Physician Stress

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					                                                                                          July/August 2007

                                   W A S H I N G T O N H O S P I TA L C E N T E R                  vol. 13, no. 7

                                                          News for Medical Staff, Residents, Fellows and Alumni

MRDI Rollout
..........3              Physician Stress
Cover Story              Its Causes and Effects

Institute Wins
 . . . . . . . . . 11

House Staff
and Hello
 . . . . . . . . . .12

Referring Physicians
An Important Part of Washington Hospital Center
by Janis M. Orlowski, MD, MACP

            e always want our patients to       There was another issue that we discussed.         for the transfer should not reflect on a
            have an excellent “Patient First”   Referrals or transfers are done by this physi-     referring physician’s ability to provide
            experience when they are here.      cian for several reasons, but the physician        appropriate treatment.
Part of that experience includes what’s said    felt as though comments made at the Hos-
                                                pital Center “made me justify my referrals.”     The take away from this is, we shouldn’t
to them, from the time they arrive until
                                                                                                 denigrate any physician’s reason for transfer
they leave.                                     I The doctor may have an office full of           or referral. They are the lifeblood of a terti-
Recently, I had dinner with a physician who       30 patients to see on a given day. While       ary referral care center. Just say, “yes.”
no longer refers patients to the Hospital         good care can be provided for the patient
                                                  in question, the physician must decide         While I have not heard this physician’s
                                                  whether to spend all day at the hospital       comments from anyone else, I believe from
Our conversation was long and involved, but       with that one patient, or see the 30           this single experience we need to take a step
here’s the bottom line: this physician                                                                  back, and examine what we say to
no longer refers to us, because com-                                                                    patients. Patients may not be aware
ments we made to patients ruptured                                                                      that a tertiary care facility like Wash-
their relationship with this physician.                                                                 ington Hospital Center has the best to
                                                                                                        offer. In our zeal to sing the praises of
We have done ourselves a disservice.                                                                    the Hospital Center, we should be
                                                                                                        careful how we give patients that
This physician practices in a commu-
                                                                                                        information. Our comments should
nity where care can involve several
                                                                                                        not sow doubt about the referring
members of an entire family. The com-
                                                                                                        physician’s decisions or prior care for
munity itself is smaller, and many of
                                                                                                        that physician’s patients. If questions
the physician’s patients know each
                                                                                                        concerning appropriate care arise,
other and talk about their experiences
                                                                                                        they should be discussed first with the
with health care.
                                                                                                        referring physician.
Here’s an example of what was said to
                                                                                                       We need to carefully maintain our
one of the physician’s patients. The
                                                                                                       relationships with all referring physi-
patient arrived here, and the comment
                                                                                                       cians. Patients do go back to their
was, “Thank goodness you’re at Wash-
                                                                                                       communities and talk about what was
ington Hospital Center. You should
                                                                                                       said and done while they were patients
have been here much sooner for treat-
                                                                                                       here. We don’t want to be misinter-
ment.” Of course, we want patients to
                                                                                                       preted or misunderstood in what we
know that they are getting the best of
                                                                                                       say to patients.
care from us, but we don’t want to imply that     patients in the office. If the decision is
the referring physician was not providing         made to transfer, our comment has been,        Our referring physicians are important
appropriate care to the patient.                  “Why is this patient being sent here? The      to the continuing success of the Hospital
                                                  doctor should be able to handle that,          Center. They should be part of the “Patient
The physician also gave an example of how
                                                  instead of sending the patient to us.” This    First” experience that guides us every day,
patients are spoken to at a different hospi-
                                                  casts doubt on the referring physician’s       as we focus on excellence in patient-
tal. The referring doctor’s patient was met
                                                  ability to make a decision that is right for   centered care. I
at the emergency department. The ED
                                                  his or her practice and patients.
physician’s comment was, “your physician
did the right thing by deciding to transfer     I The physician may be competent to care
you here. We will take good care of you.”         for a complicated case, but may not have
At this hospital, everyone got credit for the                                                    Dr. Orlowski is senior vice president, medical
                                                  the backup—technology, ICU nurses and
good medical decision to transfer the                                                            affairs, and chief medical officer at Washington
                                                  surrounding care—to ensure continuing
patient—the referring physician as well as                                                       Hospital Center. She can be reached at (202) 877-
                                                  good care for a patient. Again, comments
the receiving hospital.                                                                          5284 and at


Saving Time and Space
by Scanning Patient Charts
McKesson Medical Record Imaging Rollout Scheduled for September

            ashington Hospital Center physicians may find a little
            breathing room in their hectic schedules, when the new
            McKesson Medical Record Document Imaging (MRDI)
rolls out in mid-September.
Richard Walker, director, health information management (HIM),
says, “Not only will physicians save the time it takes to walk over to
Medical Records to sign charts, they’ll have access to the scanned
records anywhere they have Internet access. They won’t have to
track down the paper chart when they need to review a diagnostic
test or a consult. It will be right there.” He notes that physicians who
currently authenticate via transcribed reports through SoftMed
have some of those capabilities now, but with MRDI, all physicians
will have access online.                                                   MedStar Health began implementation of MRDI in the Baltimore
                                                                           hospitals last year. Marya Ford, project manager, says the implemen-
Margo Smith, MD, director, infectious diseases, and the physician          tation in the other hospitals has gone well, but notes that Washington
representative on the MRDI steering committee, says, “We’ll have           Hospital Center is in a unique position because of its larger size, its
access at our fingertips, rather than having to request a chart that        own billing system and the number of ancillary services that will
may be in another department and may have missing pieces. We’ve            feed electronically into the system. “We’ve created more interfaces
all experienced the problem of having to repeat a test or a consult        here than at the other hospitals and will have more physicians to
because a report is missing. We won’t waste that time anymore.”            train, but we anticipate the rollout will go smoothly,” she says.
Physicians won’t be the only ones to                                                                    Beginning Sept. 17, all inpatient and
benefit from MRDI. Walker says often                                                                     outpatient surgery records will be
several hospital departments need access                                                                scanned into MRDI as soon as patients
to patient charts at the same time,                 Beginning Sept. 17, all                             are discharged. Technicians in health
including billing, infection control,
quality, risk management and clinical
                                                   inpatient and outpatient                             information management will review
                                                                                                        charts and send any signature deficien-
resource management. “Getting a patient         surgery records will be scanned                         cies to the physicians electronically.
chart on paper can often take several                                                                   Physicians will access their queue
days. It will make a huge difference to us
                                                into MRDI as soon as patients                           through the MedStar Web site, where
all once we can view charts simultane-                  are discharged.                                 incomplete patient charts will be com-
ously,” he says.                                                                                        pleted electronically.
Moving to MRDI has given the entire                                                                      Walker is setting up numerous training
hospital a chance to review forms and eliminate superfluous ones.          sessions in the weeks preceding the Sept. 17 launch date. “We’ll
For instance, Kathy Srsic-Stoehr, MSN, MS, RN, CNAA-BC, director           come to staff meetings, arrange special sessions for 10 or more
of nursing excellence, says, “We’ve reduced our inventory of clinical      physicians, and post scheduled times at various locations around
forms by about one fourth. In addition, nurses will also have the          the hospital where physicians can learn how to use the program. For
advantage to conduct medical record audits for regulatory compli-          most physicians, it will only take about 10 to 15 minutes of train-
ance and for performance improvement more easily through the               ing,” he says.
online access.”
                                                                           Walker says his initial goal for completion of a medical record will
For the hospital, the main savings won’t be measured so much in            be 48 hours after discharge, with a final goal of reducing that to 24
minutes as in inches. Scanning records means the paper records can         hours. “We’ll have four scanners working around the clock,” he says.
be destroyed, which will eliminate the need for paper storage. “In         “Some of the Baltimore hospitals have reached 24 hours, but not all.
two or three years,” says Walker, “we’ll vacate more than 5,000 sq. ft.    With everyone at Washington Hospital Center doing his or her part,
of space on campus that can be converted to much needed clinical           we can make it in 24 hours.” I
space. We’ll also save significantly on the off-site storage we now use.”                                                    — Norma Babington


Physician Stress
Its Causes and Effects
By Catherine Avery

      he truth is plain to see. Physicians        sacrifice and broken rest. To compensate for        So why can’t physicians just slow down? Dr.
      live in a fast-paced world and play a       that, physicians have to build up a special        Myerson notes that physicians are highly
      high-stakes game. Stress is a daily         identity—we have to sacrifice to do this            goal-directed individuals. “That’s the nature
fact of life.                                     wonderful, special work. This leaves us more       of people who go into medicine. If you’re a
                                                  vulnerable.”                                       physician, you worked hard in college, med-
“As physicians, every day we see lots of                                                             ical school and residency. Your training and
patients and make lots of fast decisions,”        Frederick Finelli, MD, JD, a general surgeon       professional activities were all-consuming,”
says Stephen Peterson, MD, chair of psychia-      and president of the Hospital Center’s med-        he notes. “People who join this profession
try. “Stress can manifest itself in many          ical and dental staff, knows this vulnerability    are usually naturally hard workers, and tend
different ways.”                                  well. “There’s a weight of responsibility          not to smell the flowers as much as others. A
                                                  when you have someone’s health on your             lot of pressure makes it hard to relax.”
Stress can be defined as a non-specific             shoulders. Even when you do everything
response of the body to any demand placed         perfectly, sometimes things don’t go right.        Indeed, most physicians can continue to
on it. Acutely, it causes increased heart rate,   Everyone says it’s not your fault, but you still   practice effectively even when stressed. But
blood pressure and muscle tension. Chroni-        go home feeling like you did something             sometimes that everyday stress gets to be too
cally, it leads to cardiovascular, gastro-        wrong. There’s no solace in surgery unless         much, leading to behavioral changes and
intestinal, musculoskeletal and immunologic       everything goes perfectly.”                        substance abuse.
                                                  Dr. Peterson points out that physicians are        Dr. Peterson distinguishes between short-
It also can lead to behavioral changes, such      perfectionists by nature. “This relentless         term and long-term stress. “In the short
as anger, chronic lateness and sloppiness.        pursuit of perfection leads to internal pres-      term, physicians may experience extreme
And over time, it can manifest as depression,     sures. Along with the forces in society that       fatigue or emotional distress. In the longer
burnout and substance abuse.                      are arrayed against us, like managed care,         term, stress can manifest as anger, tardiness,
                                                  malpractice lawyers and unhelpful politi-          mistakes or incomplete paperwork.”
Why physicians are stressed                       cians, it’s not as rewarding as it was in years
Medical professionals are prone to stress,                                                           Overly-stressed physicians can make it hard
                                                  past. Ours is noble work, but it’s not always
says Ross Myerson, MD, medical director of                                                           on those around them. Such behaviors as
                                                  regarded as that by others.”
occupational health and envi-                                                                                     verbal hostility, thrown charts
ronmental services at Washing-                                                                                    or instruments, slammed
ton Hospital Center. While there                                                                                  doors, defied orders or requests
is no data to suggest that physi-      “People who join this profession are people                                and chronic lateness can tax the
cians suffer more work-related                                                                                    patience of co-workers and
stress than other occupations,         who naturally work hard, and tend not to                                   really interfere with teamwork.
the very nature of their jobs
causes stress.
                                          smell the flowers as much as others.”                                In years past, such behaviors
                                                                                     —ROSS MYERSON, MD         have largely been ignored. But
“The buck stops with the physi-                                                                                the American Medical
cian,” Dr. Myerson says. “There                                                                                Association (AMA) now has
are lots of mportant decisions,                                                                                established a policy that defines
                                                  And, adds gastroenterologist I. David
and most often, the decision-making tree                                                         bad behavior, stating, “Personal conduct,
                                                  Shocket, MD, “Physicians don’t do the
ends at the physician.”                                                                          whether verbal or physical, that affects or
                                                  things we tell our patients to do—relax-
                                                  ation, yoga. We often work through lunch,      that potentially may affect patient care
Add the relative degree of risk and urgency
                                                  and schedule more than we realistically have   negatively constitutes disruptive behavior.
built into medical decision-making and you
                                                  time to do. There’s so much pressure to get    (Criticism that is offered in good faith with
have a pressure-cooker. Some areas have
                                                  so many things done in a day, that we are      the aim of improving patient care should
especially pressurized environments—for
                                                  rushing, rushing, rushing.”                    not be construed as disruptive behavior).”
example, the emergency department and
                                                                                                 The Joint Commission soon will require
operating room.
                                                  How stress can manifest itself                 that all hospitals have committees to handle
Dr. Peterson explains the psychological           Dr. Myerson finds that negative coping          concerns about disruptive physicians.
component to physicians’ stress. “As physi-       responses are directly related to the magni-
                                                  tude of the stressors an individual faces, the “It used to be that these issues were not
cians, we work so hard to be competent.
                                                  individual’s personality and the availability  addressed forthrightly,” Dr. Myerson says.
Medicine requires a lot of hard work,
                                                  of social support.

                                                      TO HELP RELIEVE STRESS
                                                      Constant, intense involvement with people; critical decision-making under
“We used to just keep five feet away from
these individuals. But now we’re starting to          pressure; decreased autonomy; shift work and long hours; the threat of
look at some of these issues with a more              malpractice; managed care pressures; business pressures and expectations
holistic mind, to figure how best to serve the
                                                      from patients all contribute to stress. Here are some actions to take to
medical staff and provide some assistance
for professionals under stress.”                      counter those stressors:
The Physicians Health Committee histori-              G Take time to include recreation, hobbies and exercise in your daily life.
cally has dealt with physicians with substance
abuse problems. “Now we’re looking at the             G Get together with your colleagues to discuss ways to decrease stress.
physical and emotional well-being of physi-
cians to see how this impacts their ability to                                                                   ”
                                                      G Set aside a few minutes each day for yourself—“alone time.
practice medicine,” says Dr. Myerson, who is
a committee member. “Behavioral issues can            G Confer with a department chair or hospital administrator about the cause
affect the quality of practice.”                        of any stress.
In his role as president of the medical and           G Use the stress-reduction programs available through the Medical Society
dental staff, Dr. Finelli agrees. “Temper
tantrums are no longer accepted. If a physi-            of the District of Columbia.
cian is routinely rude or intimidating,
nurses and other doctors will try to avoid            G Utilize the stress-reduction programs from the Physicians Health
him or her. This leads to lack of communi-              Committee at the hospital.
cation, which leads to sub-optimal care.”
                                                      G Use referrals to private practitioners, which are available through
Complaints about disruptive behaviors are
investigated by department chairs, Dr.                  Dr. Orlowski’s office.
Finelli and Janis M. Orlowski, MD, MACP,
senior vice president and chief medical
officer. “We sit down with the physicians
and discuss any unprofessional or inappro-        The intent is to correct the impairment,         colleagues. We all need to take our own
priate behavior,” Dr. Finelli says. “Physicians   whether it manifests as behavioral issues or     advice, and set aside a few minutes each day
are usually mortified. But medical boards          substance abuse. “An impaired physician can      just for ourselves, even if that means closing
and hospitals are taking this much, much          undermine the morale of team members,            your office door for ten minutes.”
more seriously than ever before.”                 spark lawsuits and make it harder to retain
                                                  staff. In extreme instances, it can impact       Dr. Finelli suggests that stressed physicians
Sometimes long-term stress leads to sub-                                                           talk to their department chair or a hospital
stance abuse. Physicians have a tendency to       patient care, and impact the reputation of
                                                  the physician and the hospital,” Dr. Peterson    administrator. Residents can go to their
self-assess and self-treat, Dr. Myerson notes.                                                     program director or the chief resident.
Studies show that practicing physicians are       explains. Dr. Finelli emphasizes that every
more likely to use sedatives and minor tran-      attempt is made to help physicians before        When physicians notice that a colleague has
quilizers. Substance abuse problems—with          the situation deteriorates to that point.        difficulty, Dr. Peterson advises that they
drugs or alcohol—can develop in those             What physicians can do                           “Acknowledge it in a caring way. Recom-
who are predisposed and have easy access.         Fortunately, many physicians recognize that      mend that they seek help.” Signs can be
                                                  they are under stress. Dr. Peterson advises      subtle, but may include increased irritability,
The Physicians Health Committee deals                                                              decreased concentration, disheveled appear-
extensively with these issues. “We work with      that they reprioritize their lives to include
                                                  more family time and recreation. “Develop        ance or sloppy record-keeping.
the physician to advise him or her how to
get help for their problem(s). In many cases,     hobbies and other areas of interest. Exercise    But Dr. Finelli cautions that when a physi-
we refer the physician to the Medical Society     is a great outlet, too. Also get together with   cian suspects a substance abuse issue in a
of the District of Columbia, which provides       your colleagues and talk about stresses.”        colleague, they should “Enlist the support of
a pathway for physicians with substance           Adds Dr. Shocket, “sometimes there are           someone who knows what they’re doing. Go
abuse problems,” Dr. Myerson says.                issues you can’t discuss at home, and you        to an administrator or the Medical Society.”
                                                  may not be able to discuss them with your
                                                                                                                            continued on page 6


The 2007 Maryland
Legislative Session
by Clarence Brewton Jr., FACHE

          edStar Health was involved in a       and/or tort reforms. With the improving            ted hospitals in Maryland to provide elective
          wide variety of health care issues    medical malpractice environment and                (or non-emergency) angioplasty procedures
          that were debated in bills intro-     reduced frequency of malpractice claims            in hospitals without requiring surgical
duced in this year’s legislative session in     and award payouts, there was little appetite       backup. Current Maryland regulations only
Annapolis. One difference in this session was   to revisit the 2004 battle over medical liabil-    permit primary (emergency) angioplasty
control, as Democrats held both the major-      ity reforms. MedStar Health continues to           procedures to be performed in hospitals
ity in the legislature as well as in the top    press the issue of reforms, because by 2009        without surgical backup capabilities. If
elected post, with former Baltimore mayor       the Health Care Provider Rate Stabilization        passed, the legislation would have circum-
Martin O’Malley as the state’s new governor.    Fund will expire. The Fund was enacted in          vented Maryland Health Care Commission
                                                special session in 2004 to avert the malprac-      regulations based on American College of
But despite high hopes for major legislation    tice crisis. It currently subsidizes malpractice   Cardiology guidelines, that recommend elec-
addressing health care access, expanding        insurance premiums for physicians; when it         tive angioplasty procedures be performed
insurance coverage and other health care        ends, malpractice insurance premiums will          only in facilities with surgical backup.
reforms, little was accomplished. The prob-     return to market rates.
lem: lack of money. Faced with a looming                                                           In summary, key health care legislation
structural budget deficit estimated to reach     The legislature also failed to act on another      during the 2007 session was simply put off
$1.5 billion by 2008, the legislature—partic-   key health care problem, the financially-           to 2008 or beyond.
ularly the Senate and the new Governor—         strapped Prince George’s County Hospital
                                                System. A plan was introduced that would           As the regular session ended, discussions
took a cautious approach to enacting legis-
                                                have established a hospital authority to take      began for a special session of the legislature
lation requiring new revenue sources.
                                                over the operations of the financially failing      in September, to address budget issues to
House speaker Michael E. Busch (D-Anne          system, with the authority to seek a buyer         include funding for expanding health care
Arundel County) endorsed a bill to expand       to take over the system. The bill included         coverage. There is a fear among Annapolis
health care coverage for the nearly 800,000     state funding and required funding from            insiders that if the state’s budget deficit is
uninsured Maryland residents, by raising the    Prince George’s County. As the session             not dealt with in a special session before
tobacco tax $1 per pack of cigarettes. This     came to a close, negotiations on the ele-          January, the regular session in January 2008
bill was passed in the House of Delegates but   ments of the plan failed with the Prince           will be consumed with budget issues, and
it failed to win enough votes in the Senate.    George’s County Council, and the proposed          not much else will be accomplished. I
                                                legislation died with the end of the session.
There were no significant medical liability                                                         Clarence Brewton Jr., FACHE, is vice president,
reform bills passed this session, even          In the area of regulatory reform, we worked        regulatory compliance and community develop-
though 17 bills focused on malpractice          to defeat legislation that would have permit-      ment, MedStar Health.

COVER        STORY        continued from page 5

PHYSICIAN STRESS                                evaluate and assist physicians with other          with the Physicians Health Committee to
                                                physical and emotional problems,” Dr.              help develop positive programs for stress
                                                Myerson says.                                      reduction, so physicians can receive what
                                                                                                   they need before that stress becomes a
                                                Department chairs are well equipped to             professional issue,” she says. “We can use
What the hospital can do                        work with physicians who need assistance.          resources within the hospital and also in the
Washington Hospital Center has several          Similarly, residency program directors work        community, including the hospital’s
mechanisms for helping stressed physicians.     with residents in need. Dr. Finelli gives an       Employee Assistance Program, programs at
                                                annual lecture to residents about how to           the Medical Society and referrals to private
The Physicians Health Committee is striv-
                                                recognize stressors and what to do about it.       practitioners.”
ing to work with physicians with physical
                                                “I tell them cautionary tales of how to han-
or emotional issues, not just substance
                                                dle it properly and how not to handle it.”         “The most important thing to remember is,
abuse. “We already have a mechanism for
                                                                                                   we’re here to help.” I
helping physicians with substance abuse         Dr. Orlowski’s office plays a key role in
issues; now we are expanding our ability to     constructive support of the issues. “I’ve met


A Grade-A Tour of the
Heart Beat of Cardiology

      he assignment for the Gifted & Tal-
      ented 7th grade science class sounded
      simple enough. Choose a field of
study that ends in “ology,” and research that
topic for the entire school year, culminating
with an in-person interview with someone
who works in that field. Then, report your
findings to your class at Rocky Run Middle
School in Chantilly, Va.
Zack Haubach chose cardiology. “I figured
it would be easy, because of the number of
cardiologists in the metropolitan area. It
wasn’t. It took time to find someone who
could meet with me.”
Zack got the opportunity to spend an hour
with Howard Cooper, MD, associate direc-
tor, Coronary Care Unit. Zack first
interviewed Dr. Cooper, asking what it’s
really like to treat patients with cardiovas-
cular disease.
“I treat very sick people when I work in the
cardiac ICU,” he told Zack. “Many of those
patients are not fully aware of what is hap-      Howard Cooper, MD, with Zack Haubach after their tour of non-invasive cardiology.
pening to them. Sometimes, I must tell their
families that the patient may not survive.
Talking to families about end-of-life deci-
sions is the most difficult part of my job.”       Other questions included what kind of             together a PowerPoint for his classmates
His favorite part of the job? “I have two.        grades did you get in middle and high             that included all of his findings, and a
The first comes when I can see that some           school, what kind of extracurricular activi-      glossary, to explain the terms a cardiologist
treatment that I have given a patient has         ties did you take part in and what made you       would use. Despite his interest in the field,
made a big difference in the way he or she        decide to become a doctor?                        at least for now, Zack doesn’t believe being
feels. The second is when some research                                                             a cardiologist is in his future. “I know now
                                                  As might be expected, Dr. Cooper was vale-        the life of a cardiologist is difficult. I don’t
that I have done gets published in one of         dictorian of his high school and edited the
the medical journals.”                                                                              think I could do it—I’m not patient enough.”
                                                  school’s literary magazine. A surprise was
That research currently includes an intra-        finding out he played ultimate frisbee as a        Dr. Cooper gave Zack a tour of the non-
aortic balloon pump. “For a long time, we         club sport. And what made him decide on           invasive cardiology areas, explaining equip-
have used heparin, a blood thinner, to pre-       cardiology? “My father is a cardiologist who      ment for specific procedures and why
vent clotting complications while the pump        just loves his job, and he’s still in practice.   patients would have those procedures. The
is in place, but there is no evidence that this   So I knew I wanted to be a doctor. Origi-         coolest part of Zack’s visit? “When I got to
actually helps, and it does increase the risk     nally I wanted to be a cardiac surgeon, but       watch my own echocardiogram, because it
of bleeding,” he explained. “We are cur-          during my training, I noticed that the car-       was mine.”
rently investigating whether patients with a      diac surgeons were usually at the hospital
                                                  when I arrived and were still there when I        And the final grade for Zack?
balloon pump have more or fewer compli-
cations when heparin is used, compared to         left. That wasn’t the lifestyle I wanted.”        “Thanks to my visit with Dr. Cooper, I
when it is not. The results of this investiga-    Zack’s year-long research investigated all        got an A.” I
tion will very likely impact how cardiologists    types of cardiovascular disease. He put
all over the world treat patients with bal-                                                                    — Paula Faria and Marge Kumaki
loon pumps.”

NEWS        &   NOTES

HOSPITAL CENTER                                      AWARDS FOR PHYSICIANS & PHYSICIAN
ONE OF “AMERICA’S                                    S  everal physicians have been recognized for their writing in the 13th Annual
                                                        Communicator Awards, an international awards program recognizing creative
BEST HOSPITALS”                                      excellence in the communication field.
                                                     Frederick C. Finelli, MD, JD, was given the Award of Distinction
A    gain this year, Washington Hospital
     Center was named one of “America’s
Best Hospitals” by U.S.News & World Report.
                                                     for his article, “Saving Others Without Killing Ourselves.”
                                                                                          Robert Bunning, MD, FACP, FACR and
In its annual issue rating hospitals in 16 spe-                                           Stephen W. Peterson, MD, were given
cialty categories, the Hospital Center ranked                                             an Honorable Mention for their article,
17th in Heart/Heart Surgery, up from 18th                                                 “Physicians and Our Defense Mecha-
                                                                                                                                                        Frederick C.
last year, and 38th in Kidney Disease, up from                                            nisms.” Both articles were printed in the                     Finelli, MD, JD

45th last year. After a year’s absence, the                                               February issue of Physician.
specialty of Geriatrics was again rated, and       Robert Bunning,            These same physicians and the articles they wrote
                                                                      Stephen W.
                                                   MD, FACP, FACR     Peterson, MD
the Geriatrics program at the Hospital Center                                 won the “Award of Excellence” from Apex 2007, The
was ranked 26th in the country.                      19th Annual Awards for Publication Excellence. In addition,
Only 173 of the 5,462 hospitals evaluated            I Physician won an “Award of Excellence” from Apex 2007, recognized for
this year were named to the list. Quoting               overall communications excellence.
from U.S.News, “…In 12 of the 16 special-
                                                     I Physician took the Gold Award in the 2007 Aster Awards competition, a
ties, a hospital’s standing was measured by
                                                        national competition for health care marketing. It was judged on creativity,
hard data. …Initial eligibility was based on
                                                        layout/ design, production and overall quality.
meeting any of three standards: membership
in the Council of Teaching Hospitals, affilia-       I Physician won the Gold Award for the 2007 Hermes Creative Awards, an
tion with a medical school or availability of at        international competition judged by the Association of Marketing and
least six of 13 advanced services, such as              Communication Professionals.
image-guided radiation therapy and robotic           I Physician received a Merit Award in the 24th Annual Healthcare Advertising
surgery. Each specialty had its own eligibility         Awards, a competition drawing 4,300 entries this year.
requirements. A hospital either had to have
                                                     Physician’s managing editor wishes to thank the editors, James Jelinek, MD
seen a specified minimum number of
                                                     and Margo Smith, MD; the members of the Physician editorial board; the
Medicare inpatients during 2003, 2004 and
                                                     members of the Physician review board; all the physicians who generously give
2005 who had certain conditions or under-
                                                     their time and energy for each story; our writers and the hospital’s Print Shop.
went certain procedures, or the hospital had
                                                     Special thanks go to Jean Wilhelmsen-Exter, senior graphic designer, who puts
to be named among the best in the specialty
                                                     incredible creative efforts into each issue.
by at least one physician in the latest three
annual surveys. …Hospitals then received a
score combining three equally-weighted                                                                          I physicians transferring complete responsibility
elements: reputation, death rate and care-         SBAR REMINDER                                                  for a patient
related factors such as nursing and advanced
services.” Other factors taken into account
were the mortality index, patient volume,
                                                   A    nytime a patient is transferred from one
                                                        service to another—the “handoff”—please
                                                   remember the National Patient Safety Goal
                                                                                                                I physicians transferring on-call responsibility
                                                                                                                I temporary responsibility for staff members
                                                                                                                  leaving the unit for a short period of time
relative availability of nurses, advanced tech-    that requires everyone to use our standardized
nology and credentialing by professional           approach for handoff communications, SBAR.                   I anesthesiologists reporting to the post-
bodies.                                                                                                           anesthesia recovery room nurse
                                                   SBAR—Situation, Background, Assessment,
                                                   Recommendation—organizes information                         I nurse and physician handoff from the emer-
Other MedStar Health hospitals named in
                                                   about a patient and presents it in a way to                    gency room to inpatient units, different hos-
this year’s ratings were Georgetown Univer-
                                                   give the facts quickly and coherently. It doesn’t              pitals, nursing homes and home health care
sity Hospital, 48th in Kidney Disease; Franklin
Square Hospital, 43rd in Endocrinology and         matter if the handoff is for a brief time or is              I nursing shift changes
Union Memorial Hospital, 43rd in Ortho-            permanent. SBAR ensures accurate information                 I critical laboratory and radiology results sent
paedics. National Rehabilitation Hospital was      about a patient’s care, treatment and services,                to physician offices
                                                   current condition and any recent or anticipated
ranked 9th on a reputational scoring.                                                                           Any physician questions about SBAR should
                                                                                                                go to Sunil Madan, MD, associate medical
                                                   Patient handoff situations include, but are not              director, Emergency Department, at
                                                   limited to:                                        

                                                   CORRECTION: The June story, “The Griffin-Gonzalez Connection: Family Matters at Washington Hospital Center,” should have
–8–                                                been credited to Carol Yeh. Physician regrets the error.
OFFICE           OF     CONTINUING                  MEDICAL             EDUCATION


July/August 2007 Highlights
      Upcoming CME Events                                           REGULARLY SCHEDULED CATEGORY 1 CONFERENCES
  Activities listed are approved for
       category 1 CME credit.              ANESTHESIOLOGY                           American Board of Emergency         ONCOLOGY Presented by the
    Category 2 activities are self-        Anesthesiology Clinical                  Medicine Literature Review          Washington Cancer Institute (WCI)
 reporting, effective October 2002.        Conference                               Monthly, 1st Friday, 7:30 a.m.      Gastrointestinal Oncology
                                           Weekly, Tuesdays, 7:00 a.m.              Emergency Department Conf. Rm.      Case Presentations
                                           Room G-200                               1 AMA PRA Category 1 Credit TM      Twice Monthly, 2nd & Last Fridays,
FEBRUARY 24 – 28, 2008                     1 AMA PRA Category 1 Credit TM           (202) 877-9393
Controversies in Medicine—                                                                                              8:00 – 10 :00 a.m.
                                           (202) 877-7500                                                               Surgical Classroom – Room G-270
13th Annual Multidisciplinary                                                       MEDICINE
                                           CARDIOLOGY/CARDIOVASCULAR                GRAND ROUNDS                        2 AMA PRA Category 1 Credits TM
Conference                                                                                                              (202) 877-3908
Presented by Washington Hospital Center    Cardiac Catheterization                  Weekly, Wednesdays, 12:30 p.m.
                                           Conference                               True Auditorium                     Multidisciplinary Breast Cancer
and the department of Academic Affairs     Weekly, Wednesdays, 7:30 a.m.            1 AMA PRA Category 1 Credit TM      Treatment Conference
Wm. James Howard, MD – Act. Dir.           True Auditorium                          (202) 877-3109 or (202) 877-6749    Weekly, Wednesdays, 7:30 a.m.
Snowbird Ski & Summer Resort               1 AMA PRA Category 1 Credit TM                                               Siegel Auditorium
                                                                                    NRH Medical Grand Rounds
Salt Lake City, Utah                       (202) 877-8574                           Weekly, Fridays, Noon               1 AMA PRA Category 1 Credit TM
(202) 877-8206                             Updates in Cardiovascular                NRH Auditorium                      (202) 877-7937
AMA PRA Category 1 Credits TM offered      Medicine Lecture Series                  1 AMA PRA Category 1 Credit TM      OPHTHALMOLOGY Presented by
                                           Biweekly, Tuesdays, 6:30 p.m.            (202) 877-1660                      Washington National Eye Center
                                           District of Columbia, Maryland and
                                           Virginia Area Restaurants                NEONATOLOGY                         Saturday Morning Lecture Series
         Code Orange                       1 AMA PRA Category 1 Credit TM           Visiting Lecture Series in          Weekly, Saturdays, 8:30 a.m.
      Simulation Training                  (202) 877-2992                           Perinatal Pediatrics                True Auditorium
                                                                                    Twice Monthly, 1st & 2nd Tuesdays   2.5 AMA PRA Category 1 CreditsTM
  is available as a web module on          Echocardiography Conference              12:30 p.m., 5B–3 Conference Room    (202) 877-6159
     SitelMS Online Learning               Weekly, Thursdays, 7:45 a.m.             1 AMA PRA Category 1 Credit TM
   Management System. Go to                Cath Lab Conference Room (5th Flr)       (202) 877-6527                      ORTHOPAEDIC ONCOLOGY to register          1 AMA PRA Category 1 Credit TM                                               Orthopaedic Oncology
 and create your personal account.         (202) 877-7853                           NEUROLOGY                           Preoperative Conference
                                                                                    Cerebrovascular Case Conference     Weekly, Thursdays
                                           EMERGENCY MEDICINE                       Biweekly, Wednesdays, 8:00 a.m.     7:30 a.m. – 8:30 a.m.
                                           Emergency Medicine                       Various locations                   Siegel Auditorium
 William M. Steinberg’s Board              Grand Rounds                             1 AMA PRA Category 1 Credit TM      1.5 AMA PRA Category 1 Credits TM
 Review in Gastroenterology—               Monthly, 3rd Thursdays, 7:00 a.m.        (202) 877-3154                      (202) 877-8098
   Audio, Video & DVD sets                 Emergency Department Conf. Rm.
  40 AMA PRA Category 1 Credits TM         1 AMA PRA Category 1 Credit TM           NEUROSURGERY                        Multidisciplinary Sarcoma
                                           (202) 877-9191                           Neurosurgery Conference             Conference
  Call 1-800-283-1997 to order.
                                                                                    Weekly, Tuesdays, 7:30 a.m.         Biweekly, Tuesdays, 7:30 – 9:30 a.m.
                                                                                    CTEC Board Room–6th Floor           Siegel Auditorium
                                                                                    1 AMA PRA Category 1 Credit TM      2 AMA PRA Category 1 Credits TM
                    ER One 4th Annual Conference:                                   (202) 877-5580                      (202) 877-8098
       HOSPITALS ON THE FRONTLINE: Hospitals Saving Lives                                                               OTOLARYNGOLOGY
   through Community Integration in Response to Mass Casualty                       OBSTETRICS/GYNECOLOGY
                                                                                    OB/GYN Grand Rounds                 Multidisciplinary Head and Neck
           Events Conference is available as a web module on                        Weekly, Tuesdays, 8:00 a.m.         Tumor Board Conference
        SitelMS Online Learning Management System. Go to                            5B–3 Conference Room                Weekly, Thursdays, to register and create your personal account.               1 AMA PRA Category 1 Credit TM      4:00 p.m.
                                                                                    (202) 877-6054                      Room CI-119
                                                                                                                        1 AMA PRA Category 1 Credit TM
                                                                                                                        (202) 877-9403
                             May & June Statistics                                                                      SURGERY
                                                                                                                        General Surgery Orange Team
                                                  MAY                           JUNE                                    Teaching Conference and Lecture
                                                                                                                        Weekly, Thursdays, 8:00 a.m.
                                          2007          2006                2007        2006                            General Surgery Conference Room
                                                                                                                        2 AMA PRA Category 1 Credits TM
    Inpatient Admissions                  3,827         4,054               3,687        3,962                          (202) 877-9847
                                                                                                                        Surgery Grand Rounds
    Outpatient Clinic Visits              8,533         8,548               8,288        8,124                          Weekly, Tuesdays, 8:00 a.m.
                                                                                                                        True Auditorium
    ED Visits                             6,974         6,410               6,478        6,398                          1 AMA PRA Category 1 Credit TM
                                                                                                                        (202) 877-6426
    ED Admissions                         1,577         1,615               1,525        1,604                          UROLOGY
                                                                                                                        Urology Academic Series
    Average Daily Census                   674             688               701           697                          Weekly, Tuesdays, 8:00 a.m.
                                                                                                                        Siegel Auditorium
    Births                                 392             349               383           382                          1 AMA PRA Category 1 Credit TM
                                                                                                                        (202) 877-3968


Crossing the Line:
Defining the Business of Surgery

      urgeons have been taught there is a        Dr. Kirkpatrick called surgery the financial
      fine line between the practice of sur-      cement of health care systems. “It has the
      gery and the business of surgery. It’s a   highest margin, uses the greatest technical
line that traditionally separated the two,       advances, accelerates the growth in inpatient
but surgeons today need to think differ-         admissions, utilizes the strongest market
ently, says John R. Kirkpatrick, MD, MBA,        advantage and is an important cornerstone
FACS.                                            for philanthropy.” And, he added, the oper-
                                                 ating room and its services can be the            and support personnel. OR time is the most
“You can practice surgery in an honorable        CEO’s hero. “Increasing costs, decreasing         valuable resource, so you must use it wisely
way and also be a businessman,” he states.       profit margins and increased need for patient      and strategically.”
                                                                        services created an        The business of surgery means the tradi-
                                                                        environment that           tional surgical culture and long-established
                                                                        favors systems and         behaviors must be modified, stated Bruce
                                                                        favors well-managed        M. Smith, MD, medical director, operating
                                                                        surgical service lines.”   rooms. “The factors affecting profitability
                                                                        Agreeing was Thomas        now include a balance of clinical outcomes,
                                                                        Marchozzi, chief           the academic mission, community needs,
                                                                        financial officer at the     extramural mandates, the research mission,
                                                                        Hospital Center.           the need to recruit new surgeons and the
                                                                        “More than half the        need for strategic loss leaders,” he
                                                                        profits for 82 percent      explained. Dr. Smith cited four areas—OR
                                                                        of hospitals across the    leadership, efficiency, case contribution
                                                                        country came from          margins and scheduling—where surgeons
                                                                        four service lines—        should be included in the strategic deci-
                                                                        cardiac services,          sion-making process, to create a balanced
                                                                        general surgery,           schedule that matches operating needs and
                                                                        orthopaedics and           the hospital’s vision.
                                                                        pulmonary surgery.         The business of surgery also means hospi-
                                                                        Hospitals are finan-        tals must look at the surgeon as a customer
John R. Kirkpatrick, MD, MBA, FACS, addresses physicians at the         cially dependent on
symposium.                                                                                         of the hospital. James F. Caldas, president,
                                                                       procedures, and             called the surgeon “not only a customer but
                                                                       growth projections          also a partner for success in the OR, and an
                                                                       to 2014 indicate that       integral part of the organization.” Caldas
“We need to look at the impact ‘crossing         inpatient demand will increase 13 percent         said this partnership creates “positive
the line’ has on patient care and patient        as the population ages.” But, he cautioned,       energy at the epicenter.” One successful
outcomes, on cost effectiveness and profita-      as the DRGs change every October, the pay-        connection point, he explained, was having
bility of service, as well as funding for other  ments for surgeries will be lowered as those      a “barometer group”—handpicked
projects, including charity care.”               for medicine services increase.                   respected surgeons who could be thought
Dr. Kirkpatrick, the Harold H. Hawfield           M. Joy Drass, MD, MBA, president, George-         and influence leaders. Their regular break-
chair of surgery at Washington Hospital          town University Hospital, stressed balancing      fast meetings proved to be an effective
Center, led a two-day symposium, Crossing        resource allocations as a key to profitability.    forum for information on whether the OR
the Line: Defining the Business of Surgery,       Using Georgetown from 2001 to 2006 as a           experience was improving for surgeons,
which looked at the power of the operating       case study, Dr. Drass cited four take-away        Caldas stated.
room as a profit center within a hospital.        lessons from those five years. “We had to          “Clinical and business goals are not only
The symposium focused on a wide variety          focus matters in an environment of con-           compatible but synergistic,” said Dr. Kirk-
of topics, including converting cost centers     strained resources, and we required a             patrick. “This is not at all bad if it’s done in
to profit centers, constraints to profitability,   data-driven review of program perform-            a straightforward way, and it will have a
survival strategies for profitable services       ance to support resource allocation               tremendous impact on patient care and
and indispensable services with an imper-        decisions,” she stated. “Remember, your           patient outcomes.” I
fect revenue base.                               resources include space, advertising dollars                                    — Marge Kumaki

– 10 –

Cancer Institute Staging Process
Wins Commendations for Compliancy

  n December 2005, Washington Cancer            Hoyler says the information helps bench-         Hospital Center standards, initially did not
  Institute faced a monumental task.            mark the Cancer Institute against other          get rave reviews. Medical and Dental staff
  The American College of Surgeons              cancer centers. The data sent becomes part       president Frederick Finelli, MD, reported to
Commission on Cancer (ACSCC), which             of the National Cancer Data Base Web site,       the PIC that the old form was not user
strength- ened the standard for staging         a rich data base of statistics from institutes   friendly, particularly for private physicians.
cancer in 2004, would be surveying it in        like Washington Hospital Center, from all        The Cancer Institute refined it, made the
June 2006. After reviewing patient charts,      over the country.                                forms site-specific for each kind of cancer
staff members discovered they were 45                                                            and included detailed instructions for com-
                                                Part of the new process requires that the        pletion. Dr. Finelli reported afterwards that
percent compliant.
                                                treating physician assumes responsibility        the newer forms were much easier to use,
The ACSCC now required 90 percent com-          for staging. Dr. Lessin says the task of         and gave the Cancer Institute thumbs-up
pliancy, so the Cancer Institute had just six   bringing the Cancer Institute into compli-       approval from the medical staff.
months to make some significant changes          ance was made much easier, because the
or face delinquency. “We knew we had to         pathology department was undergoing a            Another issue the Cancer Institute faced
achieve compliance, and we did it,” says        parallel process for compliance. The             involved both gynecologic oncologists and
Lawrence Lessin, MD, associate medical          department used guidelines for the content       orthopaedists. They used different staging
director, Washington Cancer Institute. The      of pathology reports on cancer specimens,        systems, FIGO and MSTS, respectively.
Cancer Institute not only reached                                                                               “There was some dispute,
its goal of 90 percent, it received                                                                             but in the end, we were able
seven commendations from the                                                                                    to accept both of those stag-
ACSCC for going “above and                                                                                      ing forms and integrate them
beyond its requirements,” says           The Cancer Institute …received seven                                   into the AJCC system,” Dr.
Suzy Hoyler, director, Washington                                                                               Lessin says.
Cancer Institute information
                                       commendations from the ACSCC for going
                                                                                                              Hoyler says now, a year later,
management.                              “above and beyond its requirements”                                  most of the wrinkles have
Dr. Lessin recalls, “We quickly                                                           —SUZY HOYLER        been straightened out, and
identified all the physicians who                                                                              they continue to look for
were responsible for staging of                                                                               ways to refine the process to
cancer patients, and let them                                                                                 ensure that the Cancer Insti-
know they had six months to                                                                                   tute stays in compliance.
bring all their active cases into compliance    as specified by the College of American        Health information management (HIM)
by the end of June. Some of them had two        Pathology. Pathology installed new soft-      reviews inpatient discharge notes and the
or three cases, others had 25 or 30. Also, we   ware and within three or four months had      cancer registry reviews outpatient charts
let them know that all newly diagnosed          reached its compliance goal.                  and they hold any that are incomplete. The
cancer cases had to be staged using new                                                       physician in charge of the staging is sent a
forms that provided the AJCC (American          “This made our work much easier, since        new form and a reminder and given 30 days
Joint Commission on Cancer) tumor-              pathology is where T and N status (tumor      to complete the form.
specific TNM and stage grouping to               and lymph nodes) is examined. The infor-
                                                mation that pathology reports takes care of   In addition, Dr. Lessin says, the staging
facilitate compliance.”
                                                two of the four components of the staging     process will continue to be streamlined as
The staging process is divided into four        process,” he says.                            the Hospital Center becomes more techni-
components—the TNM, to assess the                                                             cally savvy. Much of the information
tumor (size and extent), lymph nodes and        Each month after the new process started,     needed for staging already is available
metastases. A fourth uses the information       Dr. Lessin and Dr. Pamela Randolph-Jackson, online to MedStar physicians. He notes that
gathered to assign a stage grouping (I–IV)      interim chair, radiation oncology, reported   the rollout of the McKesson Medical Record
to the disease. This information is essential   the progress to the Performance Improve-      Document Imaging (MRDI) this fall, and
in developing the treatment plan and pre-       ment Committee (PIC). “Each month our         the new patient enterprise-wide electronic
dicting outcomes. Data from the staging         compliance rate improved until May 2007,      medical record called Centricity will further
reports go into a national data bank, where     when it exceeded 90 percent,” he recalls.     streamline the staging process. I
it is available for a variety of uses.
                                                But the process was not without its prob-                                — Norma Babington
                                                lems. The staging form, tailored to meet

                                                                                                                                        – 11 –

                              2007 House Staff
                              Congratulations Graduates…
                                                                                Maico Melo,
                                                                              MD, starts the
                                                                              buffet line. Dr.
                                                                              Melo is in pri-
                                                                             vate practice in
                                                                             Victoria, British
(photos by Sandy Schaeffer)


                                  Tom Lin, MD, posed for the camera
                              with Mario Golocovsky, MD, surgery. Dr. Lin                                                             Timothy Koch, MD, program director
                              is in private practice in Takoma, WA.                                                               and section director, gastroenterology,
                                                                                                                                  presents the graduation certificate to
                                  Celebrating at the reception with his wife,                                                     Sean Karp, MD. Helping Dr. Karp accept
                                      Yun Jin Lee and daughter, Kaylee was                                                        it are his daughter, Dylan and sons, Max
                              Ji W. Kim, MD. Dr. Kim is now a chief resident                                                      and Grady.
                                                     in Internal Medicine.

                              …And Welcome
                              New House Staff 2007–2008
                              W        elcome and best wishes to the new house staff members, who began their tenure at
                                       Washington Hospital Center on July 1, 2007.
                                                                                                                                         Chhaya Aggarwal, MD, resident
                                                                                                                                         Nima Aghili, MD, resident
                                                                                                                                         Ishita Arya, MD, resident
                              Anesthesiology-Cardiothoracic       Cardiac MRI                       Elizabeth Pontius, MD, resident
                                                                                                                                         Farzam Ayazi, MD, resident
                              Erin Kate Harrington, MD, fellow    Roquell Wyche, MD, fellow         Robin Roland, MD, resident
                                                                                                                                         Alexander Bagasra, MD, resident
                              Breast Disease                      Colon/Rectal Surgery              Gastroenterology                     Todd Barbosa, MD, resident
                              Lea Blackwell, MD, fellow           Vivek Patil, MD, fellow           Raman Battish, MD, fellow            Katrina Bassett, MD, resident
                                                                  Dermatology                                                            Nashida Beckett, MD, resident
                              Cardiovascular Disease                                                Gynecologic Endoscopy
                                                                  Sara Heldt, MD, resident                                               Cassie Blankenship, MD, resident
                              Federico Asch, MD, fellow                                             Isabel Green, MD, fellow
                                                                  Ivy Lee, MD, resident                                                  Jillian Curran, MD, resident
                              Nicholas Balaji, MD, fellow
                                                                  Kathleen Moe, MD, resident        Hematology/Oncology                  Olivier de Senarclens, MD,
                              Michael Gaglia, MD, fellow                                                                                     resident
                                                                                                    Christine Kaiser, MD, fellow
                              Seth Lessner, MD, fellow            Diabetes Fellowship                                                    Gurpreet Dhillon, MD, resident
                                                                                                    Lois Kemilembe Kamugisha, MD,
                              Jonathan Patrick, MD, fellow        John Sharretts, MD, fellow          fellow                             Munit Emlaelu, MD, resident
                              Alex Ryzhikov, MD, fellow                                             Ubaidullah Sharief, MD, fellow       Rafid Fadul, MD, resident
                                                                  Emergency Medicine
                              Cardiovascular Disease-Research                                                                            Arash Farhadi, MD, resident
                                                                  Kirsten Bendeck, MD, resident     Infectious Disease
                              Ana Barac, MD, fellow                                                                                      Michael Fishman, MD, resident
                                                                  Joelle Borhart, MD, resident      Federico Hinestrosa, MD, fellow
                                                                                                                                         Christopher Fox, MD, resident
                              Cardiac CT                          Alice Gouvernayre, MD, resident   Annick Nguewou, MD, fellow
                                                                                                                                         Ana Garg, MD, resident
                              Subodh Joshi, MD, fellow            Jon Hall, MD, resident
                                                                                                    Internal Medicine                    Ajeetpal Hans, MD, resident
                                                                  Genese Lamare, MD, resident
                              Cardiac Electrophysiology                                             Seyeda Masomeh Abedi, MD,            Phuong Ho, MD, Chief Resident
                                                                  Michael Morgan, MD, resident        resident
                              Traian Anghel, MD, fellow                                                                                  Naima Jacbos-El, MD, resident

                              – 12 –
                                                                                                 John Lynch,
                                                                                             MD, program
                                                                                             director, urol-
                                                                                             ogy, congratu-
                                                                                             lates Christian
                                                                                             deBeck, MD,
                                                                                             with Mohan
                                                                                             Verghese, MD,
                                                                                             acting chair,
                                                                                             urology. Dr.
                                                                                             deBeck is in
   Shabnam Shahabadi, MD, derma-                                                             private practice
tology, enjoyed the breakfast with her                                                       in Wilmington,
husband, Reza Mirali. Dr. Shahabadi                                                          NC.
has joined the faculty of Thomas Jef-
ferson University in Philadelphia.
                                                                                                                    Mohsin Sheikh, MD,
                                                                                                                physical medicine and reha-
                                                                                                                bilitation, is now at the
                                                                                                                University of North Carolina,
                                                     director, GME,
                                                                                                                Chapel Hill, in a pain medi-
                                                     talks with
                                                                                                                cine fellowship. Dr. Sheikh is
                                                                                                                holding his daughter, Amara.
                                                     Dr. and Mrs.
                                                     Jaime Chavez.
                                                                                                                    Briana Robinson-Walton,
                                                     Dr. Chavez
                                                                                                                MD, associate program direc-
                                                     now has a
                                                                                                                tor, OB/GYN, presents Keisa
                                                                                                                Godwin, MD, her certificate.
                                                     fellowship at
                                                                                                                Dr. Godwin has joined the
                                                     Advocate Illi-
                                                                                                                faculty group practice at
                                                     nois Masonic
                                                                                                                Emory University in Atlanta.
                                                     Medical Center
                                                     in Chicago.

Adrienne James, MD, resident       InterventionalCardiology/          Haroon Chaudhry, MD, resident        Surgery
John Josephson, MD, resident       Research                           Milap Mehta, MD, resident            Beth Amundsen, MD, resident
Khadir Kakal, MD, resident         Saquib Samee, MD, fellow           Nima Moainie, MD, resident           Karina Arbatova, MD, resident
Kathryn Delores Kelly, MD,         Tina Slottow, MD, fellow                                                Gabriel Bonilla, MD, resident
                                   Daniel Steinberg, MD, fellow       Oral & Maxillofacial Surgery
   resident                                                                                                Xzabia Caliste, MD, resident
                                                                      David Clark, DDS, resident
Siddharth Kharkar, MD, resident    Medicine/Dermatology                                                    Wellington Chang, MD, resident
                                                                      Antoine Johnson, DDS, resident
James Kim, MD, resident            Combined Program                                                        LaKiesha Crawford, MD, resident
Ji Kim, MD, Chief Resident         Cynthia Deklotz, MD, resident      Orthodontics                         Otis Egins, MD, resident
July Anna Lau-Deza, MD, resident   Sridhar Dronavalli, MD, resident   Alexis Lyons, DDS, resident          Eleisha Flanagan, MD, resident
Elena Lumezanu, MD, resident                                          Barbara Marston, DMD, resident       Aaron Grant, MD, resident
Tania Markowski, MD, resident      Melanoma                           Mayuri Patel, DMD, resident          Kristopher Hamwi, MD, resident
Mitchell Miglis, MD, resident      Meredith Warnick, MD, fellow       Jodi Prine, DMD, resident            Gustavo Pena-LaGrave, MD,
Michaela Mocanu, MD, resident      Nuclear Medicine                                                           resident
                                                                      Pain Management                      Virginia Park, MD, resident
Shanthi Nadar, MD, resident        Marta Aiken, MD, fellow            Thomas Heckman, DO, fellow           Costa Soteropoulos, MD, resident
Chatchai Orsuwana, MD, resident    Varalakshmi Bandaru, MD, fellow
Mayank Patel, MD, resident                                            Podiatric Surgery                    Annyce Treherne, MD, resident
Aruna Phayal, MD, resident         OB/GYN                             LaToya Carson, DPM, resident         Patricia Wehner, MD, resident
Gaurav Raman, MD, resident         Patricia Enekwe, MD, resident      Miguel Cunha, DPM, resident          Xiujun Zhao, MD, resident
John Reyes Castano, MD, resident   Isabelle Guichard, MD, resident    Sarah McCurdy, DPM, resident
                                   Ashley Hothem, MD, resident                                             Female Pelvic Medicine and
Rana Siddabattuni, MD, resident                                       Wendy Perry, DPM, resident           Reconstructive Surgery
Bharat Singh, MD, resident         Sheena Mathew, MD, resident
                                                                      Pulmonary Critical Care              Bela Kudish, MD, fellow
Amit Tibrewala, MD, Chief          Antonios Papanicolau-Seng, MD,
                                      resident                        Lev Agarunov, MD, fellow             David Skvieky, MD, fellow
Cheryl Turowski, MD, resident      Michaela Vasil, MD, resident       Nicholas Castellano, MD, fellow      Vascular Surgery
Rosemary Verghese, MD, resident    Ophthalmology                      Rheumatology                         Roger Walcott, MD, fellow
Carren Wang, MD, resident          Marissa Albano, MD, resident       Vrishali Dalvi, MD, fellow
Natash Yousaf, MD, resident        Laxmi Atkuru, MD, resident         Angela Hawkes, MD, fellow
Homeira Zahiri, MD, resident       Joseph Buglisi, MD, resident

                                                                                                                                        – 13 –

Andrew Campbell, DDS
Oral and Maxillofacial Surgery

           here Dr. Andrew Campbell grew
           up, there were no oral surgeons.
           That’s probably not surprising,
given that his hometown of Antigonish, a
tiny hamlet in northern Nova Scotia, is
home to fewer than five thousand people.
“It’s kind of funny,” Dr. Campbell says of
his journey from small-town Nova Scotia to
Washington, D.C. “I grew up in this rural
town and went to the smallest dental school
in Canada, and now I’m in the capital of
the United States on the busiest facial
trauma service in the whole city.”
And things for Dr. Campbell are now
busier: He is one of the chiefs of oral and
maxillofacial surgery—at a hospital that
employs more people than the entire popu-
lation of Antigonish.
As a prospective medical student, Dr.
Campbell was first drawn to dentistry
because Canadian dentists seemed happy,
and the specialty offered a high quality of     “I definitely believe I’ve found the
life as compared to other health care spe-     right place.”
cialties. But the medical student quickly
realized he wouldn’t be satisfied with gen-     And don’t mistake this doctor for some
eral, private-practice dentistry. He wanted    rural bumpkin overwhelmed by life in this
the exposure and the interaction that came     nation’s capital. Dr. Campbell’s first long-
with hospital life—and the diversity of        term experience outside of Canada was in
patients and procedures that came with         another American metropolis: Dallas, where
hospital life in the United States.            he completed his oral surgery internship         Like his wife, Dr. Campbell has younger
                                               prior to joining the Hospital Center.            patients on his mind. As he considers his
“There’s more exposure to everything, from                                                      future specialization, one area of interest is
extracting teeth to pathology to facial mal-   The young intern may have been a fish out
                                                                                                children with cleft lips and palates. He
formations and trauma,” Dr. Campbell says,     of water in that big city, but he didn’t waste
                                                                                                hopes to make an annual trip to volunteer
of being an oral surgeon south of the Cana-    any time getting acquainted with the Lone
                                                                                                with one of several cleft-lip and cleft-palate
dian border. “The scope of a surgeon here is   Star State’s culture. When an attractive
                                                                                                organizations like The Smile Train, an
broader than in Canada.”                       fourth-year dental student—and Texas
                                                                                                international charity that concentrates its
                                               native—walked into his outpatient clinic as
Dr. Campbell says he thrives in the Wash-                                                       efforts in third world and impoverished
                                               part of a five-day rotation, Dr. Campbell
ington Hospital Center environment, where                                                       countries. And who knows? He hasn’t ruled
                                               wasted no time asking her out. And later, he
he gets to work with doctors in other spe-                                                      out someday forming a volunteer clinic of
                                               asked her to marry him—the couple wed in
cialties and is the “end-of-the-line” doctor                                                    his own in an affected country.
                                               May of 2006.
for oral and maxillofacial problems.                                                            When it comes to new opportunities and
                                               Now the dental duo has settled inside the
Even if that means longer hours than the                                                        new places, Dr. Campbell doesn’t seem to
                                               Beltway, and as Dr. Campbell is settling in
average, private-practice dentist.                                                              mind broadening his exposure. I
                                               his new post as chief resident, his wife has
                                               graduated from the University of Maryland                                    — Maggie Master
                                               as a pediatric dentist.

– 14 –
SPOTLIGHT             ON…

Edward B. Healton, MD, MPH

          hen he was about 8 or 9 years old, Edward B.
          Healton decided to become a physician. “It was not
          an informed decision,” he says, “but it turned out to
be a good one.”
By the time he entered medical school at Creighton University
in Omaha, Dr. Healton expected to focus on psychiatry, but a
couple of “really great” teachers inspired him to become a
Dr. Healton came to Washington in 2000 with his wife. She
had accepted the position of president of the American Legacy
Foundation, an organization that aims to end children’s use of
tobacco and help smokers give up their dependence on nicotine.
“I wasn’t sure exactly what I was going to do when I arrived,”
says Dr. Healton, who in addition to being on staff at the Hos-
pital Center, serves as senior vice president, medical affairs and
medical director at National Rehabilitation Hospital and chair-
man of the Department of Neurology at Georgetown University
Hospital and Medical Center.
But before landing in D.C., Dr. Healton, a native of Sacramento,
Calif., had spent a good number of years establishing himself        opportunity to help to integrate programs with the hospitals,
in New York. “After medical school I began my training in            and everyone has been extremely supportive of what I do.”
internal medicine at Harlem Hospital Center, and then entered        At NRH, Dr. Healton oversees six core programs for patients:
the neurology residency program at Columbia University,” he          three neurological programs, including spinal cord injury,
says. “I was initially a physician seeing patients, teaching and     stroke and traumatic brain injuries (which is growing due to
conducting clinical research, but then I became more involved        war-related injuries), and three other programs, including
with the hospital’s medical board.”                                  orthopedics /musculoskeletal, cardiac and, the newest program,
That involvement led him to become the medical director of           children’s pediatric rehabilitation.
the hospital and senior associate dean of the medical school at      As chair of neurology at Georgetown, Dr. Healton has concen-
Columbia University. It was a position that presented a number       trated his efforts on expansion and integration of the clinical,
of challenges, including determining how to balance programs         research and residency training programs.
and politics in a public institution that had affiliations with the
city of New York, Columbia University and the Harlem com-            Neurology, and more recently, rehabilitative medicine are
munity. “There was an expansive set of programs, and it was          making important contributions to our understanding of the
challenging to make sure that everything came out in the right       cause of impairment in these diseases and how health care
direction,” Healton states. “But I worked with great people and      professionals can more effectively treat them. “We are learning
it was terrific training.”                                            more and more about recovery and over the past 10 to 15 years
                                                                     we have seen tremendous advances,” notes Dr. Healton.
But if he had to juggle politics and competing interests in New
York, Dr. Healton notes that his experience in Washington had        When he is not on duty, Dr. Healton’s passions—in addition to
been dramatically different. “It’s a cliché, I know, but the Hos-    his wife, two grown children and another child who is setting
pital Center, Georgetown and National Rehabilitation Hospital        off for college in the near future—are skiing, the theatre and a
are really excellent places, very energetic and all are focused on   love of travel. “I have a great family and am very proud that
the growth of neurosciences,” says Healton, whose research has       I’ve been able to have several different chapters in my career.”
been published in the American Journal of Public Health,
Journal of the National Medical Association, Neurology and           “I’ve had the privilege of taking care of many patients over the
many other professional publications. “I have a tremendous           years, have taught and taken on some very interesting leader-
                                                                     ship roles. I’ve really had a great career.” I
                                                                                                                    — Mary Medland

                                                                                                                                     – 15 –
NEWS                                                                                              CONTACT                    INFORMATION
                                                                                                               James S. Jelinek, MD
                                                                                                                Editor • (202) 877-6088
                                                                                                                  Margo Smith, MD
                                                                                                           Associate Editor • (202) 877-7164

New Administrative                                                                                 
                                                                                                                     Marge Kumaki
                                                                                                          Managing Editor • (202) 877-8530

Resident: Elizabeth Dollens                                                                       

                                                                                                  Washington Hospital Center Physician is an
                                                                                                  informative monthly publication for all the members of the
                                                                                                  Washington Hospital Center Medical and Dental Staff. It is a
                                                                                                  forum to report news of interest to the medical staff, disseminate
                                                                                                  information about what is going on in the hospital, introduce new
                                                                                                  providers and profile current ones, exchange ideas and opinions
                                                                                                  about subjects of interest and controversy, and recognize the

   t’s a long way from the heartland of          all its flaws, just                              professional and personal accomplishments of our practitioners.
                                                 how lucky we are                                 Its overall goal is to help foster and celebrate a sense of commu-
   Indiana to the metropolitan lifestyle of                                                       nity among the broad diversity of the Hospital Center physician
   Washington, D.C., but new administra-         to have a good                                   membership. The newsletter is published by the editorial services
                                                                                                  division of Public Affairs for the Office of Medical Affairs.
tive resident Elizabeth Dollens knows it         health care system
                                                                                                  MISSION—Washington Hospital Center, a valued member of
can be done.                                     in this country,”                                MedStar Health, is dedicated to delivering exceptional patient
                                                 she states.                                      first health care. We provide the region with the highest quality
                                                                                                  and latest medical advances through excellence in patient care,
Dollens grew up in a health care family, and                                                      education and research.
she intended to go on to medical school          The purpose of                                   Washington Hospital Center, a private, not-for-profit hospital,
when she started her undergraduate studies       the administrative                               does not discriminate on grounds of race, religion, color, gender,
                                                                                                  physical handicap, national origin or sexual preference.
at Indiana University. “I began taking busi-     resident program                                 Visit the hospital’s Web page at:
ness classes along with my science classes,”     is to teach future
she recalls, “and I found I liked the business   hospital adminis- Elizabeth Dollens                 James F. Caldas, President, Washington Hospital Center
                                                 trators the ins and                                                    Richard A. Weiss
aspect.” She graduated with a bachelor’s                                                               Chairman of the Board, Washington Hospital Center
degree in health administration from Indi-       outs of how a hospital system works—what                   John P. McDaniel, CEO, MedStar Health
ana University and made her way to George        the different departments and functions do
                                                 and how they work together to ensure a                 James Jelinek, MD              Editorial Board Members
Washington University, where she is pursing                                                                    Editor                    David Downing, MD
a master’s degree in health services admin-      smooth and efficient hospital operation. So             Margo Smith, MD                    Jeffrey Dubin, MD
istration. After concluding a year-long          far, Dollens has attended a wide range of                Associate Editor                 Cheryl Iglesia, MD
                                                 meetings and is spending time getting to                 Marge Kumaki                   Stephen Peterson, MD
residency at the Hospital Center, she will                                                               Managing Editor
                                                 know executives and other staff members,                                                 Micheal Pistole, MD
graduate in 2008.                                                                                    Jean Wilhelmsen-Exter                  Kevin Reed, MD
                                                 before she begins taking on individual proj-             Graphic Design                 Marc Schlosberg, MD
She began developing her health care man-        ects. “Everyone at all levels has been very        Frederick C. Finelli, MD              Douglas Snyder, MD
agement skills while still an undergraduate,                                                                  President,                   Eric Skolnick, MD
                                                 friendly and helpful, and they seem very will-     Medical and Dental Staff
when she organized four different medical                                                                                                  Thomas Stahl, MD
                                                 ing to teach me what they know,” Dollens            Janis M. Orlowski, MD                 Guy Weigold, MD
mission trips to Honduras and the Domini-        observes.                                             Senior Vice President                Larry White, MD
can Republic. She organized everything                                                              and Chief Medical Officer
                                                                                                             Lisa Wyatt                  Contributing Writers
from gathering supplies to recruiting physi-     In her free time, Dollens enjoys cooking                                                  Catherine Avery
                                                                                                         Sr. Vice President,
cians and students for week-long trips           and traveling. She hopes to become a hos-                 Public Affairs                 Norma Babington
aimed at providing basic preventive medical      pital executive in the future. I                         Christine Vinh                     Paula Faria
                                                                                                        Asst. Vice President               Maggie Master
care. “It really made me realize that despite                                                         Medical Affairs/Quality
                                                                              — Tracey Young                  Resources
                                                                                                                                           Mary Medland
                                                                                                                                            Tracey Young

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