October 2018 • Vol. 48, No. 9
Mecklenburg Medicine A Publication of the Mecklenburg County Medical Society | www.meckmed.org
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Mecklenburg Medicine • October 2018 | 3
Table of Contents 5 President’s Letter: The Arms Race By Scott L. Furney, MD, President, MCMS
6 Feature: Physician Burnout: Prevalence, Causes and Potential Solutions to Reclaim Joy and Meaning in Practice By Dael Waxman, MD, Vice Chair of Professional Development, Department of Family Medicine, Atrium Health
8 Feature: The Problem of Overdiagnosis By Gordon Hull, Director, Center for Professional and Applied Ethics, Associate Professor Philosophy and Public Policy, UNC Charlotte
9 Charlotte AHEC Course Offerings for October 10 Feature: The Effects of Posture at Your Workstation By Andrew Sumich, MD, and Graham Claytor, PT, MPT, SCS, CSCS, Carolina Neurosurgery & Spine Associates
12 12 13 13 13 14 16 16
Congratulations to Practices National Health & Wellness Observances Member News New Members Upcoming Meetings & Events At the Hospitals Independent Physicians of the Carolinas Advertising Acknowledgements
1112 Harding Place, #200, Charlotte, NC 28204 704-376-3688 • FAX 704-376-3173 meckmed@meckmed.org Copyright 2018 Mecklenburg County Medical Society Mecklenburg Medicine is published 10 times per year by the Mecklenburg County Medical Society, 1112 Harding Place, Suite 200, Charlotte, NC 28204. Opinions expressed by authors are their own, and not necessarily those of Mecklenburg Medicine or the Mecklenburg County Medical Society. Mecklenburg Medicine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. Mecklenburg Medicine is not responsible for unsolicited manuscripts. Classified Ads: Open to members, nonprofits and non-member individuals only; advance approval of the Managing Editor and advance payment required. Member rate is 0, non-members $20 for the first 30 words; $.75 each additional word. Display Ads: Open to professional entities or commercial businesses. For specifications and rate information, contact Mark Ethridge at mecklenburgmedicine@gmail.com. Acceptance of advertising for this publication in no way constitutes professional approval or endorsement of products or services advertised herein. We welcome your comments and suggestions: Call 704-376-3688 or write Mecklenburg Medicine, c/o Mecklenburg County Medical Society, 1112 Harding Place, Suite 200, Charlotte, NC 28204.
4 | October 2018 • Mecklenburg Medicine
October 2018 Vol. 48 No. 9 OFFICERS
President Scott L. Furney, MD President-Elect Elizabeth B. Moran, MD Secretary Babak Mokari, DO Treasurer John R. Allbert, MD Immediate Past-President Stephen J. Ezzo, MD
BOARD MEMBERS
Raymond E. Brown, PA Sarah M. Edwards, MD E. Carl Fisher, Jr., MD Donald D. Fraser, MD Vishal Goyal, MD, MPH Jane S. Harrell, MD Stephen R. Keener, MD, MPH B. Lauren Paton, MD Anna T. Schmelzer, MD Rachel L. Storey, DO Andrew I. Sumich, MD G. Bernard Taylor, MD
EX-OFFICIO BOARD MEMBERS Tracei Ball, MD, President-Elect Charlotte Medical Dental & Pharmaceutical Society Sandi D. Buchanan, Executive Director Mecklenburg County Medical Society Darlyne Menscer, MD NCMS Delegate to the AMA
Meg Sullivan, MD, Medical Director Mecklenburg County Health Department
Douglas R. Swanson, MD, FACEP, Medical Director Mecklenburg EMS Agency
EXECUTIVE STAFF
Executive Director Sandi D. Buchanan Finance & Membership Director Stephanie D. Smith Meetings & Special Events Coordinator Jenny H. Otto
MECKLENBURG MEDICINE STAFF Editor Scott L. Furney, MD Managing Editor Sandi D. Buchanan Copy Editors Lee McCracken Stephanie Smith
Advertising Mark Ethridge mecklenburgmedicine@gmail.com Editorial Board Stephen J. Ezzo, MD N. Neil Howell, MD Jessica Schorr Saxe, MD Graphic Design Wade Baker
President’s Letter
The Arms Race By Scott L. Furney, MD
A
few months ago, one of my patients brought me a bill from his recent surgery. Unbeknownst to me, he had undergone an outpatient knee arthroscopy for persistent knee pain. He is in his mid-40s and had an injury to his meniscus in high school sports. An MRI before surgery showed a chronic medial meniscal tear with early degenerative changes. He was optimistic about getting back to running as his preferred exercise, but was startled by his bill. As many of our patients do now, he has a high-deductible plan and was responsible for much of the up-front cost of the procedure. The total bill was more than $30,000. He described the procedure as uneventful and his stay in the ambulatory surgery center was measured in hours. The operation itself took less than an hour. His question should be apparent: How could a few hours of medical care cost so much? A few days ago, I got a personal look at some of the waste in the system as I tried to order an echocardiogram on an elderly patient with dyspnea and lower extremity edema. Using those two ICD-10 codes, I sent the order electronically to my staff, expecting the test to be scheduled and performed quickly. It was, after all, medically indicated and relatively inexpensive. A few hours later, one of my staff asked for my help in getting the pre-authorization completed. She had been on the phone for 45 minutes and was not sure how to get it approved. As she talked with the insurance company, I asked her to put the call on speakerphone so I could quickly provide the necessary information. What I heard was frankly disturbing. “Does the patient have elevated troponin blood tests? Does the patient have acute systolic heart failure? Does the patient have …” The pronunciation and halting nature of the questions told me the insurance representative was non-clinical. She was running a checklist of words that would allow the test to pass their first level review. My staff member is non-clinical as well, so it was a tough conversation for them to have! I politely interrupted and told her I was concerned about diastolic heart failure from hypertension
Those three levels of review are the tip of an iceberg when compared to the infrastructure needed to “justify” medical care in the hospital environment. We have hired a small army of people to support the billing of medical care in the United States.
and that the echo was the best test to guide our further testing and treatment. There was long pause and it became clear to me those words were not on the checklist. She started right back on the checklist and I asked to speak with their nurse or MD to bypass this step. A few minutes later, the nurse approved the test without further delay. In reviewing our process for tests, I learned these orders frequently get passed from my non-clinical staff to my nurse. My nurse can take care of 90 percent of these “second level” reviews with her peer nurse on the phone, which leaves me with the most complex 10 percent that requires MD peer review. Those three levels of review are the tip of an iceberg when compared to the infrastructure needed to “justify” medical care in the hospital environment. We have hired a small army of people to support the billing of medical care in the United States. On average, the U.S. has three to five times the administrative costs of the Canadian system. We feel these costs in the time it takes our clinical staff to get tests scheduled. The patients feel it when they pay their deductibles, which must include the costs for the staff on both sides of the administrative arms race. So, what do I tell my patient about the cost of care? Do I justify the costs as a necessary evil for working in a complex system? Do I tell him his procedure, compared to physical therapy, is unlikely to provide a long-term benefit toward his goal of returning to running for exercise? Do I tell him, if he had seen me first, I would have been unlikely to order the MRI or refer him for surgical evaluation without first exhausting other evidence-based and higher value services? I am impatient for change. In writing this, I carefully considered the solutions for this conundrum and came up with what will likely be an unpopular conclusion: We either need a single payor system to reduce the “arms race” or move more rapidly to value-based contracts where we (physicians and health care systems), and not patients, take on the financial risk of providing good care. I am not sure if officers of the Medical Society can be impeached, but I figured with just a few months left in the year, I would risk it. In humble service,
P.S. If you are interested in a graphic representation of the “arms race,” Google images with the terms “growth physicians and administrators health care.”
Mecklenburg Medicine • October 2018 | 5
Feature
Physician Burnout: Prevalence, Causes and Potential Solutions to Reclaim Joy and Meaning in Practice By Dael Waxman, MD, Vice Chair of Professional Development, Department of Family Medicine, Atrium Health
“I
’m done,” said Meredith, a 47-year-old intensivist. “I just don’t have the energy to be interested any longer. I am going through the motions of looking like I care about my patients, but it is getting harder to do. I don’t think I’m very good at this anymore ... I better get out before I hurt someone.” At some point in training or practice, all health care professionals have experienced at least one of the feelings Meredith expresses. In most cases, it is short-lived, perhaps only hours or days. When it is sustained over weeks and months, it is most likely burnout — a state of diminished emotional, social, mental and physical capacity as a result of perceived demands on these energies. When present, it harms us, distresses our family members, fractures relationships with teammates, disrupts systems of care and, most important, can affect patient safety and clinical outcomes. Burnout is almost twice as prevalent among physicians as workers in other fields. In a landmark study published in 2012, Shanafelt showed 45 percent of physicians reported at least one symptom of burnout.1 When the study was repeated three years later, the prevalence had increased to 54 percent.2 Coinciding with its
Burnout is almost twice as prevalent among physicians as workers in other fields.
publication, books and articles in newspapers, magazines and on the internet, have mushroomed. Workshops, seminars, retreats and conferences on physician burnout are burgeoning. While some authors describe it as an epidemic, others have gone further and pronounced burnout as endemic to modern health care.
What’s going on?
First, as with any occupation, physician burnout has always been with us. Christina Maslach, a leader in the field of occupational burnout and the author of the gold standard survey to measure it, states burnout is the result of a mismatch between personal factors an individual brings to the workplace and the system factors in their chosen setting.3 Personal factors include personality, values, motivation, training and expectations. People who are selected for training in health professions tend to have similar personal factors — perfectionism, self-directed learning, type-A personalities, a tendency toward compulsiveness and they have a preference for working autonomously. All of these qualities are reinforced in our training, as well. While these are valuable attributes for this important work, disease processes are anything but predictable and this results in a setup for most health professionals to self-blame when things don’t go well medically. This takes a toll, and burnout purely from personal factors can occur. Personal factor issues are why burnout has always been present in our occupation. System factors include the work environment, team culture, job expectations and all of the external forces that determine and regulate what we do and how we do it. Contemporary health care has seen significant additions to workflow as a result of these external forces. Performance measurement (quality, cost, patient satisfaction), implementation of electronic health records (with increased clerical burden), payor issues (coverage, prior authorization, formulary changes) and efforts to improve efficiency (to make up for declining reimbursement), have all unintentionally conspired to create a milieu that is an increasingly unfamiliar workspace for clinicians. This has led to an often-heard refrain from today’s stressed physicians, “Why do I have to do all of this stuff? I just want to take care of my patients!” Most authors and medical societies who have studied this area agree that these system factors have caused the rise in the prevalence of physician burnout in recent years.
What can be done about physician burnout?
As the antecedents to burnout are both personal and systemic, interventions designed to improve both are necessary to reduce burnout. A systematic review and meta-analysis of interventions, published in The Lancet by West, et al in 2016 showed a 10 percent overall reduction in burnout when personal factor interventions (therapy, coaching, communication skills groups, mindfulness
6 | October 2018 • Mecklenburg Medicine
Feature training, well-being seminars and scheduled group lunches) and system factor interventions (work hours restructuring, workflow changes, reduction of administrative burden) are pooled together.4 As this data is perused, keep in mind a common mistake made by leaders of medical groups and healthcare organizations is to place too much emphasis on the personal factor contribution to burnout and not enough on the systemic reasons. As Ron Epstein, MD, author of Attending: Medicine, Mindfulness, and Humanity, put it in a private conversation (paraphrased), “Suggesting physicians attend mindfulness classes to reduce stress when they have to return to the same demanding and dysfunctional system is disregarding and reinforces the notion that physicians are solely to blame for their burnout.” 5 Rather, it is suggested groups and organizations regularly assess practitioner burnout and workplace factors that might contribute to it simultaneously. This assists with identifying root causes and therefore determines appropriate interventions. Fortunately, many national healthcare organizations have taken notice and developed initiatives, consortiums and evidence-based tools to suggest assessments and interventions. The overarching goal of all these bodies is to not only reverse the trend of burnout, but to reclaim joy and meaning in the practice of medicine. Finally, MCMS members should be aware their Board of Directors has heard the voices of members about the level of burnout among colleagues, and is taking steps to raise awareness and gather objective data to form action steps — all toward strengthening physicians, and ultimately, the health of the community.
References
1. Burnout and Satisfaction with Work-Life Balance Among U.S. Physicians Relative to the General U.S. Population. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, West CP, Sloan J, Oreskovich MR. Arch Intern Med. 2012 Oct 8;172(18):1377-85. 2. Changes in Burnout and Satisfaction with Work-Life Balance in Physicians and the General U.S. Working Population Between 2011 and 2014. Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, West CP. Mayo Clin Proc 2015 Dec;90(12):1600-13. 3. Burnout: The Cost of Caring. Maslach C. ISHK, Los Altos, CA. 1982. 4. Interventions to Prevent and Reduce Physician Burnout: A Systematic Review and Meta-Analysis. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Lancet. 2016 Nov 5;388(10057):2272-2281. 5. Attending: Medicine, Mindfulness, and Humanity. Epstein R. Scribner, New York, 2017.
Some notable resources: AMA www.ama-assn.org/physician-wellness-program www.stepsforward.org/modules/physician-burnout n American College of Surgeons www.facs.org/member-services/surgeon-wellbeing n National Academy of Medicine nam.edu/initiatives/clinician-resilience-and-well-being n American College of Physicians www.acponline.org/about-acp/chapters-regions/united-states/new mexico-chapter/physician-burnout-and-wellness-information-andresources n American Academy of Family Physicians www.aafp.org/membership/benefits/physician-health-first.html n
Membership Social Thursday, Oct. 25
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6:30-8:30 p.m.
The Olde Mecklenburg Brewery 4150 Yancey Road, Charlotte To RSVP, email Sandi Buchanan at sbuchanan@meckmed.org.
NCMS LEAD Health Care Conference Don’t miss the North Carolina Medical Society’s (NCMS) LEAD Health Care Conference on Oct. 18-19, Raleigh Marriott Crabtree Valley. Thanks to the line-up of stimulating speakers addressing issues that matter most to you and your practice, you will leave the conference feeling inspired and renewed — and with up to 10.25 hours of CME! Contact Nancy Lowe at meetings@ncmedsoc.org. Register today and join us in Raleigh and plan on having some fun, too. In addition to dinner and dancing at the landmark Angus Barn pavilion on Thursday evening and a gala celebration dinner on Friday evening, you may want to consider staying on Saturday to enjoy the North Carolina State Fair.
Members Meet and Greet with
SENATOR JEFF JACKSON Wednesday, Oct. 10 5:30 p.m.
110 Perrin Place Charlotte, NC 28207 RSVP to Sandi Buchanan at sbuchanan@meckmed.org
Mecklenburg Medicine • October 2018 | 7
Feature
The Problem of Overdiagnosis By Gordon Hull, Director, Center for Professional and Applied Ethics, Associate Professor Philosophy and Public Policy, UNC Charlotte
C
linical tests always have to calibrate sensitivity (the ability to avoid false negatives) and specificity (the ability to avoid false positives). This is a well-known problem, and is inherent to pretty much any process of looking for something. The TSA has to calibrate its airport machinery to detect explosives, but not to ring the alarm at deodorant. It’s been getting a lot of attention in the context of mammography, as screening technology gets more and more sensitive. Getting this right is hard, and of course, is an ethical judgment at the end of the day. How much anxiety in false positives is “worth it” for detecting an actual cancer? At what age is the underlying risk great enough to warrant screening? Today, I want to look at a different, perhaps even more difficult, problem. It’s one that’s gotten less attention but is equally as serious. “Overdiagnosis” happens when one treats as clinically relevant a tumor that is not. More specifically, a current (June, 2018) paper by Louise Davies et al.1 proposes defining it as “the detection of a (histologically confirmed) cancer through screening that would not otherwise have been diagnosed in a person’s lifetime had screening not been done.” Lynette Reid, a bioethicist at Dalhousie University (and Ethics Center speaker last year) frames her discussion of the problem with a pair of seemingly contradictory data points. On the one hand, the evidence says we are getting a lot better at breast cancer screening. Detection rates are way up. On the other hand, mortality rates are barely budging. The problem seems to be we are treating tumors that would never be clinically significant. That the problem is overdiagnosis, and not something else, is suggested by autopsy studies which show by the time someone reaches old age, they almost certainly have a number of indolent tumors in their body. This “disease reservoir” represents a potentially serious overdiagnosis problem; Reid quotes research indicating if all of the indolent tumors had been detected with screening, then more than 99 percent of all thyroid cancers would be overdiagnoses. Even now, perhaps nearly a third of breast cancers are overdiagnoses. That said, a number of population-level variables influence whether a cancer is likely an overdiagnosis, making such estimates difficult. For example, Davies et al. point out that overdiagnosis is less likely in a population with a lower life expectancy from time of diagnosis, since a patient is more likely to die of other causes before a slowly-growing cancer could become clinically relevant. So too, there is a fundamental conceptual difficulty: whatever can be said at the population level, it is impossible to know if a given cancer, once treated, represented an overdiagnosis. These conceptual difficulties turn into clinical ones. Davies et al. cite a significant body of research indicating, in essence, that difficulties in understanding and communicating screening risks and benefits of screening generally, and of overdiagnosis specifically, make it hard to reach clinical decisions guided by patients’ values and risk tolerances. Even more fundamentally, Reid concludes by pointing out that the statistics put us in a paradoxical situation, “The more overdiagnosed
8 | October 2018 • Mecklenburg Medicine
cancer we detect, the less predictive of clinically significant outcomes it will be; at some point, its detection will confer no elevated risk of mortality. At some point before we get that far … it will no longer make sense to consider finding a risk factor (97).” In other words, detecting a tumor may someday not actually predict disease progression, or at least not well enough to guide clinical decision-making. Importantly, though, overdiagnosis is real. Each overdiagnosis stands for someone who will most likely undergo a physically-demanding and potentially dangerous treatment regimen and (hopefully) emerge on the other side with the socially-difficult label “cancer survivor.” In short, and paradoxically, improvements in cancer screening are making ethical choices about how to treat cancer harder, not easier. Defining, Estimating, and Communicating Overdiagnosis in Cancer Screening. Louise Davies, MD, MS; Diana B. Petitti, MD, MPH; Lynn Martin, PhD; Meghan Woo, ScD, ScM; Jennifer S. Lin, MD, MCR. Annals of Internal Medicine, July 3, 2018. 1
NATIONAL HEALTH & WELLNESS OBSERVANCES OCTOBER 2018 Alzheimer’s Association Memory Walk n American Heart Walk Eat Together, Eat Better Month n Children’s Health Month Domestic Violence Awareness Month n Health Literacy Month n Healthy Babies Month Healthy Lung Month n National Breast Cancer Awareness Month National Bullying Prevention Month n National Chiropractic Month National Dental Hygiene Month n National Depression and Mental Health Screening Month National Family Sexuality Education Month n National Liver Awareness Month National Physical Therapy Month n National Spina Bifida Awareness Month National Sudden Infant Death Syndrome (SIDS) Awareness Month Talk About Your Medicines Month n Vegetarian Awareness Month October 1: Child Health Day October 1-7 : National Mental Illness Awareness Week October 8-12: National School Lunch Week October 8-12: National Consultant Pharmacy Week October 10: World Mental Health Day October 10: Put the Brakes on Fatalities Day October 14-20: International Infection Prevention Week October 14-20: National Health Education Week October 14-20: National Healthcare Quality Week October 20: World Osteoporosis Day October 21-27: National Respiratory Care Week October 23-31: National Red Ribbon Celebration/National Plant the Promise Week October 27 : Make a Difference Day October 29: World Stroke Day
CHARLOTTE AHEC COURSE OFFERINGS
Charlotte AHEC is part of the N.C. Area Health Education Centers (AHEC) Program and Carolinas HealthCare System.
The MCMS office will be relocating downstairs in the same building and swapping spaces with Clean Air Carolina at 1112 Harding Place, Suite 100. The move will take place the week of November 5-9, with limited access to phones, email and databases. Your patience will be appreciated!
OCTOBER 2018
Continuing Medical Education (CME) 10/7-10 10/18 10/19 10/19 10/20 10/23 10/25 10/26 Webinar Online Online Online Online Online Online Online Online Online Online Online Online Online
30th Annual Fall Foliage Cancer Conference The APRN/PA Continuing Education Symposium Behavioral Health Bootcamp for the Primary Care Provider Advancing Innovation and Outcomes in Neurosciences IV: The Future of Cerebrovascular Care LCI 4th Annual Symposium on Hematologic Malignancies 13th Annual Charlotte Neonatology Symposium Francis Robicsek Symposium 3rd Annual LGBTQ Symposium for Healthcare Professionals Project ECHO: Sickle Cell Breaking the Cycle: Opioid Epidemic — Alternatives to Opioids in Primary Care Breaking the Cycle: Opioid Epidemic — Chronic Pain & Safe Opioid Prescribing Best Practices Breaking the Cycle: Opioid Epidemic — Considerations of Co-Morbid Mood and Anxiety in Chronic Pain Breaking the Cycle: Opioid Epidemic — Neonatal Abstinence Syndrome Breaking the Cycle: Opioid Epidemic — Pain Management in the Cancer Patient Breaking the Cycle: Opioid Epidemic — Responsible Pain Management in the Emergency Department CHS Approach to Sepsis and Infected Patients Requiring Hospitalization Heart Failure Patient Education for Primary Care Providers High-Risk Medications in the Elderly Introduction to HCCs for Practice Managers and Physicians Medical Genomics 101 Protecting Your Patients From Air Pollution The Role of the PCP in the Management of Pediatric Obesity (5-2-1-0 Principles)
For more information or to register for these courses, call 704-512-6523 or visit www.charlotteahec.org.
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Mecklenburg Medicine • October 2018 | 9
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Raise screen and arm rests Proper elbow and wrist support
Congratulations The following practices paid 2018 MCMS dues for most or all eligible physicians in their practice. Carolina Neurosurgery & Spine Associates Charlotte Gastroenterology & Hepatology Charlotte Radiology Mecklenburg Radiology Associates Novant Health Carolina Family Physicians Novant Health Heart and Vascular Institute Novant Health Mintview OB/GYN Oncology Specialists of Charlotte Piedmont Plastic Surgery & Dermatology Presbyterian Pathology Group Southeast Anesthesiology Consultants Southeast Pain and Spine Care Urology Specialists of the Carolinas
Thank You for Your Support!
IT’S NOT JUST ADULTS. OVER 64% OF YOUTH WITH DEPRESSION DO NOT RECEIVE ANY MENTAL HEALTH TREATMENT. STOP THE TREND. SECU Youth Crisis Center, a Monarch program, is the first of its kind in North Carolina for ages 6–17. We are currently accepting referrals.
12 | October 2018 • Mecklenburg Medicine
MonarchNC.org (844) 263-0050
Member News
NEW MEMBERS Gaurav Bharti, MD, FACS Plastic and Reconstructive Surgery Hunstad Kortesis Bharti Cosmetic Surgery 11208 Statesville Road #300 Huntersville, NC 28078 704-659-9000 East Tennessee State University, 2006 Parag Butala, MD Plastic and Reconstructive Surgery Piedmont Plastic Surgery and Dermatology 959 Cox Road Gastonia, NC 28054 704-866-7576 Brown University, 2006 Melissa C. Hennessey, MD Internal Medicine Tryon Medical Partners 5950 Fairview Road #330 Charlotte, NC 28210 704-495-6334 University of Louisville, 2004 Alison J. Johnson, MD Rheumatology Arthritis & Osteoporosis Consultants of the Carolinas 1918 Randolph Road #600 Charlotte, NC 28207 704-342-0252 University of South Carolina, 2005 Amanda M. Lanier, MD Pediatrics Charlotte Pediatric Clinic 4501 Cameron Valley Pkwy. #100 Charlotte, NC 28211 704-367-7400 West Virginia University, 1998
Upcoming Meetings & Events OCTOBER Upcoming Events
Upcoming Meetings
Tuesday, Oct. 2 Fighting for Women with Fashion CenterStage @ NoDa 7 p.m. n Wednesday, Oct. 10 Meet and Greet with Sen. Jeff Jackson Napa on Providence 5:30 p.m. n Thursday-Friday, Oct. 18-19 NCMS Annual Meeting/ LEAD Healthcare Conference Raleigh Marriott Crabtree Valley n Thursday, Oct. 25 MCMS Membership Social Olde Mecklenburg Brewery 6:30 p.m.
Meetings are at the MCMS office unless otherwise noted.
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Tuesday, Oct. 9 MedLink meeting Community Care Partners of Greater Mecklenburg 4701 Hedgemore Drive, Charlotte 8:30 a.m. n Monday, Oct. 15 MCMS Executive Committee meeting 5:45 p.m. n Tuesday, Oct. 16 Charlotte Dental Society meeting Myers Park Country Club 6 p.m. n
Welton Society Fall Luncheon The Welton Society Fall Luncheon on Sept. 6 at Charlotte Country Club featured Stephen Wyatt, MD, as speaker. His topic was “Opioid Epidemic: Where We Are with Prevention and Management.” The luncheon was well-attended by MCMS Emeritus and Early Retired members and a fun time was had by all!
Aaron R. Prosnitz, MD Pediatric Cardiology Sanger Heart & Vascular Institute 1001 Blythe Blvd. #200-D Charlotte, NC 28203 704-373-1813 University of Pennsylvania, 2010 Jack F. Scheuer III, MD Plastic Surgery Charlotte Plastic Surgery 2215 Randolph Road Charlotte, NC 28207 704-837-7191 Medical University of South Carolina, 2008
Mecklenburg Medicine • October 2018 | 13
At the Hospitals Mammography and Diagnostic Services Available at Mint Hill Medical Center Novant Health Mint Hill Breast Imaging center is easily accessible and conveniently located at the Mint Hill Medical Center campus. The 3,866-square-foot facility is designed in a modern and spa-like setting. The center is fully equipped to provide comprehensive breast imaging services that include 2D and 3D screening and diagnostic mammography, ultrasound, breast biopsy, nurse navigation, high-risk breast assessment calculation, genetic testing referrals and bone density testing. For more information, call 704-384-SCAN.
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Novant Health Mint Hill Medical Center Now Open Novant Health’s newest hospital, Mint Hill Medical Center, opened its doors on Oct. 1 at 8201 Healthcare Loop, at the corner of Albemarle Road and I-485. Joy Greear has been named president and chief operating officer of Mint Hill Medical Center. Greear has worked at Novant Health for more than 25 years. Mint Hill Medical Center is a 46-bed, 145,000-square-foot acute-care hospital equipped to meet the needs of the growing community. It is the first hospital in Mint Hill. This state-of-the-art hospital and adjoining medical campus offers acute, primary and urgent care, as well as easy access to subspecialties, including: • Breast imaging • Infusion services • Diagnostic cardiology • Diagnostic radiology • Sleep center • Neurology and spine care • Orthopedics and sports medicine The attached 67,000-square-foot physician plaza brings a wide variety of specialty care and services to the area with the convenience of one centralized campus. Clinics inside the physician plaza include: • Novant Health Pulmonary and Critical Care • Novant Health Inpatient Care Specialists • Novant Health Cancer Specialists • Novant Health Neurology and Sleep • Novant Health Spine Specialists • Novant Health Mint Hill OB/GYN • Novant Health Heart & Vascular Institute • Novant Health Surgical Wellness • Novant Health Breast Imaging • Novant Health Transitional Care & Infusion Services By bringing together world-class technology and clinicians to provide quality care, we are committed to creating a health care experience that is simpler, more convenient and more affordable, so patients can focus on getting better and staying healthy. n
Novant Health Opens New Outpatient Surgery Center Novant Health is responding to the need for more affordable, high-quality, and easy to access surgical locations to serve Mecklenburg and surrounding communities with the opening of Center City Outpatient Surgery. The surgical center is located on the second floor of the Charlotte Orthopedic Hospital and is considered a department of Presbyterian Medical Center. The surgical center is a multi-specialty facility providing surgery and procedures in an outpatient setting with more efficient care for our patients. Center City Outpatient Surgery houses five operating rooms in a space of about 20,000 square-feet and provides state-of-the-art outpatient surgical services for both adults and pediatric patients. Surgical services include orthopedics, general surgery, gynecology and urology. For more information, call 704-316-5310. n
Novant Health Heart & Vascular Institute Welcomes New Surgeons Ashish K. Jain, MD, RPVI, is a vascular surgeon at Novant Health Heart & Vascular Institute Surgery Center. Dr. Jain attended the University of Virginia in Charlottesville for his undergraduate studies and received his medical degree Ashish K. Jain, MD, RPVI from Emory University in Atlanta. Jain then completed his internship and residency in general surgery at the University of North Carolina at Chapel Hill, where he also served as an administrative chief resident in his final year. Although n
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Jain’s practice encompasses a variety of vascular and endovascular procedures, his specific clinical interests include aortic pathology, aneurysms, carotid stenosis, and peripheral arterial disease. Timothy Brand, MD, is a cardiothoracic surgeon at Novant Health Heart & Vascular Institute Surgery Center. Dr. Brand received his medical degree from the Medical University of South Carolina in Charleston and completed Timothy Brand, MD his residency at the University of North Carolina at Chapel Hill. Brand performs the following procedures: open heart surgery, coronary artery bypass grafting, heart valve replacement/repair, minimally invasive mitral and aortic surgery, surgery for atrial fibrillation, thoracic aortic aneurysm repair, and trans catheter aortic aneurysm repair (TAVR). Novant Health Heart & Vascular Institute Surgery Center is at 301 Hawthorne Lane, Suite 200. For appointments, call 704-316-5100. Novant Health Pelvic Health & Surgery Welcomes Dr. Mattingly Patricia J. Mattingly, MD, is a gynecologic specialist who completed an AAGL-accredited fellowship in minimally invasive gynecologic surgery at Columbia University Medical Center. She has expertise Patricia J. Mattingly, MD in advanced gynecologic surgery and the treatment of uterine fibroids, endometriosis, pelvic pain and other complex conditions. She is trained in laparoscopy, robotics, hysteroscopy, and vaginal and complex open surgical techniques. Mattingly is passionate about minimally invasive gynecologic surgery; this approach is safer for women and leads to a faster recovery, with less pain. She offers minimally invasive myomectomy, hysterectomy for large pathology, resection of advanced endometriosis, cerclage placement and tubal sterilization reversal, among other surgeries. Mattingly is originally from Atlanta and completed her residency at Carolinas Medical Center. Novant Health Pelvic Health & Surgery is at 6324 Fairview Road, Suite 390. For more information, call 704-316-1120. n
At the Hospitals
Carolinas Medical Center Named “Best Hospital” in Charlotte Carolinas Medical Center has again been recognized as the “Best Hospital” in the Charlotte Metro region by U.S. News & World Report’s annual hospital rankings and, for the second consecutive year, orthopedics was ranked among the top 50 programs in the nation. Carolinas Medical Center was also recognized for high-performing programs in cancer, gastroenterology and gastrointestinal surgery, neurology and neurosurgery, pulmonology and urology. In June, Levine Children’s Hospital also was ranked among the Top 50 children’s hospitals by U.S. News & World Report.
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Atrium Health Foundation Receives $1.8 Million to Support Community Health Initiatives Atrium Health Foundation has received three grants totaling $1.8 million from The Duke Endowment to support Atrium Health in addressing population health and improving access to cardiac care and pediatric dental care. The largest of the three grants — $1.1 million — will fund the Perfect Care: Personalized Cardiac Care and Collaborative, a novel initiative that Atrium Health’s Sanger Heart & Vascular Institute will pilot in six hospitals within its network. The initiative aims to improve patient access and education, as well as eliminate disparities in follow-up cardiac care after surgery. It will be the first of its kind, nationally, focused on engaging patients and their families through remote telemonitoring. A $480,000 grant will support new “food pharmacies” operated by the ONE Charlotte Health Alliance, a collaboration between Atrium Health, Novant Health and the Mecklenburg County Health Department. With support from The Duke Endowment, the program will expand to include two
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clinic-based emergency food pharmacies and two refrigerated food vehicles, creating a comprehensive food assistance option for economically challenged areas of the community, a key element in maintaining the health of at-risk populations. The Department of Oral Medicine at Carolinas Medical Center also will receive a $200,000 boost to integrate dental care into Levine Children’s Hospital. Funding will support a pediatric dentist who will both promote preventive oral health and ensure that patients who have lacked access to dental care, especially those with special medical needs or chronic health issues, receive optimal dental care. Over the last three decades, The Duke Endowment has proven to be a substantial and visionary supporter of healthcare initiatives in the Carolinas and has provided nearly $20 million in grants to Atrium Health Foundation. “Awareness and access to innovative treatment options can make a tremendous difference in the lives of our at-risk populations,” says Alisahah Cole, MD, vice president and system medical director of Community Health for Atrium. “Philanthropy, through partnerships with organizations like The Duke Endowment, helps ensure patients in our communities, regardless of where they live or their socio-economic status, have access to world-class care.” Atrium Health Nationally-Recognized by American Hospital Association for Quality of Care and Reducing Disparities Atrium Health has been recognized by the American Hospital Association (AHA) as an honoree for two of its most prestigious awards, the Quest for Quality prize and the Equity of Care award, celebrating Atrium Health’s efforts to achieve quality healthcare, reduce disparities and advance health in communities. Atrium Health ranked in the top five of the Quest for Quality prize, which recognizes leadership and innovation in improving quality and advancing health in communities. This is the first year the AHA allowed healthcare systems, in addition to individual hospitals, to apply. Atrium Health was also a top-five honoree for the Equity of Care award, which recognizes hospitals and health systems for their efforts to reduce healthcare disparities, advance equity of care to all patients, and spread lessons learned and progress toward the promotion of diversity.
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Specifically, the AHA recognized Atrium Health for its commitment to serving populations that lack access to adequate health services; improving clinical outcomes by reducing harm and avoiding readmissions; utilizing sophisticated technology, including predictive analytics and telehealth services; and engaging patients and families. Mobile Medicine: Ready at a Moment’s Notice Many people remember the 2017 hurricane season as historic. The extremely active period produced 10 hurricanes. Two of these hurricanes, Harvey and Irma, struck the continental United States — and one, Maria, tore through the Caribbean and Puerto Rico. Abby Peterson, MHA, CMTE, director of operations for Atrium Health’s Mobile Medicine team, helped coordinate evacuations of at-risk patients to locations out of the storms’ paths. It was a busy fall for the team, which operates the MedCenter Air fleet of aircraft, helicopters, ambulances and a one-of-a-kind mobile hospital unit — Carolinas MED-1. Nearly every resource the team staffs was put to the test in the past 12 months as they responded to different types of emergencies. The fixed-wing aircraft team, in particular, had one of its busiest years in 2017. They were called upon to help with multiple missions during the hurricane season. Over the course of six-and-a-half weeks, the teams deployed to Texas, Florida and Puerto Rico. Every mission is different, and the time it takes to get out the door varies on who is needed and where. But flight crews with MedCenter Air can move within minutes, while larger operations, such as Carolinas MED-1, can be ready within hours. Thankfully, Peterson has enough staff to help during these situations. Atrium Health teammates have always been eager to serve on a Mobile Medicine assignment, if needed. “The hours can be long and tiresome,” says Peterson, who notes that during long deployments, they try to rotate staff out every five to seven days. “But knowing you impact a patient’s care, whether indirectly or in person, really keeps you going. None of the missions would be possible without the amazing team support. We rely on so many different departments within Atrium Health to make every mission a success. And we’re grateful to be able to do what we do.”
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Independent Physicians of the Carolinas
Independent Physicians of the Carolinas is a nonprofit 501(c)(6) membership organization whose mission is to create public awareness of medical doctors not employed by a network or hospital system and to provide educational programs and resources to physician members and their administration. Visit us at IndependentPhysicians.org.
Join oncologist, Dipika Misra, MD, with Oncology Specialists of Charlotte, at the annual Race For The Cure, Komen Charlotte Race in uptown Charlotte on Oct. 6. Dr. Misra is a 2018 More Than Pink Woman and is raising funds and awareness for breast cancer research, patient support and early detection. Sign up or donate on Misra’s team, Dr. Misra’s Movement, at KomenCharlotte.org — click on Race For The Cure, register for the race, click “Join A Team” to find Oncology Specialists of Charlotte.
Randolph Audiology & Hearing Aid Clinic TOMORROW’S TECHNOLOGY FOR TODAY’S EARS
Wade Kirkland, M.A. Audiologist
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No-cost trial period on hearing aids
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Auditory processing evaluations
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All new patients receive complimentary balance and memory screenings
704-367-1999 Randolph Medical Park | Randolph Building 3535 Randolph Road, Suite 211 Charlotte, NC 28211 Terry P. Jordan, M.S. Audiologist
SERVING THE CHARLOTTE AREA FOR OVER 20 YEARS
www.randolphaudiology.com 16 | October 2018 • Mecklenburg Medicine
Did you know your zip code can predict the diseases you will develop and your life expectancy? David Smith, MD, and Premier Cardiovascular Care will host the Spirit of the Heart Health Fair Oct. 5-6, in conjunction with the Association of Black Cardiologists and the American Heart Association. It is supported by the Heartbright Foundation and members of the Independent Physicians of the Carolinas. The multidisciplinary event will focus on how incomes, housing and other socioeconomic factors affect health outcomes throughout life and endanger the entire community. We congratulate David Smith, MD, 2018 Charlotte Top Doc in Cardiology; and Willie Hester, MD, and Premier Cardiovascular Care for their success in launching new integrative medicine support groups in dysautonomia, pulmonary hypertension, cardiac amyloidosis and cardiorenal disease.
Advertising Acknowledgements The following patrons made Mecklenburg Medicine possible.
Atrium Health.........................................................................................19 Carolina Neurosurgery & Spine Associates..........................................3 Charlotte Eye Ear Nose & Throat Associates.................................... 17 Charlotte Radiology........................................................................12, 17 DJL Clinical Research........................................................................... 17 Flagship Healthcare Properties...............................................................9 LabCorp..................................................................................Back Cover Monarch...................................................................................................12 Novant Health...........................................................................................2 Parsec Financial Wealth Management...................................................3 Randolph Audiology & Hearing Aid Clinic........................................16 Southeast Radiation Oncology Group.................................................18 Surgical Specialists of Charlotte.............................................................3
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We’re Growing Three new eye physicians will start October 9, 2018.
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Veena Rao, MD Ophthalmologist Matthews, Monroe
Boyd Vaziri, MD Ophthalmologist SouthPark
Nicole Rose, OD Optometrist SouthPark
ceenta.com | 704.295.3000
Mecklenburg Medicine • October 2018 | 17
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FOR THE CAROLINAS
Every day, more than 32,000 people choose us for their healthcare. From the region’s most advanced heart program and cancer institute to a nationally ranked children’s hospital, we remain strong in our commitment – not just to delivering better care, but to delivering the best care. For all. Mecklenburg Medicine • October 2018 | 19
Mecklenburg County Medical Society
PRSRT STD U.S. POSTAGE PAID CHARLOTTE, N.C. PERMIT NO. 1494
1112 Harding Place, #200 Charlotte, NC 28204 CHANGE SERVICE REQUESTED MCMS Mission: To unite, serve and represent our members as advocates for our patients, for the health of the community and for the profession of medicine. Founders of: Bioethics Resource Group, Ltd., Hospitality House of Charlotte, Teen Health Connection, N.C. MedAssist, Physicians Reach Out
LabCorp Laboratory Corporation of America
PATIENT SERVICE CENTERS
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15830 John Delaney Drive 300 Billingsley Road, Suite 200A 5633 Blakeney Park Drive, Suite 100 478 Copperfield Blvd. 8401 Medical Plaza Dr, Ste 140 1718 E. 4th Street 660 Summitt Crossing, Suite 206 16525 Holly Crest Lane, Suite 250 10030 Gilead Road, Suite B100 134 Medical Park Drive, Suite 102 1500 Matthews Township Parkway, Suite 1147 5031-G West W.T. Harris Blvd. 10410 Park Road, Suite 450 2460 India Hook Road, Suite 101 601 Mocksville Avenue 809 N. Lafayette Street 1710-A Davie Avenue 10320 Mallard Creek Road
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20 | October 2018 • Mecklenburg Medicine
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