The Message, April 2014 by Spokane County Medical Society

INSIDE FRONT COVER AD

2014 Officers and Board of Trustees

Table of Contents

David Bare, MD President Matt Hollon, MD President-Elect Anne Oakley, MD Immediate Past President

President’s Message: Physicians As Leaders . . . . . . . . . . . . . . . . . . 1

In-Depth Interview: Buried Treasure: Poetry In Medicine . . . . . . . . . . . . . . 4

J. Edward Jones, MD Vice President Gary Newkirk, MD Secretary-Treasurer Trustees Charles Benage, MD Audrey Brantz, MD Karina Dierks, MD Elizabeth Grosen, MD Clinton Hauxwell, MD Louis Koncz, PA-C Frank Otto, MD Fredric Shepard, MD Carla Smith, MD

Health Sciences: WSU Medical Program Takes Another Step Forward . . . . . . . . . . 7

SCMS Foundation: Hot Spotters Care Coordination Takes On Community Court . . . . . . . 9

Medical Education In Spokane: Medical Education Growth, Under The Radar . . . . . . .

Rockwood Health System: Inland Northwest’s First Provider of Bronchial Thermoplasty . . . . 13

Newsletter Editor – Matt Hollon, MD

Guest Column: The Emily Program: A Place For Healing, A Place For Hope . . . . . . . . . 15

Spokane County Medical Society Message A monthly newsletter published by the Spokane County Medical Society. Advertising Correspondence SCMS Publications Attn: Daniel Klemme 518 S. Maple Spokane, WA 99204 509-343-0123 Fax 509-325-3889 Daniel@quisenberry.net All rights reserved. This publication, or any part thereof, may not be reproduced without the express written permission of the Spokane County Medical Society. Authors’ opinions do not necessarily reflect the official policies of SCMS nor the Editor or publisher. The Editor reserves the right to edit all contributions for clarity and length, as well as the right not to publish submitted articles and advertisements, for any reason. Acceptance of advertising for this publication in no way constitutes Society approval or endorsement of products or services advertised herein.

Providence Health & Services: Transforming To Patient Centered Medical Home . . . . . .

For Your Information: Medicine And The Courtroom: A Unique Program Training New Physicians About Liability . . . . . . . . . . . . .

Guest Editorial: Patient Safety And Advocacy (Part 2 of 2) . . . . . . . . . . . . . . 21

New SCMS Members . . . . . . . . . . . . . . . . . . . . . . . . . 23

Classified Ads . . . . . . . . . . . . . . . . . . . . . . . . . . .

Meetings / Conferences / Events / Continuing Medical Education . . . . . . . . . . .

General Membership Meeting . . . . . . . . . . . . . . . . . . . . . .

“Poetry is language at its most distilled and most powerful.” – Rita Dove

President’s Message

PHYSICIANS AS LEADERS By David Bare, MD

took care of other very sick patients in the

care over to them. We also have specialized

SCMS President

ICU. We of the old guard “did it all” and we

team members who do certain parts of our

depended on our own skills and abilities to

patients’ care like physical therapists, care

I’ve shared information

manage our patient load. But as medicine

coordinators, social workers and all sorts

before about my

progressed in its increasing complexity

of other players who take part in their care.

practice “back when”

and new advances, it required specialized

We have call coverage within larger and

and this is the place

training, so many of us soon began to rely

larger groups to the point that if asked, many

where I will start this

on our “specialty” comrades to step in and

patients don’t even know who their Primary

particular exposé into the need for physician

care for our patients when we didn’t have

Care Provider is. In all of this there is

leaders. I’ve been in the business for 30+

the skills or the privileges to do what was

unfortunately potential for more fragmented

years and autonomy was a very apt word

required. Although everything was more

care for our patients and many times

to describe how doctors functioned in the

expensive, no one worried about the cost

poorer outcomes at a much larger financial

world of medicine. I got up early, saw each

as insurance would pay for it. At times we

investment as tests and procedures are ever

patient that I was in charge of in each of

saw miraculous cures that saved patients

more expensive and there’s no one “go to”

the two hospitals when their needs were

lives. We saw improvements in procedures

person “running the show”.

beyond outpatient effectiveness. I delivered

and techniques that had patients out of the

the moms who were pregnant; I assisted on

surgery centers the same day as the surgery

What’s needed in this time of chaos for our

all the surgeries of all my patients including

and back to work in a week instead of a

patients is new leadership at every level of our

those that had appys, cholecystectomies

five-day hospital stay and 30 days off work.

health care system, in no more vital area than

and even those getting neurosurgery. I

In the last 10 years, Hospitalists, both adult

the position of provider. But to begin to “get

cared for newly diagnosed MIs in the CCU

and pediatric along with OB, have entered

there” we as providers have to come to grips

and the progressive care units and also

the scene and we have turned inpatient

with three realities.

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

| THE MESSAGE | APRIL , 2 014

1. Performance matters. That is to say

difficult to serve up the quality, efficient care

teamwork—reflect a deep-seated belief

that merely seeing all of our patients

that will be needed to compete. It will truly take

that physician autonomy is crucial to quality

and keeping the production up is not a

a team approach to accomplish best outcomes.

in health care. Precious as this passion

measure of performance (outcomes).

New physician leaders will need to focus on

for patients’ interests might be, physician

Though not all aspects of outcome

outcomes and use performance measurement as

autonomy is not synonymous with quality and

have easily obtained measurements,

a motivating tool to organize their colleagues and

in the changing world of healthcare Quality

most disease processes and health

drive improvements.

must trump autonomy.

been determined to be best practice.

These leaders will have to be expert at change

For the needed structural and operational

Sometimes it requires looking at bundles

management, which can be particularly

changes—performance measurement,

of measurement, for instance with DM it is

challenging with groups of physicians. It is

process improvement, teamwork—to become

not just good glycemic control measured

often compared to “herding cats”! At times as

mainstream, doctors must accept that to be

by A1C levels but also control of lipids,

a leader in my own organization, I thought that I

all-caring is different from being all-knowing

blood pressure, weight, and teaching and

merely needed to put the evidence in front of my

or all-controlling. To foster such acceptance,

surveillance of self management ability in

provider colleagues and they would see the better

leaders can use three approaches:

the individual patients.

outcomes with the “new way” and willingly drop

maintenance have parameters that have

into line to follow. However, change is a process

1. Appeal to the better angels. People

2. Value is not a bad word. Measuring

that any leader has to understand will consist of

who are drawn to health care want to focus

outcomes and costs does allow providers to

the thinking part of our make up which can be

their life’s work on something good: helping

push for improvement—and to learn from

compared to the driver, in this case an elephant,

patients. Altruism is core to the identity

their competitors. When outside entities like

which is the emotional part of our make up. We

of physicians and virtually everyone else

health plans give organizations feedback on

can have perfect alignment of all the drivers in

in medicine. Health care leaders cannot

performance based on outcome measures it

terms of their intellectual understanding of how

succeed without making it explicit that they

can be seen as an opportunity for patient care

best practices can really be better for our patients,

share and will act on the same aspiration.

improvement and not so much as intrusion on

but if the elephant, with the emotions of being

In medicine, more than in most other fields,

our individual autonomy. In fact in this new

“good docs” with years of experience, hard work

a senior leader’s appeal to doing “the right

era of medicine we have to understand that

and faithful followers, isn’t ready to go where the

thing” can serve as inspiration.

quality trumps autonomy. There actually are

driver would lead, it’s an impossible task to get

organizations and individuals that have risen

them there. As leaders we have to acknowledge

2. Show them the data. Physicians are

to the top as demonstrating best practice and

the importance of what providers do, but at the

quick to challenge performance data and

these then are the performers that we need to

same time make explicit that getting there needs

to identify methodological problems with it.

immolate. Good leadership in this regard thinks

to be done differently. So what part of our provider

But the fact is that doctors are mesmerized

outside the box and promotes changes suggested

anatomy has us stuck in the old ruts even when

by data and cannot look away. Basic steps

by front line workers that can continue to raise

the data shows us new ways to produce better

need to be taken in the determination of

the bar of quality and cost effectiveness.

outcomes for patients? Why is collaboration

how data is to be collected and what data

so hard in a field that attracts idealistic people

will best reflect outcomes. Once a common

3. Improvement in performance requires

who want to do good? Why are performance

language has been defined people will get

teamwork. Gone are the days when the provider

measurement and improvement so problematic for

comfortable with the accuracy of these measures.

can do it all. Not even close. At any organization

some of the smartest, hardest-working, and most

that provides health care, superior coordination,

competitive people in society? Why is the concept

information sharing, and teamwork across

of value rejected by providers that would benefit if

3. Define strategy around patients’ needs.

disciplines are required if value and outcomes are

they improved their care? In a word: autonomy.

What doctors know and do is constantly changing, but the needs of patients remain

to improve. A Harvard Health Care economist, when asked what one of the biggest threats

Doctors’ resistance to being measured,

to needed change was, answered, “The solo

their need to be “perfect,” their reluctance

practitioner” as that individual will find it very

to criticize colleagues, their resistance to

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

the same. They want to avoid getting CONTINUED ON NEXT PAGE

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Toyota in Japan but has spread from the auto

project. The day will never come when

industry to the health care industry and from

readmission rates are low enough, heart-attack

sick, but they still get diseases, they worry

Japan to America. It is a systematic teachable

treatment is fast enough, or all the processes

and they hope to be cured or relieved of

approach to move health care organization

of care delivery are efficient and reliable

suffering. Meeting their needs is what

closer to best care. It takes leaders trained in

enough. Thus leaders must work relentlessly to

health care is about.

such a process to help this along. Part of this

improve quality, efficiency and cost so patients

Once providers are on board and believe

has to do with the set up of a physical plant,

will have the best outcomes and the best

that outcomes can be measured and with

always having a forward motion in any of the

experience in their journey through the health

measurement, best practices can be

processes that happen with patient care with

care system to obtain those outcomes. All

identified, there still needs to be a process

minimum “waste”, motion and time studies

of you as providers have the opportunity and

improvement that allows for ongoing quality

that help shorten cycle time for every patient

the obligation to be leaders at whatever level

improvement. There are many ways to work

seen and many other processes that improve

you find yourself. Get involved wherever you

through each organizations point of origin

patient experience.

find opportunity. Our own SCMS organization

CONTINUED FROM PREVIOUS PAGE

helps provide both opportunities and training

and vision for where they want to advance to. Process is the nuts and bolts of how they can

Finally as mentioned in the last series of

for those who avail themselves of these. Get

get there. This is not one size fits all but a good

articles is the value and necessity of Care

hold of our CEO Dean Larsen at (509) 325-5010

example of a process that has proven worthy

Teams. Health care teams can’t view their

or dean@spcms.org for details of where you

is Lean Management. It was started with

purpose as time-limited or focused on one

might be involved. n

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In-Depth Interview

BURIED TREASURE: POETRY IN MEDICINE By Bonny Laughary

The selected patient rises and starts moving

SCMS Accounting Assistant

toward the door as the people in the room go back to waiting. The anticipation mixed

Shortly before 9 a.m. on a Wednesday morning,

with anxiety and unease is palpable; the

the seats in the waiting room are filling up

patients are all hoping the doctor will be able

quickly. The room is brightly lit, fluorescent

to help them. They’re hoping their doctor will

bulbs buzzing overhead as people file in,

be a healer and a listener, someone who is

one-by-one or in pairs, stopping at the glass-

knowledgeable and experienced. They hope

enclosed counter to check in. Patients stare

their doctor will be efficient and will know

absent-mindedly at the framed art prints hung

how to get them exactly what they need to

on the walls next to tacked-up notices about

make them better as soon as possible. They

vaccinations and health rights. One person

are probably not hoping that their doctor is

flips carelessly through a magazine while

also a poet. But maybe they should be.

another pretends to read a book brought to pass the time. A mother whispers to her fidgeting

Dr. Samuel Palpant practices Internal

children to sit and be quiet as a weary-looking

Medicine at Providence Internal Medicine

son fills out forms on a clipboard for his father.

Residency Spokane and is the Associate

Slouching in a wooden armchair, a woman

Program Director and faculty, providing

stares at her phone. Low voices form a steadily-

instruction to medical residents. Dr. Palpant

rising murmur overlaid by coughs, a sneeze,

is also a poet. The image of an experienced

and the sound of a walker being pushed slowly

physician, thoroughly equipped to effectively

with effort through the entryway. A phone rings

respond to the medical needs of a roomful

incessantly in the background while the sharp

of waiting and expectant patients contrasts

smell of coffee permeates the air.

sharply with the stereotypical idea of a dreamy poet stooped over a leather-bound

A door opens, and for a moment, all eyes look

journal penning verse about love and nature.

up at the person standing in the open frame. A

Instead, Dr. Palpant directly contradicts this

patient’s name is called and there is a pause.

conventional regard of poets. He says that

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

he “did not develop an early love of poetry” but rather that he “fell into poetry later in life.” In fact, he so dreaded the one English class he had to take as an undergraduate student that he put it off until his senior year. Surprisingly, he would now argue that his practice of poetry, as well as his appreciation for it, actually contributes to his proficiency as an effective physician and assists him in engaging with his patients and colleagues in a more efficacious manner. CONTINUED ON NEXT PAGE

| THE MESSAGE | APRIL , 2 014

CONTINUED FROM PREVIOUS PAGE

verse that he wrote for one of his residents after she experienced her first loss of a

Dr. Palpant’s unassuming and affable

patient. Slowly reading the poem, the words

demeanor is immediately evident upon

clearly create a detailed picture of a few

meeting him. Despite his packed schedule for

moments in a hospital, a brief yet significant

the day that allows him only a small window

interaction, and the resident’s empathy and

of time in which to discuss his writing, his

concern for her patient. He explains that he

broad smile and welcoming greeting convey

wrote the poem to help the young doctor

both his eagerness and enthusiasm for poetry

understand and heal from her experience.

as well as the significant role it plays in his

Unlike the majority of writers who write

personal and professional life. His small office

primarily for publication, he writes poetry

is cluttered with the usual medical reference

for individual people in response to specific

books, journals and files. But here and there

situations with hope that his words will

is an indication of a second interest: a book of

provide healing, comfort or encouragement.

verse, a framed poem. Family photos line the walls and gather on the window sill. He takes

As a physician, Dr. Palpant understands

one of the pictures off a hook on the wall for a

and attempts to address in his poetry

closer look. Mounted in the center is a poem

the perception that physicians should be

he wrote, titled Fishing with Ron. The poem is

impervious to just about everything. It is

flanked on either side by a picture, one of Dr.

now commonly understood that physicians

Palpant and one of an older gentleman, each

must make critical decisions affecting human

bedecked in fishing attire.

lives while negotiating a labyrinth of everchanging hospital, insurance and government

Dr. Palpant reads the poem and explains its

regulations and requirements, navigating

significance: “Every fall for about four to five

changes in technology and record-keeping

days, we go to St. Joe’s River to fish. It’s not

procedures under increased time constraints

about the fishing,” he says, “It’s our time

and demands for efficiency.

poetry and medicine are generally thought to be mutually exclusive. He acknowledges that his efforts to engage residents in purposeful conversation before rounds, discussing a poem, relating a story or sharing something personal, are usually met with resistance at first. However, he states that “even the ones who think it’s a waste of time, once they’ve done it, they get it.” He has even received

away; our time to think about the important things.” The poem, he explains, “alludes to

In response to these assertions, Dr. Palpant

the Biblical account of the Pool of Bethesda

explains that there is an extreme amount of

where a sick man was waiting to be healed

tension amongst these competing interests

but had no one to put him into the pool when

and that it is his experience that the greatest

the waters were stirred up.” Dr. Palpant

challenge is often how to find a way to

relates that the waters of St. Joe’s River in

forge the meaningful relationships with

the poem symbolize the healing waters of the

colleagues and patients that are necessary to

Pool of Bethesda. As the fish bites and stirs

providing effective and quality patient care.

the water around the line, he experiences his

He suggests that “connecting for just ten

own sort of healing through contemplation

to fifteen minutes, talking about something

and time away from the hustle and bustle of

important, whether it’s poetry or a personal

everyday life.

story” provides physicians with “a way to get below the surface, to remember who we are

This idea of healing is a thread that runs

and get to know one another on that deeper

through Dr. Palpant’s poetry. Sitting down

level.” He says that the resulting empathy and

in a small office chair, he pulls onto his lap a

acknowledgement of vulnerability amongst

two-to-three inch thick stack of paper tucked

colleagues spills over into patient interactions

within a battered manila folder. Inside are

and produces greater compassion, patience

hundreds of original poems. He selects one

and focus on the healing of the patient.

off the top of the stack: a poem, notes in free

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

Dr. Palpant is not oblivious to the notion that

poems from his students at graduation. To verify this perspective, Dr. Palpant arranges a quick conversation with a few of his available residents. In the hallway outside the waiting room, three residents stand in a semicircle, waiting to see who is going to respond first to the question: How do they really feel about taking time before rounds to discuss something personal, share a story, talk about a poem? One resident crosses his arms and stares at the floor. Another puts his hands in his pockets and stares into space as if trying to remember something. The third resident shuffles his weight from one foot to the other, looking as though he’s readying to flee. These are science people; adults who are incredibly focused and pragmatic. To become physicians, they

| THE MESSAGE | APRIL , 2 014

have sacrificed a vast portion of their

where vulnerability or other emotions are

lives learning all kinds of complicated

encountered is usually off-limits. Instead, he

procedures and complex systems;

says that Dr. Palpant encourages them to try

memorizing countless facts and tables,

to better understand their experiences and

diseases and symptoms and then applying

reframe them to become more empathetic

this knowledge in practical settings.

and compassionate toward patients and colleagues.

Expecting polite responses and maybe a few words about how Dr. Palpant’s “style”

As with most things that are worthwhile,

as an instructor is “different” from that

writing or reading poetry, getting to

of other physicians, it is surprising when

know a colleague or connecting with

they begin to speak earnestly about how

a patient, takes time and effort. As

the time they’ve taken to engage in more

Dr. Palpant suggests, it is through this

meaningful ways with one another has

extra effort and time that the “buried

impacted each of them in a substantial

treasure” you may be seeking is

way. One resident comments that Dr.

ultimately discovered.

Palpant’s “unique nature” allows them to slow down and focus on the “humanistic

To learn more about poetry, there are a

side to medicine that is often forgotten but

number of upcoming events and workshops

so critical to the healing of the patient.”

where you can experience, learn about

He shares that Dr. Palpant encouraged him

and create poetry as part of Eastern

to relate his own experience as a patient

Washington University’s Get Lit! Literary

and seek to understand how it shaped his

Festival in April. For more information, visit

view of his own mortality, influencing his

www.ewu.edu/getlit. n

perspective as a doctor. Another resident discusses how the pressures of time can

Senior Physicians Golf Tournament and Lunch

make physicians feel as though they can only “treat the disease” and don’t have time to focus on the whole patient. With

Friday 16 May 2014

a slight smile, he comments that “rounds

Manito Golf Course

may take a little more time with Dr. Palpant,

8:00 a.m. Shotgun Start

but he embodies the ideal attitude toward and relationship with patients.” The

12:30 p.m. Lunch

third resident points out that there is a

Join in the fun!

perception that physicians aren’t supposed

Poem by Sam Palpant For my wife October 7, 2010

Physician’s House The kitchen light flickers in florescent seizures, and epileptic fits. The garbage disposal chokes when prompted to chew and swallow. The dishwasher leaks in unabashed incontinence wetting the wood floor. Enamel flakes off the bathroom basin like large psoriatic plaques. The camera fall left a compound fracture with flash askew. The cracked wall marks the overweight state of winter’s snow. The broken and aging appeal for healing in entropy’s domain. My wife says, “The doctor will be with you shortly.”

to show weakness so sharing personal stories or talking about experiences

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SPOK ANE COUNT Y MEDICAL SOCIE T Y |

| THE MESSAGE | APRIL , 2 014

Howard M. Kenney, M.D. Jeffrey B. Butler, M.D. Gary L. Craig, M.D. Sean P. LaSalle, M.D. Eric C. Mueller, M.D. Christopher M. Valley, N.D. Diana M. Webster, ARNP Erin E. Saunders, PA-C Dale R. Raschko, PA-C Kari M. Holman, PA-C

Health Sciences

WSU MEDICAL PROGRAM TAKES

ANOTHER STEP FORWARD By Ken Roberts, PhD

and the WWAMI (Washington Wyoming

professional education programs on the

Director, WSU Medical

Alaska Montana Idaho) medical education

campus in Spokane. We are excited that

Sciences

program that we run with the University of

we will have a class of 40 first-year medical

Washington School of Medicine.

students and we are actively planning for

The program in Medical

Medical Sciences began at WSU Spokane

this growth. We will continue to emphasize

Sciences at WSU

with the formation of the WWAMI Program

the small group experience and an emphasis

Spokane has taken

in Spokane and has grown steadily since its

on active learning even as we double the size

another major step

beginning in the fall of 2008. We have grown

of the class.

forward in its development. On February

to more than 25 full-time faculty, a similar

27, the WSU Faculty Senate approved our

number of part-time faculty, and several

As we grow in student numbers we continue

request to formally convey “college” status

dozen clinical preceptors, all involved with

to expand our faculty and their related

on our program. That paves the way for

teaching students in our program. We teach

scholarly activities. Five new faculty will

one final vote of approval; our university’s

20 first-year and 19 second-year medical

have joined or will join Medical Sciences

Board of Regents will consider it in late

students and more than 100 students, both

over the next several months.

March. We’re optimistic we will receive an

graduate and undergraduate, in Speech and

affirmative vote.

Hearing Sciences.

I know that, to the outsider, this won’t mean

Medical education at WSU Spokane will

in the area of lung cancer and pulmonary

much. But at WSU Spokane, it’s a big deal. It

continue to grow next year as we merge

fibrosis. His lab uses cellular and

means that we’ll have an academic umbrella

our Pullman-based WWAMI Program

molecular approaches to unravel the gene

under which we can group our growing

with the WWAMI class in Spokane. The

regulatory mechanisms that drive these

medical research program with our new

reorganization is part of WSU’s overall effort

pathologic processes.

partner, WSU Speech and Hearing Sciences,

to consolidate many of its health sciences

• Bin Shan, MD, PhD, joins our faculty from Tulane University. His research focuses

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

| THE MESSAGE | APRIL , 2 014

• Weimin Li, MD, PhD, comes to us from the University of Wisconsin School of Medicine where he is a research scientist in the Department of Pharmacology. Dr. Li also studies cancer biology and the cellular signaling processes that drive tumorigenesis. • Jingru Sun, PhD will join our faculty after completing her postdoctoral training at Duke University. Her research interests are the interaction between the nervous system and the innate immune system. • Marcos Frank, PhD, joins our faculty from the University of Pennsylvania where he is an associate professor

SAVE THE DATE Spokane County Medical Society Presents

Medicine 2014 Friday—September 26, 2014 8:00 a.m. to 5:00 p.m.

with tenure in the Department of Neuroscience. His research interests

Red Lion Hotel at the Park

include the cellular and molecular basis of neural plasticity and the interaction of this process with sleep.

Watch for more details!

• Lucia Peixoto, PhD, is also from the University of Pennsylvania where she is a postdoctoral fellow in the Center for Neurobiology and Behavior. Her laboratory uses genomics and computational biology to study

Invested in Your Comfort and Your Care Hospice of Spokane’s first priority is patient care so our patients can focus on what’s important to their lives.

mechanisms of learning and memory with applications in areas such as autism.

We are very excited to have these five talented scientists joining our faculty. Each will enrich the academic environment in Medical Sciences and bring unique opportunities for students training in Medical Sciences.

“I’ve got an excellent team with Hospice of Spokane that’s doing everything they can to keep me comfortable and feeling better. They give me the will to live.” – Denis, Hospice of Spokane patient

We are enthusiastic about the additional growth we anticipate for

Northeast Washington’s only nonprofit hospice, providing care and support for terminally ill patients and their families since 1977.

our faculty and programs in Medical

Comfort. Dignity. Peace of Mind.

Sciences. We will bring you more

509.456.0438

announcements as they happen. n

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

hospiceofspokane.org

| THE MESSAGE | APRIL , 2 014

Spokane County Medical Society Foundation

HOT SPOTTERS CARE COORDINATION TAKES ON COMMUNITY COURT By Jim Ryan

their excessive utilization of costly services.

we were rather taken aback to find a sweet,

Patient Care Coordinator

“Kirk”—an alias that derives from his love of

cooperative and jovial man on the other side of

Star Trek books—has been very near the top of

the glass. He was eager to go to treatment and

The driving force behind the Hot Spotters Group

that list for quite some time. The term “chronic

extremely grateful for our presence and our

is data. The Agency for Healthcare Research and

inebriate” doesn’t really begin to describe the all-

efforts to obtain a hearing aid and glasses for him.

Quality (AHRQ), reported in 2009 that 1 percent of

consuming nature of Kirk’s constant and complete

We promised to reconnect with him at PCE within

patients accounted for roughly 20 percent of all

drunkenness, nor the mayhem he was inclined to

days of his transfer.

health care spending, while 5 percent of patients

unleash under the influence. Banned from House

accounted for half of overall health costs. While

of Charity and just about anywhere else he could

On the morning of Tuesday, February 25, we

some of those patients are the elderly and others are

get a hot meal or a roof to sleep under, Kirk’s life

learned that Kirk had been—brace yourselves—

just very sick individuals, we know that a significant

had become a pretty predictable cycle: Get stinking

accidentally released from jail the previous day.

portion of healthcare spending goes toward the

drunk. Get in trouble and/or get hurt. Go to jail and/or

At the same time we were told that if he was not

care of a handful of highly complex patients who

the hospital. Get out. Start the cycle again.

found almost immediately, he would lose his bed

overutilize the system due to lifelong homelessness,

date at PCE. This prompted an all-out search for

medical problems and/or behavioral health

The calculus changed, however, once Kirk

Kirk. At around 9:00am we alerted our contacts at

challenges that make their path to stabilization highly

appeared on the Community Court docket and

House of Charity and the fire department, Sacred

complex. The cycles they are ensnared in cannot be

Hot Spotter care coordinators were given

Heart’s ED social workers and his Intensive Co-

broken by working through the standard channels

the opportunity to engage with him as part of

Occurring Services (ICOS) case manager from

and courses of action.

his court ordered requirement for engaging

Frontier Behavioral Health, asking everyone to be

in support services. The Hot Spotters care

on the lookout. At about 1:30pm we received word

In a city the size of Spokane, this translates

coordinators worked collaboratively with his

that Kirk had turned up at House of Charity and

into focusing on a relatively small number of

Frontier Behavioral Health case manager and

we made arrangements for him to stay put until

individuals in an effort to improve their health

other community partners in an effort to ensure

we arrived. Sarah and I went straight there and

and stability, thus reducing the cost of their care

that he would not slip through the cracks if we had

found Kirk asleep on a bench. When we woke him

and the community costs associated with their

anything to say about it. The way this has played

and asked him to talk with us he became deeply

support. The Hot Spotters Group has something

out in recent weeks is instructive.

concerned that he was in trouble for being out of

of a “Most Wanted” list comprised of individuals

jail. It took repeated assurances from us that he

who are highly vulnerable and who are the

Sarah Bates and I first engaged with Kirk on

had done nothing wrong before he could calm

most frequent users of fire, police and hospital

February 21 while he was in the county jail

down and start to discuss the best way forward.

emergency department services. Those folks

awaiting a February 27 transfer to Pioneer

are known throughout the community for their

Center East (PCE) for 60-90 days of treatment.

While Sarah sat with Kirk (and was treated

unfortunate circumstances, their poor health and

Having heard stories of a legendary curmudgeon,

to a look at some extremely infected toenails,

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which were promptly disinfected and wrapped

the end of March—possibly back to jail. We knew

as ever, but that’s mostly an act. Talk to him for

by Grace from House of Charity), I attempted to

this would be a devastating blow to the hard-

a few minutes and you’ll discover that what

sort out where Kirk needed to go in order to a)

won progress Kirk had made and the trust we

he wants more than anything is to never take

stay on track toward treatment at PCE and b)

had earned. We intervened by connecting with

another drink—to never again, for example,

be in compliance with the court. I called the jail

various service providers and ultimately Calipsel

vomit and accidentally flush his dentures into

and was told that they could not take him back

was granted permission to keep Kirk until his

the toilet at the downtown Arby’s after a full day

for the two days until his PCE bed date. Kirk’s

transfer to PCN.

of drinking. And yet he’s self-aware enough to

ICOS case manager, Andrea Griechen, arrived

know that after drinking anywhere from a fifth

and arranged for a bed at Frontier’s Calispel

In the meantime, we are visiting him regularly

to a handle (gallon) a day since he was 14, he

Evaluate & Treat as a stopgap until Thursday.

in an effort to keep his spirits up and his

will immediately return to the bottle the second

First, though, he was taken by ambulance to

commitment to treatment firm. Much to the

someone lets him slip through the cracks. We

Sacred Heart for medical clearance.

surprise of staff at Calispel, Kirk has shown no

have assured him that we will do everything we

interest in leaving the facility. He’s as grumpy

can to prevent that from happening. n

Sarah and I followed Kirk to the ED, where he remained somewhat agitated and disoriented, unsure why he had been taken to the psychiatric holding area. Keeping him calm required continued assurances from us that he was on the right track and that we would ensure his eventual arrival at PCE (and, truth be told, a couple of Dick’s Whammy Burgers

WE PRACTICE EXCELLENCE.

didn’t hurt). Despite our fear that the tenuous connection we had established might break amid the chaos, he remained steadfastly determined to end up in treatment and just needed to know that someone was looking out for him. We coordinated with the Sacred Heart social worker to arrange a taxi to Calispel. Throughout the day, we had made attempts to alert the appropriate parties to the fact that we had located Kirk, but somehow the message never got through. His bed date at PCE was revoked sometime during the five hours that had lapsed between the time we were notified that his bed date was in danger (at 8:30am) and the time we found him (1:30pm). It is not entirely clear why his temporary absence caused his bed to be reassigned so quickly. There is a legal process involved in clients accessing the treatment beds

Pediatrician

Spokane, Washington Group Health Physicians, the Northwest’s premier multi specialty group, is currently seeking a BE/BC Pediatrician to join our Lidgerwood Medical Center team in Spokane, Washington. This position will replace one of our established physicians who is retiring in late 2014. • Group Health provides 24/7 telephone triage support for pediatric non-emergency problems. • Competitive salaries, flexible schedules and generous benefits packages offered. • Outstanding teams in a collegial environment make these opportunities worth exploring.

that we are working to understand for future reference.

For additional information or to submit your CV, please contact:

As I write this in mid-March, it appears that Kirk

Aggie Swanson swanson.ax@ghc.org

will go to Pioneer Center North (on the west side of the state) on April 7 – almost six weeks past the original date. For a moment, it looked as though he would have to be discharged from Calispel by

GroupHealthPhysicians.org

GHP Recruiting Dept: 1-800-543-9323

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Medical Education In Spokane

MEDICAL EDUCATION GROWTH, UNDER THE RADAR

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By John McCarthy, MD

in this newsletter). Eastern Washington

educators and mentors will also continue

Assistant Dean

University is now offering a Master's of Public

to increase. Our community is going to need

Regional Affairs

Health degree. There will be a teaching health

a lot of help to educate the workforce that

WWAMI Clinical

center "look alike" on the Riverpoint campus

is winding through the pipeline. I believe

Coordinator, Eastern/

within the next two years, allowing training in a

there are challenges ahead which we will

Central Washington

multidisciplinary setting for a variety of health

successfully overcome as our intentional

professionals. This will also allow growth

growth continues. n

I recently found myself reflecting on the

in the number of Spokane based resident

changes in medical education since WWAMI

physicians to occur with up to 6 residents a

Spokane started in August of 2008 with

year or eventually increasing the total number

matriculation of the first Spokane class.

of residents in existing programs by 18 over

There has been a significant amount of

3 years. This essentially is a 25% increase in

growth and accompanying change in medical

the amount of funded GME (residencies). In

education in Spokane. This growth, having

addition, the Psychiatry residency that folded

started will inevitably continue. There is no

is re-emerging in a more stable fashion with

going back.

Enjoy your very own copy.

plans to begin taking residents in 2015. Finally, the Medex program has transitioned from a

For 41 years WWAMI was a model with

Bachelor’s to a Master’s program.

only the first year of medical school being delivered at sites outside of Seattle. This

This growth has been intentional; though

year, for the first time the second year has

muted in comparison to the needs of the

been delivered successfully in Spokane.

state. It is both heartening and telling that

This fall, Pullman (one of the first campuses

our community’s investment in medical

to be enlisted as a regional campus) is

education has allowed growth in our

transferring its 20 students to Spokane’s

recent economic environment. There

Riverpoint campus. This results in Spokane

will invariably be continued growth as

becoming the largest regional campus

Washington remains a significant importer

outside of Seattle. The consolidation of

of physicians and Eastern Washington is

medical students in Spokane makes sense as

clearly a larger importer than Western

it will focus resources and provide a critical

Washington. We all know that there is a

mass both in terms of teaching and research.

workforce shortage of both primary care

This move also helps WSU and Eastern

physicians and specialists in our region.

Washington to solidify medical sciences on

Regardless of your political leanings and

the Riverpoint campus.

controversies about the correct number of doctors per capita, there are few of us in

Additionally, the Riverpoint campus has been

the five state W WAMI region that would

consistently growing since 2008. The nursing

argue that the six OB/GYNs being produced

building was completed a couple of years

each year comes close to meeting the

ago and is fully occupied. Five months ago,

obstetrical needs of our region.

Many physicians share their newsletter with other doctors and physician assistants who are not SCMS members. If you are reading this and would like to become a member, please call 325-5010.

the Pharmaceutical and Biomedical Sciences building was opened and is home to WSU’s

With this much change in medical

pharmacy students as well as the 1st and 2nd

education, we can anticipate some growing

year medical students. WSU is finalizing the

pains. Change invariably upsets the status

concept of having a new College, the College

quo. As we continue to increase the

of Medical Sciences (see Dr. Robert’s article

number of medical learners, our needs for

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Rockwood Health System

INLAND NORTHWEST’S FIRST PROVIDER OF BRONCHIAL THERMOPLASTY

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By Sasha Weiler

Thermoplasty is the first asthma treatment

About Jiten

Senior Director of Marketing and

aimed at reducing the muscle thickness and

Patel, M.D.

Communications

mass, making room for easier airflow.

Jiten Patel,

Rockwood Health System

What are the benefits of this procedure?

M.D., joined

Clinical studies of this treatment have

the Rockwood

A new treatment option for severe asthma

demonstrated sustained improvements

Pulmonary

sufferers is now available at Deaconess

in asthma control up to 5 years following

Critical Care

Hospital. Bronchial Thermoplasty is a

the treatment. Treated patients not

Center in

minimally invasive procedure that uses

only enjoyed improved asthma-related

April 2012. He

thermal energy to reduce the frequency and

quality of life at years 1, 3 and 5 following

severity of asthma attacks, making it easier

treatment with fewer severe asthma

undergraduate degree in Zoology from the

for patients to breathe and improve their

attacks, but also experienced fewer visits

University of Calgary in Alberta, Canada,

quality of life.

to the emergency room for respiratory

and his medical degree from the University

received his

symptoms, and fewer days lost from work/

of the West Indies in St. Augustine,

How does Bronchial Thermoplasty treat

school or other daily activities due to

Trinidad. Dr. Patel completed a residency

Asthma?

asthma symptoms.

and chief residency in Internal Medicine and Pediatrics, as well as a fellowship in

Asthma is chronic inflammation of the airways with episodic narrowing (a.k.a.

First provider in the Inland Northwest

Pulmonary and Critical Care Medicine,

bronchoconstriction). Symptoms include

Rockwood Health System is the first provider

through the University of Kansas/ KU

coughing, wheezing and chest tightness,

of this treatment in the Inland Northwest.

Medical Center in Kansas City. He is a

which often come on suddenly in the form of

Jiten Patel, M.D., of Rockwood Clinic, is the

member of the American Thoracic Society,

an asthma attack. Persistent inflammation

first physician performing this procedure

the Society of Critical Care Medicine and

can eventually cause the airway’s smooth

in Spokane. Please contact Rockwood

the American College of Physicians. n

muscle to thicken, which restricts air flow

Respiratory Coordinator Debra Maxwell at

and makes breathing difficult. Bronchial

(509)342-3076 for more information.

A special sneak preview of Providence Medical Park

16528 E. Desmet Ct., Spokane Valley I-90 to Sullivan, north to Indiana, east on Indiana for 1.1 miles, right onto Desmet. Tour this unique new facility where primary care and specialty physicians, urgent care, pharmacy, lab and imaging services exist under one roof for one-stop medical care! Refreshments will be served.

Sullivan Rd.

Just for physicians | Wednesday, April 16 • 5-7 p.m.

ana

▲ N

Av e.

Desmet Ave. Providence Medical Park

Providence Medical Park will open for patient services on April 28. Questions? Call (509) 474-3081.

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Guest Column

DOCTOR WITH PATIENT

THE EMILY PROGRAM: A PLACE FOR HEALING, A PLACE FOR HOPE By Wendy Blackshaw The Emily Program is a new resource for eating disorder treatment in Spokane and surrounding areas. Since opening in June 2013, The Emily Program has provided comprehensive eating disorder treatment to male and female adults and adolescents struggling with anorexia, bulimia, compulsive overeating, binge eating, eating disorder not otherwise specified and related conditions. Founded in 1993 in Minnesota, The Emily Program has become nationally recognized for our compassionate and personalized approach to eating disorder awareness, treatment and lifetime recovery. We understand the tangled complexities of eating disorders, often from personal experiences. Our team of therapists,

dietitians and medical staff provide an individualized approach for every client. We know that recovery is possible and The Emily Program provides a safe place for healing. The Emily Program offers a wide array of treatment services for all ages and genders. Services include (but not limited to): • Eating Disorder Assessments

1. Do you feel like you sometimes lose or have lost control over how you eat? 2. Do you ever make yourself sick because you feel uncomfortably full?

• Individual Therapy

3. Do you believe yourself to be fat, even

• Group Therapy • Family-Based Treatment (FBT) • Nutritional Evaluation and Counseling • Partial Hospitalization and Intensive Outpatient Programs • Psychiatric and Medical Services • Residential Services (Minnesota)

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

Eating Disorders: What to Look for… The signs of an eating disorder are not always visible. It is important to know the questions to ask that could save a life. If you do suspect an eating disorder, ask your patient these simple questions:

when others say you are too thin? 4. Does food or thoughts about food dominate your life? 5. Do thoughts about changing your body or your weight dominate your life? 6. Have others become worried about your weight?

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In this informal survey, two or more “yes” answers could indicate the presence of disordered eating. * If your patient would like to schedule an assessment or if you or anyone in your practice have questions about eating disorders, please call Krista Crotty, Clinical Manager at The Emily Program at (509) 2521366 ext. 2106. Direct referrals can also be faxed to: (509) 252-1367.

“An Evening with The Emily Program” Monday, April 7 Please join us for dinner and an evening of conversation to learn more about The Emily Program. The evening will begin at 5:30 at Steam Plant Grill, located at 159 South Lincoln Street in Spokane. We promise an interesting – and fun – evening with members of our clinical team and senior leadership.

Upcoming Events New COE (compulsive over eating) Group Starting in May The Emily Program will be adding an Adult Compulsive Overeating – Intensive Outpatient Program beginning May 15. This focused, therapeutic group will meet three evenings per week and include therapeutic meals, development of recovery skills and family participation. The emphasis of this group will be on recovery and relapse prevention skills. The group will meet at The Emily Program Spokane, 2020 East 29th Avenue, Suite 200 in Spokane.

“The Overlap Between Compulsive Overeating, Binge Eating Disorder and Obesity” - Monday April 7 The Emily Program is hosting a Continuing Education breakfast on April 7 from 8:00 – 10:00am at The Emily Program Spokane office. Dr. Jillian Lampert, Senior Director at The Emily Program and an expert on this topic, will discuss how eating disorders may interface with obesity and weight loss. This is a great and informative event for anyone who has patients/clients struggling with weight-related issues and/ or eating disorders.

Eating Disorders Journal Club The Emily Program is hosting an Eating Disorder Journal Club. This is open to health professionals in the community who are interested in learning more about eating disorders and related topics. Meetings are held at The Emily Program, Spokane office, 2020 East 29th Avenue, Suite 200, from 8:30 – 10:00 am. The next meeting will be held on Tuesday, May 27 (due to Memorial Day on Monday) and focus on males and body image. Upcoming 2014 Journal Club meetings: July 28, September 22, October 27, November 24 and December 22. If you have questions or are interested in attending any of these events, please contact Krista Crotty, Clinical Manager at The Emily Program at krista.crotty@emilyprogram.com or (509) 252-2106. We would like to make sure that all medical providers in the city are aware of our services and referral process and that we would like to work alongside them treating this population. n

PATIENT’S JOURNAL

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Providence Health & Services

TRANSFORMING TO PATIENT CENTERED MEDICAL HOME

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By Brian Seppi, MD

To be successful, providers must be

The use of technology and utilizing a team-

Providence Medical

open to this new delivery model and be

based approach to primary care has the

Group

willing to:

potential to reduce duplicative tests and

Those of us who have been providing care to patients

• increase capacity in their practice;

decrease overall healthcare costs. Studies

• expand office hours to improve patient

show that as much as 30 percent of the care

access;

delivered in the country is duplicative or

• utilize the care team to decrease hospital

unnecessary and we must change how we

for more than 20 years know all too well

readmissions, emergency room visits and

deliver care if we are to chip away at the

just how disconnected health care can

improve management of high risk patients;

waste in our current delivery system.

be, not only for patients, but also for physicians and staff. Today, however, health care providers across the country

• use standard patient protocols to improve preventive care and chronic disease

For those people with multiple chronic

management;

medical illnesses, or who are too sick

are focusing on coordinated care to

• improve office work flow and efficiency;

to actively participate in their care,

improve the patient experience and

• and use new visit models such as e-visits

the importance of care coordination

provide higher quality care to patients

and group visits.

becomes even more important. The

while reducing the overall cost

average Medicare patient

of health care.

currently sees five to six specialists and two primary

Providence Medical Group

care physicians in a year,

in eastern Washington is

taking multiple medications

implementing the patient

for three or four chronic

centered medical home. The

conditions.

pilot project utilizes a model that has been shown to improve the value of

This team based approach is supported by

The old system was made up of a lot of

patient care by improving patient

technology to improve communication and

disconnected one-on-one transactions

satisfaction and clinical outcomes and

coordination of care between team members

directed by the patient without the

lowering overall medical costs.

and between providers during transitions

help of a care team. The new patient

of care. Providence medical clinics have

centered medical home is an approach

The basis of the medical home concept is

implemented Epic, a robust electronic health

to delivering care that provides

to provide patient centered care in a team

record that is now linked to all Providence

patients with a team of experts who are

based approach. Each member of the

facilities throughout the region, and across

focused on coordinating care across

health care team works at the top of their

five states from Alaska to Washington,

the full range of an individual’s health

licensure with a focus on patient centered,

Oregon, Montana and California. Patients

care needs. The result is better care

proactive and coordinated care. The patient

have access to their health information and

coordination, enhanced quality and less

is supported by a team that is led by their

can electronically communicate with their

duplication of costly services.

primary care physician and consists of

providers. Having a single record used

other team members such as registered

by hospitals, specialists and primary care

If you would like to know more about

nurses, medical assistants, behavior health

providers will decrease duplication of tests

Providence Medical Group’s work to

providers and pharmacists. These added

and allow better communication which will

transform the delivery of care,

resources improve care between office

improve patient care.

contact Dr. Brian Seppi at

visits, reduce hospital admissions, and

brian.seppi@providence.org. n

improve health outcomes of our patients.

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MEDICINE AND THE COURTROOM: A UNIQUE PROGRAM TRAINING NEW PHYSICIANS ABOUT LIABILITY SPOK ANE COUNT Y MEDICAL SOCIE T Y |

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For Your Information Sophia is a 38-year-old married, nonsmoking

medical student’s education career. In

the role of the physician during the claim

female establishing with a new PCP. Her

fact, according to a recent Health Affairs

process. A course originally designed

medical intake form reports a history of chest

article the average physician will spend

for residents, it has proven valuable

pain with a negative cardiac workup, thyroid

nearly 11 percent of his or her 40-year

for all practicing physicians. For more

cancer and subsequent hypothyroidism,

medical career with an open, unresolved

information, contact the Physicians

hyperlipidemia, menorrhagia, GERD, and an

malpractice claim.*

Insurance Risk Management Department

esophageal stricture. Her family history is

To learn more the Medicine and the

at risk@phyins.com or visit www.phyins.

significant for cardiac disease, HTN, and

Courtroom program taking place in

com/MedicineCourtroom. n

hyperlipidemia, and she has a surgical history

Spokane on May 22, visit www.phyins.

of laparoscopy for an ovarian cyst. She

com/MedicineCourtroom.

presents with a list of current complaints, none of them urgent, such as sinus problems,

Medicine and the Courtroom provides

headaches, cold intolerance—and she is most

an early introduction to liability, trials,

troubled by a facial rash.

case law, common misperceptions, and

Physicians Insurance designates this live activity for a maximum of 1.5 AMA PRA Category 1 credit(s).TM Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity meets the criteria for up to 1.5 hour(s) of Category I CME to satisfy the relicensure requirements of the Washington State Medical Quality Assurance Commission. *Seth Seabury, Amitabh Chandra, Darius Lakdawalla, and Anupam Jena, “On Average, Physicians Spend Nearly 11 Percent of Their 40-Year Careers with an Open, Unresolved Malpractice Claim,” Health Affairs 32 (2013): 111-119.

This is one of several true cases that are posed to residents during Physicians Insurance’s Medicine and the Courtroom —a new, interactive program that brings together attending physicians and their residents, claims experts, and defense attorneys to explore how and why patient care sometimes goes from the exam room to the courtroom. Using a physician moderator and facilitator, the 1.5-hour program reviews the medicine of the case. Participants learn that Sophia’s life-threatening condition will not be diagnosed for nearly two years, despite care by numerous additional providers —all of whom might have made a positive difference in her outcome. What happened to Sophia? What might have prevented her poor prognosis and the resulting lawsuit? She saw seven providers in two years. Who might have caught this? What would “medicine in a perfect world” look like in this case? Residents wrestle with not just the medicine (the standard of care), but also with patient responsibility and how the system supported or inadvertently hindered patient safety. This type of case-based learning is critical in a

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Guest Editorial

PATIENT SAFETY AND ADVOCACY (PART 2 OF 2) By Ward B. Buckingham, MD

what they titled “Guide To Patient and

The Institute for Healthcare Improvement

Retired Physician

Family Engagement:Enhancing the Quality

(IHI), a major player in this area for the

and Safety of Hospital Care”. One finding

past 25 years, published in 2008 their 2nd

Realize that one in seven Medicare

worth noting is providers tend to think safety

edition of Seven Leadership Leverage

patients experience a medical error

is under an individual’s control and thus

Points for Organization-level improvement

according to AHRQ. The best way you can

place less emphasis on the importance of

in healthcare. Leverage point four

prevent medical errors is to be an active

system-level changes. Identified facilitators

reads: “Our rationale for this change is

member of your health care team. AHRQ

to promoting engagement from providers’

straightforward. Quite simply, we have

has recently published a 20 item list of

standpoint included occurrence of a sentinel

observed that in a growing number of

actions patients can and should take.

event, enhanced reputation, increased

instances where truly stunning results

employee satisfaction, reduced malpractice

have been achieved, organizations have

What about promoting patient and family

claims (shown, for example, by the Medical

asked patients and families to be directly

engagement? A 2009-2010 study contracted

College of Georgia over five years), desire to

involved in the process. And those

by the AHRQ looked at this question with

improve quality and patient safety, feedback

organizations’ leaders often cite this

the stated goal being to promote patient

from patients and families, and altruism…it

change…putting patients in a position

and family engagement in hospital settings

is the right thing to do!

of real power and influence, using their

by developing implementing and evaluating

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

wisdom and experience to redesign and

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improve care systems…as being the single

without understanding the patient (the

your healthcare delivery system works.

most powerful transformational change in

hospital system of care). Patients often

But my family and I have all been patients

their history.”

suffer cardiopulmonary arrest on hospital

at one of your area’s largest facilities. I

wards despite warning signs present for

can attest to the fact that while overall

Having highlighted the safety challenges

hours before the event. But these cases

care was good, it was not perfect. I have

awaiting the patient entering our US health

are merely symptoms of a sick system.

discovered that nursing leadership is very

care delivery system and identified some

Adopting a reactive one-size-fits-all

receptive to the message I have shared,

actions available to the patient what else

solution like RRT without also analyzing

but remember it is we physicians who

can we do to enhance patient safety and

and addressing the underlying reasons

write the orders driving the delivery of

care efficacy? Two years ago I happened

why patients decline unattended will

healthcare. If physician leadership is not

across a San Francisco-based non-profit,

likely accomplish little. The fundamental

on board with the importance of their

The Empowered Patient Coalition, with

answer to preventing in-hospital clinical

being engaged in a shared quality agenda

similar interests and mission to mine. This

deterioration and cardiac arrests ultimately

why should nurses or any other members

was started by two mothers of children

lies in proactively reengineering systems

of the care provider team feel compelled

who died while navigating our health

to prevent such deterioration in the first

to do so? I submit that physician

care system. Their website offers free

place”. Although your local hospital here

leadership in this community need to

educational publications like this one….

and its involved professional staff continue

digest and embrace what is so well

their “Hospital Guide For Patients and

to maintain their care of my daughter’s

detailed in IHI’s “Engaging Physicians in

families”. Their original edition included a

postpartum protracted shock state on an

a Shared Quality Agenda”, part of their

fairly lengthy section on specific diagnoses

open ward met the “standard of care” in

Innovation Series 2007. Change can be

and treatment recommendations which I

2008 they do so at the peril of future ladies

painful as I’m sure many discovered with

suggested might be too ‘medical practice

in that condition as well as their institution’s

Providence’s recent conversion over to

oriented’ and hence threatening to the

standing in the realm of patient safety.

their third generation of EMR adoption.

turf of health care providers….I was

Managing an actively bleeding postpartum

But feeling cozy with the status quo

pleased that they chose to remove that

patient with the rare HELLP syndrome, with

regarding patient safety is no longer

section. There is nothing in this guide

coagulation deficiencies, in recurrent and

acceptable…if it truly ever was.

that should represent a threat to health

protracted hypovolemic shock, during early

care providers. This guide/brochure is 58

morning hours on a regular postpartum ward

In this presentation I’ve illustrated the

pages in concise yet complete form and

is dangerous to patients and unfair to nursing

patient health care safety problem. I

there is a companion abbreviated 12- page

units unaccustomed to such emergencies.

have suggested actions for patients

version “Quick Reference Guide” intended

That patient belongs in a critical care setting.

to take designed to empower them

to provide crucial patient information in

as key members of the health care

a condensed easily readable format. The

Borrowing again from the Baylor patient

team. I have emphasized patient

Empowered Patient Coalition mission is

safety officer, a culture of safety is

education as a key to achieving patient

to educate patients, advocates, health

required. Such a culture represents

empowerment. Historically health care

care providers and policy-makers. In my

change. Medicine has traditionally

providers have not been transparent

PowerPoint presentations for patients,

been characterized by autonomy among

about their shortcomings when it

families and advocates, there are about

physicians, a lack of teamwork, a lack of

comes to medical errors and their

30 slides based on the content of the

transparency about medical errors, and

human cost measured as increased

Hospital Guide which are well designed

poor communication. The new safety

morbidity and mortality. This secrecy

educational tools. One discussing RRT

culture focuses on learning each time an

has fostered suspicion and fear

(rapid response team) needs focused

error occurs. The strategy is to identify

among consumers as the media has

attention here. Drawing again on Dr. Ranji’s

system failures rather than individual

increasingly revealed tales of medical

expertise in that March 25, 2013 expert

failures within a non-punitive environment

errors. Providers need to rebuild

commentary previously cited, he says “The

that encourages occurrence reporting.

patient trust in the system of health

mixed performance of RRT’s illustrates

care delivery, and I see no better way

the flaw of attempting to treat the disease

As a relative newcomer to Spokane I

than empowering the patient as I’ve

(failure to rescue deteriorating patients)

have limited firsthand knowledge of how

outlined here. n

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

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New SCMS Members The following physicians and physician assistants have applied for membership and notice of application is presented. Any member who has information of a derogatory nature concerning an applicant’s moral or ethical conduct, medical qualifications or such requisites shall convey this to our Credentials Committee in writing to the Spokane County Medical Society, 104 South Freya Street, Orange Flag Building, Suite 114, Spokane, Washington, 99202.

PHYSICIANS PRESENTED A SECOND TIME

Coons, Christopher S., DO Internal Medicine / Hospitalist Joining IPC, The Hospitalist Co. 07/2014 Cosma, Mihaela, MD Internal Medicine / Endocrinology Joining Rockwood Clinic 07/2014

PHYSICIANS

Reed, William F., MD Internal Medicine Hospitalist Med School: U of Washington (1999) Internship: Internal Medicine Spokane (2000) Residency: Internal Medicine Spokane (2002) Currently working for IPC, The Hospitalist Co. (Holy Family) Rabe, Jacob B., MD Emergency Medicine Med School: Medical College of WI (2011) Internship: OSF, St Francis Medical Center – IL (2012) Residency: OSF, St Francis Medical Center – IL (2014) Joining Valley Hosp Emerg. Dept. (Hospital Physician Partners) 08/2014 Mueller, Anthony R., MD Emergency Medicine Med School: U of WA (2011) Internship: Nebraska Medical Center (2012) Residency: Nebraska Medical Center (2014) Joining Valley Hosp Emerg. Dept. (Hospital Physician Partners) 08/2014 Allred, Jared J., MD Orthopedic Surgery Med School: TX A&M Health Sciences Ctr (2008) Internship: TX A&M - Scott & White (2009) Residency: TX A&M - Scott & White (2013) Fellowship: San Diego Arthroscopy & Sports Medicine (2014) Joining Rockwood Orthopedics & Sports Medicine Center 09/2014 Mickelson, Joseph D., MD Family Medicine Med School: West Virginia U (2007) Internship: Naval Hospital Jacksonville (2008) Residency: Naval Hospital Jacksonville (2010) Joining Rockwood Hospitalists 08/2014

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

Cruite, Irene W., MD Radiology / Body Imaging / Oncology Imaging & Nuclear Medicine Joining Inland Imaging, A Division of Integra 11/2014 Glazier Jr., Robert U., MD Ophthalmology Joining Rockwood Eye Center 08/2014 Hing, Andrew, MD Anatomic & Clinical Pathology / Hematopathology Practicing with Incyte Diagnostics 01/2013 Kinard, Krista, MD Ophthalmology / Neuro-Ophthalmology Joining Spokane Eye Clinic 07/2014 Nandagopal, Radha, MD Pediatrics / Pediatric Endocrinology Joining PMG Pediatric Endocrinology & Diabetes 03/2014 Petersen, Brian, MD Diagnostic Radiology Joining inland Imaging, A Division of Integra Imaging 07/2014

MEMBERSHIP RECOGNITION FOR APRIL 2014 Thank you to the members listed below. Their contribution of time and talent has helped to make the Spokane County Medical Society the strong organization it is today. 40 Years Royce F. Van Gerpen, MD, MPH Eric C. Sorensen, MD

4/18/1974 4/28/1974

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SPOK ANE COUNT Y MEDICAL SOCIE T Y |

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Classified Ads POSITIONS AVAILABLE ESTABLISHED SPOKANE CLINICAL RESEARCH COMPANY is seeking primary care and specialty physicians interested in serving as Principle Investigators or as Sub-Investigators. There is an opportunity to assume an on-going research portfolio and to join new studies that are opening in the spring of 2014. For more information, contact Dalyn Boehm or John Driscoll at Premier Clinical Research at (509) 343-3710 or research@ premierclinicalresearch.com. QTC MEDICAL GROUP is one of the nation’s largest private providers of medical disability evaluations. We are contracted through the Department of Veterans Affairs to manage their compensation and pension programs. We are currently expanding our network of Psychology, Psychiatry, Physical Medicine and Rehabilitation, Family Medicine, Occupational Medicine, Internal Medicine and General Medicine providers for our Washington Clinics. We offer excellent hours and we work with your availability. We pay on a per exam basis and you can be covered on our malpractice insurance policy. The exams require NO treatment, adjudication, prescriptions to write, on-call shifts, overhead and case file administration. Please contact Maggie Dillon directly at (909) 978-3548 or mdillon@qtcm. com or visit our website www.qtcm.com to learn more about our company. PROVIDENCE FAMILY MEDICINE RESIDENCY SPOKANE - Immediate opening with Providence Family Medicine Residency Spokane (PFMRS) for a fulltime BC/ BE FP physician who has a passion for teaching. PFMRS is affiliated with the University of Washington School of Medicine. We have seven residents per year in our traditional program, one per year in our Rural Training Track and also administer OB and Sports Medicine Fellowships. This diversity benefits our educational mission and prepares our residents for urban & rural underserved practices. We offer a competitive salary, benefit package and gratifying lifestyle. Please contact Linda Barkley, Program Assistant at (509) 459-0688 or Linda.Barkley2@providence.org.

PROVIDENCE MEDICAL GROUP (PMG) – Eastern Washington has immediate opportunities for BE/BC Family Physicians to join our expanding primary care team in Spokane, eastern Washington’s largest city. Newborns to geriatrics, no OB. Excellent compensation and benefits. PMG – Eastern Washington is our physician-led network of more than 450 primary and specialty care providers in multiple clinic locations in Spokane and Stevens County. PMG partners with some of the region’s most advanced hospitals: Providence Sacred Heart Medical Center & Children’s Hospital, Providence Holy Family Hospital, Providence Mount Carmel and Providence St. Joseph’s Hospital. Contact Mark Rearrick at mark.rearrick@providence. org or (509) 474-6605 for more information. BC/BE PEDIATRICIAN WANTED, SPOKANE – The State of Washington Division of Disability Determination Services seeks a BC/BE pediatrician to perform contract service in our Spokane office. Contract services include the evaluation of physical impairment severity from medical records and other reports, utilizing Social Security regulations and rules of law. Medical consultants function as members of the adjudicative team and assist staff in determining eligibility for disability benefits. Reimbursement: $65/hour base; potential for $68/hour for high productivity. Interested physicians should contact Chief Medical Consultant Dr. Gene Profant at (360) 6647454; or Spokane Office Manager David Bennett at (509) 329-2508. This position reviews interesting cases; teaching is thus an integral function; hours are quite flexible. PHYSICIAN (OB/GYN and Urgent Care) OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE-Spokane Locations (CHAS) Enjoy a quality life/work balance and excellent benefits including competitive pay, generous personal time off, no hospital call, CME reimbursement, 401(k), full medical and dental, NHSC loan repayment and more. To learn more about physician employment opportunities, contact CHAS Human Resources at (509) 444-8888 or hr@ chas.org. Visit our website to learn more and to apply www.chas.org.

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

PROVIDENCE MEDICAL GROUP (PMG) – Eastern Washington is recruiting for an excellent Family Medicine physician to join our care team in Spokane Valley, a scenic suburb of Spokane. Full-time opportunity with our growing medical group in what will be a large, state-of-the-art medical ambulatory center (construction completion target is spring 2014). No OB. Outpatient only. Competitive compensation and comprehensive benefits. PMG – Eastern Washington is our physicianled network of more than 450 primary and specialty care providers in multiple clinic locations in Spokane and Stevens County. PMG partners with some of the region’s most advanced hospitals: Providence Sacred Heart Medical Center & Children’s Hospital, Providence Holy Family Hospital, Providence Mount Carmel and Providence St. Joseph’s Hospital. Contact Mark Rearrick at mark. rearrick@providence.org or (509) 474-6605 for more information. SPECTRUM HEALTHCARE RESOURCES has an immediate opportunity for a civilian Family Practice Physician at Fairchild Air Force Base. This contract position offers: Fulltime; Outpatient setting; Monday through Friday, 7:30am to 4:30pm; Manageable patient load (20-25 per day) and Shared on-call responsibilities (mostly telephone consulting). The position will have the following requirements: Current and unrestricted medical license; Successful completion of a family medicine residency; Board Certified by the ABFM or AOBFP; BLS, ACLS, PALS and Ability to work in a team setting. Contact Spectrum recruiter Lisa Paska for more information at Lisa_Paska@spectrumhealth. com or (314) 744-4107. MID-LEVEL OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANE-Family Practice ARNP and Physician Assistant needed in Spokane, WA and Moscow, ID. Enjoy a quality life/work balance and excellent benefits including competitive pay, generous personal time off, no hospital call, CME reimbursement, 401(k), full medical and dental, NHSC loan repayment and more. To learn more about employment opportunities, contact CHAS Human Resources at (509) 444-8888 or hr@chas.org. Visit our website to learn more and to apply www.chas.org.

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We are looking for a COMPASSIONATE AND SKILLED FAMILY/INTERNAL MEDICINE PHYSICIAN/ FINAL YEAR RESIDENT for our growing clinic in the Olympic Peninsula. This setting provides a place and all the resources for setting up your own private practice in a complete turnkey manner with regulatory and administrative matters taken care of professionally. The organization is physician led and takes care of physicians very well. We would expect the new physician to start with some urgent care hours and slowly transition to a full time private practice primary care. Candidates signing up in during their residency are eligible for a $1000 per month stipend for the remainder of their residency. For further details, please call (509) 414-6390. FULL-TIME LICENSED PHYSICIAN ASSISTANT (PA) wanted for expanding clinic in Spokane, Washington. Currently patients are seen four days per week, Monday through Thursday, 8 a.m. to 5 p.m. Approximately 24 patients per day. This could expand into five days a week in the future. No call, weekends or holidays. Fabulous benefit package offered, including vacation and CME benefits. Starting salary depends on experience. Submit resume and cover letter to Kris Norton, Office Manager Inland Neurosurgery & Spine Associates, P.S. 105 W 8th Ave, Ste. 200 Spokane, WA 99204 or knorton@neuroandspine.com. N.E. WASHINGTON HEALTH PROGRAMS LOON LAKE COMMUNITY HEALTH CENTER is seeking a family practice ARNP or PAC. The ideal candidate will enjoy working with a medical team that is dedicated to the mission of NEWHP and have the ability to work autonomously. The Loon Lake clinic is nestled in the rural area of Loon Lake in N.E. Washington State. The area allows for the recreational enthusiast who enjoys, skiing, hiking, hunting, fishing, snowshoeing, horseback riding and any other outdoor event that you desire. Competitive salary and benefits. N.E. Washington Health Programs is also a NHSC/State student loan repayment eligible site. Please send resume to NEW Health Programs/Attn: HR DTR/PO Box 808/ Chewelah, WA 99109 or email to: vickien@ newhp.org. EOE & Provider

MANN-GRANDSTAFF VA MEDICAL CENTER in Spokane has immediate opportunities for Psychiatrists, Emergency Medicine Physicians, Internists, and Hospitalists and an immediate opening for a Director of the Emergency Department. Recruitment incentives and Education Debt Reduction Incentives may be available. Please contact Rodney Gile (509) 434-7590 (Rodney.gile@va.gov) or Robyn Highbarger (509) 434-7393 (Robyn. Highbarger@va.gov) for specific information about positions. NORTHWEST MEDICAL SPECIALTY EVALUATIONS SEEKS BOARD ELIGIBLE / BOARD CERTIFIED PHYSICIANS FOR SSI EXAMINATIONS. Flexible hours. No call or ongoing patient care responsibilities. This is an excellent way to supplement your clinical income. Please send your CV or call for more information. kcave@nwmse.com (509) 588.7340

REAL ESTATE COMFORTABLE THREE-BEDROOM HOME IN QUIET NEIGHBORHOOD FOR RENT. Good storage in kitchen, gas stove, dishwasher, refrigerator, washer/dryer and fireplace. Comes furnished or can negotiate. Close to Hamblen Grade School, Sac Middle School and Ferris High School. Three bedrooms, three baths, large living room, family/TV room, master bedroom has private bathroom, two-car garage. Large windows in living room look out into large fenced yard with automatic sprinkler system (front and back). Snow blower and lawnmower provided. Call (408) 594-1234 or (509) 993-7962.

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

LARGE SECOND OWNER CUSTOM BUILT EXECUTIVE HOME WITH UNPARALLELED VIEWS OF LIBERTY LAKE AND SPOKANE VALLEY ON FIVE ACRES AVAILABLE FOR SALE OR LEASE. Custom hardwood floors and woodwork throughout, cherry office shelves, cathedral ceilings, central air, three car garage, brick porch, tile roof, large deck, three fireplaces, four bedrooms, four bathrooms, formal dining room, large kitchen, large eating room and den. Walk out basement, wood stove, kitchen and bathroom. Large 30’ x 100’ pole barn with separate utilities, two phase power, three twelve-foot overhead doors. 30 x 60 sports court. Large animals allowed. Water rights included. 4Kw grid interactive, portable battery backup solar system available. Offered for $600k or for lease $3250, no pets/smokers. Seller is a real estate broker at (509) 220-7512. RIVER FRONT AND ACREAGE, 3300FT², 4 BEDROOM HOME FOR LEASE (OR SALE) $1,850/MONTH. Close in but feels like the country. Four bedroom, three and ½ bath, master suite with corner jetted tub and large walk-in closet, open living and dining area with great views and gas fireplace, family room with wood stove, attached two-car garage and detached two-place carport. Forced air natural gas furnace. Large multilevel deck and patio looking toward river. Wooded acres on the Little Spokane River with private trails, sandy beach and swimming hole. Plentiful wildlife. School bus comes to front drive. Mead school district. Close to Whitworth, shopping and freeways but very quiet and secluded. Cable hook-up. Grounds are river irrigated. First and last plus cleaning deposit. Utilities not included. No indoor pets. $150/month grounds maintenance fee if you choose not to do it yourself. Contact Scott (509) 435-7099. For photos go to Craig’s list - http://spokane. craigslist.org/apa/3984125910.html.

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Classified Ads ONE OF COPELAND’S BEST NORTH SIDE HOMES ON OVER FIFTY ACRES WITH MEADOWS, TREES, COMPLETE PRIVACY AND GORGEOUS VIEWS. This home offers contemporary living at its best featuring four bedrooms, four bathrooms, three-car garage, hard rock maple floors, cabinets and built-ins, three balcony decks plus a patio with water feature. The second level has a distinctive master suite with custom built-ins, large walk-in closet, lovely master bath with lowboy toilet and bidet, a large sitting room with built-in shelving, raised gas fireplace and extraordinary views! The main floor great room boasts granite, stainless appliances, oversized pantry and very functional laundry suite with chute. Super-efficient geothermal heating and cooling affords economical year ‘round comfort. Twenty minutes from Holy Family Hospital. Mead schools! $665,000 Call Marilyn Amato at (509) 979-6027.

MEDICAL OFFICES/BUILDINGS

MEETINGS/CONFERENCES/EVENTS

PHYSICIAN FAMILY ALANON GROUP: Physicians, physician spouses or significant others and their adult family members share their experience, strength and hope concerning difficult physician family issues. This may include medical illness, mental illness, addictions, work-related stress, life transitions and relationship difficulties.

SAVE THE DATE! Primary Care Update 31st Annual Conference May 2 and 3, 2014 Red Lion at the Park – Spokane, WA This well established update is a tremendous opportunity for physicians and other health professionals to choose from more than 20 CME sessions and workshops designed specifically for primary care practitioners. Touted as the largest gathering of primary care providers on the West Coast, this forum provides time to connect with long-time colleagues and learn from others. Combined with the general excitement of Spokane’s Bloomsday Run on Sunday, May 4, this conference is one not to miss! Watch for registration information coming soon! INSTITUTIONAL REVIEW BOARD (IRB) Meets the second Thursday of every month at noon at the Heart Institute, classroom B. Should you have any questions regarding this process, please contact the IRB office at (509) 358-7631.

SOUTH HILL – on 29th Avenue near Southeast Boulevard - Two offices now available in a beautifully landscaped setting. Building designed by nationally recognized architects. Both offices are corner suites with windows down six feet from the ceiling. Generous parking. Ten minutes from Sacred Heart or Deaconess Hospitals. Phone (509) 535-1455 or (509) 768-5860.

We meet Tuesday evenings after 6 p.m. The format is structured by the 12-Step Alanon principles. All is confidential and anonymous. There are no dues or fees. To discuss whether this group could be helpful for you, please contact Bob at (509) 998-5324. MRC OF EASTERN WASHINGTON – General Membership Meeting Wednesday 09 April 2014 6:00 -8:00 p.m. at the Spokane Regional Health District 1101 W. College Ave., Auditorium. Meeting agenda to include a presentation on the Spokane Regional Health District (SRHD) Microbiology Laboratory; an update on training, exercise, equipment, recruitment, recognition and

SPOK ANE COUNT Y MEDICAL SOCIE T Y |

NORTH SPOKANE PROFESSIONAL BUILDING HAS SEVERAL MEDICAL OFFICE SUITES FOR LEASE. This 60,000 sf. professional medical office building is located at N. 5901 Lidgerwood directly north of Holy Family Hospital at the NWC of Lidgerwood and Central Avenue. The building has various medical office spaces available for lease from 635 to 10,800 contiguous usable square feet. and has undergone extensive remodeling, including two new elevators, lighted pylon sign, refurbished lobbies, corridors and stairways. Other tenants in the building include urgent care, family practice, pediatrics, dermatology, dentistry, pathology and pharmacy. Floor plans and marketing materials emailed upon request. A Tenant Improvement Allowance is available, subject to terms of lease. Contact Patrick O’Rourke, CCIM, CPM®with O’Rourke Realty, Inc. at (509) 624-6522, mobile (509) 999-2720 or psrourke@ comcast.net.

communication and reports on the Eastern Washington Hospital Wellness Fair, Primary Care Conference, Bloomsday participation and Basic Disaster Life Support, Advanced Disaster Life Support and Disaster Mental Health Trainings. Next meeting scheduled for 14 May 2014 – Annual Volunteer Recognition Dinner

CONTINUING MEDICAL EDUCATION SPRING 2014 SPORTS MEDICINE UPDATE: This seminar is jointly sponsored by Pullman Regional Hospital and the Spokane County Medical Society. 3.0 AMA Category 1 Credits. Conference will be held on April 12, 2014 from 9:00 a.m. – noon at Pullman Regional Hospital, Pullman WA. For additional information please contact Patty Snyder at (509) 336-7388 or email patty.snyder@pullmanregional.org.

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17 APRIL 201 4

THURSDAY

GENERAL MEMBERSHIP MEETING A social evening of laughter and collegiality for SCMS members and their guests. R E D

3 0 3

L I O N

H O T E L

N O R T H

6 : 0 0 P M 7 : 0 0 P M 8 : 0 0 P M

A T

T H E

R I V E R

P A R K

D R

S O C I A L H O U R D I N N E R A N D B U S I N E S S M E E T I N G G U E S T S P E A K E R A N D B O O K S I G N I N G

Guest Speaker: Mack Dryden Comedic Motivator and Emcee

“He was a BIG hit! Everyone was rolling in the aisles with laughter.”

Live Happy, Laugh Loud As a comedian he’s performed on dozens of TV shows, including The Tonight Show with both Johnny Carson and Jay Leno. As an actor he’s appeared in several movies and on many TV shows, including JAG and a recurring role as a judge on ABC’s The Guardian. Before becoming an entertainer, he was an award-winning journalist and a black belt karate champion.

MEAL CHOICES SERVED WITH SALAD, BREAD, DESSERT AND COFFEE/TEA

Double Cut Pork Loin Chop Served with apple bourbon mustard glaze, smashed red potatoes and fresh vegetable

Chicken Oscar Boneless skinless breast of chicken topped with Dungeness crab, asparagus and béarnaise sauce with saffron rice and fresh vegetable

Vegetarian Chef’s choice

$20 per person

CREDIT CARD

MAKE CHECKS PAYABLE TO SCMS

Visa MasterCard

TOTAL$ Account Number Expiration Date

Phone #

Card Holder’s Name Card Holder’s Billing Address City

State

Zip Code

Meal Requests: Name_________________________________________

Pork Chicken Vegetarian

Name_________________________________________

Pork Chicken Vegetarian

SCMS * Orange Flag Building * 104 S. Freya St., Ste. 114 * Spokane, WA 99202 (509) 325-5010 Fax (509) 325-5409

RSVP by April 10, 2014 No cancellations or refunds after April 10.

PRIZES FOR DRAWINGS PROVIDED BY THE FOLLOWING SPONSORS: The Prewitt Group Northland Team

PRSRT STD

SPOKANE COUNTY MEDICAL SOCIETY - ORANGE FLAG BUILDING 104 S FREYA ST STE 114 SPOKANE, WA 99202

U.S. Postage

PAID

Spokane, WA Permit No. 307

ADDRESS SERVICE REQUESTED

Please Recycle

COMMUNITY OF PROFESSIONALS

The Prewitt Group

For more information regarding the Community of Professionals program contact Dean Larsen, CEO or Michelle Caird, Executive Assistant at (509) 325-5010.