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Worcester Medicine
FROM THE EDITOR
A Message from the President
209th
Oration of the Worcester District Medical Society
"Stem
Cell Research and the Sanctity of Human Life" LEGAL CONSULT
The Gerald F. Berlin
Creative Writing Award Enhancing
Patient Services In Memoriam - WDMS
Remembers its Colleagues
Worcester Medicine - Times Are Changing I’d like to welcome you to my first issue as Editor of Worcester Medicine and to thank my predecessor Paul Lock for giving me a model to emulate and build upon after completing his remarkable fourteen-year tenure as Editor. “They always say time changes things, but you actually have to change them yourself.” This quote, attributed to Andy Warhol, sums up the situation we faced almost a year ago when George Abraham asked a task force to re-examine the mission of Worcester Medicine. The task force met over several months and, with your feedback, developed the following mission for Worcester Medicine: To provide a forum in Central Massachusetts for commentary on health care. To achieve this mission, we have expanded the Editorial Board to include representatives from the pharmaceutical industry, the biotech industry and the nursing profession. Based on your suggestions, we will increase the number of issues from 4 to 6 per year, add more pages to each issue, use features to explore controversy in medicine, and improve the readability and format. Before this current issue went to press, the new Editorial Board had already started meeting in June and we are excited to tell you that the first issue under the new model will be published in November. This issue has two articles that reflect the direction we plan to take. The first is an article on electronic medical records based on Dale Magee’s excellent oration delivered to Medical Society members and guests in February, 2005; it is teamed with a parallel legal analysis of the issues associated with electronic records. The second, by Marjorie Clay, is an ethical analysis of the issues involved in stem cell research and is an early example of our plan to explore areas of controversy. We plan to add features that allow you to state your views on issues about which you feel strongly. I encourage you to send your thoughts and comments to wdms@massmed.org
A Message from the
President At the beginning of each year it is useful to ask whether the role of an organization like the Worcester District Medical Society (WDMS) remains as critical today as it was when the organization was founded. It is also helpful to ask why it is necessary for a physician practicing in Worcester County to belong to WDMS. Our Society was founded in 1794 by 41 physicians from all over Worcester County who made a commitment to each other to get together at least twice a year to exchange ideas for the purpose of improving the quality of care provided to the citizens of Central Massachusetts. Certain components of their then-stated objectives can be summarized as follows: Keep member physicians informed about the latest advances in medical care. Agree to participate in the training of medical apprentices following consistent educational guidelines. Establish and preserve the boundaries of ethical medical practice. Coordinate physician activities in times of crisis in ways that will best serve the need of individual patients and the public health of the community as a whole1. Upon careful reflection it seems that meeting these four goals, allowing slight modification for the complexity of life in general and for the environment in which we practice medicine in the 21st century, continues to support the existence of WDMS. Let us evaluate our current activities in each of the four areas mentioned as objectives and consider additional activities we may wish to pursue: The Education of the Practicing Physician In 2005 it is essential that all physicians make a commitment to be life-long learners and competent teachers of their patients. Physicians must stay up-to-date in the area of practice they have chosen as part of their commitment to serve their patients in the best way possible. Physicians must also maintain a contemporary knowledge base to best teach patients how to manage existing diseases, prevent the development of serious complications from these diseases and prevent through proper lifestyles the development of other diseases. WDMS now serves members through education in many ways. Worcester Medicine has served to bring the opinions of experts from many fields to WDMS members. Articles such as “AIDS: A Twentieth Century Plague,” by Anthony L. Esposito, MD, are an example of the type of article made available to WDMS members through Worcester Medicine. The WDMS Committee on Medical Education is accredited to sponsor CME programs and regularly schedules educational programs that are of interest and value to physicians from all specialties. WDMS has taken a prominent role in the education of physicians regarding “end of life care.” WDMS programs in this area have received recognition and support from the AMA Board of Directors. We will strive to be more active in informing members about promising areas of medical research and in discussing how advances in these research areas might affect their future practice. The Education of Physicians in Training Many WDMS members are involved in the education of medical students, residents and fellows from the University of Massachusetts Medical School and the Worcester teaching hospitals. WDMS sponsors a career night to help students understand the various specialties they may wish to pursue. WDMS also encourages aspiring physicians by offering scholarships to citizens of Central Massachusetts pursuing medical careers in Massachusetts or elsewhere. Perhaps members of WDMS could explore new ways to encourage bright students in high schools and colleges to consider medical careers. Establish and Preserve the Boundaries of the Ethical Practice of Medicine WDMS and its parent organization, The Massachusetts Medical Society (MMS), have in place resources to evaluate proposed medical treatments from the point of view of scientific integrity based on properly conducted research trials. WDMS and MMS also work closely with the Massachusetts Board of Registration in Medicine to address any alleged deviations from accepted medical practice. Membership in WDMS and MMS assures members access to a fair and unbiased evaluation should their professional actions be questioned. In 2005, another way that WDMS helps define the border of ethical practice is to serve as a community resource for any individuals or groups who have questions about medical care. Individuals, non-medical organizations, the media and community government bodies regularly interact with WDMS regarding health policy, the acceptance of new treatment technology, and issues pertaining to the education of the public regarding health care. The education of first responders and the use of automatic external defibrillators -- and overseeing the proper distribution of these devices -- is an example of important work being done by WDMS members. Members of WDMS are encouraged to work with WDMS leadership to serve as an accurate and reliable source of medical information when approached by the media, government officials or interested organizations. Coordination of Physician Activities in the Best Interest of the Health of the Public For many years, WDMS has supported programs designed to discourage children and adults from using drugs and tobacco products. Beginning in 2001 with the attack on the World Trade Center in NYC, WDMS joined forces with the Worcester Department of Public Health and the regional Metropolitan Response System. MMRS has initiated a Syndromic Surveillance Initiative for 79 cities and towns in Central MA to provide early identification of and warning about potential disease outbreaks from biological warfare or natural causes. WDMS has a long history of taking a leadership role in infectious disease epidemics such as small pox in the 1940s, polio in the 1950s and influenza in more recent years. Ample opportunities exist for members to get involved with public health and public health policy issues through the existing committees of the WDMS. Finally, why is the existence of WDMS as important in 2005 as it was in 1794, and why is it important for physicians to maintain membership in WDMS? No other organization has the same degree of knowledge, interest and expertise in matters pertaining to the health and medical welfare of the citizens of Central Massachusetts. WDMS has the ability to respond rapidly and effectively to health-related crises that may arise. WDMS is not affected by economic restraints of individual health plans or by issues of hospital allegiances. WDMS’s aim is to preserve the sanctity of the physician-patient relationship, to assist physicians in overcoming external challenges, and to preserve and where possible improve the health of our community. Our District Society preserves the time-honored values of the medical profession and deserves the support of all those practicing or who have practiced medicine. 1. Bergin, Paul, A History
of the Worcester District Medical Society
209th
Oration of the Worcester District Medical Society Old Dog, New Tricks Our ability to make a diagnosis has never been better. Imaging and testing have never been more accurate. Our ability to treat patients has never been more effective. Our medications work better. Procedures are safer and more effective. I am going to illustrate for you how much medicine has changed in just one generation by telling you about two of my uncles. Uncle Eli was born in 1910. In his 40s he was found to have high blood pressure. He may have been given medication for it, but I would be surprised if he took it. He was very active and played handball several times per week. One day, when he was 59 ~ in 1969 ~ he finished a game of hand ball and did not feel too well. He thought that he would lie down and have a massage to feel better. He never got up. He had died from his first heart attack. Those of you who recall medicine in the 1960’s know that whether he lived or died was more up to nature than medicine. What disabilities he may have been left with were more up to chance than good care. Yet, even today, doctors refer to medicine in the 60’s as the “Golden Era.” Most patients only had one doctor and went there with a problem that was usually addressed in one visit. If they were really sick they would be admitted to the hospital where an “ad hoc” group practice would gather around them and communicate through a single medical record. When they were well they went home and returned to their normal life. Uncle Biff was born in 1922. When he was in his forties he was found to have high blood pressure and was put on medication. He did not like the way that it made him feel and besides, when he went to his doctor his blood pressure was no lower. So he stopped taking it. One day, when he was 59 ~ in 1981~ he did not feel very well. He went to his doctor and was examined, had an EKG and was told to go immediately to the hospital. There he was stabilized and underwent a coronary angiogram and then coronary artery bypass surgery. And he survived. He now had a cardiologist and a few more medications. A few years later he was diagnosed with diabetes and added a dietician, a podiatrist and an ophthalmologist to his group. A few years later, he had trouble with his prostate and met with a urologist. A few years after that, problems arose with his kidneys and he added a nephrologist. Then, peripheral vascular disease hit and along came a vascular surgeon. He eventually died at age 82 from complications of congestive heart failure. At that time, he had never stopped being a patient. Good medicine bought him 23 years of life that his brother did not get. But it was not 23 years of good health. It was 23 years of chronic and increasingly complex illness. Health care today is complex, it is dispersed and it deals with chronic illness. There has never been a better time to be practicing medicine. But if I were to ask a doctor today what he or she thought, I doubt that that would be the first thing said. Doctors are overworked and dispirited. They have their doubts. We all know why: There are more patients to see, less time in which to see them. The content of visits is going way up and all this time, the day is holding steady at 24 hours and we are passing the breaking point. I am going to go over some numbers with you to give more perspective on our world of health care delivery so that we can better understand the needs. Patients are being seen more often ~ three times per year if they are young and healthy, more than six if they are older. The time allotted for visits is 12-18 minutes. One third of visits involve chronic care and by the time we get to 45, over half of visits do. One study looked at how long it would take the average doctor to deliver all of the recommended preventive medicine to her patients and essentially it was all day. There would be no time left for taking care of problems. So it comes as no surprise that study after study has shown that the complete content of recommended care is only delivered about one half of the time to patients. Health care is more complex. We use powerful drugs and we use them often. About two thirds of visits result in at least one prescription. Yet when researchers looked at patients at a dialysis clinic, they found that three-fifths of the time there were disparities between the medical record and the medications that patients were actually taking. And one out of four primary care patients has experienced an adverse drug reaction. The more medications a patient is taking, the more likely he or she is to have a new medication inappropriately prescribed. Care is also more dispersed. Forty percent of conditions involve more than one doctor. When a primary care physician refers a patient, two thirds of the time the specialist does not receive enough information to know what question is supposed to be answered. One quarter of the time primary care doctors say that they do not hear back from specialists about a referral. In one out of seven visits important information is missing ~ lab results, referral letters, etc. ~ and tests are repeated, time is lost or patients are cared for without all of the data that is needed. One of the riskier times is when a patient is transferred either to the care of another doctor or from inpatient to outpatient. One out of five patients discharged from the hospital experiences an adverse event, usually drug related. Part of the reason for this poor communication is that we try to communicate using largely illegible notes. More and more care takes place as outpatient care and outreach has never been more important. Four out of five doctors have noted significant delays within the past few months in getting results to patients. One out of three patients asked to have a repeat mammogram within six months did not. One out of three patients with an abnormal Pap smear was lost to follow-up. Yet in spite of this, I said that Uncle Biff received exemplary care. The reason is not only that he had fine doctors, but also that they had the tools that enabled them to do their best. You see, he was a proud veteran and insisted on getting his care at the Veterans’ Hospital. I would often call his doctors and inquire about his condition. Starting in the 1990s, I noticed a distinct change in what I was being told. The answers were clear and informed. The reason is that any doctor near a computer could call up his patient’s chart and view a summary page that listed his problems, procedures, labs, recent visits, needed care and more. Everyone was, literally, on the same page. The electronic medical record is the most important advance in health care delivery in the last one hundred years. It is legible, accessible, organized, and contains drug checkers, structured notes and the ability to track orders to completion so that things do not get lost. These systems can prevent up to 80% of the inappropriate drug prescribing that occurs. Lab work can be downloaded directly and reviewed by the doctor. Letters can be sent to the patient with little effort and their responses tracked. Internal e-mail takes the current burden of responding to phone calls and cuts the work in half. But the value of this technology goes beyond doing what we currently can do, only better. It also enables us to improve care in ways that are not now possible. A small electronic device which can be attached to a keychain can carry a compact medical record with the patient and be given to anyone with a medical records program. A website can welcome a patient to his own webpage that is customized to address his specific health problems, list his medications, and provide e-mail to his doctor. Finally, reporting that now would take hours or days to complete, i.e. a report on patients who are overdue for components of diabetes care, can be run in less than one minute by simply pressing a few buttons. All of our sick patients are not in the hospital or office. Most are at home. These reports enable us to make rounds on those who are at home and see to it that nothing is overlooked. There are both opportunities and risks involved in adopting this technology at this time. Small practices are capable of changing quickly if they want to. Larger organizations have experts in information technology who provide needed support. All can see the benefits of information moving with patients throughout the system. But at this time, there are substantial risks. Perhaps the most significant barrier is the fear of workflow change. We are working in the flow mode, with layers of routines carrying us through the day. We fear the repercussions of slowing down to learn something new when we already cannot finish our work. We fear making a mistake when our routines are disrupted. Even if the doctor feels that it is worth a try, valued staff members may not. The vendor pool is unstable. Companies are small (there are currently over 300 medical record companies). Databases that make up these programs cannot talk to each other. That means that if a patient changes doctors, the information cannot flow electronically. If a doctor changes practices and the new office has a different electronic medical record, she may not be able to take her records with her. Finally, if the vendor goes out of business, the practice may have to hire a database expert to pry the information out of the defunct program and put it into another. Should we expect everyone to change now? No. A researcher named Rogers described over forty years ago an “adoption curve” that illustrates how people change. There are those who are innovators. These folks take pride in understanding and adopting something new. Those near the top of the curve need the security of seeing others succeed with a new approach. The good news for us “old dogs” is that age does not play a role in where we are on this curve. Older practitioners are as likely as young to be early on the curve. What does seem to matter is familiarity with the problem, familiarity with the solution, and the time and the means to undertake the change. There has never been a better time to be practicing medicine. But this success has led to changes that have left doctors doubting. I have tried to show you not only the new needs but also the solutions that are available. I am going to close with a quote from Franklin Roosevelt from the last speech that he wrote. “The only limits to what we can achieve tomorrow are the doubts that we have today.” I hope that I have removed some of these doubts. Tomorrow’s medicine will be even better. And each of us will be part of it. Dale Magee has practiced in our community for his entire career. A board certified Obstetrician-Gynecologist, he is an Assistant Professor of Clinical Obstetrics and Gynecology at the University of Massachusetts Medical School. Dr. Magee is Vice President of the Massachusetts Medical Society and a past President of the Worcester District Medical Society.
"Stem Cell
Research and the Sanctity of Human Life" With the passing of Pope John Paul II, the world lost a tireless champion of the sanctity of human life. The Pope’s unswerving belief in the intrinsic value of each human person helped shape the way we approach many of the complex moral issues of our time. Whether the topic is oppression, abortion, stem cell research or cloning, in every case we confront the late Pope’s proscription against anything that “…fail[s] to respect the dignity and value of the person.” As he explained in his message celebrating the 2001 World Day of Peace, “Human life cannot be seen as an object to do with as we please, but as the most sacred and inviolable earthly reality.” This sustained and eloquent defense of the primacy of human life appears to command the “moral high ground” in the current debate over stem cell research. Attempts to justify stem cell research by appealing to the anticipated good that may result puts its advocates in the unenviable position of trying to save human life by sacrificing human life, a position that seems on the surface to be both logically contradictory and ethically indefensible. However, I believe that stem cell research can be justified ethically, even if one accepts the Pope’s view that human life should be valued intrinsically (for its own sake and not for the sake of what we can do with it). It is worth remembering that the Catholic Church’s view of reproduction is largely based on the scientific speculations of Aristotle, a Greek philosopher who wrote some three centuries before Christ’s birth. It should come as no surprise to us that knowledge has progressed a great deal in the 20-plus centuries since Aristotle’s time. In fact, it’s probably true that the average 6th grader has a better grasp of science than did Aristotle, despite his remarkable intellect and extensive observations of the natural world. The basic problem is that Aristotle described human conception as discrete events happening in and to metaphysical substances, the coming together of “form” (provided by the sperm) and “matter” (represented by the egg). This combining event happens instantaneously, much like two cars colliding at an intersection. Thus when the Catholic Church writes that “…the fruit of human generation, from the first moment of its existence, that is to say from the moment the zygote has formed, demands the unconditional respect that is morally due to the human being in his bodily and spiritual totality,” it assumes that form and matter unite in a single moment to form a human person. Unfortunately for the ethical position based on this view, we no longer believe that human life begins with the union of form and matter. Using scanning electron microscopes, scientists now know that there is no “moment of conception;” rather, fertilizing a human egg is a process that takes about 24 hours to complete. For the fertilized egg (zygote) to divide one time takes another 6 hours or so, and to reach the blastocyst stage (the stage at which stem cells are derived) takes a total of about 40 hours. None of these early stages of development is a human person, nor does any of them have the potential to become persons unless and until they are implanted in a uterus (a process that takes about 2 weeks). Understanding the world as developmental processes rather than as substance and event makes a huge difference in how we view the moral status of stem cell research. It means that we can now say with absolute certainty that the bright line separating cells that may become human beings from cells that do not have that potential is implantation. The significance of this line of demarcation becomes clearer when we reflect on the chances of implantation occurring at all. Scientists tell us that only about 40% of fertilized eggs survive their passage to the uterus and successfully implant, meaning that some 60% of them pass out of the body through menstruation. What would we do if we believed that each of these discarded “embryos” were a human person whose life demanded “unconditional respect?” Wouldn’t we develop elaborate “search-and-rescue” efforts to save the lives of these innocent human beings? Similarly, would we allow human persons to be frozen alive and then, perhaps at a later time, to be thawed and permitted to continue living (a necessary part of in vitro fertilization)? Would we allow 400,000 of these so-called “frozen persons” to be stored? The fact is we don’t act as if these fertilized eggs are persons, no matter what theologians and others may say about their moral status. Our lack of concern about them seems to suggest that on a deep level we don’t believe that they are human persons. And science supports us in this view; they are not even “potential human persons” unless they become implanted in the uterus. Some opponents of stem cell research rebut this claim by saying, “Well, they are certainly not elephants or birds. If they are allowed to develop, they will become human beings.” This argument confuses the issue. No one denies that this pre-embryonic state consists of human cells as opposed to elephant cells or bird cells. The issue is whether these cells have the potential to become human persons. Unless and until they are implanted in a uterus, pre-embryos created by means of in vitro fertilization or somatic cell nuclear transfer do not have the conditions necessary for developing into human persons. They only acquire the potential to become a human person if we supply the proper conditions. But we have no more moral obligation to provide those conditions than we have a moral obligation to find an egg for each of the 200 million sperm that are “wasted” in the act of fertilization. Each of them could become a potential human person if we supplied the right conditions, yet no one is demanding that we do so. Accepting these scientific facts means that conducting research with stem cells is ethically permissible. We violate no rights by retrieving blastocysts from in vitro fertilization or through somatic cell nuclear transfer because the “pre-embryos” created by these processes neither are nor have the potential to become human persons. These cells are biological materials that can be used in research that ultimately leads to clinical applications, just as we have used other biological materials over the centuries. Replacing Aristotle’s metaphysical position with a scientifically accurate view of conception allows us to reconcile stem cell research and belief in the sanctity of human life. Science tells us that it is implantation, not fertilization, that begins what the Roman Catholic Church calls the “…the adventure of a human life . . . [with] its great capacities . . . to find its place and to be in a position to act.” Implantation distinguishes between fertilized eggs that become human persons and those that pass out of the body in the menstrual fluid. Only with implantation does it make sense to talk about the value that should be placed on human life, because it is implantation that gives the fertilized egg the potential to become a person whose rights must be respected. Accepting scientific fact as the basis for its ethical stance would still allow the Church to maintain its longstanding commitment to the sanctity of human life along with its opposition to abortion (defined as termination of an implanted embryo). Rather than appealing to a metaphysical view of reality that was constantly being challenged even in Aristotle’s own lifetime, the Church can remain loyal to its values and yet still embrace the fruits of 21st century science, applications of basic research that we hope will free people of the ravages of disease. If valuing human life means anything, it should include efforts to reduce affronts to human dignity caused by pain and chronic or progressive debilitation.
Safeguarding Electronic Medical Records - Legal Standards Every week, it seems, brings alarming news reports of mishandled personal information held in electronic forms. Incidents involving lost laptops containing accessible personal information, compromised Internet-based data repositories, and outright identity theft seem to be on the rise just when the merits of “paperless” medical records are being widely touted. Is it prudent to take the leap into electronic medical records when the good old filing cabinet may be more secure? Put another way, are there standards for handling electronic medical records that might minimize physicians’ liability in the event of a security breach? This spring, the Security Standards under the Health Insurance Portability and Accountability Act of 1996 went into effect. These HIPAA Security Standards follow the widely-reported Privacy Standards by about two years. Unlike the Privacy Standards, which apply to individually identifiable health information held or transmitted in any format by an entity subject to HIPAA, the Security Standards apply to such information only when it is held or transmitted in electronic form. Subject to certain exceptions pertaining to the records of educational institutions and to employment-related records, these Security Standards apply to protected health information (or PHI) held in electronic storage media (e.g., hard drives and removable digital memory media) or transmitted electronically (e.g. through the Internet, private networks, the physical movement of storage media). Some transmissions, such as telephone calls and paper faxes, are not considered “electronic” under the Security Standards because the information transmitted was not in electronic form prior to the transmission. Although adherence to the Security Standards does not exempt providers from liability should electronic PHI they hold or transmit be lost or stolen, the Security Standards likely will become a kind of best practice standard for the reasonableness of a provider’s efforts to protect electronic medical records. It is therefore worthwhile to review the Security Standards to determine what physicians might do to secure their electronic medical records should they choose to adopt the new technology. The Security Standards fall into three broad categories. The first are administrative safeguards which generally refer to managing the people who deal with electronic medical records. Critical to compliance with the Security Standards in general, and with the administrative safeguards in particular, is providers conducting a risk assessment. This effort involves asking a number of questions about how electronic health information flows through the organization, and in what form. For example, do the practitioners in the group use PDAs and do these devices contain PHI? Who in the group needs access to electronically maintained health information, and who does not? Another administrative safeguard requires providers to deal with security incidents by identifying and documenting them and mitigating to the extent practicable any harmful effects of a security incident. This is a problematic area of the Security Standards because a “security incident” under the rule could be understood to include even an unsuccessful attempt by an unauthorized person to gain access to electronic medical records, such as the many “pings” that providers’ computer systems connected to the Internet receive every day. Fortunately, what constitutes a “security incident” can be evaluated in the context of the provider’s business operations and the required response tailored to the type of information involved and the actual effect of the “incident” on the provider’s electronic medical records. The second type of safeguard required by the Security Standards involves physical security. These measures deal with such issues as the location and functions of workstations and laptops. Which devices should have access to all of the practice’s electronic medical records, and which should not? Should the practice use special locks for laptops or password-protected screen savers when a workstation has not been used for a period of time? These safeguards also call for tracking electronic storage media containing PHI. If such information is taken outside the workplace, then workforce members’ homes may have to be evaluated in light of these standards. The Security Standards also require the practice to securely dispose of media containing PHI, for example through adequate erasure or overwriting of disks prior to disposal or re-use, by cutting up or otherwise adequately destroying disks, and by appropriately disposing of intact workstations and PDA's. Finally, the Security Standards require certain technical safeguards. These safeguards do not require providers to utilize any particular technology and do allow providers to determine what measures are reasonable and appropriate for their organization, including the cost of the proposed solution, given their specific circumstances. However, the technical safeguards designate certain issues that must be addressed. One such safeguard is to assign a unique identifier to all users of the electronic system. This identifier must enable the provider to track specific user activity within that system, for example through a user name or numeric identifier. Another required safeguard is the establishment of procedures for obtaining electronic PHI during an emergency such as a natural or manmade disaster. Who has access to that information during the emergency, how is that access monitored, and how does the practice return to normal operations? The technical safeguards do not require that PHI be encrypted either in storage or when being transmitted unless the provider determines that encryption is a reasonable and appropriate safeguard. There are no guarantees that a provider’s use of electronic medical records will prevent the provider’s name from landing on the front page. Compliance with the HIPAA Security Standards does not shelter providers from lawsuits. However, because a good faith attempt to comply with those standards constitutes a reasonable effort to be a responsible custodian, providers would be well advised to consider those standards when contemplating the leap to electronic medical records. Peter Martin is an attorney with Bowditch & Dewey, Worcester
The Gerald F. Berlin
Creative Writing Award Sushrut Jangi has been chosen as the winner of the Gerald F. Berlin Creative Writing Award at the University of Massachusetts Medical School. The Gerald F. Berlin Creative Writing Award is one of the few medical student creative writing awards in the United States and is funded by a $1,000 donation from Richard M. Berlin, MD, a poet and Associate Professor of Psychiatry at the University of Massachusetts Medical School. Berlin established the award to encourage creative writing in medical students and to honor his father, who struggled with a severe chronic illness. Sushrut Jangi, Class of 2008 Dissection It is only September and already the leaves Interstate 290 I saw a falling star above the highway one night. Enhancing
Patient Services Taking an holistic approach to patient care has been endorsed by the medical community in recent years. Our goal is to inform physicians and their practices of some of the resources that have developed (and that continue to develop) to provide support, continuing health augmentation, and quality of life management following patient contact, diagnosis and/or medical treatment. Currently, the YWCA of Central Massachusetts offers a variety of post- patient care services. These include the Encore Plus After Breast Cancer (ABC) program that provides valuable physical and emotional support for women diagnosed with breast cancer. Exercise classes held in and out of the water help women who have undergone surgery to increase their upper body strength and mobility. Peer group support sessions, led by a trained facilitator, allow participants to share their experiences and gain emotional support from one another. The MS/YWCA Encompass Program is a collaboration between the Multiple Sclerosis Society and the YWCA that provides access to special exercise equipment and pool programs and to fitness trainers who work with participants diagnosed with MS at whatever their functioning level may be. In addition, participants receive both employment support through the Career Resource Department and volunteer career counseling and referral for meaningful volunteer job placement. Ongoing emotional and social support is also provided, encouraging participants to reach the optimum of their potential. Daybreak, a department of the YWCA that serves victims of domestic violence, provides free services that include a 24-hour confidential hotline, non-residential counseling and support groups, crisis intervention, court advocacy and prevention education. Often, the medical office setting is the place where domestic abuse is divulged by a patient or suspected to be a problem by medical personnel. Familiarity with domestic violence service provision ~ and with how to refer a patient to it ~ is extremely important for the well-being and safety of that individual. In addition, free consultation and assistance can be given to medical personnel when needed regarding how best to help a person involved in an abusive relationship. The U.S. Justice Department estimated that one in four females will experience abuse in an intimate relationship (1999). Considering the number of female patients seen by physicians, and understanding the emotional and physical toll this abuse can take, becoming knowledgeable about the problem and familiar with appropriate referrals makes good medical sense. But what is the best approach to make this happen? One way might be for practices to designate a point person (i.e. nurse practitioner, nurse, office staff) to be responsible for the resource information and, possibly through staff meetings, advise the group members of what is available for referral assistance. The YWCA and the Daybreak program are available to work with physicians to help develop an effective and improved connection to assist patients in obtaining helpful and meaningful referral information that will in turn enhance their medical treatment connection. In Memoriam - WDMS Remembers its Colleagues Erna Hamburger, MD (1915-2005) Dr. Erna Hamburger, a most dedicated school physician, died on March 25, 2005, at the age of 90. Erna’s husband, Dr. Herbert Hamburger, died in 2003. They came to Worcester in 1938, a year when many German Jewish physicians relocated to Central Massachusetts as they fled Nazi cruelty. She was born in Austria and received her medical degree from the University of Pisa, Italy. Learning a new language, acclimating to a new cultural environment, parenting two children and aspiring to practice their profession were just a few of the challenges that faced this talented couple. Beyond medicine, they shared a special interest and knowledge in classical music. Erna served her professional career in school health as the physician for the Worcester School Department with an annual aggregate of approximately 20,000 students! She was affectionately admired by the school nurses, public heath nurses and the multitude of grateful students whose lives she touched. Dr. Hamburger is survived by daughter Susan, an educator in Homewood, IL, son Ronald, a physician in Reading, MA, and by two grandsons. Leonard J. Morse, MD Leroy E. Mayo, MD (1907-2004) When Dr. Leroy E. Mayo died on November 26 at the age of 97, Central Massachusetts lost one of its finest physicians. For more than three generations, Dr. Mayo served the greater Wachusett townships as an exemplary primary care physician. He was one of the “running backs” for Holden District Hospital during its halcyon era. In 1934, as a senior student at Tufts University School of Medicine, Dr. Mayo spent a few weeks as an extern at the then 20-bed Holden District Hospital and, two years later, was invited back to practice Family Medicine as the fifth member of the Holden Clinic. In 1942, his practice was interrupted by WW II. He served as a Flight Surgeon in the US Air Force and was discharged four years later after having achieved the rank of Major. It was my privilege to know and share clinical responsibility with Dr. Mayo for many years. He was always available, never seemed hurried, and related harmoniously to everyone. His example gave the HDH its own friendly personality. Always wearing a tie but preferring to work in shirtsleeves, he presented as a wonderful role model. Dr. Mayo’s gentle manner, respectfulness, indefatigability, excellent medical judgment, compassion and sensitivity to human needs made him a valued friend and respected physician. He was, and will continue to be, recognized as the measure of a physician. Dr. Mayo served as President of the Worcester District Medical Society from 1985-86. As his wife Constance, son-in-law Roy Lane, eight grandchildren and 23 great grandchildren survive him, so do endless memories of countless patients and their families for whom he made a difference. In 1999, the Town of Holden honored Dr. Mayo by naming its new elementary school “The Dr. Leroy E. Mayo Elementary School.” Leonard J. Morse, MD Philip G. Sanfacon, MD (1937-2005) Imagine a world where there is no craving for power or wealth, where there is respect rather than arrogance or carelessness, where there is love rather than conquest, where people try to bring out the best in each other rather than compete with each other. If you can image such a world, then you are thinking like Phil Sanfacon did. Philip G. Sanfacon died April 27, 2005 during cardiac surgery to bypass his stenotic aortic valve. He had been a family practice physician in Worcester for the past 25 years. He was a graduate of Mount Saint Charles Academy, Francis Xavier University in Nova Scotia, and Dalhousie Medical School in Nova Scotia. He has been on the faculty of both the University of Vermont and the University of Massachusetts. He was well respected by his medical colleagues and is well remembered for his gentility, empathy and equanimity. Some called him the Frenchman from Maine because he was born in Grand Isle, Maine, had married a Canadian (Donna Hatheway) and was well versed in French Canadian culture. He often used French words when English words were inadequate. He was an avid reader, a classical music enthusiast and a talented piano player. He was not cynical, but he did appreciate satire. He was an eager participant in the 1993 High Fever Frolics (the last of the Memorial Hospital fundraisers) in which we spoofed American health care policy. Phil was a dedicated physician and much loved by his patients. His genuine curiosity in his patients gave him a diagnostic edge. He had a diligence for detail, a healthy skepticism and a knack for providing or finding the right care for his patients. He would sit his patients down in his office to interview them before taking them to the exam room. He appeared to have unlimited time regardless of a person’s race, creed, wealth or status. He inspired compassion and commitment because he was compassionate and committed. Although Phil was clever with finances, he was not obsessed with wealth. To quote Phil, “Money is not what it’s all about.” In a world of self-promoters and fast talkers, Phil knew how to listen and allow dialogue. He was introspective, cautious and deliberate. He was not one to impose his ideas on others, but he did enjoy repartee; we miss his participation in our daily Memorial Hospital lunchroom rap sessions. He had a sense of humor and an enigmatic charm that motivated people not to take themselves too seriously but rather to focus on basic friendship and decency. He believed that wisdom comes from many sources, from experience, and from asking many questions. He did not consider you educated just because you could memorize somebody else’s questions to somebody else’s questions. When you die, the things you do for yourself die with you, but the things that you do for others live on. There is so much of Phil living on. Countless patients will tell you how he changed their lives. His three children (David, Stephen and Julia) are well educated and accomplished. His charisma, his faith, his dedication, his enthusiasm and his grace have influenced us all. The world will be a different place without Phil. It has lost a piece of its conscience. It has lost a noble philosopher, a diplomat, a problem solver, a healer, a very good man. His kindness is a major part of his legacy. Let’s try to keep it going. Dick Whitten, MD Joseph E. Silverberg, MD (1924-2005) Dr. Silverberg, a fisherman and woodworker, a veteran of both World War II and the Korean War and a retired board certified obstetrician/gynecologist who delivered more than 6,000 babies, died peacefully in his home in Sturbridge (the town of his birth 81 years ago) on Thursday, April 14, 2005, after a long illness. He left Angela, his wife of 52 years, three daughters, three sons, sons-and daughters-in-law, grand children and numerous other relatives and friends. Joe helped his hometown of Sturbridge by serving on its Board of Health and its School Committee. He graduated from Tufts Medical School and Clark University. He was a member of the Massachusetts Medical Society and the Worcester District Medical Society. He is remembered and missed. Robert Lebow, MD |