2019-Nov/Dec - SSV Medicine by Sierra Sacramento Valley Medical Society

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

November/December 2019

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MEDICINE 4

The Much-Needed Return of the Physician Lounge

Photos by SSVMS Staff

Never Home Alone

PRESIDENT’S MESSAGE

Christian Serdahl, MD

EXECUTIVE DIRECTOR’S MESSAGE

Take a Break and Meditate! Aileen Wetzel, Executive Director

OPINION

Peaceful Resistance To the Almighty Screen Caroline Giroux, MD

PROFILE

Rich Isaacs, MD Asks “What’s Possible” at TPMG Ken Smith, Managing Editor

2019 Joy of Medicine Summit

OPINION ESSAY

You Died By Suicide Megan Babb, DO

The Medical Hazard of Being a Smith

Ken Smith, Managing Editor

BOOK REVIEW

Jack Ostrich, MD

SSVMS Election Results

Board Briefs

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 Sierra Sacramento Valley Medical Society for permission to reprint.

New SSVMS Members

A Booster on Vaccines And Public Health George Meyer, MD

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

Feeling Acronymish Faith T. Fitzgerald, MD

Use Societal Privileges As a Power for Good Stacie Walton, MD

VOLUME 70/NUMBER 6 Official publication of the Sierra Sacramento Valley Medical Society

Cover photo: A cabin sits amid fall colors in Hope Valley near Carson Pass on Highway 88..

5380 Elvas Avenue Sacramento, CA 95819 916.452.2671 916.452.2690 fax info@ssvms.org

Photo by David Evans, MD

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

November/December 2019

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 R. Adams Jacobs, MD Barbara Arnold, MD Helen Biren, MD Adam Dougherty, MD Richard Gray, MD Richard Jones, MD Charles McDonnell, MD Sandra Mendez, MD Rajiv Misquitta, MD Tom Ormiston, 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 1 Alternate Vacant 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

HOSTED BY LOCAL PHYSICIANS

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

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

Sierra Sacramento Valley Medicine

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 membersâ&#x20AC;&#x2122; 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. ÂŠ2018 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, ccneye@sbcglobal.net

In his final message as the 2019 SSVMS President, Dr. Serdahl looks at the return of the much-desired yet underappreciated physician lounge. He personally tested the cofffee at each health facility in the area.

George Meyer, MD trochetg@gmail.com

Dr. Meyer, a retired gastroenterologist, volunteers his services locally and internationally. This month, he looks at common vaccines and how they have protected public health.

Caroline Giroux, MD cgiroux@ucdavis.edu

Megan Babb, DO

ssvmedicine@ssvms.org

Dr. Giroux, a psychiatrist at UC Davis, writes this month about how her kids’ obsessions with screens led her to re-examine her role as a psychiatrist, question her profession and seek joy.

Dr. Babb specializes in family medicine. Her first contribution to SSV Medicine, “You Died by Suicide,” is a riveting essay on how today’s health care system failed a patient and the daily pressures physicians face.

Stacie Walton, MD

Faith T. Fitzgerald, MD

Dr. Walton retired as a praticing pediatrician at Kaiser Permanente. She now focuses on training health care providers in cultural competency and decreasing unconscious bias.

Dr. Fitzgerald, a UC Davis professor of internal medicine, has an international reputation as a master clinician, diagnostician and humanitarian. But she’d like to see fewer medical acronyms ASAP.

thediversitydoctor@gmail.com

ftfitzgerald@ucdavis.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.

Jack Ostrich, MD jmost119@aol.com

This month, Dr. Ostrich reviews Never Home Alone, which describes how we share our homes—even our faces—with a multitude of creatures, some of whom get a bad rap.

Ken Smith

ken@kdscommunications.com

Ken is SSV Medicine’s managing editor. This month, he profiles Dr. Rich Isaacs of The Permanente Group and also explains the pitfalls and uncertainty in the doctor’s office that come with a common name.

November/December 2019

| PRESIDENTâ&#x20AC;&#x2122;S MESSAGE |

The Much-Needed Return Of the Physician Lounge By Christian Serdahl, MD ccneye@sbcglobal.net

The physician lounge, for those readers unfamiliar with this topic, is a place where doctors can go for breakfast or lunch or a quick cup of coffee and catch up socially with colleagues. Golf matches and dinner dates could be scheduled and, of course, the curbside consults regarding mutual patients or family members could take place. As the electronic medical record was developed, computer terminals were added to the lounges so that charting could be done in private and away from the nursing station, patients and their families. I recently visited every hospital in the tri-county SSVMS area that indicated it had a lounge available to physicians. I want to thank each of them for warmly welcoming me into their facilities and for the efforts many of them are making to bring collegiality back by

Photo: Ken Smith

hysician lounges have become an endangered species. But like the California Condor and American burying beetle, they appear to be making a comeback. Hospitals are listening to the house staffs and are once again funding physician lounges. Over the past two decades, several hospitals had closed their lounges to save money and because some administrators felt they had no role in the modern hospital. Now, many of our local hospitals have brought back a place that is a source of collegiality and has been sorely missing from medicine. This resurgence is likely due to the epidemic of physician burnout. A common refrain among physicians is that isolation from their colleagues is a major factor behind why they are experiencing less joy in medicine.

The new, 450-square-foot UC Davis Medical Center lounge offers abundant seating, computer access and food. 4

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Photo: Megan Sharpe

Sutter Lounge Photo

The physician lounge at Sutter Medical Center, Sacramento, offers bright windows, comfortable seating and flatscreen televisions. incorporating new or improved physician lounges— ones separate from those located adjacent to operating rooms or are accessible to members of the health care team other than physicians—into their designs. While I found several of our local hospitals had lounges with an array of comforts and conveniences, Sutter Medical Center, Sacramento sets the gold standard. Its new and spacious lounge includes a flatscreen TV, comfortable chairs and a sofa, an area of small circular tables in the walkway overlooking Capitol Avenue, and a 24-hour food and drink service. This setup encourages conversation and interaction while also providing a quiet refuge in one of the area’s most active health facilities. I was very pleased to see the lounges at Mercy San Juan and Sutter Roseville packed with busy physicians enjoying conversations and good food in tasteful settings. The windows provide re-energizing natural light and the lounges are inviting. Congratulations are also in order for UC Davis, which recently opened its long awaited new physician lounge that includes private, comfortable seating and a large screen TV. If there were an award for the most relaxing lounge it would go to Mercy Folsom because of its secret weapon, past CMA President Ruth Haskins, MD. The lounge includes a physician library with real books, lavender potpourri and healthy food and snacks. Dr. Haskins is famous for her chocolates, but she and the wellness committee have also taken the extra step of having a

daily wellness theme for colleagues to partake in including Meditation Mondays, Walk on the Wild Wednesday and Free Form Fridays. Most impressively, an IT tech visits the lounge each Friday in an effort to reduce EMR anxiety. A haunting reminder of the reasons physician lounges are important could be found at Sutter Davis, which offers the “Dr. Joel Rubin Physician Wellness Lounge.” Dr. Rubin was a young orthopedist who struggled with work-related anxiety prior to his sudden and shocking death in 2012. The current lounge next to the OR is small, but I was very pleased to learn that a larger and more centrally located lounge was set to open this fall. Some of the area’s larger hospitals do not have physician lounges despite what seems to be a strong desire for a dedicated gathering place for doctors. It is my sincerest hope that all hospitals in the region will eventually have a space where physicians can assemble and take a break. Not only would it improve collegiality and reduce physician burnout, it would provide an incentive for more physicians to join the medical team. If I were a physician looking to relocate, I would want to know if the hospital had a physician lounge full of lively conversation and where I could find a decent cup of coffee. Kudos to those leaders who have recognized the importance and symbolism of the physician lounge, and I’m hoping that more administrators will help bring this important part of the practice of medicine back from the edge of extinction.

November/December 2019

| EXECUTIVE DIRECTOR’S MESSAGE |

Take a Break and Meditate! New Benefit for SSVMS Members

By Aileen Wetzel, awetzel@ssvms.org

ver the last three years, SSVMS has heavily invested in the health and well-being of local physicians through our Joy of Medicine programs and services. Our goal is to shift individual and organizational culture to help you find happiness in the profession of medicine. Since 2017, hundreds of physicians in the Sacramento region have accessed Joy of Medicine programs and services that include educational programs, peer groups, resiliency consultations, podcasts, social events and activities, and much more. Our recently published white paper, Joy of Medicine: Assessing Physician Well-Being in the Sacramento Region—Strategies to Promote Physician Well-Being at the Individual and Organizational Level provides a roadmap to promote a culture of wellness in the Sacramento medical community. It is in the spirit of the Joy of Medicine program that we are proud to offer our newest member benefit, a free one-year subscription to the meditation and mindfulness app Headspace. Meditation is an ancient art that helps practitioners become more mindful of their thoughts, feelings and sensations and how you interpret them. As Headspace notes in its introduction to meditation, it isn’t about becoming a different person, a new person, or even a better person. Meditation is about training in awareness and getting a healthy sense of perspective. You’re not trying to turn off your thoughts or feelings. Instead, you’re learning to observe them without judgment, which may help you better understand them as well. The benefits of meditation and mindfulness are undeniable. Studies show meditation helps reduce stress and burnout in health professionals while boosting happiness, compassion, resilience and satisfaction. Headspace is meditation made simple and has been shown to reduce stress and increase focus and happiness in just a few minutes a day. Headspace puts a personal meditation guide right in your pocket. The app includes bite-sized meditations 6

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for busy schedules, SOS exercises for tough situations, and hundreds of guided meditations on everything from sports to anxiety to kids and parenting. You’ll also have access to Sleep by Headspace—sleep music, soundscapes, and sleepcasts aimed at creating the perfect conditions for a restful night’s sleep. My personal favorite is the walking meditation series that can help you walk off frustrations or reconnect with nature.

Hundreds of SSVMS members have already accessed their complimentary one-year subscription to Headspace, a $99 value. SSVMS members should have received an email from me in early September with a unique activation code to access your one-year subscription to Headspace, valued at $99. Please check your email, and if you cannot find your unique code, contact our office at (916) 452-2671 or Sam Mello at smello@ssvms.org. Our staff will walk you through the steps to activate your Headspace subscription. This member benefit is valid through September 1, 2020. To date, hundreds of physicians have accessed their complimentary Headspace subscription. This morning, I opened my email to find the following message: “Thank you so much for the one-year subscription to Headspace. I just signed up and already I know this gift from SSVMS will have a huge positive impact on my life.” We sincerely enjoy knowing that SSVMS is making an impact on the professional and personal lives of the physicians we serve. When you’re busy caring for others, it’s easy to forget about your own mental health. You deserve to take a break and meditate. Thank you for your membership and for letting us take care of you so that you can take care of others.

Catch Your Breath

One Year of Headspace Available for SSVMS Members Download your personal meditaï¿½on guide to your phone now

November/December 2019

| OPINION |

Peaceful Resistance To the Almighty Screen

Fighting Back by Cultivating Joy

othing really bad happened last night. Yet, I felt so down I could cry. I wanted to run away and wished to rewind time so we could be traveling again in New Zealand, inhaling the forest air and listening to strange birds. But nothing is exactly the issue. The nothing in my household means that everyone is connected to something except each other. My kids can’t even watch a documentary with me without looking at another screen and playing some stupid game at the same time. This morning, a Tuesday, is one of my favorites because I get to start work later so I am more present and available to my children as they get ready for school in the vortex of modern day life. Ten minutes before my boys are supposed to meet their friend at the corner so they can bike together, my middle son pulls out a two-sided math sheet he had forgotten to complete and says, “I need to turn this in today.” I try to stay calm as I redirect him, because he finds a way to be distracted by his older brother playing video games on his computer, who says, “But I am done with my homework, mama!” One by one, the son-about-tobe-in-trouble and I go through his six-digit numbers he is supposed to round. The instructions vary from 8

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one exercise to the next. I try to summarize what rounding means. He misses most of them. My heart bleeds. My son is smart. He knew how to read in kindergarten. He is a very elaborate sketch artist. His sense of humor tells me he has some spirit. But he didn’t integrate the new info I was trying to convey. Or is it that he didn’t care? Then I have this horrifying vision of our boys sitting in a sordid apartment all day, playing these evil video games

By Caroline Giroux, MD cgiroux@ucdavis.edu

structured their son enough? Over 15 years ago when I did my child psych rotation at Ste-Justine Hospital, one boy was so addicted to his video games that he ended up going in his pants, not wanting to miss anything by going to the bathroom! Quite alarmed, I immediately texted my husband who agreed with me that all their devices needed to be confiscated for one week. We need to reset their learning. He will

“The nothing in my household means that everyone is connected to something except each other.” because they can be supported by us, their parents. I had watched a documentary many years ago in Quebec. A young man, whose face was hidden, shared his relationship with video games. I could recognize the house of his parents, it was a beautiful red-brick house in Outremont, where only people from higher socio-economic class can afford to live. He admitted that his goal in life was to find a job to rent an apartment so he could play video games most of his spare time. I wondered if the palpable absence of his parents had anything to do with it. Were they pickling themselves on a cruise, helpless and plagued with guilt for not having

do school time again with them. I should teach them French more consistently. Meanwhile, I post on social media, “How long is this video game phase supposed to last? Why can’t kids be addicted to meditation or Dalai Lama quotes?” Comments arrived within seconds. Messages of sympathy. “I FEEL YOUR PAIN.” “Our son lost interest in things he used to enjoy.” “The Struggle is real! When he’s not playing them he’s talking about them or reading about them!” Not to mention the peer pressure, ridicule and stigma a lot of these kids have suffered because they were sheltered from this addiction by parents who are conscientious!

I am so thankful for these moms’ generous sharing. Their struggles are detailed, which makes me even more concerned but less alone. And most of the comments come from mothers of boys. Then, one remarks, jokingly, that it affects the male gender 99% of the time, “which is bad news for you.” I reflected back on my own video game phase. I was about 13 and rather unstructured (pseudo-mature oldest child from a broken home). I liked playing Frogger (yikes! poor little amphibian) or PacMan. But I never neglected my schoolwork and did impeccably in all classes (except in P.E.!). I was using this to zone out, like a lot of people, maybe to cope with my parents’ recent divorce, my dad’s new partner, the move, all on top of frightening changes from puberty. Eventually I didn’t find any satisfaction and I dropped this waste of time. How frequently I wished I could have those lost hours back once I started really discovering the world, connecting with other people, reading life-changing novels… Maybe our kids have it too easy. Far from being ideal or optimally effective parents (we have had our moments of epic inelegance), I believe we have learned from our upbringing and are able to catch ourselves sooner than our parents did when we mess up. But maybe that is not necessarily a good thing; certain kids who have lived through adverse childhood experiences tend to apply themselves academically (I can speak for myself here), maybe as a way to regulate their self-esteem and to obtain a parent’s approval. So our boys are more likely to

get away with certain stuff because they seem securely attached to us and probably know we love them unconditionally. My down mood from last night was most likely stemming from the sense of alienation from them, the fact that their flat screens are the default

In fact, by meditating, by listening to podcasts from France Culture (my eyes are not glued to any screen while drinking those profound words), I am hoping to model a healthy approach to life in which joy is “le réel,” the truth of life. The active process of letting go of

“The active process of letting go of control—or mindfulness— opens up a space to welcome good stuff.” activity. Hence my escape fantasy… this morning, I had gotten up with the firm resolution of entering a “no excuse” phase of my life, doing things I know are good for me, and this disappointment with my sons and my deep concerns for their future shouldn’t prevent me from cultivating joy.

control—or mindfulness—opens up a space to welcome good stuff. Once you truly experience joy, the instant seems bigger or eternal, it seems like nothing else matters. Something shifted in me when I started approaching life that way. If everyone could practice this, my clinic hours at work would suddenly

November/December 2019

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become available for other things, like creative endeavors, for the sake of bringing more of my authenticity to the world. Patients would no longer need to ask for a pill to cope with their moods or insomnia. The world would be a much better and more sustainable place because people would all be empowered from knowing about their sacred haven. Once they gain that insight, they can access compassion, this infinite source of connection and positive energy between all people. Maybe my current mission as a psychiatrist is about questioning the usefulness of this very field I embarked on decades ago, and inviting other doctors to unlearn. We are now a compass serving to point possible sources of healing to people we encounter, but perhaps we should instead remind them that they already possess inside them the keys to their problems. After all, if one assumes that the goal of existence is evolution of consciousness, and if my specialty doesn’t work in that direction, who will? Once we are out of business, I will see this as a sign that a transformation from Joy in Medicine to Joy as Medicine took place, forcing me to adapt my trajectory toward new challenges (such as tackling plagues like video games!). This will mean extra time to savor the joy of creativity while leaning on this pillar of truth and, as Frédéric Lenoir wrote, touch eternity. And there is a nice evolution to my family story: After two days, our kids stopped sounding like martyrs while asking for their tablets and regained interest in the outdoors, music, and reading. Pure joy!

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November/December 2019

| PROFILE |

Constantly Seeking “What’s Possible” Drives Rich Isaacs, MD at TPMG Leader Embraces Stimulating Innovation Through Engagement

hen Rich Isaacs, MD, interviewed before The Permanente Medical Group (TPMG) board of directors in 2017 for the opportunity to lead over 10,000 physicians as its executive director, one question was central to the discussion: “What’s possible?” But it was Dr. Isaacs, not the board, who had asked that question. “What’s possible…” has become the guiding focus of Isaacs’ leadership at TPMG and in his additional roles as president and CEO of the Mid-Atlantic Permanente Group and also as co-CEO of the Permanente Federation, an alliance of all eight Permanente medical groups. Dr. Isaacs was tapped to take on his multiple titles after serving as the physician-in-chief at Kaiser Permanente South Sacramento Medical Center. “That’s where I really got to spread my wings and explore what’s possible,” Dr. Isaacs said. “Some of the things I’m most proud of came out of South Sacramento.” At the time, the South Sacramento Emergency Department only had 28 bays and saw a rapidly growing number of patients coming through its doors—a number that exceeded 170,000 last year, only half of whom were Kaiser members—after joining Sacramento County’s trauma safety net. It was the first time a Kaiser Permanente Medical Center received a Level II Trauma Designation and opened its hospital doors for this high level surgical critical care. Dr. Isaacs and the hospital’s leadership were faced with the need to take innovative steps to make the best use of the facility’s resources. “We had to redesign the way we think,” Dr. Isaacs explained. “What’s possible in emergency care delivery? I had some very innovative leaders in emergency medicine who said we could solve this problem by putting physicians further upstream in the presentation. If you By Ken Smith, Managing Editor ken@kdscommunications.com 12

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have the physician actually in the waiting room when the patients present, the lower acuity patients, instead of being triaged and put in line, they’re actually treated.” This approach grew into Kaiser Permanente’s physician-in-treatment model, which Dr. Isaacs said has set a national standard for providing quality, expedited care that also produces better outcomes. Stimulating innovation is a big part of his leadership philosophy, which follows the “servant leadership” model developed by writer and consultant Robert Greenleaf. Servant leadership essentially flips the traditional business pyramid upside down so that the leader’s job is to serve the workers who are critical to getting the job done.

Both of Dr. Isaacs daughters are in medical school. Rachel (left) just entered California Northstate University and Dayna is studying at UC Davis.

Cycling is a passion, whether it’s on the American River Bike Trail or at home on the Peloton. “You start to engage, and listen, and understand more about what the needs are where the core business is happening,” Dr. Isaacs said. “You see a transformation of culture, where people actually feel supported by their leadership to do the work instead of the other way around, where people tend to manage up to support the leader. “I think that’s the best way to lead, because then the leaders are aware of the challenges that are being faced where the work is being done. Then you empower the people who are actually doing the work to come up with the solutions. That’s how this physicians-in-treatment model was developed. It was pure servant leadership.” An important part of stimulating innovation, Dr. Isaacs said, is ensuring that people who see opportunities for improvement have the support they need to try and make those changes a reality. “The leader’s job is to make it safe for the people doing the work to experiment,” he said. “It’s not the leader’s job to prevent error. The leader’s job is to make it safe for people to make errors so you can learn from them. It creates a huge environment of an innovative culture [of people] willing to challenge the status quo and do things differently.” Dr. Isaacs, who specializes in otolaryngology and received his head and neck oncologic and skull base

surgical training from UC Davis, also believes keeping physicians engaged in the process of innovation reduces physician burnout. That is a regular discussion topic at TPMG, which is placing a priority on joy and meaning in medicine. “Joy and meaning comes from autonomy and mastery,” he said. “If you get to the workplace and there are barriers to creating mastery, it’s a moral injury, and people feel disengaged and burn out. I know that when you have engaged and satisfied physicians, the work is better, the quality is better and the outcomes are better.” He sees the Kaiser Permanente approach as a role model for the development of an American health care system that can create affordability and access by focusing on prevention and integrated care. Members, for example, have a 52% reduced mortality rate from colon cancer because of preventive measures. Dr. Isaacs oversees a medical group with a huge Northern California presence of over 3 million members and also the Mid-Atlantic Permanente Medical Group that serves parts of Virginia, Maryland and Washington, D.C. He relishes the opportunity to shape policy in the nation’s two most influential capitals and notes that the foundation of Obamacare is “basically an accountable care organization, and that’s what Kaiser Permanente represents.” He also said that while everyone supports health coverage for all, he believes the discussion has mistakenly focused almost exclusively on how to provide that coverage. Instead, the focus should be on how reforming health care delivery can improve efficiency and access. “I’m not sure that the current state of care delivery in this nation is what people need to have coverage to,” Dr. Isaacs said. “People need to have coverage to what I’m seeing, which is integrated care and what we provide at Kaiser Permanente. There would be over 250,000 fewer heart attacks in the country if people had access to the care that we deliver.” Dr. Isaacs, 56, joined The Permanente Medical Group in 1995 after his training at UC Davis. He met his wife Debra Karling-Isaacs, MD in medical school—she is an internist at the Veterans Affairs clinic at the former McClellan Air Force Base—and splits his time between their home in El Dorado Hills and an apartment in Lafayette where he has easy access to Kaiser Permanente’s Oakland

November/December 2019

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Unsettled by taking this radical approach without knowing exactly where the tumor was, Dr. Isaacs decided to approach it sequentially by making the first incision and then seeing its exact location. “I started with a lateral rhinotomy that removed the turbinates,” he said. “The amazing thing was, as I did all of the cuts and removed the lateral nasal wall, the whole tumor came out en block. It was attached to the inferior turbinate and I was so excited to see that because his palate was not affected. The tumor hadn’t invaded the bone and was hanging on a stalk. I was doing cartwheels in the operating room.” Twenty years later, Dr. Isaacs and his patient still meet regularly for breakfast. Although the patient has given Dr. Isaacs a number of gifts of fine woodworking over the years, including a recent one on the 20th anniversary of the surgery, the one he cherishes most arrived on the first anniversary of that fateful day. “He built me a clock,” Dr. Isaacs recalled. “It’s this beautiful birch wood mantel piece he designed just for me and the most beautiful gift you could imagine. He couldn’t wait for me to open it and turn it around,” That’s when he saw what was inscribed on the back: “Dear Dr. Isaacs: Thank you for the precious gift of time.”

All photos courtesy of Rich Isaacs, MD

headquarters. He is an avid skier who was a member of the national ski patrol but had to give it up after taking the CEO job because of time limitations. He can also be found frequently cycling along the American River Bike Trail or enjoying the growing schedule of concerts at the Golden 1 Center. Their two daughters, Dayna and Rachel, have both made the choice to become the next generation of physicians in the Isaacs family. Dayna is in her third year at UCD School of Medicine and Rachel just entered California Northstate University College of Medicine . “I’m sure it was their mother who showed the girls what’s possible when you are a caring physician and mom, and we always told them to follow their passion,” Dr. Isaacs said when asked what inspired their daughters to join the family profession. “Hopefully they saw a little bit of that in their Dad, too.” Dr. Isaacs expects his daughters, when they have reached the point in their career that he has, to be the beneficiary of tremendous strides in technology and treatments. However, he believes that in many ways the medical profession will be similar to what it is today. “There’s the advancing tech nology, which is just amazing, but I still feel that it’s the noblest profession, and that my kids in 25 years will still value the patientphysician relationship as it is fundamental to the profession of medicine,” he said. “That will not be lost.” One case early in his career is a defining doctorpatient story for him. Two decades ago, he had a patient who was experiencing a complete nasal blockage on the left side. A scope found a “pretty red, angry looking tumor” at the soft and hard palate junction that was a form of aggressive cancer and normally a death sentence. The situation called for a radical maxillectomy, and Dr. Isaacs prepared the patient for the very real possibility of losing his teeth, hard palate and maybe an eye.

Dr. Isaacs served on the National Ski Patrol for several years. Above left, he makes a different kind of downhill run on a family trip to Disneyland.

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| DIVERSITY |

Use Societal Privileges As a Power for Good

Turn Them Into a Superpower to Help Teams Thrive

he team stood around the older woman's bedside. As one of the medical students, I prepared to meet my new patient. As she was being assigned to me, Mrs. R yelled, “I'm not letting that N*** take care of me!” As the only Black person in the room, her words meant for me hung in the air. Frozen in place, my heart racing, I fantasized walking out of the room. Without a break in the conversation, my third-year resident, the most senior on the team, used the privileges of whiteness, maleness, and seniority he held in the situation to inform Mrs. R that her bigoted behavior distressed the team. He granted her a choice: She could change her attitude, or we would help her find another hospital. Forty-eight hours later, arriving at the ward, I learned that she transferred to another hospital in the middle of the night. My third-year resident had chosen to be my ally. He set a tone for the team and reminded everyone that my skin color didn't allow anyone, including a patient, the right to disrespect and degrade me. He had turned the societal privileges he had, at least as perceived by that patient, into superpowers that he could use for good. It has been over 30 years since this episode occurred, but as a diversity trainer I know that similar situations still happen every day and that the lessons I learned continue to apply today. We all have privileges afforded to us in society. Many of those traits were given at birth and we didn’t get to choose them. In America, there are physical traits and societal status that put you in an advantaged position over others in the population. Some are the result of hard work or luck. As an African American woman, I too have advantages as someone who is well educated and economically secure. You, too, may have achieved a high level of education as I have or, unlike me, you

Sierra Sacramento Valley Medicine

By Stacie Walton, MD thediversitydoctor@gmail.com

may be male, tall or white. You may have inherited lots of money. Perhaps, you are socially agile or recognized as being pretty. You may be abled-bodied or straight. You may be a Christian. You may have been born here. The characteristics mentioned above have been proven to create significant advantages in navigating a life in our society. But as in the classic superhero story, one frustrating aspect about potential superpowers is that you may not have realized yet that they are available to you. I work with medical professionals to identify the societal privileges they enjoy and how to use them—as they say in superhero stories—for good. When you hold a privileged position in society, that privilege can blind you to the effects of your social condition on others. What many might consider an advantage becomes the "norm" for you. One strategy for identifying your advantages and to realize your superpowers is to listen to those who are at a disadvantage. Don't be too quick to discount the stories about patients refusing care from the colleague with the foreign accent or about sexual harassment continually occurring in the hospital. Just because it has never happened to you, that doesn't mean it never happens. These stories are the key to stepping into and owning your privileges, your superpowers! Like any true superhero, it is essential to be able to discern how and when to use your superpower. The most important thing when you decide to embark on a courageous act or conversation is to understand your role in bringing a positive resolution. It is also essential to act from conviction rather than emotion and to understand the ramifications. Everyone has one or more superpowers in the right situation, so identify your privileges and commit to using them for good. Advocate for others in situations

Stacie Walton, MD, uses the analogy of an iceberg at a workshop to explain how unconscious bias can lead to judgments based only on the small part of what others see of you rather than your â&#x20AC;&#x153;below the waterâ&#x20AC;? characteristics that are not as readily apparent.

where their social position, medical condition, race, country of origin, LBGTQ status, disability, size or gender, or rank in a medical setting sets them up for discrimination or harm. You could become the superhero that saves the day on rounds, helps boost team morale, or secures the opportunity to strengthen a special relationship. That is what my third-year resident did for me. Diverse teams mean that an array of superpowers become available to help those teams thrive and do great things for patients and their families. And when you turn your superpowers into a force for good, I guarantee that your life in medicine will be more vibrant and that friendships and collegial relationships will develop and flourish for a lifetime.

Together, transforming lives Vitalant* (formerly BloodSource) extends our best wishes to all in the healthcare community this holiday season. Thank you for your support in sharing a message of holiday giving, including blood donation. For the giver, the recipient and the professionals who make blood components available to treat your patients, blood donation transforms lives every day, every season. *pronounced vye-TAL-ent Join the Vitalant community! Visit vitalant.org or call 877.258.4825 (877.25VITAL)

November/December 2019

Photos by SSVMS staff

2019 Joy of Medicine Summit

Sierra Sacramento Valley Medicine

Over 150 SSVMS members attended the 2019 Joy of Medicine Summit at the historic Clunie Community Center in McKinley Park on September 28. The day started with greetings from therapy animals from Paws on Call, the pet therapy program at Sutter Medical Center, Sacramento. Daniel McCrimons, MD then treated the crowd to a discussion on the art of medicine and mindfulness, while Liana Lianov, MD, MPH addressed the power of positive psychology and physician health. The day ended with a panel of physician leaders from medical groups in the Sacramento region discussing their organizational physician wellness strategies. Lightning rounds throughout the summit featured Drs. Ruth Haskins, Sharon McCoy George and Lydia Wytrzes presenting on topics that included restoring joy in medicine, therapy dogs and sleep medicine.

On the opposite page, clockwise from the top: Emcee Rajiv Misquitta, MD and the attendees share a selfie; from left, Cindy Schorzman, MD, Rochelle Frank, MD, and medical students Alena Cave and Nawal Maher Abou Zahr; medical students Deyu Wang and Eileen Ly enjoy a visit with Lily the mini horse from Paws (and hooves) on Call; Pragati Rohatgi, MD listens to presentations while coloring. This page, from top right: Lydia Wytrzes, MD and her colleagues take a yoga break; massages were offered to promote relaxation; John Chuck, MD, with Gail Bower and Buster of Paws on Call; medical students from California Northstate and UC Davis.

November/December 2019

You Died By Suicide More Means Less for Patient Care

ou died by suicide.

like you. More’s ally, however, This morning I was rushed. I always feel rushed. I feel is less scary looking then itself. rushed by More. Resembling a human form, it is In health care, More is this tangible thing like a fork or often found wearing a suit, tie, a spoon. It is creative, continually morphing into a new and fake grin. It is the ultimate shape, disguising its true self when it is nothing more gaslighter, manipulating society than a plague meant to turn physicians into machines, to believe its actions are motihoping to one day remove all of humanism from the vated by kindness and altruBy Megan Babb, DO incredibly delicate and difficult practice of medicine. ism while physician’s actions mbabb1522@gmail.com Yesterday, More was the number of patient visits deemed to be driven by money being tracked. The day before this More took form as and greed. patient satisfaction scores. Last week More was the This manipulation is accomplished by promoting system reminding me of the hundreds of incomplete deceptive agendas that only they benefit from. For tasks that needed completion—if only there were thirty example, some agendas aim to reduce the number of hours in the day I tell myself; if only I was a machine hospital staff despite the overflowing patients who often which never needed sleep. How dare of me to require spill into hallways, requiring more work with less staff. such a thing. Or agendas that cause More is the villain perseveration over irrelThe clinic seems quiet this morning. Usually filled with creating a sense of rush evant data whereby any in all physicians, resempercentage less than laughter, music, witty banter, today there is none. bling a dementor, no one hundred means the empathy for humans, physician has failed. Or no sympathy for doctors, existing only as a dark shadow the agenda to replace physicians with less trained of greed moving through the world sucking the life out individuals who are often cranked out by an education of all who cross its path. Its existence is to act exclusystem that allows both 100 percent acceptance and sively at the benefit of its most trusted ally: Corporate pass rates to any who apply. Healthcare. All of which are nothing more than ineffective soluCorporate Healthcare is a system designed to make tions meant to be a ruse to deflect the truth: More and its money at the expense of vulnerable individuals— ally are the cause of our nation’s health care crisis. They 20

Sierra Sacramento Valley Medicine

| OPINION ESSAY |

disguise the word agenda behind words like budget cuts, decreasing health care costs, providers, the economy of scale, ACO’s. All mascaraed agendas and all real sources of poor patient outcomes and of the ever-rising cost of our very broken health care system. They are responsible for your death. I thoroughly dislike them both. This is especially true today. Today started the same. 4:00 a.m alarm goes off. The snooze button pushed. 4:10, the alarm goes off again. I tell myself, one more snooze. 4:20, the alarm goes off— already? I have to get up now. I get myself ready, allowing thirty minutes of quiet while all four of my babies sleep. I blink; it’s 4:50. I head to the hospital to round on the newborns who just came into the world, the irony this would later create, as this is where you and I first met. I quietly go from room to room apologizing to the parents for waking them up so early, explaining my being there was to examine their daughter or son and I needed to do so before my clinic started. One baby, two babies, three babies, the last one. I blink. I had examined and confirmed all the newborns are healthy, and I head back home. It is now 6:40 a.m. and time to get lunches and backpacks ready. I blink again; it’s now 6:50. Kids are up and running around the house like madmen. Sentences that reverberate between the walls seem to always be the same: Where is your homework? Mom, Kaeden took my water bottle. No, this is my water bottle. Kids, please be kind. Mom, I said I wanted the green bowl. Where is my library book? Those are not your socks; those are mine. Mom, Ryan took my socks. I blink. It is 7 a.m. Our nanny arrives. I spend a few minutes filling her in on the day’s activities. Kisses go around to all of my little nuggets. 7:10 and I am out the door. The clinic seems quiet this morning. Usually filled with laughter, music, witty banter, today there is none. I thought this was weird, but I am rushed, no time to ponder the change in atmosphere, I have hospital charting to complete from my early morning work before my first patient arrives otherwise More will creep into my day like a heavy fog rolling into the San Francisco Bay. I blink, the quiet is because of you. You died, they said, by suicide. My medical staff repeats this over and over again, each time revealing a greater sense of worry

with each time it is repeated, and with each time I fail to respond. You died by suicide. This will be hard to hear. Instantly, this warm, vibrant, alive person who I spent so much time with treating, healing, caring for is now laying, lifeless on a cold metal table surrounded by others, lifeless, laying on cold metal tables. You died by suicide. This is all I hear in my mind. You laying on the cold metal table is all I see in my mind. I can feel my insides panic, break, my heart now in the middle of my gut, feeling so heavy I succumb to gravity and it drops me to the ground. 7:28, my first patient has arrived. I blink. 7:34, my first patient is roomed and ready to go. I, however, am not. I am not prepared for today because twelve minutes ago I learned that you

died by suicide and instead of lying comfortably in your warm bed where you should be, you are now lying on a cold metal table. I feel rushed. More is so unkind; it won’t even allow me the opportunity to release one of the millions of tears I wish to shed over you. Even the internal panic I have buried in my core which I hold on to so stoically feels rushed; even it is terrified of More. I blink. I move through my morning like a great actor. I could be an actor. All physicians could be. I take a deep breath, enter each room, plaster a smile on my

November/December 2019

| OPINION ESSAY |

face and pretend that the hurt and pain inside me isn’t consuming me, praying it does not show because More would never allow it. More controls me, and I am a slave to it. I have to emotionally detach from you for the next eight minutes and will have to repeat this many times today. I feel rushed. Always rushed

You died by suicide, but it was not your fault. There was a time when I would have blamed myself as your physician. I will not blame you. I will not blame me. More and its ally are to blame. When I begged the system to admit you because I feared for your safety, but they sent you home anyway—that

There was a time when I would have blamed myself as your physician. I will not blame you. I will not blame me. More and its ally are to blame.

to see more, be more, smile more, treat someone’s pain more. There is still the need for more yet because More is not my friend. More is never for me, the physician, but always for someone else demanding it, financially gaining from it.

was because of More and its ally. When I tried tirelessly, spending hours on the phone, missing family events, making other patients wait, to locate outpatient resources for you that ultimately were denied due to your inability to pay and

rejected by an insurer who decided they knew more about your needs than me, this was because of More and its ally. Corporate Healthcare is responsible for your death. You did not die by suicide; you died by Corporate Healthcare. I now hear this in my head. I will remain committed to working tirelessly for you, exposing those whose sole intention is to profit off of illness and the vulnerability of others. More and its ally are not your friends. I am, and I am a physician. I am your physician. You died by Corporate Healthcare. I am now home, where I am safe, away from More and its ally. I am now free to release the millions of tears over the loss of you. Editor’s note: The original version of this essay appeared on Vocal, a blog site.

SSVMS Winter Upcoming Events NOV Creating the Extraordinary Patient Experience DEC CME, Lucca Restaurant, Sacramento, CA 4 14 Dec 11 FEB 29

Celebrate the Season! - Winter Social SAVE THE DATE, Davis, CA

Jan 23

Medical-Dental Learning Collaborative CME, Dinner Gratitude and Money Workshop Sponsored by SAFE Credit Union

SSVMS Honors Medicine, Elks Tower - Sacramento, CA To RSVP contact Sam Mello at rsvp@ssvms.org or (916) 452-2671

Sierra Sacramento Valley Medicine

Y O U ’ R E

I N V I T E D

Oral Health in the Medical Home:

The Critical Role of Oral Health in Optimal Health Learning Objectives: Describe the importance of oral health on systemic health Incorporate the use of oral health screening into the primary care practice Integrate application of fluoride varnish in the pediatric setting Locate dental referral resources Identify pain-free ways for providers to support oral health

Keynote Presenter Susan Fisher-Owens, MD, MPH, FAAP For any questions regarding the ESC! Medical-Dental Learning Collaborative and/or the event, please contact Katie Andrew, Senior Associate of Oral Health at Children Now:

W H E N December 4th, 2019 6:00pm — 8:00pm Dinner to be provided.

W H E R E Sierra Sacramento Valley Medical Society 5380 Elvas Ave. Sacramento, CA 95819

R E G I S T R A T I O N http://bit.ly/Dec2019MedDentalLC

kandrew@childrennow.org or (916) 379-5256 Ext. 134 CE for dental providers pending approval Accreditation Statement: This activity has been planned and implemented in accordance with the Essential areas and policies of the Institute for Medical Quality/ California Medical Association (IMQ/CMA) through the joint sponsorship of Fresno-Madera Medical Society (FMMS) and Sierra Sacramento Valley Medical Society. The FMMS is accredited by the Institute for Medical Quality/California Medical Association (IMQ/CMA) to provide continuing medical education for physicians. Credit Designation Statement: FMMS designates this live activity for a maximum of 1.0 hour(s) of AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The Medical Hazard of Being a Smith

What’s in a Name? Apparently, a Lot of Confusion.

t was someone’s bright idea on Ellis Island, or maybe just an act of laziness. Whatever the reason, somewhere around the turn of the 20th Century my family name changed from the original Danish Schmidt to the anglicized Smith. Obviously, we weren’t the only family to have this happen to us, as Smith became the most common name in the United States. According to a recent survey, there are 2.4 million people in America with the last name of Smith. We lead the Johnsons and Williams by a heady margin and, at least as of a couple years ago, there were twice as many of us as there are Garcias in the country. It’s not hard to imagine that this can cause some problems in our daily lives, even if we’re asked far less often how to spell our last name. Sometimes the issues are mildly annoying or even amusing, such as when an obviously young caller dialed my number several years ago and asked if I played for the Kings. (Kenny “The Jet” Smith played for them at the time, but no one who saw me on a basketball court or anywhere else would ever mistake me for him.) At least twice while returning from out of the country, I have been stopped and questioned by Customs— delaying my airport exit by nearly an hour—because there were “resemblances” to someone who had apparently been arrested a few times. I even remember almost verbatim the dialogue at the Customs officer’s desk at LAX on my return from Mexico, here in a condensed version: Officer: Have you ever been arrested? Me: No. Officer: Are you sure? Me: Yes. Officer: It’s OK if you’ve been arrested. Me: Believe me, I’d remember. Officer: Have you ever had any trouble in Stockton? Me: I try to avoid Stockton. Officer: Did anyone give you anything to you to 24

Sierra Sacramento Valley Medicine

By Ken Smith ken@kdscommunications.com

bring with you? Me: Frijoles. (I had been given a sample bag of beans from a manufacturing facility I visited as part of a business tour.) Officer: Have a nice day. But when it comes to health care, an error in identity can be much more concerning. There is a local man who has worked for the state and county for the past few decades, and he and I not only have the same first name but a very similar middle name that starts with the same letter. I can’t remember if we’ve ever met in person, but I’m sure he’s just as aware of me as I am of him. At one point, we were working on the same issue (albeit on different sides) and were scheduled to be at the same conference in Southern California. When I checked in to the hotel, I found my reservation had been canceled because he had already arrived and they thought it was a duplicate.

The X-rays were missing something I wasn’t: wisdom teeth. Closer to home, I discovered that in addition to having similar names we share the same dentist. I learned that when I looked at the X-rays they had put on the wall one day and noticed that the pictures were missing something I wasn’t: wisdom teeth. Ever since then, all my records are listed by my first initial and middle name. At a recent visit to the endodontist to see if I had an infection under a decade-old root canal—fortunately, it turned out I didn’t—the X-rays looked suspiciously unfamiliar and the initial probe involved teeth that didn’t include the one I had come to have looked at. There was good reason, of course, because they belonged to another Ken Smith. These kinds of mistakes don’t happen just within a

Ken Smith

K. Smith

Kenneth Smith

That’s Me, Too!

doctor’s office. Late last year, I had a minor infection that required a urinalysis and blood panel. When I went onto Quest Diagnostics’ patient portal, I saw a rather frightening chart in the shape of an Arizona mesa that indicated some major spikes. But on closer examination, the high points were connected to a doctor in the Lake Elsinore area of Southern California. My records had been combined with those of someone in that area who has the exact same name and birthdate—month, day and year—as I do. For all I know, he saw an inverted version of my chart and was either impressed by his improvements or freaked out by the sudden changes. I notified Quest by phone and the woman at the end of the line said she would file a “breach report,” which was the last I heard from them. Interestingly, however, I went online today to check those results and there is a test result from February that includes the wrong phone number, wrong doctor (one located in Murrieta) and very possi

bly the wrong information. I have no idea if the only mistake is in the patient information, if those are his readings instead of mine, and whether he’s looking at my results when he goes online. It’s not really that funny when you consider the patient privacy ramifications. This is also where it gets a little scary. What if my doctor had used someone else’s results to determine a course of treatment for me, one that I might not need or could be of the wrong magnitude? I can’t have confidence that what I’m seeing isn’t what he’s seeing, so any care I receive often requires me reminding them to double-check that their records are right. Even though this age of defensive medicine has led to a system of double- and triple-verification that everything is correct, it’s still hard to have comfort as a patient. I had some wrist surgery in April, and every step of the way I took pains to ensure that the doctor and his team had the right imaging and medical history for me because it’s really hard to say, “Uh, you sure

that’s right?” while you’re under anesthesia. Fortunately, they were extremely thorough and all went very well. I know you go through extensive training on handling records and that your staff is careful. But on behalf of all the Smiths, Johnsons, Garcias and even the Browns, I’m taking this opportunity from a patient’s perspective to remind physicians, clinics, hospitals, labs, urgent care centers and others that it’s still apparently easy to make mistakes when people have similar and common names. Please go the extra mile to give us the peace of mind that the records you’ve pulled, whether on paper or electronic, are the right ones and that the information in them is correct. Don’t assume that a corporate lab that serves millions of people got it right or that your filing system is perfect. Doing so could lead to a life-changing error for you and your patient. There is only so much your patient can do to make sure you’re visiting with the person you think you are. But we took at least one purposeful proactive step when my son was born: His first name is Couver, and as far as we know he’s pretty much the only one. In fact, most of the time he really only needs one name to identify himself, like Cher or Elvis. Still, if he ever turns out to be your patient, please make an extra effort to ensure your have the right records, just as you should for all the John, Bob—and Ken—Smiths out there. Ken Smith is managing editor of SSVMS Medicine.

November/December 2019

A Booster on Vaccines And Public Health By George Meyer, MD geowmeyer@icloud.com

n view of the discussions about immunizations these days, it is prudent to review some of the diseases we get protected against when we are immunized and the effect these vaccinations have had on public health. We’ll look at the common vaccinations children get today: German measles (rubella), measles (rubeola), mumps, whooping cough (pertussis), polio, and tetanus.

Rubella (German Measles)

Photo: Centers for Disease Control and Prevention

The CDC says, “Before the availability of rubella vaccines in the United States, rubella was a common disease that occurred primarily among young children. The last major epidemic in the United States occurred during 1964 to 1965, when there were an estimated 12.5 million rubella cases in the United States. “Because of successful vaccination programs, rubella has been eliminated from the United States since 2004.

A classic rubella rash that starts on the face and then extends to the trunk, arms and legs. 26

Sierra Sacramento Valley Medicine

However, rubella is still common in other countries. Unvaccinated people can get rubella while abroad and bring the disease to the United States and spread it to others.” German measles is a much milder illness than measles. Patients may have a low-grade fever, sore throat, and a rash that starts on the face and spreads to the rest of the body. Some people may also experience headache, pink eye and general discomfort before the rash appears. The rash lasts about three days, explaining why rubella is also known as three-day measles. Rubella is of tremendous concern for women who have not been immunized and acquire the disease in the first trimester of pregnancy. This happened to one of my friends, who, just after her husband died from multiple sclerosis, caught Rubella in her first trimester. Her baby was born blind, deaf, and mentally disabled. The CDC says that 90% of children whose mothers had rubella during pregnancy get congenital rubella syndrome (CRS). The baby may be born with multiple birth defects if it survives at all. Worldwide, 100,000 babies are born each year with CRS. The only way to prevent this from occurring is to immunize all women with a rubella vaccine, which is normally given as part of the MMR (measles, mumps, rubella) or MMRV (measles, mumps, rubella, varicella) vaccine. There is no immunization available in the United States that just protects against Rubella. Side effects from vaccination that may occur go away in a few days are usually mild. They can include fever, mild rash and swollen glands in the neck or cheeks. Pain or joint stiffness may occur in up to 25% of patients, more often in females. Seizures, usually related to high fever, are reported in about one out of 3,000 doses. One case out of 30,000 may have a brief episode of thrombocytopenia.

Photo courtesy of Arch Virtual

In 1952, nearly 3,000 people had died from polio and children in “iron lungs” populated wards in most hospitals. By 1991, however, the disease had been eradicated in the Western hemisphere.

Rubeola (Measles) Measles, on the other hand, is one of the leading causes of death among children around the world. The case fatality rate is 4-10% in developing countries. Every day, 246 children die from measles, mostly due to respiratory tract infections or encephalitis. Following exposure, 90% of those not vaccinated get clinical disease, with complications occurring in up to 30% of affected cases. Pregnant women and immunosuppressed patients are at the highest risk for complications. The infection may cause suppression of T-cell responses to infection; consequently these patients are at risk to acquire pneumonia and diarrhea, and their ability to resist tuberculosis is decreased. It is estimated that 300 per million infected patients are at risk to develop subacute sclerosis panencephalitis (SSPE) seven to 10 years after infection.

Mumps Mumps carries fewer complications than rubella or rubeola. Mumps is usually limited to the parotid glands, especially in children, and there are normally few complications. In adults, 30-50% of males will have orchitis but sterility is rare. Five percent of post-puber-

tal women may develop inflammation of the ovaries accompanied by abdominal pain, fever and vomiting. Mastitis and premature menopause are reported but are said to be rare. Encephalitis, meningitis and deafness may also occur; Guillain-Barre is a rare complication. Like any medicine, there is an extremely small chance that the measles/mumps/rubella vaccine could cause a potentially serious reaction, but the vaccine is much safer than any of the complications from these diseases.

Polio I doubt there is anyone who grew up in the ’40s and ’50s whose parents were not frightened about polio. I was forced, in summers, to take a nap or rest daily for two hours in the middle of the day to make certain I had adequate rest to fight off this dreaded disease. We did not understand what caused it nor how one acquired it. Rehabilitation hospitals were full of iron lungs that kept people alive; their polio was so bad it paralyzed the respiratory muscles. (Please make time to visit the SSVMS Museum of Medical History to see the iron lung on display and try to imagine spending your whole life in one of these machines). Then, in 1955, it was announced that Dr. Jonas Salk

November/December 2019

had developed an immunization of inactivated polio virus that would prevent polio. I remember the lines of people waiting to get this shot. After the series of three shots, there is an expectation of 99% protection against polio. In 1961, Dr. Albert Sabin developed a vaccine of a live attenuated virus. Instead of a shot, children would take this vaccine in drops on a sugar cube. One dose of the trivalent oral (OPV) vaccine will give 50% immunity and after 3 doses, there is greater than 95% protection. The live attenuated OPV vaccine can cause paralytic polio, but at a rate of approximately three per million cases. Thanks to the advances provided by Drs. Salk and Sabin, the risk of polio is virtually nonexistent in the developed world today.

Tetanus I have seen only one case of tetanus, and that was as a medical student at Charity Hospital in New Orleans in 1963. I remember the patient being a young man who had been exposed to C. tetani and was admitted to the ER with muscle rigidity, trismus and painful muscle spasms. He was kept in a dark room and away from stimulation. In the 1960s, any male patient with an injury was asked if he had ever been in the military because all veterans

had been immunized for tetanus. According to the CDC, there were 233 cases of tetanus in the United States from 2001-2008. The case-fatality rate was 13.2 percent overall but was 31.3 percent among individuals over 65 years of age; these older individuals also were twice as likely to get tetanus as the general population. Tetanus in the U.S. has declined 99% since 1947 and there are now about 30 cases a year. The most common sign of tetanus is spasming in various muscles and especially the jaw, which is why the disease is also commonly called lockjaw. More than 50% of patients present with trismus or lockjaw. Often there may be periods of apnea and or upper airway obstruction due to the strong contractions of the airway and/or thoracic muscles. According to UpToDate, other presentations include neonatal tetanus, cephalic tetanus (when injury has occurred to the head ) and local tetanus, isolated to one part of the body. The best prevention is immunization! Despite the low rate of occurrence, we are constantly exposed to possible sources so immunization is imperative. This is mostly done with the combination DPT (diphtheria, pertussis and tetanus) vaccine, and boosters need to be kept up to date.

New at the Museum By Bob LaPerriere, MD ssvmsmus@gmail.com

A generous donation of approximately 150 books on medical history, numerous medallions and a wide variety of other artifacts was made by Dr. Roger Shepherd. The most unique item was a pleximeter, circa 1860. This instrument, made from ivory and

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sterling silver, was hinged to fold for holding. It was applied to the chest wall and percussed with a hammer to determine areas of fluid or consolidation in the lung. The ruler on the plate allowed recording of the location, and measurement, of the sound.

Photo: Bob LaPerriere, MD

PLEXIMETER

Feeling Acronymish Sometimes Words Just Get in the Way

By Faith T. Fizgerald, MD ftfitzgerald@ucdavis.org

he history of medicine suggests that Latin and Greek—both in books and speech—were the required languages for creating educated doctors in Europe. The written books and papers were a testament to the erudition and excellence of a physician. Once Latin and/or Greek were mastered, multiple doctors and scientists from multiple European states could read it (as less educated men could not) and presumably understand what they were reading. The history of medicine in the current era in the United States is now, in naming diseases and therapies, largely written in acronyms, both in published papers in outstanding journals, but now also the preferred language used on television to promote sales of medicines and medical procedures. They may also be prominent in medical journals and magazines as well as electronic medical records. I frequently now have to take time to look up long lists of medical acronyms online. Many acronyms, I find, have several possible meanings. I have also noticed that many of my students, house staff and patients use acronyms in vocal presentations, but—when asked— don’t quite know what they mean or its origin.

I have learned much and enjoyed much from reading multiple outstanding medical journals and listening over half a century to talks by learned men and women in medicine, but now find myself periodically desperate in translation of acronyms. Sometimes, when I raise my hand during grand rounds or other talks, it is to ask what the acronym stands for, and sometimes—mirabile dictu (‘wonderful to relate’)—that is a difficult question for the speaker. Historically, this could be a new form of the use of Latin and Greek in medical writing for many centuries (to impress a doctor’s higheducation standing, I suppose). I have read on the Internet that the word “acronym” itself is a conjunction of the Greek akron (meaning end or tip) merged with the English “onym” (as in the English words pseudonym, homonym, eponym). Page after page of lists of medical acronyms can be found on the internet and heard on television ads. I have no problem with this type of secret language as long as it isn’t secret to the doctors or the TV ad watchers who are our patients— even if it requires that they sometimes agree to use made-up words without knowing what they really mean.

November/December 2019

| BOOK REVIEW |

Never Home Alone

From Face Mites to Friendly Spiders, We Always Have Visitors By Jack Ostrich, MD jmost119@aol.com

efore you take your next shower, you might want to read Rob Dunn’s 2018 book, Never Home Alone. Dunn is an ecologist/biologist at North Carolina State University, and has spent most of his academic life studying the human macro- and microbiome in and around our homes and on our bodies. The book is a compilation of his own extensive research as well as findings and ecological lessons gleaned from studies done around the world. For example, with regard to the typical American showerhead’s bacterial population, the most commonly found chronic inhabitants are nontuberculous mycobacteria (NTM), a few of which are potential pathogens. They are most likely to thrive where the water has been “treated” from a central municipal source. Treatment with chlorine or chloramine favors the emergence of mycobacteria, as they seem to be minimally bothered by these chemicals or by the occasional drenching with hot water. They are hardy survivors of your local water district’s attempts to make your water “safe.” Surprisingly, Dunn reports that if your water is from a well and untreated, the likelihood of mycobacteria living happily in your showerhead was often zero and generally about fifty per cent less than at the house of your neighbor who is showering with treated municipal water. The same was true for untreated municipal water, rarely found in the U.S. but not uncommon in Europe. Dunn writes for the general, non-scientific, reader, but also presumes that you are inquisitive and not squeamish. He describes our bodies as covered with a 30

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multi-layered “shag rug” of microscopic fungi and thousands of species of bacteria. He reassures us that only a few dozen (so far) of the millions of species of fungi and bacteria are consistent pathogens, and that our personal and domiciliary biomes are overwhelmingly benign and often helpful as they compete with—and ward off—potentially harmful microbes. Dunn believes that there is good epidemiological evidence that we should encourage biodiversity around ourselves and in our homes. Population studies have revealed, for example, that Amish children have much less atopic and asthmatic disease than their Hutterite countrymen who have a lifestyle similar to the Amish but have adopted modern “industrial” farming methods. In Europe, a comparison of children in the province of Karelia, which was divided after the Finnish-Russian war in 1940, revealed the same data. The kids in

Amish children have much less atopic and asthmatic disease than Hutterites, who have a lifestyle similar to the Amish but have adopted modern “industrial” farming methods. the more rural and less industrialized Russian sector showed less atopy and asthma than their former countrymen on the Finnish side. Author Dunn, tongue firmly in cheek, recommends that we all may benefit by keeping a dairy cow, a horse, some chickens and a couple of sheep in our backyards and that we encourage our children and their friends to play with the creatures regularly. They need to wash their hands afterward to remove most of the “new arrivals,” but otherwise contact with these animals doesn’t normally have a lasting effect on one’s personal manual microbiome. Frequent use of topical agents such as alcohol (e.g., Purell), hydrogen peroxide, triclosan, and benzalkonium has been found to actually encourage the emergence of resistant germs.

Photo: David Monniaux/Wikimedia Commons

Are German cockroaches more worrisome than your neighbors or kids? Maybe so, but not when it comes to what pathogens we each carry. Spiders seem to alarm us, but Dunn says, “Spiders…are nearly always our allies… Venom is costly to spiders, and they don’t want to waste it on you.” He merrily reports on a 2014 study, published in the journal Animal Behaviour, in which several Western black widow spiders were caged then repeatedly—up to sixty times over several minutes—poked by soft objects made from gelatin to resemble human fingers. None tried to bite. In the Kansas City suburb of Lenexa, an old house under renovation was studied for the presence of brown recluse spiders. Exactly 2,055 were found, even though there had never been reports of spider bites from the human inhabitants. Dunn says most reports of brown recluse bites come from parts of the country where the creature probably does not occur and are actually superficial bacterial infections. By the way, it is all right to clean up those unsightly cobwebs on the chandelier and over the front door.

Okay, so what about cockroaches? They are scary and spread germs and filth all over the place, right? Dunn devotes many pages to the evolution and modern biology of cockroaches, of which there are over 4,500 species. Only about 30 of them have abandoned life in the wild and moved in with us, with the German cockroach the most common. It is true that cockroaches can carry pathogens, Dunn says, but not any more than your neighbors or children carry them. Dunn also delves into the biology and epidemiology of what he considers the two most common infestations of mankind, Toxoplasma gondii and the face mite, Demodex folliculorum. Fifty per cent of French

adults have positive serology for “Toxo.” In Germany it is about 40%, and in the U.S., about 20%. Considering how common human exposure to T. gondii seems to be, the frequency of clinically significant toxoplasmosis is rather low although the most devastating disorder, congenital toxoplasmosis, affects about 200,000 children each year but is rare in the U.S. And, considering that all or most of us have D. folliculorum thriving on our faces, the frequency of mite-related disease is extremely low. Dunn’s book is easy to read and enriched by hundreds of footnote citations, most of which are made even more useful, and more fun, by his comments. He offers reassurance to all of us who fret about what microbe might be lurking on an airport toilet seat, the TV remote control in our hotel room, or on— and in—our pets. I also suggest viewing his TED talks and one by Anne Madden—who did postdoctoral work with Dunn—from 2017 titled, “Meet the Microscopic Life in Your Home… and on Your Face.” After you have read the book you will probably no longer bother washing your face before you go to bed. Don’t bother soaking your showerhead in bleach either. If you do, the NTM already present will probably thank you for helping to eliminate their competition.

Seeking Physician Mentors for Medical/PA Students Are you a physician willing to donate a few hours of your time to mentor medical, PA, and NP students? The Joan Viteri Memorial Clinic, a UC Davis School of Medicine student-run clinic, is searching for physicians to serve as mentors and preceptors to teach students from 10:30 a.m to 2 p.m. Scheduling is flexible, volunteer physicans are welcome to come as often as they desire. For more information, please contact jvmclinic@gmail.com.

November/December 2019

SSVMS Election Results 2020 Board of Directors President: John Wiesenfarth, MD

District 3, South: Ravinder Khaira, MD

President-Elect: Carol Kimball, MD

District 4, El Dorado County: Ranjit Bajwa, MD

Immediate Past President: Chris Serdahl, MD District 1, North: Ashutosh Raina, MD

District 5, The Permanente Medical Group: Sean Deane, MD, Fazam Gorouhi, MD, Angie Yu, MD,

District 2, Central: Adam Dougherty, MD, J. Bianca Roberts, MD; Vanessa Walker, DO

District 6, Yolo County: Marcia Gollober, MD

Paul Reynolds, MD, Roderick Vitangcol, MD

2020 CMA Delegates District 1, North Area: Reinhardt Hilzinger, MD, Delegate; Megan Babb, MD, Alternate District 2, Central Area: Lydia Wytrzes, MD, Delegate; Ann Gerhardt, MD, Alternate District 3, South Area: Katherine Gillogley, MD, Delegate; Thomas Valdez, MD, Alternate District 4, El Dorado County: Russell Jacoby, MD, Delegate; Anand Mehta, MD, Alternate District 5, The Permanente Medical Group: Sean Deane, MD, Delegate; Ernesto Rivera, MD, Alternate District 6, Yolo County: Marcia Gollober, MD, Delegate; Christopher Swales, MD, Alternate At-Large Office 7: Carol Kimball, MD, Delegate; Neil Parikh, MD, Alternate At-Large Office 8: John Wiesenfarth, MD, Delegate; J. Bianca Roberts, MD, Alternate At-Large Office 9: Don Wreden, MD, Delegate; Vacant, Alternate At-Large Office 10: Ruenell Adams Jacobs, MD, Delegate; Lucy Douglass, MD, Alternate At-Large Office 11: Paul Reynolds, MD, Delegate; Brian Bernhardt, MD, Alternate At-Large Office 12: Kuldip Sandhu, MD, Delegate; Natasha Bir, MD, Alternate At-Large Office 13: Charles McDonnell, MD, Delegate;

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Leena Mehta, MD, Alternate At-Large Office 14: Richard Jones, MD, Delegate; Romero Santiago, MD, Alternate At-Large Office 15: Richard Gray, MD, Delegate; Derek Marsee, MD, Alternate At-Large Office 16: Helen Biren, MD, Delegate; Gordon Garcia, MD, Alternate At-Large Office 17: Tom Ormiston, MD, Delegate; Arlene Burton, MD, Alternate At-Large Office 18: Barbara Arnold, MD, Delegate; Jocelyn Kim, MD, Alternate At-Large Office 19: James Sehr, MD, Delegate; Alternate Mark Drabkin, MD At-Large Office 20: Senator Richard Pan, MD, Delegate; Karen Hopp, MD, Alternate At-Large Office 21: Sandra Mendez, MD, Delegate; Amber Chatwin, MD, Alternate At-Large Office 22: Chris Serdahl, Delegate; Ronald Chambers, MD, Alternate At-Large Office 23: Ajay Singh, MD, Delegate; Rachel Ekaireb, MD, Alternate At-Large Office 24: Adam Dougherty, MD, Delegate; Mohammed Kahn, MD, Alternate At-Large Office 25: Rajiv Misquitta, MD, Delegate; Brian Jones, MD, Alternate

Board Briefs September 9, 2019 Meeting: THE BOARD: Received a presentation from SSVMS Vetted Vendor Nicholas Maloof, Esquire, Maloof Law Group. Approved the proposed revisions to SSVMS Membership and Peer Review Policies. Approved the Nominating Committee recommendations for nominations to vacancies on the Board of Directors and SSVMS Delegation to the California Medical Association in 2020. Approved the recommendations from the Scholarship & Awards Committee to provide the 2019 medical student scholarships to: Brynn Sargent, 1st year medical student at U. C. Irvine School of Medicine; Lisa Teixeira, a 2nd year medical student at Albany Medical College; Wendy Woo, a 2nd year medical student at Virginia Commonwealth University School of Medicine, and the Paul J. Rosenberg Medical Student Scholarship to Ashley Kyalwazi, a 1st year medical student at Harvard Medical School.

September 2019 For Active Membership — Sam Afshar, DO; Tierney Allen, MD; Ashish Bharolia, MD; Kelsey Childress, MD; Marisa Crawford, DO; Michael Crist, MD; Darilyn Falck, MD; Daniel Fisher, MD; Sara Ann Gilbert, MD; Julia Gold, MD; Yu Kao, DO; Benjamin Kemp, DO; Marketa Leisure, MD; Michael Loudin, MD; Elizabeth Lynn, MD; Nadeem Mukhtar, DO; Sherman Padda, DO; My Pham, DO; Moqueet Qureshi, MD; Paige Radell, MD; Bradley Stauber, DO; Chung Wong, DO; Alaa Zahriya, MD. For Resident to Active Membership — Maya Bauer, MD; Amir Taefi, MD; Lei Wang, MD. For Retired Membership — Gregory Blair, MD; Debra Horney, MD; Douglas Lurie, MD; Karen Murrell, MD. For Transfer of Membership — Afiba Arthur, MD, Orange County.

Approved the 2nd Quarter Financial Statements, Investment Reports and Recommendations. APPROVED THE FOLLOWING MEMBERSHIP REPORTS: August 2019 For Active Membership — Sammy Almashat, MD; Rachel Baltasar, MD; Scott Baron, MD; Yi-Ren Chen, MD; Christopher Gomez, MD; Jeffrey Hoover, MD; Brian Kim, MD; Dung Thi Le, MD; Jessica Masocol, MD; Robert Masocol, MD; Guillermina Morales, MD; Babak Rajabi, MD; Austin Saavedra, MD; Zainab Saifee, DO; Homayoon Shahidi, MD; Aaron Skelton, MD; David Terca, MD; Navneet Virk, MD; Shuhao Zang, MD. For Reinstatement to Active Membership — Douglas Young, MD. For Retired Membership — Peter Carruth, MD. For Transfer of Membership — Priyanka Teckchandani, MD to Orange County; Jeffrey Wei, MD to Los Angeles.

November/December 2019

| 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. Marianne Abouyared, MD, OTO, UC Davis Medical Group

Marisa Crawford, DO, PD, The Permanente Medical Group

Melissa Hopkins, MD, P, UC Davis Medical Group

Sam Afshar, DO, AN, The Permnente Medical Group

Michael Crist, MD, IM, The Permanente Medical Group

Tierney Allen, MD, HOS, Mercy Medical Group

Maneesh Dave, MD, IM, UC Davis Medical Group

Vladimir Ivanovic, MD, R, UC Davis Medical Group

Sammy Almashat, MD, OM, Woodland Clinic Medical Group

Danielle Alexander D’Cruz, MD, P, UC Davis Medical Group

Grace Amadi, MD, FP, UC Davis Medical Group Edris Aman, MD, IM, UC Davis Medical Group

Jeremy DeMartini, MD, P, UC Davis Medical Group

Maria Pia Anderson, MD, OBG, UC Davis Medical Group

Lee Donohue, MD, PD, UC Davis Medical Group Imo Ebong, MD, IM, UC Davis Medical Group

Mustafa Ansari, MD, N, UC Davis Medical Group

Joshua Edwards, MD, HOS, Mercy Medical Group

Simon Ascher, MD, IM, UC Davis Medical Group

Elizabeth Ekpo, MD, N, UC Davis Medical Group

Reza Assadsangabi, MD, R, UC Davis Medical Group

Bashir El-Khoury, MD, IM, UC Davis Medical Group

Gagan Badhwar, DO, HOS, Mercy Medical Group

Bruce Espenshade, MD, HOS, Adventist Health

Norkamari Shakira Bandolin, MD, EM, UC Davis Medical Group

Darilyn Falck, MD, EM, California Northstate University College of Medicine

Scott Baron, MD, CD, Capitol Interventional Cardiology

Jennifer Fan, MD, IM, UC Davis Medical Group

Katherine E. Barton, MD, R, UC Davis Medical Group Maya Bauer, MD ,PD, The Permanente Medical Group Alana Beres, MD, PDS, UC Davis Medical Group

Marcia Faustin, MD, PM, UC Davis Medical Group Daniel Fisher, MD, CD, Capitol Interventional Cardiology Ryan Fuller, MD, P, UC Davis Medical Group

Yihung Huang, MD, IM, UC Davis Medical Group

Tiffani Johnson, MD, EM, UC Davis Medical Group Helen Kales, MD, P, UC Davis Medical Group Lisa H. Kang, MD, R, UC Davis Medical Group Kiran Kanth, MD, N, UC Davis Medical Group Yu Kao, DO, FP, Woodland Clinic Medical Group Kevin Keenan, MD, N, UC Davis Medical Group Benjamin Kemp, DO, DR, The Permanente Medical Group Laura Kenkel, MD, P, UC Davis Medical Group Manoj Kesarwani, MD, IM, UC Davis Medical Group Brian A. Kim, MD, APM, Mercy Medical Group Chris Kim, MD, PD, UC Davis Medical Group Nicholas Klimberg, MD, IM, UC Davis Medical Group Mimmie Kwong, MD, VS, UC Davis Medical Group Dung Thi Le, MD, FP, Sutter Medical Group Sky Lee, MD, FP, UC Davis Medical Group

Ashish Bharolia, MD, HOS, Mercy Medical Group

Liliana Garcia-Vargas, MD, IM, UC Davis Medical Group

Andrew Birkeland, MD, OTO, UC Davis Medical Group

Michael Gibson, MD, IM, UC Davis Medical Group

Andrew Li, MD, PS, UC Davis Medical Group

Orin Bloch, MD, NS, UC Davis Medical Group

Sara Ann Gilbert, MD, OBG, The Permanente Medical Group

Allison Liu, MD, OPH, UC Davis Medical Group

Joey Boiser, MD, N, Mercy Medical Group Allison Brashear, MD, Neurology, UC Davis Medical Group Rebecca Brooks, MD, OBG, UC Davis Medical Group Colin Brown, MD, R, UC Davis Medical Group Olivia Campa, MD, IM, UC Davis Medical Group Catherine Cansino, MD, OBG, UC Davis Medical Group John Du Cha, MD, HOS, Mercy Medical Group Rinita Chakrapani, MD, IM, UC Davis Medical Group Florence Chau-Etchepare, MD, IM, UC Davis Medical Group

Ammara Gill, MD, IM, UC Davis Medical Group Regina Godbout, MD, IM, UC Davis Medical Group Lindsey Goetz, MD, IM, UC Davis Medical Group

Marketa Leisure, MD, PD, Thygeson Pediatrics John Lim, MD, IM, UC Davis Medical Group Michael G. Loudin, MD, GE, Mercy Medical Group Nancy Luo, MD, CD, Mercy Medical Group Elizabeth Lynn, MD, FP, The Permanente Medical Group

Julia Gold, MD, FP The Permanente Medical Group

Victoria Lyo, MD, GS, UC Davis Medical Group

Brian W. Goldner, MD, R, UC Davis Medical Group

Joseph Marsano, MD, IM, UC Davis Medical Group

Christopher Gomez, MD, HOS, Mercy Medical Group Susan Gorman, MD, OBG, UC Davis Medical Group Brian Goudy, MD, PD, UC Davis Medical Group

Kirti Malhorta, MD, IM, UC Davis Medical Group

Kristy Mathes, MD, IM, UC Davis Medical Group Melissa Matulich, MD, OBG, UC Davis Medical Group Steven Maximus, MD, VS, UC Davis Medical Group

Hui Amy Chen, MD, OBG, UC Davis Medical Group

Reshma Gupta, MD, IM, UC Davis Medical Group Michael Han, MD, ORS, Mercy Medical Group

Christine McBeth, MD, EM, UC Davis Medical Group

Ling-Xin Chen, MD, IM, UC Davis Medical Group

Harliv Hans, MD, HOS, Mercy Medical Group

Mina Momenin, MD, R, UC Davis Medical Group

Yi-Ren Chen, MD, NS, Mercy Medical Group

AnneMarie Hargadon, MD, IM, UC Davis Medical Group

Guillermina Morales, MD, OBG, Woodland Clinic Medical Group

Marwah Helmy, MD, R, UC Davis Medical Group

Christabel Moy, DO, HOS, Mercy Medical Group

Kelsey Childress, MD, PD, The Permanente Medical Group Kayla A Cort, MD, R, UC Davis Medical Group

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Jeffrey Hoover, MD, NPM, Mercy Medical Group

| NEW MEMBERS |

Nadeem Mukhtar, DO, HOS, Mercy Medical Group

Austin Saavedra, MD, FP, Mercy Medical Group

Steven W Thorpe, MD, OS, UC Davis Medical Group

Stanley Naguwa, MD, IM, UC Davis Medical Group

Zainab Saifee, DO, OBG, Mercy Medical Group Deepika Sankaran, MD, PD, UC Davis Medical Group

Olivia Tong, MD, N, UC Davis Medical Group Melody Tran, MD, IM, UC Davis Medical Group

Dani Sarohia, MD, R, UC Davis Medical Group

Marcia Unger, MD, P, UC Davis Medical Group

May Thu Saung, MD, HOS, Mercy Medical Group

Wesley Valdes, MD, IM, UC Davis Medical Group

Bahman Sayyar Roudsari,MD, R, UC Davis Medical Group

Navneet Virk, MD, HO, Sierra Hematology & Oncology

Randall Schaefer, MD, ORS, Randall Schaefer, MD

Ingrid Wahjudi, MD, D, Woodland Clinic Med Group

Farah Shaheen, MD, IM, UC Davis Medical Group

Lei Wang, MD, RHU, Woodland Clinic Medical Group

Homayoon Shahidi, MD, HO, Sierra Hematology & Oncology

Hussein Warda, MD, OBG, UC Davis Medical Group

Aaron Skelton, MD, OPH, Mercy Medical Group

Huixia Wei, MD, IM, UC Davis Medical Group

Bradley Stauber, DO, IM, Capitol Interventional Cardiology

Susan Wilson, MD, OBG, UC Davis Medical Group

Benjamin Stripe, MD, IM, UC Davis Medical Group

Chung Wong, DO, HOS, Mercy Medical Group

Amir Taefi, MD, IM, The Permanente Medical Group

Alaa Zahriya, MD, HOS, Mercy Medical Group

Kathryn Newell, MD, IM, UC Davis Medical Group Diana Nguyen, MD, IM, UC Davis Medical Group Adam Oesterle, MD, IM UC Davis Medical Group Sherman Padda, DO, HOS, Mercy Medical Group Sushma Pant, MD, IM, UC Davis Medical Group Sapna Patel, DO, IM, Mercy Medical Group Bennett Penn, MD, IM, UC Davis Medical Group My Pham, DO, FP, Woodland Clinic Medical Group Nisha Punatar, MD, IM, UC Davis Medical Group Moqueet Qureshi, MD, VS, Mercy Medical Group Paige Radell, MD, D, Woodland Clinic Medical Group Swati Rao, MD, P, UC Davis Medical Group Babak Rajabi, MD, ON, Sierra Hematology & Oncology Tanya Rinderknecht, MD, TRS, UC Davis Medical Group

Veronique Tache, MD, OBG, UC Davis Medical Group

Felix S Wong, MD, R, UC Davis Medical Group Shuhao Zhang, MD, PS, Mercy Medical Group Yan Zhao, MD, OBG, UC Davis Medical Group

November/December 2019

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

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