has protected many of our citizens. In California, the insurance premiums have risen by an average of only 7% the past three years, less than before the ACA. “Out of the ashes Unfortunately, the majority of states, particularly those with Republican governors, have not created exchanges or taken Medicaid expansion and are having some of the issues we hear about in the news. will rise a medical San Mateo County is a fairly prosperous county, and our current uninsured rate is 4%, yet we have about community united 20,000 people who have obtained insurance through the exchange and another 35,000 through Medicaid expansion. If the ACA is dismantled, we could be facing 55,000 uninsured patients, out of the 760,000 by a mission to population in San Mateo County, over the next few years. Under the Republican plan, people do not have to buy insurance, but the Republicans fail to recognize that we still have to provide emergency care. When assure the health people don’t have insurance, they don’t get routine care. This means their chronic conditions, like hypertension and diabetes, aren’t treated until they get so sick that they go to the emergency department and often end up and well-being of hospitalized. It is better to maintain one’s health rather than have to wait until a crisis to get care. Also, the cost of that care is expensive and uses valuable resources. How do we deal with this? all our citizens.”

The San Mateo County Medical Association decided to be proactive and not wait until the hammer falls.

The strategy for this process was developed by David Goldschmid, MD. I convened a meeting of the physician leadership and political representatives from the county, state and national level. We had a tremendous turnout.

We discussed the magnitude of the issue, what resources are currently available and our options. The purpose was to get to know each other, brain-storm some basic concepts and be prepared to get together once some legislation is passed. We learned what free programs already exist, what resources the county may need and how we can support each other. For example, one idea was to share doctors: have doctors from the larger groups provide some help to the county. We did feel that the most important thing was to provide outpatient, preventative, proactive care to the population at risk of serious morbidity, such as diabetics. This group will be chaired by David.

It was beautiful; I’ve never seen anything like it before. The AHCA will be a disaster and it will be huge!

Believe me! But out of the ashes will rise a medical community united by a mission to assure the health and well-being of all our citizens, regardless of payor, especially in their time of need. It truly was inspiring and made me proud to be a physician in San Mateo County.

2 S A N M AT E O C O U N T Y P H Y S I C I A N | A P R I L 2017

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TELEMONITORING SAVES LIVES AND IMPROVES CARE

By Thomas Shaughnessy, MD, MBA

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When the American painter Chuck Close was giving an award in New York City, he had chest pain. He presented the award and then walked across the street to Beth Israel Medical Center. He had a seizure from a collapsed spinal artery and was left paralyzed from the neck down. He has regained some of his ability to ambulate and has continued to paint since the “event” on Dec. 7, 1988. Everyone is not so lucky as to be across the street from a major teaching hospital when life-threatening events occur, and telemedicine seems like the next best thing. We in San Mateo County are fortunate to have Tom Shaughnessy, MD, MBA, to guide us in this new medical frontier.

SHARON ANN CLARK, MD, FACS

The first of its kind on the west coast, sutter’s eicu system debuted in sacramento in 2003 and in the san francisco bay area over 12 years ago.

A 60-year-old man was transferred from rural Lakeside Hospital to Sutter Santa Rosa Medical Center when a physician diagnosed him with a heart attack amenable to urgent treatment. On the same night, a 70-year-old woman at Mills-Peninsula Hospital had a rapid deterioration and was evaluated by the same physician to be in need of emergency surgery. The doctor who recognized the issues and facilitated care for these patients, including their resuscitation, actually managed that care from many miles away. The physician was able to see, hear and assess the patient with accuracy and organized appropriate tertiary specialists for both patients’ procedures.

Under the watchful eye of round-the-clock nurses and intensivists — both onsite and in a remote tele-ICU — they subsequently spent a week recovering and then returned to lives with their families.

The outcomes for these patients may be traced to a new concept in the extension of physician services — telemedicine through telemonitoring. Many, if not most, patients are unconscious for most of their stay in the ICU. Therefore, most patients and their families remain unaware of the benefits of this new medical technology. Their care providers have begun to adopt these advances in order to provide higher levels of care in a faster, more efficient manner than has previously ever been possible.

The eICU is an advanced monitoring system that uses high-speed data transmission tools to network ICUs together in order to provide supplemental monitoring and consultative support.

Clinical interventions are performed through intensivist physicians and critical care nurses from a single location.

The first of its kind on the West Coast, Sutter’s eICU system debuted in Sacramento in 2003 and in the San Francisco Bay Area over 12 years ago. This concept has been adopted in over 50 other hospital-based healthcare systems across the United States. An estimated 15% to 20% of ICU beds in the United States are supported using this technology. Through early-warning software and advanced video and electronic monitoring systems, intensivists and nurses keep an even closer eye on critically ill patients seven days a week. Sutter’s tele-ICU system serves as a high-tech, centralized safety net for patients who may be right down the street or over 100 miles away.

It is currently monitoring beds throughout the Sutter affiliate network from two hub sites located in the San Francisco Bay Area and in the Sacramento region.

Currently, this network services 256 lCU beds with an average daily census of 140 to 150 patients in 15 Sutter and non-Sutter hospitals throughout the Bay Area region. Patients are monitored 24/7 by an experienced critical care nurse, and a critical care-certified intensivist physician is available to provide timely support. This tele-intensivist not only handles crisis situations but also identifies and suggests corrections of small problems before they become major issues. Telemedicine promotes the ever-evolving standards of care and best practices demanded of various quality and regulatory organizations. Clinical interactions are coordinated through the managing physician, and the teleICU’s level of involvement is tailored to the preferences of each attending physician.

A P R I L 2017 | S A N M AT E O C O U N T Y P H Y S I C I A N 5

EARLY RECOGNITION SAVES LIVES

Through the tele-icu, doctors can now see early warning signs, proactively intervene, and prevent adverse outcomes. This also helps to minimize the amount of time a patient spends on invasive support measures.

Studies have shown that patients’ intensive care have better outcomes when care is driven by specialist physicians called intensivists. These individuals have completed fellowship training in critical care medicine and are eligible or board-certified in internal or pulmonary medicine, anesthesiology or surgery.

With this technology bringing more skill and judgment to the bedside, the chances of patients coming out of the ICU alive and healthy are much higher than in years past. While a full-time intensivist continuously on-site could achieve the same effect, these highly trained physicians are less available, and the critical care needs of a progressively aging population continue to grow. Thus, placing these physicians in all the locations where they are needed is becoming a less sustainable solution over the long term. Through the tele-ICU, doctors can now see early warning signs, proactively intervene, and prevent adverse outcomes. This also helps to minimize the amount of time a patient spends on invasive support measures.

PARADIGM SHIFT Care in the 21st century is geared toward improving processes and quality. With the teleICU system, technology can be used to transform the practice of intensive care medicine from each doctor’s personal style and integrate that art with the standard best practice approaches to patient care.

The tele-ICU physician is constantly learning about new treatments and can discuss current studies with the bedside caregivers. The need for support is greatest at night, when nurse staffing may be least familiar with overall management plans and physician oversight functions are at a minimum. While some speculate that such a program is intended to replace bedside staffing, its roots are as a quality and process improvement initiative: It does not replace any services already in place at a facility. Rather, it offers a second set of eyes, with an ancillary benefit of access to higher-level support to act as mentor to nurses new to the ICU, or to empower experienced staff to execute and adapt care plans throughout the day and night. The versatility of this program is evident by its ability to integrate into those areas of need within any participating affiliate. The tele-ICU program is seen as a valuable tool to allow specialty physician consultation in smaller institutions where access to these providers is limited. It also has become the perfect mechanism to improve oversight of care in larger facilities where on-site physician input is greater but the process of care more complex and cumbersome.

TELE-ICU AND IMPROVEMENTS IN OUTCOME Vigilance is the watchword for physicians who practice in a telemonitoring environment. The value of engaging the eicu program is that care happens faster and in a more coordinated fashion.

Vigilance is the watchword for physicians who practice in a telemonitoring environment.

The value of engaging the elCU program is that care happens faster and in a more coordinated fashion. With a disease process like sepsis, timely management is essential to better outcomes.

Data collection through the Sutter tele-ICU has allowed work to be published relating to the management of sepsis, as well as in facilitation of ICU care transitions. By channeling a practice of patient screening through the hubs, telemedicine facilitates management of sepsis patients. This has helped affiliates realize a decrease in the adverse events associated with this high-morbidity, high-mortality event. At a time when patient care can become more fragmented and complex, the tele-lCU program has demonstrated that, by working in collaboration with affiliates, compliance with best practice initiatives can be achieved for every patient, every day. As an example, compliance with DVT prophylaxis in most ICUs had ranged between 70% to 80%. Using the oversight and interventions through the teleICU to fill gaps in care when detected, compliance with this best practice increased to 95% to 100%.

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CRITICAL CARE: REVISITING THE FOREFRONT In combination with electronic patient records and computerized physician order entry systems, the addition of bringing ICUs together as a network stands to optimize the use of this costly resource among participating affiliates for the benefit of patients, providers and payers. The tele-ICU concept has been recognized by the Leapfrog Group for its technological innovations that trigger “leaps” in quality, customer service and affordability. Advances in telemedicine such as a tele-ICU serve as a catalyst to drive a reorganization and greater leveraging of our more limited healthcare resources.

The success realized with programs such as the eICU draws attention in the healthcare industry and medical community to adopt other emerging technologic solutions with the goal of bringing the right care to the right patient at the right time.

Footnote: A video link with a local media review of Sutter’s teleICU overview may be found at https:// youtu.be/SS8E39yR5Gg

Advances in telemedicine such as a tele-icu serve as a catalyst to drive a reorganization and greater leveraging of our more limited healthcare resources.

The author, Thomas Shaughnessy, MD, MBA, is a medical director of the eICU program for the Sutter Health Bay Operating Unit. He is also the chair of the Department of Anesthesiology at Mills-Peninsula Medical Center and an associate clinical professor of anesthesiology at University of California, San Francisco.

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or call (650) 312-1663 A P R I L 2017 | S A N M AT E O C O U N T Y P H Y S I C I A N 7

RETIREMENT Healthy Financial Planning for Doctors

BY W. BEN UTLEY, CFP, PRESIDENT OF PHYSICIAN FAMILY FINANCIAL ADVISORS

PHYSICIAN RETIREMENT PLANNING is tricky business since doctors get a late start on saving for retirement.

Medical practitioners begin earning “real money” in their mid-30s, but during their first 10 years of practicing medicine— when the power of compound investment growth has the biggest impact on retirement accounts—doctors are strapped with student loan payments, childcare expenses and mortgage loan payments that make it challenging to contribute to tax-qualified retirement plans. And young physicians, fresh out of training and excited about a new career, seldom understand the burnout that causes almost half of mid-career physicians to wish they were better prepared for retirement.

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Healthy FINANCIAL PLANNING

5 WAYS PHYSICIANS CAN SAVE FOR RETIREMENT A successful plan for retirement means saving money and saving taxes. Doctors have at least five ways to save for retirement before considering other options like real estate, cash value insurance and other vehicles. Most of these retirement strategies receive a measure of asset protection via the Bankruptcy Abuse Prevention and Consumer Protection Act of 2005 (BAPCPA).

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TAX-DEFERRED RETIREMENT PLANS FOR PHYSICIAN EMPLOYEES

Physicians who receive a Form W-2 showing wages or salary may have a workplace retirement plan that allows them to defer income by making a contribution to the plan.

• 401(k) plans allow employees of for-profit healthcare organizations and self-employed doctors to defer up to $18,000 per year ($24,000 per year if age 50+) to the plan on a pre-tax basis. Account balances can grow taxdeferred. Qualified distributions are taxed as ordinary income when withdrawn. Other withdrawals, including those made before age 59½, are generally subject to income taxes and a 10% penalty.

• 403(b) plans work the same way that 401(k) plans do, but they are offered by government and nonprofit healthcare organizations.

• Government-sponsored 457(b) plans are offered by state and local government healthcare organizations.

Physicians can defer up to $18,000 per year ($24,000 if age 50+) to the plan on a pre-tax basis in addition to the money they contribute to a 403(b) plan. Account balances can grow tax-deferred. Qualified distributions are taxed as ordinary income when withdrawn. Other withdrawals, including those made before age 59½, are generally subject to a 10% penalty and income taxes. Balances from these plans are generally available to roll over to IRAs (Individual Retirement Accounts) or other employersponsored retirement plans, provided that the receiving plan allows for inbound rollovers.

• Non-government organization 457(b) plans, or NGO 457 plans, present a special risk for unwary physicians saving for retirement. While these plans also allow for pre-tax contributions and tax-deferred growth, they only gain these tax benefits due to a “substantial risk of forfeiture” imposed by the Internal Revenue Service (IRS). Doctors

who hold these plans can lose everything if the sponsoring employer goes bankrupt. While account balances from one non-government 457(b) can usually be rolled over to another non-government 457(b) plan, they cannot be rolled over to an IRA or any other type of plan.

• 401(a) plans are offered by nonprofit employers who may make contributions on behalf of physicians. Contributions by employees are usually mandatory deferrals based on a flat dollar figure or a percentage of compensation.

401(a) plan balances may be rolled over to an IRA or other qualified retirement plan.

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TAX-DEFERRED RETIREMENT PLANS FOR SELFEMPLOYED PHYSICIANS

Physicians who receive income reported on Form 1099 (including doctors who “moonlight” or work locum tenens) and self-employed physicians have other options to help save for retirement.

• SEP-IRA is a Traditional IRA established under a Self Employed Pension Plan document (often the Form 5305SEP) that allows a physician to contribute more to a Traditional IRA than they could contribute outside the plan. Physicians with a SEP may still be able to contribute to a separate Traditional IRA or Roth IRA. Physicians can contribute the lesser of $54,000 or 25% of compensation (as adjusted for self-employment tax). Like other Traditional IRAs, account balances can grow tax-deferred, are taxable when distributed, and may be rolled over to other qualified plans.

• One-participant 401(k) plan (as it’s described by the IRS) is also known as a “solo 401(k)” or solo-k for short. This plan works like a traditional 401(k) plan except that (1) it’s for a practice with only one owner or a practice that employs only an owner and spouse; (2) it is not required to perform nondiscrimination testing; (3) if it holds less than $250,000 at the end of the year, it is generally not required to file Form 5500-SF. Many brokerage firms and mutual fund companies offer off-the-shelf or “prototype” documents that physicians can use to establish a solo-k, though few of these firms are qualified to give advice regarding compliance with IRS, Employee Retirement Income Security Act of 1974 (ERISA) and Department of Labor rules that govern their creation and maintenance.

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Healthy FINANCIAL PLANNING

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TAX-QUALIFIED PENSION PLANS OF PHYSICIAN EMPLOYERS

Physicians who are self-employed may establish a special kind of retirement plan known as a defined benefit plan, and physician employees may be fortunate enough to work for an organization that has adopted one of these plans. Traditionally known as “pension plans,” defined benefit plans have been around for decades. Actuaries — the professionals who design and administer these plans — refer to them collectively as “DB plans.” The most recent incarnation of the DB plan is called a “cash balance plan” because the plan’s annual statement shows a 401(k)-like balance representing the present value of the plan’s future benefits, making it easy for doctors and other plan participants to grasp.

• Contribution limits vary according to a physician’s age, but younger doctors might contribute as little as $40,000 per year to a plan while doctors nearing retirement might contribute as much as $200,000 per year, all on a pre-tax basis.

Contribution limits vary according to a physician’s age, but younger doctors might contribute as little as $40,000 per year to a plan while doctors nearing retirement might contribute as much as $200,000 per year, all on a pre-tax basis.

• Regulatory compliance is burdensome since these retirement plans must comply with ERISA and the IRS code. Physicians who are interested in setting up a plan can consult a thirdparty administrator (TPA) who generally handles the plan documents, the plan adoption process, ongoing testing and required filings. Most TPAs will neither manage the account nor act as a custodian for the plan’s assets. These services are typically provided by a brokerage and a registered investment advisor.

• A strong case for a defined benefit plan includes a stable medical practice with a small number of highly compensated physicians who are substantially older than the average staff member (e.g., radiologists and anesthesiology practices).

• Layering a defined benefit plan on top of a defined contribution plan (401(k) or profit sharing plan) may allow 1 0 S A N M AT E O C O U N T Y P H Y S I C I A N | A P R I L 2017

physicians to substantially increase their own ability to save for retirement while costing very little in the way of required additional contributions to staff.

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TAX-ADVANTAGED PERSONAL RETIREMENT ACCOUNTS FOR PHYSICIAN FAMILIES

Physicians who receive earned income from employment and their spouses who are under age 70½ are eligible to contribute to an IRA even if their contributions may be non-deductible.

• Traditional IRA allows doctors to defer up to $5,500 per year ($6,500 per year if age 50+) to the account. Physicians who are not covered by a workplace retirement plan may deduct pre-tax contributions while those covered at work can make non-deductible or partially-deductible contributions depending on their earned income and filing status. The nondeductible portion of the account, also known as “basis,” is tracked with each year’s tax return on Form 8606. Account balances can grow tax-deferred. Qualified withdrawals (excluding the basis) are subject to ordinary income tax while non-qualified withdrawals generally result in a penalty.

• Roth IRA contribution limits are the same as Traditional IRA limits, but most physicians earn income at levels exceeding the adjusted gross income (AGI) limitations, so they simply are not allowed to contribute directly to a Roth IRA. Doctors can make “backdoor Roth IRA contributions” by first contributing to a Traditional IRA and then converting the Traditional IRA to a Roth IRA. (Note: This tactic requires careful planning to avoid unnecessary taxation.) Roth IRA balances can grow tax-deferred, and qualified withdrawals are free of income tax. For more details, see IRS Publications 590-A and 590-B. • Spousal IRA is a Traditional IRA or Roth IRA that receives contributions on behalf of a non-earning spouse. In order to contribute, the non-earning spouse must meet the ordinary requirements for making an IRA contribution, but they are not required to have earned income. Instead, the earning physician must make enough income to cover the spouse’s contribution. Otherwise, the same IRA contribution limits apply to the Spousal IRA. • Health Savings Account (HSA) is not truly a “retirement account,” but physicians may allow balances to grow tax-deferred and make tax-free distributions for qualified healthcare expenses in retirement. While contributions are tax-deductible, a doctor must first be covered by a High Deductible Health Plan (HDHP) in order to be eligible to contribute to the account. Physician families covered by a HDHP can contribute up to $6,750, while doctors with selfonly coverage can contribute $3,400. For more details, see IRS Publication 969.

Healthy FINANCIAL PLANNING

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TAX-EFFICIENT INVESTMENTS IN TAXABLE ACCOUNTS

Physicians that manage to max out contributions to all their tax-advantaged retirement accounts can still make use of a taxable account (a.k.a. joint account, trust account or individual account) by investing in certain securities that are inherently tax-efficient.

• Tax-exempt bonds and bond funds pay dividends or interest that can be federally tax-free or doubly tax-free when owned by a physician who lives in the state where the bonds were issued.

• Low-cost index funds and other passively managed mutual funds that have a low internal “turnover” seldom pay out capital gains distributions, and when they do, these distributions tend to be small and are taxed at favorable capital gains rates.

• Stocks of U.S. corporations, certain foreign corporations and mutual funds that own them may pay dividends that qualify to be taxed at favorable capital gains rates.

We hope that our Physician Retirement Planning Guide can help you make sense of the personal finance issues that affect doctors while helping you avoid mistakes and seize opportunities as you and your family plan for financial security that can last a lifetime.

W. Ben Utley, CFP, is president of Physician Family Financial Advisors, a fee-only firm helping doctors save taxes and time while managing student loans, financing a home, saving for college and investing for retirement.

To learn more, call (541) 463-0899 or visit www.physicianfamily.com.

A P R I L 2017 | S A N M AT E O C O U N T Y P H Y S I C I A N 11

The Effects of

Implicit Bias T H I S Y E A R AT I T S A N N UA L R E T R E AT, the California Medical Association Board of Trustees was treated to an excellent talk on “Implicit Bias” by René Salazar, MD. The effects of conscious bias and discrimination have been studied over many years and are well known; for example, most of our CME presentations have to start with some statement about possible conflicts and biases the speaker may have. But what about biases that don’t even make it into our awareness?

It is now thought that bias is a normal process due to the need to organize the overwhelming amount of information that is presented to us at any given time, and that much of it is unconscious, shaped by our own personal experiences.

Unconscious (or implicit) bias is not limited to ethnicity or race but can be found around issues of age, gender, gender identity, physical abilities, religion, sexual orientation and weight, among others. And these biases can be learned early in life, with young children picking up on non-verbal signals from adults around them.

In the medical world, unconscious bias may affect the medical environment of patients and staff, the hiring of doctors and staff, evaluation of our patients, and our patients’ overall care. There is a growing body of literature about microaggressions — which are small events that are often unintentional that occur whenever people are perceived to be “different.” Examples given included asking an Asian-American about their ethnic origin (“where are you from?”) or even complimenting a Latino for their ability to speak English without an accent. I immediately thought of a young, thin, tall African-American man I had seen in clinic who felt like when he went out for a walk, he could see people in their cars noticing him and locking their doors. If these microaggressions occur in the office, they will lead to a sense of a hostile work environment. (For more about microaggressions, I suggest http://world-trust.org/wp-content/uploads/2011/05/7Racial-Microagressions-in-Every-Life.pdf.)

The classic study on implicit bias involved hiring among U.S. symphony orchestras. It found that if there was a physical screen to conceal the identity of the candidate, it increased the probability that women would advance from preliminary rounds by 50%, and increased hiring of women by 25%. Another study showed that traditionally white names received more callbacks

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for interviews when identical resumes were sent to help-wanted ads. Even in our medical field, there have been some studies showing male students were more hireable for research science faculty, and males had had more “standout” adjectives in their faculty recommendation letters.

Finally, implicit bias can be seen in patient evaluation and care. Medical students showed more negative stereotyping and anticipated less patient adherence when given an obese vs. a non-obese virtual patient. Black children with appendicitis were found less likely to receive opioid medication than white children.

There is a set of tests called the Implicit Association Test.

The tests were developed in 1998 and are relatively resistant to social desirability concerns, and cover a number of known age, gender, racial and other biases. You can find them at https:// implicit.harvard.edu/implicit/selectatest.html; you do not have to register or log in, just click the link for “Project Implicit Social Attitudes.” Each test takes only a few minutes to do. Being aware of your own possible biases is one thing that can help create positive changes. Other ideas suggested by the speaker included activities that enhance empathy and programs to enhance communication skills. Having concrete objective indicators and outcomes can also reduce stereotyping. Studies have shown that institutions can see changes with even fairly short educational interventions.

Barbara Weissman is a psychiatrist practicing in San Mateo. She serves as a California Medical Association Board of Trustees member for the Specialty Delegation and a San Mateo County Medical Association member.

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San Mateo County Medical Association Distinguished Service Award Nominations Requested The Distinguished Service Award honors an individual who exemplifies the medical profession's highest values:    

commitment to service community involvement leadership dedication to patient care

(Achievements might include: promoting medicine and the betterment of the public health; demonstrating the values of the medical profession through leadership, service, excellence, integrity, and ethical behavior; enriching patients, colleagues, and the community through dedicated medical practice or service; or offering improved access to quality health care for an underserved patient population.)

Award will be presented at SMCMA's Annual Meeting of Members on Friday, June 16, 2017.

Submissions must include: 1) the name of the nominee; 2) SMCMA member submitting nomination; 3) a brief statement why the candidate should be considered for the Award. 

Submit nominations by 5:00 pm Friday, May 12, 2017 to SMCMA, DSA Award, 777 Mariners Island Blvd, #100; San Mateo, CA 94404; or Email: smalone@smcma.org A P R I L 2017 | S A N M AT E O C O U N T Y P H Y S I C I A N 1 3

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Request a no-obligation quote for med-mal coverage and membership.

You give your all to helping others live full, healthy lives. You go the extra mile to seek out answers and cures, knowing that sometimes even your best efforts aren’t enough. You’re a physician, and that’s how you do your job.

At CAP, we salute your dedication and support you in every way we can — with protection to reduce the worry of professional liability lawsuits, but also with a host of value-added services to help manage your practice so you can focus on the highest quality professional care. Ask for a no-obligation quote and more information on CAP membership.

For Your Protection. For Your Success.

800.356.5672 CAPphysicians.com/quote