Cap Scan - August 2019

AUGUST EDITION, VOLUME 2019, NO. 8

CALLING FOR AUCTION ITEM DONATIONS! The Capital Medical Society Foundation Holiday Auction will be held on Thursday, December 5, 2019. We want to make it bigger and better than ever, so we need donated items!

The deadline to receive items is November 20.

All items, large or small, are needed. Do you have any of the items on our wish list or know someone you can ask to donate them?

Holiday Auction invitations will be mailed on November 1!

If you have any questions or would like to donate an item, please call the CMS office at (850) 877-9018.

• Vacation getaways • Hunting trips or fishing trips • Hunting or fishing gear • Sports tickets • Concert tickets • Children’s toys • Cars • Boats • Jewelry • Art • Fine Wine & Spirits • Holiday Décor • Sports Memorabilia, etc. ine W e ts Fin Spiri &

Sports & Concert T ickets

Vacation Getaways

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CAPITAL MEDICAL SOCIETY 2019 MEETINGS CALENDAR August 24, 2019 CMS/CMSA Connect the Docs Family Picnic 11:00 am – 2:00 pm Maclay Gardens ($6 entrance fee)

September 5, 2019 Connect the Docs Happy Hour sponsored by Capital City Bank 6:00 pm – 8:00 pm The Wine House on Market Street (1355 Market Street, A1)

CONTINUED ON PAGE 3

BOARD OF GOVERNORS Maribel U. Lockwood, 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

2019 CMS Foundation Holiday Auction.................................1 Professional Notes......................................................................3 CMS/CMSA Connect the Docs Family Picnic......................5 Announcements..........................................................................6 Viewpoint......................................................................................7 CMS Connect the Docs Happy Hour......................................8 Medical Student Perspective.................................................10 Medical/Legal............................................................................. 11

Ken Whithaus, M.D., President-Elect

CMS Foundation........................................................................ 13

Rohan Joseph, M.D., Secretary/Treasurer

CMS Foundation: We Care Network.................................... 14

David Dixon, D.O., Immediate Past President Christie Alexander, M.D. Todd Hewitt, M.D. Marc Inglese, M.D.

HAPPY BIRTHDAY!

Melissa Inglese, CMS Alliance Sarah Ko, M.D.

{AUGUST BIRTHDAYS}

Matt Lee, M.D. Paresh Patel, M.D. Helen Paulson, M.D. Cody VanLandingham, M.D. Julia Weeks, M.D. Pam Irwin, Executive Director, Capital Medical Society Dermatology Residents Samantha Marrone, M.D./Shalini Thareja, M.D. Family Medicine Residents Tristan Brooks, D.O./Mary Claire Smallwood, M.D. General Surgery Residents 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.

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.

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Oliver Reyes, D.O. – 1st Cielo Rose, D.O. – 1st Katherine Mackenzie, M.D. – 1st Michael Douso, M.D. – 2nd Sangeeta Nair-Collins, M.D. – 2nd Christopher Rumana, M.D. – 3rd Ronald Ray, M.D. – 4th Stacia Groll, M.D. – 5th William Paul Sawyer, M.D. – 5th Bob Soni, M.D. – 6th Emily Ashmore, M.D. – 7th T. Adam Oliver, M.D. – 7th John L. Williams, Jr., M.D. – 7th T. Dean Dalrymple, M.D. – 8th Lisa Flannagan, M.D. – 8th Stanley Gwock, M.D. – 8th David Pascoe, M.D. – 8th Akash Ghai, M.D. – 9th Simon Lopez, M.D. – 9th Eugene Wang, M.D. – 9th Marc Inglese, M.D. – 11th Sergio Ginaldi, M.D. – 13th Alice Pomidor, M.D. – 13th SchMiyah Smith, M.D. – 13th

David Craig, M.D. – 15th Gadi Silberman, M.D. – 17th Joshua Fuhrmeister, M.D. – 18th Dung Nguyen, M.D. – 18th Terence Reisman, M.D. – 18th Rachel Vanderby, M.D. – 19th Marie Becker, M.D. – 20th William Morse, M.D. – 20th Frank Walker, M.D. – 20th Eric Bouchard, M.D. – 22nd Michael Forsthoefel, M.D. – 22nd Shayla Gray, M.D. – 22nd Claras Ellis, M.D. – 23rd Tracy Graham, M.D. – 25th P.S. Krishnamurthy, M.D. – 25th Joshua Hickman, D.O. – 26th James Thomas, M.D. – 26th Charles Yowell, M.D. – 26th Jeffrey Ferraro, M.D. – 27th Richard Thacker, D.O. – 28th Stan Whitney, M.D. – 28th Camille Blake, D.O. – 29th Rick Damron, M.D. – 29th Ashton Byington, M.D. – 30th

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!

PROFESSIONAL NOTES

PROFESSIONAL NOTES Les Beitsch, M.D., J.D., FSU College of Medicine Chair of Behavioral Sciences and Social Medicine, and Christopher Uejio, Associate Professor of Geography, are part of a research team that has been awarded more than $400,000 by the National Institutes of Health to study how Hurricane Michael affected birth outcomes in the Florida Panhandle. They will partner with researchers from Tulane University to examine how infrastructure damage and exposure to carbon monoxide may have increased stress and trauma and decreased access to health care.

CMS Members: If you receive accolades, please let us know so we can include you in this section!

Email the details to Shannon Boyle at sboyle@capmed.org.

CAPITAL MEDICAL SOCIETY 2019 MEETINGS CALENDAR CONT. FROM COVER

September 17, 2019 CMS Membership & CME Meeting Disaster Preparedness Speaker: Joe Mazziotta, M.D. 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks October 15, 2019 CMS Membership & CME Meeting Prevention of Medical Errors Speakers: Julia Weeks, M.D. and Jesse Suber, Esq. 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks November 12, 2019 CMS Membership & CME Meeting Women are from Venus; Men are from Mars: Sexual Dysfunction on both Planets Speakers: Andrea Friall, M.D. and Kenneth DeLay, M.D. 6:00 pm Maguire Center for Lifelong Learning at Westminster Oaks December 5, 2019 CMS Foundation Holiday Auction 6:30 pm FSU University Center Club

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 3

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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

3900 WOOD GREEN WAY

4 BR | 2.5 BA | 2,289 sf

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CMS/CMSA CONNECT THE DOCS FAMILY PICNIC

The Capital Medical Society and Capital Medical Society Alliance invite you and your family to the

Family Picnic Saturday, August 24, 2019 11am - 2pm Maclay Gardens State Park 3540 Thomasville Road ($6.00 per car entrance fee)

Food Truck, Games, and Lots of Fun! Come on out and enjoy the day with your colleagues and their families!

Please RSVP by August 14 to Rosalie Carlin at (850) 877-9018 or rcarlin@capmed.org.

Title Sponsor

Event Sponsor

In-Kind Sponsors

Maclay School

Tami Frankland, Realtor with The Naumann Group Real Estate Seminole Sitters

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

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ANNOUNCEMENTS

CAPITAL MEDICAL SOCIETY LUNCH AND LEARN SEMINARS MARK YOUR CALENDARS FOR THE FALL 2019 LUNCH AND LEARN SEMINARS: September 18, 2019 Challenging Patients: To Dismiss or Not to Dismiss, that is the Question Unfortunately, not all patients and families are easy to work with.

Attend this session for the answers to these questions and more: • Should you continue to care for patients who don’t adhere to their treatment plan, pay their bills or no show frequently?

• Is there right way to dismiss a patient? Is there a wrong way and what are the consequences?

• Should you do anything if the patient fires you?

Learn how to protect you practice, your providers and your patients during the dismissal process.

Speaker: Sue Boisvert, The Doctors Company Sponsor: Medical AR Revenue Solutions, LLC

October 16, 2019 Improving Patient Communication Within the Medical Community Speaker: Zach Finn, HIE Networks Sponsor: HIE Networks November 13, 2019 Technology Roundtable Speaker: TBA Sponsor: TMH Federal Credit Union Seminars are held at the Capital Health Plan on Governors Square Blvd. – and we thank them for providing this venue to us.

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 RSVP, please contact Rosalie Carlin at (850) 877-9018 or rcarlin@capmed.org.

CMS MEETS INCOMING RESIDENTS Dr. Maribel U. Lockwood, CMS President, and Pam Irwin, CMS Executive Director, welcomed new residents from the Family Medicine, General Surgery, and Internal Medicine Residency Programs during an orientation luncheon at TMH on June 19, 2019.

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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

Dr. Lockwood shared the benefits of residents becoming engaged in organized medicine through Capital Medical Society membership.

New residents will be introduced at the September 17 CMS Membership Meeting.

VIEWPOINT

PRECIOUS MEMORIES AND WRINKLED HANDS

By Charles D. “Pedro” Williams, M.D., FACR, FAAP I was sittin’ on the back porch with my wife, Pat, reflectin’ on our grandkids and then remembered that a special gift of my childhood was havin’ my Grandma and the special memories and lessons she left behind. She once told me that one day I would bundle up all my yesterdays and head for a tomorrow but it would be the memories of my yesterdays that would get me through my tomorrows.

Grandma has passed on but I’m so glad she passed my way. The only thangs she had to pass on to Pedro were here memories.

Grandma touched a part of my life that can only be handed down in stories. She used her stories to teach us about life. It didn’t come from books on parenting. It had come from her Mama who had learned it from her Mama. It was not always what she said with her mouth but what I felt from her heart and saw in her eyes. For many of us the old times were the best of times or at least it seems that way.

Grandma and I spent time catchin’ lightenin’ bugs, making home-made ice cream in a hand-cranked churn, and spittin’ watermelon seeds off the front porch but my main most favorite memories were when we went walkin’ and talkin’.

She would reach down with her strong but wrinkled hands which were like dried apples and say, “Pedro, I want to spend some time with you. Let’s go walkin’.”

Back when Pedro was still wet behind the ears and littler’n most folks his age, Grandma and I walked down our long dirt road to get our mail from our rusty tin mailbox which had some of our last name spelled rite. Some folks said that we lived so far back between Moultrie and Doerun that we got the Saturday night Grand Ole Opry on Tuesdays. They were teasin’, I think. I do know that we got the Saturday paper on Tuesday. As we walked, Grandma said it was OK to be little but I might need to run twice as fast to keep up. She also said that no tree gits too tall that a short dog cain’t tee tee on it and a person shuldn’t git too big for their britches.

Another main most favorite time would be our walks through the garden. We walked past the corn fields as Grandma talked with a twinkle in her eyes and a joy in her heart. She could rip an ear of corn from the stalk, clean and strip the husk from each ear and toss it in a basket. As we walked and Grandma talked, she said to watch out for snakes but most of the time they were more scareder of us than we were of them. I cudn’t imagine anything that scared.

She told Pedro to go off to college and git educated and git a

dilemma and I did just that but it has taken me a long time to git over it.

Grandma said that she loved this dirt but she loved Pedro more. Diggin’ helped her to git recharged. She told Pedro that if he ever found himself in a deep hole to stop diggin’.

One time Willard gave her a new thermos. On one of our walks through the garden she threw the thermos under her arm as we headed out. I asked, “Grandma, what’s a thermos?” She replied, “A magic jug. It keeps hot thangs hot and cold thangs cold.” I said, “What you got in it?” She giggled and responded “Hot chili and iced tea.” I think she was pullin’ my leg.

Another time on the way to the garden, we passed by the barn and the mule shed and Grandma asked, “Has that mule ever kicked you?” Pedro replied, “No, but he did kick one time right where I had been.

Even when communication became world wide and instantaneous from way far off, nothing could beat goin’ home and holdin’ Grandma’s hand and lookin’ her in the eyes. She gave me such precious memories, a gift she gave unknowingly or perhaps she did know. Maybe that’s why she took the time. I had no idea how to thank her and never did have an idea. A government man once asked her if she had an ID and she replied, “About what?”

Recently my grandson was visitin’ and I took him for a short walk to the mailbox. I started tellin’ him to wash behind his neck, to study hard in school, and to keep on the sunny side of life. As I was holdin’ his hand, I felt a twinkle in my eye and looked down and noticed a few wrinkles in my hand.

A chill set in my body and wetness set in my eyes. I then remembered that the memories Grandma left behind were the only thangs that her death didn’t take away. I then turned to my grandson and said, “You’re a special little man. Let’s go for a long walk.”

When the day ended, I leaned back in my rockin’ chair, closed my eyes, and heard Grandma sing “Precious Memories, How They Linger.” I must have fallen asleep. I think.

Reprinted with author permission from More Simpler Times, Tales of a Southern Boy.

Dr. Williams’ book, More Simpler Times, can be purchased from the Capital Medical Society. All proceeds from the book are donated to the We Care Network program.

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 7

CMS CONNECT THE DOCS HAPPY HOUR

JOIN YOUR COLLEAGUES FOR A

HAPPY HOUR THURSDAY, SEPTEMBER 5, 2019 6:00 PM – 8:00 PM THE WINE HOUSE ON MARKET STREET (1355 MARKET STREET, A1)

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PLEASE RSVP BY AUGUST 29TH TO ROSALIE CARLIN AT (850) 877-9018 OR RCARLIN@CAPMED.ORG.

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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

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MEDICAL STUDENT PERSPECTIVE

A REFLECTION ON THE THIRD YEAR OF MEDICAL SCHOOL

By Brian Bowden, FSU College of Medicine, Class of 2020 The third year of medical school is the first year that students get to experience what it means to be part of the healthcare system. We have studied hard for the first two years, learning as much book knowledge as we can. Now, it is time for us to take that knowledge we have gained and apply it in the real world to real patients.

What you neither learn nor even know of, are all of the things that are not in books, the things that cannot be memorized and must be learned first-hand: how to efficiently do an ear, nose, and throat exam on a toddler; know the best place for your hands in surgery so that they are always ready to assist yet do not get in the surgeon’s way; or determine where to devote the most time with a patient who has a multitude of chronic conditions.

Each of us at the Florida State University College of Medicine progresses through the third year with a different schedule. Some, like me, start with Internal Medicine, while others may begin with a different rotation, such as Pediatrics or Surgery. However, by the end, we all complete the same six core rotations, each six weeks in length. In addition, we have the opportunity to complete two electives in areas of medicine in which we have a particular interest.

Along with our rotations, we meet weekly at our regional campuses for a lecture given on a common medical topic, usually by a specialist in the field, which is related to what we would see during our rotations.

These lectures refresh and remind us of the complexity of medicine. It may be a discussion on mood disorders when you have already finished your Psychiatry rotation months’ prior, a lecture on first-trimester bleeding before you have started your OB/GYN rotation, or topics we would see during many of our rotations, such as anemia, incontinence, or atrial fibrillation.

Each rotation had its own unique challenges. The first week of each rotation, no matter whether it was your first or your last rotation, was similar to learning a new playbook. You learned the flow of the clinic or office, how to round on patients if it was a rotation in the 10 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

hospital, and what the typical style of patient encounters would be. It was also a case of trial and error, some rotations fairing better than others, in determining what style of learning and what resources would be the best to help you succeed for the next six weeks.

Some rotations you enjoy more than others, and that is all right. Some surprise you, as you did not know how truly amazing it is to deliver a baby (or even two, when you get to assist with twins!). The gratitude patients express when they thank you for taking the time to explain a diagnosis or medical terminology, in a way that they can understand, helps remind you of the reason you chose medicine.

Other rotations, like Psychiatry, pull you out of your comfort zone. How well did First Aid for the USMLE Step 1 actually prepare me for the first time I discussed thoughts of self-harm and suicidal ideation with a teenager? Or the patient suffering from depression and PTSD who tearfully recounted the story of her husband having a heart attack and dying in her arms?

It was a rotation like this where both the patients’ personal struggles, as well as your own troubles with understanding, were tested daily. Times like these, where I was most challenged, will be the ones I will remember forever and be able to draw on in the future.

Not enough credit for our learning goes to the wonderful faculty members we are paired with as FSU medical students. They give us nearly unrestricted access to their patients, which allows to us to become part of their medical practice and see patients as if they were our own. They spend time to teach us, have us assist in deliveries or surgeries, and oftentimes extend visit lengths to allow us the time we need to learn from their patients.

Now that I am beginning my fourth year of medical school, and in less than one year will begin my residency, I have a better understanding of the privilege it is to be the provider of healthcare for others. The third year allowed me to see the strengths I have in my clinical knowledge and interpersonal skills, while also highlighting those areas where I still have a great deal to learn and to grow.

MEDICAL/LEGAL

TERMINATING PATIENT RELATIONSHIPS

By Julie Brightwell, JD, RN, Director, Healthcare Systems Patient Safety, Department of Patient Safety and Risk Management, The Doctors Company, and Richard Cahill, JD, Vice President and Associate General Counsel, The Doctors Company Just as it is an acceptable and reasonable practice to screen incoming patients, it is acceptable and reasonable to know when to end patient relationships that are no longer therapeutic. It is critical, however, that the physician end the patient relationship in a manner that will not lead to claims of discrimination or abandonment.

communicated with the third-party payer to request that the patient be transferred to another practitioner or otherwise complies with the terms of the payer-provider agreement.

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A patient may not be dismissed or discriminated against based on limited English proficiency or because he or she falls within a protected category under federal or state legislation. Examples of civil rights laws include the Americans with Disabilities Act (ADA), the Civil Rights Act, and the Emergency Medical Treatment and Labor Act (EMTALA).

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If a patient is pregnant, the physician can safely end the relationship during the first trimester if the pregnancy is uncomplicated and there is adequate time for the patient to find another practitioner. During the second trimester, a relationship should be ended only when it is an uncomplicated pregnancy and the patient is transferred to another obstetrical practitioner prior to the cessation of services. During the third trimester, a relationship should end only under extreme circumstances (such as illness of the practitioner, etc.).

The criteria for terminating a physician-patient relationship are numerous and varied. Although the list is not exhaustive, it is appropriate and acceptable to terminate a relationship under the following circumstances: •

Treatment nonadherence—The patient does not or will not follow the treatment plan.

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Follow-up nonadherence—The patient repeatedly cancels follow-up visits or is a no-show.

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Office policy nonadherence—The patient fails to follow office policies, such as those for payment, prescription refills, or appointments. For example, the patient uses weekend on-call physicians or multiple healthcare practitioners to obtain refill prescriptions when office policy specifies how to obtain refills between visits.

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Verbal abuse—The patient or a family member is rude and uses improper language with office personnel or other patients, visitors, or vendors; exhibits violent behavior; makes threats of physical harm; or uses anger to jeopardize the safety and well-being of anyone present in the office.

Physician or dental groups with more than one practitioner may want to consider dismissing a patient from the entire practice. This will avoid the possibility that the patient might be treated during an on-call situation by the practitioner who ended the relationship.

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Nonpayment—The patient owes a backlog of bills and has declined to work with the office to establish a payment plan.

The presence of a patient’s disability cannot be the reason(s) for terminating the relationship unless the patient requires care or treatment for the particular disability that is outside the expertise of the practitioner. Transferring care to a specialist who provides the particular care is a better approach.

Exceptions and Special Circumstances • A few situations, however, may require additional steps or a delay or even prohibit patient dismissal. Examples of these circumstances include the following: •

If the patient is in an acute phase of treatment, delay ending the relationship until the acute phase has passed. For example, if the patient is in the immediate postoperative stage or is in the process of a medical workup for a diagnosis, it is not advisable to end the relationship.

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If the practitioner is the only source of medical or dental care within a reasonable driving distance, he or she may need to continue care until other arrangements can be made.

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When the practitioner is the only source of specialized medical or dental care, he or she is obliged to continue care until the patient can be safely transferred to another practitioner who is able to provide treatment and follow-up.

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If the patient is a member of a prepaid health plan, the patient cannot be discharged until the practitioner has

Steps for Withdrawing Care When the situation with the patient is such that terminating the relationship is appropriate and acceptable and none of the restrictions mentioned above are present, termination of the patient relationship should be completed formally. Put the patient on written notice that he or she must find another healthcare practitioner. The written notice should be mailed to the patient by both regular mail and certified mail with a return receipt requested. (Both types of mailing are required in some states.) Keep copies of all the materials in the patient’s medical record: the letter, the original certified mail receipt (showing the letter was sent), and the original certified mail return receipt (even if the patient refuses to sign for the certified letter).

Elements of the Written Notice The written notice terminating the relationship should include the following information: CONTINUED ON NEXT PAGE

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MEDICAL/LEGAL

CONTINUED FROM PREVIOUS PAGE

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Reason for termination—Although a specific reason for termination is not required, it is acceptable to use the catchall phrase “inability to achieve or maintain rapport” or to state that “the therapeutic practitioner-patient relationship no longer exists.”

Effective date—The effective date of termination should provide the patient with a reasonable amount of time to establish a relationship with another practitioner. Although 30 days from the date of the letter is usually considered adequate, follow your state regulations. The relationship may be terminated immediately under the following circumstances: •

The patient has terminated the relationship.

(Acknowledge this in writing with a letter from the practice.)

•

The patient or a family member has threatened the practitioner or staff with violence or has exhibited threatening behavior.

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Interim care provisions—Offer interim emergency care. Refer true emergency situations to an emergency department or instruct the patient to call 911 as necessary.

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Continued care provisions—Offer referral suggestions for continued care through medical or dental societies, nearby hospital medical staffs, or community resources. Do not recommend another healthcare practitioner by name.

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Request for medical or dental record copies—In your written notice, offer to provide a copy of the medical or dental record to the new practitioner by enclosing an authorization document (to be returned to the office with the patient’s signature). One exception is a psychiatric record, which may be offered as a summary in lieu of a full copy of the medical record.

•

Patient responsibility—Include a reminder that the patient is responsible for all follow-up and continued medical or dental care.

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Medication refills—Explain that medications will be provided only up to the effective date of termination.

Case Examples The following scenarios illustrate some of the issues involved in terminating a patient relationship.

Case One A patient has been in your practice for about 10 years, has faithfully made regular visits, but has not been compliant with your medical regime for taking hypertension medications. You have repeatedly explained the risks of nonadherence, and you have rescued the patient on many occasions with emergent medications, usually in the local emergency department over a

weekend. You are convinced that the patient understands but stubbornly refuses to comply.

Should This Patient Relationship Be Terminated?

With any nonadherent patient, it is essential to document your recommendations, the patient’s continued nonadherence, your efforts to help the patient understand the risks of nonadherence, and his or her failure to follow the treatment plan and advice.

Terminate the relationship if the patient and physician agree that the patient would achieve better compliance with another practitioner. The written notice terminating this relationship should be explicit in stating the reason you are no longer willing to provide care—that the patient’s outcome is predestined to be unfavorable because of his or her nonadherence with recommended treatment plans. Suggest that the patient would benefit from a relationship with another physician, and state that continued medical care is an absolute requirement.

Case Two A new patient has made an appointment with your office for a full and complete physical examination. Before the appointment, the patient experienced an unusually long wait in your office as a result of your need to address an urgent situation with an infant.

Your office personnel explained the delay to those in the waiting room, and this new patient reacted by becoming loud and abusive, insulting the registration person, and shouting that his time is as valuable as that of the doctor.

Options for the Practitioner In the privacy of an office or an examination area, address your concerns about his behavior by indicating that the practice maintains a zero-tolerance policy for loud, threatening, or abusive behavior, and state that this type of reaction will not be tolerated in the future. After you have completed his physical examination, suggest that he seek medical care elsewhere if he is reluctant to observe office decorum. If the patient indicates a refusal to comply, consider preparing and sending a termination letter. If the patient fails to keep subsequent appointments or has notified your office that he will be seeking care with another physician, document the conversation and send the patient a letter reiterating his decision to seek care elsewhere. ________________________________________ 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)

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CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

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 – along with their annual dues payment Charles Deal, M.D. Celeste Paquette, M.D. Michael Wilhoit, M.D. Scholarship Fund David Bellamy, M.D. – In Memory of Frank Carlisle Walker, Sr., Father of Frank Walker, M.D. We Care Network David Bellamy, M.D. We Care Network – along with their annual dues payment Gregory Eckert-Raczniak, M.D.

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. $42,000 was awarded in 2018. ➢ 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 2019, the CMSF awarded a total of $10,000 in grants to Elder Care Services for their In-Home Services Program, the Big Bend Hospice for bereavement services, and the Lighthouse of the Big Bend to provide clients who have vision loss with the aids needed to manage their health and medical care independently.

Gifts to Honor and In Memoriam: You can make a donation 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 donate 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 Checks should be made payable to the CMS Foundation and indicate on the memo line of your check to which designation you would like to donate. Bring your check to the CMS Office or mail it: Capital Medical Society Foundation ~ 1204 Miccosukee Road ~ Tallahassee, FL 32308.

Donations may be made by credit card from the CMS website.

Your gifts to the Capital Medical Society Foundation transform lives in the Big Bend.

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: Pam Irwin Executive Director pirwin@capmed.org or (850) 877-9018 or after hours at (850) 559-8611

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

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CMS FOUNDATION: WE CARE NETWORK

FOUNDATION

We Care Network

THANK YOU To our CMS members and We Care partners who saw new patients for the We Care Network in June 2019.

Your generosity and support of the We Care Network makes a difference.

Physicians Clifton Bailey, M.D. Nicole Balmer, M.D. Venkata Bavikati, M.D. Marie Becker, M.D. David Bellamy, M.D. Robert Bradford, M.D. David Burns, M.D. J. Brewster Caldwell, D.O. Carlos Campo, M.D. Joseph Camps, M.D. Francisco Carpio, M.D. Michael Cavallaro, M.D. Gilbert Chandler, M.D. Alan Chen, M.D. Kenneth DeLay, M.D. William Dixon IV, M.D. Chesley Durgin, M.D. Nicholas Farber, M.D. Jerry Ford, M.D. Alexander Franz, M.D. Hong Gao, M.D. Gian-Carlo Giove, M.D. Aaron Guyer, M.D. Jerry Harris, M.D. Todd Hewitt, M.D. Hank Hutchinson, M.D. Lawrence Kaelin, M.D. Kenneth Kato, M.D. Fang Sarah Ko, M.D. Amulya Konda, M.D. Carey Linker, M.D. Kurt Luhmann, M.D. Michael Mangan, M.D. Jayan Nair, M.D. Thomas Noel, M.D. Michael Pentaleri, M.D. Jorge Perez de Armas, M.D. Andres Rodriguez, M.D. Garrison Rolle, M.D. Karen Russell, M.D. Philip Sharp, M.D. Gadi Silberman, M.D. David Smith, M.D. Joshua Somerset, M.D.

Timothy Sweeney, M.D. Ernesto Umana, M.D. Lucas Watkins, M.D. Tony Weaver, M.D. Graham Whitaker, M.D. Kenneth Whithaus, M.D. William Yaakob, M.D. Daniel Yang, M.D. Samuel Yu, M.D. Brian Zirgibel, M.D. Dentists Ransey Boyd, D.M.D. Walter Colón, D.M.D. William McFatter, D.D.S. Lawrence Pijut, D.M.D. Jordan Rigsby, D.M.D. James Sykes, D.M.D. Facilities Advanced Urology Institute Anesthesiology Associates Apalachee Primary Care Aspros, Badger, & Boyd Dental Associates Bond Community Health Center Capital Regional Cancer Center Care Point Health & Wellness Center CESC Dental Clinic Desloge Home Oxygen Dermatology Advanced Care Dermatology Associates Digestive Disease Clinic Eye Associates of Tallahassee First Care Dental Florida Cancer Specialists and Research Institute Gadsden County Health Department Havana Health & Wellness Center Jessie Furlow Medical Center Ketchum, Wood, & Burgert Pathology Associates Lawrence J Pijut DMD PA Lawrence Weaver DDS Madison Medical Center Neighborhood Medical Center North Florida Women’s Care North Monroe Medical Center Periodontal Associates of North Florida Radiology Associates of Tallahassee Red Hills Endodontics Southern Medical Group, P.A. Southern Vitreoretinal Associates Tallahassee Diagnostic Imaging

14 CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION

Tallahassee Ear, Nose, & Throat Tallahassee Memorial HealthCare TMH Family Medicine Residency Program TMH Family Medicine - Wakulla TMH Physician Partners Cancer & Hematology TMH Physician Partners Cardiology and Internal Medicine 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 Quincy TMH Rehabilitation Center TMH Transition Center TMH Wound Healing Center Tallahassee Orthopedic Clinic Tallahassee VA 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 June 2019 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. Also, 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 June 2019:

Ebonie Allen, APRN

Anneka Gaffney, APRN

Alexander Ramirez-

Anne Ananga, APRN

Gian-Carlo Giove, M.D.

Mary Jane Bailey, APRN

Judy Griffin, APRN

Brandi Richardson, APRN

Karen Bartley, M.D.

Amy Haddock, M.D.

Adrian Roberts, M.D.

Megan Bassett, APRN

Paul Hartsfield, M.D.

Andres Rodriguez, M.D.

Sherry Bramblett, APRN

Hantz Hercule, M.D.

Karen Russell, M.D.

Daniel Breivogel, APRN

Amit Jain, M.D.

Lucilita Salvador, PA

Tim Broeseker, M.D.

Stefanie Kreamer, M.D.

Philip Sharp, M.D.

Logan Brooks, M.D.

Elaine Larkins, APRN

Hardeep Singh, M.D.

Joedrecka Brown-

Michael Mangan, M.D.

Joshua Somerset, M.D.

Ashok Manocha, D.D.S.

Abisoye Somorin, APRN

J. Brewster Caldwell, D.O.

Ovidiu Marina, M.D.

Anthony Speights, M.D.

Frances Carney, APRN

Damon McMillan, M.D.

Alanna Steaple, APRN

Francisco Carpio, M.D.

Kelley Miller, APRN

Kris Stowers, M.D.

Lysmar Carrion-Dinguis, M.D.

Marcia Morris, APRN

Scott Tetreault, M.D.

Armand Cognetta, Jr., M.D.

Jayan Nair, M.D.

Lacie Thompson, APRN

Deborah Congdon, APRN

Chukwuma Okoroji, M.D.

Jean-Paul Tran, M.D.

William Dixon IV, M.D.

Rose Origa, APRN

Daniel Van Durme, M.D.

Louisa Dowling, APRN

Kyara Paulk, APRN

Andrea Venturini, M.D.

Margarett Ellison, M.D.

Jorge Perez de Armas, M.D.

Ramona Vossler, R.D.H.

Cynthia Evans, APRN

Lisa Perkins, APRN

Jeffrey Wasserman, D.O.

Klive Forde, M.D.

William Placilla, M.D.

Lucas Watkins, M.D.

Sharron Foster, M.D.

Stephen Quintero, M.D.

Eula Weaver, APRN

Speights, M.D.

Valderrama, M.D.

DURING THE MONTH OF JUNE 2019, THE WE CARE NETWORK: RECEIVED 200 REFERRALS, WITH 122 PATIENTS NEW TO THE PROGRAM

SCHEDULED 131 APPOINTMENTS WITH VOLUNTEER PHYSICIANS AND DENTISTS

$271,257.93 IN DONATED CARE WAS REPORTED BY WE CARE VOLUNTEERS

CAP SCAN - A CAPITAL MEDICAL SOCIETY PUBLICATION 15

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