JULY EDITION, VOLUME 2020, NO. 7
CMEs SHIFTING TO VIRTUAL! Due to the COVID-19 pandemic, the Westminster Oaks Maguire Center for Lifelong Learning is not expected to be available for CMS membership meetings until 2021. Therefore, CMS has reformatted its fall schedule to still offer the same CME topics in a virtual format. September CME - has been changed to a free 1-hour CME opportunity that we have available through the University of Florida’s Department of Epidemiology on Alzheimer’s disease (AD) and dementia, funded through the Florida Department of Health, titled, “From Brain Disorders to Brain Health: Prevention and Management of Cognitive Decline and Dementia.” It is a panel discussion format. Those interested in the CME can learn more and access it at the following link: http://healthstreet.program. ufl.edu/healthstreet-intiatives/continuing-medicaleducation-cme/. This pre-recorded CME may be accessed at any time. You do not need to wait until September. Through this CME, cognitive health experts from UF provide the latest information on the screening, diagnosis, and treatment of mild cognitive impairment and dementia, including referral to specialty care all from the comfort of your own home. CME credit will be coordinated through UF.
The Florida Medical Association has graciously agreed to assist the Capital Medical Society in providing the following two CMEs virtually: October 20, 2020 CME, 6:30 PM Dr. Suzanne Harrison will present the required 2-hour CME on Domestic Violence virtually. November 10, 2020 CME, 6:30 PM Terry Coonan, J.D., Executive Director at FSU Center for the Advancement of Human Rights will present the required 1-hour CME on Human Trafficking virtually. Watch for emails from CMS with more information on the October and November CMEs. WE THANK OUR MEETING SPONSORS AND DISPLAYERS September 2020: MagMutual (https://www.magmutual.com/) – Staige Hoffman Novo Nordisk, Inc. (https://www.novonordisk-us.com/) – Stephanie Ellis and Michelle Glazier October 20, 2020: MagMutual (https://www.magmutual.com/) – Staige Hoffman Novo Nordisk, Inc. (https://www.novonordisk-us.com/) – Stephanie Ellis and Michelle Glazier November 10, 2020: Novo Nordisk, Inc. (https://www.novonordisk-us.com/) – Stephanie Ellis and Michelle Glazier
CAPITAL MEDICAL SOCIETY 2020 MEETINGS CALENDAR October 20, 2020 Virtual CME Domestic Violence (2 Hours) Speaker: Suzanne Harrison, M.D. 6:30 pm
November 10, 2020 Virtual CME Human Trafficking (1 Hour) Speaker: Terry Coonan, J.D., Executive Director at the Florida State University Center for the Advancement of Human Rights 6:30 pm
December 3, 2020 CMS Foundation Holiday Auction 6:00 pm FSU University Center Club
BOARD OF GOVERNORS Ken Whithaus, M.D., President
I N T H I S I SS U E :
MISSION: TO PROMOTE THE PRACTICE OF MEDICINE FOR THE ULTIMATE BENEFIT OF THE PATIENT. (850) 877-9018 Fax: (850) 878-0218 www.capmed.org
CME Update..........................................................................1 CMS Announcements.........................................................3 CMS Dues Invoices.............................................................4 CMS News.............................................................................8 FSU College of Medicine-Tallahassee Regional Campus...............................................................................10 Portraits in COVID-19....................................................... 11 Simpler Times.................................................................... 15 Medical/Legal.................................................................... 16 Donate to the CMS Foundation..................................... 17
Rohan Joseph, M.D., President-Elect
CMS Foundation: We Care Network............................ 18
Paresh Patel, M.D., Secretary/Treasurer
Thank You to PPE Donors and Volunteers................. 20
Maribel U. Lockwood, M.D., Immediate Past President Nicole Balmer, M.D. David Burns, M.D. Sybil Holt, CMS Alliance
HAPPY BIRTHDAY!
Sarah Ko, M.D. Amulya Konda, M.D.
{JULY BIRTHDAYS}
Matt Lee, M.D. Helen Paulson, M.D. Cody VanLandingham, M.D. Julia Weeks, M.D.
Amer Rassam, M.D. – 1st
Thomas Peele, Jr., M.D. – 19th
Raymond Shashaty, M.D. – 1st
Andres Rodriguez, M.D. – 19th
Family Medicine Resident
Larry Deeb, M.D. – 2nd
Judith Lewis, M.D. – 20th
Mary Claire Smallwood, M.D.
Lynn Jones, M.D. – 2nd
Robert Thornberry, M.D. – 20th
General Surgery Residents
Margaret C. Boltja, M.D. – 3rd
Alan Ming-Fong Chen, M.D. – 21st
Rodrigo Agbunag, M.D. – 4th
Walter Bunnell, III, M.D. – 22nd
Robert Campbell, M.D. – 12th
William Dixon, M.D. – 22nd
Charles Newell, M.D. – 13th
Breanna Walters, M.D. – 22nd
Carey Dellock, M.D. – 14th
Paresh Patel, M.D. – 24th
Seymour Rosen, M.D. – 14th
Niraj Pandit, M.D. – 27th
Daniel Conrad, M.D. – 17th
Tracey Hellgren, M.D. – 30th
J. Daniel Davis, Jr., M.D. – 17th
John Katopodis, M.D. – 30th
Brence Sell, M.D. – 17th
Kaushal Patel, M.D. – 30th
James Totten, M.D. – 17th
Adrian Roberts, M.D. – 30th
Richard Henry, M.D. – 18th
Joseph Soto, M.D. – 31st
Pam Irwin, Executive Director, Capital Medical Society
Hamzah Mansoura, M.D./SchMiyah Smith, M.D.
PUBLICATION EDITOR Frank Skilling, M.D.
MANAGING EDITOR Shannon Boyle
GRAPHIC DESIGN Gandy Printers
EDITOR EMERITUS Charles E. Moore, M.D.
ARE YOU INTERESTED IN WRITING AN ARTICLE FOR CAP SCAN?
Please contact Shannon Boyle at sboyle@capmed.org. All articles submitted will be reviewed by your peers prior to publishing.
Amulya Konda, M.D. – 19th 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. 2
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!
CMS ANNOUNCEMENTS
NEW DOC ON THE BLOCK
Vamsi Ponnaganti, M.D. Medical School: Andhra Medical College Internship/Residency: Cleveland Clinic Practice: TMH Physician Partners - Hospitalists Specialty: Internal Medicine
IN MEMORIAM
ROBERT CHRIS GOODHOPE, M.D. 1950 - 2020
CELEBRATION AWARDS DINNER TO HONOR DR. GINALDI AND DR. SAINT IN 2021! It saddens us all that due to the COVID-19 pandemic, hosting the Celebration Awards Dinner on March 26, 2020 was not possible. The event to celebrate Dr. Sergio Ginaldi and Dr. David Saint is rescheduled on March 25, 2021. Please save the date for this well-deserved celebration.
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
3
CMS DUES INVOICES
CMS MEMBERS DUES INVOICES HAVE BEEN SENT!
RENEW YOUR MEMBERSHIP TODAY. If you didn’t receive your dues invoice, please contact the CMS office at (850) 877-9018.
Dues revenue enables staff to provide mission-driven, physician-focused, and relevant services, communication, and resources to members. We encourage you to take the time to read the condensed "words of appreciation" shared by your colleagues and local medical practices. The coronavirus (COVID-19) pandemic has thrust our medical community into unknown territory. We recognize that hospitals, medical practices, and physicians have faced both health and economic impacts. We continue to work on your behalf and value you and your membership. The Capital Medical Society is proactively communicating information and resources to help physicians and practices stay abreast of changing COVID-19 recommendations, breaking news impacting the practice of medicine, reimbursement information, and financial support for practices. As a service, the Capital Medical Society Foundation (CMSF) is distributing donated Personal Protective Equipment to protect the healthcare community. To help circumvent the need for practices to make large bulk orders for PPE, the CMSF has submitted orders collaboratively.
WE ARE HERE FOR YOU! 4
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
CMS DUES INVOICES
MISSION-DRIVEN • PHYSICIAN-FOCUSED • RELEVANT The intent of this message (as if you needed another one cluttering your inbox), is to add my thanks to you and staff. Your communications, and efforts at procurement of much needed supplies, have been invaluable. We owe you and your staff a huge debt of gratitude. Best regards, DAVID SHAPIRO, M.D.
Pam, Just wanted to thank you for all your incredible hard work during this pandemic. You and the CMS folks have been amazing. We are lucky you are there. Please stay safe and get some rest yourself! PAUL ROBINSON, M.D., FAAP
Thank you, Pam. Your input has been invaluable in our practice successfully applying for relief funding. God bless, JUAN FUENTES, MHA - Practice Administrator, Vascular Surgery Associates, PA
I am thankful for Pam Irwin at the Capital Medical Society as she has been instrumental in coordinating most of the PPE we have received so far. WILLIAM “BILL” HAMBSH, CPA, FACMPE - Chief Executive Officer, North Florida Women’s Care
Pam, You are doing yeoman’s work keeping everyone informed. Thank you for your effort. BILL - CEO, CRH Healthcare
Thanks Pam. All of this information is valuable as we try and work though this mess. WILLIAM BALDOCK, D.D.S.
First and foremost – thank you so much for all that you have done to keep everyone informed about COVID-19 related issues. As a physician who has been involved in the care of COVID-19 patients, it has been so appreciated! JANICE LAWSON, M.D. - Tallahassee Memorial HealthCare Physician Partners, Cancer and Hematology Specialists
Pam, Thanks for all the references, they are all very informative. RICH HENRY, M.D.
I just wanted to thank you for your tireless efforts in helping us all through this crisis! The information and assistance you provide is invaluable and so much appreciated. I just cannot thank you enough for the countless hours you have spent researching, collaborating and communicating! It just would not be possible for us all, as individual practices, to accomplish all that you have accomplished in the past weeks. ANGELA FUQUA, MPA, MT (ASCP), CMPE - Administrator, KWB Pathology Associates
BTW – Your emails have been very helpful during this time. We appreciate all y’all are doing to help. JON GARDNER - TMH
I just wanted to let you know how much I personally appreciate all the work you are doing for the community! Keeping us all up to date on COVID informational meetings, arranging for PPE supplies etc. It doesn’t go un-noticed! Thank you so much!!! MARGARETT C. ELLISON, M.D., MHA, FACS, FACOG, Gynecologic Oncology of Tallahassee
CONTINUED ON NEXT PAGE
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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CMS DUES INVOICES
CONTINUED FROM PREVIOUS PAGE
You are doing an amazing job of keeping everyone informed. Thanks for all you do. DR. LINDA MILES
Just want to say how impressed I am by all the things CMS is doing. I really appreciate all the information and links and updates you and CMS provides on a daily basis during this very difficult time. Thank you and CMS for all you do!! I am proud to be a member of the Capital Medical Society. NIRAJ PANDIT, M.D., F.A.C.C., F.S.C.A.I. - Capital Regional Surgical Associates
Thank you so much for the N95 masks. We had to close for lack of masks and patients really don’t want to go to the hospital now for obvious reasons if they can avoid. Even with restrictions on elective cases there are many who need procedures and if we can stay open to keep people out of the ER or inpatient hospital that should help as COVID cases increase in the area. Thanks again. We, our staff and patients, are all appreciative. Just like our CMS mission statement attests! ANDRES RODRIGUEZ, M.D. - Digestive Disease Clinic
Dear Pam, You are giving such strong and helpful leadership. Thank you for all that you are doing for the community and the healthcare professionals with your thoughtful work and inspiration. I am praying for you. Blessings, CANDACE - Big Bend Hospice
Thank you so much for coordinating and undertaking this effort to help our community during this time. GAIL - EMS Outreach & Relations, CRMC EOC Supply Chain Coordinator
We appreciate all you all have done (AND) continue to do to keep us informed! DAVID MILES, M.D.
This is a great service for our community that you are offering! Thank you! NATALIE MIZE - Director, Supply Chain, Capital Regional Medical Center
Thank you for helping us. NATHALIE HOOD - Capital Health Plan
Thank you for all of the COVID-19 information that is being emailed out. PAM POST - Southern Medical Group
Thanks for your help Pam. JOHN HOGAN, CEO - Capital Health Plan
QUOTES REGARDING DONATIONS: “You are not only the N-95 ninja but the K N-95 Kninja as well!” RON SAFF, M.D.
I was almost tempted to also order the curbside beer. But, perhaps after 3 more weeks of what we’ve been through the last 3 weeks, I just might. :-) I appreciate all you are doing to help us! (A GRATEFUL PRACTICE ADMINISTRATOR)
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
CMS DUES INVOICES
So glad to hear you on the Surgeon General’s calls...made me extra proud to be a CMS member... Thanks! JSP
I was pondering, and thought I should share with you my thanks. You and all of our CMS staff has demonstrated how important it is for physicians to belong, be active, and support our local medical society. If they can't see it, they have their heads in the sand. Well, I guess the members appreciate it. THANK YOU! You are amazing. NANCY LOEFFLER, M.D. - Anesthesiology Associates
I greatly appreciate all of your efforts in helping to locate PPE and keeping us all informed. You are much appreciated! LYNN BUSH - Operations Accounting Manager, Tallahassee Primary Care Associates
Dear Pres. Thrasher, I am a non-hospital based physician and I am paying for masks that are graciously provided through Capital Medical Society. The Society should be receiving awards, honors and praises for its work in providing protective gear to local doctors. I have a brother and sister in South FL, both physicians, and they are not receiving the protective gear they need for their personal protection from their medical societies. I personally know that Pam Irwin, Executive Director of CMS, has been virtually working around the clock including weekends to do her at utmost to provide protective gear to physicians that they require. She’s been on the phone/emailing numerous companies globally to get needed medical equipment sent to Tallahassee. When this passes, I hope you and the Mayor get together and provide an honorary trophy or medallion to Pam Irwin, who has gone above and beyond the call of duty to protect the medical community. She and CMS are doing a heroic job working behind the scenes and her gallant work has likely resulted in preventing doctors from getting sickened/killed by COVID-19. I hope you can find time in your busy schedule to shoot her and CMS a thank-you email. Thanks, RON SAFF, M.D.
President Thrasher, This is Temple Robinson, MD CEO of the Bond Community Health Center. I am writing to express my thanks for the service the Innovation Hub and the Capital Medical Society has provided to the physicians and health centers in town. This is another example of this community’s strength and ingenuity. During this COVID-19 crisis, the Capital Medical Society has taken the lead in dispersing information from the Leon County Health Department and keeping us abreast of EOC notices. As you are aware, Bond, along with many other health centers have joined with Tallahassee Memorial Healthcare to staff the community-wide COVID-19 drive-up collection center. Bond’s clinical teams are also screening for COVID-19 in our office parking lot as we continue to care for scheduled patients. The donated face shields distributed on Monday by Capital Medical Society were perfectly timed as our mobile unit was deployed on Tuesday to care for the homeless that had been recently relocated from the Kearney Center. Thanks again for including the Capital Medical Society and Bond Community Health Center in your efforts. TEMPLE ROBINSON, M.D. - Bond Community Health Center
Hi Pam, We are Sew Happy to Help! We hope that your institution is able to make good use of the face coverings and/or gowns sent by Woodhaven. Woodhaven Furniture Industries is a nationwide manufacturer of upholstered living room furnishings, mattresses, and other bedding products. Woodhaven is a division of Aaron’s, Inc. Aaron’s, the company that owns Woodhaven, is a leader in lease ownership of furniture, electronics, and appliances. The story you shared about the Digestive Disease Clinic’s Surgery Center was very inspirational. It is so nice to get to share stories like these with the production team, and it would be nice to have your permission to share the story with others. Heart-warming. Thank you for the information, and thank you for your role in the COVID-19 struggle on behalf of us all. Best Regards, DAVID PITTMAN - Director of Procurement & SCM, Woodhaven Furniture Industries, LLC, a Division of Aaron's, Inc. CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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CMS NEWS
CMS MEMBERS: ARE YOU RETIRING? If you are planning to retire, please be sure to contact Rosalie Carlin at the Capital Medical Society office (850) 877-9018 or rcarlin@capmed.org. As a Retired CMS Member, your membership dues change to: Retired - $150.00 with meals (includes dinner at CME meetings) or Retired - $50.00 without meals (you are billed for dinner if you attend a CME meeting). It is your choice. Do you plan to change the status of your Florida Medical License to Retired? Visit this link: https://flboardofmedicine.gov/helpcenter/how-do-i-change-the-status-of-my-license-toretired/, or search online for: Florida Board of Medicine How do I change the status of my license to retired? You must formally request Retired status with the Board of Medicine (BOM) for your medical licensure and pay a fee rather than just not renewing. The penalty for being late in requesting a Retired status change with the BOM can be $515.00. Remember, be sure to let CMS know of your change in status.
CAPITAL MEDICAL SOCIETY VIRTUAL LUNCHTIME LEARNING SEMINARS ~ These seminars will be virtual until further notice ~ Save the Date for the Fall 2020 Virtual Lunchtime Learning Seminars: September 16, 2020 Employee Law Updates With record litigation and a dramatic increase in governmental audits impacting local business, come join us for a fun interactive look at the areas that are most likely to create costly legal exposure at your company. Topics to be covered will include key points of risk throughout the employment life cycle, common mistakes involving employee leave, and preparing for coming changes to federal wage and hour laws. This is a cannot miss for small business owners, human resource professionals, and Chief Executive Officers alike! Speaker: Bill Krizner, The Krizner Group Sponsor: Traci Poucher, CAMPUS USA Credit Union (https://campuscu.com/)
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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
October 21, 2020 No Ego: How Leaders Can Cut the Cost of Workplace Drama, End Entitlement, and Drive Big Results Speaker: Bert Mitchell Sponsors: Walt Haley, FMI Printing & Distribution (https://fmibusiness.com/) Liz Thiele, TMH Federal Credit Union (https://www.tmhfcu.org/) November 18, 2020 Exploring Telemedicine Speakers: Paige Dixon and Eric Friall Sponsor: Liz Thiele, TMH Federal Credit Union (https://www.tmhfcu.org/) Time: 12:30 PM to 1:30 PM Cost: $10 per person, per seminar For more information, please contact Rosalie Carlin at (850) 877-9018 or rcarlin@capmed.org.
6957 BUCK LAKE ROAD
403 FAIR HAVEN ROAD
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320 OAKS WILL COURT | WATERFRONT
3908 BOBBIN BROOK CIRCLE
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5 BR | 6 FULL BA | 2 HALF BA | 8,038 sf
3 BR | 3 FULL BA | 3,959 sf
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$995,000 | POOL | TENNIS COURT
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$635,000 | LAKEFRONT
1406 LLOYDS COVE ROAD
PHIPPS POINT ROAD
502 BEARD STREET
3 BR | 2 FULL & 2 HALF BA | 4,548 sf
2.55 ACRES | WATERFRONT | LAKE HALL
4 BR | 3 BA | 3,252 sf
$599,900 | LAKEFRONT | 2+ ACRES
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$549,900
TUSCAN HILL DRIVE
4762 PLANTERS RIDGE DRIVE
7002 DUCK COVE ROAD 4 BR | 4.5 BA | 3,222 sf
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3.29 ACRES | GATED NE COMMUNITY
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3 BR | 2 BA | 1,548 sf
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Hettie Spooner (850)509-4337 Lindsay Elliott (850)545-2463 Calynne Hill (850)545-6140 1390 Timberlane Road Tallahassee, Florida 32312
HILLSPOONER.COM CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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FSU COLLEGE OF MEDICINE - TALLAHASSEE REGIONAL CAMPUS
CMS PRESENTS CHECK TO FSU COLLEGE OF MEDICINE TALLAHASSEE REGIONAL CAMPUS Dr. Christie Alexander and CMS Executive Director Pam Irwin welcomed incoming 3rd-year medical students at the FSU College of MedicineTallahassee Regional Campus by hosting a campus breakfast and the first ZOOM Capital Medical Society orientation. Dr. Alexander shared the importance of engaging in organized medicine as students through the local medical society and the FMA. Pam Irwin explained the role the Capital Medical Society plays in serving as a voice and resource for physicians.
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Students were invited to join the association. The Capital Medical Society continues to keep the medical community informed and with access to PPE during COVID-19. Its foundation awards scholarships to FSUCOM students annually. A check for $2,000 was presented by the CMS to the regional campus for scholarships. Dr. Rahangdale closed the meeting by expressing his appreciation for the Capital Medical Society and its service to physicians and medical students.
PORTRAITS IN COVID-19
NEW CAP SCAN SERIES: "PORTRAITS IN COVID-19" – PLEASE SHARE YOUR EXPERIENCE
Capital Medical Society is accepting stories for its Cap Scan magazine from CMS and CMSA members as part of a new occasional series called “Portraits in COVID-19,” to capture the changes happening in healthcare and our personal lives due to COVID-19 as experienced by physicians and laypeople. These stories can be about your experiences treating COVIDpositive patients, supporting patients and coping
with families during “no visitation,” entering the world of telehealth, concerns about PPE shortages, distancing from your own families, family celebrations by social distancing, newfound time with family, newbie ZOOM meeting experiences worthy of an SNL skit, staycations extraordinaire, or schooling from home. You get the idea. Please try to stay within 800 words, include a photo if it makes sense, and be mindful of HIPAA, if writing about a patient experience. Please send by email to Shannon Boyle at sboyle@capmed.org. All submissions are reviewed by the Cap Scan editor prior to publication.
Margarett Ellison, MD
Serving the needs of our patients in Tallahassee. 2626 Care Drive, Suite 101
888-GYNONC1
GYNONCof Tally.com CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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PORTRAITS IN COVID-19
COVID-19: DIVIDER OF EPOCHS, AS SHARED BY FRANK SKILLING, M.D.: At one time I remember learning about the abbreviations “B.C.” and “A.D.” They were so numerous that it almost seemed like every government document, building inscription, or bookplate made reference to them. They stood for “Before Christ” and “Anno Domini.” The fact that they were an amalgamation of English and Latin was accepted unthinkingly because they referred to the time designator of history that was marked in Western society by the birth of Jesus, the Savior, the Christ, the Chosen One. In my later studies I came to learn of the now preferred abbreviations: “B.C.E.” and “C.E.” representing “Before the Christian (or Common) Era” and “Christian (or Common) Era.” One rarely encounters “B.C.” or “A.D.” in contemporary references. After the last few months of living in a pandemic, I have started thinking in terms of “B.C.” and “A.C.” Before Corona and After Corona. It seems that the separation of these eras is so complete and so pervasive that I can’t think in another way without effort. Now when I watch a televised drama, or read a short story, or follow a news report on the internet, I immediately draw the demarcation mentally of “B.C.” and “A.C.” There seems to be no other way of thinking. Nothing in my lifetime stretching back to the 1940s has been so complete or so encompassing. I’m constantly assessing and re-assessing the change in the very fabric of human existence that has been wrought by this scourge which remains invisible, pervasive, and silent. It’s as if the effects of a zombie invasion are being felt without sighting of the zombies themselves. Our reactions to the pandemic are based on our belief systems which accept or reject zombies, except that the zombies are real but invisible. I feel that part of this crisis is a test of risk versus reward. How much isolation and social restructuring are you able to tolerate to be safe in the pandemic environment? How much do you perceive an invisible threat is to the existence of you and your family? Everyone’s answer is a bit different, as I’m starting to realize. As someone who’s devoted his entire professional, and most of his personal, life to the study and practice of medicine, the crisis has caused me to wonder what the implications are for the future of medicine. Of course, anyone connected with medical education thinks about the future of practice when one is trying to prepare students who are entering the field, but what concerns me in a nebulous way is how the very foundation of medical practice has been changed as 12
CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
we go forward. Already the switch to telemedicine seems to have been accomplished overnight with virtual office visits and medication checks through the internet. Both parties, doctors and patients, seem to have made the transition instantaneously and have forced third party payors to adjust too. Now we have no touch, poor visibility, virtual contacts that deprive physicians of one of the gauges that was so useful in the practice of medicine: face to face encounters. In teaching physical diagnosis to students, the inviolable sequence of the encounter was history, physical examination, differential diagnosis, treatment plan, follow up. While the history part was often the most revealing for setting the student on the right path to the physical exam, the positives and negatives of the physical were confirmation that the examiner was on the right path. Now we’re not going to have the physical contact because of telemedicine. Whereas practitioners of old relied on all five senses to lead to a plausible diagnosis, the modern encounter may well exclude any sensory input except that of a video screen. The posture of the patient, the tone of voice, the inflections of the answers, the body language are difficult to project through a 5G cable. If the patient is not accustomed to talking via camera in an empty room, the breadth of the interview may be shallow and truncated. My own field of ophthalmology is overwhelmingly visual in nature. We are servants to our slit lamps and ophthalmoscopes. While photography and videography have been huge advances in teaching and documentation, they require someone to be present with the patient to arrange the equipment. Close physical contact is imperative, and a mask is a hindrance to both patient and examiner. One of the things I have emphasized for senior medical students to learn during their first post-graduate year of training is to discern who is a critically ill patient when they first walk into a patient’s room. While we’re going to have video cameras in ICUs and outpatient exam rooms, how are students to learn who is truly sick by watching a screen? Already the FSU College of Medicine has made the transition by introducing first-year medical students to simulated patient encounters via video conferencing. What will happen when the same students encounter real live patients in a real clinical setting for the first time? How can surgical technique and clinical maneuvers be taught in a virtual setting? What does the breath of a dying patient really smell like? How can you listen to chest sounds without having a stethoscope physically placed on a patient? What does the belly of a patient with appendicitis actually feel like? These are questions that medical providers will have to learn to answer as we are engulfed in the COVID-19 pandemic.
PORTRAITS IN COVID-19
MY NEW OFFICE, AS SHARED BY MICHELLE MILLER, M.D.: The neighborhood stray cat is lounging in my new office, the back deck of our home. He ignores me as I point my phone camera and tell my patient that she is the only one present during our virtual visit. Currently, I am enjoying the slight breeze while working from home, sitting under a shade umbrella. I generously apply sunscreen every two hours as I respond to tasks sent via EHR from my nurses, and I conduct four to ten virtual visits a day. This is down from my normal twentyone face to face visits in the office. Fortunately, I don’t have to worry about billing for RVUs since I am an employed physician on a salary, unlike some of my colleagues who are scrambling to keep their work production up. Other physicians are looking for new jobs after being terminated or furloughed. To keep the total number of people in the office at any one time to less than ten, I and my colleagues are working a rotating schedule from home. Each provider works from home for two weeks, while each nurse rotates weekly. I went last, which was fine for me, as I was worried that the peak would hit later than expected. Since I have multiple sclerosis, I hear a nagging voice in the back of my head which questions me: What if I am exposed to the virus and it causes a relapse? Should I take the personal leave time offered by my employer due to my autoimmune disorder now or wait? If the local hospitals need volunteers, should I risk my health to help out? It’s the same one I heard even before the pandemic. Then it would ask me if I should retire early to decrease my risks of exposure or consider becoming a telemedicine physician. Thank goodness I was already working in the outpatient office setting at the time of my diagnosis, as I know that the voice would have been screaming at me in the hospital during rounds. The pandemic has also put a halt on my new treatment plan. I was to start Lemtrada to reconstitute my immune system, by taking a daily infusion for five days to deplete my T and B lymphocytes. During a pandemic this scary idea has been put on the back-burner, so I continue with my three time weekly subcutaneous injections
of Copaxone to modulate, but not suppress, my immune system and hopefully keep my MS from flaring up. Prior to COVID-19, the scariest exposure I had on a regular basis was the flu. My nurses and patients have learned that during flu season I will give them my spiel: If you refuse your flu shot, don’t come to see me in my office. If you have classic flu symptoms, instead call for Tamiflu or go to urgent care. I have told my staff that if I get influenza, I might end up in the hospital with a flare of my MS that could lead to losing my vision, my balance or control of my bladder. Most patients will understand my request, and some actually change their minds and get the vaccine. All patients are expected to wear masks now, but I demanded that they wear one if sick in the office prior to COVID for this reason. Prior to this pandemic, I would hear a guilty voice with every sick exposure I encountered, but now the voice doesn’t end with the guilt over exposing just myself. When I work in the office now, I change out of my work clothes prior to leaving for the day, leaving behind my work shoes in the office. When I enter my garage, those clothes go into a hamper that my family isn’t exposed to. We are fortunate that my husband is a stay at home dad, so when the daycare closed, my family didn’t have a disruption in their daily life. However, it is impossible to explain to a twoyear-old that mommy has to work from home and that means she can’t play with you. Thus, I’m sequestering myself on the back deck away from physical access and hearing. Besides the stress of trying to keep quiet so he doesn’t have a meltdown, I have had the strange “pandemic dreams” that I think many people are having - vivid dreams that should be recorded in a dream diary, if I had the energy to do so. “You are having a normal response to the crazy world we now all find ourselves in” is a common phrase I have had to say to patients, my nurses, staff, family, friends and to myself. Self-care has been a hot topic so I remind my patients (and everyone else I talk to) that we need to give ourselves permission to be imperfect: to have patience with ourselves while adjusting to this new normal while hoping that life will return to some semblance of the old normal in the future. Although I must admit that I am enjoying my new office right now.
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PORTRAITS IN COVID-19
About the Author: Beauvais McCaddon is a former member of the Medical Auxiliary. She holds a master's degree in Creative Writing from the Florida State University.
MAD DOG, AS SHARED BY BEAUVAIS MCCADDON: “A mad dog’s coming,” my mother had phoned from her office. The lady, who was keeping my sister and me, called us inside where we sat on the sofa and peeked through the venetian blinds, fearful of a dog, foaming at the mouth, and zig zagging down the main street. Now, with the COVID-19 pandemic, and “sheltering in place,” I feel as if there is another mad dog stalking us. Although this one can’t be stopped by being shot. Born in 1944, I grew up in a small town in Mississippi where few if any dogs were vaccinated. According to a vet, vaccinations didn’t become common until the early 1950s, but even then, not in our town. My four-year-old sister was bitten by a puppy and then given the painful injections to prevent her contracting rabies. From playing in sandboxes, we got the creeping eruption. I’m horrified now to discover that the winding rash is caused by hookworms. There was also impetigo, pin worms, and ringworm. I remember sitting behind a boy at the picture show, who was wearing a “ringworm beanie” to cover his shaved head. Another boy cruelly snatched the beanie off, exposing the red rash. Why were these infections so common? Was it because we children played outside all the time, digging in our backyards with our mothers’ teaspoons, making mud pies, and playing with our cats and dogs? We lived through the polio scare with “polio naps.” We suffered through German measles and measles. My sister, a doctor, reminds me that we had chicken pox and measles “parties,” so that the diseases could be spread among the children. As doctors are aware, the illnesses can cause serious reproductive complications in adults. I suppose parents wanted to “get them over with,” knowing the diseases were inevitable.
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When I contracted rubeola, the blinds were kept drawn in my room because the light hurt my eyes. I hallucinated, seeing butterflies everywhere. Of course, the doctor (always smelling of isopropyl alcohol) made a house call to check on me. There was his dreaded black bag, which held the penicillin shot for most occasions. It was comforting then, knowing that the doctor would come and take care of me. These are particularly scary times for a person living alone. When I was married to a doctor, it was reassuring to have him in the house. There is a huge underlying anxiety about this virus, the unknowns, the changing guidelines about how to stay safe, and no one to put some order into the everyday chaos. Getting the mail, picking up the newspapers, opening packages are no longer simple tasks. When I unpack groceries, I wonder if I am using enough disinfectant wipes; will a wipe disintegrate the plastic bag around the bread? If I stick the package of green beans in the refrigerator and not touch it for three days, is that okay? Do doctors themselves have these same worries? My friends and I socialize in the garden, six feet apart. Is that enough? I haven’t been to a store yet. I went to Trader Joe’s with my mask and couldn’t bring myself to go in. I have to adjust; this is going to be a new way of life for a long while. For the time being, I am thankful for what I have and I take comfort in small pleasures—walking around my garden, talking to friends on the phone, and reading. In particular, I have enjoyed Eudora Welty’s short stories. I think partly because they are about characters in small towns, who are insular in a similar way to what I am feeling. As a child, I didn’t appreciate how brilliant and important the doctors and scientists were in discovering vaccines. And I know there’s hope that a vaccine will eventually stop this mad dog coming straight at us down main street.
SIMPLER TIMES
PICKIN’ ON REDNECKS By Charles D. Williams, M.D., FACR, FAAP Nowadays it seems that the only group that people can pick on and not be politically incorrect are those of us raised in the South and referred to as rednecks.
also knew how to say thank you and yes ma’am and he did give us love. On Saturday night he was standing by the radio listening to Hank Williams on the Grand Ol’ Opry and on Sunday morning he was down on his knees thanking the Lord.
People such as Jeff Foxworthy have made fortunes talking about rednecks. He says that you’re a redneck if the Salvation Army ever declined your mattress. He also says that a redneck considers a pick-up truck with lawn furniture in the back to be a limo.
I’m from the South and I’m fixin to tell you something. I might bless a few hearts and piddle around. I’ll greet you with a howdy or hey y’all and say ma’am and sir. If you are proud to be a southerner, then go up yonder. If you don’t know where yonder is, then you ain’t no southerner.
However, all rednecks ain’t bad. Many of them have risen to great heights. At least a couple are listed in Ripley’s Believe It Or Not – one for being an only child and the other for having liability insurance on his truck. Believe it or not at least one redneck has become a doctor. Sometimes I think rednecks have been given a bad rap and folks need to be eduakated. The term got its start when folks like mine made their living in the fields in the hot summer months trying to grow food for their families and others and their necks became red. When these country folks, farmers and sharecroppers went into town on Saturday to git feed, seed and flour and to see what was happening, city folks noticed that their necks were red. Some of the city folks thought that these country folks were ignorant and uncouth. These folks drove pick-up trucks that didn’t need washing and trucks that nobody would steal. They listened to the Grand Ol’ Opry on Saturday night and they knew all the words to the old gospel hymns on Sunday. They freely used y’all and ain’t in their sentences. When they wore their overalls they weren’t trying to make a fashion statement. My Dad was one of these folks. He had one of the biggest hearts and he was one of the most kindest and most caring people I have ever known. In his earlier years his neck got red walking behind a mule trying to make a living for his family. He was at his best when his hands were in the soil. He didn’t know how to read but he did know how to give a dollars worth of work for a dollars worth of pay. He
These folks would take time to sit on the porch with you and visit for a spell. They also took food cooked from scratch to a home where there had been a death and would stay long enough to do the dishes. They would pull off the side of the road when they met a funeral even though they didn’t know the deceased. They would go to the cemetery and stand over the grave of a loved one long after the family member had died. These were people you could trust and people you could count on when you were in a bind. Their handshake and word wuz much better than a contract. They would pick you up when you were down, comfort you in time of sorrow, share with you when you were in need and tell your Mama when you done something wrong. They helped this ol’ boy git his educashun. I'm an offspring of these folks who worked the soil and became red of neck and I'm proud of it. If folks don't quit pickin' on rednecks, I think I'm going to go out to the doctors parking lot, git in my pickup trunk, listen to Hank Williams, eat some boil peanuts and pout. Reprinted with author permission from More Simpler Times.
Dr. Williams’ sequel book, More Simpler Times, can be purchased from the Capital Medical Society. All proceeds from the book are donated to the Capital Medical Society Foundation’s We Care Network program. The total sales from his books have raised over $39,000 for the CMS Foundation’s We Care Network. CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION
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MEDICAL/LEGAL
REOPENING YOUR PRACTICE: AVOID RISKS WHEN TREATING STRESSED PATIENTS DURING COVID-19 While most resources are directed at screening for COVID-19 and treating affected patients, there is another important aspect of the pandemic: the impact on your patients’ mental health.1
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Anxiety is being exacerbated by patients’ mistrust of the healthcare system and fear that they or their loved ones will contract the virus. A recent survey indicated that 67 percent of people have increased levels of stress since the start of the COVID-19 outbreak.2
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What are some warning signs or cues that show a patient is in emotional distress? Watch for the following signs when seeing a patient onsite or via telehealth: • • • • • • • • • •
Changes in appetite, sleep, and/or behavior. Nonverbal cues during an interview. Decreased or no energy. Changes in cognition. Feelings of hopelessness/ helplessness, being overwhelmed, irritability, fear/worry. Withdrawal from friends/family and activities. Increased conflict within relationships. Lack of follow-through with seeing therapist and/ or psychiatrist. New somatic complaints. Excessive smoking, drinking, or using drugs.
If these warning signs are missed and an adverse event— such as suicide—occurs, the healthcare provider may face the risk of a medical malpractice claim. While the vast majority of your patients who are anxious and stressed about the COVID-19 virus are not suicidal, it is important to keep in mind the possibility of suicide as you complete your assessment. A helpful resource is the Suicide Prevention Toolkit for Primary Care Practices from the Suicide Prevention Resource Center and the Western Interstate Commission for Higher Education Mental Health Program. The following key elements of the Stress First Aid peer support model3 have been linked to better functioning during times of ongoing stress and should be used in discussion with patients showing signs of anxiety:
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COVER: Restore and support a sense of safety. CALM: Calm and orient distressed persons by asking if they have experienced any changes. CONNECT: Connect in a helpful and respectful manner. COMPETENCE: Remind them of skills that have worked in the past for them. CONFIDENCE: Foster a sense of hope, limit selfdoubt and guilt, and help patients concentrate on strengths During these discussions, explain to patients the importance of self-care during times of stress and the importance of staying connected to their support system. Provide positive encouragement and reinforcement.
References
1. Diamond R. Watch for the signs: Screen all patients for suicidal thoughts. The Doctors Company. Published November 2016. Accessed May 19, 2020. https://www.thedoctors.com/articles/watch-forthe-signs-screen-all-patients-for-suicidal-thoughts/ 2. Qualtrics. The other COVID-19 crisis: Mental health. Published April 2020. Accessed May 19, 2020. https:// www.qualtrics.com/blog/confronting-mental-health/ 3. National Center for PTSD. For Leaders: Supporting Your Staff During the Coronavirus (COVID-19) Pandemic. Published April 9, 2020. Accessed May 18, 2020. https://www.ptsd.va.gov/covid/COVID_leaders_ support_staff.asp The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered. Contributed by The Doctors Company (thedoctors.com)
DONATE TO THE CMS FOUNDATION
The Impact of Private Support:
Donate to the CMS Foundation – We Thank Our Donors We thank the following individual donors who made a donation to the CMS Foundation this past month: Capital Medical Society Foundation – Area of Greatest Need AmazonSmile Frueauff Foundation – for COVID-19 response Dr. Rohan Joseph and Elizabeth Medley Joedrecka Brown Speights, M.D. Scholarship Fund David Bellamy, M.D. – In Memory of Cynthia Marie Golson We Care Network Anonymous Frueauff Foundation – for case management services
The Capital Medical Society Foundation’s community of donors strategically help fulfill its mission “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.” ➢ Access to healthcare is increased through gifts to the We Care Network and the We Care Network Endowment Fund. More than $105.4 million in donated specialty medical and dental care has been provided to low-income, uninsured patients since the program was created in 1992. In fiscal year 2018-19, which ended June 30, 2019, more than $7.4 million in health care was donated. Gifts support the operational expenses of the program including salaries and benefits of the case management team who coordinate the donated care. ➢ To provide incentives to keep medical students trained at the FSU College of Medicine in the Big Bend after completion of their residencies and help meet the growing demand for physicians in Florida, gifts to the Scholarship Fund provide scholarships to FSU College of Medicine students who have expressed an interest in returning to the Big Bend to practice after completion of their residencies. $50,000 was awarded in 2019. ➢ Gifts to the Capital Medical Society Foundation help provide operational resources for the Capital Medical Society Foundation. In addition, modest grants are awarded to area non-profits whose programs improve access to healthcare for the underserved. In 2020, the CMSF awarded a total of $10,000 in grants to Elder Care Services for their In-Home Services Program and the Big Bend Hospice Foundation for bereavement services. Gifts to Honor and In Memoriam: You can make a gift to the CMS Foundation 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 or your family. The CMS Foundation will send an acknowledgement letter to those you memorialize and honor. How to Give: Through the generosity of donors, funds have been created in order to establish financial stability to meet our mission. You can make a gift at any time to one of the CMS Foundation’s current funds: 1) Capital Medical Society Foundation-area of greatest need 2) The Capital Medical Society Foundation Endowment 3) We Care Network 4) We Care Network Endowment 5) Scholarship Fund 6) The Ronald G. Pickett Endowment 7) Physician Wellness Fund Gifts should be made payable to the CMS Foundation and indicate on the memo line of your check to which designation you would like to give. Bring your check to the CMS Office or mail it: Capital Medical Society Foundation ~ 1204 Miccosukee Road ~ Tallahassee, FL 32308. Gifts may be made by credit card or direct debit from the CMS website. If you would like to discuss a gift of appreciated securities, an insurance policy, designation of retirement plan assets, estate gift, or multi-year pledge, please contact:
Your gifts to the Capital Medical Society Foundation transform lives in the Big Bend.
Pam Irwin Executive Director pirwin@capmed.org or (850) 877-9018 or after hours at (850) 559-8611
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CMS FOUNDATION: WE CARE NETWORK
FOUNDATION
We Care Network
THANK YOU To our CMS members and We Care Network partners who provided healthcare to new patients in May 2020. Your generosity and support of the We Care Network makes a difference.
Physicians David Alvarez, M.D. Emily Ashmore, M.D. Venkata Bavikati, M.D. Marie Becker, M.D. Tony Bryant, M.D. Viet Bui, M.D. David Burns, M.D. J. Brewster Caldwell, D.O. Joseph Camps, M.D. Francisco Carpio, M.D. Gilbert Chandler, M.D. Matthew Connor, M.D. Raymond Cottrell, M.D. Marilyn Cox, M.D. William Dixon IV, M.D. Hong Gao, M.D. Spencer Gilleon, M.D. Gian-Carlo Giove, M.D. Frank Gredler, M.D. Aaron Guyer, M.D. Muhanad Hasan, M.D. Todd Hewitt, M.D. David Huang, M.D. Marc Inglese, M.D. Barbara Jaeger, M.D. Floyd Jaggears, M.D. Amit Jain, M.D. Rohan Joseph, M.D. Arjun Kaji, M.D. Fang Sarah Ko, M.D. Maribel Lockwood, M.D. Kurt Luhmann, M.D. Michael Mangan, M.D. Jayan Nair, M.D. Charles Newell, M.D. Karan Patel, M.D. Vatsal Patel, M.D. Mitchell Peabody, D.O. Michael Pentaleri, M.D. Jorge Perez de Armas, M.D. Alexander Ramirez Valderrama, M.D. Pablo Rengifo-Moreno, M.D. 18
Davis Rierson, M.D. Andres Rodriguez, M.D. Abel Romero-Corral, M.D. Tim Ruark, M.D. Ronald Saff, M.D. Stephen Sgan, M.D. Eliot Sieloff, M.D. Joshua Somerset, M.D. Timothy Sweeney, M.D. John Thabes, M.D. Briana Thompson, M.D. William Thompson, M.D. Ernesto Umana, M.D. David Vermess, M.D. Graham Whitaker, M.D. Chien-Yi Williams, M.D. William Yaakob, M.D. Charles Yowell, M.D. Dentists Laban Bontrager, D.M.D. Walter Colón, D.M.D. William McFatter, D.D.S. Barrett Tolley, D.D.S. Facilities Advanced Urology Institute Airway Works, LLC Allergy & Asthma Diagnostic Treatment Center Anesthesiology Associates Apalachee Primary Care Beachton Denture Clinic Bond Community Health Center Bristol Dental Clinic Capital Health Plan Capital Regional Cancer Center Capital Regional Surgical Associates Care Point Health & Wellness Center Dermatology Advanced Care Dermatology Associates Desloge Home Oxygen Digestive Disease Clinic Florida Cancer Specialists & Research Institute Gadsden County Health Department Jessie Furlow Medical Center Ketchum, Wood, & Burgert Pathology Associates Madison Medical Center Neighborhood Medical Center North Florida Women’s Care Oral & Facial Surgery Center
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Periodontal Associates of North Florida Radiology Associates of Tallahassee Southern Medical Group, P.A. Southern Vitreoretinal Associates Tallahassee Diagnostic Imaging Tallahassee Memorial HealthCare TMH Family Medicine Residency Program TMH Physician Partners Cancer & Hematology TMH Physician Partners Cardiology and Internal Medicine TMH Physician Partners Clinical Genetics Center TMH Physician Partners Gynecologic Oncology Specialists TMH Physician Partners Pulmonary, Critical Care, and Sleep Specialists TMH Physician Partners Radiation Oncology Specialists TMH Physician Partners Surgical Specialists TMH Physician Partners Urology Specialists TMH Transition Center Tallahassee Orthopedic Clinic Wakulla County Health Department Wakulla Medical Center Women’s Imaging Center
Please contact Diana Bixler at dbixler@ capmed.org or 201-0130 if you are a We Care volunteer and you provided volunteer specialty care in the month of May 2020 and your name is omitted.
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. In addition, up to five hours, per biennium, of CE credit may be fulfilled by performing pro bono medical and dental services to We Care Network patients, if we have received documentation of value of services. You can send your value of donated services via fax to Diana Bixler at (850) 2010085 or mail to 1204 Miccosukee Road, Tallahassee, FL, 32308. Thank you!
CMS FOUNDATION: WE CARE NETWORK
We thank our referring providers from May 2020:
Ebonie Allen, APRN
Matthew Lee, M.D.
Clifton Bailey, M.D.
Ian MacDonald, APRN
Marie Becker, M.D.
Michael Mangan, M.D.
Dhananjay Bendre, M.D.
Damon McMillan, M.D.
Timothy Bolek, M.D.
Jonathan Melquist, M.D.
Jonna Bradley, APRN
Kelley Miller, APRN
Daniel Breivogel, APRN
Marcia Morris, APRN
Fran Bridges, APRN
Jayan Nair, M.D.
J. Brewster Caldwell, D.O.
Paresh Patel, M.D.
Joseph Camps, M.D.
Mitchell Peabody, D.O.
Lysmar Carrion-Dinguis, M.D.
Jorge Perez de Armas, M.D.
Matthew Connor, M.D.
Lisa Perkins, APRN
Raymond Cottrell, M.D.
Hussein Rayatzadeh, M.D.
William Dixon IV, M.D.
Charlie Richardson, M.D.
Shirleen DuPont, APRN
Tim Ruark, M.D.
Joyce Dwyer, APRN
Gadi Silberman, M.D.
Cynthia Evans, APRN
Abisoye Somorin, APRN
Sharron Foster, M.D.
Alanna Steaple, APRN
Anneka Gaffney, APRN
Briana Thompson, M.D.
Hantz Hercule, M.D.
Lacie Thompson, APRN
Jessica Hill, M.D.
Faye Tinson, APRN
Amit Jain, M.D.
Marianne Towler, APRN
Kenneth Kato, M.D.
Mary Tucker, M.D.
James Killius, M.D.
Jeffrey Wasserman, D.O.
Elaine Larkins, APRN
Lucas Watkins, M.D.
DURING THE MONTH OF MAY 2020, THE WE CARE NETWORK: RECEIVED 201 REFERRALS, WITH 129 PATIENTS NEW TO THE PROGRAM
SCHEDULED 102 APPOINTMENTS WITH VOLUNTEER PHYSICIANS AND DENTISTS
$284,710.57 IN DONATED CARE WAS REPORTED BY WE CARE VOLUNTEERS
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THANK YOU TO PPE DONORS AND VOLUNTEERS
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