S e p t e m b e r 2 012
Carolina Vascular & Vein Specialists Delivering a Continuum of Quality Health Care
Also in This Issue
Social Media Practice Insurance Checkup
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Editor’s Note
More with Less Health care has entered a new and exciting chapter, with the introduction of minimally invasive advances. Today, treatments that replace major surgery with as much as a tiny incision are part of the armamentaria of almost every medical
Editor Heidi Ketler, APR Contributing Editors Lester S. Borden Jr., M.D. Rod Guthrie Amanda Kanaan
specialty, including our cover story on Carolina Vascular & Vein Specialists. Photography - Anna Paschal Photography
Patients of Dr. Andrew Hearn of CVV have access to minimally invasive and noninvasive treatments for a range of conditions, from aneurysms to varicose veins. He also provides keen insight into how personal lifestyle changes – the epitome of noninvasive – might have the greatest impact on a patient’s overall health and wellbeing.
Also this month, we welcome Dr. Lester Borden, who reviews strategies for improving the risk/benefit ratio associated with PSA screening, including active surveillance, in men whose risk of prostate cancer is relatively low. Attorney Rod Guthrie suggests an annual insurance checkup for physician practices and offers a list of insurance considerations. Regular contributing editor Amanda Kanaan returns in support of the use of social media as a useful information and communication tool connecting doctor and patient.
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Heidi Ketler Editor
2
The Triad Physician
Creative Director - Joseph Dally
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Category
Contents
COVER STORY
4
Carolina Vascular & Vein Specialists
Delivering a Continuum of Quality Health Care
september 2012
FEATURES
9
Marketing
Three Reasons Why Doctors Should Consider Social Media
V ol . 1 , I s s u e 7
13
DEPARTMENTS 12 Legal Time for Your Annual
Urology
Insurance Checkup?
14 News
Active Surveillance for Prostate Cancer
- Forsyth Is First Hospital In State to Achieve Cycle IV Accreditation
Dr. Lester Borden discusses strategies
Amanda Kanaan reviews social
to improve the risk/benefit ratio of PSA
media benefits that give practices
screening, such as selective screening,
a competitive edge, including cost-
and active surveillance over aggressive
effective marketing and improved
treatment.
patient relationships.
- Diversity MBA Magazine Recognizes Achievements of Two Novant Leaders
15 News
- Newborn Channel Provides Baby
- Bariatric Center Earns Center of
Care and Postpartum Education Excellence Recertification
16 News
- New physician and physician assistant listing
On the cover: Andrew Hearn, vascular surgeon with Carolina Vascular & Vein Specialists, serves as medical director of the interventional diagnostic lab at Alamance Regional Medical Center, where he is also chief of surgery.
- Letter of Apology
- 2013 Editorial Calendar
September 2012
3
Category On the Cover
Carolina Vascular & Vein Specialists Delivering a Continuum of Quality Health Care By Amanda Kanaan
Carolina Vascular & Vein Specialists has set the standard in vascular
Dr. Hearn, a graduate of the Ohio State University College of
care in the Triad since its origination in 2006. The Burlington practice
Medicine, completed a vascular surgical fellowship at Good
offers a comprehensive approach to vascular disease, ranging from
Samaritan Hospital in Cincinnati.
preventive services to diagnostic expertise to innovative, minimally invasive surgical and endovascular techniques.
“Simply put, when patients go to him for venous problems, he can improve their quality of life,” says Richard L. Gilbert Jr., M.D.,
Andrew Hearn, M.D., owner and the sole practitioner at Carolina
a family practitioner in Burlington who doesn’t hesitate when
Vascular & Vein Specialists, was the first surgeon in the Triad
referring patients from his family practice to Dr. Hearn. “It used to
dedicated solely to vascular surgery. Certified in both vascular and
be in the old days when you had the type of problems he treats,
general surgery by the American Board of Surgery, Dr. Hearn started
you lived with them. No more. His procedures are minimally
the vascular lab at Alamance Regional Medical Center. At ARMC
invasive, offering a high reward and low risk. It’s rare that patients
he has recently served terms as medical director of the vascular
who I refer to him don’t feel significantly better afterward.”
interventional lab and chairman of the department of surgery. Treating the whole patient is a point of pride for Dr. Hearn, whose practice stresses a holistic approach to improving wellbeing, whether he is evaluating a young person with spider veins or treating an older patient with an aortic aneurism. “The philosophy in this office is that patients are human beings, not just medical problems,” he says. “We have a caring staff that strives to address all their concerns. We want them to leave our office feeling better.”
Diagnosis via Doppler: It’s Not Just for Meteorologists Quality care at Carolina Vascular & Vein Specialists starts with proper diagnosis. A Doppler ultrasound measures blood flow and blood pressure by bouncing high-frequency sound waves off of circulating red blood cells. “Everybody has heard of Doppler when it comes to weather, which uses ultrasound to bounce off the clouds and tell you which direction the clouds are moving and how fast,” says Dr. Hearn. “In a likewise fashion, we can use Doppler with arteries Improved quality of life for patients is central to treatment at Carolina Vascular & Vein Specialists.
4
The Triad Physician
and veins to tell us which direction the blood is flowing, how fast and if there might be a blockage.”
legs will look better, and the patient will be more apt to put on those shorts, more likely to slip on a bathing suit. In the long run, they’ll be more active and that makes them healthier.”
Noninvasive Treatments Becoming Standard More than half of the patients Dr. Hearn sees come in with a vein problem – the most common vascular condition. And the good news is treatment has evolved to the point where long hospital stays are the exception, not the rule. “With vascular care, there’s been a revolution in the last five years with nonsurgical treatment,” Dr. Hearn says. “That means patients return to their daily lives much quicker than before.”
Doppler ultrasound is available at Carolina Vascular & Vein Specialists for on-site diagnosis.
Vein stripping or surgery that removes The Doppler ultrasound is among the on-
While many might dismiss varicose vein
varicose veins in the leg is no longer the
site, state-of-the-art technology available at
treatment as cosmetic only, Dr. Hearn
gold standard for the chronic problem
Carolina Vascular & Vein Specialists.
stresses that the improved appearance
that affects half of Americans, particularly
of the legs pays off in multiple ways and
women.
“Ultrasound tells us immediately what’s
encourages patients to treat the problem.
going on with all aspects of circulation,”
“Now we can make the problem much
says Dr. Hearn. “There is no delay in
“People who feel self conscious about
better by doing a laser procedure in the
learning the results; It’s immediate. There
their legs don’t want to wear shorts in the
office,” says Dr. Hearn. “What used to be
is no waiting around for test results.”
middle of a 95-degree North Carolina day,
a hospital stay with possible complications
and that becomes lifestyle limiting,” he
and a recovery period can now be
Two of the most common ailments Dr.
says. “I like the term ‘healthy appearance’
accomplished in an afternoon.”
Hearn finds following ultrasound diagnosis
when talking about why to treat. Their
are peripheral arterial disease and varicose veins. PAD usually affects the arteries in the legs, causing numbness and pain, particularly when walking or climbing stairs. Varicose veins are swollen, twisted and often painful veins filled with an abnormal collection of blood. The legs often ache and feel heavy. If an ultrasound confirms either, Dr. Hearn directs patients to the catheterization lab at Alamance for an angiogram, an imaging test that uses X-rays to view the body’s blood vessels. With further information, Dr.
Hearn
immediately.
can
authorize
treatment
Noninvasive diagnosis and treatment at Carolina Vascular & Vein Specialists typically leads to fewer complications and quicker recoveries.
September 2012
5
Endovenous ablation relies on radiofrequency or laser energy to
Generally recovery involves one night in the hospital and a return
cauterize or burn abnormally enlarged veins close to the surface
to normal activity within a few days.
of the leg skin. This image-guided procedure starts with an IV into the vein that’s not working, thus fixing the vein from the inside out.
Surgery is no longer the only option, either, when uterine fibroids develop, says Dr. Hearn, noting many women do not want to
“The heat of the laser gently closes down the abnormal vein,” Dr.
undergo a hysterectomy, which routinely calls for a recovery time
Hearn says. “It takes a half hour, and the patient walks out of our
of six weeks.
offices and returns to work the next day.” “We offer uterine fibroid embolization, which is really a fancy name Minimally invasive treatments can even help aortic aneurisms,
for going in with a catheter and shutting off the blood supply to the
one of the most feared complications in vascular disease, often
uterus or uterine fibroids,” he says.
occurring in patients 70 or older. When the aorta becomes bigger than it should be, the consequences can be internal bleeding and
Tiny particles the size of grains of sand block the blood flow to
if not treated, death.
the fibroid tumor, causing it to shrink and alleviate the symptoms associated with the fibroids.
Whereas once traditional surgery was the only treatment, Dr. Hearn stages a stent procedure done under light sedation is now
“This is a treatment that is about 85 percent effective, and there’s
another option. A synthetic graft is attached to the end of a thin
no incision,” Dr. Hearn says. “There’s usually a one-night stay in the
tube inserted through the femoral artery in the groin. The graft is
hospital and minor cramping that resolves itself due to the change
threaded up into the aorta and placed at the site of the aneurism,
in blood flow. Patients are back to work within a week’s time.”
reinforcing the weakened section of the aorta to prevent rupture.
Treating the Whole Patient “I It can be a less risky procedure than an open operation and the
Dr. Hearn is a proponent of ensuring all of his patients’ needs are
recovery is quick,” says Dr. Hearn.
met, not just their vascular concerns. Two of the main causes of vascular disease are smoking and diet. Both are topics he routinely discusses with his patients, offering treatment options, therapies and support. “We talk to our patients about smoking cessation techniques and what is available to them,” he says. “Cholesterol is another precursor to vascular disease. We work with our patients to control their cholesterol and improve their nutrition.” Dr. Hearn is a proponent of a conservative approach, something he practices himself by wearing compression stockings, among the simplest tools for addressing leg problems. Usually recommended to control chronic leg swelling that stems from venous insufficiency, compression stockings are an excellent option for anyone suffering from leg problems. “Our entire approach at Carolina Vascular & Veins Specialists is based on making our patients feel better,” Dr. Hearn says. “Sometimes that can be accomplished by wearing stockings; other times it can be through exercise or proper nutrition. Sometimes a stent is necessary or a laser treatment. Whatever the problem, we’ll work to find the solution.” Carolina Vascular & Vein Specialists is located at the campus of Alamance Regional Medical Center in the Grandview Specialty
Dr. Hearn counsels patients about the lifestyle changes that can improve their vascular health.
6
The Triad Physician
Building in Burlington. Call (336) 585-1869 or log on to www. carolina-vascular.com for information.
Expertise
In the final analysis, choosing your legal representation is a matter of trust. As a specialized and highly experienced law firm, Bennett & Guthrie is privileged to provide effective legal representation to the Triad medical community, including many of this region’s leading healthcare and insurance organizations. We are also pleased to provide that same quality representation in commercial and business matters. Let us show you the difference our expertise can make.
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BetheaAugust2012GWAd_QuarterGW 7/5/12 12:10 PM Page 1
Celebrating Our Two Year Anniversary! We would like to send a heartfelt thanks to all our patients, referral sources, vendors, consultants, etc. for your consistent support throughout this second year! We are continuing to grow! God is good all the time! The best years are yet to come!!
Dr. Bethea offers conservative non-surgical treatment in a compassionate supportive environment. Take that first step. Call today and learn how you can live pain-free again! • • • • • • • •
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Most commercial insurance and self-pay accepted
September 2012
7
Marketing
Three Reasons Why Doctors Should Consider
Social Media Physicians are eager to embrace new ad-
for health information, and nearly all of
vances in medical technologies, but as a
those people (94 percent) turn
whole they tend to be late adopters when
to Facebook. Addition-
it comes to progressive communication
ally, they found that
tools, such as social media.
Americans using
By Amanda Kanaan
social media for Although health care is innately social,
health care are af-
policies, like the Health Insurance Portabil-
fluent, and on aver-
ity and Accountability Act (HIPAA), have
age, 41 years of age.
caused, what I believe to be an unhealthy fear among physicians to interact with pa-
It’s clear that social media is not a fleeting
tients outside of the office.
trend, and patients find it to be a valuable
think their social media strategy to not just
resource for health care information and
focus on marketing but on an overall busi-
Whether you cite HIPAA, a lack of time or
interaction. So now the real question is,
ness strategy to improve outcomes and
limited computer skills as reasons for not
“what’s the advantage for doctors?”
lower the cost of providing care.
Three Advantages of Social Media for Doctors
The physician-patient relationship is a
major opportunities to use social media to your advantage.
1. Cost-Effective Marketing
the opportunity for both to speak, listen,
While there are many advantages to so-
understand and learn from one another.
Are Patients Really Using Social Media?
cial media, one of the major benefits is
Embrace the opportunity to educate and
the ability to attract new patients. Social
interact with your patients to help better
First, let’s take a look at the numbers when
media acts like a megaphone, amplifying
manage their conditions and coordinate
it comes to patient interaction online. Ac-
your message across various channels and
care. Just be careful to never give personal
cording to a 2012 study by Pricewater-
potentially reaching those who may have
medical advice or reveal patients’ private
houseCoopers, a survey of more than 1,000
no idea who you are. This is especially
health information online. Think of your
adults in the United States revealed:
effective when it comes to patient testimo-
online interactions as communicating with
• One third of consumers now use
nials and connecting with other referring
your patient population as a whole in or-
social media sites for health-related
doctors online. It’s a powerful branding
der to avoid HIPAA concerns.
activities;
tool in enhancing the reach of your repu-
pursuing social media, there’s a strong possibility you could be missing out on three
two-way street, and social media provides
• 40 percent of consumers have sought
tation. Facebook now even offers analyt-
3. Competitive Edge
out reviews of treatments, physicians
ics for your page so you can monitor the
Social media is an extremely powerful
and other patient experiences;
impact you’re having online and analyze
platform that allows physicians to position
• 45 percent of consumers say informa-
what type of content resonates best with
themselves as an expert in their specialty.
tion from social media sources would
patients. This makes the ROI much more
For example, maybe a doctor wants to
affect their decisions; and
trackable.
position himself/herself as an expert in ro-
• 73 percent would welcome social
botic surgery within the ob/gyn specialty.
media-based tools for such things as
2. Patient-Centered Relationships
While their peers sit on the sidelines, doc-
making an appointment or asking a
The reason patients are eager to connect
tors have an opportunity to take a leader-
question.
with their doctors online isn’t so they can
ship role and put themselves ahead of
see where you went to dinner on Saturday
the competition. Now is the time to build
A separate survey by the National Research
night. They want to use social media as a
up your social media network online and
Corp. reported that more than 40 percent
tool to better manage their health. This is
show your patients that you are not only a
of respondents rely on social networking
prompting health care organizations to re-
leader in your specialty but also in terms
8
The Triad Physician
Amanda Kanaan is the president and founder of WhiteCoat Designs, a North Carolinabased marketing agency catering specifically to physicians. WhiteCoat Designs offers doctors affordable marketing solutions to help them grow their practices. Services include website design, search engine optimization (SEO), social media management, online reputation monitoring, brochure and collateral design, branding makeovers and physician liaison services to build patient referrals. Ms. Kanaan can be reached at amanda@whitecoat-designs. com or (919) 714-9885. To learn more, visit www.whitecoat-designs.com.
336-659-4814 • Winston Salem - Kernersville - N. Wilkesboro - Mt. Airy Breathe Better. Live Better. We can Help. Services • Asthma • Nasal and Eye Allergies • Sinusitis • Insect Allergy • Chronic Cough
of the progressive way you interact with
• Drug Allergy
patients.
• Food Allergy
Although social media may not be an op-
• Contact Dermatitis
tion for all practices, the advantages of
• Recurrent Infections
participating are at least worth consider-
• Eczema
ing. Negative reviews will happen whether you like them or not. The good news is that
• Urticaria
social media at least gives you the opportunity to be part of the conversation and show off your customer-service skills. If you decide to pursue social media, you need to ensure you have the time to interact consistently and if not, who you are going to trust to manage your page for you. Also, it is strongly advised – even by AMA – to put social media policies in place. This ensures all members of your practice understand what type of behavior is acceptable on your social media sites. The policy also should be easily accessed by patients.
Physicians/Providers • Brian D. Stone, MD • Kent J. Nastasi, MD • Ingrid M. Hoffmann, MD • Holly M. McPherson, MD • Elizabeth R. Scannell, MD • Carrie C. DeLong, PA-C • Joel M. Hartman, MD
• Immunotherapy (allergy shots)
www.allergypartners.com/Piedmont
Phone: 336-659-4814
Start the Conversation Have an opinion on social media for health care? Want to ask Amanda Kanaan a question about getting started with social me-
www.allergypartners.com/piedmont
www.facebook.com/APPiedmont
www.twitter.com/AP_Piedmont
www.allergypartners.com/piedmont/blog
dia? Send her a message on Facebook at /whitecoatdesigns or on Twitter @whitecoatdesign.
September 2012
9
Guest Column
No Headache Real Estate Brokerage Services Exploring medical office options and ne-
ond to none and was something our prac-
Triad Commercial Properties’ founding
gotiating a lease on the chosen space call
tice was grateful to have negotiated on our
partners each have more than two decades
for expertise that few local commercial real
behalf,” Betsy Hicks, Practice Manager for
of real estate experience, much of which is
estate brokerage firms offer. If you’re a phy-
Physicians for Women of Greensboro, said.
in real estate development and is inclusive
sician or medical office manager seeking
“Triad Commercial Properties exceeded
of extensive ground-up development expe-
new or expanded office space, Triad Com-
our expectations and became a partner we
rience. Triad Commercial Properties is the
mercial Properties is the answer to your
trust and rely on and has proved to be ‘the
Triad’s leading commercial real estate bro-
property leasing worries.
Agent of Choice’ in the Triad area medical
kerage firm based on market share in medi-
office market.”
cal office, general office, and industrial and investment property transactions.
Triad Commercial Properties provides commercial real estate brokerage and ad-
When seeking medical office space, the first
visory services to clients in Winston-Salem,
objective of the Triad Commercial team is to
“Our mission for medical office practices
Greensboro, High Point and surrounding
become extensively acquainted with a prac-
is clear: provide unparalleled value-added
counties. The firm is a third-party service
tice’s overall real estate objectives to man-
brokerage services or development as-
provider, specializing in real estate bro-
age the flow of market information, allowing
sistance as a third-party service provider,”
kerage. Triad Commercial Properties lists
physicians and their staffs to focus on daily
Bobby Finch of Triad Commercial Prop-
properties for sale or lease but is focused
office operation priorities. Triad Commer-
erties said. “By employing a single real
on tenant and buyer representation.
cial Properties quickly positions itself as a
estate provider, local medical practices
strategy partner with medical practices and
control dissemination of information to
“Triad Commercial Properties provided us
provides access to a team ready and willing
the real estate market. A strategic, properly
with skill, care and expertise throughout
to provide, at no up-front cost, services such
sequenced negotiating process provides
the office search process. The experience
as cataloging of properties, property value
leverage to optimize results.”
in the medical office submarket was sec-
opinions and market analysis.
Triad Commercial Properties has extensive market knowledge of real estate for medical practices and counts Piedmont Ear Nose & Throat Associates (PENTA) in Winston-Salem among its valued clients.
10
The Triad Physician
Real Estate Consulting Services Offered • Tenant representation • Buyer representation • Listing representation, including sale, lease and sub-lease • Disposition/acquisition strategy • Consulting • Lease review and abstraction • Financial analysis • Sale and leaseback analysis
land, retail and income properties. An independent company, Triad Commercial Properties offers extensive market knowlPictured above is Signature Place in Greensboro, NC where Triad Commercial Properties has represented Central Carolina OBGYN, Greensboro Orthopaedics, Southeastern Heart and Vascular Center, and Solstas Lab Partners.
edge, flexibility and rapid response and is widely respected for its financial analysis capabilities.
Triad Commercial Properties offers a thor-
Consistently ranked as the market’s lead-
ough understanding of site and building
ing commercial real estate brokerage firm,
For more information about
development, with special expertise in
Triad Commercial Properties offers a com-
Triad Commercial Properties, please
structuring leases for all sizes of medical
plete line of services for office, industrial,
go to www.TriadCommercial.com.
practices. Focusing solely on brokerage and third-party advisory services, Triad Commercial Properties offers expertise with no inherent conflicts of interest associated with ownership or development agendas. “Another benefit of using a single real estate source is that medical practices can better ensure the confidentiality of activities. This could be particularly important to a practice or business in an acquisition mode,” Ryan Gioffre of Triad Commercial Properties said. “By aligning with a real estate company with deep resources, medical practices can accomplish necessary tasks during peak real estate activity periods without permanently adding staff or burdening existing staff members with new or unfamiliar assignments.” Medical practices throughout the Triad also benefit from the knowledge Triad Commercial Properties has gained through numerous transactions negotiated on behalf of other companies and practices. Among other benefits, broad market knowledge allows medical practices to assess costs compared to those of other general and medical office users.
About (l) Ryan Gioffre and (r) Bobby Finch Triad Commercial Properties’ Bobby Finch and Ryan Gioffre are members of the North Carolina Medical Managers Association and have represented many of the Triad leading medical practices. Ryan Gioffre (336) 821-3303 direct ryan@triadcommercial.com
Bobby Finch (336) 812-3303 direct bobby@triadcommercial.com
September 2012
11
Legal
Time for Your Annual
Insurance Checkup? By Rod Guthrie
Physicians, perhaps more than any other
exclusions in insurance policies is far be-
professionals, spend enormous amounts
yond the scope of this article.)
of time and energy preparing themselves to practice in their chosen fields. Unfortu-
However, professional liability is not the
nately, as with most other professionals,
only way a physician can be subjected to a
they receive very little practical training in
claim. Premises liability, products liability,
how to operate a business.
acts (intended or unintended) by an employee – all are potential sources of claims.
There are basic business needs, such as
Medical practices are in no way immune
securing and maintaining office space,
from accidents involving automobiles,
hiring and retaining competent employ-
vans, wheelchairs, etc. The receptionist
ees and paying those employees. Another
you ask to pick up a record or X-ray on his/
basic need that most busy professionals
her lunch hour who causes an auto colli-
find easy to ignore, or at least neglect, is
sion could be considered in the course of
adequate insurance protection.
his/her employment and thereby bring the employer into the mix.
For physicians who own and manage their own practices, here are some suggestions
Workers’ Compensation. This coverage
on the types of insurance coverage avail-
is not optional. North Carolina mandates
able and well advised.
that any employer with three or more employees provide compensation to those
Property and Casualty. This provides
employees when they are injured on the
protection from damage to or destruction
job. The courts of our state have consis-
of property (real, personal, equipment,
tently expanded the application of “in the
etc.) you own or possibly lease. Fire, wind,
course and scope of employment,” gener-
water and theft are some of the risks usu-
ally making claims more common and this
ally covered, but these policies are very
insurance more expensive.
often customized or endorsed to meet specific needs. It’s important to ask and
Employment Practices. Claims of dis-
confirm whether the property is insured
crimination, sexual harassment or unfair
only for its value at the time of loss or for
practices in the workplace continue to
replacement cost.
increase. Specific insurance coverage is usually available for this type of claim
Liability. Professional negligence claims
and should be included in your insurance
are certainly a risk in every licensed occu-
portfolio. Insurance also can be acquired
pation, but nowhere more so than the med-
to protect your practice from theft by em-
ical profession. Adequate coverage here
ployees.
should be a given and reviewed regularly to determine that the breadth and limits of
Excess Liability. This insurance, often
the policy you have are sufficient. Every
referred to as “umbrella” coverage, is de-
insurance contract contains a significant
signed to apply only when your underly-
number of exclusions. (A full discussion of
ing “primary” liability coverage has been
12
The Triad Physician
Rod Guthrie is a founding partner with Bennett and Guthrie P.L.L.C., a Winston-Salem law firm focusing on defending claims of all types. The firm represents a variety of insurance carriers and business clients, including a number of health care providers throughout the Triad area. Mr. Guthrie regularly handles claims involving insurance coverage disputes, professional negligence and general liability. exhausted. Relatively inexpensive, it is a cost-effective way to provide peace of mind against major claims that might expose personal assets. Here again, it is important to confirm that the policy coordinates with the other coverage in place to avoid gaps. Disability. The inability to work, particularly for highly compensated individuals, can be devastating. Disability insurance, long-term and/or short-term, is designed to protect your income while recovering from an injury or illness or even a permanent impairment of your earning ability. Even in insurance, this adage holds true: “An ounce of prevention is worth a pound of cure.” Regular review of your insurance needs is good business and good medicine. Readers are invited to contact a lawyer at Bennett & Guthrie P.L.L.C. and have their legal questions answered. Call (336) 7653121 or send an e-mail to Rod Guthrie at rgutherie@bennett-guthrie.com.
Urology
Active Surveillance for
Prostate Cancer By Lester S. Borden Jr., M.D.
Prostate cancer continues to be a signifi-
Another strategy which is now part of
cant public health problem and remains
standard practice is to offer active surveil-
the most common non-cutaneous cancer
lance for men diagnosed with lower-risk
and the second-leading cause of cancer
prostate cancer. Realizing that the risk of
death for men in the United States. An es-
death from competing medical comorbidi-
timated 217,000 men were diagnosed with
ties is substantial in older men, not all men
prostate cancer, and more than 30,000 men
diagnosed with prostate cancer need to un-
were estimated to have died from prostate
dergo aggressive treatment. Active surveil-
cancer in 2010.
lance involves clinical follow up with serial PSA testing and physical examination,
Prior to 1990, one out of four men diag-
along with periodic biopsies of the pros-
nosed with prostate cancer was diagnosed
tate to monitor for evidence of progression.
Dr. Lester Borden is with Alliance Urology Specialists, Greensboro. He earned his medical degree at Ohio State University College of Medicine, Columbus, Ohio. He completed his urology residency at Wake Forest University, Winston-Salem, and a fellowship in urologic oncology at Virginia Mason Medical Center, Seattle, Wash.
with metastatic disease and only about 50 percent of men were deemed candidates
Active surveillance is not the same as the
for curative therapy. In the early 1990s,
concept of “watchful waiting,” which im-
which can include urinary-, sexual- and
prostate specific antigen (PSA) blood test-
plies treatment only when a man develops
bowel-related side effects. The potential
ing was approved for the use of early pros-
symptomatic or metastatic disease. Rather,
disadvantages of this approach include the
tate cancer detection. The introduction of
active surveillance is the concept of moni-
psychological consequences of living with
PSA screening allowed prostate cancers to
toring the disease with the goal of inter-
a cancer that is not treated and the obvious
be detected much earlier, with less than
vening with definitive therapy at a curable
risk of disease progression during surveil-
4 percent of all men currently presenting
stage, if necessary in the future. In other
lance. Currently, data suggest a very low
with metastatic disease.
words, it is a strategy of trying to select out
risk of progression or death from prostate
the men who truly require aggressive cura-
cancer in appropriately selected men who
Despite the earlier detection of prostate
tive therapy, while avoiding it in those who
undergo active surveillance, although lon-
cancer and the decreasing death rates from
will not.
ger follow up is necessary to determine the true risk of progression while on a surveil-
prostate cancer throughout the past two
lance protocol.
decades, there remains substantial contro-
Men with lower-risk cancer, including
versy surrounding PSA screening for pros-
those with a PSA less than 10 ng/mL, a
tate cancer. Although high-level evidence
Gleason score less than or equal to 6, and
Active surveillance is now a standard op-
exists that suggests improved survival rates
those with an early clinical stage and with
tion for management of men with low-risk
in men who undergo PSA screening, many
lower-volume disease on biopsy, are felt to
prostate cancer. This approach will help
question whether this benefit outweighs
be the most appropriate candidates for a
to significantly reduce the number of men
the risks associated with treatment.
surveillance approach. Therefore, not all
who undergo unnecessary aggressive treat-
men diagnosed with prostate cancer are
ment and, thereby, reduce the risk or harm
Multiple strategies have been employed
suitable candidates for active surveillance
associated with PSA screening. While pros-
to improve the risk/benefit ratio of PSA
and many men diagnosed with prostate
tate cancer is certainly over diagnosed in
screening for men. Selectively screening
cancer should still seek aggressive curative
the current era, over diagnosis no longer
only those men with longer life expectan-
therapy with surgery or radiation.
implies overtreatment. Future research will help to improve the selection of men who
cies (greater than 10 years) and those most at risk – the men who receive the greatest
The potential advantages of surveillance
are best managed with active surveillance,
benefit of screening – helps.
are clear. Men are not subjected to the
and protocols for surveillance are likely to
potential risks of surgery or radiation
become more standardized with time.
September 2012
13
News
Forsyth Is First Hospital in State to Achieve Cycle IV Accreditation Forsyth Medical Center has become the
means our program has met or exceeded
attack to ensure that they are not
first hospital in North Carolina to earn
the SCPC’s stringent criteria, and patients
sent home too quickly or needlessly
Cycle IV Chest Pain Center designation
with chest pain and heart attack symptoms
admitted to the hospital
from the Society of Chest Pain Centers.
who come to Forsyth Medical Center
Forsyth is now one of 26 facilities across
can expect the highest level of excellent,
Forsyth Medical Center first became an
the nation to have this designation.
quality care.”
accredited chest pain center in 2008. Last year, the hospital affiliated with the
Society of Chest Pain Centers (SCPC)
SCPC rigorously evaluated Forsyth Medical
Cleveland Clinic heart care program to
accreditation denotes the highest level
Center for its ability to assess, diagnose and
enhance patient care and outcomes.
of expertise in dealing with patients with
treat patients who may be experiencing a
Forsyth Medical Center has earned the
symptoms of a heart attack, according to a
heart attack. The hospital demonstrated
Society of Thoracic Surgeon’s three-star
Forsyth press advisory.
that it has processes in place to meet strict
rating for heart surgery and was the first
criteria aimed at:
in North Carolina to earn heart failure
“As an accredited chest pain center, we
•R educing the time from onset of
certification from The Joint Commission.
emphasize the importance of standardized
symptoms to diagnosis and treatment;
diagnostic and treatment programs that
•T reating patients more quickly during
Heart attacks are the leading cause of death
provide more efficient and effective
the critical window of time when the
in the United States, with 600,000 people
evaluation,” said Robert Preli, M.D.,
integrity of the heart muscle can be
dying annually of heart disease. More than
cardiologist and medical director of the
preserved; and
five million Americans visit hospitals each
cardiac catheterization lab at Forsyth Medical Center. “Achieving Cycle IV status
•M onitoring patients when it is not
year with chest pain.
certain that they are having a heart
Diversity MBA Magazine Recognizes Achievements of Two Novant Leaders Two Novant Health leaders have been named among the “Top 100
30- and 60-day readmission rates and returns to the emergency
Under 50 Diverse Executive & Emerging Leaders” by Diversity MBA
department. Dr. Nnadi and his team successfully developed
Magazine.
innovative roles for technicians to advance pharmacy practice in North Carolina by starting an associate degree in pharmacy
Michael Nnadi, Pharm.D., vice president and chief pharmacy officer
education.
for Novant Health, and Chere Gregory, M.D., medical director of the neurosciences department at Forsyth Medical Center, were
Chere Gregory was the first African-
selected based on their position within their company and for their
American
scope of responsibility, community service work and education
fellowship in neurocritical care at The
achieved. The honorees were featured in Diversity MBA Magazine’s
Johns Hopkins University School of
summer 2012 issue and honored at the magazine’s awards gala this
Medicine and the first African-American
woman
to
complete
a
woman in the United States to open and
month.
direct a neurocritical care unit. Under
14
The Triad Physician
Michael Nnadi provides pharmacy
her leadership, Forsyth Medical Center
services to 13 hospitals. According to
became the first hospital in North Carolina and South Carolina to
a Novant press advisory, he initiated
earn The Joint Commission’s accredited Primary Stroke Center
consolidation
among
designation. Dr. Gregory is also an integral member of the team
Novant’s hospitals and has assisted in
that envisioned and recently launched the Maya Angelou Center for
improving medication safety that reduced
Women’s Health and Wellness at Forsyth Medical Center.
of
pharmacy
News
Newborn Channel Provides Baby Care and Postpartum Education The Newborn Channel now available at High Point Regional Health System delivers essential newborn and parenting information, such as infant and mom care, siblings and family living, work-life balance and more. The free resource for parents and families also is available online at www.newbornchannelonline.com and via smartphones by texting the word “newborn” to 411247. The educational content on the Newborn Channel is overseen and reviewed by a medical advisory board that ensures it is
up to date and presented in a clear and understandable way for parents and their families. The Newborn Channel promises engaging and accessible programming on many topics, including: •D iapering, bathing and general infant care •M om health and birth recovery topics •B reastfeeding basics and tips for success • Car seat safety • Smoking cessation • Sudden infant death syndrome
Programs and transcripts are available on demand. “The Newborn Channel helps supplement our nurses’ patient education efforts,” said Donna Timpf, Women’s Center Program coordinator. “Because it is always available, our nursing and education staff is able to recommend quality, up-to-date education for new parents in their time of need.” Instructions on how to access the Newborn Channel online can be found at www. highpointregional.com.
Bariatric Surgery Center Earns Center of Excellence Recertification The Regional Center for Bariatric Surgery
Roux en-Y (RNY) gastric bypass; sleeve
High Point’s Regional Center for Bariatric
at High Point Regional Health System
gastrectomy; and adjustable gastric banding
Surgery also is accredited through the
earned recertification as a Bariatric Center
(AGB). Bariatric surgical procedures have
American College of Surgeons Bariatric
of Excellence from the Clinical Sciences
been shown to effectively treat obesity
Surgery Center Network accreditation
Institute of OptumHealth Care Solutions.
particularly when patients are dedicated to
program, which recognizes facilities with
following their surgeon’s post-operative diet
the highest quality standards of care and
and follow-up recommendations.
excellent clinical outcomes.
“The staff at the bariatric center is an exceptional team,” said Carin Hiott, director of chronic care at High Point Regional. “It is not just their knowledge and expertise that sets them apart, it is truly the genuine care and concern they have for each individual patient.” According to a High Point Regional Health press advisory, through a rigorous evaluation
process,
OptumHealth
has developed networks of centers of excellence that provide access to clinically superior, cost-effective health care. The Regional Center for Bariatric Surgery offers four surgical weight-loss options: the sleeve gastric bypass (SGB), sometimes referred to as the mini gastric bypass;
September 2012
15
News Welcome to the Area
Physicians
Heather Norris Beard, DO
Emergency Medicine Wake Forest University Baptist Medical Center Winston-Salem
Sidney Lee Callahan, DO Obstetrics and Gynecology Greensboro
Joshua Wesley Courtney, DO Anesthesiology Mooresville
Shuja Ahmed, MD Winston-Salem
Fahad Aziz, MD Internal Medicine Winston-Salem
Jennifer Rebecca Badik, MD
Pediatrics; Diabetes; Pediatric Endocrinology Pediatric Sub-Specialists of Greensboro Greensboro
Miranda Elizabeth Blevins, MD Family Medicine; Family Practice Davis Regional Hospital Statesville
Fred Gary Bromberg, MD
Administrative Medicine; Internal Medicine Wake Forest University Baptist Medical Center Winston-Salem
Lydia Turlykina Cater, MD
Hospitalist; Internal Medicine Wake Forest University Baptist Medical Center Winston-Salem
Kehinde Temitayo Eniola, MD
General Preventive Medicine; Adolescent & Young Adult Medicine; Family Medicine; Geriatric Medicine; Family Practice Winston-Salem
Timothy Alois Fife, MD
Facial Plastic Surgery; Head and Neck Surgery; Maxillofacial Surgery; Allergy and Immunology; Otolaryngology - Plastic Surgery Within the Head & Neck; Otolaryngology - Sleep Medicine; Otolaryngology, Otology-Neurology; Otology; Otorhinolaryngology Wake Forest University Baptist Medical Center Winston-Salem
Onyedika John Ilonze, MD
Internal Medicine; Hospitalist Wake Forest Baptist Health, Winston-Salem
Melanie Jeannine Johnson, MD
Child Psychiatry; Psychiatry Wake Forest University Baptist Medical Center Winston-Salem
Robert Peter Lockwood, MD
Anesthesiology - Critical Care Medicine; Anesthesiology - Pain Medicine Wake Forest University Baptist Medical Center Winston-Salem
Riddhishkumar Shah, MD Internal Medicine; Hospitalist Cone Health Internal Medicine Greensboro
Nicholas Jay Sparler, MD
Anesthesiology Wake Forest University Baptist Medical Center Winston-Salem
Andrea Jennings Strathman, MD
Hospitalist Winston-Salem
Physician Assistants
Jesse Joseph Miller, MD
Family Medicine; Hospitalist; Internal Medicine; Pediatrics; Psychiatry; Public Health; Urgent Care Winston-Salem
Jade Leigh Breeback, PA
Neonatal-Perinatal Medicine; Pediatrics Clemmons Internal Medicine; Pulmonary Disease and Critical Care Wake Forest University Baptist Medical Center Winston-Salem
Dawn Marie Delo O’Reilly, PA
Catherine Meghan O’Hara, MD
Heather Joy Van Wingen, PA
Winston-Salem
Internal Medicine Wake Forest University Baptist Medical Center Winston-Salem
Wake Forest Dept of Emergency Medicine Greensboro
Peters Ehiosuorea Okonoboh, MD
Abdominal Surgery; Critical Care Surgery; Emergency Medicine; General Surgery Wake Forest Baptist Health Winston-Salem
Hospitalist; Internal Medicine Wake Forest University Baptist Medical Center Winston-Salem
The practice had forwarded a number of final edits to me before the article was to be published; however, in the rush to meet deadlines, I completely overlooked the e-mail that contained them. We will begin a series of features on each of the Duke Eye Center of Winston-Salem physicians starting in the October issue. I would like to convey once again my sincere apologies to Drs. Parag Gandhi, Philip McKinley, Frank Moya, Terry Semchyshyn and Carol Ziel for my oversight and for the embarrassment this has caused you. It is certainly my goal each month to highlight top-notch physicians and surgeons, such as you, and the remarkable ways you serve our community every day. I thank you for your understanding regarding this extremely unfortunate incident.
The Triad Physician
Cone Health Family Practice Greensboro
Cristina Maria Miller, MD
The cover story in the July/August issue of The Triad Physician was published with misspellings and erroneous information, which resulted in much embarrassment for the entire medical staff at Duke Eye Center of Winston-Salem.
16
Jose Salvador Reyes, MD
Sangita Verma, MD
Theresa Ann McClung, MD
This is a letter of apology to all of you.
Sincerely, Angela W. Griffin
Obstetrics and Gynecology Woman Care, Winston-Salem
Anesthesiology Wake Forest University Baptist Medical Center Winston-Salem
Emergency Medicine WFBH Medical Center Winston-Salem
Dear Readers,
Laura Best Ramsay, MD
David M White, PA
The Triad Physician 2013 Editorial Calendar January
Glaucoma Wound Management Accounting
February
Asthma and Allergies Heart Disease Consulting for your Practice
March
Nutrition Sleep Disorders Legal
April
Autism Irritable Bowel Syndrome IT Services
May
Arthritis Women’s Health Medical Billing
June
Men’s Health Vascular Diseases Medical Collections
July
Imaging Technologies Psoriasis Medical Insurance
August
Orthopaedics Gastroenterology Medical Real Estate
September
Atrial Fibrillation Urology Web Design
October
Cancer in Women COPD - Lung Health Medical Software - EMR
November
Alzheimer’s Disease Diabetes Financial Planning
December
Pain Management Spine Disorders Practice Management
News North Carolina’s Premier Interior Design Firm
Thank You for Voting Us Best Interior Designers!
INTERIOR DESIGN Helping physicians make their patients feel more comfortable at home Spinal Orthotics Knee bracing Heat and Cold Applications Transcutaneous Electrical Nerve Stimulators (TENS) Neuromuscular Electrical Stimulators (NMES) Power Operated Vehicles (Scooters) Wheelchairs - Standard Power and Manual Urological Supplies Penile Pumps We honor those women who have been diagnosed with Ovarian Cancer and the valiant battle they fight every day with an ongoing 5% donation of monthly Catheter revenues to the Forsyth Medical Center Foundation GYN Cancer Fund.
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