J U N E 2 015
New Century Ophthalmology
Offering Newest Technology for Cataract Surgery
T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
Also in This Issue
Treating Adenomyosis Communication Barriers
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“My family history of heart disease is frightening. My father, his brother and my grandfather all died of their first heart attacks. For two of the three, their first symptom was death,” says Dr. Dennis Koffer. “My cardiologist knew about this history. So when I called and told him I was having a little bit of chest pain and feeling light-headed, he told me to go to the emergency department right away. Thankfully, test results showed that I was not having a heart attack. But he thought it was a good idea to have a diagnostic cath to determine the cause of my chest pain. The next day, Dr. Matthew Hook was at Johnston Health in Smithfield to do the procedure. He found one vessel was blocked about 70 percent. He opened the vessel using balloon angioplasty and inserted a stent to restore blood flow. The procedure was a piece of cake, absolutely unremarkable. Within a week, I was back seeing patients and doing surgery. This community should be really proud of what Johnston Health has become and the services it can offer. It’s nice to not have to leave home for your health care.”
Dr. Dennis Koffer General Surgeon Johnston Health Smithfield, NC
For Dr. Koffer’s full story visit:
www.johnstonhealth.org
Healing Neighbors... It’s What We Do. It’s Who We Are! 509 N. Bright Leaf Blvd. Smithfield, NC
919-934-8171
COVER STORY
6
New Century Ophthalmology Offering the Latest Technology for Cataract Surgery
j u n e 2 0 15
Vol. 6, Issue 5
DEPARTMENTS
FEATURES
10
9 Women’s Health
Physician Advocacy
One Small Antitrust Case, One
17 Duke Research News Old Bones Can Regain Youthful
Giant Step for Independent
Healing Power Using Beta-
Doctors
Catenin Modulation
Adenomyosis: Special Expertise Needed for Diagnosis and Effective Relief
12 Gastroenterology
18 UNC Research News
My Approach to Pharmaco-
Entire Human DNA Repair Map
Lindsay Wojciechowski reviews diagnosis and
therapy Targeted for Chronic
treatment of a common gynecologic problem
Abdominal Pain
that is often overlooked by providers.
14
Created
19 News 15 Legislative News
- $150 Million in Bonds Raised for
- Credible Announces
U.S. Rep. Holding Files
Practice Management
The Art of Communication, Part I Margie Satinsky discusses the value of ef-
Legislation to Improve Medicare
New Heart and Vascular Hospital
Audit System
Partnership with North Carolina Medical Society
16 Duke Research News Interferon-Free Therapy Clears
fective informal and formal communication
Hepatitis C in 93 Percent of
and the barriers that can include digital
Patients
20 News
- Wake County’s First Women’s Hospital Opens on WakeMed Campus
technology.
- Welcome to the Area
COVER PHOTO: Dr. Jindal of New Century Ophthalmology offers the advances of bladeless cataract removal, using the LenSx Laser by Alcon, at Granville Medical Center in Oxford.
2
The Triangle Physician
From the Editor
Eyes on Experience Cataracts are among the most inevitable of aging diseases, making cataract removal one of the most frequently performed surgeries in the world. As such, the surgical treatment of cataracts is on a development fast track. T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
The use of femtosecond “bladeless” lasers with image guidance is among the latest advances. The desired benefits include making the procedure safer, more effective and predictable. Obviously, all is dependent on the experience of the ophthalmologist wielding the technology, which is the focus of this month’s cover story on New Century Ophthalmology. From Oxford and North Raleigh offices, ophthalmologist Vinod Jindal provides comprehensive ophthalmologic care and the latest diagnostic and treatment technology – including bladeless laser surgery – for patients in the Triangle and surrounding rural counties. As a measure of his experience, Dr. Jindal has performed more than 15,000 procedures that include glaucoma and vitreo-retinal surgeries and 12 to 18 cataract removal procedures per week. Every month The Triangle Physician’s contributing editors share the wealth of their
Editor Heidi Ketler, APR heidi@trianglephysician.com Contributing Editors Douglas A. Drossman, M.D. Marni Jameson Margie Satinsky, M.B.A. Lindsay Wojciechowski, F.N.P.-C. Creative Director Joseph Dally jdally@newdallydesign.com
Advertising Sales info@trianglephysiciancom News and Columns Please send to info@trianglephysician.com
experience. In this issue, gastroenterologist Douglas Drossman reviews the pharmacological treatments for abdominal pain. Nurse practitioner Lindsay Wojciechowski discusses the diagnosis and treatment of adenomyosis, a common gynecologic problem often overlooked by providers. Practice management consultant Margie Satinsky begins a two-part series that underscores the importance of effective communication skills. In this issue, she talks about the pitfalls, and next month she will advise on strengthening communication skills. Marni Jameson, who
The Triangle Physician is published by: New Dally Design Subscription Rates: $48.00 per year $6.95 per issue Advertising rates on request Bulk rate postage paid Greensboro, NC 27401
advocates for independent physicians, writes about a landmark court of appeals decision that sided with a lower district court that this merger between a hospital and a large medical group was illegal. Eyes on The Triangle Physician are eyes on you, the health care provider/professional in the Raleigh-Durham medical Triangle. There are more than 9,000 of you. That’s why making The Triangle Physician a partner in your marketing mix makes sense. News and insight pieces serve to underscore experience. Articles that are submitted run at
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Cover Story
New Century Ophthalmology
Offering the Latest Technology for Cataract Surgery When Vinod K. Jindal, M.D., opened his
Initially, Dr. Jindal focused mostly on dis-
fully-equipped ophthalmology practice in
eases and surgery of retina and vitreous.
Oxford in 2001, his intention was to bring
He discovered, however, that many older
patients in rural Granville, Vance, Warren
patients suffered from cataracts, glaucoma
and Person counties the high-quality care of
and other anterior segment diseases and
a big-city practice while keeping the charm
couldn’t travel long distances for quality eye
and accessibility of a small-town clinic.
care. This inspired him to add comprehensive ophthalmology to his practice.
“Many of my patients are older and need frequent follow-up visits, so it’s much easier
Dr. Jindal remains committed to offering
for them to come to a practice within easy
the most advanced technology in diag-
driving distance,” said Dr. Jindal.
nostics like IOL (intraocular lens) Master, Pentacam and Verion. He also provides a
New Century Ophthalmology has grown
variety of treatment options, such as mul-
into a thriving practice with a second office
tifocal, accommodative and toric intraocu-
in North Raleigh. The practice has devel-
lar lenses.
oped so much, says Dr. Jindal, that it now offers some of the most innovative proce-
Each year, more than 3 million Americans
dures in the state, even among more urban-
undergo cataract surgery, making it one of
based, larger practices.
the country’s most commonly performed
What Is a Cataract?
A cataract is a clouding of the normally clear lens of the eye that can be compared to a window that is frosted or yellowed. The amount and pattern of cloudiness within the lens can vary. Patients may not be aware that a cataract is present if the cloudiness is outside the center of the lens. Common symptoms of a cataract include the following: • A painless blurring of vision • Glare or light sensitivity • Poor night vision • Needing brighter light to read • Fading or yellowing of color Misconceptions about a cataract are widespread, the following are not true: • A cataract is a film over the eye • A cataract is caused by overusing the eye • A cataract spreads from one eye to the other • A cataract is a cause of irreversible blindness Aging is the most common cause of cataract. The list of causes also includes: • Family history • Injury to the eye • Long-term, unprotected exposure to sunlight • Medical problems, such as diabetes • Medications, especially steroids • Previous eye surgery • Radiation • Unknown factors
surgeries. Dr. Jindal offers the advances of bladeless cataract removal, using the LenSx Laser by Alcon, at Granville Medical Center in Oxford. There are only a handful of hospitals equipped with this technology in the Triangle region and fewer than 500 facilities nationwide, according to Dr. Jindal. “The LenSx laser was the first femtosecond laser in use for cataract surgery. Femtosecond technology provides new levels of safety and accuracy in cataract surgery Dr. Jindal of New Century Ophthalmology offers the advances of bladeless cataract removal, using the LenSx Laser by Alcon, at Granville Medical Center in Oxford.
6
The Triangle Physician
because of the speed and precision achieved,” says Dr. Jindal. A femtosecond
is one millionth of a nanosecond or 1015 of a second. The bladeless, or femtosecond, laser helps in a precise, individualized measurement and incision that can correct astigmatism to a certain degree. The centration of the capsulorhexis provides the precise placement of the multifocal and toric intraocular lenses, giving more predictable results in comparison to the traditional cataract surgery. Patients come to New Century Ophthalmology on their own or through referrals from optometrists or primary care physicians. “Patients who present to their primary care physician with complaints of blurred vision
Yewande “Teju” Olagoke, M.D., and Surgery Coordinator Jeanne Champion review a patient diagnosis with Dr. Jindal.
and glare, difficulty driving at night or difficulty performing their regular work could have cataracts and should be referred as soon as possible,” says Dr. Jindal.
3. Slit-lamp examination – for anterior and
Dr. Jindal performs about 12 to 18 cataract removal procedures each week at Granville
posterior segment evaluations. 4. Dilated-eye exam – for examining optic
Medical Center. Additionally, he performs procedures for retinal detachment, vitreous
nerve and retina. What Causes Cataracts?
hemorrhages, macular diseases, glaucoma
Located behind the iris and pupil, the lens
How Are Cataracts Treated?
of the eye works much like a camera lens.
The treatment for cataracts is removal of
It focuses light onto the retina at the back of
the lens. Thanks to innovative medical ad-
Advancing Technology at
the eye and adjusts the eye’s focus for see-
vances, cataract surgery is a common out-
Granville Health System
ing close up and farther away.
patient procedure. The goal of the surgery
“Dr. Jindal’s cataract surgery technology ad-
and other eye conditions.
is to break the cloudy cataract-effected lens
vances the Granville Health System Board
The lens is made up mostly of water and
into easily removable pieces. Those pieces
of Trustees and medical staff’s commitment
protein. As people age, the protein can start
are then removed and an artificial intraocu-
to offering the highest level of quality care to
clumping together, clouding the lens. This
lar lens is inserted into the eye in place of
our patients,” says L. Lee Isley, Ph.D., who
cloudy area may grow larger, involving more
the natural lens.
is Granville Health System’s chief executive officer. “This partnership with Dr. Jindal’s
of the lens and making it difficult to see. Traditionally, the surgeons accomplished
team underscores our commitment to en-
There are multiple factors that can aggra-
this goal by making tiny incisions in the eye
sure that our patients always have access to
vate cataract formation. Age-related senile
using a surgical knife. Today, patients have
the most advanced eye care possible.”
cataract is the most common. Other factors
a choice: traditional manual surgery or a
can be congenital or acquired – traumatic,
bladeless procedure assisted by advanced
Part of Granville Health System (GHS),
diabetic, inflammatory etc.
laser technology that offers image guidance
Granville Medical Center is fully-staffed and
for predictability and enhanced precision.
equipped to handle delicate ophthalmologic surgeries, such as vitrectomy, sclera
How Are Cataracts Diagnosed? Following evaluation of the patient’s medi-
Recovery from Cataract Surgery
buckles, glaucoma surgeries like filtering
cal history, the certified ophthalmologist
After cataract surgery, Dr. Jindal’s patients
procedures and endo-cyclophoto-coagula-
will perform a comprehensive eye exam,
can expect to spend about an hour in the re-
tion, cataract extractions and other anterior
which includes:
covery room. After that, patients are free to
segment and retinal surgeries.
1. Visual acuity test – eye chart test for sight at various distances. 2. Tonometry – for measuring pressure in-
go home, although they should have someone to drive them home. In-office post-op
GHS has been recognized by the North
appointments are typically the next day.
Carolina Quality Center for outstanding performance during a three-year initiative
side the eye.
june 2015
7
in patient safety and quality improvement. The system was one of the Top 10-performing hospitals in the 116-member North Carolina/Virginia Hospital Engagement Network. The recognition stems from Partnership for Patients, a public-private partnership working to improve the quality, safety and affordability of health care. The group is comprised of federal agencies, hospitals, health care organizations, patient organizations and private-public partners. The federal agencies involved include the United States Department of Health and Human Services, the Centers for Disease Control and the National Institutes for Health. Partnership for Patients was a three-year national initiative that began in 2012. Its goals were to decrease hospital-acquired conditions by 40 percent and to reduce hospital readmissions by 20 percent. About New Century Ophthalmology New Century Ophthalmology was the first practice to offer vitreo-retinal specialty services in the four-county Oxford region. Dr. Jindal opened his North Raleigh practice in 2010, offering a blend of ophthalmologists and optometrists that cover complete eye care – medical, laser, surgical and opti-
Dr. Jindal stands with the surgical services staff at Granville Medical Center.
cal. He and his team have been in Granville
Dr. Jindal has performed more than 15,000
County for more than 13 years.
procedures that include cataract, glaucoma and vitreo-retinal surgeries.
New Century Ophthalmology offers comprehensive and specialty eye care, includ-
He is board certified by the American Board
ing the recently-introduced laser-assisted
of Ophthalmology; a fellow of the American
eyelid surgeries and these treatments:
College of Surgeons and of the American
• Diseases and surgery of retina and vitreous • Macular diseases-degenerations, pucker, holes
The Triangle Physician
of the American Society of Retina Specialists, the American Society of Cataract and Refractive Surgery, the North Carolina Medi-
• Cataract and glaucoma
cal Society and the North Carolina Eye Phy-
• Comprehensive ophthalmology
sicians and Surgeons.
• Ophthalmic plastic surgery • Refractive surgery
For more information on new technology or to
• Low visual aids
schedule an appointment, contact New Cen-
Dr. Jindal stands with his New Century Ophthalmology staff.
8
Academy of Ophthalmology; and a member
tury Ophthalmology Group at (919) 693-6661.
Physician Advocacy
One Small Antitrust Case, One Giant Step for Independent Doctors By Marni Jameson
In a striking victory for independent doc-
“enhance efficiencies.” But analysts say
tors, competition and the future of the na-
it’s a way for hospitals to capture market
tion’s health care, the United States Court
share and higher revenues.
of Appeals for the Ninth Circuit for Idaho
Marni Jameson is the executive director for the Association of Independent Doctors. You may reach her at (407) 865-4110 or marni@aid-us.org.
came down with a ruling in February in an
Studies show such mergers dramatically
antitrust case that will have a ripple affect
increase health care costs, and do not im-
across America.
prove outcomes.
In short, the appeals court’s landmark de-
Orlando Doctor’s
cision in St. Alphonsus Medical Center v.
Association Steps In
In addition to AID, four other groups – at-
St. Luke’s Health System found that a com-
“The ruling puts hospitals on notice,” said
torneys general from 16 states, a group of
mon situation – merging of hospitals and
Tommy Thomas, C.P.A., founding member
economics professors, America’s Health
certain medical groups – is against the law.
of the Association of Independent Doctors
Insurance Plans and Catalyst for Payment Reform – also filed amicus briefs asking
“This ruling puts hospitals on notice.”
the Ninth Circuit to affirm the lower court ruling. “All Americans have felt firsthand the negative impacts these mergers have on costs, care and communities,” said Mr. Thomas. “Buying up market share to the point of creating a monopoly in the community is against the law.”
The court ruled that a lower district court
(AID), the only national trade association
was correct when it found the St. Luke’s
that solely represents the interests of in-
Antitrust attorneys around the country
Health System 2012 acquisition of Saltzer
dependent doctors, played a role in the
took note of the decision, the Idaho States-
Medical Group, a large medical group, vio-
decision.
man reported.
The association retained Washington,
Many felt the ruling sets a precedent that
lated federal antitrust laws and had to be dissolved.
D.C., law firm Mayer Brown to write an
might slow merger activity in the health
The Nampa County practice was Idaho’s
amicus brief affirming the district court’s
care industry, where consolidation has
largest independent medical group before
decision. “The association’s brief pro-
increased in recent years. Mr. Thomas
it sold out to the hospital system in winter
vided its unique perspective to the Court
hopes the decision will spur more lawsuits
of 2013 for just under $30 million, accord-
of Appeals and described the significant
to unwind similar hospital-doctor mergers.
ing to court documents.
challenges independent physicians face. The association’s fight to provide the best,
“It certainly puts a spotlight on any hospi-
Like many hospitals that acquire medical
most cost-effective care is an important
tal looking to acquire physicians,” Jona-
practices, St Luke’s claimed that the merg-
part of this case,” said Robert E. Bloch, a
than Lewis, a partner and antitrust lawyer
er would be better for the patient commu-
Mayer Brown attorney who helped write
at Baker Hostetler in Washington, D.C.,
nity, as it would help “integrate care” and
the brief.
told the Statesman.
june 2015
9
Women’s Wellness
Adenomyosis
Special Expertise Needed for Diagnosis and Effective Relief By Lindsay Wojciechowski, F.N.P.-C.
Adenomyosis is a common gynecologic
of the endometrial surface within the cavity,
problem often overlooked by providers.
and this is one of the causes of the heavy
Many women have never even heard of
menstrual bleeding.
this diagnosis. Uterine enlargement is up to 12-week size The incidence of adenomyosis has not
(related to enlargement of the uterus during
been accurately determined for a variety of
pregnancy). However, the uterus can be-
reasons. Estimates range from 20-40 percent
come even larger, up to 20 weeks.
of women during their reproductive years. Diagnostic Challenges The condition is defined by the presence
The gold standard in diagnosis of adeno-
of endometrium (or lining of the uterus,
myosis is magnetic resonance imaging or
glands and stroma) within the muscle or
hysterectomy. However, neither is always
myometrium of the uterus. Normally the en-
affordable, feasible or desired.
dometrium is found only within the cavity of the uterus not in the muscle.
Lindsay Wojciechowski is a nurse practitioner and consultant to the Women’s Wellness Clinic and the Carolina Women’s Research and Wellness Center (CWRWC). She has worked as a clinical nurse practitioner for Triangle Family Practice at Duke University Medical Center since 2006. She also has lectured and taught courses at the Duke University School of Nursing. Ms. Wojciechowski’s focus is on women’s health and family medicine, and she also is the lead medical writer for the Women’s Wellness Clinic.
Diagnosing adenomyosis by ultrasound can
changes in the junctional zone, hypoechoic
be difficult. Not all radiologists, technicians
striations, heterogeneous myometrium and
When endometrium (glands and stroma)
and gynecologists who perform transvaginal
myometrial cysts.
is found outside the uterus – this is called
ultrasound are familiar with the findings on
endometriosis. Women can have adenomy-
ultrasound when adenomyosis is present.
Treating Symptoms Treatment for adenomyosis should be based
osis with and without endometriosis. The typical problems that women with adeno-
Here at Women’s Wellness Clinic, medical
on a woman’s complaints, which again is typi-
myosis have are moderate to severe men-
providers have the training and experience
cally heavy menstrual bleeding and cramp-
strual cramping and heavy periods.
to accurately diagnose adenomyosis using
ing. Although no medications are indicated
state-of-the-art ultrasound.
for adenomyosis, clinicians typically use birth control pills or tranexamic acid (Lysteda).
The endometrium changes during the menstrual cycle due to fluctuations of hormones (estrogen and progestin) secreted by the ovary. The week prior to menstrual bleeding, endometrial cells “swell” and enlarge.
“Treatment for adenomyosis should be based on a woman’s complaints”
This is thought to be one reason why womThe “typical findings on ultrasound can be
Both heavy periods and cramping will im-
a diffusely enlarged uterus, but also there
prove with use of medications that stop the
When endometrium is found within the
can be focal adenomyosis with asymmetri-
cycle completely. This can be done with
myometrium of the uterus – this causes
cal enlargement of one area of the uterus,”
continuous use of birth control pills, GnRH
hypertrophy and hyperplasia, often creat-
says Andrea Lukes, M.D.
agonist therapy (Lupron), which is given
en with adenomyosis have cramping.
as an intramuscular injection every three
ing a diffusely boggy and enlarged uterus. The enlargement creates more surface area
10
The Triangle Physician
Other findings on ultrasound include
months and oral daily testosterone (Dan-
azol). Again though these are all off-label
55 Vilcom Center Drive Boyd Hall, Suite 110 Chapel Hill, NC 27514
Drossman Gastroenterology PLLC a patient-centered gastroenterology practice focusing on patients with difficult to diagnose and manage functional GI and motility disorders. The office is located within the multidisciplinary health care center, Chapel Hill Doctors. Dr. Douglas Drossman is joined by physician’s assistant, Kellie Bunn, PA-C. Appointments are scheduled on Tuesday and Wednesday and most laboratory studies are available.
919.929.7990
www.drossmangastroenterology.com
uses for these medications, they can be safely used and do improve both bleeding and cramping. The Mirena levonorgestrel (LNG IUS) intrauterine system also can be effective. This is a small device that is placed within the uterine cavity that delivers a small amount of the progestin (levonorgestrel) at steady amounts for up to five years. This is placed within a clinic setting. If a woman has side effects or does not like
Drossman Gastroenterology
the LNG-IUS, then it can be removed before five years. Surgical therapies for adenomyosis include hysterectomy, endometrial ablation, as well as UAE (uterine artery embolization). Treatment of uterine cramping (dysmenorrhea) includes nonpharmacologic options, such as using a heat pack on the lower abdomen, exercise and even relaxation techniques. When medication is used, the first option is a nonsteroidal anti-inflammatory drug (NSAID), birth control pill or LNG-IUS. Dr. Lukes notes that more than one therapy may be needed to improve the heavy periods and cramping in a woman with adenomyosis.
MOHS MICROGRAPHIC SURGERY • EXCISIONAL SURGERY • CRYOSURGERY
“She wanted to move on with her life.” I REFERRED HER TO SOUTHERN DERMATOLOGY
Clinical Trials Dr. Lukes serves as an advisor to sponsors of research on adenomyosis trials. This fall, she will conduct a clinical trial at Women’s Wellness Clinic using a novel therapy for adenomyosis. Women with heavy periods and cramping may be trial candidates. Subjects in our Food and Drug Administration clinical trials can earn from $900 to $1,500.
FOR THE MOST ADVANCED SKIN CANCER TREATMENTS, REFER YOUR PATIENTS TODAY!
Referrals are welcome. To schedule an appointment for patient evaluation, call (919) 251-9223, or visit our website www.cwrwc.com.
southernderm.com
919-782-2152
PHOTODYNAMIC THERAPY • LASER SURGERY • TOPICAL MEDICATION
DER131_AD_Triangle Physican I Want 4.indd 1
june 11 2/18/152015 12:43 PM
Gastroenterology
My Approach to
Pharmacotherapy Targeted for Chronic Abdominal Pain
By Douglas Drossman, M.D.
When working with patients who have abdominal pain, my first
inhibitors (SSRIs), serotonin, norepinephrine reuptake inhibitors
consideration is whether their pain originates primarily from with-
(SNRIs) and some “atypical” antidepressants (e.g., mirtazapine).
in their gut (afferent excitation) or results from failure of their cen-
Because the TCAs and SNRIs (duloxetine, milnacipran) cause
tral nervous system to down
both norepinephrine and
regulate (even subliminal)
serotonin activation, they
visceral signals.
are effective for generalized chronic pain as well
When pain is chronic, i.e.,
as GI pain.
continuous and not related to bowel functioning (e.g.,
It’s difficult to get to high
not affected by eating or
doses with some TCAs
defecation), its major influ-
(tertiary amine agents like
ence is derived from the
imipramine and amitripty-
central
system
line), because they have
(CNS), and treatment must
potent anticholinergic and
focus on CNS pain regula-
antihistaminic effects that
tion rather than therapy be-
produce side effects of dry
ing directed at the gut.
eyes/mouth, constipation
nervous
and orthostatic dizziness. This essay will focus on cen-
Other TCAs (secondary
tral pharmacological agents,
amine type), like nortripty-
although behavioral therapy
line and desipramine, have
also can be a complementa-
lower side effect profiles.
ry treatment modality. Antidepressants all treat depres-
The
sion but even in low dosages
etine, citalopram) are not
can treat chronic gastrointes-
as helpful for pain, but if
tinal pain to varying degrees
symptoms are exacerbated
as discussed below. This
by anxiety, one could con-
is because the brain, CNS
sider using SSRIs alone
and enteric nervous system
or in combination with a
are “hardwired,” so these
low-dose TCA. The SNRIs
medications affect neuro-
do not have the TCA side
transmission throughout the
SSRIs
(e.g.
fluox-
effects, and nausea is their
neuroaxis, which comprises both brain and gut.
primary side effect, but they can be just as effective for pain.
The primary central treatment agents are antidepressants, includ-
It is also important to consider the effect of SSRIs on bowel symp-
ing tricyclic antidepressants (TCAs), selective serotonin reuptake
toms: the serotonin effect of SSRIs increases the gastrointestinal
12
The Triangle Physician
Gastroenterology Dr. Douglas Drossman graduated from Albert Einstein College of Medicine and was a medical resident and gastroenterology fellow at the University of North Carolina. He was trained in psychosomatic (biopsychosocial) medicine at the University of Rochester and recently retired after 35 years as professor of medicine and psychiatry at UNC, where he currently holds an adjunct appointment. Dr. Drossman is president of the Rome Foundation (www.theromefoundation. org) and of the Drossman Center for the Education and Practice of Biopsychosocial Care (www.drossmancenter. com). His areas of research and teaching involve the functional GI disorders, psychosocial aspects of GI illness and enhancing communication skills to improve the patient-provider relationship.
the pain. Aripiprazole is another atypical
A more detailed discussion of these medi-
antipsychotic that is not sedating.
cations and their side effects is described elsewhere1, 2.
When single agents are not helpful we apply augmentation methods, i.e. combining
Reference List
agents in low dosages to minimize side ef-
1. Tornblom H, Drossman DA. Centrally-
fects and enhance benefit. For refractory
targeted pharmacotherapy for chronic
pain, a TCA or SNRI can be combined with
abdominal
an atypical agent; with anxiety and pain,
pain.
Neurogastroenterol
Motil 2015.
buspirone can be combined with a TCA/
2. Dekel R, Drossman DA, Sperber AD. The
SNRI; and with nausea, mirtazapine can
use of psychotropic drugs in irritable
be added to a TCA or SNRI.
bowel syndrome. Expert Opin Investig Drugs 2013;22:329-339.
Drossman Gastroenterology P.L.L.C. (www.drossmancenter.com) specializes in patients with difficult-to-diagnose gastrointestinal disorders and in the management GI disorders, in particular severe functional GI disorders. The office is located at Chapel Hill Doctors, 55 Vilcom Center Drive, Suite 110 in Chapel Hill. Appointments can be made by calling (919) 929-7990.
transit rate and can cause diarrhea (i.e., helpful for constipation), while TCAs decrease colon transit rate and can cause constipation (i.e., helpful for diarrhea). Other psycho-pharmacological agents to consider include mirtazapine, an atypical antidepressant that is particularly helpful for nausea, vomiting and anorexia. Buspirone is an azapirone, an anti-anxiety agent that has serotonergic action that increases compliance of the gut and in particular enhances gastric receptive relaxation to improve functional dyspepsia (post-prandial distress syndrome). The atypical antipsychotics like quetiapine in low dosages (50-100 mg; not schizophrenia treatment dosages of 600-800 mg) can produce normal sleep. (Sleep disturbance is common among patients with GI pain.) They also can reduce anxiety and augment the benefit of antidepressants for Womens Wellness half vertical.indd 1
12/21/2009 4:29:23 PM
june 2015
13
Practice Management
The Art of Communication Part 1 By Margie Satinsky, M.B.A.
This article is Part I of a two-part series on
or information.
communication within medical practices and between medical practices and external
Today’s technology makes it possible to
resources, colleagues and organizations. Part
send a message to a recipient that is not
II will appear in the July 2015 issue of The
present or aware of the sender’s intent to
Triangle Physician.
communicate at the time of the communication. The transmission can occur across
Last fall we had the privilege of teaching a
great distances in time and space.
course on health care consulting to graduate students in the Health Policy and Ad-
Every student in our class was smart and am-
ministration Program at the University of
bitious. Each one believed that the analytical
North Carolina at Chapel Hill. We shared our
and problem-solving skills required in con-
thoughts on the nuts and bolts of consulting
sulting would help them advance in their
and arranged for each student to do a real
careers. Their similarities ended right there.
consulting project for a client. Having been
Margie Satinsky, MBA, is President of Satinsky Consulting, LLC, a Durham, NC consulting firm that specializes in medical practice management. She’s provided HIPAA compliance consultation to more than 100 Covered Entities and Business Associates. Margie is the author of numerous books and articles, including Medical Practice Management in the 21st Century. For additional information, go to www.satinskyconsulting.com.
and financial projections in a clear enough manner to attract the interest of potential em-
in the practice management consulting busi-
The students varied greatly in their abilities
ness for many years, we know that effective
to clearly express themselves in both written
consultant-client communication can be
and oral communications. A contributing
Another project was for a large physician or-
more challenging than the substance of the
cause for communication problems was the
ganization that had successfully negotiated
project. Our students had much to learn!
habitual way in which so many of us relate
many pay-for-value contracts on behalf of its
to each other, i.e., by dashing off quick and
many member practices. The organization
The No. 1 lesson we taught was that com-
abbreviated text and e-mail messages and by
lacked an effective communication strategy
munication between or among relevant par-
using language that is ineffective in making
to connect with both providers and office
ties has a significant impact on the outcome.
a point. We coached and prodded, encour-
managers. Member practices lacked clarity
Good communication between two or more
aging improvements in listening skills and in
on the details of each opportunity.
parties facilitates problem identification and
expressing observations and recommenda-
resolution. Poor communication can sink
tions logically and respectfully in both infor-
Still another practice wanted to explore the
the ship.
mal and formal settings.
potential for expanded weekend hours. Both
ployees or partners.
financial feasibility and staffing were imporLet’s get theoretical. Just what is communi-
Although the technical nature of each proj-
tant considerations. Poor communication
cation? It’s a purposeful exchange of infor-
ect was unique, communication was a chal-
between the practice administrator and the
mation and meaning between a sender and
lenge not only for our students, but also for
clinicians who would potentially staff the
a recipient.
the clients who had graciously agreed to
weekend clinic discouraged the very people
participate.
who needed to provide care from making
The sender develops the message as a con-
that commitment.
cept, idea, information or feeling and sends
Two practices, one a concierge model and
the message to a receiver in words or other
the other a primary care practice, explored
Next month we’ll recommend ways in
symbols, using available and preferred tech-
expansion in both the number of geograph-
which you can improve communication
nical or natural means. At the receiving end,
ic locations and number of providers. Both
within your practice and between your prac-
the receiver translates or decodes the words
encountered the same challenge – difficulty
tice and external resources, colleagues and
or symbols into a comprehensible concept
in expressing their missions, goals, priorities
organizations.
14
The Triangle Physician
Legislative News
U.S. Rep. Holding Files Legislation to Improve Medicare Audit System Rep. George Holding (R-NC) introduced
wide. We commend Congressman Holding
“The Fair Medical Audits Act of 2015,” which
for his leadership on this critically important
addresses physician concerns about the
issue.”
islation in the near future. “Unfortunately, one of the most common complaints I hear from North Carolina’s
current Medicare audit program. Former NCMS President Robert Monteiro,
health care community is the need to im-
Currently, Medicare pays recovery audit
M.D., testified in March 2014 before a special
prove Medicare’s audit and appeals process-
contractors, or “RACs,” on a contingency
meeting of key Senate Finance Committee
es,” Sen. Burr said. “I will continue working
basis to find overpayments to health care
staff, hosted by Sen. Orrin Hatch (R-Utah).
with my constituents and colleagues in
providers, providing these contractors with
Dr. Monteiro detailed his practice’s experi-
Congress, to restore the proper balance to
monetary incentives to audit doctors. The
ence with a flawed RAC audit and the finan-
Medicare’s audit and appeals processes on
new legislation would establish incentives
cial hardship it caused.
behalf of all North Carolinians.”
efforts to help physicians avoid common
According to a press advisory, Sen. Richard
For more information, contact PAI Executive
mistakes.
Burr (R-NC), has been supportive of RAC
Vice President Kelly Kenney at (312) 543-
reform and has sights set on introducing leg-
7955 or k2strategiesllc@gmail.com.
for audit accuracy and increase educational
“… My bill will bring transparency and fairness to the audit process so doctors can spend more time caring for their patients and less time proving their innocence,” said Rep. Holding. “Medicare frauds must be found and severely punished but not at the cost of the independent practice of medicine.” Rep. Holding is a member of the House Ways and Means Committee, which has jurisdiction to consider legislation to reform the RAC program. The Physicians Advocacy Institute (PAI) and North Carolina Medical Society (NCMS) have been advocating for more fair and transparent medical audits. They cite concerns that the current audit process lacks transparency, is overly expensive and timeconsuming and is often unfair. “Here in North Carolina, I have witnessed firsthand how the current Medicare audit process can destroy a practice,” said Robert W. Seligson, M.B.A., M.A., who is executive vice president and chief executive officer of NCMS and president of PAI. “It is time to address fundamental problems that have contributed to the backlog of audit appeals and caused a great deal of unnecessary expense and confusion for physicians nation
june 2015
15
Duke Research News
Interferon-Free Therapy Clears Hepatitis C in 93 Percent of Patients A 12-week dose of an investigational three-
liver failure and death if untreated. Most
The trial was conducted between Decem-
drug hepatitis C combination cured the
who are infected don’t know they have
ber 2013 and September 2014 at nearly
virus in 93 percent of patients with liver cir-
the disease until they have symptoms and
50 sites across the United States, Canada,
rhosis who hadn’t previously been treated,
have already sustained liver damage, said
France and Australia. All patients were in-
according to a study in the May 5 issue of
Andrew Muir, M.D., M.H.S., chief of the di-
fected with Genotype 1 hepatitis, a com-
The Journal of the American Medical Asso-
vision of gastroenterology at Duke and the
mon strain of the C virus in North America,
ciation.
study’s lead author. For this reason, Ameri-
Western Europe and Australia.
cans born between 1945 and 1965 – baby Bristol-Myers Squibb funded the trial of the
boomers – should automatically be tested,
The drugs had minimal side effects for most
combination of three drugs – daclatasvir,
he said.
participants. Nine patients experienced serious adverse events, three of which were
asunaprevir and beclabuvir. None of the three drugs are approved by the Food and
For most of the past 20 years, therapies for
considered related to treatment, according
Drug Administration, but daclatasvir is cur-
hepatitis C relied on interferon drugs, which
to the study.
rently under review by the FDA. Duke Med-
require regular injections for as long as one
icine researchers collaborated on the de-
year and trigger miserable, flu-like side ef-
Among the study’s limitations were the
sign and analysis of the trial and authored
fects that prompt many patients to quit the
absence of a placebo group that could
the findings.
regimen. Some patients aren’t eligible for
pinpoint the sources of side effects and a lack of racial diversity, with 88 percent
“The development of interferon-free treatments has been a tremendous step forward in the standard of care…”
white participants. The study also did not statistically distinguish the impact of the addition of ribavirin to some participants’ daily regimen. In addition to Dr. Muir, study authors in-
The trial recruited patients with hepatitis C-
this treatment if they have anemia, low plate-
related cirrhosis, or scarring of the liver. A
lets or other conditions, Dr. Muir said.
clude Fred Poordad, Jacob Lalezari, Gregory Everson, Gregory J. Dore, Robert Herring, Aasim Sheikh, Paul Kwo, Christophe
total of 112 had not previously been treated for hepatitis C, and 90 had previous unsuc-
“Those with more advanced disease were
Hézode, Paul J. Pockros, Albert Tran, Jo-
cessful therapies. For those with past failed
unlikely to tolerate interferons, and many
seph Yozviak, Nancy Reau, Alnoor Ramji,
therapies and potential resistance, the
patients would decide against even getting
Katherine Stuart, Alexander J. Thompson,
drugs were slightly less successful, elimi-
treatment,” Dr. Muir said. “For those who
John Vierling, Bradley Freilich, James Coo-
nating the virus in 87 percent.
could tolerate it, it was only moderately ef-
per, Wayne Ghesquiere, Rong Yang, Fiona
fective.”
McPhee, Eric A. Hughes, E. Scott Swenson and Philip D. Yin.
However, for those with past failed therapies, incorporating a fourth drug, ribavirin,
Since late 2013, several drug companies
appeared to enhance results. Ribavirin is
have released new, interferon-free regi-
Bristol-Myers Squibb sponsored the study.
a commonly used hepatitis C treatment.
mens. In many cases, these have proven to
Dr. Muir received grant funding from Bris-
When added to the investigational regi-
be more effective than previous treatments.
tol-Myers Squibb during the conduct of the trial, as well as grant funding and personal
men, success rates in previously treated patients reached 93 percent – on par with
“The development of interferon-free treat-
fees from AbbVie, Achillion, Bristol-Myers
those receiving treatment for the first time.
ments has been a tremendous step for-
Squibb, Gilead and Merck; personal fees
ward in the standard of care,” Dr. Muir said.
from Theravance; and grant funding from
No vaccine has been developed to protect
“These drugs are highly effective and well-
Roche.
patients from the hepatitis C virus, which
tolerated by patients at all stages of liver
is spread through blood and can lead to
disease.”
16
The Triangle Physician
Duke Research News
Old Bones Can Regain Youthful Healing Power Using Beta-Catenin Modulation Broken bones in older people are notoriously slow to heal, but researchers at Duke Medicine have identified a potential way to speed the process. In studies using mice, the researchers not only traced what signals go wrong when aged bones heal improperly, they also successfully manipulated the process by both circulating blood and transplanting bone marrow from a young mouse into an older mouse, prompting the bones to heal faster and better. The findings, reported online May 19 in the journal Nature Communications, address one of the largest problems draining health care resources. According to the Centers for Disease Control and Prevention, fractures are the most common and costly nonfatal
Top slide illustrates an older bone, where fracture repair is slower and can lead to deposits of weak fibrotic tissue. Bottom slide shows rejuvenated fracture repair from exposure to a youthful circulation; the rate and amount of bone tissue deposited is enhanced.
injuries to adults over age 65. They account for more than onethird of that population’s nonfatal injuries and 61 percent of total nonfatal care costs. The recent study builds on earlier research by the Duke-led team and others, which identified an important role for a protein called beta-catenin in the healing process. The protein requires precise modulation for successful bone fracture repair. In older people, beta-catenin levels are elevated during the early phases of bone repair, leading to the production of tissue that is more like scar than bone, which is not good for bone healing. Using mice as a surrogate for humans, the researchers found that they could manipulate beta-catenin levels by exposing older animals to the blood circulation of younger animals, essentially correcting the intricate formula necessary for healthy bone repair. “It’s not that bone cells can’t heal as efficiently as we age, but that they actually can heal if they are given the right cues from their environment,” said senior author Benjamin A. Alman, M.D., chair of the Department of Orthopaedic Surgery at Duke University School of Medicine. “It’s a matter of identifying the right pathway to target, and that’s what’s exciting about this work.” The researchers replicated the findings using bone marrow cell transplantation between young and old mice, again demonstrating that young hematopoietic cells are able to recalibrate the beta-catenin signaling during early fracture repair, restoring healthy
Dr. Alman said the findings suggest that drug therapies might be able to decrease beta-catenin levels or modulate the inflammatory process to improve fracture repair in older adults and perhaps in people who have received bone implants. “The next steps are to figure out what’s making beta-catenin go up in older adults, so that we can target that cause,” Dr. Alman said, “and to explore drugs that can be used in patients to change betacatenin levels safely and effectively.” In addition to Dr. Alman, study authors include Gurpreet S. Baht, David Silkstone, Linda Vi, Puviindran Nadesan, Yasha Amani, Heather Whetstone and Qingxia Wei. The study received funding from the Canadian Institutes of Health Research and from Duke. The work was done at Duke and the Hospital for Sick Children in Toronto.
bone-healing in old mice.
june 2015
17
UNC Research News
Entire Human DNA Repair Map Created The new experimental assay can help sci-
the repair of DNA damage over the entire
posed the cells to ultraviolet radiation and
entists find the precise locations of repair of
human genome.
used an antibody against the enzyme TFIIH to isolate the enzyme complex with the ex-
DNA damage caused by UV radiation and common chemotherapies. The invention
“Now we can say to a fellow scientist, ‘tell
cised DNA damage. Then he created experi-
could lead to better cancer drugs or improve-
us the gene you’re interested in or any spot
mental techniques to pull the enzyme – as
ments in the potency of existing ones.
on the genome, and we’ll tell you how it is
well as the excised DNA fragment it was
repaired,’” said Dr. Sancar, co-senior author
bound to – from the cells.
and member of the UNC LCCC. “Out of six billion base pairs, pick out a spot, and we’ll
The fragment was stable enough for Dr. San-
tell you how it is repaired.”
car’s lab to sequence it. Then, Sheera Adar,
Photos by Max Englund, UNC School of Medicine
Ph.D., fellow postdoc and paper co-first When DNA is damaged, cells use many
author, and Jason Lieb, Ph.D., co-senior in-
enzymes to cut the strand of DNA and ex-
vestigator of the study, used their expertise
cise the damaged fragment. Then, other en-
in computational biology to analyze where
zymes repair the original DNA so the cells
the DNA repair happened throughout the
can function properly. Previously, Dr. San-
entire genome and thus generate a human
car’s lab used purified enzymes to discover
genome repair map for the first time.
how this process happens in DNA damaged Because UV radiation and common chemotherapy drugs, such as cisplatin, cause DNA damage in similar ways, Dr. Sancar’s team is now using their new DNA excision repair
Aziz Sancar, M.D., Ph.D.
When the common chemotherapy drugs cisplatin or oxaliplatin hit cancer cells, they damage DNA so the cells can’t replicate. But the cells have ways to repair the DNA, making the cancer drugs less effective.
Jinchuan Hu, Ph.D.
Researchers at the University of North Caro-
by ultraviolet irradiation and by che-
lina School of Medicine and UNC Lineberg-
motherapeutic drugs, such as cispla-
er Comprehensive Cancer Center (LCCC)
tin and oxaliplatin.
Sheera Adar, Ph.D.
method – called XR-Seq – to study cells af-
have developed a method for finding where this DNA repair happens throughout all of
In recent years, Michael Kemp, Ph.D., a re-
fected by cisplatin. They also hope to use it
human DNA.
searcher on Dr. Sancar’s team found that a
to study the biochemical reactions in animal
particular protein called TFIIH bound tightly
models with the goal of finding the specific
The findings, published in the journal Genes
to the excised damaged DNA fragment in the
mechanisms that allow cancer cells to re-
& Development, offer scientists a potential
test tube. But for this information to be truly
pair DNA damage to survive.
way to find and target the proteins cancer
useful to biomedical researchers, the ex-
cells use to circumnavigate therapy. The
periment needed to be replicated in human
“Cisplatin is an old drug,” Dr. Adar said.
benefit of this new method could be more
cells. Extracting a stable TFIIH-DNA fragment
“Right now, it’s used with other drugs as a
effective and better tolerated classes of can-
proved difficult. Not until postdoctoral fellow
combination therapy. We know these drugs
cer therapeutics.
Jinchuan Hu, Ph.D., co-first author on the
make cancer cells more sensitive to cispla-
Genes & Development paper, joined Dr. San-
tin. But we don’t really know how they do
car’s lab could it accomplish the task.
this. We now have an assay to find out how
The research, led by Aziz Sancar, M.D.,
the cells’ DNA is being repaired. Our goal is
Ph.D., the Sarah Graham Kenan professor of biochemistry and biophysics, marks the
Through a series of sophisticated experi-
to make cancer cells even more sensitive to
first time scientists have been able to map
ments with human skin cells, Dr. Hu ex-
existing drugs to help patients.”
18
The Triangle Physician
News The research also revealed that parts of the
“People have thought that this DNA didn’t
Christopher Selby, Ph.D., a research instruc-
genome scientists previously thought did very
do anything,” Dr. Adar said. “But it turns
tor in the Sancar lab, is also an author on
little are actually part of this repair process.
out that proteins bind to these other DNA
the Genes & Development paper. Dr. Lieb,
sequences, and this affects other nearby or
formerly a UNC researcher, is now a profes-
On chromosomes, DNA forms genes that
far-away genes. Our analysis shows that these
sor of human genetics at the University of
create proteins – the building blocks of life.
DNA regulatory sequences are also being
Chicago.
Between these genes, there are DNA se-
repaired. So, if they’re being repaired, then
quences – simple bits of genetic information.
they’re likely important. And now we can
The National Institutes of Health funded this
find their locations throughout the genome.”
research.
$150 Million in Bonds Raised for New Heart and Vascular Hospital Rex Healthcare raised $150 million in debt to
improve the overall health of our commu-
care across the UNC Health Care system. It
help pay for constructing and equipping the
nity and patients for generations to come,”
will consolidate existing services at Rex into
new North Carolina Heart & Vascular Hospi-
said Steve Burriss, president of Rex. “This
one convenient facility, improving access
tal and refinancing existing, older debt.
is the largest construction project since we
and care for patients and their families.
moved to this campus in 1980, and we’re Rex sold $50 million in tax-exempt, fixed
pleased that investors share our confidence
Some of the total cost of the new hospital
rate bonds that were issued by the North
in Rex’s bright future.”
will be paid for through philanthropy. Learn
Carolina Medical Care Commission. The
more about the N.C. Heart & Vascular fund-
non-profit health system raised another $100
Scheduled to open in early 2017, the eight-sto-
raising campaign that the Rex Healthcare
million in variable debt directly with a bank.
ry, 300,000-square-foot N.C. Heart & Vascular
Foundation is conducting by visiting online
Hospital will be a destination for innovative
at
“Borrowing this money is an important step
cardiovascular treatment, research, preven-
“Donate for a special purpose” click on:
rexhealthcarefoundation.com.
Under
for Rex as we continue building a state-of-
tion and education. The new hospital is part
North Carolina Heart & Vascular Hospital
the-art heart and vascular hospital that will
of a larger effort to improve cardiovascular
Campaign.
Credible Announces Partnership with North Carolina Medical Society North Carolina Medical Society has part-
nancing process,” said Stephen Dash, found-
nered with a student loan marketplace that
er and chief executive officer of Credible.
can help reduce debt.
dent loan refinancing options. “We are pleased to partner with Credible
According to the press advisory, the average
and know they will offer excellent service to
The partnership with Credible, an indepen-
medical school graduate who refinances
our members,” said Franklin Walker, NCMS
dent student loan marketplace, will help
with Credible saves more than $40,000.
director of programs and practice management. “Our Vendor Services Program has
address the growing student debt issues of young doctors, who graduate from medi-
Credible serves as a matchmaker between
become the go-to website for NCMS mem-
cal school with an average of more than
borrowers and lenders through its online
bers when they are looking for a variety of
$170,000 of student debt, according to a
marketplace, providing medical school
services to help manage their practices.”
press advisory.
graduates with personalized offers from multiple lenders to refinance their student
NCMS is the largest and oldest professional
“We’re thrilled to be able to partner with
loans. Using a single form, student debt
member organization in North Carolina,
NCMS to enable (members) to alleviate some
holders can receive offers from multiple
representing approximately 12,500 physi-
of their student loan burden through simpli-
lenders. The service enables graduates to
cians and physician assistants who practice
fying the student loan management and refi-
save money by easily comparing their stu-
in the state.
june 2015
19
News
Wake County’s First Women’s Hospital Opens on WakeMed Campus Wake County’s fifth full-service hospital – and the first and only women’s hospital in the area – opened May 11 to provide specialized care and unique amenities on the WakeMed Health & Hospitals North Healthplex campus. The 248,800-square-foot, 61-bed WakeMed North Family Health & Women’s Hospital brings with it new and expanded services that include general surgery, urology, gynecology and obstetrical care as well as maternal-fetal medicine, lactation specialists, gestational diabetes education, pediatric audiology screening and outpatient diagnostic mammography. Childbirth facilities include private labor and delivery rooms, a C-section room, a family-centered postpartum unit and a six-bed Level III special care nursery. “Women of every age will have access to a variety of services, while close to family and close to home,” said Sheri De Shazo, R.N., M.B.A., M.H.A., vice president and administrator, WakeMed Sheri De Shazo, R.N., M.B.A., M.H.A. North. “The campus will continue to serve men and children through our existing emergency department and outpatient surgery, rehabilitation, imaging, lab and physician office services.” The new hospital combines advanced technology and providers with a hotel-like, environmentally-friendly design, creating a tranquil space with large, private rooms alongside amenities tailored to women and families. Amenities and specialty offerings include 24-hour, room-service dining; in-room massage therapy and eco-friendly spa products; flower service; in-room WiFi and video connections for the family; specialized infant/family photography and
20
The Triangle Physician
women’s gift shop, among others. WakeMed’s hospitals in Raleigh and Cary each year deliver 7,500-plus babies, which is more than any other hospital system in Wake County. WakeMed North Family Health & Women’s Hospital will be the health system’s third full-service hospital offering a birthing experience. “Women’s health has always been a top priority for WakeMed,” said Seth Brody, M.D., executive medical director for the Women’s Hospital at WakeMed North. “We will continue this Seth Brody, M.D. tradition at our new hospital, providing an outstanding health care environment that will benefit growing families for years to come.” The new hospital also ushers in a new model of maternity care – the laborist program. A specialized group of obstetric hospitalists, laborists are experts in caring for women in labor and delivering babies. These in-house physicians will provide 24/7 inpatient care, ensuring an extra level of quality and safety, while working directly with a patient’s primary OB/GYN.
contractor for the expansion project, teaming with Triangle-based design consultants ColeJenest & Stone, Mulkey Engineers & Consultants, BBH Design and Dewberry. WakeMed first received Certificate of Need approval in 2009 to expand the existing North Healthplex, located at 10000 Falls of Neuse Road in Raleigh, and build WakeMed North Family Health & Women’s Hospital. Construction began in September 2013. Visit www.wakemed.org for more information.
Welcome to the Area
Physicians Fielding Carter Fitzpatrick, DO Diagnostic Radiology; Radiology
Duke University Medical Center Durham
Nicholas Daniel Andersen, MD Cardiovascular Surgery; General Surgery; Thoracic Cardiovascular Surgery
Duke University Hospitals Durham
Tyler Jay Armstrong, MD Emergency Medicine
University of North Carolina Hospitals Chapel Hill
Diana Arsene, MD Gastroenterology, Internal Medicine
University of North Carolina Gastroenterology Chapel Hill
Prashanti Aryal, MD Gynecology; Gynecologic Surgery
Wake Internal Medicine Consultants Raleigh
Michelle Barry Aurelius, MD
WakeMed North Family Health & Women’s Hospital will continue to offer outpatient care for the entire family, including 24/7 emergency services, day surgery, diagnostic and lab services and physical rehabilitation as well as several specialty care and primary care practices.
Anatomic and Clinical Pathology; Forensic Pathology; Pathology-Medical Examiner
NC Office of the Chief Medical Examiner Raleigh
Sujeev Bains, MD Internal Medicine
Veterans Administration Goldsboro CBOC Goldsboro
Derek Pehrson Bitner, MD Ophthalmology; Pediatric Ophthalmology
Duke Eye Center Durham
Additionally, as part of its commitment to provide the highest quality of care in the healthiest environment, WakeMed is pursuing LEED for Healthcare Gold certification from the United States Green Building Council. Brasfield & Gorrie served as general
Carley Ann Bria, MD Emergency Medicine
University of North Carolina Hospitals Chapel Hill
Matthew James Bruehl, MD Pediatric Pulmonology; Pediatrics
University of North Carolina Hospitals Chapel Hill
News Welcome to the Area Robert Augustus Buchanan Jr., MD
Laura Christine Hart, MD
Timothy William Menza, MD
Bradley James Sumrow, MD
Cardiology; Cardiovascular Disease
Internal Medicine; Pediatrics
Durham
UNC General Internal Medicine Chapel Hill
Infectious Diseases, Internal Medicine; Pediatrics; Public Health
Anesthesiology
Nicole Chaumont, MD Abdominal Surgery; Colon and Rectal Surgery
University of North Carolina Hospitals Chapel Hill
Xi Chen, MD Ophthalmology
Duke Eye Center Durham
Sarah Beth Corley, MD
Jessica Cook Heestand, MD Internal Medicine
Seth Matthew Miller, MD
Wake Internal Medicine Consultants, Inc. Raleigh
Radiation Oncology; Therapeutic Radiology
John Patrick Hemming, MD
Mitushi Mishra, MD
124 Stateside Drive Chapel Hill
Psychiatry
Michele Alyssa Hendrickson, MD
University of North Carolina Hospitals Chapel Hill
Anesthesiology - Pain Medicine
Duke University Hospitals Durham
Surgery (general); Vascular Surgery
Samuel Trent Hester, MD
University of North Carolina Hospitals Chapel Hill
Hospitalist; Internal Medicine
Robin Claire Davis, MD
University of North Carolina Hospitals Chapel Hill
Neurology
Steven Todd Hobgood, MD
University of North Carolina Hospitals Chapel Hill
Anesthesiology
David Harris Delman, MD Neurology
University of North Carolina Hospitals Chapel Hill
Lindsey Markell Deschamps, MD Obstetrics and Gynecology
WakeMed Physician Practices Raleigh
Jennifer Joan Dorsch, MD Internal Medicine
University of North Carolina Hospitals Chapel Hill
Jayanth Radhamohan Doss, MD Rheumatology, Internal Medicine
Duke Rheumatology Clinic Durham
Mackenzie Esch, MD Pediatrics
University of North Carolina Hospitals Chapel Hill
Joseph James Fantony, MD Urology
Duke University Hospitals Durham
Colby Danielle Feeney, MD Hospitalist; Internal Medicine; Pediatrics
Duke University Hospitals Durham
Michael Anthony Fierro, MD Anesthesiology - Critical Care Medicine
Duke University Hospitals Durham
Duke University Hospitals Durham
Kristen Elizabeth Harring, MD Pediatrics
University of North Carolina Hospitals Chapel Hill
Duke University Hospitals Durham
Mark Nicholas Perlmutter, MD Orthopedic Surgery; Hand, Ankle/Foot, Adult Reconstructive, Pediatric, Trauma
Carolina Regional Orthopedics Rocky Mount
Jessica Dionne Randolph, MD Ophthalmology
Robert Arthur Rayson, MD
Duke University Medical Center Durham
Christopher James Hostler, MD Infectious Diseases, Internal Medicine
Duke University Hospitals Durham
Rachel Helen Hughes, MD Hospitalist; Internal Medicine
Duke Regional Hospital Medicine Durham
Wesley Matthew Jackson, MD Neonatal-Perinatal Medicine
UNC Hospitals Chapel Hill
Kirk Anderson James, MD Dermatological Immunology, - Pediatric -
University of North Carolina Hospitals Chapel Hill
Claire McMurrian Kappa, MD Internal Medicine
Duke University Hospitals Durham
Tara Laura Kaufmann, MD University of North Carolina Hospitals Chapel Hill
Jeremy Inkwon Kim, MD Radiology
Bilal Danish Lateef, MD Anesthesiology
University of North Carolina Hospitals Chapel Hill
Brianna Marie Wielhorski Lyttle, MD Obstetrics and Gynecology- Reproductive
UNC Reproductive Endocrinology Chapel Hill
Kathryn Marie Sweeney, MD Internal Medicine
University of North Carolina Hospitals Chapel Hill
Mekdem Tesfaye, MD Pediatrics
Duke University Medical Center Durham
Ian William Udell, MD Abdominal Surgery; Pediatric Urology
University of North Carolina Hospitals Chapel Hill
Alice Becker Uflacker, MD Neurology/Psychiatry; Geriatric
Duke University Hospitals Durham
Ami Vijay Vakharia, MD Radiology; Diagnostic Roentgenology, Musculoskeletal, Neuroradiology; Nuclear, Pediatric, Radiologic Physics; Vascular and Interventional Radiology
Univ of North Carolina Hospitals Chapel Hill
Charanjit Singh Virk, MD
5002 Gaithers Pointe Drive Durham
Family Medicine; Urgent Care
Jonathan Charles Riboh, MD
Alex Jordan Warren, MD
Orthopedic Sports Medicine & Surgery
Durham Emergency Medicine
Duke Sports Science Institute Durham
Nash General Hospital Rocky Mount
Caroline Collins Roberts, MD
Kate Alison Myers Woll, MD
Family Medicine
Pediatrics
University of North Carolina Hospitals Chapel Hill
Duke University Hospital Durham
Michael David Rosenberg, MD
Amber Marie Wood, MD
Diagnostic Radiology; Radiology
Maternal and Fetal Medicine; Obstetrics and Gynecology
Duke University Hospitals Durham
Duke University Medical Center Durham
Katherine Chandler Bart Roy, MD Dermatology; Dermatology Immunology
University of North Carolina Hospitals Chapel Hill
Marisa Ann Ryan, MD Otolaryngology/Facial Plastic Surgery; Pediatric Otolaryngology
Duke University Hospitals Durham
Jerry Allen Saunders Jr., MD Internal Medicine; Pediatrics
University of North Carolina Hospitals Chapel Hill
Amanda Marie Sayed, MD Pediatrics
5011 Sunny Creek Lane Apex
Family Practice/Sports Medicine
UNC Hospitals Chapel Hill
134 Grey Elm Trail Durham
Internal Medicine
Internal Medicine
Emily Elizabeth Krodel, MD
UNC Hospitals Chapel Hill
Pediatrics
Anatomic and Clinical Pathology; Dermatopathology
Abdominal Surgery, Adolescent Medicine, Obstetrics/Gynecology/Critical Care Medicine
Obstetrics and Gynecology; Public Health
Kalindi Yajnik Narine, MD
Alamance Eye Center Burlington
Nurain Mohammed Fuseini, MD
Jacqueline Holt Grant, MD
Psychiatric Associates of NC, PA Raleigh
Hedieh Honarpisheh, MD
UNC Hospitals Chapel Hill
UNC Dept of Ob & Gyn Chapel Hill
Univ of North Carolina Hospitals Chapel Hill
General Practice; Internal Medicine
Dermatology
Jason Ryan Crowner, MD
UNC Division of Infectious Disease Chapel Hill
Matthew James Sewell, MD
Physician Assistants Seth Abel, PA Pediatrics
Rocky Mount
Corrina Baglia, PA Critical Care; Emergency Medicine; Orthopedic Sports
Whitsett
Laura Alice Ciompi, PA Family Medicine
Raleigh
Lisa Christine Higgins, PA Family Practice; Internal Medicine; Obstetrics and Gynecology; Pediatrics
Dermatology - Pediatric Dermatology
Raleigh
UNC Dept of Dermatology Chapel Hill
Amelia Kay Martin, PA
Kevin Pradip Shah, MD
Doctors Making Housecalls Durham
Internal Medicine; Urgent Care
Duke University Hospitals Durham
Alan Matthew Smeltz, MD Anesthesiology
University of North Carolina Hospitals Chapel Hill
Family Medicine - Geriatric Medicine
Sinead Meghan McFarlane, PA Emergency Medicine
Mebane
Anne Marie Stephano, PA Orthopedic Sports Medicine & Surgery
Raleigh
june 2015
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