Winter (October-December)

MISSOURI Official Publication of the Missouri Academy of Family Physicians

Family Physician

October-December 2014 Volume 33, Issue 4

ANNUAL FALL CONFERENCE Big Cedar Lodge November 7-9

Resident Grand Rounds Peter J. Koopman, MD Jesse Hirner pg. 8

AAFP National Conference pg. 12

FM Residency Program Composites pg. 21

MAFP Annual Fall Conference

DO YOU NEED

CME? www.bigcedar.com VISIT WWW.MO-AFP.ORG • ONLINE REGISTRATION FORM • ROOM RESERVATION FORM • SCHEDULE OF EVENTS

2 Missouri Family Physician October-December 2014

Register online now!

Join us for the

22nd Annual Fall Conference & SAM Working Group to be held at Big Cedar Lodge Ridgedale, Missouri

November 7-9, 2014

Contents MAFP

Annual Fall Conference

MARK YOUR CALENDAR executive commission Board Chair - Bill Fish, MD (Lake Ozark) President - Daniel Purdom, MD (Independence) President-elect - Peter J. Koopman, MD (Columbia) Vice President - Kathleen Eubanks-Meng, DO (Blue Springs) Secretary/Treasurer - James Stevermer, MD (Fulton) board of directors District 1

District 2

District 3

District 4

District 5

District 6

District 7

District 8

District 9

District 10

Director: Dana Granberg, MD Alternate: Jared Dirks, MD Director: Lisa Mayes, DO Alternate: Carrie Peecher, DO Director: F. David Schneider, MD Director: Caroline Rudnick, MD Alternate: Sarah Cole, DO Director: Jennifer Scheer, MD Alternate: Kristen Weidle, MD Director: Lucas Buffaloe, MD Alternate: Afsheen Patel, MBBS Director: Jamie Ulbrich, MD Alternate: Vacant Director: Sudeep Ross, MD Director: Wael Mourad, MD Alternate: Vacant Director: Mark Woods, MD Director: John Paulson, DO, PhD Alternate: Charlie Rasmussen, DO Director: Patricia Benoist, MD Alternate: Vacant Director: Mark Schabbing, MD Alternate: Steven Douglas, MD

AAFP Congress of Delegates October 20-22, 2014 Marriott Marquis, Washington, DC AAFP Annual Assembly October 21-25, 2014 Walter E. Washington Convention Center Washington, DC

AAFP Family Medicine Congressional Conference May 12-13, 2015 Renaissance Downtown Hotel Washington, DC MAFP 67th Annual Scientific Assembly June 5-7, 2015 The Lodge at Old Kinderhook Camdenton, MO

MAFP 22nd Annual Fall Conference & SAM Working Group November 7-9, 2014 AAFP National Conference of Family Medicine Big Cedar Lodge Residents & Students (NCFMRS) Ridgedale, MO July 30-August 1, 2015 Kansas City Convention Center MAFP Board & Kansas City, MO See page 16 for Commission Meetings schedule of events November 8, 2014 AAFP Congress of Delegates September 28-October 3, 2015 AAFP State Legislative Conference Hyatt Regency November 14-15, 2014 Denver, CO Loews Hotel AAFP Annual Assembly New Orleans, LA September 29-October 3, 2015 Hyatt Regency MAFP Advocacy Day & Board Meeting Denver, CO February 24, 2015 Capital Plaza Hotel & State Capitol MAFP 23rd Annual Fall Conference & SAM Working Group Jefferson City, MO November 6-8, 2015 Big Cedar Lodge Multi-State Forum Ridgedale, MO February 28-March 1, 2015 Grand Hyatt DFW Dallas, TX AAFP Annual Chapter Leadership Forum/National Conference of Constituencies Leaders (formerly ALF/NCSC) April 30-May 2, 2015 Sheraton Kansas City Hotel at Crown Center Kansas City, MO

resident directors Betsy Wan, MD Kevin Gray, MD (Alternate)

INSIDE THIS ISSUE 4

President's Perspective

Advertisements

student directors Sarah Williams Jenny Eichhorn (Alternate)

5

Help Desk Answers

2 Physicians Professional Indemnity Association (PPIA)

8

Resident Grand Rounds

aafp delegates Larry Rues, MD Darryl Nelson, MD Bruce Preston, MD (Alternate) Keith Ratcliff, MD (Alternate) mafp staff Executive Director - Kathy Pabst, MBA Education & Finance Director - Nancy Griffin Member Services/Managing Editor - Sarah Mengwasser Missouri Academy of Family Physicians 722 West High Street Jefferson City, MO 65101 p (573) 635-0830 f (573) 635-0148 www.mo-afp.org office@mo-afp.org

Dan Purdom, MD, FAAFP

Resident Case Studies Jessie Hirner Peter J. Koopman, MD

6 ProAssurance 7 UMKC 9 UMKC and St. Luke's Hospital

11 Member Opinions 12 AAFP National Conference

20 Missouri Health Professional Placement Services

14 E-Cigarette Roundtable 15 Members in the News 16 Fall Conference Schedule 18 Tar Wars速 Program 19 2015 Advocacy Day 21 FM Residency Program Composites

Missouri Family Physician October-December 2014

3

Fall Perspective Conference MAFP Annual President's

dan purdom, md, faafp 2014-2015, mafp president

- Dan Purdom, MD

We continue to provide some of the best Continuing Medical Education experiences in the country. This magazine provides outstanding articles to help us grow in the practice of medicine. Our fall conference at Big Cedar has become a destination for family physicians from our entire region, and we are very excited about our new venue for our Summer Meeting/Scientific Assembly this June, The Lodge at Old Kinderhook in Camdenton, Missouri. You don’t want to miss it.

Finally, your Missouri Academy of Family Physicians continues to provide all of this with low dues and no dues increase this year. What a value!

The only thing that could make our Academy better is you. Join us for Advocacy Day in Jefferson City on February 24, obtain your CME with our conferences, participate on one of our commissions, and always let us know how we can provide better service to you.

After all, it’s your Academy.

It's EASY TO PAY YOUR

DUES online

2015

"

The only thing that could make our Academy better is you."

W

hen I moved to Missouri to begin my family practice residency over twenty-five years ago, one of the things I heard most often was, “If you don’t like the weather, wait fifteen minutes and it will change.” I think the same can be said about the practice of medicine in the Show-Me State. In my twenty-six years here, I have seen tort reform come and go. No caps on pain and suffering, caps and now no caps again. Mid-level providers were few in number twenty-five years ago; now you find them in many settings, and their scope and location changes almost weekly. Now we will have “Assistant Physicians” in our state. Medical students who did not match will be able to practice in rural areas of our state in collaboration with another physician. This may be a larger issue than you think. Since medical schools have rapidly expanded class size without a comparable expansion of residency slots, almost 500 U.S. students didn’t match in a residency last year.

Daily, each of us struggle with improving our own care of our patients. Many of us are engaged in initiatives such as the Patient Centered Medical Home, Patient Safety initiatives and the American Board of Family Medicine’s Maintenance of Certification process. We are confronted with converting our coding and billing practices to ICD10 after a one-year reprieve. Change is constant and sometimes close to overwhelming.

But one thing will never change. Your Missouri Academy of Family Physicians will continue to represent and support you. Whether it is lobbying the state legislature, representing your interests before state regulators, or getting the word out to all of Missouri about what a valuable resource our family physicians are in this state, your Academy will assure that all of our family physicians have a voice. We have an excellent staff in Jefferson City, led by our new executive director Kathy Pabst. We also have an outstanding lobbyist, well respected in Jefferson City, keeping a close watch on the issues that are important to us.

www.aafp.org

4 Missouri Family Physician October-December 2014

MAFP Annual Fall Conference

Help Desk Answers MAFP

HDAs HelpDesk Answers

is there a correlation between maternal diet in breastfeeding mothers and infantile colic?

Mary C. Harrel, MD & Sandra Minchow-Proffitt, MD Mercy Clinic Family Medicine, St. Louis, MO Evidence Based Answer Limited evidence suggests infantile colic is influenced by maternal diet in a small number of breastfed infants.

Reducing maternal intake of allergenic foods such as cow’s milk, eggs, nuts, wheat, soy and fish may contribute to reduced fussiness in infants 6 weeks of age or younger.

(SOR: B, RCTs of limited quality).

A

2012 systematic review evaluated three randomized controlled trials on the effect of maternal diet on colic symptoms in breastfed infants.1 Two trials weakly supported a low allergenic maternal diet.

A randomized control trial of 90 breastfeeding mothers of infants with colic during the first 6 weeks of life compared a self-reported low-allergen diet to an unrestricted diet.2 The trial compared pre-intervention cry/fuss duration over 48-hours to cry/fuss duration over 48-hours after 7 days of prescribed dietary regimens. While there was no significant difference in maternal categorical assessment of treatment response between groups, cry/fuss duration was reduced ≥25% in more infants in the low-allergen group than the placebo group (74% vs. 37%) with an ARR of 37% (95% CI, 18–56%). Cry/fuss duration per 48 hours was also less in the low-allergen group with an average reduction of 3 hours (95% CI, 3–37%). Study limitations include lack of blinding and small sample size.

Another randomized, double-blinded, placebo controlled trial examined the role of dietary changes in colic symptoms in 38 bottle-fed and 77 breast-fed infants.3 Bottle-fed infants were assigned either caseinhydrolysate or cow’s milk formula. All breastfeeding mothers were instructed regarding a preservativefree, additive-free and artificial color-free diets, then assigned to either unrestricted or low-allergen maternal diets. Assessments at days 1 and 8 monitored dietary responses using parent-reported infant distress charts. Mothers on the low-allergen diet reported

distress reduction of 39% vs. 16% (P=0.012) on the unrestricted diet. This study’s major weakness is a high dropout rate.

A cross-sectional study of 447 exclusively breastfed infants <4 months old demonstrated a non-dose dependent relationship between maternal intake of cruciferous vegetables, cow’s milk, onion, and chocolate and colic symptoms.4 Participants completed a questionnaire regarding symptoms of colic and maternal food avoidance. Twenty-percent had at least one colic symptom, and positive relationships were identified between colic symptoms and cruciferous vegetables, chocolate, onions and cow’s milk with RR of 1.6 [95% CI, 1.1–2.4] for intake of >1 cruciferous vegetable per week. This study’s most significant limitation is a population bias, with >50% of participants avoiding certain foods and thus likely maintaining certain beliefs about the affects of foods on colic symptoms.

About HDAs Resident authors work directly with a physician faculty mentor as "author teams."

Residencies meet RRC requirements, and many programs have developed their faculty into local evidencebased medicine experts!

1. Hall, B., et al. Infantile colic: A systematic review of medical and conventional therapies.

Journal of Paediatrics and Child Health 48 (2012) 128–137. [LOE 1a] 2. Hill, J., et al. Effect of a Low-Allergen Maternal Diet on Colic Among Breastfed Infants: A Randomized, Controlled Trial. Pediatrics. 2005; 116: 709-715. [LOE 2a] 3. Hill, J., et al. A low allergen diet is a significant intervention in infantile colic: Results of a community-based study. J Allergy Clin Immunology. 1995; 96:886–92. [LOE 2b] 4. Lust, K., et al. Maternal Intake of cruciferous vegetables and other foods and colic symptoms in exclusively breastfed infants. J American Diet Assoc. 1996; 96(1) 46-48. [LOE 4]

Missouri Family Physician October-December 2014

5

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2015 MAFP

2015 Family Physician ofContents the Year MAFP

nominate the

MAFP Annual Fall Conference

family physician of the year

Do you have an outstanding, caring colleague or physician in your community that deserves the title, "Missouri Family Physician of the Year?" The Missouri Academy of Family Physicians (MAFP) supports over 1,000 active members in the work-force doing extraordinary things every day. You know them, and we would like to acknowledge them. MAFP is now seeking nominations for this prestigious award. Nominate your family physician or a family physician that you know. Nominations may be made by any member of the MAFP or the public. Winner will be honored at the MAFP annual meeting in June 2015.

You may also request information by calling MAFP at: (573) 635-0830 or by emailing smengwasser@mo-afp.org

UMKC Physician Leadership Program CME Credits Available Payment Plan Available Class Size Limited

Enroll Now: Classes Start January 29th The Physician Leadership Program is designed to provide comprehensive healthcare management skills that will prepare physicians to successfully fulfill the leadership requirements of 21st Century healthcare delivery.

umkc.edu/plp | umkcexeced@umkc.edu | 816.235.6184

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the University of Missouri-Kansas City School of Medicine and the UMKC Henry W. Bloch School of Management. The UMKC School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The University of Missouri-Kansas City School of Medicine designates this live activity for a maximum of 82.50 AMA PRA Category 1 Credits TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Missouri Family Physician October-December 2014

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Fall Conference MAFP Annual Resident Grand Rounds

lupus pernio as the presenting symptom of sarcoidosis: a case report Hirner, JP1, Koopman, PJ2 1 University of Missouri School of Medicine, 2 University of Missouri Hospitals & Clinics, Department of Family &Community Medicine Introduction: A case report of lupus pernio as the initial manifestation of sarcoidosis is presented. A review of the literature discusses this condition, its prognostic significance, and the state of evidence regarding treatment.

Figure 1: Indurated, violaceous papules and plaques around the alar rim in this patient.

Figure 2: Biopsy taken from this patient showing noncaseating granulomas in the dermis.

Case report: A 39 year old African American male presents with a treatment resistant skin lesions on the alar rim and left eyelid. The diagnoses of lupus pernio and sarcoidosis are made by biopsy and exclusion of other etiologies. His skin lesions continue to resist treatment, which is common with lupus pernio.

Discussion: Lupus pernio, a rare condition, is a characteristic skin manifestation of sarcoidosis. It can be the presenting symptom, and it is associated with systemic involvement and chronic, treatment resistant sarcoidosis. No clear best treatment exists although many have been studied in small cohorts or single cases.

Conclusion: Recognition and diagnosis of lupus pernio necessitates evaluation for systemic sarcoidosis. Effective treatment options are not clear in the literature and further studies are needed to understand the best treatment options for this condition.

INTRODUCTION: A case report of lupus pernio is presented along with a review of the literature regarding this rare entity. Lupus pernio is the most characteristic skin lesion of sarcoidosis. It has prognostic significance in that it portends a more chronic course of sarcoidosis with multisystem involvement and treatment resistance. Treatment failure is common in lupus pernio and a need exists for studies further evaluating treatment options.

8 Missouri Family Physician October-December 2014

Jesse Hirner

Peter J. Koopman, MD

CASE REPORT: A 39 year old African American male with no significant past medical history initially presented to clinic with a one year history of violaceous, indurated papules and plaques with overlying scale on the bilateral alar rims of the nose and a single similar plaque on the left upper eyelid (Figure 1).

He had previously been treated by an outside provider with one year of topical betamethasone daily, but his lesions had worsened during that time.

He denied vision changes, cough, dyspnea at rest or with exertion, wheezing, chest pain, abdominal pain, hematuria, joint pain, fever, night sweats, or weight changes. There was no history of trauma to these areas. He had no other similar skin lesions.

Exam demonstrated the lesions described above and hypopigmentation and scarring of a tattoo on the right shoulder. Biopsy of the alar rim lesions demonstrated noncaseating granulomas (Figure 2), consistent with sarcoidosis. Polarized microscopy of the lesion was negative for foreign body; PAS-D stain was negative for fungi, and Fite stain was negative for acid fast bacteria.

Complete blood count with differential, serum electrolytes, serum calcium, renal function, urinalysis, and ANA were within normal limits.

Serum ACE and PPD skin test were not performed.

Serum transaminases were mildly elevated, but upon discontinuing nightly wine consumption his transaminases decreased to normal limits and have remained normal on three rechecks. CXR showed upper and middle lobe fibrotic changes. Pulmonary function testing showed a DLCO of 65% predicted, but otherwise demonstrated good pulmonary function.

Hydroxychloroquine, 200 mg, twice daily was started and intralesional injections of triamcinolone were performed. The patient's lesions continued to worsen for ten months. At that time topical clobetasol was started. Three months later his lesions were essentially unchanged.

MAFP Annual Fall Conference DISCUSSION: Lupus pernio is the most characteristic skin lesion of sarcoidosis. It is characterized by violaceous, indurated papules, plaques, and nodules on the face, especially the nose and cheeks, ears, arms, hands, and/or fingers. It ranges from a few papules under the nose to disfiguration of more than 50% of the face.1,2 It can cause social distress and adversely affect patient's quality of life. It is associated with multisystem sarcoidosis, chronic disease course, and treatment resistance.2-6 Lupus pernio occurs in 1.6-4% of sarcoidosis patients.2,6-8 It primarily presents in the fifth decade of life,2,5-7 slightly later than sarcoidosis overall. Sarcoidosis more commonly presents in the third to fourth decade. However, lupus pernio may be the presenting symptom of sarcoidosis,7,8-11 as in this case. It occurs much more commonly in women than men with sarcoidosis,5,7 and is disproportionately common in African American patients in the US1,12 and West-Indies born patients in the UK2 when compared to Caucasian sarcoidosis patients.

Skin lesions in sarcoidosis are classified as specific or nonspecific. Specific lesions are those that demonstrate noncaseating granulomas on biopsy. Lupus pernio falls into this category.

Nonspecific lesions do not demonstrate noncaseating granulomas. The most common nonspecific lesion is erythema nodosum.

Erythema nodosum is associated with a benign course of sarcoidosis.6,13 Lupus pernio and erythema nodosum rarely occur in the same patient.2,7 Most patients with lupus pernio have extracutaneous sarcoidosis. They are also at increased risk of extrapulmonary sarcoidosis, especially upper respiratory involvement and bone cysts.1,2,5,7 The prevalence of bone cysts in these patients is 21-43% and the prevalence of upper respiratory involvement is 35-54%.2,5,6,12 Bone cysts may occur in the hands, feet, or both and can cause pain, stiffness, and/or swelling.2 Upper respiratory involvement can present with a sensation of congestion and nasal discharge.

It may lead to nasal ulceration and/or septal perforation,5 especially if submucousal resection of lesions is attempted. Lupus pernio rarely spontaneously remits, and when it does it usually recurs within two years.2,3 The diagnosis of lupus pernio is based on the characteristic clinical appearance and distribution of lesions, skin biopsy demonstrating

Resident Grand Rounds MAFP

noncaseating, epithelioid granulomas with minimal surrounding lymphocytes, and the exclusion of other causes. A scoring system for the extent of the skin lesions has been proposed, and may be useful for consistent grading of disease among future studies.12 The differential diagnosis of lupus pernio includes tuberculosis (lupus vulgaris), leprosy, systemic lupus erythematosus, chilblain lupus, leshmaniasis, fungal infection including histoplasmosis, blastomycosis, and coccidioidomycosis, rosacea, rhinophyma, and lymphoma cutis. Diagnosis of lupus pernio should prompt evaluation for extracutaneous sarcoidosis.

Early treatment of cutaneous sarcoidosis can help prevent scarring and improve quality of life.

Lupus pernio treatment frequently fails.1-4,8,9,14,15 The extent of disease does not necessarily predict likelihood to respond to treatment.1 The literature on treatment of lupus pernio consists mostly of case reports and small case series with a few larger retrospective analyses. The largest contains 54 patients.1 There are currently no large, randomized controlled trials available, and thus it is difficult to assess the best treatment for this 44TH ANNUAL PRESENTATION OF THE condition.

Dr. Robert D. Conn Therapy choices depend on the patient's extracutaneous involvement, comorbidities, DECEMBER 11-12, 2014 and preference. Corticosteroids, TheWestin WestinKansas KansasCity City at at Crown Crown Center The Center with or without a steroid-sparing KansasCity, City, Missouri Missouri Kansas agent, are the most common

initial treatment. They may be This conference is intended for: given systemically, topically, or ◦ General Practitioners as intralesional injections. The ◦ Internal/Family Physicians effect of intralesional injection ◦ Cardiologists is very short term and may predispose to skin ulceration.2 ◦ Nurses Hydroxycholoroquine and ◦ Physician Assistants methotrexate are also commonly ◦ Other Healthcare Professionals used agents. Many medications have shown modest results or To register and learn more: intolerable side effects. Recent Visit https://cmetracker.net/UMKC/ case reports have suggested that Catalog (case sensitive) adalimumab14 and lenalidomide16 or call (816) 235-6808 may be useful agents.

One study found infliximab to Jointly be the most effective treatment JointlyProvided providedBy: by: for achieving resolution or The University of Missouri-Kansas near resolution of recalcitrant City School of Medicine and lupus pernio lesions when Saint Luke’s Hospital of Kansas City compared to corticosteroids alone, corticosteroids with

HEART CONFERENCE

Missouri Family Physician October-December 2014

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Annual Fall Grand Conference Rounds MAFP Resident another medication, or other agents including hydroxychloroquine and methotrexate. The same study found that corticosteroids and infliximab were approximately equal for achieving at least some improvement (as opposed to resolution or near resolution). Treatments other than infliximab or corticosteroids were less effective.1 Infliximab is a chimeric antibody with a murine portion and severe allergic reaction is a relatively common side effect. Therefore, it must be administered at an infusion center where close observation is possible. Adalimumab, a fully humanized monoclonal antibody, can be administered at home, and was effective at treating recalcitrant lupus pernio in one case report.16 CO2 laser, flashlamp pulsed dye laser, and pulsed light17 therapy has been used for aesthetic effect on lupus pernio lesions. These treatments may reduce erythema or disfiguration but do not appear to affect the underlying granulomas.3,4 They are thought to work by ablating the vasculature in skin lesions.4 Relapses may occur afterward,3,18,19 which is also common with medical therapy.2 These may be options for symptomatic relief in cases refractory to medical treatment.

Lupus pernio may respond to medication within weeks, but often months are required for full effect.1,2,14 Relapses are common after treatment is withdrawn. In addition to medical therapy, makeup may help reliev e social discomfort and improve quality of life. Long term follow up is important for monitoring skin lesions and continuing assessment for systemic involvement.

CONCLUSION: Lupus pernio is the most characteristic skin lesion of sarcoidosis. Diagnosis and treatment is important for two reasons. First, it may be disfiguring and negatively affect the patient's quality of life. Second, it carries prognostic significance. Presence of this condition increases likelihood of multisystem involvement, chronic unremitting sarcoidosis, and treatment resistance. Corticosteroids are common therapy, but further study is needed to evaluate optimal treatment.

REFERENCES: 1. Stagaki E, Mountford WK, Lackland DT, Judson MA. The treatment of lupus pernio: results of 116 treatment courses in 54 patients. Chest. 2009.

135(2):468-476.

2. Spiteri MA, Matthey F, Gordon T, Carstairs LS, James DG. Lupus pernio: a clinico-radiological study of thirty-five cases. Br J Dermatol. 1985. 112(3):315322.

10 Missouri Family Physician October-December 2014

3. Young HS, Chalmers RJG, Griffiths CEM, August PJ. CO¬2 laser vaporization for disfiguring lupus pernio. J Cosmet Laser Ther. 2002. 4(3-4):87-90.

4. Cliff S, Felix RH, Singh L, Harland CC. The successful treatment of lupus pernio with the flashlamp pulsed dye laser. J Cutan Laser Therapy.

1999. 1(1):49-52.

5. Neville E, Mills RGS, Jash K, MacKinnon DM, Carstairs LS, James DG. Sarcoidosis of the upper respiratory tract and its association with lupus pernio. Thorax. 1976. 31(6):660-664.

6. Sharma, OP. Cutaneous sarcoidosis: clinical features and management. Chest. 1972. 61(4):320325.

7. Yanardag H. Pamuk ON, Pamuk GE. Lupus pernio in sarcoidosis: clinical features and treatment outcomes in 14 patients. J Clin Rheumatol. 2003.

9(2):72-76.

8. Maña J, Capdevila O, Solanich X, Jucgla A, Marcoval J. Lupus pernio: a report of a series of 8 patients. Rev Clinic Esp. 2010. 210(11):550-555.

9. Efthimiou P, Kukar M. Lupus pernio: sarcoidspecific cutaneous manifestation associated with chronic sarcoid arthropathy. J Clin Rheumatol. 2011.

17(6):343.

10. Uddin MJ, Huda SM, Rahaman MM, Siddique RU, Islam MA. Lupus pernio - a rare case report.

Med Today. 24(2):87-88.

11. Anjaneyan G, Vora R. Lupus pernio without systemic involvement. Indian Dermatol Online J. 2013. 4(4):314-317.

12. Baughman RP, Judson MA, Teirstein A, et al.

Chronic facial sarcoidosis including lupus pernio: clinical description and proposed scoring systems.

Am J Clin Dermatol. 2008. 9(3):155-161.

13. James DG. Erythema Nodosum. Br Med J. 1961.

1(5229):853-857.

14. Judson MA. Successful treatment of lupus pernio with adalumumab. Arch Dermatol. 2011.

147(11):1332-1333.

15. Haley H, Cantrell W, Smith K. Infliximab therapy for sarcoidosis (lupus pernio). Br J Dermatol.

2004. 150(1):146-149.

16. Dalm V, van Hagen PM. Efficacy of lenalidomide in refractory lupus pernio. Arch Dermatol. 2013.

149(4):493-494.

17. Rosende L, del Pozo J, de Andres A, Perez Varela L. Intensified pulsed light therapy for lupus pernio.

Actas Dermo-Sifiliograficas. 2012. 103(1):71-73.

18. O'Donoghue NB, Barlow RJ. Laser remodeling of nodular nasal lupus pernio. Clin Exp Dermatol.

2006. 31(1):27-29.

19. Goodman MM, Alpern K. Treatment of lupus pernio with the flashlamp pulsed dye laser. Lasers Surg Med. 12(5):549-551.

MAFP Member Opinions

Contents MAFP

MEMBER

OPINIONS we can do better

T

he fact that I can tell my own horrific experience is a testament to the capabilities of my treatment team: doctors, residents, nurses, and technicians.

However, after my almost 3 week stay in the hospital, I can attest that healthcare professionals need more than just academic knowledge. We need major training in the humanity and the dignity of patient care.

Denise HooksIn the fall of 2011, I suffered the worst Anderson, MD Lupus attack in my 10 years of having the disease. It started with ulcerations within my mouth and pharynx which resulted in my inability to eat or drink and subsequent weakness and weight loss. My initial hospitalization was simply to rehydrate me and figure out what happened. During this stay, I was keenly aware of how noisy hospitals were, how long it took someone to respond to a call light, and how early morning labs were annoying. However, this stay was a 4-star hotel vacation compared to my next round of treatment.

After being discharged, I was quickly readmitted to a different hospital. It started with the excruciatingly long wait in admitting.

By this time, I was in severe pain and could hardly sit up straight.

By the time I got to my room, I could not even inhale deeply because of the pain. The resident prescribed a short-acting narcotic and needless to say, it was not adequate. I explained to the resident that he was not ahead of my pain and my vitals which showed tachycardia and hypertension, none of which I had previously, were indicative of the degree of pain. I explained to him that I was not breathing well and that I was fearful that something bad was going to happen.

After days of agonizing discomfort, the team finally agreed to a PCA, patient-controlled analgesia. However, by then my

condition worsened. I went into respiratory distress and was immediately taken to the ICU. Because of my previous admission and the healing ulcerations, before being intubated I requested that I not be intubated by a resident. One of the residents in the back of the room yelled out, “This is a teaching hospital!” That was my last memory before intubation.

COMMENTARY When did we as health professionals stop caring about the patient’s wishes? My treating team knew I was a physician and treated me this way. I can only imagine how they treat my patients.

For years, my patients have complained about hospital care and at times I felt like they must be over exaggerating. Now I know the truth.

Patient care is more than being technically sound: knowing the correct ventilator settings, prescribing the appropriate antibiotics, and ordering the best imaging modalities. Patient care must also provide the best qualities of humanity and consist of providers who possess the ability to know the difference.

There were countless other indignities that I endured during my stay, such as having the attending walk in on my bath and overhearing the rounding team discuss my need for pain medications as someone who was a drug-seeker, but I survived. I survived to share this story in hopes that my fellow laborers in medicine will learn from my ordeal. Patients, regardless of their income, education level, or ethnicity deserve top-rate care.

Let’s treat patients as if they were our own family and vow to incorporate genuine concern and the utmost dignity in their care.

Future generations of physicians cannot continue to exhibit our bad habits.

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Fall Conference MAFP Annual AAFP National Conference

"

It was a great experience - one that I hope other residents will take advantage of next year."

- Jennifer Allen, MD, Mercy Family Medicine Residency, St. Louis

aafp national conference - a success!

T

he AAFP National Conference was again a success with 1,211 medical students and 1,092 residents attending.

There were 50 attendees from Missouri who learned the ins and outs of family medicine residency and met with residency programs and employers. The Missouri Academy was again active in setting up Missouri Street in the Exhibit Hall with all residency programs participating: A. Cox Health Family Medicine Residency B. Mercy Family Medicine Residency C. Saint Louis University Family Medicine Residency D. Research Family Medicine Residency E. University of Missouri-Columbia Family Medicine Residency F. University of Missouri-Kansas City Family Medicine Residency

B A 12 Missouri Family Physician October-December 2014

Based on a rotation cycle of medical schools and residency programs, Missouri was represented at this conference by the following individuals: Student: Jenny Eichhorn, University of Missouri, Kansas City and Resident: Jennifer Allen, MD, Mercy Family Medicine Residency, St. Louis.

Jennifer Allen, MD, served on the resolution review committee and submitted a resolution which was passed and will be taken to the National Congress of Delegates in Washington D.C. in October. Dr. Allen met many other residents and students who have interesting and passionate ideas about how the future of family medicine and our nation's healthcare should be shaped. Dr. Allen states that “It was a great experience-one that I hope other residents will take advantage of next year.” Jenny Eichhorn met many other students and residents from across the country. “It was a great learning experience and I look forward to continuing to work with the Academy in the coming years.”

MAFP Annual Fall Conference

AAFP National Conference MAFP

C

E

D

F Missouri Family Physician October-December 2014

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MAFP E-Cigarette Annual Fall Roundtable Conference

missouri goverenor jay nixon holds e-cigarette roundtable

l to r: Dr. Lucas Buffaloe, Assistant Professor of Clinical Family and Community Medicine, University of Missouri School of Medicine; Dr. Kevin Everett, Professor at University of Missouri School of Medicine and Tobacco Cessation expert; Governor Nixon's Policy Director, Jeff Harris; Governor Jay Nixon; Ashleigh Johnson, Chair of the American Lung Association Leadership Council; Stacy Reliford, Government Relations Director, American Cancer Society; and Jace Smith, Government Relations Director, American Heart Association.

A

t the request of Missouri Governor Jay Nixon, the Missouri Academy of Family Physicians participated in a roundtable discussion on e-cigarettes. Lucas Buffaloe, MD, District 5 Board Member, represented the Academy at this meeting in Columbia, Missouri last month. Dr. Buffaloe was one of five participants from other Missouri healthcare organizations. Bill Fish, MD, sent a letter to Governor Nixon in May expressing the Academy’s opposition to SB 841, legislation relating to alternative nicotine and vapor products. The Governor did veto the bill, which was subsequently overturned in the September veto session.

Dr. Buffaloe’s comments addressed concerns that patients use e-cigarettes to quit smoking and consider it a safer alternative. "With this new nicotine product, there is no good evidence available to support these assumptions or the long-term effect of their use," Dr. Buffaloe stated. Although the legislation prohibits the sales of e-cigarettes to children under the age of 18, it also prohibits these products from being taxed or regulated as tobacco products.

The Food and Drug Administration is proposing rules that would extend the agency’s tobacco authority to cover additional products that meet the legal definition of a tobacco product, such as e-cigarettes.

"

With this new nicotine product, there is no good evidence available to support these assumptions or the long-term effect of their use."

- Dr. Lucas Buffaloe, University of Missouri School of Medicine

Don't Forget!

MAFP Advocacy Day February 24, 2015 Jefferson City

14 Missouri Family Physician October-December 2014

Follow us on Twitter @MO-AFP

Members in the News/Health Care Workforce MAFP MAFP Annual Fall Conference

Members in the News

alternate board members elected MAFP Student and Resident Alternate Board Members are elected by their peers of the National Conference of Family Medicine Residents and Students. The Missouri Caucus was once again held at the Midland Theater and the following individuals were elected to serve a one-year term as the Alternate Board Member: Student: Jenny Eichhorn, University of Missouri, Kansas City.

Resident: Kevin Gray, MD, University of Missouri, Kansas City.

The previous Alternate Board Members will move to the board member position for the 2014-15 year: Student: Sarah Williams, University of Missouri, Columbia.

Resident: Betsy Wan, MD, St. Louis University.

Congratulations to these students and residents as they represent their profession and family medicine on the Missouri Academy of Family Physicians Board of Directors.

l to r: Kevin Gray, MD (Alternate Resident Board Member), Betsy Wan, MD (Resident Board Member), Sarah Williams (Student Board Member), and Jenny Eichhorn (Alternate Student Board Member).

NEWS TO SHARE?

interim committee on health care workforce meets

T

he Missouri Academy of Family Physicians presented testimony before the Missouri Interim Committee on Health Care Workforce, chaired by Representative Diane Franklin (R-Dist. 123) on September 9. Todd Shaffer, MD, UMKC Program Director, along with third-year resident, Dylan Werth, MD, and Emily Gray, a fourth-year medical student, interested in family medicine, addressed primary care and medical education in the United States.

The Missouri Family Physician magazine welcomes your input. If you have "Members in the News" information you would like to share and include in the next issue, please submit newsworthy items for review to: smengwasser@moafp.org.

l to r: Emily Gray (Student), Dylan Werth, MD (Resident), and Todd Shaffer, MD, Program Director, University of Missouri Kansas City.

Missouri Family Physician October-December 2014

15

Annual Annual Fall Conference Fall Conference Schedule MAFP 2014

22nd Annual Fall Conference & SAM Working Group Big Cedar Lodge, Ridgedale, MO

SCHEDULE OF EVENTS Friday, November 7, 2014 7:00 - 8:00 am

Registration & Breakfast Buffet with Exhibitors

7:00 - 11:30 am Exhibit Hall Open (Grandview Ballrooms A & B)

7:55 am Welcome and Introductions *All lectures held in Grandview Ballrooms C & D

8:00 - 9:00 am Pediatric Hypertension: A Review Mark Suenram, MD

9:00 - 10:00 am Epigenetics and Migraine Pathophysiology Roger Cady, MD

10:00 - 10:45 am Refreshment Break with Exhibitors

10:45 am - 11:45 am The Evidence on Treating Hyperlipidemia James Stevermer, MD, MSPH

11:45 pm - 1:00 pm Lung Cancer Screening: USPSTF Recommendations Michael LeFevre, MD, MSPH *Box Lunch Included (at end of lecture) 1:00 - 2:00 pm

AAFP Chapter Lecture Series: Adolescent Immunizations â&#x20AC;&#x201C; Barriers that Exist *This activity is funded by an educational grant to the AAFP from Merck.

Belinda Vail, MD, FAAFP

2:00 - 2:15 pm BREAK

ER/LA Opioid REMS: Achieving Safe Use While Improving Patient Care Katherine E. Galluzzi, DO, CMD, FACOFP

Saturday, November 8, 2014 7:00 - 8:00 am Registration & Breakfast with Exhibitors 2:15 - 4:15 pm

7:00 - 11:30 am

Exhibit Hall Open (Grandview Ballrooms A & B) *All lectures held in Grandview Ballrooms C & D

8:00 - 9:00 am Healing the Healer Charles Sincox, MD

16 Missouri Family Physician October-December 2014

9:00 - 10:00 am 2014 Evidence-Based Guidelines for the

Management of High Blood Pressure in Adults:

Report from the Panel Members Appointed to JNC 8 Michael LeFevre, MD, MSPH

10:00 - 10:45 am Refreshment Break with Exhibitors

10:45 am - 12:15 pm The Emerging Role of the Kidney and SGLT2

Inhibition in Patients with Type 2 Diabetes

Silvio E. Inzucchi, MD

12:15 -1:45 pm Management of Patients with Chronic Hepatitis

C: The Route to Safe and Effective Care Kenneth Lichtenstein, MD *Box Lunch Included 1:45 - 2:45 pm AAFP Chapter Lecture Series: Barriers to Adult Immunizations *This activity is funded by an educational grant to

the AAFP from Merck.

4:45 - 6:45 pm

MAFP Board Meeting

David Glenn Weismiller, ScM, MD, FAAFP

2:45 - 3:45 pm Improving the Identification and Management of

Osteoporosis: A Curriculum for the PCP Kathryn Diemer, MD

3:45 - 4:45 pm MAFP Commission Meetings (Advocacy, Education

and Member Services)

Sunday, November 9, 2014

8:00 am - 2:30 pm SAM Working Group: Pain Management (Grandview Ballroom A)

James Stevermer, MD, MSPH &

Lucas Buffaloe, MD

Contents Form MAFP MAFP Annual Fall ConferenceAnnual Fall Conference Registration 22nd Annual Fall Conference November 7-9, 2014 Big Cedar Lodge, Ridgedale, MO 722 West High Street Jefferson City, MO 65101

Registration Form Four ways to register: 1. Online with credit card at www.mo-afp.org 2. Fax this form to (573) 635-0148 3. Call us at (573) 635-0830 4. Mail this form with payment to: MAFP, 722 West High Street, Jefferson City, MO 65101-1526

Office Information Name:

MD

AAFP ID#:

Other

DO

Address:

Phone:

Rate

MAFP Member

$375

MAFP Life Member, MAFP New Physician (within 7 yrs of residency completion), or Allied Health Professional

$300

AAFP Member

City: State

Registration Type

Non-Member

Zip: Fax:

Syllabus Materials (Print only) Free for Life Members

Amount $ $

$400

$

$475

$

$ 25

$

SAM Working Group (Sunday 8:00 am-2:30pm)

$200 $ (no discounts)

Opt-out Option: □ In an effort to keep attendee costs at an affordable rate, MAFP accepts financial support from Sponsors and Exhibitors. Please check this box if you do not wish for MAFP to share your office address with our generous supporters.

50/50 Raffle to support FHFM Tax deductible donation to FHFM Tax ID 43-1480324

$10 per ticket $ or 6 for $50

Syllabus Materials - Please Select One (Free for Life Members) □ I would like to receive an electronic syllabus (included) -OR□ I would like to receive a printed syllabus ($25 Fee)

CME sessions, meals, breaks, and electronic syllabus are included in the registration fee. All functions in the Exhibit Hall are for registrants only.

Email:

I will be attending: □ Friday Buffet Breakfast □ Friday Luncheon with Speaker □ Saturday Buffet Breakfast □ Saturday Luncheon with Speaker

Make your lodging reservations early! Complete the Big Cedar Lodge Room Reservation Form and return directly to Big Cedar Lodge.

Reservation deadline is Monday, October 6, 2014. After this date, additional rooms may be reserved subject to space and rate availability.

Cancellations & Refunds All requests for conference refunds must be made in writing or emailed to office@mo-afp.org and received no later than October 6, 2014.

MAFP policy requires a $50 administrative fee be deducted from each refund processed.

$

Payment Information

Special dietary needs or physical accommodations required:

__________________________________________________________

XXXXXXXXX

Total Amount Due

Amount Due $ □ Enclosed is my check made payable to: MAFP Please charge to my credit card: □ MasterCard

□ Visa

□ Discover

Name on Card Card # Expiration Date Signature

Questions? Call (573) 635-0830 or email: office@mo-afp.org

Billing Zip

MAFP Tar Wars速

Today

more than 3,500 children will try their first cigarette.

Stop kids from starting.

Volunteer to be a Tar Wars presenter.

educate fourth and fifth grade students on the dangers of tobacco use

D

o your local schools participate in the Tar Wars速 Program?

Tar Wars速 is a program for fourth and fifth grade students involving a one-hour class session and a follow-up poster contest. The first part is a lively, interactive lesson in which students learn why people use tobacco, the consequences of tobacco use, and the truth about tobacco advertising. A poster contest is enouraged following the presentation. Schools will have the opportunity to submit the top three posters to MAFP before April 24, 2015. The top five posters are chosen by a panel of judges and awarded prizes.

www.tarwars.org

Supported in part by a grant from the American Academy of Family Physicians Foundation.

18 Missouri Family Physician October-December 2014 TW hlf vert.10.indd 1

5/22/12 2:04 PM

Advocacy Day 2015 MAFP

MAFP Annual Fall Conference

register online now

advocacy day february 24, 2015 state capitol jefferson city MAFP Political Action Committee

722 West High Street

Jefferson City, MO 65101 www.mo-afp.org

Bring a colleague & join fellow MAFP Members Phone: (573) 635‐0830 (Actives, Residents, Students, etc.) to promote the Tax ID 90‐0162481 Monday, February 23, 2015 ~ 6:30 – 8:30 pm importance of family medicine & primary care. This www.mo‐afp.org

Detailed legislative briefing ~ Capital Plaza Hotel is your opportunity to educate your State Senator

& State Representative on issues affecting you, Tuesday, February 24, 2015 ~ 8:00 am – 2:00 pm your profession, and your patients. MAFP Staff Legislative briefing and breakfast ~ Capital Plaza Hotel What is the MAFP PAC? MAFP PAC is the state political action committee of the Missouri Academy of Family Physicians. MAFP PAC is a will schedule the appointments for you with your special organization set up to collect contributions from a large number of people, pool those funds and make contributions to state Visit legislators’ offices (appointments to be scheduled for you by MAFP staff) legislators. It's easy - all you have to do is register! election campaigns.

Board of Directors Meeting (with working lunch/dinner) ~ 2:30 – 5:00 pm Questions? Call MAFP at (573) 635-0830 Where does my donation go? MAFP PAC will make direct contributions to candidates for the Missouri General Assembly (either State or email: office@mo-afp.org.

House of Representatives or State Senate), and statewide offices. Contribution decisions are made in a nonpartisan way based on candidates’ positions, policies and voting records as they relate to family physicians and our patients. Direct contribution decisions are made by the PAC Committee.

you can make a difference!

I already pay my dues? Isn’t that enough? Election laws prohibit the use of membership dues for donations to political candidates.

Funds to be used for donations to candidates must be raised separately from membership dues. Voluntary MAFP PAC donations are what will enhance MAFP’s clout in the elections and with elected members of the Legislature.

“Your voice in the political process.”

"Your voice in the political process."

YES! I believe in Family Medicine and I’m interested in investing in our future.

Please accept my ___ personal or ___ corporate contribution: $

I would like to Join Club Jefferson ($104 annually) Other $__________________

The Missouri Ethics Commission requires the following information for all contributions of $25.00 or more:

Name: ___________________________________________________________________________________________________ Employer:_________________________________________________________________________________________________ Address: __________________________________________________________________________________________________

City/State/Zip: _____________________________________________________________________________________________

E‐mail Address: _____________________________________________________ Phone:__________________________________

I am aware of the political purposes of the MAFP PAC. I understand that contributions to the MAFP PAC are purely voluntary and that these suggested contribution amounts are only guidelines. I further understand that I will not be favored or disadvantaged by reason of the amount of my contribution or a decision not to contribute. Contributions to the MAFP PAC are not tax‐deductible for federal or state income tax purposes.

Payment is being made by: Check (payable to MAFP PAC) Credit card: VISA MasterCard Discover

Today’s Date:

____________

Name on Card: ________________________________________________________________

Card # _________ ‐ _________ ‐ _________ ‐ _________ Expiration Date: _______________

Signature _______________________________________ Billing Zip Code: ________________

Missouri Family Physician October-December 2014

19

Annual Scientific Assembly MAFP 2015 Annual Fall Conference

join us at the 2015 annual scientific assembly

T

his two-day conference held each year in June attracts primary care physicians, residents, students, non-physician attendees and exhibitors.

The educational sessions provide AAFP approved (AMA Category 1) CME.

June 5-6, 2015

The Lodge at Old Kinderhook • 20 Eagle Ridge Road Camdenton, Missouri 65020 • P: (888) 346-4949 or (573) 317-3570

attention residents!

Do you need to be published?

Missouri Health Professional Placement Services (MHPPS) is a non-profit recruiting service dedicated to rural and underserved areas of our great state! We partner with safety-net providers and health care systems throughout Missouri to help health care professionals, like yourself, find a community that best fits your personal and professional needs. Whether it’s a scenic rural setting, dynamic urban location, or somewhere in between, we are committed to focusing on your interests and careers that count!

Find Out More: Joni Adamson 573.636.4222 jadamson@mo-pca.org www.3rnet.org/locations/missouri

Family Medicine Opportunities -

Available throughout MO’s Rural & Urban Areas Loan Repayment Options Competetive Salary & Comprehensive Benefits Contact us Today!

Proud Partners:

MHPPS is located within the MO Primary Care Association

20 Missouri Family Physician October-December 2014

Are you interested in submitting your report to be published as a Resident Grand Rounds article in our quarterly Missouri Family Physician magazine?

Contact MAFP staff at (573) 635-0830 for more information!

MAFP Annual Fall Conference

Mercy Family Medicine MAFP

Mercy Family Medicine First-Year Resident Physicians

Perini Shah, DO

Mallorie Rhymer, MD

Alex Meyer, DO

Alex Mazzaferro, MD

Mihiret Belihu, MD

Catherine Moore, DO Moore, DO

Second-Year Resident Physicians

Isaac Sparks, DO

Ted Eckelkamp, MD

Melissa Lao, MD

Andy Bryant, MD

Abbey Woods, MD

Chris Young, MD

Third-Year Resident Physicians

Laura Covert, DO

Tawny Ross, DO

Dawn Davis, MD

Jen Allen, MD

Julianna Lippert- Shahbaz Qalbani, MD Keck, MD

Nick Moore, MD Missouri Family Physician October-December 2014

21

Family MAFP Cox Annual Fall Medicine Conference

2014-2015

COX FAMILY MEDICINE RESIDENCY Third-Year Resident Physicians

Ryan E. McDowell, MD ***Chief Resident

Timothy R. Burnett, DO, MBA

Christopher B. Carter, MD

Katie L. Davenport-Kabonic, DO ***Chief Resident

Michael C. Kabonic, DO

Ruth M. Pitts, MD

Hailey C. Small, MD

Jamie N. Tribo, MD

Luke A. Van Kirk, DO

Andrew L. Benbow, DO

Sarah E. Duda, MD

Bridget N.T. Gruender, MD, MS

Dayna R. Jett, MD

Chelsea K. Koehn, DO

Justin W. Nowlin, MD

Jessica D. Standeford, MD

Mehdi M. Tajouri, DO

Meghan E. Blay, DO

D. Wes Campbell, DO

Ian T. Cheyne, MD

Angela L. Conklin, DO, MBA

Samantha A. Potter, DO, MBA

Timothy T. M. Sirard, MD

Shawn M. Stranckmeyer, MD

Steven E. Zinter, DO

Second-Year Resident Physicians

First-Year Resident Physicians

Brett A. Mossberger, DO

22 Missouri Family Physician October-December 2014

Caleb Caleb Baughn, Baughn,MD MD

Lindsay Lindsay Allan, Allan,MD MD

Nida Nida Dillon, Dillon,DO DO

Andy Andy Brouwer, Brouwer,MD MD

Jeffrey Jeffrey Mincher, Mincher,MD MD

Harmandeep Harmandeep Khosa, Khosa,MD MD

Brittani Brittani Moeller, Moeller,DO DO

CLASS OF2017 2017 CLASS CLASS 2017

Meghan Meghan McManus, McManus,DO DO

Adam Adam Morawski, Morawski,MD MD

Edward Edward Moellmer, Moellmer,MD MD

Maja Maja Stefanovic, Stefanovic,MD MD

Jessica Jessica Colanese, Colanese,MD MD

Jennifer Jennifer Cummins, Cummins,MD MD

Erin Erin McGonigle, McGonigle,DO DO

2014 2014––2015 2015R3 R3CHIEF CHIEFRESIDENTS RESIDENTS

Casey Casey Gee, Gee,MD MD

Masud Masud Hassan, Hassan,MD MD

TuTuAnh Anh Luong, Luong,MD MD

CLASS OF 2016 CLASS CLASS2016 2016

Cory Cory Jabara, Jabara,DO DO

Joshua Joshua Richards, Richards,DO DO

Nathan Nathan Norris, Norris,MD MD

Emily Emily Valenta, Valenta,DO DO

Phone: Phone:816 816276-7650 276-7650

Kansas City, Missouri

Katelyn Katelyn Falk, Falk,MD MD

Holly Holly Gault, Gault,MD MD

Garrett Garrett Hooker, Hooker,MD MD

--

CLASS OF 2015 CLASS CLASS2015 2015

Kansas KansasCity, City,Missouri Missouri64131 64131

Regan Regan Dulin, Dulin,DO DO

--

--

Genna Genna Siemons, Siemons,MD MD

Wes Wes Roodhouse, Roodhouse,DO DO

Eileen Eileen Westhues, Westhues,DO DO

Benjamin Benjamin Skoch, Skoch,DO DO

Christopher Christopher Standley, Standley,DO DO

Fax: Fax:816 816276-7090 276-7090

FOR FORMORE MOREINFORMATION INFORMATIONON ONOUR OURPROGRAM, PROGRAM,FACULTY FACULTYAND ANDRESIDENTS RESIDENTSVISIT VISITOUR OURWEBSITE WEBSITEAT ATWWW.RESEARCHRESIDENCY.COM WWW.RESEARCHRESIDENCY.COM

Daniella Daniella Boyer, Boyer,DO DO

Marisa Marisa Argubright, Argubright,DO DO

Eric Eric Daharsh, Daharsh,DO DO

6675 6675Holmes, Holmes,Suite Suite450 450

RESEARCH MEDICAL CENTER

RMC RMCFAMILY FAMILYMEDICINE MEDICINERESIDENCY RESIDENCYPROGRAM PROGRAM

Merlin Merlin Sunny, Sunny,DO DO

Zaynab Zaynab Zarrabi, Zarrabi,DO DO

MAFP Annual Fall Conference Research Family Medicine MAFP

Missouri Family Physician October-December 2014

23

MAFP University of Missouri School of Medicine DEPARTMENT OF FAMILY & COMMUNITY MEDICINE UNIVERSITY OF MISSOURI | SCHOOL OF MEDICINE 2014-2015 HOUSE STAFF Chief Residents

Seth Freeman, MD GM-Green

Natalie Long, MD Family Health Center

Jamie Luetkemeyer, MD Fulton

Mark Mueller, MD Family Health Center

Third-Year Residents

Kristina Anderson, MD GM-Gold

Blake Corcoran, MD Family Health Center

Andrew Horine, DO Fulton

Christopher Howse, MD Fulton

Allison Kolker, MD Fulton

Craig Luetkemeyer, MD Fayette

Morgan Schiermeier, MD GM-Blue

Kenneth Tan, MD GM-Green

Kate Williams, MD GM-Green

Sarah Yong, MD GM-Green

Second-Year Residents

Scott Bartkoski, MD Fulton

Anna Hulbert, MD Fulton

Joshua Billington, MD Fayette

Candy Lincoln, MD GM-Green

Megan Cates, DO Family Health Center

Amelia Frank, MD GM-Green

Kendal Geno, MD Family Health Center

Adam Harrold, MD Family Health Center

Alicia Ludden, MD GM-Gold

Rick Manhas, MD GM-Blue

Andrew Patel, MD Fulton

Andrew Valleroy, MD Fulton

First-Year Residents

John Ballantyne, MD GM-Green

Andrea Bickerton, MD Fulton

Carlos Rubio-Reyes, MD Family Health Center

Andrea Schuster, MD GM-Green

Asa Chu, MD GM-Green

Ben Stevens, MD Fulton

Veronica Conaway, MD Fulton

Chase Ellingsworth, MD GM-Gold

Howard Tseng, MD GM-Green

Megan Warhol, DO Fayette

Integrated Residents

Krystal Foster Fulton

24 Missouri Family Physician October-December 2014

Sarah Kapala Fulton

Erin Pearson, MD GM-Gold

Christine Wilson, DO GM-Green

MAFP

St. Louis University Family Medicine MAFP

CONFIDENTIAL SAINT LOUIS UNIVERSITY FAMILY MEDICINE RESIDENCY 2014-2015

Clarice Nelson MD PGY3-Chief Resident

Imani Anwisye MD-PGY3

Gopy Arumugam MD-PGY3

Brandon Luk MD–PGY3

Victoria Spencer MD-PGY3

Jackson Pugh MD-PGY2

Betsy Wan MD-PGY2

Christopher Wedell MD-PGY2

Matthew Witthaus MD-PGY2

Muhammad Dalal DO-PGY1

Kenetra Hix MD-PGY1

Preethi Schmeidler MD-PGY1

Kanika Turner MD-PGY1

Saint Louis University Family Medicine Residency At SSM St. Mary’s Health Center Phone 314-951-7230 / Fax 314-951-7234 http://familymedicine.slu.edu/residency NRMP code 1202831704 FAMILY MEDICINE INPATIENT SERVICE Attending Pager = 314-318-0077 Senior Resident Pager = 314-360-0772 (For Daytime Use Only)

Missouri Family Physician October-December 2014

25

S

MAFP University of Missouri - Kansas City Family Medicine

7900 Lee's Summit Road Kansas City, MO 64139 Ph: 816-404-7751 Fax: 816-404-7756 Email: info@umkcfm.org

Hailey Avila, DO Western U of Pacific

Jason Arribas, DO Des Moines University

Jenni Blair, DO KCUMB

Misty Bowen, DO AT Still

Jayme Decker,DO,MS KCUMB

Neil Bryan, MD University of Kansas

Jason Arribas, DO Gillian Housman, DO, MPH Des Moines University KCUMB

James Kirkpatrick, MD, PhD SLU

Laura Kresta, DO, MBA KCUMB

Caitlyn Nguyen, MD University of Kansas

Chris Paynter, DO, MS KCUMB

Gillian Housman, DO, MPH KCUMB

Laura Peterson, MD U of Nebraska

Hailey Avila, DO

Colleen Quinn, MD SUNY of Buffalo

Eli Katz, Jenn MD, MSBihlmaier,DO,MS James Kirkpatrick, MD, PhD University of Iowa KCUMB SLU

Shawn Lillig, MD University of Kansas

Barry Palizzi, DO Des Moines COM

Cierra Johnson, MD, MS University of Kansas

Jennifer Forsyth, DO, MBA UMKC Family Medicine

Mala Goyal, MD UMKC Internal Medicine

Eli Katz, MD, MS University of Iowa

Caitlyn Nguyen, MD University of Kansas

Drew Glover MD UMKC Family Medicine

Cory Offutt, MD MU—Columbia

Jenni Blair, DO Laura Kresta, DO, MBA KCUMB KCUMB

Chris Paynter, DO, MS KCUMB

Rachel Seymour, MD, MSc University of Kansas

Matthew Bihlmaier, DO UMKC Internal Medicine

Sara Fearn, MD University of Kansas

Christine Luke, DO KCUMB

Christine Lilly, DO, MS KCUMB

Cory Offutt, MD MU—Columbia

Ben Reine, DO KCUMB

Misty Bowen, DO AT Still

Case Everett, MD University of Kansas

Kristin Duncan, MD Ross University

Cierra Johnson, MD, MS Western U of Pacific of Kansas University

Daniel Lalli Hills, MD U of OK

Jenni Blair, DO KCUMB

Jenn Bihlmaier,DO,MS KCUMB

Mikael MacKinney, MD University of Kansas

Laura Peterson, MD U of Nebraska

James Kirkpatrick, MD, PhD SLU

Aniesa Slack, MD University of Kansas

Jennifer Forsyth, DO, MBA UMKC Family Medicine

James Smith, DO, MBA Penn State

Jayme Decker,DO,MS KCUMB

Neil Bryan, MD University of Kansas

Chris Gifford, DO KCUMB

Misty Bowen, DO

Daniel Lalli Hills, MD OK Still U ofAT

Jayme Christine Decker,DO,MS Neil Bryan, MD Luke, DO Christine Lilly, DO, MS KCUMB of Kansas KCUMB KCUMB

Nicholas Miller, DO KCUMB

Kristen Michael, DO KCUMB

Ben Reine, DO KCUMB

Colleen Quinn, MD SUNY of Buffalo

Laura Kresta, DO, MBA KCUMB Whitney Trusty, MD University of Kansas

Stephanie Million, DO KCUMB

Rachel Seymour, MD, MSc University of Kansas

Daniel Lalli Hills, MD U of OK

Shawn Wadsworth, DO, MA KCUMB

Drew Glover MD UMKC Family Medicine

Casey Dluhos-Sebesto, DO Mayo Clinic FL Family Medicine

Chris Paynter, DO, MS KCUMB

Laura Peterson, MD U of Nebraska

Matthew Bihlmaier, DO UMKC Internal Medicine

Jennifer Forsyth, DO, MBA UMKC Family Medicine

Mala Goyal, MD UMKC Internal Medicine

Chris Gifford, KCUMB

Kristin Duncan, MDKristen Michae Mikael MacKinney, MD U Ross University KCUMB of Kansas University

Michael Moreland, DO TX Col of Osteopathic Med

Aniesa Slack, MD University of Kansas

Shawn Lillig, MD University of Kansas

Dylan Werth, MD UMKC

Sara Fearn, MD University of Kansas

Mary Hoang, MD UMKC

Shawn Lillig, MD Kansas University ofUniversity

Barry Palizzi, DO Des Moines COM

26 Missouri Family Physician October-December 2014

Emily Grewe-Nelson, DO Oklahoma State

Kevin Gray, MD UMKC

Mala Goyal, MD UMKC Internal Medicine

Chris Jenks, MD UMKC Family Medicine

Case Everett, MD University of Kansas

Kristin Duncan, MD Ross University

Doyle Witt, MD SLU

James Smith, DO, MBA Penn State

Whitney Trusty University of Ka

Christine Lilly, DO, MS KCUMB

Chris Jenks, MD UMKC Family Medicine

Sam Mikhail, DO U of Illinois Family Medicine

Colleen Quinn, MD SUNY of Buffalo

Ben Reine, DO KCUMB

Rachel Seymour, MD, MSc University of Kansas

Drew Glover MD UMKC Family Medicine

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Fam

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MAFP

University of Missouri - Kansas City Family Medicine MAFP

7900 Lee's Summit Road Kansas City, MO 64139 Ph: 816-404-7751 Fax: 816-404-7756 Email: info@umkcfm.org

Case Kristin Everett,Duncan, MD Jayme Decker,DO,MS Kristin Duncan, MD Jayme Decker,DO,MS Neil Bryan, MD MD of Kansas UniversityRoss KCUMB Ross University KCUMB University of Kansas University

Lillig,Lalli MDHills, MD ChristineShawn MD Lillig, Lilly, DO, MSMD DO, MBA Shawn Daniel University of U Kansas University KCUMB of Kansas MB of OK

D MD son, aska

yal, MD KC Medicine

Ben Colleen Reine, DO Ben MD, Reine, DO Rachel Seymour, MSc Quinn, MD KCUMB KCUMB SUNY of Buffalo University of Kansas

Drew Glover MD UMKC Family Medicine

Everett, SaraCase Fearn, MD MD University of Kansas University of Kansas

Christine Luke, DO DO, MS Mikael MacKinney, Christine Luke, MD DO Lilly, Christine KCUMB University ofKCUMB Kansas KCUMB

Chris Gifford, DO MD Sara Fearn, KCUMB University of Kansas

Kevin Chris Gray, Gifford, MD DO Emily Grewe-Nelson, Kevin Gray,DO MD Oklahoma UMKC State UMKCKCUMB

Chris Jenks, MD UMKC Family Medicine

Mary Hoang, MD Emily Grewe-Nelson, DO UMKC Oklahoma State

Kristen Michael, DO Miller, DO Million, DO DO Michael Moreland, DO DO Kristen Michael, DO Stephanie Miller, Stephanie Million, Nicholas Mikael MacKinney, MDNicholas KCUMB KCUMBKCUMB KCUMB TX Col of Osteopathic KCUMB KCUMBMed University of Kansas

Shawn Wadsworth, DO, MA Trusty, MDDO, MBA Whitney James Smith, MBAMD MD Whitney Trusty, Aniesa Slack, MD MD, MSc James Smith, Rachel Seymour, AniesaDO, Slack, KCUMB of Kansas University of Kansas Kansas University of Kansas Penn Stateof Kansas University ofPenn University University State

Chris Jenks, MDMD Drew Glover UMKC UMKC Family Medicine Family Medicine

7900 Lee's Summit Road Kansas City, MO 64139 Ph: 816-404-7751 Fax: 816-404-7756 Email: info@umkcfm.org

Casey Dluhos-Sebesto, DO Mayo Clinic FL Family Medicine

Mary Hoang, MD UMKC

Michael Moreland, DO TX Col of Osteopathic Me

Witt, MD Dylan MD DO, MA DoyleDylan ShawnWerth, Wadsworth, Werth, MD UMKC SLU UMKC KCUMB

Sam Mikhail, DO Casey Dluhos-Sebesto, DO U Mayo of Illinois Clinic FL Family Medicine Family Medicine

Doyle Witt, MD SLU

Sam Mikhail, DO U of Illinois Family Medicine

Missouri Family Physician October-December 2014

27

MAFP Annual Fall Conference

U stability N predictability P reliability A believability R sustainability A L trustability L respectability E accountability L availability E D professional liability Timothy H. Trout Managing Director

287 North Lindbergh Blvd.

Saint Louis, Missouri 63141

314 587 8000 OFFICE 314 587 8001 FAX 28 Missouri Family Physician October-December 2014

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