E-DMN - July 2, 2007

July 2, 2007

Editor's Column: Special Care
Resident Kudos
Health Systems Go Smokefree
DMC, Karmanos Go To Court
Sicko
Quality & Access: Michigan In The Middle
Disaster Medicine Journal Unleashed

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Editor's Column: Special Care

By JOSEPH WEISS, MD
As a rheumatologist, I become annoyed when I read or hear that: “specialist care is expensive care.” First, the usual cause of the expense is not the physician but the condition that he or she is called upon to treat.

Second, specialists recognize simple conditions and treat them appropriately. A Mayo Clinic study on treatment of uncomplicated urinary tract infections (Mayo Clinic Proc Feb 2007, p 181-185) makes that point. The study found that urologists showed the best adherence to accepted guidelines, but among Mayo staff and residents only 30 percent overall treated urinary tract infections according to that standard.

Of course, there are physicians who act more like unbridled capitalists than as disciplined professionals. Such individuals cut across all fields of medicine and represent a small number. It is unfair to extract these exceptions and make them the rule.

Rather then complaining that patients receive fragmented care from six or more physicians, critics should recognize that the needs of the ill often are complex; specialists make total care possible. No doubt, better coordination ranks high in improving that care. But to begin a dialogue with specialists by saying we are expensive, reveals the speaker as carping and uninformed.

I am on firm ground when I speak for rheumatologists, and I believe others will agree, that attributes of being a specialist include practicing efficiently, effectively, and appropriately. No place there for “expensive care.”

Resident Kudos

The graduating pediatric residents of St. John Hospital and Medical Center (SJH&MC) recently scored second highest out of 210 pediatric programs in the United States on the American Board of Pediatrics Certifying Examination.

"The students are the first ones who deserve credit because they worked and studied so hard," said Douglas Ziegler, MD, pediatric program director, SJH&MC. "But the high scores also are a testament to all the faculty in the Pediatric Department who helped guide them in their studies."

Dr. Ziegler credits Ali Rabbani, MD, chair of pediatrics, with assembling an outstanding teaching faculty that has helped to provide everything the residents need to achieve their success.

Of the seven graduating residents, five took their boards in April, including: Saleem Raza, MD; Ramalingam Maruthavanan, MD; Ahmad Mourad, MD; Yaseen Rafee, MD; and Haissam El Takech, MD. Dr. Raza's individual score was second highest of any individual nationwide for this year's exam. One year ago, for the in-training exam, Dr. Raza scored first in the nation.

SJH&MC's Pediatric Residency Program hosts eight residents per year over the course of three years of training, for a total of 24 residents. The training program is continuously adapted with significant input from pediatric residents to maximize their learning experience. In addition to inpatient and ambulatory rotations, pediatric residents at SJH&MC gain experience in the Emergency Center (pediatric visits average 22,000 a year) and one of the area's busiest Neonatal Intensive Care Units, as well as a wide variety of subspecialty electives.

St. John Hospital and Medical Center is a member of St. John Health, a growing network of community-based hospitals and health care services in Southeast Michigan and one of the largest employers in metro Detroit. St. John provides comprehensive prevention, primary care and advanced treatment programs with more than 125 outpatient centers and eight hospitals spanning five counties.

Health Systems Go Smokefree

In a move that is sure to make AMA President and WCMSSM Member Ron Davis, MD, proud, four Wayne County health care systems banned smoking and the use of tobacco products on their campuses effective Sunday, July 1, 2007.

Detroit Medical Center, Henry Ford Health System, Oakwood Healthcare System and St. John Health are committed to providing safe and healthy workplaces by eliminating tobacco use.

In partnership with the Michigan Health and Hospital Association, the metro-Detroit area health systems will extend their current indoor no-smoking policy to outdoors including the grounds of their facilities, leased properties, vehicles, walkways and parking lots.

The new tobacco-free policy will apply to all employees, students, physicians, volunteers, visitors, patients, contractors and other guests.

Each health care system is offering a variety of smoking cessation support programs for not only their patients but employees and in some cases, family members of employees:

Detroit Medical Center (DMC)
“We have young people who see our hospital employees smoking and it sends the wrong message about the dangers of smoking, and the danger to your health. Like the other hospitals in this community, the DMC Board has decided that our hospitals must not communicate any mixed message on smoking. This is a major step in that direction,” said Michael Duggan, DMC President and CEO.

At Detroit Medical Center (DMC) smoking will be banned inside and outside of all DMC buildings, on pathways to and from DMC buildings, parking lots and in personal vehicles parked in DMC parking lots and structures. Smoking will also be prohibited in DMC-owned vehicles (on or off campus).

At many of its nine hospitals and institutes, DMC offers smoking cessation programs to employees and their loved ones. Programs are supported by the Employee Assistance Program (EAP), pulmonary services, respiratory care and community health education departments. Smoking Cessation brochures will be distributed upon admittance into the hospital. DMC Care covers a variety of nicotine replacement prescriptions and other resources, including gum and patches, that will be available over-the-counter without a prescription at all DMC pharmacies.

DMC is also offering a reduced three month membership at Rehabilitation Institute of Michigan’s Brasza Outpatient Center, a high-tech and fully equipped fitness center.

Henry Ford Health System
“The health and well-being of our patients, employees and visitors is a top priority,” says Ronald Davis, MD, director of Henry Ford’s Center for Health Promotion and Disease Prevention and incoming-president of the American Medical Association. “We acknowledge and understand that nicotine is addictive and, therefore, we are committed to offering free smoking cessation and treatment resources to support and assist not only our employees but our patients and visitors as well.”

Henry Ford will provide smoking cessation support at no cost to employees who use tobacco, through its Smoking Intervention Program

(SIP) as well as benefit-eligible family members who live in the same household and one documented cohabitant with a common address on state-issued identification. Henry Ford will also provide support to visitors and guests in the form of “Tobacco Free Assist Kits” at no cost to help them be tobacco-free while on site. The kit, which consists of a nicotine lozenge and instructions for use, will be available at select Henry Ford facilities in which visitors may be for an extended period of time. In addition, each patient admitted to one of Henry Ford’s hospitals will be assessed for their tobacco-use and the appropriate nicotine replacement therapy will be provided.

Oakwood Healthcare System
"By eliminating secondhand smoke from our campuses, we further demonstrate our commitment to be a role model for healthy behavior, and we ensure that our employees, physicians, patients, volunteers and visitors will work and receive medical care in a healthier, safer environment," says Brian Connolly, CEO, Oakwood Healthcare, Inc.

Oakwood will assist its employees and physicians who use tobacco products, to quit, by offering individuals up to $150 in coupons for the purchase of nicotine replacement products. Oakwood has also developed a free, quit smoking resource line for employees, volunteers, physicians and family members who smoke and would like to quit. Smoking cessation workshops are also being offered regularly at multiple Oakwood sites. In addition, physicians will offer nicotine replacement products or other medical treatments to help patients quit smoking during and after their stay. Visitors over the age of 18 will be offered free samples of over-the-counter nicotine gum, upon request. Visitors will need to sign a "Release from Liability" form, which includes instructions on how to use the gum. Visitors may also purchase larger quantities of nicotine gum in hospital gift shops and Oakwood pharmacies.

St. John Health
"St. John Health is creating a healthier atmosphere for all patients, visitors and staff by maintaining a tobacco-free environment. It puts the health of patients and families first by providing a healthy, smoke-free atmosphere for everyone, and it supports the St. John Health mission to sustain and improve the health of individuals in the communities we serve," says Mary Naber, senior vice president, Worklife Services, St. John Health.

The Tobacco-Free Environment also supports the employee Health Enhancement Program, a preventive care program offered to St. John employees, their spouse and dependents who also are medically insured by St. John Health. Comprehensive tobacco cessation assistance has been offered to all St. John Health employees, physicians and volunteers at no cost. To date, a total of 544 employees, spouses and volunteers have sought cessation assistance through Occupational Health.

DMC, Karmanos Go To Court

The Detroit Medical Center and Karmanos Cancer Institute officially begin their court battle today in Wayne County Circuit Court. The DMC is expected to allege that it will lose $25 million per year over several years when the cancer institute moves to the former St. John Riverview Hospital on Detroit's east side. The DMC is also expected to argue that the move violates an agreement reached in 2005, when Karmanos officially split from DMC to become an independent entity.

The court battle ensues several days after news reports of indicating quiet conversations occurred well in advance of official negotiations between St. John and Karmanos.

According to published reports, both DMC CEO Mike Duggan and Karmanos chief Dr. John Ruckdeschel are expected to testify in court proceedings.

Sicko

As might be expected, filmmaker Michael Moore's new documentary, Sicko, is making huge waves among the public and movie critics. It has also prompted a response from the American Medical Association and stirred debate on both the merits of an American universal health system and the viability of such systems operating in other countries. Below is the AMA's position on Sicko followed by excerpts from several reviews published the online movie review clearinghouse www.rottentomatoes.com

"Physicians grapple daily with the shortcomings of our U.S. health-care system, and we also marvel at the miracles that stem from its strengths.

This movie addresses some of the core issues that AMA has been actively working on for years: the plight of the uninsured, the abuses of corporations that put profits over patients."

"We disagree, however, that the only solution is to give up and turn our health-care system over to the government under a single-payer system. The AMA has a plan for covering the uninsured that builds on what’s great in our system - world-class medical innovations and research, and health care professionals dedicated to the health of their patients. America’s health-care system is far from perfect, but by building on its strengths and expanding coverage to the uninsured, we can provide top quality health care to all Americans."
-- Edward L. Langston, MD
Chair, American Medical Association

-"SiCKO" isn’t about the 50 million Americans living without health care, of which 18,000 will die needlessly this year, but rather about middle-class Americans living with medical coverage in a system that charges increasing prices for an ever-shortening list of services while poorer countries run circles around us. The point is summed up in a "Star Wars"-style scroll that lists conditions that will make you ineligible for health care under corporate health care pirates like Aetna or Cigna. The juxtaposition of George Lucas’ famous sci-fi motif alongside the anti-humanitarian index provokes the kind of uncomfortable laughter that Moore is famous for extracting in the face of systemic failures.

-The baseball-capped provocateur gets credit for trying to tackle the complex topic of health-care reform. Unfortunately, he doesn't make an elegant case for socialized medicine. And on top of that, the film just isn't that powerful as agitprop compared with "Fahrenheit 9/11" and "Bowling for Columbine."... Moore highlights the advantages of a universal system -- everything's free -- but doesn't explore the downside -- higher taxes.... The filmmaker sings the praises of programs in Canada and overseas, failing to take a closer look at things like quality of treatment and standards of training.

-And though pre-release news stories assumed that "Sicko" would be little more than a compendium of health care horror stories, Moore in fact has broader points in mind. He believes that profit-driven health care is a system that dehumanizes everyone it touches. And it's not working particularly well, either, placing our level of care at No. 37 in the world, "just slightly ahead," Moore says in that disbelieving voice, "of Slovenia."

Quality & Access: Michigan In The Middle

By PAUL NATINSKY
According to the National Conference of State Legislatures, Michigan is in the second quartile of states in a recent measure of overall health care performance. The "scorecard" ranked states on 32 indicators including access to care, quality of care, equity, avoidable hospitalizations, cost and healthy lives.

Michigan fared about as well as Ohio, Pennsylvania and New York, worse than top-quartile states Wisconsin, Minnesota and Iowa, and better than third-quartile states Indiana and Illinois.

Almost all of the nation's southern states and California finished in the bottom quartile and virtually all of New England in the top quartile.

Hawaii finished in the top quartile, but doctors in that state are challenging a Commonwealth Fund study that reported high marks for access to care there. In a statement, the Hawaii Medical Association called the study’s conclusion that Hawaii leads the nation in access to care “deceptive and misleading,” noting that the results do not include the availability of physicians to provide care. The study suggests that there are more people in Hawaii with insurance coverage than any other state, but a high rate of insurance coverage does not equate access to care, the HMA said.

“The ability for patients in Hawaii to find a physician is dangerously limited due to Hawaii’s lack of medical tort reform and low insurance reimbursements,” HMA President Linda Rasmussen, MD, said. “In fact, access to health care in Hawaii is in a state of crisis.”

Disaster Medicine Journal Unleashed

About one-fourth of physicians who left the Gulf Coast in the aftermath of Hurricane Katrina were still gone six months later, and some displaced physicians had no plans to return, according to a study in the inaugural issue of Disaster Medicine and Public Health Preparedness, a new peer-reviewed journal published by the AMA.

Another study found that the death rate between January and June 2006 in the greater New Orleans area was nearly 50 percent higher than pre-Hurricane Katrina rates, due in part to a compromised public health infrastructure after the storm.

The results of the studies were announced at a June 21 news conference at the AMA’s Chicago headquarters. Published in collaboration with Lippincott Williams & Wilkins—a Wolters Kluwer Health business—the journal features innovative research, in-depth review articles and other coverage of the many aspects of public health preparedness and disaster response from experts around the globe.

View http://www.ama-assn.org/ama/pub/category/17709.html to read a news release about the study on physicians displaced by the hurricane.

View http://www.ama-assn.org/ama/pub/category/17710.html to read a news release about increased mortality rates following the hurricane.

Visit http://www.lww.com/AMA to subscribe to the journal and receive an exclusive offer of six issues for the price of four. AMA members will receive a 40 percent discounted subscription rate.

This publication brought to you by Natinsky Publishing Network.

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