12.04.2014 Views

May 2006 Bulletin - Allegheny County Medical Society

May 2006 Bulletin - Allegheny County Medical Society

May 2006 Bulletin - Allegheny County Medical Society

SHOW MORE
SHOW LESS

Create successful ePaper yourself

Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.

<strong>May</strong> <strong>2006</strong> ♦ Vol. 95 No. 5<br />

BULLETIN of the <strong>Allegheny</strong> <strong>County</strong> <strong>Medical</strong> <strong>Society</strong><br />

ARTICLES COLUMNS DEPARTMENTS<br />

<strong>2006</strong> <strong>Bulletin</strong> Reader Survey .... 224<br />

Pill Box .................................... 232<br />

Tdap Vaccines: Which, When and How?<br />

Noreen H. Chan-Tomkins, PHARMD<br />

Legal Report ............................ 240<br />

Retirement 101: A Basic Understanding of<br />

Two Plans<br />

Susan F. Jordan, ESQ<br />

Practice Management ..............243<br />

HIPAA Q&A<br />

Joan M. Kiel, PHD<br />

Feature .....................................244<br />

Disaster Response and Impaired Communication<br />

Samuel Stebbins, MD, MPH<br />

Sidebar.....................................245<br />

New Disaster Planning Certification<br />

Special Report..........................246<br />

Temp to Permanent Hiring: Everyone Wins<br />

Patrick Dudley<br />

Thoughts from Our<br />

<strong>Medical</strong> Editor .........................214<br />

Are You a Terrorist, Doctor? Beans of<br />

Conversation<br />

Safdar I. Chaudhary, MD<br />

Editorial................................... 216<br />

Crystal Balls and Bad Seeds<br />

Scott Miller, MD,MA<br />

Getting There: Reflections of a<br />

Resident Physician ...................218<br />

Go. Learn. Do.<br />

Lynne Williams, MD<br />

Perspective ...............................255<br />

The Western Pennsylvania Hospital’s<br />

Affiliation with Temple University<br />

Elliot Goldberg, MD<br />

Perspective ...............................256<br />

Creation and Darwinism<br />

Patrick J. McMahon, MD<br />

<strong>Society</strong> News ........................... 220<br />

♦ Photo: David C. Martin award winners<br />

♦ Geriatricians meet in Pittsburgh<br />

♦ <strong>Bulletin</strong> reader feedback needed<br />

♦ OSHA update draws crowd<br />

♦ Photo: Diversity seminar, Dr. Goma<br />

♦ Photos: <strong>2006</strong> Science and Engineering Fair<br />

♦ Measuring patient satisfaction<br />

♦ Photo: April 26 Twerski talk<br />

Dear Doctor ............................225<br />

In Memoriam ..........................225<br />

Edward L. Bamonte, MD<br />

Ruben A. Tenicela, MD<br />

Activities & Accolades .............226<br />

Community Notes ...................227<br />

Tributes to a Mentor ................229<br />

Continuing Education .............230<br />

Calendar ..................................231<br />

Special Report..........................247<br />

Reported Diseases: Q1-<strong>2006</strong><br />

Technology & Medicine .......... 248<br />

Voice Recognition Technology<br />

Basil A. Marryshow, MD<br />

Sidebar.....................................249<br />

Medicare Interactive Voice Response (IRV)<br />

Cover Art:<br />

Grant Street<br />

by Lester O. Prince, MD<br />

Dr. Prince specializes in physical<br />

medicine rehabilitation.<br />

“<br />

Board of Directors ...................251<br />

Classifieds ................................258<br />

There is nothing<br />

wrong with change if<br />

it is changed in the<br />

right direction.<br />

”<br />

—Sir Winston Churchill


Affiliated with the Pennsylvania <strong>Medical</strong> <strong>Society</strong> and the American <strong>Medical</strong> Association<br />

<strong>2006</strong> OFFICERS and<br />

Executive Committee of the<br />

Board of Directors<br />

President<br />

Terence W. Starz<br />

President-elect<br />

Krishnan A. Gopal<br />

Vice President<br />

Adam J. Gordon<br />

Secretary<br />

Douglas F. Clough<br />

Treasurer<br />

David L. Katz<br />

Board Chair<br />

Mark A. Goodman<br />

DIRECTORS<br />

<strong>2006</strong><br />

Christopher J. Daly<br />

David J. Deitrick<br />

John F. Delaney Jr.<br />

Steven Evans<br />

Joseph J. Schwerha<br />

James E. Wilberger Jr.<br />

John P. Williams<br />

2007<br />

Edward M. Barksdale Jr.<br />

Melinda M. Campopiano<br />

Barbara M. Harley<br />

Charles N. Lebovitz<br />

Edmund C. Watters<br />

2008<br />

Eugene A. Bonaroti<br />

Kevin O. Garrett<br />

Carol E. Rose<br />

Edward Teeple Jr.<br />

G. Alan Yeasted<br />

PEER REVIEW BOARD<br />

<strong>2006</strong><br />

Jeffrey A. Perri<br />

Adam J. Gordon<br />

Jan D. Smith<br />

2007<br />

William D. Hetrick<br />

Barbara A. Swan<br />

2008<br />

Gerald W. Pifer<br />

David S. Zorub<br />

PMS DISTRICT TRUSTEE<br />

Paul W. Dishart<br />

DISTRICT CENSOR<br />

Phillip R. Levine<br />

COMMITTEES<br />

Bylaws<br />

Adam J. Gordon<br />

Communications<br />

Leo McCafferty<br />

Finance<br />

Paul W. Dishart<br />

Legislative<br />

David J. Deitrick<br />

Membership<br />

Anthony A. Spinola<br />

Nominating<br />

Carol E. Rose<br />

Occupational Medicine<br />

Joseph J. Schwerha<br />

ACMS ALLIANCE<br />

President<br />

Sandra DaCosta<br />

President-Elect<br />

Irene Payan<br />

First Vice President<br />

Sally Buchanan<br />

Second Vice President<br />

Patty Barnett<br />

Recording Secretary<br />

Jo Martinez<br />

Corresponding Secretary<br />

Susan Rihn<br />

Treasurer<br />

Suzanne Leehan<br />

Assistant Treasurer<br />

Mary Kay Schaner<br />

ADMINISTRATIVE STAFF<br />

Executive Director<br />

John G. Krah<br />

(jkrah@acms.org)<br />

Assistant to the Director<br />

Dorothy S. Hostovich<br />

(dhostovich@acms.org)<br />

Bookkeeper<br />

Susan L. Brown<br />

(sbrown@acms.org)<br />

Communications<br />

Director<br />

Lisa M. Goetz<br />

(lgoetz@acms.org)<br />

Assistant<br />

Elizabeth L. Fulton<br />

(efulton@acms.org)<br />

BULLETIN<br />

<strong>Medical</strong> Editor<br />

Safdar I. Chaudhary<br />

(safdar3@gmail.com)<br />

Associate Editors<br />

Christopher J. Daly<br />

(cdaly55@hotmail.com)<br />

Robert L. Ferris<br />

(ferrisrl@upmc.edu)<br />

Indira P. Jevaji<br />

(jevajiip@upmc.edu)<br />

Timothy G. Lesaca<br />

(tlesaca@hotmail.com)<br />

D. Scott Miller<br />

(smiller4@wpahs.org)<br />

Adam Z. Tobias<br />

(azt3@pitt.edu)<br />

Frank T. Vertosick, Jr.<br />

(fvertosick@acms.org)<br />

Managing Editor<br />

Linda L. Smith<br />

(lsmith@acms.org)<br />

Contributing Editors<br />

John L. Falcone<br />

Adam J. Gordon<br />

Ravi Kant<br />

Heather A. Sakely<br />

Deval Paranjpe<br />

Erin A. Sullivan<br />

Carey T. Vinson<br />

Assistant Executive Director,<br />

Membership/Information<br />

Services<br />

Director<br />

James D. Ireland<br />

(jireland@acms.org)<br />

Manager<br />

Dianne K. Meister, R.N.<br />

(dmeister@acms.org)<br />

Assistant<br />

Nadine M. Popovich<br />

(npopovich@acms.org)<br />

Visit www.acms.org<br />

EDITORIAL/ADVERTISING<br />

OFFICES: BULLETIN of the <strong>Allegheny</strong><br />

<strong>County</strong> <strong>Medical</strong> <strong>Society</strong>,<br />

713 Ridge Avenue, Pittsburgh, PA<br />

15212; (412) 321-5030; fax (412)<br />

321-5323. USPS #072920. PUB-<br />

LISHER: <strong>Allegheny</strong> <strong>County</strong> <strong>Medical</strong><br />

<strong>Society</strong> at above address.<br />

The BULLETIN of the <strong>Allegheny</strong><br />

<strong>County</strong> <strong>Medical</strong> <strong>Society</strong> welcomes<br />

contributions from readers, physicians,<br />

medical students, members of<br />

allied professions, spouses, etc. Items<br />

may be letters, informal clinical reports,<br />

editorials, or articles. Contributions<br />

are received with the understanding<br />

that they are not under simultaneous<br />

consideration by another<br />

publication.<br />

Issued the third Saturday of each<br />

month. Deadline for submission of<br />

copy is the SECOND Wednesday<br />

preceding publication date. Periodical<br />

postage paid at Pittsburgh, PA.<br />

BULLETIN of the <strong>Allegheny</strong> <strong>County</strong><br />

<strong>Medical</strong> <strong>Society</strong> reserves the right to<br />

edit all reader contributions for brevity,<br />

clarity, and length as well as to<br />

reject any subject material submitted.<br />

The opinions expressed in the Editorials<br />

and other opinion pieces<br />

are those of the writer and do not<br />

necessarily reflect the official policy<br />

of the <strong>Allegheny</strong> <strong>County</strong> <strong>Medical</strong><br />

<strong>Society</strong>, the institution with which<br />

the author is affiliated, or the opinion<br />

of the Editorial Board. Advertisements<br />

do not imply sponsorship<br />

by or endorsement of the<br />

ACMS, except where noted.<br />

Publisher reserves the right to exclude<br />

any advertisement which in its<br />

opinion does not conform to the standards<br />

of the publication. The acceptance<br />

of advertising in this publication<br />

in no way constitutes approval or<br />

endorsement of products or services<br />

by the <strong>Allegheny</strong> <strong>County</strong> <strong>Medical</strong><br />

<strong>Society</strong> of any company or its products.<br />

Subscriptions: $25 nonprofit organizations;<br />

$35 ACMS advertisers, and<br />

$45 others. Single copy $4. Advertising<br />

rates and information sent upon<br />

request by calling (412) 321-5030.<br />

COPYRIGHT <strong>2006</strong>:<br />

ALLEGHENY COUNTY MEDICAL<br />

SOCIETY<br />

POSTMASTER—Send address<br />

changes to: BULLETIN of the<br />

<strong>Allegheny</strong> <strong>County</strong> <strong>Medical</strong><br />

<strong>Society</strong>, 713 Ridge Avenue,<br />

Pittsburgh, PA 15212.<br />

ISSN: 0098-3772


Keep talking to your patients about colon cancer screening.<br />

So you won’t have to talk to them about colon cancer.<br />

©<strong>2006</strong> American Cancer <strong>Society</strong>, Inc.<br />

If everyone who’s 50 and older would get screened for colorectal cancer, the death rate could be cut in half * .<br />

You play a critical role in your patients’ decisions to get tested. So make it a priority to talk to your patients<br />

about getting screened. For some helpful tools, call us at 1-800-ACS-2345 or visit www.cancer.org/colonmd.<br />

This is how we can work together to prevent colorectal cancer. This is the American Cancer <strong>Society</strong>.<br />

*Source: http://prg.nci.nih.gov/colorectal/<br />

®<br />

Hope.Progress.Answers. / 1.800.ACS.2345 / www.cancer.org/colonmd


THOUGHTS FROM<br />

OUR MEDICAL EDITOR<br />

Are You a Terrorist, Doctor?<br />

Beans of Conversation<br />

SAFDAR I. CHAUDHARY, MD<br />

The dialectic of being appreciated by surprise as this has been a new tion to this effect. Whatever houses<br />

and then having doubts about phenomenon for me. (Of course, she I may visit, I will come for the<br />

my integrity has been an interesting did not realize my religious affiliations.)<br />

benefit of the sick, remaining free<br />

phenomenon as of late. Over the<br />

I had come to expect that of all intentional injustice, of all<br />

years of my journey as a person, it saving lives, improving the quality of mischief and in particular of<br />

has been a fascinating unfolding of life and preventing sufferings are at sexual relations with both female<br />

various chapters of life. Reflecting on the forefront of our mission as and male persons, be they free or<br />

life becomes kind of a norm at a human beings and clinicians. This slaves. What I may see or hear in<br />

certain stage of life. I tend to make mission embraces all human beings the course of the treatment or even<br />

stops at various settings, learning without any exceptions or else it is outside of the treatment in regard<br />

and observing, having casual conversations<br />

prejudiced and can’t be an oath in its to the life of men, which on no<br />

and avoiding unnecessary earnest.<br />

account one must spread abroad,<br />

entanglement.<br />

I recalled the highlights from the I will keep to myself, holding such<br />

An organization recently invited oath of Hippocrates, the father of things shameful to be spoken<br />

me to accept an award for having medicine:<br />

about. If I fulfill this oath and do<br />

worked so closely with my patients “I will apply dietetic measures not violate it, may it be granted to<br />

over the years in the area of mental for the benefit of the sick according<br />

me to enjoy life and art, being<br />

health and addictions. I feel very<br />

to my ability and judgment; honored with fame among all<br />

privileged and humbled by this I will keep them from harm and men for all time to come; if I<br />

recognition, reflecting on all of the injustice. I will neither give a transgress it and swear falsely, may<br />

patients, mentors and my family deadly drug to anybody who asks the opposite of all this be my lot” 1<br />

who have made it possible for me to for it, nor will I make a sugges-<br />

This oath does not account for<br />

be me. Even a moderate amount of<br />

religious preferences so unique and<br />

neurological dysfunction can cause<br />

personal to everyone, but encompasses<br />

this apparatus of ours to be out of<br />

all human beings. I pondered<br />

shape, and usefulness gives way to<br />

over how the discussion about<br />

sorrow and grief. So there is so much<br />

religion is becoming part of our<br />

to be mindful of with this everyday<br />

profession. Not having any answers<br />

ecstasy.<br />

and somewhat puzzled, I proceeded<br />

In the midst of this thinking,<br />

to enjoy my usual artwork of seeing<br />

I made a short stop at a hospital<br />

my patients and helping them<br />

medical staff office. A familiar<br />

alleviate their sufferings. Being<br />

clinical staffer made comments<br />

mindful of my blessings and aware<br />

about a religion and how these folks<br />

of ailments that can dawn upon us,<br />

are intent to destroy us; I was taken<br />

I had yet another fulfilling day.<br />

214 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


MEDICAL<br />

EDITOR continued<br />

Another shock wave got my<br />

attention few days later when a<br />

patient, enraged by my promise to<br />

improve her life shouted, “You<br />

terrorist! Go back to Pakistan!” I<br />

have intentionally left out some of<br />

her additional comments that would<br />

not pass the muster of decency for<br />

an editorial. Some words of wisdom<br />

emerged from another intellectually<br />

challenged (as we diagnosed him)—<br />

a patient reaching out to comfort<br />

me—“You are a nice doctor; you<br />

can’t be a terrorist.”<br />

A series of similar experiences<br />

have been happening in my office<br />

setting: folks curious about my<br />

background and commenting about<br />

how they find me so different than<br />

their expectations. Where do these<br />

expectations come from?<br />

Is something in the environment<br />

around us seeping through our<br />

minds? Are we able to limit the<br />

effects of world events and take pride<br />

in our profession, being the best we<br />

can be? I take opportunities to<br />

reflect about this with my colleagues,<br />

neighbors and family. Are we creating<br />

an environment of intolerance so<br />

destructive to the creative mind? Am<br />

I good or bad? I needed to validate<br />

myself, and the insecurities and<br />

doubts begin to creep into my mind.<br />

Is my Korean teacher good or evil?<br />

How do I tell the difference?<br />

The rise and fall of civilizations<br />

and the simple operative principles<br />

of human conduct in societies,<br />

regardless of times, begin to emerge<br />

from the history books. Fair, equitable<br />

and just societies seem to be<br />

resilient to winds of seclusion and<br />

exclusions. The seeds of love and<br />

hatred come back to affect all of us<br />

with little demarcations. The intellectuals<br />

in my native country had<br />

closed their eyes to such phenomena<br />

and so are reaping the fragmentation<br />

of its fabric of tolerance today. I<br />

hope our learning from our own<br />

history makes us wise for the future.<br />

I will be heading out for my award<br />

during a dinner tomorrow and<br />

pondering about the future in the<br />

meantime.<br />

Says Bahauddine (father of<br />

Rumi):<br />

“When I am sick with fever,<br />

I tell my friends that even then I<br />

take pleasure in being conscious.<br />

It doesn’t matter if I am nauseated<br />

or shivering with chills. I still<br />

enjoy being here. Traveling or<br />

staying home, both delight. Being<br />

alone, being in public disgrace,<br />

I am clear and friendly in every<br />

state. Only in deep, self-condemning<br />

humiliation am I sometimes<br />

restrained with my conversation.<br />

Conversations break up the<br />

ground and allow vegetables to<br />

grow. Eggplant, radish, lettuce,<br />

peas, cabbage. Let talking find its<br />

way with no restrictions. Let the<br />

long pods sprout on their spontaneous<br />

stalks, so we can be fed the<br />

beans of conversation.” 2<br />

Dr. Chaudhary is a psychiatrist and medical<br />

editor of the <strong>Bulletin</strong>. He can be reached at<br />

safdar3@gmail.com or (412) 427-6828.<br />

REFERENCES<br />

1<br />

http://www.pbs.org/wgbh/nova/doctors/<br />

oath_classical.html. “Translation from the<br />

Greek,” From The Hippocratic Oath: Text,<br />

Translation, and Interpretation. Ludwig<br />

Edelstein. Baltimore: Johns Hopkins Press,<br />

1943.<br />

2<br />

The Drowned Book. Coleman Barks and<br />

John Moyne.<br />

The opinion expressed in this column<br />

is that of the writer and does not<br />

necessarily reflect the opinion of the<br />

Editorial Board, the <strong>Bulletin</strong>, or the<br />

<strong>Allegheny</strong> <strong>County</strong> <strong>Medical</strong> <strong>Society</strong>.<br />

We focus on your needs, so you can focus on work.<br />

We bring a lot more than office products to your office.<br />

Call or go online today for more details.<br />

1.888.CE TODAY<br />

(1.888.238.6329)<br />

CorporateExpress.com<br />

<strong>May</strong> <strong>2006</strong><br />

The <strong>Bulletin</strong> u 215


EDITORIAL<br />

Crystal Balls and Bad Seeds<br />

SCOTT MILLER, MD, MA<br />

As the program director of an<br />

and challenging pasts.<br />

internal medicine training<br />

And although the study didn’t<br />

program, overseeing about 50 Importantly, not all address problems that begin in<br />

internal medicine residents during medical students who residency, I see those as well, and the<br />

their three years of training to get disciplined in<br />

same observation above applies: Very<br />

become practicing board certified medical school get few of these residents go on to<br />

physicians, I read with some interest<br />

become troubled and in-trouble<br />

disciplined as licensed<br />

the recent special article in the<br />

practicing physicians. Most learn<br />

December 22, 2005, New England physicians.<br />

from their mistakes and move<br />

Journal of Medicine. The article<br />

forward.<br />

concerned licensed physicians behavior, right? From the early The dilemma for medical<br />

displaying unprofessional behavior behavior, perhaps one has a crystal schools and residency program<br />

and the ability to trace the seeds of ball of what is likely to follow? directors is whether or not we can<br />

that behavior to problems exhibited I don’t believe that is the case. As tell in advance who is going to learn<br />

by these same physicians as far back a program director dealing with from his or her unprofessional<br />

as when they were medical students. these physicians during their residency<br />

conduct early on and improve, and<br />

The results of the study, “Disciplinary<br />

training, the picture is not so who will ultimately get sanctioned<br />

Action by <strong>Medical</strong> Boards crystal clear.<br />

with disciplinary action by a medical<br />

and Prior Behavior in <strong>Medical</strong><br />

Importantly, not all medical board years later.<br />

School” (NEJM 2005; 353:2673- students who get disciplined in And unfortunately, we can’t. We<br />

2682), showed that “...disciplinary medical school get disciplined as don’t have a crystal ball. For many<br />

action by a medical board was licensed physicians. Some of these reasons.<br />

strongly associated with prior unprofessional<br />

medical students actually learn from First, every one of these residents<br />

behavior in medical their mistakes and never go on to is extremely contrite when the<br />

school...The types of unprofessional have any further episodes of unprofessional<br />

unprofessional behavior is brought<br />

behavior most strongly linked…were<br />

behavior. Given the oppor-<br />

to attention. Every one of them has<br />

severe irresponsibility and severely tunity to improve, these medical good reasons for why it happened,<br />

diminished capacity for self-improvement...”<br />

students become medical residents and everyone swears it won’t happen<br />

who obtain the respect of their peers again. I am always optimistic about<br />

At first glance, nothing too and actually become role models for the potential for improvement when<br />

shocking here. After all, the best others. They have “character” and a resident actually takes responsibility<br />

predictor of future behavior is past have learned to overcome difficult<br />

for what happened rather than<br />

216 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


EDITORIAL continued<br />

makes excuses about it or blames<br />

others, but that is not an absolute<br />

criteria for the future absence of<br />

problems, and sometimes others are<br />

responsible for the unprofessional<br />

behavior.<br />

Second, professional careers are<br />

at stake here. For most residents, this<br />

is enough motivation to improve<br />

their behaviors, and this creates<br />

enough hesitancy on the part of the<br />

program to jeopardize that future by<br />

falsely categorizing these residents as<br />

being unable to improve and learn<br />

from their unprofessional conduct.<br />

And, again, most residents do<br />

improve.<br />

Third, we don’t really know with<br />

enough certainty who to give up on<br />

or when to give up on them because,<br />

in most cases, we can’t be really sure<br />

exactly what happened. Everyone has<br />

a somewhat different version of<br />

events, and these can be difficult and<br />

time-consuming to sort out. We<br />

don’t have video to review.<br />

Finally, even those who display<br />

unprofessional behavior a second<br />

time do not all go on to do it a third<br />

time, and a third strike does not<br />

always beget a fourth. Sometimes<br />

learning takes a lot of time and<br />

intense effort at remediation. And<br />

that is one of the goals of reinforcing<br />

professionalism and professional<br />

behaviors within the training program<br />

every day.<br />

So, from the present we can<br />

shine a bright light on the behaviors<br />

of the past and see how they con-<br />

nect, as the NEJM article makes<br />

clear. But past behavior does not<br />

reliably predict future behavior for<br />

most of us; rather, it is that present<br />

behavior was likely preceded by<br />

similar behavior. There is no crystal<br />

ball.<br />

Dr. Miller is an internist at <strong>Allegheny</strong> General<br />

Hospital, where he chairs the Hospital Ethics<br />

Committee and serves as program director of<br />

the Internal Medicine Residency Program. Dr.<br />

Miller, who is the ACMS Editorial Board’s<br />

newest associate editor, can be reached at<br />

(412) 359-6401 or smiller4@wpahs.org.<br />

The opinion expressed in this column<br />

is that of the writer and does not<br />

necessarily reflect the opinion of the<br />

Editorial Board, the <strong>Bulletin</strong>, or the<br />

<strong>Allegheny</strong> <strong>County</strong> <strong>Medical</strong> <strong>Society</strong>.<br />

DEDICATION<br />

)_<br />

e /<br />

d d<br />

i a<br />

-k ‘sh n n : 1. the act of dedicating or the<br />

)<br />

e<br />

state of being dedicated; 4. selfless devotion<br />

John Reitzel, MHA, is knowledgeable and experienced in the technology field<br />

and is dedicated to sharing these skills with physicians.<br />

John works closely with a team of professionals, including: Tracey Glenn, CPC,<br />

CPC-H, CCS-P; Bonnie Meisel, CPA; Linda Benner; Jim Dunn, CMPM; and Sherry<br />

Migliore, MPA, FACHE.<br />

The PMSCO Healthcare Consulting team can: assess your practice’s readiness and<br />

capability to purchase EHR and other technology; redesign your workflow to<br />

maximize efficiency; project your return on investment; identify and evaluate software<br />

vendors based on practice needs; and facilitate EHR implementation.<br />

777 East Park Drive Harrisburg, PA 17111<br />

www.consultpmsco.com 888.294.4336<br />

Contact John today at 1.888.294.4336 or by email at jreitzel@consultpmsco.com<br />

and allow his dedication to technology enhance your practice.<br />

A subsidiary of the Pennsylvania <strong>Medical</strong> <strong>Society</strong><br />

<strong>May</strong> <strong>2006</strong><br />

The <strong>Bulletin</strong> u 217


GETTING THERE:<br />

REFLECTIONS OF A RESIDENT PHYSICIAN<br />

Go. Learn. Do.<br />

LYNNE E. WILLIAMS, MD<br />

It’s 2:17 in the morning. The<br />

morning rounds with two American<br />

ringing phone fills the small<br />

medical students, a Kenyan physician-assistant<br />

efficiency where I am staying for my<br />

student, and a Kenyan<br />

month at Tenwek Hospital in Kenya.<br />

medical intern. And I was far outside<br />

“Dr. Lynne,” the nurse says,<br />

my comfort zone in facing children<br />

“….there is a delivery.” Hopping out<br />

dying from malarial meningitis, HIV<br />

of bed, I slip on my shoes. I have<br />

and malnutrition. I had had no<br />

slept in my scrubs. The cool night<br />

experience in treating cutaneous<br />

air greets me as I sprint up to the<br />

anthrax or neonatal tetanus. I longed<br />

hospital. Scattered lights in the<br />

for a supply of indomethicin the<br />

compound can do nothing to<br />

moment I heard the roar of a PDA<br />

diminish the brilliance of the African<br />

murmur in a four-day old boy in the<br />

stars.<br />

Dr. Williams comforts a small patient. nursery. I struggled with how to<br />

I greet the security guard at the<br />

keep a baby alive after his gastroschisis<br />

gate with a smile and “Habari” and in transit, and drops of blood<br />

was corrected in the operating<br />

continue into the hospital. Rushing speckle my shoes before I am able to room. I learned to bandage the<br />

past the 20-bed women’s ward, I refasten it. She has been born early. surgical wounds of skin grafts from<br />

briefly consider that there are 24 By how many weeks, I will never devastating cooking fire burns.<br />

women sleeping there now, strangers know. She is small and perfectly I learned to rely on any resource<br />

sharing beds (not just a room, but formed. And she cries. At each I could find. In the U.S., I was used<br />

beds). On the other side of the hall, resuscitation, that cry of life is my to turning to my senior resident or<br />

children and parents doze under favorite sound.<br />

the attending for final decisions on<br />

mosquito nets as I slip up the stairs. When I arranged a rotation at patient care. For the first time in my<br />

Entering the room next to the this missionary hospital, I did not training, the final decision came<br />

operating theatre, I scan the lit realize I would be involved in so from me. If I didn’t know it, I had to<br />

neonatal resuscitation bed for my many neonatal resuscitations. I must find out. Some of my best resources<br />

equipment: oxygen tubing, a flattened<br />

confess, I did not realize I would be were the Kenyan-trained interns.<br />

face mask, laryngoscope and doing much of what I found myself Their clinical skills far exceeded<br />

rewashed ET tube (stylet has been doing.<br />

mine. Naturally, they also had a<br />

missing for weeks). The family<br />

The pediatrician missionary had better grasp of the diagnosis and<br />

practice doctor stands in the doorway<br />

embraced my arrival with the an-<br />

treatment of the infectious diseases<br />

gowned for the Cesarean, smiles nouncement that he had not had and illnesses common to that area. I<br />

a “Good morning,” and asks if I’m vacation time for months and also learned to use the other “consultants”<br />

ready. My nod and “I-guess-so” happily looked forward to some time<br />

in the hospital: the family<br />

shrug send him back in.<br />

off. Within days, I was promoted practice doctors who were volunteering<br />

Within minutes, Chepkorir is from my usual status as resident to<br />

for months at a time, the surgical<br />

pulled from her warmth and carried that of “consultant.” I became the resident who was spending three<br />

towards me. The cord clamp falls off pediatric attending and ran the months at Tenwek, the missionary<br />

218 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


REFLECTIONS continued<br />

doctors who had lived there for<br />

years. Occasionally I tried the<br />

“dinosaur” computer in the doctor’s<br />

library…but the Internet connection<br />

was too slow for any real work.<br />

Almost nightly, I took a book home<br />

from the library to read up on<br />

another new disease I had encountered.<br />

Yet ready access to “resources” is<br />

not always the answer. Chepkorir<br />

had a difficult first few days of life.<br />

On her second night, the nurses<br />

again called me in. She needed more<br />

oxygen than could be delivered by<br />

nasal cannula tubing. As her respiratory<br />

distress increased, I started to<br />

“bag” ventilate her lungs. The rising<br />

numbers on the flickering pulse ox<br />

machine rewarded my efforts and I<br />

continued. For hours I “bagged” and<br />

pondered what else I could do.<br />

Hours later, I intubated her so that<br />

bagging could be done one-handed,<br />

allowing my free hand to turn pages<br />

of the neonatal intensive care book<br />

looking for guidance.<br />

I became known as the doctor<br />

who doesn’t stop bagging. For I<br />

knew with every squeeze, that the<br />

moment I stopped, the baby would<br />

die. There was no ventilator. There<br />

was no option. Unless the premature<br />

baby’s lungs were somehow mature<br />

enough on their own, there was little<br />

to help them. By early morning, I<br />

knew Chepkorir was not one of<br />

those lucky babies. Her parents were<br />

brought in, and I explained through<br />

an interpreter that there was not<br />

much else I could do for her. I was<br />

emotionally exhausted. Hers would<br />

be the fifth death in the nursery in<br />

the past three days. I felt overwhelmed<br />

by a sense of incompetence.<br />

I was frustrated by the lack of<br />

<strong>May</strong> <strong>2006</strong><br />

There are times that we<br />

physicians face the fact<br />

that we are powerless,<br />

that what we bring to<br />

the situation still may<br />

not be enough.<br />

resources. I was saddened by the<br />

inevitable death of an infant because<br />

there was nothing more I could<br />

offer.<br />

Chepkorir’s parents sat facing me<br />

in the middle of the small nursery.<br />

Other mothers bustled around them,<br />

visiting their infants on the threehour<br />

feeding schedule. I wrapped<br />

Chepkorir in a blanket and placed<br />

her in her father’s arms. As the<br />

parents stroked her hands, tears<br />

streamed down my face and I<br />

thought, “I can’t keep doing this.”<br />

The responsibility felt too great. My<br />

inadequacy felt too deep. I had had<br />

enough. I didn’t want to face another<br />

death, another failure. I looked over<br />

at Chepkorir with such heaviness<br />

within me. In that instant, her face<br />

turned towards me. Her eyes looked<br />

right into my heart and I heard a<br />

voice saying “Lynne, you have done<br />

all that you could. This baby is<br />

coming home.” Suddenly, a peace<br />

settled upon me. Chepkorir smiled.<br />

And stopped breathing.<br />

All my resources had done<br />

nothing to save this little girl. All my<br />

training and preparation could not<br />

keep her heart beating. There are<br />

times that we physicians face the fact<br />

that we are powerless, that what we<br />

bring to the situation still may not<br />

be enough. There are also times that<br />

we learn independence and develop<br />

confidence in what we can do. There<br />

are times we find creative solutions<br />

and times we come up emptyhanded.<br />

It is in these times of<br />

difficulty when we hit our limits that<br />

we find ourselves humbled and<br />

spurred to become better, to learn<br />

more, to offer more, to do more. For<br />

we know that each tiny baby, each<br />

child, each adult we meet is precious<br />

and deserving of our best. I learned<br />

this and more at Tenwek Hospital.<br />

For weeks after returning from<br />

Kenya, I stopped fellow residents in<br />

the halls and said, “Go and learn.”<br />

And I would say the same to you:<br />

Go. Whatever it takes. Go. Learn.<br />

Do.<br />

Dr. Williams is a fourth-year internal<br />

medicine/pediatrics resident at UPMC; she<br />

can be reached at lynne.williams@chp.edu.<br />

The opinion expressed in this column<br />

is that of the writer and does not<br />

necessarily reflect the opinion of the<br />

Editorial Board, the <strong>Bulletin</strong>, or the<br />

<strong>Allegheny</strong> <strong>County</strong> <strong>Medical</strong> <strong>Society</strong>.<br />

Physician Referrals<br />

Did you know we get<br />

calls daily asking for<br />

referrals to physicians?<br />

Be sure your<br />

membership information<br />

is up to date so that<br />

you get connected,<br />

including:<br />

√ Board Certifications<br />

√ Hospital Affiliations<br />

√ E-mail address<br />

√ Correct phone/fax/<br />

address/e-mail<br />

E-mail acms@acms.org or<br />

call (412) 321-5030 and ask for<br />

Nadine Popovich (ext. 110) or<br />

Jim Ireland (ext. 101)<br />

The <strong>Bulletin</strong> u 219


SOCIETY NEWS<br />

Shown above are the student award winners of the Pennsylvania Geriatrics <strong>Society</strong>-<br />

Western Division David C. Martin Award and course directors Judith Black, MD; Neil<br />

Resnick, MD; and Victor Rudkin, MD. Appearing (l. to r.) are: Rocco Serrao, Dr. Black,<br />

Amy Zhang, Nicole Velez, Dr. Resnick, Bryan Ward, Dr. Rudkin and Andrew Fisher.<br />

Details on the March conference appear below.<br />

Conference of the American Geriatrics<br />

<strong>Society</strong>. Since its inception, the<br />

geriatrics society has awarded more<br />

than $23,000 to support medical<br />

student interest in the field of<br />

geriatric medicine.<br />

The clinical update, which<br />

continues to attract registrants from<br />

the tri-state area, is jointly sponsored<br />

by the Pennsylvania Geriatrics<br />

<strong>Society</strong>-Western Division, the<br />

University of Pittsburgh Institute on<br />

Aging, and the University of Pittsburgh<br />

School of Medicine Center<br />

for Continuing Education in the<br />

Health Sciences. The conference,<br />

which was previously awarded the<br />

American Geriatrics <strong>Society</strong> Achievement<br />

Award for Excellence in a<br />

CME program, draws prominent<br />

international lecturers, as well as<br />

nationally renowned local faculty.<br />

For information on becoming a<br />

member of the Pennsylvania Geriatrics<br />

<strong>Society</strong>-Western Division,<br />

contact society administrator Nadine<br />

Popovich, at (412) 321-5030.<br />

Geriatricians meet in Pittsburgh counterpoint discussion regarding<br />

More than 320 participants medical education and practice<br />

attended this year’s Clinical Update abetted by or being corrupted by<br />

in Geriatric Medicine conference “big pharma” was well received. Dr.<br />

held in March at Pittsburgh’s Finucane is affiliated with Johns<br />

Marriott City Center.<br />

Hopkins University School of<br />

Directed by Drs. Victor M. Medicine in Baltimore, and Dr. <strong>Bulletin</strong> reader feedback needed<br />

Rudkin, Judith S. Black and Neil M. Stefanacci is executive director,<br />

The ACMS Editorial Board is<br />

Resnick, the course offered 45 Health Policy Institute in Philadelphia.<br />

readers through a brief survey to be<br />

asking for feedback from <strong>Bulletin</strong><br />

presentations and panels featuring<br />

40 instructors. The conference<br />

At the conference dinner program,<br />

the society recognized recipi-<br />

<strong>Bulletin</strong> Reader Survey appears on<br />

returned by June 1. The <strong>2006</strong><br />

addressed nearly every geriatric<br />

syndrome (including some controversial<br />

areas), and a broad array of Martin Award (see photo, above). online at www.acms.org. Fax to<br />

ents of the prestigious David C. page 224 in this issue and is available<br />

conditions found commonly in This year’s award recipients were Mr. (412) 321-5323 or return by U.S.<br />

older adults and which benefit from Andrew Fisher, Ms. Laura Raducha- mail to ACMS <strong>Bulletin</strong>, 713 Ridge<br />

a geriatric approach.<br />

Grace, Mr. Rocco Serrao, Ms. Nicole Avenue, Pittsburgh, PA 15212. The<br />

Guest speaker Thomas Finucane, Velez, Mr. Bryan Ward and Ms. Amy board members thank you in advance<br />

for your speedy response.<br />

MD, presented a controversial Zhang, all medical students from the<br />

lecture on the effectiveness of drugs University of Pittsburgh School of<br />

in Alzheimer’s. Dr. Finucane also<br />

OSHA update draws crowd<br />

Medicine. Each received a Certificate<br />

of Excellence and an hono-<br />

participated in a dynamic interactive<br />

The ACMS held its <strong>2006</strong> <strong>Medical</strong><br />

Office Occupational Health and<br />

dinner symposium with Richard rarium of $1,050 to present his or<br />

Stefanacci, DO. The spirited point/<br />

OSHA Update on April 12 at<br />

her abstract at the <strong>2006</strong> Annual<br />

220 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


SOCIETY NEWS continued<br />

ACMS recently partnered with Gateway <strong>Medical</strong> <strong>Society</strong> in welcoming Fastone Goma,<br />

MD, who spoke to physicians and medical students on the prevalence of HIV, tuberculosis<br />

and malaria in Africa and measures being taken to treat patients and curb infection<br />

rates. Dr. Goma is family physician, cardiac physiologist, assistant dean of the University<br />

of Zambia <strong>Medical</strong> School and medical director of Mother Teresa’s Hospice in Zambia, a<br />

facility for children and adults with terminal AIDS. Shown here (l. to r.) are: Jeannette<br />

South-Paul, MD, chair, Department of Family Medicine, University of Pittsburgh School<br />

of Medicine; Dr. Goma; Gateway President Anita Edwards, MD; and ACMS President<br />

Terence Starz, MD. Also present were William and Barbara McClure who announced a<br />

$10,000 donation to Mother Teresa’s Hospice from the Pittsburgh Chapter of Safari Club<br />

International.<br />

medical society headquarters. The<br />

annual program drew nearly 100<br />

administrative personnel, physicians<br />

and nurses, and featured information<br />

on blood-borne pathogens, workplace<br />

stress, disaster planning and<br />

preparedness, as well as the latest<br />

information on occupational health<br />

and safety. Robert Szmanski, who<br />

serves as area director at the Pittsburgh<br />

Area Office of the U.S.<br />

Department of Labor/OSHA,<br />

presented the OSHA update.<br />

Faculty members also included<br />

moderator Joseph J. Schwerha, MD,<br />

MPH; Andrew Greenwood, MD;<br />

Samuel Stebbins, MD; and John P.<br />

Uribe, MD, MPH.<br />

<strong>May</strong> <strong>2006</strong><br />

Measuring patient satisfaction<br />

The Pennsylvania <strong>Medical</strong><br />

<strong>Society</strong> is making available a free<br />

booklet and a ready-to-use patient<br />

satisfaction survey to improve<br />

physician practice and make patients<br />

happier. The manual, Patient Satisfaction:<br />

A Must for Every Practice,<br />

outlines five benefits of doing<br />

satisfaction surveys in a medical<br />

practice:<br />

1. more positive relationships with<br />

patients,<br />

2. a growing patient base through<br />

positive word-of-mouth,<br />

3. reduced liability risk by uncovering<br />

problems easily,<br />

4. demonstrated satisfaction levels to<br />

Drs. Mary Ann Miknevich (top center,<br />

bottom left) and Robert Trivus served as<br />

sponsor judges at the <strong>2006</strong> Pittsburgh<br />

Regional Science and Engineering Fair in<br />

March. ACMS annually sponsors two<br />

awards, this year going to Central Catholic<br />

High School junior Philip Dulac (top left)<br />

for Will TAML + H 2<br />

O 2<br />

Inhibit Viruses?,<br />

and Shady Side Academy junior Sumedha<br />

Chablani (bottom center) for Comparison:<br />

PET/CT Scan and CT Scan.<br />

insurance companies and hospitals,<br />

5. happier patients meaning a better<br />

quality of life for physicians and<br />

their office staff.<br />

The booklet and sample survey<br />

were prepared by the practice management<br />

experts of PMSCO<br />

Healthcare Consulting, a subsidiary<br />

of the Pennsylvania <strong>Medical</strong> <strong>Society</strong>.<br />

The cost is free to members; it is not<br />

available to non-members. Order by<br />

logging onto www.pamedsoc.org/<br />

shop or calling (800) 228-7823.<br />

continued on page 222<br />

The <strong>Bulletin</strong> u 221


SOCIETY NEWS continued from page 221<br />

Abraham Twerski, MD, spoke to physician<br />

colleagues on Recharging Your Professional<br />

Battery: Managing Your Idealism in the<br />

Face of a Challenging Environment on April<br />

26 at the Herberman Conference Center,<br />

UPMC Shadyside. Sponsoring the event<br />

were Torah One On One, the Ladies<br />

Hospital Aid <strong>Society</strong> of Western Pennsylvania,<br />

University of Pittsburgh School of<br />

Medicine Center for Continuing Education<br />

in the Health Sciences, the Jewish<br />

Healthcare Foundation, and the <strong>Allegheny</strong><br />

<strong>County</strong> <strong>Medical</strong> <strong>Society</strong>. Pictured (l to r)<br />

are: Torah’s Rabbi Yaakov Rosenstein, Dr.<br />

Twerski; ACMS President Terence W.<br />

Starz, MD; and June Yonas, president of<br />

the Ladies Hospital Aid <strong>Society</strong>.<br />

NOW OPEN<br />

<strong>Allegheny</strong> Imaging of McCandless<br />

Providing quality subspecialty imaging services to the communities of Pittsburgh North<br />

We offer a full range of diagnostic imaging services, including:<br />

• MRI/MRA<br />

Women's Imaging Services:<br />

• CT • Digital Screening Mammography • Breast Ultrasound and Core Biopsy<br />

• Ultrasound • Digital Diagnostic Mammography • Bone Densitometry (DEXA)<br />

• Nuclear Medicine<br />

• General Radiography/Fluoroscopy<br />

9335 McKnight Road . . . located just minutes from Ross Park Mall<br />

Office Hours: Monday through Friday, 8:00 A.M. to 5:00 P.M. Evenings and Weekends by Appointment<br />

(412) 367-7226 (SCAN), Fax: (412) 367-3103<br />

Directions...Take McKnight Road north approximately 3 miles past Ross Park Mall. Turn left onto Arcadia Court<br />

at the Outback Steakhouse. Make an immediate left behind the restaurant and proceed to the last building<br />

on your right.The Imaging Center is on the first floor to your left as you enter.<br />

222 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


The INTERIOR You’ve Always<br />

Wanted is Closer Than You Think<br />

RESIDENTIAL<br />

COMMERCIAL<br />

· Custom Window<br />

Treatments<br />

· Fine Furniture<br />

· Upholstery<br />

· Wall Coverings<br />

· Accessories<br />

· Lighting<br />

· Floor Coverings<br />

· Area Rugs<br />

· Custom Bedding<br />

· Blinds & Shades<br />

Designing with the human experience<br />

in mind recognizes your patient’s<br />

image of high quality healthcare<br />

delivery. Let my twenty years of healthcare<br />

experience help you create that<br />

we care” image.<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

For a complimentary consultation call<br />

Nancy Sakino Spears LLC<br />

(412) 480-9922<br />

nsakinospears@decoratingden.com<br />

w w w . D e c o r a t i n g D e n . c o m<br />

<strong>May</strong> <strong>2006</strong><br />

<br />

The <strong>Bulletin</strong> u 223


<strong>2006</strong> <strong>Bulletin</strong> Readership Survey<br />

In 2003 when the medical society wanted to update the look and content of the <strong>Bulletin</strong>, we turned to our readers<br />

to help determine those changes and found your feedback invaluable. Now we are asking for your opinion once<br />

again. Please complete this brief survey by June 1 and FAX it to (412) 321-5323 or mail it to ACMS, 713 Ridge<br />

Ave., Pittsburgh PA 15212. To complete the survey online, log on to www.acms.org. Results will be published in<br />

an upcoming <strong>Bulletin</strong>.<br />

The Editorial Board is discussing the possibility of changing the <strong>Bulletin</strong> from black & white pages to a fullcolor<br />

magazine Please indicate your response to items below by circling a number, with 5 being most favorable<br />

and 1 least favorable:<br />

Agree<br />

Disagree<br />

Color pages inside the <strong>Bulletin</strong> would make<br />

the articles more interesting. ................................................ 5 ........ 4 ........ 3 ........ 2 ........ 1<br />

I would be more likely to read more of the <strong>Bulletin</strong><br />

if the inside pages were in color instead of black & white. . 5 ........ 4 ........ 3 ........ 2 ........ 1<br />

I would be more likely to look at the advertisements<br />

if they were in color instead of black & white..................... 5 ........ 4 ........ 3 ........ 2 ........ 1<br />

The added cost to publish a full-color magazine is<br />

worth consideration. ............................................................ 5 ........ 4 ........ 3 ........ 2 ........ 1<br />

I like the <strong>Bulletin</strong> the way it is right now; don’t change<br />

anything. .............................................................................. 5 ........ 4 ........ 3 ........ 2 ........ 1<br />

I am more likely to take editorial information seriously<br />

in a black & white format. ................................................... 5 ........ 4 ........ 3 ........ 2 ........ 1<br />

A full-color format would not significantly improve the<br />

<strong>Bulletin</strong> considering the increased production cost. ............ 5 ........ 4 ........ 3 ........ 2 ........ 1<br />

How do you feel about the length of the <strong>Bulletin</strong> (check one):<br />

____ Too few pages ____ Just right ____ Too many pages<br />

How would you prefer to receive the <strong>Bulletin</strong>? (check one):<br />

____ The traditional hard copy in the mail<br />

____ via the Internet, with an e-mail prompt monthly that the issue is available<br />

PLEASE RESPOND<br />

by JUNE 1st<br />

Type of respondent (check one): ____<strong>Medical</strong> Student ____Intern/Resident/Fellow ____Active ____Retired<br />

Please list below topics you would like to see covered in the following <strong>Bulletin</strong> columns:<br />

Features: ________________________________________________________________________<br />

Practice Management Reports _______________________________________________________<br />

Legal Reports ____________________________________________________________________<br />

Your Additional Comments: ________________________________________________________<br />

_______________________________________________________________________________<br />

_______________________________________________________________________________<br />

224 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


DEAR<br />

DOCTOR<br />

IN MEMORIAM<br />

Robert L. Waltrip,<br />

MD, orthopedic<br />

surgery, wrote that<br />

getting prompt<br />

injury treatment for<br />

children is important.<br />

He explained<br />

Dr. Waltrip<br />

that, because children are still<br />

growing, not treating injuries in a<br />

timely manner can<br />

cause problems for the<br />

child in the future.<br />

The Dear Doctor column is published<br />

regularly in the Pittsburgh Post-Gazette’s<br />

Health Section. To contribute a Dear Doctor<br />

column, call Elizabeth Fulton at (412) 321-<br />

5030 or e-mail efulton@acms.org.<br />

Edward L. Bamonte, MD, age 76,<br />

passed away on April 22. A family<br />

practitioner, Dr. Bamonte graduated<br />

from Hahnemann <strong>Medical</strong> College<br />

in 1954 and completed a residency<br />

at Shadyside Hospital. After serving<br />

in the U.S. Army during the Korean<br />

War, he began a practice in 1957 in<br />

Bloomfield and at Shadyside Hospital.<br />

Dr. Bamonte served as president,<br />

vice president and secretary-treasurer<br />

of the medical staff at Shadyside and<br />

was a founding board member of the<br />

Shadyside Hospital Foundation. He<br />

also directed Carnegie Mellon<br />

University Health Department from<br />

1965 to 1985. Dr. Bamonte is<br />

survived by his wife Miriam; daughters<br />

Anna Torrance, Julie Burgo and<br />

Mia Rochte; sons, Anthony and<br />

Edward Jr.; and nine grandchildren.<br />

Ruben A. Tenicela, MD, age 76,<br />

passed away on March 27. Board<br />

certified in anesthesiology, Dr.<br />

Tenicela graduated in medicine from<br />

Universidad Nacional <strong>May</strong>or de San<br />

Marcos, Programa Academico de<br />

Medicina Humana in Lima, Peru, in<br />

1960. He held an internship at St.<br />

Joseph’s Hospital and residencies at<br />

Francis Scott Key <strong>Medical</strong> Center in<br />

Baltimore, Maryland, and UPMC<br />

Presbyterian. Dr. Tenicela practiced<br />

pain management as the director of<br />

UPMC’s pain clinic and was a<br />

professor at the University of Pittsburgh<br />

School of Medicine for more<br />

than 25 years. He is survived by his<br />

son Anthony.<br />

Editor’s Note: Please see page 229<br />

for a tribute to Dr. Edward Curtiss who<br />

passed away in February.<br />

<strong>May</strong> <strong>2006</strong><br />

Member Benefit<br />

Dear Doctor<br />

Would you like to share your<br />

expertise with more than 240,000<br />

Pittsburgh Post-Gazette readers?<br />

Each “Dear Doctor” column<br />

features a different physician.<br />

This opportunity is available only<br />

to ACMS members. Call<br />

Elizabeth Fulton at 412-321-<br />

5030, ext.100 for details.<br />

Working for Physicians.<br />

Gateway <strong>Medical</strong> <strong>Society</strong><br />

presents<br />

Reducing Health Care Disparities While Ensuring the Survival of<br />

the Health Care Provider in the Era of Evidence Based Medicine<br />

Saturday, June 10, <strong>2006</strong>, 9:00 a.m. to 3:00 p.m.<br />

Herberman Auditorium<br />

UPMC Hillman Cancer Center<br />

5150 Centre Avenue, Shadyside<br />

The symposium objectives are to:<br />

• Build effective communication strategies between health care providers and patients<br />

that can engage patients and improve health outcomes<br />

• Develop a stronger understanding of communication and relationship patterns that<br />

support or detract from effective care<br />

• Provide an overview of the new Medicare Prescription Drug Program and practice<br />

based pay for performance programs and discuss their impact on the survival of<br />

health care providers caring for patients who have higher rates of chronic diseases<br />

• Define features of the new Medicare Prescription Drug Program, pay for performance,<br />

quality reporting and reimbursement programs that may impact the survival of<br />

practices serving greater numbers of racial and ethnic minority patients<br />

• Identify “real time” strategies for reducing health care disparities.<br />

For more information, contact Gateway <strong>Medical</strong> <strong>Society</strong> at 412-281-4086.<br />

The <strong>Bulletin</strong> u 225


ACTIVITIES &<br />

ACCOLADES<br />

Terence W. Starz, MD, rheumatology and internal medicine, was awarded the Richard<br />

Harris Award for Clinical Volunteer Faculty, Department of Medicine. Dr. Starz was<br />

recognized for his excellence in patient care at the <strong>Medical</strong> Grand Rounds honoring Dr.<br />

Harris on April 7. Shown here (l. to r.) are: Ms. Ronna Harris, Dr. Starz, Dr. Wishwa N.<br />

Kapoor and Ms. Jody Starz.<br />

Christopher J. Daly,<br />

MD, general surgery,<br />

spoke at a conference<br />

in March at the<br />

Emergency Care<br />

Research Institute in<br />

Dr. Daly Plymouth Meeting.<br />

The conference, “Transforming<br />

Surgical Care: Moving from Good<br />

to Great,” was co-sponsored by<br />

Health Alliance of Pennsylvania and<br />

Quality Insights of Pennsylvania. Dr.<br />

Daly presented The Principles of<br />

Surgical Care, a topic he repeated at<br />

a meeting of the Hospital Council of<br />

Western Pennsylvania; also, in April,<br />

he spoke on patient safety at Carlisle<br />

Regional <strong>Medical</strong> Center.<br />

The Pittsburgh<br />

Tribune-Review<br />

featured Andrew<br />

Fisher as a “Newsmaker”<br />

in April. A<br />

medical student at<br />

Mr. Fisher<br />

the University of<br />

Pittsburgh <strong>Medical</strong> School, Mr.<br />

Fisher recently received the American<br />

<strong>Medical</strong> Association Leadership<br />

Award and the David C. Martin<br />

Award for Academic Excellence.<br />

Several physician were listed in a<br />

special “Top Physicians” issue of<br />

Hospital News in March, including<br />

Drs. Dennis K. Gabos, cardiovascular<br />

disease; David S. Parda, radiation<br />

oncology; Richard K. Shadduck,<br />

internal medicine; and Thomas E.<br />

Starzl, surgery.<br />

Terri Johnson from<br />

the Observer-Reporter<br />

in Washington,<br />

Pennsylvania, recently<br />

interviewed<br />

Dennis J. Hurwitz,<br />

Dr. Hurwitz MD, plastic surgery,<br />

for an article on his Total Body Lift TM<br />

procedure.<br />

Hospital News profiled<br />

Eugene N.<br />

Myers, MD, otolaryngology,<br />

in its<br />

March issue. The<br />

University of Pittsburgh<br />

School of<br />

Dr. Myers<br />

Medicine honored Dr. Myers with a<br />

Distinguished Professor of the<br />

University designation.<br />

The Pennsylvania<br />

Senate confirmed<br />

Carol E. Rose, MD,<br />

anesthesiology, to the<br />

State <strong>Medical</strong> Board<br />

in March. Dr. Rose is<br />

Dr. Rose<br />

a past-president of<br />

the Pennsylvania <strong>Medical</strong> <strong>Society</strong>.<br />

Dr. Waltrip<br />

The American<br />

Academy of Orthopedic<br />

Surgeons<br />

recently inducted<br />

Robert L. Waltrip,<br />

MD, orthopedic<br />

surgery, as a fellow<br />

during the academy’s 73 rd annual<br />

meeting in Chicago. The Pittsburgh<br />

Tribune-Review featured Dr. Waltrip<br />

as a “Newsmaker” in April for this<br />

accomplishment.<br />

Rob Amen of the Pittsburgh Tribune-<br />

Review interviewed Drs. Tony<br />

Farah, cardiovascular disease, and<br />

Abraham Twerski, psychiatry, for an<br />

article on spirituality in medicine.<br />

226 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


COMMUNITY NOTES<br />

St. Clair Hospital<br />

recently awarded G.<br />

Alan Yeasted, MD,<br />

internal medicine,<br />

with a Physician<br />

Recognition Award,<br />

Dr. Yeasted given annually to a<br />

member of the medical staff who<br />

embodies the qualities of professionalism,<br />

service to the hospital and<br />

greater community, and care of<br />

patients.<br />

Send your Activities & Accolades items to the<br />

attention of Elizabeth Fulton at ACMS, 713<br />

Ridge Ave., Pittsburgh, PA 15212 or e-mail<br />

efulton@acms.org. We also encourage you to<br />

send a recent photograph indicating whether<br />

or not it needs to be returned.<br />

Women’s health<br />

As part of its “Health for Her”<br />

initiative, Jefferson Regional <strong>Medical</strong><br />

Center will present a panel discussion<br />

on Embracing Life’s Journey:<br />

Healthy Aging on June 8 from 5:30 to<br />

7:30 p.m. at its James Bibro Pavilion.<br />

The session is free, but advance<br />

registration is required. To register or<br />

for more information, call (412)<br />

469-7100.<br />

Celebrity golf classic<br />

The Larry Richert American<br />

Cancer <strong>Society</strong> Celebrity Gold<br />

Classic begins with a 12 noon<br />

shotgun start on June 9 at the<br />

Longue Vue Country Club in<br />

Verona. Proceeds from the event will<br />

benefit cancer patient programs and<br />

services of the cancer society’s<br />

Pittsburgh Chapter. For more<br />

information on the golf match,<br />

contact Leanne Schepner at (412)<br />

919-1044 or leanne.schepner@<br />

cancer.org.<br />

Senior exercises<br />

Jefferson Regional <strong>Medical</strong><br />

Center Senior Services is offering<br />

10-week health and wellness classes<br />

this summer beginning in early June,<br />

including aerobic dancing, weight<br />

training, yoga and more. Class size is<br />

limited, and the cost for most classes<br />

is $40; free parking is available. For<br />

more information, call (412) 469-<br />

7099.<br />

A series of health information presentations by UPMC<br />

Are you interested in weight loss surgery? Have you tried to lose weight?<br />

Are you still more than 100 pounds over your ideal body weight?<br />

WEIGHT LOSS SURGERY: GET THE FACTS<br />

Two sessions each month,<br />

6to8p.m.<br />

UPMC St. Margaret<br />

Conference Center<br />

815 Freeport Road<br />

Aspinwall<br />

Attendance at this program is by<br />

reservation only. For more information<br />

or to register, call 412-784-5900 or<br />

1-800-935-3309.<br />

UPMC St. Margaret’s bariatric program is<br />

designated a HealthAmerica and CIGNA<br />

Bariatric Center of Excellence. The program is<br />

accredited by the Surgical Review<br />

Corporation, a partner of the American<br />

<strong>Society</strong> of Bariatric Surgeons<br />

If you answered “Yes” to any of the questions listed above, plan to attend one of<br />

these free educational sessions. Learn about specialized surgery techniques including<br />

gastric bypass and adjustable LAP-BAND ® , criteria for a likely surgical candidate,<br />

and the serious commitment needed to achieve significant loss of excess<br />

weight. Sessions are led by Robert Quinlin, MD, medical director, UPMC St.<br />

Margaret Bariatric Program.<br />

Those considering the surgery are encouraged to attend the lecture with a family<br />

member or friend.<br />

www.upmc.com<br />

<strong>May</strong> <strong>2006</strong><br />

The <strong>Bulletin</strong> u 227


USI COLBURN<br />

is the endorsed<br />

insurance administrator<br />

for The <strong>Allegheny</strong> <strong>County</strong><br />

<strong>Medical</strong> <strong>Society</strong>.<br />

U S I C O L B U R N I N S U R A N C E S E R V I C E<br />

Specializing in<br />

offering members<br />

single-source access to<br />

a broad spectrum of<br />

quality products<br />

and services.<br />

1.800.327.1550<br />

www.colburn.com/acms<br />

228 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


Tributes to a Mentor:<br />

Edward Curtiss, MD<br />

Dr. Edward Curtiss was an outstanding<br />

physician, educator and administrator who<br />

served as a brilliant mentor in cardiology<br />

and also on how to be a physician. His<br />

passing in February leaves a great void;<br />

however, his lessons and memory will live<br />

on for so many of us. Dr. Curtiss understood<br />

that mentors play a fundamental role<br />

in the development of medical trainees.<br />

A significant element of medical education<br />

is an apprenticeship with students and<br />

graduates learning both the practice and<br />

the art of medicine from their teachers. By<br />

remembering the lessons of our mentors,<br />

we are challenged to counsel and serve as<br />

models for our younger colleagues.<br />

Not only did Dr. Curtiss mentor young medical<br />

colleagues in training, but he gave many<br />

individuals the opportunity to fulfill their<br />

goals of becoming physicians. As senior<br />

associate dean for admissions and financial<br />

aid, he actively sought non-traditional<br />

students. Dr. Curtiss understood that attracting<br />

physicians from diverse cultural backgrounds<br />

was essential in the evolution of our<br />

health care systems.<br />

Upon the death of Dr. Curtiss, many of his<br />

former trainees expressed a similar sentiment:<br />

“He changed my life.” Below are a few<br />

fond memories of Dr. Curtiss as physician,<br />

mentor and teacher.<br />

Terence W. Starz, MD<br />

Dr. Starz is an internist/rheumatologist and the<br />

president of the ACMS.<br />

I knew Dr. Ed Curtiss best in his role as senior<br />

associate dean of the University of Pittsburgh<br />

School of Medicine Admissions and<br />

Financial Aid. He led admissions for 16 years<br />

and put his stamp clearly upon the process.<br />

Ed was a meticulous man with a excellent<br />

memory and a sharp, analytical mind. He<br />

closely examined every medical school applicant<br />

to see if he or she was the right fit for<br />

our school. He was passionate about equal<br />

opportunity for women, and he rapidly<br />

changed the medical school composition from<br />

having a rather scarce number of women to<br />

approximately 50 percent women. He was<br />

equally attentive to those who were disadvantaged<br />

in any way. We mourn the passing<br />

of an exceptional person.<br />

Beth Piraino, MD<br />

Dr. Piraino is professor of medicine and associate<br />

dean of admissions and financial aid at the University<br />

of Pittsburgh School of Medicine.<br />

Dr. Edward Curtiss had a tremendous impact<br />

on my decision to attend University of Pittsburgh<br />

School of Medicine. I was a New Yorker<br />

who had lived in other major cities around<br />

the country, so Pittsburgh did not immediately<br />

jump out at me as a place that I could<br />

spend four years. Dr. Curtiss, also born and<br />

raised in New York, proved to me otherwise<br />

by his own example. Not only did he practice<br />

here, but he raised his family in his<br />

adopted hometown.<br />

Candid, outspoken, concerned: These are<br />

attributes that I believe truly applied to Dr.<br />

Curtiss, a man I regarded as a mentor. After<br />

my arrival, I did not just become a nameless<br />

face among some 600 students. Regardless<br />

of however brief an encounter in<br />

the halls, for example, he continued to show<br />

genuine interest in my progress and maintained<br />

an open door policy to his office. I<br />

aspire in my own medical career to emulate<br />

the integrity he showed by the graceful example<br />

of his own life and career.<br />

Jean Gauvin<br />

Ms. Guavin is a student at the University<br />

of Pittsburgh School of Medicine.<br />

No matter how busy he was, there was<br />

never a time when he wouldn’t push his work<br />

aside to look at an interesting EKG, while<br />

leaving you with the baffling feeling that you<br />

did him the favor.<br />

Keith T. Kanel, MD<br />

Dr. Kanel is an internist.<br />

I remember Dr. Curtiss’ expertise and enthusiasm<br />

while reviewing my patients’ difficult<br />

EKGs during my internal medicine residency<br />

in the late seventies.<br />

Gary Tabas, MD<br />

Dr. Tabas is associate professor of medicine at the<br />

University of Pittsburgh School of Medicine.<br />

<br />

<br />

<br />

<br />

<strong>May</strong> <strong>2006</strong><br />

The <strong>Bulletin</strong> u 229


CONTINUING<br />

EDUCATION<br />

Cuppy Kraft 412 521-5500 ext 258<br />

Specializing in the listing and sale<br />

of distinctive residential properties.<br />

Squirrel Hill $1,400,000<br />

On Bennington Avenue, a charming Georgian<br />

with tree shaded lawns and terraced gardens.<br />

Laurel Highlands<br />

$949,500<br />

15 th ANNUAL CASE MANAGEMENT CONFERENCE —<br />

<strong>May</strong> 31-June 2. Seven Springs Mountain Resort. Sponsor:<br />

Western Psychiatric Institute & Clinic, et al. For information,<br />

contact Joanne Slappo (412) 605-1227 orslappojm@upmc.edu.<br />

20 TH COMBINED SKIN PATHOLOGY COURSE —Sept. 8-13. Hyatt<br />

Regency Pittsburgh International Airport. Sponsor: <strong>Medical</strong><br />

Education Resources. Approved for Category 1 Credit. For<br />

information, contact Alan R. Silverman, MD, (412) 682-3083<br />

or visit www.mer.org/specconfinfo.cfm?sid=20.<br />

ONGOING CONTINUING EDUCATION PROGRAMS & CONFERENCES.<br />

Sponsor: Western Psychiatric Institute & Clinic, et al. CME<br />

available. For information, call (412) 624-2523 or log on to<br />

www.wpic.pitt.edu/oerp.<br />

ONGOING MENTAL ILLNESS & SUBSTANCE ABUSE (MISA) TRAIN-<br />

ING SERIES. Sponsor: Western Psychiatric Institute & Clinic, et<br />

al. CME available. For information, call (412) 605-1227 or e-<br />

mail slappojm@msx.upmc.edu.<br />

This listing includes local events that are coming up soon; a more<br />

complete list is available on the medical society’s website at<br />

www.acms.org or by calling (412) 321-5030.<br />

23 acre weekend retreat sold furnished with exceptions.<br />

<strong>Medical</strong> Review Officer Training<br />

(Special CME Programs)<br />

Living Room<br />

Oakland<br />

5 Stall Barn<br />

$542,500<br />

This highly acclaimed training series provides<br />

physicians with the technical, legal and business<br />

information, procedures and guidance to act as<br />

<strong>Medical</strong> Review Officers in federally regulated and private<br />

sector workplace drug and alcohol testing programs.<br />

MRO certification is a valuable credential in occupational<br />

medicine and is required by some state drug testing laws<br />

and the U.S. Department of Transportation.<br />

Seventh floor, three bedroom apartment with panoramic views.<br />

Shadyside $519,000<br />

Sleek and sophisticated renovation by Frangos Development.<br />

Take a visual tour of these and other properties marketed exclusively<br />

by Cuppy at www.PrudentialPreferredRealty.com<br />

Comprehensive MRO Training and Certification Exam<br />

August 11–13, <strong>2006</strong> New York, NY<br />

Grand Hyatt, Park Avenue at Grand Central<br />

AAFP approved for 21.75 hours<br />

MRO Update and Training Program<br />

August 12–13, <strong>2006</strong> New York, NY<br />

Grand Hyatt, Park Avenue at Grand Central<br />

AAFP approved for 13.75 hours<br />

For Information and Registration<br />

Call 800/489-1839<br />

919/489-5407<br />

Fax 919/490-1010<br />

Write P.O. Box 12873<br />

Research Triangle Park, NC 27709<br />

www.AAMRO.com<br />

230 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


MAY/JUNE<br />

CALENDAR<br />

<strong>May</strong> 25 is National Missing Children’s Day, and <strong>May</strong><br />

is the month for the following national awareness<br />

programs: high blood pressure education, osteoporosis<br />

awareness and prevention, and<br />

sightsaving. June 4 is National Cancer Survivors<br />

Day and June 12-18 is National Men’s Health Week.<br />

(Source: U.S. Dept. of Health and Human Services)<br />

<strong>May</strong> 23, 6 pm ................. ACMS Board of Directors<br />

<strong>May</strong> 24, 5:30 pm ............ Pittsburgh Pathology <strong>Society</strong><br />

<strong>May</strong> 25, 11 am-5 pm ....... Health Care Seminar<br />

Alpern Rosenthal<br />

<strong>May</strong> 29 ........................... Memorial Day: ACMS office closed<br />

<strong>May</strong> 31, 5 pm ................. Pittsburgh Pediatric <strong>Society</strong><br />

June 1, 5:30 pm ............. ACMS Foundation Board<br />

June 2, 8 am-12:15 pm .. Diversity Symposium<br />

Herberman Conference Center<br />

June 5, 6 pm .................. ACMS Editorial Board<br />

June 10-13 ..................... PMS House of Delegates<br />

You take care<br />

of your patients.<br />

We’ll take care<br />

of your billing.<br />

The ACMS <strong>Bulletin</strong>’s<br />

First-Ever Writing Contest<br />

Tap Your Funny Bone and<br />

Give Us Your Best Humorous Anecdote,<br />

short story or poem.<br />

Humor is the key word!<br />

Contest Guidelines will be available June 12.<br />

Call (412) 321-5030 or download from the<br />

medical society’s website at www.acms.org.<br />

Guidelines also will appear in<br />

the June 17 <strong>Bulletin</strong>.<br />

Entry Deadline is<br />

Friday, August 11<br />

BILLING AT A HIGHER STANDARD<br />

Pennsylvania<br />

Ohio<br />

412-788-8007 • 330-758-2775<br />

fennercorp.com<br />

<strong>May</strong> <strong>2006</strong><br />

The <strong>Bulletin</strong> u 231


PILL BOX<br />

Tdap Vaccines:<br />

Which, When and How?<br />

NOREEN H. CHAN-TOMPKINS, PHARMD<br />

Bordetella pertussis is a gram-negative coccobacillus<br />

that causes acute respiratory tract illness,<br />

characterized by paroxysmal cough, post-tussive<br />

vomiting and inspiratory whoop. It is highly contagious<br />

and can be transmitted via aerosolized droplets of<br />

respiratory secretions or by direct contact with the<br />

respiratory secretions from an infected person. 1,2 Infants<br />

less than six months of age are at highest risk of pertussis-related<br />

complications and death compared with older<br />

age groups. Although most children are protected<br />

against pertussis because of childhood vaccinations,<br />

immunity decreases over time. In 2004, 7,008 of 25,827<br />

(27%) reported pertussis cases in the United States were<br />

in adults 19–64 years of age. In 2003, the overall U.S.<br />

incidence rate was 10.9 per 100,000 population for ages<br />

10-19 years. Specifically for Pennsylvania, the average<br />

annual incidence of reported pertussis was 215 cases in<br />

persons ages 10-19 years. 1-3<br />

In 2005, the Food and Drug Administration (FDA)<br />

approved two brand names of Tetanus, diphtheria, and<br />

pertussis (Tdap) vaccines. On <strong>May</strong> 3, it approved<br />

Boostrix ® for persons 10-18<br />

years of age as a single dose<br />

booster vaccine;<br />

subsequently, on<br />

June 10, the<br />

FDA approved a second Tdap vaccine, Adacel TM as a<br />

single dose booster vaccine for persons 11-64 years of<br />

age. 3 This article briefly reviews the two vaccines with an<br />

emphasis on the pertussis component; it also reviews the<br />

Advisory Committee on Immunization Practices (ACIP)<br />

recommendations for Tdap vaccines.<br />

Boostrix ®<br />

GlaxoSmithKline Biological manufactures Boostrix,<br />

which contains tetanus toxoid, diphtheria toxoid, and<br />

pertussis antigens adsorbed to aluminum hydroxide. The<br />

three acellular pertussis antigens are: inactivated pertussis<br />

toxin (PT), formaldehyde-treated filamentous hemagglutinin<br />

(FHA) and pertactin. The antigens are the same<br />

as those in Infanrix ® (pediatric Diphtheria and Tetanus<br />

toxoids and acellular Pertussis vaccine adsorbed-DTaP),<br />

but Boostrix is formulated with reduced quantities of<br />

these antigens. Each 0.5-mL dose contains 2.5 Lf (limit<br />

of floculation unit) of diphtheria toxoid, 5 Lf of tetanus<br />

toxoid, 2.5 mcg of pertactin, 8 mcg of FHA, and 8 mcg<br />

of inactivated PT; other components per 0.5 mL dose<br />

includes 4.5 mg sodium chloride,<br />

not more than 0.39 mg aluminum<br />

adjuvant,


0.1 IU/mL, an increase of at least four times the prevaccination<br />

concentration). For anti-tetanus antibody<br />

response, the Boostrix booster response was 89.7%<br />

(88.4-90.8, 95% confidence interval [CI] vs. 92.5%<br />

(90.5-94.2, 95% CI) in the Td arm. For anti-diphtheria<br />

antibody response, the Boostrix booster response was<br />

90.6% (89.4-91.7, 95% CI) vs. 95.9% (94.4-97.2, 95%<br />

CI) in the Td arm. For the pertussis component, the<br />

immune response of a single Boostrix dose was compared<br />

to the immune response of infants following a<br />

three-dose primary series of Infanrix. The pertussis<br />

booster response was defined as: in initially seronegative<br />

subjects (20 EL.U./mL. In initially seropositive<br />

subjects with pre-vaccination antibody concentrations<br />

>5 EL.U./mL and 20 EL.U./mL, an increase of<br />

at least two times the pre-vaccination antibody concentration.<br />

The booster response ranged between 84.5-<br />

95.4% for the pertussis antigens. 4 (See Table 1, page 234.)<br />

Solicited adverse events were assessed in the United<br />

States Safety study within 15 days of vaccination with<br />

Boostrix (n=3,032 denominator) or Td (n=1,013 denominator).<br />

The most common local adverse reactions<br />

were as follows (Boostrix vs. Td, respectively): pain<br />

(75.3% vs. 71.7%), redness (22.5% vs. 19.8%), and<br />

swelling at the injection site (21.1% vs. 20.1%). The<br />

most common general adverse events were headache<br />

(43.1% vs. 41.5%) and fatigue (26.0% vs. 25.8%).<br />

Fever >100.4º Fahrenheit occurred in 5.0% in the<br />

Boostrix arm vs. 4.7% in the Td arm. 4<br />

The FDA-approved dose of Boostrix is a single 0.5<br />

mL intramuscular (IM) injection into the deltoid muscle<br />

continued on page 234<br />

<strong>May</strong> <strong>2006</strong><br />

Are you doing everything you can to<br />

help your patients stop smoking?<br />

Youandyourstaffareinvitedtoattendafree<br />

Clean Air for Healthy Children and Families Smoking<br />

cessation counseling training at<br />

Tobacco Free <strong>Allegheny</strong><br />

One <strong>Allegheny</strong> Square, Suite 101<br />

Pittsburgh, PA 15212<br />

June 6, <strong>2006</strong> 1:30 - 3:30 p.m.<br />

or<br />

June 7, <strong>2006</strong> 9:30 - 11:30 a.m.<br />

As a result of this training you and your staff will:<br />

Learn a brief smoking cessation intervention.<br />

Be motivated to refer patients to the PA Free<br />

Quitline and community resources.<br />

Receive information on pharmacotherapy and<br />

reimbursement<br />

Learn how to integrate the 5As/ 2As and R into your<br />

office routine.<br />

Receive patient materials and practice tools.<br />

ReceivefreeCME/CEUcredits<br />

Receive information on coding and billing for<br />

counseling<br />

To register call<br />

(484) 446-3002 or (724) 327-2756<br />

by June 1, <strong>2006</strong><br />

The <strong>Bulletin</strong> u 233


PILL BOX continued from page 233<br />

Table-1. Booster Responses to the Pertussis Antigens<br />

Following Boostrix ® in Individuals 10 to 18 Years of Age 4<br />

N Boostrix ®<br />

% Booster Response (95% CI)<br />

Anti-PT 2,677 84.5 (83.0-85.9)<br />

Anti-FHA 2,744 95.1 (94.2-95.9)<br />

Anti-pertactin 2,752 95.4 (94.5-96.1)<br />

of the upper arm in persons 10 to 18 years of age. There<br />

are no data to support repeat administration of Boostrix<br />

and it should not be administered subcutaneously or<br />

intravenously. 4 The wholesale acquisition cost of one 0.5<br />

mL dose is $119.<br />

Adacel TM<br />

Aventis Pasteur Inc. manufactures Adacel, which<br />

contains tetanus toxoid, reduced diphtheria toxoid and<br />

acellular pertussis (Tdap) adsorbed to aluminum phosphate.<br />

The five acellular pertussis vaccine components<br />

are detoxified pertussis toxin (PT), filamentous hemagglutinin<br />

(FHA), pertactin (PRN), and fimbriae (FIM)<br />

types 2 and 3. Each 0.5-mL dose of Adacel contains the<br />

following active ingredients: 5 Lf of tetanus toxoid, 2 Lf<br />

of diphtheria toxoid, 2.5 mcg of PT, 5 mcg of FHA, 3<br />

mcg of pertactin, and 5 mcg of fimbriae types 2 and 3.<br />

Other ingredients per dose include 1.5 mg aluminum<br />

phosphate (0.33 mg aluminum) as the adjuvant, 100.4°F (1.4% vs. 1.1%). 5<br />

The FDA-approved dose of Adacel vaccine is 0.5 mL<br />

IM as a single injection. The preferred site is into the<br />

deltoid muscle. The vaccine should not be injected into<br />

the gluteal area or areas where there is a major nerve<br />

trunk. It should also not be administered intravenously<br />

or subcutaneously. 5 The wholesale acquisition cost of<br />

one 0.5 mL dose is $44.13.<br />

234 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


PILL BOX continued<br />

Table-2: Booster Responses to Pertussis Antigens One Month After Adacel• 5<br />

Adolescents (n=524)<br />

(95% CI)<br />

Adults (n=739)<br />

(95% CI)<br />

ACIP & CDC Recommendations for Tdap in Adolescents<br />

(ages 11-18 years) 7<br />

Recommendations for Use<br />

• Adolescents should receive a single dose of Tdap<br />

instead of tetanus and diphtheria toxoids vaccine (Td)<br />

for booster immunization against tetanus, diphtheria,<br />

and pertussis if they have completed the recommended<br />

childhood diphtheria and tetanus toxoids and whole<br />

cell pertussis vaccine (DTP)/diphtheria and tetanus<br />

toxoids and acellular pertussis vaccine (DTaP) vaccination<br />

series (five doses of pediatric DTP/DTaP before<br />

the seventh birthday; if the fourth dose was administered<br />

on or after the fourth birthday, the fifth dose is<br />

not needed) and have not received Td or Tdap. The<br />

preferred age for Tdap vaccination is 11–12 years.<br />

• Adolescents who received Td, but not Tdap, are<br />

encouraged to receive a single dose of Tdap to provide<br />

protection against pertussis if they have completed the<br />

recommended childhood DTP/DTaP vaccination<br />

series. An interval of at least five years between Td and<br />

Tdap is encouraged to reduce the risk for local and<br />

systemic reactions after Tdap vaccination. However, an<br />

interval less than five years between Td and Tdap can<br />

be used, based on Canadian studies. Tdap was admin-<br />

Pre-Defined<br />

Acceptable Rates %<br />

Anti-PT 92.0% (89.3-94.2) 84.4% (81.6-87.0) 81.2%<br />

Anti-FHA 85.6% (82.3-88.4) 82.7% (79.8-85.3) 77.6%<br />

Anti-PRN 94.5% (92.2-96.3) 93.8% (91.8-95.4) 86.4%<br />

Anti-FIM 94.9% (92.6-96.6) 85.9% (83.2-88.4) 82.4%<br />

istered at a two-year interval<br />

(Td received 18-23 months<br />

before Tdap) in 214 patients.<br />

In the largest Canadian study,<br />

intervals as short as approximately<br />

two years were acceptably<br />

safe.<br />

continued on page 237<br />

DONALD J. GRANDIS, M.D.<br />

DANIEL A. RUBIN, M.D.<br />

PANKAJ MOHAN, M.D.<br />

are very pleased to announce the association of<br />

James F. Shanahan. M.D.<br />

in their practice of Cardiology, effective July 1, <strong>2006</strong>.<br />

Dr. Shanahan will complete his fellowship<br />

at the University of Pittsburgh.<br />

<strong>May</strong> <strong>2006</strong><br />

Hospital Affiliations:<br />

Jefferson Regional <strong>Medical</strong> Center<br />

<strong>Allegheny</strong> General Hospital<br />

South Hills <strong>Medical</strong> Building<br />

Suite 574<br />

575 Coal Valley Road<br />

Jefferson Hills, PA 15025<br />

Phone: (412) 469-7660 Fax: (412) 469-7547<br />

On-target investment results are no random walk, but a simple function of<br />

research firepower applied at the exact intersection of value and opportunity.<br />

At Fort Pitt Capital Group, we stay within our circle of competence. We<br />

avoid the sort of scattershot thinking which makes investing more complex than<br />

it needs to be.<br />

We calculate, plan and execute for our customers in a way that leaves little room<br />

for error, and we tell you exactly how your account is doing. If this sort of pointblank<br />

approach sounds good, or if lately your investment results have been more<br />

miss than hit, give us a call at Fort Pitt Capital Group.<br />

PITTSBURGH • NAPLES<br />

412.921.1822<br />

WWW.FORTPITTCAPITAL.COM<br />

MANAGING PORTFOLIOS OF STOCKS,<br />

BONDS AND NO-LOAD MUTUAL FUNDS<br />

The <strong>Bulletin</strong> u 235


It’s your reputation and assets at risk.<br />

Entrust them to only the strongest.<br />

Only <strong>Medical</strong> Protective.<br />

Protecting more of the nation’s healthcare providers than any other<br />

insurance carrier by delivering:<br />

■<br />

■<br />

■<br />

■<br />

Strength – the highest-rated medmal insurance<br />

with “AAA” S&P and “A+” A.M. Best ratings<br />

Defense – the nation’s most proactive winning defense<br />

Solutions – the foremost continuous risk management expertise<br />

Since 1899 – the commitment to the medical malpractice field,<br />

three times longer than our nearest competitor<br />

For more information on how you may qualify to obtain<br />

the nation’s best coverage call us at 800-4MEDPRO,<br />

visit us online at medpro.com or contact your<br />

<strong>Medical</strong> Protective appointed agent.<br />

<strong>Medical</strong> Protective is a member of the Berkshire Hathaway group of businesses.<br />

All insurance products are underwritten by The <strong>Medical</strong> Protective Company ® or National Fire and Marine Insurance Company ® .<br />

Product availability varies based upon business and regulatory approval and may be offered on an admitted or non-admitted basis.<br />

©<strong>2006</strong> The <strong>Medical</strong> Protective Company. ® All Rights Reserved.<br />

236 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


PILL BOX continued from page 235<br />

• Vaccine providers should administer Tdap and tetravalent<br />

meningococcal conjugate vaccine (MCV4,<br />

Menactra®) to adolescents during the same visit if<br />

both vaccines are indicated and available. When Tdap<br />

or Td is administered after MCV4, the adverse reactions<br />

might be higher than when the dose is administered<br />

before MCV4 because pre-existing diphtheria<br />

antibody levels might be higher.<br />

Interchangeable Use of Tdap Vaccines<br />

• A single dose of either brand name (Boostrix or<br />

Adacel) can be administered to adolescents.<br />

Preventing Adverse Events<br />

• Some experts recommend a 15-20 minute observation<br />

period after administering vaccines because syncope<br />

might occur more often in adolescents and young<br />

adults. If syncope occurs, patients should be observed<br />

until symptoms resolve.<br />

Record Keeping<br />

• Health care providers are required to keep permanent<br />

vaccination records of vaccines covered under the<br />

National Childhood Vaccine Injury Act in the patient’s<br />

medical record. For details, see http://www<br />

immunize.org/catg.d/2027law.htm. 8<br />

Provisional ACIP Recommendations for Tdap in Adults 3<br />

On October 26, 2005, the ACIP recommended<br />

routine use of a single dose of Tdap for adults 19-64<br />

years of age to replace the next booster dose of tetanus<br />

and diphtheria toxoids vaccine (Td). The ACIP also<br />

recommended Tdap for adults who have close contact<br />

with infants


PILL BOX continued from page 237<br />

Provisional Recommendations for Tdap in Adults (Adacel<br />

for ages 19-64 years)<br />

Routine<br />

• Adults should receive a single dose of Tdap to replace<br />

a single dose of Td for booster immunization if they<br />

received the last dose of tetanus vaccine (e.g., Td) >10<br />

years earlier.<br />

Shorter interval between Td and Tdap<br />

• Tdap may be given at an interval shorter than 10 years<br />

since receipt of the last dose of tetanus vaccine to<br />

protect against pertussis. Refer to the adolescent<br />

discussion above. The dose of Tdap replaces the next<br />

scheduled booster dose of Td.<br />

Prevention of pertussis among infants


• History of arthus reaction to a tetanus (and/or diphtheria)<br />

vaccine administered


LEGAL REPORT<br />

Retirement 101: A<br />

Basic Understanding of<br />

Two Plans<br />

SUSAN F. JORDAN, ESQ<br />

How do you envision retirement? Do your<br />

thoughts turn to pleasant, carefree hours spent<br />

on the golf course, tending to your garden or<br />

playing with your grandchildren? While the concept of<br />

retirement is appealing, getting there is becoming more<br />

of challenge for many of us. Social Security benefits<br />

provide a drop in the bucket, and they are tenuous at<br />

best. Squirreling away funds on a regular, structured<br />

basis takes tremendous discipline and is easily derailed<br />

by tuition bills and other day-to-day expenditures. For<br />

professionals, one of the most effective vehicles for<br />

ensuring a comfortable and financially secure retirement<br />

is a qualified retirement plan.<br />

Whether you are part of a group practice or selfemployed,<br />

a variety of retirement plan designs are<br />

available, all of which can provide tremendous<br />

opportunities for tax deferral and<br />

retirement savings. In addition, a retirement<br />

plan can be a powerful tool in<br />

recruiting and retaining employees.<br />

There are two basic types of retirement<br />

plans: defined contribution<br />

plans and defined benefit plans.<br />

For professionals, one of the most<br />

effective vehicles for insuring a<br />

comfortable and financially secure<br />

retirement is a qualified retirement<br />

plan.<br />

participant. The focus is on the amount to be contributed<br />

each year, with no promise of ultimate benefit at<br />

retirement age. It is the accumulation of annual contributions,<br />

as augmented by investment earnings (but also<br />

adjusted for losses and expenses) which is the<br />

participant’s eventual benefit at retirement or earlier<br />

termination of employment.<br />

Many defined contribution plans<br />

allow participants to direct the<br />

investment of their accounts,<br />

enabling each participant to<br />

tailor investment selection to<br />

his or her needs, objectives<br />

and risk tolerance, and to<br />

assure the accumulation of<br />

the desired “nest egg.”<br />

Among the many types<br />

of defined contribution<br />

Defined Contribution Plans<br />

Defined contribution plans are<br />

retirement plans that provide for<br />

an individual account for each<br />

plans are a money purchase<br />

240 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


LEGAL<br />

REPORT continued<br />

pension plan, under which the employer is obligated to<br />

make a contribution each year based on the formula<br />

specified in the plan, and a profit-sharing plan, under<br />

which employer contributions are discretionary and can<br />

vary from year-to-year. Until a few years ago, many<br />

employers maintained a combination of a money purchase<br />

pension plan and a profit-sharing plan, in order to<br />

be able to maximize deductible contributions and<br />

allocations. Thanks to an increase in the deduction limit<br />

applicable to profit-sharing plans, that maximum now<br />

can be achieved with a profit-sharing plan alone.<br />

401(k) Plans<br />

The defined contribution plan most in vogue these<br />

days is the 401(k) plan, a profit-sharing plan with a “cash<br />

or deferred option” that permits participants to make<br />

elective deferral contributions to their own accounts.<br />

What makes the 401(k) plan particularly attractive is its<br />

flexibility. Elective deferral contributions by the employee<br />

can be pre-tax or, if the plan permits, they can be<br />

designated as “Roth” deferrals which, though after-tax,<br />

may result in a tax-free distribution at retirement. In<br />

<strong>2006</strong>, these elective deferrals can be as much as $15,000<br />

(plus an additional “catch-up” deferral of up to $5,000<br />

for those 50 years of age or older). The employer can<br />

match these deferrals and/or make additional profit<br />

sharing contributions with the total of all additions<br />

being as much as $44,000 ($49,000 for those who have<br />

reached age 50).<br />

Defined Benefit Plans<br />

Defined benefit plans are the traditional pension<br />

plans designed to provide a targeted benefit at normal<br />

retirement age; customarily these are funded completely<br />

with employer contributions. The benefit can be a flat<br />

dollar amount, a percentage of average annual compensation,<br />

or dollar amount computed with reference to<br />

earnings, length of service or some combination of the<br />

two. There are no individual accounts; rather, all of the<br />

plan assets are held and invested as a single fund. The<br />

annual employer contribution required is determined by<br />

an actuary based on reasonable interest and mortality<br />

assumptions.<br />

Obviously, defined contribution plans are much<br />

more individualized and flexible. So, why would one<br />

choose a defined benefit plan? Well, to begin, these plans<br />

<strong>May</strong> <strong>2006</strong><br />

offer far more generous funding limits. The often<br />

substantially higher funding levels appeal to those<br />

looking for more sizable tax deferrals and to those who<br />

started their retirement planning late and need to catch<br />

up quickly. In addition, many prefer the security of<br />

knowing what their benefits will be worth at retirement.<br />

But defined benefit plans have drawbacks. Funding<br />

requirements, which are tied in large measure to investment<br />

performance, can be unpredictable, which makes<br />

advance budgeting difficult. When investments fail to<br />

perform at or above the projected rate, contribution<br />

requirements increase. Likewise, when the market is hot<br />

and plan investment return exceeds the projected rate of<br />

interest, contributions (and the corresponding deductions)<br />

decline, but benefits don’t grow. In addition,<br />

defined benefit plans are more complex and administrative<br />

expenses are higher. Finally, the costs attributable to<br />

individual benefits frequently depend upon proximity to<br />

retirement age, and this can create inequities among the<br />

professionals who are compensated equally but may be<br />

years apart in age.<br />

Some of the “negatives” associated with defined<br />

benefit plans are neutralized by a relatively new kid on<br />

the retirement block, the cash balance plan. This is a<br />

hybrid that borrows the individual account idea from<br />

defined contribution plans and incorporates it in a<br />

defined benefit plan setting. A “phantom” or bookkeeping<br />

account is set up for each participant. Each year, the<br />

employer credits to that account a fixed percentage of<br />

the participant’s compensation, as well as hypothetical<br />

earnings at a predetermined rate. The ultimate benefit at<br />

retirement is the accumulation of these credits; like other<br />

defined benefit plans, the actual assets securing payment<br />

of benefits are commingled in a single pool, and the<br />

funding requirements are determined actuarially. The<br />

individual account design makes the plan more understandable,<br />

and the annual credits provide consistency in<br />

allocations among the professionals in the group. The<br />

combination of cash balance plan and 401(k) plan can<br />

be used effectively to maximize deductible contributions,<br />

while allowing individual participants some<br />

flexibility with regard to their individual deferrals.<br />

Simplified plan options<br />

Two simplified retirement plan options also are<br />

continued on page 242<br />

The <strong>Bulletin</strong> u 241


LEGAL<br />

REPORT continued from page 241<br />

available to employers who want to provide a “no frills”<br />

retirement benefit. Funding limits are somewhat lower,<br />

but there are no reporting requirements and virtually no<br />

administrative obligations or costs.<br />

With a Simplified Employee Pension Plan (SEP-<br />

IRA), the employer’s involvement is limited to making a<br />

(discretionary but uniform) contribution to an individual<br />

retirement account (IRA) which is established for<br />

each employee. All amounts are fully vested, and the<br />

employee manages his or her own account.<br />

A Simplified Incentive Match Pension Plan<br />

(SIMPLE) is somewhat similar to the SEP-IRA, in that a<br />

separate (fully self-directed) IRA is set up for each<br />

employee. The difference, however, is in the way the<br />

arrangement is funded. Employees may make pre-tax<br />

salary reduction contributions to the IRA of up to<br />

$10,000 (plus, for those age 50 or older, catch-up<br />

contributions of up to $2,500), which then are matched<br />

by the employer, dollar for dollar, up to 3 percent of<br />

compensation. The SIMPLE plan is available to employers<br />

with no more than 100 employees, and may be<br />

adopted by self-employed individuals, even those without<br />

employees.<br />

Identifying the “best” plan for you may depend on a<br />

number of factors, including your needs and objectives,<br />

the size of your practice, your anticipated cash flow and<br />

your investment philosophy. Thorough analysis of your<br />

situation with your legal, accounting and investment<br />

advisors is strongly recommended to be sure you make<br />

the right choice.<br />

Ms. Jordan is a partner at Fox Rothschild LLP, which serves as council<br />

to the <strong>Allegheny</strong> <strong>County</strong> <strong>Medical</strong> <strong>Society</strong>. She chairs the firm’s employee<br />

benefits practice group and can be reached at (412) 391-1334 or<br />

sjordan@foxrothschild.com.<br />

Corporate (888) 232-7026, ext. 6702<br />

www.cimplify.net<br />

Tier 1 EHR $500-$600 per doctor<br />

per month with minimal<br />

upfront investment<br />

¨ CIMplify partners with practices to improve profitability without increasing patient load.<br />

¨ CIMplify’s outsourcing back-office billing partnership bills and collects more money, more<br />

efficiently. Our services provide superior reporting, better collections, and improved appeals<br />

processing while reducing outstanding AR.<br />

¨ CIMplify delivers a truly affordable Tier 1 EHR, along with its outsourcing service. Through<br />

our high-speed Internet technology, practices can receive the benefits of an EHR for $500-<br />

$600 per doctor per month with minimal upfront cost.<br />

¨ CIMplify solutions eliminate the need for practices to invest in expensive computer<br />

hardware, maintenance, and support. Furthermore, CIMplify practices do not need to spend<br />

vital capital for in-house technology staff.<br />

Corporate (888) 232-7026, ext. 6702 www.cimplify.net<br />

242 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


PRACTICE<br />

MANAGEMENT<br />

HIPAA Q & A<br />

Q<br />

: It seems that not many people are talking about<br />

the HIPAA Privacy and Security Rules. A few<br />

years ago, that was widely covered in the journals and<br />

on the web. What does a physician practice have to do<br />

in regards to HIPAA Privacy and Security?<br />

A<br />

: The HIPAA Privacy Rule was implemented<br />

on April 14, 2003. The HIPAA Security Rule<br />

was implemented on April 20, 2005. Time does not<br />

make compliance policies go away. Physician<br />

practices need to continue with their HIPAA<br />

committees. These committees are to ensure that<br />

audits are up to date and, if corrective measures are<br />

needed, that they are followed up on. Training and<br />

awareness are critical, and the corresponding documentation<br />

needs to be on file. With any changes in<br />

the operations of the practice, HIPAA Privacy and<br />

Security must be assessed. Just as health care is 24/7,<br />

so too is HIPAA.<br />

CASE | SABATINI<br />

One of Pittsburgh’s premier CPA firms<br />

specializing in serving health care providers.<br />

CPA Servic<br />

ices<br />

Accounting / auditing<br />

Tax planning services<br />

Estate planning<br />

Practice valuations<br />

Divorce planning<br />

Budgeting assistance<br />

Training services<br />

IT Servic<br />

ices<br />

Practice Mgmt. &<br />

Electronic Health<br />

Records (EHR)<br />

services for<br />

hundreds of<br />

medical practices.<br />

Call Brian for a<br />

FREE consultation.<br />

www.CASESABATINI.com/MEDTECH<br />

412.881.4411<br />

OR T OLL-FREE<br />

AT 866. 392.<br />

2.CAS<br />

CASE<br />

Information for this column was provided by Joan M. Kiel, PhD,<br />

who serves as the university HIPAA compliance officer at<br />

Duquesne University and is certified in healthcare privacy and<br />

security. She can be reached at (412) 396-4419. Submit your<br />

questions to HIPAA@acms.org. The column will publish answers<br />

to the most frequently asked questions; individual questions will<br />

not be answered. Log on to the ACMS website (www.acms.org)<br />

for upcoming HIPAA training opportunities.<br />

Member Benefit<br />

A Place to Turn<br />

The answer to your question may be just a<br />

phone call away. Your medical society can<br />

almost always give you an answer or direct you<br />

to exactly where you can get it.<br />

Problem Solved.<br />

So get back to your patients. They’re the<br />

reason you became a doctor in the first place.<br />

Working for Physicians.<br />

<strong>May</strong> <strong>2006</strong><br />

The <strong>Bulletin</strong> u 243


FEATURE<br />

Disaster Response<br />

and Impaired<br />

Communication<br />

SAMUEL STEBBINS, MD, MPH<br />

As a physician new to Pennsylvania, I spend much information was sketchy at best. Better information<br />

of my time meeting people—in person, on the would have been an optimal weapon against Katrina:<br />

phone, through e-mail. Sometimes it is a information sent to the right people at the right place at<br />

planned get-together and, at other times, I find that the the right time. Information moved within agencies,<br />

stranger I am talking with at a conference or meeting is across departments and between jurisdictions of government<br />

just the person I was hoping to bump into—someone<br />

as well. Seamlessly. Securely. Efficiently.”<br />

who has something interesting and important to tell me. This lack of information and communication—<br />

Some of this is serendipity, but much is being in the called “situational awareness”—impaired command and<br />

right setting at the right time. It is clear that <strong>Allegheny</strong> control at all levels, delayed relief efforts, stranded<br />

<strong>County</strong> is a wonderful place to be: rich in history, rich in hospitals and medical facilities, caused unnecessary and<br />

medical care and research, and rich in people with a preventable secondary deaths and prolonged the shock<br />

“can-do” attitude.<br />

and grief of the original disaster. The impaired communication<br />

As I continue to settle in, this process of meeting<br />

was caused by two major factors. One was lack<br />

people and learning new facts highlights for me the of or loss of physical equipment and supplies. The<br />

importance of communication, collaboration and second was less obvious: that “Joint Task Force Katrina<br />

information sharing. This issue is particularly salient in command staff lacked joint training, which contributed<br />

these times as we try to learn lessons from the disastrous to the lack of coordination between active duty components.”<br />

response to Hurricane Katrina. These lessons are important<br />

To use a football analogy, it was as though the<br />

as we look backward, but also as we anticipate team had prepared for the big game with the quarterback<br />

future disasters such as pandemic influenza.<br />

and the running backs in one room, wide receivers<br />

Katrina illustrated a wide variety of systems failures. and tight end in another, and linemen in a third—and<br />

One of the main systems that failed was that of communication,<br />

hadn’t practiced together when it was time for the big<br />

not just at the home and cellular level when the game. This was (and remains) a recipe for disaster.<br />

power supply to the phone system and the cell towers The concern I want to raise today is that I see a<br />

went under water, but at the leadership and emergency similar lack of communication and coordination between<br />

response level. In the House Report released February 15,<br />

the medical care and public health establishments.<br />

<strong>2006</strong>, the authors noted that information (or lack And this dysfunction and lack of shared “situation<br />

thereof) was one of the key issues: “Many of the problems<br />

awareness” exists at federal, state and local levels. In my<br />

we have identified can be categorized as ‘informa-<br />

previous job, I spent six years as the deputy health officer<br />

tion gaps’—or at least problems with informationrelated<br />

for San Mateo <strong>County</strong> in California. And it would<br />

implications, or failures to act decisively because occasionally come up that a physician had not reported<br />

244 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


FEATURE continued<br />

...for medicine and public health to<br />

not work closely together and know<br />

each other’s capacities will manifest<br />

in the worst possible way in the face<br />

of larger threats on the scale of<br />

Katrina.<br />

an important and reportable disease in a timely manner,<br />

and sometimes we would write them up. But is it really<br />

so surprising that providers didn’t think of us when it<br />

must have seemed that we didn’t think of them? Of all<br />

the thousands of diseases they had reported, how much<br />

information had we supplied back to tell them what had<br />

happened to their cases, how important it was to hear<br />

the information, how useful the contact investigation<br />

was that resulted? Did we ever try to make it easy to<br />

report diseases by creating an on-line system? Had we<br />

ever developed quality two-way communication so that<br />

there was an actual, on-going relationship? In most cases,<br />

no. This disconnect is, in my opinion, a two-way street.<br />

Part of the reason it is important to rectify this split<br />

is because we miss so many opportunities to improve the<br />

health of individuals and populations. These opportunities<br />

are readily apparent in the very high numbers of<br />

people who smoke in <strong>Allegheny</strong> <strong>County</strong>, in the increasingly<br />

overweight and obese adult and pediatric population<br />

throughout the state and country, in our less than<br />

optimal vaccination rates for influenza and preventable<br />

childhood diseases. These are ongoing disasters, but for<br />

medicine and public health to not work closely together<br />

and know each other’s capacities will manifest in the<br />

worst possible way in the face of larger threats on the<br />

scale of Katrina. I won’t belabor the very real concern<br />

(though not certainty) about a possible influenza pandemic,<br />

but I will say that if ever there was a time to<br />

improve our collaboration and communication skills,<br />

this is it.<br />

The world is becoming more tightly networked<br />

every day. Approximately 80 percent of raw ingredients<br />

for pharmaceuticals come from overseas. Our supplies<br />

arrive “just in time,” and companies do better by how<br />

little excess inventory they can maintain (which is to say,<br />

surge capacity). Populations expand and become more<br />

<strong>May</strong> <strong>2006</strong><br />

diverse. The Internet goes from fun search engine to<br />

essential tool of everyday life. Blackberries become<br />

ubiquitous and you can see physicians using them at<br />

every available moment. Individual needs are increasingly<br />

met by the smooth functioning of the entire<br />

society. In this setting easy conversation and collaboration<br />

between partners are necessary and worthy goals.<br />

In the process of researching this article, I visited the<br />

<strong>Allegheny</strong> <strong>County</strong> <strong>Medical</strong> <strong>Society</strong> website to learn more<br />

about it. I reviewed the links section, and clicked on<br />

“<strong>Allegheny</strong> <strong>County</strong> Health Department.” I received a<br />

File Not Found message; apparently, you can’t get there<br />

from here.* What is worse, it appears that no one is<br />

aware that the link is broken, or has reported the problem<br />

to the webmaster. This seems very emblematic of<br />

the break in communication between the worlds of<br />

medicine and public health, and it is a problem whose<br />

fixing requires our very best efforts.<br />

Dr. Stebbins is principal investigator and director of the University of<br />

Pittsburgh Center for Public Health Preparedness, and assistant<br />

professor of epidemiology at the the schools Graduate School of Public<br />

Health. He can be reached at stebbinss@edu.pitt.edu.<br />

*Editor’s Note: The broken link on the <strong>Allegheny</strong> <strong>County</strong> <strong>Medical</strong><br />

<strong>Society</strong>’s Website has been repaired. Please explore all the many<br />

resources this site has to offer at www.acms.org.<br />

New Disaster Planning Certification<br />

The American Board of Disaster Medicine is accepting<br />

applications from physicians of various specialties and plans to<br />

administer the first examination this fall. Board certification in<br />

disaster medicine was formed after two years of intense focus<br />

on the need for responders to effectively organize and<br />

coordinate disaster planning. Physicians from a wide range of<br />

backgrounds are needed to enable comprehensive response<br />

when disaster strikes.<br />

“This program is an integral step in preparing our nation’s<br />

health system so, when disasters strike, we can work together<br />

as a team,” says William Carbone, CEO of the American Board<br />

of Physician Specialties. “Our goal is to foster, coordinate, build<br />

and facilitate partnerships with all affected organizations and<br />

entities at all levels to communicate a new and advanced body<br />

of knowledge to physicians and other health care professionals,”<br />

says Carbone.<br />

For more information, contact Shaz Powell at (404) 885-9596,<br />

ext. 25, or (404) 713-2317.<br />

The <strong>Bulletin</strong> u 245


SPECIAL REPORT<br />

Temp to Permanent Hiring:<br />

Everyone Wins<br />

PATRICK DUDLEY<br />

Employers and staffing agencies tend to agree that paid to staffing agencies. Whether or not employers<br />

the most compelling advantage of a temporaryto-permanent<br />

hiring arrangement (temp-to-hire) that tend to make the temp-to-perm arrangement so<br />

realize hard cost savings, it’s their lessened hiring risks<br />

is the chance for the employer and employee to have desirable. Today’s employers understand the cost of a bad<br />

time together prior to hiring. “From the candidates’ hire.<br />

perspective, it’s very positive for them to have a chance Generally offered as a standard part of a staffing<br />

to show employers what they’re capable of,” says Sacha solution agreement, conversions can be economically<br />

Henry, regional director for ACMS Staffing. “In turn, beneficial to an employer. ACMS Staffing offers the<br />

employers get to see potential employees’ skills in action, following:<br />

and how they fit with the company.”<br />

• Temporary to Hire—ACMS Staffing recruits, screens<br />

Flexibility is another advantage. Most often,<br />

and tests its candidates before<br />

companies bring someone into a temporary<br />

matching them to your job<br />

position, but often find that the individual’s<br />

specifications. This allows you<br />

skills can be used in a permanent position<br />

and your contract employee the<br />

elsewhere in the company. Using a temp<br />

opportunity of mutually evaluating<br />

allows employers to focus on what they need<br />

your employee relationship<br />

at the moment, without locking them into a<br />

prior to making a serious commitment.<br />

certain direction. The option to convert<br />

temps to permanent workers later gives<br />

• Direct Hire—Direct hire is the<br />

employers a shot at a qualified worker if<br />

option used by clients who want<br />

the position does turn out to be long<br />

to bring a candidate on full-time<br />

term.<br />

right away. Candidates chosen for<br />

Many businesses may be able to<br />

these positions are specifically prequalified<br />

trim recruiting expenses for time,<br />

for an interest in long-<br />

office space, headhunters and<br />

term employment with a company.<br />

advertising by using a staffing<br />

• Payroll Services—ACMS Staffing<br />

agency. These expenses tend to be<br />

provides an effective and benefi-<br />

a wash when compared to what<br />

cial approach to simplifying and<br />

would have been the company’s<br />

streamlining your payroll process.<br />

own recruiting costs versus fees<br />

Our proven ability to manage all<br />

246 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


aspects of payroll administration results in timely,<br />

accurate services that bring convenience and efficiency<br />

to your accounting and administrative staff. We also<br />

cover the employee’s taxes, unemployment and<br />

Worker’s Compensation costs while they remain on<br />

our payroll.<br />

The ACMS Staffing Division opened its doors last<br />

August, a service made available in partnership with the<br />

<strong>Allegheny</strong> <strong>County</strong> <strong>Medical</strong> <strong>Society</strong> for physician members<br />

who wish to staff their offices with a minimum of<br />

effort. ACMS Staffing services are available at discounted<br />

rates for medical society members. ACMS<br />

Executive Director John Krah says, “Staffing is a critical<br />

component of a successful medical practice, and it is<br />

important to the medical society to support physicians<br />

in meeting their needs for competent and caring office<br />

personnel.”<br />

Mr. Dudley is the owner of ACMS Staffing. For additional information,<br />

please contact Dana Dagnal, business development manager, at<br />

(412) 325-2746 or dagnal@acms.org.<br />

SPECIAL REPORT<br />

Reportable<br />

Diseases<br />

<strong>Allegheny</strong> <strong>County</strong> Health Department<br />

Selected Reportable Diseases<br />

Jan-Mar<br />

Disease <strong>2006</strong> 2005 2004<br />

Campylobacteriosis ........................... 9 .............112 ............ 129<br />

Cryptosporidiosis ............................... 2 .............. 16 ................ 5<br />

E. coli 0157:H7 .................................. 1 .............. 12 ................ 5<br />

Giardiasis .......................................... 9 .............. 72 .............. 97<br />

Guillain-Barre Syndrome ................... 1 ................ 9 ................ 4<br />

Hepatitis A ......................................... 1 ................ 8 .............. 16<br />

Hepatitis B (acute) ............................. 7 .............. 27 .............. 42<br />

Hepatitis C (confirmed) .................. 231 ............ 393 ............ 238<br />

Legionellosis...................................... 9 .............. 86 .............. 61<br />

Listeriosis .......................................... 1 .............. 10 ................ 4<br />

Lyme Disease .................................... 0 .............. 32 .............. 27<br />

Malaria .............................................. 0 ................ 2 ................ 1<br />

Aseptic/Viral Meningitis ..................... 5 .............. 89 .............. 78<br />

Bacterial Meningitis ........................... 1 ................ 8 ................. *<br />

Meningococcal Invasive Disease ...... 6 ................ 6 ................. *<br />

Pertussis ........................................... 5 .............. 41 ............ 107<br />

Salmonellosis .................................. 24 .............. 88 ............ 141<br />

Shigellosis ......................................... 0 ................ 2 .............. 11<br />

West Nile Virus Infection ................... 0 ................ 6 ................ 0<br />

Tuberculosis ...................................... 4 .............. 27 .............. 22<br />

AIDS ................................................. ** ................** .............. 99<br />

HIV ................................................... ** ................** ............ 100<br />

Gonorrhea ..................................... 358 ......... 1,804 ......... 1,532<br />

Chlamydia .................................. 1,024 ......... 4,302 ......... 4,256<br />

Syphilis, Primary & Secondary ........ 17 .............. 61 .............. 21<br />

Carbon Monoxide Poisoning ............. 8 .............. 26 .............. 45<br />

*Different format used in 2004<br />

**Temporarily unavailable (transistion to new reporting system)<br />

Disease reports may be filed weekdays during regular<br />

business hours from 8:30 a.m. to 4:30 p.m. by calling<br />

(412) 578-8060. At all other times, please call the Health<br />

Department’s 24-hour telephone line (412) 687-2243.<br />

ALLEGHENY COUNTY HEALTH DEPARTMENT<br />

Been wondering how to get<br />

involved in this post-911 world?<br />

<strong>Allegheny</strong> <strong>County</strong> Health Department is looking for<br />

volunteer healthcare workers, including all varieties of<br />

physicians to respond to public emergencies as part of<br />

a volunteer <strong>Medical</strong> Reserve Corps.<br />

For more information, call (412) 578-8349.<br />

<strong>May</strong> <strong>2006</strong><br />

The <strong>Bulletin</strong> u 247


TECHNOLOGY & MEDICINE<br />

Voice Recognition<br />

Technology<br />

BASIL A. MARRYSHOW, MD<br />

The electronic age has finally visited the medical relatively indispensable. I have watched my productivity<br />

profession. Despite the fact that medical recordkeeping<br />

is one of the principal areas that cries hours are now being accomplished in minutes leaving<br />

increase by leaps and bounds. Tasks that normally took<br />

out for computerization, many physicians are still loath more time for other projects or for recreation.<br />

to embrace such radical changes in their comfort zones. I happened upon this technology quite by accident<br />

And sadly, the ones who have not taken the necessary and in desperation. My transcriptionist, on whom I<br />

steps to upgrade their practices have found themselves relied for all my typing needs, found it necessary to issue<br />

unable to compete professionally on an equal footing in me an ultimatum that exceeded the limits of my generosity.<br />

the 21st century.<br />

I was therefore compelled to make other arrange-<br />

It has taken an act of Congress to mandate the first ments. For a week or so, my remaining office staff<br />

step and to insist that all claims on Medicare be submitted<br />

graciously picked up the slack while I evaluated other<br />

electronically and that no longer will bills and permanent options.<br />

payments be entertained through the postal service. One On the Web I found three systems that showed some<br />

would think that alone would have been an economic promise of satisfying my requirements. I bought and<br />

incentive for some physicians to quickly embrace this tested the IBM ViaVoice, the Kurtweiler, and Dragon<br />

technology, but instead many have opted to resist this Naturally Speaking, version 2. I found the Dragon<br />

“intrusion” on their rights and have tenaciously clung to system the easiest to use and the easiest to edit. It is the<br />

their old ways of doing business.<br />

one I now use exclusively.<br />

It is hard to believe that there are physicians out There have been several upgrades of the system and<br />

there, specialists even, who still conduct record-keeping the latest (version 8) is a true technological marvel.<br />

in longhand. And given our renowned talents for illegibility,<br />

Dragon Naturally Speaking 8 (Dragon), Preferred<br />

it is not very hard to see the many opportunities Edition sells for about $150. This basic system accom-<br />

for medical errors. Even so, our present methods of modates five users. (It is vitally necessary for each user to<br />

dictating into a recorder at the end of a busy day or establish a separate unique vocabulary. One would<br />

perhaps two days hence and then getting the work to a corrupt the system rather quickly if one were to use<br />

transcriptionist the following day is time-consuming and another’s speech pattern).<br />

costly. Add to that the time of editing and retyping and Dragon will recognize most language variations and<br />

one is looking at a four- to eight-day turnaround time can quickly distinguish between UK English, US English,<br />

and transcription costs of over $1,600 a month.<br />

thickly accented Indian English, Australian English<br />

I would like to commend for consideration the use and SE Asian English with a simple change of screens.<br />

of voice recognition technology for a practice of one or a As with all voice recognition systems, a period of<br />

network of 100.<br />

training is required so that the program learns to recognize<br />

I have been using it almost exclusively in my practice<br />

your voice, speech patterns, inflections and enuncia-<br />

and home life for the past eight years for anything and tion. This means, of course, that one has to read a few<br />

everything that requires typing, and I have found it prescribed paragraphs into the computer before the<br />

248 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


<strong>May</strong> <strong>2006</strong><br />

TECHNOLOGY continued<br />

system can be used to advantage.<br />

Dragon has its own word processor but works well<br />

with all the usual applications such as Microsoft Word,<br />

WordPerfect, Excel, PowerPoint and Outlook express.<br />

All dictation is automatically saved in “My Documents”<br />

and in the particular application.<br />

Training takes as little as five minutes but, in this<br />

case, the more the merrier. Along the way, periodic<br />

additional training improves accuracy.<br />

With each subsequent use, accuracy increases and<br />

the casual user can expect about 95 to 99 percent accuracy<br />

in just a few days.<br />

In its memory is the entire Webster’s Collegiate<br />

Dictionary. Specialized words may be added merely by<br />

spelling them and commanding the system to add them<br />

to the vocabulary.<br />

Within the last five or six years, the company introduced<br />

Dragon Naturally Speaking 8 <strong>Medical</strong> which<br />

seems to be remarkably accurate on medical dictation. It<br />

is a bit pricey at about $800, but well worth every<br />

penny. The user can recoup the cost, and more, in just<br />

the first month. After that, it is pure gravy.<br />

Dragon comes complete with specialty vocabularies<br />

for radiology, cardiology, surgery, general medical, family<br />

practice, ob/gyn, neurology, pathology, orthopedics,<br />

emergency medicine, mental health, oncology, pediatrics<br />

and gastroenterology—more than 25,000 words and<br />

phrases.<br />

I do not have the medical package (although I wish I<br />

had), but I started very early in the development of the<br />

program. Through the years, I’ve programmed most of<br />

the medical terminology that I use frequently into the<br />

computer and so, at this stage, the computer recognizes<br />

my style rather easily.<br />

Dragon is network ready with the ability to let any<br />

user access his/her distinct Dragon Naturally Speaking 8<br />

medical profiles from any PC on the organization’s local<br />

area network.<br />

It has scores of templates that make repetitious work<br />

a snap with a one- or two-word command.<br />

It is compatible with most PDAs and high-end<br />

handheld recorders. So it is quite possible to dictate a<br />

patient’s findings in the examination room on a wireless<br />

PDA or through a wireless headphone and have a copy<br />

of the records available before the patient gets to the<br />

continued on page 250<br />

Medicare Interactive Voice Response (IRV) Unit<br />

Information is Just a Phone Call Away<br />

HGS Administrators has implemented a new self service option<br />

called an Interactive Voice Response (IVR) Unit. The IVR is speech<br />

enabled so that you can actually tell the IVR what information you<br />

are looking for. The IVR will also offer you assistance as you step<br />

through the options.<br />

If you are more comfortable with entering your information, the touch<br />

tone options are still available and can be used at any time, but won’t<br />

be voiced until after unsuccessful attempts to speak the information.<br />

Here are some helpful tips:<br />

• Speak clearly and do not use a speaker telephone.<br />

• Say or enter your six-digit provider number. Do not follow with<br />

your suffix or the pound (#) key.<br />

• Say or enter the entire Medicare number all at once. There is no<br />

prompt to enter the letter suffix. If you are entering the number<br />

with your touch tone keypad, press the * key to indicate you are<br />

now entering the letter and then select the number on your keypad<br />

that corresponds to the suffix letter along with the position that it<br />

appears on the key.<br />

--For example, the letter A would be entered as *21. The letters<br />

Q and Z are exceptions. For keying information, they reside on<br />

the number 1 key, not the key they appear on. (Q=*11 and<br />

Z=*12).<br />

• Press 1 for Male and 2 for Female within the Eligibility option.<br />

• HICs with double letter suffixes are no problem; just say the entire<br />

HIC with the letters. To enter an HIC that has double letters on<br />

your keypad, you must hit the * key in front of both letters. So, to<br />

enter the suffix TA, you would key the numbers and then hit *81<br />

*21.<br />

• The eligibility option allows you to check current eligibility. Future<br />

dates will receive an error message.<br />

• The format to key a patient’s name is last name, first initial. Select<br />

the number key that represents the letter you with to enter.<br />

--For example, to enter the name John Smith, you would press<br />

7-6-4-8-4-5 (entered as Smith J). Remember the letters Q and<br />

Z are exceptions when keying information. If they appear in the<br />

patient’s name, use the 1 key for these letters. There is no need<br />

to key the position of the letter like you do when entering the<br />

suffix of the HIC.<br />

• When you select the claim status option and enter your provider<br />

number, the IRV provides you with pending and finalized claim<br />

counts. You can speak or key over this information if you have<br />

already heard it or are not interested in this information.<br />

• Press 9 to get back to the main menu.<br />

For a comprehensive step-by-step instruction on using the IVR, visit<br />

http://www.hgsa.com/professionals/pdf/ivrguide.pdf.<br />

Ms. Amy Ascher is a communications analyst with HGS Administrators<br />

in Camp Hill. She can be reached at (717) 302-3659 or<br />

amy.ascher@hgsa.com.<br />

The <strong>Bulletin</strong> u 249


TECHNOLOGY continued from page 249<br />

front desk. Alternatively, a doctor may dictate office<br />

notes in the car on the way home, and plug the recorder<br />

directly into the computer when he gets there; with a<br />

simple command such as, “Save that,” or “Print that,”<br />

the finished product is ready for editing or disposition in<br />

less than one minute. And if, perchance, a year from<br />

now, part of the dictation does not sound or look right,<br />

one may simply command the computer to play back, in<br />

your own voice, a word, a phrase, a line or a paragraph<br />

and corrections may be made then, if necessary.<br />

The computer will transcribe words as fast as you<br />

can speak with proper enunciation at better than 120<br />

wpm, whereas fast typists can only do 40 wpm at best.<br />

If one were to add to the home or office computer a<br />

$200, 300 GB, USB 2 external hard drive, which is<br />

stackable, by the way, then one can store tens of thousands<br />

of records without generating any paper files and<br />

without any demands on your computer’s own hard<br />

drive.<br />

Prescriptions may be forwarded directly to the<br />

pharmacies, and lab work can be obtained within<br />

seconds from various hospitals with simple voice commands.<br />

The system requires a fairly fast computer for a high<br />

degree of accuracy, 512 MB or better. A 1 GB or 2 GB is<br />

ideal. If your computer does not go that high, it is<br />

prudent to buy an upgrade for $50 and have it installed.<br />

Another essential is a high-end microphone headset. The<br />

cheap ones, the handheld ones, or the wireless ones<br />

simply do not work very well. I use a Plantronics DSP<br />

500 but others have found the Sennheiser without the<br />

“reverb” effect just as reliable.<br />

It must be noted that there is also a Dragon Naturally<br />

Speaking 8 Legal which makes the lawyers 10 times<br />

more prolific. Hmmmm, if only there were a way…<br />

Dr. Marryshow is an orthopaedic surgeon and a former long-term<br />

associate editor of the ACMS <strong>Bulletin</strong>. He can be reached at<br />

docshow@comcast.net.<br />

Secrets of <strong>Medical</strong> Billing:<br />

Revealed<br />

The Kell Group reads spreadsheets, fee schedules, and<br />

A/R reports, scanning for any abnormalities in the inner<br />

workings of your medical practice. The Kell Group quickly<br />

spots, investigates, and corrects problems areas.<br />

Call the Kell Group today and request a diagnostic exam<br />

of your books 412-381-5160.<br />

www.kellgroup.com<br />

250 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


ACMS BOARD OF DIRECTORS<br />

The <strong>Allegheny</strong> <strong>County</strong> <strong>Medical</strong> <strong>Society</strong> Board of Directors met<br />

on March 21, <strong>2006</strong>. Board Chair Mark A. Goodman, MD,<br />

called the meeting to order at 6:05 p.m.<br />

Leo McCafferty, MD, chair, Communications<br />

Committee, reported that the committee formulated<br />

a mission statement:<br />

The Mission of the ACMS Communications Committee<br />

is to provide, in coordination with the Board<br />

of Directors, dissemination of information regarding<br />

the mission, goals and programs of the <strong>Allegheny</strong><br />

<strong>County</strong> <strong>Medical</strong> <strong>Society</strong>. The Committee reviews and<br />

recommends strategies for communication to increase<br />

awareness of the image, identity, and objectives of the<br />

ACMS to its members and the general public. The<br />

Committee monitors communication efforts to assure<br />

that outgoing messages focus on the <strong>Society</strong>’s priorities<br />

to represent the interest of all physicians and to<br />

provide effective advocacy for patients.<br />

The committee is concerned over<br />

advertisements for medical care that may<br />

be questionable or distasteful to some<br />

physicians. It contacted the Pennsylvania<br />

<strong>Medical</strong> <strong>Society</strong> (PMS) to see if any<br />

guidelines exist; PMS has no written<br />

guidelines and there are no state regulatory<br />

requirements. The committee drafted a resolution<br />

Dr. McCafferty<br />

on physician advertising, which will be presented to the<br />

House of Delegates in October:<br />

Whereas, county medical societies and the Pennsylvania<br />

<strong>Medical</strong> <strong>Society</strong> are committed to truth in<br />

advertising as outlined in American <strong>Medical</strong> Association<br />

guidelines; and<br />

Whereas, a renewed increase in advertisements<br />

featuring physicians recently has appeared that potentially<br />

could not be in compliance with AMA guidelines;<br />

and<br />

Whereas, addressing the gray areas of advertising<br />

that could be interpreted as crossing an ethical threshold<br />

can be difficult, but such a review is important;<br />

therefore, be it<br />

Resolved, that the Pennsylvania <strong>Medical</strong> <strong>Society</strong><br />

adopt a position on ethics in advertising; and be it<br />

further<br />

Resolved, that the Pennsylvania <strong>Medical</strong> <strong>Society</strong><br />

<strong>May</strong> <strong>2006</strong><br />

develop a review mechanism to address advertising<br />

complaints.<br />

Because cooperation between the <strong>Bulletin</strong> Editorial<br />

Board and the Communications Committee is essential,<br />

board members agreed that an editorial associate should<br />

sit on the committee. The Communications Committee<br />

chair will recommend an editorial board member to the<br />

president to serve on the committee to facilitate coordination<br />

of activities and information.<br />

Guest Robert Carroll, MD, noted the <strong>Society</strong> for the<br />

Education for Physicians and Patients will hold a health<br />

care conference.<br />

Regular Business<br />

Drs. Goodman and Terence Starz commented on the<br />

Executive Committee report regarding the Highmark<br />

meeting about the Radiology Management Program.<br />

Costs for radiology have gone up 100 percent in five<br />

years. Individuals meeting criteria after an initial evaluation<br />

should be excluded.<br />

The Executive Committee recommended the society<br />

prepare two draft notices, one to the attention of<br />

Highmark subscribers informing them of the changes<br />

and indicating the possibility of delays and a second to<br />

ACMS members on how to access and process the<br />

program. ACMS will monitor the program as it develops<br />

and asked members to advise ACMS of experiences with<br />

the process. ACMS will solicit information and questions<br />

from the membership to discuss with Highmark.<br />

A courtesy copy of the notices will be forwarded to<br />

Highmark representatives before distribution.<br />

Anthony Spinola, MD, chair of the Membership<br />

Committee, presented the committee report. A March<br />

membership list was reviewed, including a list of unpaid<br />

members and members who have moved, resigned and<br />

transferred. The committee listed three action items,<br />

peer-to-peer recruitment, informal physician gatherings<br />

and a fall event on mentoring. The committee asked the<br />

board to recommend physicians to write letters and<br />

contact non-member physicians. An event held last year<br />

for residents was well attended; it will try again for<br />

physicians to meet in a comfortable atmosphere. ACMS<br />

will help contact medical staff leaders at local hospitals<br />

to discuss membership with physicians. The board<br />

suggested networking with the Osteopathic, TAPI and<br />

continued on page 252<br />

The <strong>Bulletin</strong> u 251


BOARD OF DIRECTORS continued from page 251<br />

Gateway medical societies. Recruitment is an obligation<br />

of the board and membership in general.<br />

The alliance is hosting its annual International<br />

Doctor’s Day celebration on April 8. Dr. Starz noted the<br />

importance of supporting the alliance and asked the<br />

board members ensure their spouse is a member.<br />

Fred Peterson reported on the Hospital Council of<br />

Western Pennsylvania. Approximately 50 organizations<br />

discussed Regional Health Information Organizations.<br />

They are not creating a monolithic information structure<br />

among hospitals, rather providing structure and<br />

support and linking information to hospitals. The<br />

council completed a project where it went to rural<br />

locations educating physicians and nurses about strokes.<br />

Mr. Peterson asked if another study would be appropriate<br />

to conduct and provide feedback to the society.<br />

Recent news articles that indicate hospital financials are<br />

improving are deceiving. Several hospitals are in trouble;<br />

a number of hospitals have closed. Whole communities<br />

have been affected.<br />

Michael Chapman reported on the <strong>Medical</strong> Student<br />

Section. It is focusing on recruitment and keeping<br />

students in the area after graduation. It is hosting a social<br />

event to get students interested and involved in organized<br />

medicine and is looking for more participants,<br />

especially from outlying hospitals. Cost may make it<br />

prohibitive; ACMS budgets $2,000 for the section,<br />

which is usually used for travel expenses to AMA and<br />

House of Delegates meetings. However, the section is<br />

free to use the funds as it sees fit. Adam Gordon, MD,<br />

MPH, noted, if this generates a great response, perhaps<br />

ACMS could provide additional funding. Mr. Chapman<br />

inquired about medical student statistics and physician<br />

retention for Congressman Mike Doyle. Ralph<br />

Schmeltz, MD, volunteered information from a report<br />

by the Pennsylvania Department of Health and will<br />

provide materials to Mr. Chapman.<br />

Obesity Task Force programs are offered statewide.<br />

A Philadelphia project evaluates Latinos and their health<br />

care issues. UPMC was awarded a grant to evaluate<br />

morbid obesity. Hospitals are revising cafeteria food<br />

services and walking areas. The Heinz Foundation<br />

provided funding to evaluate Medicare population<br />

obesity. A House Bill in the Senate makes it necessary for<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

<br />

252 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


BOARD OF DIRECTORS continued<br />

school boards to show food contracts to PTA groups.<br />

Paul Dishart, MD, reported on the<br />

PMS Board of Trustees meeting. It discussed<br />

four major areas: (1) the role<br />

medical care plays in the economy;<br />

(2) health insurance status; (3) physician<br />

practice costs; and (4) physician manpower.<br />

PMS compiled The State of Medicine<br />

in 2005, which will be distributed to<br />

Dr. Dishart<br />

government, hospitals and insurance companies. Mark<br />

Piasio, MD, president, PMS, and Roger Mecum, executive<br />

vice president, will discuss the report at the <strong>May</strong><br />

board meeting.<br />

ACMS sent an inquiry to the Department of State<br />

regarding a chiropractor who notified his patients against<br />

immunizations for children. Anthony Spinola, MD, has<br />

not received further information. It has been more than<br />

a year since the investigation began. A follow-up letter<br />

will be sent to the State Licensing Board.<br />

The board reviewed ACMS awards drafts, Community<br />

and Physician Workplace diversity awards and<br />

questioned if other groups provide diversity awards or<br />

recognition. It suggested the diversity group give a<br />

collaborative award. The definition of diversity and the<br />

parameters of the award were discussed. While the board<br />

supports the concept, awards criteria must be defined.<br />

The Communications Committee will determine two<br />

one-time diversity awards for consideration by the board.<br />

James Ireland, assistant executive director, noted four<br />

seminars the society is hosting on immigration and<br />

employment issues, HIPAA, OSHA and Workers’<br />

Compensation.<br />

John Krah, executive director, noted the auditors<br />

have completed their report and the Finance Committee<br />

will meet to review the portfolio performance of the<br />

reserves. Also, PMS delegation chair and vice chair<br />

elections are being conducted.<br />

The meeting adjourned at 8:15 p.m.<br />

This is a summary report. A full report is available by calling the<br />

ACMS office at (412) 321-5030. Board meetings are open to<br />

members. If you wish to attend, contact the society to receive a schedule<br />

and meeting agenda. The next regular Board of Directors meeting is<br />

Tuesday, <strong>May</strong> 23, <strong>2006</strong>.<br />

www.acms.org/directory<br />

Want quick access to<br />

membership information?<br />

The most up-to-date ACMS Member<br />

Directory is now available online for your<br />

immediate access. Additional information on<br />

the Membership Directory will be available<br />

in the June <strong>Bulletin</strong>.<br />

GE’s #1 Distributor for 100% Windows-based,<br />

Award Winning Practice Management and<br />

Electronic <strong>Medical</strong> Records Systems<br />

Ranked #3 of the region’s fastest growing<br />

companies within the Healthcare Industry<br />

Penn Center West<br />

Building III, Suite 320<br />

Pittsburgh, PA 15276<br />

1-888-950-0688<br />

www.virtualofficeware.net<br />

<strong>May</strong> <strong>2006</strong><br />

The <strong>Bulletin</strong> u 253


254 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


ACADEMIC PERSPECTIVES<br />

The Western Pennsylvania<br />

Hospital’s Affiliation with<br />

Temple University<br />

ELLIOT GOLDBERG, MD<br />

In the fall of 1998, The Western<br />

Pennsylvania Hospital began a<br />

search for a strong medical school<br />

affiliation. Several of the medical<br />

schools in Pennsylvania were interested.<br />

At the time, Temple University<br />

School of Medicine was working<br />

on a clinical campus in the Scranton<br />

area. They were having some difficulty<br />

because of the lack of graduate<br />

medical education programs. After<br />

several months, it became apparent<br />

that Temple had the most interest of<br />

any of the schools we spoke with.<br />

They initially visited our campus in<br />

the late spring of 1999 and decided<br />

not only to affiliate with us, but to<br />

develop a clinical campus here.<br />

Over the next several months, it<br />

was decided to begin our campus in<br />

June 2000 with just a few students.<br />

Now we accept 24 students in the<br />

third year, who then remain for their<br />

senior year. The students live in the<br />

community and become a part of<br />

not only the educational functions<br />

but the hospital functions as well.<br />

This month we will graduate our<br />

sixth and largest class. In addition to<br />

our own clinical campus students,<br />

additional students are sent for<br />

rotations in internal medicine,<br />

general surgery and several of our<br />

medical and surgical subspecialties.<br />

This has brought new life to our<br />

educational programs and has<br />

allowed us to attract high caliber<br />

faculty. All of the full-time faculty<br />

on the West Penn campus have nonprefixed<br />

academic appointments at<br />

Temple University School of Medicine.<br />

Physicians who participate on a<br />

limited basis have clinical faculty<br />

appointments.<br />

So far our students have performed<br />

at the same level or higher<br />

than the students at the main campus.<br />

There are not many true clinical<br />

campuses throughout the United<br />

States. When we began ours, there<br />

were only a half dozen or so. With<br />

the physician shortage and the<br />

interest of many medical schools to<br />

Moving? (Home or Office)<br />

Be sure to let the medical society know.<br />

That way you won’t miss out on any of the great<br />

benefits you’re entitled to as a member!<br />

E-mail acms@acms.org or<br />

call (412) 321-5030 and ask for<br />

Nadine Popovich (ext. 110) or Jim Ireland (ext. 101)<br />

Contact Linda Smith to inquire about a professional ad<br />

in the <strong>Bulletin</strong> (ext. 105 or e-mail lsmith@acms.org)<br />

increase class size, I suspect that<br />

more clinical campuses will develop<br />

throughout the United States.<br />

Attracting medical students upgrades<br />

the graduate education programs<br />

and the level of faculty the school is<br />

able to recruit. We expect our<br />

relationship with Temple to last for<br />

many years ahead.<br />

Dr. Goldberg is director of medical education<br />

and vice chairman of the Department of<br />

Medicine at The Western Pennsylvania Hospital;<br />

he can be reached at (412) 578-5038.<br />

The opinion expressed in this column<br />

is that of the writer and does not<br />

necessarily reflect the opinion of the<br />

Editorial Board, the <strong>Bulletin</strong>, or the<br />

<strong>Allegheny</strong> <strong>County</strong> <strong>Medical</strong> <strong>Society</strong>.<br />

<strong>Allegheny</strong><br />

<strong>County</strong><br />

<strong>Medical</strong><br />

<strong>Society</strong><br />

<strong>May</strong> <strong>2006</strong><br />

The <strong>Bulletin</strong> u 255


PERSPECTIVE<br />

Creation and Darwinism<br />

PATRICK J. MCMAHON, MD<br />

People have long endeavored to is not far from age-old belief in<br />

understand life’s complexity, creation. Proponents need<br />

diversity and origin. Today’s two only to sift though<br />

major explanations are intelligent earth and find<br />

design and evolution, but discussion numerous<br />

of these can be acrimonious. Reasons fossils from<br />

for the rancor are evident in our creatures no<br />

current understanding of intelligent longer alive,<br />

design, evolution and truth, so let’s gaze into<br />

examine each of these.<br />

the heavens at uncountable stars or moths against smoke-darkened<br />

Intelligent design is based on look into the body of the living to background trees or periods of<br />

probabilities, using calculations of conclude that life’s complexity and drought that correlated with longer<br />

current scientific theory that existence<br />

diversity defy human understanding beaks in birds better able to forage<br />

could have occurred on its own. and is their evidence of God. on remote islands. Then, imagining<br />

The strong and weak forces known Now let’s turn our attention to life in simple forms hundreds of<br />

to be at work in our universe are evolution. Because it is taught in millions of years ago and the profound<br />

examples. Strong forces hold together<br />

grade schools across America, a full<br />

effects over those many years,<br />

matter composed of electrons, explanation is unnecessary. In we come to the present state of<br />

protons, neutrons and other small summary, the theory of evolution things. This may be taken to show<br />

particles. If altered by the smallest includes two kinds of processes. The that natural selection can do something.<br />

amount, all matter would be unstable,<br />

first is chance, which alone is not<br />

resulting in chaos. In addi-<br />

credible for understanding life’s Nevertheless, advocates of<br />

tion, the earth and all other celestial complexity. Everyone acknowledges evolution need to also explain the<br />

bodies are held in their orbits by that living organisms are enormously existence of all things. This is much<br />

gravity and other weak forces. These more complex than a computer or more difficult. Scientific advances in<br />

too, if altered by the smallest an airplane. That such complex geology and other fields of study<br />

amount would be incompatible with entities came into existence simply combined with his own well-known<br />

the organization of the cosmos. In by chance is not credible. Therefore, findings allowed Charles Darwin to<br />

either case, the probability of events there is a second process of evolution write The Origins of Species in 1859.<br />

being compatible with existence as that is a complexity-building force Today, we know of complexity on<br />

we know it today are so far removed that is mindless and purposeless, both the macro- and micro-level far<br />

from human experience that they are namely natural selection.<br />

surpassing that known in the midimpossible<br />

to comprehend. The best Natural selection’s power is best 19th century. With no better evidence<br />

plausible explanation for the complexity<br />

supported in evidence for life’s<br />

for origins, some cling to this<br />

and diversity of life and the complexity and diversity. Examples century-and-a-half old theory. It<br />

origin of all things is that intelligence,<br />

include a moth population in which seems that evidence is not necessary<br />

separate from our own, the percentage of dark moths in-<br />

to prove something that is practically<br />

designed the universe.<br />

creased during a period when the self-evident. Instead, the evidence<br />

The theory of intelligent design birds were better able to see light for evolution follows deductively<br />

256 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


PERSPECTIVE continued<br />

from the philosophical premise that<br />

nature had to do its own creating.<br />

There can be argument about the<br />

details but, if there was no designer,<br />

then something like evolution<br />

simply has to be true.<br />

This leads us to the examination<br />

of truth, which today has two<br />

different meanings. First, there is<br />

truth as an unchanging absolute and<br />

then there is truth that is personal<br />

and dynamic. In the latter, each<br />

person decides his or her own truths,<br />

and these truths may change over<br />

time. For Darwinists, the creator<br />

does not establish the truth, science<br />

does; and scientific knowledge is a<br />

dynamic concept. Proponents of<br />

evolution will gladly concede that<br />

the theory is incomplete, and that<br />

further research is needed. At any<br />

given point in time, however, the<br />

reigning theory of evolution represents<br />

the state of scientific knowledge<br />

about life’s complexity, diversity<br />

and origin. Scientific knowledge, by<br />

definition, yields the best understanding<br />

of truth available. To ask<br />

whether this knowledge is true is<br />

therefore to miss the point, and to<br />

betray a misunderstanding of “how<br />

science works.”<br />

Since science is the purveyor of<br />

knowledge to some scientists, it is<br />

exempt from belief. Belief, instead,<br />

involves any entity unknown to<br />

science. This includes the intelligence<br />

of intelligent design. But all<br />

scientists know that rigorous scientific<br />

methods cannot be applied to a<br />

research question on origins. Instead,<br />

scientists are left with conjecture and<br />

then attempt to fit discovery into its<br />

framework.<br />

Debate of origins causes considerable<br />

rancor because it necessitates a<br />

discussion much broader than its<br />

participants will often allow. This<br />

includes but is not limited to discussion<br />

of truth. Today with available<br />

data, the origin of life depends<br />

instead on one’s beliefs.<br />

Dr. McMahon is an orthopedic surgeon. He<br />

can be reached at mcmahonp@upmc.edu.<br />

The opinion expressed in this column<br />

is that of the writer and does not<br />

necessarily reflect the opinion of the<br />

Editorial Board, the <strong>Bulletin</strong>, or the<br />

<strong>Allegheny</strong> <strong>County</strong> <strong>Medical</strong> <strong>Society</strong>.<br />

101 01<br />

Introducing Scan<br />

on Demand ṬM<br />

B<br />

usiness Records Management, Inc.<br />

is introducing a high speed digital solution that allows<br />

documents to be scanned and available for instant access<br />

TM<br />

within minutes. Scan on Demand makes it easy to meet<br />

the most demanding needs of your health care organization.<br />

001 001011 01 10110 10111110 0010 11 10001<br />

010101000 10 100 101 0<br />

1 10 1<br />

00 1 0 01<br />

1 1 1010 01110 110001000001110 00<br />

00110 11 010010<br />

0<br />

01<br />

100<br />

Instant access to documents<br />

from your desk through<br />

authenticated authorization.<br />

Save time and reduce<br />

delivery costs.<br />

Reduce risk of exposing<br />

protected health information.<br />

1<br />

<strong>May</strong> <strong>2006</strong><br />

Call Today<br />

to learn more about Scan on Demand ṬM<br />

412.321.0600<br />

www.businessrecords.com<br />

The <strong>Bulletin</strong> u 257


CLASSIFIEDS<br />

Help Wanted<br />

GREAT OPPORTUNITY for<br />

highly skilled FAMILY PHYSI-<br />

CIAN in growing Grove City<br />

area. Well-established, successful,<br />

progressive primary care group<br />

seeking board certified family<br />

physician to maintain busy practice<br />

of retiring partner. EMR recently<br />

implemented. Small college<br />

town with strong schools,<br />

very close to shopping outdoor<br />

activities and easy access to Pittsburgh.<br />

Evening and weekend call<br />

1 in 4. Competitive salary and<br />

benefits. Signing bonus. Partnership<br />

option available. Reply to<br />

Family Healthcare Partners, 420<br />

Hillcrest Avenue, Grove City, PA<br />

16127.<br />

For Sale<br />

ASPINWALL–MLS#603820–<br />

$435,000–This classic and stately<br />

brick home in Aspinwall features<br />

a large front porch with tile floor,<br />

original woodwork, stained glass<br />

windows, den with fireplace, formal<br />

living and dining rooms,<br />

third floor suite offering two bedrooms,<br />

full kitchen and bath, and<br />

a charming courtyard. Bunny<br />

Wolff and Lucy Oliver at 412-<br />

782-3700 ext. 238 or 210.<br />

FOX CHAPEL–MLS#600195–<br />

$798,000–Beautifully appointed<br />

4 bedroom brick Colonial home<br />

in close-in Boro location features<br />

many updates and improvements.<br />

Completely remodeled<br />

kitchen, family room with fireplace,<br />

first floor laundry, mature<br />

landscaping and walled patio.<br />

Bunny Wolff and Lucy Oliver at<br />

412-782-3700 ext. 238 or 210.<br />

For Sublease<br />

SUBLEASE–SOUTH HILLS:<br />

Manor Oak Two–new, fully<br />

equipped medical office located<br />

near St. Clair Hospital. Free parking,<br />

space available for half days<br />

or full days on Tuesdays and<br />

Thursdays. For additional information,<br />

contact Shirley at 412-<br />

687-2100.<br />

CLINICAL OFFICE SPACE<br />

available immediately for sublease<br />

at: North Hills, 5000 McKnight<br />

Road, Suite 202 - 3 exam rooms,<br />

education room, free parking,<br />

available Monday, Wednesday,<br />

Thursday, and Friday; Beaver,<br />

701 Fifth Street, 2nd Floor - 2<br />

exam rooms, free parking, available<br />

Monday, Wednesday, and<br />

Friday; RIDC Park, 107 Gamma<br />

Drive, Suite 110 - 3 exam rooms,<br />

free parking, available Wednesday<br />

and Thursday; Penn Hills, 1000<br />

Integrity Drive, Suite 320 - 3<br />

exam rooms, free parking and<br />

available Wednesday. For additional<br />

information call 412-359-<br />

4576.<br />

For Rent<br />

MEDICAL OFFICE SPACE<br />

FOR RENT–Route 60-<br />

Robinson Township. Finished<br />

space. Prime location. 1250<br />

square feet. $1750/month plus<br />

utilities. First 3 months free.<br />

Great parking. 412-787-8590<br />

x117<br />

DESIRABLE PRIVATE OF-<br />

FICE SPACE for rent, in Psychiatric<br />

Suite, Oakland area, approximately<br />

21’x15’. Call<br />

412-687-1966.<br />

Professional Services<br />

SOCIAL SECURITY FORMS/<br />

CONFLICT OF INTEREST–If<br />

you aren’t sure whether your patient<br />

is medically disabled, you<br />

may be reluctant to fill out Social<br />

Security papers for them. A<br />

conflict of interest may arise. You<br />

want to support your patient, but<br />

not doing so could mean you lose<br />

this patient. Avoid this conflict altogether.<br />

My office performs<br />

medical disability evaluations so<br />

you don’t have to. Furthermore,<br />

we represent patients in Social<br />

Security proceedings to win their<br />

case. Leslie Tar, MD, JD, MPH -<br />

Rheumatology/Occupational<br />

Medicine, Physician & Attorney<br />

at Law. 412-488-0218. Offices<br />

throughout the South Hills.<br />

www.MyLawDoc.com<br />

The medical society appreciates<br />

and depends on its advertisers.<br />

Please remember to tell them<br />

you saw their ad in the <strong>Bulletin</strong>.<br />

258 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>


<strong>May</strong> <strong>2006</strong><br />

The <strong>Bulletin</strong> u 259


www.malachy.com<br />

GREAT NEWS! Your Specialty<br />

to Age 65 Disability Insurance!<br />

It’s Back! A “Your Specialty” definition of<br />

total disability is available again!<br />

¨<br />

This means that, if you are totally disabled<br />

from your specialty, you may work<br />

elsewhere and still collect!<br />

¨<br />

¨<br />

We have an exclusive 10% discount!<br />

Please visit our website at www.malachy.com<br />

or e-mail us at help@malachy.com. We can<br />

be reached by e-mail, fax (412/261-5955) or<br />

phone (412/281-4050).<br />

We are always available as your<br />

insurance consultants. Please call<br />

us at any time if you have<br />

questions about your existing<br />

coverage or new options you may<br />

have heard about. We assure<br />

prompt response, realistic advice<br />

and no sales pressure.<br />

Malachy Whalen<br />

mw@malachy.com<br />

Clark Whalen<br />

clarkw@malachy.com<br />

Peggy McNamee<br />

peggymc@malachy.com<br />

Malachy Whalen & Co., Inc.<br />

Visit www.malachy.com<br />

(412) 281-4050<br />

(800) 343-5382<br />

FAX (412) 261-5955

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!