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Doctors MetroDoctors THE JOURNAL OF THE TWIN CITIES MEDICAL SOCIETY

July-August Index to Advertisers Acute Care, Inc. .................................................30 ClassiďŹ ed Ad .......................................................20 CrutchďŹ eld Dermatology................................27 The Davis Group .............. Inside Front Cover ENT SpecialtyCare ...........................................24 Fairview Health Services .................................31 HCMC ................................................................... 4 Healthcare Billing Resources, Inc. ...............18 Kathy Madore....................................................... 1 Lakewood Health System ...............................10 Lockridge Grindal Nauen P.L.L.P. ................. 2 Minnesota Epilepsy Group, P.A....................22 Minnesota Physician Services, Inc. ..............26 The MMIC Group .............Inside Back Cover MMIC Health IT ........... Outside Back Cover Pediatric Home Service .....Inside Back Cover Gregory Plotnikoff, M.D................................28 Saint Therese......................................................... 4 Stillwater Medical Group................................29 University of St. Thomas ................................24 Uptown Dermatology & SkinSpa................18 U.S. Navy ............................................................31 Welcyon/Fitness After 50................................22 Winona Health ..................................................28

TCMS OfďŹ cers

President: Thomas D. Siefferman, M.D. President-elect: Peter J. Dehnel, M.D. Secretary: Edwin N. Bogonko, M.D. Treasurer: Melody A. Mendiola, M.D. Physician Co-editor Lee H. Beecher, M.D. Physician Co-editor Peter J. Dehnel, M.D. Physician Co-editor Thomas B. Dunkel, M.D. Physician Co-editor Gregory A. Plotnikoff, M.D., MTS Physician Co-editor Marvin S. Segal, M.D. Physician Co-editor Charles G. Terzian, M.D. Managing Editor Nancy K. Bauer Assistant Editor Katie R. Snow TCMS CEO Sue A. Schettle Production Manager Sheila A. Hatcher Advertising Representative Betsy Pierre Cover Design by Outside Line Studio 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 Minneapolis, 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 reect the ofďŹ cial 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. 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. 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 Katie Snow at (612) 362-3704.

Past President: Ronnell A. Hansen, M.D. TCMS Executive Staff

Sue A. Schettle, Chief Executive OfďŹ cer (612) 362-3799 sschettle@metrodoctors.com Jennifer J. Anderson, Project Director (612) 362-3752 janderson@metrodoctors.com Nancy K. Bauer, Assistant Director, and Managing Editor, MetroDoctors (612) 623-2893 nbauer@metrodoctors.com Andrea Farina, Executive Assistant (612) 623-2885 afarina@metrodoctors.com Barbara Greene, MPH, Community Engagement Director, Honoring Choices Minnesota (612) 623-2899 bgreene@metrodoctors.com Katie R. Snow, Administrative Coordinator (612) 362-3704 ksnow@metrodoctors.com For a complete list of TCMS Board of Directors go to www.metrodoctors.com.

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July/August 2011

MetroDoctors

The Journal of the Twin Cities Medical Society


CONTENTS VOLUME 13, NO. 4

2

Index to Advertisers

4

LETTERS

5

IN THIS ISSUE

J U LY / A U G U S T 2 0 1 1

Promoting Wellness and Well-being By Lee H. Beecher, M.D.

6

PRESIDENT’S MESSAGE

Practicing Medicine is Great, Pediatrics is Even Better By Thomas Siefferman, M.D.

7

TCMS IN ACTION By Sue Schettle, CEO

Page 8

HEALTH AND WELLNESS

8

s Why I Focus on Physician Well-being By Patricia J. Lindholm, M.D.

9

s Colleague Interview By Joshua Riff, M.D.

12

s What is Health and What are Health Goals in the Community? By Atum Azzahir

15

s Well at Work, Well in Life By Lora Geiger, SPHR, IC®, M.Ed.

17

s Shhh...We Have a Secret By William M. Spinelli, M.D., MPA

19

s Restoring the Elements of a Resilient Life By Henry Emmons, M.D.

Page 9

21

s A Customer's Suggestion for Your Worksite Medical Clinic By Jill Hamilton

23

s Exercise: The Prescription for Better Health By Mark Richards, MS, PT, CEEAA

25

YOUR VOICE

Health Care as a Bowl of Cherries... By Peter R. Bartling

Page 27 MetroDoctors

26

In Memoriam

27

Caring Hearts for the Homeless/EMMS Foundation Donors

28

New Members/Honoring Choices Minnesota/ Career Opportunities

32

LUMINARY OF TWIN CITIES MEDICINE

Valerie Ulstad, M.D. The Journal of the Twin Cities Medical Society

On the cover: Employers and employees are adopting a workplace culture of health and wellness. Articles begin on page 8.

July/August 2011

3


LETTERS

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I thoroughly enjoyed Dr. Segal’s warm Luminary piece on Dr. Owen Wangensteen’s career as Chief of Surgery at the Medical School. Permit me to add an additional anecdote, perhaps humorous, to Dr. Wangensteen’s reputation. When I was a junior medical student in 1952 on a surgery clerkship, Dr. Wangensteen was made aware that some of his faculty and surgery residents were less than pleasant in dealings with the clerkship students. He, therefore, created small luncheon sessions with the students to get to know them better and promote warmth. I happened to be at Dr. Wangensteen’s ďŹ rst luncheon, during which he was describing his current research on subtotal gastrectomies. At the time, I had become acquainted with a primary care physician in St. Cloud who did a wide range of surgery, a practice not unusual for that era in small towns. This physician had performed a series of subtotal gastrectomies without problems and with good results. I related this story to Dr. Wangensteen and the luncheon group. That may have been the start of my hoof-inmouth disease. There was a brief discussion during which Dr. Wangensteen expressed amazement at this primary care physician’s surgical skill. Dr. Wangensteen wanted to know my name; I complied. Later in my junior year, when I was nominated for membership in Alpha Omega Alpha, Dr. Wangensteen happened to be the ofďŹ cial for the award ceremony. When I approached him to shake hands and receive my certiďŹ cate, he looked at me with obvious recognition and said in a loud, clear voice for everyone to hear: “Handler, what are you doing here?â€? The audience roared in laughter at my embarrassment at being the butt of a good joke. I learned from then on to be very careful what you say in the presence of someone with a photographic memory. Dr. Wangensteen could indeed be a very warm and funny man. Seymour Handler, M.D. Class of 1953 MetroDoctors

The Journal of the Twin Cities Medical Society


IN THIS ISSUE...

Promoting Wellness and Well-being

THIS ISSUE OF METRODOCTORS FEATURES employee and com-

munity wellness and well-being, which is different from diagnosing and treating our patients’ illnesses. Physicians are not immune to personal and workplace stresses, and our workplaces (often clinics and hospitals) are a potential source of support and resources for us. The adage “Physician, ďŹ rst heal thyselfâ€? calls out our tendency as physicians to deal with sickness and distress in others while not properly caring for ourselves. Doctors cannot properly care for patients if we are ourselves overstressed, overtired, clinically depressed, or otherwise impaired. I’m reminded of the ďŹ rst day of my psychiatric training when the residency director told our small group that we are no good to patients and will cause harm to them and ourselves if we do not ďŹ rst tend to our personal and team well-being and safety. Personal and workplace stressors are necessary topics for a physician “well-beingâ€? agenda.

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Articles In This Issue:

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$EPRESSIONSAPSOURABILITYTOPROVIDEOPTIMALPATIENTCAREANDIS associated with professional burnout. MMA president, Patty Lindholm, M.D., relates her personal experiences as an introduction to her presidential theme this year — physician well-being. 4ARGET#ORPORATIONMEDICALDIRECTOR *OSHUA2IFF -$ RESPONDS to wide-ranging questions from the MetroDoctors editorial board and other colleagues on employee well-being and Target’s vision for consumer-friendly in-store retail clinics. %LDER!TUM!ZZAHIRDESCRIBESTHE#ULTURAL7ELLNESS#ENTER ANONproďŹ t educational resource for health care planning and support for persons in communities of diverse cultural backgrounds and traditions. ,ORA'EIGERAT452#+ANINDUSTRIALAUTOMATIONCOMPANY PROmotes the advantages of onsite workplace clinics for improving employee well-being and reducing their overall company health care insurance costs. 7ILLIAM3PINELLI -$ AFAMILYPHYSICIAN ARRANGESMEETINGSAND seminars to deal with physician job burnout, illness, and suicide prevention.

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!CCORDINGTOPSYCHIAtrist Henry Emmons, M.D., strengthening a person’s resilience and well-being includes stress reduction and relaxation techniques, lifestyle changes, and dietary (nutritional) modiďŹ cations. *ILL(AMILTON MANAGer of Hennepin County’s wellness program, explains the importance of knowing the needs and preferences of a subject population before implementing a workplace medical clinic. 4HEBENElTOFPRESCRIBINGREGULARPHYSICALEXERCISE ACCORDINGTO Mark Richards, includes reducing the use and costs of prescribed medications. (EALTHCARECONSULTANT0ETER"ARTLINGSAYSTHATGOODIDEASCOME from many quarters as he raises pertinent questions about current and future health care policy proposals. !ND ONOURLASTPAGE 6AL5LSTAD -$ISHONOREDASOURPHYSICIAN luminary.

Future issues of MetroDoctors will look at how concepts of health and illness determine available clinical services, insurance coverage options, and how physician performance is evaluated. Your ideas, suggestions, and articles for MetroDoctors are most welcome. Past editions of MetroDoctors are available on our website at metrodoctors.com, click on Publications. Send a Letter to the Editor via email to nbauer@metrodoctors.com. We want to hear from you! Best regards, Lee

By Lee H. Beecher, M.D., Member, MetroDoctors Editorial Board

MetroDoctors

The Journal of the Twin Cities Medical Society

July/August 2011

5


President’s Message

Practicing Medicine is Great, Pediatrics is Even Better THOMAS SIEFFERMAN, M.D.

N

ot to begrudge the other specialties but pediatrics is the best field of medicine. “Where else can we legally hit teenagers with rubber hammers and give them shots just for fun,” is how I warn my own teenagers! Rarely does a day go by without a patient making me laugh or smile or wonder at the miracles of growth and the resilience of the human body to recover from illnesses. It was this latter aspect that cinched my decision to choose a pediatric career even prior to medical school; that and the fact that kids are cool. Throughout my residency I was constantly amazed at the recovery powers of children. At my Continuity Clinic at Community University Health Care Centers under the tutelage of Doctors Karl Chun and Amos Deinard, the public health nature of pediatric care was reinforced, and, again, I had fun playing with and caring for my young patients for those three years. As I entered private practice at the bequest of Dr. Stanley Leonard and partners, again I was humbled at the amazing growth and development of the children that came to see the “young Doctor Siefferman.” I was honored to find two families that followed me in the move from Minneapolis to St. Paul and have been thrilled to watch three of those children go on to college. As I became a true “Minnesotan,” having lived more years here than in my native state of Georgia, I adopted the feeling that if things are going well, something bad is sure to come. After my fifth new diagnosis of Acute Lymphocytic Leukemia, one oral Lymphoma, one Hepatoblastoma, one Astrocytotoma and a mid-chest T-cell lymphoma, I found myself on “speed-dial” with St. Paul Children’s Hematologists and Oncologists, and wondering what happened to my care-free plans of playing with and caring for children. Those previous thoughts of my “healing prowess” of residency years was again being checked by the harsh realities of my inability to cure the incurable and forced realization that I had more “staving off death for another day” similarities to my internal medicine cohorts than I cared to admit. Around this time my senior partners circled the wagons and reminded me that they too had similar events in their early careers. As a new doctor, due to the openness of your schedule and speed at which you can see patients, I was destined to see someone struck suddenly ill as was typical for these diagnoses. As days turned to weeks, there was a return to normal healthy patients and new babies every couple of years. Life seemed to reach a more stable keel. Still, I am often reminded of our own limitations, and that one of the real reasons for going into medicine was to relieve suffering whenever possible, guide people to correct paths, comfort those that are ill, and try to provide the best care possible within the limitations of my humanity. I am even more humbled by our medical lack of faith, as I was reminded once more today. I was presented with a gift celebrating the first birthday of a child that “should not be here.” I’ll call him Clay. Clay had an uneventful entrance into a world of older brothers, adoring parents and an increasingly balding pediatrician. But at one month of age he re-entered the hospital with late onset Group B Streptococcal Meningitis and Sepsis; through the outstanding work and skill of Children’s Emergency Room staff and doctors and the continuing care of the Pediatric Intensive Care Unit, Clay was stabilized. Clay was put on life support only to find that he had infarcted at least a third of his brain, he appeared to be cortically deaf and blind and losing more by the minute. The end was in sight, and in comforting the parents through prayers and discussions we prepared for the inevitable. Clay had other plans. Over days and months, he has regained stereo vision, he can hear and is starting to talk and walk and do other things that continue to astound and amaze us all. I am humbled at the greatness of His creation and at the lack of faith I have shown at times, and in the inherent desire to thrive and live that He has given us all. So whatever befalls medicine in our future, I know I will always have a purpose. I love my job. I get a smile, hug or drawing every day from at least one of my patients; and I still get paid to hit teenagers with hammers.

6

July/August 2011

MetroDoctors

The Journal of the Twin Cities Medical Society


TCMS IN ACTION SUE A. SCHETTLE, CEO

TCMS Caucus

Honoring Choices MN

The Twin Cities Medical Society (TCMS) caucused on Monday, May 2nd and reviewed 11 resolutions submitted by members of TCMS. Ben Chaska, M.D. again served as the TCMS caucus chair. Bob Moravec, M.D., vice speaker of the MMA House of Delegates, provided a summary of the substantial changes to the resolution review process that will be occurring at this year’s MMA annual meeting. Delegates are still needed to fill TCMS designated seats. Please visit our website for additional information about the resolutions that were approved and for information about the 2011 MMA annual meeting (www.metrodoctors. com; click on the Get Involved tab).

Honoring Choices MN has officially moved from a project of the TCMS to a movement. Many events are happening across the metro area with much more to come throughout 2011 and 2012. A grassroots nature to this initiative has really taken off in a way that we couldn’t have imagined when we started this project a few years ago. Visit metrodoctors.com for the latest news and accomplishments.

Foundations Hold Strategic Planning Retreats

When the East Metro Medical Society and West Metro Medical Society merged at the end of 2009 establishing the Twin Cities Medical Society, the respective foundations remained separate. Each maintained its name and separate 501(c)(3) organizational structure — the East Metro Medical Foundation and the West Metro Medical Foundation. Both Foundations are now undertaking strategic planning initiatives this summer. Kent Wilson, M.D. is the chair of the East Metro Medical Foundation and Richard Schmidt, M.D. serves as chair of the West Metro Medical Foundation. New Online Newsletter

You have probably received our new online newsletter. This newsletter is intended to give you timely information about the activities of TCMS in between issues of MetroDoctors. Please give us your feedback! MetroDoctors

Thanks to Outgoing Board and Committee Members

The leadership of TCMS wishes to thank Arthur Beisang, M.D. for his leadership and service on the TCMS Board of Directors. The West Metro Medical Foundation also wishes to thank Richard K. Simmons, M.D. (outgoing chair), Paul F. Bowlin, M.D., Virginia R. Lupo, M.D., Edward Spenny, M.D. and medical student Wade G. Swenson for their years of service as faithful board members of the West Metro Medical Foundation Board of Directors. After serving on the MetroDoctors editorial board for 12 years, Tom Dunkel, M.D. has informed us that he’d like to officially retire from the MetroDoctors editorial board and become fully engaged in his other commitments — gardening, golf, and spending time with his wife, Diane. We are sincerely appreciative of his many years of wisdom and guidance and wish him the best. TCMS Offers Insurance Programs to our Members

insurance programs from Gallagher Benefit Services designed specifically for physicians, your practices and your families. Included in this offering is the availability of a network of insurance professionals experienced in working with physicians. TCMS and MMA brought the management of the program in-house in order to be more responsive to our members’ needs. We believe this is a winwin situation as you will receive competitive pricing and we have the ability to benefit by non-dues revenue. One of the other benefits Gallagher offers to TCMS physicians and their employees is free seminars. “Creating a Culture of Well Being in Today’s Changing Winds” will be held on July 26, 11 a.m. – 1 p.m.; lunch provided. Visit the Gallagher link on our website, www.metrodoctors.com. Click on Membership, and then Products and Services to get more information and register for this seminar. TCMS Welcomes New Member to Editorial Board

Richard Sturgeon, M.D. has joined the MetroDoctors editorial board. Many of you may recognize his name as the former vice president of medical affairs at Abbott Northwestern Hospital. He also served in a similar capacity at Fairview Southdale and Ridges Hospitals. If you have interest in serving on the editorial board, please contact Nancy Bauer, managing editor, at (612) 623-2893, nbauer@metrodoctors.com.

Through a partnership with the MMA, TCMS is offering physician members

The Journal of the Twin Cities Medical Society

July/August 2011

7


Health and Wellness

Why I Focus on Physician Well-being

W

hat was your dream when you decided to enter the profession of medicine? For me it was to be present with people in the midst of painful and stressful life events and to offer empathy and a chance for healing. The dream included breaking through the mysterious veil of medical knowledge, to be on the “inside,” close to the acts of diagnosis and treatment. I was 15-years-old when my youngest brother died of leukemia and felt excluded from the caring and dying process that occurred during his last hospitalization. Hospice did not yet exist in our culture. I was filled with pain and curiosity. The literature indicates that most medical students come from families where there has been a serious medical illness during their formative years. Many students enter medicine with pre-existing vulnerabilities to depression and other affective disorders. It is only in retrospect that I am able to say that I was one of the vulnerable. I wish I knew then what I know now. I was asked to consider becoming the President-elect of MMA at a time early in my recovery from my last major depressive episode. It occurred to me during that time that I was not the only one suffering in our profession. Of course we have all had our difficult times and have complained to and commiserated with each other about our stress, fatigue and even burnout. The recent literature, including papers authored by colleagues at the University of MN and Mayo Clinic, indicates that even now about 60 percent of medical students at any given time have signs and symptoms of burnout and that 11 percent are even suicidal. This rate is likely not much different among practicing physicians, as I learned from an unscientific sample in my local medical community when we started a physician support group. By Patricia Lindholm, M.D., FAAFP

8

July/August 2011

Therefore, once I agreed to serve I accepted the post under the condition that I would focus on physician well-being. This presidential term has been more of a joy for me than I ever would have imagined. There is much that I have learned from our colleagues near and far who have been working in the area of physician wellness and who also have admitted to their own need for healing. In October of 2010, I attended the International Conference on Physician Health in Chicago, hosted by the AMA and cosponsored by the British and Canadian Medical Associations. One of the lessons I learned there is that the majority of attention and resources in wellness are being used in the treatment of “impaired physicians” or those who are already at risk of losing licensure or practice privileges. Very little was presented on proactive, preventive approaches to maintain or re-establish wellness before a crisis occurs. I chaired a task force for MMA on the issue of physician well-being. Many members have been involved in the study and care of physicians who are experiencing burnout and/or questioning the purpose in their lives. Some are currently trying to establish wellness programs for their local colleagues/partners. Others are

participating in training to be retreat leaders, group facilitators and career coaches. My current dream is to help promote a new culture in medicine. Physicians are in short supply and the shortage is projected to worsen as baby boomers like myself enter our “senior” years. The culture would be characterized by mutual respect between trainers and trainees, between cognitive specialties and procedural specialties and between all members of the health care team. We would all become each other’s supporters. Our human propensities to mental and physical illness would be openly acknowledged and treated without shame or stigma. I have been approached by people in other health care disciplines who are interested in having MMA facilitate or coordinate interdisciplinary wellness activities and/or conferences. Also, we are considering a request to facilitate conversations between different physician groups who wish to learn from each other about some successful well-being programs. We have recently added a Physician Wellbeing section to the MMA website under the “issues” tab. There is an extensive bibliography, links to the January 2011 issue of Minnesota Medicine, and to the MMA President’s Blog. We are continually adding resources to this site and would welcome any suggestions from members to improve the site. Please also contact us if there are appropriate links that we should add. It is my vision that our medical societies will promote professionalism, collegiality and well-being for all members. Our patients will only benefit. Patricia J. Lindholm, M.D., is president of the Minnesota Medical Association and has made physician well-being the focus of her MMA presidency. Dr. Lindholm practices family medicine at Lake Region Healthcare in Fergus Falls.

MetroDoctors

The Journal of the Twin Cities Medical Society


COLLEAGUE INTERVIEW

A Conversation With

Joshua Riff, M.D.

J

OSHUA RIFF, M.D. has served as the medical director for Target (since July 2009) and Target Clinics (since April 2007). His primary responsibilities include increasing the health and wellness of the employees in addition to creating the clinics’ scope of practice, hiring staff, managing quality, and acting as a community liaison. Trained and board certified in emergency medicine, Dr. Riff is an attending physician at United Hospital’s Emergency Department. Dr. Riff received his medical degree and an MBA in health care administration from Tufts University and completed his emergency medicine residency at Johns Hopkins Hospital.

An increasing number of employers are promoting health and wellness opportunities for their employees. What specific programs has Target implemented and what behavior modifications have been reported? At Target, giving team members (what Target calls our employees) the tools, resources and support they need to be healthy is not only the right thing to do, it’s also good for business. Our more than 355,000 team members across the country are a key factor in our success, and we know that healthier team members are more productive and innovative, take fewer sick days and contribute more actively to their communities. For example, we’ve seen remarkable success with our Team Member LifeResources program, which offers team members and members of their household a wide variety of support to help them deal with life’s challenges — from finding daycare, elder care or affordable housing to saving for college — 24 hours a day, seven days a week. At select Target stores, we provide OnSite LifeResources. This program provides a certified counselor who can provide face-to-face support for our team. In 2010, after a year with OnSite LifeResources, stores new to the program saw an increase in attendance of about 11 percent, which is 2.5 percent higher than the total company’s increase. These stores also were better than the chain in turnover by an average of 2.8 percent. Overall, in one year, use was up 245 percent, which clearly shows the value of the program. Target’s annual flu vaccination program is another great success story. All team members can receive a free flu vaccination onsite every year, and in 2010, more than 109,000 team members received one — a 65 percent increase from 2009. Overall, we have found at Target that if we educate, engage and empower, we can affect healthy behaviors. MetroDoctors

The Journal of the Twin Cities Medical Society

Obesity is at epidemic levels and increases in body mass index correlate very closely with increased worker injury, disability costs and medical claims expenses. There are very few truly effective long-term medical, educational, or psychosocial treatment strategies for obesity; what are your thoughts about management of obesity and the future economic burden of this condition on our working and retired populations? Prevention is a top health care priority at Target because we believe it’s the foundation for a healthier America. Our team members are a snapshot of the U.S. population, and as a major employer, we know it’s critical to give our team members the best tools, services and support to achieve their health and well-being goals and then let them take it from there to find what works for them. We offer all team members discounts for weight-loss programs such as Weight Watchers and information and resources through our wellness portal. In addition, some locations offer clubs and intramural teams like the Target Run Club. Another big success is our participation in Minnesota’s Biggest Loser Challenge. About 2,700 team members participated in the 2010 competition, sponsored by the Alliance for a Healthier Minnesota, and more than 2,000 are signed up for 2011; to date, the Target team has lost a total of 9,400 pounds and logged nearly 1.6 million minutes of exercise. We also add incentives for people to take charge of their health; at Target, team members enrolled in a medical plan and a covered spouse or (Continued on page 10)

July/August 2011

9


Health and Wellness Colleague Interview (Continued from page 9)

partner can each earn a $250 discount toward the following year’s health insurance premiums by taking a few healthy steps such as completing a biometric screening. Target has introduced an expanded fresh food layout in more than 460 general merchandise stores, bringing more fresh food, including fruits and vegetables, to our guests, including guests in urban areas where fresh food is not as readily accessible.

As a physician within a corporation, how do you balance the care delivered within the workplace with that provided in the community at primary care clinics? With the concepts of ACOs, medical home, pay-for-performance, etc., it would seem that the corporate clinic needs to be especially careful about perceptions of overstepping the bounds of care delivery that might be argued should be delivered in the community rather than in the workplace. If we can drive use of preventive services or treat something earlier in its clinical course because it’s easy and convenient, we are doing a great service for our team members and our communities. Our Target Clinic locations — we’ll have 45 by the end of July, including one at our corporate headquarters—are focused on providing access to quality, affordable health care to our guests, team members and their families. The services offered at Target Clinic follow treatment

protocols derived from evidence-based medical standards and meet or exceed the guidelines of the American Medical Association and the American Academy of Family Physicians. Additionally, Target Clinic offers a convenient complement to a patient’s primary health care provider. While they offer quality medical services, our clinics are not intended to replace primary health care or the doctor/patient relationship.

What conďŹ dentiality standards exist for Target employees seen in clinic? Is this type of information ever shared with the Human Resources Department (if not, what about the employee deemed to be a danger to the organization or themselves, e.g. a substance abuse issue)? Target follows all legal and compliance directives including HIPAA. We also use a third party to remove patient identifying features from our data so we can track trends but not individual team members.

Employee productivity is an indirect burden on total health care costs for any self-insured employer. How is Target proactively addressing the issue of employee health status and on-the-job productivity? Employers like Target look at productivity as it relates to health status through two lenses — absenteeism and presenteeism. When talking about health, absenteeism is when a team member is not at work because they

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MetroDoctors

The Journal of the Twin Cities Medical Society


or a dependent is sick. Just as important is presenteeism, which means team members come to work when they are sick but their performance suffers. Target addresses this with sick leave policies and investments in preventive care to help keep our team members healthy in body, mind and soul. We believe that healthy and happy team members are engaged and productive team members so we invest in the programs and services to reach those goals. Target also takes a holistic approach to well-being for our team members that includes focusing on five elements, identified by Gallup, that shape a person’s total well-being: health, relationships, career, financial stability and the community. We know that healthy and happy team members are engaged and productive team members, so we invest in benefits like employee assistance programs, a 24-hour nurse line and flu vaccinations — all of which we offer to all of our team members for free. As a result, we see positive changes like higher employee retention and job satisfaction and fewer sick days.

Target is viewed widely as a very creative and innovative organization. How do you as the corporate medical director best support a healthy and creative work environment? In what new directions do you hope to take Target? When it comes to supporting a healthy work environment at Target, we have learned that we have to make it simple, engaging and fun. For example, over the last few years we’ve seen an increase in use of competitions to engage team members in healthy behaviors; I have even seen a game of wellness bingo being played in a Target store (i.e. instead of cards with letters and numbers, they have cards with exercises that team members can do). We also have seen positive changes by using information to promote healthy behavior by including things like motivational signs in the stairwell to calorie counters on food products in our cafeteria. Long-term, our health and well-being team will look to leverage Target’s phenomenal marketing capabilities to make healthy behaviors the fun and exciting choice, both in our stores and in our communities. And we’ll continue to search for innovative tools and support that encourage team members to take charge of their well-being.

Target now has in-store medical clinics to provide convenient, cost competitive medical/health care services to consumers. Given the increasing demand for these services, what is the future of Target retail clinics? Will this business segment include inter-actional services with customers (patients) using the Internet? Since introducing Target Clinic in 2006, we’ve continued to evolve and expand our services to better meet the needs of our guests. For example, we now offer camp and sports physicals, cholesterol screenings and a variety of vaccinations. And as a result of very positive guest response, we’ve expanded our clinic model to four markets, where we’ll have 45 locations by the end of July. But the goal remains the same: to make quality, convenient and affordable health care accessible to even more people. Just as we do across the store, we continually evolve our services at Target Clinic to meet guests’ needs. MetroDoctors

The Journal of the Twin Cities Medical Society

For walk-in patients seen in Target Clinics, is there a list of acceptable common diagnoses seen? If a more complex condition beyond those is encountered, or if a need exists for lab or imaging or specialty referral, what is the standard protocol to satisfy those referral needs? Target Clinic locations currently offer more than 60 services, and treatment of minor illnesses and vaccinations are among the most used services. Diagnoses that fall out of our normal range are considered out-of-scope conditions, and our clinicians follow best practices to provide the appropriate referral support.

Target pharmacies compete with other chains such as WalMart, Costco, and Walgreens which may offer discounts on generic medications, for example. What do you see the impact of large, integrated retail pharmacies to be on pharmaceutical pricing and services for patients? Target Pharmacy’s $4 generic program has been a huge success; we offer more than 300 prescription drugs at $4 for a 30-day supply and $10 for a three-month supply, which guests can search by drug name and condition at Target.com/pharmacy. This is one of the cases where what is good for business is truly good for the patient. Zhang et al in Archives of Internal Medicine extrapolated the $4 generic program to the entire population of the U.S. They estimate that if all people switched their drugs to the generics on, for example, Target’s $4 list, there would be $5.78 billion in total savings and more than $3 billion in out-of-pocket savings. Our $4 generics program is just one way Target makes health care more affordable and convenient.

What are the greatest challenges and greatest rewards in your work? The greatest reward is my ability to affect change and improve health on a much greater scale than I could as an individual practitioner. Whether it’s the 100,000s of flu vaccines Target gives our team members each year or our push to bring more fresh fruits and vegetables to stores where fresh food isn’t readily available, we are making a difference in the health of our communities. I also take great joy in the motivational speeches I give to team members. It makes my day when a person comes up to me and tells me that because of a talk I gave they became motivated to wear a seat belt or take vitamin D. I had one team member come to me a year after hearing one of my presentations. I had asked the audience to “raise your hand if you contribute to your 401(k) plan” (almost all raised their hands). I then asked them to “raise your hand if you are up-to-date on all of your preventive care.” When only half the room raised their hands, I asked how enjoyable their nest egg would be if they were sick because of a preventable disease. This team member shared with me that since my presentation, he had seen a doctor and lost 80 pounds. It doesn’t get much better than that.

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Health and Wellness

What is Health and What are Health Goals in the Community?

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he mission of the Cultural Wellness Center is to unleash the power of citizens to heal themselves and to build community. The mission is achieved through supporting community members in finding the support services that they need in order to achieve health. The Center has created a model called the Community Care System to compliment medical and clinical services. The staff provides health education through classes which address details of conditions such as diabetes and other chronic diseases. The curriculum includes how different cultural beliefs and customs impact perceptions of healing and health. The staff of the Cultural Wellness Center is best known for facilitating support groups, accompanying people to medical and social service appointments and nurturing the relationship between health care providers and patients. To date they have offered classes to over 2,000 people per year including community members, medical students, and residents from Hennepin County, the University of Minnesota, and HealthPartners. The staff also connect community members to services that meet the social determinants of health such as housing, transportation, food, clothing, and child care. Many people who have been diagnosed with medical conditions also come to the Center for wellness support which includes yoga, meditation, massage, and nutrition advice. To date the number of people who have participated in cultural wellness practices has grown. In 2010 alone the Cultural Wellness Center offices in Minneapolis and St. Paul had 16,551 visits from 1,880 people. To move from the mentality of approaching health as a service for the individual, the By Atum Azzahir, Elder

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Cultural Wellness Center specializes in bringing together communities to look at health collectively in so defining community as the unit of measure for health. After articulating a definition of health in the context of community, community members then begin building their health through ways of healing both ancient and new. The Cultural Wellness Center facilitates the coming together of community and health professionals in dialogue in order to build a unity of thought between the two, which sets the stage for effective partnerships in health improvement efforts. In order to achieve financial viability the Center’s goal is to become a recognized authority on cultural approaches for preventing sickness and improving the health of individuals in a community context. The Cultural Wellness Center is a 501(c)(3) non-profit organization. In addition to foundational support, the Center staff generates revenue from student tuition, consulting, professional staff development, and institutional community-based research and program design. The Cultural Wellness Center organizes groups of people who seek to share in the responsibility for improving the health outcomes of individuals and their families. We have learned from community and health care professionals that a goal of a unity of thought between them is especially difficult to achieve in communities under stress. Nevertheless, unity of thought is more critical in health care and medicine now than ever before. Unity of thought between community and health care professionals would result in more effective utilization of primary care, more follow through on agreed upon treatment plans, increased understanding of the ways that each group deals with conflict and life changes, and most importantly, increased teamwork in the

prevention of health care crises through working together, talking to each other, and sharing what each knows about how the imbalances in health and life developed. It is now 18 years since I began organizing community and facilitating dialogues across many professional and cultural backgrounds. The topics for examination in the dialogue continue to be “diseases of the body and of the spirit” and how to best co-manage the treatment of diseases in society. We have organized local community groups who have studied and developed approaches to addressing issues in health care such as disparities in infant mortality and diabetes. The example that we present to you here came about as the Cultural Wellness Center facilitated work to try to understand infant mortality rates in the African American community. Public health research literature defines risk factors in mothers for infant mortality

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The Journal of the Twin Cities Medical Society


as the following: teenagers or young moms, mothers with less than a high school education, limited income, and African American mothers. All of these are described as crucial factors which create greater risk for babies to die before the age of one year old. These mothers are also thought to be at greater risk for preterm births for many of the same reasons. The Cultural Wellness Center facilitated a community group of African American parents coming together to look at pregnancy through the context of the data, as well as their own life experiences, and to examine the current treatment of pregnancy as a disease in the health care setting. This was a group of African American parents who did not have a high school diploma at the time of their children’s birth, who had children at a young age or whose children were born to them when they were unemployed and with few material resources to draw from. Cultural interpretations of life experiences and sickness surfaced as something which might give greater clarity to the community around these issues and also lend power to strategies for getting better birthing results. After studying and documenting the groups’ life experiences, as well as the birth

The Cultural Wellness Center birth attendants have organized 87 birthing teams and delivered 90 babies. The results have been great. The following are the results: U U U U U

90 live births 90 weighing more than 5.5 lbs. 2 required Cesarean sections 83 deliveries within 12 hours of arriving at the hospital 90 breast feeding babies

and early child-raising experiences of other mothers of the community that the Cultural Wellness Center collected, we began to see that with sufficient skills in cultural ways of knowing and strong kinship circles of support, each person is able to cope with and adjust as needed when under pressure or when changes in life occur. A powerful lesson that was articulated from the women’s own experiences is that pregnancy is a natural happening in the life of a community and a family, not a medical event to be regarded in the same light

The People’s Theory of Sickness and Disease MetroDoctors

The Journal of the Twin Cities Medical Society

as a disease. According to the participants in the infant mortality study groups, pregnancy cannot be viewed as an individual occurrence for an individual to undertake alone. The group was introduced to studying the old African ways of birthing and many other cultural practices which have been lost to the struggling African American community. Learning from these practices gave the women the concept of the birthing team which is not a clinical service but a social support network for pregnant mothers. Participating in this birthing team effort gave the women greater confidence in their own knowledge about healthy pregnancy and birthing. They became Cultural Wellness Center elders who not only teach in their own communities, but who are now advancing the teachings to improve birth outcomes among all cultural groups. Research literature on culture is replete with examples of how daily rituals in the lives of the old communities brought comfort, balance and harmony to people beyond the physical. The cultural teachings that address the spiritual and the physical provide people with the capacity to cope with and confront the many layers of life before sickness comes upon them, the family, and the community. Our work of reestablishing traditional ways of living for people of African descent is reinforced by research which shows that African women who have come to the U.S. recently have better birth outcomes than the African women born in the U.S. The preservation of culture and full sharing of cultural views on sickness and on (Continued on page 14)

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Health and Wellness What is Health? (Continued from page 13)

deďŹ ning health is a way to support unity of professionals and community. Culture matters â&#x20AC;&#x201D; not as separate from the study of sickness or health but as integral to it. The lessons from the African American communityâ&#x20AC;&#x2122;s birth practices study experience undergirds work with many cultural groups now and is expanding a ďŹ eld of study in health improvement that we have named the Cultural Wellness Approach. These basic lessons are integrated into the community health strategies that are now commonplace in the partnerships that Cultural Wellness Center facilitates between the health professionals and the community groups who

are teaming with them. All of these ingredients are blended into what is now called the Cultural Wellness Approach. Cultural Wellness states that (1) When an event happens in your life you should not be alone. You should always have a coach to support your growth and lifelong learning. When you are about to fall or have been weakened, your support steps in. When you are strong you are a support to others. (2) The family and the kinfolk are at the core of the individuals coping and ability to stand up to life. (3) If you donâ&#x20AC;&#x2122;t have blood kin you always have extended kin through intimate/ loving connections in life. (4) Relationships are built, not born. The Cultural Wellness Center Elder Coaching Model is about hand holding each

A Community-Centered DeďŹ nition of Health: A New Starting Point for Public Health and Wellness Promotion

In 2009 and 2010, the Cultural Wellness Center, in collaboration with Allinaâ&#x20AC;&#x2122;s Backyard Initiative, facilitated a year-long effort by Phillips-Powderhorn community members to generate a meaningful, engaging and shared deďŹ nition of health. The purpose was to establish a strong partnership and foundation for future health promotion efforts within the community. The resulting deďŹ nition surprised many physicians and academic public health advocates. In the deďŹ nition, health is not deďŹ ned as access to mammograms and medications. In fact, one cannot ďŹ nd in this deďŹ nition any reference to current measures of quality. Furthermore, there is no emphasis on personal autonomy nor is there any emphasis upon doctors, nurses or systems for health. Instead, the community focused on the following points: s (EALTHISASTATEOFPHYSICAL MENTAL SOCIAL ANDSPIRITUALWELL BEINGITISNOTONLYTHE absence of inďŹ rmity and disease. s (EALTHISTHESTATEOFBALANCE HARMONY ANDCONNECTEDNESSWITHINANDBETWEENMANY systems â&#x20AC;&#x201D; the body, the family, the community, the environment, and culture; it cannot be seen only in an individual context. s (EALTHISANACTIVESTATEOFBEINGPEOPLEMUSTBEACTIVEPARTICIPANTSTOBEHEALTHYHEALTH cannot be achieved by being passive. Now, in 2011, this deďŹ nition of health is a driving force for the development of 16 highly active community groups who are taking action to work toward greater health outcomes speciďŹ cally in behavioral and mental health. This is a remarkable development. Historically, health care institutions and communities have not successfully partnered on health promotion. In part, this may have been due to conďŹ&#x201A;icting understandings of health and the lack of mutually-understood and shared goals. Such clashes are a nationally-recognized phenomenon. However, this effort in Minneapolis has already begun to overcome traditional barriers. One example is the communityâ&#x20AC;&#x2122;s formal approval, with community-centered modiďŹ cations, for a multi-centered clinical trial of vitamin D and hypertension in the Phillips-Powderhorn neighborhood. This degree of partnership and community leadership around the potentially explosive topic of clinical research in the neighborhood is unprecedented in Minnesota. As a result, the communityâ&#x20AC;&#x2122;s groundbreaking work has generated great interest across the country.

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group while they begin to see a vision of health which is seeking to merge the communityâ&#x20AC;&#x2122;s goals and the professionalâ&#x20AC;&#x2122;s goals. The goal for sick care treatment in many cultural communities is to restore balance in systems of the mind, the spirit, and the soul. The goal of health care professionals as we know it today is to restore the functioning of the body. Integrating methods demands from each group the best of both ways. As professionals and nonprofessionals join up to do the work with the Cultural Wellness Center in advancing a unity of thought between the professional and the community, many opportunities for further study on cultural interpretations of sickness and disease will be forced to surface instead of being forced underground. This achievement alone will create a way for health to happen. Atum Azzahir is the president and executive director for the Cultural Wellness Center. Elder Atum is a teacher and a practitioner of African Thought & Spirituality. She received her D-Litt Kemii Doctor of Literature from the International Khepran Institute in 2007. This honor acknowledges Elder Atumâ&#x20AC;&#x2122;s work in building sustainable, cultural institutions in African communities. Atum received the Leadership in Neighborhoodâ&#x20AC;&#x2122;s Award in 1997. She has been awarded several community and foundation awards and in 2008 Blue Cross Blue Shield Foundation acknowledged Atum for the Cultural Wellness Centersâ&#x20AC;&#x2122; â&#x20AC;&#x153;Peopleâ&#x20AC;&#x2122;s Theory of Sicknessâ&#x20AC;? with their prestigious leadership in Health Award and invested $15,000 in the work of Elder Atum. References Azzahir, A. (1997, May). Cosmology: The Concept of the Body and the Connection of Cultural Health to the Future of the Planet. The Edge, p. 34. Bukanaga, J. (1997, April). The Spirit of a People. The Edge, p. 35. Harley, D. (2006, December). Indigenous Healing Practices among Rural Elderly African Americans. International Journal of Disability, Development and Education, 53 (4), 433-452. Wilson, S. (2008). Research is Ceremony: Indigenous Research Methods. Fernwood Publishing. Halifax & Winnipeg. Helmstetter, C. et al. (2010, October). The unequal distribution of health in the Twin Cities: A study commissioned by the Blue Cross and Blue Shield of Minnesota Foundation. Wilder Research. St. Paul, MN. The Cultural Wellness Center and Allina Hospitals and Clinics (2010). Community at the Core: Backyard Initiative Assessment Report. Minneapolis, MN.

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Well at Work, Well in Life

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here has been extensive research in recent years on wellbeing, what contributes to it and why leaders of organizations may want to start taking note, especially in relation to their investment in worksite health promotion — also known as wellness. According to Rath and Harter (2010), leading researchers at the Gallup organization, there are five elements of wellbeing, including career, social, financial, physical, and community. In addition, Martin Seligman, Ph.D., (2011), University of Pennsylvania, has found that engagement, sense of accomplishment, positive emotion, relationships and meaning are also key components of wellbeing. Rath and Harter (2010) state that each person’s wellbeing is critical to an organization’s success as it significantly impacts goal achievement with the additional benefits of increased retention, innovation, and high levels of engagement. Conversely, each day an employee is absent, or does not give their full effort, it negatively affects organizations’ productivity and costs companies millions of dollars in opportunity loss and health care costs. Disengaged leaders or team members are nearly 50 percent more likely to be diagnosed with depression, have higher stress levels, and are at increased risk for heart disease (Rath and Harter, 2010). Yet a mere 8 percent of American workers believe that their organization offers support to help them improve their wellbeing. These numbers do not add up when the majority of health care costs are paid for by employers and when estimates show that 75 percent of all health care costs in the U.S. are due to lifestyle factors that are modifiable and within our control (Rath and Harter, 2010).

By Lora Geiger, SPHR, IC®, M.Ed.

MetroDoctors

Therefore, employers are in a unique position to make a positive impact to address these issues by promoting worksite health with a broader wellbeing framework. Though some may ask: Is it practical and does it make a difference? A look into one organization’s initiative to foster wellbeing at work and in life and a review of the positive outcomes may help other organizational leaders consider it as an opportunity that is both practical and ultimately the right thing to do. TURCK Inc. is an international manufacturer of industrial control products with about 400 employees at their United States headquarters in Plymouth, MN. As with any other transformational change, building a culture of wellbeing starts with small steps. TURCK's strategy, which gradually evolved over time, is multifaceted, incorporating broad elements that are based on the latest research, though at the core is truly valuing each individual’s wellbeing. Resources, support and benefit incentives are offered to encourage and reward each person who chooses to attain wellbeing based on their own intrinsic motivation with the philosophy that only through ongoing, mindful choices can sustainable change happen.

The Journal of the Twin Cities Medical Society

TURCK’s wellbeing strategy is aligned with becoming an employer of choice, and the health and wellbeing benefits are a differentiator in the total rewards offered to employees and their families. Members of TURCK’s health plan have richer than market benefits and competitive employer contributions toward the cost of premiums, which account for the company’s third largest expense. Employees share approximately 7 percent of the overall claims cost in copayments and deductibles compared to national normative data showing the average plan participant paying 17 percent according to Verisk, a leading health care data analytics company. When comparing TURCK’s cost to normative data provided by HealthPartners, TURCK’s per member per month (PM/ PM) cost was 26 percent lower than the norm in 2010, adjusted for demographic mix and plan design. Employees also save costs through TURCK’s onsite Well@Work clinic, in partnership with HealthPartners, as TURCK charges no copayment for either office visits or Rx costs filled at their onsite clinic, which is also available to family members of plan participants. Since opening the onsite clinic in April, 2007 employees have saved over 6,000 paid time off (PTO) hours since they may use the clinic, as well as one-to-one wellbeing coaching, on company time. Employees have also saved over $100,000 in clinic copayments. The return on investment from an organizational and individual perspective may correlate to having the convenience of the onsite clinic and pharmacy services, biometric health screenings, wellbeing and career coaching, regular communication through monthly newsletters and/or monthly educational seminars on everything from managing back pain and

(Continued on page 16)

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Health and Wellness Well at Work (Continued from page 15)

diabetes prevention to work/life balance, ďŹ nancial planning and leveraging personal strengths at work and in life. The ROI may also be directly related to individual and team enthusiasm about actually getting active, gaining new energy and making wellbeing challenges fun, as they have also been reported to foster both teamwork and a spirit of competition. Though in reality, transformation is truly happening for those who are intrinsically motivated to make lasting lifestyle changes for their own wellbeing. Ultimately each participant has identiďŹ ed and is taking action on what is personally important. Whatever the combined reasons, the positive outcomes for all are apparent. The following data is based on aggregate per 1000 PM/PM changes in utilization in the health plan data from 2008 -2010: s  PERCENT REDUCTION IN OFlCE VISits â&#x20AC;&#x201D; noting that increased access is provided onsite by a Physicianâ&#x20AC;&#x2122;s Assistant. s PERCENTREDUCTIONINCHIROPRACTIC services â&#x20AC;&#x201D; signaling that physical activities programs may be taking effect. s PERCENTREDUCTIONININPATIENTADMISsions â&#x20AC;&#x201D; TURCK has changed its proďŹ le from being above the norm in 2008 to well below the norm in 2010. s PERCENTREDUCTIONINAVERAGELENGTHOF stay â&#x20AC;&#x201D; signifying a potential reduction in acuity or severity. s PERCENTREDUCTIONINPRESCRIPTIONS ďŹ lled â&#x20AC;&#x201D; noting a potential relation to better health, reduced need. s PERCENTREDUCTIONINTHENUMBEROF MRI/CT scans â&#x20AC;&#x201D; an important indicator for program management, signifying a potential reduction in acute and chronic conditions. TURCKâ&#x20AC;&#x2122;s population has also achieved a better than average risk stratiďŹ cation when compared to national norms, as a focus on preventative care and wellbeing promote healthier lifestyles given the demographics are not dissimilar from other organizations of similar size. To date TURCK has saved over $950,000, when combining productivity and direct medical savings and subtracting onsite clinic and lab costs, including over 6,000 production hours. Additionally, early and appropriate identiďŹ cation of chronic disease has climbed each year to 16

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treat before a disease stage has advanced. This is important when you consider that in 2009, 87 percent of all of TURCKâ&#x20AC;&#x2122;s medical claims were due to modiďŹ able health factors. Progress has been made year over year, as aggregate data indicate that for 2011, hypertension, high cholesterol, and diabetes management or prevention are all in the top ďŹ ve diagnoses treated at the onsite clinic. As a complimentary beneďŹ t for employees, wellbeing coaching and seminars are offered focused on what employees have selfselected as goals important to them, e.g. weight management, exercise, nutrition, diabetes, and blood pressure. Nearly 250 employees voluntarily participate in wellbeing coaching to focus on what is important to them in their work and/or life, including stress management, work/ life balance, ďŹ nancial and/or career wellbeing, and all are rewarded in reduced premiums for participating. By taking a whole person approach to wellbeing and what the industry may call â&#x20AC;&#x153;health management,â&#x20AC;? TURCK members outperformed the market by a conservative estimate of $755,000 over the three year period in lower than market cost trends (according to statistics by David Martin Agency â&#x20AC;&#x201D; DMA). DMAâ&#x20AC;&#x2122;s metrics also indicate TURCKâ&#x20AC;&#x2122;s plan memberâ&#x20AC;&#x2122;s ER utilization has a three year average of 37 percent lower than the normative data. TURCK also has a lower percentage of participants who are overweight, have high blood pressure, or have high cholesterol than all JourneyWellÂŽ (by HealthPartners) employer groups. JourneyWell has also quantiďŹ ed the return on investment from TURCKâ&#x20AC;&#x2122;s focus on health and wellbeing based on year-over-year increases in plan memberâ&#x20AC;&#x2122;s health potential score, which based on JourneyWellâ&#x20AC;&#x2122;s research, TURCKâ&#x20AC;&#x2122;s ROI reached over $430,000 in 2010 alone. In keeping a broader wellbeing perspective in mind, TURCK recognizes that all of its employees have life passions and personal responsibilities outside of work and therefore implemented a Work/Life Pursuit beneďŹ t to support workplace ďŹ&#x201A;exibility. The Work/Life Pursuit beneďŹ t encourages telework and ďŹ&#x201A;exible schedules as important components of TURCKâ&#x20AC;&#x2122;s healthy and productive culture. It also allows for part-time work schedules and up to six month sabbaticals for reasons that may include spending time with children or elderly parent(s), traveling abroad, volunteering to serve a community or charitable

organization, taking a full-time educational program, extended transition period back from maternity leave beyond FMLA, or to ease with the transition into retirement. In addition, the Work/Life Pursuit beneďŹ t supports employees in contributing their time and/or money to a charitable cause that is personally important to them or their family, as the company will match both money and paid time off to volunteer for a charitable organization. In this way, the Work/ Life Pursuit beneďŹ t supports employees in attaining wellbeing and work-life ďŹ t, and aligns with the organizationâ&#x20AC;&#x2122;s core value to improve quality of life for friends, family, colleagues and community. TURCK is proud of all of its team membersâ&#x20AC;&#x2122; inspiring personal successes and self-initiative to improve not only their own quality of life, but also that of others as well. As TURCKâ&#x20AC;&#x2122;s President & CEO shared at an all employee meeting, â&#x20AC;&#x153;All of you are here for a reason, and without you, we are nothing.â&#x20AC;? Our employeesâ&#x20AC;&#x2122; achievements in making life work at TURCK and beyond serve as positive examples that what you set your mind to is possible. It is through their encouraging stories that organizational and individual wellbeing becomes contagious for others to join the fun and begin to truly thrive in work and life. Lora Geiger is the director of human resources for TURCK Inc. an internationally recognized developer and manufacturer of sensors, connectors and networks specializing in factory and process automation applications. Lora has extensive experience in HR business partner, organization development and leadership roles, as well as consulting and account management experience. She received her Bachelor of Science degree in Business Administration/Human Resource Management; minors in Training and Development and International Studies from Winona State University. She received her Masterâ&#x20AC;&#x2122;s degree in Human Resource Development and Organizational Development from the University of St. Thomas and is currently enrolled at Pepperdine University to earn her Doctorate in Organizational Leadership. References: 1) Rath, T. and Harter, J. (2010). Well Being: The Five Essential Elements. New York, NY: Gallup Press. 2) Seligman, M. (2011). Flourish: A Visionary New Understanding of Happiness and Wellbeing. New York, NY: Free Press. 3) Rath, T. and Harter, J. (2010). The Economics of Wellbeing. Gallup Press. 4) Verisk; David Martin Agency.

MetroDoctors

The Journal of the Twin Cities Medical Society


Shhh... We Have a Secret

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re you chronically tired? Frequently angry and short tempered? Do you look at your schedule and see tasks to complete by the end of the day rather than patients who are looking for your help? If so, like many of your peers, you may no longer be enjoying your work and are looking for a way to change your career or retire. These are classic symptoms of burnout. In excess of 30 percent (!!!) of physicians are currently experiencing burnout, and a recent survey indicated that 49 percent of primary care physicians plan on decreasing their work or retiring within three years.1 Everyone recognizes the impending primary care physician shortage and the potential for delivery system stress that the loss of these physicians will cause, but it is not only primary care physicians who struggle with stress and burnout. Medical literature documents equally high levels of distress in virtually all specialties.2 The suicide rate for physicians is approximately twice that of the general population;3 surgeons have reported increased errors as a function of burnout;4 and a brief literature search turns up high levels of burnout in oncologists, emergency medicine physicians, obstetricians and subspecialists such as hand or vascular surgeons. And just in case you were thinking of going overseas to practice, international literature reports similar outcomes. Physician burnout may be the hidden secret of health care. It is often mentioned in passing and relegated to light hearted jokes or worse yet perceived as an individual weakness of the new generation of doctors — just suck it up! In my day we worked 100 hours a week, saw 80 patients a day, did hospital rounds and were proud of it. But physician burnout is a

By William M. Spinelli, M.D., MPA

MetroDoctors

serious, job-related phenomenon that carries enormous consequences for doctors and their patients. It increases medical errors, decreases patient and physician satisfaction, and can lead to substance abuse, depression and marital disruption. More than a professional hazard, it is also a personal hazard. Educational programs, health system changes, transforming the processes of care and increased personal awareness are all possible ways to address the issue; but most of these interventions will require mobilization of massive resources (and money). What can you do immediately to identify the syndrome and help yourself? Research has demonstrated repeatedly, in nearly all professions, that managing work/life balance and attention to self-care practices have been beneficial in limiting the adverse consequences of burnout on you, your practice and your family. Mindfulness Based Stress Reduction, meditation practices, yoga, meaningful conversation with like-minded colleagues and yes, periodic, restful vacations have all been shown to reduce the symptoms in physicians. There are a host of resources available to teach these practices, but how do you find the time in a day that is already filled with

The Journal of the Twin Cities Medical Society

patient care, documentation demands, hospital rounds and administrative meetings? The bigger question, the “secret question,” is what are the consequences if you don’t find the time? One approach to this problem developed several years ago by Rachel Naomi Remen, M.D., is entitled Finding Meaning in Medicine (FMM).5 This work can be accessed safely online through a moderated chat room, or experienced first-hand in many communities around the country as FMM Groups. The groups meet in a relaxed, non-clinical setting to share thoughts and have meaningful conversation with peers. The website, http:// theheartofmedicine.org/, offers access to both models. For the past year, I have been hosting a monthly series that we call, Reflective Conversations. Similar to FMM groups, these conversations include topics related to the challenges of medicine but are NOT about the latest treatment protocol for asthma or current recommendations for controlling the five critical diabetes measures; rather we talk about the values that brought us to medicine originally, or read a poem that speaks to our inner teacher, or discuss the humor that relieves tension in our daily actions. As one of my coconversationalists pointed out recently, “I look forward to this every month because I can have a conversation here that I can’t have anyplace else.” There is no pre- or post-data to prove that we have decreased burnout in our group, but if regular attendance demonstrates value, it has meaning to all of us. Starting such a group is simple; participating in such a group is voluntary; getting in touch with peers through exceptional dialogue is priceless. If you wish to start your own group (Continued on page 18)

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Shhh....We Have a Secret (Continued from page 17)

and want some ideas on how to begin, check out Dr. Remenâ&#x20AC;&#x2122;s website or feel free to send me an e-mail at wmspin@gmail.com. Peace and Great Conversation!

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William M. Spinelli, M.D., MPA has been practicing family medicine and living in Hastings, MN, for 30 years. During the course of his career, in addition to clinical medicine, he has been involved in quality improvement and medical management, and was on the Guideline Planning team at the inception of ICSI. Recently, his interests have shifted to questions of late career transitions, physician burnout and enhanced community engagement. In 2008, he received a Bush Foundation Fellowship to explore this topic and currently is pursuing research and intervention strategies about physician well-being and burnout as a Fellow at the Allina Center for Healthcare Innovation. References:

Uptown Dermatology & SkinSpa

Welcomes Rehana Ahmed, MD, PhD Dr. Rehana Ahmed joins the staff of Uptown

1. Key_Findings_for_Survey_Report.pdf (application/pdf object) http://www.physiciansfoundation. org/uploadedFiles/Key_Findings_for_Survey_Report. pdf. Accessed 2/21/2011, 2011. 2. Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med. 2003;114(6):513-519. 3. Schernhammer E. Taking their own livesâ&#x20AC;&#x201D;the high rate of physician suicide. N Engl J Med. 2005;352(24):2473-2476. 4. Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995-1000. 5. Remen RN. Recapturing the soul of medicine: Physicians need to reclaim meaning in their working lives. West J Med. 2001;174(1):4-5.

Dermatology. She specializes in Medical and Surgical Dermatology. Same Day urgent referrals and Same week routine appointments available at our clinic. We are located in Uptown Minneapolis, one block east of Calhoun Square. We accept all major insurance and offer discounted parking. Call us at 612-455-3200 to schedule an appointment. Healthy Skin is Gorgeous Skin.

Rehana Ahmed, MD, PhD Dermatologist

Search for Twin Cities Medical Society on Facebook

Uptown Row, 4VJUFt8 -BLF4USFFUt.JOOFBQPMJT ./ tXXX6QUPXO%FSNBUPMPHZDPN

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July/August 2011

MetroDoctors

The Journal of the Twin Cities Medical Society


Restoring the Elements of a Resilient Life

A

s you know, anxiety, depression and other stress-related conditions are rampant problems that appear to affect a continually greater percentage of people in our society. No one is immune to these problems, and if they linger, they are not only unpleasant, but also depleting. As an integrative psychiatrist, I see more and more people who have tried all the usual remedies without getting long-term relief, and they come with a simple yearning: “I want to know what I can do for myself to feel better.” Restoring Resilience

In response to the need to develop effective selfcare, to help patients more fully recover from these illnesses, and to prevent their common recurrences, we have developed the Resilience Training Program at the Penny George Institute for Health and Healing. It is based upon a model that holds that it is our nature to be resilient, to be able to face the stresses and losses that life inevitably places before us and still maintain a sense of equanimity, emotional steadiness and calm. More than that, one can learn to respond to difficult life events in a skillful and effective way. That should come naturally, but there are many things that can and do erode our birthright gift of resilience. To reclaim it, I like to think of seven different aspects of ourselves that we need to attend to if we wish to find an effective pathway to recovery. I call these the Seven Roots of Resilience,1 and we focus upon all of these in the Resilience Training Program: 1. Balancing brain chemistry first through diet, then with supportive nutritional supplements when needed, and finally using medication only if other measures By Henry Emmons, M.D.

MetroDoctors

are insufficient. As neurotransmitter levels are not routinely measured, it is the goal to restore a healthy mood by recommending practices that routinely improve brain chemistry balance (e.g. diet and exercise and stress reduction), as well as nutritional supports that target one or another neurotransmitter. Supplements are recommend based upon clinical presentation (anxious, agitated or sluggish depression). 2. Managing energy through exercise, diet and occasionally nutritional supplements. 3. Aligning with nature, with an emphasis on sleep, alternating rest with activity, and attending to daily, weekly, monthly and seasonal biorhythms. 4. Calming the mind through awareness of breathing, mindfulness meditation, and applied mind-body skills. 5. Skillfully facing emotions, another form of mindfulness practices that aims for a complete experience of painful emotions so that they do not become either reactive or stagnant. 6. Cultivating a good heart by learning to hold oneself and others with a greater degree of kindness and compassion. 7. Creating deep connections, that is developing the capacity to be open, to create a sense of belonging, and to connect with one’s own sense of meaning and purpose. These Seven Roots of Resilience are all essential aspects of who we are as vital and healthy human beings. This is not a simple approach, but then we humans are complex, multi-faceted beings. We need a model that is as full and rich as we are. Resilience Training begins with an integrative psychiatric assessment to understand the full context of the problem, why the individual has not been able to recover from it,

The Journal of the Twin Cities Medical Society

and what might help them to do so. Later, the patient meets individually with our integrative nutritionist to see how diet is affecting them systemically and to find dietary changes that might help their body, and their brain, to begin to heal. Thirdly, there is a comprehensive fitness assessment with our exercise physiologist and another with our physical therapist to craft an individualized fitness program. We view both food and exercise as medicine, but recognize that everyone’s needs are different in these areas, and that simply recommending healthier practices is unlikely to lead to lifestyle changes. We find that adherence is improved if we give individualized attention, relevant information, and adequate guidance, structure and accountability. The final part of this program is a group that meets weekly for two and a half hours per week for eight weeks. Mindfulness practice, including meditation, forms the basis of these groups, but it differs from Mindfulness Based (Continued on page 20)

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Health and Wellness Restoring the Elements (Continued from page 19)

Stress Reduction (MBSR) in that we are much more psychologically based. We begin with awareness practices similar to those in MBSR (such as awareness of breathing, and observation of thoughts). We quickly expand upon that foundation to focus on: s THESKILLFULEXPERIENCINGOFUNPLEASANT emotions. s LEARNINGTOREMAINEMOTIONALLYSTEADY when confronted by overwhelming emotions (such as a panic attack or the early stages of a depressive episode). s SILENCING THE VOICE OF SELF CONDEMnation and replacing it with genuine self-acceptance. s CULTIVATINGSUCHPOSITIVEINNERSTATESAS compassion, caring for self and others, belonging, and having a regular experience of the sacred. Physician, Heal Thyself

As health care professionals, of course we are not immune to these conditions either. Within our own organizations, depression and anxiety add greatly to the costs of care, the loss of productivity, and the sheer amount of suffering that we healers carry within ourselves even as we go about trying to relieve the suffering of others. Aware of the extent of this problem, our parent organization — Allina — offered us the opportunity to conduct an observational study on the impact of the Resilience Training Program on our own employees. (HealthPartners recently began offering coverage for the Resilience Training Program for any Allina

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July/August 2011

employee; however, broader coverage is not yet available.) We had an overwhelming response to our recruiting — over 450 people responded within the first two weeks. Applicants were screened and 38 people who met criteria for the study, including a diagnosis of major depression, were divided into two groups. The first group went through the Resilience Training Program while the other waited a few months and then went through the same program. As they waited, they served as the control group. The results were striking. Average PHQ-9 depression scores dropped by 71 percent, from 12.3 to an average score of 3.6 at the end of the eight week program. By definition, a PHQ-9 score above 9 denotes major depression while a patient with a score of <5 is considered to be in remission. This was statistically significant at p<.01. More than 60 percent of participants achieved full remission, and at six months there appears to be no change in this degree of improvement. Quality of life scores using the SF-12 Health Survey: Mental Status Subscale were also measured. These scores improved 71 percent in the treatment groups from 28.6 to 49.1, relative to a 19 percent increase in the control group (29.5 to 35.1), a statistically significant difference (p<0.01). This is all without the addition of any medications.2 We measured several other outcomes, all of which showed similar degrees of improvement: Center for Epidemiological Study-Depression (CES-D), Perceived Stress Scale (PSS), State Trait Anxiety Inventory (STAI), and single item questions related to sleep and fatigue. We found that the amount of sleep improved from an average of five hours to seven hours per night, and daytime energy improved accordingly.3 We also looked at improvements in productivity by tracking a measure called “presenteeism.” Presenteeism refers to lost productivity when an employee is present at work but unable to perform his or her job duties effectively due to illness or life stresses that distract from that work. Presenteeism decreased 63 percent in the treatment groups (significant at p<.01) and reflected a cost savings of $1,676 to the organization for each participant. That is a return on investment of $1.86 for every dollar spent on this program.4 Most of us entered medicine out of a desire to serve others, and in our youthful inspiration,

we seldom thought about our own well-being, or considered what it might take to sustain ourselves for a lifetime of service. Yet our own need for renewal is at least as strong as those in any other profession, and if we allow this need to go unmet for too long, something within us will demand that we attend to it. The roots of resilience, when properly nurtured, can help us avoid a state of depletion, and even create the kind of life we are longing for. When we feel better, more alive and engaged, there is less room for anxiety, depression or any form of depletion to enter our lives. Henry Emmons, M.D. is a psychiatrist who integrates mind-body and natural therapies, mindfulness and Buddhist teachings, and compassion and insight into his clinical work. Henry developed the Resilience Training Program, which is currently offered at the Penny George Institute for Health and Healing. This unique program is based upon the ideas developed in his books, The Chemistry of Joy and The Chemistry of Calm. Henry is a sought-after presenter and a respected consultant on such topics as integrating natural and mindfulness therapies in psychiatry, building personal resilience, and personal and professional renewal. References 1. Henry Emmons, The Chemistry of Calm, Touchstone: New York, October 2010. 2. “Overview and Outcomes Report 2010,” Penny George Institute for Health and Healing. http:// abbottnorthwestern.com/ahs/anw.nsf/page/ANW_ PGIHH_Outcomes_FNL-1.ForWeb.pdf/$FILE/ANW_PGIHH_Outcomes_FNL-1.ForWeb.pdf. 3. Jeffery A. Dusek Ph.D., Gregory Plotnikoff MD, Lori Knutson RN, Susan Masemer MS, Carolyn Denton MA, Henry Emmons M.D., “Evaluation of an 8 week Resilience Training Program in Moderate to Severely Depressed Patients,” Poster Presentation, 2009 North American Research Conference on Complementary & Integrative Medicine, Minneapolis, Minnesota, May 2009. 4. “Overview and Outcomes Report 2010,” Penny George Institute for Health and Healing. http:// abbottnorthwestern.com/ahs/anw.nsf/page/ANW_ PGIHH_Outcomes_FNL-1.ForWeb.pdf/$FILE/ANW_PGIHH_Outcomes_FNL-1.ForWeb.pdf. 5. Sarris, J, Schoendorfer, N,and Kavanagh, DJ. Major depressive disorder and nutritional medicine: a review of monotherapies and adjuvant treatments. Nutrition Reviews® Vol. 67(3):125–131. 6. Lakhan, S and Vieira, KF. Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutrition Journal 2010, 9:42. 7. Cooley, K, Szczurko O, Perri, D, Mills, EM, Bernhardt, B, Zhou, Q, Seely, D. Naturopathic Care for Anxiety: A Randomized Controlled Trial ISRCTN78958974. PLoS ONE; August 2009 | Volume 4 | Issue 8 | e6628. 8. Kaplan, B, Crawford, S, Field, C, Simpson, JS. Vitamins, Minerals, and Mood. Psychological Bulletin Copyright 2007; American Psychological Association. 2007, Vol. 133, No. 5, 747–760 0033-2909/07/$12.00 DOI: 10.1037/0033-2909.133.5.747.

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The Journal of the Twin Cities Medical Society


A Customer’s Suggestion for Your Worksite Medical Clinic

I

n 2006, an on-site medical mini-clinic was built in the Hennepin County Government Center for county employees and their adult dependents. The clinic would provide services primarily for acute conditions at no cost to employees. Appointments were suggested, although, walk-ins were also welcome. Promotional magnets and fliers blanketed employee offices. Yet, contrary to the anticipated excitement of the clinic opening, few employees sought service. Utilization remained low until the county — the customer — provided the missing information necessary for the clinic’s success. As with many on-site clinics, a third-party medical organization planned and operated the county’s clinic. The clinic was purposefully built next to the county’s employee wellness offices to cultivate the integration of medical and wellness services. This model provides a “one-stop shop” for employees who can access medical care, financial and health information, wellness coaching and programs. (As a point of reference, the clinic and wellness offices share a common door, with the clinic’s entrance locked. One person staffs the clinic. Given this, the wellness staff often assists patients with nonmedical questions as the Physician’s Assistant works inside the clinic. Having county staff interact with patients was not originally intended, yet has provided meaningful insight to the customers’ perspective of the clinic and the impetus for this article.) The clinic offered services for acute respiratory illness, gastrointestinal conditions, minor skin irritation, musculoskeletal pain, vaccinations, and laboratory tests. An initial analysis indicated services rendered at the clinic were as thorough as services received at a traditional clinic. The majority of patients seen at the on-site clinic were treated appropriately and By Jill Hamilton

MetroDoctors

did not need to seek additional care outside of the clinic. This information helped employees understand the depth of services available and elevated the clinic’s reputation from “school nurse clinic” to “real clinic.” The staff that opened the clinic was competent. The clinic services were appropriate for the population it served. The clinic was suitable for any organization interested in offering their employees the convenience of on-site health care. But we aren’t “any organization.” We are our own organization with our own culture and our own expectations. In other words, even an on-site medical clinic (which we presumed would not need more than itself to succeed) needed the context of its location and population in order to thrive. In planning the clinic, conversation about square footage occurred, but no one thought to talk about what would make employees feel comfortable using the clinic. Marketing materials boasted of the clinic offering Pneumovax vaccinations, but no one thought to ask employees if they cared — or understood what that meant. In retrospect, we made two erroneous assumptions in our eagerness to implement this worksite wellness “best practice.” Both the county and the third-party assumed “if we build it, they will come” since

The Journal of the Twin Cities Medical Society

employees had received promotional materials from the third-party announcing this undeniably convenient service. The materials may have reached employees but did not resonate with them. Employee interest in the clinic piqued after marketing materials were reproduced using the format, look, and feel of the county’s employee wellness program — an established and familiar program. Using pictures of employees, rather than corporate models promoted the clinic as if it was specifically about and for county employees. The person on the flier was actually the provider in the clinic. User-friendly descriptions made the clinic more approachable. “Laryngitis” became “sore throat.” “Diagnose acute conditions and monitor chronic conditions” translated into “diagnose and treat.” The second incorrect assumption involved staffing the clinic. Several providers staffed the clinic the first few years it was open — all of whom, as mentioned, were qualified and professional. Few employees expressed dissatisfaction with the medical services they received. Unfortunately, far more employees indicated frustration with the personal interaction they experienced at the clinic when it first opened. Utilization did, however, inch upward as employees promoted the clinic by word-of-mouth. Employees commented on the current provider’s patience and kindness. It became apparent users wanted not only a skilled provider but someone who listens to stories not medically related, follows an appointment with a phone call to check on the patient, remembers kid’s names, provides services — as appropriate — not listed on the list on the flier, and accommodates individual schedules — as able. Most employees would agree these gestures are desired and appreciated. Yet the customer never thought to request these traits in a provider. (Continued on page 22)

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Health and Wellness A Customer’s Suggestion (Continued from page 21) Minnesota Epilepsy Group is the largest and most comprehensive epilepsy program in the Midwest. As a regional referral facility, we are the recognized leader in treating epilepsy and other seizure-related conditions in patients of all ages, from infants to the elderly. We also offer comprehensive neuropsychological assessment for a broad range of acquired or developmental neurological conditions in both adult and pediatric patients. Adult Epileptologists Deanna L. Dickens, MD Julie Hanna, MD Patricia E. Penovich, MD Pediatric Epileptologists Jason S. Doescher, MD Michael D. Frost, MD Frank J. Ritter, MD Functional Neuro-Imaging Wenbo Zhang, MD, PhD Neuropsychologists Elizabeth Adams, PhD Robert Doss, PsyD Ann Hempel, PhD Donna Minter, PhD Gail Risse, PhD

Appointments

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(651) 241-5290

(717) 377-1616

225 Smith Avenue N St. Paul, MN 55102 www.mnepilepsy.org

1610 Maxwell Drive Hudson, WI 54016 www.mnepilepsy.org

July/August 2011

In conclusion, expecting a third-party to know and understand the elusive characteristics of their customers’ culture is ideal and impossible. The customer has more responsibility in operating an on-site clinic than many assume. The customer must bridge the third-party’s expertise with the organization’s physical and psychosocial environment. In addition to establishing medical and financial goals in an on-site clinic, the third-party and the customer must determine the organization’s customer service expectations. The third-party’s processes and procedures must align with the customer’s personality! Jill Hamilton manages Hennepin County's wellness program serving 12,000 employees, spouses, and retirees. In addition to administering health and wellness opportunities for individuals and departments, she coordinates services among the on-site clinic, employee assistance program, employee benefits, and the county’s third-party administrator, and has worked for the county for four years. Jill has a masters degree in Health Promotions and Exercise Physiology.

MetroDoctors

The Journal of the Twin Cities Medical Society


Exercise: The Prescription for Better Health

T

he Minnesota Board on Aging reports some sobering facts on prescription drug use by Minnesota seniors; 82 percent take one or more prescribed drugs daily, with 25 percent taking three to four medications, and 21 percent ingesting five or more. The average senior spends 8 percent of monthly income on prescription medications, soaring to 22 percent for those who take a larger number and/or more costly drugs. It is even more startling to note this data is from 2002. With increasing incidences of obesity, diabetes, and cardiovascular disease, in 2011, these figures are undoubtedly worse. While pharmaceutical treatment approaches are certainly necessary for many patients, a great number of medical conditions can be treated equally well, if not better, with another approach — exercise! According to its guidelines for those 65 years of age or older, the Centers for Disease Control and Prescription states, “Not doing physical activity can be bad for you, no matter your age or health condition. Keep in mind, some physical activity is better than none at all. Your health benefits will also increase with the more physical activity that you do.” The Centers for Disease Control and Prevention (CDC) recommends regular performance of aerobic and muscle-strengthening activities. The benefits of these particular exercises are realized by many seniors, including decreases in medication usage. Aging adults, after exercising for a reasonable period of time, realized these benefits: s

s

-ARY AGE NOLONGERTAKESMEDICAtions to aid her breathing. Her weight has decreased; she has more lean body mass and less percent body fat. 4WOYEARSAGO 3UEHADBILATERALKNEE replacement surgeries. One month after

created the internal muscular support necessary to walk with a stable gait. Results like these do not just happen with simple increases in physical activity. These individuals benefitted because their exercise programs met specific dosage criteria. Just like prescribing a medication, specific elements must be considered when counseling elderly patients regarding exercise and physical activity. 1.

s

s

s

s

s

By Mark Richards, MS, PT, CEEAA

MetroDoctors

The Journal of the Twin Cities Medical Society

exercising, for the first time since her surgeries, she was able to climb stairs one leg per step, alternately step over step. !FTERFOURMONTHSOFEXERCISE-ONA AGE 64, has cut her anti-hypertensive blood pressure medication dosage in half. /NAROUTINEVISITTOHERPHYSICIAN 0ATS blood pressure was found to be the lowest it had been in 10 years. When asked by her doctor, “What are you doing?” she replied, “Exercising!” 3PENCEWASlNALLYABLETOHITABUCKETOF golf balls without low back pain, and pain medication. $ARLENEHADSMOKEDFORYEARSANDWAS about to be included in a COPD investigation at the University of Minnesota. She was dropped from inclusion in the research study because her lung capacity had improved too much. !FTERPERFORMINGMUSCLE STRENGTHENING exercises for a reasonable period of time, Patsy no longer walked with the external support of a cane because, essentially, she

2.

3. 4.

5.

Safety: The exercises performed must minimize the risk of injury. Considering the CDC recommends both aerobic and muscle-strengthening exercises, stable exercise platforms such as recumbent bicycles and single-plane motion strength machines provide stable exercise opportunities. Additionally, seniors need proper exercise instruction and individualized requisite supervision. Dosage: The CDC recommends moderate to vigorous exercise intensities. For both aerobic and muscle-strengthening activities, a certain threshold of physical exertion and volume of exercise must be achieved (and/or maintained) to provide the controlled stresses required to generate physiologic improvements. Frequency: One must exercise with enough regularity to benefit. Education: Patients must have knowledge about basic exercise principles regarding intensity, frequency, and duration. Just as they are instructed regarding taking a medication, patients need to understand the “do’s and don’ts” of exercise and physical activity. Adherence: There are two primary reasons patients will exercise on an ongoing basis: a) the exercise experience is reasonably (Continued on page 24)

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Health and Wellness

UST Health Care Programs UST Executive Conference on the Future of Health Care October 28, 2011 Mini MBA in Health Care Management Wednesdays; September 7, December 14, 2011; 6:00 p.m. – 9:00 p.m. Mini Master of Medical Technology Management Wednesdays; September 7, December 7, 2011; 6:00 p.m. – 9:00 p.m. UST Executive Education in Nurse Leadership May 8 – 11 and June 5 – 8, 2012 Physician Leadership College Begins September 2012 UST Health Care MBA Begins September 2012 For more information call (651) 962-4600 or visit StThomas.edu/ExecEd/Healthcare. Custom Programs We can tailor programs or develop new programs to meet your strategic goals.

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Exercise (Continued from page 23)

pleasant; and b) they feel noticeably better. If a patient’s quality of life is improving, they are much more motivated to continue to exercise. In addition, performing a sufficient intensity of exercise will stimulate the production of endorphins that contribute to that “feel-good” feeling. Finally, if the exercise experience involves exercising with peers and the sense of community and connectedness that it provides, exercise adherence is better. With increasing rates of disease, polypharmacy, and federal and state insurance funding challenges, it is now more important than ever to prescribe meaningful exercise programs for aging adults. Doing so can result in the realization of healthier, happier, and more appreciative patients. Mark Richards, MS, PT, CEEAA is vice president of program development at Welcyon, Fitness After 50. The fitness centers in Edina and Bloomington are dedicated to providing a welcoming and personalized fitness environment where people over 50 can achieve their best health.

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YOUR VOICE

Health Care as a Bowl of Cherries...

Ken Paulus’ excellent article on “Cherry-pick(ing) the best ideas for health care” is a must read for all thoughtful analysts of the current state of medicine in Minnesota, and I thank Mr. Paulus for sharing his vision (Star Tribune, April 11, 2011). Cherry-picking is defined by Wikipedia as “the act of pointing at individual cases or data that seem to confirm a particular position, while ignoring a significant portion of related cases or data that may contradict that position.” I am not suggesting that Mr. Paulus ignored other components of this most critical issue, but that his hospital and clinic network experience might have precluded him from seeing other important subsets of health care. We are, after all, products of our own experiences. And our experience is the view from below: small providers serving and supplying large metropolitan, even state-wide health care systems. Since an “extreme makeover” is not a current reality, I would like to offer the following proposals for contemplation by the body politic and the powers that be… 1.

2.

3.

Accountable Care Organizations – Encourage the formation of ACOs that promote team-based care under risk–bearing contracting. ACOs are organizations that will bring together and integrate doctors, clinics, hospitals and ancillary providers to share resources, with the duo expectations of improving the quality of care, while at the same time decreasing the cost of that care. Mobile Medicine – Hospitals have historically been at the epicenter of the medical mission. We have evolved, however, from “Bricks and Mortar” to “Bricks and Clicks,” and now to “Bricks and Wheels.” Mobile Medicine is the logical outgrowth of the current health care delivery system. It features lower cost, better patient safety, no transportation hassles, improved security for the frail elderly, an on-premise review of the patient’s living environment and lower malpractice expense. Examples include in-home physician visits, portable x-ray, rehabilitation services, laboratory processing, oxygen supply, etc. Consolidation and Its Impact on Competition – Christine Varney, the assistant attorney general in charge of the Department of Justice’s Anti-Trust Division has stated that “Unfettered competition among hospitals is vital to insuring that patients receive

By Peter R. Bartling Health Care Consultant

MetroDoctors

The Journal of the Twin Cities Medical Society

4.

5.

6.

7.

high-quality, low-cost health care.” With integration acceleration, how do we insure competitive pricing and open bidding in an already oligopoly marketplace? As Milton Friedman once stated: “The greatest enemies of the free market system are university professors and corporate CEOs.” Is it prudent public policy, for example, to have large health care systems owning or partnering in ownership of health plans, which contract with their respective facilities to provide health care services? Non-Compensated Care – KSTP-TV reported that the national average for charitable care is about 6 percent for non-profit hospitals vs. 2 percent for Minnesota’s Hospitals. Minnesota has 98 non-profit hospitals. What would be the financial impact of them providing non-compensated care at 6 percent or paying property taxes in lieu of non-compensated care? Benefits Managers – How could Employer/Employee Benefits Managers across the State, acting as a collective body, reduce health and dependent care costs? Could they develop a generic tool kit, whose utilization could improve the health status of all Minnesotans, while reducing the cost of the delivery of this vital resource? Price Transparency – How do we achieve true price comparisons through the posting of not billed charges, but actual payments from third party payers? How do we distinguish between the advertised price and the actual paid price? What is charged is not generally what is paid, unless one is a non-participating facility or provider. The federal government does a better job legislating prices than does the private sector. According to David Blitzer, Medicare per capita growth costs in 2010 were 3.27 percent vs. 7.5 percent for commercial plans — how is this possible? The Role of Vendors – Suppliers can be and want to become partners, not just contributors of goods and services. They can contribute through GPO’s, analytics and strategic sourcing. Vendors and health care providers have the same goals: satisfied customers in an expanding marketplace. Both sides are better together.

I am offering a medical reformation starter kit and thoughts on health care for the new millennium in an effort to build upon those of Mr. Paulus; because I know that health care reform is a journey, not a destination. I also know that what Winston Churchill once stated is true: “You shape your houses and then they shape you.”

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In Memoriam

Proceeds from MPS help to support the operations of TCMS. Please consider our business partners listed below as you look to reduce your operational costs.

JOHN IRA COE, M.D., passed away on March 26, 2011, at the age of 92. Dr. Coe attended Carlton College continuing at the University of Minnesota graduating in 1944 with his medical degree. After serving in the Army Medical Corp from 1946 until 1948 he returned to the U of M to complete his residency in pathology. Dr. Coe became chief of pathology from 1950 — 1984 at the now HCMC, as well as the principal pathologist for the Hennepin County Coroners office through the 1950s and 60s. He was also heavily involved with the University of Minnesota for 50 years rising to the rank of full professor. Dr. Coe became the first physician in the Midwest to be certified in forensic pathology and was known for his research with SIDS, postmortem chemistry, and firearm injuries. Dr. Coe has received several honors throughout his career, and during retirement he testified on high profile trials in the U.S. and internationally. Dr. Coe has been a member since 1950. LAWRENCE A. FARBER, M.D., of Scottsdale, Arizona, passed away on April 29, 2011, after a six-year battle against cancer. Dr. Farber attended the University of Rochester for his undergrad and obtained his medical degree from the University of Buffalo Medical School. He furthered his studies at the University of Minnesota completing his training in neurology in 1962. Dr. Farber was one of the founding partners of Noran Neurological Clinic where he practiced for 32 years. While practicing he also worked as a clinical professor of neurology associated with the University of Minnesota. Dr. Farber retired in 1993 and moved to Scottsdate, Arizona where he became a master printer pursuing his passion for landscape photography. Dr. Farber became a member in 1962. RAFAEL AUGUSTO GUERRERO, M.D., age 80, died April 25, 2011. Dr. Guerrero attended the Universidad Nacional de Nicaragua graduating with a degree in medicine before moving to Minnesota in 1959. He specialized in internal medicine and practiced for 50 years. He was highly regarded by his patients for his compassion, generosity, and clinical knowledge. Dr. Guerrero became a member in 1967.

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July/August 2011

ERNEST J. SOWADA, M.D., of St. Paul, died April 29, 2011, at the age of 97. Dr. Sowada attended St. John’s University in 1939, and became a pitching great defeating the U of M Gophers in 1937. He continued his education at the U of M obtaining a Masters in chemistry in 1941. While there he continued his pitching career for the Minneapolis Millers until he joined the Naval Officer’s Candidate School and served in the U.S. Navy as Chief Engineering Officer until his discharge in 1946. After his discharge, Dr. Sowada then pitched for the Minor Leagues known as “Lefty Sowada” while attending the U of M Medical School graduating in 1950. He was in family practice for 35 years delivering over 3,000 babies and certified in 1979 as a Diplomate by the American Board of Family Practice. During retirement Dr. Sowada wrote and published a memoir Freedom Through Faith. Dr. Sowada became a member in 1951. ERIC BRUCE STEIN, M.D., died March 24, 2011, at the age of 59 of pancreatic cancer. Dr. Stein attended Ohio State University and completed his residency in anesthesia at the University of Wisconsin, Madison. Dr. Stein was a board certified anesthesiologist practicing at Fairview Ridges Hospital in Burnsville. Dr. Stein enjoyed golfing, spending time at the lake, and being surrounded by his family and friends. Dr. Stein has been a member since 1982. MetroDoctors

The Journal of the Twin Cities Medical Society


Caring Hearts for the Homeless 2011 Supply Drive Report Earlier this year, clinics were invited to participate in the 19th annual Caring Hearts for Homeless People supply drive. This project is a joint effort of HealthEast Care System, Cerenity Senior Care and East Metro Medical Foundation (through Twin Cities Medical Society). By collecting donations, we are able to assist in offering local homeless some physical comfort and increased self-respect by providing over-the-counter medications and basics for personal cleanliness. This drive is the primary source of supplies for the homeless served at Listening House, SafeZone, and Health Care for the Homeless. We are proud to report that $5,188 were

raised and $33,994 worth of health, hygiene and baby items were donated! St. Paul Surgeons staff even learned how to knit and made several hats and scarves. The 2011 collection sites: s !DVANCED$ERMATOLOGY#ARE s !LLINA-EDICAL#LINICn3HOREVIEW s #ONSULTANTS)NTERNAL-EDICINE 0! s &AMILY,IFE-ENTAL(EALTH#ENTER s -.-EDICAL*OINT3ERVICES/RGANIZATION (MMA and TCMS) s 3T0AUL3URGEONS ,TD s 3URGICAL#ONSULTANTS 0! s 5NIVERSITYOF-.0HYSICIANSn0HALEN Village Clinic

Thank You, EMMS Foundation Donors

Thank you for your efforts on behalf of the local homeless!

St. Paul Surgeons staff from left: Wendy Craven, surgery scheduler, Cary Robinson, front desk staff (taught the others to knit), and Toni Muellner, ofďŹ ce manager, with their handcrafted items for the homeless.

CrutchďŹ eld Dermatology â&#x20AC;&#x153;Remarkable patient satisfaction from quality, service, convenience and excellent resultsâ&#x20AC;? â&#x20AC;&#x153;Exceptional care for all skin problemsâ&#x20AC;?

The East Metro Medical Society Foundation would like to recognize those who made contributions in late 2010 and early 2011. Associated Anesthesiologists, P.A. Blanton Bessinger, M.D. John Diehl, J.D. Thomas Dunkel, M.D. Robert Dunn, M.D. Phillip Edwardson, M.D. Frank Indihar, M.D. Dr. Patrick & Mary Lou Irvine Dr. Chris & Valerie Jackson James LaFave, M.D. Stanley Leonard, M.D. Midwest Ear, Nose & Throat Specialists Foundation Robert Moravec, M.D. & Roxanne Rosell Thomas Yue, M.D. Max Zarling, M.D. MetroDoctors

The Journal of the Twin Cities Medical Society

Charles E. CrutchďŹ eld III, M.D. &SEVH 'IVXM½IH(IVQEXSPSKMWX

Psoriasis &

Acne Specialist

Your Patients will Look Good & Feel Great with Beautiful Skin www.CrutchďŹ eldDermatology.com

8S[R'IRXVI(VMZI 7YMXI )EKER 12

Appointments 651-209-3600 %X]SYVVIUYIWX [ILEZI WEQIHE]ETTSMRXQIRXWEZEMPEFPI JSV]SYVTEXMIRXW[MXLEGYXI WOMRGEVIRIIHW

July/August 2011

27


New Members Brian J. Allen, M.D. Metropolitan Anesthesia Network, LLP Anesthesiology Peter A. Hilger, M.D. Facial Plastic & Reconstructive Surgery Specialists Otolaryngology/Facial Plastic Surgery David S. Johnson, M.D. Fairview Eden Center Clinic Family Medicine Thomas Kozhimannil, M.D. University of Minnesota Physicians Anesthesiology

By the Numbers 12

5

pilots

languages for printed materials (English, Hmong, Russian, Somali, Spanish)

6 month test implementation for each pilot site

18 Advisory Committee members

500 trained facilitators

14 grants received

22

Mary C. Lechner, M.D. Center for Diagnostic Imaging Radiology

trained instructors

3

1

year public engagement campaign

Thomas K. Pettus, M.D. Geriatric Services of Minnesota Internal Medicine/Geriatric Medicine

3

Charming Cottage in Historic Old Frontenac, MN 3 blocks from Lake Pepin $175,000

1 health care directive

staff

CAREER OPPORTUNITIES

See Additional Career Opportunities on page 29.

What are you looking for?

l

RESIDENT Michael Min, M.D. Abbott Northwestern Hospital

medical director

Enjoy life in Winona, Minnesota, a beautiful community bordered by spectacular bluffs and the mighty Mississippi River. At Winona Health, nearly 100 healthcare providers offer a full continuum of care in several specialty areas.

Join our progressive healthcare team, full-time physician opportunities available in these areas: Lovely screened porch looking north to Frontenac State Park and bluffs. Generous corner lot with garage, patio and extensive gardens bordered by lilacs, frequented by songbirds. 2 BR, gas fireplace, new roof, vaulted kitchen/dining room. Gregory Plotnikoff, MD Plotn002@hotmail.com

28

July/August 2011

t&NFSHFODZ.FEJDJOFt'BNJMZ.FEJDJOFt)PTQJUBM.FEJDJOFt0SUIPQFEJDT t1FEJBUSJDTt*OUFSOBM.FEJDJOFt6SHFOU$BSF Winona, a sophisticated community with art exhibits, museums, theater and several festivals, also offers excellent schools, two universities, international businesses, and endless recreational opportunities from boating and fishing to golf and indoor tennis. Winona is located within 45 minutes of two airports.

Contact Cathy Fangman tcfangman@winonahealth.org .BOLBUP"WFt Winona, MN 55987 t 800.944.3960, ext. 4301 t winonahealth.org

MetroDoctors

The Journal of the Twin Cities Medical Society


CAREER OPPORTUNITIES

Please also visit www.metrodoctors.com for Career Opportunities.

Recruit With

MetroDoctors!

Rates starting as low as $185â&#x20AC;&#x201D;call today! Options for website listings available as well. www.metrodoctors.com

Betsy Pierre, ad sales (763) 295-5420 betsy@pierreproductions.com

Visit TCMS at www.metrodoctors.com

With just one click you will ďŹ nd information on the latest TCMS news, events and legislative issues; Board and committee actions; past issues of MetroDoctors; and new career opportunities!

MetroDoctors

The Journal of the Twin Cities Medical Society

July/August 2011

31


LUMINARY of Twin Cities Medicine By Marvin S. Segal, M.D.

VALERIE ULSTAD, M.D. THERE ARE MANY AVENUES FOR PHYSICIANS to

express their talents and experience beyond the practice of clinical medicine. Our current Luminary is a great example of a fine clinician with a myriad of interests who has successfully branched into interesting pursuits, seemingly all with the same goals and outcomes…to help others. Dr. Val Ulstad is a Minnesota native whose formal education included St. Olaf College and the U of M Medical School where respectively she earned the honors of Phi Beta Kappa and Alpha Omega Alpha membership. Her internal medicine residency and cardiovascular fellowship were completed in the U of M system and her leadership capabilities were evident as she served in the capacities as both Chief Resident and Chief Fellow. Dr. Ulstad has practiced cardiovascular medicine in both academic and private settings. Her clinical interests range widely and include echocardiography, women’s heart health, cardiac rehabilitation, congenital heart disease in the adult and coronary care. Her abstracts, peer reviewed journal articles and book chapter publications have covered a numerous array of subjects from cardiovascular disease prevention through patient-doctor relations and even cardiac transplantation. Val has been honored with numerous Distinguished (and Lifetime) Clinical Teaching Awards by the Minnesota Medical Foundation and the Cardiology Fellowship Training Program at the U of M, and was voted Best Staff Teacher at Hennepin County Medical Center. Other accomplishments include a Bush Foundation Fellowship, Masters Degrees from Harvard University and the U of M and the designation of Outstanding Alumna of the U of M Medical School. For the past seven years, Dr. Ulstad has added to her professional endeavors the further designation of Independent Practice Educator in the fields of Leadership Development and Professional Renewal. Her client list is lengthy and in addition to having a prominent

32

July/August 2011

local presence, it stretches from coast to coast. She applies the principles of Adaptive Leadership as a facilitator and coach to enhance the effectiveness of those in the healing professions and their organizations as they undergo transformative change. Val loves to teach. During her experience as an educator, she’s found that people and organizations in distress are good learners. Her work helps people to initially focus upon what they do and then leads them to determine what they can do. Through this process, her clients become able to make meaningful changes so their energized capabilities play major roles in their professional activities. When not engaged occupationally, Dr. Ulstad has freely given of herself in a number of community board and advisory positions, the University’s Center for Spirituality and Healing, and as an international volunteer physician in Nicaragua, India and Tanzania. When asked what she wishes to do with the remainder of her career, she replied, “To serve others by reflecting, working hard and making contributions that make sense.” One of her favorite poets, Mary Oliver, asked (paraphrased), “What shall we do with this one precious life?” Dr. Val has certainly answered that question by the way she conducts her life. There is every indication that she will continue to serve others as she skillfully and passionately makes those contributions. This last page series is intended to honor esteemed colleagues who have contributed significantly to Twin Cities medicine. Please forward names of physicians you would like considered for this recognition to Nancy Bauer, managing editor, nbauer@metrodoctors.com.

MetroDoctors

The Journal of the Twin Cities Medical Society


“suppose I wasn’t to live. The doctors said

But I did.

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Article topics: Health & Wellness

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