2019-Jul/Aug - SSV Medicine

Sierra Sacramento Valley Serving the counties of El Dorado, Sacramento and Yolo

July/August 2019

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Sierra Sacramento Valley

MEDICINE 4

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Everyone’s Covered Down Under

SSVMS Historical Committee and Museum of Medical History

George Meyer, MD and Lynn Pesely

PRESIDENT’S MESSAGE

Christian Serdahl, MD

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The Blood Train

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Call Me Ash

EXECUTIVE DIRECTOR’S MESSAGE

Ken Smith, Managing Editor

Aileen Wetzel, Executive Director

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The Symptoms of Joy

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Physicians for a Healthy California

Record Turnout for CMA Legislative Advocacy Day

Adam Dougherty, MD

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It’s OK to Not Be OK

Mustafa Bahramand, MS III

Got Pain?

There Is No Magic Pill Mei Lin Jackson

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Join the Sacramento Medical Reserve Corps

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Unaccountable: A Call for Transparency in Health Care Gerald Rogan, MD

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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 SSVMedicine@ssvms. org.

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

Board Briefs

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New SSVMS Members

Britteny Randall, MS III

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Visit Our Medical History Museum 5380 Elvas Ave. Sacramento Open free to the public 9 am–4 p.m.

M–F, except holidays.

Study Smarter With Spaced Repetition Elijah Abramson, MS III

OPINION

A Wholesome Adventure Caroline Giroux, MD

VOLUME 70/NUMBER 4 Medical students attending CMA’s 45th Annual Legislative Advocacy Day gathered at the State Capitol for a photo between visits with legislators. In all, over 600 CMA members and medical students participated. For more on their visit, see page 6.

Photo courtesy of the California Medical Association

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

SSV Medicine is online at www.ssvms.org/Publications/SSVMedicine.aspx

July/August 2019

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Sierra Sacramento Valley 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.

2019 Officers & Board of Directors

Christian Serdahl, MD, President John Wiesenfarth, MD, President-Elect Rajiv Misquitta, MD, Immediate Past President District 1 Ashutosh Raina, MD District 2 Adam Dougherty, MD J. Bianca Roberts, MD Vanessa Walker, DO District 3 Ravinder Khaira, MD District 4 Ranjit Bajwa, MD

District 5 Sean Deane, MD Cynthia Ramos, MD Vijay Rathore, MD Paul Reynolds, MD Roderick Vitangcol, MD District 6 Carol Kimball, MD

2019 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 Ruenell Adams Jacobs, MD Barbara Arnold, MD Helen Biren, MD Adam Dougherty, MD Richard Gray, MD Kevin Jones, DO Richard Jones, MD Charles McDonnell, MD Sandra Mendez, MD Rajiv Misquitta, MD Sen. Richard Pan, MD Paul Reynolds, MD Kuldip Sandhu, MD James Sehr, MD Christian Serdahl, MD Ajay Singh, MD John Wiesenfarth, MD Don Wreden, MD

District 2 Alternate Ann Gerhardt, MD District 3 Alternate Thomas Valdez, MD District 4 Alternate Richard Bermudes, MD District 5 Alternate Armine Sarchisian, MD District 6 Alternate Christopher Swales, MD At-Large Alternates Megan Anzar Babb, DO Natasha Bir, MD Arlene Burton, MD Ronald Chambers, MD Amber Chatwin, MD Mark Drabkin, MD Karen Hopp, MD Carol Kimball, MD Derek Marsee, MD Anand Mehta, MD Leena Mehta, MD Ernesto Rivera, MD J. Bianca Roberts, MD

CMA Trustees

District XI Douglas Brosnan, MD

Margaret Parsons, MD

CMA Speaker Lee Snook, MD AMA Delegation Barbara Arnold, MD

Sandra Mendez, MD

Editorial Committee Mustafa Bahramand, MS III Joshua Bloomstein, MS I Sean Deane, MD Caroline Giroux, MD Sandra Hand, MD Nate Hitzeman, MD Robert LaPerriere, MD

George Meyer, MD Eric Ovruchesky, MS II John Ostrich, MD Karen Poirier-Brode, MD Neeraj Ramakrishnan, MS III Gerald Rogan, MD Glennah Trochet, MD Lee Welter, MD

Executive Director Managing Editor Webmaster

Aileen Wetzel Ken Smith Melissa Darling

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Sierra Sacramento Valley Medicine

HOSTED BY LOCAL PHYSICIANS

Listen and subscribe to Joy of Medicine - On Call on your favorite Podcast App or visit joyofmedicine.org

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.

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.

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. Š2018 Sierra Sacramento Valley Medical Society SIERRA SACRAMENTO VALLEY MEDICINE (ISSN 0886 2826) is published bimonthly 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.

| FE ATURED CONTRIBUTORS |

Christian Serdahl, MD,

Caroline Giroux, MD

Adam Dougherty, MD

Dr. Serdahl is the 2019 SSVMS President and an ophthalmologist in private practice in Sacramento. He recently learned it is best to avoid saltwater crocodiles at all costs.

Dr. Giroux is a psychiatrist at UC Davis who specializes in empowering survivors of trauma. She strives for social justice and writes candid essays in a unique style that reflects her deep French-Canadian roots.

Dr. Dougherty practices emergency medicine at Sutter Medical Center Sacramento.

He is a board member of SSVMS as well as Physicians for a Healthy California, formerly the CMA Foundation.

Mustafa Bahramand, MS III

Elijah Abramson, MS IV

2Lt. Britteny Randall, MS III

Mustafa is a third-year medical student who wrote about about wearable technology in the March/April issue. This month he chronicles the record turnout at CMA’s Annual Legislative Advocacy Day.

Elijah is a fourth-year medical student at California Northstate University. He last wrote about changing attitudes toward residency duty hours and loves cycling and skiing when not studying.

Britteny is a U.S. Army Reserve second lieutenant and third-year medical student.

She offers a candid, touching look at dealing with the pressure of medical school after the devastating loss of her father.

ccneye@sbcglobal.net

mustafa.bahramand8181@cnsu.edu

cgiroux@ucdavis.edu

elijahabramson@gmail.com

apdougherty@gmail.com

britteny.randall1453@cnsu.edu

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ssvms.org.

Gerald Rogan, MD

jerryroganmd@sbcglobal.net

Dr. Rogan practiced emergency medicine and family care for 23 years. He has been a Medicare and Medi-Cal contractor medical director and volunteered as a primary care doctor at the Sacramento County Clinic.

Lynn Pesely

peselyl@SacOES.org

Lynn Pesely is Coordinator of the Sacramento Medical Reserve Corps at the Sacramento County Office of Emergency Services. She and co-author George Meyer, MD, encourage you to join the SMRC.

July/August 2019

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| PRESIDENT’S MESSAGE |

Everyone’s Covered

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Down Under

he sting of a box jelly fish will kill you in 10 agonizing minutes, should you have the unfortunate opportunity to encounter one,” my Australian guide casually informed me.

He went on to illustrate in excruciating detail that Australia is home to hundreds of venomous creatures that include the innocuous cone snail, the blue ringed octopus, the brown snake and the funnel-web spider, to name a few.

Any of the friendly Australian natives can name these as if they were on a shopping list. But the creature they most fear is the dreaded saltwater crocodile. The mere mention of this prehistoric monster is enough to raise any Aussie’s eyebrows and cut short further uncomfortable conversation about the dangers Down Under.

So it was that we began a recent family vacation to Australia with some paranoia we might encounter such creatures. To our great fortune we found none, but we did discover an environmental and social utopian paradise, which explains why no Australians ever want to move to California. This was surprising to my ethnocentric pride since it seemed on all of our prior travels that when you mention you’re from California, everyone says how lucky you are to live there.

Indeed, there was much I liked about Australia, such as all school children wearing uniforms, sensible gun laws, elections on Saturdays, a working immigration policy, universal health coverage, no annoying TV drug commercials, and the Aussie sense of humor.

I saw no homeless in Sydney, Brisbane and Melbourne.

When I rented a car and drove on the left, other drivers allowed my lane changes, even when I inadvertently signaled by activating my windshield wipers. And, perhaps most striking of all was the overall level of happiness and satisfaction with their health care system.

“I can’t believe you Americans pay so bloody much for drugs,” my Australian friend Greg, a dermatologist, noted. Evidently, under Australia’s national health care system—it’s called “Medicare,” but unlike the U.S. 4

Sierra Sacramento Valley Medicine

By Christian Serdahl, MD ccneye@sbcglobal.net

program of the same name it guarantees health services to Australians of all ages—an independent board called the Pharmacy Benefit Scheme (PBS) sets one price.

In the late 1990s, Australia and many other European countries realized that drug costs were on the rise and set up strict pricing regulations that have left America holding the proverbial bag for funding new drug development and Big Pharma profits.

Let’s look at Humira, for example. In Australia two 40mg/0.8ml injection pens cost $1,269.60. At Costco, you will pay $5,130.76 for the same medicine.

Medicare in Australia covers all citizens and is funded by a 2% tax on income. In order to reduce the burden on the public health care system, higher wage earners purchase private insurance. Additional funding comes from patient copays based on income.

Physicians are paid via a combination of salary and fee for service, and there are public and private hospitals. General practitioners are paid reasonably well and there is no shortage. The government also sets prices for surgical procedures and exams, but many physicians have felt that the government panel has fallen behind in updating these fees, making private practice a bit more difficult.

This hybrid model of health care has a relatively high level of satisfaction from both physicians and patients, particularly when it comes to drug pricing.

While I am not excited about the prospect of a faceless panel of government bureaucrats negotiating prices for surgical procedures and exams, I am certainly in favor of Medicare setting prices on all the drugs we use in our country. The savings would be on the order of $10-$20 billion dollars each year and we would not have to watch drug commercials during the nightly news hour.

Any country that even considered naming Melbourne, Australia’s most diverse and largest city, Batmania in 1837 has to have something Americans can learn from.

In addition, of course, to staying away from saltwater crocodiles.

| EXECUTIVE DIRECTOR’S MESSAGE |

The Symptoms of Joy Third Annual Joy of Medicine Summit

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njoyment, calm, focus, sense of community, autonomy, collegiality and support are all symptoms of joy that I hope physicians are rediscovering through SSVMS’ Joy of Medicine program. Over the last two years, the program has flourished thanks to the input and engagement of local physicians and their affiliated medical groups.

I am proud to share that nearly 80 physicians have accessed over 220 Resiliency Sessions. These SSVMSsponsored sessions with a psychologist or life coach are confidential, convenient, and cost-free to physicians practicing in the Sacramento region.

SSVMS’ Joy of Medicine program has enhanced physician collegiality through our Physician Peer Groups.

Nearly 100 physicians have engaged with one or more of the six monthly peer groups that meet in physician homes throughout the four-county Sacramento region.

These Peer Groups are not group therapy, but a means for physicians to connect with one another to discuss personal and professional successes and challenges.

This September marks the third year of our original program component, the annual Joy of Medicine Summit.

Based on feedback from previous year’s attendees, we are shaking things up a bit! This year’s Joy of Medicine Summit will be held at the Clunie Community Center in McKinley Park on Saturday, September 28 from 8 a.m. to noon. Our keynote speaker is Liana Lianov, MD, MPH, an innovative leader in lifestyle medicine and lead faculty member of the American College of Lifestyle Medicine (ACLM). She also currently serves as the Chair of the Happiness Science and Positive Health Committee of the ACLM. Her session, “The Power of Positive Psychology for Physician Health and Well-Being,” will explore positive psychology interventions for self-care and help attendees develop a personal action plan.

We will also have a presentation on “The Art of Medicine and the Mindfulness of Thought: The Simple Thread Woven into Scientific and Spiritual Discovery,” led by Daniel McCrimons, MD and Reverend James

By Aileen Wetzel, awetzel@ssvms.org

Trapp, JD. Dr. McCrimons is an author, pediatrician, and long-time member of SSVMS. Rev. Trapp currently serves as Senior Minister of Worship at the Spiritual Life Center, an interfaith unity ministry in Sacramento.

Their session will focus on how to create a satisfying experience that allows patients to feel heard and physicians to embrace the virtues 3rd Annual of the Hippocratic Oath.

Joy of Medicine The final presentation of Summit the morning will focus on September 28, 2019 “Organizational Strategies to 8 a.m. to 12 p.m.

Improve Physician Wellness.”

This session will feature a panel of physician leaders representing Mercy Medical Group, Sutter Independent Physicians, Sutter Medical Group, The Permanente Scan to Medical Group, UC Davis, and Register Now! Woodland Medical Group. The panel will share each group’s physician wellness strategies, successes and resources. Bring your walking shoes because the morning will conclude with a walk through the park and a tour of the McKinley Rose Garden.

Rajiv Misquitta, MD, chair of the Joy of Medicine Advisory Committee, will once again serve as emcee for the summit. Along with the featured presentations, there will be three “Lightning Grand Round” presentations from local physicians focused on taking charge, getting engaged, and also getting sleep. Attendees can expect a delicious and nutritious breakfast, terrific raffle prizes, chair massages, CME credits, and a chance to win one of several gift cards. Sacramento region physicians and medical students may attend the summit at no cost, but must register at https://tinyurl.com/y5jmxusy. Space is limited, so I encourage you to register early!

On behalf of SSVMS, I hope the 2019 summit brings you enjoyment, calm, focus, a sense of community, collegiality and support for your practice of medicine!

July/August 2019

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Record Turnout for CMA Legislative Advocacy Day Hundreds of MDs, Students Swarm Capitol

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turers and distributors of sugary/ soft drinks from using manipulative discounts to drive sales in low income communities, and Senate Bill 276, authored by State Senator and SSVMS member Dr. Richard Pan, which would limit the abuse of the medical exemption loophole for parents of unvaccinated children by requiring approval of exemptions by the California Department of Public Health. Another focus was advocating for Proposition 56 funds to be used for three years of Medi-Cal reimbursements. Prop 56, which increased taxes on tobacco products and was passed by the voters in 2016, generated funds to

increase Medi-Cal reimbursements but that money was instead allocated for different uses by the previous governor’s administration.

As medical students, we partner with our local physicians and medical societies not only to represent the views of the current and future physicians of the state, but to advocate for California patients. In my second year attending this event, I immediately remembered why I enjoyed this experience so much and why I had encouraged so many of my classmates to participate this time around. The energy and enthusiasm was uplifting, and the feeling of being involved in something

Photo: Lindsay Coate

he California Medical Ass­ o­ ciation’s Legislative Advocacy day had a record turnout at its 45th annual meeting on April 24th. I was fortunate enough to be able to join a group of 600 members of the CMA, including 140 of my fellow medical students, as we converged on the Capitol to advocate for or against important upcoming legislation.

Physicians, residents, medical students, and other stakeholders from all over the state came together to meet with their representatives.

Our efforts this year focused on supporting two key pieces of legislation: Assembly Bill 764, which would prevent manufac-

Mustafa Bahramand, MS III Mustafa.bahramand8181@cnsu.edu

California Northstate University medical students Pranav Sathe and Mustafa Bahramand, along with Richard Gray, MD, meet with Assembymember Jim Cooper (right) during CMA’s Annual Legislative Advocacy Day. 6

Sierra Sacramento Valley Medicine

Photo Courtesy CMA

greater than myself was extremely rewarding.

Legislative Advocacy Day is a great reminder that helping patients does not begin and end in the exam room, and that there is so much potential to do good on a level that affects millions of individuals. It is a valuable opportunity that brings the state’s most active physicians together to advocate on behalf of organized medicine and collaborate on ideas and strategies.

As fun and exciting as this experience is for the participants, it is also a very serious endeavor. The bills we address have the potential to significantly impact—for better or worse—the practice of medicine, our patients, and the overall health of Californians.

In a group including physicians and other members of SSVMS, our California Northstate University cohort of first- and second-year medical students met with our representative, Assemblyman Jim Cooper of Elk Grove. A separate group that included UC Davis medical students met with Assemblyman Kevin McCarty of Sacramento. We voiced our support for the bills in question and stressed our unique concerns as medical students, explaining that our future practice can be greatly affected by the legislative decisions of today.

In addition to the many meetings in legislative offices throughout the day, the CMA Legislative Advocacy Day events also included a keynote speech by Gov. Gavin Newsom. He expressed his interest and passion for health care and declared that he aimed to focus on health care much in the way that Gov. Brown had focused on climate change. Gov. Newsom even went as far as to state that he wanted to be known as

Physicians and medical students meet with soda bills supporter Assemblymember Kevin McCarty.

the “Health Care Governor.” These statements were met with appreciation and excitement from the crowd of physicians and medical students.

As has been the case in every experience I have had with state representatives, we were welcomed

and treated very graciously. We were made to feel like our concerns as medical students mattered and were taken seriously. This reassurance was very encouraging for our advocacy efforts and for our future involvement in organized medicine.

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July/August 2019

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Got Pain?

There Is No Magic Pill SSVMS’ Efforts to Address the Opioid Epidemic

By Mei Lin Jackson mjackson@ssvms.org

I

t is no secret that the nation is in the midst of an unprecedented opioid epidemic. While the media often focuses on headlines from the Midwest and East Coast, the epidemic is steadily growing throughout the West Coast, too. In 2017, Sacramento County alone faced 61 opioid overdose deaths, 157 opioid overdose hospitalizations and 207 opioid overdose emergency department visits. Furthermore, there were over one million opioid prescriptions dispensed to county residents, equating to approximately one prescription for every two out of three residents.

Physicians must play a key role in addressing the local opioid crisis. Therefore, SSVMS created the Rx Safe Physicians program, which is focused on increasing public education about opioid misuse, treatment and recovery, expanding the number of X-waiver physicians, and on improving access to Naloxone.

Through a grant awarded by the California Department of Public Health, Rx Safe Physicians has partnered with the Sacramento Opioid Coalition to bring together diverse stakeholders, including the Sacramento County Departments of Behavioral Health, Alcohol and Drug Services, and Public Health, Harm Reduction Services, law enforcement, health care providers at all levels, folks in recovery, and other community members from a variety of backgrounds who aim to prevent opioid misuse and abuse.

In collaboration with local pain management physicians, SSVMS has developed the “Got Pain? There Is No Magic Pill” poster campaign to encourage physicians and patients to explore a full range of options to address chronic pain.

The campaign is not meant to cut patients off from Mei Lin Jackson is a program coordinator at SSVMS.

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Sierra Sacramento Valley Medicine

their current opioid prescriptions. Instead, the goal is to keep patients opioid naïve (if possible). The “Got Pain” campaign emboldens patients to explore other ways to find pain relief in lieu of, or in addition to, their current prescriptions—because an empowered patient can prove to be a healthier and happier patient.

The poster lists complementary therapies, in both English and Spanish, such as nerve blocks, help for depression and anxiety, diet and exercise, and spinal cord stimulation. Additionally, it directs viewers to an online resource guide, www.sacramentoopioidcoalition. org/directory/, which details where to access these resources in the Sacramento region. The posters are

Over 1,000,000 opioid prescriptions were dispensed to county residents in 2017, or about one prescription for every two out of three residents. currently displayed in over 40 local pharmacies and physician offices.

If your office would like to take part in this poster campaign, please contact me at mjackson@ssvms.org.

We can provide you with multiple posters for your waiting and clinical rooms. For more information about our other efforts to combat the opioid crisis in our region, please visit sacopioidcoalition.org and follow @sacopioidco on Twitter.

This free poster from SSVMS and the Opioid Coalition can help you and your patients have productive discussions about opioids and complementary therapies. The poster is available for your exam room by contacting Mei Lin Jackson at mjackson@ssvms.org.

GOT PAIN? TIENE DOLOR?

?

There Is No Magic Pill No hay una pastilla mágica

HYDROTHERAPY

ASK ABOUT MEDICATED ASSISTED TREATMENT

HIDROTERAPIA

QUIT SMOKING

PHYSICAL & OCCUPATIONAL THERAPIES

DEJE DE FUMAR

STRETCHING, YOGA OR TAI CHI

TERAPIA FÍSICA Y OCUPACIONAL

MASSAGE

SPINAL CORD STIMULATION

UN MASAJE

ESTIRAMIENTO, YOGA O TAI CHI

PREGUNTA POR EL TRATAMIENTO ASISTIDO CON MEDICACIÓN

ACUPUNCTURE ACUPUNTURA

ESTIMULACIÓN DE LA MÉDULA ESPINAL

PURSUE A HOBBY AND/OR VOLUNTEER NERVE BLOCKS BLOQUE DE NERVIOS

BUSQUÉ UN PASATIEMPO Y/O ENCUENTRA OPORTUNIDADES PARA PARTICIPAR COMO VOLUNTARIO

HELP FOR DEPRESSION & ANXIETY AYUDA PARA LA DEPRESIÓN Y LA ANSIEDAD

RADIO WAVES

ABLACIÓN POR RADIOFRECUENCIA

DIET/ EXERCISE

PRACTICE RELAXATION & MEDITATION

COMPLEMENTARY COMPLEMENTARY PAIN MANAGEMENT PAIN MANAGEMENT

DIETA/ EJERCICIO

Manejo complementario del dolor

PRACTIQUE RELAJACIÓN Y MEDITACIÓN

Talk To Your Doctor About Non-Addictive Medications Hable con su médico sobre medicamentos que no sean adictivos

To access complementary pain resources in the Sacramento Region visit www.sacopioidcoalition.org/directory/

඘එ඗එඌ Sacramento County

sacopioidcoalition.org | facebook.com/sacopioidcoalition | @sacopioidco ssvms.org | facebook.com/ssvms | @ssvms

COALITION Together, We Save Lives

July/August 2019

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| OPINION |

A Wholesome Adventure

Lessons Abound in New Zealand

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his is such a wholesome bag,” said the woman at the airport after a cute beagle had sniffed with interest our day backpack that had contained some snacks and other residues. Her smile providing some context to this new word (and world) for me made my prodrome of embarrassment melt as she was going through all the unused plastic cutlery I had rescued from the plane as I was once again taken over by these attacks of determination to save the planet.

This was after a somewhat tedious inspection of all our hiking and camping gear (tents, poles, sticks, boots) after we landed in Christchurch. But I hadn’t minded this; as a real vacation I had decided to embark in a complete work email detox (which hadn’t happened in years) and this meant not worrying about time and its straightjackets we call schedules and deadlines. Plus, we had skipped Friday because of the time zone change, so travelling in the future makes you want to be ahead in terms of progress, evolution, consciousness.

I couldn’t wait to finally leave this treadmill of modern life for two and a half weeks and indulge with my family in an overdose of awe in New Zealand’s natural, bountiful beauty. It had also become neces-

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Sierra Sacramento Valley Medicine

sary to turn off the hyperactive outrage alarm of my activism pager, and switch my cognitive settings to positive, open-minded, Zen perspective. A fantail flew above our heads as we were heading out of the airport, and I immediately liked the fluidity of the environment, so welcoming to all its inhabitants.

It would be challenging to not disconnect from the toxicity of billboards we see back home when

By Caroline Giroux, MD cgiroux@ucdavis.edu

adaptation, by then the pace for seeking sensation has slowed down enough, hibernating, to allow a serene, expectation-less appreciation of life. The reality is devoid of the usual clutter of our procedures (no liability form to fill out to do luge in Queenstown, so all the brain power is available to admire the view and the low-hanging clouds nonchalantly floating lower than the mountains like scarves). Your

Near the Moeraki Boulders, a sign reminds drivers to slow down: “No doctor, no hospital, one cemetery.” a village of sheep with a snowcovered mountain as a background becomes a common sight. Or when cows grazing casually by a river seem to provide encouragement as we are hiking to Aspiring Hut, not being able to keep up with three women and their toddlers or local bikers. The numerous species of fern (some of which cover trees and help those that can’t grow many roots in granite stay hydrated) create a fairy tale-like scenery.

It is impossible to experience boredom in such a diverse landscape, while hearing melodious and foreign birdsongs. And even when it becomes the new norm and puts you at risk of hedonic

mind stays awake as it is tickled by the local sense of humour: as we drove through a small town near the Moeraki Boulders, a sign reminds drivers to slow down: “No doctor, no hospital, one cemetery.”

The “leave no trace” rule seems Utopian when we engage in a nomadic, hippie-like journey, hopping from holiday park to camping, to hut, or boat, but the scarcity of rubbish cans forces us to realize the horrendous amount of waste we produce each day and makes us more mindful of the importance of the 6 Rs: Refuse, Reduce, Reuse, Repair, Recycle, Rot (there are variants of those Rs, such as “Rethink”).

Surprisingly, litter seems extremely

Photos by Caroline Giroux

New Zealand’s Doubtful Sound

rare in New Zealand, so it is possible to follow that algorithm and lead a frugal lifestyle, with judicious use of resources. I was glad to have rescued those adorable plastic containers from the plane, to put olives in for lunch during a day hike, or the tiny jam container from the boat as a small enough receptacle for night cream and meeting constraining carry-on luggage requirements (even though some of my kids made continuous fun of my soft hoarding tendencies). And “petrol” is about four times as expensive as at home (the way it should be), and as you might know, Kiwis have universal health care!

I was pleased to observe that words were written the British way, like “centre,” “programme,” “litre,” “metre,” “flavour,” and “theatre,” which made me feel even closer to home and my native French

Canada. Culture is this thing you didn’t know you had until you get cut out from it. I was glad I had taken some good habits with me, such as my Contigo bottle for hot liquids, as my morning tea kept me warmer during the rather fresh, mindfulness-inviting mornings of the autumn. I came to appreciate eating whatever was left until we would find a grocery store and the communal kitchen of our next holiday park to store the food, even though the combinations seemed odd, not to say heretic: instant noodles, a can of beans (excellent source of “fibre”), apples, water, cheese, and the sublime Whittaker’s chocolate. But then, everything tastes sublime when you picnic with a view of a glacier.

I was so inspired by the effort at reparation of trauma from colonialism by seeing how the Maori

culture seems well integrated. Many quotes and proverbs are displayed in the original Maori language and my soul was delighted from the contemplation allowed by such poetry. The legacy of their culture is not only present in museums but in this vibrant, eclectic and progressive society, which seems to strive for diversity on all levels of the ecosystems and not just the flora, which makes so much sense to me.

I wish all civilizations of this world could acknowledge the potential for resilience and creativity that is inherent to biodiversity among human creatures. Heterogenous societies have a multiplicity of perspectives, hence a better ability to adapt and evolve.

I had many reflections about sustainability and how it is not only desirable and necessary, but also a

Continued on page 12

July/August 2019

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Maori art at the Otago Museum in Dunedin

good sign of life balance. In the medical profession, we often have a hard time putting our lifestyle prescriptions into practice, but not caring about our carbon footprint as we exit from a take-out restaurant with our meal in a Styrofoam container and plastic bag, not being able to reduce waste based on the excuse that we are working long shifts is an indication that this is not 12

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a healthy rhythm (for us, for our patients, and for the planet) to begin with.

Medicine is full of opportunities to reduce waste as well and we should encourage “bring your (reusable) bottle or mug” meetings instead of providing plastic bottles, for instance. We should advocate for work spaces with windows and access to greenery, natural light and breaks to get fresh air outside throughout the day.

During our daily walks (we hiked on average of 4-6 hours per day in various areas on the South Island among the 3,500 km of road travel), I felt so energized, with the feeling I could have walked even more. I should thank the phytoncides, these fragrances emitted by plants and trees, apparently known to decrease inflammation while boosting our mood and immune system.

Instead of being in a complaining mode, I decided to let myself admire and be inspired by what other parts of the world are doing well or better. Change will happen incrementally, but we can try to do something every day for our world and it doesn’t have to be complicated. In fact, one of the sustainability principles is “enoughness,” and I was content with our reusable jute bags bought at the grocery store as a legitimate souvenir from New Zealand. They are not only “wholesome” and rustic, but they will bring such good memories while I can continue to use them in our life here.

Indeed, we were building precious memories together. I often try to imagine what it is like for our kids to see their parents rush in the morning to go give a talk or come late at night to sit down for yet another “shift” in front of a laptop to finish notes. But instead of that frantic routine, they finally saw me not caring about wearing the same pair of leggings (so comfy and perfect travel clothes, by the way) three days in a row or repeating “Dunedin” until my oldest, with the overconfidence that comes from entering the pre-teen phase, swore I had no idea how to pronounce it (none of us did, really).

We enjoyed teasing each other about our respective neuroses. I journaled like I usually do, with the added flavour of being out in the open, among boulders, in the forest or inside a boat on Doubtful Sound when it was raining, or coming back from a glowworm cave expedition, my head full of those rosary-like chandelier beads produced by those surreal worms, as bright as the ecstatic Milky Way we got to smile at, the moon with its pearl head upside down in the opposite side of the world, taking in a wholesome landscape of harmony to create a brighter future.

July/August 2019

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THE BLOOD TRAIN

Western Pacific’s Bloodmobile on Rails Saved Countless Lives During the Korean War, and It May Be Back

T

he Western Pacific Railroad was famous for its Feather River Route, which wound through the Sierras to connect Oakland with Salt Lake City. Located along that historic route at the Western Pacific Rail Museum, in the scenic Plumas County town of Portola, is a unique railroad car that helped save the lives of countless GIs in the Korean War. The Charles O. Sweetwood rail car rolled across the western U.S. and collected over 25,000 pints of blood for This article is a project of the SSVMS Historical Committee and Museum. Research on the Sweetwood car and the history of blood collection was done by Kent Perryman, Ph.D and Bob LaPerriere, MD. This article is based on “A Higher Calling,” a wonderful history of the Charles O. Sweetwood car by Eugene Vicknair of the Western Pacific Railroad Museum that can be found at wplives.org. Assistance for the story came from the California State Railroad Museum. A special exhibit on railroad hospitals and doctors is featured through the end of the year at the SSVMS Museum of Medical History.

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wounded GIs through a novel collaboration between Western Pacific and the American Red Cross.

Sweetwood, an Elko, Nevada native, had re-enlisted in 1950 for his second stint in the U.S. Army and was sent to the Korean Conflict as a field medic in the 7th Cavalry Regiment. On September 8, 1950, Sweetwood was killed in action while helping wounded comrades under fire.

A former carman for Western Pacific, Sweetwood was the first member of the WP family—and the first Nevadan—to be killed in Korea. He was awarded multiple honors, including the Purple Heart.

During the height of the Korean conflict, Western Pacific’s public relations director, Gilbert Kneiss, began promoting a collaboration with the Red Cross to collect blood on a rolling rail car, according to the museum’s Eugene Vicknair. The Red Cross had become instrumental in providing aid for soldiers in WWI and was called upon to collect millions of pints of blood for the armed forces before the outbreak of the Second World War, just a few years after blood was first banked for transfusions in 1936.

The rapid infusion of blood, which had been discovered as the key to treating shock, had become an essential

life-saving measure on the Korean battlefield. Sweetwood himself had saved a childhood friend’s life twice as a medic in Korea by using techniques that included infusion.

The Red Cross’ effort to collect blood for the war effort was especially suited to partner with the railroad. Western Pacific’s Eastern Division Superintendent’s Car 106 (a former Pullman executive observation car) was chosen as the candidate for the rolling bloodmobile. Rail had often been used for transporting military supplies, but a traveling blood collection vehicle had never been tried before.

In honor of his heroic wartime performance and sacrifice, the blood procurement car was christened the “Charles O. Sweetwood” on January 10, 1951 at a ceremony in Oakland. Ironically, in 1946 one of the tasks of a newly hired WP carman was to take care of the car—previously known as the “Davy Crockett”—as it was used by a railroad superintendent.

Above: Donors, including a member of the Paiute-Shoshone tribe, wait during the car’s dedication in Sweetwood’s home town of Elko. Below: Blood is transferred to the California Zephyr for delivery.

The carman’s name was Charles Sweetwood.

During the subsequent collection process by Red Cross volunteers and nurses onboard the car, whole blood was transferred to the California Zephyr passenger train where it was stored in the lounge and dining car freezers before continuing on for processing at Cutter Laboratory in Richmond, California. The Charles O. Sweetwood military blood procurement car collected enough blood to perform over 2,100 complete transfusions during its service from January 1950 until it was decommissioned in November 1953.

A member of Sweetwood’s family, often his mother, was on board the train for nearly every one of the 28,488 miles the car traveled over 11 railroads across Nevada, Utah, Colorado and Northern California to accomplish this humanitarian feat. The train made its way from town to town and often faced severe weather and the threat of becoming snowbound. In 1951, George N. Swallow and Irwin Fehr, two Continued on page 16

July/August 2019

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Blood transfusions between dogs were done as early as 1665, but the first successful transfusion between humans didn’t take place until 1818.

Although blood typing began in 1907, it wasn’t until 1935 that doctors at the Mayo Clinic first used stored blood for transfusions. Unfortunately, it wasn’t until five years later that the rH factor that had killed many blood recipients was discovered.

The nation’s first blood bank had been established at the Cook County Hospital in Chicago in 1937, and at the outbreak of World War II the American Red Cross was called upon to collect millions of pints of blood for armed forces members.

Blood had been collected into glass vacuum bottles at that time, but plastic containers developed in 1948 by Dr. Carl W. Walker allowed for easier transport and shipping. These new, more portable containers were key to enabling the Charles O. Sweetwood car to travel the West and collect over 25,000 pints of blood to support troops overseas.

All photos courtesy of the Feather River Rail Society from the Western Pacific Railroad Corporate Archives/Kenneth J. Meeker Collection

volunteer pilots, risked their lives by flying blood from a snowbound train to Elko through heavy weather. The blood arrived safely and would have deteriorated had it not been delivered immediately.

The Charles O. Sweetwood car was eventually purchased from the Western Pacific Railroad and fully restored with help from the American Red Cross and the Feather River Rail Society. The car was rededicated in honor of Sgt. Sweetwood on September 9, 1984 and relocated to the Western Pacific Railroad Museum in Portola, where it is available for viewing today.

Vicknair said that in 2017 the Western Pacific Museum received a visit from the last known surviving Red Cross nurse who worked in the car. The museum is seeking to do a total restoration of the Charles O. Sweetwood car at an estimated cost of $1.4 million, and the Red Cross has indicated interest in using the car again once it has been restored.

For more on the Charles O. Sweetwood car and pictures from its journey, visit A Higher Calling on the Western Pacific Railroad Museum’s website at wplives.org.

Left: Donors were allowed to rest in the car’s Pullman beds after donating blood. Above: Western Pacific porter Lewis Griffin was on board the Charles O. Sweetwood car for nearly its entire journey, and many nurses worked long stretches.

Together, transforming lives Vitalant* (formerly BloodSource) works with our healthcare community to change lives. Whether it’s with a blood donor in the donation chair or the Vitalant physician consulting by phone with a critical care physician or in our laboratories developing the precise blood component needed by patients, we are an important link in life-transforming communities. *pronounced vye-TAL-ent

Join the Vitalant community! Visit vitalant.org or call 877.258.4825 (877.25VITAL)

July/August 2019

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Call Me Ash

Ash Raina, MD is on a mission to treat student-atheletes with concussions as students first, athletes second

By Ken Smith ken@kdscommunications.com

C

all him “Ash,” not Dr. Raina, because that’s what he prefers his patients—even little kids—call him.

One of a handful of pediatric neurologists in the nation, he is on a mission to rewrite the protocols used to treat the 300,000 concussions children and teens experience each year.

In the meantime, he can also choreograph a Bollywood routine for you.

A little over two years ago, Dr. Ash Raina opened his private practice in Rocklin. Built around the motto of “Care, Collaboration, Community,” the Center of Excellence for Pediatric Neurology incorporates art and music into treatments. The clinic is designed to revolve around the child and to be more of a gathering place than the typical medical office.

“If a child is not ready for an exam room, we’ll walk outside or I’ll see them in the reading corner, or we’ll walk and talk,” he explained, noting that his office includes a library where children can quietly read or take books home that have been donated by families.

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Making books available to children who might not have access to a library is important to him, and it also gives his 10-year-old daughter Avantika more incentive to come to work with him when she is off from school.

When the exam room is used, a computer is conspicuously missing. He never puts notes in while he is with his pediatric patients and waits until later in the day.

“Part of pediatrics is being on their level, and being on the carpet with them, watching them,” Ash said. “I cannot be taking notes and have a meaningful conversation with the family at the same time.”

Ashutosh Raina, 44, was born in the northern Indian state of Kashmir in the shadow of the Himalayas, where he went to a school funded by Mother Teresa that she visited frequently. Terrorism from the ongoing border dispute over Kashmir between Pakistan and India led the family to move to Mumbai, where he entered medical education at age 18. He had been a choreographer in school and taught Bollywood dancing, but it was made clear to him that wasn’t a career path.

| PROFILE | and let them see you are the same.”

He builds relationships by giving patients and their parents his personal cell number, something he says has never been abused.

He uses social media to proudly keep them updated on his family that includes wife, Reetu Sharma, MD, a Roseville cardiologist and author of a children’s book, Uneek, about a tiger who seeks the stripes he was born without. Ash believes his frequent use of social media strengthens the connection he has with his patients’ families because they see him as a member of the community, not just a doctor.

Burnout “A Moral Injury” The road to his practice has not always been easy, and he has taken an interest in physician burnout because of his own experiences.

“It is what many physicians are

talking about now as ‘moral injury,’” he said of the stress that can come from starting a new position in medicine. “You start feeling you are unable to take care of patients completely, the way you want it. My first burnout taught me that.

“I was working too hard, but I did not see fulfillment at the end of the day. Patients were dying and I was seeing life a lot differently— I was a young attending at the time—and that taught me that I cannot save everyone if I cannot save myself.”

He later experienced a second episode brought on by a similar lack of fulfillment that he said was caused by a need to do more than see patients in a large medical group setting.

“At some point I think I started feeling that all I did was make Continued on page 20

Photo by Lindsay Coate

Ash came to the U.S. at age 24 and settled in Stockton, where the cardiologist uncle who had sponsored him practiced. Soft-spoken and introspective, Ash explained that an experience he had while working as a pharmacy technician shaped his approach to medicine and much of his life. Just after the 9/11 attacks, a woman at the pharmacy told him she didn’t want medicine from him and it made him realize how people’s prejudices shaped their behavior, even to the level of from whom they would receive lifesaving care and medications.

“The only way to destroy stereotypes is to meet people and show them who you really are, and they will see you are the same,” he said. "You work on forging relationships that no stereotype can ever undermine. The only way that can happen is if you open your doors

Ash tests the reactions of Sophia Bailey, who received a concussion in a lacrosse game. Sophia was still showing some effects from the concussion two months after her injury. As part of his “Return to Learn” protocol, Sophia received extra time at school to take tests and had her homework limited as her cognitive abilities returned.

July/August 2019

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money for myself,” he said quietly. “I went to work nine to five, I was making good money, but I was not really paying back in any way.”

That was when he reached out to the Child Abuse Prevention Center. “I had done enough for my bank, I wanted to do something for my soul,” Ash said. He is working to stop the cycle of abuse that afflicts so many families from generation to generation.

Return to Learn Many of the concussions he sees have been suffered by student athletes, who have historically been treated with the goal of returning them to their sports. Instead, Ash uses a protocol he calls “Return to Learn,” which places a priority on modifying their schoolwork and testing while they recover their cognitive skills.

St. Francis High School student Sophia Bailey, who along with her mother agreed to tell her story, received a concussion when she was hit in the head by a lacrosse ball during a game. She required two months to be cleared for her concussion. Ash often sees patients such as Sophia weekly as they recover, and he performs regular cognitive and balance tests to chart their recoveries.

“That’s what people don’t realize,” Ash said. “The typical protocol in many places is still that you go to a doctor, and the doctor is going to tell you, ‘Take off for a week and then you can go back.’ And that’s not how it works. So many of these kids have concentration issues.

What we are trying to do is return to learn before return to play.”

Ash said it is important for coaches and physicians to realize that these patients are students first and athletes second, and that a discussion about the ability to retain information is an important part of the patient’s care.

He calls the recovery protocol Return to Learn, with the focus on recovering a student’s ability to learn rather than how fast they can return to the field. While under the Return to Learn protocol, students may have limited attendance at school, have homework reduced, and be granted extra time for tests until he clears them.

St. Francis High School, where Sophia is a student, uses a test known as ImPACT to provide a baseline memory test that is valuable for assessing the extent of a concussion and the patient’s progress.

“I’ve been taking the baseline since I was in sixth grade, because I had been playing in a club every year 20

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Reetu Sharma, MD, Ash’s wife, is a Roseville cardiologist and author of a children’s book.

where I had to take that,” Sophia said, explaining that the tests provided results that could be compared to those following a concussion. “At St. Francis, I had to do it in my freshman year and then my trainer had me take it again in April (after her injury). Everything was kind of the same, but my reaction rates were lower.”

Let’s MeSH (and Dance!)

Ash believes the next area of focus will be subconcussions, the smaller but repeated hits that some athletes take and that are suspected as a cause of CTE, the degenerative brain condition that has affected so many NFL players. The general advice he gives athletes and their families is simple: “When in doubt, sit it out.”

Ash joined the SSVMS Board of Directors this year, and his top priorities include increasing awareness of proper concussion protocols and ensuring that trained athletic trainers are on the sidelines for all youth sports to help spot concussions. Another is bringing health care to inner city children.

“When people tell me they went to India or to a thirdworld country for a free clinic, my question has always

been, ‘What about Sacramento?’” he said. ”We as physicians aren’t targeting those schools. A girl I saw came from an inner city school, and the school had no knowledge about concussion protocols. She is at a disadvantage. She is being discriminated against because of a lack of knowledge.”

One of Ash’s latest undertakings is a program called Let’s MeSH, in which medical providers, school officials and parents meet to coordinate care for kids with ADHD (MeSH stands for medical, school, home). Seventy families showed up for the first session two months ago, and the discussion started with the

signs of ADHD and how it doesn’t mean you are a bad parent.

Characteristically, Ash started the meeting—joined by parents and school officials—on the dance floor doing “the floss.”

“I’m not afraid to make fun of myself,” he said. “I always tell people, even in my clinic, that when you’re coming to me do not look at the white coat, if I’m wearing a white coat that day. You’re looking at a dad first, you’re looking at a neurologist second.”

Ken Smith is managing editor of Sierra Sacramento Valley Medicine.

100 Iron Point Circle, Folsom, CA Ideal for medical practice 2100 sq. ft. Rent+CAM charges, $3.00/sq.ft.

Contact Tom Lewis at 650-208-8624 or turtle924@hotmail.com Ash has earned an orange belt in Taekwondo. “It was my 10-year-old who pushed me into this. There is something about this sport which brings out the beast in her and makes her nasty. Seeing her do those forms and take those challenges motivated me to push my own ceiling. She was happy and proud today. She said, ‘Papa, you did good!’”

•Visible building in attractive office park •Easy access to US-50 •Security & fire systems •Lots of Parking •24/7 access •Built in 2002 •WiFi

•Independently controlled HVAC •Campus fitness center •Attractive landscaping •Building shared with dental practice and financial services company

July/August 2019

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Physicians for a Healthy California

New Solutions to Expand Access, Address Chronic Physician Shortage

I

t’s not the CMA Foundation that you used to know!

The “public health arm” of the California Medical Association has gone through a seismic transformation over the last two years, and we’re only getting started.

We’ve got a new name (Physicians for a Healthy California, or PHC), a dynamic new president/CEO in Lupe Alonzo-Diaz, a revamped board of directors, a growing staff, and an exciting new set of multimilliondollar projects that puts physicians at the front of the effort to address health access and disparity issues in our state.

These projects fit well into the mission statement that PHC adopted over a year ago: “PHC is dedicated to improving community health, growing a diverse physician workforce, and promoting health equity.”

The chronic physician shortage in our state is well recognized, and PHC’s new programs will create real solutions to expand access to physicians in the communities that need it the most.

These projects were made possible by Proposition 56, which was passed by voters in 2016. CMA led a coalition of parties to create and pass the tobacco tax initiative.

CMA included two provisions in Prop. 56 that target funds to fuel our efforts to expand California gradual medical education (GME) residency programs and help pay down student loan debts for physicians who serve the underserved.

$40 Million to Fund Residency Training

Recognizing the demand to train more physicians in California and keep them in the areas with the greatest need, Prop 56 allocated $40 million to fund residency training in the state, mostly those in primary care and emergency medicine. PHC is contracted to administer these funds, and the priorities for granting them include 22

Sierra Sacramento Valley Medicine

By Adam Dougherty, MD apdougherty@gmail.com

a preference for new residency positions in underserved areas.

Named the CalMedForce Program, a board and advisory council comprised of subject matter experts were tasked with steering the funds. In all, 131 programs requested $147 million to expand their numbers, and PHC ultimately awarded $38 million to 73 residency programs supporting 156 residents. Of these, 82 are brand new residency slots.

Clearly, there is an even greater need in California than we can answer. While initially a one-time allocation, we are thrilled that Governor Newsom’s 20192020 budget includes this funding as an ongoing appropriation.

Up to $300,000 Available to Pay Debt

Prop 56 also allocated $220 million to assist physicians and dentists with significant student loan debt who are committed to serving Medi-Cal beneficiaries. The CalHealthCares Loan Repayment Program payments will be made to awardees who are accepted over a five-year period, so the program actually extends to 10 years to assist those chosen in the fifth year. Individual awardees are eligible to receive as much as $300,000 to repay educational debt incurred in pursuit of a medical or dental degree.

The first cycle attracted more than 1,200 applications from physicians and dentists who agreed to see more of California’s 13 million Medi-Cal patients in exchange for repayment of their student loans. In all, requests totaled more than $300 million, and the 2019 awards will be announced by June 30. We received even more good news to help meet this need, as Governor Newsom’s revised 2019-20 Budget proposes an additional $120 million for loan repayments.

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| ESSAY |

It’s OK to T

Not Be OK

he stone walls begin to shift inward and the water continues to rise. The exit, high up on its ledge, is still in view. I don’t know how we got here or how it got this far, but I do know we have to get out. All of us.

Think Britteny, think! You can figure this out.

Of course! As the waters rise, we can float to the top and reach the exit. But what about the walls? What if there isn’t enough time to get everyone out?

I watch as each member of my family heads for the exit and heaves themselves up onto the ledge. Time is running thin and the water is now nearing my chin.

The water’s pace seems to quicken and the walls move increasingly closer. I reach for the ledge and pull myself upward as the water engulfs my body.

I don’t think I can make it, the force is too great.

With every bit of strength that I can muster, I push through the wall of water and land on the dry ledge.

My mother helps me stand as I look back to see a wall of water, like glass, separating me from my previous terror. Not everyone is here, I can feel it. Then the realization of my father’s absence overwhelms me.

Dad is still in there. You have to get him out!

I see him struggle for air as the stone walls fight to move closer in and the water reaches maximal capacity.

I try to reach back through the water wall, but I can’t.

My hands abruptly stop as they hit the clear barrier. I am helpless. I can do nothing to save him. I must watch as the man who raised me, loved me, and would die for me, now struggles for life before my eyes.

My mother’s calm voice rings in my ear, ripping my attention away from the horrific scene before me.

“Britteny, you have to let him go. It’s all right. You must let go.”

My eyes spring open as I struggle to regain consciousness. I take a few deep breaths and lay on my back looking at the empty blackness above me.

It was just a dream.

Another night of restless sleep. Another nightmare.

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By 2LT Britteny Randall, USAR, MS III britteny.randall1453@cnsu.edu

Another crushing sense of despair as reality sinks into my now conscious mind.

Your dad is dead and he’s not coming back.

The words sting like venom as I tightly close my eyes and the tears begin their descent down my cheeks to my pillow.

Stop. Britteny, you must put this away for another time. You have a test tomorrow. You can’t think about this right now. Focus on the task at hand. What would your dad want you to do?

I turn back on to my side and run through the various reproduction drugs locked in my short-term memory until the line of conscious thought and sleep begins to blur.

It has been three months since my father’s desperate fight with illness came to an end. I stood helpless as my father was ripped away from me five days after his 54th birthday. I often catch myself trying to place external rules like “fairness” on life’s recent challenges, as if they hold any sway.

This isn’t how it’s supposed to be. He was too young.

I am too young.

My role as a concerned daughter with caregiving responsibilities has been replaced by a simple student trying to balance the pressures of medical school with grief and a new questioning of life’s priorities.

My studies have become mere tasks necessary for a greater end. Devoid of passion, I drudge through my medical school education in the hope that I will feel “something” again. I think of my father, his pride in my accomplishments thus far and his deathbed pleas for me to change the world through medicine. I know I once felt this same passion for medicine too, but right now I feel lost.

I’m tired of feeling nothing. I’m tired of suppressing my emotions due to inconvenience only to be strangled by them when I’m alone, vulnerable. I’m tired of being haunted by flashbacks of his lifeless body and final

breaths as unresolved grief manifests in my dreams.

And how will I maintain this composed facade when I am forced to work where I spent my darkest days? How will I offer hope and support to patient’s families as they stand where I stood only six months prior? Will I truly be able to suppress my emotions when I’m surrounded by the hospital staff who revealed my worst fears?

The pressure to overcome my grief grows with each day as I prepare for third-year clinical rotations, but I am only human, bound by the constraints of my own emotional intelligence. Time may lessen my sorrow, but bereavement is not linear and does not succumb to one’s own will-power, despite my greatest efforts.

My mother often reminds me that it’s okay to not be okay. Life has a way of bringing us to our knees no matter how hard we fight to stand. Perhaps this is God’s way of humbling us in our hubris, reminding us of our weakness and inevitable end. Or, perhaps falling to our knees isn’t a weakness but rather an epiphany of selfrealization and perspective.

I miss my father. He had a simplicity that suggested humble beginnings, yet displayed a deep understanding of human emotion and suffering which he used to comfort and inspire others. He maintained a positive attitude even when times looked bleak and offered sound advice when I needed guidance. Now he is gone, and with him, his wisdom and comforting counsel.

Like most young adults, I feel like a child trying to navigate an adult world. I must now create a future filled with his absence. He will not see me fulfill my 18-year dream of becoming a physician and my children will never know him. I will never hear his voice again except through the memories I hold dear. I miss him and

Britteny and her father, Vance J. Graves

am devastated by a future without him, but this is my life. This is one of many likely moments in life that will bring me to my knees and no amount of forced smiles, passed tests, or necessary suppression will change that.

I am not okay and it’s okay to not be okay.

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Colorectal Cancer Best Prac�ces CME Michael Po�er, MD, UCSF Sierra Sacramento Valley Medical Society

CMA House of Delegates Disneyland, Anaheim, CA To RSVP contact Mei Lin Jackson at mjackson@ssvms.org or (916) 452-2671.

July/August 2019

25

| SCIENCE AND TECHNOLOGY |

Study Smarter With Spaced Repetition

Use Your Brain’s Natural Learning Process

By Elijah Abramson, MS IV elijahabramson@gmail.com

P

re-clinical medical education demands rapid mastery of voluminous amounts of curriculum.

I recall studying 200 total flashcards for an undergraduate biology final examination. But in my first and second years of medical school, I would regularly study 500 to 600 flashcards per day.

For my two pre-clinical years, the number of unique flashcards reached 5,000 per semester and more than 20,000 in total. The vast number of items to remember is a huge challenge of a medical education. With this in mind, my personal experiences in medical school have convinced me that spaced repetition should be a requirement—not an option—in medical education.

(Disclaimer: I am a fourth-year medical student and not a physician of 20 years with extensive research.)

Spaced repetition involves revisiting a fixed amount of material on a regular basis over an extended period of time. This approach to learning takes advantage of the “spacing effect,” which is how the human brain naturally stores information: by learning through repetition over time and building stronger neural connections.

It is a process that is used early in our education, such as how it is ingrained that children should 26

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repeat their times tables until the facts become muscle memory.

In Outliers, Malcolm Gladwell famously claimed that 10,000 hours of practice was required to master any skill or field. But while that number has entered the popular culture, less known is that he specified that those hours be spent using deliberate practice, which is a focus

deciphering which material was necessary to study and determining how best to study that material. The stress caused by both elements was not fun.

A benefit of California Northstate University College of Medicine is that the exams in preclinical years are based upon questions written by the National Board of Medical

Spaced repetition is a biological process that works on all animals, not just humans. on ensuring that time spent working on a skill is time well spent.

Spaced repetition is a form of deliberate practice.

A 2007 study led by Helene M. Sisti at Rutgers University found that learning over time enhances memory and the survival of new neurons. It is a biological process that works on all animals, not just humans. The study found that neural longevity in the hippocampus of rat brains improved significantly with spaced repetition. A good memory is essential to physicians as a tool that increases both effectiveness and efficiency.

At the beginning of my first year of medical school, I felt overwhelmed by the volume of material that was required to master each exam. The biggest challenges were

Examiners—a board whose mere name instills anxiety in medical students for obvious reasons. I am grateful that the school’s faculty took this approach because it helped decrease stress in ferreting out which material is necessary to study, and I know from anecdotes from other students that not all medical schools follow this model.

I am also extremely grateful for intelligent and compassionate classmates who readily shared successful study strategies with me.

Unfortunately, determining exactly what to study does not relieve stress related to how to study this material. Enter Anki, a spaced repetition software program that allows individuals to study flashcards in an organized manner at intervals that promote learning.

A flash card created in Anki, which uses spaced recognition to assist learning.

The benefit this type of app offers medical students like me is priceless.

Creating a platform with which to study thousands—or tens of thousands—of flashcards is something that no person can feasibly do by hand and maintain sanity, but a computer program can do it easily.

The main drawback of Anki is that there is a steep learning curve involved in utilizing the program and creating flashcards is not nearly as simple as doing it by hand.

While there is currently minimal research on the value of spaced repetition in a formal setting, my research in an informal setting (i.e. reviews and comments shared on the internet as well as anecdotes shared with me personally) has led me to believe that those using Anki tend to score higher—often substantially higher—than the national average on board exams. This informal research has also led me to believe students using Anki perform better on medical school exams.

There is also a value to spaced repetition in medical education

that is more difficult to quantify but significant: student well-being.

There is research aplenty regarding the unique mental health challenges medical students face and in my

experience, Anki’s most valuable benefit was decreasing my levels of stress. Physicians (and those in training) love to use a 0-to-10 scale to quantify pain; to use that scale in the setting of medical student stress, I would estimate my level of stress prior to Anki as at least a 6. After Anki, it’s more like a 2.

I firmly believe that teaching spaced recognition techniques and their use should be required in medical education. I sincerely appreciate how my classmates (three, in particular) encouraged me to take this approach to learning seriously and that there is software available that makes it work to its utmost. Spaced repetition has became a large part of the engine in the vehicle I am driving to navigate medical school, and I know other students can benefit from it as much as I have.

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Patty M. Estopinal, CIMA®, CDFA 916-783-6554 . 877-792-3667 pattyestopinal.com | pestopinal@rwbaird.com

©2018 Robert W. Baird & Co. Incorporated. Member SIPC. MC-237590.

July/August 2019

27

Join the Sacramento Medical Reserve Corps Support Public Health and Emergency Operations

By Lynn Pesely

By George Meyer, MD peselyl@SacOES.org geowmeyer@icloud.com

A

fter the events of September 11, 2001, the U.S. Surgeon General’s Office initiated a program to establish Medical Reserve Corps across the nation. The Sacramento Medical Reserve Corps (SMRC) is a program of the Sacramento County Office of Emergency Services and is called to action to help with emergency response efforts in Sacramento County and beyond.

The SMRC was the forty-second MRC to be formed of the 1,000 now in operation across the United States.

When the SMRC is activated for emergencies, its acti-

A SMRC volunteer carries an automatic defibrillator to a first aid station.

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Sierra Sacramento Valley Medicine

vated members are covered by the state as California disaster service workers and by Sacramento County for insurance purposes.

The SMRC contributes throughout the year to the Sacramento County Public Health Department by staffing flu clinics and training to support the department in the event of a public health emergency. Our members provide first aid at large public events including the Capitol Air Show and the California International Marathon. We also staff tables at emergency preparedness fairs and the California State Fair, where we distribute emergency preparedness and SMRC program information.

The SMRC has also helped to provide medical care at shelters for people displaced by flood and fire or affected by extreme weather. For example, our members were active in the Camp Fire response effort by providing medical care at shelters in Chico and by helping the Sacramento County Coroner’s Office process remains from those lost in the fire.

Some of our members were activated in New Orleans and the Mississippi Gulf Coast for Hurricane Katrina.

Other medical reserve corps were activated to support the New York City flooding after Superstorm Sandy. A major earthquake in California could cause activation of medical reserve corps in places not affected by the earthquake.

The SMRC offers training opportunities that include membership meetings and participation in exercises with emergency response partner agencies including law enforcement, fire departments and hospitals.

Training topics include CPR for the professional, first aid, psychological first aid, radio communications, Coroner’s Office, moulage to simulate injuries, and more. Our May 2019 training was “Stop the Bleed,” which taught lifesaving bleeding control techniques and

Photos courtesy of Sacramento County Office of Emergency Services

Sacramento Medical Reserve Corps members prepare to staff a large public event in conjunction with emergency agencies. The team consists of a variety of medical professionals including physicians, nurses, PAs, EMT and others.

offered a chance to practice wound packing and using tourniquets. A national bleeding control training course, “You Are the Help Until Help Arrives,” is available free online at www.ready.gov/untilhelparrives. The course is designed to educate and empower the public to take action in emergency situations and provide lifesaving care before professional help arrives.

Come be part of the action, have some fun and make a difference in your community! The SMRC welcomes medical professionals including MDs, RNs, LVNs, PA’s, and EMTs, as well as students and support members without medical experience who are age 18 or older.

The SMRC meets at 6:30 p.m. on the third Tuesday of

each month, usually in the auditorium on the first floor of the Shriners Hospital, 2425 Stockton Blvd., across from the main UC Davis hospital. Parking is free in the garage. Anyone wishing to attend any of these activities is invited to RSVP to Lynn Pesely at peselyl@sacoes.org.

For more information and to apply to be a SMRC member, visit www.SacMRCfoundation.org. We hope to have you on board as an active SMRC member soon!

George Meyer, MD is a retired Sacramento gastroenterologist who donates medical care services to several clinics and organizations and is a volunteer with the Sacramento Medical Reserve Corps.

July/August 2019

29

| BOOK REVIEW |

UNACCOUNTABLE:

A Call for Transparency in Health Care

By Gerald Rogan, MD jerryroganmd@sbcglobal.net

T

he Shah of Iran needed a splenectomy for his blood cancer. His team engaged the man many considered the “best surgeon in the U.S.,” the renowned Dr. Michael DeBakey. Even though he was not an expert with splenectomies, DeBakey operated. He failed to place a drain into the splenic bed. Pancreatic fluid leaked out, leading to infection and sepsis. In a few months, the Shah was dead.

The death of the Shah is one of several similar stories Marty Makary, MD, tells in his 2012 book Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care. Makary includes his own story of how his disillusionment with medical education drove him to drop out of medical school to study public health, then return to become a surgeon with an emphasis on quality improvement.

A nationally known expert, Makary has extensive experience with medical practice and government oversight. His book explains how medical outcomes are measured and reported by hospitals. Makary offers practical solutions physicians can champion at their institutions to improve measurable quality of outcomes.

Unaccountable can serve as a guide for patients who want to learn how to ensure they receive quality care as well as for hospital board members who want to serve their communities through greater accountability of

hospital-based care.

For example, would you agree to have your failed hip implant replaced by a prominent surgeon (e.g., a chief of staff) who has never performed one, or would you prefer a surgeon with special post-graduate training? Why would your surgeon offer to perform such a procedure when better-trained surgeons are available?

Does your hospital allow surgeons to perform low-volume operations when a sister hospital nearby performs 10 times more every year? Does your institution measure its post-op complication rate and share its results online for patients to evaluate? What questions can you expect your patients to ask in order to know whether the quality of care your institution provides is acceptable?

My copy of Unaccountable, signed by Makary himself, was given to me by a colleague who worked with Makary and who now works at Public Citizen in Washington, D.C. Makary’s book details practical measures which may eventually improve outcomes through the use of data that compels preventive and corrective action, rather than blame and shame. It is the best book I have read on the subject.

Had the Shah of Iran or his medical advisor read or followed the advice in this book, the Shah would have hired a surgeon who was an expert in splenectomy, not the “superdoctor” who had made his name as a cardiovascular surgeon.

Leave your ego at the door when you read this enlightening book.

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30

Sierra Sacramento Valley Medicine

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.

| BOARD BRIEFS |

Board Briefs May 13, 2019 Meeting: THE BOARD: Received a presentation from SSVMS Vetted Vendor Lonnie Dickson, Branch Manager/Owner of The Mortgage Company. The Mortgage Company is a locally owned boutique residential mortgage lender focused on delivering tailored financing solutions to their clients and sets itself apart by delivering exceptional, concierge-level service. They are backed by a top ten nationally ranked independent mortgage bank, American Pacific Mortgage, also locally owned.

Glennah Trochet, MD, Chair of the Public & Environmental Health Committee, updated the Board on the work the committee has accomplished this past year and its plans during 2019.

Approved the 2018 Audit Report.

Approved updates to SSVMS/CSERF accounting policies.

Approved sending a letter in support of AB 521 to fund a program for educating health care providers statewide on firearm violence and suicide prevention.

APPROVED THE FOLLOWING MEMBERSHIP REPORTS: April 22, 2019 For Active Membership — Anthony Albanese, MD; Hannah Awai, MD; Sherry Bajwa, MD; Brea Bondi-Boyd, MD; Luke Hiatt, MD; Lance Holtry, DO; Jinping Lai, MD; Melody Law, MD; Steven Lee, MD; Guillermo Mantilla, MD; Susmita Mishra, MD; Kevin Moynihan, MD; Priyanka Priyanka, MD; Sumita Ram, MD; Lauren Ritz, MD; Erik Shwarts, MD; Erum Tariq, MD; Byron Van Dyke, MD. For Reinstatement to Active Membership — Thuy Do, DO; Caron Houston, MD; Schuyler Wood, MD. For Resignation — James Nuovo, MD.

Approved the 1st Quarter 2019 financial statements.

May 13, 2019

Approved the 2019 Nominating Committee as follows: Chair, Rajiv Misquitta, MD, Immediate Past President; District Representatives: Ruth Haskins, MD, District 1; Margaret Parsons, MD, District 2; Barbara Arnold, MD, District 3; Russell Jacoby, MD, District 4; Paul Reynolds, MD, District 5; Marcia Gollober, MD, District 6; At-Large Members: Richard Jones, MD and Katherine Gillogley, MD.

For Active Membership — Elliott Adams, MD; William Austin, MD; Surinder Bahia, MD; Kathleen Baker, DO; Joseph Bistrain, MD; Scott Braley, MD; Renee Brown, DO; Cynthia Chambers, MD; Connie Chang, MD; Wonjae Choi, MD; Jennifer Conwell, MD; Rochelle Frank, MD; Trevor Heneveld, MD; Anubhav Kapoor, MD; Manav Khullar, MD; Alicia Kurtz, MD; Navreet Mann, MD; Kaitlin Nicoletti, DO; Jennifer Scott, MD; Gregory Sokolov, MD; David Tang, MD; Earl Weyers, MD.

Approved Drs. Adam Doughtery and Rajiv Misquitta moving from Alternate-Delegates to Delegates.

Approved supporting the CMA resolution, Physician Awareness and Training in Response to Human Trafficking Victims, by Ronald Chambers, MD. Approved Maloof Law Group as an SSVMS Vetted Vendor.

The law group focuses on estate planning, business transactions (entity formations, contracts, buy-sell agreements, etc.) and commercial real estate transactions.

Approved sending a letter opposing AB 290 which harms low-income dialysis patients by limiting what health insurers pay for the care of dialysis patients who receive charitable premium assistance (CPA) and for SSVMS to join the Dialysis is Life Support Coalition in its opposition to AB 290.

For Reinstatement to Active Membership — Nathan Allen, MD; Charles Brownridge, MD; Chandan Cheema, MD; Margaret Portwood, MD; John Riddle, MD; Kamran Sahrakar, MD. For Retired Membership — Robert Diamond, MD; Martin Rubin, MD. For Termination of Membership for Non-Payment of Dues — Caron Houston, MD; Joel Kahn, MD; Kathleen O’Brien, MD. For Resident Physician Active Membership — See the list of UC Davis Residents and Fellows approved for Resident Physician Active Membership under New SSVMS Members.

July/August 2019

31

| NEW MEMBERS |

New SSVMS 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. — Carol Kimball, MD, Secretary.

New Active Members

*Physician specialty abbreviated following name.

Elliott Adams, MD, D Anthony Albanese, MD, VA William Austin, MD, HOS, Mercy Medical Group Hannah Awai, MD, Department of Health Services Surinder S. Bahia, MD, HOS, Mercy Medical Group Sherry Bajwa, MD, HOS, Mercy Medical Group Kathleen Baker, DO, EM, Vituity

Erik Shwarts, MD, P, The Permanente Medical Group Gregory Sokolov, MD, P, Vituity David Tang, MD, AN, Vituity Erum Tariq, MD, FP, The Permanente Medical Group Byron Van Dyke, MD, D, The Permanente Medical Group Earl Weyers, MD, AN, Vituity

Joseph Bistrain, MD, EM, Vituity Brea Bondi-Boyd, MD, FP, The Permanente Medical Group Scott Braley, MD, GS, Vituity Renee Brown, DO, EM, Vituity Cynthia Chambers, MD, D, Pacific Skin Institute Connie Chang, MD, AN, Vituity Wonjae Choi, MD, AN, Vituity Jennifer Conwell, MD, OBG, Mercy Medical Group

New Resident Physician Active Members

UC Davis Medical Center Resident & Fellow Program Matthew Adams, MD Adebusola Adesina, MD Garima Agrawal, MD Daniel Ahlers, MD Ziad Alhassen, MD

Rochelle Frank, MD, N, California Northstate University College of Medicine

Ryan Alward, MD

Trevor Heneveld, MD, EM, Vituity

Gregory Amend, MD

Lance Holtry, DO, FP, The Permanente Medical Group Anubhav Kapoor, MD, AN, Vituity Manav Khullar, MD, P, Mercy Medical Group Alicia Kurtz, MD, EM, Vituity Jinping Lai, MD, PTH, The Permanente Medical Group

Shehabaldin Alqalyoobi, MD Edris Aman, MD Amy Anderton, MD Luther Arms, MD Simone Asare, MD Paiyuam Asnaashari, MD Adrienne Atencio, MD Kwame Atsina, MD Jameson Azul, MD

Melody Law, MD, Department of Health Services

Lindsay Bach, MD

Steven Lee, MD, R, The Permanente Medical Group

Colin Bacorn, MD Justin Badal, MD

Navreet Mann, MD, P

Megan Barlow, MD

Guillermo Mantilla, MD, HOS, Mercy Medical Group

Patrick Barousse, MD

Susmita Mishra, MD, Department of Health Services

Sarah Bateni, MD

Kevin Moynihan, MD, FP, Moynihan Family Practice

Nathaniel Barusch, MD Maya Bauer, MD William Baumgartner, MD

Kaitlin Nicoletti, DO, AN, Vituity

Derek Bays, MD

Priyanka Priyanka, MD, P, Community Psychiatry

Christopher Beck, MD David Benjamin, MD

Sumita Ram, MD, PD, The Permanente Medical Group

Robert Benzl, MD

Lauren Ritz, MD, FP, The Permanente Medical Group

Jefferson Berryman, MD

Jennifer Scott, MD, FP

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Sierra Sacramento Valley Medicine

Kyle Bickel, MD Tamar Binyamin, MD Melissa Blaker, MD Noelle Boctor, MD Jeremy Bolin, MD Christina Bourne, MD Willis Bowman, MD Andrew Branting, MD Daniel Bravin, MD

Thuy Do, DO, OBG, The Permanente Medical Group

Luke Hiatt, MD, OSS, Sierra Spine Institute

Maninder Bhutani, MD

Neil Beri, MD David Betting, MD Carl Beyer, MD

Josh Bukowski, MD Andrea Bunker, MD Kristina Cade, MD David Campos, MD Gerardo Canedo, MD Connor Caples, MD Michael Cardenas, MD Jacob Carl, MD Alexander Carlin, MD Zachary Chaffin, MD Melony Chakrabarty, MD James Chalfant, MD Natalie Chan, MD Stephen Chan, MD Alison Chang, MD Diana Chang, MD Michael Chang DO Ana Chartier, MD Heath Charvet, MD Brittany Chatterton, MD Carol Chen, MD David Chen, MD Hui Chen, MD Justin Chen, MD Lily Chen, MD Peggy Chen, MD Doris Cheng, MD Jessica Cheng, MD Hou-Hsien Chiang, MD Oliver Chin, MD Zahabiya Chithiwala, MD Lisa Chu, MD Charleston Chua, MD James Clark, MD Naren Clark, MD Spencer Clark DO Lauren Coleman, MD

| NEW MEMBERS |

Luz Contreras Arroyo, MD

Jena Fujimoto, MD

Sarah Hirata, MD

Jessica Cox, MD

Ryan Fuller, MD

Corey Hiti, MD

Tamika Coy, MD

Lucy Funk, MD

Joshua Hoerger, MD

Jessica Cruz Whitley, MD

Mary Gable, MD

Hallie Hogan, MD

Claire Cutting, MD

Laura Galganski, MD

Ananaomi Holland, MD

Robert Dahlin DO

Maria Galkin, MD

Christopher Holland, MD

Neha Damle, MD

Guofeng Gao, MD

Austin Holmes, MD

Lauren Damon, MD

Nuria Garcia-Ruiz, MD

Gillian Hoshal, MD

Emily Daniel, MD

Jennifer Geiger, MD

Steven Hoshal, MD

Tatini Datta, MD

Kimberley Gerard, MD

John Howard, MD

Ananya Datta Mitra, MD

Shanchita Ghosh, MD

Philip Hsiao, MD

Anders Davidson, MD

Nicholas Gianaris, MD

Jonathan Hu, MD

Michael Davis, MD

Nolan Giehl, MD

Jia Xin Huang, MD

Raj Dedhia, MD

Amarbir Gill, MD

Richard Hurley, MD

Nathaniel Defelice, MD

Alicia Gingrich, MD

Jasmine Huynh, MD

Qurieno Deguchy, MD

Marcoandrea Giorgi, MD

Alexander Hwang, MD

Connor Delman, MD

Arielle Gire-Dumas, MD

Ijeoma Iko, MD

Rahel Demisse, MD

Luis Godoy, MD

Sameeia Iqbal, MD

Emilie Dempsey, MD

Daniel Goff, MD

Tahera Iqbal DO

Steven Dennis, MD

Jesse Goitia, MD

Melissa Itsara, MD

Erik Desoucy, MD

Raymond Gong, MD

Katherine Iverson, MD

Shumon Dhar, MD

Amir Goodarzi, MD

Allyson Jang, MD

Ryan Di Geronimo, MD

Laura Goodman, MD

Lauren Jansen, MD

Amar Dodda, MD

Kristin Gotimer DO

Guy Jensen, MD

James Dodge DO

Julia Graham, MD

Forrest Jespersen, MD

Robert Doiron, MD

Sirisha Grandhe, MD

Tiana Jespersen Nizamic, MD

Katherine Donaldson, MD

Tiffany Green, MD

Lilyanne Jewett, MD

Trent Dondero, MD

Melissa Grigsby, MD

Vidhi Jhaveri, MD

Alyrene Dorey, MD

Timothy Guenther, MD

Angela Jiang, MD

Aneil Dosanjh, MD

Aditi Gupta, MD

Alexandra Johns, MD

Jane Dyball, MD

Jaimish Gwalani, MD

Jeremy Johnson, MD

Brandon Dyer, MD

Dennis Ha, MD

Sheeva Johnson, MD

Anke Eder, MD

Max Haffner, MD

Cecilia Jojola, MD

Michael Ellis, MD

Moosa Haider, MD

Louis Jones, MD

Maia Eng, MD

Katrina Halloran, MD

Timothy Jordan, MD

Armen Eskandari, MD

Molly Hallweaver, MD

Sean Judge, MD

Bethel Essaw, MD

Cori Hanagami, MD

James Jung, MD

Naseem Esteghamat, MD

Joel Harding DO

Sandra Kabagambe, MD

Mark Evans, MD

Nisha Hariharan, MD

Sukhraj Kahlon, MD

Sabrina Evans, MD

Lindsey Harms, MD

Sangeeta Kalsi, MD

Alex Farias, MD

Kristina Hart, MD

Petrina Kaluzhny, MD

Amir Farid, MD

Carly Harvey DO

Elham Kamangar, MD

Olanrewaju Fasusi, MD

Nisa Hatami, MD

Nandakishor Kapa, MD

Quraish Fazleabas, MD

Michael Hayoun, MD

Nikos Karakashian, MD

Jacob Fennessy, MD

Michelle Heare, MD

Tejas Karnati, MD

Amanda Ferguson, MD

Tiffany Heckendorn, MD

Harris Kashtan, MD

Jed Ferrell, MD

Rachel Heidt, MD

Kristen Kelley, MD

Danielle Fincher, MD

Justin Hellman, MD

Donald Kephart, MD

Jason Fogleman, MD

Daniel Helmy, MD

Fakhra Khalid, MD

Jaime Fong, MD

Stephen Henrichon, MD

Satinderpal Khera, MD

Sarah Forrest, MD

Landon Herrera, MD

Christine Kho, MD

Lisandra Franco, MD

Zachary Hill, MD

Christopher Kim, MD

Alex Fu, MD

Michelle Hines, MD

Continued on page 34

July/August 2019

33

| NEW MEMBERS |

Eric Kim, MD

Nikia Mcfadden, MD

Lauren Perry, MD

Ian Kim, MD

Shelby Mclaughlin-Patel, MD

Laura Pestana, MD

Michael Kinzinger, MD

Mary McPhail-Ciufo DO

Brian Pham, MD

Benjamin Kipper, MD

Conor Mcwade, MD

David Pham, MD

Scott Kirkorsky, MD

Geoffrey Mcwilliams, MD

Tai Pham, MD

Aleksandar Kitich, MD

Patrick Michelier, MD

Jonathan Phuong, MD

Carter Kittleson, MD

Kristine Miller, MD

Cindy Piao, MD

Nicholas Klimberg, MD

Ashley Mills, MD

Wesley Pidcock DO

Arunima Kohli, MD

Vanita Mistry, MD

Trevor Plescia, MD

Abhinav Koul, MD

Rachel Mitchell, MD

Christina Poh, MD

Adam Kruse, MD

Myles Mitsunaga, MD

Mark Portman, MD

Edwin Kulubya, MD

Reika Miyokawa, MD

Cara Pozolo, MD

Alexander Kuo, MD

Lynda Montgomery, MD

Pooja Prasad, MD

Kim Kwai, MD

Angel Moran, MD

Shreesh Prasad, MD

Lucia Kwong, MD

Megan Morisada, MD

David Pritchard, MD

Mimmie Kwong, MD

Lekha Mukkamala, MD

Janelle Pugashetti, MD

Nicholas Lange, MD

Elizabeth Mullins, MD

Neil Pugashetti, MD

Jennifer Laroy, MD

Kevin Mullins, MD

Shaun Rafael, MD

Andrew Lee, MD

Samuel Murray, MD

Michael Ramirez, MD

Philippe Levy, MD

Ravi Nakrani, MD

Maricela Rangel-Garcia, MD

Simone Lew, MD

Natasha Namjoshi, MD

Ruwan Ratnayake, MD

Wentao Li, MD

Brie Nardy, MD

James Reynolds, MD

James Liao, MD

Kyle Natsuhara, MD

Tanya Rinderknecht, MD

Shu-Yi Liao, MD

Anh Nguyen, MD

Katherine Robertson, MD

Gary Lin, MD

Diana Nguyen, MD

Steven Rockoff, MD

Jonathan Lin, MD

Hoanvu Nguyen, MD

Rosa Rodriguez, MD

Sharon Lin, MD

Ky Nam Nguyen, MD

Robert Rominski, MD

Diamond Ling, MD

Minh-Vu Nguyen, MD

Melissa Rosas, MD

Benjamin Liu, MD

Vinu Ninan, MD

Stacey Rotta, MD

Ying Liu, MD

Cole Nishikawa, MD

Ashly Ruf, MD

Justin Louie, MD

Nandini Nittur, MD

Miguel Ruvalcaba, MD

Rafael Lozano, MD

Onika Noel, MD

Meghan Sampson, MD

Lancy Lu, MD

Douglas Nowacki, MD

Bradley Sanville, MD

Marie Luce, MD

Craig Nowadly, MD

Amir Sarkeshik, MD

Shaan Ludder, MD

Ryan Nugent, MD

Dani Sarohia, MD

Keith Lui, MD

Daniel O’connor, MD

Victor Saunders, MD

Timothy Macdonald, MD

Leslie Oesterich, MD

Aaron Schelegle, MD

Jinno Magno, MD

Bjork Olafsdottir-Gardali, MD

Alexander Schmalz, MD

Leanna Mah, MD

Lindsay Olinde, MD

Linda Schutzman, MD

Kevin Maher, MD

Jennifer Olson, MD

Kosal Seng, MD

Corby Makin, MD

Oluwaseun Omofoye, MD

Farah Shaheen, MD

Kirti Malhotra, MD

Ifeanyi Onyeji, MD

Marcus Shelby, MD

Pankaj Malhotra, MD

Rafael Ornelas, MD

Richard Shelton, MD

Dania Malik, MD

Caroline Ornellas, MD

Trevor Shelton, MD

Zainab Malik, MD

Mary Orsulak, MD

Dana Sheng, MD

Stephen Malutich, MD

Mohamed Osman, MD

Elan Sherazee, MD

Patrick Mangialardi DO

Benjamin Owen, MD

Vishwa Sheth, MD

Sriniwasan Mani, MD

Steffanie Owens, MD

Alvin Shieh, MD

Rashmi Manjunath, MD

Roland Palvolgyi, MD

Afua Shin, MD

Leslie Markun, MD

Dana Pan, MD

Victoria Belle Shin, MD

Taylor Martin, MD

Joann Park, MD

Rebecca Short DO

Monica Mattes, MD

Dhruv Patel, MD

Rakendu Shukla, MD

Melissa Matulich, MD

Jaymin Patel, MD

Maureen Shuma, MD

David Maurier, MD

Shruti Patel, MD

Eric Shurtleff DO

Matthew Maynard DO

Swati Patki, MD

Stacie Silva, MD

Christine Mcbeth, MD

Neiman Paw, MD

Meryl Simon, MD

Kelli Mcentee, MD

Andrew Perry, MD

Michaela Simoncini, MD

34

Sierra Sacramento Valley Medicine

| NEW MEMBERS |

Anita Singh, MD

Farrukh Virani, MD

Avreeta Singh, MD

Prachi Vishwasrao, MD

Sonia Singh, MD

Stephen Vong, MD

Abdala Sirajeldin, MD

Alexander Vu, MD

Aaron Skelton, MD

Vivian Vuong, MD

Kelsey Sloat, MD

Sandeep Walia, MD

Sarah Smiley, MD

Stephen Wall, MD

Simrit Sodhi, MD

John Walter, MD

Eleasa Sokolski, MD

Caroline Wang, MD

Ping Song, MD

Lei Wang, MD

Laura Sonoda, MD

Timothy Wang, MD

Steffan Soosman, MD

Priyanka Wani, MD

Rebecca Speier, MD

Alexandra Warrick, MD

Anne Spichler Moffarah, MD

Sarah Watson, MD

Ted Spiewak, MD

Jennifer Weber, MD

Marguerite Spruce, MD

Dongguang Wei, MD

Trevor Starnes, MD

Jeffrey Wei, MD

Bradley Stauber DO

Robert Welch, MD

Daniel Stewart DO

Alexander Wessel, MD

Derek Stewart, MD

Ron Wexler, MD

Ernest Stewart DO

Colter Wichern, MD

Suzanne Stewart, MD

Joseph Wick, MD

Sarah Stokes, MD

Katherine Wick, MD

Benjamin Stripe, MD

Peter Wickwire, MD

Isabelle Struve, MD

Alexander Willoughby, MD

William Swanson, MD

Laura Willoughby, MD

Angel Tabuyo-Martin, MD

Bryn Willson, MD

Amir Taefi, MD

Brenton Winship, MD

Isaac Talbert, MD

Andrew Wishy, MD

Shawn Tejiram, MD

Andrew Wong, MD

Matthew Tenold, MD

Felix Wong, MD

Patricia Tenold, MD

Gordon Wong, MD

Ruth Tessema, MD

Rachel Woodside, MD

Bart Thaci, MD

Evan Wu, MD

Christina Theodorou, MD

Jaimie Wu, MD

William Thieu, MD

Julie Wu, MD

Harjot Thind, MD

John Wuellner, MD

Debi Thomas, MD

William Wung, MD

Maria Joana Thomas, MD

Weichen Xu, MD

Ryan Thomas, MD

Anna Xue, MD

Kyle Thompson, MD

Yunfeng Xue, MD

Miao Tian, MD

Kaeli Yamashiro DO

Mary Roz Timbang, MD

Stephanie Yan, MD

Amar Tomar, MD

Mio Yanagisawa, MD

Kavian Toosi, MD

Wei Yang, MD

David Torres Barba, MD

Samuel Yap, MD

Melody Tran, MD

Alae Yaseen, MD

Brandon Trapp, MD

Amirfarbod Yazdanyar, MD

Katherine Tribble, MD

Stephanie Yen, MD

James Tur, MD

Jocelyn Young, MD

Suji Uhm, MD

Angela Yuen, MD

Marcia Unger, MD

Nathan Zacharias, MD

Erika Valentine, MD

Lucia Zaffuto, MD

Jason Van Rompaey, MD

Xin Zhang, MD

Matthew Van Uitert, MD

Amy Zhou, MD

Nathan Vanden Berge, MD

Cathy Zhou, MD

Hunter Vincent DO

Arta Zowghi DO

July/August 2019

35

Contact SSVMS to Access Your

Member Only Benefits

info@ssvms.org | (916) 452-2671 BENEFIT

RESOURCE

Reimbursement Helpline FREE assistance with contracting or reimbursement.

CMA’s Center for Economic Services (CES) www.cmadocs.org/reimbursement-assistance | (888) 401-5911

Legal Services CMA On-Call, Legal Handbook (CPLH) and more…

CMA’s Center for Legal Affairs www.cmadocs.org/legal-resources | (800) 786-4262

Insurance Services Life, Disability, Long Term Care, Medical/Dental, Workers’ Comp, etc.

Mercer Health & Benefits Insurance Services LLC www.countycmamemberinsurance.com | (800) 842-3761

Travel Accident and Travel Assistance Policies This is a free benefit for all SSVMS members.

Prudential Travel Accident Policy & AXA Travel Assistance Program www.ssvms.org/Portals/7/Assets/pdf/AXA-travel-accident-policy.pdf

Career Center Member groups receive free basic job postings and access to the Career Center resume bank.

California Physician ™ Career Center www.careers.cmadocs.org

Mobile Physician Websites Save up to $1,000 on unique website packages.

MAYACO Marketing & Internet www.mayaco.com/physicians

Auto/Homeowners Insurance Save up to 10% on insurance services.

Mercury Insurance Group www.mercuryinsurance.com/cma

Car Rental Save up to 25% - Members-only coupon codes required.

Avis or Hertz

CME Certification Services Discounted CME Certification for members.

Institute for Medical Quality (IMQ) www.imq.org

Student Loan Refinancing Members receive a rate discount of 0.25% off the approved loan rate.

SoFi www.sofi.com/rate-discount-25

Healthcare Messaging Free secure messaging application

DocBookMD www.docbookmd.com/physicians

HIPAA Compliance Solutions Members receive a discount on the Toolkit.

PrivaPlan Associates, Inc www.privaplan.com

Magazine Subscriptions Members get up to 89% off the cover price of popular magazines.

Subscription Services, Inc www.buymags.com/cma

Confidential Physician Wellness Resources 24-hour confidential assistance hotline is free and will not result in any disciplinary action. Additional Physician wellbeing resources also available through SSVMS’ Joy of Medicine.

Physicians’ Confidential Line (650) 756-7787 www.cmadocs.org/confidential-line www.joyofmedicine.org

Medical Waste Management Save up to 30% on medical waste management and regulatory compliance services.

EnviroMerica www.enviromerica.com

Office supplies, facility, technology, furniture, custom printing and more… Save up to 80%

StaplesAdvantage

Physician Laboratory Accreditation 15% off lab accreditation programs and services Members only coupon code required

COLA (800) 981-9883

Security Prescription Products RxSecurity Members receive 15% off tamper-resistant security subscription pads. www.rxsecurity.com/cma-order

SSVMS Vetted Vendor Partners SSVMS’ Vetted Vendors are trusted partners of the Medical Society. Each business has gone through an application process and provided multiple physician references that can attest to their satisfaction with the business. Access Vetted Vendors 916-452-2671 or msharpe@ssvms.org.

Cooperative of American Physicians (CAP) Medical professional liability protection to over 12,000 of California’s finest physicians.

Sotheby’s International Realty Mela Fratarcangeli is consistently ranked in the top 5% of all real estate agents in the Sacramento Valley serving the buyers and sellers at all levels in the Sacramento Region.

Crumley & Associates Drawing on more than 120 years of experience, Crumley & Associates emphasizes sound financial planning, along with a variety of personal financial services.

The Mortgage Company The Mortgage Company brings a wealth of experience to every purchase and refinance loan, and exceptional concierge level service.

Bank Card USA By eliminating the middleman, Bank Card USA is able to offer special pricing for our members.

www.ssvms.org/physician-resources/vendor-partners

JOY of MEDICINE 2019 ANNUAL SUMMIT

The Power of Positive Psychology for Physician Health and Well-Being Liana Lianov, MD, MPH

An innovative leader in lifestyle medicine, Dr. Lianov is a lead faculty member of the American College of Lifestyle Medicine (ACLM) and currently serves as the Chair of the Happiness Science and Positive Health Committee of the ACLM. This session will explore positive psychology interventions for self-care that will enable attendees to develop a personal action plan.

The Art of Medicine and the Mindfulness of Thought

The Simple Thread Woven into Scientific and Spiritual Discovery Daniel McCrimons, MD and Reverend James Trapp, JD This session will focus on how to create a satisfying experience so the patient feels heard and the provider is able to embrace the virtues of the Hippocratic Oath.

Organizational Strategies to Improve Physician Wellness

Panelists representing Mercy Medical Group, Sutter Independent Physicians, Sutter Medical Group, The Permanente Medical Group, UC Davis, and Woodland Medical Group will share their physician wellness strategies, successes and resources.

EMCEE: Rajiv Misquitta, MD Brunch Provided; CME Credits Available Bring your walking shoes for a meditative walk through McKinley Park No Cost for Physicians, Residents & Medical Students

Register At https://tinyurl.com/y5jmxusy

Join other physicians in the region for fellowship and hands-on educational sessions to help you build resilience and bring joy back to your practice of medicine.

SEPTEMBER

28

8:00 am - 12:00 pm Clunie Community Center McKinley Park, Sacramento Limited Spots: Reservations Required

by September 13th RSVP with MJackson@ssvms.org

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