FEBRUARY EDITION, VOLUME 2015, NO. 2
A Message from the CMS President By Joshua Somerset, M.D.
Welcome to 2015! I have the pleasure of serving as your CMS president this year. I have been on the Capital Medical Society Board of Governors for the last 4 years, which pales in comparison to the years of service from physicians like Drs. Skilling, Mahoney and Hellgren (to name a few). What an eminent organization with a simple focus, “To promote the practice of medicine for the ultimate benefit of the patient.” And in case you haven’t noticed, the practice of medicine could use a little promoting. Our healthcare system can be challenging to navigate. When the tables get turned and one finds their spouse, children or parents becoming the patient, a more complete and unflattering picture of healthcare emerges. I don’t want to sound pessimistic because I think our healthcare system has some incredible assets and a bright future. I just think that the current
healthcare costs are unsustainable and the system is not inclusive. These 2 factors, cost and exclusions, are going to spawn a high cost system with mediocre outcomes. How many articles have you seen blasting the US Healthcare System as having the
this area has been astounding. Only more astonishing has been the cost of this progress. Current hepatitis C medication can cost $1000 per pill daily for an expected 90 day treatment course. With over 3 million people in the United States chronically infected with hepatitis
highest costs in the world with average outcomes? As a physician I feel defensive about this, but also feel as if I have little control over it.
C, this new therapy will breach some budgets. This is just another example of how healthcare system costs can explode and individual physicians may have little control of costs.
The cost of overconsumption of food/ beverage, lack of exercise and poor lifestyle choices including smoking can make an otherwise healthy population present with preventable diseases. These preventable diseases substantially impact the cost of healthcare; at the same time they worsen the outcomes. Look at the negative effects the obesity epidemic has had on healthcare costs and outcomes. Despite seeing this effect daily in my clinical practice, most of my overweight patients cringe when I touch on lifestyle changes. Most people do not welcome input on weight loss; similarly our cigarette smoking patients roll their eyes when we tell them to stop smoking. As a Gastroenterologist, I treat patients chronically infected with hepatitis C. The progress over the last 10 years in
I am sure those of you in other areas of medicine have numerous examples of how complex and overwhelming the healthcare system can be. We are faced with an outsized challenge and we need to respond. In these situations, there is a tendency to think that individual efforts at improving the system are futile. Add a busy practice, a busy family, and spare time is at a premium. This is where CMS can help. CMS can help physicians focus on common goals. CMS is a support network for physicians. CMS can play an integral role in Florida’s healthcare industry by addressing issues to improve quality and affordability of patient care. I look forward to having a great year and building on the momentum of past CMS presidents. I look to collaborate and build with you in 2015 and beyond. CMS
CAPITAL MEDICAL SOCIETY 2015 MEETINGS CALENDAR March 26, 2015 Celebration Awards Dinner 6:30 pm FSU University Center Club
April 21, 2015 May 19, 2015 CMS Membership & CME Meeting CMS Membership & CME Meeting 6:00 pm 6:00 pm Maguire Center for Lifelong Learning at Maguire Center for Lifelong Learning at WestminsterCAP Oaks Westminster Oaks SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 1
MISSION: TO PROMOTE THE PRACTICE OF MEDICINE FOR THE ULTIMATE BENEFIT OF THE PATIENT. (850) 877-9018 Fax: (850) 878-0218 www.capmed.org
BOARD OF GOVERNORS Joshua Somerset, M.D., President J. Daniell Rackley, M.D., President-Elect Tracey Hellgren, M.D., Secretary/Treasurer Alfredo Paredes, M.D., Immediate Past-President Shelby Blank, M.D. Garrett Chumney, M.D. David Dixon, D.O. Shakra Junejo, M.D. Maribel Lockwood, M.D. Amy Pagano, CMS Alliance President Paresh Patel, M.D. Philip Sharp, M.D. Ernesto Umaña, M.D. Kenneth Whithaus, M.D. Pam Wilson, Executive Director Family Medicine Residents William Carlson, M.D./Anna Hackenberg, M.D. Internal Medicine Residents Chris Rosadzinski, M.D./Prerna Satyanarayana, M.D.
PUBLICATION EDITOR Charles E. Moore, M.D.,
MANAGING EDITOR Shannon Boyle
GRAPHIC DESIGN Young Design
ARE YOU INTERESTED IN WRITING AN ARTICLE FOR CAP SCAN? Please contact Dr. Charles Moore at cmoore5186@aol.com and Shannon Boyle at sboyle@capmed.org. All articles submitted will be reviewed by your peers prior to publishing. Cap Scan is published during the first week of each month and is the official publication of the Capital Medical Society. Advertising in Cap Scan does not imply approval or endorsement by the Capital Medical Society. The opinions expressed are those of the individual authors and do not necessarily reflect the official policies of the Capital Medical Society. If you are a member of the Capital Medical Society and would like a copy of the Minutes from the Board of Governors meeting, please call the CMS office. Thank you. 2
I N T H I S I SS U E :
CMS FAMILY FUN NIGHT
A Message from the CMS President…
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Celebration Awards Dinner ...
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CMS New Members ...
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2015 CMS Foundation Board of Directors ...
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CMS Lunch & Learn …
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Doctor of the Day Program …
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Reflections from the Editor …
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Viewpoint …
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CMS Foundation: We Care Network …
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CMS Foundation …
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Medical/Legal …
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HAPPY BIRTHDAY! {FEBRUARY BIRTHDAYS}
Nelson Kraeft, M.D. – 1st
William Simmons, M.D. – 14th
Robert Steinmetz, M.D. – 1st
Kenneth Kato, M.D. – 15th
Bert Morales, M.D. – 2nd
Chris DeRosier, M.D. – 16th
David O’Bryan, M.D. – 2nd
Jacqueline Lloyd, M.D. – 16th
Brian Sherman, M.D. – 3rd
Jose Rodriguez, M.D. – 16th
C. Raymond Cottrell, M.D. – 4th
Garrison Rolle, M.D. – 16th
Shakra Junejo, M.D. – 6th
Robert Snyder, M.D. – 16th
Wade Douglas, M.D. – 7th
Robert Atwater, M.D. – 18th
Ramel Failma, M.D. – 7th
Narlito Cruz, M.D. – 19th
Donald Loucks, M.D. – 7th
Meredith McKinney, M.D. – 19th
James O’Neill, M.D. – 7th
Jerry Ford, M.D. – 21st
Stephen Quintero, M.D. – 7th
Joseph Camps, M.D. – 22nd
William Thompson, M.D. – 7th
Jamell Walker, M.D. – 22nd
Frank Gredler, M.D. – 8th
James Geissinger, Jr., M.D. – 23rd
John MacKay, M.D. – 8th
Angela Spencer, M.D. – 24th
Michael Cavallaro, M.D. – 9th
Elizabeth King, M.D. – 25th
Larry Harper, M.D. – 10th
Abbey Peters, M.D. – 25th
Krista Rankin, M.D. – 10th
Joseph Baker, M.D. – 26th
Jeannine Silberman, M.D. – 10th
Gregory Albright, D.O. – 28th
Satish Mital, M.D. – 11th
Charles Bianco, M.D. – 28th
Happy Birthday! We are so glad you were born!
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
Did we miss your birthday? If so, please email Rosalie Carlin at rcarlin@capmed.org!
CELEBRATION AWARDS DINNER
2015 MEETINGS CALENDAR May 28, 2015 CMS Doctor/Daughter Banquet 6:00 pm Golden Eagle Country Club
September 15, 2015 CMS Membership & CME Meeting 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
October 20, 2015 CMS Membership & CME Meeting 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
November 10, 2015 CMS Membership & CME Meeting 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks
December 3, 2015 CMS Foundation Holiday Auction 6:30 pm Location: TBA
Mark Your Calendar for the 14th Annual Celebration Awards Dinner Celebrate the profession of medicine with your colleagues! Mark your calendars for the Capital Medical Society’s annual Celebration Awards Dinner on Thursday, March 26th at 6:30 pm at the University Center Club at Florida State University. Our Celebration Awards Dinner honors Doctors’ Day, which is on March 30th every year.
An exciting part of this event is the presentation of two prestigious awards. The I.B. Harrison, M.D. Humanitarian Award will recognize a local physician’s humanitarian effort to help patients. The Outstanding Physician Award will recognize a local physician’s effort to help the profession of medicine. The 2015 winners will be announced in early February.
Invitations will be sent in early March. We hope to see you there! CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 3
CMS NEW MEMBERS
Capital Medical Society is pleased to welcome the following New Members:
Babatunde Adekola, M.D. Medical School: Mayo Medical School Internship/Residency: Mayo Clinic Fellowship: University of Minnesota Specialty: Pain Management Practice: Tallahassee Neurological Clinic
Omodele Awoniyi, M.D. Medical School: University of South Florida Internship/Residency: University of Miami Fellowship: University of Tennessee Specialty: Internal Medicine/ Endocrinology Practice: TMH Physician Partners, Endocrinology Specialists
Sharron Foster, M.D. Medical School: University of Medicine & Dentistry of New Jersey Internship/Residency: University of Medicine & Dentistry of New Jersey Specialty: Internal Medicine Practice: Neighborhood Medical Center
Andrew Hsia, M.D. Medical School: University of Florida Internship: Shands University of Florida Residency: George Washington University Hospital Fellowship: University of Alabama Specialty: Ophthalmology Practice: Southern Vitreoretinal Associates
Join your colleagues for a
Happy Hour Social Thursday, February 19, 2015 5:30 pm – 7:30 pm The Front Porch 1215 Thomasville Road
Hors d’oeuvres and first select beer or wine provided by our sponsor:
Please RSVP by February 12 to Rosalie Carlin at (850) 877-9018 or rcarlin@capmed.org. This event is limited to 75 people. Be sure to RSVP today to reserve your spot! * Due to space limitations, this event is for Active and Associate CMS Members Only.
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
2015 CMS FOUNDATION Board of Directors John Mahoney, M.D. President Pathology Pathology Associates Married to Barbara Mahoney University of Florida
Nancy Loeffler, M.D. Anesthesiology Anesthesiology Associates of Tallahassee Married to Duane Pickel Baylor College of Medicine
Al McCully, M.D. Vice President Urology Retired University of Tennessee
J. Daniell Rackley, M.D. CMS President-Elect Urology Southeastern Urological Center Married to Jennifer Rackley Medical College of Georgia
Barbara Williams, M.D. Secretary Family Medicine Patients First Married to Dennis Williams, M.D. University of Florida
Katrina Rolle, Esq. Attorney Married to Gary Rolle, M.D. University of Florida
Kenneth R. Wasson, M.D. Treasurer Pulmonary Medicine Retired Married to Lee Wasson Vanderbilt University
J. Brian Sheedy, M.D. Hematology/Oncology Retired Married to Wende Sheedy State University of Buffalo
Walt Col贸n, D.M.D. Dentistry Married to Marybeth Col贸n University of Kentucky
Joshua Somerset, M.D. CMS President Gastroenterology Digestive Disease Clinic Married to Wendy Somerset, M.D. University of Florida
Avon Doll, M.D. Nephrology North Florida Nephrology Associates Married to Louie Doll Oral Roberts University
David Stewart, M.D. Pathology Pathology Associates Married to Gillian Stewart University of New Mexico
Tracey Hellgren, M.D. Family Medicine Patients First Married to Brian Bryson University of Florida
Hugh VanLandingham, M.D. Family Medicine Tallahassee Primary Care Associates Married to Mary VanLandingham University of Florida
David Jones, M.D. Pediatrics Capital Health Plan Married to Dottie Jones Ohio State University
Jay Walton, D.D.S. Dentistry Married to Susan Walton Emory University
Nelson Kraeft, M.D., Emeritus Cardio/Thoracic Surgery Retired Vanderbilt University
Charles Williams, M.D. Radiology Radiology Associates Married to Pat Williams Medical College of Georgia
Fred Lindsey, M.D., Emeritus Radiology Retired Married to Jimmie Lindsey Medical College of Georgia
Pam Wilson Executive Director, Capital Medical Society Married to Jim Guerry
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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CMS LUNCH & LEARN
CAPITAL MEDICAL SOCIETY Lunch & Learn Seminars
SPRING 2015
February 18, 2015
March 18, 2015
Method to the Madness: 10 Payment Collection Strategies That Work
Reputation Intelligence: Hear What Your Patients Are Saying About You Online
“Are you like a lot of medical organizations, up against unprecedented revenue and margin pressure, and figuring out how to boost revenue has become the focal point of your work life? You’re not alone. With significant payment responsibility shifting to consumers, medical businesses are increasingly battling bad debt, long A/R cycles and reduced revenue. Historically, most payment collection activities occurred long after the patient left facility, which creates back-end work that can significantly delay payment and reduce total collections. But health care reform, the growth of high-deductible health plans and decreasing reimbursements are forcing a shift of collection efforts upstream. The session will provide you with best-practice guidance from Patient Access experts, lessons learned from our most successful customers and leading market research all in one session.”
Speakers: Scott R. Marshall and Josh Vanderpool, Boardroom Alliance Sponsor: Tony Shah, Express Printing April 15, 2015 Affordable Care Act: Status/Overview and Legislative Updates Hear from the only insurer offering coverage in Florida through the federal marketplace-Florida Blue. - Overview of the changing health insurance market - Implications of ACA on the Florida health insurance market - Impacts on operations for insurers and providers Speakers: Gordon F. Bailey, II, Asst. General Counsel, and Kelly James, Senior Manager – Government Affairs, Florida Blue Sponsor: Terry Bush, Office Depot May 20, 2015 Payment Advocacy
Speaker: Colleen Wood, Vice President, Availity
Speaker: Jarrod Fowler, Florida Medical Association
Sponsor: Tom McHaffie, Aargus Facility Services
Sponsor: Diana Cureton, Hancock Bank
Time: 12 Noon to 1:30 PM (Seminars start at 12:30 PM) Place: CHP Auditorium, 2nd Floor, 1491 Governors Square Blvd. • Cost: $10 per person, per seminar FOR MORE INFORMATION OR TO REGISTER, CALL ROSALIE CARLIN AT 877-9018.
Welcomes Natarajan Rajagopalan, MD
P U L M O N A R Y A S S O C I AT E S
Medical Education
Professional Experience
• M.B.B.S Kilpauk Medical College (affiliated to University of Madras), India
• Fellow of the American College of Chest Physicians
Services Include:
Now Accepting Patients
850.402.0202 2626 Care Drive, Suite 106 Tallahassee, FL 32308
www.CapitalRegionalPA.com
• Allergies and Asthma • Chronic Obstructive Pulmonary Disease/ Emphysema • Lung Cancer • Bronchiectasis • Sarcoidosis • Chronic Bronchitis • Shortness of Breath • Vocal Chord Dysfunction • Sleep Disorders • Interventional Pulmonology
• Board Certified in Internal Medicine, Pulmonary Medicine, Critical Care Medicine and Sleep Medicine • Residency in Internal Medicine at Baylor College of Medicine, Houston, Texas • Fellowship in Pulmonary Medicine at University of Toronto, Canada • Fellowship in Critical Care Medicine at Mayo Clinic, Rochester, MN • Asst. Professor of Medicine, Department of Pulmonary Medicine, Critical Care and Sleep Disorders UMass Medical Center, Worcester, MA
Capital Regional Heart and Lung Surgical Associates accepts Capital Health Plan and most all other insurance carriers. 6
CAP-6404 CapScan -Dr. Welcome Ad_B&W_7.5x5.indd CAP SCAN ARajagopalan CAPITAL MEDICAL SOCIETY 1PUBLICATION
12/8/14 10:11 AM
DOCTOR OF THE DAY PROGRAM
If the House and Senate are not in session, physicians are encouraged to attend committee meetings and/or visit legislators' offices. Your participation not only provides a valuable service, but also continues a noble tradition and helps the physician community build valuable relationships within the Legislature. Decisions made at the state Capitol and in Congress have a major impact on medicine, making it vitally important for physicians to be engaged at all levels.
DOCTOR OF THE DAY PROGRAM Since the 1960s, the Florida Legislature's Doctor of the Day program has provided lawmakers with medical care during Legislative Session while serving to strengthen physicianlegislator relations. Two physicians — one for the House of Representatives and one for the Senate — provide any necessary care to legislators, their staff members, and others at the Capitol. If the House or Senate is in full session on a day when a physician is volunteering, either the House Speaker or the Senate President will introduce the Doctor of the Day. Within the House or Senate Chambers, the physician may sit with his or her local delegation.
The 2015 Legislative Session begins Tuesday, March 3, 2015, and the Florida Office of Legislative Services is seeking volunteer physicians to participate in the Doctor of the Day program. Physicians who are willing to spend a day in Tallahassee during the Legislative Session perform an invaluable service by providing health care for members of the legislature and legislative employees. The 2015 Legislative Session is scheduled to adjourn on Friday, May 1, 2015. Tuesdays and Wednesdays of session are usually the most exciting as Mondays and Fridays are often used as “travel days” for the legislators. In addition, should you want to ensure the chambers are in actual session (where all members of the House or Senate are in chambers), it would be best to volunteer any day the last 2 weeks of session (the weeks of April 20th and April 27th), but volunteers are needed for all of the Legislative Session. The time commitment is typically from 8:00 a.m. – 3:00 p.m. on any given day. The legislature has a clinic onsite that is staffed by 2 full-time RNs. CMS
If you are interested in serving as a Doctor of the Day or have more questions about the program, please contact Takeshia Stokes with the Office of Legislative Services by email at stokes.takeshia@leg.state.fl.us or call her at 850.717.0301.
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 7
AN EVENING WITH DR. JOHN AGWUNOBI:
LEADERSHIP THROUGH PREPARATION, PREVENTION, AND RESPONSE MARCH 19, 2015 | 5:30 PM – 7:30 PM Imagine juggling the responsibilities of responding to four major hurricanes and the nation’s first-ever anthrax attack while combating a high infant mortality rate and rising youth tobacco use. This was just a normal workday for former Secretary of Health Dr. John Agwunobi. Join us for an intriguing evening of shared stories about the unprecedented Public Health challenges he faced during his appointment. The Florida Historic Capitol Museum gratefully acknowledges the following sponsors and partners:
400 S. MONROE STREET | TALLAHASSEE, FL 32399-1100 | (850) 487-1902 |
WWW.FLHISTORICCAPITOL.GOV
Tallahassee Memorial Behavioral Health Center Welcomes Esther Undag-Elphick, MD Specialty:
Child and Adolescent Psychiatry
Medical School: Angeles University Foundation, College of Medicine, Angeles City, Philippines Residency:
The Ohio State University Columbus, OH
Fellowship:
The Ohio State University Columbus, OH Accepting New Patients.
Esther Undag-Elphick, MD
1616 Physicians Drive | Tallahassee | 850-431-5100 8
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
REFLECTIONS FROM THE EDITOR
WORTH POSSIBLY DEBATING By Charles Moore, M.D.
Amidst all the forgettable thises and thats that my wife found in the depths of her Christmas stocking, there at least lurked a “Samsung Note 4,” with an elegantly pointed stylus with which she could write an elegantly scripted memo to herself lest she forget to buy milk, eggs, and caviar next time she went to Publix or Harrod’s. She spent the week after Christmas lost in this device, which compared to her merely primitive, early edition iPhone propelled her into warp-speed mode. She stares at it with the intensity of any teen-ager, practicing at it as assiduously as any aspiring young gunslinger in some fifties Western. It is, as we all know, a marvel of this and that, all packed into a slender, shiny little package containing far more than our poor, aging brains can fully fathom. And it is innocent: altogether passive, even when turned on, unless you believe that holding it up to your ear will give you a glioblastoma.
For her birthday, which was only two weeks before Christmas (and such a challenge this is for us lovers of wives) among other thises and thats she got an “I-bot,” or is it a “Roomba;” I’m not sure I know the difference. Lynn is one of these rare, beautiful women who almost loves to vacuum, thankfully, for in order to stay ahead of the fur-balls in our house, as well as the other fuzz and dust-bunnies that I am responsible for, she is generally found vacuuming constantly. Now she is grateful for robotic assistance. With the arrival of the Samsung Note, and Lynn’s engagement with it, we were delighted that the Roomba/I-bot was in operation, doing its business without complaint, beating back fuss and fur while Lynn discovered yet another App. The I-bot works pretty well, too, except when Rosie, our Maine Coon cat, a big girl, rides about on it, and accidentally pushes the off button. At least I know enough about it to push the “on” again. So I vacuum too!
CONTINUED ON PAGE 10
TMH Physician Partners welcomes
Tim Ruark, M.D.
General Surgery, Board Certified
Jeffrey Crooms, M.D.
General Surgery, Board Certified
Eliot Sieloff, M.D.
General Surgery, Board Certified
Specialized Surgical Care. Here in Tallahassee. Services by Tallahassee Surgical Associates
1405 Centerville Road, Suite 400 | Tallahassee, FL | 850-877-6212 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 9
REFLECTIONS FROM THE EDITOR
Yes, we are in the grip of our smart electronics, whose A.I. remains so far fully obedient to our will, capable of being turned on or off even by a cat. Well, the I-bot does have enough sense to stop at a step, and very cleverly backs off rather than precipitating itself into the void. I suppose that’s “intelligence” of some sort, but purely mechanical and thoughtless for all that. On the other hand, everyone knows these charming devices are harbingers of things to come. They are to “intelligence” what Lillienthal’s gliders were to flight in the 1890s. How can we not, being human and always craving to “go where no man has gone before,” do other than develop intelligent robots that will, just for the fun of it, outstrip in speed and strength anything our own poor biological brains and muscles can ever be made to perform. Yes, yes…I heard on the radio something of that interview with Hawking: his ominous remark, made all the more doleful by the artificiality of his prosthetic, prophetic voice, saying of “Artificial Intelligence” that “It would take off on its own, and re-design itself at an ever-increasing rate, (and that) we Humans, who are limited by slow biological evolution, couldn’t compete, and would be superseded.” My humanity, my human pride in having after all these millennia risen from a paramecium to the heights we have achieved, blasting ourselves into space and carrying in our pockets the power of the Samsung Note, surely is forgivable. We are a remarkable species, and there is Hawking and, I suppose, LeBron James and Jameis Winston to prove it. Throw in Fleming and Salk, Newton and Einstein as well; which also reminds me not to neglect the other side of the coin, Hitler, Stalin, Pol Pot, and Idi Amin. There is so much we have created and (more or less) conquered. But there is so much we have not: as Pogo so famously observed way back when in the fifties, “we have met the enemy, and he is us.” And we will always be “us,” for it has taken us all these millennia to become so, and despite the utopian wishes of idealists we will never be more than what we are, which sadly includes some serious flaws. Ah, but wait!
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I have an idea, which may be worth debate at some place like the Oxford Union or Leon High: “Might it be better, for the sake of the world, if the human race were to voluntarily relinquish its claim to superiority, and grant it to robots endowed with an artificially intelligent, superhuman capability?” Don’t get me wrong if for the moment I choose to take the affirmative position. Let me cast aside my human pride; or rather, and even better, take pride in embracing the self-sacrificial, call it even (if you will) noble position that the world might be better off ruled by something of our creation, but which, in fact, is better than we. Yes, with gestures of elegant emphasis I would argue that we, so captivated by ourselves, so demanding of nature, of this earth and this delightful universe, might consider abdicating our crown. Does anyone really think there will ever be a time when the wars we make are no more? That prisons will vanish from the face of the earth? That we will ever be content living within the natural world that surrounds us, instead of wasting it? Will greed vanish from the face of the earth? “We talk,” I would finally summarize to powerful effect, “about ‘evolving man,’ but man is what he is, and will always be.” Our brains will not grow bigger or better, and no tinkering with our chromosomes will guarantee some perfect balance between heart and mind. But how much to our credit it would be if we were to become the creators of an entity, even if it were to supersede us, that would make us as Gods, giving to the world, so in need of a gentler, kinder care, a more perfect creature capable of it. Of course there will be questions. Could the creature turn Frankensteinian? And what about love? Would it ever really be possible for your I-bot to love you? What about feelings? What about initiative and spontaneity? What about sudden insight? What about art? Music? The Haiku? Where is all of this in a world roamed by a perfection of robots with giga gigs of information and intelligence? Are we simply to be trampled underfoot by these devices? Who knows, but let me reminisce a bit. I remember in college when, instead of taking biology one and chemistry one-half, I took a course on “modern” drama for some reason; you know: Ibsen, Shaw, and that lot. It included also a play that appeared in 1920 by the Czech playwright Karel
REFLECTIONS FROM THE EDITOR
Capek called “R.U.R.,” or “Rossum’s Universal Robots.” Previously called “Automata,” it was Capek who first introduced the word “robot” to language, deriving it from the Czech word for a “forced laborer” or serf. Interestingly, but only parenthetically (and begging your pardon) Spencer Tracy made his theatrical debut on Broadway playing the role of a Rossum’s robot in 1922. Rossum’s robots, which were more like what we would call “androids,” were so endowed with intelligence that poor humanity was simply overwhelmed. We were dead ducks; and the world left to these unfeeling beings of our own creation, until…at the end of the play…guess what happens? Two handsome drop-dead beautiful robots fall…yes…in love. The proof of it is demonstrated with a more than mere Turing-Test rigor when each of these two…never mind the details…will beg to accept its own destruction if the
other be spared. We realize that these two are to be the new, enlightened Adam and Eve, whose legacy will indeed be a more perfect world. They are granted a conscience, call it a soul if you prefer, willing to sacrifice itself for another. Who can guess how this transmutation occurred. It was a play. But I wonder if we mortal designers of A.I. software will be able to grant so much to our own A.I. creations, no matter how well they may do on a college entrance exam or playing chess? Give me a break, and appreciate the possibility. Otherwise, enough being enough, I must find my wife, which should be easy since all I have to do is find her Samsung Note. She’ll be right with it, rapt, intertwined, enmeshed and in love with her smart little A.I. proto-robot. And in the background I hear the soothing whirr of I-bot, glance smugly at the spiffy floor, and Rosie, the cat, riding on its back, the best cat toy ever devised. So far, so good.
P U L M O N A R Y A S S O C I AT E S
CMS
Welcomes Saurabh Sheel, MD
Medical Education
Professional Experience
• Maulana Azad Medical College, New Delhi, India
• Pulmonary Critical Care Fellowship Medical College of Wisconsin, Froedert Hospital
Services Include:
Now Accepting Patients 850.402.0202 2626 Care Drive, Suite 105. Tallahassee, FL 32308
www.CapitalRegionalPA.com
• Allergies and Asthma • Chronic Obstructive Pulmonary Disease/ Emphysema • Lung Cancer • Bronchiectasis • Sarcoidosis • Chronic Bronchitis • Shortness of Breath • Vocal Chord Dysfunction
• Internist/Hospitalist Ogallala Community Hospital, Banner Health Facility, Ogallala, Nebraska
• Medical Director Garden County Health Services Oshkosh, Nebraska
Capital Regional Heart and Lung Surgical Associates accepts Capital Health Plan and most all other insurance carriers. CAP-6457 Dr. Sheel Welcome Ad_B&W_7.5x5.indd 1
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 1/8/15 4:52 PM 11
VIEWPOINT
The Eyes Have It By Frank Skilling, M.D.
My mother claimed that I announced I was going to be a doctor when I was three years old. This should not seem a prescient forecast from a toddler’s mouth since my father was an ophthalmologist and my mother a nurse. However much I wanted to become a physician came up against the harsh reality of the first year of medical school, arguably the worst year of my life. After graduating as an English major from a small liberal arts college, I was thrown among the highly competitive science majors at the University of Alabama in Birmingham, long steeped in the principles of William Osler, the father of modern internal medicine. For the first time I could not assume that I was going to be in the top ten percent of the class since everyone else there had been in the top ten percent of their respective classes. After slogging through the first year, I took a summer elective in ophthalmology at the University of Miami which had one of the top eye programs in the country. I found the field engaging, but UAB had been directed by Tinsley Harrison, one of the great medical educators of the twentieth century and still memorialized in Harrison’s online website. Internal medicine was THE most important department at UAB, and many students had been inspired by the patient-centered teachings of Harrison. I naturally gravitated to the men (there were virtually no women in academic medicine in the early 1970s) in that department. However, I found that I enjoyed all of my clinical rotations. I liked general surgery, but thought the hyper-competitive, supercharged atmosphere and the long hours of residency too demanding to be my life’s work. Pediatrics was interesting, but not as much as internal medicine. Psychiatry was also interesting, but there were not many biological applications at the time, and I wasn’t sure about being a psychoanalyst. On the gynecology rotation I was inspired by one of the cancer surgeons as he tried to save women’s lives from the scourge of cervical carcinoma, a common occurrence in rural Alabama at the time. My obstetrical rotation was tough: thirty six hours straight on duty with teenagers in tiny labor rooms. The medical students were supposed to transfer the mothers to the large delivery room in time for the entire staff to be present. After I let two girls labor too long at 4 AM
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
and deliver in the labor room rather than the delivery room, I knew that the obstetrician’s life was not for me. One of the African-American mid-wives who assisted the medical students looked up at me after we delivered the second baby and said, “Dr. Skilling, I just don’t see you getting up at night to deliver babies.” She was right. As many graduates did at the time, I chose an internship in internal medicine with the thought that it would be useful later no matter which field I chose. I spent a year at the University of Miami in a free-wheeling program that was supersaturated with very sick patients, often with very unusual diseases. But I struggled with the choice of internal medicine versus ophthalmology. I had excellent mentors in both fields, and I just couldn’t make a decision. Fortunately, I had a military obligation (this was the Vietnam era), so I deferred my choice while I spent two years as a general medical officer with the Navy and Marine Corps. While serving overseas with the Marines I decided to try for an ophthalmology residency since they were more competitive. If I didn’t get in one, I could apply for internal medicine, and if I didn’t like ophthalmology after one year as a resident, I told myself I could switch back to medicine as well. While on active duty, I also found out that I didn’t like being a general practitioner running a night clinic where military dependents showed up to get tranquilizers or refills for birth control pills when they didn’t feel like going to the regular day clinics. I was accepted at the University of Texas Medical Branch in Galveston for an ophthalmology residency. After feeling that I was floundering around a bit the first year, I started the second year with the realization that I had learned a lot of ophthalmology, and I really liked it. It is a field that encompasses medicine, surgery, physical diagnosis, laboratory examination, pathology, and, most importantly, the eye is a direct extension of the brain, an organ that fascinates me. I always wanted to be in a clinical field that had direct patient contact, and ophthalmology offered as much as I wanted. It felt like I was home, and I’ve never looked back. I still have twinges of envy when I see some of my colleagues who are great internists solving and treating some of the most daunting medical problems, but I like the variety of diagnoses and treatments that ophthalmology has afforded me, and I like being able to help patients who have vision-threatening problems live more normal lives. Would I choose the same specialty today? Emphatically yes, but I still admire the internists who walk in William Osler’s footsteps. CMS
CMS FOUNDATION: WE CARE NETWORK
Thank you! To our CMS members and We Care partners who saw new patients for the We Care Network in December 2014. Your generosity and support of the We Care Network makes a difference. Physicians Ricardo Ayala, M.D. Marie Becker, M.D. Dhananjay Bendre, M.D. Alexander Brickler, III, M.D. Tim Broeseker, M.D. Viet Bui, M.D. Carlos Campo, M.D. Joseph Camps, M.D. Ray Dolly, M.D. David Durden, M.D. Tanya Evers, M.D. Spencer Gilleon, M.D. Sergio Ginaldi, M.D. Joseph Gray, M.D. Kristin Harmon, M.D. Celeste Hart, M.D. David Huang, M.D. Iman Imanirad, M.D. Amit Jain, M.D. Arjun Kaji, M.D. James Killius, M.D. Stephanie Lee, M.D. Maribel Lockwood, M.D. Michael Pentaleri, M.D. Duncan Postma, M.D. Jeffrey Rawlings, M.D. James Renehan, M.D. Bryan Robinson, M.D. Andres Rodriguez, M.D.
William Sawyer, M.D. Scott Sellinger, M.D. Jeannine Silberman, M.D. Hardeep Singh, M.D. J. Orson Smith, M.D. Robert Snider, M.D. Robert Snyder, M.D. Joshua Somerset, M.D. Joseph Soto, M.D. Mary Swain, M.D. Timothy Sweeney, M.D. David Vermess, M.D. Tony Weaver, M.D. William Yaakob, M.D. Dentists Eric Amundson, D.D.S. Susan Byrne, D.M.D. Walter Colón, D.M.D. William McFatter, D.D.S. E. Lynn McLarty, D.D.S. Jim McSoley, D.M.D. Lawrence Pijut, D.M.D. Frank Swerdzewski, D.D.S. James Sykes, D.M.D. Jay Walton, D.D.S. Lawrence Weaver, D.D.S. Ronald Willis, D.M.D. Ed Zapert, D.M.D. Facilities Affordable Dentures Anesthesiology Associates Beachton Denture Clinic Capital Regional Medical Center Dermatology Associates Desloge Home Oxygen Leon County Dental Clinic Pathology Associates Radiology Associates Seven Hills Surgery Center Southeastern Surgery Center Tallahassee Diagnostic Imaging Tallahassee Endoscopy Center Tallahassee Health Imaging Tallahassee Memorial HealthCare Tallahassee Orthopedic and Sports Physical Therapy Tallahassee Outpatient Surgery Center TMH Family Medicine Residency Program Women’s Imaging Center
The We Care Network strongly encourages our volunteer physicians and dentists to send their value of donated services to us. The value of donated services is important for us to share with our funders and the community. You can send your value of donated services via fax to Monica Demott, R.N. at (850) 201-0085 or mail to 1204 Miccosukee Road, Tallahassee, FL, 32308. Thank you! Please contact Monica Demott, R.N. at mdemott@capmed.org or 201-0130 if you are a We Care volunteer and you provided volunteer specialty care in the month of December 2014 and your name is omitted.
We thank our referring providers from
December 2014:
Anne Ananga, ARNP
Eve James-Wilson, D.M.D.
Viralkumar Bhanderi, M.D.
David Kahn, M.D.
Faith Blocker, ARNP
Marta Klisinska, M.D.
Daniel Breivogel, ARNP
Esaias Lee, M.D.
Tim Broeseker, M.D.
Kurt Luhmann, M.D.
Acquinonette Bryant, M.D.
J. True Martin, M.D.
Viet Bui, M.D.
Helen Nitsios, M.D.
Kendall Campbell, M.D.
Whit Oliver, M.D.
Joseph Camps, M.D.
Rose Origa, ARNP
Jeffrey Crooms, M.D.
Paresh Patel, M.D.
Lysmar Dinguis, M.D.
Adrian Roberts, M.D.
Susan Dunbar, ARNP
William Sawyer, M.D.
Cynthia Evans, ARNP
Hardeep Singh, M.D.
Tanya Evers, M.D.
Alanna Steaple, ARNP
Elizabeth Fajer, M.D.
Nina Sumlar, M.D.
Anneka Gaffney, ARNP
Christopher Sundstrom, M.D.
Judy Griffin, ARNP
Frank Swerdzewski, D.D.S.
Richard Henry, M.D.
Tallahassee VA Clinic
Hantz Hercule, M.D.
Marianne Towler, ARNP
Susan Horton, ARNP
Jeffrey Wasserman, D.O.
Iman Imanirad, M.D.
Quandra Whaley, ARNP
Simha Jagadeesh, M.D.
Donald Zorn, M.D.
During the month of DECEMBER, the We Care Network: Received 76 referrals, with 57 patients new to the program
Scheduled 67 appointments with volunteer physicians and dentists
$170,293 in donated care was reported by We Care volunteers
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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CMS FOUNDATION
The mission of the Capital Medical Society Foundation is to support the charitable efforts of physicians and others, increase access to healthcare, promote education and serve the community’s health needs through innovative projects that are exemplary, affordable and dignified.
DONATE TO THE CMS FOUNDATION
We Thank Our Donors We thank the following people who made a donation to the CMS Foundation: In Honor Jerry Harris, M.D. – in honor of Nicole Balmer, M.D., Anthony Clark, M.D., Marc Fisher, M.D., Lisa Flannagan, M.D., John Mahoney, M.D., Charles F. Manning, Jr., M.D., Nola Munasifi, M.D., Margaret Havens Neal, M.D., Christopher Price, M.D., Steve Sarbeck, M.D., Stephen Sgan, M.D., David Stewart, M.D., and Kenneth Whithaus, M.D. In Memory Barbara Johnson – in memory of Robert P. Johnson, M.D. For the CMS Foundation Charles A. Frueauff Foundation
Reasons to Give: Funds raised by generous donors benefit the We
Care Network. The We Care Network is a past Blue Foundation Sapphire Award winner and its impact on the community is featured in the Sept/ Oct 2014 issue of the Tallahassee Magazine. The We Care Network provides over $5 million in donated specialty medical and dental care to the community’s low-income uninsured annually. In addition, donations support medical school scholarships for first and second year students at FSU College of Medicine committed to returning to NW Florida after completion of their residencies. In 2014, $40,000 in scholarships were awarded to nine FSU College of Medicine students.
Gifts to Honor and in Memoriam:
For the We Care Network Anonymous – for the We Care Dental Network Charles A. Frueauff Foundation Charles F. Manning, Jr., M.D.
You can make a donation to the CMS Foundation
For the We Care Network Year End Appeal Ray Bellamy, M.D. C. Raymond Cottrell, M.D. Ron Saff, M.D. David Stewart, M.D.
or your family. CMS will send an acknowledgement
For Scholarships Charles F. Manning, Jr., M.D. Kenneth Wasson, M.D.
been created in order to establish financial stability
For CMS Foundation Endowment Fund Lenox Family Limited Partnership John Mahoney, M.D. J. Brian Sheedy, M.D. – in memory of Jack MacDonald, M.D. David Stewart, M.D.
1) The CMSF Endowment
Along with their annual dues payment: C. William Applegate, M.D. Myrle Grate, Jr., M.D. Valerie Lazzell, M.D. James Patty, M.D. Drew Williams
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in memory of someone who has passed away or in honor of someone, such as a fellow physician you hold in high esteem or has taken care of you letter to those you memorialize and honor.
How to Give: Through the generosity of donors, three funds have to meet our mission. You can donate any time to one of CMS Foundation’s funds. 2) The We Care Network Endowment 3) The Scholarship Fund Checks should be made payable to the CMS Foundation and indicate on the memo line of your check to which fund you would like to donate. Bring your check to the CMS Office or mail it: Capital Medical Society ~ 1204 Miccosukee Road ~ Tallahassee, FL 32308.
MEDICAL/LEGAL
Communication Is Key to Improving Diabetic Patient Outcomes and Reducing Liability By Susan Shepard, Director, Patient Safety Education, The Doctors Company
Nearly 30 million children and adults in the United States have diabetes, and another 86 million Americans have prediabetes and are at risk for developing type 2 diabetes.* Because diabetes has the potential for serious complications and requires immense involvement by patients and physicians for successful outcomes, healthcare professionals who treat diabetic patients may be at risk for malpractice lawsuits. In a study of claims closed from 2007 to 2013, The Doctors Company identified four common allegations made by patients with diabetes: improper management of treatment (37 percent), failure or delay in diagnosis (31 percent), failure to treat (9 percent), and improper management of medication regimens (6 percent). Diabetic patients’ treatment is often managed by a multidisciplinary care team, which may include a primary care physician, endocrinologist, dietician, ophthalmologist, podiatrist, and dentist. When patients file claims, it’s not uncommon for them to name the entire care team in the complaint, alleging failure to properly diagnose, supervise, monitor, and/or treat their disease. To promote patient safety, the healthcare team should engage the patient in collaborative care planning and problem solving to produce an individualized care plan as well as team support when problems are encountered. Other ways to promote patient safety and mitigate the risk of malpractice claims related to diabetes care are: • Communicate. Talking openly with diabetic patients about their condition and encouraging them to take an active role in decision making enhances patient safety. - Overcome patients’ fears about their disease by taking time to answer questions. - Discuss all associated risk factors, including weight gain. As obesity and diabetes rates continue to increase in the U.S., it is worthwhile for physicians to recognize
their own barriers to such communication and seek assistance. The American Medical Association and American Diabetes Association have resources available to help physicians talk to their patients about weight and diabetes. Primary care physicians can refer their atrisk patients to a diabetes educator for more information on how to successfully manage their condition. - Provide written instructions and information about adverse effects for prescription drugs and complex prescription drug regimens. - Communicate with the patient and prepare written information in the language and at the literacy level that the patient understands. - Ask patients to repeat the information shared, not just whether they understand what they have been told. • Educate. Educate patients about the importance of self-management to help increase their compliance and to reduce the risk of patients attributing their injuries to substandard care. Diabetic patients should be able to articulate the importance of lab tests, medication management, diet, and exercise. Barriers to selfmanagement such as financial issues or lack of social support, healthcare literacy, and patient-caregiver relationships should be assessed. • Document. Document any and all patient interactions and discussions regarding the patient’s condition, including diagnosis, specialist referrals, and treatment options. • Manage care. Implement a program that ensures timely follow-up when a patient fails to schedule an appointment, misses an appointment, or cancels an appointment and does not reschedule. Failure to follow up and provide intensive patient management can lead to missed or delayed diagnoses, accelerated disease symptoms, morbidity, and/or mortality. CMS Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety. Susan Shepard, MSN, RN, is the director of patient safety education at The Doctors Company. She earned a master’s degree in nursing administration from Medical Colleges of Virginia–Virginia Commonwealth University, a master of arts degree in management from Webster University, and a bachelor of science degree in nursing from St. Louis University. Reference *American Diabetes Association. American Diabetes Month®. http:// www.diabetes.org/in-my-community/american-diabetes-month.html. Accessed September 17, 2014. CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 15
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