April 1 2012 Physicians Bulletin

A P U B L I C A T I O N O F T H E M E T R O O M A H A M E D I C A L S O C I E T Y • w w w . omahamedical . com

A pril 1 , 2 0 1 2

Bringing Colonoscopies to the People

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Pushing Aside a Cadaver’s Intestines A Three-consultant Approach to Electronic Health Records

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Methodist Hospital Foundation salutes members of the medical staff who believe it is best to practice generosity and made a contribution of $100.00 or more during 2011. eir support is greatly appreciated!

Kenton Amstutz, D.O. Anesthesia West, P.C. Monte Christo, M.D. Mark D'Agostino, M.D. Tad Freeburg, M.D. Michael Grubb, M.D. Gregg Hirz, M.D. Stephen Hosman, M.D. Wes Hubka, M.D. Kent Hultquist, M.D. Kent Hutton, M.D. Paul Jacobsen, M.D. John Lindsey, III, M.D. Robert Moore, M.D. Thomas Ohrt, M.D. John Peterson, M.D. Hap Pocras, M.D. Douglas Rennels, M.D. Chris Robertson, M.D. J. Kenneth Tiojanco, M.D. Mark Wilson, M.D. Gary J. Anthone, M.D. Deanna M. Armstrong, M.D. K. Don Arrasmith, M.D. Khalid A. Awad, M.D. Steven T. Bailey, M.D. Kenneth P. Barjenbruch, M.D. Craig A. Bassett, M.D. Ann Marie Bausch, M.D. Jennifer S. Beaty, M.D. Russell E. Beran, M.D. Paige S. Berryman, M.D. Philip Jay Bierman, M.D. Julia K. Bishop, M.D. Garnet J. Blatchford, M.D. Daniel G. Bohi, M.D. Carl L. Boschult, M.D. Mark D. Carlson, M.D. Randal S. Cassling, M.D. Colleen Christensen, M.D. Paul E. Coleman, M.D. Colon & Rectal Surgery, Inc. Alan G. Thorson, MD Garnet J. Blatchford, MD Charles A. Ternent, MD M. Shashidharan, MD Jennifer S. Beaty, MD Terence M. Cooney, M.D. Bradley B. Copple, D.P.M. David R. Crotzer, M.D. John B. Davis, M.D.

John C. Denker, M.D. David A. Denman, M.D. Elizabeth A. Denman, M.D. Timothy B. Denzler, M.D. Dennis DeRoin, M.D. Gary DeVoss, M.D. Margarita A. Dickey, M.D. James W. Dinsmore, M.D. George Dittrick, M.D. Tamara A. Doehner, M.D. Michael J. Domalakes, M.D. John Y. Donaldson, M.D. Joseph Dumba, M.D. Gregory L. Eakins, M.D. R. J. Ellingson, M.D. George Emodi, M.D. Carey A. Ertz, M.D. Robert J. Fonda, M.D. Mark G. Franco, M.D. Muriel Frank, M.D. Gordon Fredrickson, M.D. Theodore A. Freeburg, M.D. Sarah V. Gernhart, M.D. A. Sasan Gholami, M.D. Michael F. Giitter, M.D. William E. Graham, M.D. Norman L. Grosbach, M.D. John A. Haggstrom, M.D. Louis E. Hanisch, M.D. Christine P. Hans, M.D. Herbert A. Hartman, Jr., M.D. Leslie C. Hellbusch, M.D. Gene N. Herbek, M.D. Brett C. Hill, M.D. Kristen L. Hoffman, M.D. James M. Horrocks, M.D. Stephen L. Hosman, M.D. Jeffery J. Hottman, M.D. Harold R. Huff, M.D. Kent T. Hultquist, M.D. Kirk S. Hutton, M.D. Kayvon D. Izadi, M.D. Rebecca L. Jacobi, M.D. Ajoy K. Jana, M.D. Christine M. Jeffrey, M.D. Kent D. Johnson, M.D. Henry Kammandel, M.D.

Teresa A. Karre, M.D. F. William Karrer, M.D. David G.J. Kaufman, M.D. Brady A. Kerr, M.D. Michelle S. Knolla, M.D. Shane K. Kohl, M.D. Rudolf Kotula, M.D. Steven C. Koukol, M.D. R. Michael Kroeger, M.D. Robert L. Kruger, M.D. Richard A. Kutilek, M.D. Anna C. Lavedan, M.D. Michael G. Levine, M.D. Jack K. Lewis, M.D. Kirk Lewis, M.D. John R. Lohrberg, M.D. Douglas J. Long, M.D. Erin A. Loucks, M.D. William M. Lydiatt, M.D. Cheryl R. MacDonald, M.D. Thomas E. Martin, M.D. Patrick J. McCarville, M.D. Joseph T. McCaslin, M.D. Michael P. McDermott, D.D.S. Harry W. McFadden, Jr, M.D. Edward M. McGill, M.D. Thomas R. McGinn, M.D. Katharine I. McLeese, M.D. Methodist Physicians Clinic Women's Center Craig Bassett, M.D. Paige Berryman, M.D. Julia Bishop, M.D. Mark Carlson, M.D. Sarah Gernhart, M.D. Lanette Guthmann, M.D. Kristen Hoffman, M.D. Rebecca Jacobi, M.D. Carolee Jones, M.D. Michelle Knolla, M.D. Thomas Martin, M.D. Nancy Mathews, M.D. Mia Nagy, M.D. Allison Phillips, M.D. Judi Scott, D.O. Tifany Somer-Shely, M.D. William Weidner, M.D. Susan Westcott, M.D. Patrick G. Meyers, M.D. Midwest Neurosurgery, P.C. Oleg N. Militsakh, M.D.

David W. Minderman, M.D. Iris J. Moore, M.D. Peter C. Morris, M.D. Paul Mueller, M.D. Mia Nagy, M.D. Nebraska Cancer Specialists Margaret Block, M.D. M. Salman Haroon, M.D. Ralph J. Hauke, M.D. Robert M. Langdon, M.D. Kirsten M. Leu, M.D. John M. Longo, M.D. Patrick J. McKenna, M.D. Geetha Palaniappan, M.D. David A. Silverberg, M.D. Gamini S. Soori, M.D. Yungpo B. Su, M.D. Stefano R. Tarantolo, M.D. Peter M. Townley, M.D. Nick L. Nelson, M.D. Diana L. Nevins, M.D. Stephen M. Nielsen, M.D. Thomas C. Nilsson, M.D. John P. O'Gara, M.D. Daniel R. Olson, M.D. Mark D. Omar, M.D. Oncology Associates, P.C. Elisa Tso Bomgaars, M.D. Stephen J. Lemon, M.D. Irina E. Popa, M.D. G. William Orr, M.D. D.R. Owen, M.D. William R. Palmer, M.D. Jeffrey A. Passer, M.D. Deborah A. Perry, M.D. Allison H. Phillips, M.D. Anton F. Piskac, M.D. Mark A. Pitner, M.D. Trent W. Quinlan, M.D. Radiologic Center, Inc. Lisa A. Bladt, M.D. Kevin M. Cawley, M.D. Paul S. Christy, M.D. Merlyn D. Gibson, M.D. David J. Hilger, M.D. Richard A. Kutilek, M.D. Van L. Marcus, M.D. Robert H. McIntire, M.D. Nick L. Nelson, M.D. Kevin L. Nelson, M.D. O. Douglas Osterholm, M.D. Temple S. Rucker, M.D.

Linda A. Sing, M.D. Kristofer A.Vander Zwaag, M.D. Andrew G. Rasmussen, M.D. Neal Ratzlaff, M.D. Roalene J. Redland, M.D. James A. Reilly, M.D. Rebecca B. Reilly, M.D. C. Lee Retelsdorf, M.D. Eric C. Rice, M.D. Alan T. Richards, M.D. Virginia M. Ripley, M.D. Andrew W. Robertson, M.D. Eric J. Rodrigo, M.D. Charles P. Rogers, M.D. Scott G. Rose, M.D. John C. Sage, M.D. Shane A. Schutt, M.D. Judith A. Scott, D.O. Thomas W. Seidel, M.D. William A. Shiffermiller, M.D. Ronald D. Silvius, D.O. Chester F. Singer, M.D. Gregory S. Smith, M.D. Russell B. Smith, M.D. Vale H. Sorensen, M.D. Milton N. Stastny, M.D. David P. Stearnes, D.O. Betsy J. Stephenson, M.D. Carol A. Stessman, M.D. Alan G. Torell, M.D. John S. Treves, M.D. Carl J. Troia, M.D. Stanley M. Truhlsen, M.D. Harold K. Tu, M.D. Eugene A. Waltke, M.D. Ronald L. Wax, M.D. William D. Weeks, M.D. William D. Weidner, M.D. Matthew C. Weiland, D.O. Michael Westcott, M.D. Susan A. Westcott, M.D. Kathryn S. Wildy, M.D. Thomas L. Williams, M.D. Mark V. Wilson, M.D. Howard R. Woodward, M.D. Dorothy A. Zink, M.D.

8401 West Dodge Road, Suite 225 • Omaha, NE 68114-3447 (402) 354-4825 • www.MethodistHospitalFoundation.org 4 PHYSICIANS BULLETIN April 1, 2012

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thisissue E S

Approach to Communication. . . . . . . . . . . 20 Leads to Achievement Award

Young Physician Report . . . . . . . . . . . . . . . . . . 15

R

Management in Medicine . . . . . . . . . . . . . . . . 16

Taking Aim at . . . . . . . . . . . . . . . . . . . . . . . . . 22 Discriminatory Language

U

State Medical Society . . . . . . . . . . . . . . . . . . . . 10

Legal Update. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Taking Aim at Malpractice Claims Still Waiting to be Seduced

Beyond Biomedical Science . . . . . . . . . . . . . . . 17 Legal Update. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 What to Do with Frequent Flyer Miles

Events. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Member Benefits . . . . . . . . . . . . . . . . . . . . . . . .

Campus Updates . . . . . . . . . . . . . . . . . . . . . . . . .

Editor’s Desk . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

On a Serious Note…

6 PHYSICIANS BULLETIN April 1, 2012

32 33 34 37

Pushing Aside a Cadaver’s Intestines. . . . 25

A T

Your State Society Says Don’t Take the Elevator

F E

D E P A R T M E N T S

Table of Contents: april 1, 2012

Cover Story: Bringing Colonoscopies . . . 26 to the People A Three-consultant Approach . . . . . . . . . . 28 to Electronic Health Records

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april 1, 2012 PHYSICIANS BULLETIN 7

april 1, 2012 VOLUME 33, NUMBER 2

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Physicians Bulletin is published bi-monthly by Omaha Magazine, LTD, P.O. Box 461208, Omaha NE 68046-1208. © 2012. No whole or part of contents herein may be reproduced without prior permission of Omaha Magazine or the Metro Omaha Medical Society, excepting individually copyrighted articles and photographs. Unsolicited manuscripts are accepted, however, no responsibility will be assumed for such solicitations. Omaha Magazine and the Metro Omaha Medical Society in no way endorse any opinions or statements in this publication except those accurately reflecting official MOMS actions.

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Your State Society Says Don’t Take the Elevator It’s one thing for Nebraska

physicians to express concern about the increasing prevalence of obesity. It’s another to translate that concern into action. That’s where the Nebraska Society of Physicians is at work. We call our program “NObesity.”

We are going beyond exhortations to take the stairs, not the elevators. “It’s faster” is the oft-heard excuse for choosing elevators, and our NObesity/elevator initiative is doing something about it. Already several office buildings in Omaha and Lincoln have signed on to our two-part program to discourage elevator use: • Reprogram elevators to slow them down.

• In any bank of two or more elevators, keep at least one out of service at all times.

Added benefits: less energy use, more opportunity to service elevators.

We are eating our own cooking, so to speak. At all of our meetings, we’ve taken a second look at the menus for snacks at break time. Think you’ll find Danish rolls in the morning or chocolate chip cookies in the afternoon? Think again! Raw broccoli and spinach leaves are the new treats! It’s not just our own meetings. We’re reviewing the menus for any CME progams that we accredit, and we’re proposing a resolution at the AMA House of Delegates that will require menu review as a condition for CME accreditation.

NObesity has paid attention to epidemiologic clues to the root causes of the surge in obesity seen throughout the United States. Epidemiologic data have a striking

message: Obesity is much less of a problem in Europe, and smoking may be a factor.

Smoking rates remain higher in Europe.

The decline in smoking in the United States parallels the growth in girths. That’s why NObesity launched a pilot study to encourage smoking in those who just can’t seem to lose weight.

In the meantime, we are realistic. We don’t expect obesity to disappear overnight.

We are working to mitigate the consequences of obesity. Consider pulmonary embolism, a condition more prevalent among the obese. One of our members, Dr. Grover Zafra, is a baseball fan. He realized that the “Seventh Inning Stretch” is a great way to cut down on deep vein thrombophlebitis. It breaks up the multi-hour period of sitting in one place that occurs during a baseball game. It would be even more effective, though, if it occurred earlier in the game. That’s why the NObesity campaign is working with the Nebraska School Sports Association to replace the Seventh Inning Stretch with the Fourth Inning Stretch.

More exciting than any of these initiatives, however, are the conclusions of our task force’s report on its review of the literature on methods to combat obesity.

The task force reviewed dozens of programs and methods. The review revealed a strikingly effective approach to obesity. Our NObesity program intends to promote this as the primary method for weight loss: Eat less, exercise more.

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Legalupdate

Taking Aim at Malpractice Claims Despite our company’s

commitment to handling malpractice claims in a compassionate but professional manner, it is always a distressing experience for any of our insured physicians to receive a malpractice claim. A claim typically generates a litany of worry—about finances, professional reputation, patient attitudes, and what really happened in the events surrounding the claim.

That distress, we have found, is one of the most powerful motivators for those who participate in our malpractice prevention seminars. These are available throughout the year and throughout the state to those we insure.

Recently, we have received comments on our seminars like those of Nigel Cardafel, M.D.: “This is all very valuable. I wish I had this instruction when I was in medical school.”

We have taken this to heart, and a program for medical students is in the advanced stages of development. We faced several challenges in developing instructional material for medical school, not the least of which was the already crowded medical school curriculum. Realistically, we had no chance of displacing a lecture on diagnosis of myocardial infarction or the complications of diabetes mellitus—even though our material on malpractice prevention is far more important and should replace this material.

That’s how we realized that any instruction for medical students would need to be something they could access outside of the regu-

lar curriculum. Our program would need to be sufficiently attractive to the students so that they would devote some of their limited quantity of free time to learning more about malpractice rather than self-experimentation with two-carbon chemical compounds affecting the liver.

The current generation of medical students includes many who enjoy video games and, indeed, would have foregone medical careers if video game playing offered six-figure salaries. That fact determined the format of our instruction: a video game.

Selecting content was straightforward. We reviewed problem areas in our claims database. We took another look at comments on our seminars for practicing physicians. We spent time with attorneys and claims managers. This systematic review generated a curriculum that was current and relevant.

The next step was to develop a conceptual framework for presenting our content as a video game. We had our board of directors spend time with teenagers to watch them play video games. We asked them how that experience, particularly their observations of what made the games compelling, could be applied to developing our instructional material.

The answer, in a word, was “conflict.” That was the theme of most games. Because conflict is most intense when a malpractice claim reaches the courthouse, we had our conceptual framework in the malpractice trial. Our beta version is out now, and you may find some of the medical students you know who are taking a break from their studies to play “Little Litigator.”

Editor’s Note: The material included in this article was provided by the law firm Jones, Jones and Johnson.

12 PHYSICIANS BULLETIN April 1, 2012

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young physicianreport

By Lance Smith, Medical Resident

Still Waiting

to be Seduced It’s a moment

I still remember. I remember that day so vividly. I got the word I was accepted to medical school. It was one of the best days of my life. I was so excited.

It wasn’t just the prospect of being a physician. Sure, I was glad that the doors to a medical career had swung open. But there was more. I knew that this country had developed the finest system of medical education in the world. Pick any school accredited by the Liaison Committee on Medical Education. They’re all excellent. They do more than transfer facts and skills.

They all pay attention to the well-being and development of each student.

That, for me at least, turned out to be crucial. The student counseling services were, for me, of inestimable value. You see, I had a problem. It’s one I never imagined. Yet it was real. It didn’t hit me in the first year even though the academic load was enormous. Nor did it hit me in the third year when I got into the full schedule of clinical rotations.

I am very glad that I did know about the availability of counseling services. I don’t know how I would have kept going if it hadn’t been for the counselor they assigned me. My experience with the problem—surprising as it was—and the counseling service—right there when I needed it—taught me a lesson that I’m glad I learned. As I continue in my medical career, I know there may be stresses. I also know that there are always trained professionals available to help a physician confront and deal successfully with those stresses.

My own problem, ironically, had its roots in the same series of orientation lectures where I learned about the school’s counseling services. One

lecturer had a special warning for the men in the class, including me, and I took it very seriously. That lecturer warned each of us to watch out for women in our patient population who would try to seduce us. I remember some of the words: “You’ll be a bit tired and stressed yourself.

You’ll find in a woman for whom you are caring more than a little friendly. If you pay attention, you’ll realize that she has found you very appealing, and she’s acting out those feelings. You’re being seduced. Watch out!”

A few weeks before graduation, I recalled those words. I thought back on all my rotations. Not once did I think I was being seduced. That’s how my problem developed. I came to the conclusion that I was unattractive physically, mentally, socially, and emotionally—completely unattractive. Why else would I be about to graduate and hadn’t been seduced even once? Faced with that conclusion, I couldn’t bear it. What would be my future? It was unthinkable.

Fortunately, I recalled the availability of the counseling service. Without going into a lot of detail, let me just say that they helped. I learned something that you can learn too, if you don’t already know it. Do things seem hopeless?

Do you wish you had been seduced? Remember, there’s help.

april 1, 2012 PHYSICIANS BULLETIN 15

MOMS Member Physician

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16 PHYSICIANS BULLETIN April 1, 2012

Management in Medicine Brief Guidance for Everyday Events

Sooner or later, a medical student will ask you: “How should I choose a specialty?” When you answer, be sure to emphasize the keyword, money. In an era of burgeoning student loans and declining reimbursements, don’t let the student forget that they simply can’t continue a successful career without putting money at the top of their priority list.

••• More and more limits on the hours that a resident can work are translating into shorter and shorter shifts. The result: more frequent hand-offs care. This poses tremendous risk to the patients whose care is transferred. Will every key fact be transmitted from the first resident and understood by the second resident? Be alert for this practice to cause problems.

••• Rapid response teams are becoming commonplace. The goal is to cut down on cardiopulmonary arrests. The method is to encourage anyone—nurses, students, residents, or staff—to call the rapid response team when a patient starts to deteriorate. Don’t wait for an arrest. With early intervention, lives can be saved. This is an admirable advance in medical care.

••• Telemedicine is in growth phase. A physician sits in front of a TV camera in the office, and the patient is in front of another camera miles away. Specialized instruments, ranging from stethoscopes to retinal cameras, can be manipulated electronically. Yet nothing can substitute for the intimacy and subtle communication of face-to-face interaction. That’s why many experts expect communication breakdowns and many more malpractice suits.

••• Taking a lesson from successful corporations like Kodak and Borders Bookstores, physicians are learning the importance of “just in time” inventory practices. Don’t maintain a large inventory of supplies. That’s just money lying idle. Instead, arrange for deliveries each day for each day’s supplies.

••• Have a lot of computer passwords? Write them down. All in one place. Why? When you die, imagine how difficult it will be for your estate to clear up all your computer accounts—unless they have your passwords. Make it easy for your loved ones.

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What do you say when a medical student talks to you about career choice? Find your passion and pursue it. That’s the sine qua non of a successful medical career. Don’t worry about money. All physicians are well paid by the standards of our society.

••• One of the best things to happen in medicine lately has arisen from the rules limiting the hours that a resident can work. The result: Repeatedly, one resident will talk with another about the patients whose care is being transferred from one resident to the other. That forces the first resident to stop and think about the key issues with each patient and to explain the plans coherently. The second resident must, at the same time, critically examine the situation. This kind of review is just what’s needed to identify gaps in thinking and weaknesses in care plans. Expect more and more quality to suffuse hospital care.

••• Experts in intensive care have pointed out the fundamental flaw in rapid response teams. When a patient is unstable, the goal should not be to call in the rapid response team. That patient should have been in an intensive care unit all along. Rapid response teams are a poor substitute for adequate number of intensive care beds.

••• By making medical care far more accessible—even to remote rural areas, telemedicine is sure to improve health, especially in a state like Nebraska. Many areas are sparsely populated. Residents face long drives to medical offices. Telemedicine is a boon.

••• Last year’s tsunami in Japan taught many corporation a painful lesson that medical offices need to learn as well. Manufacturers who carried minimal inventories, based on the “just in time” principle of daily deliveries of daily needs, were in trouble. The tsunami disrupted their supplies. Result: production shut down. Tornados, snowstorms, fires, and floods do happen. Don’t let them shut down your office. Maintain a substantial inventory of all supplies as a cushion against delays.

••• You may have dozens of computer passwords. Safeguard them.

Don’t write them down in one place. Imagine what could happen if someone got hold of your complete password list. All your bank accounts could be looted in a few minutes. Your email account could be hacked. And more.

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april 1, 2012 PHYSICIANS BULLETIN 17

Legalupdate

What to Do with

Frequent Flyer Miles?

Have you been told to

review your estate plan on a regular basis?

Aside from traditional reasons for review of an estate plan, a set of new issues has arisen. Estate plans have a great deal to do with disposition of assets, and new types of assets need consideration in estate planning.

Many physicians travel extensively, and they have accumulated hundreds of thousands of frequent flyer miles. What happens to frequent flyer mileage at the time of death? The answer depends on several factors.

In some cases, for example, accounts are cancelled and mileage is lost at death. In these settings, mileage may not be bequeathed in a will. Nor may it be passed to others through a trust. Just think of the consequences of such a situation. You may lose hard-earned mileage accumulated through delayed connections in Dallas and long flights with nourishment confined to small packets of peanuts.

18 PHYSICIANS BULLETIN April 1, 2012

With proper planning, however, this need not occur. Do you think you will die if you have to sit through another bad CME presentation? And is there just such a lifethreatening CME presentation on your schedule of mandated activities? The prospect of a quick death may be your golden opportunity to transfer your miles to a charity that you value. However, you may need to take action before reaching your grave. Keep in mind, though, that such transfers depend on the rules of your frequent flyer program and are not tax deductible if the manner of earning miles was considered a tax-free rebate rather than taxable income.

Consult your tax adviser.

Another asset to consider is LED bulbs. Estate planners traditionally advise clients to inventory possessions of material or sentimental value. Planning for disposition can prevent squabbles among heirs for your great-grandparents’ wedding portrait or heirloom silver. In the past, light bulbs have not been on the list of items to inventory. LED bulbs have changed that, though. Their cost is substantially more than traditional incandescent bulbs, and they may well function years after your demise. Perhaps you are one of those who doesn’t care to change light bulbs. “I’d rather die than change a light bulb,” you thought at the time of purchase— and this means it is your responsibility to consider how your LED bulbs will be distributed at the time of your death. A tip: Do some of your heirs have light fixtures with dimmers?

Bequeathing them your LED bulbs may be unwise unless your estate holds dimmer-compatible LED bulbs.

Disclaimer: The above does not constitute valid legal, accounting, or financial advice, and it should not be relied on in the state of Nebraska and other jurisdictions within the United States, and its territories. Consult your advisers. Any federal tax advice contained in this article should not be used or referred to in the promoting, marketing or recommending of any entity, investment plan or arrangement, and such advice is not intended or written to be used, and cannot be used, by a taxpayer for the purpose of avoiding penalties under the internal revenue code. In matters of business and personal taxation, you are urged to put the criterion of reducing your total tax bill foremost without any consideration of other issues, including, but not limited to: patient care, customer service, and personal enjoyment.

(720) 858-6000 • (800) 421-1834

feature

Approach to Communication Leads to Achievement Award For a medical institution,

the priority is patient care, not necessarily communications. Nonetheless, the prestigious National Award for Achievement in Organizational Communications for 2011 was bestowed on one of Omaha’s medical centers recently, according to spokesman Sol Melangina.

“For us at the center,” he explained, “communication is a tool, but not our central goal. We were both surprised and honored to receive the 2011 award.

We put patients first. Communication is important, but it’s not our focus.”

The jury’s award citation explicitly recognized the special nature of the achievement. The award-winning work was done not by professional writers but rather by lawyers in the quality department. Also special was the medium—not a printed or broadcast message but, rather, an online computerized training program.

“Previous winners of the National Award,” noted the citation, “have included high-visibility communicators faced with urgent challenges, such as providing practical information in a chaotic, urgent setting, such as the aftermath of a hurricane or, at times, a corporate crisis that could generate considerable embarrassment. The 2011 award was different. The award recognizes achievement, and the medical center in Omaha had an utterly

20 PHYSICIANS BULLETIN April 1, 2012

remarkable achievement.”

The citation added that the National Award for Achievement jury considers achievement in communications to be, ultimately, a matter of producing an effect on the audience. “Achievement in visual arts is not a matter of a particular medium, such as sculpture or painting. Nor is it a matter of a particular style. Achievement is simply the impact on the viewer. By the same token, achievement in music is measured by the impact on the listener. In our review of organizational communications for 2011, all members of the jury were struck by what an Omaha organization had done to achieve an impact on its audience.”

Melangina, as spokesman for the center, explained the origins of the prize-winning work. “Our center’s quality department was tasked with delivering an online training program to meet federal requirements for sexual harassment training. Since it’s a legal obligation, our lawyers were the lead, and they deserve credit for the award. That’s

MOMS MEMBER DIRECTORY 2012/2013 All Omaha area physicians who are ac�ve members of MOMS as of May 30, 2012 will be featured in the MOMS 2012/2013 Directory.

why we won it. The award jury stated our accomplishment plainly. The citation reads: ‘Their sexual harassment program took on a subject that can arouse intense passion and enormous interest: Sex. That’s why their achievement was so remarkable. They made sex seem dull.’”

The citation analyzed the methods used by the center’s attorneys in this achievement. They included extensive use of legalistic language, abstract descriptions, examples confined to highly unusual and often irrelevant situations, avoidance of guidance related to commonly occurring problems, excessive length, and near total reliance on passive voice.

The citation is more than an honor. It carries with it an unrestricted $500,000 grant. “We have already decided how to use the grant money,” Melangina explained.

“We are plowing it back into our quality department. They are using it for yet another foray into communications. Most of our staff are old enough that they never had formal training in writing email when they were in high school or college. We are using the grant to remedy that deficiency. We know that, all too often, email is used inappropriately or written poorly. The root cause is what we will attack with the grant. The root cause is the ease with which email can be written, which leads to communication without much thought or consideration.”

Melangina explained the focus of the center’s efforts to see that staff put some thought into their work before they send email. “Our training will require all email to be written as haiku. This Japanese format is concise and tightly structured.

There is no way to dash off haiku without thought.”

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april 1, 2012 PHYSICIANS BULLETIN 21

feature

The Office of Civil Rights’ goal is to eliminate language that is offensive in the workplace.

The phrase “nursing a drink” is one of the organization’s targets.

Taking Aim at Discriminatory Language MOMS invites members to attend a seminar on Office of Civil Rights’ new regulations on terminology in healthcare settings.

The Office of Civil Rights is a branch of the federal government whose activities center about the elimination of discrimination in all forms. Its inclusive terminology regulations are intended to eliminate language that creates an unwelcome atmosphere.

In 2013, OCR will enforce the new regulations for inclusive terminology. The goal is to make every member of the healthcare team feel valued and to eliminate terminology that 22 PHYSICIANS BULLETIN April 1, 2012

Photo by www.minorwhitestudios.com

sends unwelcome signals to some staff.

The standard applies not only to medical records but also to any communication in the healthcare setting, including informal conversations.

If OCR receives a complaint that someone in a hospital was talking about “nursing a drink,” expect a citation. Nursing is a respected profession. It is inappropriate to conflate nursing activities with alcohol intake, according to the OCR. The inclusive terminology standard has affected federal documents. No longer will you find programs on “Disaster Preparedness.” The word “disaster” is inappropriate. Its origin is from the root “aster,” modified by the prefix “dis.” The root “aster” reflects the belief that events are related to astrology. Although OCR will permit organizations to hire staff who read horoscopes and organizations may place advertisements in newspapers that print horoscopes, OCR emphasizes that untoward events should not be regarded as originating in astrological configurations. As a result, the word “disaster” must be avoided.

OCR has special concern about the microbiology laboratory. Microbiologists recognize that some streptococci do not grow on routine media. When routine media are supplemented with pyridoxal, these organisms do grow. Because of the pyridoxal requirement, these organisms had been termed “nutritionally deficient streptococci.” OCR recognizes that such terminology reflects humans making judgments about what nutritional characteristics are normal for another species and what characteristics represent a deficiency. To label a species as being “deficient” is an inappropriate judgment. Unlike most mammals, humans require ascorbic acid to survive.

Who would think to call their friends “nutritionally deficient mammals”? OCR has pointed this out and will insist on the use of “nutritionally variant streptococci.”

This is a more inclusive, welcoming term for this life-form.

OCR expects healthcare organizations to demonstrate leadership in promoting inclusive terminology in their communities.

OCR has expressed concern about the use of red cards in soccer. About 10 percent of men are colorblind. Using red cards does not respect their visual limitations. OCR has pointed out that there are many reasonable accommodations that avoid colorcoded cards. Soccer officials could hand out cards with distinctive shapes. A player could be given a round card or a triangular card, for example. Distinctive patterns are yet another possibility. OCR envisions the day when sportscasters will tell the audience that a player has received a polka dot card.

Another concern of OCR is the practice of naming medical schools after individuals who donate millions of dollars. Nearby states have the Sanford School of Medicine and the Carver College of Medicine. The problem here is that the names are overwhelmingly those of men. Women are underrepresented. OCR officials have asked how women can be welcome at medical schools that, by and large, have taken on the names of men, not women. OCR officials are encouraging schools to take lessons from those who are addressing this problem. Currently, there are negotiations to secure for a Chicago school a donation from a successful media personality.

They expect that we will soon know of the Oprah Winfrey School of Medicine.

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april 1, 2012 PHYSICIANS BULLETIN 23

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Pushing Aside a Cadaver’s Intestines Historically, the first two years of medical school consisted of lectures on subjects like biochemistry and laboratories with cadavers and dogs. As of 2012, that’s history.

Added to the mix are video games. Students arrive on campus having spent much of their lives with video game controllers. Today’s medical educators have capitalized on those skills to teach crucially important concepts that could never be learned from a cadaver’s intestines or a dog’s heart.

“The adaptability of video games, coupled with local teenagers who believe their destined career is that of video game programmer,” observed one dean for medical education, “has answered a big question for those of us who train physicians of the future: How are we going to teach the new doctors to cope with bureaucracy?”

Commercially available video games, sold to the general public, confront the player with challenges. One might be to find and retrieve a valuable object, despite many obstacles. Another might be to traverse a course and do so in the face of attackers.

“That’s the basis for our interest in video games as tools for teaching medical

students,” continued the dean. “You’ve got to admit it. Day after day, physicians are trying to do the right thing for their patients. And, day after day, what are they facing? Bureaucrats as dangerous as weapon-wielding aliens in a video game.

Bureaucracy. . .video games. . .that was our insight.”

In one challenge, students learn how to get an invoice for medical equipment paid. Sounds simple? Just show the packing slip that came with the equipment to the accounting clerk who has the invoice in hand?

“I started laughing when one of our students said it was too easy a task,” added the dean. “How do you think a hospital actually works? Can you even begin such a task without knowing the fund number, the fund category, the billing authorization number, and the billing authorization date—all of them? And which accounting clerk? The billing challenge in our game was based on an actual situation where naïve staff struggled for 10 months before a bill got paid. How much time they wasted! And that’s what our video game is designed to avoid. Medical organizations have made a game out of accomplishing the simplest of tasks, and we have made a game out of teaching students how to outwit the bureaucrats.”

Once word of the game was out, admissions interviews started to change. No longer did prospective students talk only about their desire to understand the human body and its disorders—or their passion to conquer cancer or diabetes. At first a few—and then more and more—expressed their fascination with fighting the bureaucrats. “I knew I was interested in medicine,” went one personal statement on an application, “when I met a physician who had dealt with a seriously disordered clerk. He sent her a request by postal mail from a government hospital. She didn’t respond. That didn’t discourage him. He didn’t give up.

He called her. Finally, he found out the basis for her disorder when she told him that she didn’t bother to think his request was even worth looking to because ‘It came in a government envelope so I didn’t think it was important.’”

The video game provides many other challenges for students, all of them based on actual situations faced by physicians. One scenario starts with the student physician being barred from seeing any patients. The reason: The student failed to appear for special training—training which no one had bothered to announce to the student in advance. A particularly popular scenario requires the student to convince an Electronic Health Record specialist to prepare a template.

The actual task of preparing the template requires the specialist to spend 30 minutes. But the specialist in the video game typically takes four months to turnaround the request.

The students with the most video game savvy, however, have whittled this down to four weeks. One of the favorites for the most competitive students, though, involves working on a project with a student-character in the video game, a character who refuses to discuss scheduled meeting times, frustrating any efforts to finish the project. april 1, 2012 PHYSICIANS BULLETIN 25

cover story

Bringing Colonoscopies to the People The Eastern Nebraska

chapter of the National Cancer Foundation has taken a big stride in the struggle against colon cancer.

“I can’t tell you how frustrated all of us have been,” explained Rose Canterra, president of the local chapter. She added: “We know that deaths from colon cancer would fall drastically, if only we could get everyone screened. Colonoscopy can be a very efficient screening method, particularly since it does not need to be repeated very often. Yet we have struggled to get people to undergo colonoscopy.”

Canterra explained the barriers to colonoscopy. “There are many things that get in the way of screening colonoscopy. One of the most vexing barriers seemed insurmountable.

Many of the people who need screening are adults who are in the work force. How can we get them to take time off from work for the procedure and time off from work to recover from the procedure? On top of that, we have required them to supply someone to drive them to and from the procedure—typically taking yet another adult away from the workplace. And then there’s the cost and the preparation.”

That’s exactly why the foundation is so excited about the solution that our chapter developed: the colonoscopy van. It’s a standard-sized van that doesn’t appear to be anything special as it cruises up and down the streets of Douglas and Sarpy Counties. Inside, though, it’s 26 PHYSICIANS BULLETIN April 1, 2012

Photo by minorwhitestudios.com

another story. It’s a fully equipped colonoscopy suite, complete with a pre-procedure area and a recovery area.”

Canterra said some people doubted all that could fit into a van. “My husband and I are RVers, and we know how—with careful organization—you can fit a lot in a small place. That’s what we did with the van.”

By making the colonoscopy van bring the procedure suite to the patient instead of making the patient make the trek to the procedure suite, multiple problems are solved. Gone are the transportation issues.

Gone is the requirement for someone else to take off work to drive the patient home.

Also gone is the patient who, fearful of the colonoscopy, decides to forego the procedure at the last minute. There’s no getting out of the screening when the colonoscopy nurse comes knocking at your door!

“Some people thought it would be dangerous to have the colonoscopy van driving through traffic while the gastroenterologist was trying to advance the scope. What if we went over a bump? What if we had to stop suddenly? Would the scope make a hole in the patient’s bowel?” Canterra explained that this was a not a problem. “We decided to do the actual procedure while the van is parked.

We can do the pre-procedure care and the recovering while the van is in motion.”

“Best of all,” she added, “it’s ecologically sound. Let’s say we do a half-dozen procedures. We’ve eliminated a half-dozen round trips to the procedure suite. We’ve replaced it with an efficiently designed route through the urban area. Think of the fuel we save.

And . . . we save even more. After a procedure, it’s normal for the patient to expel a large quantity of gas. It has energy-rich carbon compounds fed directly into the van’s fuel system. The van burns nearly all of that intake material. Sure, a small amount does reach the exhaust pipe. But the neighbors haven’t complained about it yet.”

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feature

Photo by minorwhitestudios.com

A Three-consultant Approach To Electronic Health Records Two years ago,

Helen Zannia, M.D., was worried. Her colleagues at Omaha’s 100-physician Rockstone Clinic assigned her to lead the clinic’s switch to electronic health records (EHR). She met that challenge, but it wasn’t easy.

Dr. Zannia first considered a simple approach: Delay. She realized that was not a viable option. She explained: “Pharmaceutical manufacturers had stopped giving us pens with drug advertising. We had depended on those pens for making notes in our paper medical records. Without those pens, there was no way we could make entries.

28 PHYSICIANS BULLETIN April 1, 2012

So we were forced to abandon our pen and ink records—which meant moving to EHR.” That’s when she hit upon her solution: Consultants. “When I encounter a medical problem outside my field, I rely on consultants. I did the same for EHR adoption,” she explained.

“I am delighted that Dr. Zannia asked me to work for Rockstone,” said Edgar Remol, her first consultant. “Previously I had worked for the military. There I was responsible for keeping their computers functioning 24 hours a day, 7 days a week. It wouldn’t do for the president to order a nuclear attack and find the system down for maintenance.”

“Rockstone is a different story. If the system crashes or I need to turn it off for an upgrade, I just tell the staff they’ll have to function without EHR for a few hours. I’m so glad to be free of the stress involved with the demand for constant availability.”

The second consultant added to the EHR team by Dr. Zannia was just as enthusiastic about his work in a health-care setting, even though it was a switch from earlier involvement with banking.

Claude Martone explained: “The bank insisted on highly secure communications. Customers needed to transmit instructions to transfer millions of dollars. Those instructions must be secure from eavesdroppers or hackers. This is tough. It was hard for me to handle. I’m much more enthusiastic about working with the Rockstone staff. If they want to communicate sensitive patient information, I simply tell them that it can’t be done with our EHR because of HIPPA federal regulations. It makes my work easier, and doctors are already used to spending extra hours in the office taking care of paperwork and phone calls. They just spend a bit more time with communications in the EHR system—no need for me to add features to let them use email for protected health information.”

Oliver Dohy was the third consultant to join the Rockstone team, and he was the one who found a way to pay for EHR. This was a second career for him. He was an early hire for a search engine company, and he became independently wealthy after it went public. “I was glad to get out of there,” he volunteered.

“They hired me after I aced their screening interview. You may have heard of their questions. They gave me a scenario where I’d been miniaturized to an inch tall, placed in a blender, and had to tell them how I’d survive once the blender blades started whirling.

I gave them a clever answer to that question but, surprisingly, in all my years there, there wasn’t even one time when they actually miniaturized me and stuck me in a blender. Instead, they insisted that I make their programs user-friendly. What a ridiculous idea! I hated it.”

Dohy explained why he relished working for Rockstone. “In a health setting, there’s no fussing about a user-friendly interface.

Instead, we require our physicians to take training. Initially, it’s eight hours. And I mean eight hours by the clock. No shortcuts.

That’s just the initial training.”

“There’s more,” he noted. He went on to explain why he’d become the hero of Rockstone’s EHR implementation. “I immediately realized how to pay for it. Context-sensitive advertising. When a physician is documenting care of a diabetic, for example, ads for hypoglycemic agents appear at the side of the screen. The pharmaceutical manufacturers love it. They’re glad to get their message to the right physician just as the prescribing decision is being made. They pay a lot for it. Bottom line: EHR advertising put Rockstone in the black.”

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We keep you informed

Members receive the latest in local, regional and national health-care news through the MOMS eBulletin and NMA STAT email newsletters, as well as the Physicians Bulletin and Nebraska Medicine magazines, and the NMA News.

We keep you connected

Members have unique opportunities through local MOMS events to network with their peers, interact with local medical students and communicate with community leaders. Members also have a wide variety of opportunities to make a difference by serving on MOMS and NMA committees and through involvement with our many local health-care related partners.

We represent physicians and patients

MOMS and NMA work diligently to monitor state legislation that will impact the future of health care. Together, our cumulative voice is heard by those who make decisions impacting Medicaid, Medicare, professional liability, insurance, rural health and public health…just to name a few.

Other member benefits

• • • •

Access to the NMA Blue Cross Blue Shield health and dental plans for physicians, their family and staff.

Premium reductions for all members utilizing COPIC. Access to services provided by Foster Group Wealth Management.

Savings on your annual AAA membership renewals with no initiation fee for new members.

If you would like more information on MOMS membership, call (402) 393-1415 or email Laura@omahamedical.com.

Boys Town Ear, Nose & Throat Institute

Welcomes

D. Richard Kang, M.D. Dr. Kang specializes in the diagnosis and medical and surgical therapy for ear and hearing problems including chronic otitis and mastoiditis, cholesteatoma, hearing loss, and cochlear implants.

• Board Certified in Otolaryngology • Medical Degree, Boston University • Residency, Otolaryngology – Head and Neck Surgery, Naval Medical Center – San Diego, CA • Fellowship, Pediatric Otolaryngology, Washington University School of Medicine, St. Louis, MO

D. Richard Kang, M.D.

Referring physicians call (402) 498-6540

Pediatric Otolaryngologist and Co-Director, Cochlear Implant Center

Recognized as one of America’s Best Doctors

by U.S, News & World Report and America’s Top Physicians by Consumer’s Research Council of America.

Boys Town Medical Campus Downtown Clinic 555 North 30th Street Omaha, NE

Boys Town Medical Campus Pacific Street Clinic 14040 Hospital Road Boys Town, NE

BOYS TOWN

National Research Hospital boystownhospital.org

®

april 1, 2012 PHYSICIANS BULLETIN 31

MOMSevents

Photo by minorwhitestudios.com

Making Our Point with a Kick— and a Can Several weeks ago

Congress repeated itself in a way that left physicians frustrated.

In Beltway lingo, faced with the need for the “doc fix,” Congress “kicked the can down the road.”

Your medical society doesn’t want this to happen again. We’re going to explain the problem to the public—and dramatize it.

The need for the “doc fix” has its origins several years ago in the formula for funding the Medicare program. In budgeting for Medicare, payments to physicians are part of a pool of money. A limit was placed on the growth of this pool from year to year. That’s how the problem arose.

Advances in medical technology have rapidly increased the demand for physician services that are paid out of this pool of money. Patients in 2012 benefit from better diagnoses, which come from radiologists who interpret imaging unavailable 10 years earlier.

This is beneficial, but it has a cost. Multiply this by the number of other specialties where medical care has improved, and add in the other non-physician charges that come out of the pool. You’ll see why the old budget formula simply isn’t working.

Indeed, adjusting physician payments in order to live within the old budget formula would have the dramatic effect of cutting fees some 30 percent. Year after year, Congress has approached this problem in a temporary fashion, the so-called “doc fix.” The approach has been to temporarily maintain physician reimbursements—unsheared by the cuts called for in the budget formula.

The temporary nature of each doc fix—sometimes a year or so, sometimes some months—is the problem. Congress has simply not 32 PHYSICIANS BULLETIN April 1, 2012

addressed the fundamental discrepancy between the burgeoning of appropriate medical services and the limits of the budget formula.

Rather than address the fundamental problem and revise the budget formula, the temporary “doc fixes” have postponed the time when this must be addressed. In other words, Congress has been “kicking the can down the road.”

The American Medical Association has struggled to avoid yet another set of legislation that is simply “kicking the can down the road.” This, however, has been to no avail. That’s why we here in the Omaha are taking our case to the public. We recognized the need for a new approach. We need to make our case dramatically.

That’s why we’re asking members to participate in our road race.

It’s not just another 10K run/walk. Instead, participants will literally be “kicking the can down the road.” Each physician who registers for the race will be required to bring an empty, clean tin can.

Participants won’t just walk or run. Instead, they will walk—and kick the can down the road—or run and kick the can down the road.

The oddity of dozens of white-coated physicians kicking their cans down the road will, we hope, grab the attention of the general public. It’s a ridiculous way to run a race. Our society’s goal is to get the general public to tell Congress: “Kicking the can down the road” is a ridiculous way to approach the “doc fix.”

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talking with someone in India or the Philippines. Times have changed, though.

A few months ago, I bought a new laptop computer. One of the selling points was the manufacturer’s helpline. They promised prompt responses by US-based experts.

If the insurance companies cared about physicians the way computer manufacturers care about their customers, they’d get rid of those complicated menus and long waits. Also, I wonder what happened to the thousands of people in New Delhi and Manila who used to work for the computer helplines.”

You may have guessed it. Your society’s new benefit is “Insurance Authorization Services.” Do you use an electronic health record? It already has all the information needed for an authorization: patient insurance information, medical condition, and proposed intervention. Requirements for secure data transmission mean that the patient’s record can be viewed securely across the hall or across the globe. That’s where your society has stepped in to provide jobs for some of the people who used to staff computer help desks on the other side of the globe. We’re arranging for them to call the insurance companies and seek authorization. Wages on the other side of the world are far less than you pay your staff—so it’s a much better use of resources.

Your society is arranging the secure network connections and the privacy training.

Want to free up time for you and your staff to talk with patients instead of waiting on hold? Sign up for your society’s Insurance Authorization Services.

PERMIT NO. 5377 DENVER,

Your society continues to offer special member benefits, and we are now introducing a benefit that promises to mitigate one of the greatest frustrations for physicians and staff.

This winter, dozens of members participated in focus groups. Facilitators sought to understand what was most frustrating about medical practice and what your society could do about it. We were especially interested in identifying sources of frustration that affected large segments of the membership. In other words, the focus groups went beyond identifying the concerns of a single specialty. We wanted to find problems that were felt by both specialists and generalists, problems felt by those who cared for the young and those who cared for the old, problems felt by those who were office-based and those who were hospital-based, problems felt by those who were procedure-oriented and those who weren’t.

One frustration emerged as widely felt and a source of much waste of staff time and physician time. You may have guessed it: getting authorization from insurance companies. Listening to ever-changing phone menus, waiting on hold, and finally explaining the patient’s needs—that’s what generated many expressions of frustration.

One of the older focus group participants, Dr. Millard Swoieble, made a comment that, ultimately, led your society to devise the benefit: “Years ago, I would have computer or printer problems, and I’d call the 800-number help desks. Predictably, I’d spend a lot of time on hold before

402.932.9711

Omaha maGazine • 5921 S. 118th CirCle • Omaha, ne 68137

We Heard Your Frustrations

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74470 63856

w w w. b 2 b o m a8 .com

The Omaha-Metro Business to Business Magazine

april 1, 2012 PHYSICIANS BULLETIN 33

campusupdates Center is Home in Former Apartment Building

P

Honduran mahogany. With its hysicians may recall the proximity to the medical school, Fettato Apartments, a the Center hopes to explore small building that was the close relationship between popular with medical students. environmentally sound policy “The school bought the apartand human health. Among its ments and demolished the first projects is an building to provide “The school bought effort to reduce energy used for a place for the apartments indoor lighting the Center and demolished by promoting the for Ecology and Health,” the building to pro- use of dilating eye drops. “Because explained vide a place for the everything seems spokesperson so much brighter Dolly Zanna.

Center for Ecology when your eyes “When we and Health.” have been dilated tore down -Dolly Zanna for an ophthalthe building, mological exam,” most of the explained Zanna. students living there moved out to locations in “Center researchers realized that routine use of the drops could west Omaha.” reduce the need for bright lights at home, cutting down on elecThe new building is contricity use.” structed of Italian marble and

Rintara Foundation Grant Targets Business Alignment

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edical alumnus This could be an attorney who Ricardo Rintara has kills deal after deal, an accoundonated $2 miltant who wastes time at meeting lion for a special after meeting fund designed to Ricardo Rintara with incompreimprove the alignhensible data rechas donated ment of the busiitations, or even $2 million. ness office and acaa secretary with demic functions. a reputation for It will support a delay. With the two-step process. The first step balloting complete, the second will be polling of faculty to iden- step will start. This is the firtify the business office employee ing of the designated employee. responsible for the most impedi- Rintara Foundation monies will ments to the academic mission. provide severance pay.

34 PHYSICIANS BULLETIN April 1, 2012

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Making Memorization Easier

here’s no getting around tion associated with resistance to lamivudine, for example, is memorization in medical education, but a new termed “M184V.” project will evaluate a creative Underway is an way to make it effort to teach HIV easier. It will focus Underway mutations with a on mutations of variant of bingo. The HIV associated is an effort caller will pick out with resistance to to teach HIV balls with mutation drugs used to treat designations, such as HIV. These mutamutations The players tions carry a threewith a variant M184V. will need to recogpart designation: of bingo. nize that designation the amino acid and place markers in the wild-type on the relevant drug, virus, the sequence such as lamivudine, on their number of that amino acid in bingo cards. The hope is to the protein that is altered, and make memorization an exciting the amino acid in the mutated task, not just drudgery. virus. An important muta-

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Distracted Drivers and Music

joint project with the that especially intricate classical music compositions may departbe more dangerUltimately, they ous that simple ment is investigating a hypothesis rock music. may develop about distracted Using a driving chips for car drivers. Studies simulator and a have shown that radios that will library of music, engagement in they are testing block music by the hypothesis. cell phone conversations is linked composers such Ultimately, they to car crashes. may develop as Beethoven The investigators chips for car and Stravinsky. radios that will hypothesize that engaging music block music by can have a similar composers such as effect. In particular, they suspect Beethoven and Stravinsky.

Have you been supporting the

MOMS Foundation?

The Metro Omaha Medical Society Foundation identifies and provides support to community priorities where physician involvement can make a difference in improving the health of the Metro Omaha Community.

Commercial Construction Green Environments Disaster Recovery Industrial Medical Education

We appreciate your Best of B2B Vote!

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MOMS Women In Medicine Meeting “Quick-Fix Healthy Meals” Cooking Demonstration Wednesday, April 25th Hy-Vee 76 & Cass (Demonstration Kitchen)

Social 5:30 - 6:00 p.m. with Optional Wine Tasting ($10 per person) Interactive Cooking Demonstration/Dinner 6:00 p.m. - 7:00 p.m.

No cost to attend with the exception of wine tasting.

Exclusively for MOMS member physicians.

RSVP by calling 402-393-1415 or email laura@omahamedical.com

Trust your gut to MGI, the region’s largest and most established gastroenterology practice.

MOMS Foundation 7906 Davenport Street Omaha, Nebraska 68114 402-393-1415

The area’s best choice for high quality and cost-effective digestive health care. Our physicians provide the most comprehensive, state-of-the-art, specialized patient care with our consultative and endoscopic services.

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402.397.7057 or 402.504.3880 402.885.8700

www.midwestgi.com april 1, 2012 PHYSICIANS BULLETIN 35

Application for Membership This application serves as my request for membership in the Metro Omaha Medical Society (MOMS) and the Nebraska Medical Association (NMA). I hereby consent and authorize MOMS to use my application information that has been provided to the MOMS credentialing program, referred to as the Nebraska Credentials Verification Organization (NCVO), in order to complete the MOMS membership process.

Personal Information Last Name: _____________________________ First Name: _______________________ Middle Initial: ______ Birthdate: _________________________________________________ Gender: Male or Female Clinic/Group: __________________________________________________________________________________ Office Address: ________________________________________________________________ Zip: __________ Office Phone: ____________________ Office Fax: ___________________ Email: _________________________ Office Manager: _______________________________________ Office Mgr. Email: ________________________ Home Address: ____________________________________________________ Zip: ________________________ Home Phone: __________________________________________ Name of Spouse: ________________________ Preferred Mailing Address: Annual Dues Invoice: Event Notices & Bulletin Magazine:

Office

Home Other: __________________________________

Office

Home Other: __________________________________

Educational and Professional Information Medical School Graduated From: __________________________________________________________________ Medical School Graduation Date: ____________________ Official Medical Degree: (MD, DO, MBBS, etc.) _______ Residency Location: _____________________________________________ Inclusive Dates: _________________ Fellowship Location: _____________________________________________ Inclusive Dates: _________________ Primary Specialty: ______________________________________________________________________________

Membership Eligibility Questions YES

NO

(If you answer “Yes” to any of these questions, please attach a letter giving full details for each.)

Have you ever been convicted of a fraud or felony?

Have you ever been the subject of any disciplinary action by any medical society, hospital medical staff or a State Board of Medical Examiners?

Has any action, in any jurisdiction, ever been taken regarding your license to practice medicine?

(Including revocation, suspension, limitation, probation or any other imposed sanctions or conditions.)

Have judgments been made or settlements required in professional liability cases against you?

I certify that the information provided in this application is accurate and complete to the best of my knowledge.

_____________________________________

Signature

___________ Date

B

Fax Application to: 402-393-3216

Mail Application to: Metro Omaha Medical Society 7906 Davenport Street Omaha, NE 68114

Apply Online: www.omahamedical.com

editor’sdesk

Marvin Bittner, M.D.

On a Serious Note…

This article is serious.

The rest of this magazine is not.

Look at the publication date. It’s April 1, 2012. The other articles may seem to be ordinary articles in the Metro Omaha Medical Society Physicians Bulletin. Do you think they are real articles?

April Fool’s!

I know some people may think we’re too harsh with the humor.

Many of these articles highlight foibles of the medical community. For example, there’s an article about information technology.

Perhaps you know someone who is working hard on integrating information technology with clinical medicine, and you may wonder why there’s an article ridiculing some aspects of IT in medicine.

My answer is contained in your question: People have to work hard to integrate IT into medicine because, unfortunately, the software is nowhere near as user-friendly as the most popular software aimed at the general public. Medical software has fallen victim to federal regulations that prioritize security and specialized features—but not ease of learning and ease of use. This is unfortunate, it requires many people to work hard, and it deserves to be the target of humor.

The Metro Omaha Medical Society is not a place for those who lack a sense of humor. Nearly every year, we have put on a MESS Club performance. At the heart of MESS, you’ll find songs that make light of a panoply of practices of Omaha-area medicine. The

talent of our writers, musicians, dancers and staff transform frustration into a fun-filled evening of laughter and joy.

This year we’re not putting on MESS. We’re taking a breather to get set for another production in 2013. Have an idea for a song?

Want to work on the writing team? Have some talent in music or dance? Or just want to perform, even if you don’t have any talent?

The MOMS office can put you in touch with the MESS Club group that is emerging for 2013.

My work with MOMS makes me feel grateful at almost every turn. It goes far beyond my gratitude for those who have done so much, often repeatedly, to make MESS Club a success. I’m feeling especially grateful as this April Fool’s issue is being prepared. I do want to say a special “thank you” to our advertisers whose routine support makes this publication possible—and whose willingness to go along with the April Fool’s issue allows MOMS to have a little fun. I’m also grateful to those who would ordinarily be featured in this issue—such as some of our new members who’d be in the “New Members” column—who are tolerating a two-month delay.

It’s no secret that medicine can be a source of stress—or that humor can help us cope with stress. I’m glad MOMS is an organization that doesn’t take itself too seriously. I think it helps make us the kind of organization that can be a welcome place for every physician in Sarpy and Douglas Counties.

april 1, 2012 PHYSICIANS BULLETIN 37

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Metropolitan Omaha Medical Society 7906 Davenport Street Omaha, NE 68114

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PA I D

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ADDRESS SERVICE REQUESTED

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When a newborn is critically ill, a single call gives you instant access to our neonatal intensive care specialists and a full range of pediatric and surgical subspecialists, all supported by state-of-the-art technology and equipment. It can also link you to our neonatal transport service team, who will arrange for transport to Children’s Hospital & Medical Center based on the child’s needs. Twenty-four hours a day, seven days a week, one call links you to physician-to-physician consults, referrals and admissions. There’s no problem too large, no child too small. www.ChildrensOmaha.org