May 2006 Bulletin - Allegheny County Medical Society
May 2006 Bulletin - Allegheny County Medical Society
May 2006 Bulletin - Allegheny County Medical Society
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<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 />
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that they are not under simultaneous<br />
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Issued the third Saturday of each<br />
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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 />
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Publisher reserves the right to exclude<br />
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in no way constitutes approval or<br />
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COPYRIGHT <strong>2006</strong>:<br />
ALLEGHENY COUNTY MEDICAL<br />
SOCIETY<br />
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ISSN: 0098-3772
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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 />
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<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 />
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222 u The <strong>Bulletin</strong> <strong>May</strong> <strong>2006</strong>
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<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 />
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the articles more interesting. ................................................ 5 ........ 4 ........ 3 ........ 2 ........ 1<br />
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if the inside pages were in color instead of black & white. . 5 ........ 4 ........ 3 ........ 2 ........ 1<br />
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anything. .............................................................................. 5 ........ 4 ........ 3 ........ 2 ........ 1<br />
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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 />
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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 />
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575 Coal Valley Road<br />
Jefferson Hills, PA 15025<br />
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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 />
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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 />
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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 />
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<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 />
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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 />
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The <strong>Bulletin</strong> u 257
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SOCIAL SECURITY FORMS/<br />
CONFLICT OF INTEREST–If<br />
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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
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