2016-Mar/Apr - SSV Medicine by Sierra Sacramento Valley Medical Society

Sierra Sacramento Valley

MEDICINE Serving the counties of El Dorado, Sacramento and Yolo

March/April 2016

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We welcome articles from our readers by email, facsimile or mail to the Editorial Committee at the address below. Authors will be able to review articles before publication. Letters may be published in a future issue; send emails to e.LetterSSV Medicine@gmail. com or to the author.

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Medicine 2

Interested in Shaping Health Policy?

Annual Meeting

PRESIDENT’S MESSAGE The “Balance Billing” Crisis

2016 Education Series

Thomas W. Ormiston, MD

The Importance of Nurses

EDITOR’S MESSAGE The Nurse Factor

Glennah Trochet, MD

Classified Advertising

Nathan Hitzeman, MD

EXECUTIVE DIRECTOR’S MESSAGE Congratulations All Around

A Posit Addressing How Patients Address You

Aileen Wetzel, Executive Director

BOOK REVIEW The End of Power

John Loofbourow, MD

2016 SSVMS Committee Appointments

New School on the Block

Steven Nemcek, MS I

The New MCAT: An Improvement?

Alexandra Mullen, MS I, and John Paul Aboubechara, MS II, GSI

IN MEMORIAM Robert Brooks Harris, MD

Coroner’s Office – Striving for Forensic Excellence

Board Briefs

Bob LaPerriere, MD

Welcome New Members

BOOK REVIEW The Acute Abdomen in Rhyme

Jack Ostrich, MD

All articles are copyrighted for publication in this magazine and on the Society’s website. Contact the medical society for permission to reprint.

Visit Our Medical History Museum 5380 Elvas Ave. Sacramento Open free to the public 9 am–4 pm M–F, except holidays.

SSV Medicine is online at www.ssvms.org/Publications/SSVMedicine.aspx This lovely photo of the Tower Bridge was made by David Lee, DO, Resident Physician with Sutter Health. “I always try and shoot in a way that recreates the mood I experienced at the time of the photo. One of the nice things when shooting at night is the amount of time you have to play around with different compositions, focal lengths, apertures, and shutter speeds. Although the Tower Bridge is beautiful in its own right, I wanted to shoot from an angle below the bridge to make it look more majestic. On this particular night, the moon provided much of the ambient lighting you see in the sky, and the stillness of the water allowed for the light reflections to be seen.” The image was made last November at 18mm, F11, 30 seconds. – dlee3278@gmail.com

March/April 2016

Volume 67/Number 2 Official publication of the Sierra Sacramento Valley Medical Society 5380 Elvas Avenue Sacramento, CA 95819 916.452.2671 916.452.2690 fax info@ssvms.org

Sierra Sacramento Valley

MEDICINE The Mission of the Sierra Sacramento Valley Medical Society is to bring together physicians from all modes of practice to promote the art and science of quality medical care and to enhance the physical and mental health of our entire community. 2016 Officers & Board of Directors Thomas Ormiston, MD, President Ruenell Adams Jacobs, MD, President-Elect Jason Bynum, MD, Immediate Past President District 1 Seth Thomas, MD District 2 Vijay Khatri, MD Darin Latimore, MD Christian Serdahl, MD District 3 Thomas Valdez, MD District 4 Alexis Lieser, MD

District 5 Rajiv Misquitta, MD Paul Reynolds, MD Sadha Tivakaran, MD John Wiesenfarth, MD Eric Williams, MD District 6 Anne Neumann, DO

2016 CMA Delegation District 1 Reinhardt Hilzinger, MD District 2 Lydia Wytrzes, MD District 3 Katherine Gillogley, MD District 4 Russell Jacoby, MD District 5 Sean Deane, MD District 6 Marcia Gollober, MD At-Large Alicia Abels, MD Ruenell Adams Jacobs, MD José A. Arévalo, MD Barbara Arnold, MD Alan Ertle, MD Richard Gray, MD Karen Hopp, MD Richard Jones, MD Charles McDonnell, MD Janet O’Brien, MD Tom Ormiston, MD Senator Richard Pan, MD Anthony Russell, MD Kuldip Sandhu, MD James Sehr, MD

District 1 Anissa Slifer, MD District 2 Don Wreden, MD District 3 Thomas Valdez, MD District 4 Vacant District 5 Jason Bynum, MD District 6 Rajan Merchant, MD At-Large Natasha Bir, MD Helen Biren, MD Kevin Jones, DO Thomas Kaniff, MD Vijay Khatri, MD Sandra Mendez, MD Armine Sarchisian, MD Joseph Sison, MD John Tiedeken, MD Vacant Vacant Vacant Vacant Vacant Vacant

Interested in Shaping Health Policy? The Sierra Sacramento Valley Medical Society (SSVMS) has vacancies on its delegation to the California Medical Association (CMA) House of Delegates. The CMA House of Delegates convenes annually to debate and act on resolutions and reports dealing with a myriad of issues concerning medical practice, public health and CMA governance. Policies adopted by the House of Delegates are implemented by the CMA Board of Trustees either at the state level or referred for national action or legislation. Delegates and Alternate-Delegates are responsible for representing their colleagues in the House of Delegates by attending and actively participating in delegation caucus meetings and all sessions of the House of Delegates. SSVMS reimburses all of its delegation members for transportation and hotel accommodations. A daily meal allowance is also provided. Delegation members must stay for the entire meeting (Saturday-Sunday) in order to be eligible for reimbursement. In 2016, the House of Delegates will meet in Sacramento, October 15-16, 2016 at the Sacramento Convention Center. Interested in learning more? Contact: Chris Stincelli, Associate Director, (916) 452-2671 or cstincelli@ssvms.org.

CMA Trustees District XI Douglas Brosnan, MD

Margaret Parsons, MD

CMA President-Elect Ruth Haskins, MD

CMA Vice Speaker Lee Snook, MD

AMA Delegation Barbara Arnold, MD

Sierra Sacramento Valley Medicine, the official journal of the Sierra Sacramento Valley Medical Society, is a forum for discussion and debate of news, official policy and diverse opinions about professional practice issues and ideas, as well as information about members’ personal interests.

Richard Thorp, MD

Advertising rates and information sent upon request. Acceptance of advertising in Sierra Sacramento Valley Medicine in no way constitutes approval or endorsement by the Sierra Sacramento Valley Medical Society of products or services advertised. Sierra Sacramento Valley Medicine and the Sierra Sacramento Valley Medical Society reserve the right to reject any advertising.

Editorial Committee Nate Hitzeman, MD, Editor/Chair John Paul Aboubechara, MS III George Meyer, MD Sean Deane, MD Jillian Millsop, MD Adam Doughtery, MD Steven Nemcek, MS I Ann Gerhardt, MD John Ostrich, MD Caroline Giroux, MD Mary Pauly, MD Sandra Hand, MD Gerald Rogan, MD Albert Kahane, MD Robert LaPerriere, MD Glennah Trochet, MD John Loofbourow, MD Lee Welter, MD Executive Director Managing Editor Webmaster Graphic Design

Aileen Wetzel Nan Nichols Crussell Melissa Darling Planet Kelly

Opinions expressed by authors are their own, and not necessarily those of Sierra Sacramento Valley Medicine or the Sierra Sacramento Valley Medical Society. Sierra Sacramento Valley Medicine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. Not responsible for unsolicited manuscripts. ©2016 Sierra Sacramento Valley Medical Society Sierra Sacramento Valley Medicine (ISSN 0886 2826) is published bi-monthly by the Sierra Sacramento Valley Medical Society, 5380 Elvas Ave., Sacramento, CA 95819. Subscriptions are $26.00 per year. Periodicals postage paid at Sacramento, CA and additional mailing offices. Correspondence should be addressed to Sierra Sacramento Valley Medicine, 5380 Elvas Ave., Sacramento, CA 95819-2396. Telephone (916) 452-2671. Postmaster: Send address changes to Sierra Sacramento Valley Medicine, 5380 Elvas Ave., Sacramento, CA 95819-2396.

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President’s Message

The “Balance Billing” Crisis By Thomas W. Ormiston, MD I FIRST HEARD the term “balance billing” years ago at the House of Delegates. It seemed an obscure term then, but last fall it quietly became a crucial concern to all physicians. When a patient sees a physician who is not a participant in the patient’s insurance program, often in emergency situations, there can be a dispute over the amount of compensation owed to that physician. Most physicians feel they should be fairly compensated for their work. Many insurers, however, have a different idea of what constitutes fair compensation for physician services. Should the patients, who have already in their mind paid for health insurance, be responsible for the difference? Should the physician be able to bill the patient for the balance? Should the insurance company pay the nonparticipant physician, who, assuming extenuating circumstances, needed to participate? Medical care is nuanced and complex, and a “one-size-fits-all” solution often backfires. CMA has extensive policy on this issue, forged over years of debate in the House of Delegates. But the issue has remained in legal limbo…until the insurance industry tried to quietly sneak in their fix at the end of the special legislative session last year. Let me give an example that may have given the insurance industry the impetus to act. It also illustrates, I think, why CMA is the best group to guide the legislature to a fair resolution. Several years ago a patient, whose medical care was capitated to a medium-size Southern California medical group, presented to an emergency room in the midst of a myocardial infarction. The cardiologist on call, who was not contracted with the medical group, performed cardiac catheterization and stenting. The cardiologist billed the medical group

$20,000 for services rendered, about 10 times the customary physician fee. The group offered compensation at about 2.5 times the amount Medicare would have paid for the same service. The cardiologist insisted on the full billed amount. The medical group took the case to court, a tremendously-expensive process. The court decided that the medical group should pay the entire billed amount to the non-contracted cardiologist. Most people would consider this type of price gouging unfair. And humans detest unfairness. The insurance industry can use this type of case to galvanize support for a legislative remedy, which they did. But most people also do not realize that this kind of practice is the exception rather than the rule, and certain circumstances may arise where noncontracted physicians need to get involved. Going into the last week of the legislative session, AB 533 (Bonta) would have drastically changed the current health care marketplace by allowing a massive transfer of negotiating power to the health plans at the expense of physicians. The bill would have required non-contracted physicians to accept Medicare rates as payment in full when performing services in a contracted or “in-network” facility. In addition, the bill would have implemented barriers for PPO patients seeking to access their out-of-network benefits. Overnight, the bill became, essentially, a health plan-sponsored bill, with the strong support of consumer groups and organized labor. With myriad resources, the health plans spent tens of thousands of dollars hiring contract lobbying firms to lobby in favor of AB 533. The California Federation of Labor, the California Firefighters and most of organized labor, who were misinformed

March/April 2016

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

about the full intentions of the bill, also lent their political muscle to the passage of the bill, for they believed it would protect patients from exorbitant, unexpected charges. Finally, the California Chamber of Commerce and consumer groups, led by Health Access, also spent their political resources in favor of the bill. In order to defeat AB 533, it was “all hands on deck” at SSVMS and CMA, as we called upon our Legislative Key Contacts, members of the Board of Directors and other interested physicians to call their legislators on the last night of session to ask them to vote “No” on AB 533. The bill was stopped, literally, a minute before the legislative session was called to a close. In my mind, the passage of AB 533 would have been a disaster for all physicians and medical groups. With the industry limited to Medicare rates at a maximum, there would be no reason for any of them to contract with physicians or medical groups for anything

more than Medicare rates. Few physicians could survive on Medicare alone, much less below Medicare compensation. Physician voices were influential in stopping AB 533 from passing the Assembly Floor this legislative session, but the bill has not yet been defeated as it was granted reconsideration. This legislative session, CMA will proactively continue to oppose this poorly-drafted bill and is introducing a solution that is fair for patients and physicians. We appreciate your support, and invite you to participate to promote a thoughtful solution to the problem where one size doesn’t fit all. CMA represents both physicians, who provide medical care, as well as physicians in groups who are delegated by the insurance industry to manage medical care, and to compensate those physicians. I believe that CMA policy on the issue, which essentially states that physicians should be fairly compensated for their work, will be able to guide the legislature to an equitable solution. And, I also believe that dangerous outsider proposals like AB 533 make this the time for CMA to propose legislation that will resolve the issue fairly for all physicians. The time will come this year when SSVMS and CMA call upon our members to contact our legislators, urging them to support a reasonable resolution that recognizes the importance of fair physician compensation that assures medical services will continue to be available to our patients. Our legislators listen when we, as individual physicians and constituents, advise them on matters of appropriate patient care. tom.ormistonmd@dignityhealth.org

Sierra Sacramento Valley Medicine

Editor’s Message

The Nurse Factor By Nathan Hitzeman, MD WE’VE HAD A FEW ARTICLES on nurses in our magazine. Dr. John Loofbourow highlighted the good work of Nurse Florence Nightingale a year or so ago, and in this issue, Dr. Glennah Trochet honors an exemplary County nurse with whom she worked, who recently passed. I think all of us can remember key interactions with nurses during our formative years, most of them humbling ones. In an era when medical care is becoming a “team approach,” it sometimes seems everyone and no one is responsible for the patient. In one of his essays, Dr. Atul Gawande actually counted the number of caregivers who came into his family member’s room during her stay for an orthopedic surgery. He tallied off more than 60. No wonder patients give us that blank stare! Still, the nurse is the one who knows what’s going on with the patient. Will he/she ever be supplanted by the EHR or robots? I seriously doubt it. Recently, I was reminded of this yet again, when I rounded with the residents on a woman admitted for pneumonia vs. COPD exacerbation vs. heart failure. It was a judgment call, and we erred on the side of maintenance fluids. The next morning, the nurse wondered if we should reconsider and start a diuretic instead. The resident wanted to get a chest X-ray first. I said fine. The patient was transferred to ICU an hour later and found to be in flash pulmonary edema. The nurse’s intuition is usually right, and we should have listened! I sometimes joke with my colleagues about how I haven’t had my 15-minute break or if they could watch my patients for me while I take my lunch. Nurses have the buddy system perfected and also, mandated breaks can be a union thing. We docs must have missed the bus on that one. Still, nurses are far from pampered,

and after talking with friends and acquaintances who are nurses, I know their work is intense and exhausting. They interface with the patient and family. They touch, clean, and maintain body areas that may not have seen the light of day, or instruments of hygiene, for years. They are the ones dealing with patients not always in their right mind. They handle the concerned, distraught, nosy, noisy, loving, obnoxious, demanding, or otherwise poorly coping family member. They are consummate judges of motive and what is going on in the medical soap opera. I see a number of patients who happen to be nurses. At the end of the visit, I try to take the time to thank them for what they do. I see a lot of young and middle-age nurses with bad backs. Patients aren’t getting any lighter. Most hospitals have tried to help with “lift teams” and nursing assistants, but nurses still take the brunt of it. Three years ago, my father was recovering from cardiac surgery at Kaiser S.F., and he complained that the last thing in the world he wanted to do was get up out of bed. My mom and I couldn’t persuade him. The doctor couldn’t. Then the nurse came into the room with the walker and said, “Ok, if you want to live, you have to get out of that bed … now!” She said it not harshly, but with a tone that meant negotiation was not an option. My dad paused for a second, almost as if preparing some kind of rebuttal, but thought twice, and stood up and walked what would be the world’s slowest victory lap around the CICU. I knew at that point that he would be ok. Thanks to a great nurse. hitzemn@sutterhealth.org

March/April 2016

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

Executive Director’s Message

Congratulations All Around By Aileen Wetzel, Executive Director The Sierra Sacramento Valley Medical Society (SSVMS) proudly congratulates the following members: Ruth Haskins, MD 2016 CMA President-Elect

and as chair of the CMA Council on Legislation from 2010 to 2013. She has been a Delegate representing the voice of the American College of Obstetricians and Gynecologists in the House of Delegates for over 20 years. Barbara Arnold, MD Compassionate Service Award Recipient

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

At the California Medical Association’s (CMA) annual House of Delegates meeting in October, Ruth Haskins, MD, was elected to the office of President-Elect. Dr. Haskins will serve in this capacity for one year, and at the conclusion of the 2016 CMA House of Delegates in October, she will be installed as President. Dr. Haskins becomes the third female physician to join the ranks as President-Elect and President of CMA since the organization was established in 1856. Specializing in Obstetrics and Gynecology, Dr. Haskins has been in practice in the Sacramento area since leaving military service in 1993. She is currently in solo practice in Folsom, California. She has been a member of the California Medical Association and the Sierra Sacramento Valley Medical Society for 23 years, serving as CMA Trustee from 2013 to 2015

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Dr. Barbara Arnold was awarded CMA’s first Compassionate Service Award at the House of Delegates meeting. The award honors the California physician who best illustrates the association’s commitment to community and charity care. In addition to her Ophthalmology practice in Sacramento, Dr. Arnold is a gifted artist who teaches art classes for visually impaired and legally blind individuals through the Crocker Art Museum. Since the program’s inception in 2012, her efforts have helped visually-impaired individuals develop creative and meaningful hobbies. There is a waiting list for Dr. Arnold’s classes, and many of her students come from out of the Sacramento area, some traveling with their guide dogs via Amtrak, to take her classes.

Dr. Arnold has been teaching Ophthalmology to residents at the University of California, Davis, for more than 20 years where she is an Emeritus Chair in the UC Davis Department of Ophthalmology. She serves as a Delegate to the CMA House of Delegates and is an AlternateDelegate to the American Medical Association House of Delegates.

Margaret Parsons, MD Elected CMA Trustee

The Honorable Senator Richard J. D. Pan, MD Special Recognition Award

At the SSVMS and Alliance Annual Installation and Awards event, held on January 21, 2016, Senator Richard Pan, MD, was presented a Special Recognition Award and received a standing ovation for his outstanding contributions to public health with the introduction and passage of SB 277, the vaccination bill. In early 2015, Senator Pan authored SB 277, ensuring that all children can safely attend school. The law abolishes the personal belief exemption to legally-required vaccines for school attendance in California that contributed to the spread of life-threatening, preventable contagions. Faced with considerable hostility from opponents of the bill, including threats against his life, Senator Pan persevered. On June 30, 2015, Governor Jerry Brown signed the bill into law, which becomes effective July 1, 2016.

Also at the CMA House of Delegates meeting, SSVMS Past President, Margaret Parsons, MD, was elected to the CMA Board of Trustees. She represents our Medical Society as well as seven other county medical societies north of Sacramento that comprise the 11th District Delegation to the CMA. A Dermatologist in a small group practice in Sacramento since 1996, Dr. Parsons has extensive experience with CMA through her leadership in the California Academy of Dermatology and the American Academy of Dermatology. She has served on the CMA Council on Legislation, and as a Delegate to the CMA House of Delegates and the AMA Young Physicians Section. Dr. Parsons looks forward to being a strong voice for the physicians in our region at the CMA Board of Trustees. awetzel@ssvms.org

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March/April 2016

New School on the Block An Insider’s Look at California Northstate University College of Medicine

By Steven Nemcek, MS I

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

I WALKED INTO CLASSROOM 1B to the sound of roaring applause, with a line of beaming faces on either side of me, and it was at that moment I knew I had been given the opportunity to be a part of something extraordinarily special. This was my first day of orientation at California Northstate University College of Medicine (CNUCOM), as a member of its first class of 60 students; and I saw upon the faces of faculty and administrators a sense of fulfillment and pride. Finally, their project, which had been years in the making, had come to fruition, and our class, standing before them in flesh and blood, represented the school’s future. Before deciding to attend this brand new school, I admittedly had hesitations and doubts. But I also saw that the opportunity to be a part of an inaugural class only presents itself once in a lifetime. I knew that our class would be able to shape the future of a medical institution in a profound way, and that the school’s modernity and private status would allow for experimentation and innovation. I earned my MS degree in physiology last year at the University of Cincinnati College of Medicine, so I already had been given a taste of what medical school is supposed to be. So far at CNUCOM, I have experienced a curriculum that has been developed from the ground up in a thoughtful and unique approach. The LCME (Liaison Committee on Medical Education) had deemed the curriculum design to be one of the school’s strengths; from the beginning, we would be learning our basic sciences in a clinically-relevant manner through focusing on clinical case presentations. It was a fundamentally new approach, and it makes

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sense. The theory behind the science should be directly connected to the realities of everyday practice. This takes conceptual learning into the realm of experiential learning. It also helps that these experiences are happening in state-of-the-art facilities. The anatomy lab tables gleam with silver, and the space is complete with electronic displays to supplement typical dissections. There are a variety of rooms staged as doctor’s offices and rigged with recording software. Here, students engage with standardized patients each week to learn elements of the physical exam, how to procure an appropriate patient history (full or focused, depending on the scenario), and how to have good bedside manner. Just this past week, we combined the standard back exam with the neurologic leg exam to diagnose patients with sciatica. Perhaps the most standardized patients are the expensive training manikins that we use to run full team-based patient care scenarios. The classrooms include lecture recording software and expansive workspaces for students, which is a refreshing alternative to traditional tight desks in lecture halls. It seems every aspect of the school’s facilities was designed with student learning in mind. I am glad to be in good company. My classmates are compassionate and smart individuals who have a strong desire to make the school the best it can be. Furthermore, being a part of an inaugural medical school class has allowed us to build student organizations from scratch. We formed our own AMA chapter with the kind assistance of a member at the UC Davis School of Medicine, and were graciously welcomed into the SSVMS family. We formed

student interest groups in surgery, internal medicine, emergency medicine, pediatrics, and neurology. We formed an organization that focuses on aiding underserved populations. We formed a medical Spanish interest group, a book club, and even a musician’s club. We formed our own student government whose goal is to interface with administration and the student body to facilitate curricular feedback. As Academic Co-President, I have experienced firsthand how receptive faculty have been to student feedback. While the program has a solid, well-developed foundation, there have been minor changes here and there to make things even better for future classes. Our school has a focus on community. It was designed to address the shortage of physicians in Northern California, and the student body has a strong desire to give back to the city of Elk Grove and the greater Sacramento area. At our white coat ceremony, over 10 community physicians presented to our class of proud students, and State Senator Richard Pan, MD, gave an inspirational keynote address. A few weeks after this ceremony, our school had a gala to celebrate our new class and the physicians, donors and investors who made this endeavor a reality. We are developing our community service program. We’ve already attended a variety of community health events, including “Celebrando Nuestro Salúd” and a Thanksgiving community event in which we provided basic blood pressure screening services. We hope to visit the California Health Care Facility to provide services for local prisons in upcoming months, and we’re always looking for new ways to give back. If you see us out and about, don’t be afraid to introduce yourselves. We’d love to meet you! California Northstate University College of Medicine is a bold project that has taken a unique approach to providing medical education to its students. As our Dean, Dr. Joseph Silva, said, the good part of being a new, private school is that we get the chance to do things right, to innovate when necessary, and to develop something unique and different to

address the new challenges the field of medicine will face in the coming years. I am honored to be learning among such a wonderful group of students and faculty. I eagerly look forward to everything the future holds.

The CNUCOM inauguration included a White Coat Ceremony for new students.

stevennemcek@gmail.com

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March/April 2016

The New MCAT: An Improvement? By Alexandra Mullen, MS I, and John Paul Aboubechara, MS II, GSI

Comments or letters, which may be published in a future issue, should be sent to the authorâ&#x20AC;&#x2122;s email or to e.LetterSSV Medicine@gmail. com.

MOST OF US REGARD the Medical College Admissions Test (MCAT) as that burdensome and frustrating hurdle we had to traverse to become doctors. Could it be that it really serves a crucial role in ensuring that future physicians are prepared for an increasingly complex medical world? Historically, the focus of medical education has been on teaching the pathophysiology of disease, with the expectation that other interpersonal attributes would develop during training. Some might argue that the latter has been hit or miss. The past several decades have realized a shift in medicine; behavioral and social factors, especially, have been shown to profoundly affect patient health. Accordingly, modern physicians need proficiency in social skills, social awareness, and addressing the root causes of their patientsâ&#x20AC;&#x2122; maladies. Enter the New MCAT. Will the emphasis on improving social knowledge truly translate to improving the lifestyles of our patients? It is tough to say. How do you get your patient to quit smoking, change their diet, or implement an exercise routine? How do you get a working wife and mother to spend more time taking care of herself? Lifestyle modification can be an extremely daunting task in the eyes of the patient. There are few magic words or pills that can inspire patients to change their daily habits. If we really want to be able to help our patients, we need to understand human behavior and psychology. Medical schools have begun incorporating the behavioral and social sciences into their curricula. However, medical students arrive with varied preparation. Behavioral and social sciences have evolved into sophisticated fields

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with complex methods and theories. Therefore, medical students are unlikely to be able to comprehend advanced research studies without adequate background. Just as all medical students are expected to have learned the fundamentals of molecular biology in college, so too must they be expected to have learned those of psychology. Last year, the American Association of Medical Colleges (AAMC) updated the MCAT to include these subjects. This marked the first major revision to the exam since 1991. It is hoped that the updated exam will not only identify students who have attained sufficient knowledge in these topics, but also will encourage universities to update their pre-medical coursework. The new MCAT features several major changes. To the collective joy of many, the test nearly doubled in length. Students now face 230 questions over a grueling 6 hours and 15 minutes, versus 144 questions in 3 hours 20 minutes. These questions are divided up into four sections: biology and biochemistry, chemistry and physics, critical analysis and reasoning skills, and social and behavioral sciences. Note that the social and behavioral sciences were not just incorporated into other sections, but received their own section. These changes to the MCAT have received broad support as well as criticism. Pre-medical students will be expected to take several additional courses to prepare for the increased emphasis on biochemistry, genetics, psychology, and sociology. Critics claim that it will be tough for students to cram this additional work into their four years of college. Others

consider the execution of the changes to be poor. Whereas the intent of adding behavioral and social sciences is noble, in practice, some students found themselves merely needing to memorize more terms, definitions, and names of scientists. Will the new MCAT make better doctors? Time will tell. Meanwhile, medical schools will need to make sure that they evaluate applicants holistically. As students, we are optimistic about these changes, and hope that this will facilitate the training of physicians who are sensitive to, and proficient in addressing, the social and behavioral needs of those they treat. We are glad, however, not to have had to take a 6-hour MCAT! jjaboube@gmail.com Alexandramullen3@gmail.com

Sample pages of questions from the MCAT test.

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March/April 2016

Coroner’s Office − Striving for Forensic Excellence By Bob LaPerriere, MD

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

FOR THOSE WHO REMEMBER the TV series, Quincy, ME, you are probably familiar with the role of medical examiner. Autopsy, Body of Proof, Crossing Jordan, Da Vinci’s Inquest, Dr. G: Medical Examiner, Hawaii Five-0, NCIS, Psych, and Rizzoli and Isles are other shows that feature medical examiners or coroners. But how does the medical examiner, where the coroner is an MD, usually a pathologist, relate to the coroner system? Fewer than 10 percent of California counties have medical examiners, whereas 80 percent of California counties have the sheriff coroner system – a model where the two roles are combined. In at least one Northern California county, the coroner is under the district attorney. The remaining 10 percent of counties utilize the same autonomous model as Sacramento, where the coroner is a separate office. This helps to ensure an independent death investigation, perhaps less influenced by other segments of the criminal justice system. In fact, Sacramento is, at times, called upon to do autopsies for other counties. The Sacramento County Coroner’s Office was the first coroner’s model in California to be certified by the National Association of Medical Examiners. The mission of the Sacramento County Coroner’s Office is to serve and protect the interest of the Sacramento community by determining the circumstances, manner and cause of sudden or unexplained deaths in the county. Decedents and their families are treated with the utmost dignity and respect. A coroner’s case is any sudden or unexplained death, or by default, a death where the attending physician refuses to sign the death

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certificate, even in an evident cause of natural death. Certain modes of death are coroner’s cases by government code, including suicides, homicides, motor vehicle accidents and “in custody” deaths. There are 21 specific types of death which require immediate reporting to the coroner’s office. A pending death certificate can be provided if the relatives wish to bury their kin promptly, as the final death certificate could take four months to be completed. In Sacramento, the coroner is appointed by the local board of supervisors. The coroner’s staff consists of two supervising deputy coroners, 10 full-time and two part-time deputy coroners, and five administrative and office personnel, all of whom are county employees. Pathology services consist of four forensic pathologists. Pathology support and morgue staff consist of approximately 10 to 12 additional personnel. There are about 26 deaths daily in Sacramento County, over half of which are called in to the coroner’s office, and fewer than half of these become coroner’s cases (about six per day). Each indigent cremation case is researched to determine whether the decedent is a veteran and, if so, internment will be at the Dixon National Cemetery. Forensic science is a continuum that starts with the death scene. The role of the coroner also includes notification of the decedent’s next of kin and the arrangement for the disposition of the remains of the deceased. Components of the coroner’s responsibility include: 1) Death Investigation: Deputy coroners are sworn peace officers; they carry a badge and a gun. The coroner does not “declare” or “pronounce” a person dead; this is the

responsibility of a paramedic or physician. 2) At the investigation of a homicide or suspicious death, the coroner focuses on the manner of and cause of the death, whereas the detectives gather evidence for the prosecution. Manner of death falls under one of several standard categories: accident (i.e. motor vehicle accident), homicide, suicide, natural, and undetermined. In some regions, an additional cause is included: “Death by Cop.” 3) Clinical and forensic pathology: This includes a review of medical records, an external exam of the body, and if indicated, an autopsy. The coroner recommends the extent of the exam. A medical record review and external examination following the heart attack of an elderly person might be adequate, whereas an autopsy, toxicology studies, chemistry panel and neuropathology consult might be indicated in a suspected homicide case. 4) Legal: The case documentation and potential court presentation. The office of the coroner has come a long way since the 1800s, when the coroner might gather several passersby to form a coroner’s jury, pronounce a “floater” as having died at his own hands or the hands of others, and then put the floater back into the river for the Yolo County Coroner to investigate. He would also gather his fees for doing such. The current coroner’s facility, which opened in 1996, is adjacent to the Sacramento District Attorney’s Laboratory of Forensic Services. It is large enough to be a regional facility in a major disaster. The morgue has a large refrigerated area and a smaller freezer with a total capacity of 200 bodies. This space is shared with the Donated Body’s Program. Also, due to ample space, the coroner contracts with UC Davis for morgue and pathology services. There are six standard autopsy stations, a contagious autopsy room with negative air flow, and a homicide autopsy room with a glassed-in viewing area for law enforcement officers to observe. In addition,

there are two refrigerated trucks with the capacity to hold 15 and 100 bodies respectively, and a mobile office trailer. The Sacramento County Coroner’s Office is happy to arrange tours for physician groups, and also to speak at hospital/medical meetings. Their phone number is (916) 874-9320 and they are located at 4800 Broadway. Kim Gin is the Coroner.

The office of the Sacramento County Coroner has come a long way since the 1800s.

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March/April 2016

Book Review

The Acute Abdomen in Rhyme By Zeta (Author), Peter Collingwood (Illustrator); Publisher H. K. Lewis & Co.; First Edition (1947); ASIN: B003WZSNJ0

Reviewed By Jack Ostrich, MD

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

A FEW WEEKS AGO, Dr. Bob LaPerriere handed me a diminutive, hardbound book and suggested that it might be worthy of a review in this magazine. Bob is the stalwart chairman of our Historical Committee and the guiding light of the SSVMS Museum of Medical History. He had found the little book tucked among its much larger literary neighbors on a shelf in his office. The cover is fire engine red and measures 5 by 7 inches. It contains 88 pages. The title is emblazoned on the cover in gold capital letters: THE ACUTE ABDOMEN IN RHYME. Under the title, highlighted by a black background, still in gold capital letters, are the words: BY ZETA. The year of publication was 1947. The author “Zeta” was Zachary Cope (Sir Vincent Zachary Cope, Kt, BA, MD, MS, FRCS) whose textbook, Early Diagnosis of the Acute Abdomen, first published in 1921, is still in print, last revised as the 22nd edition in 2010 by Harvard surgeon Dr. William Silen. The slim volume that Bob had given me is likely the most unusual medical textbook ever produced. Cope meant it as an eccentric complement to his famous textbook, a unique mnemonic device that might help students and house staff to think more creatively and critically about the various abdominal pain complaints that they would surely encounter in their years of training. It is written entirely in doggerel. According to Cope’s contemporaries, he greatly enjoyed

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composing doggerel. In 1944, on the occasion of Alexander Fleming’s knighthood, Cope wrote a small poem in honor of Fleming and Joseph Lister (1827-1912). The ceremony was at St. Mary’s Hospital in London’s Paddington District. Fleming had done most of his work at St. Mary’s, where there is now a small museum in his honor; and Cope had been on the staff at St. Mary’s since 1930, having graduated from its medical school in 1905. St. Mary’s, by the way, has been in the news quite a bit in the last few decades. Prince William and Prince Harry, sons of Prince Charles and Princess Diana, were born there in 1982 and 1984 respectively. Then, Prince William’s and Kate Middleton’s son, George, was delivered there in 2013, and their daughter, Charlotte, in 2015. At the time of Charlotte’s birth, the 20-bed Zachary Cope Surgical Ward at St. Mary’s was closed, due to an outbreak of carbapenemresistant enterobacteria. Other, less noble, births at St. Mary’s include Elvis Costello in 1954 and Kiefer Sutherland in 1966. Diamorphine, given the trade name Heroin in 1898 by Bayer Pharmaceuticals, was first synthesized in 1874 by a St. Mary’s Medical School chemistry teacher, named Charles Romley Alder Wright, who was searching for an effective narcotic without the unpleasant side effects of morphine. So it was that Cope’s doggerel ode to Lister and Fleming was written three years before his little red book was published. It goes thus:

The septic microbes, not so long ago Were to the surgeon the most bitter foe; They got into the wound, which, thus inflamed Oft killed the patient or might leave him maimed. ‘Twas Lister first showed us the simple way To keep the microbes out, and thus to stay The dreaded sepsis of but yesterday. Yet there remained a battle still to win; How to destroy the germs that had got in ‘Twas Fleming showed the way that gap to fill in By finding that great wonder - penicillin Which kills the germs, and has this extra charm It scarcely ever does the patient harm Thank God for what these two men achieved For all the sick that they have from death reprieved Or of their ailments painlessly relieved. Cope was clearly no Wordsworth, or even Ogden Nash, but he did not limit himself to versifying. He wrote 13 books and served as editor for many compilations, including a 1,300-page digest of British medical and surgical case reports from World War II. Most of his works focused on medical history, but also included two biographical books about Florence Nightingale, and one about Sir John Tomes (1815-1895), a British pioneer in dental surgery and restoration. He last edited and revised his own textbook (14th edition) in 1971, at age 90. As “Zeta,” however, he gave us The Acute Abdomen in Rhyme. He starts with a few lines that even today reflect the concern of many in clinical medicine: The Diagnostic problem of today Has greatly changed − the change has come to stay; We all have to confess, though with a sigh On laboratory tests we much rely And use too little hand and ear and eye. Then a few lines later − the capital letters are Cope’s: Examine from the head and toes

Before you dare to diagnose. MORE HARM IS DONE BECAUSE YOU DO NOT LOOK THAN FROM NOT KNOWING WHAT IS IN THE BOOK. On page 32, a house officer is summoned to see a man who earlier had been seen by his GP. The man had suffered acute severe upper abdominal pain. The GP gave him a shot of morphine and sent him to the emergency ward having first written a summary of his findings and diagnostic thoughts − probable perforating peptic ulcer. Now the patient is in the ED, very sleepy and in no distress at all under the influence of the morphine. And Cope writes: The morphia has given relief to pain And he begins to feel himself again... The house-surgeon, a callow cocky youth Who from his books has learned much doubtful truth Is summoned by the nurse to see the case And soon walks down the ward with stately pace; As he comes near the bed where the patient lies Unconscious and with sleepily closed eyes, He looks astonished and says, “Gracious me! Is this the case that I was asked to see? Where is the note that came from the GP? Well, well, he says there is a perforation, A clever piece indeed of divination!”

Sir Vincent Zachary Cope, or “Zeta”

Luckily, the house officer calls “the Chief” to review the case, and “the Chief” immediately recognizes the gravity of the case, comes to the emergency ward, and his orders for prompt surgery saves the day, but not face, for the “callow cocky” young surgeon. In 88 pages, Cope entertainingly describes the symptoms, signs and basic treatment for nine conditions: perforated ulcer, acute pancreatitis,

March/April 2016

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appendicitis, cholecystitis, intestinal obstruction, “colics,” ectopic pregnancy, peritonitis and abdominal injuries. The copy in the SSVMS Museum of Medical History is in very good condition and once belonged to Dr. Sheldon Swift, who was a colleague of Dr. Bob LaPerriere’s in Dermatology at Kaiser. It is a rare book and valuable, so if you would like to see and read it, please call the Medical Museum at 916-456-3152 to make an appointment in order to spend some pleasant time with Mr. Cope and his alter ego, “Zeta.” NOTE: As you may have noticed, Cope is called “Mr.,” not “Dr.” in the last paragraph. Surgeons in Britain have been called “Mister,” “Miss” or “Missus” for many centuries. They were originally labeled as “barber surgeons” or “apothecary surgeons” and were not eligible for a doctorate degree. When, in the early 19th century, the College of Surgeons received its royal charter, the already long-established Royal College of Physicians insisted that the surgeons have accredited MD training, and the surgeons have done so ever since. They chose, however, to retain their ancient appellation as a matter of historical pride. jmost119@aol.com

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Annual Meeting

Annual Meeting THE 2016 SIERRA SACRAMENTO Valley Medical Society and Alliance Annual Awards and Installation Dinner was held January 21, 2016 at the Hyatt Regency Hotel in Sacramento with over 200 guests in attendance. Thomas Ormiston, MD, Family Practitioner with the Woodland Clinic Medical Group, was installed as the 142nd President of SSVMS. Also installed were the following SSVMS 2016 Officers and Board of Directors: Ruenell Adams Jacobs, MD, President-Elect; Chris Serdahl, MD, Secretary; Rajiv Misquitta, MD, Treasurer; Jason Bynum, MD, Immediate Past President; and Directors, Vijay Khatri, MD; Darin Latimore, MD; Alexis Lieser, MD; Anne Neumann, DO; Paul Reynolds, MD; Seth Thomas, MD; Sadha Tivakaran, MD; Thomas Valdez, MD; John Wiesenfarth, MD; Eric Williams, MD. The Societyâ&#x20AC;&#x2122;s highest honor, the Golden Stethoscope Award, was presented to Robert Kahle, MD, a neonatologist at Mercy San Juan Hospital. Dr. Kahle received the award for his devotion to patient care and the medical needs of the community. The Medical Honor Award was presented to George W. Meyer, MD, in recognition of his outstanding volunteer contributions to the health of the people in our community and throughout the world. A Special Recognition Award was presented to The Honorable Senator Richard J. D. Pan, MD, for his outstanding contributions to public health with the introduction and passage of SB 277, the vaccination bill. The Alliance presented its highest honor, the Dorothy Dozier Helping Hands Award, to Ingrid Niles for devoting her time, energy and talents to the Alliance and community. Guests at the event were entertained with traditional jazz music by Cyrâ&#x20AC;&#x2122;s Combo, a group of young musicians from the Sacramento area who play regularly throughout California.

L-R Dr. Tom Ormiston, Incoming President and Dr. Jason Bynum, Outgoing President

March/April 2016

Annual Meeting

Sierra Sacramento Valley Medical Society and Alliance Annual Dinner January 21, 2016 Hyatt Regency Hotel 3 Photos by David Flatter (flickr.com/davidflatter)

1 Alliance Members L-R Celeste Chin, Past President; Mary Sterner-Sosa, MD, President-Elect; Kim Majetich, President

2 Dr. Robert Kahle (middle) recipient of the Golden Stethoscope Award, with his spouse, Janet (left) and colleagues

3 L-R Dr. Tom Ormiston, President with Dr. George Meyer, Medical Honor Recipient 4 Medical Students from CA Northstate University College of Medicine and UC Davis School of Medicine 5 UC Davis Recipients of SSVMS Medical Student Scholarships with the Chair of Scholarship Committee; L-R Kim Le, MS III; Dr. Margaret Parsons (chair); Kristiana Lehn, MS II; Olivia Nguyen, MS IV

Sierra Sacramento Valley Medicine

Annual Meeting

6 L-R Ingrid Niles, Alliance Helping Hands Award Recipient and Sita Lachandani 7 SSVMS Board of Directors present at the event include L-R Drs. Jason Bynum, Immediate Past President; Tom Ormiston, President; Sadha Tivakaran; Paul Reynolds; Ruenell Adams Jacobs, President-Elect; Thomas Valdez; Rajiv Misquita, Treasurer; Darin Latimore and Eric Williams 8 L-R Dr. Tom Ormiston and Senator Richard Pan, MD, recipient of the Special Recognition Award 9 Dr. and Mrs. Thomas Ormiston

March/April 2016

to our sponsors who have helped make our event possible.

All webinars are free for SSVMS/CMA members and their staff. Nonmember price is $99. For more information or to register, visit www.cmanet.org/events or call CMA’s Member Help Center at (800) 786‐4262.

March 9: Closing a Medical Practice 12:15 – 1:15 p.m. This webinar will cover some of the major practical and legal issues that may arise when closing a medical practice, and will assist physicians who are retiring or otherwise leaving their practice. March 10 – 11: Stepping Up to Leadership Conference The Institute for Medical Quality (IMQ) and the PACE Program at UC San Diego are proud to announce an unparalleled opportunity for medical staff leaders in issues of communication, problem‐solving, and improving outcomes for patients and staff. For more information call (415) 882‐5151. March 23: CMA Legislative Advocacy Day Webinar Training 7:00 p.m. – 8:00 p.m. CMA will host its 42nd annual Legislation Advocacy Day on Wednesday, April 13, at the Sheraton Grand in Sacramento. Attendees will also go to the Capitol to meet with legislators on health care issues. More than 400 physicians, medical students and CMA Alliance members will be coming to Sacramento to act as champions for medicine and their patients by lobbying their legislative leaders. Join CMA for a webinar to review in detail CMA’s list of bills to be lobbied and effective advocacy tips. The webinar is available to CMA members only. April 6: MACRA Implementation: A Review of the CMS Proposed Rule 12:15 – 1:15 p.m. This webinar will review the details of the proposed rule around the Merit‐Based Incentive Payment System (MIPS) Implementation. It will also review any new details available regarding Alternative Payment Models (APM) and next steps.

April 13: CMA Legislative Advocacy Day, The California Medical Association will host its 42nd Annual Advocacy Day at the Sheraton Grand in Sacramento. Attendees will have the opportunity to go to the Capitol throughout the day to meet with legislators on health care issues. To participate, please contact Chris Stincelli at SSVMS at (916) 456‐2018 or cstincelli@ssvms.org. April 20: How to Reduce Overhead Expenses and Increase Profitability 12:15 – 1:15 p.m. There are three ways to realize increased net income: raise fees, increase productivity or decrease overhead. With managed care contracting difficulty, increased fees are difficult to achieve. The doctor/group may already be working at maximum capacity so this may not be an option. One way to assure profitability is to control and reduce overhead expenses. This webinar will provide information on how to do just that in a way that works for your practice.

May 13 ‐ 15: Western Healthcare Leadership Academy, Save the date for the 2016 Western Healthcare Leadership Academy to be held at the Hilton San Francisco Union Square. More details are available at www.westernleadershipacademy.com

Physician members of Sierra Sacramento Valley Medical Society and the California Medical Association may register for webinars at no cost. Call CMA’s Member Help Center at (800) 786‐4262 to register or for more information.

The Importance of Nurses By Glennah Trochet, MD

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

MY FRIEND AND COLLEAGUE, Reiko Osaki, died in November of last year. Her death was unexpected and mourned by all who knew her. She was born in Tule Lake Internment Camp during World War II, married and raised two wonderful children, and she was a public health nurse for more than 40 years. I had the good fortune to work with Reiko as she was the Nurse Manager of the county clinics when I was the Medical Director from 1993 to 1999. At the time, there was a network of nine clinics, including a dental clinic, which provided primary care for medically-indigent adults and public health services such as immunizations, TB control, and STD diagnosis and treatment. Working so closely with her, I saw how Reiko cared for our staff and our patients. She had worked in many areas of public health, having been a nurse in Chest Clinic, caring for patients with active TB disease, and also developing wellchild clinics and primary care clinics. When I asked orthopedic surgeons in our community to come to the county clinics to treat our patients and to teach our physicians orthopedic office procedures, Reiko made it work by hiring a casting technician and assigning staff to work with the volunteers. These volunteers were later enrolled in the SPIRIT project which was created with a grant from the Robert Wood Johnson Foundation under the auspices of SSVMS. As the number of SPIRIT volunteers increased, Reiko found a place where they could see patients and provide medical treatments not covered by the County Medically-Indigent Services Program (CMISP). One patient had a very large sebaceous cyst on his cheek that distorted his face. It was too large for any of the family doctors to attempt removal, and because removal was not “medically necessary,” the CMISP program would not pay for treatment at

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a specialist’s office. The SPIRIT volunteer plastic surgeon, removed the cyst as an outpatient procedure at one of the county clinics, leaving a barely-noticeable scar. Three months later, a delighted patient came to the clinic to let the staff know that he now had a job, something he had been unable to get when his face was marred by the cyst. It was this kind of outcome that Reiko reported regularly and that she used to enlist the help of community members to advocate for our services when the ever-present budget cuts were being considered. Another program that would not have succeeded without Reiko’s support was a diabetes education program for county clinic patients that was taught by county pharmacists and nurses. A preliminary study one year after the program started showed a significant improvement in hemoglobin A1c levels in our patients with diabetes, compared to levels before the educational program began. Together we started a monthly clinic staff training program to ensure that the quality of the services given was continually improving. We held monthly meetings where there was an educational program followed by committee meetings for medical care and nursing. Around the holidays, we would hold an all-staff party during the latter portion of the training period. One year, Reiko decided to give a small gift to every staff member who worked in the clinics. With her own money, she purchased these gifts and found something that fit the unique interests of each person. To someone who won’t even participate in Secret Santa schemes because I can’t figure out what to buy, it was amazing how Reiko managed to do this giftgiving effortlessly. As I think about the kindness exhibited by Reiko, I realize this is an attribute that I most

commonly see in people (mostly women, in my experience) who become nurses. I started noticing this as a medical student, when nurses were very kind to me, as a 20-year-old who had no idea what she was doing; these observations were followed by my experiences during my residency, when listening to nurses and reading their notes in charts helped me give better medical care to my patients. One time, during my emergency department rotation, the attending physician congratulated me for my “clinical acumen” when, in fact, I was following the emergency department nurses’ recommendations about whom to see first and what patient signs and symptoms were most worrisome. I never understood why some of my fellow residents disdained the observations of the nurses. We were all newcomers to the hospital, while many of the nurses had been working for years in the departments through which we rotated. My observations are confirmed by the late Dr. Arnold Relman, former editor of the New England Journal of Medicine and Professor Emeritus at Harvard Medical School in Boston, who wrote in his February 6, 2014 article: “What personal care hospitalized patients now get is mostly from nurses. In the MGH ICU, the nursing care was superb; at Spaulding it was inconsistent. I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.”1

During my career in Sacramento County, I have encountered people who come to work only to collect a paycheck – the stereotype of a “government worker” that is so frequently mocked. I have also met amazing, dedicated professionals who have a passion for their work and for the people they serve. Many of these professionals are nurses. In addition to long hours making sure the job is done right, they volunteer their services at health fairs and in free clinics; they travel to other countries on medical missions; and they advocate for their patients, collecting clothing, food and other necessities for them. In Sacramento County, nurses are essential to public health services. In addition to giving patient care in settings such as the Chest Clinic, public health nurses perform communicable disease surveillance and outbreak investigations, they are essential to home visitation programs such as Nurse Family Partnership, they run immunization clinics and case manage children with serious chronic diseases. Although physician supervision and input is necessary at times, these programs could not exist without nurses. As I look back on my career in Public Health, it is impossible to exaggerate the importance of nurses such as Reiko to the protection of the health of our community.

Public Health Nurse Reiko Osaki

trochetg@gmail.com Reference 1 New York Review of Books, February 6, 2014, “On Breaking One’s Neck” by Arnold Relman, www.nybooks.com/articles/2014/02/06/on-breaking-ones-neck/

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Office Space for Lease: Corner of 39th and J Street, 675 sf, fully serviced. Contact R. J. Frink, MD at (916) 801-5276 or email at rjfrink@surewest.net. See photos on Craigslist Sacramento: rental real estate section.

Are you a physician willing to donate a few hours of your time to mentor eager new medical students? The Willow Clinic, an affiliated UC Davis School of Medicine program, needs doctors like you. We’re recruiting friendly people with a desire to teach the next generation of physicians and to help the community. The clinic serves Sacramento’s homeless and is open every Saturday from 9 a.m. to 1 p.m. Volunteer physicians are welcome on a one-time only or rotating basis. For further information, contact: managers@willowclinic.org.

March/April 2016

WHEN IS A CHILD’S BRUISE FROM AN ACCIDENT OR SOMETHING MORE?

Do you know What, When and How to Report? Take this complimentary online course and: 

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Share with your colleagues. Pre-register for this free course at: http://www.imq.org/education/caprrc.aspx

A Posit Addressing How Patients Address You “Patients should not address physicians by their first names”

Background: Medscape recently posted an article exploring the etiquette of how patients should address their physicians. In the article, many physicians gave interesting comments for or against patients calling a doctor by their first name, or a physician promoting such. Issues that came up were respect, power differentials, chumminess for an ulterior motive, or reciprocation, as patients are often called by their first names. How do you feel about it? http://wb.md/1QuH4R7. Note: Results do not constitute valid polling data and may not reflect the position of the Editorial Committee, or the SSVMS Board of Directors. Results: 41/Agree – 9/Disagree. Commentary follows: I agree. I do not address patients by their first names, and I think the relationship works both ways and should at least start with this formality and respect. −Rochelle Frank, MD I agree. Conventional wisdom holds that physicians should not be treating family members or close friends. This proviso acknowledges that the excessive familiarity, as is associated with the use of first names, undermines objective analysis required in professional relationships. Thus, it is preferred that the patient be addressed as Ms./Mrs./Mr./Dr./ professor/officer/captain/etc. AND that the patient refer to her/his doctor using the doctor’s last name. −Bruce Barnett, MD I agree. We should not be addressing patients by their first names either. (That’s what I was taught in residency!) −Mary Moleta, MD I agree. This also applies to physicians when referring to a colleague in the presence

of a patient or if the colleague(s) happen to be present during a multi-specialty conference with a patient present. In my opinion, a professional atmosphere and appropriate decorum originates with the physician(s). −Michael Klein, Jr., MD It depends on age and circumstances, but mostly on patience preferences. They should take the lead. −Robert Spensley MD I disagree. Personally, I don’t care how patients address me. However, I introduce myself by my first and last names and not with my title. I also make it a point not to call a patient by his/her first name unless that person is a minor. −Franklin Chinn, Jr., MD I disagree. Many of my patients have become my friends. I am their partner in health, and I will present myself to them in the form that best meets their needs. Some would never call me by my first name, and some I am honored they do. Whatever is best for them is ok with me. −Thomas Atkins, MD I disagree. In a primary care setting, patientphysician collaboration is key. In building a relationship with the patient, they will commonly find greater comfort when interacting with a professional whom they can communicate with on a first-name basis. The patient is more likely to comply with recommendations and instructions provided by a provider whom they respect and appreciate and with whom they have a constructive relationship. This also creates a perception that the provider has a personal interest in their well-being and fosters trust. −Ryan Nicholas, MD I disagree. Even though I am more comfortable being addressed as “doctor,” due to my age (been around a while), I don’t think it March/April 2016

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

matters or affects my relationship with patients. −Dennis Michel, MD I disagree. If a physician addresses the patient by his/her first name, the patient should be able to address the physician similarly. The respect needs to flow in both directions. −Gary Roach, MD I was brought up to refer to men whom I knew casually or little as “Mister,” regardless of his apparent age; obviously young women as “Miss” and older women as “Missus” (Mrs.) and then change the honorific word only if the addressee asked me to do so (even though he might be, for example, a WW II veteran who had won a Silver Star at Iwo Jima), and I continued to follow that practice until I retired. Since I always used those terms, I must say I felt a bit put off when the patient would address me as “John” or “Jack,” and that was almost always the case only with younger patients. Even when the patient used my first name, or nickname, I would continue to use, when addressing him/

her, the appropriate honorific prefix unless he or she insisted that I address him/her by their first name. I used to cringe when I would hear my clinic assistant open the door to the waiting room and call out, “Molly, come on in!” Now, as a patient, I go to see my PCP and his assistant opens the door and says, “John, come on in!!” She doesn’t know my nickname. One day, I might tell her/ him. Maybe I won’t be as bothered if I hear “Jack, come on in!” −Jack Ostrich, MD I, for one, am uncomfortable being called by my first name by anyone except good friends, especially by patients. My first name is something I am allowed to give when I feel close enough to someone. −Sandra Hand, MD To be most agreeable, I’ll disagree. We live in a pathologically thin-skinned society. If my patient addresses me by my first name, I choose to respond in my own manner, by formally addressing my elders and people who are not continued on page 28

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Book Review

The End of Power From Boardrooms to Battlefields and Churches to States, Why Being In Charge Isn’t What It Used to be, by Moisés Naím, Publisher Perseus Books, Reprint Edition 2014. ISBN-13: 978-0465065691

Reviewed By John Loofbourow, MD THIS IS A BOOK FOR millennials. It is an extensive and possibly seminal work, not a quick or easy read. There are 11 chapters, each consisting of about 10 sections. I found it almost impossible to summarize, so I will start with some observations that may put it in context: We live in a time of worldwide societal upheaval, arguably brought about by critical developments in technology. Similar radical change has occurred in the past, as when: 1) Mobile hunter-gathering was replaced by place-bound agriculture, leading chaotically but ultimately to cities, tribal religions, kingdoms, art, architecture, scientific discovery, and monarchic faith-backed nation-states. 2) Knowledge, tediously recorded in manuscripts by hand and limited to the monastic and wealthy few, became available to the many because of the printing press. The bloody period called the Thirty Years War followed, culminating in the overthrow of monarchic religious states, and the birth of political and individual religious freedom. 3) A series of scientific developments like the chronograph, compass, telescope, and gunpowder, led to the “age of discovery,” and brutal conquest, and colonial domination. 4) A period of philosophic and political enlightenment led to the overthrow of colonial powers, like the rebellion of the American Colonies. These revolutions continue to this day in the Middle East where the imposed borders make sense only to former colonial powers. Today, here we go again. The unlimited internet and its consequences make old limits and barriers obsolete: national borders, commercial, religious, and political fiefdoms

are violated; the powerful − nations, presidents, CEOs, large multinationals, − all are insecure, and weak causing public disillusionment, anger and rebellion. Nowhere is the old order respected, or trusted. What are we, therefore, the Millennials, who live at the beginning of this century, to do? It appears the most interesting reaction of many millennial young people is to try to adapt continuously, like children of miners, diplomats, or warriors who live in diverse realities, and move over and over into a new town, country, language, and culture. They learn: To adapt to new people, groups, languages, cultures. To be astute and adept at knowing and learning about the other. To embrace, value, and respect one another above self. To consider the earth, and even the universe, as home. To be family to every age, race, sex or condition. They find that: Personal liberty requires constant shedding of the old and taking on the new. Nations and peoples have their own beauty, and truth, but all are transient. Each person has the right to accept or to ignore any religious belief or unbelief. “Scientific certainty” can be useful, but is always suspect and transient. Doubt is the primal force of both science and religion. Every age, race, sex, or condition can be both confining and liberating. Author Moisés Naím finds that those who hold power try to retain it by erecting barriers to keep challengers at bay; but multiform insurgent forces from every remote area of the earth dismantle those barriers quickly. He calls dispersed collective power micropower. Example: personal diverse acts of both terror and March/April 2016

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com. 27

commercial or scientific innovation collectively challenge civilizations. Micropower defeats megapower in warfare because of plentiful and diverse microweapons, and the rejection of more chivalrous “rules of war” (Isis, Jihad). Yet power, once grasped, fades fast; the new power quickly becomes vulnerable and loses that edge. Maybe the process could be thought of as constructive or creative destruction. Naím catalogs the general changes as three revolutions: 1) More − people have more and more means to overwhelm or evade control. 2) Mobility − people are not controlled by governments, borders or distance. 3) Mentality − even the most remote people are now aware of possibilities, options, needs, desires and rights. He notes that in chaos, we tend to listen to “Terrible Simplifiers”: People who offer vague, bombastic simple solutions to complex problems. He summarizes the decay of national politics (parentheses mine): Empires to States. Despots to Democrats. Majorities to Minorities (as in the U.S.). Parties to Factions. Capitals to Regions (Pinks, Blues, Rural, Ranch, City). Governments to Lawyers (unjust courts,

straitjacket laws/regs). Leaders to Laymen (NGOs, Buffet-SlimGates-Bono). Hedge Funds to “Hactivists” (Assange, Snowden, etc). Naím ends with suggestions to reorder the national and world chaos. This is the most disappointing part of the book for me because I’d prefer a quick fix. Yet that is, de facto, unlikely. The author’s suggestions are rational, but require great and gradual, likely painful, public reorientation, and a conscious and conscientious media. No quick fix there either! He suggests to begin with: 1) Forget about who is first or what country is up or down, whom we like or fear. 2) Reject the Terrible Simplifiers. (You know them!) 3) Restore the power of our institutions. (Well, yeah but not yet!) 4) Bring back trust. (Time line?) 5) Strengthen political parties. (Ha!) 6) Increase political participation. (But maybe nonvoters are zoned out quiet patriots!) Wow! This book is well worth some time, for at least one rational evaluation of what the next few decades could be about. john@loofbourow.com

Posit continued from page 26 close friends; it’s not so much for their comfort as for my own. However, sometimes even a formal address can be offensive, maybe haughty or high-handed. Once a consultant became outraged when I answered, “Yes, Ma’am.” She apparently wanted a more respectful “Yes, Doctor.” I get that, considering she likely had to overcome sexual barriers that I can only imagine. But my point is, her outrage was more demeaning and debilitating to her than to me. −John Loofbourow, MD I’ve always looked younger than my age and far too many people, who would have called a male doctor “Doctor,” called me Ann. I also 28

Sierra Sacramento Valley Medicine

recognized that my style as a nutrition doctor has always been as much coach as doctor, which breeds familiarity, especially with the eating disorder patients, many of whom have problems with boundaries. Therefore, in the many instances someone has presumed to use my first name, I tell them that I address them by their formal title and I ask that they do the same for me. As a corollary, when I place a food order at a walk-up counter and am asked by someone young enough to be my grandchild to give my name, I usually say something like “Evangelista” or “Mrs. Doubtfire.” −Ann Gerhardt, MD

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Sierra Sacramento Valley Medical Society 2016 Committee Appointments EDITORIAL -- REAPPOINTMENTS: Drs. Nathan Hitzeman, Editor/Chair; Sean Deane, Adam Dougherty, Ann Gerhardt, Sandra Hand, Albert Kahane, Robert LaPerriere, John Loofbourow, George Meyer, John Ostrich, Gerald Rogan, Glennah Trochet , Lee Welter, John Paul Aboubechara, MS III (UCD), and Nan Crussell, Managing Editor NEW APPOINTMENTS: Drs. Caroline Giroux, Jillian Millsop, Mary Pauly and Steven Nemcek, MS I (CNSU) EMERGENCY CARE -- REAPPOINTMENTS: Drs. Peter Hull, Chair; Seth Thomas, Vice Chair; Matthew Donnelly, Troy Falck, Roel Farrales, Hernando Garzon, Kendrick Johnson, Vinh Le, Alexis Lieser, Devin Merchant, Maurice Makram, Karen Murrell, Jeff Rogerson, Dwight Stalker, R. Steve Tharratt, Sam Turnipseed, Justin Wagner, David Wisner, and Rodolpho Zaragoza; Lee Welter (guest) NEW APPOINTMENT: Dr. Joseph Morris HISTORICAL -- REAPPOINTMENTS: Drs. Robert LaPerriere, Chair, Malcolm Ettin, Christine Fernando, Francine Gallawa, James Hamill, Julian Holt, Donald Hopkins, Elisabeth Mathew, Jack Ostrich, Gail Pirie, and F. James Rybka; Kent Perryman (guest) NEW APPOINTMENTS: Drs. Richard Astorino and Rosalind Kirnon JUDICIAL -- REAPPOINTMENTS: Drs. Alicia Abels, José Arévalo, Jose Cueto and Anthony Russell NEW APPOINTMENTS: Dr. Paul Phinney PROFESSIONAL CONDUCT AND ETHICS -- REAPPOINTMENTS: Drs. Joanne Berkowitz, Chair, George Chiu, Richard Gray, and Richard Jones NEW APPOINTMENT: Dr. Barbara Hays PUBLIC AND ENVIRONMENTAL HEALTH -- REAPPOINTMENTS: Drs. Donald Lyman, Chair; Ruenell Adams Jacobs, Regan Asher, Clinton Collins, Anthony DeRiggi, Christine Fernando, Maynard Johnston , Albert Kahane, Olivia Kasirye, Robert LaPerriere, Stephen McCurdy, Robert Meagher, Dennis Michel, Robert Midgley, Caroline Peck, Richard Sun, Glennah Trochet, and David Unold, and Rabia Aslam, MS II (UCD) NEW APPOINTMENTS: Drs. Catherine Dycaico and Maya Heinert; and Michael Lee, MS I (CNSU) SCHOLARSHIP AND AWARDS -- REAPPOINTMENTS: Drs. Margaret Parsons, Chair, Ruenell Adams Jacobs, Sean Deane, Paul Kelly, Travis Miller, Jack Ostrich, Patricia Samuelson, and Pandur Yenumula NEW APPOINTMENTS: Drs. Paul Kaplan, George Meyer, Susan Murin, and Mary Pauly WELLNESS COMMITTEE -- REAPPOINTMENTS: Drs. Michael Parr, Chair, Lee Snook, and Captane Thomson

As of January 2016

In Memoriam

Robert Brooks Harris, MD 1921–2015

Everyone knew Bob Harris. Whether he was in the surgeons’ lounge, the operating room, the doctors’ lunch room, a medical staff committee or on the patient floors, his persona dominated the scene in the most pleasant way. With a twinkle in his eye, his raspy voice full of humor and a story for every situation, he was just darn pleasant to be around. And everyone knew if they needed an operation, they wanted Bob Harris. If you were called to be his assistant on a case, you knew the surgery would be fast, done well and it would be a pleasure to be involved. This was the man we lost last November at the age of 94, one of Sacramento’s most skilled surgeons who was at home most anywhere in a patient’s anatomy. Bob graduated from Stanford University School of Medicine in 1947, interned at San Francisco General Hospital and did his surgical residency in Winston-Salem, NC at Bowman Gray Hospital. He was in that cadre of boardcertified general surgeons, trained as well, in thoracic and pediatric surgery. He practiced in Sacramento for 40 years at the Sutter and Mercy Hospitals, and was an Associate Clinical Professor of Surgery at UCDMC. He served his time on hospital boards and Medical Society committees, providing his valuable pragmatic and candid counsel. No stranger to house calls and years of constantly being “on call,” he worked long and hard in his career. In the later years of his practice, he brought recently-trained and highlyskilled young surgeons into his practice.

Bob Harris came from semi-rural roots, one of the children of Dr. Junius Harris, a general surgeon, also prominent in Sacramento medical history. Bob and his internist brother, John, were and are wonderful keepers of this Harris medical legacy, for which Sacramento is so fortunate. Bob’s stories of his life outside of the operating room are legendary. He was a farmer and a general outdoorsman. His stories of his life and times on the farm and in the wild were told with self-deprecating humor that held listeners captive, hoping for one more story before he left the nurse’s station or the lunch table. Bob married Marjorie Fearon when he was at Stanford, and they Robert Brooks Harris, MD were a duo throughout their 70 years of marriage, raising five children, one of whom became a general surgeon. A man like Bob does not come our way often. Missing him brings to my mind the last lines of Edwin Markam’s poem about Abraham Lincoln: And when he fell in whirlwind, he went down As when a lordly cedar, green with boughs, Goes down with a great shout upon the hills, And leaves a lonesome place against the sky. That lonesome place against the sky is very real for all of us who knew and loved Bob Harris. − Jim Hamill, MD

March/April 2016

Board Briefs January 11, 2016 The Board: The Board received an update from BloodSource representatives, Rob Van Tuyle, CEO, and Chris Gresens, MD, Senior Medical Director regarding the merger of BloodSource with Blood Centers of the Pacific and the transfer of SSVMS sole membership in BloodSource to Blood Systems, Inc. Elected Chris Serdahl, MD, 2016 Secretary and Rajiv Misquitta, MD, 2016 Treasurer of SSVMS. The remaining officers are Tom Ormiston, MD, President; Ruenell Adams Jacobs, MD, PresidentElect and Jason Bynum, MD, Immediate Past President. Approved the 2015 Year-End Pre-Audit Financial Statements. Approved the 2016 Committee Appointments. Approved the Membership Report: For Active Membership — Zeenat R. Hasan, MD; Tejpal S. Randhawa, MD. For Resident Active Membership — Mausam Damani, MD. For Retired Membership — Maynard Johnston, MD.

December 14, 2015 The Board: Serving as the Board of Directors to the Community Service, Education, and Research Fund (CSERF), the Board received the annual report from Liza Kirkland, Program Director. CSERF, a 501(c)(3) organization, encompasses the Sierra Sacramento Valley Medical History Museum, the William E. Dochterman Medical Student Scholarship Program and the Sacramento Physicians Initiative to Reach Out, Innovate and Teach (SPIRIT) Program. In June 2015, the Sacramento County Board of Supervisors approved a new program, Healthy Partners, for undocumented residents of Sacramento County meeting specific eligibility criteria. While community clinics provide some primary care services for the undocumented, these new primary

Sierra Sacramento Valley Medicine

care services will be provided at the County’s Primary Care Clinic. The four local health systems and the Sierra Sacramento Valley Medical Society will expand the SPIRIT Program to address the significant needs for specialty care and outpatient surgery to undocumented patients served at both community and county clinics. Serving as the Board of Directors for the Sierra Sacramento Valley Medical Society, the Board: Approved the November 30, 2015 month-end financial statements. Approved the December 14, 2015 Membership Report: For Active Membership — Maqbool Ahmed, MD; Randy C. Arai, MD; Mary E. Blair-Rogers, MD; Scott D. Bricker, MD; Howard H-V Dinh, MD; Lindsey N. Dyson, MD; Thomas D. Edwards, DO; Julia M. Gabhart, MD; Andrea T. Garland, MD; Ronald D. Greenwood, MD; Mark Grijnsztein, MD; Karen E. Hart, MD; TaiJuana A. Jackson, MD; Christopher R. Juels, MD; Jeffery S. Kahn, MD; Loredo M. Lawsin, MD; David Lee, MD; Edwin A. Lichwa, DO; Cristina Dela Cruz Lilagan, MD; Vanessa McGowan, MD; Amy M. Nguyen, MD; Thomas J. Reda, II, MD; Anna T. G. Siao, MD; Sita Kaur Singh, MD; Jena Torres, MD; Ganesan Venkatapathy, MD; Stacie Walton, MD; Lina N. Wasio, MD; Leon D. Williams, MD; Hon Woo, MD; Dominica N. Wood, MD; Natasha Zohuri, MD. For Resident/Fellow Active Membership — Jillian W. Millsop, MD. For Retired Membership — Michael Bugola, MD; Ronald J. Cole, MD; Victor H. Jung, MD. For Resignation — Benjamin Kaufman, MD; Janet M. Walker, MD. For Transfer of Membership — Hengli Lin, MD (to Orange County). For Change in Status from Active to 65-20 Active Membership — Clifford Marr, MD. Termination of Membership for Nonpayment of Dues — Richard Detwiler, MD.

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SPONSORS:

IN E ,

FU FA S HIO N &

Saturday, April 2, from 6:30 - 9:30 pm Del Paso Country Club

Please join us for our 12th annual benefit gala c

c c

Sample the region's finest wines and sweet and savory foods Honor our 2016 Safety Net Hero, William McGowan, CFO Emeritus, UC Davis Health System; board member of Serotonin Surge Charities and the Paul Hom Free Clinic Enjoy an upbeat fashion show

William McGowan Learn about the safety net medical clinics that this event supports: Bayanihan Clinic Imani Clinic Clinica Tepati Joan Viteri Memorial Clinic CommuniCare Health Centers Knights Landing Clinic CSERFâ&#x20AC;&#x2122;s SPIRIT Project MercyClinic Loaves & Fishes Elica Health Centers MercyClinic Norwood Health & Life Paul Hom Asian Clinic Organization (HALO) WellSpace Health Health For All Willow Clinic

..................................................................................................... FOOD AND WINE DONORS:

..................................................................................................... ..................................................................................................... ShuShu s clothing & accessories

For sponsorship and donor information, contact John Chuck at john.chuck@kp.org or 530-757-4114. To register to attend, go to www.serotoninsurge.org or contact Tina Bozzini at tina.bozzini@kp.org or 530-757-4121. Cost is $100 per person; early-bird registration by March 1 is $75 per person. Serotonin Surge Charities is a 501(c)(3) public benefit nonprofit organization (tax ID # is 68-0411254).

March/April 2016

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Sierra Sacramento Valley Medicine

Welcome New Members The following applications have been received by the Sierra Sacramento Valley Medical Society. Information pertinent to consideration of any applicant for membership should be communicated to the Society. — Chris Serdahl, MD, Secretary. Maqbool Ahmed, MD, Pulmonary Medicine, Dow Medical College – University of Karachi – 1989, Mercy Medical Group, 3000 Q Street, Sacramento 95816

Zeenat R. Hasan, MD, General Surgery, University of Missouri School of Medicine – 2007, Mercy Medical Group, 8220 Wymark Drive, Ste. 200, Elk Grove 95757

Randy C. Arai, MD, Critical Care Medicine/ Pulmonary Disease, Tufts Medical School – 1979, The Permanente Medical Group, 6600 Bruceville Road, Sacramento 95823

TaiJuana A. Jackson, MD, Internal Medicine, Albert Einstein College of Medicine – 2012, The Permanente Medical Group, 6600 Bruceville Road, Sacramento 95823

Mary E. Blair-Rogers, MD, Pediatrics, Meharry Medical College School of Medicine – 2006, The Permanente Medical Group, 6600 Bruceville Road, Sacramento 95823

Christopher R. Juels, MD, Emergency Medicine, University of California Irvine – 1989, The Permanente Medical Group, 6600 Bruceville Road, Sacramento 95823

Scott D. Bricker, MD, Surgical Critical Care, Hahnemann University School of Medicine – 2003, The Permanente Medical Group, 6600 Bruceville Road, Sacramento 95823

Jeffery S. Kahn, MD, Psychiatry, University of Hawaii, John A. Burns School of Medicine – 1998, The Permanente Medical Group, 9201 Big Horn Blvd., Elk Grove, 95758

Mausam Damani, MD, Internal Medicine, UCLA School of Medicine – 2011, UC Davis Medical Center, 4860 Y Street, Ste. 2400, Sacramento 95817

Loredo M. Lawsin, MD, Internal Medicine/Critical Care Medicine/Nephrology, University of South Carolina School of Medicine – 1996, The Permanente Medical Group, 6600 Bruceville Road, Sacramento 95823

Howard H-V Dinh, MD, Cardiology, SUNY Stony Brook – 1999, The Permanente Medical Group, 6600 Bruceville Road, Sacramento 95823 Lindsey N. Dyson, MD, Obstetrics and Gynecology, Jefferson Medical College – 2008, The Permanente Medical Group, 6600 Bruceville Road, Sacramento 95823 Thomas Edwards, DO, Family Medicine, University of North Texas Health Science Center at Fort Worth, Texas College of Osteopathic Medicine – 2004, The Permanente Medical Group, 9201 Big Horn Blvd., Elk Grove 95758 Julia M. Gabhart, MD, Pediatrics/Hospital Medicine, The Chicago Medical School – 2007, The Permanente Medical Group, 6600 Bruceville Road, Sacramento 95823 Andrea T. Garland, MD, Obstetrics and Gynecology, University of Hawaii, John A. Burns School of Medicine – 2009, Mercy Medical Group, 4860 Y Street, Suite 2500, Sacramento 95817 Ronald D. Greenwood, MD, Pediatrics, Northwestern University Medical School – 1969, Elica Health Centers, 3701 J Street, Ste. 201, Sacramento 95816 Mark I. Grijnsztein, MD, Allergy & Immunology, Tel Aviv University/Sackler School of Medicine – 1998, Sutter Medical Group, 8170 Laguna Blvd., #200, Elk Grove 95758 Karen E. Hart, MD, Family Medicine, Roy J. and Lucille A. Carver School of Medicine – 1997, The Permanente Medical Group, 6600 Bruceville Road, Sacramento 95823

David Lee, MD, Internal Medicine, The Ohio State University College of Medicine and Public Health – 2001, Mercy Medical Group, 8220 Wymark Drive, Elk Grove 95757 Edwin A. Lichwa, DO, Family Medicine, University of North Texas Health Science Center Ft. Worth/ TCOM – 1992, The Permanente Medical Group, 1995 Cowell Blvd., Davis 95618 Cristina Dela Cruz Lilagan, MD, Pediatrics, Saint Louis University School of Medicine – 2012, The Permanente Medical Group, 9201 Big Horn Blvd., Elk Grove 95758 Vanessa McGowan, MD, Physical Medicine/ Rehabilitation, University of California Davis School of Medicine – 2010, The Permanente Medical Group, 6600 Bruceville Road, Sacramento 95823 Jillian W. Millsop, MD, Dermatology Resident, University of Utah School of Medicine – 2013; UC Davis Department of Dermatology, 3301 C Street, Ste. 1400, Sacramento 95816 Amy M. Nguyen, MD, Head and Neck Surgery, University of Missouri-Kansas City School of Medicine – 2009, The Permanente Medical Group, 7300 Wyndham Drive, Sacramento 95823

Tejpal S. Randhawa, MD, Cardiovascular Disease, Ross University School of Medicine – 2001, Mercy Medical Group, 3000 Q Street, Sacramento 95816 Thomas J. Reda, II, MD, Internal Medicine, Temple University School of Medicine – 2000, The Permanente Medical Group, 9201 Big Horn Blvd., Elk Grove 95758 Anna T. G. Siao, MD, Pediatrics, University of Santo Tomas Faculty of Medicine and Surgery – 2007, The Permanente Medical Group, 1650 Response Road, Sacramento 95815 Sita Kaur Singh, MD, Obstetrics and Gynecology, Albany Medical College – 2007, The Permanente Medical Group, 6600 Bruceville Road, Sacramento 95823 Jena Torres, MD, Family Medicine, St. George’s University School of Medicine – 2012, The Permanente Medical Group, 9201 Big Horn Blvd., Elk Grove 95758 Ganesan Venkarapathy, MD, Family Medicine, University of Madras – 1974, Elica Health Centers, 155 15th Street, Ste. 1, West Sacramento 95691 Stacie Walton, MD, Pediatrics, College of Physicians and Surgeons, Columbia University – 1987, The Permanente Medical Group, 9201 Big Horn Blvd., Elk Grove 95758 Lina N. Wasio, MD, Pediatrics/Hospital Medicine, Boston University School of Medicine – 2012, The Permanente Medical Group, 6600 Bruceville Road, Sacramento 95823 Leon D. Williams, MD, Family Medicine, Medical College of Ohio – 2004, The Permanente Medical Group, 6600 Bruceville Road, Sacramento 95823 Hon Woo, MD, Radiology, University of California Davis School of Medicine – 1992, The Permanente Medical Group, 6600 Bruceville Road, Sacramento 95823 Dominica N. Wood, MD, Pediatrics, Howard University College of Medicine – 2007, The Permanente Medical Group, 6600 Bruceville Road, Sacramento 95823 Natasha Zohuri, MD, Internal Medicine, St. George’s University School of Medicine – 2012, The Permanente Medical Group, 6600 Bruceville Road, Sacramento 95823

Anh-Thu Thi Nguyen, MD, Pediatrics, Eastern Virginia Medical School – 2012, The Permanente Medical Group, 6600 Bruceville Road, Sacramento 95823

March/April 2016

Hilton San Francisco Union Square

May 13 - 15, 2016

San Francisco, CA

Physicians, nurses, medical practice managers and all other health care industry professionals—Join us in the heart of San Francisco to prepare for changes affecting your profession, your practice and your economic future.

Health care power players will share strategies and resources for accelerating the shift to a more integrated, high performing and sustainable health care system. Speakers include Dr. Atul Gawande, distinguished surgeon, teacher and writer – named one of TIME magazine’s 100 most influential thinkers; Karl Rove, former Deputy Chief of Staff and Senior Advisor to President George W. Bush; and Donna Brazile, Al Gore campaign manager and Democratic National Committee Vice Chair.

800.795.2262 www.westernleadershipacademy.com 36

Sierra Sacramento Valley Medicine

THE

Art

April 30, 2016

Medicine

Auction & Dinner

The SSVMS Alliance is hosting an evening of fine art & fine wines. Proceeds from the auction go directly toward our Community Endowment Fund which is the sole source of funding for our community health grant and medical/nursing school scholarship programs. Last year SSVMSA gave over $53,000 in 2015. Join Us!

April 30th, 2016

$125 Dinner and Host Bar Del Paso Country Club Enjoy Premium Napa Wines from Our Dinner & Bar Sponsors: s

Join our efforts to give back to our community. Become a sponsor or donate to our art and wine auction. Current Sponsors*

Patron Sponsors $5,000 Mercy Medical Group Sutter Medical Group Masters Sponsors $2,500 Dignity Health Niello Maserati of Sacramento Dr. Allen & Glenda Morris Dr. Chris and Gabby Neubuerger

Featured Artists & Galleries* Tim Collum Gary Dinnen, Adamson Gallery Gregory Kondos Clay Vorhes Member Artists Barbara Arnold, MD Paula Cameto Jon Finkler, MD Eric Williams, MD Eliot Fouts Gallery Helen Jones Gallery

*To preview artwork and see a complete list of sponsors, please visit our website at ssvmsa.org. To make a donation or become a sponsor contact Gabby Neubuerger at gabby@surewest.net or (916) 7361613. For reservations contact Catherine Doggett at catdoggett@comcast.net (916) 903-7529. SSVMSA is a 501 (c) 3, Donations/Sponsorships are fully tax deductible.

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