SAFE Opioid Prescribing: Strategies. Assessment. Fundamentals. Education
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The mission of the Texas Chapter of the American College of Physicians is to promote quality health care for all Texans by strengthening the practice of internal medicine.
As I sit here on the plane waiting to leave Reagan National from Leadership Day my mind begins to reflect on all of the quotations I’ve heard over the past several years relating to politics such as:
“Politics is the gentle art of getting votes from the poor and campaign funds from the rich, by promising to protect each other from the other” Oscar Ameringer
“Bad officials are elected by good citizens who do not vote” George Jean Nathan
Some may consider the above quotes inflammatory, satirical, or possibly even entertaining but all would agree that views on politics are as vast as the sea and we as a society will never agree on everything. We too as physicians are a diverse group but whether we label ourselves as Democrats, Republicans, or Independents the one thing that we all share is our love for medicine and our desire to care for our patients.
How do we define the phrase “care for our patients”. Is it what we do solely in the exam room during our physicals, diagnostic testing, and medications we prescribe? Or is it the advice we give even when it is not received whole heartedly? Is it taking the time to sometimes listen to extended stories about spouses, children, or co-workers which many times may be completely unrelated to the chief complaints yet the simple act of us listening makes it all seem better at least for a short time. I believe we all agree that these are all integral parts of the patient-physician relationship but what if we take it one step further. What if caring became not just what we did inside our offices but also what we do when we emerge from the exam rooms? What if caring meant taking that extra step to become further advocates for our patients in the one arena many physicians are still apprehensive to enter? With issues looming before us such as SGR physician payment cuts, cuts to GME funding, sequestration, and elimination of funding for state preceptorship programs the preservation of an adequate workforce in this country is at stake. And in the end, our patients will be the ones to suffer.
I assert that part of caring for our patients is to speak up and let our voices be heard by our legislators. This is not the time to sit idly by in our offices and clinics and wait to see what happens and wait to see what they decide. We need to stop treating Medicine like a spectator sport.
I do not know what the future holds on November 6th and I can not tell you who will have a seat and who will be left standing after musical chairs is over; but what I do know for sure is that our fundamental purpose and responsibility will always be to advocate for our patients, advocate for our profession, and lead by example.
This year will see a series of events that reminds me of the THE PERFECT STORM. This is a true tale of a 1991 weather pattern in the northeast that included two storms and a hurricane. A perfect storm is defined as a confluence of events that drastically aggravates a situation (Wikipedia). In the very near future, the combination of Congressional elections, the Supreme Court’s ruling on the Affordable Care Act, and the Presidential Election may precipitate a vast game-change that combine to affect the Nation for many years to come. But like all storms this one shall also pass.
So where will all this lead for the ACP? My prediction is that upcoming current events will not change the College’s current trajectory. It is a fundamental truth that health and quality medical care is essential for the community, the right thing to do and is good for business. The American College of Physicians at the national and state level is prepared to continue its present course of representing you and your patients in the areas of advocacy, education and promoting best practices.
The changes we have seen in the last ten years have been transformational because the College has assumed a position of non-partisan leadership nationally. Congress trusts us to deliver accurate information focusing on what is best for our patients. Please take a minute to sign on to the ACP website and explore the vast resources available to you. Our own Texas Chapter’s website is also new, greatly improved and strives to be the “go to” site for what is important in Internal Medicine in our State.
The educational programs, publications (Annals, ACP Internist, MKSAP, etc.) and the ability to obtain important real-time information from our organization is nothing short of extraordinary. The national scientific meetings are outstanding and I encourage everyone to attend annually. Next year’s national meeting will be held in San Francisco April 11-13, 2013.
Our state scientific meetings are a chance to receive updates, complete modules for recertification and network with colleagues and old friends. Dr. Clark Gregg will be host Governor for the Texas ACP Scientific meeting at the Omni Hotel in Fort Worth November 3-4 this fall. I encourage everyone to sign up now and make your reservations to attend this wonderfully rounded educational event.
In summary, I would not let the perfect storm become a major distraction. It is just not worth the energy and angst to worry about a natural phenomenon (i.e., change) that we individually have no control over. Being prepared, however, is essential in order to emerge in the best possible position. The ACP and our local chapter are doing just that. Advocating for physicians and our patients in the ACP’s most seaworthy vessel will allow us to successfully navigate the treacherous waters of the upcoming perfect storm!
My patient. In the beginning of medical training, the words my patient conjures nothing more than a hypothetical entity: a cadaver stewing in formaldehyde, an acid-base problem with multiple choice answers, a textbook of details for memorization. As you progress through medical training, you begin to interact with my patient.
My patient is the catalyst behind the rush of excitement and anxiety as your team comes to the door of your patient and it is your turn to present. Did you gather all the pertinent data from the last twenty-four hours? Did you catch all the pertinent physical exam findings? After the medical student goes home for the day, this patient is largely left behind in the hospital and is traded for a textbook with the goal of acing the next shelf exam.
Then there is residency. My patient incurs a slow burning reflux – every order is because you wrote for it. Every blood draw is because you requested it. My patient needs me; my patient depends on me.
These are the patients who come home with me every night, some more present than others. The sickest ones tend to come home with me more often, the ones with the saddest stories, the most family members involved in their care. These are the patients who make me a doctor… all the time.
As I sit at dinner with friends after a long day at the hospital, I think of my patient with end stage Burkitt’s lymphoma whose tumor burden prevents him from closing his mouth. He cannot taste the coolness of this watermelon raspa or feel the warmth of the Texas summer breeze in his monitored intermediate care bed. There is an empty seat at the table saved for my patient. When I get home, the Electronic Medical Record is open and ready for me to check on my patient, his latest vitals, the latest update from our consultants.
Sometimes I awaken in the middle of the night thinking about my patients: Have I done all I can do? Am I doing the right thing? I inquired to a midlevel with greater experience if the feeling subsides with time and wisdom, “Not in thirty years,” she said with a shrug.
Where does being a doctor end and me begin? When can I stop being at work and start just being? Is it when I check out my patients to the on call team? Is it when the pager quiets down signaling all my patients are tucked in for the night? Is it when I take off my white coat at the end of the day and change out of my scrubs?
Medical students are taught the great symbolism of the white coat. We engage in a white coat ceremony which marks our transition into this club of intelligence and altruism. At the time, it seems like a spectacle designed for family celebration. On further review, it seems as if the ceremony was designed to publicly ordain us with this article weighted with responsibility. Here is your white coat; take care of us.
While we contentedly accept the responsibility of the white coat, we must remember that the responsibility is shared among thousands of us. Should one of us drop out of line at any one point, another would step in to fill the place. Are we needed? Yes. Are we irreplaceable? No.
This electronic age has extended the ability of the physician to continue to monitor her patients from remote locations, further blurring the line between work and home. The physician, while not physically at work, can continue to monitor his patients and place orders on their behalf. This system eliminates any hope of a work/life balance. Where do we find ourselves in this sea of endless responsibility?
To find the “me” in medicine, we must embark upon a paradigm shift. We must become the generation of physicians that says it is okay to be an outpatient physician who leaves hospital admissions to the hospitalists. It is okay to be a shift intensivist who clocks in at 7 am and clocks out a 7 pm.
If we create an environment which supports a normal work schedule instead of one which reveres those with workaholic tendencies (80 hours a week? There are no work hour restrictions in the real world), we might hope to find ourselves again. We might find the long lost hobby we never had the time to pursue. Read the New Yorker cover to cover instead of letting them pile up in the mail stack. Travel to that place we have been longing to go but could never get away. Spend time with family.
There will always be patients. There will always be illness. There will not always be you, or me, or any given physician. We must work together, as a united collective, towards a goal of valuing our personal time as much as we value our physician time. We must understand that though our degrees are exclusive, hard fought and well deserved, the MD is just a part of who we are. We existed before it became our existence and we must continue to pursue finding ourselves. Today, I challenge you to leave my patient with the doctor on call and just be you.
Associates and medical students are invited to submit new entries that have never been submitted in the past for several competitions during the Texas Chapter of the ACP Annual Meeting Nov. 3-4 in Ft. Worth.
Medical Student Poster Competition: Medical students are invited to submit abstracts of clinical vignettes that have clinical relevance to internal medicine to the 2012 Texas Chapter of the ACP medical students’ poster competition via the medical student abstract submission form on the Texas chapter’s web site. Research abstracts will not be considered for this year’s meeting. On the submission form, students can indicate whether they want their abstract considered for the poster competition only or for the poster and/or clinical vignette competition. In order to submit an abstract for either competition, you must be a member of the American College of Physicians. Submission deadline for medical students is Friday, August 31, 2012. Abstracts will be reviewed and submitters will be notified of the status of their abstract via e-mail by Monday, October 1, 2012. Those who are accepted to the competition will be invited to present their abstract in poster format or as a clinical vignette at the 2012 Annual Meeting, November 3-4, 2012 at the Omni Hotel in Ft. Worth.
Associate Poster Competition: Associates are invited to submit abstracts of clinical vignettes and clinical research (not basic science research) that have clinical relevance to internal medicine to the 2012 Texas Chapter of the ACP associates’ poster competition via the associate abstract submission form on the Texas Chapter’s web site. In order to submit an abstract for either competition, you must be a member of the American College of Physicians. Submission deadline for associates is Friday, August 31, 2012. Abstracts will be reviewed and submitters will be notified of the status of their abstract via e-mail by Monday, October 1, 2012. Those who are accepted to the competition will be invited to present their abstract in poster format at the 2012 Annual Meeting, November 3-4, 2012 at the Omni Hotel in Ft. Worth.
On Being a Doctor creative writing competition: Associates and medical students are invited to submit original prose or poetry dedicated to the theme, “The new doctor: The impact of generational shifts and a changing medical educational environment.” Submissions are limited to 1,000 words or less and must be submitted via the submission form on the Texas Chapter of the ACP web site by Friday, August 31, 2012. Contestants must reside in Texas and be members of the ACP.
A panel of physicians will review the submissions, and the winner will be announced no later than Monday, October 1, 2012. The winning author will be invited to present his or her work in a 10-minute oral reading during the general session at the Annual Meeting. The author will win an all expense paid trip to attend the Texas Chapter of the ACP Annual Meeting in Ft. Worth.
For more information, please visit www.txacp.org.
ACP Regional Competitions Associate Winners
All across the state of Texas, internal medicine residents are hard at work learning, practicing, and teaching medicine. The Texas Chapter of the ACP has the honor of allowing these young physicians to showcase their hard work locally at one of our five Associates regional competitions.
This year’s meetings followed in the successful tradition of those of the past. Competition was stiff, participation was high and all of the work was exceptional quality. An enormous amount of time and energy went into the planning of each event. Recognition for the extensive meeting preparation goes to Drs. Curtis Mirkes for the Southwest region, Jose Perez for the Southeast region, Kenneth Nugent for the Northwest region, Leigh Hunter for the Northeast region, and Pedro Blandon for the Far Northwest region. Thank you all for your diligence and hard work. A special thank you goes out to Dr. Suma Pokala for all of her involvement with these regional events as the Texas Chapter of the ACP Associates Committee Chair.
The Texas Chapter supports the regional Associates’ councils with annual grants of up to $1,000 per Council to help fund their programming. Each regional clinical vignette competition winner will receive Chapter support to allow them to travel to Ft. Worth, November 3-4, 2012, to represent their region at the Annual Meeting.
The Foundation was established in 2011 by the TXACP for educational and philanthropic purposes that enhance health care in Texas. If you would like to make a donation to the Foundation, please make a check payable to the TXACP Foundation, Attn: Claire Foster, 401 W. 15th Street, Austin, TX 78701. We are currently working on the ability for all TXACP members to make a contribution to the Foundation online using any major credit card, but at this time, we are only able to process checks.
After the Texas Legislature eliminated all funding for the General Internal Medicine Statewide Preceptorship Program (GIMSPP) in May 2011, the TXACP Board decided to continue with the program, but would not be able to offer the students financial compensation. The program continued working with The Higher Education Coordinating Board (THECB had administered the state grant in prior years) and made a goal to match 50 students, unpaid, for the 2012 summer. The GIMSPP received 137 student applications this year, compared to the 208 applications from last year. Even without being able to offer financial compensation, the interest for GIMSPP is still high amongst first and second year medical students. The program was able to match 61 students this summer, surpassing the goal of 50 students. The program would not be possible without the help of the general internists that have volunteered their time and services without compensation. Thank you to all of the physicians that served as past preceptors and to the ones that participated in the program this summer.
Drs. DDrDrsDDrs. Koko Aung and Thwe T. Htay of Shavano Park visit with Congressman Francisco "Quico" Canseco.
ACP Services Inc. holds an annual advocacy day on Capitol Hill. This event provides an opportunity for ACP and our members to increase our presence in Washington and bring visibility to issues of common concern. Participants receive a comprehensive orientation and briefing on ACP's top legislative priorities and then have an opportunity to meet with legislators and the staff on Capitol Hill.
We would like to thank the following physicians for taking time out of their busy schedules to attend ACP Leadership Day 2012.
Koko Aung, MD, FACP, Shavano Park
Felicia Austin-Tolliver, MD, FACP, Sugarland
Fred C. Campbell, Jr., MD, FACP, Spring Branch
Laura C. DeMoya, MD, Dallas
Andrew K. Diehl, MD, FACP, San Antonio
Maureen Francis, MD, El Paso
Kelly H. Grillo, MD, College Station
Homam Ibrahim, MD, Associate, Houston
Robert E. Jackson, MD, FACP, Houston
Roger S. Khetan, MD, FACP, Dallas
Walter H. Maloney, MD, FACP, Waco
Alejandro Moreno, MD, MPH, JD, Austin
Julie C. Nguyen, MD, FACP, Houston
Oyeniyi Oyesina, Medical Student, Grand Prairie
Thwe T. Htay, MD, FACP, Shavano Park
Abeezar T. Shipchandler, MD, Dallas
Lavanya Viswanathan, MD, Associate, San Antonio
Scott Yates, MD, FACP, Plano
While at Leadership Day these members met with Sen. John Cornyn, Rep. Bill Flores, Rep. Francisoc “Quico” Canseco, Rep. Charles Gonzalez, Rep. Lloyd Dogget, Rep. Gene Green, Rep. Kenny Marchant, Rep. Lamar Smith, Rep. Silvestre Reyes, Rep. Sam Johnson, Rep. John Culberson, Rep. Ron Paul, Rep. Charles Gonzalez, Rep. Pete Olson, and Rep. Pete Sessions.
Over 300 Texas Chapter members enjoyed the outstanding medical education in New Orleans at this year's ACP Internal Medicine 2012.
The Texas Chapter governors; Robert E. Jackson, MD, FACP, TXACP Southern Governor, Houston and Clark R. Gregg, MD, FACP, TXACP Northern Governor, Fort Worth escorted nineteen new Fellows of the College during the convocation grand procession, along with five new Masters of the College: Andrew K. Diehl, MD, MACP, San Antonio; Randall L. Rosenblatt, MD, MACP, Dallas; Ned Snyder III, MD, MACP, Houston; and Barbara J. Turner, MD, MSEd, MACP, San Antonio.
COL Duane R. Hospenthal, MC, USA, FACP was recognized as the recipient of the James D. Bruce Memorial Award for Distinguished Contributions in Preventive Medicine.
Justin Fried from Texas A&M Health Science Center and Chetan Ramamurthy from Baylor College of Medicine Houston competed in the Medical Student’s abstract competition during the ACP Internal Medicine 2012.
Mike McNeal, MD from Texas A&M Health Science Center Scott and White, competed in the Associate’s abstract competition during the ACP Internal Medicine 2012.
Farshad Forouzandeh, MD, Methodist –Houston, competed in the Associate's abstract competition during the ACP Internal Medicine 2012.
Drs. Prathit Kulkarni, Premel Lulla and Salma Bandeali, Baylor College of Medicine, represented the Texas chapter in the Doctor's Dilemma competition and placed 4th in the competition.
A Texas ACP Chapter and Alumni reception was held on Friday evening, April 20 to honor our award winners, new Masters of the College, and to celebrate Sue S. Bornstein, MD, FACP as Governor-elect for the Texas Northern Region.
Salma Bandeali, MD, Baylor College of Medicine Associate member, competed in the national Doctor's Dilemma competition at the ACP Internal Medicine 2011 in New Orleans, as a member of the winning team from the statewide competition hosted by TXACP in November. The team placed 4th at the national competition.
Andrew K. Diehl, MD, MACP, San Antonio, was awarded Mastership in the ACP.
Farshad Forouzandeh, MD, Methodist –Houston, Associate member, was invited to present a poster at the ACP IM12 in New Orleans.
Justin Fried, Texas A&M Health Science Center College of Medicine student, was invited to present a poster at the ACP IM12 in New Orleans, as the winner of the statewide competition hosted by TXACP in November.
Robert E. Jackson, MD, FACP, Houston was appointed Chairman of the Texas Medical Association Physician Distribution Committee.
Roger Khetan, MD, FACP, Dallas received a 2012 LEAD certificate from ACP. The Leadership Enhancement and Development (LEAD) Program targets internists early in their careers and offers a variety of activities designed to provide participants with the skills, resources, and experiences necessary to become effective leaders in any setting.
Prathit Kulkarni, MD, Baylor College of Medicine Associate member competed in the national Doctor's Dilemma competition at the ACP Internal Medicine 2011 in New Orleans, as a member of the winning team from the statewide competition hosted by TXACP in November. The team placed 4th at the national competition.
Premel Lulla, MD, Baylor College of Medicine Associate member, competed in the national Doctor's Dilemma competition at the ACP Internal Medicine 2011 in New Orleans, as a member of the winning team from the statewide competition hosted by TXACP in November. The team placed 4th at the national competition.
Mike McNeal, MD from Texas A&M Health Science Center Scott and White, Associate member, was invited to present a poster at the ACP IM12 in New Orleans.
Chetan Ramamurthy from Baylor College of Medicine Houston competed in the Medical Student’s abstract competition during the ACP Internal Medicine 2012.
Randall L. Rosenblatt, MD, MACP, Dallas, was awarded Mastership in the ACP.
Ned Snyder III, MD, MACP, Houston, was awarded Mastership in the ACP.
Barbara J. Turner, MD, MACP, San Antonio, was awarded Mastership in the ACP.
Send news of your accomplishments, or that of a colleague, to: Gena Girardeau, TXACP Executive Director, 401 W. 15th St., Austin, TX 78701; fax to (512) 370-1635; or e-mail to Gena Girardeau.
Timothy Daniel, MD, FACP, Pearland
Melvin Laski, MD, FACP, Lubbock
Jordan Lovy, DO, FACP, Houston
Nicholas Verne, MD, FACP, Galveston
The General Internal Medicine Statewide Preceptorship Program would like to thank all of the physicians that served as preceptors for medical students this summer. Their dedication to the program, the students and to internal medicine is greatly appreciated.
Alan Kaye, MD, FACP
Alan Keister, MD
Alejandro Moreno, MD, MPH, JD, FACP
Allan Kelly, MD, FACP
Brad Snodgrass, MD
Carlos Herrera, MD
Caroline Mbogua, MD
Ellen Manzullo, MD, FACP
Everardo Cobos, MD, FACP
Fay Simon, MD
Felicia Austin-Tolliver, MD, FACP
Gnana SumathiNaini, MD, FACP
Gopinath Chandrahasan, MD
Gregory Phillips, MD, FACP
Gus Krucke, MD
Joel Walker, MD, FACP
John Crommett, MD
John Flores, MD
John Matlock, MD
Julie Nguyen, MD
Karen Hill, MD
Kathleen Smalky, MD
Keith Schrader, MD
Khanh Diem Vu, MD, FACP
Koko Aung, MD, FACP
Lonzetta Newman, MD, FACP
Mark Armstrong, MD, MACP
Mark Farnie, MD
Mark Johnston, MD, FACP
Michael Robertson, MD
Michelle Ho, MD, FACP
Pamela Dugano-Daphnis, MD
Patricia Salvato, MD
Philip Johnson, MD, FACP
Robert Frachtman, MD
Robert Jackson, MD, FACP
Roxana Rhodes, MD
Scott Yates, MD, MBA, FACP
Steve Rosenbaum, MD
Suma Pokala, MD, FACP
Suresh Antony, MD, FACP
Susan Andrew, MD
Teresa Coats, MD, FACP
Thwe Htay, MD, FACP
Uyen-Thi Cao, MD
William Mania, MD, FACP
Texas Chapter Annual Scientific Meeting
November 17-18, 2018, JW Marriott Austin
Book Your Hotel Now!