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Bush and Kerry

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					                                                                                                                                            September 2004




                    Physician
                                                                           W A S H I N G T O N H O S P I TA L C E N T E R                            vol. 10, no. 7




                                                                                                       News for Medical Staff, Residents, Fellows and Alumni




Inside…
The Aging
Athlete
A Golden
Moment
Joint Practice
Net Results
                       Justin Sullivan/Getty Images




                                                                                                                                                                      Pool/Getty Images
                       John Kerry
                        Democrat,
                      Senator from
                                                                             Bush and Kerry                                                        George W. Bush
                                                                                                                                                     Republican,
                      Massachusetts
                                                                                  on Health Issues                                                   incumbent

                                                                                                By Melanie Howard



                                                  F       or many physicians this presidential election
                                                          will boil down to just one issue: tort reform.
                                                      One candidate — President George W. Bush — sup-
                                                                                                            This is the elephant in the room whenever physicians
                                                                                                            discuss politics these days, whether they support or
                                                                                                            abhor the war, believe in tax cuts or dread deficits,
                                                                                                            support oil drilling in Alaska or more environmental
                                                      ports it wholeheartedly, while another — challenger   protections.
                                                      John Kerry — has hedged on the lynchpin issue of
                                                      limits on damages for pain and suffering.             For stalwart Republicans Bush is a slam-dunk choice.
                                                                                                            But for others, the concept of casting a vote for the
                                                                                                            GOP is distressing. For one ob-gyn who came of age
                                                                                                            in the feminist 1970s in liberal California, reproduc-
                                                                                                            tive choice has always been a critical factor in deter-
            HIPAA on My Mind                                                                                mining her vote. But this year, as she told her
                                                                                                            astounded life-long Democrat mother recently, “If I
            Reality Check One Year Later                                                                    don’t vote for the candidate who supports tort reform,
                                                                                                            I may not be in business much longer to help women
            By James Jelinek, MD                                                                            make reproductive choices.” She remains one of the



            T
                  he Health Insurance Portability and Accountability Act                                                                     continued on page 10
                  of 1996 (HIPAA) was designed to protect patients on
                  how their personal health and information is to be used
            and disclosed, particularly to third parties. Specifically, a
            patient’s private health care information should not be given
            to insurance companies, third-party people (friends), or third-
            party vendors (pharmacies and drug companies). This task has
            been an unfunded mandate thrust upon all health care
            providers and, in particular, has been more onerous due to the
            misconceptions about HIPAA.
                                                                                continued on page 6
                                                                                                                                         MedStar Health
      Viewpoint

Taking Issue with
Malpractice Advice
T
      his letter is in response to               In the section, “Whom to                                               The Physician Newsletter
      “Malpractice Lawsuits: Prevention          contact,” advising physicians                                          article advises physicians
      and Preparation” in the June 2004          to go the legal route first if                                        concerned about a case to
Washington Hospital Center Physician             they suspect there may be a suit                                      “…remain aloof and
Newsletter. Not only do I disagree vehe-         brewing against them, suggests that one can                           detached…” But the data
mently with the tone it sets, much of the        predict which cases will go to court. This       show that such behavior is precisely what
advice is outdated and antithetical to reduc-    advice, however, doesn’t match up with the       makes difficult situations become court
ing physician liability (Forster, Schwartz,      facts. Many obviously actionable cases, e.g.     cases. The first step down the path towards
DeRenzo, 2002).                                  the wrong kidney was removed, never get to       legal liability is for a patient or a patient’s
                                                 court. If an action is brought in such a case,   family member to believe there has been
Telling physicians “Like a general, if you       often the hospital just opens the checkbook      harm and for an attorney to believe there
know you’re going to be attacked on the          and asks, “How many zeros would you like         was enough harm to achieve legal success.
western front, you can shore up your             with this?” But such obviously actionable        But for there to be a physician’s success, i.e.,
defenses” sends the wrong message and sets       cases don’t always result in a claim. And        that the situation calms down without the
physicians up for acting in ways that merely     although data illuminating this issue are        lawyers getting involved, the data show that
increase, not decrease, liability. Perhaps war   hard to come by, evidence for the lack of        the physician’s interpersonal competence
language motivates attorneys in ways that        linkage between event and liability claim is     and the strength of the physician-patient
bring attorneys success. Success for attor-      beginning to surface.                            relationship are what matter most (Moore
neys means winning or advantageously set-                                                         et al, 2000).
tling cases. But success for attorneys is not    The Wall Street Journal (May 18, 2004)
the same as success for physicians. Success      reported the case of a 43-year-old female        Rather than run to risk management and the
for physicians is never being involved with      arresting during routine ankle surgery           hospital attorneys at the first sign of a prob-
attorneys. And the way to keep attorneys         because of an anesthesiology error. Angry,       lem, it might be better to run to the chair of
out of the medical setting is to practice        the patient sued. Against hospital legal         that hospital’s ethics committee. Rather than
patient-centered medicine, not the kind of       advice, the anesthesiologist contacted the       the attorney who is trained to see everything
anachronistic defensive medicine advo-           patient and apologized. The patient dropped      as adversarial combat, the chair of a hospi-
cated in this article.                           the suit.                                        tal’s ethics committee will approach the situ-
                                                                                                  ation within the context of Hippocratic tra-
                                                                                                  ditions. This is the approach that goes the
                                                                                                  furthest in reducing liability, not the
  Response From the Editor                                                                        approach practiced by those whose success is
                                                                                                  focused on battle readiness.
  James Jelinek, MD
                                                                                                  Evan G. DeRenzo, PhD
  Everyone involved with patient care rec-       the article specifically dealt with “How To      Bioethics Consultant
  ognizes that the most important facet of       Avoid Lawsuits.” It states that “poor com-       Bioethics
  improving patient care and avoiding mal-       munication with patients and families,           June 24, 2004
  practice issues is communication. A            and failure to document gets doctors in
  strong doctor-patient relationship is the      trouble time and time again.” This was a
  most important factor contributing to          direct quote from Marilys Gilbert, direc-        References
  perceived quality of treatment by a            tor of Risk Management.
                                                                                                  Forster, HP, Schwartz, J, DeRenzo, EG. (2002).
  patient. The stronger the patient-doctor
                                                 The article specifically dealt with physi-       Reducing Legal Risk by Practicing Patient-
  relationship, the less likely there will be                                                     Centered Medicine. Arch Intern Med.
  malpractice activity no matter how bad         cians who are confronted with a lawsuit,
                                                 after patient care has taken place. No one       162:1217-1219.
  the actual health care delivered is.
                                                 would disagree with Dr. DeRenzo that             Moore, PH, Adler, N, Robertson, P. (2000).
  On the other hand, a superb physician          excellent rapport with the patient would         Medical malpractice: The effect of doctor-
  who has a poor relationship with his           likely have prevented the lawsuit but,           patient relations on medical patient percep-
  patients is more likely to be sued in the      once the lawsuit happens, this is a com-         tions and malpractice intentions. Western
  event of a bad outcome, even if malprac-       pletely different environment, which             Journal of Medicine. 173:248.
  tice was not involved. The article             needs to be approached carefully.                Zimmerman, Rachel. (2004). Medical contri-
  “Malpractice Law Suits: Prevention and                                                          tion: Doctors’ new tool to fight lawsuits:
  Preparation” focused on defending law-                                                          Saying ‘I’m sorry’sorry’. Wall Street Journal.
  suits when they appear. One section of                               continued on page 7        May 18: A1.


–2–
      Insider

Study Looks at Cholesterol-Lowering
Statin to Prevent Heart Attacks
Reducing Inflammation May Boost Coronary Health

T
      he link between using a cholesterol-
      lowering statin to reduce inflamma-
      tion and preventing heart attacks in
people who currently do not have any car-                                                                                     DESIRED
diac or coronary disease but who may be at                                                                                    LEVELS
risk of heart attack is being studied by
Washington Hospital Center researchers.                                                                                   Total Cholesterol:
                                                                                                                              less than
The drug rosuvastatin manufactured by                                                                                      200 milligrams
AstraZeneca Pharmaceuticals is being used
                                                                                                                             LDL 100-129
to reduce high-sensitivity CRP (hsCRP), an
                                                                                                                           (LDL 70 mg or less
indicator of inflammation, as part of a dou-
                                                                                                                          for people who have
ble blind, placebo-controlled study of par-
                                                                                                                          had heart attacks or
ticipants who have LDL-C cholesterol levels
                                                                                                                           are at high risk for
that currently do not require drug therapy.
                                                                                                                              heart disease)
Men who are older than 55 and post-
menopausal women age 65 or older who
have no history of heart attack or stroke are                                                                                 HDL 60 mg
being sought to participate in the study led                                                                                   or more
by primary investigator Wm. James Howard,                                                                                    Triglycerides
MD, the Hospital Center’s vice president for                                                                                under 150 mg
Academic Affairs.



    Men who are older
     than 55 and post-                            stroke. hsCRP is a substance that is produced
                                                  by inflammatory cells and is a marker that
                                                                                                     will be followed for three years, including
                                                                                                     follow up visits every six months during
   menopausal women                               can be used to detect possible cardiac dis-        which blood will be drawn and medications
    age 65 or older who                           eases and other conditions such as rheuma-
                                                  toid arthritis or lupus.
                                                                                                     will be reviewed and dispensed. A small
                                                                                                     stipend is given to offset their travel costs.
     have no history of                           “In previous clinical trials, when the LDL         Anyone who is interested in participating in
   heart attack or stroke                         has been lowered so has hsCRP,” said               this study should call study coordinator
    are being sought to                           Howard. “Patients who have high hsCRP
                                                  and who have high LDL cholesterol have a
                                                                                                     Aynn Feller at (202) 877-6839.

  participate in the study.                       very high risk of coronary disease. But of sig-                                 — LeRoy Tillman
                                                  nificant interest to physicians is the fact that
                                                  individuals with relatively low LDL levels           WASHINGTON HOSPITAL CENTER
“We’re hoping to learn whether there are          but elevated hsCRP levels are also at
other actions of the statin above and beyond      increased risk for a heart attack or stroke. We               June Statistics
lowering LDL cholesterol that can con-            want to determine whether lowering hsCRPs                                        2004     2003
tribute to the prevention of heart disease,”      can be correlated with preventing heart dis-
said Howard. “And if that’s the case, we may      ease and strokes.”                                   Inpatient Admissions        3,988    3,781
be able to extend the drug’s benefits to peo-
ple whose LDL, or bad cholesterol, is cur-        Individuals who know that their LDL level is         Outpatient Clinic Visits    7,512    7,080
rently at a level that is currently not consid-   less than 130, but who are concerned that
                                                  they may be at increased risk for a heart            ED Visits                   5,624    5,639
ered at high risk for a heart attack.”
                                                  attack of stroke can have their hsCRP level          ED Admissions               1,374    1,374
Recent research has found that the hsCRP          measured at no cost for possible participa-
blood test may be a marker for inflamma-          tion in this study. Participants will be ran-        Average Daily Census          675      673
tion of the arteries. The test may indicate a     domized to receive either daily doses of 20
                                                                                                       Births                       345       354
higher risk for first-time heart attack or        mg of rosuvastatin or a placebo. The patients

                                                                                                                                              –3–
      News & Notes




                                                                                                          Four Seasons Hotel
    TERRY FOX RUN
    T   he 2004 Terry Fox Run, along with an April golf tournament – both sponsored by the Four
        Seasons Hotel — have raised $70,000 for the Washington Cancer Institute. Here, runners and
    walkers stretch before the event. Hospital Center President James Caldas and his son Chris were
    participants in this year’s 5K run, which included a Kid’s Dash and a Farmer’s Market that featured
    fresh potted herbs, specially mixed rubs and dried herbs, flowers and baked goods. New this year
    was a “Restaurant Grab,” in which participants took a chance that the envelope they selected
    contained a certificate to The Palm, Galileo, Mendocino Grill or Ceiba restaurants. The third event
    from the Four Seasons to benefit the hospital will be a jazz concert featuring Jonathan Butler and
    a silent auction/raffle.



NEW ERA OF MEDICINE:                                       DOCSLINK SURVEY RESULTS
“MEETING THE CHALLENGE” CME
                                                           T  hank you to everyone who participated in the
                                                              first DocsLink survey to mark the two-year
                                                                                                                               FAMILIES
J  oin your colleagues Dec. 5-8, 2004 at the new
   Westin Casuarina Resort and Spa on Grand Cayman
Island. In this era of fast advancing medical technol-
                                                           anniversary of the e-newsletter. Here are the
                                                           results:
                                                                                                                               TEAMING UP
                                                                                                                               TO MEET THE
ogy and research, physicians are often challenged by          • 96% of those responding read DocsLink.                         COUNT
the task of keeping up with the most current research
and knowledge in fields outside their own. This con-
ference will provide an opportunity to absorb this
                                                              • 83% read DocsLink regularly or every time
                                                                it is published.
                                                              • 80% find the information useful.
                                                                                                                               D    avid Buck, MD, radiology,
                                                                                                                                    and his daughter
                                                                                                                               Margaux, visited the Blood
knowledge in a peaceful and relaxed setting, away
                                                                                                                               Donor Center this summer
from the demands and pressures of clinical practice.          • 64% of respondents are attendings; 35%
                                                                of respondents are staff.                                      to help Washington Hospital
The conference is a four-and-a-half day event, with a
                                                                                                                               Center “Meet the Count.”
focus each morning on a specific clinical challenge in     Each physician’s office should receive DocsLink.                    The Hospital Center’s goal
the areas of infectious disease, endocrinology, surgery    It is one of the communication tools that the                       for the 2004 MedStar Health
and medicine. Discounted airfare, room rates and           Hospital Center will use to notify the medical and                  blood donor campaign is 50
recreational packages are available. 20 category 1         dental staff in the event of emergencies. To sub-                   percent participation. Please
AMA-PRA credits. Micheal Pistole, MD, activity drec-       mit or update your (or your office) e-mail address,                 call (202) 877-5250 and
tor. Contact Ramona Finch (202) 877 8201 or at             e-mail Annamarie.G.DeCarlo@Medstar.net.                             make your appointment to
Ramona.Finch@MedStar.net to register or for more
                                                                                                                               donate today.
information.

–4–
                                           W A S H I N G T O N                                   H O S P I T A L                       C E N T E R
                                           OFFICE              OF       CONTINUING MEDICAL EDUCATION
                                                             SEPTEMBER 2004 — HIGHLIGHTS
                                                            Upcoming CME Events Sponsored by Washington Hospital Center

FINANCIAL                            SEPTEMBER 18, 2004                            DECEMBER 5 – 8, 2004                      MARCH 5 – 12, 2005
UPDATE                               ASCO Highlights Conference
                                     Presented by Washington Cancer Institute at
                                                                                   New Era of Medicine:
                                                                                   Meeting the Challenge
                                                                                                                             Controversies in Medicine
                                                                                                                             Conference
                                     Washington Hospital Center                                                              Presented by Washington Hospital Center
I n early 2004 the Hospital                                                        Conference
                                     Dennis A. Priebat, MD – Act. Dir.             Presented by Washington Hospital Center   Wm. James Howard, MD – Act. Dir.
  Center began its initiative to     Hilton McLean, Tyson’s Corner, Va.            Michael Pistole, MD – Activity Director   Vail, Colo.
streamline the patient reserva-      (703) 683-1666                                Grand Cayman Island                       (202) 877 - 8201
tion and registration processes to   7 “category 1” credits                        (202) 877-8201
make life easier for our patients    SEPTEMBER 28 – OCTOBER 2, 2004                     REGULARLY SCHEDULED CATEGORY 1 ACTIVITIES
and to get better control over       Board Review in
                                     Gastroenterology                              CARDIOLOGY/CARDIOVASCULAR                 NEONATOLOGY
collecting the revenue the hospi-    Presented by Washington Hospital Center &     Cardiac Catheterization                   Visiting Lecturer Series in
tal has earned for services. Here    Capital Academics of Greater Washington,      Conference                                Perinatology
are some recent accomplish-          Inc.                                          Weekly, Wednesdays, 7:30 a.m.             1st & 2nd Tues., 12:30 p.m.
                                     William M. Steinberg, MD – Act. Dir.          True Auditorium                           Room. 5B-03
ments, as of the end of June:        Wyndham Baltimore Inner Harbor                1 “category 1” credit per lecture         1 “category 1” credit per lecture
                                     Hotel – Baltimore, Md.                        (202) 877-8574                            (202) 877-6527
■ As of June 30, only a few          1-800-283-1997
days after the process began,        40 “category 1” credits                       Interventional Vascular                   NEUROSURGERY
                                                                                   Conference                                Neurosurgery Conference
the Emergency Department had         OCTOBER 15 – 16, 2004                         Weekly, Thursdays, 7:00 a.m.              Tuesdays, 7:30 a.m. — Room G2-70
collected $2,640 in co-pays in its   Cutting Edge in Radiation                     CTEC Auditorium                           1 “category 1” credit per lecture
acute care area. The dollar          Oncology Symposium –                          1 “category 1” credit credits             (202) 877-5580
                                     “Technology, Techniques and                   (202) 877-8050
amount reflects payments made        Treatment Modalities”                                                                   OBSTETRICS/GYNECOLOGY
                                                                                   Updates in Cardiovascular                 OB/GYN Grand Rounds
during the hours of 8 a.m. to 4      Sponsored by Washington Hospital Center &     Medicine Lecture Series
                                     MedStar Radiation Oncology Network                                                      Weekly, Tuesdays, 8 a.m.
p.m., Monday through Friday,                                                       Bi-weekly, Tuesdays, 6:30 p.m.            5B-3 Auditorium
                                     Paul B. Fowler, MD – Activity Director        Area DC, MD, and VA Restaurants
when the discharge desk is           Princess Royale Conference Center                                                       1 “category 1” credit per lecture
                                                                                   2 “category 1” credits per lecture        (202) 877-6054
staffed. Evening hours will be       Ocean City, Md.                               (202) 877-2994
added soon.                          (410) 682-6805
                                                                                   Echocardiography Conference               ONCOLOGY
                                     OCTOBER 29, 2004                              Weekly, Thursdays, 7:45 a.m.              Presented by the Washington Cancer
■ The GI Lab, Center for Breast      Vocal Cord Dysfunction:                       Cath Lab Conference Room (5th Flr)        Institute (WCI)
Health, and Medicine/Sub-            An Overview of Diagnosis and                  1 “category 1” credit per lecture         Gastrointestinal Oncology Case
Specialty Clinics have collected     Treatment Symposium                           (202) 877-7853                            Presentations
                                     Presented by Washington Hospital Center &                                               Bi-Monthly, 2nd & Last Fridays,
$12,120 in fees since April 1        the Hearing and Speech Center                 EMERGENCY MEDICINE                        8 – 10 a.m.
that patients are required to pay    Ziad E. Deeb, MD – Activity Director          Emergency Medicine Grand                  Surgical Classroom – Room G-270
                                     Cardiovascular Research Institute and         Rounds                                    2 “category 1” credits per lecture
at the time of service (co-pays or                                                 Third Thursdays, 7:00 a.m.
                                     Siegel Auditorium                                                                       (202) 877-3908
co-insurances).                      (202) 877-5189                                Emergency Dept. Conference Room
                                     6 “category 1” credits                        1 “category 1” credit per lecture         Multidisciplinary Breast Cancer
■ The Central Financial                                                            (202) 877-9191                            Treatment Conference
Clearance Department is now          NOVEMBER 12, 2004                                                                       Weekly, Wednesdays, 7:30 a.m.
                                                                                   Emergency Medicine Continuous             Seigel Auditorium
                                     Maintenance of Vitality and                   Certification (EMCC) Literature
operative for inpatient and out-     Quality of Life: Living with                                                            1 “category 1” credit per lecture
                                                                                   Review                                    (202) 877-7937
patient surgical services, mean-     Cancer and Cancer Treatments                  Last Thurs. of each month, 7:30 a.m.
ing that financial clearance now     Conference                                    Emergency Dept. Conference Room
                                     Jointly sponsored by Washington Hospital                                                OPHTHALMOLOGY
is conducted using a centralized,                                                  1 “category 1” credit per lecture         Presented by Washington National Eye
                                     Center & The National Rehabilitation          (202) 877-9393
                                     Hospital                                                                                Center
real-time system.
                                     Brendan Conroy, MD – Activity Director        Emergency Medicine Faculty                Saturday Morning Lecture Series
■ The hospital estimates that        National Rehabilitation Hospital              Development Series                        Weekly, Saturdays, 8:30 a.m.
denials for payment will be 1        Auditorium                                    TBD                                       True Auditorium
                                     (202) 877-1952                                Emergency Dept. Conference Room           2.5 “category 1” credits per lecture
percent of net revenue in FY 04,     6 “category 1” credits                        at Washington Hospital Center             (202) 877-6159
down from 1.8 percent in FY 03.                                                    1 “category 1” credit per lecture
                                     DECEMBER 3, 2004                              (202) 877-9393                            SURGERY
                                     Thyroid Disorders:                                                                      General Surgery Orange Team
                                     Recent Advances Conference                    GASTROENTEROLOGY                          Teaching Conference and Lecture
                                     Presented by Washington Hospital Center &     Gastroenterology Research Topic           Weekly, Thursdays, 8 a.m.
                                     the Department of Medicine/Division of        Monthly, Wednesdays, 4:30 p.m.            General Surgery Conference Room
U.S. NEWS &                          Endocrinology
                                     Kenneth Burman, MD & Kathleen
                                                                                   2A50 Medicine Conference Room
                                                                                   1 “category 1” credit per lecture
                                                                                                                             2 “category 1” credits per lecture
                                                                                                                             (202) 877-9847
WORLD REPORT                         Prendergast, MD – Activity Director
                                     Washington Hospital Center
                                                                                   (202) 877-2848                            Surgery Grand Rounds
                                                                                                                             Weekly, Tuesdays, 8 a.m.
RANKINGS                             True Auditorium
                                                                                   MEDICINE
                                                                                   GRAND ROUNDS                              True Auditorium
                                     (202) 877-6563                                Weekly, Wednesdays, 12:30 p.m.            1 “category 1” credit per lecture
W     ashington Hospital Center
      placed 15th in the Heart
and Heart Surgery category and
                                     8 “category 1” credits                        True Auditorium
                                                                                   1 “category 1” credit per lecture
                                                                                   (202) 877 3109 or (202) 877 6749
                                                                                                                             (202) 877-6426
                                                                                                                             UROLOGY
                                                                                                                             Urology Academic Series
30th in the Hormonal Disorders                                                     NRH Medical Grand Rounds                  Weekly, Tuesdays, 8 a.m.
category in the annual U.S.                                                        Fridays, Noon — NRH Auditorium            Siegel Auditorium
                                                                                   1 “category 1” credit per lecture         1 “category 1” credit per lecture
News & World Report’s list of                                                      (202) 877-1660                            (202) 877-3968
the top 50 hospitals.

                                                                                                                                                                 –5–
   Feature


                                                HIPAA                                              HIPAA was never designed to obstruct
                                                                                                   patient health care. Unfortunately the zeal
 Common Myths                                   continued from page 1                              with which HIPAA was pushed forward has
                                                                                                   led to over-zealous enforcement of HIPAA
 Regarding HIPAA                                I recently was shocked when employees of           mandates. For example, it is explicitly stated
                                                the Radiology Department refused to fax            in the United States Department of Health
 T   he United States Department of Health
     and Human Services Fact Sheet on
 HIPAA states that “To promote the best
                                                reports or send a copy of films to referring
                                                physician offices. They did so under the mis-
                                                                                                   and Human Services Fact Sheet on HIPAA
                                                                                                   that “To promote the best quality care for
                                                understanding that HIPAA prevented them            patients, the rule does not restrict the ability
 quality care for patients, the rule does not   from sending the X-rays or results without         of doctors, nurses, and other health care
 restrict the ability of doctors, nurses, and   having a specific signed release from the          providers to share information needed to
 other health care providers to share infor-    patient. I was also appalled when trying to        treat their patients.”
 mation needed to treat their patients.”        reach a physician regarding a significant
                                                finding on an MRI to a physician. The refer-       The disclosure of test results on a patient
                       •••
                                                ring physician’s office refused to provide any     from one physician’s office to another is a
 MYTH: It is illegal for a physician to fax                                                        part of the health care process and HIPAA
 or e-mail patient data to a consulting         information about the patient, even though
                                                the findings could jeopardize the patient’s        does not ban the faxing of medical records
 physician.                                                                                        and disclosure of the patient when one
                                                health care. The gross misunderstanding of
 TRUTH: HIPAA specifically allows               HIPAA’s intent has prevented health care           health care facility is sending results to
 this. Customary safeguards should              providers from taking good care of their           another health care facility. No patient
 apply when using e-mail and caution            patients. It is time for all of us to recognize    authorization is required for this. The send-
                                                what HIPAA was intended to do and what             ing party should, however, have in place
 where patient records are being
                                                HIPAA does not forbid.                             mechanisms that e-mails or faxes are indeed
 faxed.                                                                                            being sent to a physician’s office involved
                     •••                                                                           with the patient’s health care.
 MYTH: It is illegal for departments to
 fax reports or send a copy of films to             It is time for all of us                       Patient Rights
 referring physician offices without a                to recognize what                            Other major misconceptions about HIPAA
 signed release from the patient.                                                                  are related to the patient’s rights. For exam-
                                                    HIPAA was intended                             ple, parents or guardians are permitted to
 TRUTH: The use and disclosure of
 health information from one covered               to do and what HIPAA                            have access to their loved ones’ medical
                                                                                                   records. HIPAA defers to state law regarding
 health care provider to another for                    does not forbid.                           how a parent or guardian has access to a
 the purpose of providing treatment is                                                             minor or dependent’s medical care data.
 specifically covered and no authoriza-                                                            HIPAA does not supercede or pre-empt state
 tion from a patient is required.               There are several common myths that have           law regarding minors. This means, in most
                    •••                         created obstacles to delivering patient health     states, parents or guardians have access to
 MYTH: It is illegal for health care work-      care. For example, some physicians, physi-         medical records of their children and loved
 ers to share patient medical information       cians’ office employees, and hospital              ones without the minor’s or dependent per-
 with family members.
                                                employees believe that it is not legal to fax or   son’s permission.
                                                e-mail patient data. This is completely incor-
 TRUTH: HIPAA requires only that                rect. HIPAA specifically allows this.
 physicians and nurses check with their         Customary safeguards should apply when
 patients prior to disclosing informa-          using e-mail and caution where patient                   QUESTIONS?
                                                records are being faxed.
 tion, assuming the patient is mentally
 competent. A minor or a patient who
                                                                                                         HELP IS HERE
 is a dependent of a family member              Authorization
 must have information shared.
                   •••
                                                Another myth that has been pushed forward
                                                and prevents health care is that physicians’
                                                                                                         W     ashington Hospital Center’s Media
                                                                                                               Relations team, in the Department
                                                                                                         of Marketing and Public Affairs, is avail-
                                                offices are being denied access to patient               able to help physicians and health care
 DOs and DON’Ts                                 records that have been referred on the                   workers handle media inquiries regard-
 DO NOT discuss patient information in          grounds that the patient has not specifically            ing patient information.
 the elevators and hallways.                    authorized their results to be sent to a refer-
                                                                                                         Reporters often call during a breaking
                                                ring physician’s consult office. The use and             news event to ask for a patient’s name
 DO NOT give patient information to the         disclosure of health information from one                or condition. Or a reporter may call for
 media.                                         covered health care provider to another for              information regarding a local official’s
 DO call a media relations representative if    the purpose of providing treatment is specif-            procedure you performed to ask the
 you have questions about a media query.        ically covered and no authorization from a               extent of the official’s illness, diagnosis,
                                                patient is required.                                     treatment or prognosis. All of this infor-
 (See box at right.)


–6–
    Feature                                                                                    Viewpoint


                                                                                              Response From
                                                                                              the Editor
                                                                                              continued from page 2

                                                                                              Physicians usually have no experience
                                                                                              dealing with malpractice issues.
                                                                                              Physicians need immediate help and
                                                                                              should find their best resources.
                                                                                              Physicians who have already been
                                                                                              named in a potential suit should contact
                                                                                              their malpractice attorney and, for those
                                                                                              who are associated with a hospital,
                                                                                              should contact the hospital’s risk man-
                                                                                              agement staff. Washington Hospital
                                                                                              Center’s risk management service is
                                                                                              excellent. They know the importance of
                                                                                              immediately meeting the patient to dis-
                                                                                              cuss the issue. They are experts at how to
                                                                                              avoid unnecessary lawsuits by approach-
                                                                                              ing the patient with care and compassion
                                                                                              and attempting to meet their needs.
Patient Confusion                             Lower the Chatter                               Most physicians are stunned by their first
Finally, patients in hospitals are confused   It is equally appalling to observe friends of   lawsuit. Many talk openly about this
about the meaning of HIPAA. In some cases,    friends or even friends of doctors freely       (perhaps one of the worst things they
patients and family members may be            chatting about a recent surgery that Dr. X      could do) because they feel “no malprac-
extremely disturbed when they have been       had and what the implications are. A            tice occurred.” Their discussions about
informed that they are no longer allowed      patient’s results or another physician’s        the case could be admissible in court.
information regarding their family mem-       health should never be discussed in an ele-     Some physicians inappropriately go back
ber’s medical information. Some physicians    vator but more important, should not be         to the patients after a suit has been filed.
and nurses categorically refuse to give any   part of the lunch-time conversation.            This, without appropriate counsel or
information to family members.                Physicians, in their intent to do well, must    advisement from Risk Management,
                                              never give results of their patients, in par-   almost never benefits either the patient
However, HIPAA requires only that physi-      ticular if they are VIP, when called by news    or the physician being sued. As was
cians and nurses check with their patients    media. If a health care worker or physician     stated in the article, correction of fact
prior to disclosing information, assuming     provides information about a patient’s care     after the matter is certainly one of the
the patient is mentally competent. A minor    in response to a call from the media it is a    worst things possible.
or a patient who is a dependent of a family   clear and gross violation of the HIPAA
member must have information shared.          mandate. Any such questions should be           All physicians should recognize the most
                                              handled by a skilled media relations expert.    important way to avoid a malpractice
                                              Media relations is always available to help     suit is by practicing and establishing an
                                              with consults 24/7. (See box at left.)          excellent rapport with the patient and
mation is HIPAA-protected and should                                                          family members.
be referred to Media Relations.               HIPAA was put in place to protect patients
You can reach a member of the Media           from inappropriate release of their data, in
Relations team at any time by calling:        particular to insurance companies or third-
                                              party pharmacies/marketing vendors or
Paula Faria, director, (202) 877-7594,
pager 1-866-474-0805
                                              media who might have economic benefit
                                              from understanding and discussing a
LeRoy Tillman, associate director,            patient’s condition. HIPAA was never
(202) 877-7072, pager 1-866-474-1779          intended to obstruct patient health care.
So Young Pak, senior media relations
specialist, (202) 877-2748,
pager 1-866-474-0901
                                              James Jelinek, MD, is chairman of the
For HIPAA questions and requirements,         Department of Radiology and editor of
contact MedStar Health’s corporate            Washington Hospital Center Physician
privacy officer, Diane H. Meyers
                                              Newsletter.
(410) 772-6535.



                                                                                                                                    –7–
    Feature


Providing Innovative Services
to the Elderly
2 New Outpatient Behavior Health Programs

T
      wo new outpatient behavioral health         ered to do a little more,”                                        home watching television
      programs reach further into the com-        she notes. She strives to                                         and sleeping. Samuel tries
      munity to offer services to elderly         encourage her patients to                                         to motivate them to expand
patients who have not been served by other        get out and be with others.                                       their horizons. “I try to
programs. One program provides in-home                                                                              recharge their minds,” he
psychiatric care for elderly patients who are     “I had one woman in her                                           explains.
homebound. The other program brings eld-          90s,” she remembers. “She
erly patients to Washington Hospital              resumed going to her                                              At the center, Samuel gets
Center’s outpatient behavioral health center      weekly church service. She                                        participants talking about
at Trinity Square for lunch, therapy and          said, ‘I’m getting back to                                        things that are important to
socialization from noon to 3 p.m., Monday         my life!’”                                                        them.“The other day I asked
through Friday.                                                                                                     a group what was their life
                                                  Another patient had                                               like in D.C. when they were
                                                  become housebound be-                                             teenagers,” he says. “Their
In-Home Program                                   cause her wheelchair was
The in-home program sends social workers                                                                            faces just lit up and they
                                                  broken and she could not                                          started smiling. They
to the homes of elderly people who need           manage to get it repaired.
psychiatric services as an extension of                                                                             remembered their successes
                                                  After a few therapy ses-                                          and it reminds them they
Washington Hospital Center’s House Call           sions, the patient was less
Program.                                                                                                            can still have fun.”
                                                  depressed. She had her
“Dr. (Eric) DeJonge shared with me that           wheelchair fixed, and then                                          He has many success stories
many homebound elderly had psychiatric            was able to get out of her Karen Van Allen, LICSW — In-             to share. “There was one
                                                  home.                           home program “is wonderful.” woman who was psychotic.
issues,” explains Desi Griffin, PhD, adminis-
trator for the Hospital Center’s Outpatient                                                                           She was very confused and
Behavioral Health Services. “He wondered if
                                                  Day Break                                        confrontational. Now she’s communicating
we would be able to provide psychiatric sup-      The need to break social isolation led to the better, letting others finish their conversa-
port services for these homebound patients.”      establishment of the second new behavioral tions and has reduced psychotic symptomo-
                                                  health program, called Day Break. This pro- tology.”
Accordingly, the in-home behavioral health        gram provides a place for elderly residents to
service started in September 2003. One part-      gather and receive treatment from their psy- Samuel also works with participants to keep
time social worker traveled to patients’          chiatrist and participate in group psy- their minds alert. He initiates games that
homes to provide behavioral health services.      chotherapy.                                      require simple addition and subtraction, for
The program quickly grew; the third part-                                                          example. He also favors games that require
time social worker began in March 2004.           Established in the fall of 2003, this program interaction and stimulate conversation. “The
                                                  provides a van to pick up participants from point is to help people recognize that even
“It’s really quite a wonderful program,” says     their homes and bring them to Trinity Square though they’re getting older, they’re not
Karen Van Allen, LICSW, who was the first         at noon. Participants eat lunch, see their psy- worthless. Age has nothing to do with a per-
social worker to make house calls. “It’s like     chiatrist and/or mental health clinician and son’s ability to feel good about themselves.”
an old-fashioned model of health care, with       attend individual or group therapy sessions.
people being seen where they live.”               The van then returns them home at 3 p.m. Length of stay is based on patient need, with
                                                  The program operates Monday through most participants spending about three
Some elderly residents cannot leave home          Friday. Family involvement is encouraged.        months in the Day Break program. The goal
for physical reasons. Other patients are so                                                        is to stabilize their symptoms, improve their
depressed that they lack the motivation to        Frank Samuel, LICSW, is one of two clinical level of functioning and connect them to
leave home. Still others are so frail that they   social workers who work with the Day Break other Behavioral Health Services programs
fear leaving home. In any case, at-home serv-     program. “Most patients are pretty or community resources prior to discharge.
ices provide a necessary link to behavioral       depressed, withdrawn and isolated,” Samuel
health.                                           notes.“This is due largely to the fact that they “These programs are part of our effort to
                                                  have gotten older, their friends and family provide a comprehensive web of behavioral
Van Allen works on a variety of issues with       have died, they have physical disabilities and health services to the community,” Griffin
her patients, using traditional psychotherapy     their ability to get around is hampered.”        concludes. For more information or to refer
techniques. “Our hope is that people can                                                           a patient, call the Outpatient Service Intake
begin to feel a little better, and feel empow-    As a consequence, they spend a lot of time at Line at (202) 877-6339.
                                                                                                                              — Catherine Avery
–8–
    Feature


Preventing Injury in




                                                                                                                                                        Ryan McVay/Getty Images
the Aging Athlete
Wiemi A. Douoguih, MD



P
      rofessional athletes often perform          the rate of muscle fiber                                                     regimen that consists of
      amazing feats on the playing field.         loss increases to 10 per-                                                    30-60 minutes of exer-
      Despite their tremendous condition-         cent per decade. Rates                                                       cise at 60-90 percent of
ing, they often experience significant mus-       of loss have been                                                            the age-adjusted maxi-
culoskeletal injuries that can have long-         reported to be as high                                                       mum heart rate, three
term effects on their bodies. If highly           as 35 percent per                                                            to five days per week.
trained young athletes can sustain serious        decade in certain sub-                                                      For resistance training it
injuries, it is easy to understand how the        sets of the aging popula-                                                   is recommended that an
“weekend warrior” attempting to mimic             tion. As a result, by the                                                  individual engage in two
their favorite television sports hero can also    age of 80, individuals                                                    sessions per week in
sustain significant injuries.                     may lose as much as 60                                                    which one set of 8-10
                                                  percent of their peak                                                    exercises are performed,
Professional athletes are young, for the most     strength.                                                               targeting the major muscle
part, and their bodies are able to recover                                                                               groups.
quickly from most injuries. The older one         Tendons and ligaments
gets, the more difficult it becomes to physio-    undergo similar changes with                                         For people under the age of
logically recover from injury. Therefore, it is   age. One study showed a pro-                                        50 a weight that can be lifted 8-
important to understand the risk factors for      gressive decline, with age, in the                                 12 times is appropriate. For
athletic related injuries so that one can pre-    stiffness and ultimate load to fail-                             individuals over the age of 50,
vent them from occurring.                         ure (maximum force that a struc-                               weights that can be lifted 10-15
                                                  ture can withstand) of human anterior                       times are more appropriate. Resistance
The human body undergoes predictable,             cruciate ligaments. The decrease in load to          programs have been shown to both improve
age-related changes that can increase the risk    failure was most rapid between the third and         muscle strength and maintain bone density.
of injuries and affect its ability to heal. The   fifth decades of life. In subjects older than 60     In all, a moderate resistance exercise pro-
average person reaches his or her peak bone       years, the anterior cruciate ligament was            gram combined with a regular cardiovascu-
mass by the age of 30 years. After 30, both       found to fail with only one-third the force          lar fitness program can significantly enhance
men and women experience a steady decline         applied in younger patients. Decrease in             strength, flexibility and joint mobility. This
in their bone mass until they die. Women          blood supply and cellular function also              prescription for health reduces the risk of
experience a greater decrement in their bone      occurs with age in these tissues contributing        injury, and improves the body’s ability to
mass around menopause. After menopause            to their increased susceptibility to injury and      heal in the aging athlete.
the rate of decrease returns to levels equiva-    inferior ability to heal.
lent to men. Decreasing bone mass increases
the likelihood that an aging individual will      Benefits Outweigh Risks
sustain a fracture. Not only does bone mass                                                            Wiemi Douoguih, MD, is an orthopedic sur-
                                                  Despite age-related changes that can                 geon and has served as assistant team physi-
decrease with age, but the process by which       increase the risk of injury and decrease heal-
old or injured bone is removed and new                                                                 cian for several professional sports teams,
                                                  ing rates, the benefits of regular exercise sig-     including the Los Angeles Dodgers, Anaheim
bone is formed decreases significantly with       nificantly outweigh the risks posed by a
age. This process, referred to as bone                                                                 Angels, and Washington Redskins.
                                                  sedentary lifestyle. Exercise has long been
turnover, helps heal broken or injured bone.      known to reduce the risk of premature mor-
Decrease in the rate of bone turnover means       tality, strokes, coronary artery disease and
increased time to heal fractures in older                                                              References:
                                                  hypertension. It also has been shown to pre-
individuals.                                      vent age-related degradation of bones, joints
                                                                                                       1. Woo SL, Hollis JM, Adams DJ, Lyon RM, Takai S.
                                                                                                       Tensile properties of the human femur-anterior cru-
Muscles, tendons and ligaments also experi-       and muscles. However, prior to beginning a           ciate ligament-tibia complex. The effects of speci-
ence age related changes, which render them       new exercise program an individual should            men age and orientation. Am J Sports Med, 1991;19:
                                                  determine his or her physical limitations and        217-25.
more susceptible to injury and less likely to
heal. Just as with peak bone mass, men and        set specific exercise goals. Determining phys-       2. Galloway MT; Jokl P. Aging Successfully: the
women reach their peak muscle mass at             ical limitations should be done objectively          Importance of Physical Activity in Maintaining
                                                  with the aid of a physician.                         Health and Function. J Am Acad Orthop Surg 2000;
around 30 years of age. After 30, muscle                                                               8:37-44
fibers decrease in both size and overall num-     Setting realistic exercise goals is also critical.   3. Buckwalter JA; Heckman JD; Petrie DP. An AOA
bers. Skeletal muscle mass has been found to      The American Academy of Orthopaedic                  Critical Issue: Aging of the North American
decrease at rate of four percent per decade       Surgeons endorses a cardiovascular exercise          Population: New Challenges for Orthopaedics. J
between the ages of 25 and 50. Thereafter,                                                             Bone Joint Surg Am 2003 85: 748-758

                                                                                                                                                    –9–
    Election 2004


Election
continued from page 1                                           HEALTH CARE REFORM                       ket system, and the low reimburse-
                                                                FAST FACTS: There are currently          ments and heavy administrative bur-
truly undecided voters, and in all like-                        more than 43 million Americans           dens posed by Medicare haven’t been
lihood there are other physicians in                            without health insurance, four mil-      exactly a great advertisement for what
her situation.                                                  lion more than four years ago.           the government could accomplish on
                                                                                                         a wider scale. Although the AMA
The American Medical Association                                PERSPECTIVE: Physicians dedicated        remains steadfastly silent on candi-
and most other major medical associ-                            to patient care are deeply distressed    dates, the keywords in their policy
ations do not endorse political candi-                          about this issue (and can certainly      statements remain “tax credits” and
dates but, based on their policy state-                         empathize, since they face skyrocket-    “consumer choice.” The AMA would
ments as well as information from the                           ing insurance rates and limited avail-   limit the role of government, avoid-
candidates position papers, Physician                           ability in their own sphere). But the    ing a one-size-fits-all approach to
Newsletter has prepared a point-by-                             medical community historically has       coverage.
point analysis of where Bush and                                been resistant to any plan that repre-
Kerry stand on issues of concern to                             sents what they view as excessive gov-   John Kerry
the medical community. We’ll begin                              ernment intrusion into our free mar-     Under Kerry’s plan the existing health
with tort reform.                                                                                        insurance system for federal employ-
                                                                                                         ees would be expanded to private citi-
                                                                                                         zens through tax credits and subsidies,
                                                                                                         and the unemployed would get a 75
     MEDICAL MALPRACTICE                        John Kerry                                               percent tax credit to help pay for
     REFORM                                     According to his campaign literature,                    insurance. Tax credits would also help
     FAST FACTS: One in seven ACOG              Kerry “strongly opposes capping                          small businesses cover their employ-
     (American College of Obstetricians         damages in medical malpractice                           ees. Citizens aged 55 to 64 could buy
     and Gynecologists) Fellows has             suits.” Kerry’s plan to reduce liability                 into the federal employees’ health
     stopped practicing obstetrics because      insurance costs would have “qualified                    plan. The government would step in
     of the risk of liability claims. Over 76   specialists” analyze cases and deter-
     percent of ACOG Fellows reported           mine if they have enough merit to end
     they had been sued at least once; 57       up in court, require states to offer
     percent had two or more claims filed       non-binding mediation and eliminate
     against them, and 41.5 percent had         the award of punitive damages except                     REPRODUCTIVE CHOICE
     three or more claims.                      in cases of intentional misconduct,                      AND RELATED ISSUES
                                                gross negligence or reckless indiffer-                   FAST FACTS: Earlier this year the
     PERSPECTIVE: For doctors this              ence to life.                                            FDA ruled to keep emergency contra-
     remains the most critical issue on the                                                              ception a prescription-only drug. And
     political horizon. With an aggressive      George W. Bush                                           although enforcement of the Partial
     tort reform plan already before            Bush claims his tort reform play                         Birth Abortion act is enjoined by the
     Congress and backed by the president,      would reduce health care costs for all                   courts, the Justice Department issued
     they are unlikely to throw support         Americans by $60 billion. The Bush                       multiple subpoenas to hospitals
     behind any watered-down version of         plan would limit non-economic dam-                       demanding medical records of
     reform. Possibly driving more physi-       ages to $250,000, reserve punitive                       women who had undergone second-
     cians to the Bush camp is Kerry’s          damages for “where they are justified,”                  and third-trimester abortions. Under
     selection of John Edwards, a noted         provide for payments of judgments                        Bush, government-funded stem cell
     plaintiffs’ attorney, as his running       over time rather than in a lump sum,                     research has been limited to a number
     mate.                                      prevent cases from being brought                         of existing lines and adult stem cells.
                                                years after an alleged event and reduce
                                                doctors’ payments to plaintiffs that                     PERSPECTIVE: The FDA decision
                                                have been compensated by insurance.                      and the Justice Department actions
                                                Bush’s plan, strongly backed by the                      came as a blow to medical organiza-
                                                AMA and other medical organiza-                          tions that have had a remarkably
                                                tions has passed the House and                           strong relationship with this admin-
                                                remained stalled in the Senate. But the                  istration. Willingness to ignore med-
                                                president, who considered tort reform                    ical recommendations in the FDA
                                                important enough to include in his                       case drew criticism from physicians
                                                State of the Union speech, has vowed                     as did the attempted record search.
                                                to see it pass if reelected.                             Many articles appeared quoting doc-




– 10 –
     Election 2004



to help companies and insurers pay           rumor mill has it that key Bush offi-                        GUN CONTROL
catastrophic medical costs for               cials knew and suppressed the higher                         FAST FACTS: In 2001, 11,348 of the
employees if firms hold down premi-          cost estimates during legislative                            nation’s 20,308 homicides were com-
ums. The federal government would            debate. Critics have also said the bill is                   mitted with firearms. In 2002, more
also expand access to insurance for          a windfall for pharmaceutical compa-                         than 13,000 children were injured by a
children who are currently covered by        nies rather than seniors. The president                      firearm. During the decade of 1992 -
state programs. Estimated cost: $895         has also signed legislation allowing                         2001 an average of 1,273 children a
billion over 10 years to cover 27 mil-       medical savings accounts and health                            year committed suicide with guns.
lion people. While the Kerry plan is far     care tax credits to make insurance
from the dread Canadian single-payer         more affordable, both measures sup-                              PERSPECTIVE: The AMA sees
model, it might be too much govern-          ported by the AMA. In addition he                                  gun violence as a public health
ment for some wary physicians.               supports plans that allow small busi-                               issue and largely supports
(Kerry also vows to expand and               nesses to pool together for health care                               plans, such as a national wait-
reform the troubled health care sys-         options, and the president’s plan also                                  ing period and background
tem for veterans.)                           offers federal matching funds to state                                   check, to restrict access to
                                             health insurance programs for poor                                       handguns. The AMA also
George Bush                                  children.                                                              favors collection of firearm
The cornerstone of Bush’s health                                                                                  death and injury data by the
reform strategy, a prescription drug         While these plans have met with AMA                                CDC. Ultimately, however, this
benefit for seniors, has already passed      approval and have more modest cost                               issue may break along personal
Congress with the support of the             estimates than the Kerry proposal,                             lines: country docs who grew up
AMA and America’s most powerful              critics doubt their ability to seriously                     hunting versus urban ER docs who
senior organization, AARP. But the           reduce the vast numbers of uninsured                         treat 15-year-olds with gunshot
bill has not been without controversy.       in the country. Under Bush the num-                          wounds. Unlike reproductive issues,
First, the cost is now estimated at $534     ber of uninsured Americans has                               there have been no direct conflicts
billion rather than $395 and the             steadily increased from 39 million.                          with the medical community and the
                                                                                                          administration on gun control.

                                                                                                          John Kerry
tors who feared they could be investi-                                                                    Kerry is a gun owner and hunter as
                                             John Kerry                                                   well as a combat veteran, but he sup-
gated for performing or referring            Kerry is a longtime abortion-rights
patients for procedures that remain                                                                       ports gun control legislation outlined
                                             supporter and a stalwart on issues                           in the Brady Bill and supported by the
legal. ACOG and the AMA protested            important to women’s groups, which
this intrusion into confidential med-                                                                     AMA.
                                             would include emergency contracep-
ical records in writing.                          tion. He voted against the Partial                      George W. Bush
In terms of stem cell                                Birth Abortion Bill and has                          As Vice President Dick Cheney said to
research, many feel that                                vowed to appoint only                             a supportive crowd of NRA members
Bush — as in the case of                                 Supreme Court judges                             in Pennsylvania in April, “The
emergency contracep-                                      who support reproduc-                           Republican ticket this year, once
tion — has allowed the                                     tive choice. (As a pro-                        again, is two Westerners who are life-
voices of the religious                                     choice politician, Kerry                      long gun owners, hunters, and anglers
right to out-shout                                          has no problem with                           — and strong believers in the Bill of
those with medical                                          using embryos for                             Rights of the Constitution.” No fan of
knowledge. Many pro-                                        stem cell research.)                          gun control measures or lawsuits,
minent GOP figures,                                                                                       Bush has also brought his passion for
including Nancy Reagan                                      George W. Bush                                tort reform to the firearms arena, sup-
on the eve of her hus-                                     Bush is out front in his                       porting a bill that would immunize
band’s death, have urged                                 opposition to abortion                           gun manufacturers from lawsuits by
Bush to reconsider his posi-                           and has pushed programs                            victims of gun violence.
tion, but he has been unmove-                       such as abstinence-only edu-
able. The question is, will these issues       cation. He supports abortion only
matter enough to some physicians —           in cases of rape, incest and life of the                         Melanie Howard, a long-time writer
particularly ob-gyns — to put them           mother, and does not believe in                                  for Physician Newsletter, is a former
in the Kerry camp despite his tort           exceptions to preserve the health of                             staff writer for The Washington
reform stand.                                the mother.                                                      Times. She currently writes on health-
                                                                                                              related issues for American Health,
                                                                                                              Family Circle, and Glamour, among
Note: Washington Hospital Center Physician Newsletter does not endorse a particular party or candidate.       other publications.
                                                                                                                                                – 11 –
    Feature


‘Lifted Spirits,’ Improved Patient Care
Joint Practice Initiative Nets Results

A
        consolidated effort to promote qual-      a very strong camaraderie and collegiality,”        First and foremost, he makes himself avail-
        ity clinical outcomes and improve         she says.“The medical director serves as ‘unit      able as an ongoing resource. Every week he
        the working environment at                champion.’” She also points to objective            participates in discharge rounds and then
Washington Hospital Center has achieved           proof that the practice model is effective. On      conducts a didactic session that serves as a
solid results, report physicians and nurses       unit 2C, for example, the March 2004 patient        forum for discussing that week’s patients
involved with the Joint Practice initiative.      satisfaction data showed an increase of 19          and resolving issues. Pessagno adds that lec-
                                                  points in overall nursing care.                     ture topics may include information about
The Joint Practice Committee was estab-                                                               technology, equipment or flow processes.
lished in December 2002 to foster collabora-      DeJonge adds that his unit, 1C, also has a
tion among physicians and nurses to               collaborative and supportive team of staff          “It’s like being the coach of a football team,”
improve clinical care and provider satisfac-      and physicians with “superb morale and              Pistole explains. “The head nurse is the cap-
tion. Two goals of the group are to recom-        patient service.” He describes how the              tain. Your job [as a physician] is to be avail-
mend appointment of medical directors for         process works.“Elderly and disabled patients        able. Be a confidante to the nurses, be an
each nursing unit and to formalize the            receive caring and compassionate care from          information conduit, offer another forum
nurse-physician rounding process.                 all the staff on 1C. Frail elders need to get out   for getting answers. It gives nurses a sense of
                                                  of bed, receive help with feeding and stay as       connection with the rest of the hospital; it’s
Two units already had medical directors —         little time in the hospital as possible, all of     total empowerment.”
Micheal Pistole, MD, gastroenterology, a pri-     which the 1C team accomplishes. The best
vate practice physician, is medical director of              part of working on that unit as a        Unit 2C consists of general medical patients,
unit 2C, and Eric DeJonge, section director,                     physician is our practice of bed-    many with chronic illnesses. Still, the team
geriatrics, is medical director of unit 1C.                        side rounds with the primary       approach has been able to reduce length of
Efforts are underway to identify medical                            nurses and aides that care for    stay through ongoing communication and
directors for additional units.                                       our elderly patients.”          effective discharge planning.
“There’s been a lot of support [for the                              Pistole describes what           Pistole sees ways that the Joint Practice ini-
Joint Practice initiative] from Mr. Caldas                           goes into serving as med-        tiative can have additional positive impact.
[Washington Hospital Center President                                ical director for a unit.        He would like to encourage the concept of
James Caldas],” said Anthony Watkins,                                                                 ‘geographical residents’, in which groups of
MD, co-chair of the Joint Practice                                                                    residents would be assigned to units, so they
Committee. “There’s been a signifi-                                                                   would work as part of patient care teams. He
cant degree of collaboration among                                                                    also would like to see the educational com-
head nurses and physicians that has                                                                   ponent of the nurse-physician rounding
improved communications and                                                                           process become more formalized so nurses
lifted spirits, and that’s improved                                                                   could earn continuing education credits.
patient care. We’re continuing to
look for more physicians who                                                                            Watkins has a few plans of his own. “I’d
have the time to devote and can                                                                           like to find way to support our nurses
serve as medical directors for                                                                              while the Hospital Center is attempt-
units.”                                                                                                       ing to achieve Magnet status,” he
                                                                                                               says. Magnet status is awarded by
Pistole is enthusiastic about the                                                                              the American Nurses Credentialing
program. “It’s been a very posi-                                                                               Center (ANCC) in recognition of
tive experience for all of us,” he                                                                             excellence in all aspects of nursing,
said. “We’ve established better                                                                                from management to patient care.
relationships among those who
work on the unit so we work                                                                                    But the team approach to patient
together better. That improves                                                                                 care is an end in itself. “It makes us
patient care and expedites effec-                                                                              a family,” Pistole concludes. “It
tive discharges. As a team, we                                                                                 establishes better relationships.
come together in the right way.”                                                                               Problems are easier to handle when
                                                                                                               they are shared. It’s very positive
Ann Marie Pessagno, RN, direc-                                                                                 for all of us. I’ve learned a lot
tor of oncology and ambulatory                                                                                 myself. I’ve been empowered. It
services and co-chair of the Joint                                                                             works!”
Practice Committee, agrees that         Ann Marie Pessagno, director of oncology and ambulatory
the program works well. “There’s        services, and Eric DeJonge, MD, section director, geriatrics,                            —Catherine Avery
                                        medical director of Unit 1C

– 12 –
    Foundation


A Pathway to a “Golden Moment”
By Bob Levey, Senior Vice President for Development



T     he laminated card is now a fact of life.

                                                                                                          de and who
By the time you read this, every physician                                               s express gratitu
                                                               For doctors whose patient                    pital Center:
(and every nurse) who works at Washington                                                  Washington Hos
Hospital Center will have a way to refer                       may wan  t to contribute to
grateful patients to the Washington Hospital                                                        ppreciation
                                                                                     show your a
Center Foundation.                                                    you'd like to
Information on how to do that is contained                     “   If
                                                                 in a more sub
                                                                                stantive way,
                                                                                                 I'd like to giv
                                                                                             y in the Wash
                                                                                                                e
                                                                                                             ington Hospit
                                                                                                                          al
on a laminated blue-and-yellow card,                                             Bob Leve                         members
approximately four inches by three inches.                       your name to                     ne of his staff
                                                                                a  tion. He or o
The Foundation distributed approximately                          Center Found                     days, when y
                                                                                                                  ou're
3,000 cards in late June and early July.                                         a  call in a few
                                                                  will give you
On one side of the card, physicians will find
language that they can use if a patient says
he’d like to make a gift in honor of good
                                                                  feeling bette
                                                                                r.
                                                                                       ”
treatment or a good outcome.
                                                                                        oundation
On the other side are my phone number
                                                                       Hospital Center F
(202-877-7983) and the main phone num-                       Washington 202-877-6558
ber of the Foundation (202-877-6558).
                                                                                                                       lopment
The card fits very neatly into the breast                                                      es        ident for Deve
                                                                                 Senior Vice Pr
                                                                      Bob Levey,                             d st a r. n e t
pocket of a physician’s white coat. The idea is
                                                                             983 or b o   b .l e v e y @ m e
that physicians will always carry it, and                           202-877-7
always have it on hand if a patient asks where
and how he can contribute.                                                                    undation an
                                                                             also send the Fo
                                                              Doctors should on any such conversation, so .
Let me stress that no laminated card has ever                 e-mail to report has a record and can follow up
raised a nickel, and no laminated card ever                   the Foundation
will.                                                                                                                       MedStar Health
                                                                            Thank you!
People give to people. People give in honor
of top-notch care. People will give to the
hospital only if the Foundation can get con-
nected to them at the time when they feel
most generous.
Physicians are almost always the pathway to       results that make Washington Hospital               Please bear in mind that gifts to the
that “golden moment.” After all, it’s physi-      Center so well-respected.                           Foundation do not float quietly onto some
cians whose training and talent produce the                                                           profit-and-loss sheet, never to be seen again.
                                                  Physicians can produce another kind of              Donations always go — and only go for
                                                  result, too: More contributions to help bal-        equipment, training, research and new ini-
                                                  ance the Hospital Center’s budget.                  tiatives. By helping steer prospects to the
             Bob Levey                                                                                Foundation, physicians can help assure a sol-
                                                  You doubt that it will work? It already has.
      Senior Vice President for                                                                       vent future for this wonderful institution.
            Development                           This summer, a patient was being seen by Dr.
                                                  Arnold Kwart. The patient mentioned that            So please keep your laminated card handy,
     Washington Hospital Center
                                                  he was very grateful for great urological care.     and please use it. You can be the difference
             Foundation
                                                  Dr. Kwart whipped out the laminated card            between a gift that’s given, and a gift that the
        202-877-7983 PHONE                                                                            Foundation never hears about.
                                                  and rattled off the language on it.
         202-877-5148 FAX
                                                  The patient wrote a $10,000 check on the            Many thanks!
       bob.levey@medstar.net
                                                  spot!

                                                                                                                                               – 13 –
   Spotlight On…

Frank Spellman, MD —
Physician With a Clear Vision
                                                                                  was devastated when my grandmother died of uncon-

                       I
                         t’s no wonder that Frank Spellman, MD, has chosen
                         to specialize in retinal surgery, a highly challenging   trolled hypertension in a leaky basement hallway
                         subspecialty of ophthalmology that employs intri-        because African-Americans couldn’t be admitted to
                       cate surgical techniques to combat vision loss.            regular rooms in the hospital,” the younger Dr.
                                                                                  Spellman notes.
                                After all, he’s spent his life keeping a vision
                                alive. His vision — and that of his father and    To no one’s surprise, the next generation produced
                                grandfather — is of a color-blind society,        another physician. Mitchell Spellman, MD, graduated
                                where each person succeeds based on his or        from Howard Medical School in 1944, and earned a
                                her efforts. And he has lived that belief in      doctorate during his thoracic surgery residency at the
                                singular fashion.                                 University of Minnesota. He was the first thoracic sur-
                                                                                  geon at Howard and was head of Howard’s surgery
                                Dr. Spellman was born and raised in               service. He left Washington in 1969 to be the founding
                                Washington, D.C., the oldest of eight chil-       dean of the Charles Drew Medical School in Los
                                dren. “I was programmed from birth to be a        Angeles. Then in 1979 he became a professor of sur-
                                physician,” he remembers, with a chuckle.         gery and dean of medical services at Harvard Medical
                                “My mother brainwashed me from the age of         School in Boston. Today he is dean emeritus and is
                                five. I thought it was my own idea.” It didn’t    involved in Harvard Medical International, an
                                hurt that his father was a respected local sur-   exchange program that helps third-world countries
                                geon. His mother, too, had been admitted to       send students to Harvard for training.
                                medical school, but she decided to attend
                                nursing school so she could fulfill her larger
                                ambition of raising a large family.                   “I was made to understand
Dr. Frank Spellman —
“Education is the
                       But his medical roots go back even further. His pater-           that if I did not become
                       nal grandfather, Frank, was orphaned at the age of 12
key.”
                       or 13 in Louisiana, and couldn’t start first grade until       successful, the only person I
                       age 16. “He was teased without mercy by his 6- and 7-           could blame was myself.”
                       year-old classmates,” his grandson says now. But his
                                 parents had impressed on him the impor-
                                 tance of education, so he soldiered on until     It’s no wonder that our Dr. Spellman professed an
                                 he graduated from high school.                   early interest in medicine. But he knew education was
                                                                                  the key. “I was told that if I worked hard, I could be the
                                The family myth is that grandfather Frank
                                                                                  first African-American graduate of Georgetown Prep,”
                                walked from Louisiana to Washington, D.C.
                                                                                  he recalls. So he enrolled there as a seventh grader in
                                carrying his only pair of shoes so he would-
                                                                                  1962, where he was the only African-American stu-
                                n’t wear them out. When he arrived, he
                                                                                  dent until he was joined by John McKnight, who now
                                enrolled at Howard University Medical
                                                                                  is on oncologist on the medical staff at Washington
                                School and got a job at the Government
                                                                                  Hospital Center.
                                Printing Office, working his way through
                                medical school. He graduated in 1909, and         “There were certainly some painful moments,” he
                                returned to Alexandria, Louisiana to set up       recalls, “but there were some wonderful ones as well.
                                practice several years later, where he prac-      Those were different times.” He had an agreement
                                ticed from 1915 to 1953. “He wanted to be a       with his father that he would pay half his tuition, so he
                                big fish in a small pond,” his grandson           dutifully rose each morning at 4 to deliver the
                                explains.                                         Washington Post before school.
                                But times were different then. He was the         He graduated from Georgetown Prep in 1968, and
Father, Dr. Mitchell            only African-American physician in town           went on to Johns Hopkins University with a National
Spellman — First       and was not allowed to have hospital privileges. He        Achievement Scholarship to study pre-med. “I got my
thoracic surgeon at    had to transfer care to Caucasian physicians when          most meaningful medical experience during my jun-
Howard University.     patients needed to be admitted to the hospital. “He        ior year, when I was hospitalized for six weeks with
    Spotlight


viral pericarditis,” Dr. Spellman said. The experience
was invaluable in preparing him for his medical career.
“I found that all doctors are well-educated, and some
are even brilliant. But some are far better doctors than
others,” he says.
After graduating from college in 1973, he went on to
medical school at the University of California in San
Francisco. He then did an internship in the Bay Area
and a fellowship in ocular pathology, before moving to
Boston for a residency in ophthalmology at Harvard’s
prestigious Massachusetts Eye and Ear Hospital.
The choice of ophthalmology came about from setting
a stringent goal for himself. “While I was in med
school, a fellow student told me that his research indi-
cated that ophthalmology was the best specialty. The
only negative factor was that it was the most difficult
specialty to get into,” he recalls. “I thought that would
give me a great goal. If I could do that, I would have
my pick of specialties.”
But after several electives in ophthalmology, he dis-
covered that was what he really wanted to do. While at
Mass Eye and Ear, he decided to specialize in retinal
surgery, thanks to the encouragement of a professor.
Again, the challenge appealed to him. “I think retinal
surgery is the most challenging area in ophthalmol-
ogy,” he says. “You’re working on the inside of the back
of the eye, dealing with vascular and degenerative con-     generation. He mentors young people interested in
ditions, tumors and trauma. There are any number of         pursuing a career in medicine, and teaches residents at
extremely challenging conditions that you have to           the Hospital Center and medical students at Howard
manage. Retinal conditions are the leading cause of         and George Washington.
vision loss.”                                               He and his wife Beverly Brown Spellman, a retired
His particular area of interest is diabetic retinopathy,    attorney, live on the Montgomery County line, with
which he notes has a 60 percent higher prevalence in        their 13-year-old son and 11-year-old daughter. He
the African-American community. In fact, his mater-         and his wife will celebrate their 27th wedding anniver-
nal grandfather was a diabetic. “Dating back to my          sary in September, he proudly notes.
childhood, I wanted to take care of the folks,” he          In his spare time, he and his wife play golf, and he has
explains.                                                   coached his son’s basketball and baseball teams since
Accordingly, when he finished his fellowship in retinal     pre-kindergarten. He also has restored a 1963
surgery as the Bascom Palmer Eye Institute in Miami,        Mercedes, which puts him in mind of Martin Luther
where he was the first African-American retinal fellow,     King’s “I Have a Dream” speech. “I wanted to go to the
he came home. He joined the staff of the Hospital           March on Washington, but my mother was afraid
Center in 1983 and also served as director of the reti-     there would be rioting, so she wouldn’t let me go. She
nal service at Howard University Hospital for 13 years.     went, and told me about the ‘I Have a Dream’ speech.
                                                            She said, ‘The only way you can make your dreams
“There’s no way to overestimate how satisfying it is to     come true is to pursue your education. That’s how
practice in this community,” Dr. Spellman says. “There      you’ll be able to buy one of those cars you like!’”
were many African-American physicians who were
role models for me as a child, and some have become         So he did just that, and has no regrets. “Not a day goes
my patients over the years.” Recently, he even treated a    by that I’m not grateful for the educational opportu-
patient who lived on his old newspaper route. He also       nities given to me by my parents, teachers and role
feels fortunate to have many family members living in       models,” he says. “I was never denied opportunity. I
the area.                                                   was made to understand that if I did not become suc-
                                                            cessful, the only person I could blame was myself.”
Today he works hard to pass his vision on to the next
                                                                                                —Catherine Avery


                                                                                                                       – 15 –
    Research Update                                                                               CONTACT                      INFORMATION
                                                                                                                James S. Jelinek, MD
                                                                                                                 Editor • (202) 877-6088
                                                                                                               James.S.Jelinek@MedStar.net
                                                                                                                   Margo Smith, MD
                                                                                                          Associate Editor • (202) 877-7164

Lombardi-MedStar Oncology                                                                                    Margo.A.Smith@MedStar.net
                                                                                                              Annamarie G. DeCarlo
                                                                                                          Managing Editor • (202) 877-3118
Research Network Created                                                                                  Annamarie.G.DeCarlo@MedStar.net


                                                                                                 Washington Hospital Center Physician is an


A
       new MedStar Health system-wide           with representation of diverse patient           informative monthly publication for all the members of the
        initiative for cancer research has      groups.”                                         Washington Hospital Center Medical and Dental Staff. It is a forum
                                                                                                 to report news of interest to the medical staff, disseminate informa-
        been formed with the goal to                                                             tion about what is going on in the hospital, introduce new providers
                                                The new research network is chaired by           and profile current ones, exchange ideas and opinions about subjects
involve more than 1,000 patients in oncol-
                                                John Marshall, MD, of the Lombardi               of interest and controversy, and recognize the professional and per-
ogy clinical trials within the next three                                                        sonal accomplishments of our practitioners. Its overall goal is to
                                                Institute. Perry is in charge of the system-     help foster and celebrate a sense of community among the broad
years.
                                                wide Oncology Institutional Review Board.        diversity of the Hospital Center physician membership. The newslet-
                                                                                                 ter is published by the editorial services division of Public Affairs for
The MedStar Research Institute (MRI),           In addition to Lessin, senior advisors           the Office of Medical Affairs.
established by Washington Cancer Institute      include William McGuire, MD, Franklin            MISSION—Washington Hospital Center, a valued member of
                                                                                                 MedStar Health, is dedicated to delivering exceptional patient first
at Washington Hospital Center in1999, and       Square Hospital, and Barbara Howard,             health care. We provide the region with the highest quality and
the Lombardi Research                           PhD, president of MedStar Research               latest medical advances through excellence in patient care, educa-
                                                                                                 tion and research.
Network at Georgetown                                                Institute.                  Washington Hospital Center, a private, not-for-profit hospital, does
University      Hospital,                                                                        not discriminate on grounds of race, religion, color, gender, physical
                                                                     While oversight of trials   handicap, national origin or sexual preference.
have merged to become                                                                            Visit the hospital’s web page at: www.WHCenter.org. This newsletter
                                                                     being conducted in this
the Lombardi-MedStar                                                                             is printed by Washington Hospital Center Printing Services.
                                                                     new network is limited
Oncology Research Net-                                                                                James F. Caldas, President, Washington Hospital Center
                                                                     to MedStar physicians,
work. This new initiative                                                                                        The Honorable Togo D. West, Jr.
                                                                     all trials are open to             Chairman of the Board, Washington Hospital Center
will provide more
                                                                     patients referred by any                John P. McDaniel, CEO, MedStar Health
patients with access to
                                                physician. The coordinated effort with
new clinical trials than any other regional                                                             James Jelinek, MD                       Editorial Board
                                                large numbers of investigators and poten-                      Editor                              Members
cancer center.
                                                tial participants strongly positions MedStar            Margo Smith, MD                      David Downing, MD
                                                Health to competitively attract cutting-                  Associate Editor                       Roy Flood, MD
The MedStar Oncology Network has been                                                                Annamarie G. DeCarlo
                                                edge clinical research studies – including                                                     Cheryl Iglesia, MD
led by David Perry, MD, medical director of                                                              Managing Editor                     Stephen Peterson, MD
research at the Cancer Institute, and Becky     those that previously may have been                         Ann Lesnik
                                                                                                                                              Micheal Pistole, MD
                                                                                                       Sr. Graphic Designer
Montalvo, administrative director.              awarded elsewhere because of the need for                Mark Smith, MD                         Kevin Reed, MD
                                                larger numbers of patients. It also gives the             Editor Emeritus                    Marc Schlosberg, MD
                                                                                                                                              David Shocket, MD
“In its most recent year, the MON accrued       system leverage with leading organizations           Frederick C. Finelli, MD
                                                                                                                                               Thomas Stahl, MD
                                                                                                              President,
more than 300 patients to clinical trials,      like the National Cancer Institute. Most             Medical and Dental Staff                   Larry White, MD
with greater than 30 percent minority par-      important, it provides MedStar’s oncology              Janis Orlowski, MD
                                                                                                                                             Contributing Writers
ticipants,” said Lawrence Lessin, MD, med-                                                             Senior Vice President
                                                patients with access to the latest targeted            and Medical Director                    Catherine Avery
ical director at Washington Cancer              cancer therapies.                                            Lisa Wyatt                          Carol Casey
Institute, and a senior advisor. “Our goal is                                                      Vice President, Public Affairs              Melanie Howard
                                                Physicians who want more information                      Christine Vinh                      Deborah Schwartz
to involve more than 1,000 patients in                                                                  Asst. Vice President
                                                should call (202) 444-4000.                                                                     LeRoy Tillman
oncology clinical trials within three years,                                                      Medical Affairs/Quality Resources




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