March/April 2015 - Medical Reflections

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March/April 2015

Doctors MetroDoctors

In This Issue:

• Shotwell Award • TCMS Annual Dinner/ First a Physician Award • National Healthcare Decisions Day-5K Walk/Run • Luminary of Twin Cities Medicine

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CONTENTS VOLUME 17, NO.2

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MARCH/APRIL 2015

IN THIS ISSUE

Medical Reflections By Marvin S. Segal, M.D. LETTER TO THE EDITOR

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PRESIDENT’S MESSAGE:

Looking Ahead . . . By Kenneth N. Kephart, M.D.

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Page 6

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TCMS IN ACTION By Sue Schettle, CEO MEDICAL REFLECTIONS

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Luminary of Twin Cities Medicine

By Janis Carol Amatuzio, M.D., and Marvin S. Segal, M.D.

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Meanderings of a Short Coat: Palpating Truth

By Ethan Bernstein, MS3

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Three Experiences Out of the Ordinary

By Thomas B. Dunkel, M.D.

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The Military: Musing on that more real, more profound and unforgettable Parallel Universe

By Ronald Glasser, M.D.

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Advocating for Patients in the Era of Health Care Reform

By Robert G. Hauser, M.D., FACC, FHRS

Page 26

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Chinese Fan

By Charles R. Meyer, M.D.

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Life Saving Serendipity

By Marvin S. Segal, M.D.

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“It’s All in My Mind”

By Selma Sroka M.D.

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“Retirement is the Ugliest Word in the Language”

By Richard Sturgeon, M.D.

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Bulletin From UMDSM

By Patrick C.J. Ward, M.D.

Page 27

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TCMS Annual Board of Directors Meeting Peter Dehnel, M.D. Receives First a Physician Award Robert G. Hauser, M.D. Receives Shotwell Award National Healthcare Decisions Day A Planned Response to E-cigarettes and Smoking Pens

By Ellie Parker, MPH

Page 24 MetroDoctors

29 30 31 32 The Journal of the Twin Cities Medical Society

Advocate for Your Profession at Day at the Capitol New Members In Memoriam Career Opportunities

On the Cover: Interesting short stories, mostly medical in nature, are shared by nine physicians and a medical student in this “lighthearted” edition of MetroDoctors. Articles start with the Luminary on page 6.

March/April

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Doctors MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY

Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Robert R. Neal, Jr., M.D. Physician Co-editor Marvin S. Segal, M.D. Physician Co-editor Richard R. Sturgeon, M.D. Physician Co-editor Charles G. Terzian, M.D. Medical Student Co-editor Katherine Weir Managing Editor Nancy K. Bauer TCMS CEO Sue A. Schettle Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Andrea Farina MetroDoctors (ISSN 1526-4262) is published bi-monthly by the Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. Periodical postage paid at St. Paul, Minnesota. Postmaster: Send address changes to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413.

To promote its objectives and services, the Twin Cities Medical Society prints information in MetroDoctors regarding activities and interests of the society. Responsibility is not assumed for opinions expressed or implied in signed articles, and because of the freedom given to contributors, opinions may not necessarily reflect the official position of TCMS. Send letters and other materials for consideration to MetroDoctors, Twin Cities Medical Society, 1300 Godward Street NE, Broadway Place West, Suite 2000, Minneapolis, MN 55413. E-mail: nbauer@metrodoctors.com.

March/April Index to Advertisers TCMS Officers

President: Kenneth N. Kephart, M.D. President-elect: Carolyn McClain, M.D. Secretary: Thomas Kottke, M.D. Treasurer: Matthew Hunt, M.D. Past President: Lisa R. Mattson, M.D. TCMS Executive Staff

Sue A. Schettle, Chief Executive Officer (612) 362-3799 sschettle@metrodoctors.com Nancy K. Bauer, Associate Director, and Managing Editor, MetroDoctors (612) 623-2893 nbauer@metrodoctors.com Barbara Greene, MPH, Community Engagement Director, Honoring Choices Minnesota (612) 623-2899 bgreene@metrodoctors.com Emily Johnson, Marketing and Communications Coordinator (612) 623-2885 ejohnson@metrodoctors.com Ellie Parker, Project Coordinator Physician Advocacy Network (612) 362-3706 eparker@metrodoctors.com Karen Peterson, BSN Director of Program Operations, Honoring Choices Minnesota (612) 362-3704 kpeterson@metrodoctors.com

Allergy and Asthma Center of MN .............17 Allina Health.......................................................32 Classified Ad .......................................................31 Coldwell Banker Burnet..................................21 Community Healthworker Alliance ............21 Crutchfield Dermatology.................................. 2 Dermatology Consultants...............................12 Fairview Health Services .................................32 Federal Bureau of Prisons ....................................

Outside Back Cover Greenwald Wealth Management .......................

Inside Front Cover HCMC .................................................................14 Healthcare Billing Resources, Inc. ...............10 Lakeview Clinic .................................................32 PrairieCare ...........................................................14 QUITPLAN® .....................................................22 Saint Therese......................................................... 9 Senior LinkAge Line......... Inside Front Cover St. Cloud VA Medical Center ............................

Inside Back Cover Uptown Dermatology & SkinSpa................19

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For advertising rates and space reservations, contact: Betsy Pierre 2318 Eastwood Circle Monticello, MN 55362 phone: (763) 295-5420 fax: (763) 295-2550 e-mail: betsy@pierreproductions.com MetroDoctors reserves the right to reject any article or advertising copy not in accordance with editorial policy. Advertisements published in MetroDoctors do not imply endorsement or sponsorship by TCMS. Non-members may subscribe to MetroDoctors at a cost of $15 per year or $3 per issue, if extra copies are available. For subscription information, contact Andrea Farina at (612) 623-2885.

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March/April 2015

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The Journal of the Twin Cities Medical Society

IN THIS ISSUE...

Medical Reflections

Dear Reader, This copy of MetroDoctors represents a unique departure from our usual composition that ordinarily focuses upon one subject theme per issue. Instead of that direction, it was decided that for this March/April issue we’d move “out of the box” and invite some experienced physicians to contribute a potpourri of loosely related articles on divergent subjects.

The strategy supporting this approach was the following: All physicians have had interesting encounters in this wonderful profession of ours that lend themselves to “telling a story.”

Our hospital doctors’ lounges, lunchrooms and clinic break areas have been the sites for many of those stories being told.

Unfortunately, most of those tales became lost to posterity after their first or second verbalization. So — why not commit the recounting of those encounters to the printed word where the preservation of their inherent humor and wisdom would be easier to remember and savor? Thus, the concept of MetroDoctors Medical Reflections was born.

There were no frank ground rules for these articles, though it was hoped that they might be related in a lighthearted vein — possibly humorous or amusing, possibly poignant, and/ or possibly with a moral or message displayed for the reader to ponder.

And so, our authors responded by providing us with a fascinating variety of original medically related experiences — some comical, some starkly serious, some unconventional — but all hoping to stimulate a spectrum of emotions and interest on the part of the reader.

As you will see, the authors represent quite a broad cross section of medical specialties and previous writing experience, and their messages — in provoking many feelings ranging from hip-slapping guffaws to the sheading of a tear — are most captivating, each in their own way.

If you enjoy this Medical Reflections issue or would like to see it repeated in some future form, or even if you’d like to participate one day as a contributor, please do let us know; it would be great to hear from you.

On another topic, our planned July/August MetroDoctors will be devoted to the contemporary subject of the Independent Practice of Medicine.

We hope to explore this theme from many angles and would appreciate receiving from you some of the unique success stories encountered in your independent practice experience. Please be in touch with us if you’d like to play a contributing role in those plans. We’d love you to share those meaningful occurrences with us.

Enough of this! It’s time for you to dig into this journal and enjoy. It’s a good read.

Your MetroDoctors Editors.

LETTERS

Two things struck me about the January/February, 2015 issue.

First, all the TCMS leadership had listed Employer. There was a not too distant past when we were all self-employed and independent and proud of it. Good or bad, in the eye of the beholder.

Second: Dr. Chris Johnson’s article (The 5th Vital Sign, Visual Analogue Scale, and the “Patient Experience”) is spot on. We don’t prescribe whiskey to alcoholics. We need to do what is best for the patient whether or not they like it. I will suggest to all your readers that the people who lose their prescriptions or go through them faster than they should are diverting their pills to support themselves. Do you really want those pills in our schools?

David Walcher, M.D.

By Marvin S. Segal, M.D. Member, MetroDoctors Editorial Board MetroDoctors

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March/April

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President’s Message

Looking Ahead . . .

KENNETH N. KEPHART, M.D.

2015 WILL BE AN IMPORTANT YEAR for the Twin Cities Medical Society. It has been five

years since we merged East Metro and West Metro into TCMS and we need to plan for the next five years. We will be having a strategic planning retreat this spring and will be soliciting your input. In looking at our Vision and Mission statements and our five areas of strategic focus laid out in 2010 I think we are on track with most of them. You can review them yourself by visiting our TCMS website, metrodoctors.com.

The one area we have not been successful is in retaining and attracting membership. Our active membership has declined by over 30 percent in the last five years. We need to understand why and determine if we can better meet the needs of our physicians so they see value in membership. This will not be simple. We have physicians in small independent groups, large independent groups and physicians employed by large health care systems in the metro. What provides value may be different for physicians in different practice types. If you are reading this you are likely one of our dues paying members. I challenge you to speak to one or two of your colleagues who are not members and see if you can convince them to join. If they don’t join, find out why and share the reason with us. We are already planning on focusing one of our future issues of MetroDoctors on independent practice. I expect we will focus another on the employed physicians and their needs. Since we are a component medical society of the MMA and our dues are linked, we will certainly continue working with the MMA on their focus on increasing membership as well.

Our focus on community health projects in contrast to our membership issue has really taken off.

Honoring Choices Minnesota (HCM) has continued to grow and is bringing in dollars to support it. In addition to continued growth of the program to other communities in Minnesota and other states, we are working with our lobbyist and Senator Kathy Sheran of Mankato to introduce legislation to help sustain us financially in our work with communities. I feel the health care systems will continue their work inside their systems but that leaves out important parts of our community that aren’t actively engaging the health care systems. This is particularly true in our minority communities where health care disparities are the greatest.

We have good studies that tell us members in those communities have a very low incidence of advance care planning (ACP), tend to distrust providers in the health care system when they try to discuss ACP and have a higher incidence of prolonged ICU care at time of death. Led by our staff we have a robust effort to bring ACP through HCM directly to these communities using trusted community and faith organizations. This effort is one of the rationales for pursuing state funding. Another initiative of HCM this year will be to work with the Academic Health Center at the University of Minnesota to embed ACP curriculum into nursing and medical students’ learning. In addition, we want to work with the graduate medical education office at the U to introduce ACP into the resident’s experience. It will be easier to sustain the work of HCM if our future doctors and nurses are exposed to ACP in their training and have a chance to begin doing it in their residencies.

Our other community health initiative that just received funding is around e-cigarettes and clean air policy. Similar to our efforts on smoking restrictions, we will work with other county medical societies across Minnesota to educate physicians on e-cigs and cessation, and work to limit the exposure and effects of ecigarettes on our patients — especially our youth. Early nicotine addiction is clearly a danger to the health of our teenagers and we already know that they are a target for the marketers of e-cigarette manufacturers.

Lastly, I will mention my intent to ask our TCMS board and legislative committee to specifically endorse (Continued on page 5)

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March/April 2015

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The Journal of the Twin Cities Medical Society

TCMS IN ACTION SUE A. SCHETTLE, CEO

TCMS Welcomes Two New Staff Members:

Ellie Parker, MPH joined TCMS on February 2 and is the new Program Coordinator working on a statewide e-cigarette education and advocacy initiative funded by the BCBS Center for Prevention. Ellie is coming to TCMS from Kentucky and will be leading efforts to engage physicians and medical students in the public discussion surrounding e-cigs.

She begins her work by conducting a poll of physicians from across the state on what they know about e-cigs and cessation. From there she’ll enhance the physician toolkit and begin to engage physicians in six regions across the state, working with other county medical societies. She will also be developing a continuing education module for physicians from across the state to become more aware of the latest information about e-cigs and other tobacco products.

Ellie’s email address is eparker@metrodoctors.com and her phone number is (612) 362-3705.

Emily Johnson also began her work with TCMS on February 2 serving as the Marketing and Communications Coordinator.

She will assist us in enhancing our presence in the community and with our members. TCMS physicians are doing some really meaningful work through our various committees and initiatives.

Emily is going to help us tell that story by working collaboratively with TCMS, TCMS Foundation, Honoring Choices MN and all of our committees and task forces. Emily will also be the lead staff person with the Senior Physician Association and will work with Nancy Bauer on outreach to our members and to the medical student section. Emily’s email is ejohnson@metrodoctors.com and her phone number is (612) 623-2885.

CEO Makes Presentation at MN Cancer Alliance Steering Committee

As chair of the MN Cancer Alliance Workgroup on Advance Care Planning, I presented an update on January

22, 2015 to the MN Cancer Alliance Steering Committee on the workgroup’s progress. The workgroup has been charged with doing an environmental scan of advance care planning — who is doing what? What data is currently being captured? What is happening to that data? And what opportunities exist to expand the data collection? Phase two of the work is now unfolding with the long-term goal to have a publicly reported advance care planning measure.

Advance Care Planning Legislation Introduced

Two advance care planning bills have been introduced: SF 410 calls for advance care planning resource organization appropriation; and SF 410: Let’s Talk Now Act — advance care planning grant program establishment. Both bills are sponsored by Senators Kathy Sheran (D19), Melisa Franzen (D49), David Senjem (R25), Julie Rosen (R23) and John Marty (D66). Companion bills in the House are also being written.

President’s Message

Medical Students

(Continued from page 4)

On February 2, MDH Commissioner Edward Ehlinger, M.D. was the featured speaker at the University of Minnesota Medical Student Lunch ’n Learn. He spoke on the topic of health disparities and current health issues facing Minnesota.

position statements and policy to protect the doctor-patient relationship and fertility rights that our members from the OB/GYN specialty have brought forward. They have testified that nationally there have been multiple attempts to infringe on these important rights and I feel we need to heed their warning and be better prepared if similar legislation is introduced in Minnesota. I was disappointed that the MMA has not chosen to specifically respond to their concerns and explicitly list them in their legislative priorities.

I would like TCMS to do this.

That’s all for now. Please contact me directly with any concerns you have. I want to hear from you. You can contact me through TCMS or through my work e-mail, kkephar1@fairview.org.

Remember, the best care for your patient is actually caring about them.

MetroDoctors

The Journal of the Twin Cities Medical Society

March/April 2015

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LUMINARY of Twin Cities Medicine

By Marvin S. Segal, M.D.

JANIS CAROL AMATUZIO, M.D. Our Luminary for this Medical Reflections issue is a locally bred and professionally trained distinguished Forensic Pathologist. She is also a writer of some renown, a wife, a horsewoman, a loving daughter and a continual student of the human condition. The foundational influences in her successful professional career have been profound, the earliest of which may well have begun when — as an adolescent — she accompanied her physician father on house calls. She noted his great compassion and ability to give comfort to those in need — characteristics that became indelibly etched into the infrastructure of her future journey.

Let’s depart from our usual Luminary narrative and “listen” to Dr. Janis Amatuzio’s story in her own words . . .

“Being Seen” In the Coroner’s Office Dr. Donald Amatuzio, my father, was a physician who practiced internal medicine in Minneapolis. His example inspired me to follow his footsteps into medicine and be just like him; an internist as well. As I approached completion of my medical studies, he began urging me to study pathology. He said “pathology” would always be the perennial basis of medicine. To me, pathology seemed so tedious, so meticulous, and far less exciting than other new, emerging subspecialties of medicine. I balked at first; I didn’t want to take his advice.

But he persisted, and eventually, I listened and transferred from an internal medicine residency into a pathology residency at the brand new Hennepin County Medical Center. My father was not surprised when I found the study of pathology very exciting, even cutting edge; my knowledge rocketed, along with deeper understandings of disease, health, and injury. I was guided by some of the most legendary of teachers of the day; Dr. Robert Anderson, Dr. Calvin Bandt, and the Hennepin County Medical Examiner, 6

March/April 2015

Dr. John Coe at HCMC; and Dr. Patrick C. J. Ward, Dr. Charles Horowitz, and Dr. Desmond Burke at Mount Sinai Hospital in Minneapolis.

These teachers were giants; they made profound impacts as they taught us to recognize and diagnose disease.

For the next five years I virtually lived in the recesses of the clinical laboratories and the morgue. I concluded pathology was fascinating, but pathologists were always kept well hidden, in dark windowless rooms.

What I didn’t see coming during that time, was my nascent fascination with forensics. It seemed to take root insidiously within the cool, silent recesses of the new morgue hidden beneath the Hennepin County Medical Examiner’s Office.

Down there, the meticulous search for medical answers broadened to include larger questions such as: who are you, what happened, how, and even, why? Although many cases rocked me with their blood and violence, I felt great pleasure by solving these mysteries through application of MetroDoctors

The Journal of the Twin Cities Medical Society

forensic and scientific principles, and careful medical practice. Forensic pathology allowed the “truth of the matter” to emerge; it was deeply satisfying.

The subspecialty of forensic pathology began to pull me inexorably, like iron filings to a magnet. Scientific explanations help loved ones resolve the very natural human emotion of grief at the time of death; saying good-bye when one didn’t want to. It was a privilege to “speak for those who had died.” I followed that force.

Mid-career, forensics presented me with a new mystery.

Family members occasionally shared their experiences of dreams, visits, and extraordinary synchronicities after the death of someone I had examined. These extraordinary experiences quelled their hearts and deepened their understanding of life. It was apparent in the peace, relief, and deep understanding which flooded their lives and mine. I had no forensic answers to explain these experiences, but was again mesmerized.

A wise teacher once said, “If you look at something closely enough, you begin to see right through it.” I began to see forensics and death investigation as more than an examination of a body at a scene or on an autopsy table.

Death investigation became life investigation; the examination of a human “being.” I wrote about these experiences in two books, Forever Ours (2004) and Beyond Knowing (2006). (New World Library). Life seemed larger, deeper, and more astonishing than I ever expected.

Forensic principles say, “When possible, make a positive identification first; then everything starts to fall into place.”

We may have too narrowly identified a person by just the physical characteristics of their body. Could the truth of the matter be a human “being” much more than their body?

Could the physical body be just the visible and smallest part of the larger invisible energies of a person?

Perhaps the study of medicine will come to realize our “being” stretches far beyond the physical body. Could powerful invisible energies resonate and regulate the body?

Inquiry may shift perceptions and open new dimensions and deeper understandings.

A great teacher once remarked that at the end of his career he knew less than at the beginning. Perhaps this is true of all who ask the larger questions such as: What makes some holders of disease and others live vibrantly into old age? Is cancer caused by random stem cell mistakes, or do we shape our health by how we hold and channel our energy? Why do some die so young; bad luck or are they on some level complete?

I have the sense the largest (yet almost unexamined) part of humanity lies in the amazing, mystical, and beautiful MetroDoctors

The Journal of the Twin Cities Medical Society

quantum dimensions of our energy; most already know this intuitively. Perhaps we are actually “beings of light”’ with roots deep in the soil of the immortal pulsating energy of Life. I find hope in this, and prefer it to the sterile thought we are just physical bodies on a spinning planet in a random universe.

To a “reasonable degree of medical certainty,” I believe pathology is the basis of medicine, and forensics a lens into the rich language of Life. This might explain humanity’s “forensic fascination” and mine.

I also believe answers to life’s largest questions will emerge when the scope of “positive identification” is deepened. But that may take awhile because tracing humanities’ invisible roots lies in the exploration of “inner space.” It’s an inside job.

I have never found anything so fascinating; and like before, I’m pulled like iron filings to a magnet by those profound implications.

Dr. Amatuzio combines the scientific, sometimes stark, objectivity in the field of Forensic Pathology with the more ethereal subjectivity of her ongoing exploration of the human condition — and it works! A fruitful product of that approach has been demonstrated with the many understanding contacts she’s had with family members of the “departed.” The compassion she radiates and the comfort she provides to those she serves are not unlike those practiced by her dad so many years ago. He would be proud — as are we.

Dr. Janis Amatuzio is a physician, a board certified forensic pathologist, and recently retired Chief Medical Examiner of the Anoka County System, Midwest Forensic Pathology Medical Examiner’s Office which includes eight MN counties, and 14 referral counties in both MN and WI. Over the course of her 30-year career in forensic pathology, she has performed thousands of autopsies, and visited the scenes of hundreds of suspicious deaths. She has testified in state and federal court numerous times and considers it an honor to, “Speak for the Dead.” She retired from her position as Chief Medical Examiner in January 2010; is consulting and working to finish her third book.

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Medical Reflections

Meanderings of a Short Coat: Palpating Truth

I

’ve been told over and over to learn three things from every patient, which is an effortless task for a third year medical student. Demonstrating my knowledge during rotations, however, is a constant struggle.

From my very first ENT patient I learned that children with benign epistaxis should get a finger-full of K-Y Jelly. If only J & J knew that K-Y jelly was ideal for protecting nasal mucosa, perhaps they’d have a blockbuster campaign marketing it to everyone living in cold, dry places like Minnesota. I have a hunch that “three out of four ENT physicians recommend K-Y nasal moistening gel” would be a local moneymaker.

The physician I was trailing on ENT forecasted with alarming clairvoyance that, “Pediatricians love to put Vaseline ointment up there, but it doesn’t work as well.”

It wasn’t four weeks later on a Pediatrics rotation that I was rounding with my team at St. Paul Children’s Hospital, and just before discharging a “kiddo,” “Mom” wanted to know what to do about the minor nosebleeds he would inevitably get throughout the winter. When the pediatrician suggested Vaseline, I was almost visibly excited to contribute to the patient’s care and leave my mark, “you know, when we addressed this question in ENT clinic, they

By Ethan Bernstein, MS3

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March/April 2015

preferred K-Y jelly.” Laughter erupted as if on cue from the entire team: “I’m not going to tell ‘Mom’ to put a pleasure lotion in her son’s nose,” said the attending with an air of “boy, lucky you are a rookie.” I had the explanation at the ready but knew no one would listen, and worse, etch forever in their minds what an outrageous comment I’d made.

Demonstrating your knowledge while rounding from service to service is like a game of jeopardy where you don’t know when questions will be asked, and it is insufficient just to know the right answer (Didn’t I put it in the form of a question, Mr. Trebek?). You have to answer with tact, and the answer that was correct two weeks ago just isn’t anymore.

Every week the group dynamic changes as students, residents, and attendings shift. I was cool enough not to add that the ENT attending told me Pediatricians do that, but the response I expected was “great idea” or “that’s really useful information,” the way Pediatric attendings are supposed to support their students.

Instead, all levels of the team laughed as if they’d gotten the memo and I hadn’t.

The attending physicians pose the greatest challenge because everyone wants something different and I have to assume they already know what you’re attempting to teach or answer. We are all interested in showing that we have done our homework, but no one wants to be considered pompous, or worse still, answer in a manner that implies you think that they know nothing. That’s

evaluation suicide 101 and every student knows it. And, there’s no way to explain that you knew they knew, and you were so basic, so 3rd year basic, because well, you are a third year. Navigating these changing expectations is as sloppy as adolescence, when even eating a sandwich at this table, meant choosing one group of friends and offending another.

When I was in Ecuador teaching English, I took comfort in the fact that I was the only native speaker and the de facto expert. Like Tevye in Fiddler on the Roof, sometimes it didn’t matter if the grammar was right or wrong, because if I said it, it had to be right. Contrast that with the terror a 3rd year student feels while delivering a talk to a group of Nephrologists about ADH. Sounding knowledgeable and trying to impress while still showing deference to their decades of experience is an art form.

Rotate from an Internal Medicine rotation to a Surgical rotation and the wheels spin again. “Too much depth, detail and thinking,” was the response when I gave my first presentation to the surgeon. He quipped, “we have work to do.” Which message do I focus on here, not to think too much, or that Medicine people don’t work very hard?

I learned quickly to cone down my presentations and found acceptance, to my own amazement, as I was still wondering why none of the Medicine patients get lactated Ringers.

I’m still uncertain as to how to interact with my peers in such a dynamic

MetroDoctors

The Journal of the Twin Cities Medical Society

setting. We all know that we learn better as a team, non-competitively and sharing the work load. This is the model we are taught that works best. One day I’m getting pimped and I don’t know the answer, I’m trying to explain my thought process, but everyone is looking at me like I need an intellectual Heimlich maneuver. I know my face is flushed and just hope I’m not visibly sweating . . . then one of my classmates saves me with the correct response and the crosshairs shift. Two days later the same student interrupts when I know the correct response and I’m immediately upset and color rises in my cheeks for the second time in as many days. Was this another act of benevolence as she thought she had to save me again, or was she trying to gain leverage by underscoring my incompetence, or only dispassionately furthering her own cause?

Then there’s the all-knowing, everaccessible computer that wanders the halls with us. Accountability has altered the landscape again, as there is no excuse not to know, not to be informed. Lab values change between pre-rounding and rounding like the giant departures board at Grand Central Terminal. Sometimes a single scan or culture will appear and my assessment and plan are completely irrelevant; another missed opportunity, and do I still get credit for the work? Is the point to be right, or to have thought through the differential? Do I dovetail my assessments, presentations and management in real time, or stick with the direction the history suggests? Am I to be reproached for not taking the specialists’ suggestions, or applauded because I followed my logic and instincts? Am I thankful or incensed when the consultant writes orders on my patient? And, no matter the emotion, is it safe to express this, and to whom on this rotation?

In the end, I think this system persists because it is a helpful rite of passage. A casual observer of our medical MetroDoctors

educational system can’t help but see the flaws, and the humor, but the earnest student focusing uniquely on patient care and knowledge misses out on half the learning and possibly a more accurate appraisal of their performance. The hazardous apprenticeship that is the 3rd and 4th year of medical school trains you to be nimble in thought and realize there is almost no absolute truth outside its context. Is this the same for new lawyers working in a firm, or employees in the first months working at Target? And, even as professional pupils, the trouble is, that by the time you master the game, it is time for residency.

Pass me the K-Y Jelly; I feel a nosebleed coming on.

Ethan Bernstein, MS3, University of Minnesota Medical School.

The Journal of the Twin Cities Medical Society

This is me, Ethan Bernstein, with some Peruvian alpacas. I love practicing medicine in Spanish and am thinking of going into internal medicine after graduation next year. My hometown is Rochester, NY, but I have been living in Minnesota since starting at Carleton College in 2007.

At Carleton I majored in Spanish literature and played a lot of Ultimate Frisbee.

March/April 2015

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Medical Reflections

Three Experiences Out of the Ordinary

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Some years ago I established a pulmonary rehabilitation program for patients with chronic lung disease, mostly emphysema. We had discussions about how smoking affected the lung tissues, and how to adjust life activities to match declining lung function, as well as the importance of exercise to maintain fitness.

One spring my mother came to visit and wanted to see what her son was teaching.

By the end of the session she became very

By Thomas B. Dunkel, M.D.

quiet. Without saying a word to me she decided to quit smoking, and she did. She lived to be 90, but for years suffered the consequences of her smoking.

2

Part of my practice was to care for patients who required long-term ventilator support on a respirator. One of my patients was a young Somali male who had been shot in the neck as part of gang warfare — the idea being not to kill him but to give him a lifetime of suffering. Late one afternoon his sister came to visit him, and I was on the floor so I went in to give her an update on his progress. As I started to talk she became very agitated and left the room. She complained to the nursing staff that how could I, a male, be so crass as to talk to her, an unmarried female, directly. We both had some learning to do.

3

One of my patients was a retired engineer who suffered from advanced emphysema. He came in at regular intervals and we discussed gardening and the progress he was making on his robotic lawn mower as well as his health issues.

But his favorite topics were what was in the last issue of the New England Journal of Medicine, which he read front to back every week. Whenever he came in, I was sure to at least review my latest copy so that he knew I was keeping up. We had good laughs and very good discussions about the articles that interested him.

Thomas B. Dunkel, M.D. practiced pulmonary medicine in Minneapolis and St. Paul for 30 years and served for several years on the MetroDoctors editorial board. He retired in 2009.

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The Journal of the Twin Cities Medical Society

The Military Musings on that more real, more profound and unforgettable Parallel Universe

I

was drafted in the spring of 1968; a month after the start of the Tet Offensive that would ultimately shatter the myth of another sure and easy victory. At the time that I received my induction notice I was in the midst of a pediatric residency program at the Hennepin County Medical Center. The Chief of Pediatrics, Dr. Richard Raile, wanted me to stay on and finish my residency and wrote a letter that I was sure would at least get me deferred that extra year to finish my training. Three days later he received a return certified letter that, as I remember, contained only two sentences and no more than a dozen or so words . . . something like “No” and then another line or two stating something close to “In case you haven’t noticed, there is a war going on and we expect everyone to do their part.”

Well not quite and not everyone.

As I remember virtually everyone and anyone I knew had been deferred in one way or another either because of school or a bad back. First lesson . . . In the real world, there are other people who can and will tell you what to do and if you don’t want to listen they will just make you do what they expect you to do . . . so you had better be looking around and seeing what is really happening or could happen.

I entered Basic Training at Fort Sam Huston the month the Marines retook the City of Hue from the Viet Cong and

By Ronald Glasser, M.D. MetroDoctors

the North Vietnamese by simply leveling the city block-by-block and then street-by-street.

The truth was that the Tet Offensive probably saved me. I had orders for Vietnam which meant that as a Pediatrician I would have most likely been out on Med Cap Missions, delivering iron pills to villages in the Central Highlands or most likely the Delta to show the people that Americans cared. Looking back on it now, I would have lasted maybe a month traveling down the most dangerous roads in the world, alone in a Jeep with a 19-yearold driver who carried no more than an M-16. Like so many thrown into a war that neither the generals nor our government understood but went along with, I would not have survived.

But with the Tet Offensive clearly in mind the Army changed my orders and I was sent as a Pediatrician to the Army Hospital at Camp Zama Japan to take care of the children of the military and government dependents across Southeast Asia. The main function of the hospital though was to care for the wounded

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that had survived to at least make it to an Evac Hospital on their way, hopefully, back to the States for their ongoing recovery.

The wounded from Nam landed at the airbase at Yokota and were either kept there to be stabilized or, if critical, sent on by chopper to Zama and the Burn Unit at Kishine or the orthopedic unit at Camp Drake for additional orthopedic surgeries. If they survived they were evaced back to the States to Walter Reed, Fitzsimmons or the hospital at Fort Sam Houston. Lesson two. War is a very rough trip and many don’t make it home alive or intact. Napoleon was right. When he was asked what quality he admired most in his generals he answered without hesitation, “Luck.”

A third lesson, though more personal . . . the Army in its wisdom does actually expect a doctor to be a doctor.

The non-surgeons at Zama were assigned to help out the surgeons in the operating rooms during times of mass casualties.

None of us non-surgeons liked the idea.

But the Golden Rule in the Army is basically “He who has the power makes the rules.” In a way we were stuck with being doctors. I was assigned operationally, in case of mass casualties, to the orthopedic operating rooms.

A few weeks after I was at Zama, they sent the 101st Airborne into Laos and they got whacked. The wounded started to reach Zama a day or two later (Continued on page 12)

March/April 2015

11

Medical Reflections The Military (Continued from page 11)

as they made more room for incoming casualties in the military hospitals in Vietnam. I remember hearing the choppers coming in by the dozen shaking the walls of the hospital from one end to the other. I was unhappy. I did not want to have to help the surgeons — that wasn’t why I had gone into medicine and

definitely not what I had been trained for in my internship or residency. This was part, of course, of the sub-specialization of medicine since the Second World War that the military had somehow decided to ignore. I knew what I wanted and knew what I could do and more importantly should do, and as a Phi Beta Kappa in college, a graduate of Johns Hopkins Medical School and partially

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through a prestigious residency training program in Pediatrics. I simply expected to do what I was trained to do, expected to do, and as importantly, what I wanted to do. I was full of myself and having drunk the cool-aid didn’t want anyone to make me do something that seemed stupid if not ill-conceived. And in a way I was determined not to be helpful. Most likely to let those in charge know how stupid it all was. In short, that they should at least try to do this differently.

On the way over to the operating rooms I met the hospital commander, Col. Peyton, a veteran of the Second World War and Korea. I had the nerve to stop him and say “you know Colonel Peyton I’m a pediatrician . . . I haven’t been in an operating room since medical school.”

I should have noticed that he was unmoved. We both stood there for a moment with the choppers still coming in rattling the walls around us. He finally seemed to come out of himself and as he put his hand comfortably and kindly on my shoulder and with an understanding and pleasant smile said quite sympathetically and without the slightest hint of irony, “I understand Captain . . . believe me I understand so I’ll make sure that we just give you the little fucken wounds.”

I have heard that comment ever since but mostly whenever I have tried to get out of doing something that I consider too hard or ill-conceived. Mostly when I am being forced to do something that I don’t want to do but that I know can no longer be ignored or simply has to be done no matter what . . . .

Ronald Glasser, M.D. is a pediatric nephrologist at Pediatrics Consultants, PA and author of the best-selling book, 365 days, which has been translated into nine languages and nominated for the National Book Award.

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Advocating for Patients in the Era of Health Care Reform

I

n 1974 I was in charge of the pacemaker clinic at Rush-Presbyterian-St. Luke’s Medical Center in Chicago.

One morning a senior cardiologist, Dr. James Clark, came into my office to tell me that one of his pacemaker patients had died suddenly. The patient was a 40-yearold father who had congenital heart block and was “pacemaker dependent,” meaning that he had no heartbeat without pacing.

His wife had found him dead on the front porch of their home.

Dr. Clark wanted to know if his patient’s pacemaker had malfunctioned and caused his death. We retrieved the pacemaker from the funeral home and returned it to the manufacturer for engineering analysis. It showed that moisture had penetrated the pacemaker’s electronic circuit and caused a short-circuit. When the circuit shorted, the pacemaker stopped and the patient died. Incredibly, the manufacturer knew that this pacemaker model was prone to moisture intrusion but had failed to inform patients that they may be at risk.

Many of us have had sentinel moments in our careers. This was one of mine. We had dozens of patients who had the same pacemaker model. There was no method for determining if their devices had moisture and were prone to abrupt, catastrophic failure. Therefore, we identified the patients who were pacemaker dependent — like Dr. Clark’s patient — and prophylactically replaced their devices with a new model from a different manufacturer. Ironically, a year later this

By Robert G. Hauser, M.D., FACC, FHRS

MetroDoctors

new model developed the same problem, i.e. moisture intrusion, and some patients had to undergo a second “prophylactic” procedure.

This was the mid-1970s and Congress had just given the FDA the authority to regulate medical devices. The FDA funded a national multi-center pacemaker registry and we joined the program. By pooling data from a dozen hospitals we were able to identify which pacemaker technologies were performing well and which ones were inferior or simply unsafe. This effort was good for patients. At last we had the data to inform patients as to which pacemakers were likely to be the safest and most effective for them. Inexplicably, the FDA did not renew the registry’s funding, but we kept it going for another 15 years simply because it was the right thing to do.

The FDA approved the implantable defibrillator (ICD) in 1985. ICDs are far more complex than pacemakers. Its

The Journal of the Twin Cities Medical Society

circuitry has to develop over 1,000 volts and deliver a 30 joules shock promptly when the heart develops ventricular fibrillation. There are no second chances; like a parachute, the ICD has to work the first time.

By 1998 the ICD had become a multibillion dollar market and competition was fierce. New ICD models and leads were being rolled out at a rapid pace. Manufacturers wanted to be first in the market with the smallest and most sophisticated products. Predictably, quality issues arose, and once again the medical community had no access to the data required to guide the selection of devices or to inform patients.

With support from the Minneapolis Heart Institute Foundation and the Abbott Northwestern Hospital Foundation we created an ICD registry that collected device information and data from over a dozen U.S. hospitals. Between 2005-2012 this multi-center research effort identified six critical ICD device defects. Our observations were reported to the FDA and published in major peer-review journals.

Once again registry data had benefited patient care. Today, ICD technology is performing well and industry has learned (at least for the present) to stick with products and technologies that have been proven safe and durable.

The physicians who participated in the ICD registry did so without any form of compensation. Their principal motivation was to serve the best interests of patients. It was our obligation, as physicians, to do what we did. We never said it was our duty, but that was how we felt.

(Continued on page 14)

March/April 2015

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Medical Reflections Advocating for Patients (Continued from page 13)

Our actions were based on the fundamental ethical principles of beneficence and the preservation of patient autonomy.

These and other medical ethical principles help us navigate complex clinical issues every day. They should also guide us as we deal with the myriad of changes occurring almost daily as government, insurers, and our health systems attempt to control how we manage our patients.

Robert G. Hauser, M.D., FACC, FHRS, is Senior Consulting Cardiologist at the Minneapolis Heart Institute, and Past President of the Cardiovascular Services Division at Abbott Northwestern Hospital in Minneapolis. Dr. Hauser’s major career research interest is the safety and efficacy of implantable pacemakers and defibrillators.

Email: rhauser747@gmail.com Telephone: 612-863-3900.

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The Journal of the Twin Cities Medical Society

Chinese Fan

A

bove the fireplace in our living room hangs a Chinese fan. Against a gold backdrop amidst rocks and trees, a solitary eagle sits. At Christmas, he stares down at the stockings hung on the fireplace grate, seemingly watching over the gifts to children and grandchildren peeking out of the stocking tops on Christmas Eve. The fan was a gift from my patient Mr. Liu. As I entered his hospital room, I saw a slight, tannish man curled up on the bed.

When I greeted Mr. Liu, he barely raised his head from the pillow and muttered something incomprehensible. His English was confined to single words so I talked with his son, who unfolded the history of a gradual, relentless decline in Mr. Liu’s well-being. A native of mainland China, he had immigrated to the United States years ago and lived with family in Minneapolis. Normally healthy and vibrant, he had failed in the months before I saw him. His appetite was poor, he had lost weight, and was almost too weak to get out of bed. He had had an extensive medical workup but the cause of his physical skid remained obscure. His exam revealed a cachectic male with no other pertinent findings. The only clues in his laboratory results were a slightly low sodium and a slightly high potassium. All the common possibilities had been excluded so I grasped for a rarity and ordered a serum cortisol.

The low result confirmed the diagnosis of Addisons disease and we started him on replacement treatment. Within days he was strong enough to go home.

Over the ensuing months, I saw Mr.

By Charles R. Meyer, M.D. MetroDoctors

Liu in the office a number of times. Each time he looked more vigorous and, according to his family, was gaining weight and displaying his old energy. Despite his improvement, his family said he could no longer continue to see me because he had no insurance and little money.

I saw him a few times more at no charge until he started going to HCMC where his care would be covered.

I lost track of Mr. Liu until the next Christmas when my front desk staff told me a patient wanted to talk to me in the waiting room. There was Mr. Liu holding a basket of fruit. Bowing, he handed me the fruit, saying in halting English, “you gave me life.” Every Christmas for the next 20 years, Mr. Liu came to my office with a gift with the same message, “You gave me life.” Frequently the gifts were a fruit basket but one year he brought the Chinese fan. He had journeyed back to China that year and purchased the fan and two Chinese vases which sit on a shelf in my living room close to the fan.

There are two sides to every gift. Each year as I encountered Mr. Liu in the waiting room, I was tempted to tell him that I was just doing my job, that I made a lucky guess at his diagnosis, that we were both fortunate that he had a treatable condition. But he saw it differently. It was a gift that changed his life, the magic touch that raised him Lazarus-like from his death bed.

Perhaps Mr. Liu would say his gift to me was no big deal, merely a glorified fruit basket. Perhaps Chinese fans like mine are

The Journal of the Twin Cities Medical Society

sold in every street market in China. But it holds center stage in my living room, not just a beautiful decoration overlooking Christmas stockings but a daily reminder of the gift of being a doctor.

I haven’t had a Christmas visit from Mr. Liu for years and I don’t know how to find out about him. Yet as I sit before a winter fire with the eagle looking at me, the words “you gave me life” still give me shivers and the tears well up.

Above the eagle on the fan are Chinese characters. Until recently I just looked at them as part of the design. But I decided to snap a picture of them and the next time a Chinese interpreter came to the office I asked him to look at the picture and tell me what it said. He said next to the artist’s name and a date from the Chinese calendar, it said “from a high place you can see farther.” Sometimes it takes an eagle eye to see our gifts.

Charles R. Meyer, M.D. practices Internal Medicine in South Minneapolis and is editor-in-chief of Minnesota Medicine.

March/April 2015

15

Medical Reflections

Life Saving Serendipity

I

t was a dark and coolly crisp Wisconsin early summer morning when the middle-aged couple hurried to their car.

The star-filled sky vaguely outlined them quickly placing small suitcases into the back seat before starting their trip. There was an air of both anticipation and resolve in their postures as the engine roared to life and the tires rumbled over the pebbled driveway onto the country road. Their important journey had begun.

Mitch Cranston, a 59-year-old energetic and successful businessman of significant local repute and a patient of mine, suffered a series of heart attacks beginning with a massive anterolateral infarction at age 48. That initial insult was complicated by hypotension and rhythm disturbances requiring a lengthy hospital stay. His four ensuing attacks over the next 10 years, though not as serious as the first, each consumed additional portions of his left pumping chamber resulting in decreasing ejection fractions, waning cardiac output, and episodes of cardiac failure which became more and more resistant to our therapeutic management efforts. After referral to and evaluation by the University of Minnesota cardiology department, he was accepted as a potential heart transplant recipient and placed on their waiting list.

Mitch continued life as best he could, though in a much more sedentary fashion. As the long wait for an appropriate matching donor heart unfolded, he strictly followed an imposing schedule of cardiac meds, a low sodium diet, and massive curtailment of his legal, family and personal

By Marvin S. Segal, M.D.

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March/April 2015

activities. He was to remain within one and a half hours of the University Hospital, keep the transplant team aware of his location and carry a “beeper” that could be triggered by the heart team. Unfortunately, that “beeper” remained silent for well over a year, until . . .

Mitch and his wife Liz were enjoying a quiet weekend at their western Wisconsin family cabin when they were awakened about 2:00 a.m. by the startling simultaneous sounds of their telephone ringing and his ever-present “beeper” finally sounding off. Perhaps their hopes and prayers would be answered? They were instructed to make their way to the University Hospital with dispatch. They quickly dressed, locked up the cabin and headed to their waiting car just beyond the front door.

Perhaps 10 minutes into their westward journey down a two lane county road which was enveloped by dense woods on either side, Mitch’s headlights suddenly picked up the reflecting eyes and the form of a large deer loping directly at them.

The accident couldn’t be averted. The deer crashed into the left front fender area of the car and was thrown into the air — finally landing in the middle of the roadway — as the car spun nearly totally around, finally coming to rest on the right highway shoulder. It took a few seconds for the dust to settle and for the auto’s frightened occupants to be enveloped by total silence — no engine noise; probably only heavy breathing.

Liz and Mitch finally spoke and determined that, miraculously, neither were physically any the worse for wear. They peered behind them, and in the dim light determined that the unfortunate deer was

lying motionless and dead on the road.

Mitch recounted to me how he first crossed his fingers before turning the ignition key in hopes of restarting the car. After all — he had an important appointment awaiting him.

The engine turned over easily and Mitch cautiously guided the car back onto the road. Except for a constant rubbing of the left front wheel, he was able to proceed to the hospital’s entrance area — another hour away — without further incident.

As Mitch was being registered and the inevitable paper work was completed, Liz placed a call to the Wisconsin Highway Patrol to report the accident. The answering officer, after taking the location information stated, “Thanks for reporting this, ma’am. There’ve been an unusually

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The Journal of the Twin Cities Medical Society

high number of deer-vehicle collisions this early summer. I’m glad that you folks were among the lucky ones with no serious injuries.”

Mitch was quickly whisked off to the chilly pre-operative chambers where the many scrub suited staff members were bustling about readying the area for his impending heart transplant. Lab personnel were drawing Mitch’s blood from one arm for baseline purposes as the anesthesia folks were securing venous lines in the other arm. An artery was being canalized for pressure measurements and sterile cardiac monitoring leads were being affixed after a vigorous and chilling iodine chest scrubbing in preparation for the large midline incision that was soon to come. The pump team was at the ready — its intricate machine already purring. Tubes and lines were everywhere, instruments were being transferred from the autoclave to the O.R. and a last x-ray of his chest with the “old” heart was being taken.

Before scrubbing-in, the lead cardiac surgeon approached Mitch and in hushed tones, asked him if he fully understood what was about to occur — while assuring him that all would go well. Behind the surgeon, Mitch noted that a simple white insulated cooler had just been placed on a table across the room. Mitch asked the surgeon, “Is that the heart I’m about to receive?”

The physician replied, “Yes it is.”

Mitch then inquired, “May I ask you about the person from whom the heart came?”

“Certainly,” the doctor responded, “it came from a 19-year-old healthy young man. A perfect match.”

“May I ask how the donor died?”, asked Mitch.

The surgeon replied, “The unfortunate lad was in a motorcycle accident up north, somewhere near Duluth. He struck a deer!”

beloved profession and was nearly able to achieve the level of activity that he had enjoyed before his illness began. He and Liz resumed many activities with their supportive family and friends and were nearly continuous in the praise and appreciation they expressed to the medical personnel involved in his care. They were even able to travel once again, occasionally visiting their Wisconsin cabin — though driving extra-carefully on those country roads.

Mitch lived nearly seven years after the successful surgery before succumbing to the eventual re-establishment of arteriosclerotic heart disease, a not-infrequent outcome in post cardiac transplant patients.

Today in the U.S., there is a 55+ percent 10 year survival in heart transplant patients, who for the most part usually enjoy an excellent quality of life. The numbers of cardiac transplants being performed is steadily increasing in direct proportion to improvements in experience and technical capabilities — and, annually, thousands

of deer-vehicle collisions occur on our roadways, with Minnesota and Wisconsin ranking high among states with that dubious volume distinction.

It is our wish that this positive heart transplant performance trend will continue, and also that the numbers of deervehicle accidents diminish as a result of safety measures now being employed. If Mitch were with us today, he would surely share in those hopes.

(The above narrative is true and based upon an actual series of events. Names and rare instances have been altered only for privacy purposes.)

Dr. Segal’s 50 year career included a private practice of Internal Medicine and Cardiology and medical directorships at Mount Sinai/ Metropolitan-Mount Sinai Medical Center, Select Care, Medica and Minnesota Comprehensive Health Association. He currently serves on the editorial board of MetroDoctors.

— EPILOG — The life-saving surgery went smoothly and Mitch’s recovery and rehabilitation moved ahead swiftly and steadily. He resumed his MetroDoctors

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17

Medical Reflections

“It’s All in My Mind” “I think it’s all in my mind” is what the patient sitting before me said. This made me curious, and I asked her what she meant.

My patient had seen multiple doctors and practitioners, including conventional, allopathic doctors and practitioners of some alternative approaches. She tried her best with everything they had to offer. She would feel better at first and think that “this might be the one” medicine that could make the difference. But then she would start having strange symptoms and side effects and she always ended up feeling worse than when she started.

When she came to my Integrative Health Clinic at HCMC’s Whittier Clinic in South Minneapolis complaining of depression and fatigue, she wanted to try a natural, nutritional and functional medicine approach. She engaged fully with the process and was willing to make lifestyle and dietary changes and possibly try herbs and supplements. She told me clearly she was not interested in trying any more pharmaceutical drugs.

We started with some nutritional lab testing, looking for some points of intervention or biochemical imbalances for her neurotransmitters and energy production systems. I tested for important cofactors for enzymes that might be low and also for hormone imbalance. We found a few areas to work on.

For example, her Zinc/Copper ratio was low which might affect binding

By Selma Sroka, M.D.

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March/April 2015

sites as cofactors for enzymes that work most efficiently with zinc. Also, her RBC Magnesium was low, her free T3 was less than optimal, and her Testosterone was low for a woman her age.

We met a few times, focusing on education and I gave her a simple list of supplements that I thought might help her balance some of this better.

In addition, her depression and fatigue worsened premenstrual, and so I also suggested an herb that has helped some women improve luteal phase dysphoric dysfunction. When she returned the following month, she was feeling hopeful, actually feeling a little better, and of course I felt pretty good about that.

I didn’t see her for a few months and when she returned she said those words:

“I think it’s all in my mind.” She went on to explain that she feels it is something in her cells, or perhaps her DNA that will initially respond to treatment, and then her mind will react with fear of responding to chemical information and communication, whether it is pharmaceutical drugs, supplements or herbs.

She also went on to talk about how everyone in her family was chemically dependent, and how she had basically grown up without enough care, love or nurturing, as everyone who should have been caring for her was busy getting drunk or high. There was some physical abuse, but it sounded like it was primarily neglect. She learned not to expect or ask for anything for herself, to be invisible, and not cause any trouble. She had to grow up really fast and tried to take care of herself as well as everyone around her.

And as she grew up, she consciously made different choices for her life in order to give her children the love and mothering she had not received. She home-schools her children, and they are the priority in her life. She has a wonderful supportive husband, who has been stressed and struggling recently to find work after being laid off. He did recently find work and the financial stress has eased up a little.

She had been going to a therapist to consciously work through all the years of neglect and abuse she had experienced.

Then she came to a point where she felt so much talking and reliving the same stories over and over wasn’t getting her

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The Journal of the Twin Cities Medical Society

anywhere. She decided that 20 years of talk therapy was enough. So she stopped going to therapy a couple of months before she came to the conclusion that it was all in her mind.

She knew rationally that she needed to start loving and being compassionate with herself and mothering herself, since she did not receive these essential and vital “nutrients” necessary for becoming a healthy, optimally functioning woman.

I gave her affirmation about how great it is that she can give her children what she did not receive, and added that somehow she must find a way to receive some of that loving kindness and compassion and forgiveness for herself also. She then started to cry, and said that she knew she needed to forgive herself. She blamed herself for not being able to “fix” her parents and other family members, most of whom are dead now due to drugs and addiction. She was able to recognize her guilt as part of her co-dependency.

She believed that talk therapy wasn’t helping anymore, as she just gets stuck in the story of what happened, and around and around she goes. She expressed that somehow she needs to break free of the story. And she realized that chemical information cannot help her, in large part due to her fear of looking to chemicals to fix her problem as her parents and other family members had done.

I mentioned some of the non-chemical modalities that have been found to help some individuals with PTSD (Post Traumatic Stress Disorder), e.g. EMDR (Eye Movement Desensitization and Reprocessing) and EFT (Emotional Freedom Technique), and she took note and said she would consider trying them. I also pointed out that it may have taken her 20 years of talk therapy to get herself to this point of readiness for change and letting go of her early life traumas and experiences. She acknowledged that she could give herself some credit for her hard work.

I told her that sometimes people find rituals useful to clear or let go of MetroDoctors

past traumas and false beliefs, to break free from the past and change their story.

She said that she wished there were still people around practicing the Native American Sweat Lodge ceremony, because she had read that people could go to pray, detoxify and be healed of the emotional and spiritual illnesses they have been carrying. At that point, her eyes lit up and she said, “What I really need is spiritual healing.” Her insight and acknowledgment was so profound, she looked like a different woman after she spoke those simple words.

I did give her a referral to a community of people who hold regular sweat lodge ceremonies and maybe she will go.

Or perhaps all she needed was the insight that it wasn’t all in her mind, but was all in her spirit. She is a survivor and a very resourceful woman who is on her path to healing and living a full, happy life.

I was there to bear witness and affirm that I see her on her path. She left with hope in her eyes.

The Journal of the Twin Cities Medical Society

I learned a lot that day. Some people say that Family Medicine is too routine, just sore throats and chronic diseases. I say that the mystery of how each person finds their way to healing, in their own time and way, is an honor and privilege to experience.

Selma Sroka M.D. completed her medical degree at the U of MN in 1991. She completed her Family Medicine Residency Training at HCMC in 1994 and stayed on as Faculty for the program to the present time. Dr. Sroka has had a long-term focus on Holistic Integrative Functional Medicine. She was a Founding Diplomat with the American Board of Holistic Medicine in 2000, and completed her Fellowship with the Arizona Center for Integrative Medicine in 2009. She is Medical Director of HCMC’s Alternative Medicine Clinic, and sees patients in the Integrative Health Clinic at HCMC’s Whittier Clinic in South Minneapolis.

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Medical Reflections

“Retirement is the Ugliest Word in the Language.” Ernest Hemingway

I

spent a working lifetime practicing Internal Medicine, first at the old Abbott Hospital and then the merged Abbott Northwestern (ANW) Hospital. It was a good run for me. As I slid into retirement, I was fortunate to find a volunteer niche that allowed me to periodically spend time with patients and to connect with my longtime friends from work.

Ten to 15 years ago, under the direction of Dr. Jamie Gaviser, the Medical Staff at ANW had started the Patient Partners (PP) program. Physicians, who were no longer in practice and familiar with ANW, were invited or recruited.

Retired RNs have also become part of the team. The intent is to assist ANW patients or their families who are having extraordinary stress/struggles in their current acute care situation. The PP volunteer brings a seasoned medically enlightened person to the bedside. A knowledgeable and non-judgmental ear can help allay fears, anxiety or lack of understanding. Plus that unhurried empathy thing. They share their time, wisdom and caring support to alleviate fear, anxiety, confusion and stress. Potential patients are identified by their caregivers who request a PP consultation/visit.

The role is distinctly different from former professional activities. We are hospital volunteers, not nursing or medical staff members. It is made clear to patients we are not one of their care givers and we’re careful to avoid involvement in clinical decision making. I and others

By Richard Sturgeon, M.D.

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March/April 2015

find this at times difficult, but absolutely necessary. We do not interact with the medical record. That part is easy.

It is very gratifying to help these patients have a smoother hospital course and enhanced emotional experience during their sojourn in the acute care setting. It lets me use skills built up over a lifetime. It lets me continue to feel useful. I get to connect with lifelong friends. My wife would say it gets me out of the house.

So I am a volunteer in this Patient Partners program. We look to serve 15-20 days per year in blocks of 3-5 sequential days to maintain ease and familiarity of process. But this is not a hard and fast rule. Some of us are there a bit more than that. I am exposed to the full panoply of patients and families one would encounter while in practice.

I meet interesting people each and every time.

One volunteer day last summer I was asked to see an 80-year-old woman.

Her nurse told me she was really worried about her scheduled procedure. In spite of significant effort she had not been successfully reassured.

After introducing myself, I made sure she knew I was not one of the doctors taking care of her. “I do not know details of your case nor look at your medical record because that is none of my business.” My efforts to break the ice were not going very well. She remained very quiet.

Eventually I said, “Your nurse told me you are very worried about your procedure this afternoon.” She said, “Yes.”

Further silence. Finally I asked, “What exactly are you worried about with this procedure?” After a moment, she said, “I just don’t like the idea of living with plastic in my body.” Still in the dark, I responded, “I can understand that. Just what procedure are you having done?”

To which she replied, “You know, that angioplastic thing for my heart.”

I suppressed the laugh or smirk and got out some paper and said, “Let me explain and draw a picture for you.”

Which I proceeded to do with an explanation, “You may end up with a little coil of stainless steel, but they will leave no plastic in your body.”

As you can imagine, she was quite relieved and fortunately had an uneventful procedure later that day; without

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additional unwarranted anxiety for her to confront. And no plastic in her body!!

Sometimes just having been around for a long time and knowing the system is helpful. A man waiting for a heart transplant showed up on my list. He was trapped in his hospital room with end stage CHF on an LVAD set up. I only knew he had been there two weeks already and no clear cut end in sight. He looked pretty good and enjoyed the company. I noted he was on his computer each time I visited. I said, “It is good you have that activity to help with the boredom. Is it for business or pleasure?”

He said, “Both, but he could not do business as usual as our IT system was too slow and the IT filters prevented some activities he needed.” I said, “I’ll see what I can do.”

I knew who to go to and asked if his specific room could be given special attention. She knew what to do and did

Introducing

it. Next day I asked him if his connection was any better. I got a huge smile and he said, “It is just what I needed to get my work done, thank you a bunch.”

We shared a laugh when I said, “If you download any porn, I am in trouble.”

The physician’s role as medical confidante is quite self-satisfying. As you might imagine not all contacts are as dramatic or pleasantly successful. Nevertheless, the periodic opportunity to engage in positive and rewarding bedside activities help make my withdrawal from full-speed-ahead medical practice tolerable. Lucky me.

Success with CHWs

A project of the Minnesota Community Health Worker Alliance

Practical tools to: • Improve patient outcomes • Manage costs • Better serve diverse patients

Richard Sturgeon, M.D. practiced Internal Medicine for 35 years; and served as the Vice President for Medical Affairs at Abbott Northwestern Hospital and Fairview Southdale Hospital. He retired in 2012.

Dr. Sturgeon continues to serve on the MetroDoctors editorial board.

Learn more: successwithchws.org/asthma successwithchws.org/mental-health

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Bruce Birkeland / 612.925.8405 / BirkelandBurnet.com

The Journal of the Twin Cities Medical Society

BURNET

March/April 2015

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Free tools to quit smoking your own way.

It’s easy to help your patients quit. All Minnesotans have access to free cessation support through QUITPLAN Services, including free nicotine patches, gum or lozenges. For more information and to order QUITPLAN brochures for your office in English or Spanish, visit quitplan.com.

Bulletin From UMDSM

H

ere in the heart of the Northland are two large general hospitals which provide teaching venues for 3rd and 4th year medical students from UMDSM. Visiting faculty at UMD are often hospitalists at these institutions. As a full-time faculty member at UMD for 25 years, it has been my privilege to share the joys of molecular pathology with some 1,350 1st and 2nd year students. A few of these students have been absolutely unforgettable. One such student is the subject of this short story. By now, she has probably entered practice in Greater Minnesota. We will call her Barbara for purposes of this true story.

Barbara was a joy to teach.

Bright, alert and highly intelligent.

She always scored highly in my often ticklish examinations. She had one characteristic I have encountered only once before in my 80 years on this planet. She had a highly infectious laugh which was often triggered during my lectures. It invariably set the entire class tittering, often without understanding what set her off. In her third year, she entered a 6-week clinical rotation in one of the local hospitals. Thereby hangs a tale . . . .

One day during this rotation, Barbara was asked by her attending

physician to do a repeat history and physical on a patient already hospitalized for a major medical disorder. He also suffered from plantar fasciitis.

The patient was an elderly man with a reputation for being irritable. Upon entering the patient’s room, Barbara began.

“John: my name is Barbara and I am a medical student. I am here today to check your medical history and re-examine you in case anything has been overlooked. First, tell me how you are feeling. Is anything bothering you today?”

John looked at her crossly and half-yelled: “I have flasher panty-itis.”

Fully aware of his major and minor disorders, Barbara instantly burst into peals of laughter, peals and peals

By Patrick C.J. Ward, M.D. MetroDoctors

The Journal of the Twin Cities Medical Society

of laughter. Even as she laughed, she was acutely aware that chortling at a patient’s misfortune was a serious breach of the doctor-patient relationship and could have serious consequences. She headed for the door, still shaking uncontrollably with laughter.

As she reached the door she heard John yelling “But it really hurts.”

That did it. She lost it completely and ran from the room, now shrieking with laughter — straight into the arms of her stern-faced attending faculty member. He had run to the patient’s door in response to the loud rumpus within. She sensed danger, especially when he looked at her coldly and asked her to explain herself. When she told him, he immediately broke into a broad bellylaugh. Together, they went off for coffee.

Post-script: No medical student was hurt, disciplined, injured or expelled as a result of these events. Mrs. Malaprop lives.

Patrick C.J. Ward, MB BCh, MASCP was head of pathology at Mount Sinai Hospital where he remained until 1983 at which time he left to become Chair of Pathology at the University of North Dakota. In 1987, he returned to Minnesota as Professor and Head of the department of Pathology at the University of Minnesota Duluth School of Medicine. He retired in 2012 as Professor Emeritus.

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TCMS Annual Board of Director’s Meeting

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he New Year began with the installation of Ken Kephart, M.D. as the sixth president of TCMS and the appointment of the Executive Committee at the Annual Meeting of the TCMS Board of Directors held on Tuesday, January 13, 2015. (See President’s Message for a summary of Dr. Kephart’s comments).

Brooks Jackson, M.D., Vice President of Health Sciences and Dean of the University of Minnesota Medical School, was the keynote speaker. He spoke of the great pride of the U of M and its partners making health care affordable and accessible around the state. He noted the great faculty in research and the Governor’s Blue Ribbon Task Force to enhance the prominence of the U of M throughout the country. Dr. Brooks outlined three goals to be achieved in order to be the best medical school: 1) more scholarships; 2) legislative support for funding medical education and research; and 3) increased number Brooks Jackson, M.D. of mentoring sites and preceptors throughout the community. In response to the aging population within Minnesota, Dr. Brooks is championing the development of statewide interdisciplinary teaching centers to meet the needs of the changing demographics, including re-starting a geriatrics program next year.

Dave Thorson, M.D., MMA President stated that his involvement in the MMA began by engaging first with the county medical society (TCMS). He commended TCMS on its Honoring Choices Minnesota initiative, noting “it is transforming how we deliver health care — by working in teams.”

In addition to its legislative priorities, MMA is continuing to focus efforts on the hassles of prior authorization and physicians at risk of burnout. He concluded, “What’s best for our patients is best for the house of Dave Thorson, M.D. medicine.”

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Drs. Ken Kephart and Lisa Mattson greet Dr. Brooks Jackson (center).

Past TCMS President Peter Dehnel, M.D. and PresidentElect Carolyn McClain, M.D.

Dr. Edwin and Zipporah Bogonko visit with Michael Tedford, M.D.

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Michael Tedford, M.D., Chair of MEDPAC gave a quick plug for physicians to financially support the work of MEDPAC as it provides for a greater impact on behalf of organized medicine on health care issues at the Capitol.

And, finally, Lisa Mattson, M.D. was recognized with the outgoing President’s Award for the time, effort and passion that she brought to the role as president, including numerous hours spent in legislative visits as an advocate for the profession of medicine and testifying before legislative and policy committees on e-cigarettes and other important issues.

Board member Carrie Terrell, M.D. (right) with guest Jody Bjornstad.

Lisa Mattson, M.D. accepts the outgoing President's Award from Ken Kephart, M.D.

TCMS Executive Committee: President – Kenneth Kephart, M.D. President-Elect – Carolyn McClain, M.D. Immediate Past-President – Lisa Mattson, M.D. Treasurer – Matthew Hunt, M.D., FRCS Secretary – Thomas Kottke, M.D., MSPH At-Large Member – Nicholas Meyer, M.D. At-Large Member – Stefan Pomrenke, M.D., MPH, MATS Chris Rief, M.D., Rupa Polam, M.D., and guest Edgar Austria.

Peter Dehnel, M.D. Receives First a Physician Award

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he First a Physician Award, established in 2007, recognizes a member of the medical society who has made a positive impact on organized medicine by selflessly giving of his time and energy to improve the public health, enhance the medical community’s ability to practice quality medicine, and improve the lives of others in our community. Peter Dehnel, M.D. is the recipient of the 2014 award.

An advocate for population health, prevention and improving health, Pete developed an expertise on secondhand smoke and became the public face for TCMS on our multi-year smoke-free efforts. He also led efforts to reduce obesity by advocating to city council members and mayors that they should enact Healthy Eating Active MetroDoctors

Living strategies. He testified, wrote letters and served as a resource to staff and coalition members. Pete is now assisting TCMS as strategies are developed for regulating e-cigarettes, hookahs, and other tobacco products. He recently trained 15 physicians and medical students. His work in this area is really just beginning.

Not only is Pete a past president of TCMS, but he has also chaired many events over the years, including the educational forums on MNsure, prediabetes, and telemedicine. He serves on the MetroDoctors editorial board and is a regular contributor to its content. Pete is the cochair of the TCMS legislative and policy committee; truly a volunteer through and through. He is committed, effective,

The Journal of the Twin Cities Medical Society

a mentor and role model — and one heck of a nice guy.

Peter Dehnel, M.D. received the TCMS First a Physician Award presented by President Ken Kephart, M.D.

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Robert G. Hauser, M.D. Receives Shotwell Award

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he 2014 Shotwell Award was presented to Robert G. Hauser, M.D., FACC, FHRS at the January 6, 2015 meeting of the Abbott Northwestern Medical Staff. Richard D. Schmidt, M.D., chair of the West Metro Medical Foundation of the Twin Cities Medical Society presented the award.

The Shotwell Award is presented annually to a person within the state of Minnesota who has made significant contributions in the field of health care.

Robert G. Hauser, M.D. is Senior Consulting Cardiologist at the Minneapolis Heart Institute, and Past President of

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the Cardiovascular Services Division at Abbott Northwestern Hospital in Minneapolis. Until 1987, Dr. Hauser practiced cardiology at Rush University Medical Center in Chicago, Illinois, where he was Professor of Medicine and Co-Director of the Section of Abbott Northwestern Medical Staff President Jason Reed, Cardiology. In 1987, he M.D., (left) and West Metro Medical Foundation Chair Richjoined Cardiac Pacemakard Schmidt, M.D. (right), present the Shotwell Award to Robert Hauser, M.D. ers, Inc., (Eli Lilly & Co.) and was named President and Chief Executive Officer in for his patients by challenging the medical 1988. He served in that capacity device industry over the safety and efficacy until 1992 when he returned to of implantable cardiac devices, the West the full-time practice of cardiolMetro Medical Foundation is honored ogy with the Minneapolis Heart to present Robert G. Hauser, M.D. with Institute. the 2014 Shotwell Award,” stated Dr. Dr. Hauser graduated with honSchmidt. ors from the University of CincinDr. Hauser and his wife Sally have nati College of Medicine in 1968, three daughters and four grandchildren, is a Fellow of the American College and they reside in Medina, Minnesota, of Cardiology, and a Founder, past and Naples, Florida.

President, and Fellow of the Heart The Shotwell Award was established Rhythm Society.

by Metropolitan Medical Center in 1971 Dr. Hauser’s major career rein recognition of the support and dedicasearch interest is the safety and tion of the Shotwell Family. Upon the efficacy of implantable paceclosing of Metropolitan-Mount Sinai makers and defibrillators and Medical Center in 1991, the West Metro has published multiple papers Medical Society Foundation assumed rein peer review journals regarding sponsibility for selecting the recipient of the reliability and performance of the Shotwell Award. Abbott Northwestern implantable cardiac rhythm manHospital and Medical Staff has generously agement devices. provided funding for the Shotwell Award “In recognition of his leadership since 2003. A plaque recognizing all the as a cardiologist and researcher, award recipients resides in the Sister Kenny including the significant role he Pavilion on the Abbott Northwestern camcontinues to play in advocating pus.

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The Journal of the Twin Cities Medical Society

A guest article from Nathan Kottkamp, founder of the National Healthcare Decisions Day initiative: We’ve got a lot of work to do. That is one of the simple messages found in the Institute of Medicine’s (IOM) recent report “Dying in America.”1 To be sure, the IOM identified several flaws in the way that we address end-of-life care in America. Many of these issues are well outside the scope of what National Healthcare Decisions Day (NHDD) can address, but the IOM did strongly urge the ongoing and enhanced use of advance care planning as a key strategy to improving end-of-life care. This, of course, is right in NHDD’s sweet spot.

Although advance care planning is not exclusively for endof-life care, the fact remains that advance care planning — and the lack of it — come into play most often with end-of-life care. And, while it may be hard to pin down the actual number of those who have engaged in advance care planning, various studies (and my own personal experience) suggests that the number hovers around 25 percent.

As confirmed in the IOM report, Americans seem culturally hardwired not to talk about illness, death, and dying.

As a result, we are paying a tremendous price for it. Among other things, there is tremendous waste that comes with lack of planning. In particular, in situations in which there is a lack of planning, we often waste a lot of resources spinning our wheels trying to figure out who a patient’s decision-makers are and what the patient would have wanted. The other key price we pay is making difficult times worse. Specifically, where no advance care planning has been done, family and friends often thrust into the position of making health care choices without ever having discussed the drivers of these choices with the patient — and then they live with the burden of second guessing themselves. In other cases, families and friends never get a proper goodbye because they are too caught up in conflict.

Again, advance care planning cannot fix all of these issues, but experience shows it helps to mitigate them.

NHDD serves as a platform to do some of our nation’s much-needed work.

Admittedly, it isn’t easy to get people to pause their busy lives long enough to talk about the ends of their lives, but we need to make a concerted effort to do so. We need to be brave enough to bring up the topic in the first place, and we need to MetroDoctors

The Journal of the Twin Cities Medical Society

be mature enough to confront the topic comprehensively once it has been raised.

To facilitate this, NHDD exists as a catalyst for action.

NHDD has the benefit of being objectively selected — it wasn’t selected because of its relationship to any person in particular. Because of its objective nature, it may be easier for people to carve out some time on April 16 to “have the talk” or — better yet — to have the first of many talks. We just need people to mark their calendars, make no excuses, and do it.

NHDD cannot address all of what the IOM addressed in its report, but if we spur some action at the individual level on April 16, it will almost certainly make it easier to improve things at an institutional and societal level throughout the year.

Let’s use NHDD to get to work.

To learn more about National Healthcare Decisions Day, visit www.NHDD.org.

1.

Institute of Medicine, “Dying in America,” September 17, 2014, http:// www.iom.edu/Reports/2014/Dying-In-America-Improving-Quality-andHonoring-Individual-Preferences-Near-the-End-of-Life.aspx.

In Minnesota, we invite you to observe NHDD: • share information about advance care planning with all your patients through email announcements, flyers or cards in your lobby areas or patient rooms • Display posters in your entryways • Invite a speaker to speak about ACP to your staff, patients, or both • Join the 5K on Saturday April 18 in Roseville The Honoring Choices Minnesota staff is ready for your requests, and will work with you to develop a strategy that will work well for your situation.

To get started, email info@honoringchoices.org or call (612) 362-3704, or visit MetroDoctors.com and search on NHDD for downloadable materials, links to resources, and 5K registration information.

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A Planned Response to E-cigarettes and Smoking Pens

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emember when a ballpoint pen was a writing utensil? In todays’ era of e-cigarettes you might notice individuals smoking what appears to be a pen but is really an electronic cigarette. E-cigarettes are battery powdered electronic devices that deliver nicotine and mimic smoking and are increasing in popularity among teens and adults. The Minnesota Youth Tobacco Survey, released on November 10, 2014 by the Minnesota Department of Health, revealed 71.7 percent of our high school students and 54.3 percent of our middle school students have heard of e-cigarettes.(1) With new products such as e-cigarettes, hookah, and cigarellos emerging into the tobacco market TCMS is fervent to begin concentrated efforts on e-cigarette advocacy.

I am looking forward to partnering with physicians and activists across the state of Minnesota as the project coordinator for e-cigarette policy and education with TCMS. As a previous prevention specialist I worked closely with civic and elected leaders to educate and train community members about emerging substance abuse trends, including e-cigarettes.

TCMS’s goal is to develop an educational campaign to provide physicians and medical students with necessary tools to speak to their patients about e-cigarettes and to have conversations with local elected officials about what we know about ecigarettes. Check out the upcoming projects and goals related to our work in this area.

By Ellie Parker, MPH

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Upcoming 2015 E-cigarette Projects • Over the course of the next few months physicians across the state will be invited to participate in an e-cigarette survey. This survey will consist of questions aimed at gaining a clear understanding of physicians’ knowledge, attitudes, and clinical practices regarding e-cigarettes. The survey will also ask what other information physicians need to begin conversations with patients and local leaders about the risks associated with

•

e-cigarettes and cessation strategies.

Based upon the outcomes of the physician survey TCMS will develop a toolkit to include resources for physicians to utilize, whether working directly with patients or engaging in policy activities. Information that is expected to be included in the toolkit: Evidence and fact sheets, frequently asked questions, sample letters to elected leaders, talking points, information about what else is happening in Minnesota and the latest evidence on effective cessation tools.

Percent of middle and high school students who have heard of e-cigarettes, tried them, and used in past 20 days, 2014

Source: Minnesota Youth Tobacco Survey, 2014

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•

•

•

Our goal is to provide you with all that we know related to e-cigarettes, including emerging trends with other tobacco products including hookahs, flavored cigars, etc. We know that the literature and evidence of the impact of e-cigarettes is not as well-known as tobacco. Our intent is to serve a critical role by providing you with the latest information on the subject.

Content included in the toolkit will also be made available on the TCMS website for physicians to access materials on demand and remain engaged with e-cigarette research and policy.

Be sure to check out the TCMS website for a downloadable version of the toolkit. Visit www.metrodoctors.com.

In addition to the toolkit, training opportunities will also be provided for physicians and medical students throughout the state of Minnesota.

The goals of these trainings are for physicians and medical students to have an opportunity to gain knowledge and collaborate on strategies

pertaining to restricting e-cigarette use. Participants will also become familiar with the components of the toolkit so that the same unified message is delivered to patients, elected officials, and the public.

• Lastly, we will be developing an online continuing medical education program for physicians who are unable to attend training sessions in person. As always, I and TCMS will be working closely in partnership with several coalitions and committees that are actively involved with e-cigarette education and policy.

Watch your email, TCMS e-news and future MetroDoctors publications for e-cigarette news updates and for the latest information. If you have questions or are interested in a physician and medical student training session please contact me, Ellie Parker, at the TCMS office at (612) 362-3706, or email eparker@metrodoctors.com.

Sources: U.S. Department of Health and Human services.

Preventing Tobacco Use among Youth and Young

Adults: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012.

Ellie Parker, MPH, is the E-cigarette Policy Project Coordinator at TCMS and recently moved to Minnesota from Lexington, Kentucky where she worked as a substance abuse prevention specialist.

Ellie worked with a 17-county region to educate community leaders and citizens about emerging substance abuse trends, enhance substance abuse prevention programming, and implement evidence-based strategies to reduce the use of harmful substances, including e-cigarettes.

Ellie graduated from the University of Kentucky where she received both her Bachelors and MPH.

Advocate for Your Profession at Day at the Capitol The MMA’s annual Day at the Capitol will be held March 11 from noon to 6:15 p.m. at the DoubleTree by Hilton Hotel St. Paul Downtown, 411 Minnesota Street. It’s a great opportunity for Twin Cities physicians to meet face-to-face with their lawmakers and help influence promedicine legislation.

The event is being held at the DoubleTree due to Capitol renovation, which continues through 2016. The MMA will provide transportation to and from the Capitol via the Green LRT line.

There are many physician-centric issues we need to address this session.

• Limiting medication prior authorization burdens MetroDoctors

• • •

Increasing Medicaid reimbursement Increasing loan forgiveness funding Expediting the licensure process for physicians who want to practice in multiple states • Reducing nicotine’s harm by further regulating e-cigarettes and flavored tobacco • Ensuring the repeal of the provider tax The agenda includes: • 11:30 a.m. – 12:30 p.m. – Registration Opens • 12:00 – 1:30 p.m. – Welcome, lunch and keynote speaker at DoubleTree • 1:15 – 2:30 p.m. – Issue briefs and tips for speaking with your legislator

The Journal of the Twin Cities Medical Society

•

2:30 – 3:00 p.m. – Travel to Capitol via the Green Line light rail for individual legislative meetings • 3:00 – 4:30 p.m. – Individual legislative meetings • 4:30 – 4:45 p.m. – Back to DoubleTree via the Green line light rail • 4:45 – 6:15 p.m. – Reception and wrap-up at the DoubleTree Cost is $25 for members ($49 for nonmembers and free for students and residents.) To register and for more information, visit www.mnmed.org/DAC2015.

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New Members Tina Ayeni, M.D. Minnesota Oncology Hematology, PA Hematology, Medical Oncology Adam J. Bakker, M.D. Twin Cities Orthopedics, PA Orthopedic Surgery Elizabeth A. Baldwin, M.D. Minnesota Perinatal Physicians Obstetrics and Gynecology

Ann M. Barry, M.D. Entira Family Clinic Family Physician

Austin R. Krohn, M.D. Riverwood Healthcare Center Family Medicine

Mrunmayee Barve, MBBS North Memorial Clinic – Rockford Road Family Medicine

Kiran K. Lassi, M.D. Minnesota Oncology Hematology, PA Hematology, Medical Oncology

Mosi K. Bennett, M.D., Ph.D. Minneapolis Heart Institute Cardiovascular Disease

Alison Lindstrom Buck, M.D. Associates in Women’s Health Obstetrics and Gynecology

Craig L. Bowron, M.D. Abbott Northwestern Hospital Internal Medicine, Hospitalist

Byron J. Marquez, DO HCMC Whittier Clinic Family Medicine

Keith L. Cavanaugh, M.D. Children’s Respiratory and Critical Care Specialists, PA Pediatric Pulmonary, Sleep Medicine

Diane J. Mortimer, M.D. Hennepin Healthcare System Sports Medicine (Physical Medicine and Rehab)

Jennifer L. Chung, M.D. Northwest Family Physicians Family Medicine

Oliver Q. Phan, M.D. InterMed Consultants Internal Medicine

Bethany A. Cook, M.D. Dermatology Consultants, PA Dermatology

Natalie E. Rigelman-Hedberg, M.D. Metropolitan Pediatrics Specialists Pediatrics

Ryan M. Dick, M.D. Entira Family Clinic Family Medicine

M. Peter Sebonego, M.D. Burnsville Family Physicians Internal Medicine

Purvi D. Gada, M.D. Minnesota Oncology Hematology, PA Hematology, Medical Oncology

Nihar S. Shah, M.D. Suburban Radiology Consultants, PA Diagnostic Radiology

Vinay Gupta, MBBS Minnesota Oncology Hematology, PA Hematology, Medical Oncology

Priscilla J. Thomas, M.D. University of Minnesota Medical Center, Fairview Anatomic and Clinical Pathology

Preston J. Hatlestad, M.D. Bluestone Physician Services Family Medicine Jonathon D. Jaqua, DO Southdale OB/GYN Consultants Obstetrics and Gynecology Alla Kelly, M.D. St. Paul Eye Clinic, P.A. Ophthalmology

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Sara R. Torgerson, DO Minnesota Oncology Hematology, PA Hematology, Medical Oncology David B. Van Schyndel, M.D. Hennepin Healthcare System Internal Medicine Peter M. Yawn, M.D. North Memorial Silver Lake Clinic Family Medicine

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The Journal of the Twin Cities Medical Society

In Memoriam JOHN H. BROWN, M.D., passed away on November 23, 2014. He was a founding partner of Minnesota Oncology. Dr. Brown received his medical degree from Washington University in St. Louis in 1959. He joined TCMS in 1959.

C. SHERMAN HOYT, M.D., passed away on January 7, 2015. Dr. Hoyt received his medical degree from the University of Minnesota in 1953 and then continued his training with a fellowship in Pediatrics at Mayo Clinic. He was a founding partner of Southdale Pediatrics.

Dr. Hoyt was an active member of the TCMS Senior Physicians Association. He joined TCMS in 1985.

JAMES E. JOHANSON, M.D., passed away in November 2014. He was an orthopedic surgeon with Orthopedic Associates, specializing in club foot treatment at Gillette Children’s Hospital and Shriner’s Children’s Hospital. He received his medical degree from the University of Missouri School of Medicine in Columbia in 1963.

Dr. Johanson joined TCMS in 1972.

KHALID MAHMUD, M.D., passed away in November 2014. Dr. Mahmud, an oncologist/hematologist, was the first medical director of the Hubert H. Humphrey Cancer Center at North Memorial Medical Center and founding board member of the N.C. Little Memorial Hospice in Edina. Dr. Mahmud grew up in Pakistan and graduated from King Edward Medical College in Lahore. After a residency in New York and fellowships at the University of Minnesota, he joined Minneapolis Medical Specialists and North Memorial in 1975. He became a member of TCMS in 1994.

FLETCHER A. MILLER, M.D. passed away on January 25, 2015 at the age of 92.

MetroDoctors

Dr. Fletcher received his medical degree from the University of Iowa and received a Ph.D. in Surgery from the University of Minnesota. He served as the Chairman of the Department of Surgery at Creighton University Medical School before returning to Minnesota where he served as the Director of Surgery at United Hospital in St. Paul and Clinical Professor of Surgery at the University of Minnesota. He retired in 1977. Dr. Fletcher became a TCMS member in 1958.

KONALD A. PREM, M.D., passed away on January 25, 2015. Dr. Prem was a Professor of Obstetrics and Gynecology at the University of Minnesota and served as its Department Chair from 1976-1984.

A pioneer in the field of Gynecological Oncology, he developed techniques for radical pelvic cancer surgery. In addition, he served as Brigadier General, retiring from the military after 40 years of service.

Dr. Prem became a member of TCMS in 1955.

LEE W. WATTERNBERG, M.D., passed away on December 9, 2014. Dr. Wattenberg was described as a cancer pioneer and is credited with the creation of an entire field of cancer research, leading to understanding cancer prevention. Dr. Wattenberg received his medical degree from the University of Minnesota, and, following graduation he joined the U of M faculty where he served for more than 60 years.

Dr. Wattenberg joined TCMS in 1956.

SOLOMON J. ZAK, M.D., passed away on December 25, 2014. He graduated from the University of Minnesota Medical School in 1957 and practiced medicine in Minneapolis for over 50 years. Dr. Zak joined TCMS in 1967.

The Journal of the Twin Cities Medical Society

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March/April 2015

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Please also visit www.metrodoctors.com

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