TABLE OF CONTENTS
2014 Officers and Board of Trustees David Bare, MD President Matt Hollon, MD President-Elect Anne Oakley, MD Immediate Past President
A NEW PARADIGM: HEALTH AND HEALTH CARE FOR OUR PEOPLE (PART 2) .
MEDICAL SCHOOL REINVENTED – MEDICINE IS LEARNED NOT TAUGHT .
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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
PROJECT ACCESS REFERRALS PLUNGE AS AFFORDABLE CARE ACT TAKES EFFECT .
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HEALTH CARE AND HIGHER ED TOPICS OF THE DAY .
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PATIENT SAFETY AND ADVOCACY .
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SPOKANE IN OLYMPIA DAY 2:
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Newsletter Editor – Matt Hollon, MD
BEYOND “LOADING”: ADDRESSING THE ROLE OF EXCESS CENTRAL AND VISCERAL BODY FAT ON THE PROGRESSION OF RHEUMATOID ARTHRITIS/OSTEOARTHRITIS/ DEGENERATIVE JOINT DISEASE .
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INSIDE FRONT COVER AD HEALTH UPDATE/ALERT: UPCOMING CHANGES FOR WIC FAMILIES RECEIVING Spokane County Medical Society Message A monthly newsletter published by the Spokane County Medical Society. Advertising Correspondence SCMS Publications Attn: Shannon Hill 518 S. Maple Spokane, WA 99204 509-343-0123 Fax 509-325-3889 ShannonH.scms@gmail.com 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.
CHECKS FOR SIMILAC SENSITIVE OR SIMILAC SPIT-UP FORMULAS .
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MADNESS TO METHODS: ENRICHING EDUCATORS’ REPERTOIRE OF APPROPRIATE INSTRUCTIONAL METHODS .
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NEW PHYSICIANS .
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CONTINUING MEDICAL EDUCATION / MEETINGS / CONFERENCES / EVENTS / MEMBERSHIP RECOGNITION FOR MARCH 2014 / THOMAS J. ALLERDING, MD RETIRES AFTER 31 YEARS AT INCYTE DIAGNOSTICS .
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CLASSIFIED ADS .
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IN THE NEWS .
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“T he
first day of spring is one thing , and the first spring day is another .
T he
difference between them is sometimes as great as a month .”
– H enry Van Dyke
A NEW PARADIGM: HEALTH AND HEALTH CARE FOR OUR PEOPLE (PART 2)
comparison to these best practices. There
management and assessments to include
Program to help with patient safety where
was, because of the functionality of our
substance abuse screening. Our patient
prescribing is concerned. We have an
Electronic Medical records, the ability
service coordinators look into the
urgent care walk in clinic for access for
to look not only at individual patient’s
financial health of our population to
acute care and our patients are able to see
measures of care outcomes longitudinally
help them get the best care coverage
their assigned provider 70% of the time.
over time but populations of patients
that is available for each individual (a
(like all of our diabetics) and not only
great resource during this time of sign
Committed to Quality and Safety:
how our organization as a whole was
up for products offered in the Affordable
With ability to measure outcomes
doing but individual care teams, lead by
Care Act). Our pharmacist help as team
that align with nationally determined
individual providers. We morphed into an
members to monitor prescribing practices,
best practices surrounding treatment
organization which became transparent in
run our Coumadin clinic and work with
guidelines, we are able to see how
terms of our “score card” not only for our
specific population like our diabetics or
we compare for diseases including
individual care teams and providers but for
those who use tobacco products.
Diabetes, Depression, Hypertension and
our organization as a whole. What follows
Prenatal care related to management
are some of the changes that resulted in
Coordinated: We have developed
and Mammograms, Colorectal screening
improvement.
a referral specialty department that
and Pap screening related to Health
handles all referrals within and outside
Maintenance. Having an imbedded
Patient Centered: We have at least 51%
our organization and tracks the inflow
reporting system that allows our workers
By David Bare, MD
The science of change, especially
Testing Changes
of our board of directors (which runs
and outflow of information between the
to report issues they have observed that
SCMS President
accelerated change, can happen through
The Plan-Do-Study-Act (PDSA) cycle is
our organization) that are patients in
various entities in the community while
are demonstrative of poor Quality and/
a change process that is promoted by the
shorthand for testing a change in the real
our clinics so we have not only their
streamlining the prior authorization
or Safety to a Quality Improvement
Institute of Health Improvement (IHI).
work setting — by planning it, trying it,
perspective, they actually are in charge of
process that so many of our insurance
Committee. This committee then
The Patient Centered Medical Home (PCMH) is the central framework
observing the results, and acting on what
what we do and how we do it. We also use
carries now require to include those
determines if this is a trend or isolated
of operation in the new paradigm, a
Three questions help guide this change:
is learned. This is the scientific method
Focus Groups when changes are proposed
referrals involving imagining. The use
incident and responds with ideas for
perspective which answers: “Who will give
1. What are we trying to accomplish?
adapted for action-oriented learning.
to get feedback from patients to have an
of Project Access (PA) in this process
change to foster improvement.
care?”, “How will that care be delivered
2. How will we know that a change is an
understanding how these changes are
has also been improved with our
and coordinated?” and “How we will know
improvement?
Remember in Part one the concept of the
viewed by them.
referral specialist coordinating with PA
We have had many bumps along the way
if we have improved care?”
3. What changes can we make that will
PCMH was defined and in so doing set
specialist to know which specialty slots
with all of this. At one time we had much
result in improvement?
many of the broad areas within which aims
Comprehensive: We developed in our
are open and what criteria for referral is
more robust care teams with “Navigators”
could be formulated. These included care
system the ability to care for all basic
needed for each of these slots. We also
and “Care Coordinators” but these were
Change was necessary in order to move from where we were, to where we needed
Setting Aims
that was Patient Centered, Comprehensive,
needs of our patients from a Primary care
have Patient Service Coordinators who
grant funded and the grants dried up.
to be. If you are anything like me you
Improvement requires setting aims. The
Coordinated, Accessible, Committed to
perspective. Acute care, chronic care,
help our patients navigate through the
Without payment reform, which will
like the steady predictable same old
aim should be time-specific and
quality (including access) and Safety. So
wellness and prevention in the areas
Health care system. The fledgling Care
allow us to bill for the services that these
same old in your day to day life. I spent
measurable; it should also define
the PDSA wheel of change began to turn in
of adult medicine, pediatrics, women’s
teams that we have also have attempted
individuals provided, we are back to the
decades training and getting comfortable
the specific population of patients or
my life with the help of Change teams that
health, dental health, behavioral health
to have “huddles” (Just like football
Provider and the MA staff acting alone
with my role as physician and I liked
other systems that will be affected.
were formed in our organization. Nothing
and pharmacy services. We have an urgent
a brief time when the team comes
as the care team. This has diminished
the security of routine. But, as I was
was accepted as true unless there was proof
care that has been operational for the
together to discuss the next play) setting
the number of planned care visits, the
confronted with the facts of how poorly
Establishing Measures
through a measurement that it was. We
last 2 years that is now critical in helping
up pre-work that each patient might
population surveillance and engagement
we as a medical community did related to
Change teams use quantitative measures
became very scientific in our approach to
with the acute care needs. We have care
need related to health maintenance or
and put more responsibility on the back of
outcomes, I had to agree that there must
to determine if a specific change actually
moving our organization from a traditional
team protocols that set the “bundled”
disease management.
our providers and MA’s.
be a better way. If health care where a
leads to an improvement.
fee for service system that responded to the
parameters of best chronic care. We
acute care needs of our patients one by one
offer a free “Healthy Living” class to our
Accessible: We have 24/7 after hours on
This has been my journey over the last 10
means of air transportation it would have to come with a warning on each ticket
Selecting Changes
as they came to see us to an organization
patients for the purpose of teaching them
call providers who have electronic access to
years and my organizations journey. It will
about how often we crash and kill or
Ideas for change may come from
that was able to define best care according
about health topics and goal setting so
all of our patients outpatient records across
continue to require attention to details,
maim those on board. Individuals using
the insights of those who work in
to established treatment guidelines,
they can better care for themselves and
all 11 of our clinics. We have connections
morphing towards a better way to serve
our “planes” would enter with fear and
the system, from change concepts or
which had been scientifically proven, and
be their own best advocates. Our dental
to Stentor for imagining information,
up Health Care and Health for our people.
trembling! So how did we change, how
other creative thinking techniques,
could measure outcomes related to health
clinics do restorative care and surgical
Metitech and Epic connections for our
Next Month I will discuss the role of the
did I change?
or by borrowing from the experience
maintenance and disease management
extractions. Our behavioral health
patients’ inpatient information. We have
Physician as Leader.
of others who have successfully improved.
in our patients for the purpose of
team members help with medication
access to the Pharmacy Management
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SPOKANE COUNTY MEDICAL SOCIETY |
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It’s exciting to have a growing medical school campus here in town. The buzz on the Riverpoint Campus is hard to miss. There are currently 20 first-year and 19 second-year University of Washington School of Medicine students in town along with 25 students who have chosen to obtain their clinical training in Spokane. Next year, there will be 40 students in the first- year class as the Spokane and Pullman classes are consolidated at the Riverpoint Campus along with an anticipated 20 second-year students. There will also be approximately twenty five 3rd and 4th year UW medical students doing clinical rotations here. Expect to see these eager learners everywhere you look in the coming months.
MEDICAL SCHOOL REINVENTED – MEDICINE IS LEARNED NOT TAUGHT
While it is exciting to think of students doing all four years of medical school here in Spokane, the medical school experience they will have has little resemblance to the medical school that most of us remember. For the second year students, there are no lectures. The Spokane Campus is transitioning to an adult learning approach in which medicine is learned, not taught. The manifestations of this new philosophy are many, most notable is the “flipped classroom.” The classroom learning is flipped; the students prepare for class by reviewing new material and coming ready to discuss, clarify and expand on this material. In addition, even in the preclinical phase a concerted effort is made to provide clinical context for the basic science information being presented. Hence, the classroom focuses on guided discussion and interaction with an emphasis on student-to-student learning. In addition to these changes, curriculum renewal is underway at the University of Washington with an effort to consolidate the preclinical phase of medical education into 18 months, which will allow more
opportunities for career exploration and clinical opportunities prior to having to commit to a residency choice. In addition, the clinical teaching environment is likely to undergo a similar paradigm shift. While the required experiential learning and material covered in the third year (Surgery, Pediatrics, Internal Medicine, OBGYN, Family Medicine, and Psychiatry) won’t change, the traditional block rotations may become a thing of the past. There is a movement towards “Longitudinal Integrated Clerkships” (LIC’s). The incentive to get away from the traditional silos comes from several factors – first, is a recognition that increasingly our patients have chronic conditions that are treated primarily in the outpatient setting and second, very few patients present with a single issue. While a concentrated approach is necessary for postgraduate training, the introduction needed by medical students is a broad approach that treats the entire patient rather than single systems. So what does this, a longitudinal integrated clerkship look like? There are a variety of models in use in a variety of settings, including in rural environments throughout the WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) known as the WRITE (WWAMI Rural Integrated Training Experience) programs. While adaptation to an urban environment has its challenges, LIC’s have been done in Boston and San Francisco. If they can do it there, we can do it here. While the final structure is not well defined, the likely format would include a schedule placing the third-year medical student with a preceptor in each of the core disciplines working together one to three half-days per week. Over time the student could develop a specific panel of patients. Within each week there would
be sufficient time for the student to follow his or her patients as they navigate the system – Following the prenatal patient seen in the Family Medicine clinic to delivery nine months later, following the patient diagnosed with cholecystitis in the internal medicine clinic to the operating room with the surgeon. These structured outpatient weeks will likely be interrupted by intensive inpatient experiences lasting one to two weeks to ensure adequate exposure to the inpatient setting. This longitudinal approach has been shown to be better for the students. It fosters empathy and it improves retention of information and promotes clinical skills. This approach has been welcomed by preceptors as well. As a preceptor, you get to know your student, they know you and your office staff (you won’t be orienting a new student every month; they get to know the system better and thus are better able to contribute and help over time), and they become part of the rhythm of the office rather than being a month-long disruption. Students get to know patients over time and make meaningful contributions to their care. Embracing the adult learning model and the idea that medicine is learned, rather than taught, changes the role of the preceptor from “teacher” to “coach”. Our role is to guide the student to ensure they get what they need and to help them reach their full potential. This is clearly not the medical school most of us experienced. WWAMI Spokane is on the forefront and is delivering medical education via innovative yet proven methods in our community. We appreciate, need and value the help and support of our Spokane area providers. As medical school is reinvented, we realize we can’t achieve our goals without your participation. Thank you.
By Darryl Potyk, MD, FACP, University of Washington School of Medicine, Assistant Dean for Regional Affairs, Providence Internal Medicine Residency Spokane, Associate Program Director
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PROJECT ACCESS REFERRALS PLUNGE AS AFFORDABLE CARE ACT TAKES EFFECT By Jim Ryan, Patient Care Coordinator
The bigger questions involved
Person Assisters and advised him to
a referral to general surgery. We had to
Access for the month of February,
or-less random basis, without
place him a waitlist at that time.
during which he would not have
regard for the patient’s particular
coverage under either carrier. We are
circumstance or the provider’s
those individuals making between
immediately get started on the process
In the first month of 2014, Project
138% and 200% of FPL–the Project
of getting covered under the ACA. In the
Access referrals dropped precipitously,
Access eligibility cutoff. In theory,
meantime, however, I called Dr. Gillum’s
When his turn came up, Ted was back
currently working to ensure that he
capacity for new patients. In the
from a 2013 average of 150 per month
this population would have had the
office and asked if I could extend his
east helping his sister, who was awaiting
sees a surgeon as soon as possible.
case of clients we’ve worked with,
to 10. Yes…you read that correctly.
opportunity to purchase affordable,
Project Access coverage for the time
a liver transplant. In the meantime,
We received just 10 applications for
subsidized insurance on the Washington
being. They didn’t hesitate to say yes.
he was advised to apply for Medicaid
A couple of things stand out in this
where they would be most likely
donated specialty health care services
Health Benefit Exchange before coming
coverage for January 1st. Meanwhile,
story in terms of roles that we think
to receive the care they need on a
in January, which has traditionally
to us for help. We wondered how doctors
Now it is certainly possible that we are
Dr. Smith at Group Health expressed
it might make sense for us to play in
timeline that does not endanger
been one of our busiest months. While
would feel about donating services to
simply experiencing a bit of a system
concern about getting Ted to a surgeon
an effort to continue plugging holes
their health. In the case of clients
a drop was anticipated, the magnitude
people who had made that decision,
delay before we see a rebound in
and an endocrinologist in a timely
in the system. First, the massive
we haven’t worked with, we often
was impossible to foresee given the
either simply out of neglect to enroll or
applications, but the steepness of the
manner. Ted applied and was enrolled
influx of new Medicaid patients into
get calls from our network of
ambiguity that surrounded so many
because they thought the premiums and
immediate decline indicates to us that
with Amerigroup under Washington’s
the system has created a glut that
donating providers asking for our
aspects of the implementation of the
deductibles were too high.
a giant hole has been plugged. We do
expanded Medicaid program.
does not, as of yet, seem to allow
help in steering their patients in
for triage of situations like Ted’s. If
the right direction, knowing, as
we typically have a good sense of
Affordable Care Act as
not expect application
2013 drew to a close.
levels to ever return to
One would think that this would have
Ted had not already been connected
they do, that we have become an
Our discussions with the
what they were prior
been good news. Unfortunately, Group
to us through his past enrollment
efficient hub for making those
medical community at
to the implementation
Health does not accept Amerigroup
in Project Access, what would have
connections.
the time confirmed that
of the Affordable Care
and Ted was advised by his insurance
happened? It seems more likely
Act. That having been
carrier that he would need a new
than not that he would have fallen
Rest assured that January’s drop in
said, there remain
referral from his newly assigned PCP
through the cracks and his situation
referrals has not resulted in any thumb
fissures, including
at another clinic, where he could not
might have become more problematic
twiddling at the Medical Society
undocumented
get an appointment until June or July.
and expensive.
Foundation. In addition to our work
no one seemed to know quite what to expect come January 1st. Several things have
Several things have become clear. First, insofar as Project Access clients are concerned, the Affordable Care Act is working.
immigrants who are
As this was an unacceptable timeline,
become clear. First,
ineligible for the
we assisted Ted in making the switch
There also remains the question
Spotter’s Group, we are continuing
insofar as Project Access
Medicaid expansion. We
from Amerigroup to Molina so that he
of how people are being assigned
the work of Project Access, adapting
clients are concerned,
expect that they will
could stay within the Group Health
to PCPs by the insurance carriers.
and expanding our capabilities as the
comprise the bulk of
system. We re-enrolled him in Project
It seems to be done on a more-
situation warrants.
the Affordable Care Act is working. Those individuals who
Our donating providers have answered
our Project Access work going forward,
previously would have been referred
the second question in the same spirit
along with those who fall into the “new
to us by the community clinics are
of benevolence that has characterized
gap” of uninsured.
instead being enrolled in Medicaid
their involvement in the past. They have
onsite and directly referred to the
essentially asked “Why would we feel
We continue to encounter systemic
appropriate specialists who are now
any differently? If they’re uninsured and
issues that are relatively easy for us to
being reimbursed for their work rather
can’t afford the care they need, we’ll
fix on a person-by-person basis, but
than donating it. We had a good sense
do it.” In fact, while writing this piece,
which require a long-term game plan.
that this would be the case for people
a Project Access client called whose
Consider the case of a Project Access
making up to 138% of the federal
six-month Project Access enrollment had
client we’ll call Ted. Last September, the
poverty income level (the new cutoff
ended in January. He has an impending
Sacred Heart Medical Center Emergency
for Medicaid eligibility), but we were
appointment with Dr. Gillum at the
Department referred Ted to us for PCP
unsure about the ease with which they
Infectious Disease Center of Spokane
follow up regarding a breast mass. He
would be able to get enrolled and what
and does not yet have insurance. I
was approved for Project Access and sent
deadlines would apply.
gave him the numbers of several In-
to Group Health. In October he received
SPOKANE COUNTY MEDICAL SOCIETY |
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SPOKANE COUNTY MEDICAL SOCIETY |
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SPOKANE IN OLYMPIA DAY 2: HEALTH CARE AND HIGHER ED THE TOPICS OF THE DAY Reprinted by permission from GSI website blog
In a legislature that seems to see
Thursday shifted mostly to medical
“Our per capita residency slots are
partisan attitudes impact progress on
education in the Spokane area.
among the lowest in the country,”
some issues, there is one area where
“I think we need to do more to prepare
Hollon told legislators. Residency
bipartisanship is alive and well.
students for medical jobs,” Kohl-Welles
slots are governed by the federal
said. “Washington is the medical center
government, which put a cap on them
In discussions on higher education,
for the northwest so we need to do
in the late 90s. There are roughly 1,600
state legislators in both branches and
more for that.”
residency slots in all of Washington,
both parties are largely in agreement.
but only 75 of those are in Eastern Washington.
Health Care “We know the importance of higher
The topics of health care and higher
education,” Senator Jeanne Kohl-Welles
education meshed nicely as both
Representative Joe Schmick (R –
(D – Seattle) told a delegation of nearly
meetings dealt with – among other
Colfax) and Senator Linda Evans
90 Spokane-area business, education
things – medical education in Spokane,
Parlette (R – Wenatchee) listened as the
and community leaders Thursday. “It’s
namely growing the amount of students
Spokane delegation shared why more
something we usually find agreements
studying in Spokane.
medical students and residency slots
on.”
are needed. “We’ve been better at attracting
An aging population and the
Last year, the legislature approved a
medical students within the United
Affordable Care Act (ACA) mean more
zero dollar increase in tuition for the
States (to Spokane),” said Matthew
people are in the market – especially in
state’s public colleges and universities.
Hollon of the Spokane County Medical
rural areas.
Society. “The focus is to recruit people “Many of us don’t want a change to that
interested in primary care.”
On the topic of the ACA, Sen. Parlette
(this year),” Kohl-Welles said.
noted that a third of the nation’s Hollon cited the growth of the
Medicaid sign-ups are from California,
The legislature definitely does not have
WWAMI system in the area as a big
New York and Washington.
an appetite for increasing tuition rates.
catalyst to growing medical education
“When we increase tuition we will
locally.
Asked why that is, Parlette said, “I think
lose more young men and women who
it’s because of the huge outreach in the
want to go to college,” Representative
WSU Spokane recently saw an increase
Larry Haler (R – Richland) told the
in the amount of medical students in
delegation.
Spokane. The school currently has 40
Legislators agreed that it is still too
students with plans to grow to 80 as
soon to fully judge the ACA’s impact,
soon as next year.
though Schmick said, “I do not see how
Kohl-Welles said in a perfect world, the legislature would reduce tuition, but
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state.”
this system is sustainable.”
can’t do that unless the state increases
Growing first- and second-year medical
its funding for higher education,
students is one piece of the puzzle,
To read the complete blog from the
thereby, “making the universities
and the state legislature has helped
Olympia trip visit the GSI website
whole.” Representative Larry Seaquist
along the way. The other piece includes
at http://www.greaterspokane.org/
(D – Gig Harbor) endorses an increase
residency slots – the Graduate Medical
blog/2014/01/gsi-leads-delegation-to-
in state funds to lower tuition costs.
Education (GME) portion of training
olympia/
The higher education conversation
doctors.
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PATIENT SAFETY AND ADVOCACY (PART 1 OF 2)
By Ward B. Buckingham, MD
17 years as solo practitioner in Coos Bay,
seizure disorder controlled by correct
OR. Here are a few reasons out of my
medicine in 2012. Some of these were
Doctors Are Human…So…Why Worry?
own family history why I personally am
errors of commission while others were
In 2006 a Time Magazine cover story
concerned: 1) paternal grandmother died
errors of omission and my father’s near-
asked: “What scares doctors?” The
because healthy kidney was removed
death experience clearly involved both.
answer was “being the patient”. We
instead of non-functioning one decades
need to put ourselves in the patient’s
before dialysis availability, 2) my father
What is it about physician makeup that
place. If we are aware of errors that can
having elective rib biopsy under local rib
renders us imperfect? Here are some
occur and see errors occurring with our
block anesthesia in 1983 one hour post-
thoughts I as a physician have: 1) we
patients, we need to take a step back
op arrested from bilat pneumothoraces
are human beings with human frailties,
and say, “What else can we do?” We
inflicted by anesthesiologist who left
2) many are obsessive compulsive
need to focus on the patient rather than
without cautioning caregivers to observe
perfectionistic types who find criticism
ourselves and do whatever we can to
for sequelae of his having punctured
from others difficult to deal with, 3)
improve patient care and outcomes.
both lungs during anesthesia, 3) my
our legal system seems to convey that
youngest brother sustained unrecognized
we are expected to be perfect when
Those are not my words but rather the
knee infection during traction for
we are not, 4) we too have “off” days
words of a physician in 2008 who is the
lower extremity fracture complicating
(family problems, health problems, sleep
patient safety officer of the well known
47% body burns whose care needs
deprivation), 5) often we are called on
Baylor University Medical Center.
preoccupied burn unit caregivers…
to be two places at once…a humanly
he wound up with a fused knee, 4) my
impossible feat and 6) the ever-present
I have always believed that patient-
mother was assumed by her doctor to
mentally burdensome “hassle factor”.
directed health care of necessity
be depressed after losing my father
Please note none of the foregoing is
requires a team approach with the
and something told me to get a second
intended to excuse incompetence but
patient the key team member. After
opinion which revealed hyperkalemia
rather highlight our human frailty.
sharing several vignettes and some
of renal failure due to polyarteritis
data illustrating the problem of medical
nodosa approx two days before she
Since the prestigious Institute of
errors I will suggest specific actions the
would have died of her lethal rising
Medicine’s sentinel study “To Err Is
patient, his family and/or advocates can
potassium blood level in 1998, 5) my
Human” published in 1999 brought
and should take to improve care. My
90 year old father-in-law’s dizzy spells
attention to the problem of iatrogenic
goal also is to progressively sell health
were being evaluated for a neurologic
medical harm, the media has been
care providers and insurers on why our
cause without considering cardiac source
increasingly aggressive toward
collective interest in and application of
which I discovered during a spell in
publicizing this troubling reality of
these actions should improve patient
2007…pacemaker cured his spells, 6)
American medicine. The Health Grades
care. A fall 2012 mailing to Spokane
my daughter’s postpartum bleed and
Patient Safety In American Hospitals
residents promoted Providence’s
protracted shock complicating the
Study found 195,000 deaths annually
expressed interest in enhancing patient
HELLP syndrome was left to regular
2000-2002 due to preventable in-
health care safety.
postpartum ward for nine hours rather
hospital medical errors. Health Grades
than early transfer to a critical care
was more representative, being based
How are we doing?
setting in 2008 here in Spokane and
on all 50 states, than the Institute of
My background is as an internist, trained
7) my other brother had neurologic
Medicine Study which was based on
at the University of Washington and
symptoms interpreted by one hospital
only three states sampling. Furthermore
University of Rochester, finishing as
and doctor team as threatened stroke…
that IOM study estimated iatrogenic
chief resident at the UW in 1975. I then
my intervention again sending him to
morbidity rates at upwards of one million
spent a career in primary care, the last
another hospital and doc team revealed
patients injured annually. Now that I’ve
SPOKANE COUNTY MEDICAL SOCIETY |
9
| THE MESSAGE | MARCH, 2014
established that there is a safety problem
leaders, clinicians and patients alike…
sure you understand what your doctor is
with US health care delivery how are
and we must then work collaboratively
trying to tell you, 3) be honest with your
we doing to correct it? The Agency for
to decrease the frequency with which
doctor…don’t ‘sugarcoat’ your health
Healthcare Safety and Quality (AHRQ),
needed care causes harm. Furthermore
report just to please him or her, 4) bring
a division of the US Department of
to yield measurable improvements
a written list of items you wish to cover
Health and Human Services, published
in patient safety, full adoption of a
during your doctor interaction…realize
in 2001 the “Making Health Care Safer”
safety culture must be accompanied
you might need another appointment
report, the first effort to use evidence-
by widespread implementation of
to complete both your list and what
based principles in identifying practices
evidence-based safety interventions such
your doctor feels needs be covered,
to improve patient safety. Though there
as infection-control bundles, surgical
5) become an active participant in
was some impact from applying their
checklists, computerized order entry,
your own healthcare, 6) find another
recommendations, Sumant Ranji,M.D
bar coding and other information
doctor if you feel uncomfortable or
(Program Director for Quality and
technologies, as well as improvements in
unable to communicate freely with your
Safety at UCSF’s internal medicine
provider work hours, handoffs of patient
doctor and 7) don’t hesitate to enlist
residency program in San Francisco)
care, and working conditions.”
an advocate (family member, friend,
stated 3/25/2013 in AHRQ’s “expert
healthcare professional) to help you
commentary”: “Despite…success stories,
Since organized medicine and the
better navigate our increasingly complex
the sobering truth is that overall safety
government seem to be having difficulty
healthcare system.
has not improved throughout the past
improving overall health care safety
decade.” Furthermore Landrigan et
what about getting you…me…us…the
It is true that a chain is only as strong
al’s 2010 NEJM study running from
patients and families and advocates…
as its weakest link. Do not be the weak
2002 through 2007 is really a wakeup
involved? And all reading this will at
link in your health care team! Your
call that we are clearly not making the
some time be patients themselves even
health care team’s focus should be
impact we should be. They concluded
if their role presently is as physician
you and your health care. But you, the
that “it is imperative that we develop a
healthcare providers. Here are some
patient, also have a responsibility to do
strong transparent nationwide system
suggested protective action steps I’ve
your part. Do not expect optimal results
for tracking harm due to medical care so
identified: 1) have a low threshold for
if you the patient are living lifestyles
that the risk of harm is visible to hospital
requesting a second opinion, 2) make
counter to healthy choices.
Coldwell Banker Tomlinson
Welcomes You and Joe DiDomenico, CISP with the Entrust GroupJoel Crosby, CCIM with Coldwell Banker Tomlinson Commercial will explain some local Commercial Real Estate options Jurene Phaneuf, Realtor with Coldwell Banker Tomlinson, will explain how she and her husband have used this concept for their IRA real estate investments.
Two Opportunities 11:00 am - 1:00 pm - Lobby of the Madison Inn,
15 W. Rockwood Blvd (across from Sacred Heart Medical Center Auditorium)
7:00 to 8:30 pm at the Coldwell Banker Tomlinson, 2nd Floor Conference 4102 S Regal (near Ferris High School).
To reserve your seat or for more info call: Joel Crosby (509) 991-2312
Refreshments/lunch will be served at each gathering.
SPOKANE COUNTY MEDICAL SOCIETY |
There is no obligation or cost to attend either of these informative events. Each will involve a short presentation followed by time for you to ask questions and discuss your concerns.
crosbycommercial@gmail.com
10
Jurene Phaneuf (509) 294-1192
jurenephaneuf@gmail.com
| THE MESSAGE | MARCH, 2014
BEYOND “LOADING”
author that treatment should be aggressive
ADDRESSING THE ROLE OF EXCESS CENTRAL AND VISCERAL BODY FAT ON THE PROGRESSION OF RHEUMATOID ARTHRITIS/OSTEOARTHRITIS/DEGENERATIVE JOINT DISEASE By Christopher M. Valley, ND
that similar mechanisms involving
Limitations of this however are the use of
Arthritis Northwest PLLC
inflammatory cytokines may be playing a
the BMI as the measurement of ideal body
role with osteoarthritis as well.3-4
weight. This does not take into account
A significant amount of research has been
bone structure, water content, visceral
conducted on the relationship between
There is no question that body weight
deposition etc. Given what we know
excess adipose tissue, particularly
plays a direct role on the mechanical
about the co-morbidity associated with
central adipose, and its contribution to
loading of joints. However, with individuals
RA (heart disease, stroke, CA etc.) and
inflammatory diseases, e.g. cardiovascular
of equal weight, the degree of degeneration
the significant decrease in these diseases
disease, cancer, diabetes, stroke, and
seen in osteoarthritis is usually worse
with body fat loss, further investigation is
autoimmune inflammatory diseases such
with patients that have increased central
required to uncover the meaning behind
as rheumatoid arthritis.Several studies
adiposity and dyslipidemia.4
the “paradox”.
Treatment should also encompass focusing on the various barriers to weight loss including cultural, financial resources, living situation, mental emotional status, cravings and many others. Treatment should include a combination of nutrition interventions, clinical exercise, and potentially medicine choices tailored to each individual. References: • Acta Reumatol Port. 2009 Oct-Dec; 34(4):5908. Metabolic syndrome, inflammation and atherosclerosis - the role of adipokines in health and in systemic inflammatory rheumatic diseases. Santos
have found increased levels of “adipose
MJ, Fonseca JE.
derived angiopoietin-like protein 2
There are also direct relationships
Adipose tissue is well known to secrete
(Angptl-2)” in the synovial fluid of
between elevated C-reactive protein
IL-6 levels which in turn increase CRP
patients with rheumatoid arthritis and
(CRP) in patients with excess adipose
levels.9
significant degenerative osteoarthritis.
tissue. However, this is more often
This chemical has been shown to directly
observed in women.
• Arthritis Rheum. 2009 Jul; 60(7):1906-14. Adipocytokines are associated with radiographic joint damage in rheumatoid arthritis • Nat Rev Rheumatol. 2011 Jan; 7(1):65-8. Epub 2010 Aug 17. Obesity punches above its weight in
stimulate an inflammatory cascade of
CRP levels are shown to be much
osteoarthritis.
higher in patients with elevated waist
• Curr Opin Rheumatol. 2010 Sep; 22(5):533-7. The evolving role of obesity in knee osteoarthritis
events that can contribute to further
Interestingly, degradation of articular
to hip ratios even after adjusting for
degradation of joint tissues.1
cartilage in male patients was observed
BMI.10 Several studies have shown that
with increase adipose tissue despite
patients with psoriatic arthritis who are
Treatment approaches that focus on
a lower CRP level.5 Research is also
treated with TNFα blockers will not
decreasing adipose tissue, directly
quite strong that disability is strongly
achieve minimal disease activity (MDA)
Association of body composition with disability in
decreased Angptl-2 levels in synovial
associated with increased adipose tissue
as effectively with increased central/
rheumatoid arthritis: impact of appendicular fat and
fluid. It has also been found that
in patients with rheumatoid arthritis.
abdominal adipose tissue.
lean tissue mass.
increasing levels of what are referred
There is also some conflicting information
to as adipocytokines (e.g. adiponectin,
referring to the “obesity paradox” in
The information listed above is simply
leptin, and visfatin, IL-6, TNF-alpha,
Rheumatoid Arthritis. Several studies
skimming the surface with respect to the
NFkB) are significantly elevated in the
have shown that in patients with a BMI
amount of research performed linking
Paradoxical effect of body mass index on survival
joint spaces of patients with rheumatoid
30+ joint destruction is less severe, and
excess adipose tissue with increased
in rheumatoid arthritis: role of comorbidity and
arthritis, and that these elevated levels
mortality may be less as well.7-8 Full
systemic inflammation. Therefore, one of
systemic inflammation. Escalante A, Haas RW, del
were directly associated with increased
and complete understanding of why
the primary goals and treatment of the
articular damage on radiograph, although
this phenomenon occurs is not well
rheumatologic patient must be working
leptin may have a protective mechanism
understood. However, obese individuals
towards optimal body weight with an
(referred to as the “obesity paradox”
have higher levels of IL-1rA (Interleukin-1
emphasis on W/H ratio, improving lean
2005;165:1624-1629.
discussed below).
Receptor Antagonist) and Leptin, both of
muscle mass relative to body fat, not simply
• Yudkin JS, Stehouwer CD et al. C - reactive protein
which seem to confer anti-inflammatory
relying on BMI. Given the profound
in healthy subjects: associations with obesity, insulin
It was previously thought that the main
mechanisms in these patients. Similar
inflammatory influences that excess
pathological contributing factor of excess
paradox is seen in other wasting diseases
adipose tissue has been shown to exert in
body weight to osteoarthritis was the
(e.g. CHF, s/p heart transplant, diseases
rheumatoid arthritis, not to mention the
mechanical loading effect upon the
of the elderly) and may represent a
systemic effects well documented with
and the prediction of minimal disease activity. A
articular aspects of the joints themselves.
protective mechanism.
respect to cardiovascular disease, cancer,
prospective study in psoriatic arthritis. Arthritis
stroke, diabetes etc. It is the opinion of this
Care Res 2012. April 18 [Epub ahead of print] doi:
2
COMMUNITY OF PROFESSIONALS
and include a multi-modal approach.
However, the recent research has found
SPOKANE COUNTY MEDICAL SOCIETY |
11
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| THE MESSAGE | MARCH, 2014
11
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.
• Arthritis Rheum. 2008 Sep; 58(9):2632-41. Association of body fat with C-reactive protein in rheumatoid arthritis • Arthritis Rheum. 2008 Oct 15; 59(10):1407-15.
• Ann N Y Acad Sci. 2006 Jun; 1069:444-53. Adipose tissue has anti-inflammatory properties: focus on IL-1
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.
receptor antagonist (IL-1Ra). • Arch Intern Med. 2005 Jul 25; 165(14):1624-9.
Rincón I. • Role of Comorbidity and Systemic Inflammation. Agustín Escalante, MD; Roy W. Haas, PhD; Inmaculada del Rincón, MD, MS Arch Intern Med.
resistance, endothelial dysfunction: a potential role for cytokines originating from adipose tissue?
“You think you’re prepared for it, and you’re just not. I made the choice for Hospice of Spokane. The doctor said ‘enjoy the fact you can just be [the] daughter now.’” – Amanda, daughter of Hospice of Spokane patient
Arterioscler Thromb Vasc Biol 1999; 19; 972-8.
Northeast Washington’s only nonprofit hospice, providing care and support for terminally ill patients and their families since 1977.
• Diminno MN, Peluso R, Lervolino S, et al. Obesity
Comfort. Dignity. Peace of Mind. 509.456.0438
10.1002/acr.21711.
SPOKANE COUNTY MEDICAL SOCIETY |
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| THE MESSAGE | MARCH, 2014
hospiceofspokane.org
HEALTH UPDATE/ALERT
UPCOMING CHANGE FOR WIC FAMILIES RECEIVING CHECKS FOR SIMILAC SENSITIVE OR SIMILAC SPIT-UP FORMULAS By Spokane Regional Health District
20 calories per ounce to 19 calories per
(www.spokanewic.org/medicalproviders)
Epidemiology
ounce. Nineteen calories per ounce does
at www.spokanewic.org that can be
not meet U.S. Department of Agriculture
used to help families transition to a new
Effective March 1, 2014, Washington
(USDA) regulations for “standard”
formula. These cards are also currently
State Department of Health’s (DOH)
formulas, meant for healthy babies. Under
being distributed at SRHD WIC sites.
Women, Infant and Children’s (WIC)
USDA guidelines, if WIC were to continue
nutrition program will no longer offer
using Similac Sensitive or Similac Spit-
Call-To-Action for Medical Providers
Similac Sensitive or Similac Spit-Up
Up, it would require the client to have
Medical providers’ help in consistently
formulas to its clients. Spokane Regional
a prescription for the formula specific
communicating these upcoming changes
Health District (SRHD) is sending this
to a qualifying medical condition.
to this shared audience is greatly
health alert as it administers WIC in six
Since these formulas were designed for
appreciated. Again, many healthy babies
regional locations in Spokane, where
healthy babies, it is likely most infants
can easily transition between formulas
these formulas will no longer be offered.
would not have a medically-qualifying
without difficulty. If a medical provider
West Central Community Center operates
condition. Obtaining prescriptions would
decides a different formula is medically-
four additional Spokane WIC locations,
be cumbersome for these families, as
necessary, these are the formulas WIC
where these formulas will also no longer
well as health care providers and WIC
additionally provides with a prescription
be offered. All WIC offices will continue
staff. Healthy babies should be able to
and qualifying diagnosis:
to provide Similac Advance as its standard
transition to Similac Advance without any
formula, and Enfamil ProSobee is
significant difficulties and WIC staff are
Similac NeoSure
available without a prescription for babies
trained to help with transition plans.
Similac Alimentum
who need a soy or lactose-free formula.
MADNESS TO METHODS:
Enriching Educators’ Repertoire of Appropriate Instructional Methods Presented by Chris Surawicz, MD & Lynne Robins, PhD UW School of Medicine Department of Medical Education & Biomedical Informatics
____________________________________________ Wednesday, April 2, 2014 6:00PM - 9:00PM Spokane Riverpoint Campus Pharmaceutical & Biomedical Sciences Building, Room 101 Dinner will be served at 6PM & the presentation will begin at 7PM
Nutramigen
WIC staff appreciate that this may be a
How Will Transition Happen?
Enfamil EnfaCare
difficult transition for some clients and
Spokane WIC offices are beginning to
Good Start Gentle
appreciate medical providers’ help in
transition clients now, so babies will be
PediaSure (children only)
communicating this change.
fully-transitioned by the time Similac Sensitive and Similac Spit-Up are no
For more specific information, please
Why the Change?
longer offered on March 1, 2014. As a
visit pokanewic.org or contact Tiffany
Abbott Nutrition, the makers of Similac
resource, SRHD staff added a Formula
Schamber, program manager for
Sensitive and Similac Spit-Up formulas,
Transition card (rack card) to the medical
SRHD WIC at (509) 324-1633 or
recently changed both formulas from
community resource page
tschamber@srhd.org.
Register by emailing: jmford@uw.edu Learning Objectives: At the end of this educational activity, the participant will be able to: • Determine the Need for Interactive Teaching • Provide A Rationale For Making Teaching More Interactive • Incorporate Interactive Teaching Methods Into Presentations CME 1 Available
Providence Health Care is accredited by the Washington State Medical Association CME Accreditation Committee to sponsor continuing medical education activities for physicians. Providence Health Care designates this live activity for a maximum of 2 hours in Category 1 to satisfy the relicensure requirements of the Washington State Medical Quality Assurance Commission. Providence Health Care designates this live activity for a maximum of 2 AMA PRA Category 1 Credit(s)™. Physicians should claim only credit commensurate with the extent of their participation in the activity.
SPOKANE COUNTY MEDICAL SOCIETY |
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| THE MESSAGE | MARCH, 2014
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 Coons, Christopher S., DO Internal Medicine / Hospitalist Med School: Midwestern U (2011) Internship: Grandview Medical Center (2012) Residency: Grandview Medical Center (2014) Joining IPC, The Hospitalist Co. 07/2014 Cosma, Mihaela, MD Internal Medicine / Endocrinology Med School: U of Medicine and Pharmacy, Romania (1992) Internship: Municipal Clinic, Romania (1993) Residency #1: Municipal Clinic, Romania (1994) Residency #2: Abington Memorial Hospital (2003) Fellowship: Mayo Clinic (2007) Joining Rockwood Clinic 07/2014 Cruite, Irene W., MD Radiology / Body Imaging / Oncology Imaging & Nuclear Medicine Med School: U of Nairobi, Kenya (2002) Internship: Ministry of Health (2003) Residency #1: Royal College of Surgeons, Ireland (2008) Residency #2: U of WA (2013) Fellowship (Post-Doctoral) #: U of CA, San Diego (2010) Fellowship #2: U of WA (2011) Fellowship #3: U of WA (2012) Joining Inland Imaging, A Division of Integra 11/2014 Glazier Jr., Robert U., MD Ophthalmology Med School: Yale U (2010) Internship: Intermountain Medical Center (2011) Residency: U of Colorado, Denver (2014) Joining Rockwood Eye Center 08/2014 Hing, Andrew, MD Anatomic & Clinical Pathology / Hematopathology Med School: WA U, St. Louis (1990) Internship: WA U, St. Louis (1994) Residency #1: WA U, St. Louis (1996) Residency #2: U of WA, Seattle (2003) Fellowship (Post-Doctoral) #1: WA U, St. Louis (1997) Fellowship #2: U of WA, Seattle (2000) Fellowship #3: Pheno Path Laboratories (2004) Practicing with Incyte Diagnostics 01/2013
SPOKANE COUNTY MEDICAL SOCIETY |
Kinard, Krista, MD Ophthalmology / Neuro-Ophthalmology Med School: U of Utah (2009) Internship: U of Utah (2010) Residency: John A Moran Eye Center (2013) Fellowship: John A Moran Eye Center (2014) Joining Spokane Eye Clinic 07/2014 Nandagopal, Radha, MD Pediatrics / Pediatric Endocrinology Med School: U of WA (2003) Internship: Emory U (2004) Residency: Emory U (2006) Fellowship: National Institutes for Health (2010) Joining PMG Pediatric Endocrinology & Diabetes 03/2014 Petersen, Brian, MD Diagnostic Radiology Med School: Medical College of WI (2000) Internship: Sacred Heart Medical Center (2001) Residency: U of CO (2005) Fellowship: U of WI (2006) Joining Inland Imaging, A Division of Integra Imaging 07/2014
CONTINUING MEDICAL EDUCATION Spring 2014 Sports Medicine Update:
conference is one not to miss! Watch for
This seminar is jointly sponsored by
registration information coming soon!
Pullman Regional Hospital and the
Tran, Lan T., MD Obstetrics and Gynecology/ Maternal Fetal Medicine Joining Obstetrix Medical Group of Washington 03/14
PHYSICIAN ASSISTANTS Bachmeier, Brad J., PA-C Physician Assistant School: U of WA MEDEX (2012) Joining PMG – E WA Orthopedics 04/14 Beardslee, Donna L., PA-C Physician Assistant School: U of ND (1993) Joining Rockwood Clinic
15
| THE MESSAGE | MARCH, 2014
MEMBERSHIP RECOGNITION FOR MARCH 2014 Thank you to the members listed below. Their contribution of time and talent has helped to make the Spokane County
Spokane County Medical Society. 3.0
Institutional Review Board (IRB) -
AMA Category 1 Credits. Conference
Meets the second Thursday of every
will be held on April 12, 2014 from
month at noon at the Heart Institute,
9:00 a.m. – noon at Pullman Regional
classroom B. Should you have any
50 Years
Hospital, Pullman WA. For additional
questions regarding this process, please
Robert C. Dickson, MD
information please contact Patty Snyder
contact the IRB office at (509) 358-7631.
at (509) 336-7388 or email patty. snyder@pullmanregional.org.
MEETINGS/ CONFERENCES/EVENTS SAVE THE DATE! Primary Care Update 31st Annual Conference May 2 and 3, 2014 Red Lion at the Park update is a tremendous opportunity for physicians and other health professionals to choose from more
Brown, Keri Li, MD Obstetrics and Gynecology Joining Obstetrix Medical Group of Washington 03/2014
the general excitement of Spokane’s Bloomsday Run on Sunday, May 4, this
Spokane, WA This well established
PHYSICIANS PRESENTED A SECOND TIME
and learn from others. Combined with
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
Physician Family Alanon Group: Physicians, physician spouses or
Medical Society the strong organization it is today.
3/24/1964
40 Years Michael P. Berg, MD
3/26/1974
30 Years
significant others and their adult
William I. Bender, MD
3/7/1984
family members share their experience,
Thomas N. Fairchild, MD
3/7/1984
strength and hope concerning difficult
June S. Goldman, MD
3/7/1984
physician family issues. This may
Larry L. Milsow, MD
3/7/1984
include medical illness, mental illness,
D. Scott Redman, MD
3/7/1984
addictions, work-related stress, life
Thomas E. Richardson, MD
3/7/1984
transitions and relationship difficulties.
Stephen R. Sears, MD
3/7/1984
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
20 Years Diane L. Danly, MD
3/16/1994
L. Elizabeth Peterson, MD
3/16/1994
Deborah J. Harper, MD
3/18/1994
fees. To discuss whether this group
10 Years
could be helpful for you, please contact
William R. Martin, PA-C
Bob at (509) 998-5324.
3/24/2004
Kristin M. Treece, PA-C MS 3/24/2004
THOMAS J. ALLERDING, MD RETIRES AFTER 31 YEARS AT INCYTE DIAGNOSTICS Thomas J. Allerding, MD will be retiring
trustee of the Washington State Medical
Dr. Allerding taught at the SHMC
in early April after 31 years in Pathology
Association.
Medical Technology School and was
practice. He has been with Incyte Diagnostics since 1983.
a guest speaker at several educational Dr. Allerding chose a career in medicine
meetings throughout the state. He is
after working as a hospital orderly to earn
routinely named to the Best Doctors list.
Dr. Allerding received his medical degree
extra money in high school. Originally,
from the Ohio State University School of
he planned to become a cardiologist, but
Dr. Allerding is a classical music
Medicine and completed his residency
once he set foot in a medical laboratory,
enthusiast and longtime attendee and
at the University of New Mexico. He is
he never looked back. Dr. Allerding was
contributor to the Spokane Symphony.
board certified in anatomic and clinical
Medical Director at Pathology Associates
When he is not practicing pathology, he
pathology with subspecialty interest in
Medical Laboratory for ten years and
is probably mucking out stalls or trail
laboratory medicine. Dr. Allerding is a
at Sacred Heart Medical Center for
riding with his wife of 37 years, Helen.
past president of the Spokane County
another six years. He developed Incyte
Congratulations Dr. Allerding!
Medical Society and of the medical staff
Diagnostics’ Quality Assurance program
at Valley Hospital. He is also a past
that has been in place for over 20 years.
SPOKANE COUNTY MEDICAL SOCIETY |
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| THE MESSAGE | MARCH, 2014
THURSDAY 17 APRIL
NEW DATE!
GENERAL MEMBERSHIP MEETING A social evening of laughter and collegiality for SCMS members and their guests. R E D L I O N 3 0 3
W
6 : 0 0 P M 7 : 0 0 P M 8 : 0 0 P M
H O T E L
N O R T H
R I V E R
A T
D R
T H E
You're invited to a
Region 9 Healthcare Coalition General Membership meeting
P A R K
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
CREDIT CARD TOTAL$
Expiration Date
Served with apple bourbon mustard
Card Holder’s Name
vegetable
Chicken Oscar Boneless skinless breast of chicken
Phone #
State
Zip Code
topped with Dungeness crab,
Meal Requests:
asparagus and béarnaise sauce with
Name_________________________________________ Pork Chicken Vegetarian
saffron rice and fresh vegetable
Name_________________________________________ Pork Chicken Vegetarian
Vegetarian Chef’s choice
$20 per person
Come learn why EVERY healthcare in provider in our community is essential to making our entire healthcare system more resilient during an emergency or medical surge event. The Region 9 Healthcare Coalition works to ensure providers can deliver the best patient care in the most efficient time. Every medical office has a place in preparedness and response planning — we hope you’ll join us! Lori Upton brings years of hands-on event response and coordination experience. She’ll be talking with our coalition about relationship building, emergency medical staffing, disaster response, and many other topics. SETRAC provides stakeholder support through planning, facilitation, operations and the provision of technical assistance to their region for Preparedness, Trauma, Injury Prevention, Stroke, Cardiac and Pediatric services. SETRAC prepares their 9-county region for manmade or natural emergencies, disasters and mass casualty events.
Thursday, March 27, 2014
FREE
Card Holder’s Billing Address City
Director of Preparedness for Southeast Texas Regional Advisory Council
Lunch: 11:45 am Meeting: Noon — 2:30 pm Enduris Washington, 1610 Technology Blvd, Spokane WA 99224
Account Number
Double Cut Pork Loin Chop glaze, smashed red potatoes and fresh
MAKE CHECKS PAYABLE TO SCMS
Visa MasterCard
Keynote Speaker: Lori Upton, RN BSN MS CEM
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.
Join our efforts to increase the resiliency of your practice's and our community's health care system emergency response capacity by:
Delivering the right care in the right amount of time during emergencies Meeting the planning and response needs of the broader health care system Having a voice in the community planning process Securing Medicaid reimbursement through active participation in preparedness planning
Questions? Email: hcc@srhd.org Call: (509) 324.1465 Reserve your seat today! Registration closes March 21, 2014. Visit www.srhd.org/hcc to register for the March 27th meeting.
CLASSI F I ED A DS POSITIONS AVAILABLE PHYSICIAN (OB/GYN and Urgent Care) OPPORTUNITIES AT COMMUNITY HEALTH ASSOCIATION OF SPOKANESpokane 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. 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 full- time 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) 4590688 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) 4746605 for more information. 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-theart medical ambulatory center (construction completion target is spring 2014). No OB. Outpatient only. Competitive compensation and comprehensive 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. 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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SPECTRUM HEALTHCARE RESOURCES has an immediate opportunity for a civilian Family Practice Physician at Fairchild Air Force Base. This contract position offers: Full-time; 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. 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.
| THE MESSAGE | MARCH, 2014
CLASSI F I ED A DS MANN-GRANDSTAFF VA MEDICAL CENTER in Spokane is filling several Physician positions, both staff and leadership. 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. N.E. WASHINGTON HEALTH PROGRAMS LOON LAKE COMMUNITY HEALTH CENTER is seeking a family practice ARNP or PA-C. 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 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 resume for review. 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.
CUSTOM HOME - LITTLE SPOKANE RIVER VALLEY FOR SALE - Nestled on a slight hill overlooking the peaceful Little Spokane River Valley with 220 feet of waterfront acreage sits a beautiful custom home designed and built by the renowned architectural firm of Copeland Design and Construction. The home surroundings are wonderfully landscaped with paths that lead to the Little Spokane River and woods. The interior has natural wood details which accentuate each room. The many Hurd windows give panoramic views of the river valley. There are 4 bedrooms, library, sun room, master bedroom, master bath with imported European tile, great room with tiled gas fireplace, kitchen with Corian counters and bar seating, laundry room, mud room, large rec room, two and 1/2 baths, furnace room, utility/wine storage room and a 3-car attached heated garage. There is a heated green house with an adjacent fenced in garden area. A paver patio, back deck with hot tub and front porch allow for enjoyment of the pleasant summer evenings. The home has solar water heating and solar electric with backup batteries and generator. It is in the Mead school district and only 10 - 15 minutes from Providence Holy Family Hospital and 25 minutes from Providence Sacred Heart and Deaconess Hospitals. There are too many other details to list here. Please call: (509) 466-6947 or (509) 879-3770. 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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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. BEAUTIFUL PRIEST LAKE CABINS FOR RENT Our newly restored cabins are located on the historic site of Forest Lodge in the entrance to the scenic Thorofare. Two cabins are available. Each sleeps 8. They are located at the water’s edge, have gorgeous views, bordered by the National Forest and 18 acres of private land. The beds and furnishings are all new and cabins have all the amenities - decks, docks, beaches with fire pits, walking trails and forest to explore. Boating, hiking, swimming, sailing, snowmobiling in winter or just relaxing in the sunshine. You will enjoy a peaceful, fun-filled vacation at this amazing site. For available dates, pricing, photos and details call Jeannie or John at (509) 4480444. 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! $750,000 Call Marilyn Amato at (509) 979-6027.
| THE MESSAGE | MARCH, 2014
CLASSI F I ED A DS MEDICAL OFFICES/BUILDINGS 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 PRACTICE EXCELLENCE. Pediatrician
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.
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.
For additional information or to submit your CV, please contact: Aggie Swanson swanson.ax@ghc.org
GroupHealthPhysicians.org
GHP Recruiting Dept: 1-800-543-9323
IN THE NEWS
Incyte Diagnostics Welcomes New GI Pathologist
Dr. Grindeland graduated from the University of North Dakota
Incyte Diagnostics welcomed a new pathologist, Isaac R.
School of Medicine and completed his residency at Penrose-St.
Grindeland, MD. Dr. Grindeland is board certified in anatomic
Francis Health Services in Colorado Springs, CO. He practiced
and clinical pathology with a fellowship in gastrointestinal (GI)
pathology in Colorado and Oregon before arriving in Spokane.
pathology.
Dr. Grindeland joined Incyte Diagnostics in February.
SPOKANE COUNTY MEDICAL SOCIETY |
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| THE MESSAGE | MARCH, 2014
The Power of the Mind Has Been Well Known for a Long Time.
JOIN CHRIST CLINIC AND CHRIST KITCHEN APRIL 24TH FOR RENEW 2014 WITH JJ HELLER! Thursday, April 24th, 7-9pm, we present an acoustic performance by JJ Heller. Her music and lyrics are the perfect soundtrack to the message of God’s love expressed through the staff and volunteers at Christ Clinic and Christ Kitchen. Dramas will be presented showing the lifesaving ministry of the Clinic & Kitchen. There is no charge for this event; an appeal will be made to support the work of Christ Clinic/Christ Kitchen. Register at www.ccckrenew.org
We know your patients expect you to have all the answers. Positive Changes Hypnosis would like to present one more option that you can offer your patients. We help your patients by using powerful hypnosis backed by personal coaching to help them lose weight, stop smoking, manage pain or anxiety, and more. Hypnosis is a safe, natural and effective way for people to take control of their health and become better patients for you. Call us for a tour of our facility and experience hypnosis for yourself.
(509)462-4222 Positive Changes has programs to help with a variety of issues:
• Anxiety • Stress • Insomnia
• Weight loss • Tobacco Free • Alcohol Free
• Panic Attacks • Pain Management • Motivation
• Bed Wetting • Hair Pulling • Skin Picking
• Self-Con�idence • Self-Esteem • Grieving
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
The Spokane County Medical Society is changing
from gardening to skydiving. We just need your help
the monthly newsletter, The Message, and is
getting names and ideas. Our writers will contact
looking to include human interest stories about our
members to do interviews.
physician and physician assistant members. We are interested in exciting, different and/or
Please contact Michelle at michelle@spcms.org or
unusual activities and hobbies. It can be anything
(509) 325-5010 with any information. Thank you.