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.
Jose A. Perez, Jr., MD, FACP
Struggling for something to write about or say is not usually one of my problems. However, as I write this, those thoughts come into my head. I should probably be in the position of not having enough space for all the things I want to say, especially in a year where we will see the start of the restructuring that will become the new health system of the future. Whatever we think of the “PPACA,” the Patient Protection and Affordable Care Act, it will be continuing to come on line with different directives for the next decade. No one knows yet knows where exactly we will end up.
However, in strange way, some of this takes us back to think about why we went to medical school. When we were in medical school, we never thought about our role as maintainers of health, but rather as people who would be specially trained to bring health back from the brink. It is truly unfortunate that the medical system has evolved as one that tries to fix unhealthiness rather than maintain health. Because of this focus, we as physicians have been paid to focus on unhealthiness instead of the nicer state called healthfulness. We have been asked to do as much as possible and document all that we do in order to simply get paid for returning someone to a state of health. We haven’t gotten much or anything at all for maintaining someone’s health or checking up on them. In this vortex, we have caught ourselves, each time seeing more patients and doing more, simply to make a living. We have all been through this.
As healthcare costs skyrocket and potentially threaten our economy unless brought under control, we may want to consider the idea of our role as maintainers of health in the health system we work in and advocate for its importance at the national level. Some organizations have developed the idea of the medical home and the medical neighborhood for sub-specialists. These organizations have developed the team-based approach that both improves the service and lowers the cost of care for its “residents.” I believe this is a step in the right direction. No one way of doing things will clearly fit all situations and locations, but the Medical Homes are a good example of redirecting our role as maintainers of health.
Wherever we sit on the political spectrum, I have always been proud of the fact that ACP is about the patient. The patient’s care and the patient’s access to care. I am proud to be part of an organization that not only values the patient but has as other initiatives in place to assure that this care continues in future generations. I hope you will take an opportunity to be involved in ACP through committee service, by attending the annual meeting and potentially by serving as a preceptor in the General Internal Medicine Preceptorship Program. Thank you for being a part of this wonderful organization.
Robert E. Jackson, MD, FACP
Governor, TX Southern Region
“Wherever the art of Medicine is loved, there is also a love of Humanity. ”
This fall Texas ACP will host its Annual Scientific Meeting at the Westin La Cantera Hill Country Resort on November 16-17, 2013 in San Antonio, Texas (16641 La Cantera Parkway San Antonio, Texas 78256). We have asked Dr. Ruth Berggren, MD to serve as the Program Chair with emphasis on the humanistic aspects of medicine. Dr. Berggren is the 2011 recipient of Texas ACP Volunteer of the Year Award and is current Director of the Center for Medical Humanities and Ethics at UT Health Science Center in San Antonio. The Center recently celebrated its 10th anniversary in October 2012. It’s founding director, Dr. Abraham Verghese, MACP returned to San Antonio for the event.
At the Annual Scientific meeting, the humanities and ethics lectures are usually given Sunday morning at the close of the session. This year we are devoting the entire Saturday to topics that I believe will serve as an introspective and rejuvenating exercise. It will enable us to refocus on what Hippocrates said over two thousand years ago --“Wherever the art of Medicine is loved, there is also a love of Humanity. ”
This is the first time that TXACP has dedicated a full day to what I believe is the core value of medicine in the 21st century. It is going to be an interesting experiment. I will rely on your feedback to determine the evidence of its success!
The line-up of speakers is nothing short of extraordinary. Dr. Louise Aronson, author of “A HISTORY OF THE PRESENT ILLNESS” will give the Keynote Speech as well as lead a writers’ workshop. Dr. Susan Miller, Chair of the Institutional Review Board of the Methodist Hospital Research Institute and Director of the Chao Center for International Research Ethics, will host a panel discussion with Dr. Alejandro Moreno, MD, JD concerning human rights and a world-view of medicine’s involvement. Recently, Dr. Miller organized the first NIH approved IRB in Russia. Dr. Moreno is an expert in the care of refugees and victims of torture, an area that he has published extensively. He has testified on numerous occasions as an expert witness in cases involving human rights violations. Dr. Moreno has served as a member of the Ethics, Professionalism and Human Rights Committee of the ACP and is a world authority on human rights and torture.
Dr. Eugene V. Boisaubin, Director of the McGovern Center for Humanities and Ethics from UT Health Science Center Houston will deliver a spectacular lecture on physician burnout. Dr. Gerald Winakur, this year awarded his Mastership in the American College of Physicians, will also participate with a formal lecture as well as leading a writer’s workshop in a break-out session. Dr. Winakur specializes in the field of geriatrics and is the author of “Memory Lessons, a Doctor’s Story.”
The culmination of the day will be Saturday evening with the KEYNOTE CONCERT played by Dr. Richard Kogan, MD. Dr. Kogan is a psychiatrist and concert pianist on faculty at Weill Cornell Medical School in New York City. The lecture will begin after the Cocktail Reception and Awards Ceremony. You must have a reservation for this once-in-a-lifetime ACP event sponsored by the Texas Chapter. Dr. Kogan will focus on medical aspects of a famous composer. His repertoire includes Beethoven, Rachmaninoff, Schumann, and Gershwin among others. He plays a concert grand while he discusses how medical maladies influenced the composer’s work.
I sincerely hope to see all of you in November!
On Being a Doctor
Cassie Hartline, Medical Student, University of Texas Health Science Center at San Antonio
Second Place winner of the 2012 On Being A Doctor Competition at the TXACP Annual Meeting
Medical Education: Mine, Yours, Theirs – Ours
A room full of topless women. I was the next to be called back, welcomed into the room and instructed to remove my robe...three strangers came in, left, came back…looking, feeling, and testing for the source of the trickle of blood that oozed out of my nipple during a self-examination. Behind the leaded shield my radiologist exclaimed “textbook! This ductogram belongs in textbooks!” I asked if that should be filed under “awards” or “previous experience” on my resume when applying to residency.
Class three months previous: a lecture on the breast by an interventional radiologist. “The breast. I love the breast. I know this breast…A twenty something woman with spontaneous nipple discharge. Not normal. NEVER normal!” she emphasized, waving her laser pointer in violent circles around the luminous smudge on the x-ray.
I gasped and nearly levitated off the table as the contrast went into my breast as I experienced the “fullness” the radiologist had asked me to let him know if I felt. “Full! FULL!” I almost yelled…apologizing for my involuntary jump. The repeat test found nothing…again. My mother sat in for the physician’s final consult. Intellectually, I understood his indignation that I, a 24 year old with no family history of breast problems other than my non-spontaneous discharge containing abnormal cells, was being told to get all of these tests. My mother, an educated lawyer, did not. Addressing her, he attempted to communicate the statistics and risk factors in a way that my half-year of medical education saw as juvenile. She left unsatisfied and I left still numb, explaining to my mother why he saw my testing as unnecessary and excessive…medical student empathizing with doctor. It was futile. To a mother who has heard the word “cancer” directed at her daughter, no testing is ever excessive.
My surgeon, who still did not like the cells she saw in the smear of the discharge, ordered an MRI. Weeks went by waiting for the appointment. My medical education continued…first year basic sciences with a smattering of ethics and patient care. The sciences were graded, the latter was not. As students, we cared about the grades. My education in patient interactions came when I showed up for my MRI appointment only to be informed that it had been cancelled because “my insurance did not go through.” A call to my insurance revealed that “not going through” was code for “no call was made.” My righteous anger boiled over as, in my car, outside of the medical center that had been and would be my home for the next four years, I screamed, cried, and berated a woman who could potentially become my coworker, a superior.
Six months later. Repeat sonogram to observe the biopsied areas, one of which happened to be a papilloma. The radiologist found one of the markers left from the biopsy, but not the other. Why could she not find the other, I asked? “I see no masses, you are good to go” was her response. The next day I found a blossom of blood on my bra. Spontaneous. NEVER normal.
As I write these words I remember specific phrases from my classes: “new curriculum…self-directed learning…compassionate doctors…no education on interaction…” I chuckle and wonder how anyone ever learns compassion or is taught how to interact in a classroom. Just like in our basic science classes, we learn to fake it until you make it. Personally, this meant learning the facts by rote memorization and repetition…hoping they will stick long enough for the test. They did not solidify until a real world problem was presented – a friend came to you with a pulled IT band or your coworker had a stroke at 30 and a subsequent diagnosis of a familial clotting disorder. Then it was real. Then my education became for a purpose…for a person.
I now know that “learning” compassion and how to interact with patients happens in much the same way. I didn’t understand the fear of seeing a doctor until I saw the blood in the drain, trailing down my body from my breast. I was instantly unhealthy and thus had to admit my damage to a professional, unable to give up control because I had no control over what was happening in the first place. I simply had to trust. My limited education taught me how doctors think, and why the radiologist’s recommendations made so much sense to him, but left my mother angry and confused. I got how and why people could become so separate from a problem that was so close to them, able to ignore what was embedded in their tissues. Why at the smallest provocation someone could lose it all…expressing their fear through anger, attempting to externalize their internal battle and lesson the load. Why I couldn’t ever truly become the patient…it would mean a loss of control at a time in my life where control was paramount: control of my schedule, my studies, my grades, my future.
The Future of Medicine. Obamacare. Autism and Vaccines. Cancer. Many more medically related terms, capitalized and stylized by today’s media but still just words in textbooks that need to be memorized (hopefully understood later) for today’s medical students. I think about my class – on the path to becoming doctors. Compared to the physicians I know, we simply seem…younger…in all definitions of the word. But, we still have budding egomaniacs, nerds, bleeding hearts – all individuals with individual experiences like mine. Are we a unique generation of future doctors because of new curricula, politics, and media attention? I don’t think it is about their or our generation’s burden, lives, experiences or education. We will all specialize as physicians did before; we will all get on our own soapbox against certain diseases and be warriors for the prevention of such. Our environment will change as the environment changed 10, 20, 100 years ago. Disease will persist, and so will our desire to treat. We are still called to be there for the patient.
Nominations for the Texas Chapter Laureate, Volunteerism & Community Service, and Advocate of the Year awards are due August 9, 2013. Awards will be presented at the Annual Meeting Nov. 16 in San Antonio.
Nominations for Chapter awards must include a detailed letter of recommendation and curriculum vitae; additional letters of support are welcome. Nominations are due to the Chapter business office no later than August 9, 2013. More information on Texas Chapter Awards is available online here.
Residents 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. 16-17 in San Antonio.
Medical Student Poster Competition: Medical students are invited to submit abstracts of clinical vignettes that have clinical relevance to internal medicine to the 2013 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 23, 2013. Abstracts will be reviewed and submitters will be notified of the status of their abstract via e-mail by Wednesday, October 9, 2013. Those who are accepted to the competition will be invited to present their abstract in poster format or as a clinical vignette at the 2013 Annual Meeting, November 16-17, 2013, at The Westin La Cantera Hill Country Resort. Click here to learn more.
Resident Poster Competition: Residents are invited to submit abstracts of clinical vignettes and clinical research (not basic science research) that have clinical relevance to internal medicine to the 2013 Texas Chapter of the ACP residents’ poster competition via the resident 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 residents is Friday, August 23, 2013. Abstracts will be reviewed and submitters will be notified of the status of their abstract via e-mail by Wednesday, October 9, 2013. Those who are accepted to the competition will be invited to present their abstract in poster format at the 2013 Annual Meeting, November 16-17, 2013, at The Westin La Cantera Hill Country Resort. Click here to learn more.
On Being a Doctor creative writing competition: Residents and medical students are invited to submit original prose or poetry dedicated to the theme, “The Physician's role in the world of patient autonomy. What are the limits of physician influence in shared decision making?” 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 23, 2013. 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 Wednesday, October 9, 2013. 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 a trip paid for by the chapter to attend the Texas Chapter of the ACP Annual Meeting in San Antonio. Click here to learn more.
2013 Doctor's Dilemma Competition Team Form for the TXACP 2013 Annual Meeting
Residents can now register their team for the Doctors Dilemma competition at the annual meeting by submitting this online form. The competition is much like the TV show Jeopardy. Questions are presented as answers and teams buzz in to answer the question in the form of a question. There is a moderator asking the questions and each team has a buzzer so that the team that buzzes in first, has the first chance to answer the question. Checks are awarded to first and second place team members. The first place team advances to the National ACP competition held in Orlando, Florida, April 10-12, during the ACP Annual Session at IM2014. Members of the team who advance to the national competition must be Resident ACP members in good standing. Please contact Becca Lawson in the chapter business office at (512) 370-1463 or e-mail her at email@example.com with questions.
For more information, please visit www.txacp.org.
ACP Regional Competitions Resident 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 new physicians to showcase their hard work locally at one of our five Residents 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 A. Perez Jr. for the Southeast region, Kenneth Nugent for the Northwest region, Michael Emmett 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 Residents Committee Chair.
Saturday, November 16th 10:35-11:35. Please check our website for more details to follow soon.
Douglas Monroe, MD
System Director of Quality and Patient Safety at Memorial Hermann
This event is open to all members who are CECP eligible (in practice and less than sixteen years out of medical school training) or about to be CECP eligible.
High Reliability Health Care from Board to Bedside
In 2006 Memorial Hermann Health System (MHHS) embarked on an innovative journey to apply principles embraced by High Reliability Organizations (HROs) to health care. The most significant expectations of the MHHS HRO journey are the goals of 100 percent of evidence-based quality practices and 0 percent incidence of patient harm. The expectation for 100% safety and effectiveness applies to all measurable aspects of patient care. MHHS includes nine acute care hospitals, a children’s hospital, two rehabilitation hospitals, 18 Ambulatory Surgical Centers over 100 other ambulatory facilities, 21,500 employees and 5,000 physicians who provide 1,374,340 days of inpatient care for 260,538 patients annually.
Hospitals are recognized as potentially dangerous environments with complex systems and significant risks for patient harm. HROs (such as commercial and military aviation) learn to avoid adverse events in environments where accidents could be expected due to risk and complexity. Although all sources of variance cannot be eliminated from human patient care, MHHS employs HRO principles to systematically create resilient processes that, combined with “mindfulness” and cultural reinforcement, present multiple opportunities to prevent and “catch” potential errors before they can produce harm.
You asked. We Answered.
For Pete’s sake…I recently reviewed my CV and it’s a little lackluster. What can I do to make it look a little more impressive? What kind of things can I do to improve the way my CV looks both in appearance and content?
- Boring in Belton
There are a few things that you want to look at when polishing your CV. The first is to have a look at the structure of your CV. Did you include everything that you should have? This would include information on your educational and professional history as well as your professional affiliations and publications. Make sure that the format of the CV itself is concise, consistent and easily legible. ACP has a nice guide for the information that should be included which can be found at http://www.acponline.org/medical_students/residency/borg.htm.
The other thing you can do is try to spiff up the content of your CV. In looking at the information usually included in a CV, the place where you can make the most improvement is in the section on professional affiliations and to some extent publications if that’s an area you have interest in. Try to find ways to get involved locally or nationally and hopefully things will flow from there. Attend meetings or get involved online to figure out what groups are out there. Most organizations are happy to have people be more involved, you just have to show a little interest. If you aren’t sure where to start contact your local county medical society or ACP Council of Early Career Physicians or the TMA and I’m confident there is a committee or group that they can help you find to be involved with to help boost your CV’s appearance, but also become more involved in the healthcare community.
For the second year in a row, the TXACP Board decided to continue with GIMSPP, but just like last year, no financial compensation was offered to the students. 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 2013 summer. The GIMSPP received 96 student applications this year, compared to the 137 applications from last year. Even without being able to offer financial compensation, the interest for GIMSPP is still high amongst first year medical students. The program was able to match 53 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.
Thank you to all of our Summer 2013 Preceptors
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. To learm more about the Preceptoship Program please read more here or contact Program Manager Claire Foster at firstname.lastname@example.org.
Alan Kaye, MD, FACP
Allan Kelly, MD, FACP
Anoop Agarwal, MD
Ben Barnett, MD
Bill Mania, MD
Carlos Herrera, MD
Carmen Escalante, MD
Carmen Gonzales, MD
Caroline Mbogua, MD
Deepa Mital, MD, FACP
Donna Sue Dolle, MD
Edward Sargent, MD, FACP
Elizabeth Gray, MD
Errol Bryce, MD
Felicia Austin Jordan, MD, FACP
Francisco Fuentes, MD
Gopinath Chandrahasan, MD
Gus Krucke, MD
John Crommett, MD
John Flores, MD
Jose Burgos, MD, FACP
Josier Nisnisan, MD
Julie Nguyen, MD, FACP
Karen Hill, MD
Kathleen Smalky, MD
Khanh Vu, MD, FACP
KP Ganeshappa, MD
Lianne Marks, MD, FACP
Lisa Davis, MD
Lonzetta Newman, MD, FACP
Lynn Lester, MD
Mark Farnie, MD
Mark Johnston, MD
Michael Keith Schrader, MD
Michelle Ho, MD, FACP
Roger Khetan, MD, FACP
Sarah Smiley, MD
Suresh Antony, MD, FACP
Thomas Baxter, MD
Trevor Turner, MD
Uyen-Thi Cao, MD
Venkata Bandi, MD
To all respected members of the Texas Chapter of the American College of Physicians,
First of all, it has been an honor to serve as the Texas ACP Services President this year. The experience of being involved in advocacy efforts on behalf of our Chapter has been extremely rewarding and I sincerely thank you for allowing me to serve in this capacity.
I am writing to our membership today to share my experience from ACP Leadership Day 2013. For those new to this event, ACP Leadership Day provides an opportunity for ACP and our members to increase our presence in Washington and bring visibility to issues of common concern among all chapters. This year, it was held on May 21-22, 2013 and the Texas Chapter had 18 delegates attend. The meeting starts on Day 1 with a comprehensive orientation to healthcare policies and the current political environment and then focuses on ACP’s top legislative priorities. ACP’s top legislative priorities this year are:
The amount of information shared was perfect and ACP did an excellent job of preparing all in attendance for their meetings with legislators and their staff on Capitol Hill.
On Day 2, the ACP membership hit Capitol Hill en force! There were 350+ internists and medical students from 47 states. The Texas delegation spent a very busy and full day visiting with Texas state legislators and staffers in the Senate and House of Representatives making our voices heard and sharing the concerns we have with the future of Internal Medicine and health care for our nation. The student delegates were outstanding in sharing their experience with current educational issues and how they are being restricted from pursuing primary care by current policies. Everyone we met with was very interested and looked for our help with how to maneuver in this difficult fiscal environment. In short, your Texas delegation went out and was successful in sharing experiences with all of our legislators on what we are struggling with as we practice Internal Medicine. Not only that, but we provided solutions to many of the issues we all our facing. It was humbling to see our advocacy efforts in action. I was extremely proud of all who took the time out of their busy schedules to attend.
As I reflect on Leadership Day, I can only hope that we all understand what an important role we play in how health care is to be shaped in the future. Without a voice, we will not have input and policies will be enacted that may adversely affect your practice. As an ACP member, you have a dedicated advocacy team that wants to hear the issues you are facing and develop priorities to take to our legislators.
Again, it is an honor to serve as Texas ACP Services President, and I am optimistic that the future state of health care within Texas and our nation will be developed with a strong voice from people who are on the “front lines” and are strong patient and physician advocates.
Over 300 Texas Chapter members enjoyed the outstanding medical education in San Francisco at this year's ACP Internal Medicine 2013.
The Texas Chapter governors; Robert E. Jackson, MD, FACP, TXACP Southern Governor, Houston and Sue S. Bornstein, MD, FACP, TXACP Northern Governor, Dallas escorted 32 new Fellows of the College during the convocation grand procession, along with 3 new Masters of the College: John I Hughes, MD, MACP, Houston; J. Marc Shabot, MD, MACP, Galveston; Jerald Winakur, MD, MACP, Comfort, Texas.
Bernard M. Karnath, MD, FACP, was recognized as the recipient of the Herbert S. Waxman Award for Outstanding Medical Student Educator.
Congratulations to all Resident and Medical Student presenters at IM2013.
A Texas ACP Chapter and Alumni reception was held on Friday evening, April 13 to honor our outgoing TXACP Northern Governor Clark R. Gregg, MD, FACP, award winners, and new Masters of the College.
Article By A Member: Note Writing in an Electronic Age – Is it all Good?
Emran Rouf, MBBS, FACP
With widespread use of electronic health records, physicians are increasingly documenting in an electronic chart to meet patient care needs. A typical electronic note now includes data entered by physicians as well as laboratory tests, reports of imaging, and other clinical information pulled from other sources. All of us would agree that electronic charting has made notes legible and enhanced patient care as they can be retrieved quickly at the time of patient care. Notes are obviously longer, they often contain redundant clinical information pulled from previous notes, and require time to read. I seldom wonder if we could make our electronic notes in a SOAP format – short yet pertinent; quick to read, and above all, contained clear thoughts and plans about diagnosis and management. Am I really getting nostalgic about the SOAP format because I trained in a time when all charts were written by hand? Or, may be, electronic documentation is just not living up to our expectations.
I do like electronic records because they have transformed clinical care and have paved ways to monitor chronic conditions, disease outcomes, and quality improvement initiatives. For the last ten years, I have been working with EHRs, and believe or it not, I have yet to find the perfect one! When I talk to my colleagues and patients about electronic charts, by and large, everyone likes them. Compared to paper charts, notes are legible and always available at our fingertips. Without making any single phone calls, we can understand what other specialists and care providers are doing for our patients. In the right setting, we can actually tell if patients have filled medications or not, how many appointments they missed, and if and when they are being seen by specialists that we referred to. I would have never imagined to have access to this much information had I practiced in a paper-chart environment.
Then, what is to worry about our electronic charts? With ever increasing load of complex patient care, preventive care, and other care-related communication, our day-to-day interaction with electronic charts continue to overwhelm us. I continue to value the face-to-face time I have with my patients despite being burdened with the tasks of typing, ordering labs, and other computer-related interactions that I have to do. I guess with practice and some help from technology like speech recognition software, smart macros, copy-and-paste, and other tricks, we learn to manage office visits. In the exam room, I sure do feel awkward at times, particularly for that depressed and emotional patient who is begging for my utmost attention, caring words and gestures, and counseling. Likewise, I find myself too absorbed with electronic tasks of ordering meds, filling medications, and browsing chart when my patient tells me about his or her experience with the newly diagnosed cancer. In these circumstances, I think, like most physicians, I somehow manage to keep my compassion and empathy as a physician, but I can tell you I deal with this contention almost on a daily basis.
I also think about our learners – medical students, residents, and fellows who try to learn from us the science and art of medicine. I know they can type fast as they see patients; they are much more comfortable with basic operations of a computer and an electronic medical record; and they probably are more open to seeing electronic charts than many physicians of my generation. However, I do worry about how much they are truly learning with technology, and if they are developing patient-centered communication skills as they work with electronic charts.
A literature review done by Keenan and colleagues on the impact of EHR on medical education showed that residents felt positively about using EHR and that they saved time documenting preventive care measures.1 Carefully designed documentation templates may help students and residents track their own clinical performance with regard to evidence-based care, core quality measures, and other aspects of practice-based learning and improvement. I believe EHR-based documentation can enhance learning for medical students and residents. Many EHRs contain templates of outpatient and inpatient encounters (e.g., routine history and physical examination, consultation notes, procedure notes, inpatient SOAP notes) including preventive care reminders. What I worry most about is clinical reasoning. Templated electronic notes make it difficult to include differential diagnosis and step-wise outline of diagnostic work-up and plan for may undifferentiated problems, such as chest pain, cough, and fatigue. Unless notes are dictated or typed, it is difficult even for seasoned physicians to document thoughts and reasoning for logical, step-wise work-up of many clinical problems. Furthermore, in one study, students felt that an electronic chart negatively influenced on their ability to look at patients and to maintain rapport with them. 2
I see an electronic record as a tool with possible unintended consequences; we just need to be careful and cognizant of some of the issues as I touched on. I really like those notes that are short, portray accurate clinical information, and above all, demonstrate clear thoughts and plans, just like the old paper-based SOAP notes. When we teach to our students and residents, we must model ideal technology-related behaviors and habits. After all, paper-based SOAP notes will be a thing of the past and electronic medical records are here to stay and shape clinical care.
1. Keenan CR, Nguyen HH, Srinivasan M. Electronic Medical records and their impact on resident and medical students. Academic Psychiatry, 2006 Nov-Dec;30(6):522-7.
2. Rouf E, Chumley H, Dobbie A. Electronic health records in outpatient clinics: perspectives of third year medical students. 2008. BMC Med Educ 8:13
J. Marc Shabot, MD, MACP, Galveston, was awarded Mastership in the ACP.
Jerald Winakur, MD, MACP, Comfort, was awarded Mastership in the ACP.
Bernard M. Karnath, MD, FACP, Galveston, was recognized as the recipient of the Herbert S. Waxman Award for Outstanding Medical Student Educator.
We would like to congratulate Dr. Julie Nguyen on her elected position as Southern Region Representative of the ACP’s Council of Early Career Physicians (CECP, formerly the Council of Young Physicians). She will serve a three-year term beginning April 2013 and ending at the conclusion of Internal Medicine 2016. To view the full article please visit the TXACP Facebook page here.
Congratulations to Amy LaViolette, MD, FACP on the arrival of her baby boy, Luc, Saturday, June 15th.
Send news of your accomplishments, or that of a colleague, to: Becca Lawson, TXACP Staff, 401 W. 15th St., Austin, TX 78701; fax to (512) 370-1635; or e-mail to Becca Lawson.
Fellowship recognizes personal integrity, superior competence in internal medicine, professional accomplishment, and demonstrated scholarship.
Gabriel M Aisenberg, MD FACP, Houston
Cesar A Albarracin, MD FACP, Corpus Christi
Tanvir K Bell, MD FACP, Houston
Megan A Berman, MD FACP, Galveston
Jennifer M Bontreger, DO FACP, Flower Mound
Jose D Burgos, MD FACP, El Paso
Patrick S Chaftari, MD FACP, Bellaire
Roxana L Cruz, MD FACP, Greenville
Hedieh Davanloo, MD FACP, Ft Worth
Bonnie P Hannah, MD FACP, San Antonio
Abbas H Jafri, MBBS FACP, Spring
Marjorie R Jenkins, MD FACP, Amarillo
Gregory R Johnson, MD FACP, Houston
Salahuddin Kazi, MD FACP, Dallas
Rahul S Koushik, MBBS FACP, San Antonio
Alfred S Lea, MD FACP, Pearland
Manuel D Lopez Leyva, MD FACP, El Paso
David A Mayorga, MD FACP, Mission
Yomna T Monla, MD FACP, Houston
Christopher J Moreland, MD FACP, New Braunfels
Anuradha L Mundluru, MD FACP, Mesquite
George M Nassar, MD FACP, Houston
Catherine U Okonji, MD FACP, Fresno
Trela Parker, MD FACP, Humble
Katherine M Pickett, MD FACP, Houston
Amber S Podoll, MD FACP, Houston
Stephen L Richey, MD FACP, Fort Worth
Ralph S Rosenbaum, MD FACP, Houston
Ali Seifi, MD FACP, San Antonio
Neeraj R Sharma, MD FACP, Allen
Abeezar T Shipchandler, MD FACP, Plano
Atif S Siddiqui, MBBS FACP, Odessa
Louis M Sloan, MD FACP, Dallas
Nilam J Soni, MD FACP, San Antonio
Christopher D Spradley, MD FACP, Temple
Jean Tayar, MD FACP, Manvel
Robert A Totoe, MD FACP, Abilene
Fawad A Tufail, MBBS FACP, Richardson
Philomena E Ukwade, MD FACP, Houston
Lindsay H White, MD FACP, San Antonio
Nouansy K Wilton, MD FACP, San Antonio
We are proud to welcome the following members who have joined the Chapter during the past 6 months:
Shehetaj G Abdurrahim, MD, Dallas
Sam S Abraham, MD, Richardson
Pilar Acosta Lara, Galveston
Titilola Adio, MD, Friendswood
Elizabeth M Aguirre, MD, Temple
Shahbaz Ahmad, MD, Lubbock
Mashrafi Ahmed, MD, Amarillo
Subhan Ahmed, MBBS, Amarillo
Kalil I Al-Nassir, MD, Nederland
Melissa Amador, MD, Pearland
Jennifer O Attmore, MD, Frisco
Wesam S Aziz, MD, San Antonio
Balamurali Balasubramaniam, MD, San Antonio
Noli C Baldeo, MD, Round Rock
Nicole Bartosh, DO, Temple
Jeana Benwill, MD, Tyler
Luis F Bieler, MD, San Antonio
Thomas Bienen, MD, Helotes
Andrew C Caruso, MD, Pearland
Donna L Casey, MD, Dallas
Melodie Y Chen, DO, Austin
Gangamma Chenenda Prabhu, MBBS, Frisco
Melanie Childress, MD, Dallas
Maryann Choi, MD, Georgetown
Ashwini Chowdhury, MD, Tyler
Ginaida Cirilo, MD, Dallas
Bill Covington, MD, Franklin
Rodrigo Crespo, MD, San Antonio
Nynke C Den Hollander, MD, Katy
Dereje G Desta, MD, Houston
Shweta U Dhar, MD, Houston
Matthew E Dickson, MD, Addison
Cindy Douglas, MD, Temple
Huyen Duong, Houston
Samih El Ahdab, MD, San Antonio
Nneamaka Enwemnwa, MD, Richmond
John P Erwin, III MD, Temple
Nicole F Ewing, MD, Corpus Christi
Nilson David Feliz-Rodriguez, MD, Abilene
James G Fox, MD, Dallas
Ellen Jean Fremion, MD, Houston
Asmita Patel, MBBS,MD, Houston
ACP Recruit-a-Colleague Program
Recommend ACP membership to your colleagues and earn a significant discount on your membership dues or even free membership. Now you have the opportunity to provide your colleagues with the same clinical support and educational resources that you have enjoyed as an ACP member. READ MORE
A Special Thank You to Our RAC Recruiters
William V Harford, MD FACP
Clark R Gregg, MD FACP
Stephen Hines, MD FACP
Sue S Bornstein, MD FACP
Swathi P Ganaraj, MD
Beverly E White, MD
Laura C Demoya, MD
Tuyen V Tran, MD FACP
Juan J Olivero, MD FACP
Renu Mohandas, MD
Patrick W. Lindner
December 11, 1979 – June 24, 2013
It is with sadness that we share the passing of member, educator, clinician, father and friend, Dr. Patrick Lindner.
A faculty member of the UT Health Science Center at San Antonio’s Department of Medicine’s Division of General Internal Medicine, Dr. Lindner was highly respected as a teacher by students, residents and colleagues. His enthusiasm as an educator earned him several professional recognitions including being voted by the Internal Medicine residents as one of the best Attending Physicians in the general medicine clinic and Best Outpatient Faculty Award.
He graduated from the UTHSCSA School of Medicine in 2006, along with his wife, Dr. Laura Lindner, and stayed at the HSC for his residency training.
Dr. Lindner played a pivotal leadership role in implementing the patient-centered medical home in the Internal Medicine Residency Clinic at the Audie L. Murphy Hospital Division of the South Texas Veterans Health Care System. His teaching excellence extended beyond the boundaries of his institution through his activities with the American College of Physicians and Society of General Internal Medicine.
Born in Austin, Dr. Lindner moved to San Antonio as a child. While at Alamo Heights High School, he played on the varsity football team. He then attended Texas A&M University, from which he received his Bachelor of Science degree in 2002. He was an active member of the Alamo Heights Presbyterian Church. He enjoyed spending his free time at his family’s ranch in Comfort, Texas, and fishing at Port Aransas.
Dr. Lindner is survived by his loving family, including his wife, Dr. Laura Lindner, and their children, Andrew and Sarah. Dr. Lindner’s contributions made him a true steward to the practice of Internal Medicine and his teachings will continue to inspire all the lives he touched. Please keep his family and friends in your thoughts and prayers.
Thank you for being a member of the ACP.
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Texas Chapter Annual Scientific Meeting
November 17-18, 2018, JW Marriott Austin
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