Pierce County Medical Society Bulletin 1999

Transcription

PIERCE COUNTY MEDICAL SOCIETY
ULLETlN
January, 1999
1998 Annual M eeting
James M. Wilson, M.D. passes the gavel and the 111th
PCMS Presidency to Lawrence A. Larson, D.O.
s e e h ig h lig h ts p a g e 5 -7
Inside:
3
4
5
9
11
15
17
P re s id e n t's P a g e : 'O ld T a c o m a - N ew M e d ic in e '
In M e iu o ria m : C .B . R itc h ie , M D , c o -f o u n d e r o f D o c to r's H o s p ita l d ie s a t 95
1998 A n n u a l M e e tin g in re v ie w
J o h n C o o m b s, M D a d d r e s s c o n c e rn s a b o u t e x p a n d in g U W clin ics to P ie r c e C o u n ty
'In to th e P o litic a l A re n a ,' a p ro f ile o f D r. S h ay S c liu a l-B e rk e 's j o u r n e y to t h e le g is la tu re
'M an g led C a re ,' a c o m m e n ta r y o n th e c u r r e n t p r a c tic e o f m e d ic in e b y T e r e s a C la b o ts, M D
H e a lth D e p a r tm e n t o ffe rs g u id a n c e fo r n e w H IV n a m e s r e p o r tin g r e g u la tio n
PCMS Bulletin
P C M S O f f ic e r s /T r u s t e e s :
L a w re n c e A . L a rs o n , D O
......................P re s id e n t
C h a r l e s M . W e a th e r b y , M D ............ P r e s id e n t E le c t
M a r ily n E. P a t t i s o n , M D ................... V ic e P r e s id e n t
P a tr ic e N . S te v e n s o n , M D
S e c r e ta r y /T r e a s u r e r
J a n ie s M . W i l s o n , J r ., M D ............... P a s t P r e s id e n t
M ic h a e l J. K e lly , M D
M a r ia J. M a c k , M D
D o r is A . P a g e , M D
J. J a m e s R o o k s , J r ., M D
S u s a n J. S a lo . M D
E d w a r d 1. W a lk le y , M D
N i k k i C r o w le y , P C M S A P r e s id e n t
BULLETIN
January, 1999
W S M A R e p r e s e n ta t iv e s :
P a s t P re s id e n t: P e te r K . M a r s h . M D
S p e a k e r o f th e H o u s e : R ic h a rd H a w k in s , M D
T r u s te e : D a v id E . L a w , M D
A M A D e le g a te : L e o n a r d A le n ic k , M D
*
E x e c u tiv e D ir e c t o r : D o u g la s J a c k m a n
*
C o m m itte e C h airs:
A g in g ,R ic h a rd W altm an; A I D S . L a w re n c e S ch w artz,
B y la w s . S tan ley T u e ll; B u d g e t/F in a n c e ,N ic h o la s
R a ja c ic h ; C o lle g e o f M e d ic a l E d u ca tio n , W . D ale
O verfield:. C r e d e n tia ls. S u san S alo; E m e r g e n c y
M e d ic a l S ta n d a r d s , T e d W a lk le y ; E th ic s/
S ta n d a r d s O f P r a c tic e , D a v id L u k e n s; G rie v a n c e .
S ta n H a rris ; L e g is la tiv e , W illia m M a rs h ; M ed ica lL e g a l, P a t D o n ley ; M e m b e r s h ip B e n e fits, Inc.,
K e ith D e m irjia n ; P e r so n a l P r o b le m s O f
P h y s ic ia n s, R o b e rt S a n d s; P r o g r a m , C h a rles
W e a th e rb y ; P u b lic H e a lth /S c h o o l H ea lth , L aw re n ce
S c h w a rtz ; S p o r ts M e d ic in e , Jo h n Jig an ti.
T h e B u lle tin is p u b lish e d m o n th ly by P C M S
M e m b e rs h ip B e n efits. Inc. for m e m b e rs o f th e P ierce
C o u n ty M e d ic a l Society. D e a d lin e s for su b m ittin g
artic le s a n d p la c in g ad v e rtise m e n ts in T h e B u lle tin arc
th e 15 th o ftlie m o n th p re c e d in g p u b lic a tio n (i.e.
O c to b e r 15 for th e N o v e m b e ris s u e ).
T h e B u lle tin is d e d ic a te d to the art, sc ien ce a n d
d eliv ery o f m e d ic in e a n d th e b e tte rm e n t o f th e h e a lth
a n d m ed ical w elfare o f the co m m u n ity . T h e o p in io n s
h e re in are th o se o f th e in d iv id u a l co n trib u to rs a n d do
n o t n e c e ssa rily reflect th e official p o sitio n o f the
M e d ic a l Society. A c c e p ta n c e o f a d v e rtisin g in n o w a y
co n stitu te s p ro fe ssio n a l ap p ro v al o r e n d o rsem en t o f
p ro d u c ts or se rv ices ad v ertised . T h e B u lletin a n d P ierce
C o u n ty M e d ic a l S o ciety re se rv e th e rig h t to rc je c t any
advertising.
E d ito r : D a v id S. H o p k in s M D
M a n a g in g E d ito r : D o u g la s J a c k m a n
E d it o r ia l C o m m it te e : D a v id S . H o p k in s , ( C h a ir )
S ta n le y T u e ll, W . B e n B la c k e tt, R ic h a r d H a w k in s
A d v e r t is in g R e p r e s e n ta t iv e : T a n y a M c C la in
S u b s c r ip tio n s : $ 5 0 p e r y e a r , $ 5 p e r is s u e
M a k e a ll c h e c k s p a y a b le to: M B I
2 2 3 T a c o m a A v e n u e S o u th , T a c o m a W A 9 8 4 0 2
(2 5 3 ) 5 7 2 -3 6 6 6 , F a x 5 7 2 -2 4 7 0
E - m a il a d d r e s s : p c m s w a @ p c in s w a .o r g
H o m e P a g e : h ttp ://w w w .p c m s w a .o r g
2
PCMS BULLETIN
January, 1999
V
Features
P resid en t's P age: O ld T acom a - N ew M edicine .... 3
PC M S A nnual M e e tin g in R e v ie w ................................ 5
N e w o fficer s and tr u ste e s for 1 9 9 9 ............................. 8
Joh n C oom b s, M D an sw ers c lin ic q u e s tio n s
9
IIow to con tact le g is la t o r s ............................................. 10
D r. Shay S clm al-B erk e talk s a b o u t p o litic s
11
D o u g Jackm an talks o f h is te n u r e at P C M S
13
'M angled Care' by T er esa C lab ots, M D .................. 15
Pep artments
T P C IID U p d a te ..................................................................
PCMSA: T he P u l s e ............................................................
A p p lican ts for M e m b e r sh ip ...........................................
P h ysician D ire cto r y c h a n g e s ........................................
C o lle g e o f M ed ical E d u c a t io n .....................................
C la ssified A d v e r tis in g .....................................................
17
19
20
20
21
23
News briefs
In M em oriam : C. B. R itch ie, M D , d ie s at 9 5 .........
In te r e ste d in a n asthm a a d v e n tu r e .............................
F eb ru ary G en e ra l M em b ersh ip m e e tin g i n f o
K eep so m e p a tie n t ch arts in d e fin ite ly ......................
P e d ia tr ic exp erts a g a in st ora l v a c cin e for p olio ...
4
14
14
22
22
P re s id e n t's P a g e
President’s Page.........
Old Tacoma - New M edicine
I look forward to serving the PCM S
as president in 1999. 1 have learned
a great deal from our recent past
presidents, Jo h n R ow lands, M D,
the eternal optimist; S tan H a rris,
MD, the pragmatist/sometimes
journalist and Jim W ilson, M D, the
steady visionary. W e all owe a great
deal o f gratitude to these leaders for
their lime and energy put forth on
our behalf. The sta ff at PCM S keep
us organized with their dedication to
the physicians o f Pierce County.
Doug Jackman received a very
deserved recognition for his service
to the society. This kind o f effort is
necessary to keep the whole process
moving forward in a well ordered
fashion.
As an introduction to my first
newsletter, I thought that a little
background information might be o f
interest. You may know that I
started into practice in Tacom a in
1980, joining G eorge T a n b a ra ,
MD (PCMS President, 1986) my
childhood Explorer Boy Scout
leader and tennis partner. His
guidance, mentoring and friendship
initialed my interest in pediatrics.
He has continued to be a positive
influence on my professional career
and remains a great tennis partner.
I started my life in Pierce County;
born in 1950 at Tacoma General
Hospital, the fifth child o f Charles
and M argaret Larson. Tacoma was
a sleepy town in those days. The
taste of arsenic and smell o f pulp
was thick in the air - producing
Tacoma’s famous aroma. The
downtown bustled with activity. As
a child I would hop on a bus and
ride to downtown with m y siblings
to marvel at the department stores;
Rhodes, Sears and the Bon Marche.
W oolworth’s w as my favorite
because o f the soda fountain and
cheap toys in the basement. Small
businesses flourished in the streets
o f downtown Tacom a. I grew up
valuing family, friends, my church
and my elders. This sounds a bit
“corny” today but typified much o f
life in Tacom a in the 1950s and
60s.
1 w as introduced to medicine by
my father. I can remember hanging
out at the pathology lab, playing
with the frogs kept in the refrigera
tor for pregnancy testing - a far cry
from the plastic dip sticks used
today. When I w as “old enough” I
graduated from frogs to autopsies.
The whole process o f dissecting to
discover disease and cause o f death
fascinated me on one level and on
another level I knew I did not w ant
to become a pathologist. This
medical “initiation” occurred with
all o f my siblings and to nobodies
surprise pathology lost its appeal
for all o f us!
M y world changed with the
assassinations o f President Kennedy
and the Reverend M artin Luther
King, Jr. The innocent life o f
childhood w as erased by the
realization that good men could be
murdered for their great dreams.
Vietnam escalated and claimed my
childhood friends. Downtown
Tacom a faltered with the develop
ment o f suburban malls; the shop
pers and stores were soon replaced
with bars, prostitutes, homeless
people and derelict buildings. I still
thought o f Tacom a as I did in my
early childhood but it had changed
forever - m uch like the rest o f the
Lawrence A. Larson, /). ().
President, 1999
United Slates.
Today I am proud to see Tacoma
return to more prosperous limes.
N ot by merely sweeping the social
ills under the carpet but by con
fronting the issues o f mental illness,
substance abuse, domestic violence,
youth violence, teenage pregnancy,
infant m ortality and education.
Some solutions to these problems
have been found and Pierce County
is moving forward to a brighter
future.
M uch like the improved future o f
Tacom a, 1 see medicine moving
forw ard from the “dark days” o f big
business medicine to patient and
family oriented care. As the leaders
o f health care in Pierce County, we
have an opportunity to help ensure a
healthier population. This will lake
all o f our efforts to successfully
provide access to quality care.
Initiatives that face the medical
community today include end o f life
care, traum a management, pediatric
and adult access to care, and quality
oriented contracting for healthcare
W e need to educate ourselves and
the community about these issues.
As we head into the new year I hope
Uiat 1999 will see positive solutions
and improved care for the citizens
o f Pierce County, a
January, 1999
PCMS BULLETIN 3
News briefs
Personal Problems
o f Physicians
M e d ic a l p ro b le m s , d ru g s ,
a lc o h o l, r e t ir e m e n t ,
e m o tio n a l, o r o t h e r s u c h
d if f ic u lt ie s ?
For impaired physicians
your colleagues want to help
Please call:
.752-6056
♦ R o b e r t S a n d e ........
B i l l D e a n ............... .
2 7 2 -4 0 1 3
F . D e n n is W a ld ro n
2 6 5 -2 5 8 4
* C h a ir
C on fiden tiality
A ssured
Office Space
Pierce County Medical Society
2 2 3 Tacoma Avenue South
Tacoma, WA 9 8 4 0 2
183 s q u a r e feet o r 120 s q u a r e feet
ma in o r lo w e r level
p ro f e s s i o n a l lo c a ti on
no rt h o f d o w n t o w n
utilities in c lu de d
c o n f e r e n c e r o o m & kilc hc n
ja nitorial servic e
p a rk in g
Secre ta rial s ervic e s , off ice e q u i p m e n t and
o th e r b u s in e s s n e c e s s it ie s a v aila b le
Call PCMS 5 7 2 -3 7 0 9
for more information
4
PCMS BULLETIN
January, 1999
In M e m o ria m
C y r il B ro w n R it c h ie , MID)
C .B . R itch ie , M D , w as b o m O c to b e r 1 7 ,1 9 0 3 in
F lan ag an , Illinois. H e d ie d D e c e m b e r 1, 1998 a tth e age
o f 95. D r. R itch ie m o v e d w ith h is fam ily to Idaho in
1909 w h e re th ey h o m e s te a d e d a ra n c h n e a r H agerm an.
In 192 8 h e g ra d u a te d fro m th e U n iv e rsity o f Illinois
M e d ic a l S ch o o l in C h icag o . H e th e n in te rn ed at Tacoma
G eneral H ospital.
Dr. R itch ie b e g a n h is m e d ic a l p ra c tic e in 1929 in
M o rto n , W ash in g to n w h ere h e w a s resp o n sib le for
b u ild in g th e to w n 's first h o sp ita l, to d ay k n o w as M orton
G eneral H ospital.
In 1932 he m a rrie d M a ry T u rn b u ll a n d in 1941 they
m o v ed to T a c o m a w ith th e ir fam ily.
Dr. R itch ie w as v ery activ e in th e m ed ic al com m unity.
ITe s e rv e d as p re sid e n t o f th e T a c o m a S urgical Club,
th e P ie rc e C o u n ty M e d ic a l B u re a u , a n d in 1960 was
p re sid e n t o f the P ie rc e C o u n ty M e d ic a l Society. lie also
serv ed as an e ld e r o f Im m a n u e l P re sb y te ria n C hurch for
m any years.
Dr. R itch ie w as c o -fo u n d e r o f D o c to rs H ospital in
T acom a. A fter retirin g fro m his m ed ic al p ractice in
1968, he se rv e d as a d m in is tra to r o f D o c to rs Hospital.
D r. R itch ie is su rv iv e d by h is son, P C M S m em ber Bill
R itchic, M D a n d h is w ife M a rjo rie . D r. B ill R itchie was
p re sid e n t o f P C M S in 1989. H e is also survived by two
d a u g h te rs, Sue R itch ie, a p h a rm a c is t th a t lives in
S teilaco o m and E liz a b e th B a rk e r o f G lendale, Arizona.
H e leaves five g ran d c h ild re n a n d th re e great-grandchil
dren.
P C M S o ffe rs c o n d o le n c e s to Dr. R itch ie 's family, i
F p a ltifp
1998 Annual M eeting introduces new leadership for 1999
The 1998 PCM S/PCM SA Annual
Meeting was held at the Sheraton
Hotel on Tuesday, December 8 . The
festive event was well attended and
featured President James M. W il
son, Jr., MD passing the presidcnlial gavel lo Lawrence A. Larson,
DO.
Dr. Wilson thanked the Board o f
Trustees for their commitment
throughout the year and recognized
outgoing board members PastPresident, Stan Harris, MD, SccI'dary-Trcasurer. Nick Rajacich,
MD and Trustee Gary Taubman,
MD. Dr. Harris served five years;
Drs. Rajacich and Taubm an two.
l ie thanked his wife Dcana for her
support and his parents for “teach
ing me the importance o f educa
tion.”
The ralTlle drawing was a big hit
as always, and the lucky winners in
cluded cardiologist ICugene Lapin
and Mrs. Fran Thomas. Dr. Lapin
won the gourmet basket and Mrs.
Thomas the monthly fruit delivery
package.
A moment o f silence was given
lor members that died in 1998.
They included Drs. Marion
Larsen, Marry Lawson, Robert
Kortiner, Jack Manilcville, Carl
Kknian, Wesley Gradin, Marcel
Malden, Thomas Lawley, William
Conte and C.U. Ritchie.
Nikki Crowley gave the Alliance
Report and thanked everyone for
their generous support o f the Holi
day Sharing Card. She said over
$15,000 had been raised and will go
to various charities in Pierce
County.
Dr. Wilson introduced the speaker
for the evening. Dr. Pepper
Schwartz. Dr. Schwartz is a
professor o f sociology at the
University o f Washington and
spoke on gen
der and miscommunication. She ex
plained the nu
merous ways
that males and
females com
municate or
fail lo com mu
nicate that
causc problems
for relation
ships. Her talk
was
informative
and
humorous.
President Jim Wilson ik i s honored b y having his mother, from ()hio,
and Ins wife, Deana, help celebrate his year as PCMS President
Highlighting
the evening
was the
presentation o f
the Community
Service Award
to PCMS Ex
ecutive D irec
tor. Doug
Jackman (sec
story page 13)
The Board o f
Truslecs volcd
secretly to
honor their di
rector for
Dr. I.a n y Larson with his wife. M aty (center) and Mrs. Kit Larson,
his tireless
wife o ft'e rn Larson, retired radiologist and no relation, before he
work in the
accepted the gavel as 199') PCMS President
community and
lo thank him for
15 years o f
scrvicc. Past
W ilson for his service particularly
winners o f the
his work with insurers and his com
aw ard have included Drs. George
mitment to HIV named reporting
Tanbara, Charles W eatherby,
and T acom a’s ban on fireworks.
Terry Torneiiruil, Gordon Klalt,
Patrick Ilogan and John
Dr. Larson told the audience lie
VanHuskirk.
looked forward lo working on many
issues as president, particularly ac
Before the meeting was adjourned
cess lo care. ■
Dr. Wilson turned over the gavel lo
Dr. Larson. Dr. Larson thanked Dr.
More photos page 6 - 7
January, 1999
PCMS BULLETIN 5
Feature
Left:
Dr. Larson,
newlv elected
1999
President,
said he
looked
fo rw a rd to
working with
the
membership
on many
important
issues that
doctors will
be fa cin g next
vear
Left:
Nikki
Crowley,
Alliance
President,
thanked the
membership
f o r the
$15,000
raised via the
Holiday
Sharing Card.
The money
will be given
to
philanthropic
causes in
Pierce County
Left,
Doug
Jackman,
PCM S
Executive
D irector was
awarded the
1998
Community
Service
A w ard and
honored fo r
15 years o f
se n ’ice to
PCMS.
Dr. Wilson
presented the
award
6
PCMS BULLETIN
January, 1999
Above, fro m left, Past-President D avid Law visits with Dr. Alex
M ihali and his wife Debbie. Drs. Law and M ihali both practice
internal medicine
Dr. B ill Roes, second fro m right, and his wife Ruth, second from
left, visit with Dr. Joan Hailey, right and her husband, left, before
the meeting. Drs. Roes and Ilallev are both fa m ily practitioners
across the Narrows bridge
Dr. Dwight Williamson, left a n d his wife, Donna visit with Dr. Elsie
Claypool, fo n n e r administrator, Seattle VA Hospital
Feature
Nikki Crowley, PCMSA President and Dr. Jim Wilson. PCMS
President, drew the names fo r the raffle drawings and each
thanked their respective colleagues fo r a great year
Lakewood dennatologists, Don Gehle and John McGowen with
spouses Joan Gelile and G eriy McGowen. Dr. Gerty AfcGowen is
a fam ily physician at Madigan Army Medical Center
Left:
Fran
Thomas,
left, was the
winner o f
the monthly
fru it
delivery,
one o f the
prizes from
the PCMSA
sponsored
raffle
drawing.
She is
pictured
with John
and Karen
Dimant
Right:
Dr. Eugene
Lapin is
pictured
canying the
Gourmet
Basket that
he won from
the raffle
drawing. The
basket, a
Longaberger,
was filled
with many
terrific
goodies
Left:
Dr. Oris
Hottglum,
retired Ob/
Gyn, left,
and Dr.
Mian
Anwar,
retired
anesthes
iologist
chat during
the social
hour
Right:
Dr. Douglas
Camp and
his wife,
Dorothy,
enjoying the
pre-dinner
festivities.
Dr. Camp is
a resident
with Tacoma
Family
Medicine
practicing in
Puyallup
January, 1999
PCMS BULLETIN 7
F e a tu re
N ew officers and trustees take the 1999 h elm o f PCMS
L a w re n c e A. L a r s o n , D O p ra c
tices w ith P ediatrics N orthw est,
specializing in allergy/im m unology,
and pediatric pulm onology. H e
g raduated from th e College o f
O steopathic M edicine & S urgery in
D es M oines, Iowa. H e an d his wife
M ary live in T a c o m a ’s north end.
C h a rle s W e a th e rb y , M D is a
fam ily practitioner w ith M u ltiC are
M edical G roup. H e received his
m edical degree from the U niversity
o f W ashington M edical School and
com pleted his internship and
residency at St. L u k e’s H ospital in
M ilw aukee. H e and his wife,
S hauna, live in U niversity Place.
Ja n ie s W ilso n , J r . , M D practices
internal m edicine w ith M ultiC are
Internal M edicine. H e com pleted his
m edical education at the U niversity
o f R ochester in N ew Y ork and his
internship and residency at
M adigan. H e lives on D ay Island
w ith his w ife D eana.
M a rily n P a ttis o n , M D practices
internal m edicine a t M edalia in Gig
H arbor. She grad u ated from the
University o f W ashington M edical
School and is b oard certified in
nephrology. She and her husband.
PC M S m em ber B rad P attison, M D ,
live in Gig H arbor.
P a tric e S tev e n so n , M D practices
physical m edicine and rehabilitation
in Puyallup. She grad u ated from the
University' o f W ashington M edical
School and com pleted her internship
and residency a t the VA M edical
C enter in Los A ngeles. She and her
husband, C raig, live on L ake
T apps.
Pictured fro m lop left, left to right: Drs.
Lawrence A. Larson, Charles IVeatherhv,
M arilyn Pattison. Patrice Stevenson, James
M. Wilson, M ichael Kelly, M aria Mack,
Doris Page, Jim Rooks, Susan Salo, Ted
Walkley, and Mrs. N ikki Crowley
8
PCMS BULLETIN
January, 1999
M ichael K elly, M D is a fam ily
practitioner in Lakew ood. H e
graduated from the U niversity o f
Cincinnati C ollege o f M edicine and
com pleted his residency at O regon
H ealth Sciences U niversity. H e and
his wife, Bonnie, live in U niversity
Place.
M a r ia M a c k , M D practices
anesthesiology a t St. Joseph Medi
cal Center. She received her medical
degree from the University of
V erm ont School o f Medicine and
practiced a t M adigan Army Medi
cal C enter before joining Pacific
A nesthesia. She and her husband
D ennis live in Lakewood.
D o ris P ag e, M D is a family
p ractitio n er a t Allenmore Medical
C enter in T acom a. She completed
h er m edical education at the Univer
sity o f C olorado in Denver and her
internship a t M ercy Hospital. She
lives in T acom a w ith her husband.
Cedric.
J a m e s R o o k s, M D practices
otolaryngology in Lakewood. He
attended m edical school at the
U niversity o f M iam i School of
M edicine. H e is a Fellow in the
A m erican College o f Surgeons and
A m erican Academy o f Otolaryngol
ogy/H ead/N eck Surgery. He and his
w ife Penny live in Steilacoom.
S u sa n S alo , M D is a family
practitioner w ith Group Health in
T acom a. She earned her medical
degree from the University of
W ashington School o f Medicine and
has practiced in Tacoma for 23
years. She lives with her husband
an d fam ily in Puyallup.
E d w a r d W alk ley , M D practices
p ed iatric em ergency medicine at
M ary Bridge C hildren’s Hospital.
H e received his medical degree from
H arv ard M edical School and
com pleted an internship in pediat
rics at C hildren’s Hospital. He and
his w ife live in the north end of
T acom a.
N ik k i C ro w ley serves as President
o f th e P C M S Alliance. She previ
o u sly served as President in 19811982. She is m arried lo James
C row ley, M D , Tacom a neurosur
geon. T hey live in Edge wood*
Feature
UW addresses concerns about exp an d in g clinics to Pierce Co.
bv John B. Coombs, MD
Associate Vice President fo r M edical Affairs fo r Clinical Systems and Networks
Associate Dean fo r Regional Affairs and Rural Health o f the School o f Medicine, U o fW
As many know from the July issue
of this publication, I w as invited to
meet with the membership o f PCM S
last June to discuss the all-impor
tant issue o f how physicians should
be trained to best meet tlie future
needs of our state and region.
In the midst o f w hat I believe to
have been a very good discussion
that day, I was abruptly asked to
comment oil whether the University'
of Washington has plans to expand
its primary-care network into Piercc
County. My first reaction to this
question was, “W hat does this have
to do with the question o f the day,
on future physician training?” But
as I thought about it a moment
more, I realized that this question
could not be answered by someone
from the University o f Washington
without addressing the issue o f phy
sician training. Why? Because vir
tually everything that we do at the
UW School o f Medicine —in part
nership with so many truly out
standing volunteer physicians
across die state and region that we
serve —ties in with our core mis
sions o f education, research and p a
tient care.
After the membership meeting, I
asked to meet with your Executive
Committee to explore whether oilier
important questions existed. While I
addressed them as best I could at
that meeting, I felt that it m ight also
be worthwhile to offer to respond to
these questions in writing so that
my responses could be shared di
rectly with the entire membership o f
the Society. I was very pleased that
Dr. Wilson accepted this offer and I
am delighted to share my thoughts
here in answer to the questions he
posed. Additionally, I have ex_____
pressed my hope that it will be pos
sible to meet periodically with the
Board and tlie membership in order
to strengthen communication be
tween tlie UW and tlie Society.
O
W hy w as U W Physicians
N etw ork (U W PN ) cre ate d ?
UWPN grew out o f significant
changes in the organization o f pri
mary care in King County that re
sulted during and after liealthcarc
reform in 1993 and 1994. Previ
ously, m ost prim ary-carc practices
were owned and operated by the
physicians who worked them. H ow
ever, within a very short period o f
time, most o f these practices be
came owned or operated by larger
entities such as hospitals or large
group practices. This threatened tlie
number o f prim ary care teaching
sites that tlie UW had access to in
King County. Additionally, this was
accompanied by dram atic changes
in referral patterns to tlie UW A ca
demic M edical Center (UW AM C)
from prim ary care practices brought
about by tlie vertical integration o f
medical care. This, in turn, created
great risk for substantial change in
teaching and research opportunities
for our students, faculty and physi
cians in training.
At tlie time we saw these changes
occurring, we conducted a survey o f
King County residents in which
more than 400,000 reported they
wanted direct neighborhood access
(within 15 minutes o f their homes)
to tlie resources ofH arborvicw
M edical Center and UW Medical
Center. This showed th at tlie public,
in a period o f extraordinary popula
tion growth in King County, wanted
increased access to UW physicians.
At tlie same tim e, as described______
John B. Coombs, AID
above, we were experiencing a de
crease in our access to primary care
sites - with all o f tlie attendant, po
tentially very deleterious effects on
our ability to maintain our critical
missions o f education, research and
patient care. Thus was born UW
Physicians Network, after much
very' careful planning and consider
ation to provide:
a) high-quality, primary care prac
tice sites at which medical students
and residents could receive training
in ambulator}' care and comple
menting our arrangements with pri
vate practicing physicians
b) access points for patients desir
ing referral to specialists at the UW
AM C, who could then participate in
teaching and research efforts by the
specialists at tlie UW AMC
c) a geographically diverse primary'
care system Uiat allowed us to con
tinue contracting with major insur
ers in King County, and
d) an integrated system, including
geographic distribution o f primary'
care capable o f accepting global
capitation.
©
W h a t was the cost involved
and did state funding co ntribute
to the creation?
UWPN consists o f nine neighbor
hood clinics, all within King
County. We are very' proud o r these
clinics. Each features an array o f
state-of-the-art systems that match
see "UW" page 12____________________ _
January, 1999
PCMS BULLETIN 9
V
F e a tu re
How to contact state, national lawmakers
F or additional inform ation about contacting legislators, p lease contact the M edical Society office. W e will be happy
to help you d raft letters o r m ake dircct contact to legislative leaders regarding issues o f concern. Please call Doug
Jackm an, E xecutive D irector, 572-3667.
T he statu s o f legislation can be obtained bv calling the L e g is la tu re 's toll fre e h o tlin e (800) 562-6000. The hearing
im paired m ay call (800) 635-9993. The hotline m akes it easy to leave a m essage o r voice an opinion lo lawmakers,
even if you don't know th eir individual telephone num ber. It also provides an easy w ay to leam the status o f a bill,
w hich com m ittee it's before, w hether it's been scheduled for a floor vote o r survived various deadlines for action. You
m ay also call the hotline to leam the topics, tim e and location o f com m ittee meetings.
A legislative meeting schedule is published w eekly on T hursday. M ail subscriptions cost $10 p er year. For more
inform ation or a subscription form , call 1-360-786-7344.
Internet users m ay reach the Legislature at: leginfo.leg.w a.gov U sers can view legislation and send e-mail lo
law m akers and staff. Internet users also will have access to the state constitution, state law s, a list o f legislators and a
session calendar. The governor's hom e page can be view ed at h ttp ://w w w .w a .g o v /g o v e rn o r
P re sid e n t C lin to n m ay be reached by w riting to him at
the W hite H ouse, 1600 Pennsylvania Ave N W , W ash
ington D .C . 20500; his m essage phone is (202) 4561111. E -m ail: p resid e n t@ w h itelio u se.g o v
L e g isla to rs, by d is tric t, O ly m p ia p h o n e n u m b e r and
e-m ail a d d re ss:
Y our U.S. S enators and representatives and state
senators and state representatives m ay be contacted at
th e follow ing addresses and telephone numbers:
2 n d D istric t (S o u th P ie rc e C o u n ty )
Sen M arilyn R asm ussen-D , 786-7602
[email protected]
Rep R oger B ush-R , 7 8 6 -7824 bush_ro@ leg.w a.gov
R ep Tom C am pbell-R , cam pbell_to@ leg.w a.gov
U .S. S e n a to rs: S e n a to r S lad e G o rto n (R), 730 H art
Senate Building, W ashington, D .C . 20510-4701.
Phone: 202-224-3441 (D .C .) or 451-0103 (Bellevue).
Fax: 202-224-9393. E -m ail: se n a to r_ g o rto n @ g o rto n .
se n ate .g o v
2 5 th D is tric t (P u y a llu p , S u m n e r, M ilton)
Sen C alvin G oings-D , 786-7648 [email protected]'a.gov
R ep Jim K astam a-D , 786-7968 k astam aja@ leg.w a.gov
R ep Joyce M cD onald-R , 786-7948
m cdona I d j o@ leg.w a.gov
S e n a to r P a tty M u r r a y (D), 302 H art Senate Building,
W ashington D.C. 20510. Phone: 202-224-2621 (D .C .)
o r 553-5545 (Seattle). Fax: 202-224-0238. E -m ail:
se n a to r_ m u rra y @ m u rra y .se n a te .g o v
2 6 th D istric t (N W T a c o m a , G ig H a r b o r, South Kitsap)
Sen B ob O ke-R, 786-7650 senate_26@ leg.w a.gov
R ep P at Lantz-D , 786-7964 [email protected]
Rep Tom H uff-R , 786-7802 huff_to@ ,leg.wa.gov
U .S. R e p re se n ta tiv e s: R ep . N o rm D icks (D-6 th
D istric t), 2467 R a y b u rn H ouse B uilding, W a sh in g to n
D .C . 20515. P hone: 202-225-5916 (D .C .) o r 5936536 (T aco m a). F ax: 202-226-1176.
2 7 th D is tric t (N o rth T a c o m a , E a s t Side)
Sen L orraine W ojahn-D , 786-7652 [email protected]
R ep R uth Fisher-D , 786-7930 fisher_ru@ leg.w a.gov
Rep D ebbie R egala-D , 786-7974 [email protected]
R e p . A d am S m ith (D -9th D istric t), 1505 L o n g w o rth
O ffice B uilding, W a sh in g to n D .C . 20515. P hone:
202-225-8901 (D .C .) o r 360-951-3826 (T acom a).
F ax : 202-225-5893.
28 th D istric t (W . T a c o m a , U niv. P lace, F irc re st, Lakewood)
Sen Shirley W insley-R , 786-7654 winsley_sh@ leg.wa.gov
Rep M ike C arrell-R , 786-7958 carrell_m i@ leg.wa.gov
Rep Gigi T alcott-R , 7 8 6-7890 talcott_gi@ leg.w a.gov
S ta te offices: T he phone num ber o f G o v e rn o r G a ry
L o c k e 's office is 360-753-6780, O lym pia. W rite to him
at: L egislative Building, PO B ox 40001, Olympia,
98504-0001. H is F ax is 360-753-4110. H is home page
address is h ttp ://w w w .w a .g o v /g o v e rn o r
2 9 th D istric t (S o u th T a c o m a , S o u th E n d , P ark lan d )
Sen R osa Franklin-D , 7 8 6 -7656 franklin_ro@ leg.wa.gov
Rep B rian Sullivan-D , 7 8 6 -7996 sullivan_br@ Ieg.wa.gov
Rep Steve Conw ay-D , 786-7906 conway_st@ leg.wa.gov
W r ite to s ta te re p re se n ta tiv e s in care o f the W ashing
ton H ouse o f R epresentatives, PO Box 40600, O lym pia
98504-0600. W rite to s ta te se n a to rs in care o f the
W ashington S tate Senate, PO Box 40482, O lym pia
98504-0482. T he central Senate F ax num ber is 360786-1999. T he H ouse has no central F ax num ber.
10
PCMS BULLETIN
January, 1999
3 0 th D istric t (N o rth e a st T a c o m a , F e d e ra l W ay)
Sen T racey Eide-D , eide-tr@ leg.w a.gov
R ep M aryanne M itchell-R , 786-7830
[email protected]
Rep M ark M iloscia, m iloscia_m a@ leg.w a.gov*
In to th e P olitical A ren a
by Jean Borst
When Dr. Shay Schual-B erke left
her Tacoma cardiology practice in
1992, she thought she was taking a
leave of absence to be with her
children. Somewhere along the line,
she became a politician.
“I realized that it was the first
time in my adult life that I had the
opportunity to be involved in my
local community,” said Dr. SchualBerke, who has been a member o f
the Pierce County Medical Society
since 1990, currently on inactive
status. Inactive, however, doesn’t
seem a fitting word.
After leaving her practice. Dr.
Schual-Berke became increasingly
involved in children’s issues and
education, spending a great deal o f
time in the public schools. She
became involved in councils and
organizations and was ultimately
elected to the local school board.
After serving as the board’s legisla
tive representative for a few years,
Dr. Schual-Berke considered a more
active political role - she decided lo
run for State Representative o f the
33rd district.
“My experience on the school
board made me aw are o f various
public policy issues,” she said. “I
realized that public service is a lot
like practicing medicine. You look
at the situation, assimilate informa
tion, diagnose what is going on and
prescribe and develop thoughtful
policy to remedy the situation.”
Along with her strong involve
ment and interest in education and
children’s issues, Dr. SchualBerke’s experience as a physician
made health care a natural platform
in her campaign. “It’s such an
important issue among constitu
ents,” she noted. “I encountered
tremendous frustration and anxiety
concerning the availability o f carc.
W hen I sent out campaign literature
specifically addressing my commit
ment to quality health care, I was
truly stunned and touched by t he
enormous response I received from
people. There were multitudes o f
calls from constituents. People had
read every w ord o f that literature
and called to say they would
support me if I made good on my
commitment.” T hat support came
through. Dr. Schual-Berke said her
campaign was bolstered by the
volunteer efforts o f at least 600
people that she knows of.
The commitment to a campaign
seems ominous, particularly in an
area like the 33 rd district, which
encompasses a wide and diverse
geographical area including north
Shay Schual-Berke. A-ID
Federal W ay, south Burien,
N orm andy Park, Des Moines.
SeaTac and part ofT ukw ila.
Renton and Kent. But Dr. SchualBerke relished the experience. “ It
was wonderful,” she said, despite
the fact that she was a Democrat
running against a strong Republican
incumbent. “It was (lie most incred
ible experience imaginable. Ringing
9,000 doorbells gave me the oppor
tunity to talk to people and get an
amazing sense o f w hat’s happening
out in the community.” While she
didn’t have any preconceived
notions that she would win the
See "Arena"page 20
Legislative Summit
set for January 26
M ark your 1999 calendar for
January 26, the date o f the W SM A
Legislative Summit at the Holiday
Inn in Olympia. "Physician-Directed
Care, The Patient's Right" is the
theme for this year's conference.
Leam how legislation is made,
gain helpful tips on how to effec
tively participate in the legislative
process and useful insights on w hat
lies ahead for physicians and health
care as the 1999 Legislature gets to
work. The W SM A Olympia office
will make afternoon appointments
with legislators for all members
who are interested. Call W innie
Cline at the W SM A O lympia office,
800-562-4546 or email
w mc@ wsma.org.«
Physician for a day
at the Capitol
The free Legislative Health Clinic at
the Capitol is a unique program
which, in addition to seeing a few
patients, provides a w ay for physi
cians to enhance their visibility with
legislators and staff and to promote
a positive public image for medi
cine. As a PCM S member you are
invited to participate as a volunteer
physician any weekday morning
(9:00 a.m. until noon) during the
legislative session. You will be
equipped with a beeper so you will
be able lo w atch the legislature in
action. For information or to reserve
a day between January 12 and April
12 call Doug Jackman at 572-3667.W
January, 1999
PCMS BULLETIN 11
Feature
" U
W
V
w
*
ou r view o f w h at it takes to train
excellent physicians fo r tlie needs o f
the future. T hese include, for ex
am ple, tlie latest in electronic
(paperless) m cdical records and in
form ation m anagem ent allow ing
im plem entation o f evidence-based
medicine.
W e an ticipate th a t by tlie tim e all
o f tlie U W PN clinics break even,
the U W A M C will have invested
$40 m illion in tlie program . These
funds com e from clinical revenues
an d reserves o f our faculty practice
plan, U W M edical C enter and
H arborview M edical Center. Stateap p ro p riated funds w ere not used in
U W P N ’s creation and neither will
state-ap propriated fluids be used in
supporting tlie operation o f tlie clin
ics.
©
H ow m any m em bers cur
rently belong to U W P N and what
is the specialty mix?
C urrently, U W PN has betw een 35
and 40 providers, 80% o f whom are
physicians. T he rem aining 20% are
physician assistants and nurse p rac
titioners. O f th e physicians about
h alf are board certified in family
medicine, about one-third are board
certified in internal m edicine and
ab o u t one-sixth are board certified
pediatricians. All o f die physicians
are m em bers o f the U niversity o f
W ashington School o f M edicine
faculty. W hen fully operating at c a
pacity by the year 2005, w e antici
p ate having betw een 75 and 90 p ro
viders network-wide.
Issaquali, K ent/D cs M oines, S hore
line, W est S eattle an d W oodinville).
A ninth clinic, in A uburn, is sched
uled to open N ovem ber 1. T here
currently are no additional prim ary
care clinics planned.
©
Do U W P N clinics refer
solely to U W sp ecialists?
In a w ord, no: w e w ork h ard to
m aintain good relations w ith local
specialists and institutions such as
com m unity hospitals. O ur interest is
providing the highest quality care
and service w ithin th eir local com
munities.
A s p a rt o f their m ission o f su p
porting die education, research and
patient care needs o f tlie U W A M C ,
physicians at U W PN clinics give
patients opportunities to obtain con
sultation and in-patient care from
UW specialists and U W A M C clini
cal facilities. H ow ever, w e pay
close attention to w h at patients
w ant - if a patient prefers not to get
his or her specialized care a t U W
sites, or if tlie condition is such d iat
local care m akes better sense medi
cally, he or she is referred to local
specialists and local facilities.
D uring tlie first tw o years o f op
eration, ab o u t tw o-thirds o f refer
rals from U W PN clinics have been
to a UW specialist an d U W A M C
facilities. The rem ainder o f referrals
have been to local specialists and
local facilities.
©
W hat are your plans for
UW PN clinics in Pierce C ounty?
©
I lo w m any clinics does
U W PN currently op erate and
w hat are you r projections for the
next five years?
W e have been asked by several
groups to consider establishing clin
ics in both Pierce and Snohom ish
counties. H ow ever, U W PN cu r
rently has no plans for clinics in
these areas.
U W PN currently operates eight
clinics, all in K ing County
(B elltow n, F actoria, Federal W ay,
©
W hat w as the basis o f
C hildren’s H ospital op posin g pe
diatric cardiac surgery at M ary
12
PCMS BULLETIN
January, 1999
B rid ge C hildren ’s Hospital, and
©
C hildren ’s H ospital has es
tablished a clinic o f specialists in
O lym pia to directly compete with
M ary B rid ge C hildren’s Hospital.
A rc state funds involved here?
Tlie U W has a close working rela
tionship w ith Children's Hospital
an d R egional M edical Center
(C H R M C ). H ow ever, CHRMC is
an independently owned and man
aged institution. Pediatric specialty
services and tlie value o f regional
pediatric specialty care are sharply
d istinct from those o f primary-care
m edicine o r specialty care for
adults. T hese questions, therefore,
should be referred to CHRMC.
©
U W D epartm ent of Surgery
offered to assist Pierce County
w ith its designated trauma ccnter.
H o w did they plan to do this?
T he P ierce County Executive in
vited tlie U W to review tlie county's
cu rren t plans to reestablish major
trau m a services in Pierce County.
M oreover, w e were invited to con
sider actu ally joining in tlie planned
execution o f these services, perhaps
through a contractual arrangement,
T o date, diis is not an option that
has been pursued. The UW is very'
supportive o f efforts in Pierce
C ounty to provide in-county, high
q uality trau m a care.
1 hope die responses I have pro
vided here help strengthen the per
ception d iat there is no ambiguity in
die relationship between the UW
School o f M edicine and members of
P C M S - ail am biguity the existence
o f w hich w as raised by the title of
an editorial in this publication last
July (“ U niversity o f Washington friend o r foe?”). T his relationship
rem ains strongly positive and pro
ductive an d I assu re you diat it is
o u r w ish a t the University of
W ashginton A M C Uiat it always re
m ains s o .i
7
V.
■±S
Feature
In tlie Spotlight - Reluctantly
by Jean Borsl
PCMS Executive D irector Doug
Jackman is not one for accolades.
Which is why the PCM S Board o f
Trustees kept a tight lid on the fact
dial Doug was recipient o f this
year’s Community Service Award.
If he had known w hat w as going to
transpire at the Annual Meeting, it’s
likely he would have done some
thing to prevent it. “I was very sur
prised,” he said, adding that he
should have become suspicious
when his wife, Connie, postponed
her trip to N orway for three days so
she could attend tire dinner. “I just
thought she was anxious to hear our
keynote speaker!”
the Society as Executive Director,
praised D oug’s abilities as a leader.
“H e’s done an unbelievable job for
the Society,” Dr. D uffy said. “H e is
reliable, com passionate, coopera
tive... I ju st ca n ’t say enough good
tilings about him. H e always has the
answers, displays incredible ju d g
ment and always knows the appro
priate thing to say. W e are ex
trem ely fortunate to have him.”
“For the past 15 years, Doug has
been our mentor, our supporter and
for those who have had tire privilege
o f working with him, he has been an
advocate and a friend in the truest
sense,” said PCM S 1998 President,
Dr. Jim Wilson. “He is our eyes
and ears in the community. To a
great extent, it is because o f him
that our Society is the strongest in
the state.”
And Doug feels fortunate as well.
“This position offers so much diver
sity, bolli through its members and
its activities. T h a t’s why I enjoy7 it,”
he said. “T here’s always something
happening and tliere is rarely a dull
moment.” It’s hard to find a dull
moment with all th at has transpired
within the medical profession in re
cent years, Doug notes. H e ’s ob
served trem endous changes, includ
ing the transition o f physicians go
ing from practicing privately to be
coming employed in large groups.
There have been mergers, acquisi
tions, and greater controls and in
creased paperwork. The Medical
Society has dedicated enormous ef
fort to help physicians prepare for
managed care. B ut along with those
challenges, Society members and
staff, under D oug’s direction, have
been involved w ith several notewor
thy causes and achieved numerous
successes. “Doug truly exemplifies
the volunteer-staff partnership,” ac
cording to Dr. G o rd o n K latt, 1990
PCM S president. “H e does a superb
job in his role at the Society by al
lowing volunteers to take a leader
ship role, and does so in a very
gentlemanly manner. H aving some
one like him at PCM S is what
makes our organization so success
ful.”
Dr. P at Duffy, who was PCM S
president in 1984 when D oug joined
Dr. John Rowlands, 1996
PCM S president, concurred. “D oug
Humility aside, Doug is honored
that the Medical Society bestowed
upon him such a prize, given annu
ally to a Society member who has
contributed time and talent to the
community in order to improve
quality o f life. He feels privileged lo
be in the company o f past award re
cipients - Drs. G eorge Tanbara,
Gordon Klatt, Charles
Weatherby, John Van Buskirk,
Terry Torgenrud and Pat H ogan.
“I’m very pleased to have been
given tire award,” he said. “But a
lot of what I do is simply part o f the
job,” although the members for
whom he works so diligently beg
to differ.
Doug Jackman
PCMS Executive Director
Jackman has been an advocate for
physicians and healtli issues for a
long, long time,” said Dr.
Rowlands, who first met Doug
when he was field representative for
the Lung Association before coming
to PCM S. “ H e’s dedicated himself
to the M edical Society and the over
all health o f Pierce County.”
Among the highlights o f the last
15 years...
In 1984 the Credentials Commit
tee and the Board o f Trustees voted
to deny membership to an applicant
who had misrepresented himself on
his application. They did so with
numerous threats o f lawsuits and
litigation. The Society was sued for
anti-trust and the litigation went on
about three years until a federal
judge summarily dismissed the case.
The same year, PCM S led the ef
fort to get no smoking regulations
and ordinances in city and county
restaurants and work places. “It
w'as a great effort supported by
wonderful volunteers from our
membership,” Doug said. He re
called a state tobacco lobbyist who
was overcome with an obvious
‘smoker’s cough’ while testifying
against the regulations. One o f the
county council members became so
overcome with laughter she had lo
excuse herself.
In 1987, the Society led a suc
cessful effort to fluoridate
T acom a’s w ater supply led by Drs.
T e rry T o rg e n ru d and Bill Jackson
See "Jackman"page 18
January, 1999
_____
PCMS BULLETIN 13
News briefs
Interested in an asthma
adventure?
February m em bership meeting how to savor your work as a physician
W a n t to get aw ay this sum m er w hile giving som ething
b ac k to tlie com m unity?
D av id G rube, M D , w ill be tlie speaker a t the February
G eneral M em bership M eeting, T uesday, February 9 at the
L andm ark C onvention C enter in Tacom a.
P h y sician s, resp irato ry th erap ists and nurses can volun
te e r th eir tim e a t A sthm a C am p a t C am p Sea 1th, a fived ay overnight cam p fo r children ages 6 to 14 w ith
a sth m a w ho require daily m edication.
D r. G ru b e w ill entertain an d inspire you with anecdotes
an d illustrations th a t w ill help you really enjoy your work
as a physician. H is to p ic w ill be “H ow to Really Enjoy
Y o u r M edical P ra ctice.”
O rg an ized by tlie A m erican L ung A ssociation o f
W ash in g ton, A stluna C am p gives children w ith asthm a
tlie o p p o rtu n ity to have fun and learn ab o u t asthm a
m an ag em ent under tlie w atchful eyes o f a team o f
v o lu n teer m edical staff.
Tlie L ung A ssociation asks for at least a 24-hour tim e
com m itm ent and th a t volunteers follow die asthm a
m anag em ent philosophy set forth in tlie N H L B I G uide
lines. C am p Sealtli is located on V ashon Island. A sthm a
C am p takes place from June 22 to 26, 1999.
F or m ore inform ation please call Penny G rellier a t (253)
272 -8 7 7 7 .
TOTAL
4
4
4
4
4
4
888
-
T
A
M
R
I
A
A SSE T MANAGEMENT, INC.
OTAL
I B
JPaSL
f ;flPr
OBJECTIVITY
PE RSO NA L ADVISOR
ANAGEMENT
VALUE
LG U L AR
EDUCATION
NTEGRTIY
& EX PERIENCE
BETTER
IDEA CALI.
4 - TAM - R IA
-
o r v i s i t o u r w e b s i t e \tv
4 - T A M - R IA .C O M
David J. Roskonh, MBA. Cl-P
r
Re g i s t e r e d I n v e s t me n t Ad v i s o r
îiljAllenmore
Psychological
W l Associates, P.S.
752-7320
Do you have p a tien ts w ith difficult em otional
and stress-related problems? Psychiatric and
psychological consultations are available.
Union Avenue Professional Building
_____________ 1530 Union Ave. S.. Ste. 16. Tacoma________
14
PCMS BULLETIN
January, 1999
Since 1977, D r. G ru b e has been a fam ily practitioner at
tlie P hilom ath Fam ily M edical C linic in Philomath. Or
egon. H e g rad u ated from Lew is an d C lark College in
P o rtlan d an d w ent on to tlie U niversity o f Oregon Medical
School w here he received his m edical degree. From 1974
to 1979 he served w ith tlie U .S .P .H .S . N ational Health
Service C orps in G rand Coulee, W A and in Philomath,
OR.
D r. G rube has received num erous honors, and has many
affiliations. A m ong them are serving as President (1990)
President-E lect, Speaker, H ouse o f Delegates, ViceSpeaker and B oard o f D irector (1980-83, 1989-Present)
fo r tlie O regon A cadem y o f Fam ily Physicians. He has
been a m em ber o f tlie B enton County M edical Society
since 1977, serving as President in 1980. H e served as a
clinical instructor fo r tlie O regon H ealth Sciences Univer
sity, D epartm ent o f Fam ily M edicine from 1973-79 and
a s a clinical asso ciate professor since 1993.
D r. G rube adm its th a t his part-tim e speaking career
w as a direct result o f recognizing th a t so m any o f his per
sonal physician friends seemed unhappy. H e couldn't un
derstand w hy physicians in tlie richest country' in the
w orld, w ith tlie g reatest resources, blessings left and right,
and w onderful new diagnostic and treatm ent options,
w eren’t h appy and enthused ab o u t their profession. Be
ginning w ith a “slide show ” o f clinic bloopers for an of
fice C hristm as party an d m oving to a “hum or” talk at the
O regon A cadem y o f Fam ily Physicians, Dr. Grube says
his program has “grow n an d m utated.” It is often called:
“ Bones Set, B lood Let, W ounds Patched, Babies
H atch ed .” H is goal is sim ple, taking notes and anecdotes
from his daily p ractice, including quotes from other prac
ticing physicians, incorporating m edical cartoons and
n ew spaper blunders, he tries to m ake people laugh by rec
ognizing tlie fact th a t tlie beginning o f growing (maturity)
is tlie ability to laugh a t ourselves and to see how funny
w e are. A p a rt o f w h at he offers is reminders that vve must
n ot only take care o f p atien ts, b u t also take care o f our
practices and, especially, ourselves; thus he attempts to
rekindle tlie origins o f m otives fo r entering into medicine.
M a rk y o u r calen d ar fo r an entertaining and enjoyable
evening w ith y o u r colleagues.*
"V
F e a tu re
Mangled Care
1999 - The Year o f M anaged Care
bv Teresa Clabols, MD
Is the public and are politicians
aware of what is happening in
health care?
What other business opens its
doors with such huge overhead ex
penses, such onerous guidelines and
penalties, such self-destructive dis
counts, such irresponsible clients
and payors that simply refuse to
pay their bills on a timely basis and
we are not allowed to bill them in
terest charges, while we carry bank
loans to pay our staff?
From this week alone and there
fore fresh in my memory’ are the fol
lowing:
The baby bom in A ugust whom I
have cared for now for four months,
whose mom swears she chose me,
(the other 3 children are on my ros
ter) who finally brings the coupon
in is assigned lo my husband, a car
diac surgeon. In my naivete I said,
gosh, at least lie can bill for my ser
vices. W rong, payment will be de
nied since he is a specialist, plus...it
is considered fraud and subject to
jail time and severe monetary penal
ties. Gosh, so we w on’t do that.
Let’s call the plan and change. (Our
luck at getting moms or dads to call
from home is zero). W rong, the
provider can not initiate a change, it
has lo be done by the patient. L et’s
get the mom in our office so we can
call long distance on our phone and
get her to change. Our phone bill is
only $200 dollars a month since the
plans dropped their toll-free num
bers. W rong, the plan refuses to
retro the patient back to me as o f
August or September, even though
they made the mistake in assigning
a baby to a heart surgeon. L et’s bill
the patient and she can pay for the
care. W rong, it is a felony to bill a
welfare patient. L ei’s write the in
surance commissioner. W rong,
they are swam ped with more impor
tant tilings.
Then I got a phone call from a
friend, a gastroenterologist who did
a consult and w ants a referral on a
newborn. I never saw the baby, so I
have no records. I will do the refer
ral if it’s mine, but since all my p a
tients from my form er practice were
transferred to another doctor with
out my' perm ission (or the p a
tients’), I ask to look at the records.
His secretary faxes them lo me.
Seems the baby w as referred by a
pediatrician, with a nice letter o f in
troduction. In my naivete I ask why
they haven’t called that pediatrician
and liis corporation. They have, and
it was denied. They w ant me to do
the referral because the mother has
been assigned to me. W hat do you
mean the mother was assigned to
me? Sure enough, we check our ros
ter and we have a young 17 year old
M om assigned to a pediatrician.
I still do not understand how in
the world a mom who has gone
through a pregnancy and had a
baby can be assigned to me. So I
call the plan. “This conversation is
being recorded...” I ask them if lliey
are aw are that I have been assigned
a mom. Well, no they had no idea,
they ju st obtained all these patients
from an insurance that bailed out o f
the state, but could I call the Mom
and inform her? I suppress a laugh.
(I have to remember this is being
recorded).M adam, I do not have her
phone number. W ell, doctor, if you
terminate her you m ust mail her a
letter. B ut M adam , I respond, I have
never seen her, your roster doesn’t
give me her phone num ber OR her
Teresa Clabols, MD
address, so I can ’t send her a letter.
The plan says: neither can we. All
we get from llie state is her name
and DOB.
I am appalled at the chaos. I have
been working in hospitals since I
was 18, when I worked as a phlebotomist and paid my way through
college and medical school. 1 have
never seen so many physicians quit
medicine, or depressed, angry' and
upset. And rightfully so. We are not
providing optimal care. We are
wasting hours that could be spent
caring for patients trying to help our
poor sta ff doing the four “C ’s”:
coding (with three decimal digits
for accuracy, because even if it is a
capitated patient we must pay for a
H CFA form and code with accu
racy)
collating (superfluous paperwork
and documentation for the attor
neys)
connecting (referring patients to
needed services so they can be de
nied) and
collecting (if lucky 25 cents per
dollar).
A sad state o f affairs are the new
medical textbooks that instead o f di
agnosis PEARLS on the hard cov
ers now have ICD codes. I suppose
it is now ju st as important for medi
cal students to leam ICD codes
rather than clinical PEARLS.
Then we get audited for patient
“satisfaction” as to how our bo
nuses will be calculated. O f course
our staff is exhausted and at times
short with patients that forget their
See "Mangled Core" page 16_____________
January, 1999
PCMS BULLETIN 15
"M angled C are”
fro m page 15
card s, do n o t bring their copays, yet
w an ted th eir referral done (and a p
proved) yesterday. T hey w an t us to
send th em a bill fo r their copay, but
will only give us th eir beeper num
b er or th e ir a u n t’s address. Y et
w ithout their cards we cannot verily
th eir coverage o r their PC P. A nd
according to the co n tract w e p hysi
cians have all signed (w ithout read
ing becau se we are too busy doing
the fo u r “ C 's ”) w e are not to treat
them w ith out th e ir copaym ents. A nd
yet, they are free to change health
coverage every 30 days! So they get
m ad a t us w hen their referral is de
nied because they sw itched insur
ances again. A nd w e have to do the
referral all over again.
I have a pediatrician friend w ho
refused to refer an abusive m om to
a derm atologist for the b ab y ’s dia
p er rash. I concurred - th a t does not
need a consult. B ut the plan a p
proved th e referral and billed m y
friend fo r it in one o f his pools. And
there is no recourse o r appeal p ro
cess.
I am appalled at the cherry' pick
ing th a t is going on in medicine.
W hen I w as w ith a large organiza
tion, w e had an open door policy.
O u r m ission w as care to all. W e re
ceived the sickest and the poorest. I
received m ultiple children w ith con
genital defects, cardiac defects, a
huge panel o f illegal M exican im m i
g ran ts, children from O regon w ho
h ad been on w aiting lists and other
countries w here they could not ob
tain care. W e actually advertised for
high risk drug m om s to come. W e
advertised and becam e the center
for hom eless patients to receive
care. I cam e to know w hich provid
ers o u t there w ere closing their
doors to sick patients, the elderly,
M edicare, chronically ill and dis
abled patients. W e did not turn any
one aw ay. T h at is w hat providing
16
PCMS BULLETIN
January, 1999
care should be like. B u t everyone
has to pull their weight.
C herry picking should n o t be al
lowed. D um ping should n ot be a l
lowed. E veryone needs to do their
fair share. L aw su its should n ot be
allowed. M alp ractice insurance
should not be allow ed. A ny tiling
th a t diverts a dollar aw ay from its
intended use, health care, should n ot
be allow ed. T he insurance com m is
sioner needs to help this state p ass
the any w illing provider law . A nd
the health insuran ce com panies need
to p ay providers expeditiously, not
years later. A nd tliere should only
be one credentialing organization so
it doesn’t take five m onths to certify
for each o f 150 insurance plans.
And tliere should be only one in
spection for the office, n ot one for
each insurance com pany. O r soon,
very' soon, so m any providers will
be leaving this state th at the ones
left will close their doors to any new
patients. A new conundrum .
An expectant couple cam e to m e
for a prenatal visit. It seems they
will be com ing to L akew ood from
O lym pia for care. T hey could not
find a single pediatrician in O lym
pia w ho takes their health care plan.
This is a sad state o f affairs.
W hich rem inds me o f one m ore
tiling. T ired o f getting requests for
referrals denied? (or approved in
w riting and then paym ent ultim ately
denied like m y d au g h ter’s speech
therapy. Like the health plan said,
on the very bottom in sm all print.
“This approval is not a guarantee o f
paym ent”). I w anted to go to a plan
w here I w ould pay m ore but be able
to see the doctor o f m y choice. I
w as w illing to p ay to get cadillac
health care. Lo an d behold, the only
individual plan I can now purchase
(when my out o f pocket $ 10,000 a
year C obra coverage runs out) cov
ers only m ajor catastrophic hospital
coverage “ since the insurance com
m issioner will not let us raise our
rates we have decided not to offer
an y n ew individual p lans.”
I do n o t k now w here all this is go
ing. B u t i f doctors do not wake up
an d organize, w e will not be doctors
anym ore. W e w ill be called provid
ers, P C P s, pods plus w e will be
called a lot o f other tilings.
I w an t to be a “doctor” not a
“p rovider.” Like m y father before
m e, like m y husband, like my
h u sb a n d ’s grandfather, I want to be
a traditional doctor. I w ant to see
m y patient, provide good care and
be com pensated fairly. I refuse to lie
o n a physical and give a false diag
nosis because th a t insurance does
n o t believe in paying for physicals
an d preventive care. However, I do
urge th o se fam ilies to complain or
sw itch coverage. And I will con
tinue to provide care to the needy,
fo r children can not choose their
parents.
M aybe w e should require all plan
adm inistrators to come to our of
fices, for w e are at the front lines.
A nd if we d o n ’t fix this mess now
w ho will lake care o f us? Is the pub
lic and are the politicians aware of
th is im pending disaster? ■
Puyallup, WA: Hospital affiliated
urgent care center has immediate
openings for residency trained or
BC/BE family practice physicians to
work 10 hour shifts. Clinic hours
are 12 noon to 9:30 pm MondayFriday, 10:00 am - 7:30 pm
Saturday, Sunday and holidays,
outpatient only. $50/hr, benefits
available. Send letter of intro
duction and CV to Urgent Care
Center Application, Good
Samaritan Community Healthcare,
Attn: Kathy Guy, PO Box 1247,
Puyallup, WA 98371-0192.
TPCHD
HIV name reporting begins January 1, 1999
In September, the Tacoma-Pierce
County Board o f H ealth adopted a
regulation requiring the reporting o f
HIV seropositivity by names
beginning January 1, 1999. The
Health Department will guard
information from this addition to
the current list o f reportable
communicable diseases with the
same confidentiality and sensitivity
as it has with other diseases.
Departm ent w ill not disclose the
identity o f the infected patient to any
contact. This contact tracing is an
essential p art o f our disease control
efforts and it is impossible to do
without working directly with tlie
infected patient. HIV disease is a
serious cause o f morbidity and
mortality in our county. Please
promptly report any positive tests to
us.
The regulation requires that
physicians report all newly ob
served infections. The regulation
also requires that physicians, with
their patient’s consent, report
already known infections. D r. C ru z
hopes that physicians will help
control this disease by obtaining
patient consent whenever possible.
The H ealth D epartm ent will mail
to each physician in the county a
copy o f this regulation and State
regulatory requirements regarding
counseling and testing. O ur staff
will visit your office in the near
Medical providers and laborato
ries can report HIV positive tests
by calling (253) 798-6410 (press
“0”) and ask to speak to a N urse
Epidemiologist or calling the 24hour reporting line at (253) 7986534 and leaving the information
on the phone lines. If you prefer to
mail reports, please request mailing
materials from the H ealth D epart
ment.
The FAX line M A Y N O T be
used for HIV or AIDS case reports.
If any additional information is
needed, a Health D epartment N urse
will call.
Because an important part o f the
reporting includes partner notifica
tion, trained Health Department
personnel will contact each newly
reported HIV-positive patient to
gather partner information and to
provide information about support
ive resources in Pierce County.
Appropriate partners will be
notified o f their exposure and
offered HIV testing. The H ealth
Federico Cruz-Uribe, MD
TPCHD Director
future for follow-up and technical
assistance. If you desire additional
information and materials about
HIV counseling and testing, please
call (253) 798-6060 or if assistance
in counseling the newly infected
positive patient is needed, call (253)
798-2866.■
Pierce County disease statistics
The Tacom a Pierce County Health Department compiles a report o f diseases
in Pierce County each month, as shown at left. The report is printed in the
PCM S Bulle
tin to help
TACOMA-PIERCE COUNTY HEALTH DEPARTMENT
keep physi
Amended +
REPORTED CASES OF SELECTED DISEASES
Military
cians and
care-providers
DISEASE
1998 TO DATE
THIS MONTH
1997 TO DATE
abreast o f
ENTERIC DISEASES
Salmonella
S4
14
66
disease
Shigella
3
13
12
E. Coli 01 S7:H7
0
13
11
activity. If you
HEPATITIS (Acuwj
have questions
Hepatitis A
4
65
2
Heoilius B
M
0
*
regarding the
Hepatitis C/NANB
5
C
report, please
INVASIVE DISEASE/BACTERIAL
1
S
?
Meningococcal
call the
SEXUALLY TRANSMITTED DISEASES
Communi
1327
275
1040
Chlamydia
95
45
165
Gonorrhea
34
46
49
3 3
368
8
cable Disease
43
Herpes, Initial Infection
11
132
152
46
14
Syphilis, Ejrly
1
0
0
0
Section o f the
Syphilis, Ijte
0
1
12
16
0
0
59
2
90
4
PeMc Inflammatory Dls.(Acuie)
0
Health
De
1 16
26
91
Urethritis, Nonconococcal
12
32
partment at
36
1■
TUBERCULOSIS
31
798-6410.
VACCINE PREVENTABLE DISEASES
Mumps
Pertussis
HIV DISEASE
AIDS
1
9
OTHER DISEASES-Mjljrij
Confidential FAX {253) 79B-7666
47
52
68
736
TOTAL AIDS CASES - ! 983 to Present
Communicable Disease Control (2S3) 798-6410
65
1
4
6
24-hour Reporting Line:
(2 5 3 ) 7 9 8 - 6 5 3 4
January, 1999
Please
rem em ber to call in rep o rtable diseases
to the 24 hour
hotline, 7986534.
PCMS BULLETIN 17
V
Feature
Jackm an
fro m page 13
(an d also defeated a subsequent
an ti-fluoridation challenge). Shortly
a fter th e m easure passed, thenm ayor. D oug S utherland, got a call
from a resident w ho com plained
(hat the fluoride had killed h er gold
fish. T he fluoride. M ayor
S u therland inform ed her, had not
yet been added to the w ater supply.
In 1998, D rs. Jim Willson and
P e te r M a rs h offered testim ony on
H IV nam es reporting and D rs. W il
son an d L arson testified against the
city lifting its ban on firew orks.
A nd, m ost recently has been the
decision o f physicians electing to
unionize.
T he Society is driven by its com
m ittee structure. O ver 170 m em bers
are involved in the num erous com
m ittees. M em bers o f the public
serve on several com m ittees, w hich
is fairly unique am ong m edical soci
eties. “ It is a huge plus having lay
m em bers involved in these com m it
te e s,” D oug said. “It adds a great
deal o f credibility to our organiza
tio n .”
W ithin the P C M S office itself,
D oug takes note o f the trem endous
grow th and change that has oc
curred. N ex t year, die
o rg an ization’s building w ill be paid
in full. T he P C M S M edical P lace
m ent Service, a p a rt o f M em bership
Benefits, Inc., is grow ing beyond
expectation. “ I credit a strong, loyal
and dedicated s ta ff for tlie success
o f th e S ociety,” D oug notes.
Sue A sher, P C M S A ssistant E x
ecutive D irector, has w orked with
D oug fo r 21 years. “ D oug has been
a m entor and a friend w ho has the
uncanny ability o f malting the rou
tine o f com ing to w ork not only
w orthw hile, but enjoyable,” she
said. "H e w ill help solve any officc
dilem m a, from a sensitive political
problem to clogged plum bing.”
“D oug runs the M edical Society
18
PCMS BULLETIN
January, 1999
in such a professional, able fash
ion,” D r. R ow lands said. “W ithout
his unifying direction, I ’m n ot sure
how the M edical S ociety w ould
function. H e ’s also built a w onderful
team at the office an d w ould be the
first person to acknow ledge them fo r
the organ izatio n ’s success.
W hile m em bers active in the S oci
ety are aw are o f D o u g ’s efforts on
the jo b , m any m ay n ot be aw are o f
his com m unity involvem ent outside
the office. M em bers attending the
A nnual M eeting h eard Dr. W ilson
list several organizations in w hich
D oug is active. “T h at list blew me
aw ay,” said D r. D uffy. “ I h ad no
idea D oug w as involved in so m any
efforts.”
D oug has served on Hie b oard o f
the T acom a-P ierce C ounty M unici
pal League, T acom a U rban League,
H eath Foundation, T acom a A ctors
G uild and the Pierce C ounty C om
m unity A ID S P artnership. H e has
also been active in F orw ard T o
gether, C ity C lub, T acom a Rotary',
T acom a Pierce C ounty H ealth D e
partm ent, T acom a R a in ie r’s C om
m unity Fund and th e A udubon Soci
ety.
B ut his link to the com m unity goes
beyond his association w ith these o r
ganizations. Sue A sher noted th at
D o u g ’s com passion and concern for
others is im m easurable and she sees
it ever}' day a t the office. “H e al
w ays extends h im self to those in
need o r th o se less fortunate and that
includes anim als as well as people,”
she said.
h i addition to his w ork at the
M edical Society and his numerous
com m unity interests, Doug also
m akes tim e for his favorite hobby biking. A n avid cyclist, Doug has
p articip ated in the Sealtle-to-Portland ride for 15 years. Biking has
been a fam ily activity for the
Jackm ans as well, although Connie
and D oug are riding without the
kids these days. Son Scott lives in
C olorado and w orks at the Keystone
Ski R esort. T heir daughter, Susan,
lives in O slo, N orw ay with her hus
b and L ars and their two children
(M arianna, 18 months and tlie new
est addition to die family, Daniel
D ouglas, b o ra in November). At
p ress tim e, tlie Jackm ans were vaca
tioning in N orw ay and getting ac
quainted w ith their new grandson. ■
VOLVO
SERVICE & REPAIR
(253) 588-8669
www.volvorepair.com
B oyle’s Foreign Car Repair
7202 Steilacoom Blvd SW
P u g e t S o u n d Area, WA: You know how you want to set up your practice.
W e can help you do it. Dynamic com m unity-based healthcare organization
se e k s BC/BE Family Practitioners. Flexible financial packages and
practice positions available from independent to group settings, practice
m anagem ent to full em ployment. C onvenience, quality 225-bed hospital
and excellent location in fast-growing, family community. C lose to Seattle
with year-round recreational opportunities. W e are an equal opportunity
employer. Contact Kathy Guy, Administrative Director of Clinics, Good
Samaritan Community Healthcare, 407 - 14th A ven ue SE, Puyallup, WA
98371, (253) 848-6661, Ext. 1865.
V.
______________ PCM S A lliance
the
Pulse
Pierce County Medical S o c ie ty A llia n ce
President's M essage
Thank you to all who donated their
time and energy to make the H oli
day Sharing Card Fundraiser a
fabulous success. A record breaking
amount was donated for your
community - $15,000. Funds will be
dispersed in January' after a com
mittee meeting. The organizing
elves who planned and chose the
card were H elen W hitney, C indy
Anderson and Alice W ilhyde.
The card mailing was accom
plished December 3 by H elen
Whitney, Alice W ilhyde, S haron
Ann Law son, K ris W hite, Sue
Wulfestieg, P atty K esling, L ibby
T art, Fran T hom as, M a ry
Cordova, Alice Y eh, D ottie
Truckey and myself. Guests joined
us for lunch and included Jackie
Jensen, W SM AA President,
Wenche Faiola and Blanche Ford
from Lewis County Medical
Alliance.
The “Baby Think it Over”
program o f providing dolls to
schools in Pierce County has now
expanded to 11 schools. The
schools are delighted to have this
resource rather than flour sacks or
eggs for the students lo take home
and care for like a baby.
W e will not be sending out our
membership books this year. We
will send a copy o f last year’s book
with updated addresses and phone
numbers to be published in the
Bulletin as received.
The Holiday Joint D inner’s Raffle
Basket made a profit o f $188.00.
Thank you for your gifts to the
Y W CA Shelter. M any gifts made
their holiday planning easier and the
w om en’s gifts are used during the
year.
Program possibilities exist in the
spring. A M aster Gardener program
at a local nursery' and a financial
meeting for medical spouses are to
be decided upon. Call me at 9227233 to express interest and to
provide further topic ideas.■
—N i k k i
C row ley
K 4I
HIGHLINE COMMUNITY HOSPITAL
HEALTH CARE NETWORK
www.hchnet.oro
SEATTLE - EXCELLENT OPPORTUNITIES for BE/BC physicians in the areas of: FAMILY
PRACTICE, GERIATRIC PSYCHIATRY and PEDIATRICS. Enjoy practicing in a progressive
hospital network. Minutes from downtown Seattle, the shores of Puget Sound and the
Cascade Mountains. W e offer state-of-the-art resources, equipment and expertise to provide
outstanding care for your patients. For details, call or write us: Pat Tennent, Highline
Community Hospital Health Care Network, 16251 Sylvester Rd SW , Seattle, W A 98166.
Phone (206) 439-5578 • Fax (206) 431-3930
___________
e-mail: [email protected]______________________________
Additional Holiday
Sharing Card
contributors
Two more contributions were
received for the 1998 Holiday
Sharing Card after the publication
deadline for last month's Bulletin.
M rs. G innie M iller (Ray) and
D r. an d M rs. Ales M atzen au er
should be added to the list o f
contributors.
Thanks to all o f you that partici
pated in the success o f this project.■
Baby Think It Over
dolls very popular
Since November, 1996 we have
purchased and placed 78 "Baby
Think It Over" dolls among ten
schools in Pierce County. The most
recent school was H unt Middle
School at lOtii & Mildred Streets.
Five dolls were delivered December
3 to Claudia Randolph, a home
economics teacher. She was thrilled.
These were purchased with a grant
from lire W SM AA Health Founda
tion.
Our project will continue in 1999
with some o f the money received
from the Holiday Sharing Card and
the basket raffle at the PCM S/
PCM SA Annual M eeting held at
the Sheraton. A big thank you to all
that participated. You are making
this project a success.*
— F ran T hom as
January, 1999
PCMS BULLETIN 19
N e w s b rie fs
Arena
fro m page 11
election, she felt confident she h ad a
chance. W hen the num bers w ere
tallied. D r. Schual-B erke had
d efeated Rep. Jim M cC une w ith
o ver 5 5 % o f tlie to tal votes cast.
T he n ational political clim ate
surely played a role in tlie election,
she noted. “I heard a lot o f com
m ents from people regarding w hat
w as happening in W ashington.
B efore tlie p rim ary , people w ere
sharing a lot o f negative feelings
a b o u t President Clinton. B u t after
th e primary', the m ood changed.
V oters w ere saying, ‘Enough! I
w o u ld n 't vote fo r a R epublican for
an y th in g 1' W hile she h a d already
developed a strong base o f m oderate
voters “w ho voted fo r m e because I
w as tlie better candidate, there w ere
certainly a large num ber o f voters
w ho m arked m y nam e on tlie ballot
because o f tlie C linton issue,” she
said.
D r. Schual-B erke applauds her
h usb an d , also a physician, and her
children for their strong support
th ro u g h o u t h er cam paign. “ I feel
very' fo rtu n ate,” she said. M y
children are excited and tlie process
has been an excellent learning
experience for them . A s for my
h u sb a n d ...it’s hard to find tlie w ords
to explain how g reat h e ’s been.
A fter tlie election, 1 turned to him
and said, “T hank you fo r m aking
this so easy for m e.” A nd he
responded, “T hank you for making
this so easy o n m e.” Friends and
peers have w arned her, however,
th at the strain and stress o f w orking
in O lym pia can take its toll, even on
the strongest o f m arriages. “The
hours are long, tlie sessions can be
grueling and there is a lot o f
p ressu re involved.” She feels
how ever, th a t her background as a
physician will prep are her w ell for
the clim ate in O lym pia. “ I’m used
to being in situations w here m aking
See Arena, next column
20
PCMS BULLETIN
January, 1999
1998 Physician
Directory changes
M um taz, M u n aw ar, M D
C hange address to:
3611 S “D ” St, #5
T acom a, W A 98408
Phone: 756-8562
FAX: 475-8340
S tringfellow , S teven , M D
C hange address to:
2420 S U nion #100
T acom a, W A 9 8 405-1306
U tt, T errill, M D
C hange address to:
16515 M eridian E, # 105A
Puyallup, W A 9 8 375-1607
Phone: 770-7600
FAX: 435-8190
W right, R o b e rt, M D
C hange address to:
102-A 23rd A ve SE
Puyallup, W A 98372
Phone: 840-1999
FAX: 445-4125 ■
Arena
decisions under pressu re is critical.”
Is this tlie beginning o f a long
political career? “W ho k now s?” she
responded. “Since I stopped p ractic
ing m edicine in 1992, my life has
felt like a house. I w alk from room
to room and if 1 see som ething in
one o f tiiosc room s I like, I stay
there. I f I d o n ’t, I m ove on to
another room .” A s for tlie room
sh e’s in right now ... “ I’m anxious to
get to w ork in O lym pia and I ’m
looking forw ard to establishing
m eaningful public policy,” she said,
w ith particu lar em phasis on health
care. “There are m ultiple aspects o f
health care in need o f attention. T he
physicians and patients need to take
back control o f their care. 1 plan to
do som ething ab o u t it.”*
Applicants for
membership
Jaco b s, Jeffrey M ., M D
P ed iatric A llergy & Immunology
P ractices a t Pediatrics Northwest.
316 M L K Jr W ay, #212. Tacoma
9 8 4 0 5 ;3 8 3 -5 7 7 7
M edical School: University of
M iam i School o f Medicine
Internship: C hildren’s Hospital,
O akland C A
R esidency: C hildren’s Hospital,
O akland C A
F ellow ship: N ational Jewish
M edical an d R esearch Center
H w an g, A ndrew S., MD
P sychiatry
P ractices a t 2201 S 19th St., #201,
T acom a 98405; 627-8680
M edical School: Seoul National
U niversity
Internship: Allegheny General
H ospital
R esidency: Univ. o f Minnesota
Fellow ship: Univ. o f Minnesota
Schoenike, Sum ner L., MD
P ediatries
P ractices a t Lakewood Pediatrics,
7424 B ridgeport W ay W, #203,
T acom a 98467; 581-2111
M edical School: Baylor College of
M edicine
Internship: University o f Texas
Residency: Phoenix Affiliated
H ospitals
Residency: Oregon State Hospital ■
J lfle r
lyreciit
\\
V r ~ =g^ 3 - J - 7
think
o f u i.
|
§
1
|
§
I Union Avenue Pharmacy & |
|
Corset Shop
|
Si
|
Formerly Smith's Corset Shop
2302 S. Union Ave 752-1705
|
|
C ollege o f M edical E du catio n
COLLEGE
MEDICAL
Cardiology CME
scheduled for
January 22,1999
The College’s fourth annual pro
gram featuring subjects on cardiol
ogy for tlie primary care physician
will be held on Friday, January 22.
Tlie course director is Marilyn
Pattison, MD.
This year’s conference will focus
on improving outcomes from pre
vention to end o f life and will fea
ture top quality national speakers.
This program is scheduled for tlie
new Lagerquist Conference Center
at St. Joseph Medical Center and
will address tlie following:
M ariner's Spring Training CME set;
air and h o tel reservations urged
The second CM E & M ariner’s
Spring Training course in Phoenix
is open for registration. The actual
course is on tlie mornings o f M arch
4-6. R ich a rd H aw k in s, M D is the
program director.
A program brochure that details
planning for travel and hotel logis
tics w as mailed in December. Tlie
brochure also includes a CM E
schedule and registration inform a
tion. Please call tlie College at
(253) 627-7137 if you need a bro
chure.
The Cactus League schedule has
been finalized and it appears the
M ariner’s will play on their home
field in Peoria on M arch 4 and 6
and in M esa (across Phoenix) on
M arch 5.
The College has selected tlie Em
bassy' Suites Phoenix-North for
conference headquarters. Tlie large
and beautiful hotel is conveniently
located close to tlie M ariners Peo
ria stadium and offers reduced and
competitive rates for complete tworoom suites that include a private
bedroom and separate living area
with sofabed. You may make reser
vations by calling (602) 375-1777
and identifying yourself as part o f
the C.O .M .E. group.
Flights to Phoenix during March
often sell out in advance. In order to
assure that we will have seats avail
able for our CM E group, tlie Col
lege block-booked seats on Alaska
Airlines llights to Phoenix.
On W ednesday, M arch 3. we
have seats on two flights in the af
ternoon. On Sunday, M arch 7, we
have seats on two afternoon flights.
Olympus Travel is handling tlie
flight arrangements. Specifically.
MARILYN, is prepared to assist
you in securing these seats. We urge
you to make your travel plans now
as these seats will likely sell out.
Call M arilyn today at 565-1213.■
D a te s
P ro g ra m
B ire c to r(s l
Friday, January 22
Cardiology for Primary
Care
Marilyn Pattison, MD
• Risk Factor Modification in tlie
CHD Patient: Identifying tlie Prob
lem & Achieving Compliance
Wednesday-S unday
January 27-3 1
CME at Whistler
John Jiganti, MD
• Current Technology: Intervention
in tlie CHD Patient and tlie Use o f
Adjunct Therapy
Friday, February 26
Review of HIV
Infections
Alan Tice, MD
Thursday-Saturday
March 4-6
CME & Mariners
Spring Training
Richard Hawkins, MD
Thursday-Friday
March 1 1 - 1 2
Internal Mcdicine
Review
Surinderjit Singh, MD
Friday, April 23
Allergy, Asthma &
Pulmonology for
Primary Care
Alex Mihali, MD
Saturday, May 15
Surgery Update 1999
David Magelssen, MD
Friday, May 21
Law & Medicine
Joseph Jusl, JD
Nicholas Rajacich, MD
• Controversies in Statin Therapy:
Diabetes, Estrogen Replacement
Therapy & Other Factors
• Heart Failure U pdate:If H eart
Disease Isn’t a Terminal Illness,
Why is it the M ost Common Cause
of Death?
For registration information call
627-7137. Early registration is en
couraged as tlie conference is antici
pated lo fill. ■
January, 1999
PCMS BULLETIN 21
P e d ia tr ic ia n s ' G r o u p a d v is e s
a g a in s t o r a l v a c c in e fo r p o lio
T he A m erican A cadem y o f P ediat
rics issued new recom m endations
advising pediatricians to avoid giv
ing oral polio vaccines to infants
an d instead give injections to im m u
nize them again st tlie disease. The
p rofessional group said it w ants oral
vaccines phased out com pletely by
2001 fo r routine vaccinations.
T he new recom m endations call for
the use o f injections o f inactivated
polio vaccine for the first tw o doses
a t tw o an d four m onths o f age. E i
th er tlie injection o r oral form o f tlie
vaccine is recom m ended for tlie
th ird dose, a t betw een six and 18
m onths old, and tlie fourth dose, at
four to six years.
22
PCMS BULLETIN
January, 1999
The new policy is aim ed a t red u c
ing tlie already rare incidence o f p o
lio associated w ith th e oral vaccine,
w hich uses a live virus. It is a
change from one issued ju s t last y ear
th a t said doctors could choose either
injection only o r o ral vaccine only
for tlie four-dose regim en. Tlie
A cadem y said surveys suggest that
m ost pediatricians currently follow
the new policy in im m unizing chil
dren.
A m erican H om e P roducts C o rp .’s
W yetli-A yerst unit m akes tlie oral
vaccine, w hile Rhone P oulenc R orer
G roup’s P asteu r M erieux C onnaught
unit m arkets the injectable version. ■
Reprinted from the Wall Street Journal, J 2/JO/98
Keep some patient
charts indefinitely
Insurance com panies have always
recom m ended th a t inactive charts
be k ep t for five years after a
p atient's death, ten years after tlie
la st visit, an d 20 years after
treatin g p reg n an t women and
infants. A fter a recent court case,
D eY oung v. Providence Medical
C enter, tliere is good reason to keep
ch arts o f som e patients indefinitely
- p articu larly w hen tliere is a bad
outcom e o r any other concern for a
potential claim . Otherwise, tlie 510-20 guideline remains a practical
policy.
F o r m ore inform ation, call
P C M S a t 5 7 2 -3 6 6 7 .*
V .
Classified Advertising
P O SIT IO N S A V A IL A B L E
Tacom a/Pierce C o u n ty o u tp a tie n t
general medical care at its best. Full
and part-time positions available in
Tacoma and vicinity. Very flexible
schedule. W ell suited for career re
definition for G .P., F.P., I.M. C on
tact Andy Tsoi, M D (253) 7529669 or Paul Doty (Allen, Nelson,
Turner & A ssoc.), Clinic M anager
(253)383-4351.
BE/BC in ternist needed for m ultispecialty clinic in Renton/Kent area.
Great opportunity for ambitious
physician to join very successful
physician-owned group. Please for
ward CV to: Don Robertson, Valley
Internal Medicine, 4011 Talbot
Road S #500, Renton W A 98055.
Fax (425) 271-2561.
Seeking BC Fam ily Physician to
join independent, three family phy
sician group. Obstetrics desirable.
Pro-life. Competitive salary and
benefits. Send cover letter and CV
to Jam es A. W ilson, M D , Corner
stone Family Physicians, 5920
100th Street SW #26, Lakewood
WA 98499-2751.
Franciscan M edical G ro u p .
Franciscan Medical Group is a
multi-specialty group practice in the
South Puget Sound area o f W ash
ington. We currently have several
opportunities available for board
certified/board eligible physicians
in all primary care specialties as
well as selected sub-specialties.
FMG is an affiliate o f Franciscan
Health System, a m ember o f C atho
lic Health Initiatives. I f you are in
terested in exploring these opportu
nities, please contact N orm a Larson
at: (253) 539-9702 or fax your CV
to (253) 539-7981. EOE.
M edical C o n su ltan t position avail
able. The State o f Washington, Di
vision o f D isability Determination
Services, seeks psychiatrists to per
form contract services in the Olym
pia, Renton and Spokane area of
fices. Contract services include the
evaluation o f mental impairment se
verity from medical records and
other reports, utilizing Social Secu
rity regulations and rules. Psychiat
ric Medical Consultants function as
members o f the adjudicative team
and assist sta ff in determining eligi
bility for disability benefits. R E
Q UIREM ENTS: C urrent medical
license in W ashington State. Board
Certified desirable. REIM BU RSE
M ENT: $51.83/hr. Interested psy
chiatrists should contact G u th rie L.
T u rn e r, J r ., M D , M PH, Chief
M edical C onsultant at (360) 5864134 or the respective A rea M an
ager: Olympia, Joy Justis (360)
586-4115; Renton, Frances Stine
(425) 430-4811; Spokane, Dale
M cGruder (509) 625-5430.
P ed iatrician. G ro u p H ealth
Permanente is currently seeking two
pediatricians for Seattle-area facili
ties. W e are a well-established
H M O recently affiliated with K aiser
Permanente. Teaching opportunities
m ay be available. Join a dynamic
organization in an area close to rec
reational and cultural activities. For
further information, call 800-5439323 or fax CV and cover letter to
(206) 448-6191. Equal opportunity
employer.
E Q U IP M E N T
U sed M id M a rk 104 fem ale exam
table with heated drawer, $400. Ask
for L aura (253) 627-3159.
O F F IC E S P A C E
L akew ood, m edical space avail
able 11/01/98. Two suites 750
square feet each. One suite 2900
square feet. M ultiCare Urgent Care
leaving space which has been occu
pied by an urgent care facility since
1980. Building is a medical-dental
facility next to Albertsons. 8509
Steilacoom Blvd. Call Dr. Ken
Ring at 584-6200 or 582-5856.
M edical office space to sub-let.
Furnished. Prime Gig H arbor loca
tion. Perfect for a specialty p rac
tice. Call for details. (253) 8489484.
New office space available. Up to
4500 sq. ft. W ill finish to suit. On
Union Avenue. Close to hospitals.
Convenient parking, ground level.
Call Robin at 756-2182.
GENERAL
S portfishing enthusiasts w anted:
Come to Sitka, Alaska for a
“Sportfishing Adventure o f a Life
time." We offer worry-free
sportfishing packages. Quality
gear, personalized service. Satis
faction guaranteed. W e cater to
M edical/Dental Professionals. Call
N O W for more information.
D enny’s Guide Service 888-8473659 (toll-free).
F ound: U niversity of U tah, 1974
class ring. Initials KMW. Please
call Deputy John Jimenez, 7984200.
T A C O M A /P IE R C E C O U N TY
O u tp a tie n t G eneral M edical Care.
F u ll an d part-tim e positions
available in Tacom a a n d vicinity.
V ery flexible schedule. Well suited
for ca reer redefinition for
G P, F P , IM .
C ontact Andy Tsoi, MD (253) 752-9669
or Paul Doty (Allen, Nelson, Turner &
Assoc.), Clinic Manager (253) 383-4351
January, 1999
PCMS BULLETIN 23
We’re Here to Help You
A s your practice grows or changes, you can count on
Physicians Insurance to help. In fact, our underwriting depart
m ent processes more than 90 percent of all requests within two
business days of a call or letter.
For specific practice dilemmas, risk management representa
tives are here to help you in person, by phone, and by letter.
And if you should experience an adverse outcome or patient
reaction, you can call our local claims experts for quick and
dependable advice.
As physicians, clinics, and hospitals have known since 1982,
Physicians Insurance consistently responds to your insurance
needs quickly, efficiently, and w ith attention to detail.
W estern W ashington
1-800-962-1399
i“» 96M3T"
V
_
P k T r c i r ’i o - n c
Ily M L id llb
■ Insurance
E
X
C
H
A
N
G
E
ra ile d ,ind sponsored by tin;
Seattle. WA © WSP1A 1997
W .is Jiin ty w i Su iic Ntedical A s o c ia l ion
Pierce County M edical Society
2 2 3 T acom a Avenue So.
T acom a, WA 9 8 4 0 2
Return service requested
24
PCMS BULLETIN
January, 1999
BULK RATE
U.S. Postage
PAID
Tacoma, WA
Permit #605
■ —^
B
u l l e t in
February, 1999
Inside:
3
5
7
11
11
12
13
"E ffective P h y sic ia n O rg a n iz a tio n s ," a r e c a p fro m th e B o a rd o f T ru s te e s R e tr e a t
P h y sician s a n d I n s u r a n c e C o m p a n ie s W o rk in g T o g e th e r ? - r e a d w h a t th e M e d ic a l D ire c to rs h a v e to say
I n M e m o ria in : C le tu s I. S te v e n s, M D r e i n e m b e r d b y fr ie n d a n d c o lle a g u e T h o m a s S k rin a r, M D
P h y sician s I n s u r a n c e su g g e s t to k e e p so m e c h a r ts in d e fin ite ly
D rs. M u n i P a ttis o n a n d S tu a r t F a r b e r s e le c te d to p a r tic ip a te in e n d -o f-life c a r e tr a in in g p ro g r a m
M ed ical M a r iju a n a - In itia tiv e 6 9 2 , q u e s tio n s a n d a n s w e rs
A pril G e n e r a l M e m b e rs h ip M e e tin g - A n d y D o la n , J D , P h D w ill e n te r ta i n a n d e d u c a te
PCMS Bulletin
P C M S O ffic e rs /T ru s te e s :
L a w r e n c e A . L a r s o n , D O ................................P r e s id e n t
C h a r l e s M . W e a th e r b y , M D .............P r e s id e n t E lc c t
M a r ily n E . P a t t i s o n , M D ................... V ic e P r e s id e n t
P a tr ic e N . S te v e n s o n , M D
J a m e s M . W i l s o n , J r., M D ............... P a s t P r e s id e n t
M ic h a e l J, K e lly , M D
M a r i a J. M a c k , M D
J- J a n i e s R o o k s , J r ., M D
S u s a n J. S a lo , M D
E d w a r d I. W a lk le y , M D
BULLETIN
W S M A R e p re s e n ta tiv e s :
P a s t P r e s id e n t: P e te r K . M a r s h , M D
S p e a k e r o f th e H o u s e : R ic h a r d H a w k in s , M D
T r u s te e : D a v i d E . L a w , M D
E x e c u t i v e D i r e c t o r : D o u g la s J a c k m a n
C o m m i t t e e C h a ir s :
A g in g ,R ic h a rd W a ltm a n ; A I D S , L aw re n ce S ch w artz;
B y la w s , S tan ley T u ell; B u d g e t/F in a n c e , P a tric e
S tev en so n ; C o lle g e o f M e d ic a l E d u c a tio n , W . D ale
O v c rfie ld ; C r e d e n t i a l s , S u sa n S alo; E m e r g e n c y
M e d ic a l S t a n d a r d s , T ed W alk ley ; E th ic s /
S t a n d a r d s O f P r a c t i c e , D a v id L u k e n s; G r ie v a n c e ,
Ja m e s M . W ilso n ; L e g is la tiv e , W illia m M a rs h ;
M e d ic a l- L e g a l, P a t D o n le y ; M e m b e r s h ip B e n e fits ,
In c ., D re w D e u ts c h ; P e r s o n a l P r o b l e m s O f
P h y s ic ia n s , R o b e rt S a n d s; P r o g r a m , M a rily n
P a ttiso n ; P u b lic H e a lth /S c h o o l H e a lth , L aw re n ce
S c h w a rtz ; S p o r ts M e d ic in e , Jo h n Jig an ti.
T h e B u lle tin is p u b lis h e d m o n th ly by P C M S
M e m b e rs h ip B e n efits, Inc. for m e m b e rs o f the P ierce
artic le s a n d p la c in g a d v e rtise m e n ts in T h e B u lle tin are
th e 15 th o f th e m o n th p re c e d in g p u b lic a tio n (i.e.
O c to b e r ] 5 for th e N o v e m b e r issue).
T h e B u lle tin is d e d ic a te d to th e a rt, sc ien ce an d
d e liv ery o f m e d ic in e a n d th e b e tterm en t o f tlie h e a lth
a n d m e d ic a l w e lfa re o f th e co m m unity. T h e o p in io n s
h e re in a re th o se o f th e in d iv id u a l co n trib u to rs a n d do
n o t n e c e s sa rily reflec t th e o fficial p o sitio n o f the
M e d ic a l S ociety . A c c e p ta n c e o f a d v e rtisin g in n o w ay
c o n stitu te s p ro fe s sio n a l a p p ro v a l o r e n d o rse m e n t o f
p ro d u c ts o r se rv ices ad v ertised . T h e B u lle tin an d P ierce
C o u n ty M e d ic a l S ociety re se rv e th e rig h t to re je c t any
advertising.
E d i t o r : D a v i d S . H o p k in s M D
M a n a g i n g E d i t o r : D o u g la s J a c k m a n
E d i t o r i a l C o m m i t t e e : D a v id S . H o p k in s , ( C h a ir )
A d v e r t i s i n g R e p r e s e n t a t i v e : T a n y a M c C la in
S u b s c r ip tio n s : S 5 0 p e r y e a r, $ 5 p e r is s u e
M a k e a ll c h e c k s p a y a b le to : M B I
(2 5 3 ) 5 7 2 -3 6 6 6 , F ax 5 7 2 -2 4 7 0
E - m a il a d d r e s s : p c m s w a @ p c m s w a .o r g
H o m e P a g e : h t tp ://w w w .p c m s w a .o r g
2
PCMS BULLETIN
February, 1999
Features
E ffec tiv e P h ysician O rg a n iza tio n s ............................
P h ysician s & In su ra n ce O rgan ization s to g eth e r? .
T h e In v isib le H an d ... "C apitation".............................
K eep so m e p a tie n t charts in d e fin ite ly .....................
P h ysician s s e le c te d for e n d -o f-life tr a in in g
A ndy D o la n to sp ea k a t A pril M em bership M tg ...
In M y O pinion: by N ich o l Iv erso n , M D .................
3
5
9
11
11
13
17
Departments
In M em oriam : C letu s I. S teven s, M D ......................
H ow to con ta ct sta te, n a tio n a l la w m a k e r s.............
T P C IID U p d a te ..................................................................
PCMSA: T h e P u l s e ...........................................................
A pplicants for M e m b e r sh ip ...........................................
C o lle g e o f M ed ica l E d u c a tio n ....................................
C la ssified A d v e r tis in g .....................................................
7
14
15
19
20
21
23
News briefs
B en B lack ett, M D d isco n tin u e s surgery practice .
F eb ru ary G en er a l M em b ersh ip M e etin g ...........
M rs. P e a r le B askin, d ie s at 8 9 ....................................
M ed ical m arijuana, q u e stio n s an d a n s w e r s
C yb er Stocks to ch e ck o u t .............................................
A re you r co m p u ters rea d y fo r th e year 2 0 0 0 ? ......
A sh ort c o u r se in h u m a n r e la t io n s .............................
On the cover: The beach al Taholah Indian Reservation; Taholah, IPA
6
8
12
16
18
22
Feature
Effective Physician Organizations
A recap o fA n d y D olan's talk a t the P C M S B o a rd o f Trustees Retreat held January 9 at Fircrest G o lf Chib
The Board o f Trustees was so impressed with Mr. Dolan's talk that he has been invited to address the April 13
General Membership Meeting
by Jean Borst
At the PCMS Board Retreat, held
at tlie Fircrest G olf Club on January
9, Dolan shared his views on effec
tive physician organizations and of
fered his less-than-rosy assessment
o f tlie current state o f affairs. While
tlie situation looks bleak, Dolan did
offer some valuable information and
advice about physician organiza
tions and some thoughts on tlie fu
ture. He explored tlie issues that
have most affected physicians in re
cent years and how doctors have, in
turn, responded to those issues. He
addressed what typically goes
wrong in physician organizations
and offered some advice in making
the organizations more effective.
And, he shared his special brand o f
humor and candor that always make
him a welcome guest o f tlie Society.
W hat’s Been G oing O n?
Dolan began his presentation by
reminding tlie audience that many o f
tlie factors affecting physicians to
day are external and basically out
o f their control. “Recent difficulties
with carriers are not something that
originated just within those particu
lar carriers,” he said. “M any o f
those problems come from tlie out
side.” Dolan explained that carriers
are very tight with tlie business
community, a relationship that
originated in tlie 70s and 80s when
double-digit inflation occurred and
rates began to drop. “Carriers be
came saviors in tlie eyes o f the busi
ness community,” he said, but cre
ated problems for tlie medical com
munity. Privatized public health
care programs like Medicaid and
Medicare resulted in carriers having
more buying power and greater
clout in tlie marketplace. “Tlie gov-
ermnent is now coming on
board to increase that buying
pow er,” he added.
There are oilier external
factors currently affecting
physicians as well. Two m a
jo r competitors are vying for
health care dollars - hospi
tals and alternative medicine
providers. Physicians more
than ever need to be active
and involved, as well as pre
pared for tlie changes ahead,
because both factions will
have a dram atic impact on
Hie amount o f money avail
able in tlie health care sys
tem.
As a result o f these trends,
numerous complications
have arisen. Dolan cited four
major categories:
M e rg e r m ania. “Hospitals
and carriers are aggregating
their market pow er,” he said,
citing such examples as
Regence and Multicare.
“Physicians feel constrained
to sign on because o f tlie
sheer size o f these organiza
tions.”
R eg u lato ry Costs. Dolan
said regulatory costs are be
coming increasingly high.
“Putting together a deal now
is so complex. Everything
you do costs m ore.”
Intellectual C apital. “As
tlie complexities o f tlie world
increase, acquiring intellectual
capital is needed, but is sim
ply not possible for small or
ganizations,” Dolan re
marked, adding that intellec
tual capital is really only gosee "Dolan " page 4_______________
Pictures from the Board o f Trustees Retreat:
Top: Jim Rooks, center, fixes Dr. M ark Gildenhar's
glasses white Dr. M ike Kelley looks oil.
Center: From left, speakers Drs. R. Campbell
McIntyre, A rt Sprenkle and Don Storey talk with Dr.
Richard Hawkins after their presentations
Bottom: Drs. Jim Rooks, Maria M ack and Mike
Kelley visit during the break
February, 1999
PCMS BULLETIN 3
Feature
Dolan
fro m page J
ing to be available to larger organi
zations.
C a p ita tio n . “ W hile the issue is
still brew ing, capitation really
h a sn ’t happened as expected,”
D olan rem arked. “A nd it’s because
doctors m ade too m uch m oney from
cap itation in the eyes o f the c a rri
e rs .” H e anticipates that a lot o f
carriers will go b ack to deep dis
counted fee-for-service.
A s a result o f the above occur
rences, a num ber o f different sce
narios have em erged. F or the m ost
p art, D olan noted, physicians have
tried to link up in one w ay or an
other, and have generally chosen
from one o f four paths:
D o c to rs h av e gone to la rg e r
g ro u p p ra c tic e s and sm aller groups
merged. T he establishm ent o f group
practices '‘w ithout w alls” has in
creased and those m ergers have en
abled physicians to retain som e re
gional autonom y w hile reaping
som e o f the regulatory advantages
o f m erging.
P ra c tic e s a r e linking m o re to
n e tw o rk s (prim arily IPA s and
PH O s). “T he big question now ,”
D olan said, “is will physicians who
belong to these operations allow
them to negotiate all their contracts?
I get calls all the tim e from physi
cians w ho are upset ab o u t contracts
th ey ’ve received from carriers, b u t
th ey ’re uncom fortable saying no.
T he only w ay lo get a better deal is
to say no. B ut typically, carriers
know you w o n ’t do that. It’s likely
these terrible battles will continue,”
D olan said. “It’s getting personal
now , and I anticipate the contracts
will g et w orse.”
P h y sician s w e n t to w o rk fo r sys
tem s. T hese are typically hospitals
but n ot in all cases.
P h y sician s sta y e d in sm a lle r
p ra c tic e s w ith the intention o f w ait
4
PCMS BULLETIN
February, 1999
ing o u t the storm . “I d o n ’t think
there is a gleeful fu tu re ahead for
sm aller p ractices,” D olan said, “It’s
clear th a t the system is going to fa
vor bigger o rg an izatio n s.”
Feeling th e F a llo u t
R egardless o f w hich path they
have chosen, physicians in all types
o f practices and organizations are
feeling fallout - in one w ay or an
other.
C onflicts. “T here are huge con
flicts betw een the prim ary care and
specialty care com m unities,” D olan
pointed out. “A nd diere has been
very little sensitivity' to those con
flicts as m ixing the tw o groups has
occurred w ithin large o rganiza
tions.” D olan also expressed special
concern for ongoing conflicts b e
tw een doctors and hospitals. “ W hen
a hospital goes o ut and negotiates a
contract, it’s negotiating tw o com
ponents - the am ount o f m oney
th a t’s going to com e from the payer
for physician services and the
am ount o f m oney th at com es to the
hospital for hospital services. Is
there a conflict o f interest there?
Yes! Am I troubled ab o u t it? I’d be
less troubled if the hospitals w ould
stop denying it an d acknow ledge the
conflicts and create appropriate
structures o f dealing w ith them .”
C o r p o r a te C u ltu re S hock. P hy
sicians lost a trem endous am ount o f
autonom y in joining larger groups,
D olan noted. “ Before, physicians
were large frogs in sm all ponds,
then they becam e tadpoles in the
ocean.” And it’s m ore than business
autonom y that w as lost...financial
and clinical autonom y faded as
well.
Additionally, m any physicians
have sim ply had difficulty “getting
along.” In larger organizations,
D olan said, “going along to get
along is expected and th a t’s difficult
for a lot o f physicians. People w ho
went to medical school w ere not
typically ones to get along and
m any have to overcom e their n atu
ral im pulses to m arch to their own
d ru m m er.”
A s a resu lt o f these shifts in larger
organizations an d dealing with the
dram atic changes in the way they
p ractice m edicine, D olan has heard
a lot o f grum bling front physicians.
“Physicians a re not prepared for
co rp o rate culture change and many
ten d to do a lot o f complaining
ab o u t it.
In te r p e r s o n a l conflicts. What if
a physician doesn’t ever get the
h ang o f “getting along” within these
organizations? Recurring interper
sonal conflicts w ill eventually result
in term ination. B lack marks will go
on th e p hysician’s record; future
em ploym ent could be jeopardized
an d could eventually lead to being
p u t o ut o f practice. “Disruptive
physicians are becoming more
p revalent as a result o f the increas
ing p ressu re th ey ’re facing to con
form to ,” D olan said.
In c re a s e d o v erh ead . “One of the
reasons physicians go into larger
g roups is to have access to experts,”
D olan noted. A s a result, overhead
increases.
N ow W h a t?
“W ithout exception, I counsel
people to get into larger groups,”
D olan stated. “C arriers will cause
g reater problem s if you’re not in a
larger group. A t issue, then, is mak
ing a successful shift to these
groups. D olan shared the following
advice fo r selecting groups to join
and colleagues to link up with.
P ic k G o o d People!
P ick people w ith clinical experi
ence. (m ost im portant)
Pick people w ho are attractive to
patients
Pick people w ho are professionally
m alleable (m ost overlooked)
P ick people w ho are likable
P ick people w ho are sm art enough
to g et along in the New World
see "D olan"page 20___________________
/
Feature
Physicians and Insurance Com panies Working Together....
Can it Happen?
Medical Directors discuss their views o f the
state o f medicine with the Board o f Trustees
at the January 9 Board Retreat. The
following highlights their comments.
by Jean Borst
Wearing their “doctor hats” rather
than acting in their administrative
roles, the medical directors o f three
major insurance health plans sat
down at the PCM S Board Retreat
January 9 to discuss how insurance
plans and physicians can work
together.
Drs. Don Storey (Regence), Art
Sprenkle (QualMed) and R.
Campbell McIntyre (Premera)
collectively agreed tliere is no single
solution to the problems that exist
at present. But they also concurred
that “it is time to sit down and begin
a constructive effort to join forces.”
When all was said and done, the
following sentiments were overrid
ing:
►We’re all in business to provide
quality health care, not make a
profit
►Insurance companies are losing
money and relying on their reserves
►We’re all here to work for you not
against you
►We are not the enemy...we are
doctors and consider ourselves part
o f the profession.
Sprenkle kicked off the discussion
with ...well...garbage. While serving
in the legislature in Olympia in the
mid 80s, Sprenkle was involved in
the debate over the construction o f
garbage incinerators in Washington
state. “It was a huge issue, and
there was tremendous conflict
between the sides. The debate
involved excellent people who were
very qualified at w hat they did but
they didn’t trust or like one another.
By sitting down together, we were
able to develop a respect for one and
we eventually got the job down
without building all the incinerators.
It took us a year ju st to develop a
common understanding o f w hat the
issues really w ere and then we
developed a pathway out. The
situation we have here is very
similar only m uch more complex.
I’m cautiously optim istic that we
can begin a constructive, sustained
dialogue among us and at the stale
legislative level.”
Tilings are happening already,
Sprenkle added, citing the recent
formation o f the M edical Directors
Forum o f the Association o f W ash
ington H ealth Plans. “W e’re all
doctors and have practiced in
Washington state our entire ca
reers,” he said. “W e haven’t lost our
credentials or our perspectives.
W e’re exploring a lot o f opportuni
ties to make your lives better.”
Sprenkle noted that efforts are
currently underway to standardize
various issues to simplify proce
dures for physicians.
Don Storey agreed, “Although we
are medical directors, we do con
sider ourselves still a part o f the
profession. W e’re not cut o ff behind
enemy lines. I ’m not saying w e’re
going to agree all the time, but we
still need to sit down together,”
In his experience on the adm inis
trative side o f medicine, Storey
offered what he believes are “not
common” sentiments and opinions o f
providers.
•Discussions o f money are beneath a
professional
•Insurers are evil and a parasite on
the system
•Doctors will do the right tiling if
they are left alone
•Physicians derive much o f their
skill and value from “rugged
individualism”
•W e are professionals; wc don't
need to compete. O ur education,
training and obvious value will
speak for us
•W e are loved by the people. We
will take our concerns/needs to the
press and public opinion will
recti 5 ' the wrongs
•M edical directors are no longer
real doctors and are not one o f us.
“W e are doctors, wc just happen to
have a different specialty.” Storey
noted.
“1 feel as if organized medicine
has not taken the initiative to focus
on professional issues as opposed
to business issues,” Storey said. “A
lot o f conflicts that arise are in
regards to business issues. If
physicians led the high road in
professional issues, tliere would be
less o f a problem.”
Storey also offered his view's on
how physicians in Pierce County
can improve patient care.
♦ Consider entire society as a
patient and work for improved
health o f population
♦ Embrace concepts o f managed
care, such as accountability,
outcome measurements, disease
state management and standards
HEDIS measurements
♦ Embrace the concept o f value=
quality/cost
♦Political involvement for the good
o f the population served
♦ Support peer review' and pressure/
police yourself
♦ Understand and seriously grapple
with the conflicting cthical prinsee "Together" page 6__________________
February, 1999
PCMS BULLETIN 5
Together
fro m page 5
ciples o f beneficence, autonom y,
an d social ju stic e (distributive
ju stice).
W hile quality o f care is u pper
m ost in the m inds o f all the players
in th e m edical profession, R.
C am pbell M cIntyre w orries that
quality is being com prom ised. In a
diagram charting the relationship
betw een quantity' and quality' o f
care, M cIntyre noted th at the
m edical profession is providing too
m uch care and possibly je o p ard iz
ing the quality o f w hat is being
offered. “Things have changed
dram atically in the last five years,
b u t you better hang on for the next
five,” he cautioned. “A lot o f tilings
are colliding right now. A m ong the
entities that arc doing well right
now are the pharm aceutical indus
try, hospitals and dentists. Insurers
and physicians are not doing a t all
w ell.”
P rem era is now at y ear five o f a
dow nturn in profits, M cIntyre
noted. “T hree years dow n turn and
th ree years u pturn is th e norm. W e
are n ot in a survival mode. True,
w e 're a nonprofit organization, but
w e ’re still a business an d need a
bottom line. W e can only go on in
this m ode fo r so long.” Both Storey
and Sprenkle said their com panies
are sustaining sim ilar losses.
In light o f last y e a r’s outcry' over
the R egence co n tract, b o ard m em
bers w ere interested in know ing
w hy insurance com panies are
offering questionable co n tracts and
putting pressu re on physicians to
review , evaluate, sign an d retu rn the
contracts w ithin such a short tim e
fram e. “P erso n ally ,” said D r. M a r k
G ild e n h a r, W S M A R epresentative,
“I feel it's a ploy to pressure
doctors into m aking snap decisions
rather Ilian pu ttin g forth the ‘w o rk
ing to g eth er’ attitu d e th a t w e’re all
trying to g enerate.”
D r. Jim W ilso n , P C M S P ast
President, concurred, adding, “In
general, as doctors w e feel as if
w e’re getting the m essage, ‘H ey, get
used to it. H ie tim es are changing.
Sign the c o n tra ct.’”
I w ill n o t m iss dealing with
insurance com panies and "managed
care."
Storey, w ho agreed th a t the last
Regence contract w as poorly
worded, encouraged physicians to
contact m edical directors in the
future with th eir problem s and
concerns regarding contracts. H e
also rem inded b o ard m em bers th a t
Regence has experienced trem en
dous sta ff turnover in the last 18
m onths and believes the attitude
w ithin the organization is changing.
“W e really are trying to w ork w ith
organizations,” he said.*
HEALTH CARE NETWORK
www.hchnet.org
S E A T T L E - E X C E L L E N T O P P O R TU N ITIE S for BE/BC physicians in the areas of: FA M ILY
P R A C T IC E , G E R IA TR IC P S Y C H IA TR Y and PEDIATRICS. Enjoy practicing in a progressive
Community Hospital Health Care Network, 16251 Sylvester Rd S W , Seattle, W A 98166.
P h o n e (206) 439-5578 • Fax (206) 431-3930
____________________________e-mail: [email protected]
February, 1999
D ear P ierce C ounty Medical
Society Colleagues:
I discontinued the surgical portion
o f m y p ractice at the end o f 1998.1
did th is w ith mixed feeling as I
anticipate m issing the surgical
decision m aking m ost and the
surgery itself second.
HIGHUNE COMMUNITY HOSPITAL
PCMS BULLETIN
Editor's Note: The follow ing letter um
subm itted to the membership o f PCMS
fro m Dr. Blackett
P C M S President, D r. L a r r y
L a rs o n , added th a t he believes the
biggest problem th a t exists to d ay is
th at physicians lack die inform ation
they need to m ake decisions about
insurance com pany contracts.
H+H
6
Ben Blackett, MD
discontinues
surgery practice
I w ill continue with a medical
p ractice consisting o f independent
m edical evaluations and will
continue m y legal practice, which
largely involves medical malprac
tice defense work.
I am yours truly,
W . Ben Blackett, MD
KimMemoir Lam
Cletiuts L Stevens, MD
Steve was the first friend I met when we completed m ilitary service and entered pre-med summer school at
Creighton University (Omaha) in June 1946. W e remained friends until his death on December 30. 1998.
Steve was bom in the very small farming community o f Presho, South D akota on A ugust 29, 1922. His
grade school and high school were all in one building. H is Roman Catholic family had to drive to another
community to attend church. Steve’s strong faith formed the basis o f his character and values and sustained
him throughout his life and in the dying process.
During WWII, Steve served as the pilot o f a B24 with the 389th Bombardment group o f the 2nd Air
Division, commanded by Col. Jimtny Stewart. Steve certainly qualified as a true w ar hero, flying in a set
formation into Germany day after day with m any o f the other B 24’s around him being shot out o f the sky.
His intense loyalty to friends resulted in reunions with his crew as late as 1997 and contact until shortly
before his death.
After the war, Steve did some brief work as a crop duster but decided his luck as a pilot was used up and
quit flying altogether.
Steve graduated from the Creighton University School o f Medicine in 1952, interned in Omaha and
returned to South D akota to practice in Mitchell. He came to Tacom a in 1956 to join me at the Northern
Pacific Beneficial Association group and practiced in Tacom a until his retirement in 1989.
After graduation in 1952, Steve married Loretta Jameson, and they had five children - Christine, Mark,
David, Karen and Kathryn. Steve was genuinely devoted to bis family and the depth o f that relationship
was distinctly expressed by the care and devotion o f his children during the last year o f his life.
Steve was diagnosed with inoperable lung cancer in July 1996 but resolved to truly live in the remaining
days o f his life. Even following chemotherapy and radiation, Steve and Lorrie made several trips. Unfortu
nately, Lorrie w as diagnosed with cancer in M ay 1997 and died in October 1997, a profound loss which
Steve accepted with grace.
Steve epitomized the best o f family practitioners. He enjoyed all aspects o f medical practice, especially
delivering babies and he excelled in the one-on-one relationships with patients, who brought the third
generation in their families for his personal care. Even before CM E, Steve strove to keep his medical
knowledge updated. He was gratified by his associations with all levels o f medical practitioners, who
returned his friendship. H e was one o f the founders o f Puget Sound Clinic, served on many committees in
the medical community and was a Fellow in the Academy o f Family Practice. He was also active in the St.
Ann Catholic Church where he served on the parish council for many years.
Steve was my m ost cherished friend for 52 years. I enjoyed sharing medical practice with him, even more
sharing our family camping, visiting his Presho family, observing his children grow and achieve, but most
o f all ju st being with him.
Steve was a gentle man, wise enough to enjoy his life while demonstrating those old fashioned virtues o f
devotion to family, church, community and his medical practice. I have certainly been blessed by having
been his friend.
T hom as S k rin a r, M D
February, 1999
PCMS BULLETIN 7
N e w s b rie fs
P erson al Problem s
o f Physicians
Medical problems, drugs, alcohol,
retirement, emotional; or other
such difficulties?
Please call:
* R o b e rt S a n d s . ................ ...... 7 5 2 - 6 0 5 6
B ill Dean ..........................2 7 2 -4 0 1 3
F . D e n n is W a ld r o n
‘ C h a ir
, ..,2 6 5 - 2 5 8 4
Allenmore
jffiy Psychological
H M Associates, P. S.
...a m ulti
disciplinary
behavioral
health group
that works
with physicians
------------- , 752-7320 ■
Do you have patients w ith difficult emotional
1530 Union Ave. S.. Ste. 16. Tacoma
TOTAL
4
4
4
4
4
4
T
A
M
R
I
A
ASSE T MANAGEMENT, INC.
OTAL OBJECTIVITY
PERSONA L ADVISOR
A N A G EM EN T
EGULAR
VALUE
EDUCATION
NTEGRTIY & EXPERIENCE
BETTE R
IDEA
CALL
8 8 8 - 4 - TAM - RIA
o r v i s i t o u r w e b s i l e (a>.
4 - T A M - R1A.CO M
David J. Roskoph, MBA, CFl*
Re g i s t e r e d I n v e s t me n t Ad v i s o r
February m em bership meeting how to savor your work as a physician
D avid G rube, M D , w ill be th e speaker a t the February
G eneral M em bership M eeting, T uesday, February 9 at the
L andm ark Convention C enter in Tacom a.
D r. G rube will entertain an d inspire you with anecdotes
an d illustrations th a t w ill help you really enjoy your work
as a physician. H is to p ic will be “H o w to Really Enjoy
Y o u r M edical P ractice.”
Since 1977, D r. G rube has been a fam ily practitioner at
the Philom ath Fam ily M edical C linic in Philomath. Or
egon. H e g raduated from Lew is and C lark College in
Portland and w ent on to the U niversity o f Oregon Medical
School w here he received his m edical degree. From 1974
to 1979 he served w ith the U .S .P H .S . National Health
Service C orps in G ran d Coulee, W A and in Philomath,
OR.
Dr. G rube has received num erous honors, and has many
affiliations. A m ong them are serving as President (1990)
P resident-E lect, Speaker, H ouse o f Delegates, ViceS peaker and B oard o f D irector (1980-83, 1989-Present)
for the O regon A cadem y o f Fam ily Physicians. He has
been a m em ber o f the B enton C ounty M edical Society
since 1977, serving as P resident in 1980. H e served as a
clinical in stru cto r for the O regon H ealth Sciences Univer
sity, D epartm ent o f F am ily M edicine from 1973-79 and
as a clinical associate professor since 1993.
D r. G rube adm its th a t his part-tim e speaking career
w as a direct result o f recognizing th at so many o f his per
sonal physician friends seem ed unhappy. H e couldn't un
derstand w hy physicians in the richest country' in the
w orld, w ith the g reatest resources, blessings left and right,
and w onderful new diagnostic and treatm ent options,
w eren’t h appy an d enthused ab o u t their profession. Be
ginning w ith a “slide show ” o f clinic bloopers for an of
fice C hristm as p arty and m oving to a “hum or” talk at the
O regon A cadem y o f Fam ily P hysicians, Dr. Grube says
his program has “grow n an d m utated.” It is often called:
“Bones Set, B lood Let, W ounds Patched, Babies
H atched.” H is goal is sim ple, taking notes and anecdotes
from his daily practice, including quotes from other prac
ticing physicians, incorporating m edical cartoons and
new spaper blunders, he tries to m ake people laugh by rec
ognizing the fact that the beginning o f growing (maturity)
is th e ability to laugh a t ourselves and to see how funny
w e are. A p a rt o f w h at he offers is reminders that we must
not only tak e care o f patients, b u t also take care o f our
practices and, especially, ourselves; thus he attempts to
rekindle th e origins o f m otives fo r entering into medicine.
M ark y o u r calendar for an entertaining and enjoyable
evening w ith y o u r co lleag u es.!______________ _________ _
8
PCMS BULLETIN
February, 1999
Feature
The Invisible Hand.....
"Capitation"
The same man cannot be well skilled in everything; each has his special excellence.
Euripides (c. 450 BC)
by Andrew Statson, M D
A few days after the recent election
President Clinton stated that the
items on the Patients’ Bill o f Rights
will have high priority during the
next legislative session. “We have
to ensure that medical decisions are
made by doctors, not by accoun
tants,” he added. Commissioner
Senn said pretty much the same
tiling a few months ago - “Doctors
should make the decisions about
health care with their patients. The
decisions should not be made by
those who are economically in
vested.” So far there has been no
mention about capitation and it re
mains politically correct. W hen the
inevitable abuses occur and come to
the surface that tune will change.
Capitation was introduced in Brit
ain some fifty years ago and worked
quite well, at least at the beginning.
Long waiting periods for hospital
and other specialized services were
not unusual, such as three months
for a mammogram in the presence
of a breast mass, six months for
colposcopy in the presence o f an ab
normal Pap smear, two years or
more for hernia repair or hysterec
tomy. That brought about private
insurance and private hospitals
where people who could afford the
price would bypass the N H S. The
backbone o f the capitation system
was tlie network o f office based
general practitioners. That has re
mained intact until now but is show
ing signs o f strain. There is a plan
to integrate die general practitioners
into primary care groups. They will
have to leam on their own whether
groups can be managed more efficiently than private offices. A t die
A ndrew N. Statson, M D
same time a debate is evolving on
the issue o f rationing health care.
This all means that capitation is no
longer able to control costs. Britons
are no longer satisfied with die care
they are receiving if diey ever were.
Capitation worked in Britain be
cause the British are a disciplined
and traditionalist people. France
wisely did not choose that system. It
would not have worked there. The
French are a very independent
minded people, distrustful o f audiority. Even though in a different
sense, so are die Americans.
Capitation presumes people are
going to sign up widi a physician
who will follow them for many
years. Changing physicians in
creases costs because o f duplication
o f services. Every physician has to
know enough about a patient to
make a diagnosis and offer treat
ment. The quality o f care also suf
fers because it is impossible to leam
as much about a patient in one or
even a few visits as someone who
has treated him for years would
know. In diis country, however, p a
tients frequently go from physician
to physician, looking for die answer
to dieir problem, until they obtain
satisfaction. Frequently enough diey
are right in doing so. The idea o f a
magnetic card containing die entire
medical record o f a patient was
kicked around. H ow often do you
diink die patients would bring it
widi diem when diey came for care?
How complete and reliable do you
diink it would be?
The economic benefits o f capita
tion derive front the long term care
o f a patient by die same physician,
but there also is die subtle effect o f
die financial incentive to keep costs
down. For a variety o f reasons pa
tients change physicians frequently.
They move, diey change jobs and
insurance plans, or they simply con
sult different physicians for differ
ent problems. “W e don't have pa
tients, our patients have physi
cians,” one o f my attendings used to
say. Since long term care is not
such a big factor in actual practice,
die financial incentive becomes the
major player in keeping costs down.
Life in society brings about eco
nomic progress dirougli joint effort,
specialization and mass production.
Specialization is in fact a natural
process. The immense variety o f
biological organisms, each function
ing it its own niche, is the obvious
result. In areas o f low population
density, such as the American fron
tier, people had to make do. Even
then some people were better with
the hammer than with the sickle. As
the population density increases
people drift into the roles diat feel
comfortable.
hi diis respect, capitation is a step
backwards. It puts us in the role o f
an insurance company. Pricing the
product requires actuarial skills and
market knowledge. These are the
job o f insurance companies. There
are two possibilities here. Either we
will be able to assume this role suc
cessfully and eventually bypass the
insurance companies which will have
to leave the business or we will fail
and go out of the capitation business.
see "Capitalion"page II)
February, 1999
PCMS BULLETIN 9
N e w s b rie fs
Capitation
fro m page 9
My bet is on the latter.
Insuring risk is a serious business.
The specialists in the field, the major
insurance companies, have been
wrong 011 many occasions in assessing
risk. Probably all of them have under
written some risks where they under
estimated costs and lost huge amounts
of money. Examples of such judgment
errors in capitation contracts are be
ginning to appear. Already some
medical groups and probably indi
viduals have lost a lot of money on
capitation gambles. For instance one
common problem with pediatricians
and internists is the adverse patient
selection. People who select them do
so because of a chronic condition that
requires their expertise. Yet they are
considered primary care providers for
die purposes of capitation.
Risk assumption is one problem
with capitation. The conflict of inter
est issue and the malpractice exposure
that goes w ith it is even worse. We
can be wrong in evaluating a patient
and miss a significant problem. Fail
ure to diagnose breast cancer for in
stance is one of the highest loss items
in liability insurance. However, failure
to diagnose in the presence of a finan
cial incentive lo deny care or not to
spend enough lime with a patient can
be very difficult to defend.
In some short term studies capita
tion has been shown to reduce health
care costs. Physicians have some lee
way in choosing cheaper medications,
tests or treatments. Most of the time
they would be correct in doing so.
However, if something should go
wrong they have made themselves
open to attack both for error of medi
cal judgm ent and for the financial
conflict of interest. This system may
have worked in Britain for some time,
but even tliere it seems to be in
trouble. With American patients I am
afraid it is a dangerous experiment
and some of our colleagues are going
lo get liurt.a_______________________
10
PCMS BULLETIN
February, 1999
Mrs. Pearle Baskin, arts backer and
widow of Dr. Lester Baskin dies at 89
P earle B askin, long tim e supporter
o f the arts in T aco m a died in D e
cem ber al the age o f 89. M rs.
B askin w as th e w idow o f D r. L ester
B askin, w ho w as a long tim e P C M S
m em ber. D r. B askin served as
president o f the Society in 1972; he
died in 1978.
The Baskins w ere active su p p o rt
ers o f the T acom a Philharm onic and
the Seattle Sym phony. T hey helped
secure the old N ational B ank o f
W ashington building a t 12th and
Pacific for the T acom a A rt M u
seum . T he m useum has a gallery
nam ed in honor o f Dr. Baskin.
M rs. B askin m et her husband in
1929 w hile both w ere attending the
U niversity o f Illinois. They married
in 1931 and moved to Tacoma in
1933. D r. B askin accepted an in
ternship a t W estern Clinic where he
began his career as a distinguished
p hysician and surgeon.
In 1975, G overnor D an Evans
honored D r. B askin with the
G overnor's A rt A w ard for his con
tributions to the arts in Tacoma. ■
t / g v C.ban Air for Kids
—
Ast hma Prevention Program
Do you have patients in your p ractice with asthma?
The Clean A ir fo r Kids Program provides trained volunteers
who can assist families and medical providers with
•
a comprehensive home assessment to help identify
•
practical recommendations to reduce asthma triggers and
•
a w ritten report of the assessment and recommendations
environmental triggers of asthma
improve home air quality
to th e medical provider
Volunteers do not give medical advice, and would welcome
re fe rra ls from medical providers. The service is free. To make
a re fe rra l, or to get more information about the program,
contact Sarah Curran at (253) 798-2954.
Clean A ir fo r Kids is a partnership of the American Lung Association of Wash
ington, Tacoma Public Schools, University o f Washington, Puyallup Tribal
Health A uthority, Washington S t a t e Department o f Health, M ary Bridge
Children's Health Center, and The Tacoma-Pierce County Health Department
which is dedicated to helping people learn more about ways to reduce asthma
and health risks from pollutants in th e ir home.
Physicians Insurance suggests to keep som e charts indefinitely
Editor's Note: the following information is
from "Physicians Risk Management
Update"published by Physicians Insurance
Exchange and recommends a change in
how long lo keep patient records.
In the recent case DeYoung v.
Providence Medical Center, the
Washington Supreme Court voted
5-4 to void an eight year statute o f
repose for medical malpractice
cases. The statute was declared
unconstitutional because the court,
in a very troubling opinion by
Justice Madsen, found that the
statute affected so few claims that
there was no rational basis for the
legislation. Also in the majority
were Justices Dolliver, Smith,
Johnson and Sanders.
Justice Alexander, joined by C hief
Justice Durham and Justices Guy
and Talmadge, wrote a very concise
dissent. He pointed out that “stat
utes o f repose are justified because
they guard against untrustworthy
evidence, stale claims and undue
burdens placed on defendants.” He
went on to state “Sympathy for the
plaintiff...is not enough to compel
this court to jum p into a time
machine and undo w hat was done
by the Legislature 22 years
ago...This court cannot, alter all,
legislate - no matter how admirable
its objectives might be in doing so.”
After this case, it is still the law
that ordinarily an adult patient has
three years to file a malpractice case
or, when the existence o f a case is
not discoverable, the patient has
within one year after it becomes
discoverable. The change is that
there is no longer an eight year limit
in the time to commence a lawsuit.
Now, even if a case is not discov
ered for 15 years, the suit can be
filed 16 years after the treatment.
Say, for example, that in 1989, a
family practitioner sutured a wound
and the patient developed a very
prominent scar. In 1998, the patient
discovered that had the physician
used a different technique, the scar
would have been far less prominent.
Under the old law, the patient
cannot make a claim because the
discovery o f the potential negli
gence was made more than eight
years from the date o f the medical
procedure. However, under the new
law, the patient has 1 year from the
date o f the potential negligence was
discovered. So, the question arises:
How long should physicians keep
inactive medical records?
W e have always suggested that
policyholders keep inactive charts
for 5 years after a patient's death,
10 years after the last visit and 20
years after treating pregnant women
and infants. We have also advised
policyholders that to be absolutely
safe, they should keep inactive
charts indefinitely. After the
DeYoung case, policyholders may
w ant to be safer. N ow there is good
reason to keep charts o f some
patients indefinitely - particularly
when there is a bad outcome or any
odier concern for a potential claim.
Otherwise, our 5-10-20 guideline
remains a practical policy . ■
Drs. Pattison and Farber selected to
participate in end-of-life care program
D rs. M im i P attiso n , Gig H arbor
Internist and S tu a rt F a rb e r,
Tacom a Family Physician, were
among 270 physicians selected to
participate in a new program being
launched by the AMA's Institute o f
Ethics aimed at helping physicians
improve end-of-life care provided to
their patients.
The Education for Physicians on
End-of-Life Care or EPEC Project
will education physicians in essen
tial clinical competencies in end-oflife care, including palliative care,
ethical decision making, symptom
management, communication skills
and psycho-social issues.
The EPEC curriculum, which has
been designed with input from n a
tionally respected experts in the
field, combines didactic sessions,
videotape presentations, interactive
discussions and practical exercises.
Physicians participating in EPEC
are expected to share the skills and
knowledge they leam with their col
leagues.
"EPEC is very much a train-thetrainer program," Linda Emanuel.
M D, PhD, principal investigator for
EPEC said. "For it to be successful,
participants have to take w hat they
leam and share it with others. W e’re
encouraging institutions and physi
cian groups in Pierce County to
contact these participants after they
have completed the conference to
see about setting up Lheir own train
ing sessions."
In all, approxim ately 450 health
care professionals from around the
world submitted applications to
participate in EPEC. The first o f
four EPEC regional conferences
took place in mid-January in Phoe
nix. Others will follow in Atlanta.
Chicago and Boston in February
and March.
"We wish we could have taken
every applicant, they were all that
impressive," Dr. Emanuel said.
"But these workshops arc going to
be 'hands-on’ and highly interactive.
For that to happen, we had to limit
the physicians participating."*
February, 1999
PCMS BULLETIN 11
New s briefs
M edical M arijuana - Initiative 692, questions and answers
Since the passage of Initiative 692, the Department of Health has received numerous queries from health care providers, pa
tients, and others asking how to obtain, prescribe or, in some cases, get a license to grow marijuana. Initiative 692 allows pa
tients with terminal illnesses and persons with some chronic diseases described in the law to use and possess marijuana once
they've received documentation from their physician. The law protects the physicians and primary caregivers of these patients
against crim inal prosecution and/or penalizing administrative actions. However, a number of questions about obtaining mari
juana for medical use are not addressed by Initiative 692 and remain unanswered.
Q: How do I obtain medical marijuana?
A: Even with the passage oflnitiative 692, marijuana cannot be legally purchased and there is no identified legal way to dis
tribute marijuana. The new law only allows patients (who have written documentation) and their prim aiy caregivers to jointly
possess no more than is necessary for the patient's personal medical use. This quantity must not exceed a 60-day supply.
Q: Is a liccnse available to allow a person or firm to grow or sell marijuana?
A: The initiative did not provide for a legal means of supplying marijuana. Therefore, no license to grow or sell marijuana is
available.
Q: How do I qualify as a patient?
A: According to Initiative 692, for a person to qualify to use marijuana for medical reasons he or she must be 1) a patient of a
licensed medical or osteopathic physician; 2) diagnosed by that physician as having a terminal or debilitating illness mentioned
in the language of the law; 3) a resident of the state of W ashington at the time of diagnosis; and 4) advised by that physician of
the risks and benefits of the medical use of marijuana.
Q: W hat type of documentation do I need to prove that I am a qualified patient?
A: Initiative 692 requires that to qualify' for use of medical marijuana, a patient must 1) have a formal statement signed by the
provider or a copy of medical records, slating that in the physician's professional opinion, the potential benefits of the medical
use of m arijuana would likely outweigh the health risks; 2) have proof of identity, such as a Washington slate driver's license or
identicard; and 3) present valid documentation lo any law enforcement official w ho might question the patient.
Q: Who can be the primary caregiver?
A: Initiative 692 defines primary caregiver as a person who is 1) 18 or older; 2) responsible for the housing, health, or care of
the patient; 3) designated in writing by a patient to perform the duties of primary caregiver; and 4) a caregiver to only one pa
tient at a time.
Q: How do I prove I’m a primary caregiver?
A: A primary caregiver must keep 1) a copy of the patient's valid physician consent form and 2) a written statement designat
ing him or her as primary caregiver. Upon request by a law enforcement officer, the caregiver must be able to present both writ
ten documents.
Q: Will a physician prescribe marijuana for me?
A: Physicians cannot legally prescribe marijuana. They can only advise or not advise its use for your condition as described in
Initiative 692. Physicians, applying professional standards of care, may inform and counsel terminally ill patients and the
chronically ill as to the risks and benefits of marijuana as medicine. ■
A
mcific sports medicine
is pleased to announce the affiliation of
Gurjit Kaeiey, M.D.
Rheumatology
Board Certified- Internal Medicine
Board Eligible - Rheumatology
He welcomes referral of arthritis and osteoporosis patients, as he joins
Dr. Nancy Karr in the Division of Rheumatology at Pacific Sports Medicine.
Please call (253) 572-8326 for appointment.
12
PCMS BULLETIN
February, 1999
VOLVO
SERVICE & REPAIR
(253) 588-8669
www.volvorepair.com
Boyle’s Foreign Car Repair
invites you and your spouse/guest to the
April General Membership Meeting
Tuesday, April 13, 1999
Social Hour:
Dinner:
Program:
Landmark Convention Center
Tem ple Theatre, Roof G a rd e n
6 :0 0 p m
6 :4 5 pm
7 :4 5 p m
4 7 St. Helens A ven u e
Tacom a
“Effective Physician Organizations”
featuring
the always humorous and knowledgeable
Andy Dolan, JD, PhD
Highlights of Mr. Dolan's talk will include:
♦
♦
♦
♦
An overview o f the current state o f affairs
Issues that have most a ffe c te d doctors a n d how they h ave responded
W hat typically goes wrong in physician organizaions
Some suggestions for m aking your p ra c tic e successful
(Registration required by April 9. Return this form to: PCMS, 223 Tacom a Ave S, Tacom a 9 8402; FAX to 5 7 2 -2 4 7 0 or call 572-3667)
Please reserve________dinner(s) at $20 per person (tax and tip included)
Enclosed is my check for $
□
Visa
□
Master Card
or my credit card # is_________________________ _________________
Expiration D a te _________
S ig n atu re____________________________
I will be bringing my spouse or a guest. Name for nam e ta g :_____________________________
Signed:_______________________________________________________
Thank you!
News briefs
F o r additional inform ation about contacting legislators, please contact the M edical S ociety office. W e will be happy
to help y o u d raft letters o r m ake direct contact to legislative leaders regarding issues o f concern. P lease call Doug
Jackm an, E xecutive D irector, 572-3667.
T he statu s o f legislation can be obtained by calling the L e g is la tu re 's toll fre e h o tlin e (800) 562-6000. The hearing
im paired m ay call (800) 635-9993. T he hotline m akes it easy to leave a m essage o r voice an opinion to lawmakers,
even if you don't know their individual telephone num ber. It also provides an easy w ay to learn the status o f a bill,
w hich com m ittee it's before, w hether it's been scheduled fo r a floor vote or survived v ario u s deadlines fo r action. You
m ay also call the hotline to learn the topics, tim e and location o f com m ittee m eetings. A legislative meeting schedule is
published w eekly on T hursday. M ail subscriptions cost $10 per year. F or m ore inform ation o r a subscription form,
call 1-360-786-7344.
Internet users m ay reach the Legislature at: w w w .Ieg.w a.g o v U sers can view legislation and send e-mail to lawmak
ers an d staff. Internet users also will have access to the state constitution, state law s, a list o f legislators and a session
calendar. T he governor's hom e page can be viewed at w w w .w a .g o v /g o v e rn o r
P re s id e n t C lin to n m ay be reached by w riting to him at
the W hite H ouse, 1600 Pennsylvania A ve N W , W ash
ington D .C . 20500; his m essage phone is (202) 4561111. E -m a il: p re sid e n t@ w h ite h o u se .g o v
L e g is la to rs, by d is tric t, O ly m p ia p h o n e n u m b e r and
e-m ail address:
Y o u r U.S. Senators and representatives and state
sen ato rs and state representatives m ay be contacted at
the follow ing addresses and telephone numbers:
S en M arilyn R asm ussen-D , 786-7602
rasm usse_m a@ leg.wa.gov
R ep R oger B ush-R , 7 8 6 -7824 bush_ro@ leg.w a.gov
Rep T om C am pbell-R , 786-7912 Campbell_to@ leg.wa.gov
U .S . S e n a to rs: S e n a to r S lad e G o rto n (R), 730 H art
Senate B uilding, W ashington, D .C . 20510-4701.
Phone: 202-224-3441 (D .C .) or 253-581-1646 (Lake
w ood). Fax: 202-224-9393. E -m ail:
s e n a to r_ g o rto n @ g o rto n . se n ate .g o v
2 5 th D istric t (P u y a llu p , S u m n e r, M ilto n )
Sen C alvin G oings-D , 786-7648 goings_ca@ leg.w a.gov
R ep Jim K astam a-D , 786-7968 kastam a_ja@ leg.w a.gov
R ep Joyce M cD onald-R , 786-7948
in cd o n ald jo @ Ieg . wa.gov
S e n a to r P a tty M u r ra y (D ), 111 Russell Senate B uild
ing, W ashington D .C . 20510. Phone: 202-224-2621
(D .C .) o r 206-553-5545 (Seattle). Fax: 202-224-0238.
E -m ail: se n a to r_ m u rra y @ n riu rra y .se n a te .g o v
2 6 th D istric t (N W T a c o m a , G ig H a r b o r , S o u th K itsap)
Sen B ob O ke-R, 786-7650 senate_26@ leg.vva.gov
R ep P at L antz-D , 786-7964 lantz_pa@ leg.w a.gov
R ep T om HufT-R, 786-7802 huff_to@ leg.w a.gov
U .S. R e p re se n ta tiv e s: R ep . N o rm D icks (D -6th
D istric t), 2467 R a y b u rn H o u se B uilding, W a sh in g to n
D .C . 2 0515. P h o n e: 202-225-5916 (D .C .) o r 2535 9 3 -6 5 3 6 (T a co m a). F ax : 202-226-1176.
2 7 th D istric t (N o rth T a c o m a , E a s t S ide)
Sen L orraine W ojahn-D , 786-7652 wojalm.lo@ leg.wa.gov
R ep R uth Fisher-D , 786-7930 fisher_ru@ leg.w a.gov
R ep D ebbie R egala-D , 7 8 6 -7974 regala_de@ leg.w a.gov
R ep . A d am S m ith (D -9 th D istric t), 116 C a n n o n
H o u se O ffice B uilding, W a sh in g to n D .C . 20515.
P h o n e: 2 0 2-225-8901 (D .C .), 253-926-6683 (T acom a)
o r to ll fre e 888-764-8409. F ax: 253-926-1321.
2 8 th D istric t (W . T a c o m a , U niv. P lace, F irc re st, Lakewood)
Sen Shirley W insley-R , 786-7654 winsley_sh@ leg.wa.gov
R ep M ike C arrell-R , 786-7958 carrell_ini@ leg.w a.gov
Rep Gigi T alcott-R , 786-7890 talcott_gi@ leg.w a.gov
S ta te offices: T he phone num ber o f G o v e rn o r C a ry
L o c k e 's office is 360-902-4111, Olympia. W rite to him
at: Legislative Building, PO Box 40002, Olympia,
9 8 5 0 4-0001. H is F ax is 360-902-4110. H is home page
address is w w w .w a .g o v /g o v e rn o r
29 th D istric t (S o u th T a c o m a , S o u th E n d , P ark lan d )
Sen R o sa Franklin-D , 7 8 6 -7656 franklin_ro@ leg.w a.gov
R ep B rian Sullivan-D , 786-7996 sullivan_br@ Ieg.w a.gov
R ep Steve C onw ay-D , 7 8 6 -7906 conw ay_st@ leg.w a.gov
ton H ouse o f R epresentatives, PO Box 40600, O lym pia
98 5 0 4 -0 6 0 0 . W r ite to s ta te se n a to rs in care o f the
W ashington S tate Senate, PO B ox 40482, O lym pia
98504-0482. T he central Senate F ax num ber is 360786-1999. T he H ouse has no central Fax number.
Sen T racey E ide-D , 786-7658 eide_tr@ leg.w a.gov
R ep M aryanne M itchell-R , 786-7830
initchell_ma@ leg.wa.gov
R ep M ark M iloscia, 786-7898 m iloscia_m a@ leg.w a.gov
14
PCMS BULLETIN
February, 1999
3 0 th D istric t (N o rth e a st T a c o m a , F e d e ra l W ay)
j//
T acom a Pierce County Health D epartm ent
m
T A C O M A -P IE R C E C O U N T Y
HEALTH
D E P A R T M E N T
SatelliteTeleconferences
These opportunities for free continu
ing medical education are sponsored
by the Tacoma-Pierce County H ealth
Department. All teleconferences will
be held at the W illard Resource
Center, 3201 South D Street,
Tacoma.
“Preparing for the N ext Influenza
Pandemic”, February 25, 1999;
10:00am lo 12:30pm. Offered by the
Centers for Disease Control. Epide
miologists agree that the probability
is high that another dangerous new
strain o f the flu virus will emerge.
This teleconference will discuss
guidelines to prepare for the next
pandemic, its anticipated vaccine
shortage and disruption o f social and
community services. Call (253) 7986410 (press “0”) to reserve. Call
early as space is limited.
“Effective STD/HIV Prevention
Counseling for the Busy Prim ary
Care Provider,” M arch 18, 1999;
9:00am to 11:00am. Offered by the
National Network o f STD/HIV
Prevention Training Centers. D e
signed for physicians, ARN Ps, PAs
and nurses who provide care for
persons who have or are at risk for
STDs. Call (253) 798-6410 (press
“0”) to reserve.
“Epidemiology and Prevention o f
Vaccine-Preventable D iseases”,
March 25, April 1, April 8 and April
15,1999. Two and one-half hours
each telecast (times TBA). Offered
by the Centers for Disease Control.
Call (253) 798-6410 (press “0”) to
register. ■_________________________
New Rotavirus Vaccine available soon
hi December 1998, the American
Academy o f Pediatrics Committee
on Infectious Diseases issued guide
lines for the use o f the new rotavirus
vaccine which was licensed by the
FDA in August. Locally, the vaccine
is expected to be available prior lo
mid-year 1999.
Rotavirus is the most common
cause o f severe diarrhea in children
in the United States. Almost all chil
dren have one or more rotavirus in
fections in the first 5 years o f life.
Each year in the U .S., rotavirus
causes 500,000 physician visits and
50,000 hospitalizations. It is highly
infectious. The fecal-oral route is the
most common mode o f transmission
and common source outbreaks with
person-to-person spread do occur.
Clinical manifestations range from
asymptomatic shedding to lifethreatening gastroenteritis with se
vere vomiting and diarrhea. The in
fection is most common in winter.
The new vaccine is called
Rotashield and is a live attenuated
tetravalent vaccine. In four placebocontrolled randomized trials, three
doses o f vaccine gave a vaccine effi
cacy o f 70-95% against severe
rotavirus diarrhea and about 50%
efficacy against any diarrhea caused
by rotavirus. The vaccine is given by
mouth at 2 months, 4 months and 6
months o f age, along with the oilier
routine infant immunizations. The
first dose can be given as early as 6
weeks o f age and the minimum inter
val between doses is 3 weeks. The
first dose is not recommended to be
given to infants older than 6 months
o f age and the m axim um age for
completing the 3 dose series is 12
months. The series should not be
completed if the infant has reached
12 months o f age without having re
ceived all 3 doses. Special efforts
should be made lo immunize prior to
the anticipated annual onset o f
rotavirus disease activity in their lo
cal communities.
Increased rates o f fever have been
reported atler the first and second
doses, but the fever is generally mild
and limited to less than 24 hours.
Initiation o f the series after age 6
months is contraindicated as fevers
are more pronounced in clinical tri
als (probably due to decreased m a
ternal antibody).
The vaccine is contraindicated in
infants who are allergic to am ino
glycoside antibiotics, amphotericin
B, or monosodium glutamate which
are components o f the vaccine, in
fants with moderate or severe febrile
illness and infants with known or
suspected immune compromise. It is
not recommended for children with
acute vomiting or diarrhea and con
sideration should be given to immu
nizing children with gastrointestinal
tract disease until further data are
available."
MMR Update
The Tacoma-Pierce County Health
Department recently recommended
that cliildrcn immunized against
Measles, Mumps and Rubella (MMR)
in countries of the former Soviet
Union be revaccinaled with MMR. We
have learned that Rubella was not
routinely administered and subse
quently these children may not be
adequately protected. If these children
have not received a dose of MMR
upon or after arriving in the United
States, we recommend that they
receive a dose of MMR vaccine now.
MMR vaccine is routinely adminis
tered at 12-15 months of age and a
second dose can be given as early as
Kindergarten entry, but is required
prior to entering 6th grade. The
second dose is required for adequate
protection against rubeola; immunity
for rubella is achieved after one
vaccination. If you have questions
please call Cindy Miron at 798-6556.a
February, 1999
PCMS BULLETIN 15
V
N e w s b rie fs
whose motto is “To Educate, Amuse
and Enrich.” This site is packed with
valuable financial information. The
ubiquitous stock quote capability is
augmented with interesting on-line
polls, review of specific stocks, news
from a variety o f sources, access to on
line trading and sim ilar kinds o f infor
mation.
Cyber Stocks
T h e S tre et at h ttp ://
w w w .thestreet.com is constantly
touted as one of the finest financial
Web sites on the Internet. Very welldesigned, this site is like waking up in
the m orning and reviewing your Wall
Street Journal over a thick cup of
black coffee. Here you’ll find a scroll
ing ticker of all the major domestic
and foreign indexes, basic front-page
financial editorial and the ability to
drill down and absorb, if you want,
massive amounts of detail on markets,
companies, funds, commentary and
current news.
If it’s a slock quote you’re after, or a
review of the upward progress of your
mutual fund, why mess around with a
simple daily quote? Take a look at Big
C h arts at http://w w w .bigcharts.com
and you’ll be able to review charts
compiled and displayed in more ways
than you ever thought you wanted.
The simple historical chart is an excel
lent way to begin to acquire an overall
sense of your stock, index or fund.
You can also review stock sectors
No listing of Internet financial sites
would be complete without The M ot
ley Fools a t http://www.fool.com
(there are more than 1,100 from which
to choose), get historical quotes and
access one o f the best on-line finance
bookstores on the Web al http://
www.franchisc.fantasticshopping.com/
traders-bigcharts.
Believe it or nol, the stuffy but infor
mative Wall Street Journal has an ex
cellent Web site at h ttp ://
w m v.w s j.com. The catch, of course, is
that you have to pay to use it. If you’re
fam iliar with the print edition, you’ll
find much of the same information
here, with some additional connected
pieces impossible to convey on paper
(hence, “interactive edition”). For ex
ample, it is constantly being updated,
so regardless of where or when you
read it, it’s current. A subscription is
$49 per year but WSJ Interactive offers
a free two-week trial. ■
Now
Open
Saturdays
NION AVE
PEN M RI
2502 South Union Avenue, Tacoma, WA 98405
16
PCMS BULLETIN
February, 1999
Feature
I n M y O p in io n
....................
"You 2 Kaii Have Healthcare Access"
"Ask not what you can do fo r your countiy, ask what your country can do for m e."
Ted Kennedy, 2001
by Nichol Iverson, MD
In the face o f the frenzied
impearment proceedings that are
under way in the Senate, Medicare
has raised its ugly head again in the
process o f practicing medicine for
us. The latest effort, specifying
which medications can be used for
prostate cancer, is a portent o f
meddling to come.
The concept o f our federal gov
ernment being the medical testing
ground for Am erica’s future needs
to be explored before the millennial
bug infects us all. Using the seven
gazillion federal workers, especially
the members o f the legislature, the
judicial department and the execu
tive branch will give us a perfect
chance to experiment with a system
o f health care delivery that will be
in the best interests o f the country.
Bill “the head case” Clinton, along
with Ills wife Biliary will be the in
dex cases for this far flung system.
In the unlikely event Slick W illy
gets the shaft from the Senate, A1
“the m atador” Gore along with his
wife Skipper will take up the sword
to slash the runaway medical costs.
The essence o f this experiment is
novel. O ur feckless leaders will de
vise a system that they m ust follow.
The punishment for using any
medical system outside o f the Ini
tiative Trial would be the death
penalty, a trip to the Kevorkian
Clinic, or a life sentence o f listening
to rap music.
Using a Town Meeting format,
our government leaders will argue
amongst themselves about how they
will be treated and which technolo
N ichol T. Iverson, M D
gies will be available to (hem. Our
state to the south used this method
to come up with the famous “Organ
Decisions” to help define utilization
and rationing in order to see who
gets w ho’s organs. Used pianos can
be substituted when organs are in
short supply. There will be a system
o f queuing to arrange for surgeries,
strict formularies for pharm aceuti
cals and those lucky physicians and
nurses who will make up the
caregivers will be part o f a new
health service. This H ealth Experi
ment Advice D epartment Service,
will be run by a random selection o f
physicians who can apply for this
noble experiment provided they
speak little English and have had no
training in the United States.
The initial phase o f this process
will undoubtedly show our heads o f
government working a t their best.
Can you picture the leaders in
W ashington, under the constant
scrutiny o f the press and the public,
realizing the implications o f “their”
system would create rationing for
themselves first! H a. Can you see
the great Kennedy’s realizing that
their personal billion dollar social
ized pockets have suddenly been
sewn shut. How about those poor,
poor Republicans as they face a po
tentially fatal disease without any
options outside o f the “system .” 1
love it! Let those pants droppers
and infidels suffer the consequences
o f their great idealism before foist
ing it upon the public. Can you see
these rich dudes suddenly stuck,
helpless as they w ait their turn, or
discovering that the rules o f treat
ment do not apply to them because
they are too old. Or too wicked.
Some o f my oilier opinions have
been rather stupid at best and not
particularly responsible at their
worst. T his idea has got to fly. We
need to take this message to our
elected government officials and
cram it down their scandalous
throats, hi the unlikely event this
idea does not seem to be particu
larly popular to the DC gang, the
Social H ealth Initiative Trial will
be dumped by its own Health E x
periment Advice Department Ser
vice, which will spell its doom *
P u get S ou n d Area, WA: You know how you want to set up your practice.
W e can help you do it. Dynamic community-based healthcare organization
se ek s BC/BE Family Practitioners. Flexible financial packages and
management to full employment. Convenience, quality 225-bed hospital
and excellent location in fast-growing, family community. Close to Seattle
Samaritan Community Healthcare, 407 - 14th Avenue SE, Puyallup, WA
98371, (253) 848-6661, Ext. 1865.
February, 1999
PCMS BULLETIN 17
News briefs
New Millennium countdown underway - are you ready?
W ith th e beginning o f 1999, year
2 0 0 0 (Y 2K ) com puter system
com pliance efforts should be well
underw ay in all p ractice settings. At
the very least, the basic elem ents o f
a Y 2 K com pliance p lan should be in
place. P ractices should be budgeting
s ta ff tim e as w ell as m oney to
assess Y 2K com pliance and to
resolve Y 2K related problem s that
arise.
O ne o f the m ost serious Y 2K
issues affecting m edical practices is
the p ossible interruption o f cash
flow. T he W S M A has been com m u
nicating w ith m ajor health plans to
ascertain th eir Y 2K readiness, hi
addition, the W S M A and the
W S H A has asked the 13 largest
health plans in the state lo sign a
statem ent com m itting th eir organi
zations to the concept o f revenue
averaging in Jan u ary 2000, should
the need arise.
T he FD A is w aning hospitals,
em ergency m edical services and
physicians that som e m edical
devices m ay not have transitioned
from D ecem ber 31, 1998 to Jan u ary
1, 1999. W hile tliere does not
appear to be any risks to patients,
im proper transition from 1998 to
1999 could result in inaccurate
records.
A t the national level, a Y 2K class
action law suit ag ain st M edical
M anager C orp, a publicly traded
softw are vendor has recently been
settled. A s a resu lt (lie com pany will
p rovide a free upgraded version o f
its p ractice m anagem ent product to
th o u san d s o f purchasers. The
p o p u la r softw are p roduct is used at
ap p ro x im ately 2 5,000 sites encom
p assin g 110,000 physicians, with
ap p ro x im ately 75% o f Medical
M an ag er's custom ers using a nonY 2K -com pliant softw are version.
T h e settlem ent will cost Medical
m an ag er Corp. $1,455 million.
O nce approved by a judge, eligible
p articip an ts w ill receive notices in
th e m ail th a t will explain the
settlem ent options in detail.*
From f VSAM M embership Memo,
January 8, 1999.
We are proud to continue our tradition of providing quality
coverage and local service to our members
and physicians for the last 80 years.
Professional Netw ork Relations Representatives,
located in the Tacoma office, are available
to assist you and your staff.
CALL 5 9 7 - 6 4 7 3 OR 5 9 7 - 7 9 8 2 .
18
PCMS BULLETIN
February, 1999
W Regence
BlueShield
PCMS Alliance
thePulse
Pierce County Medical Society A llia n c e
President's Message
Well, we
are well
into the
new year
and will
soon be
looking for
spring
flowers and
more
daylight.
A ren't those
Nikki Crowlev
happy thoughts?
The Alliance recently gave aw ay
$19,879 to good causes in our
community. Thanks to you, sup
porters o f the Holiday Sharing
Card, we were able to contribute in
this generous manner.
As we look toward spring, we will
also be looking to graduation. I f any
member o f your family will be
graduating soon, please let us know
so that we may include the inform a
tion in our annual June graduation
announcement. Call Alice Y eh (see
adjacent article) or me with the
information.
W e are currently updating our
membership roster and need correct
addresses. I f your address has
changed or needs updating please
call me, 922-7233.
And, once again, we need partici
pants in our Alliance. If you know
anyone who might be interested in
joining, please invite them to our
#
M arch M embership Meeting. It will
be held on T uesd ay , M a rc h 30 at
10 a.m. at th e hom e o f F ran
T hom as, 3224 llo rse h e a d Bay
D rive N W in G ig H a rb o r. Please
call Fran (265-2774) or me to make
your reservation. W e will have
coffee and our program for the
morning will feature Ju lia M ueller
sharing her character w atch collec
tion and the history o f character
watches.
I look forward to seeing you in
March. ■
Philanthropic funds
($19,897) dispensed
Wow! Thanks lo a very generous
Holiday Sharing Card, the Philan
thropic Committee met oil Friday.
January 7 at the Harmon. We
added $5000 to our philanthopic
funds and dispensed $19,897.00 to
the following:
$5000 Family Renewal Shelter
$4000 PCM S Hospice Study
$2897 Baby Think it Over (Class
room set o f 10 babies)
$2000 Neighborhood Clinic
$2000 SANE/SARC
Send us your
graduation info
Please report any person in your
family graduating this spring for
our June graduation announce
ments. High school, college, trade
school, etc. M oms, dads, students,
etc. Please include the following
information:
$1500 Tacom a A rea Literacy
Council
$1500 PLU Wellness Center
$1000 Emergency Nurses Care
Thanks to Nikki C row ley, K ath y
S am m s, Sue W ulfestieg, Y olanda
B ru ce, M a ry C o rd o v a and
M elin d a R ajacich for your help *
F ra n T hom as
P h ilan th ro p ic C h air
N am e
School
: A M ER IC A N L U N G A SSO C IA TIO N ,,
ofWjsfrington
D egree/R ecognition
F u tu re Plans
Special achievem ents
Please contact Alice Y eh, 7560578 or fax the information to her
at 756-6744. You may also contact
her by e-mail at w enyeh@ w a.net.
Be sure and let Alice know how to
get in touch wit h you in case she
has any questions.
1 -8 0 0 -L U N G -U S A
Lung Information
Service Line
Providing patient,
education materials
Thank you. ■
February, 1999
PCMS BULLETIN 19
N e w s b rie fs
D o la n
Applicants for m em bership
fro m page 4
D eterm ine w hat type of practice
you w ant. Ask yourself, do you go
with a single-specialty or multi-spe
cialty? Are you interested in a single
or multi-geographic area?
A b d u lla h , B ish e r A ., M D ; P e d ia tric s / P e d ia tr ic G a stro e n te ro lo g y
P ractices a t 314 M LK Jr W ay, # 202, T aco m a 98405; 552-1511
M edical School: D am ascus U niversity School o f M edicine
Residency: M edical College o f Ohio
Fellowship: R iley H ospital for Children
C onsider economies of scale. You
have to become as big as you carefully
can bccause that’s where the econo
mies of scale are.
C h a n , C h r is to p h e r Y ., M D ; F am ily M e d icin e
Practices w ith C ornerstone Fam ily P hysicians, 5922 100th S t SW , #26.
T acom a 98499-2751; 588-0756
M edical School: University' o f A lberta
Internship: U niversity o f A lberta
Residency: U niversity o f A lberta
A ccept th a t you need intellectual
resources. You need to have smart
people lo help you and il costs money.
K eep th e lines of com m unication
open. This is critical!
You have to yield to others. You’re
no longer the boss
G inocchio, C h r is to p h e r J ., M D ; N eu ro lo g y
Practices at 915 6th Ave, #2, T acom a 98405; 383-5056
M edical School: U niversity o f C alifornia School o f M edicine- San Diego
Internship: G ood Sam aritan/E m anuel H ospital
Residency: O regon H ealth Sciences U niversity
Fellowship: D uke U niversity M edical C enter ■
Rem ain open to d ram atic changes
Some P a rtin g W ords of Advice
“Keeping organized medicine strong
is vital,” Dolan said, “You have to
have someone outside of these struc
tures that can question, cajole, prod,
provoke and analyze these
guys...someone who is not compro
mised by these opposing organiza
tions.” Additionally, D olan strongly
advised physicians that being politi
cally active is critical. “Nonphysicians
play the game harder,” he said. “You
need to be enthusiastic and participate
at a higher level than you are now.”
“I do not think there’s a single solu
tion to the problems,” Dolan said in
closing. “No major issues in health
care reform have arisen. No one has
the answer. There are no big, looming
proposals for fixing this game.” And,
he added, there are no entities in
W ashington state working to bring di
vergent players together. “Resistance
to serious change is now greater than
it’s ever been. While the business
community and payers will retain a
strong relationship, no one is inter
ested in playing a convening role.” “In
the meantime,” he said, “we should
slop complaining. It could be worse.”■
20
PCMS BULLETIN
February, 1999
■ A C O M A R A D IO L O G Y
Detect and Monitor
Low Bone Density
S p in e & F e m u r ( A x i a l D E X A )
A ll e n m o r e M e d i c a l C e n l e r O n ly
A ssess fracture risk
Detect clinical changes
M onitor therapeutic response
Results include comparison
to reference populations
(T-score)
H e e l (P e r ip h e r a l D E X A l
l o w r is k s c r e e n i n g
Tacoma
Call to schedule
Lakewood
Gig Harbor
(2 5 3 ) 3 8 3 -2 0 3 8
(2 5 3 ) 5 7 2 -5 1 7 4
(2 5 3 ) 5 8 8 - 6 0 8 3
(2 5 3 ) 85 8 -3 2 0 0
A lle n m o re M c d ic a l C e n le r
F r a n k s . B a k e r C e n te r
L a k e w o o d O ffic e
Poinl Fosdick Imaging
C o lle g e o f M ed ical E d u c a tio n
COLLEGE
MEDICAL
HIV Infections
CME scheduled
for February 26
Registration is open for the HIV
Infections CM E scheduled for
Friday, February 26. This popular
conference is once again developed
by local HIV expert A lan Tice, M D
and will be held at St. Joseph
Medical Center, Rooms 1A & B.
Designed for all physicians, the
conference will serve as a timely
update regarding developments in
HIV infections and AIDS. The
course will feature national, re
gional and local experts.
This year’s conference will
include presentations on local HIV
developments and will focus on
elements o f HIV management and
treatment. The program will feature
the following addresses:
♦Local Developments in HIV Care
CME and M ariners (and sun),
set for P hoenix on M arch 3-7
The second C M E & M ariner’s
Spring Training course in Phoenix
is open for registration. The actual
course is on the mornings o f M arch
4-6. R ich a rd H aw kins, M D is the
program director.
Internal Medicine Review - 1999
scheduled for March 11-12
The Tacom a Academy o f Internal
M edicine’s annual two-day CM E
program is open for registration.
The program offers a variety o f
timely internal medicine topics. The
review was organized this year by
S u rin d e rjit Singh, MD.
Dates
To register, or for more inform a
tion, call the College at 627-7137.■
P ro2r am
R e v i e w
T l i u r s d a y - S a l u r d a y
C M
M a r c h
S p r i n g
F e b r u a r y
o f
D ircctor(s)
H I V
26
A l a n
T ic e ,
M
1)
I n fe c tio n s
+-6
&
E
M a r i n e r s
R i c h a r d
H a w k i n s ,
I n Ic r n a 1 M e d ic i n c
M a r c h
1 1 - 1 2
R e v ic w
F r id a y ,
A p r il
S u r i n d e rj i t S i n g h ,
A lle r g y ,
23
S a tu rd a y , M a y
A s t h m a
P u l m o n o l o g y
15
P r im a ry
0 a re
S u r g e r y
U p d a t e
M a y
21
L a w
&
M
c d ic i n c
M
D
&
A l e x
for
19 9 9
M
D a v i d
J o s e p h
F r id a y ,
M D
T r a in in g
T h u r s d a y - F riday
Therapy
♦Challenging Cases ■
members o f the Academy and all
other area physicians. The program
will be presented in the new
Lagerquist Conference Center.
Rooms 1A & B at St. Joseph
Medical Center.
The program offers 12 Category I
CM E credits and is available to
♦HIV Medications: Problems &
♦New Frontiers in H IV Care
The College has selected the Em
bassy Suites Phoenix-North for con
ference headquarters. The large and
beautiful hotel is conveniently lo
cated close to the M ariners Peoria
stadium and offers reduced and
competitive rates for complete tworoom suites that include a private
bedroom and separate living area
with sofabed. You may make reser
vations at (602) 375-1777 and iden
tifying yourself as p art o f the
C.O.M .E. group.■
Flights to Phoenix during March
often sell out. A CCORDINGLY.
W E URGE YOU TO TIE DOWN
TH O SE PLA N E RESERVATIONS
NOW . Olympus Travel can handle
your flight arrangements. Specifi
cally, MARILYN, is prepared to as
F r id a y ,
♦Update on Anti-Retroviral
The Cactus League schedule has
been finalized and it appears the
M ariner’s will play on their home
field in Peoria on March 4 and 6
and in M esa (across Phoenix) on
M arch 5.
A program brochure that details
planning for travel and hotel logis
tics was mailed in December. The
brochure also includes a CM E
schedule and registration informa
tion. Please call the College at (253)
627-7137 if you need a brochure.
♦Assuring Access to Care
Solutions
sist you in securing these seats. Call
M arilyn at (253) 565-1213.
ill a l i ,
D
M a g e l s s c n ,
Just,
N i c h o l a s
February, 1999
M
M D
J D
R a j a c i c h ,
M D
PCMS BULLETIN 21
News briefs
A short course in human relations
Do we have
your
e-mail
address?
Please send it to
us at:
[email protected]
The S IX m ost im portant w ords:
"I adm it I m ade a mistake. "
T he F IV E m ost im portant words:
" You d id a g o o d job. "
T he F O U R m ost im portant w ords:
"What is yo u r opinion?"
The T H R E E m ost im portant words:
" If you p le a se ."
T he T W O m ost im portant words:
"Thank y o u ."
The O N E m ost im portant word:
"We"
The L E A S T im portant word:
f t J ft
Will a disability put you out
of commission?
As you know, disability in su ran ce policies for physicians are ch an g in g
rapidly— and not for the better. High claim s have caused m an y m ajor
carriers to lim it the m ost im p o rtan t benefits.
At Physicians In su ran ce Agency, there's still tim e to secure the specialtyspecific coverage you need. In addition, we can help you find superior life
a n d lo ng -term -care coverage for you an d y o u r family.
To discuss the ways you can best protect y o u r fu tu re incom e, call
Physicians In su ran ce Agency today: (206) 343-7150 or 1-800-962-1399-
r,
PHYSICIANS
INSURANCE
AGENCY
A Wholly Owned Subsidiary of
Physicians Insurance Exchange
o wsi’iAms
22
PCMS BULLETIN
S jn m o r e d b y the Washington Slate Medical Association
February, 1999
V.
P O S IT IO N S A V A IL A B L E
T acom a/Pierce C ounty o u tp atien t
schedule. Well suited for career re
definition for G.P., F.P., I.M. Con
tact Andy Tsoi, MD (253) 7529669 or Paul Doty (Allen, Nelson,
(253) 383-4351.
F ranciscan M edical G ro u p .
Franciscan Medical Group is a
multi-specialty group practice in the
South Puget Sound area o f W ash
ington. We currently have several
opportunities available for board
certifled/'board eligible physicians
in all prim ary care specialties as
well as selected sub-specialties.
FMG is an affiliate o f Franciscan
Health System, a member o f Catho
lic Health Initiatives. If you are in
terested in exploring these opportu
nities, please contact N onna Larson
at: (253) 539-9702 or fax your CV
to (253) 539-7981. EOE.
R adiation O ncologist. G ro u p
Health Permanente is currently
seeking a board certified/board eli
gible radiation oncologist interested
in locum tenens coverage for an ex
tended period o f time. This em
ployed full-time position could be
gin immediately and continue until
summer. For further information,
fax CV and cover letter to (206)
448-6191 or call (206) 448-6543.
Equal employment opportunity.
T A C O M A /P IE R C E C O U N T Y
O u tp a tie n t G e n e ra l M ed ic a l C are.
F u ll a n d p a rt-tim e p o sitio n s
available in T a c o m a a n d vicinity.
V ery flex ible sc h e d u le . W e ll su ite d
fo r c a re e r re d e fin itio n for
G P , F P , IM .
Contact Andy Tsoi, MD (253) 752-9669
or Paul Doly {Allen, Nelson, Turner &
M edical C o n su ltan t position avail
able. The State o f W ashington, Di
vision o f D isability Determination
Services, seeks psychiatrists to per
form contract services in the Olym
pia, Renton and Spokane area of
fices. C ontract services include the
evaluation o f mental impairment se
verity from medical records and
other reports, utilizing Social Secu
rity regulations and ailes. Psychiat
ric M edical Consultants function as
members o f the adjudicative team
and assist sta ff in determining eligi
bility for disability benefits. RE
Q UIREM ENTS: C urrent medical li
cense in W ashington State. Board
Certified desirable. REIM BU RSE
M ENT: $ 5 1.83/hr. Interested psy
chiatrists should contact Guthrie L.
Turner, Jr., M D, M PH , C hief M edi
cal Consultant at (360) 586-4134 or
the respective A rea Manager:
Olympia, Joy Justis (360) 5864115; Renton, Frances Stine (425)
430-4811; Spokane, Dale
M cGruder (509) 625-5430.
O p p o rtu n ity for a B C In te rn ist
for a part-tim e position with flexible
hours and benefits. Please forward
CV to Jan Brame, Internal Medicine
N orthwest, 316 MLK Jr Way,
#304, Tacom a W A 98405 or fax
253-272-5643.
E Q U IP M E N T
Used M id M a rk 104 female exam
table with heated drawer. $400.
Ask for L aura (253) 627-3159.
Furnished. Prime Gig H arbor loca
tion. Perfect for a specialty prac
tice. Call for details. (253) 8489484.
able 11/01/98. Tw o suites 750
square feet. M ultiCare Urgent Care
leaving space which has been occu
pied by an urgent care facility since
1980. Building is a medical-dental
facility next to Albertsons. 8509
Steilacoom Blvd. Call Dr. Ken
Ring at 584-6200 or 582-5856.
N ew office space available. IJp to
4500 sq. It. Will finish lo suit. On
Call Robin at 756-2182.
GENERAL
Found: U niversity of U tah , 1974
class ring. Initials KMW. Please
call D eputy John Jimenez, 7984200.
UNION AVENUE PHARMACY
Professional Compounding Center of Tacoma, WA
Vaginal Suppositories
Rectal Suppositories
Urethral Inserts
Sublingual Troche
Gel, Ointment, and Cream
IV Services
Capsules
Lip Balms
2302 South Union Avenue
February, 1999
752-1705
PCMS BULLETIN 23
We’re Here to
You
Physicians Insurance to help. In fact, our underwriting depart
dependable advice.
needs quickly, elliciently, and w ith attention to detail.
Western Washington
1-800-962-1399
Eastern W ashington
1-800-962-1398
P
_" _Phys
._/sicians
r Insurance
E
X
C
H
A
N
G
E
S w il l* . W A © W SP1A 1 9 9 7
P ie rce C o u n ty M e d ic a l S o cie ty
2 2 3 T a c o m a A v e n u e So.
T acom a, W A 98402
R e tu rn se rvice req u e ste d
24
PCMS BULLETIN
February, 1999
BULK RATE
U.S. Postage
PAID
Tacoma. WA
Permit #605
B U LLETl
M arch, 1999
Legislative Summit educates physicians
about the importance of state
government and the legislative process
See page 6-7
Inside:
3
4
7
9
13
16
18
P re s id e n t's P a g e : T h e S ev e n T e iie n ts o f P r a c tic e in P ie r c e C o u n ty
E sc a la tin g d a n g e r o f d riv in g m a k e s 'g r a d u a te d ' d r i v e r lic e n sin g a life -sa v e r, b y C e c il S n o d g rass, M D
L eg islativ e S u m m it e d u c a te s p h y sic ia n s a b o u t O ly m p ia a n d th e le g isla tiv e p ro c e s s
A pril G e n e r a l M e m b e rs lu p M e e tin g to f e a t u r e A n d y D o la n , J D , P h .D .
I n M e m o ria m : C la re n c e A n d e rs o n , M D r e m e m b e r e d b y th e p h y sic ia n s a n d s ta f f a t C a rd ia c S tu d y C e n te r
R e tir e d m e m b e r s to m e e t fo r lu n c h a n d 'V in ta g e C a r R a c in g 1u p d a te b y C o rd e E B a h n , M D
C o lleg e W h is tle r p r o g r a m f e a t u r e d fu n , su n , m o u n ta in s a n d sn o w - re v ie w e d in p ic tu re s
\
PCMS Bulletin
L a w r e n c e A . L a r s o n , D O ................................P r e s id e n t
C h a r l e s M . W e a t h e r b y , M D ............P r e s i d e n t E le c t
M a r i l y n E . P a t t i s o n , M D .................... V ic e P r e s id e n t
P a t r ic e N . S t e v e n s o n , M D
J a n i e s M . W i l s o n , J r ., M D ................ P a s t P r e s id e n t
M i c h a e l J. K e lly , M D
M a ria J. M a c k , M D
D o ris A . P a g e , M D
J . J a m e s R o o k s , J r ., M D
E d w a r d I. W a l k l e y , M D
B u l l e t in
March, 1999
W S IM A R e p r e s e n t a t iv e s :
P a s t P r e s id e n t: P e te r K , M a r s h , M D
S p e a k e r o f th e H o u s e : R i c h a r d H a w k in s , M D
E x e c u t iv e D ir e c t o r : D o u g la s J a c k in a n
C o m m itte e C h a irs:
A g in g , R ic h a rd W a ltm a n ; A I D S , L aw re n ce S ch w artz;
B y la w s , S ta n le y T u e ll; B u d g e t/F in a n c e , P a tric e
S te v e n so n ; C o lle g e o f M e d ic a l E d u c a tio n , W . D a le
O v e rfie ld ; C r e d e n tia ls, S u s a n S alo ; E m e r g e n c y
M e d ic a l S ta n d a r d s , T e d W a lk le y ; E th ic s/
S ta n d a r d s O f P r a c tic e , D a v id L u k en s; G r ie v a n c e ,
J a m e s M . W ilso n ; L e g is la tiv e , W illia m M a rs h ;
M e d ic a l-L e g a l, P a t D o n ley ; M e m b e r s h ip B e n e fits,
I n c ., D r e w D e u ts c h ; P e r s o n a l P r o b le m s O f
P a ttis o n ; P u b lic H e a lth /S c h o o l H e a lth , L aw re n ce
S c h w a rtz ; S p o r ts M e d ic in e , Jo h n Jig a n ti.
M e m b e rs h ip B e n e fits , Inc. for m e m b e rs o f th e P ierce
a rtic le s a n d p la c in g a d v e rtise m e n ts in T h e B u lle tin are
O c to b e r 15 for th e N o v e m b e ris s u e ).
T h e B u lle tin is d e d ic a te d to th e art, sc ien ce an d
d e liv e ry o f m e d ic in e a n d th e b e tte rm e n t o f the h e a lth
a n d m e d ic a l w e lfa re o f th e co m m u n ity . T h e op in io n s
n o t n e c e s sa rily reflec t the official p o sitio n o fth e
M e d ic a l S ociety. A c c e p ta n c e o f a d v e rtisin g in n o w a y
c o n s titu te s p ro fe s sio n a l ap p ro v al o r e n d o rse m e n t o f
p ro d u c ts o r se rv ices ad v e rtise d , l l i e B u lle tin a n d P ierce
C o u n ty M e d ic a l S o ciety reserv e the rig h t to reject any
ad v ertising.
E d i t o r : D a v i d S. H o p k in s M D
M a n a g in g E d it o r : D o u g la s J a c k m a n
E d it o r ia l C o m m i t t e e : D a v i d S . H o p k in s , ( C h a ir )
A d v e r t i s i n g R e p r e s e n t a t iv e : T a n y a M c C la in
S u b s c r i p t i o n s : $ 5 0 p e r y e a r, $ 5 p e r is s u e
(2 5 3 ) 5 7 2 -3 6 6 6 , F a x 5 7 2 -2 4 7 0
E -m a il a d d r e s s : p c m s w a @ p c m s w a .o r g
H o m e P a g e : h t t p : / /w w w .p c m s w a .o r g
2
PCMS BULLETIN
M arch, 1999
Features
P resid en t's P a g e .................................................................. 3
G rad u ated lic e n sin g , by C e c il S n odgrass, M D
4
1 9 9 9 P h ysician s D ir e c to r y b e in g p r in t e d ............... 4
F eb ru a ry G en er a l M em b ersh ip M e e tin g reca p .... 5
H ow to con ta ct la w m a k e r s ............................................. 6
1 9 9 9 L e g isla tiv e Sum m it r e v ie w e d ............................ 7
B oard o f T ru stees F eb ru a ry M e e tin g a c tio n s
8
In M em oriam : C la ren ce A n d erson , M D ................... 13
Departments
A pril G en era l M em b ersh ip M e e t in g ........................
9
T h e In v isib le H and: M a n a g in g C a r e ........................ 11
A pplicants for M e m b e r sh ip ............................................ 14
PCM S N ew M e m b e r s .......................................................
R e tir ed L u n c h e o n , V in ta g e C ar R a c in g ..................
C o lle g e o f M ed ical E d u c a t io n .....................................
PCM SA: T h e P u l s e .............................................................
C la ssified A d v e r tis in g ......................................................
15
16
17
21
23
News briefs
R e m e m b e r in g R ichard L ink, M D , 1 9 1 1 -1 9 9 9 ...... 10
S p e llb in d in g W e b s ite s ...................................................... 22
President’s Page.........
The Seven Tenents of Practice in Pierce County
A popular genre in this past decade
has been the self-help books.
Spawned from this has come the
"Tenet" books. Books that try to list
principles o f success. This struck
me as an interesting exercise for a
president’s page. M y list reflects
what 1 have learned from the Pierce
County medical community over the
past 20 years. M any o f you, the
readers o f this president’s page, are
the authors o f these tenets. I m ust
admit that attempting to produce
this list is a bit difficult, not only
because I would like the tenets to be
comprehensive but also once pro
duced I may need to live by them.
1 thought o f writing this when I
was in Olympia at the W SM A Leg
islative Day. It struck me that mak
ing healthcare legislation is such a
daunting task and that possibly p ro
ducing a list o f principles might
help guide our decisions. Thus my
list follows:
1. H onesty
2. Keep C u rren t
3. Keep patients and families
needs first
4. M aintain collegial relationships
w ith peers
5. K eep balance in y o u r life
6. Be a m entor
7. K now the business o f m edicine
Honesty - Honesty is basic to the
practice o f medicine, because hon
esty is the essential ingredient to
trust and trust is w hat allows us to
be a competent healer. O ur patients
expect us to be their advocates in
healthcare, helping facilitate critical
medical decisions with a clear and
honest understanding o f medical
knowledge and the scientific pro
cess. W e are the resource in this
community that is best equipped to
assess appropriateness o f care.
K eep C u rre n t - The half-life o f
medical knowledge is estimated to
be five years. W ith a knowledge
base changing so rapidly we need to
be lifelong students. The challenge
is to find time to stay academically
appropriate and to understand how
to access the resources available CM E courses, journals, reviews,
computers, and peers. PCM S has
done a great service in support o f
CM E and com puter literacy for
physicians.
K eep patients an d families needs
first in our m edical practices - I
am constantly reminded that health
care is best served when we first
consider patient and family con
cerns. This is a simple principle that
is one o f our best allies in improv
ing the health o f our community.
Efforts and program s that support
tliis tenet are the m ost profession
ally satisfying and enduring.
M aintain collegial relationships
w ith peers - hi this business ori
ented competitive world we may
find adversity with colleagues. We
need to keep in mind that our simi
larities in purpose far outweigh any
business conflicts. The PCM S pro
vides an excellent forum to discuss
our differences and arrive at the de
sired “win-win” solutions.
K eep y o u r life balanced - Take an
appropriate am ount o f time for your
profession, family, community, and
self. This is a difficult task. M edi
cine demands so m uch o f our tune
and energies. For longevity and a
Lawrence A. Larson, D. O.
President, 1999
satisfied mind, balancing our pro
fession with time for family, com
munity and self-fulfilling interests is
imperative.
Be a m en to r - Provide time for oth
ers to learn from your experience.
Invite a colleague to share profes
sional experiences. Get involved
with teaching the youth o f our com
munity, medical students, and p ara
medical professionals. O ur educa
tion, perspective, and abilities are a
great resource. Share your fortunes
with those less fortunate - your in
tellect, talent, energy, spirit, and re
sources.
K now the business o f m edicine M uch o f w hat we are capable o f
providing patients and families in
volves our approach to contracting
and management o f resources. We
need to slay in the forefront o f these
decisions and not transfer the busi
ness decisions to non-physicians.
W c provide a unique insight into
healthcare management that cannot
be learned in business school.
M uch o f our discontent with Die
changing practice o f medicine can
be alleviated by our activc role in
the business process.
These tenets have been taught to
me by many o f my colleagues in
Pierce County. They are noninclusive and may differ from those
which you would list. I would wel
come your comments and additional
principles o f practice which may
help generate a more comprehensive
hst.B
LAL
March, 1999
PCMS BULLETIN 3
Feature
Escalating danger of driving makes 'graduated' licensing a life-saver
E ditor's note: This editorial, written by
Cecil Snodgrass, MD, P uyallup emergency
and fa m ily physician, is reprinted fro m The
News Tribune, 12/21/98.
D riving is a privilege granted by the
state, n ot a right. It is th e responsi
bility o f the state to develop m ini
m um standards o f com petence in
this, as in all form s o f licensing.
T he s la te 's continual grow th and
the escalating danger presented by
o u r overburdened road system
poses an ever-increasing challenge
even to experienced drivers.
“G rad u ated licensing is not a plot
to “penalize young drivers w ho ob
serve the ru les,” as T he N ew s T ri
bune suggested in its D ecem ber 14
editorial. It is an attem pt to provide
in creased behind-the-w heel experi
ence for the novice driver in m ore
controlled situations. (E d ito r’s
note: T he editorial supported p ro
po sed legislation that w ould im pose
restrictions on novice drivers only
after th ey com m itted one o r tw o
driving infractions.)
D river error accounts for 82% o f
fatal crashes am ong 16-year-olds;
th eir n onfatal crash rates are nearly
fo u r tim es those o f adults. T hirtyfive percent o f teenage deaths are
attrib u tab le to m otor vehicle acci
dents, accounting for m ore than
5,000 deaths a year nationw ide.
T hese elevated death rates are due
to im pulsiveness, p o o r judgm ent
an d m ost im portantly, lack o f p rac
tic al driving experience.
G rad u ated licensing is a concept,
not a p articu la r system . Im plem en
ta tio n varies from state to state, but
the concept o f increasing privilege
dependent on a period o f experience
an d proven responsibility is univer
sal in th e states th a t follow this
policy. R estricting the tim e and
m an n er o f driving in stages allow s
4
PCMS BULLETIN
M arch, 1999
the novice driver to acquire ro ad ex
perience in a variety o f settings u n
der the supervision o f an adult.
N ighttim e restrictions are espe
cially effective considering th a t 40
percent o f teen driving deaths o ccur
after 9pm w hile less th an 10 percent
o f teen driving o ccurs during this
period.
T hree recent fatal accidents close
to hom e highlight the need for a
change. On D ecem ber 7 in Federal
W ay, a 17-year-old student w as
killed in a crossw alk by a 17-yearold driver passin g a stopped school
bus. O n D ecem ber 11, a 33-year
old E atonville w om an w as killed
when a 16-year-old driver crossed
into oncom ing traffic. O n S eptem
ber 23, a 16-year-old O rting boy
w as killed w hen tw o other 16-yearold drivers in sep arate cars a t
tem pted to p ass a th ird vehicle at
the same tim e.
W ho supports g raduated driver li
censing? T he W ashington State
M edical A ssociation, th e A m erican
A cadem y o f Pediatrics, the Ameri
can C ollege o f Em ergency Physi
cians, M others A gainst Drunk
D riving (M A D D ) and numerous
o ther organizations concerned with
th e safety an d w ell being o f our
youth.
W e are th e ones who pick them
up an d p ra y th a t they live. W e have
to m ake th e calls in the night that no
one w an ts to m ake o r receive. We
sit w ith you and relate the details of
life an d death.
It requires 1,600 hours o f training
to cu t hair, b u t only 34 hours to ob
tain a d riv er’s license. Consider
ations o f convenience and cost
aside, w e have a responsibility to
p rep are th e novice driver as thor
oughly as is reasonably possible.
G raduated driver licensing works
and is saving lives in slates where it
is used. W e m u st adequately pre
pare o u r young adults for this rite
o f passage; their lives depend on it.a
Dr. Snodgrass is the medical director of
the P uyallup Fire Department
1999 Physicians Directory being printed,
to be distributed in March
The 1999 issue o f the annual P C M S
Physicians D irectory is currently
being printed. D ue to the m any
changes for the 1999 book, p ro d u c
tion w as slow ed to accom m odate
new office addresses and phone
num bers.
Forty-five hundred books are
printed and distributed to physician
offices, hospitals, nursing homes
and other health related agencies.
E ach P C M S m em ber receives one
free copy o f the book w hich is sent
to their residence. A dditional copies
are available to m em bers a t a
reduced cost.
C hanges w ill be printed in the
B u lletin each m onth to keep the
inform ation in the books up to date.
P lease call PC M S , 572-3709 and
keep us inform ed o f any listing
inform ation th a t changes.
I f you have any ideas about the
annual D irectory th a t you would
like to see changed or m ade avail
able, please call us and let us know.
It takes ab o u t tw o weeks to
distribute the books, so if you don't
receive all o f your books in your
first delivery, another could be on
its w ay to y o u *
Feature
O regon Fam ily P ractition er, D a v id G ru b e, M D , h u m orist,
hum orous at F eb ru ary G e n e ra l M em b ersh ip M e e tin g
David Grube, M D, shared hum or
ous and insightful anecdotes and il
lustrations at the February General
Membership Meeting to help physi
cians get more enjoyment from the
practice o f medicine. A family prac
titioner at Philomath Family M edi
cal Clinic in Philomath, Oregon,
told his story' o f w hat began as
sharing bloopers, cartoons, etc. at a
Christmas party for his colleagues
and has developed into presenta
tions to Rotary Clubs, M edical So
cieties and other such organizations.
Dr. Grube explained that finding
the humor is not difficult. “Real life
is fUnnier than anything we could
invent,” he said. “Look for the spe
cial moments, the humorous ones,”
he added. The key is sharing the hu
morous experiences. H e asked the
audience, “W hat is the funniest
tiling diat has happened to you - did
you tell anyone?”
The real art o f medicine consists o f
am using the patient while nature
cures (he disease, according to Dr.
Grube, and he reminded physicians
to consider that em pathy is the only
real panacea in medicine.
“M ost folks are about as happy as
they make up their m inds to be,”
quipped Grube. Since physicians are
dealing with so much change he re
minded them that they can choose
their thoughts and choose to be
happy. And, m ost importantly, “no
m atter where you go you have to
take yourself with you,” he said.
“so you might as well choose lo be
in good com pany.”
Dr. G rube recommended books
for physicians to read, “The Best o f
M edical H um or” by H ow ard
Bennett, “The Y oungest Science,
N otes o f a Medicine W arrior” by
Lewis Thomas and all books by au
thor Ferrol Samms. He recom
mended saving thank you notes and
letters that patients send over the
years and revisiting them on diffi
cult days to remind yourself why
you practice medicine. His parting
words o f advice, “always bring
your love to work, remember who
you arc, make good choices and do
the right thing.” *
March, 1999
PCMS BULLETIN 5
F o r ad ditional inform ation ab o u t contacting legislators, please contact the M edical S ociety office. W e will be happy
to help y o u d raft letters or m ake direct contact to legislative leaders regarding issues o f concern. Please call Doug
Jack m an , E xecutive D irector, 572-3667.
T h e statu s o f legislation can be obtained by calling th e L e g is la tu re 's to ll fre e h o tlin e (800) 562-6000. The hearing
im paired m ay call (800) 635-9993. The hotline m akes it easy to leave a m essage o r voice an opinion to lawmakers,
even i f you don't know th eir individual telephone num ber. It also provides an easy w ay to learn the status o f a bill,
w hich com m ittee it's before, w hether it's been scheduled fo r a floor vote o r survived v ario u s deadlines for action. You
m ay also call th e hotline to learn the topics, tim e and location o f com m ittee m eetings. A legislative m eeting schedule is
published w eekly on T hursday. M ail subscriptions cost $10 p er year. F o r m ore inform ation o r a subscription form,
call 1-360-786-7344.
Internet users m ay reach th e L egislature at: w w w .Ieg.w a.g o v U sers can view legislation and send e-m ail to lawmak
ers and staff. Internet users also will have access to the state constitution, state law s, a list o f legislators and a session
calendar. T he governor's hom e page can be viewed at w w w .w a .g o v /g o v e rn o r
P re s id e n t C lin to n m ay be reached by w riting to him at
the W hite H ouse, 1600 P ennsylvania A ve N W , W ash
ington D .C . 20500; his m essage phone is (202) 4561111. E -m a il: p re sid e n t@ w h ite h o u se .g o v
L e g isla to rs, by d is tric t, O ly m p ia p h o n e n u m b e r and
e-m ail a d d re ss:
Y o u r U .S. S enators and representatives and state
sen ato rs and state representatives m ay be contacted at
th e follow ing addresses and telephone num bers:
Sen M arilyn R asm ussen-D , 786-7602
rasm usse_m a@ leg.wa.gov
Rep R oger B ush-R , 7 8 6 -7 8 2 4 bush_ro@ leg.w a.gov
Rep T om C am pbell-R , 7 8 6 -7912 Campbell_to@ Ieg.wa.gov
U .S. S e n a to rs: S e n a to r S lad e G o rto n (R), 730 H art
S enate B uilding, W ashington, D C. 20510-4701.
Phone: 202-224-3441 (D .C .) or 253-581-1646 (Lake
w ood). Fax: 202-224-9393. E -m ail:
s e n a to r_ g o rto n @ g o rto n . se n ate.g o v
2 5 th D is tric t (P u y a llu p , S u m n e r, M ilto n )
Sen C alvin G oings-D , 786-7648 goings_ca@ leg.w a.gov
Rep Jim K astam a-D , 786-7968 k astam aja@ leg .w a.g o v
Rep Joyce M cD onald-R , 786-7948
m cdonaldJo@ Ieg.w a.gov
S e n a to r P a tty M u r r a y (D ), 111 R ussell Senate B uild
ing, W ashington D .C . 20510. Phone: 202-224-2621
(D .C .) o r 206-553-5545 (Seattle). Fax: 202-224-0238.
E -m ail: se n a to r_ m u rra y @ m u rra y .s e n a te .g o v
2 6 th D istric t (N W T a c o m a , G ig H a r b o r , S o u th K itsap)
Sen Bob O ke-R , 786-7650 senate_26@ leg.w a.gov
R ep P at Lantz-D , 786-7964 lantz_pa@ Ieg.w a.gov
Rep T om H uff-R , 786-7802 huff_to@ leg.w a.gov
U .S. R e p re se n ta tiv e s: R ep . N o rm D icks (D -6 th
D is tric t), 2467 R a y b u rn H o u se B uilding, W a sh in g to n
D .C . 20515. P h o n e: 202-225-5916 (D .C .) o r 2535 9 3 -6 5 3 6 (T aco m a). F ax: 202-226-1176.
2 7 th D istric t (N o rth T a c o m a , E a s t S ide)
Sen L orraine W ojahn-D , 7 8 6-7652 wojalin.lo@ leg.wa.gov
R ep R uth Fisher-D , 7 8 6-7930 fisher_ru@ leg.w a.gov
R ep D ebbie R egala-D , 7 8 6 -7974 regala_de@ leg.w a.gov
R e p . A d a m S m ith (D -9th D istric t), 116 C an n o n
H o u se O ffice B u ild in g , W a sh in g to n D .C . 20515.
P h o n e: 202-225-8901 (D .C .), 253-926-6683 (T acom a)
o r to ll fre e 888-764-8409. F ax : 253-926-1321.
2 8 th D is tric t (W . T a c o m a , U niv. P lace, F irc re s t, Lakewood)
Sen Shirley W insley-R , 7 8 6-7654 w insley_sh@ leg.w a.gov
Rep M ike C arrell-R , 786-7958 carrell_m i@ leg.w a.gov
R ep Gigi T alcott-R , 786-7890 talcott_j5i@ leg.w a.gov
S ta te offices: T he phone num ber o f G o v e rn o r G a ry
L o c k c 's office is 360-902-4111, O lym pia. W rite to him
at: L egislative Building, P O Box 40002, Olympia,
9 8 5 0 4-0001. H is F ax is 360-902-4110. H is home page
address is w w w .w a .g o v /g o v e rn o r
2 9 th D is tric t (S o u th T a c o m a , S o u th E n d , P ark lan d )
Sen R o sa Franklin-D , 7 8 6 -7656 franklin_ro@ leg.w a.gov
Rep B rian Sullivan-D , 7 8 6 -7996 sullivan_br@ leg.w a.gov
R ep Steve C onw ay-D , 7 8 6 -7906 conw ay_st@ leg.w a.gov
to n H o u se o f R epresentatives, P O B ox 40600, O lym pia
98 5 0 4-0600. W r ite to s ta te se n a to rs in care o f the
W ashington S tate Senate, PO Box 40482, O lym pia
9 8 5 0 4 -0 482. T he central Senate Fax num ber is 360786-1999. The H ouse has no central F ax number.
6
PCMS BULLETIN
March, 1999
3 0 th D istric t (N o rth e a st T a c o m a , F e d e ra l W a y )
Sen T racey Eide-D , 786-7658 eide_tr@ leg.w a.gov
R ep M aryannc M itchell-R , 7 8 6-7830
m itchell_m a@ leg.w a.gov
R ep M ark M iloscia, 786-7898 m iloscia_m a@ leg.w a.gov
1999 Legislative Summit educates physicians about legislation
Pierce County w as well represented at
the W SMA Legislative Summit in
Olympia on January 26. A good
contingent o f physicians and sta ff
from around the state, nearly 200
strong, descended on their legislators
in the afternoon after a morning
session o f speeches and education.
Governor Locke w as scheduled to
address the delegation but found it
necessary to take his wife to the
hospital as she was experiencing pain
in her eighth month o f pregnancy. Sue
Crystal, his health care advisor, spoke
to the group on the G overnor’s
proposed legislation on tobacco
settlement monies available for health
care and the patient’s bill o f rights.
She also noted the G overnor's con
cern that the physician-patient rela
tionship be maintained in this era o f
managed care.
Attorney General Christine Gregoire
gave a spirited presentation on the
tobacco settlement issue and the need
for the money to go into lire health
services account on health care issues.
Representatives Eileen Cody (D)
and Linda Evans Parlette (R), CoChairs o f the House H ealth Care
Committee, spoke to issues before the
Committee. Cody said she was
concerned about access in the state
and she would be cooperating with
WSMA on that issue. On tort reform,
she said, she disagreed with W SM A
and she did ask for support on
contraception parody bills before the
legislature.
During lunch, Len Eltlinger,
WSMA Policy Director, discussed die
issues before the 1999 Legislature and
reviewed diem for the members before
they were to meet with their represen
tatives in die afternoon.
Those attending the summ it meeting
were:
Leonard A lenick, MD
Janies B lankenship, MD
M ichael B rennan, DO
Federico Cruz-Uribe, MD
Lawrence A. Larson, DO
Joseph M ancuso, MD
Peter M arsh, MD
Vita Pliskow, MD
Don Russell, DO
David Sparling, MD
George Tanbara, MD
Don W eber, MD
Mrs. M arnie W eber
Mrs. Kris W hite
Carl W ulfestieg, MD
The Society extends
its many thanks to
those members who
attended the
Legislative Summit.■
Pictured at right:
Top:
Dr. Don Russell, Puyallup
Pediatrician and Dr. Carl
Wulfestieg, Tacoma ENT,
listen to one o f the speakers in
the morning session prior to
meeting with their own
legislators
Center:
From left, Drs. George
Tanbara, Federico CruzUrihe, Lawrence A. Larson
and David Sparling. A ll are
pediatricians with the
exception o f Dr. Cntz-Uribe,
who is Director o f Health fo r
the Tacoma Pierce County
Health Department
Bottom:
Drs. Peter Marsh and Len
Alenick are facing the camera
as they and others meet with
their Senator, Shirley IVinsley
from the 28th District
March, 1999
PCMS BULLETIN 7
Feature
Board of Trustees discuss many issues at February meeting
Trauma, allergic emergency preparedness fo r schools and support fo r organized medicine among discussions and actions
A t th e F eb ru ary 2nd B oard o f
T ru stees M eeting, D r. C h ris J o r
d a n an d M s. B a rb a ra Y oung p re
sented an upd ate on the A dult
T ra u m a C enter D esignation for
P ierce C ounty. D r. Jordan noted
th a t botli St. Joseph and T acom a
G eneral H ospitals have been very
com m itted and have each contrib
uted $ 2 5 0 ,0 0 0 a y ear fo r tw o years.
T he trau m a system m u st be opera
tional b y June 30 to receive m atch
ing state funds o f $500,000. The
S W W ashington T rau m a Services,
PL L C w ill hire the m edical director,
three trau m a surgeons and four
trau m a physician assistants. T hey
w ill co n tra ct w idi and pay com m u
nity su rg ical subspecialists to p ro
vide physician support required for
state tra u m a destination. A rrange
m ents for hospital-based specialty
su p p o rt will be negotiated by the
hospitals. T o ensure viability, a
tru st h as been set up, titled The
T ra u m a T ru st (T3) and will be re
sponsible fo r annual fund-raising
both sh o rt and long term .
T here has been m uch discussion
and concern ab o u t hospital based
an d su b specialist participation in
this system . D r. Jordan reiterated
his confidence in the system and
noted th a t it is a voluntary operation
an d th a t there will be reasonable re
im bursem ent fo r those that w ant to
p articip ate.
In other n ew s, th e B oard o f T ru st
ees ap p roved tw o actions. O ne pro
vides $500 in supp o rt o f the F e d
e ra tio n C o o rd in a tio n T eam
(FC T ). T he F C T w as created in
1997 w ith a m ission o f cham pioning
a federation-w ide effort to m axi
m ize the strengths o f organized
m edicine. It is a cross-organiza
tional te am o f tw enty-six federation
leaders, su pported by federation
co n tributions created to im prove the
8
PCMS BULLETIN
M arch, 1999
ing allergic reaction, including life
th reatening asthm a, have immediate
access to epinephrine through
train ed individuals. In addition, a
w ritten em ergency plan should be
developed for each child in conjunc
tio n w ith th e school nurse and the
ch ild ’s physician. It will be the
p a re n t’s responsibility to inform the
school o f die m edical condition,
provide epinephrine, and to help
w ith die em ergency plan. The plan
w ill accom pany a letter o f introduc
tion, signed by D rs. L aw ren ce
L a rs o n , P C M S President,
L a w re n c e S c h w a rtz (Chair, PH/
SH C om m ittee) and A rth u r Vegh,
allerg ist w ho introduced the idea to
die com m ittee. T he letter and rec
om m endation w ill be sent to each
school adm inistrator as well as the
superintendent o f each Pierce
C ounty School D istrict.*
value o f organized m edicine. T heir
b asic assum ptio n is th a t the b asic
building blocks o f organized m edi
cine are w ell positioned to serve
m em bers, b u t everyone could all
benefit from increased efforts to co
ordinate, com m unicate and collabo
rate. T heir projects have sought
w ays to use internet technologies,
stream line the app licatio n process,
expedite the learned experiences o f
other societies and develop “how
to ” guides to pro m o te an d share
particularly successful federation
ideas, products an d services. The
F C T will conclude i t ’s w ork in
1999.
A lso approved by th e B oard o f
T rustees w as a recom m endation for
allerg ic e m erg en c y p re p a re d n e s s
for schools. T he recom m endation
calls for every student w ith th e sig
nificant potential o f a life threaten
O
r g a n
P O N
&
T is s u e
A T
IO N
S h a r e Y o u r L if e .
S h a re Your D e c isio n r
For more inform ation on organ and tissue donation
please call LifeCenter N orthw est
toll free, 1-877-275-5269
Social Hour:
6 :0 0
pm
Dinner:
Program:
6 :4 5
7 :4 5
pm
pm
4 7 St. Helens A v e n u e
Tacom a
featuring
Andy Dolan, JD, PhD
Highlights of Mr. Dolan’s talk will include:
♦
♦
♦
♦
An overview o f the current state o f affairs
Issues that have most a ffe c te d doctors a n d how they h ave responded
W hat typically goes wrong in physician organizations
Some suggestions for m aking your p ra c tic e successful
(Registration required b y April 9. Return this form to: PCMS, 223 Tac o m a Ave S, Tacom a 98402; FAX to 5 7 2 -2 4 7 0 or call 572-3667)
Please reserve________ dinner(s) at $20 per person (tax and tip included)
□
Visa
□
Master Card
or my credit card # is___________________________________________
Signature ____________________________
I will be bringing my spouse or a guest. Nam e for nam e ta g :_______________________________________
Signed:_______________________________________________________
Thank you!
N e w s b rie fs
In Memoriam
Richard Link, MD
1911-1999
Personal Problems
o f P hysician s
Medical problems, drugs, alco
hol, retirement, emotional, or
other such difficulties'?
Please call:
* R obert Sands
752-6056'
Bill Dean
272-4013
I \ D ennis W aldron
265-2584
*C hair
A family physician that did a lot o f ob/gyn, Dr.
Link practiced in Tacom a at 2517 North Wash
ington for many years. H e graduated from the
University o f Oregon in 1939 and enlisted in the
Army in 1940 serving until 1946. H e did a
residency in ob/gyn from 1951 to 1953. From
1961-1975 he served as C hief o f Medicine and
Surgery at the American Lake Veteran's Hospital.
Dr. Link retired from active practice in 1975 and
volunteered his services to CARE in Medico in
Vietnam, Indonesia and Afghanistan for five
years.
There is a note in Dr. Link’s file in the PCMS
office that he sent upon his retirement in 1975. It
reads, “To the best o f my recollection, I first
joined Pierce County M edical Society when 1 was
a resident at the old Pierce County Hospital in
1940 or while on active duty with the Army the
next year while stationed at Fort Warden in Port
Townsend, innocently believing that I was really
on “active duty for a year” and knowing that I
would be returning to m y hometown to practice
after the service. I did, but it w as in 1945 after the
end o f W W II.”
C on fiden tiality A ssu red
Allenmore
,yxh Psychological
Associates, P.S.
752-7320
Do you have patients w ith difficult em otional
_ _ _________1530 Union Ave. S.. Ste. 16. Tacoma
10
P C M S B U L L E T IN
March, 1999
Dr. Link is survived by his w ife, Rena, three
sons, a daughter and four grandchildren. The
Medical Society extends its sympathy to his
family. ■
to tal
Asset
m a n a g e m e n t , in c .
R egistered In v estm en t Advisory
PERSONAL INVESTMENT
ADVICE PROM THE PRESIDENT
INDUSTRY-LEADING LOW EEES
(NO COMMISSIONS)
Caii 8 5 8 - 2 7 4 5
W W W . 4 -T A M -R IA
Davidj. ROSkoPh , mba, cfp
C A LL OR VISIT OUR WEB FOR A
CD\CASSETTE INTRODUCTION
"Managing Care"
How can you be expected to govern a country that has hvo
hundred forty-six kinds o f cheese?
Charles de Gaulle (1962)
“I have a good feeling about this
baby,” one o f our neonatologists
told me. He did not say anything
about ventilator settings, oxygen re
quirements, blood gases, or any
thing else that could be entered into
a computer. Yet with this one sen
tence he told me more than pages o f
computer printouts could have said.
O f course a com puter also can tell
you it has a good feeling. The pro
gram will be something like this:
IF a AND b A ND c TH EN
PRINT “I have a good feeling!”
ELSE IF x AND y A ND z THEN
PRINT “I have a bad feeling!”
ELSE PRINT “I don’t know!”
END IF
How helpful w ould such a state
ment be? W hat w ould it tell? By ne
cessity the variables a, b, x, y, z
have to be predefined for the pro
gram to recognize them. They also
have to be a limited number. They
have to be quantifiable. Granted,
neural networks could do better.
Still the data have to be fed to them .
When we take a history and exam
ine a patient we pick up m any clues,
some o f them p art o f nonverbal
communication, many o f them not
quantifiable. Can we accurately ex
press these in words? C an we tran s
late them into a language the com
puter can understand?
One attempt to quantify risk in
pregnancy was done at the depart
ment o f OB-GYN at the University
o f Washington (UW). They w rote a
long list o f possible risk factors and
complications o f pregnancy, each
given a range o f numerical values,
something like the A pgar score for
newborns, but m uch more complex.
The sum o f the score determined
whether the patient w as low risk or
high risk. A few community physi
cians used this score sheet for a
while. It certainly w'as not widely
adopted and I haven’t seen anybody
use it for a long time. To my knowl
edge the U W has dropped it as well.
I suspect it w as m uch more burden
some and time consuming than it
was helpful. As medical treatments
go, pregnancy care is thought to be
rather simple, straightforw ard, and
a cinch to code and computerize.
Several university departments have
been working for years on this
project. There are a few prototypes
out there. They could be useful to
collect d ata for statistical studies.
They could be helpful in large
group practices to access the
records o f patients they don’t know.
However, until we have hand-held
units with accurate voice recogni
tion, they will not be as convenient
as paper records. Even then, scroll
ing will be a problem.
Perhaps the best established and
most widely used algorithm in medi
cal practice is the cardiac resuscita
tion protocol. Param edics, nurses
and physicians are trained and re
trained, I should say drilled, in car
diac resuscitation. The efforts have
paid off. The success rate in first
time cardiac arrest is o f the order o f
80%, if f remember correctly. Since
IM lU flH Ik m,
Andrew N. Statson, M D
cardiac resuscitation is started by
non-physician personnel, the ques
tion about the chances for success
in any individual case does not
come up. The efforts should be con
tinued until a physician, preferably
a cardiologist, can evaluate the p a
tient and decide whether to stop.
A t the beginning o f a treatm ent,
the condition o f patients m ay appear
identical, but at some point those
that are going to make it give us a
good feeling and the others don't.
Perhaps by the time we get the bad
feeling it may be too late to do any
thing that can change tire outcome.
It is also possible that by being alert
to subtle differences in the response
to treatm ent we may be able to alter
the management o f the patients
early enough to achieve a better re
sult. The time available lo decide on
a change o f treatm ent m ay be a few
minutes in the case o f cardiac arrest
o r a few weeks in the case o f a
breast mass. The nature o f early dif
ferences may lead the clinician to
choose one o f several available op
tions. The question would be not
only w hat to do, but also when, how
much, how often, and when to stop
or to switch to yet another treat
ment. At a certain point, the clini
cian may have to act on gut feeling.
N o protocol can include that. No
m atter how well planned the course
o f action after the first few moments
the situation changes. I could not
find the reference, but I remember
the statem ent th at the best plan o f
battle becomes obsolete as soon as
see "Managing"page 12
March, 1999
PC M S B U LL ET IN
U
News briefs
Managing
fr o m p a g e 11
th e first shot is fired.
h i real life w e u sually recognize
o urselves an d odiers as different
from one another. F or som e reason
it is m uch m ore difficult to under
stand th a t ju s t as ou r faces are dif
ferent, so are our thoughts, our ten
dency to health o r illness, our sensi
tivity to infections, degenerative dis
eases, m edications or other trea t
m ents; o ur ability to recover from
illness o r to live w ith a disability.
T he individual differences betw een
patients require th a t the optim al
treatm en t be tailored to the patient
ju s t like a well fitting dress o r suit.
S tan d ard treatm ents m ay w ork ju st
as o f f th e rack clothes m ay fit. P er
haps m o st o f the tim e patients
w ould do well, even w ithout any
treatm ent. I f th a t is satisfactory, we
d o n 't need physicians. Aliy clerk
can look up the algorithm and dis
pense the treatm ent. F rom tim e to
tim e physicians from a review ser
vice w ould call to tell me they are
denying a request for a certain op
eration on the basis o f A C O G or
other official guidelines. I f so, why
does their com pany have physician
review ers? A clerk should be able to
follow the guidelines and issue a de
nial.
T here are reports that patients
w ith heart disease do best when
treated by cardiologists; diabetics
do best w hen treated by endocri
nologists. N o t only th at, b u t the to
ta l cost o f care is less. O ther reports
state that the cost o f care and pre
sum ably the outcom e are the sam e
w hether patients are treated by gen
eralists o r specialists. It is possible
th a t these reports are p u t out by the
public relations departm ent o f the
respective specialty societies. 1 su s
p ect there is som e truth to them and
the ap p aren t contradiction can be
reconciled. In every field there are
people will] different interests and
abilities. T here probably are some
12
March, 1999
generalists w ho can tre a t som e co n
ditions in w hich they have a special
interest better th an som e specialists
w ho have no interest in those condi
tions. A re th e results b etter because
the physicians are b etter able to fol
low' die treatm ent algorithm ? P er
haps they d o n ’t follow an algorithm
a t all, but instead they sta rt different
patients on different treatm ents
plans based on the p atien ts’ indi
vidual characteristics and are quick
to m odify their ap p ro ach according
to the w ay the patients respond.
Any navigator can bring a boat to
harb o r in a calm sea. T he skill o f
the navigator is needed in bad
w eather. I f w e could predict the
w eather w ith certainty and knew it
w ould be good it w o u ld n ’t m atter
w ho w as steering the boat. The
sam e is tru e in clinical practice. If
w e c a n ’t b e su re the patient is
healthy, it d o esn ’t m atter who is do
ing the physical exam ination. If we
can b e su re the problem is minor,
anyone could give the treatment. If
w e ca n be su re die patient does not
have cancer, it do esn ’t m atter
w hether w e get a biopsy and persist
in establishing a diagnosis. Not ev
eryone w ith epigastric discomfort
should b e given a cardiogram , but
som e p atients ought to. Unfortu
nately th ere can be no guidelines
th a t cover everything. Appropriate
clinical decisions cannot be dictated
by protocols. They can only be
m ade by clinicians and their p a
tie n ts.!
Announcement
We are proud to announce the accreditation
of our noninvasive vascular laboratory by
The Intersocietal Commission for the
Accreditation of Vascular Laboratories.
Vascular Surgery N.W., P.S.
Allen H.B. Yu, M.D., F.A.C.S.
314 Martin Luther King Jr. Way, Suite 303
Tacoma, Washington 98405
(253)572-2844
Fax: 572-2841
V
F e a tu re
][ini M emorLam
C la r e n c e L* A n d e r s o n , M D
D e c e m b e r 4 , 19 22 - D e c e m b e r 26, 1998
C la re n c e L. A n d e rs o n s ta rte d w h a t w o u ld b e c o m e C a rd ia c S tu d y C e n te r o n O c to b e r 6 ,
1966. W e ’re s u re a t th a t tim e h e d id n o t e n v is io n w h a t w e h a v e s in c e b e c o m e , o n e o f
P ie rc e C o u n ty ’s la rg e s t s p e c ia lty p ra c tic e s.
A n y o n e w h o h a d th e p riv ile g e o f w o rk in g w ith D r. A n d e rs o n k n e w h im to b e a k in d ,
c a rin g a n d c o m p a s s io n a te m a n . In c o n v e rs a tio n , y o u a lw a y s k n e w y o u h a d h is u n d iv id e d
a tte n tio n fo r as lo n g as y o u n e e d e d it. It w a s o n e o f th e m a n y th in g s th a t e n d e a r e d h im to
his c o lle a g u e s , s ta f f a n d p a tie n ts. H e w a s a g e n tle m a n in th e tru e s e n s e o f th e w o rd ,
“ G e n tle M a n .”
D r. A n d e rs o n w a s a v e ry p riv a te m a n , a n d as a re su lt, m a n y w e r e n o t a w a re o f h is h e ro ic
d e e d s d u rin g th e K o re a n W ar. D u rin g th e firs t w e e k o f N o v e m b e r 1 9 5 0 , th e 3 rd B a tta lio n
D e fe n s iv e P e r im e te r w a s c a p tu re d by th e C h in e s e C o m m u n is t F o rc e s. R a th e r th a n e s c a p e ,
D r. A n d e rs o n v o lu n te e r e d to re m a in w ith a n d c a r e fo r th e 150 w o u n d e d s o ld ie rs , b e c o m in g
a p ris o n e r o f w a r h im s e lf fo r 3 4 m o n th s . B e c a u s e D r. A n d e rs o n n e v e r s p o k e o f h is e x p e ri
e n c e s as a P O W , w e c a n o n ly a s s u m e th a t h e , lik e o th e r P O W s o f th a t w a r, w a s d e n ie d
fo o d , s h e lte r a n d a d e q u a te c lo th in g a n d m e d ic a l su p p lie s . F o r h is s e rv ic e to h is c o u n try , h e
re c e iv e d m a n y h o n o rs , in c lu d in g a P u rp le H e a rt.
A fte r s e ttlin g in T a c o m a w ith w ife J a n e t a n d s o n s R ic h a rd a n d Jo h n , D r. A n d e rs o n
o p e n e d a n o ffic e w ith D r. J a m e s B illin g s le y a n d b e g a n p ra c tic in g c a rd io lo g y . A fte r se v e ra l
y e a rs, D r. B illin g sle y le ft a n d in 1971, D r. J o h n N a g le jo in e d D r. A n d e r s o n in p ra c tic c .
T w o y e a rs la te r th e y w e r e jo in e d by D r. G ail S tra it a n d tw o y e a rs a fte r th a t b y D r. G e n e
L a p in . T h e p ra c tic e c o n tin u e d to g ro w a n d n o w h a s 10 p h y sic ia n s. In 1 9 9 1 , D r. A n d e rs o n
se m i-re tire d . H e c o n tin u e d to f o llo w h is p a tie n ts in th e o ffic e b u t d id n o t p ra c tic e in th e
h o sp ita ls.
D r. A n d e rs o n w a s a d e v o te d h u s b a n d a n d fa m ily m a n . In h is s p a re tim e , h e e n jo y e d
g a rd e n in g (h e ra is e d e x o tic o rc h id s ), b ird w a tc h in g , ro c k c o lle c tin g a n d tra v e lin g in h is
R V . U n fo rtu n a te ly , th e la st fe w y e a rs h e w a s n o t a b le to in d u lg e h is fo n d n e s s fo r tra v e l d u e
to J a n e t’s d e c lin in g h e a lth . H e “ o ffic ia lly ” r e tire d o n J u n e 3 0 , 1 9 9 8 a n d p a s s e d a w a y o n
D e c e m b e r 2 6 , 1 998.
T h a n k s fo r th e le g a c y ...w e m is s y o u .«
T h e p h y s ic ia n s a n d s t a f f a t C a r d i a c S tu d y C e n
March, 1999
PC M S BU LLET IN
13
News briefs
Applicants for m em bership
t
C la rk , L y n n e P ., M D
G e n e ra l S u rg e ry
Practices w ith M t. R ain ier S urgical
A ssociates, 419 S “ L ” St, #101,
T acom a 9 8 4 0 5 ;3 8 3 -5 9 4 9
M edical School: E astern V irginia
M edical School
Internship: E astern V irginia School
o f M edicine
Residency: E astern V irginia School
o f M edicine
A M E R IC A N L U N G A S S O C I A T I O N ,
afWashington
1 -8 0 0 -L U N G -U S A
Lung Inform ation
Service Line
Providing patient
education materials
K aeley , G u r jit S ., M D
R h e u m a to lo g y /In te rn a l M e d icin e
Practices w ith P acific Sports
M edicine, 3315 S 2 3 rd St, #200,
T aco m a 9 8405; 572-8326
M edical School: Univ. o f London
Internship: U niversity o f Tennessee
Residency: U niversity o f Tennessee
M o o n , M ic h ae l R ., M D
A n esth esio lo g y
P ractices w ith A llenm ore Anesthe
sia A ssociates, 1901 S Union,
T aco m a 98405; 596-5131
M edical School: O regon Health
Sciences U niversity
Internship: D avid G rant U.S. Air
Force M edical Center
Residency: W ilford H all U.S. Air
Force M edical C enter ■
p liS iii
Now
Open
Saturdays
NIO N AVE
PENMRI
14
March, 1999
Feature
Welcome, new PCMS Members
Al-Mateen, M ajeed, MD
Neurology
Practices with Neurology & N euro
surgery Associates, 915 6th Ave,
#2, Tacoma 98405; 383-5056
Medical School: University o f
Califomia-Davis
Internship: Children’s Hospital,
Oakland CA
Residency: Children’s H ospital,
Oakland CA
Brooke, Marvin M., MD
Physical Medicine and Rehab
Practices at 4 0 7 -14th Ave SE,
Puyallup 98372; 841-5849
Medical School: Emory University
Internship: University Hospital
Residency: University o f W ashing
ton
Jacobs, Jeffrey M ., MD
Pediatric A llergy & Immunology
Practices with Pediatrics Northwest,
316 M LK Jr W ay, #212, Tacom a
98405; 383-5777
M edical School: University o f
Miami School o f M edicine
Internship: Children’s Hospital,
O akland CA
Residency: C hildren’s H ospital,
Oakland CA
Fellowship: N ational Jewish
M edical and Research Center
Jones, Kelly L ., MD
Family M edicine
Practices at 1102 S “I” St, Tacoma
98405; 597-3813
Kansas
Internship: Providence H ospital
Residency: Providence Hospital
Collier, III, Herman E., MD
Cardiology
Practices with Cardiac Study
Center, 1901 S Cedar, #301,
Tacoma 98405; 572-7320
Medical School: Temple University
Internship: Dwight D. Eisenhower
Army Medical Center
Residency: Dwight D. Eisenhower
Army Medical Center
K rabbe, M arjorie E., MD
Family and O B/G Y N
Practices at 2748 M ilton Way,
#102, M ilton 98354; 927-9772
C alifom ia-D avis
Internship: Tacom a Family M edi
cine
Residency: Tacom a Family M edi
cine
Ilasse, Mihaela M ., MD
Internal Medicine
Practices at 21120 M eridian E,
Graham 98338; 847-9166
Bucharest
Internship: LAC-USC M edical Ctr
Residency: LAC-USC M edical Ctr
Neff, Timothy W „ M D O B/G Y N
Practices at 222 N “J” St, Tacoma
98405; 383-2309
Kansas
Internship: W esley M edical Center
Residency: W esley M edical Center
S u rq e ru .
t k a f
%Union Avenue Pharmacy & |
|
Corset Shop
1
I
|
2302 S. Union Ave 752-1705
I
|
Overstreet, D ebora W ., MD
Pediatrics
Practices a t 1708 S Yakima,
Tacom a 98405; 597-8407
W ashington School o f Medicine
Internship: St. Louis Children’s
Hospital
Residency: St. Louis Children’s
Hospital
Park-H wang, E sth e r M ., M D
O B /G Y N
Practices at 222 N “J ” St. Tacoma
98405; 552-4747
M edical School: Loma Linda
University
Internship: University o f Illinois
Residency:University o f Illinois
S ch ro ed e r, R ic h a rd L „ M D
O B /G Y N
Practices at 222 N “J” St, Tacoma
98405; 552-2950
M edical School: Baylor College o f
Medicine
Internship: Ben Taub General Hosp
Residency: Baylor College o f Med
S m ith, Jeffrey L ., M D
Fam ily P ractice
Practices at 14916 Washington Ave
SW , Lakewood 98499: 589-7027
W ashington School o f Medicine
Internship: Swedish Medical Center
Residency: Swedish M edical Center
S o rsb y , Stephen C ., M D
Fam ily P ra ctice/G e riatric s
Practices at 2748 Milton W ay.
#102, Milton 98354; 927-9772
A rkansas
Residency: M adigan AMC
S teedm an, Jo h n T ., M D
O rth o p ed ic S u rg ery
Practices at 702-23rd Ave SE.
Puyallup 98372; 845-9520
M edical School: Johns Hopkins
University
Internship: M ayo Clinic
Residency: M ayo Clinic
Ungerleider, Ju d y R., M D
O B /G Y N
Practices at 222 N “J" St. Tacoma
98405; 552-2950
California
Residency: K aiser Pcnnanente
M edical Center ■
March, 1999
PCM S BU LLET IN
15
Retired Physician Luncheon
Friday, March 12, 1999
12:00 (noon)
Fircrest Golf Club
1500 Regents Boulevard
Oat
R a c 'W
fe a tu r in g
Cordell Bahn, MD
Cardiovascular Surgeon
Retired
(Please clip and mail in the enclosed envelope to PCMS no later than Tuesday, March 9 or call 572-3667)
YES, I (we) h a v e reserved Friday, M a rch 12 to join retired m em bers, (in c lu d in g spouses, guests, a n d widows)
o f th e M e d ic a l S ociety for lunch.
Please reserve
lunch(es) for m e a t $11.00 p e r person (in clu d e s ta x a n d tip)
I will b e b rin g in g m y spouse or a guest. N a m e for n a m e t a g : ___________________________________________
S igned: _________________________________
College o f M edical Education
{ QUEUE
MEDICAL
Internal M edicine Review - 1999
scheduled for March 11-12
The Tacom a Academy o f Internal
M edicine’s annual tw o-day CME
program is open for registration.
The program offers a variety o f
timely internal medicine topics. The
review w as organized this year by
S u rin d e rjit Singh, M D.
members o f the Academy and
all other area physicians. The
program will be presented in
(he new Lagerquist Confer
ence Center, Rooms 1A & B
at St. Joseph M edical Center.
To register, or for more
information, call the College
at 627-7137.ii
The program offers 12 Category I
CM E credits and is available to
D a tes
P r o g r a m
T h u r s d a y - S a t u r d a y
C M E
M a r c h
S p r i n g
&
B ire c to r(s )
M a r in e r s
R i c h a r d
Allergy, Asthma,
Pulmonology CME
set Friday, April 23
4-6
T h u r s d a y -I; rid a y
I n le r n a 1 M
M a rc h
R e v i e w
This is a one-day update designed
for the primary care provider. It will
focus on diagnosis and management
of common allergy, pulmonology
and asthma problems.
This program is complimentary to
all area physicians. An annual
conference, it has been developed
with support from local pharm aceu
tical companies which will be
acknowledged.
The program will be held at the
new Lagerquist Center in St. Joseph
Hospital.
For registration information call
the College at 627-7137. Although
no registration fee is required,
physicians wishing to attend m ust
complete and return a registration
form. The conference is anticipated
to fill, so early registration is
encouraged. ■_____________________
-
12
A l le r g y ,
F r i d a y ,
A pril
23
M a y
A s t h m
P u l m o n o l o g y
15
a
P rim ary
C a re
S u r g e r y
U p d a t e
M ay
2 1
L a w
&
S i n g h ,
M D
&
for
A l e x
1 9 9 9
M i h a l i .
D a v i d
J o s e p h
F r id a y ,
M D
e d ic i tie
S u r i n d e r j i t
11
S atu rday,
The College's CM E program
featuring subjects on allergy,
asthma and pulmonology is set for
Friday, April 23. The course is
under the direction o f Alex M ihali,
MD.
H a w k i n s ,
T r a i n i n g
M
D
M a g e l s s e n ,
Just.
M D
JD
M c d i c i n e
N i c h o l a s
R a j a c i c h ,
M D
P u get S ou n d Area, WA: You know how you want to set up your practice.
se ek s BC/BE Family Practitioners. Flexible financial packages and
98371, (253) 848-6661, Ext. 1865.
n - m
HEALTH CARE NETWORK
www.hchnet.org
SEA TTLE - EXC E LLE NT OPPORTUNITIES for BE/BC physicians in the areas of: FAMILY
PRACTICE, GERIA TR IC PSYCHIATRY and PEDIATRICS. Enjoy practicing in a progressive
Community Hospital Health Care Network, 16251 Sylvester Rd SW , Seattle, W A 98166.
Phone (206) 439-5578 • Fax (206) 431-3930
_______________________________e-mail: pthchrm(g)aol.com______________________________
March, 1999
PC M S BU LLET IN
17
C o lle g e o f M e d ic a l E d u c a tio n
Participants find great skiing in addition to quality
C M E at W h istle r , th e C o lle g e o f
M e d ic a l E d u c a tio n ’s w in te r resort
p ro g ra m , w a s a h u g e s u c c e s s w ith
g re a t s k iin g a n d q u a lity C M E .
T h e p ro g ra m b ro u g h t to g e th e r a
n u m b e r o f P ie r c e C o u n ty p h y si
c ia n s in B r itish C o lu m b ia for
fa m ily v a c a tio n in g an d q u a lity
C M E . P h y s ic ia n s o u ts id e P ie r c e
C o u n ty a ls o j o in e d th e grou p .
Left: Alex
Mihali, MD,
Tacoma
In tern ist and his
daughter
Melissa, pose
f o r their picture
in the bright
a n d beautiful
Whistler
sunshine
T h e p rogram featu red a potp ourri
o f e d u c a tio n a l su b je c ts o f v a lu e to
cont. on page 19
Clockwise, from left:
The Craddock and Jiganti fam ilies share smiles, from left,
back row, Elizabeth, Mark, Jenny and Kate Craddock with
fro n t row, Suzy, John and Kyle Jiganti. Jigantis' other sons
were playing in the snow close by
Thinking Snow are, from left, Drs. John Lenihan and Bill
Thomas; Fran Thomas, Kris While and Dr. Matthew White.
A ll are excited about skiing and discuss it at the College's
reception on Wednesday evening
Drs. Leslie and Barbara Fox wait patiently in the ski lift
line anxious lo g et to the sunny Blackcomb Mountain
slopes
18
March, 1999
College of Medical Education
Continuing Medical Education at W histler
Right: Whistler
program speaker
Needam Ward,
MD, addresses
the near record
physician
audience on the
latest
developments in
hypertension
all sp ec ia lties. C o n feren ce atten d ees
particularly en jo y ed th e rare op p o rtu
nity to h a v e in -d ep th d isc u ssio n s
ab out clin ica l situ ation s.
Out o f the c la ssro o m , c o n fer en ce
participants and their fa m ilies en joyed
sn o w , great fo o d and relaxation . T he
program w a s d irected by John
J ig a n ti, M D .
T h e C o lle g e p la n s to o ffer a ski
C M E program n ex t year and w ill
lik ely return to th e W h istler resort
area. ■
Clockwise, from above:
Left to right: Drs. Daniel Ginsberg, Charles Souliere, Gregg
Ostergren and Alex Mihali having fun at the pre-conference
reception and anticipating great skiing the next three days
Drs. Carol Kovanda and M ark Ludvigson attend the apres ski
function hosted by Dr. John Lenihan on Friday night
The Nordestgaardfamily, left to right, Ida, Aksel, Rie and
Lisbeth enjoying the sun
March, 1999
PC M S B U LLET IN
19
News briefs
P
The M edical Society
■
T E M P O R A R Y P L A C E M E N T SERVICE
l|________________________________________________________
J PROVIDES:
| * A pool o f qualified clinical & administrative applicants
| * C overage for vacations, illness, leaves o f absence
| * Help for peak work loads
I HOW IT WORKS:
| * W e pay em ployees' salary, taxes & benefits
| * W e com plete all payroll forms
i * Y ou pay us a low hourly rate
I
I
I
1
C A L L 5 T2 - 3T09 F O R V O I
T E M P O R A R Y H E LP
sa m e d a y co vera g e in m o st cases!
VOLVO
SERVICE & REPAIR
(253) 588-8669
w w w . v o lv o rep a ir.com
B o y le ’s F oreign C ar R epair
72 0 2 Steilacoom B lvd SW
Home page
to the world
of medicine.
T A C O M A /P I E R C E C O U N T Y
O u tp a tie n t G e n e ra l M edical C are.
F u ll a n d p a rt-tim e positions
available in T ac o m a an d vicinity.
V ery flexible sc h ed u le . W ell suited
fo r c a re e r red e fin itio n for
G P, F P , IM .
C o n tact Andy Tsoi, M D (253) 752-9669
or Paul D oty (Allen, Nelson, T urner &:
Assoc.), C linic M anager (253) 383-4351
Wm.
- -
20
profession, the world of medicine is at your
fingertips online. Plus, members have access
to AMA's exclusive Members Only Web Site.
Just complete the online registration at
www.ama-assn.org/members.htm
American Medical Association
P h y s ic ia n s d e d i c a t e d to t h e h e a l t h o f A m e r ic a
'}
./
For your patients, your practice and your
March, 1999
R
the Pulse
Pierce County Medical Society Alliance
Send os your
graduation info
President's M essage
Nikki Crowley
M y thoughts
are fleeting as I
write this note.
Thoughts o f
completing the
collection o f
income tax
data for this
year, planning
a ^rjp
Germany to see a new grand child
and planning next year’s Alliance
activities.
Pierce County will be the host for
WSMAA President K ris W h ite,
who will assume her new office in
April 1999. It would be nice to have
some Pierce County members attend
the State Annual M eeting in
LaConner from April 18-20. W atch
for registration information in the
publication “ One Voice” coming
out soon. Come to LaConner for a
“spring break” and show Kris how
much we appreciate her efforts on
our behalf.
Please report any person in your
family graduating this spring for
our June graduation announce
ments. High school, college, trade
school, etc. Moms, dads, students,
etc. Please include the following
information:
The Tulip Festival will be ju st
finishing but tliere will be flowers to
see and LaConner has interesting
shops, beautiful scenery and excel
lent restaurants. Please join us.
N am e an d School
D egree/R ecognition
F u tu re Plans
There is no point in having a
meeting without delegates from
each county to state and vote on
issues that affect our lives. Be tliere
as a delegate! W e are entitled to
have about six from Pierce County.
Call me at 922-7233 if you wish to
be included in the delegation. (It’s
more fun than work!) ■
Special achievem ents
Please contact A lice Yeh. 7560578 or fax the information to her
at 756-6744. You may also contact
her by e-mail at wenyehfflfwa.net.
Be sure and let Alice know how to
get in touch with you in case she
has any questions. Thank y o u ! ■
New Alliance M embers/New Addresses - February, 1999
A m es, R u th (G e ra ld )
G o ld b e rg , E liz a b e th (R o n a ld )
L u b e r , M a r lis e A . ( J o h n M .)
4 8 0 4 H a rb o rv ie w
PO B ox 313
1 3 0 0 6 D u B o is S W
1 0 3 L ila S t
T acom a, W A 9 8 4 2 2 -1 8 0 0
F o x Is la n d W A 9 8 3 3 3
L akew ood, W A 98498
S te ila c o o m , W A 9 8 3 8 8
R o o k s, P en n y (Jam es)
9 2 7 -6 8 4 4
5 4 9 -2 1 1 2
5 8 2 -6 0 6 1
A rth u r, D . M a rle n e (W a lte r)
G riffith , S a n d y (J a m e s )
M a rtin d a le , A n n e (R ic h a rd
PO B ox 518
4 6 1 1 P a ra d is e A v e
4 0 0 9 C ry s ta l R id g e
4 3 2 5 H ills id e D r
P u y a llu p , W A 9 8 3 7 1 - 0 0 5 3
T acom a, W A 98466
P u y a llu p , W A 9 8 3 7 2 -5 2 6 1
T acom a, W A 98422
8 4 5 -5 5 4 2
5 6 5 -1 5 3 3
8 4 8 -6 5 8 0
9 2 7 -1 1 1 7
B e ll, T h o m a s ( C o r i n n e )
Ila n s e n , G e n n y (K . R o y c e )
M a t z e n a u e r , L e o n a (A le s )
W a iw ig , A n n e tte (D a n ie l)
6 2 6 V is ta D riv e
1 2 7 2 3 G ra v e lly L a k e D r S W
1713 S S u n set D r
PO B ox 1609
T acom a, W A 98465
L akew ood, W A
T aco m a, W A 9 8 4 6 5 -1 2 3 3
G ig H a rb o r. W A 9 8 3 3 5
5 6 6 -5 5 9 4
5 8 2 -0 1 2 8
5 6 4 -4 2 9 5
851 -4 3 9 6
C o rlis s , B e v e rly V . ( R o b e r t W .)
I le lly e r , C o n s ta n c e ( D a v id T .)
M cG U S, E d ith (C h a r le s )
W a rd , R ubyc K.
98499
9 8 4 -6 3 0 4
E .)
T u e l l , I .x ) i s ( S t a n )
2006 C hannel R d E
1 1 6 1 0 T re k D r E
1 0 1 2 4 3 6 th S t N W
1 0 5 5 D e lla C t
S u m n e r, W A 9 8 3 9 0
E a to n v ille , W A 9 8 3 2 8
G ig H a rb o r, W A 9 8 3 3 5
F irc re s t, W A 9 8 4 6 6
8 6 3 -9 8 8 1
3 6 0 -8 3 2 -6 3 9 0
2 6 5 -2 3 5 0
4 6 0 -2 7 9 8
G a llu c c i, J e r o l - A n n ( J o h n J . )
K a n d a, G ra c e (Jo h n )
M o se s, G r a c e N . (D e M a u ric e )
W ic k s , M a r jo r ie J . ( M e r r ill)
128 C o rm o ra n t
1 4 4 1 9 R iv e rw a lk
1 5 6 E a g ie R id g e
6 2 2 4 -A N o rth P a rk w a y
S te ila c o o m , W A 9 8 3 8 8 - 1 7 1 8
S u m n e r, W A 9 8 3 9 0 -8 2 1 3
P u y a llu p , W A 9 8 3 7 4
T acom a, W A 98407
5 8 2 -4 9 9 4
8 6 3 -9 1 8 4
3 6 0 -8 9 3 -3 0 6 3
7 5 2 -7 4 8 1 b
G a r r e d , V irg in ia
K la tt, L o u (G o rd o n )
R itte r , L o la H . ( K e n n e th )
57 1 3 P a rk e r R d
5 1 2 1 C ro m w e ll D r
1 0 4 3 3 L a k e S te ila c o o m D r S W
S u m n er, W A 9 8 3 9 0
G ig H a rb o r, W A 9 8 3 3 5
2 6 5 -3 8 9 8
5 8 2 -9 2 6 3
March, 1999
PCM S BU LLET IN 21
News briefs
S p e llb in d in g w e b site s
B elow are the to p te n w ebsites in
D ecem ber, 1998 th a t kept users'
atten tio n the longest. T ry them!
g am esville.com
hotm aiI.com
free e-m ail; ow ned by M icrosoft
n e ta d d re ss.c o m
Do w e have
your
e - m a il
a d d re ss?
free e-mail
b ask etball pools, ro ck and roll
triv ia
e b a y .c o m
online auctions, from F urbys to
fishing rods
m o n e y ce n tra I.m sn .co m
financial new s and features; ow ned
by M icrosoft
y a h o o .co m
internet directories plus e-m ail,
shopping, etc.
u p ro a r.c o m
play bingo and oth er gam es online
sc h w ab .co m
online stock trad in g and financial
research
e tra d e .c o m
online stock trad in g and financial
research
ro o tsw eb .co m
Please send it to
us at:
[email protected]
internet’s largest genealogy site*
Reprinted fro m the Wall Street Journal, 2/99
D A
W
w \e.
WASHINGTON CASUALTY
COMPAI
asubstq&ryMSxorthwestfjialthcardtnsuranceSei
Innojptive, flexibje, respon|pFe insurance?
JE. 3 6 th
22
March, 1999
S u ite 100 • Bellfevue, W a s h im ln n 9 8 f m - 1568 ■1.800.772.1201
POSITIONS AVAILABLE
Tacoma/Pierce County outpatient
schedule. Well suited for career
redefinition for G.P., F.P., I.M. Contact
Andy Tsoi, MD (253) 752-9669 or Paul
Doty (Allen, Nelson, Turner & Assoc.),
Clinic Manager (253) 383-4351.
Medical Consultant Positions
Available. The Stale of Washington
Division of Disability Determination
Services seeks physicians with clinical
experience in psychiatry, family
medicine, general internal medicine, or
orthopedic surgery to perform contract
services in the Olympia and Renton
area offices. Contract services include
the evaluation of physical or mental
impairment severity from medical
records and other reports, utilizing
Social Security regulations and rules.
Medical Consultants function as
members of the adjudicative team and
assist staff in determining eligibility for
disability benefits. REQUIREMENTS:
Current medical license in Washington
State. Board certification is desirable.
REIMBURSEMENT: $51.83/hr.
Interested physicians should contact
Guthrie L. Turner, Jr., MD, MPH,
Chief Medical Consultant at (360) 5864134 or the respective Area Manager:
Olympia, Joy Justis (360) 586-4115;
Renton, Frances Stine (425) 430-4811.
EQUIPM ENT
Used M idM ark 104 female exam table
with heated drawer, $400. Ask for
Laura (253) 627-3159.
Furnished. Prime Gig Harbor location.
Perfect for a specialty practice. Call for
details. (253) 848-9484.
O FFICE SPACE
Lakewood, medical space available
11/01/98. Two suites 750 square feet
each. One suite 2900 square feet.
MultiCare Urgent Care leaving space
which has been occupied by an urgent
care facility since 1980. Building is a
medical-dental facility next to
Albertsons. 8509 Steilacoom Blvd. Call
Dr. Ken Ring at 584-6200 or 582-5856.
4500 sq. ft. Will finish to suit. On
Convenient parking, ground level. Call
Robin at 756-2182.
GENERAL
Found: University of Utah, 1974 class
ring. Initials KMW. Please call Depuly
John Jimenez, 798-4200.
TA C O M A R A D IO LO G Y
W hen one of the follow ing criteria are met,
beneficiaries are covered by M edicare every 23 months.
1. Estrogen deficient women at clinical risk lor osteoporosis.
Puget Sound Area. Group Health
Permanente is currently seeking family
practitioners for a variety of settings.
Two positions in Olympia require some
hospital coverage, while two positions
in Tacoma and one position in Everett
do not. We are a physician-managed
organization recently affiliated with
Kaiser Permanente and have primary
care facilities located throughout the
Puget Sound area. For further
information, call (800) 543-9323 or fax
CV and cover letter to (206) 448-6191.
You may visit our website at
www.glic.org. Equal opportunity
employer.
2.
Individuals wilh vertebral abnormalities.
3. Individuals receiving lonj> term yluccocorloid therapy.
4.
Personal history of primary hyperparathyroidism.
Monitoring of FDA approved osteoporosis
r Jiu y
therapy may allow foi theater
frequency of examinalion or further baseline axial measurement.
C all to s c h e d u le
Lakewood
Gig Harbor
(2 5 3 ) 3 8 3 -2 0 3 8
(2 5 3 ) 5 7 2 -5 1 7 4
(2 5 3 ) 5 8 8 -6 0 8 3
(2 5 3 ) 8 5 8 -3 2 0 0
A ll e n m o r e M e d i c a l C e n t e r
F ran k S. B a k e r C e n te r
PoinrfosdiGklniaging
Tacoma
March, 1999
PCM S BU LLET IN 23
You
Physicians Insurance to help. In fact, our underw riting depart
reaction, you can call o u r local claims experts for quick and
dependable advice.
As physicians, clinics, and hospitals have know n since 1982,
Physicians Insurance consistently responds l o your insurance
Western Washington
1-800-962-1399
Eastern W ashington
1-800-962-1398
Physicians
H Insurance
E
X
C
H
A
N
G
E
Seattle, WA © WSP1A 1997
223 Tacoma Avenue So.
Tacoma, WA 984 0 2
24
March, 1999
PRESORTED
STANDARD
US POSTAGE PAID
TACOMA, WA
PERMIT NO 605
B
ULLETIN
A pril, 1999
Inside:
3
5
7
9
10
11
14
"T he H e a lth o f P ie r c e C o u n ty ," T a c o m a P ie r c e C o u n ty H e a lth D e p a r tm e n t p ro v id e s d e a th d a ta
A p ril G e n e r a l M e m b e rs h ip M e e tin g will f e a t u r e A n d y D o lan , JD , P h .D .
"T he M ag ic o f N u m b e rs " b y A n d re w S ta tso n , M D
I n M e u io ria m : S a m u e l E . A d a m s, M D , (G o o d Sam ) r e m e m b e r e d by D r. D avid D ye
R e tir e d m e m b e r s g o "V in tag e C a r R acin g " w ith C o rd e ll B a h n , M D
S ta rt y o u r e n g in e s to "p o w e r s e a r c h ” t h e W e b a n d le a r n to g e t w h e r e y o u 're g o in g faste r
C o lle g e M a r in e r s a n d C M E p r o g r a m a b ig h it in P h o e n ix w ith su n , b a s e b a ll a n d le a r n in g
PCMS Bulletin
L a w r e n c e A . L a r s o n , D O ............................... P r e s id e n t
C h a r l e s M . W e a tlie r b y , M D ............ P r e s id e n t E le c t
M a r i l y n E . P a t t i s o n , M D ................... V ic e P r e s id e n t
P a t r ic e N . S te v e n s o n , M D ...... S e c r e ta r y /T r e a s u r e r
J a m e s M . W i l s o n , J r ., M D ................ P a s t P r e s id e n t
N i k k i C r o w le y . P C M S A P r e s id e n t
B
ULLETIN
April, 1999
P a s t P r e s id e n t: P e t e r K . M a r s h , M D
A g in g ,R ic h a r d W a ltm a n ; A I D S , L aw re n ce S ch w artz;
B y la w s , S tan ley T u ell; B u d g e t/F in a n c e , P a tric e
S tev en so n ; C o lle g e o f M e d ic a l E d u c a tio n , W . D a le
O v e rfie ld ; C r e d e n t i a ls , S u sa n S alo; E m e rg e s ic y
M e d i c a l S t a n d a r d s , T ed W alk ley ; E th ic s /
S t a n d a r d s O f P r a c t i c e , D a v id L u k en s; G r ie v a n c e ,
J a m e s M . W ilso n ; L e g is la tiv e , W illia m M a rsh ;
M e d ic a l- L e g a l, P a t D o n le y ; M e m b e r s h i p B e n e fits ,
I n c .. D r e w D e u ts c h ; P e r s o n a l P r o b l e m s O f
P a ttis o n ; P u b lic H e a lth /S c h o o l H e a lth , L aw re n ce
S c h w a rtz ; S p o r ts M e d ic in e , Jo h n Jig a n ti.
M e m b e rs h ip B e n e fits , Inc. for m e m b e rs o f th e P ierce
a rtic le s a n d p la c in g a d v e rtise m e n ts in T h e B u lle tin are
O c to b e r 15 fo r th e N o v e m b e r issue).
T h e B u lle tin s d e d ic a te d to th e art, sc ien ce a n d
d e liv ery o fm e d ic in e a n d the b e tterm en t o f the h e a lth
a n d m e d ic a l w e lfa re o f th e co m m u n ity . T h e o p in io n s
h e re in are th o se o f th e in d iv id u a l c o n trib u to rs a n d do
n o t n e c e s sa rily reflec t th e official p o sitio n o f th e
M e d ic a l Society. A c c e p ta n c e o f a d v e rtisin g in no w ay
c o n stitu te s p ro fe s sio n a l ap p ro v al o r e n d o rse m e n t o f
p ro d u c ts o r se rv ices ad v ertised . T h e B u lle tin a n d P ierce
C o u n ty M e d ic a l S o ciety re se rv e th e rig h t to reject any
ad vertising.
E d i t o r : D a v id S . H o p k in s M D
E d i t o r i a l C o m m i t t e e : D a v i d S . H o p k in s , ( C h a ir )
S u b s c r i p t i o n s : $ 5 0 p e r y e a r, $ 5 p e r is s u e
M a k e a ll c h o c k s p a y a b le lo : M B !
(2 5 3 ) 5 7 2 -3 6 6 6 , F ax 5 7 2 -2 4 7 0
E - m a il a d d r e s s : p c m s w a @ p c m s w a .o r g
H o m e P a g e : h t t p ://w w w .p c in s w a .o r g
2
April, 1999
%1 V
Features
T h e H ea lth o f P ie r c e C ou n ty
................
3
A pril G e n er a l M em b ersh ip M e e tin g ......................... 5
In M einoriam : S am u el E . A dam s, M D ...................... 9
Start th e e n g in e s for p o w er W eb s e a r c h in g
11
In h u m an T rea tm en t o f th e S ic k .................................. 13
Departments
T h e In v isib le Hand: T h e M agic o f N u m b e r s
7
C o lle g e o f M ed ical E d u c a t io n ..................................... 14
C la ssified A d v e r tis in g ...................................................... 19
News briefs
R e m e m b e r in g C h arles L. A n d erson , M D ..............
D r. B alm sp eak s to R etir ed m em b er s ......................
H ow to r e g iste r to v o t e ...................................................
C lin ical g u id e lin e s a v a ila b le o n lin e ...........................
On the cover: The Hoh River, on the O lympic Peninsula
6
10
12
16
T aco m a Pierce County H ealth D epartm ent
The Health o f Pierce County
Leading Causes of Death in Pierce
County, 1980-84 and 1993-97
HEALTH
D E P A R T M E N T
All C a n c e r
H eart D is e a s e
Over the next few months, the
Tacoma-Pierce County H ealth
Department’s Bulletin articles will
be installments about the health
status o f Pierce County residents.
We hope physicians and other
medical providers will find the
reports interesting and useful to
their practice.
cu
<D
Q
<D
</>
3
^
Lung C a n c e r
C e re b ro v a s c u la r D is
□ 1980-84
U n in te n tio n a l Injury
■ 1993-97
All F ire arm s
M o to r V e h icle Injuries
A lcoh o l R e la te d MVI
L iv e r D is e a s e
In addition to engaging private
providers’ interest in Pierce County
statistics on mortality and morbid
ity, the data should provide a
framework for understanding the
health department’s priorities for
prevention strategies. Over the next
several years, our goal is to reduce
illness and death related to smoking,
alcohol abuse, violence, and HIV/
AIDS. These areas are related to
behaviors which w e believe health
promotion campaigns, carefully
crafted and targeted, should be able
to change. The charts and narrative
we include in the Bulletin are
baseline statistics against which we
can compare numbers in the future
to determine the effectiveness o f our
strategies.
0
50
100
150
200
R a te p er 1 0 0 ,0 0 0 p o p u la tio n
A g e -a d ju s ie d d e a th rates
S o u rce . W a s h in g to n S ta le D e p t ot H e a lth . V ila l R e g is tra tio n S y s te m A n n u a l S ta tis tic a l F iles. 199£
Deaths From Respiratory Cancer,
1993-1997
P art O ne: L eading C auses of
Death in P ierce C ounty
Comparisons in age-adjusted
death rates for the periods 1980 to
1984 and 1993 to 1997 show an
overall decline except in causes o f
death from lung cancer. This decline
follows national and statewide
trends. The m ost dram atic declines
are seen in deaths from heart
disease, stroke and unintentional
1
*
S la tis lic a lly s ig n ific a n tly h ig h e r
3
4
5
P H S S D istrict
A g e -a d ju s te d d e a th ra le s
S o u rc e : W a s h in g to n S ta le D e p t of H e a llh , V ita l R e g is tra tio n S y s te m A n n u a l S ta tis tic a l F ile s. 1990
See "Health"page 4
April, 1999
PC M S B U L L E T IN 3
Feature
H ea lth
from page 3
injuries. T his is thought to be due to
advan ces in m edical care and higher
safety standards for autom obiles.
C an cer (all types) has exceeded
F or H ealth D ep artm en t s ta ff
assignm ents, P ierce C ounty has
been divided into seven districts
w ith approxim ately equal num bers
Deaths from Heart Disease,
1993-1997
■ Male
0 Female
co unty an d com paring by TPCHD
d istrict, th e death rates from heart
disease a re statistically higher in
m ales an d fem ales in districts 4 and
5 (central T aco m a and p art o f
L akew ood) com pared to district 7
(N o rth T aco m a an d Peninsula).
D eath rates fo r all respiratory
can cers am ong m ales in districts 4
an d 5 an d fem ales in district 1
(Sum ner, B uckley, Orting,
E atonville an d all p arts east) are
statistically significantly higher than
in d istrict 7, w hich has the lowest
rate fo r m ales an d females in the
county.
F uture articles will include data
on key public health issues, includ
ing:
♦ access to m edical care and its
effects on preventive health behav
ior
1
*
3
4
5
PHSS District
S ta tis tic a lly s ig n ific a n tly h ig h e r
A g e -a d ju s te d d e a lh ra te s
S o u rc e W a s h in g to n S ta le D e p l of H e a lth , V ita l R e g is tra tio n S y s te m A n n u a l S ta tis tic a l F ile s . 1 99 8
heart disease as the num ber one
cause o f death in ou r county.
D eaths secondary to firearm s have
increased.
Puyallup, WA 98371-0192.________
4
April, 1999
o f residents p er district (sam e as
Pierce C ounty Council district
divisions). In looking at the v aria
tion in causes o f death across the
♦ behavioral patterns for tobacco
use, alcohol m isuse and violence
♦ cu rren t attitudes and behaviors
asso ciated w ith health risk among
school children across the county
♦ variations in service capacity
acro ss com m unities
F or m ore inform ation on the data,
co n tact R ick M acC om ack, Senior
E pidem iologist and Public Health
M an ag er at 798-4 7 8 8 .*
Urethral Inserts
Sublingual Troche
IV Services
Capsules
Lip Balms
752-1705
Social Hour:
Dinner:
Program:
6:00pm
6:45pm
7:45pm
Temple Theatre, Roof Garden
47 St. Helens Avenue
Tacoma
Andy Dolan, JD, PhD
Highlights o f Mr. Dolan’s talk will include:
♦
♦
♦
♦
An overview of the current state of affairs
Issues that have most affected doctors and how they have responded
What typically goes wrong in physician organizations
Some suggestions for making your practice successful
(Registration required b y April 9. Return this form to: PCMS, 2 2 3 Tac o m a Ave S, Tac o m a 9 84 0 2 ; FAX to 5 7 2 -2 4 7 0 or call 5 72-3667)
Please reserve ________ dinner(s) a t $20 per person (tax a n d tip included)
Enclosed is my c h e c k for $
□
Visa
□
Master C a rd
or m y c re d it c a rd # is ___________________________________________
Signature ____________________________
I will be bringing my spouse or a guest. N am e for na m e t a g : _______________________________________
S ig n e d :_______________________________________________________
Thank you!
N e w s b rie fs
^ ean ^ ir ôr
- " I * " — Asthma Prevention Program
bo you have p atien ts in your p ra c tic e w ith a sth m a?
T h e Clean A ir fo r Kids Program provides train ed volunteers
who can a ssist fam ilies and medical providers with
•
a com prehensive home assessm ent to help id en tify
environm ental trig g ers o f asthm a
•
p ra ctica l recommendations to reduce asthm a trig g ers and
im prove home air quality
•
a w ritte n re p o rt of th e assessm ent and recommendations
to th e medical provider
Volunteers do not give medical advice, and would welcome
re fe rra ls fro m medical providers. The service is free. To make
a re fe r r a l, or to get more information about th e program,
contact S a ra h Curran at (25 3) 798-2954.
Clean A ir f o r Kids is a p artn e rsh ip o f th e Am erican Lung Association o f W a s h
ington, T acom a Pub lic Sch o ols, U n iv e r s ity o f W ashington, Puyallup Trib al
H e a lth A u th o r ity , W a sh in g to n S t a t e D ep artm ent o f H e a lth , M a ry B rid g e
C h ild re n 's H e a lth C e n te r, and T h e Tacom a-Pierce County H e alth D ep artm ent
w hich is d e d ic a te d to helping people learn more about w ays to red uce asthm a
and h e a lth ris k s fro m p ollutants in th e ir home.
In Memoriam
Charles L. Anderson, MD
1931-1999
D r. C h a rle s L e R o y A n d e rso n , died on Friday,
M arch 5, 1999 after a b rie f illness. H e had suffered
fo r m any years w ith hereditary elliptocytosis.
D r. A nderson p racticed child and adult psychiatry
in P ierce C ounty since 1972. H e jo in ed the Medical
Society in 1973. H e g rad u ated from the University
o f W ashington M edical School in 1962 and com
pleted his internship an d residencies in psychiatry.
H e practiced a t W estern S tate H ospital for many
years before startin g his p riv ate practice.
H e w as an active P C M S m em ber, serving as an
A lternate D elegate a t several W S M A meetings. In
1971-72 he served as a m em ber o f a Pierce County
T ask Force fo r C hildren an d in 1981 w as a member
o f the M edical Society's Jail H ealth Advisory
Board. In 1990 an d 1991 he served as President of
the Southw est W ashington Psychiatric Society and
p articip ated in P ierce C ounty M edical Society
B oard o f T rustee's m eetings as the Psychiatric
Society's representative. H e served for several years
on the W S M A 's Teen T ask Force and w as a mem
ber o f the W ashington S tate P ediatric Association.
Dr. A nderson is survived by his wife, Cindy, an
active P C M S A m em ber and children E ric, John, and
W endy and th eir spouses. H e leaves tw o grandchil
dren and tw o brothers.
Services w ere held a t Z ion L utheran Church,
w here contributions in his m em ory will be used for
children.
P C M S extends condolences to Dr. Anderson's
fam ily .!
Allenmore
.yCTjPsychological
« i Associates, P. S.
752-7320
D o y o u have patients w ith difficult em otional
___________ 1530 Union Ave. S.. Ste. 16. Tacoma
6
April, 1999
to tal
A s s e t Ma n a g e m e n t ,
in c .
Registered In v estm en t Advisory
PPRSONAI INVESTMENT
AD VIC t PROM "I I-IE PRESIDENT
INDUSTRY I PADING LOW FEES
(NO COMMISSIONS)
Cai i 8 5 8 - 2 7 4 5
WWW.
4-TAM-RIA
0avill:. R„akopi,, mw, cfp
C A LL OR VISIT OUR WEB FOR A
CD\CASSETTC INTRODUCTION
Feature
"The Magic o f Numbers"
"Truth is much too complicated to allow anything but
approximations."
John von Neumann
Sometimes I get a call from the
Labor Room about a patient. “She
is 38 6/7 weeks,” the nurse would
add. When I hear that, I have to
suppress the wild urge to ask “and
how many hours?” Perhaps “how
many 168ths?” would be more in
tune. Our perinatologists started
counting the days to keep track o f
the weeks. Their patients m ay stay
on the unit for a month or more, and
it is awkward, every few days, to
have to recalculate the gestational
age. There is no harm in being
precise, so long as precision is not
confused with accuracy, nor with
clinical relevance. For instance, our
ultrasound machines give us the
fetal weight with a precision down
to one gram. Their accuracy,
however, is nowhere near that.
I suspect tire clinical difference
between two patients, both at 33 w
3 d, is more significant than the
difference between the same patient
at 33 w 3 d and 34 w 1 d. The
problem is that the difference
between two patients is more likely
to be descriptive than numerical,
therefore not easily quantifiable.
Somehow it is easier to treat two o f
the same gestational age the same
way. At least, that is how studies
are done. W e give steroids to
patients with preterm labor to
reduce the risk o f respiratory
distress in the newborn. According
to studies, steroids don’t w ork after
34 weeks. Do they stop at the stroke
o f midnight?______________________
We, ordinary people, have a
fascination with numbers. W e think
we know something much better if
we can put a num ber on it. M ath
ematicians have a different view o f
things. The above quote from the
designer o f the com puter architec
ture that bears his name, John von
Neumann, is b u t one example.
“How long is the coast o f Britain?”
asks Benoit M andelbrot in his book
“The Fractal Geometry o f N ature”.
His answer is w orthy o f a m athem a
tician: It depends on your yardstick.
As you use a smaller and smaller
yardstick, and go around every rock
and pebble and grain o f sand, the
coast becomes longer and longer. It
is infinite, if m easured with an
infinitely small yardstick. This does
not even account for the constant
shift o fth e line between sea and
land with the waves and the
tides.
A sim ilar problem exists with
land borders. M andelbrot reports
that the border between Spain and
Portugal is 1214km according to the
Portuguese, but only 987km
according to the Spaniards; and the
border between the N etherlands and
Belgium is 449km according to the
Belgians, but only 380km according
to the Dutch. Same borders, differ
ent yardsticks.
N um bers are designed to count
discrete entities. A t some point,
however, the num ber becomes
“many” . For large num bers or
continuous functions the numbers
are only approxim ations, sometimes
good, sometimes poor. The error we
tend to make is to believe that if we
have a number, it is both exact and
true. A t least w e think it is more
exact than a description.
In medicine we use num ber
ratings as a code for descriptions,
such as in the grading o f heart
m urm urs or tendon reflexes. In the
grading o f Pap smears, however, we
w ent from numbers to descriptions.
Somehow numbers didn’t do it. The
experts still grumble that the
readings are not accurate, Ihat too
m any smears are put in a waste
basket category. T hat may be true,
b ut cell changes represent a con
tinuum. Drawing lines in a con
tinuum is always arbitrary. It
cannot be exact. It is not realistic to
expect our pathologists to never
hedge their calls.
One o f the speakers at a seminar
on cervical pathology stated that
when she read biopsies, she also
looked at who the attending physi
cian was. W hen she was not sure
whether to overcall or undercall a
lesion, she tailored the report
according to how aggressive she
expected the gynecologist to be. In a
sense, she moved the dividing lines
along the continuum depending on
the response she expected from the
clinician.
In the old days, before fetal
monitors, someone did a study to
test the accuracy o f counting fetal
heart tones. They m ade recordings
and played them a t different speeds.
see "Magic"page 8
April, 1999
PC M S B U LLET IN 7
Feature
Magic fro m page 7
A n u m b er o f physicians, m idw ives
an d nurses w ere asked to count.
O ne h a lf o f the counts w ere o f f by
m ore th an 10 beats p er m inute and
one th ird by m ore th a n 20 beats. If
w e can be o ff so m uch in counting a
h ea rt rate, how accu rate can w e be,
fo r instance, in rating p ain on a
scale o f one to ten? Is it better than
a description? O ne o f the anesthesi
ologists during m y residency had an
interesting w ay o f gauging pain.
W hen a patient said “ G od help m e!”
she w as in active labor. W hen she
said “Jesus save m e!” she w as close
to delivery and ready for a spinal.
A s clinicians w e know th a t the
num bers w e deal w ith are only
approxim ations. T he problem is that
non-clinicians, such as the people
w ho w ork fo r the various health
plans, d o n ’t know that. Recently a
bulletin from the D epartm ent o f
L ab o r and Industries crossed m y
desk. R eading it I learned th at to
m ake the diagnosis o f fibrom yalgia
the p atien t m u st rep o rt w idespread
pain for at least 3 m onths and I
have to test 18 tender point sites
w ith digital pressure o f 4kg. The
patien t m u st perceive this pressure
as pain a t eleven or m ore o f these
points to confirm the diagnosis. Ten
points w ouldn’t do it. P ressure o f
3kg or 5kg w ouldn’t do it. H ow do
w e determ ine w e are applying
digital pressure o f 4kg? D oes the
size o f the finger o r the length o f the
fingernail m ake a difference?
A nyw ay, how w ould a p atient react
to putting 4kg digital pressure on a
tender point? H ow m any w ill let us
do it eleven tunes? I suspect g rad u
ated p ressure is m ore appropriate,
b ut th a t im plies w e have to use our
judgm ent!
T he w riters o f the E valuation and
M anagem ent C odes also show a
fascin ation w ith num bers. F or a
com prehensive office visit our
8
April, 1999
record m u st show fo u r o r m ore
elem ents o f th e h isto ry o f present
illness; a review o f ten or m ore
system s; one o r m ore item s from
each o f th e p ast, fam ily an d social
histories; the exam ination o f at
least tw o elem ents from each o f
nine different system ; etc. D oes
the review o f ten system s, all o f
the negative, require m ore w ork or
skill th an the review o f only three
system s, b u t w ith significant
problem s in each?
The m anaged care plans have
decided to pay fo r m edical care by
the num bers. T hey b ase their
paym ent schedule on the num ber
o f m inutes spent, system s re
viewed, elem ents exam ined,
diagnoses m ade, prescriptions
w ritten, etc. In this respect they
have a serious problem . T hey have
no w ay to m easu re the am ount o f
w ork involved in any one case.
They are even less able to deter
m ine the value o f th a t work. W hen
p rice is n o t b ased on value, but on
p ap erw o rk , th e m arket will give
b ack p aperw ork, instead o f value.
S uch is th e n atu re o f the beast. We
can only g et w h at w e pay for.
U nder those circum stances the
first to go dow n is quality, the next
is availability. T he m arket is
already doing that. The quality of
care has decreased and over time
even p o o r care will become less and
less available. A t the same time,
outside the confines o f managed
care, a p arallel m arket will develop,
as in G reat B ritain.
A very sm all parallel market has
existed for som e tim e already. I
suspect m ost o f us have seen
patients, insured by some closed
panel group plans, come for private
care and p ay o u t o f their own
pocket. A s m anaged plans continue
to lim it care, this m arket is bound to
grow . C are by the numbers gradu
ally will lose ground and might, just
m ight, eventually disappear. ■
Fierce County Medical SocietyMedical Placement Service
The solution for all you r staffing needs
W e p ro v id e fo r y ou:
► an a v a ila b le p o o l o f q u a lifie d c lin ic a l &
a d m in istra tiv e a p p lic a n ts
► c o v e r a g e fo r v a c a tio n s, illn e s s, le a v e s o f
a b se n c e , p e a k w o r k lo a d s, p r e g n a n c y , etc.
► e m p lo y e e s w ith o u t th e h a ssle o f sa la ry ,
b e n e fits , ta x e s a n d o th e r su c h e m p lo y e e
r e q u ir e m e n ts
►
Temp to Perm: A unique opportunity to work
with a potential em ployee on a trial basis
without obligation to hire
For m ore inform ation:
Call D eborah Pasqua: 572 -3 7 0 9
Feature
r
I in M e m o ir ia m
S a m u e l IE, A d a m s , MD)
D e c e m b e r 114,119119 - F e b r u a r y n2, 11999
The sobriquet, “Good Sam ,” settled naturally on him. His mourners included families o f up to four genera
tions o f patients, friends, and neighbors, members o f local governing bodies, utilities, professions, and
sports. Elegies and eulogies were offered in respect for his dedication to medicine, family and his volunteer
ing for an awesome num ber o f jobs on regulatory bodies, and in uncompensated, unsung and unglamorous
community service. He never sought aggrandizement or favors in return for his efforts.
After listening to the praises o f the mourners, the priest dubbed him Saint Samuel E. Adams, by-passing
centuries o f liturgy and custom o f the church, tongue in cheek, because h e’d never before heard so much eu
logistic outpouring from so wide a spectrum o f speakers. Sam would have smiled a t the unconventionality.
My family lived next door to the Adams for forty years, but I find it impossible to pen an elegy because 1
cannot think o f him w ithout a smile that would belie the elegy. W e had no curtains on the facing windows
and we spent years with breakfast nooks and kitchens wide open to neighborly view. Lordy, did we share a
lot o f living midst child rearing and medicine practices! Births and deaths, jo y and sorrow, success and fail
ure, victory' and defeat, health and sickness, it is difficult to remember which family was the recipient o f any
specific entity, but always, someone cared.
Sam was raised in logging camps in the tim ber country north o f Satsop and Aberdeen. H e was the son o f
a literate logger who w rote o f his experiences. It was the time o f (lie G reat Depression and survival was the
only goal o f m ost o f his contemporaries. His desire for college and medical training w as highly fanciful, im
practical and improbable. He accomplished it in the face o f poverty and deprivation, but he related his expe
riences proudly as precious memories and education, never citing any physical, social or psychological
rigor.
He met his beloved wife, Lorraine, during medical school. She was a hospital dietitian trainee who saw to
his nutrition and once bought him new shoes. Theirs was a storybook romance. He w as her prince, her
knight in shining arm or, exactly as befit her w ants and needs. It persisted unchanged over years. She was
his princess and he won her hand each and every day. She cared for his needs and wants before he was
aware o f them and the ground she trod was holy to him. The only time she let him down was when she was
so careless as to pass aw ay before his time! He cared for her at home in her final days, the physician well
knowing there w as nothing to be done, but as a hurt lover insistent that something be done and dying a little
each day w ith her. W e physicians well know that there is no such tiling as a “broken heart” as a cause o f
death. A laughable concept, but Sam died o f a lack o f will to live that began with Lorraine’s funeral. Call it
depression if that suits you, but his religion and profession made suicide unthinkable, so he just retired from
living.
He graduated from the University o f W ashington and N orthwestern Medical College. He was in general
practice in Tacom a from 1951 to 1996. As hobbies, he coached Little League baseball, was the physician o f
a pro baseball team for twenty-five years, and followed H usky football avidly. He w as a dedicated steelhead
fisherman with a classical repertoire o f tales about it. H e loved golf and hunting and those pursuits bred sto
ries o f both success and failure and helped to feed his very active sense o f humor.
The community and profession are both a little less humane for his loss, but his five children and seven
grandchildren carry both his genetic and social attributes and will no doubt make significant contributions.
D a v id F . D y e , M D
April, 1999
J
PC M S B U LL ET IN 9
V
News briefs
R etired m em b ers go vintage car racing with Cordell Bahn, MD
D r. C o rd e ll B a h n , retired cardio
v a sc u la r surgeon, to o k the retired
m em bers fo r a drive dow n m em ory
lane a t their luncheon m eeting on
F riday, M a rc h 5. A fter a buffet
lu n ch a t F ircrest G o lf C lub, Dr.
B alm show ed slides and shared his
know ledge ab o u t vintage cars and
vintage ca r racing. H is interests are
and have been p rim arily in road
racing, and he has follow ed road
racing from N ew Y ork to P aris over
th e years. H e spoke ab o u t X K E s,
Jag uars, F erraris, noting the
2 5 0 G T E m odel F errari has “a
certain m ystique ab o u t it.” T his car
has w on a g reat num ber o f races,
has 250-350 horse pow er and w as
th e m ost valuable ca r postw ar.
H e shared stories about the
M aserati and the B ugatti, the later
being one o f his personal favorites.
T he type 35 particularly. “ They
m ade only 210 o f th em ,” he said,
an d they have w on over 1800 races
in E urope, sporting 24 valves an d 8
cylinders in their engine along w ith
cable brakes. “T he ca r is m ade to
go - not to sto p ,” added D r. Bahn.
racing c a r w ith only
112 m odels b uilt. H e
said it w as a g reat
handling car, very
forgiving, w ith a
durable, com plex
engine.
F or B a h n ’s personal
collection he favors the
B ugatti. H e has ow ned
tw o, and still h as one
w hich he b ought in
London. It is a m odel
35C , and, according to
D r. B ahn, “an all-out
race c a r.”i
Pictured above: Dr. Cordell
Balm, speaker (center) visits
with Dr. C arroll Simpson
(left) and Dr. M ian A nw ar
(right)
Pictured at right: Dr.
Robert Florence (left), and
Dr. John Stutterheim visit
with form er colleagues after
the meeting
Bentleys, M ercedes B enz, and the
P orche 904. T he P orche 904 w as a
AVAILABLE OFFICE SPACE
Fircrest Medical Arts Center
412 Bowes Drive, Fircrest
Two-tenant building
One side for lease: 1,580 sq. ft
C h eck u s out!
7424 Bridgeport Way West
Full Service Medical Bldg
Two suites: 1,177 sq. ft
and 1,570 sq. ft.
w w w .p cm sw a.o rg
Newl Menlo Park Professional Center
Bridgeport Way at 35*
O ffic e s p a c e : 5 0 0 - 5 ,0 0 0 aq . f t
Contact Gary Crawford
CRAWFORD/KATICA, INC.
(253) 272-9200
10
April, 1999
w w w .w s m a .o r g
w w w .a m a - a s s n .o r g
Feature
Start the engines for some power searching
P hysicians can w ander th e W eb with
g enera l sea rch engines. B u t a m o re
specialized o n e can g e t y o u w h e re y o u ’re
goin g fa ster.
Just as a medical library would be
virtually useless w ithout a card
catalogue, the benefits o f the Web
cannot be fully realized without a
way to find the documents.
Search sites abound, and most
W eb-saw y doctors have learned not
to pick one and stick with it. Theirs
is a process o f moving from one site
to another until they get exactly
what they want.
“I usually search Excite [http://
www.excite.com /]. It’s the home
page for my Internet service pro
vider [Prodigy Internet] and it does
a creditable jo b ,” says Benjamin
Krevsky, M D, D irector o f G as
trointestinal Endoscopy at Temple
University Hospital.
But th a t’s ju st his first step.
“When that fails, I switch to
Yahoo! [http://w w w .yahoo.com /],
especially if I w ant to search using
menus,” Dr. Krevsky says.
Next, he goes to A ltaVista [http:/
/www.altavista.com /] for w hat he
calls high-power searches or to
Healthfinders [http://
www.healthfinder.gov/] or the
National Institutes of Health
[http://www.nih.gov] for patient
information.
Directories vs. Search Engines
One o f the m ost im portant
distinctions is between directories
and search engines. It’s a bit
confusing because, in common
parlance, both directories and
search engines are often referred to
as search engines.
A directory - Yahoo! is the most
famous - is prepared by people, not
generated autom atically as are true
search engines.
W ith a director)', reviews write a
short description o f the site. When
you type in a search term, the
directory searches only for that
term.
University o f A labam a at Birming
ham. H e likes the fact that
m elasearch utilities search other
search engines and rank 1lie results
in order o f relevance in a single
window.
In contrast, true search engines,
like H otBot [http:/w w w .hotbot.
com/] or AltaVista, “craw l” (lie
Web, reading virtually every word
on millions o f W eb pages every
day.
Before using A pple’s new system.
Dr. Spooner used M e ta C ra w le r
[h ttp ://w w w .g o 2net.com /], which
searches Lycos, Infoseek,
W ebCraw ler, Excite, A ltaVista,
Thunderstone and Yahoo!
By revisiting each site every few
days or so, the search engines are
able to m aintain an up-to-date
database o f the w ords and phrases
contained on every page.
General vs. M edical Search Sites
Search engines for doctors can
also be divided into two broad
categories: general search engines
and medical search engines.
Since directories search only
descriptions, they generally provide
fewer hits - W eb pages that match
die search terms.
The basic difference lies in the
sites they search. M edical search
engines confine themselves to sites
geared to doctors or patients.
For example, a search o f the word
“diabetes” at Yahoo! yielded 391
site matches. Search the same term
at H otBot and you get 210,000.
General search engines don’t
exclude such sites, o f course, but
they should be used prim arily for
broad-based inquiries. For example,
research on head injuries may
require clinical inform ation as well
as news stories o f people who
sustained such injuries. Those news
stories can be found on general
search engines.
To narrow your searches, it pays
to remember that directories divide
the hits into categories, each o f
which leads to subcategories.
For example, Yahoo! has a
manageable 17 categories for
diabetes, including “Health: D is
eases and Conditions: Diabetes and
“Business and Economy: Com pa
nies: Health: Software: Personal
Health: Titles: D iabetes.”
While search engines do not have
a preset hierarchical structure, they
often do provide pow erful features
that help refine the search. For a
comprehensive search, it’s best to
try more than one. This is where
“m etasearch engines” can help.
“I use individual search engines a
lot less now th at A pple’s System
8.5 includes a ‘m etasearch’ utility
called Sherlock,” says Andy
Spooner, M D , a pediatrician at the
“ I usually try the medical sites
first,” says Stuart T. W einberg,
M D , a pediatrician with New'
Century Pediatrics in Findlay, Ohio.
He likes PubM ed or a pediatric
site such as P E B IN F O [h ttp ://
w w w .u ab .ed u /p cd in fo /|. I f he ca n ’t
find w hat he needs using medical
sites, he goes to a metasearch
engine.
M ost o f the dozens o f medical
search sites distinguish themselves
in some way.
For example. M edical W o rld
Search [h ttp ://w w w .m w se arch .
com/] is unique in its ability to
See "Engines" page 18__________________
April, 1999
PC M S B U LLET IN
11
News briefs
How to Register to Vote
C ancellation o f R egistration:
T o re g is te r to v o te in P ie rc e
C o u n ty , y o u m u st be:
A citizen o f th e U nited S tates; a t
least 18 years o f age by the date
o f th e n ext election; a resident o f
P ierce C ounty; and not presently
denied y o u r civil rights as a
resu lt o f a felony conviction.
Y ou m ay register at the Pierce
C ounty A nnex, 2401 South 35tli
Street, R oom 200, T acom a, or
you m ay have a form m ailed to
you b y calling 253-798-7430 or
1-800-446-4979 (in W ashing
ton). I f you register by mail,
y o u r ap plication m ust be p o st
m arked a t least 30 days prior to
an election to vote. Y ou m ay
register in person at the A uditor's
O ffice. 2401 S outh 35th Street,
R oom 200, T acom a, o r at an
A uditor's Satellite O ffice, up to
15 days p rio r to an election.
Y ou will only be rem oved from
the registration files i f you fill o ut a
cancellation card o r register to vote
If y o u w a n t to v o te b y m a il p e r m a n e n tly , fill o u t th is form and
s e n d it in . I f y o u a l r e a d y r e c e i v e y o u r b a l l o t b y m ail,
y o u d o n o t n e e d t o f il l t h i s o u t .
P ie r c e C o u n ty A b s e n te e B a llo t R e q u e st
O N G O IN G [Xj
Send
C a th y P e a rs a ll-S tip e k .C P O P ie rc e Co. Auditor
To:
2401 S 35th St, Rm 200, Tacom a, WA 98409
Ay e a r-ro u n d m ailing
(253) 798 -7 4 3 0 • 1-800-446-4979 (WA)
a d d re ss is re q u ire d
PmUNjihc as Rt-g^slertid
Print Address Where Yotj Live
Dale uf liirlh
I f you m ove, be sure to notify
the A uditor's O ffice o f your new
address - call 253-798-7430. If
y o u r nam e has changed, we will
need to send you a form to
update your signature.
City/Tovvn
X
1 Sig'nature of Applicant
l
SERVICE & REPAIR
(253) 588-8669
w w w .volvorepair.com
B o y le ’s F oreign C ar R ep air
72 0 2 S teilacoom B lvd S W
12
April, 1999
Socuii SecunLy Number
City/Town
ZipCode
Home Phone Number
Year-Round Mailing Addruss inMjuired if different fromaddress where you live)
A d d re s s o r N am e C h a n g e:
VOLVO
in ano th er county o r state. I f a voter
is deceased, another voter may fill
o ut a death c a rd to cancel the
deceased person's registration.!
______________________
ZipCode
Date
r_ ______________________ " z i : _____________________________1j
P u g e t S o u n d Area, WA: You know how you want to se t up your practice.
se e k s BC/BE Family Practitioners. Flexible financial pack ages and
m anagem ent to full em ploym ent. C onvenience, quality 225-bed hospital
and excellen t location in fast-growing, family community. C lose to Seattle
em ployer. Contact Kathy Guy, Administrative Director of Clinics, Good
Samaritan Community Healthcare, 407 - 14th A venue SE, Puyallup, WA
98371, (253) 848-6661, Ext. 1865.
Feature
Inhuman Treatment o f the Sick
F eb ru ary 11, 1912 - The headline in the Sunday T ri
bune cried “Leper has been harbored in city for m onths.”
Citizens were told that a man afflicted with this dread
disease had been found fanning a five-acre tract at Sum
mit.
Living under an assumed name, former army private,
John R. Earl, was attem pting to support his family on a
small military pension that he supplemented by fanning.
He might have gone on unknown and unsuspected, but
his deteriorating condition drew the attention o f some o f
his neighbors.
As a private, Earl had been stationed on a small island
in the Philippines when he contracted the disease. He
was taken to M anila for further examination, and within
a few hours, w as on his w ay to San Francisco, under
tight security. There arm y physicians reexamined the
private and confirmed the diagnosis. Because o f his ill
ness, Earl was granted the highest possible pension and
discharged from the military.
Earl was then sent to W ashington D.C. where he was
examined. Leprosy w as again the diagnosis, however,
there was enough doubt that Earl was sent to New York
where Dr. Duncan Buckley, a leading expert on skin dis
eases made yet another examination. “Severe eczema”
the doctor said and the pension w as immediately reduced
by half.
N o longer in (lie army, and released by the medical es
tablishment, Earl was free to go about his business. New
York City health officials, however, suggested that he
return to California where the climate was “far superior
for skin diseases to that o f N ew Y ork.”
While in California, Earl m arried and had three chil
dren. He was, according to his own words, “influenced
to travel north and live under an assumed name.” The
family ended up living on a five-acre farm on the Summit-Puyallup border. Pierce County officials later
claimed that residents o f California provided transporta
tion money for the move, with enough cash left over to
purchase the land.
When his illness worsened and he was unable to work,
Earl wrote the arm y pension office and asked that his
full pension be restored. Fearing that the change meant
confirmation o f the original diagnosis, the government
took immediate steps. All railroad officials were notified
o f E arl’s existence, w hereabouts and condition, and were
warned against transporting him to any other part o f the
country. W ith this kind o f publicity, E arl’s presence be
came public knowledge.
Pierce County officials took immediate action and Earl
Man Afflicted With Drpad P lii
Is Found Peacably Tilling' k
FiveJacre Tract at Summit j
D E P U T Y S H E R IF F H A S
' s
STOOD GUAED W O D A Y S
C o u n ty j W ill B u ild S to c k a d e j a n
A b o u t A c re o f G r o u n d — B ig
D am kg'e S u it M a y B s F i l e d I
Shoi'k and itutnigt’ Z'-’crr the response tu discol’t'iy oj a
leprusy-inftn'tt’d mini in smith 1'acotna .suburb nj Sum m it.
was forbidden to leave his land. His neighbors were out
raged and authorities were told that the entire Earl fam
ily would be murdered and their home dynamited if they
were allowed to stay.
In spite o f repeated assurances by County Com m is
sioner J.F. Libby that leprosy was not transm ittable, ex
cept by actual contact, the sheriff was ordered to guard
the property and the family. Eventually, a small shack
was built for Earl on one acre and enclosed with a high
fence. E arl’s sole communication w as through a small
hole in the gate. Mrs. Earl w as given a pistol for de
fense and additional guards patrolled the farm , but
clearly something had to be done. As the situation con
tinued, plans were made to move Earl, but that w asn ’t
enough for the locals, who gave M rs. Early two days to
move out. W hile Pierce County officials looked to see
whether they could charge California for the costs inSee "Sick" page 16
April, 1999
PC M S B U L LET IN
13
C o lle g e o f M e d ic a l E d u c a tio n
Sun, great baseball and quality CME in P hoenix
CM E and Mariner Spring Training, the College o f M edical Education’s
second program o f its kind w as a success with sun, great baseball and
quality CME.
The program brought together a number o f Pierce County physicians in
Phoenix for fam ily vacations and CME. Some physicians outside Pierce
County also joined the group.
The progam featured a potpourri o f educational subjects o f value to all
medical specialties. Conference attendees particularly enjoyed the rare
opportunity to have in-depth discussions about clinical situations.
Out o f the classroom , conference participants and their families enjoyed
sun, baseball and exploring the greater Phoenix area. The program was
directed by R ichard H aw kins, M D .
Dr. John Jiganti and his wife, Suzy, take a
break in their tennis match in Phoenix
Dr. Robert A lston responds to a question regarding
osteoporosis during the CME program
14
PC M S B U L L E T IN
April, 1999
Garth Brooks, San D iego Padres wannabe and alleged country
singer, jo g s in fro m left fie ld in a game with the Mariners
COLLEGE
MEDICAL
Surgical Update
CME, May 14 & 15
The very popular dissections, dem
onstrations and lectures presented
annually by the Tacom a Surgical
Club are set for M ay 14 & 15. The
programs will be held at Tacom a
Community College.
On Friday afternoon, dissections
and demonstrations on cadavers will
be performed for health care provid
ers and interested students. Begin
ning Saturday morning, several
short lectures featuring the latest
developments in surgery will be pre
sented by local physicians and
Army M edical Corps doctors. The
68th annual program is directed this
year by D avid M agelssen, M D . ■
Law & M edicine
Symposium May 21
The Law & Medicine Symposium
offered by the M edical/Legal Com
mittee is scheduled for M ay 21.
The M edical/Legal Committee con
sists o f representatives from PCM S
and the local B ar Association.
The symposium presents topics o f
common interest to both physicians
and attorneys. Speakers are chosen
from prominent members o f both
professions. The program offers an
insightful look at both sides o f com
mon professional interactions.
Allergy, Asthma and Pulm onology CME
scheduled for Friday, April 23
The College’s
CM E program
featuring
subjects on
allergy, asthm a
and
pulmonology
will be held
Friday, April
23. The course
is under the
medical direc
tion o f Alex
M ihali, M D .
N ew Lagcrquist
Conference Center
at St. Joseph
M edical Center in
Room s 1 A & B . It
will include presen
tations on:
❖ Sick Building
Syndrome and other
Building Related
Illness and the Role
o f the A llergist
This is a oneday update
designed for the
prim ary care
provider. It will
focus on
diagnosis and
management o f
common
allergy, asthm a
and pulmonology' problems.
This program is com plimentary to
all area physicians. A n annual
conference, it has been developed
with support from local pharm aceu
tical companies w hich will be
acknowledged.
The program will be held at the
Dates
❖ O ccupational
Rhinitis, an O ver
looked Entity
❖ Asthma Care and
C urrent Trends and
Treatm ent
<s>Lcukotncnes C urrent Status
❖Advances in the
Treatm ent o f NonSmall Cell Lung Cancer
For registration inform ation call
the College at 627-7137. Although
no registration fee is required,
physicians wishing to attend m ust
complete and return a registration
form. The conference is anticipated
to fill so early registration is
encouraged. ■
Program
Directors)
Allergy, Asthma &
Frida}', April 23
Pulmonology for
A lex Mihali, M D
Primary Care
Saturday, May 15
Surgery Update 1999
Friday, May 21
Law & Medicine
David Magelssen, M D
Joseph Just, JD
L
N icholas Rajacich, M D
Brochures will be mailed in A pril.■
April, 1999
PC M S B U LL ET IN
15
News briefs
Sick
fro m page 13
volved in Earl’s protection and fu
ture care, Spanish-Ainerican war
veterans stepped in on behalf o f the
man and his family. Room s were
prepared for the ailing veteran at
the Diamond Point Marine H ospi
tal at Port Townsend and a special
launch transported him tliere. The
final outcome for this family has
been lost to history,«
R eprinted fro m the Senior Scene,
March, 1999
16
April, 1999
Clinical guidelines
available online
The A gency for Health Care Policy
and Research (AH CPR), in partner
ship with the American A ssociation o f
Health Plans (AA H P) and the Ameri
can M edical A ssociation (A M A ), is
sponsoring a W orld W ide W eb-based
National Guideline Clearinghouse
(NGC).
The NGC is a publicly available
electronic repository for clinical
practice guidelines and related
materials that provides online access
to guidelines at WTVw.guideline.gov. ■
Do w e have
your
e - m a il
a d d re ss?
Please send it to
us at:
|K xn sw a(«^>cm sw a .o rg
O
r
g
a
D O N
n
&
A
>
T
T
is s u
I O
e
N
C oalition on D onation
Share Your Life.
Share Your Decision.
For m ore in fo rm a tio n on organ and tissu e d o n a tio n
p le a se call L ifeC enter N o r th w e st
toll free, 1-877-275-5269
April, 1999
PCM S BU LLET IN
17
News briefs
E n g in es
fro m page 1 1
u n d erstand m edical term inology.
W hen the u ser enters a standard
E nglish query, the search engine
expands the search by using syn
onym s from 500,000 term s from the
N atio n al Library' o f M edicine’s
U nified M edical L anguage System
(U M LS).
“ H ea rt disease,” for exam ple, will
autom atically yield docum ents that
contain, am ong other term s, “heart
a ttac k ,” “m yocardial infarction.”
“ infarction o f h ea rt,” “m yocardial
in farct” and “ infarct, m yocardium .”
I f you w ant, the site can autom ati
cally use the expanded set o f search
term s lo search g eneral search
engines such as A ltav ista, InfoSeek,
H otB ot o r W ebC raw ler.
1’u b M e il [h ttp ://w w w .n c b i.n lrn .
n ih .g o v /p u b m e d /] is the W e b ’s free
version o f M edline, w hich contains
ab stracts from num erous p ro fes
sional m edical jo u rn als.
T hough th e inform ation age
overload m ay seem daunting, a little
p ractice an d a b asic understanding
o f how search engines w ork can go
a long w ay to w ard helping doctors
g et com fortable w ith search sites.i
R eprinted fro m American M edical News,
M arch 15, 1999
I f th e jo u rn al p u b lish er has a W eb
site that offers full text, PubM ed
provides links to th a t site. (Som e o f
those sites m ay require th a t you
register, sub scrib e or p ay a fee to
view the full te x t o f an article.)
of commission?
As you know, disability in suran ce policies for physicians are ch anging
rapidly— and not for the better. High claim s have caused m an y m ajor
carriers to lim it the m ost im portant benefits.
At P hysicians Insurance Agency, there’s still tim e to secure the specialtyspecific coverage you need. In addition, we can help you find superior life
and long-term -care coverage for you and yo ur fam ily.
To discuss the w ays you can best protect your future incom e, call
P hysician s Insurance Agency today: (206) 343-7150 or 1-800-962-1399-
r.
PHYSICIANS
INSURANCE
AGENCY
A W h o lly O w n ed S u b sid ia ry of
P h y sic ia n s In su ra n ce E xch an ge
Sjioiisored by the Washington Shite Medical Awckdion
*;\VSPIA Wh
18
PC M S
B U L L E T IN
April, 1999
T acom a/P ierce C o u n ty o u tp a tie n t
and part-tim e positions available in
redefinition for G .P., F.P., I.M.
Contact Andy Tsoi, M D (253) 7529669 or Paul Doty (Allen, Nelson,
(253)383-4351.
P ediatrician. G ro u p H ealth
Permanente is currently seeking a
full-time pediatrician for our Port
Orchard facility. W e are a physi
cian-managed organization recently
affiliated with K aiser Permanente
internationally known for research
and clinical program development.
Our facility is located near Puget
Sound with many recreational
opportunities nearby. For further
information, call 800-543-9323 or
fax CV and cover letter to (206)
448-6191.
M edical D irecto r. In te re s te d in
making a difference in the
healthcare insurance industry, while
continuing to practice medicine?
QualMed W ashington H ealth Plan,
Inc. is looking for a dynamic
physician with a mind for business
to serve as part-tim e medical
director. I f you have a strong
interest in improving the value we
get from our healthcare dollar, a
solid history practicing general
medicine, and a little common
sense, w e’d like to hear from you.
The position is available immedi
ately and will be open until filled.
For more information, please
contact A rt Sprenkle, MD, at (425)
869-3530. EOE.
GENERAL
able 11/01/98. Tw o suites 750
square feet. M ultiC are Urgent Care
leaving space which has been
occupied by an urgent care facility
since 1980. Building is a medicaldental facility next to Albertsons.
8509 Steilacoom Blvd. Call Dr. Ken
Ring at 584-6200 or 582-5856.
New office space available. U p to
4500 sq. ft. W ill finish to suit. On
Call Robin a t 756-2182.
F o u n d : U n iv ersity o f U tah , 1974
class ring. Initials KM W . Please
call D eputy John Jimenez. 7984200.
TA C O M A /PIER C E COUNTY
O u tp a tie n t G en eral M edical Care.
F u ll a n d p art-tim e positions
available in T acom a a n d vicinity.
V ery flexible schedule. W ell suited
fo r c a re e r redefinition for
G P, F P , IM .
or Paul D oty (Allen, Nelson, T urner &
Assoc.), Clinic M anager (253) 383-4351
rA C O M A R A D IO LO G Y
Detect and M onitor
Low Bone Density
S p in e & F e m u r ( A x ia l D E X A )
A lle n m o r e M e d ic a l C e n t e r O n ly
Assess fracture risk
Monitor therapeutic response
Results include com parison
(T-score)
H e e l (P e r ip h e r a l D E X A )
L o w risk s c r e e n in g
Call to schedule
Lakewood
Tacoma
(2 5 3 ) 3 8 3 -2 0 3 8
(2 5 3 ) 5 7 2 -5 1 7 4
(2 5 3 ) 5 8 8 -6 0 8 3 .
A llen m ore M ed ical C en ter
F r a n k s . B aker C en ter
Lakew o o d O ffice
April, 1999
Gig Harbor
(2 5 3 ) 8 5 8 -3 2 0 0
. P o in t F osdick Im aging,-
PC M S B U LLET IN
19
You
m ent processes m ore than 90 percent of all requests within two
dependable advice.
Western W ashington
1-800-962-1399
Eastern Washington
1-800-962-1398
t.rc.ued .md >pori5(>i'ed by the
\V;ishini:ian 'Mate Mcdtcil Ass'xmi.
E XCHANGE
Sraule, WA © WSPIA 1997
223 Tacoma Avenue So.
Tacoma, WA 98402
20
HP Phy:ysicians
^ Insi
Insurance
April, 1999
PRESORTED
STANDARD
US POSTAGE PAID
TACOMA, WA
PERMIT NO 605
ULLETIN
May, 1999
D r e w D e u t s c h , M D , (le ft) in c o m in g M B I
P r e s id e n t , th a n k s K e ith D e m ir jia n , M D
fo r h is t e n u r e a s p r e s id e n t , 1 9 9 6 - 1 9 9 8
See story page 4
Inside:
3
4
5
7
8
9
11
P r e s id e n t's P a g e : " R e m a rk a b le M e d ic in e ," b y L a w re n c e A. L a rso n , D .O .
D re w D e u ts c h , M D a s s u m e s p re s id e n c y o f M e m b e rs h ip B e n e fits, In c . fr o m D r. K e ith D e m irjia n
F e a tu r e : " E m b e z z le m e n t, it c a n h a p p e n to a n y o n e ," r e a d tip s o n h o w n o t to b e v u ln e r a b le
D rs. F a r b e r a n d P a ttis o n to s p e a k 011 "C a re a t th e e n d o f life," a t J u n e G e n e r a l M e m b e rs h ip M e e tin g
I n te r a c tiv e M u tu a l fu n d tip s p ro v id e d b y th e W a ll S h e e t J o u r n a l
T h e H e a lth S ta tu s o f P ie r c e C o u n ty , a s g r a p h e d b y th e T a c o m a P ie r c e C o u n ty H e a lth D e p a r tm e n t
"A C a r e e r W ell S p e n t," r e p o r ts J .D . F itz , M D b e lo n g s to D r. R o b e r t A. K allsen
PCM S
Bu lle tin
P C M S O f fic e r s / T r u s te e s :
L a w re n c e A . L a rs o n , D O ..............................P re s id e n t
C h a r le s M . W e a th e r b y , M D ............P re s id e n t E lc c t
P a t r ic e N . S te v e n s o n , M D
J a n ie s M . W i l s o n , J r ., M D ............... P a s t P re s id e n t
M ic h a c l J. K e lly . M D
M a r ia J . M a c k . M D
J. J a n ie s R o o k s . J r ., M D
E d w a rd I. W a lk le y , M D
N ik k i C r o w le y , P C M S A P re s id e n t
B
p ie rc e c o u n ty m e d ic a ls o c e ty
ULLETIN
May, 1999
P a s t P r e s id e n t; P e te r K- M a r s h . M D
S p e a k e r o f t h e H o u s e : R ic h a r d H a w k in s , M D
T ru s te e : D a v i d E . L a w , M D
A M A D e le g a te : L e o n a rd A le n ic k , M D
E x e c u tiv e D ir e c to r:
D o u g la s J a c k m a n
C o m m itte e C h a ir s :
A g in g , R ic h a rd W a ltm a n ; A ID S . L aw re n ce S ch w artz;
B y la w s, S tan ley T u ell; B u d g e t/F in a n c e , P atric e
S tev en so n ; C o lle g e o f M e d ic a l E d u c a tio n , W . D a le
O v erfie ld ; C r e d e n t i a l s . S u san S alo; E m e r g e n c y
M e d ic a l S t a n d a r d s , T e d W alk ley ; E th ic s /
J a n ie s M . W ilso n ; L e g is la tiv e . W illiam M a rsh ;
M e d ic a l- L e g a l, P a t D o n le y ; M e m b e r s h ip B e n e fits ,
I n c ., Drew ' D e u ts c h ; P e r s o n a l P r o b l e m s O f
P h y s ic ia n s , R o b e rt S an d s; P r o g r a m . M a rily n
P a ttiso n ; P u b lic H e a ltlt/S c h o o l H e a lth , Jo se p h
W e a m ; S p o r t s M e d ic in e , Jo h n Jig a n ti.
T h e B u lle tin is p u b lish e d m o n th ly by P C M S
M e m b e rs h ip B e n efits, Inc. for m e m b e rs o f the P ierce
C o u n ty M e d ic a l S ociety. D e a d lin e s for su b m ittin g
a rtic le s a n d p la c in g a d v e rtise m e n ts in T h e B u lletin
a re th e 15th o f the m o n th p re c e d in g p u b lic a tio n (i.e.
O c to b e r 15 for th e N o v e m b e r issu e).
T h e B u lle tin is d e d ic a te d to th e art, scien ce an d
delivery' o f m e d ic in e a n d the b e tte rm e n t o f the health
a n d m e d ic a l w elfare o f th e co m m u n ity . T h e o p in io n s
n o t n e c e s sa rily reflect the official p o sitio n o f th e
M e d ical Society. A cc e p ta n c e o f a d v e rtisin g in no
w a y c o n s titu te s p ro fe ssio n a l a p p ro v a l o r e n d o rse
m e n t o f p ro d u c ts o r services ad v ertised . T h e B u lletin
a n d P icrce C o u n ty M e d ic a l S ociety reserv e th e rig h t
to re je c t an y ad v ertisin g .
Features
'
P resident's Page: R em arkable M e d ic in e ...............
D rew Deutscli, MD new MBI P re s id e n t...............
E m bezzlem ent: It can h a p p e n to a n y o n e ..............
Ju n e GMM: C are at th e e n d o f l i f e .........................
TPCHD: The health status o f Pierce C o u n ty
"A C a re er Well Spent," D r. K allseu r e tire s
"A M other's Tear," by D r. T eresa C lab o ts............
3
4
5
7
9
11
17
Departments
S u b s c r i p t i o n s : $ 5 0 p e r j'c a r , $ 5 p e r is s u e
In My Opinion: "I'm D epressed," ...........................
Applicants for M e m b e rsh ip ......................................
The Invisible Hand: Cost, Value and P r ic e
F. D ennis W aldron to be h o n o red by C C F A
College of M edical E d u c a tio n ...................................
PCMSA: The Pulse .....................................................
Classified Advertising .................................................
M a k e a ll c h e c k s p a y a b le to: M B I
(2 5 3 )5 7 2 -3 6 6 6 , F a x 5 7 2 -2 4 7 0
News briefs
E -m a il a d d re s s : p c m s w a @ p c in s v v a .o rg
H o m e P a g e : h ttp ://w w w .p c m s w a . o rg
Interactive m utual-fund tip s ..................................... 8
A pproved In te rp re te rs for M edicaid changed .... 10
Effective Physician O rganization r e c a p ................. 12
E d i t o r : D a v i d S. H o p k in s M D
E d i t o r i a l C o m m i t t e e : D a v id S . H o p k in s , (C lia ir)
2
PCM S
B U L L E T IN
M ay, 1999
13
14
15
14
18
19
21
23
P re s id e n t's P age
President's Page.........
Remarkable M edicine
The past five years have been a
great learning experience for me.
Through the leadership o f D avid
Sparling, M D 1 have had the op
portunity to become involved with
the health care in Chelyabinsk,
Russia. My entry into the Handford
- Chelyabinsk movement started
slowly by involving some o f the vis
iting physicians from Chelyabinsk
into the CF, pulmonary, and allergy/
immunology clinics at MBCHC and
Pediatrics Northwest Specialty
Care. Through these visits the phy
sicians in Chelyabinsk expressed a
desire to learn more about the
practice of medicine in North
America. A number o f physician
exchanges were arranged by Dr.
Sparling; and in 1997, I had my first
opportunity to visit Chelyabinsk.
The trip to Russia was a great
adventure from my first experience
with Aeroflot (Russia's notorious
airline) to the shear distance from
Tacoma to Chelyabinsk. This is a
city of 1.3 million people located on
the East slope o f the Ural moun
tains. The Oblast (region surround
ing) Chelyabinsk is about the size
of Western Washington and looks
very much like M innesota with
large birch forests and lakes o f
various shades o f blue scattered
about. The beauty o f the country
side belies the environmental prob
lems. Chelyabinsk prior to
perestroika was a closed city and
the primary site for the Soviet
nuclear arms development. In 1957
a tank o f radioactive waste ex
ploded contaminating much o f the
region with high levels o f strontium90. This remained unannounced to
the local population and the world
until 1969. There remains a very
large exposure to nuclear waste in
the region. Chelyabinsk is also an
important mining center with high
levels o f heavy metals exposure
and other industrial pollution.
I found our hosts to be gracious
and inviting. 1 was able to stay in
the family apartment o f one o f the
physicians, a wonderful pediatric
radiologist Dimitri Ovsianitsky, MD,
and three generations o f his family.
Included on this trip was my brother
Charles, a pediatric epidemiologist
from McGill University. At that visit
we lectured at several meetings and
began plans for an asthma epidemi
ology project. Over the ensuing
year the project was jointly devel
oped by our Russian partners,
McGill University and the physi
cians o f Tacoma. Through a second
visit last fall to Chelyabinsk and
much work by all members o f the
team, a research proposal was
funded by CIDA and USAID.
As a result o f this project my
hosts from my second visit to
Chelyabinsk Drs. Yaroslav Zhakov
and Igor Federov came to Tacoma
for a visit. As usual David Sparling
had arranged a full schedule. Our
charge was to show these physi
cians how we practice medicine
and why. In preparing for their visit
I wanted to give them the essence
o f what we do - a large task at
best. Com plicating this task was
having the physicians understand
the dramatic differences o f W est
ern healthcare. The healthcare sys
tem in Russia is a hospital inpatient
based system with very little outpa-
L a w r e n c e A. L a rso n , D O.
P r e s id e n t 1 9 9 9
tient medicine. Much o f the public
health support is also hospital
based. With loss o f the government
financial and political support for
medicine in Russia healthcare de
livery has suffered. Physicians of
ten go for months without payment
for their services, and when paid
are done so at a subsistence level.
Despite these obstacles the physi
cian community remains focused,
dedicated, and determined to pro
vide their best level o f care. There
is an obvious esteem for our pro
fession above the enormous turmoil
o f their life. Further complicating
the political/economic issues are
the ever-present environmental ca
tastrophes.
The visit o f Drs. Zhakov and
Federov occurred this February
and turned out to be a great suc
cess. The healthcare community of
Pierce County welcomed them
with a supportive and com prehen
sive view o f our system o f care.
They left with an appreciation of
how we deliver services in a
timely, efficient and caring manner.
It is impressive to pause and exam
ine what we have built in our
county. Yes, there is room for im
provement, but there is also a level
o f care and dedication to medicine
that we can all be proud. 1 look
forward to my continued participa
tion with these remarkable people
both in Chelyabinsk and Pierce
C ounty.■
May, 1999
PCMS BULLETIN
3
F e a tu re
P C M S S u b sid ia ry , M e m b e r sh ip B e n e fits , In c .,
p r o v id e s s e r v ic e a n d r e v e n u e s fo r m e m b e r s
T he M em bership Benefits, Inc.
(M B I) B oard o f D irectors pre
sented a plaque to D r. Keith
D e m irjia n at their M a rc h meeting
in recognition o f his service as
P resident, 1996-1998. Dr. D rew
D eutsch thanked him for his years
o f service, acknow ledging the
financial success o f M B I, the
P C M S w holly-ow ned, for-profit
subsidiary. Dr. D eutsch currently
serves as President.
M B ! oversees the publication
departm ent th a t generates the
m onthly B ulletin and the annual
P hysician D irectory and operates
the P C M S placem ent service for
both tem porary' and perm anent
personnel. M BI ow ns the PCM S
building at 223 T acom a Avenue
South, and leases space to other
m edically related organizations
such as the Pierce C ounty D ental
Society. Pierce C ounty N urses
A ssociation, A m erican Lung
A ssociation o f W A and the newly
form ed SW W ashington T raum a
S ervices.
T he placem ent service began it's
tem porary division in 1993 and has
proven to be a tim ely and success
ful venture. Providing temporary'
personnel from one day to several
m onths, it allow s the em ployer to
ob tain staffing w ithout having to
hire, fire, do payroll or provide
benefits. T em porary w orkers are
placed in the office and then the
em ployer pays a fee to the place
m ent service for the use o f that
tem p o rary w orker. N o record
keeping o r taxes required. The
w orker is an em ployee o f the
agency and is reim bursed as such.
T he service has grow n from gross
revenues o f $23,000 in 1993 to over
$350,000 in 1998.
M B I w as incorporated in 1978 as
4
PCM S
B U L L E T IN
M ay, 1999
an avenue for P C M S to generate
non-dues incom e w ithout je o p ard iz
ing the nonprofit statu s o f PC M S.
Revenues from advertising, p lace
m ents, rents, p ro g ram s, etc. are
used to forestall dues increases.
PC M S has seen one dues increase
( $ 10) in m any years.
MBI has not alw ays operated in
a for-profit mode. In 1985-1986
M B I borrow ed heavily from PC M S
to subsidize their business, as they
did initially in 1978-79. All loans
have been repaid and M BI cu r
rently enjoys financial freedom.
They are w orking to build reserves
should difficult financial tim es
return.
O ther m em bers th a t have served
as M BI Presidents since its incep
tion include: D rs. D rew D eutsch,
1999; K eith D em irjian, 19961998; Joe W earn, 1992-1995;
M ark G ildenhar, 1989-1992;
R obert W h itn ey, 1988-1989;
D on Shrew sbu ry, 1985-1987;
G regory P opich, 1984; Dale
Ilirz , 1981-1983; Richard Bowe,
1979-1980; K en G raham , 1978.
C u rren t M B I B oard members arc
D rs. S tev e S ettle, Steve
D uncan, Tim Schubert, Art
M aslow , an d Secretary-Treasurer,
P atrice Stevenson in addition to
D rs. D em irjian, Deutsch,
G ildenhar and W earn.
M BI strives to provide benefits lo
P C M S m em bers as well as remain
financially viable. L ast year, MBI
produced the P harm acy Directory,
a com plete listing o f Pierce County
pharm acies. T he year before,
lam inated coding m atrixes were
produced. Both the Pharm acy
Directory' an d coding matrixes were
distributed free to members, and
w ere developed at the suggestion of
m em bers. The M B I Board wel
com es ideas about benefits that
w ould be o f help to the member
ship. Please call Sue Asher. 5723667 at the Society office with your
su g g estio n s.!
Do we have your
e-mail address?
Please send it to us at:
pcm swa@ pcm swa.org
Feature
Embezzlement: it can happen to anyone
Business p eo p le, p h ysicia n s in
cluded, often f e e l h u m ilia te d
that th e y ’v e b een fo o le d b y
som eone th e y tru sted . T h a t’s
w hy system s should b e s e t up to
give p h ysician s o versigh t an d
regular review .
by Suzanne B. Taylor, CPA
She was the perfect employee. She
worked long hours, and never had
anyone fill in for her lo do her book
keeping duties. She never took a va
cation unless tlie doctor, her em
ployer, was also away. She took care
of all the office details herself.
The only problem: She was stealing
the doctor blind.
Fraud. Embezzlement. Theft. Phy
sicians are particularly vulnerable be
cause they often entrust their office
manager and bookkeepers with nearly
all o f the duties and oversight o f the
books.
But that is exactly w hat should not
happen.
Most em
bezzlement starts
small. The indi
vidual may be
struggling finan
cially to pay bills,
or is going
through a divorce
and finds that
money is tight.
Rationalization is
easy: “I ju st need
a little and I’ll
pay it back next
month.”
But if controls
aren’t in place,
that person sees
how easy it is to
not pay it back,
and how simple it would be to
take more.
Ingrid A ndnilis, a private inves
tigator in Portland, and Yergen
and Meyer, LLP, recently helped
uncover embezzlement in the of
fice o f a private practice physi
cian who lost much o f his
practice’s income and thousands
o f dollars from his retirement
funds to a trusted employee. That
perfect sta ff member who
handled all die details o f the of
fice books.
“H er books were so com plex,”
Andrulis says. “She moved
money around through various
business accounts. It was an ar
duous task to identify true in
come.” The w om an’s thieving
was eventually discovered, but
only after the physician closed his
practice and the unpaid bill no
tices started rolling in - bills the
doctor thought had been paid long
ago.
Then, after getting bank
records for
several
years, Uie
doctor dis
covered that
his loyal,
long-time
employee
had taken his
money.
She used
many meth
ods to divert
patient pay
ments. She
kept no
records to
verify the
form o f pay
ment, for ex
ample,
See "Embezzlement" page 6____________
W h e r e a p r a c tic e is v u ln e r a b le
Embezzlement methods van-, but
generally occur in three business
practice areas; the cash receipts
cycle, cash disbursem ent cycle
and in oilier accounting adjustments.
In the cash receipts cycle, an
employee m ay pocket any
patient payments, particularly
those paid in cash, and never
enter the charge or paym ent into
the system. Or, the charge may
be recorded then removed later
through'the use o f an adjust
ment.
H ow to avoid this? Regularly
review your appointm ent sched
ule, follow several patients
through the process from charge
tickets, claims filed, payments
received, and to the bank deposit
slip. Investigate all differences.
In the cash disbursem ent cycle,
always authorize all expendi
tures, verify the receipt o f
purchased items and require that
you authorize the actual dis
bursement o f cash. D on’t keep
any signature stam ps in the
practice. O ften the employee
creates fake companies to issue
invoices. The employee prints
false invoices to that imaginary'
vendor, the invoices are sent to
the practice and paym ent is sent
to a post office box - which
actually belongs to the thieving
employee.
How td avoid (his scenario?
Be fam iliar with your vendors.
Ask about new vendor names.
Require that invoices and proofs
o f purchase be attached to any
checks to vendors. Call.phone
numbers on new vendors to be
See "i'uhienM e"pa'tf 6
May, 1999
PC M S BU LL ET IN
5
N ew s
b r ie fs
E m b e z z le m e n t
V ulnerable
fro m page 5
fro m page 5
whether patients paid by cash or
check. Vague record keeping made
it im possible to collect on old ac
counts. as well.
He also gave significant authority
to this single individual.
“This individual provided all ncccssary information to the accountants.
So there w as no need for the doctor
to review canceled checks. N o one
ever saw any tiling out o f the ordi
nary.” Andrulis says. Physicians
must take an active part in their
businesses to avoid embezzlement.
For example, simply having cancelcd checks and bank statements
sent to their homes to review can
have the potential o f deterring a
th ief
The bottom line: Trust no one.
And when you feel something’s not
right - immediately check it out.
How common is embezzlement?
It's not clear because it tends to be
an under-reported crime. Business
people, physicians included, often
feel humiliated that they've been
fooled by someone they trusted.
But they shouldn’t because it's sur
prisingly easy to fall victim to som e
one who is intent on cheating. In
deed. this loyal employee was well
respected and never suspected.
“N o one could say a bad word
about her,” says Andrulis. “She
worked long hours and looked like a
dutiful assistant.”
What is the best deterrent to em
ployees considering embezzlement?
The knowledge that someone will
be reviewing their work. Physicians
must set up the system s within their
practices to have oversight, and
regular review.*
Suzanne Tavlor, CPA is a partner with
Yergen and Meyer, LLP. This article
originally appeared in the 3/19/99 issue o f
the Portland Physicians 'SCRIBE, the news
paper o f the M edical Society o f Metropolitan
P o ll land. Reprinted with permission._______
6
PCM S
B U L L E T IN
M ay, 1999
certain they exist. Check the
addresses on invoices. N ever issue
a check without an invoice or check
request. D on’t pay o f f o f state
ments.
Embezzling em ployees also may:
* Use a bad debt expense account
to hide stolen funds. The employee
may adjust a patient charge into a
bad debt account, eventually write
if o ff as uncollectible, thus leaving
the em ployee free to take the cash
when the patient pays.
* Overstate adjustments from
insurance companies, and pocket
the difference.
* Input bogus charges on an
otherwise bonafide insurance claim
form. When the check is received,
the employee converts the check
and skims die overage.
* Create fraudulent claim forms,
based 011 a likely diagnosis/proce
dure for a particular patient. When
the check comes in, the employee
cashes it.
So what can a physician do,
without taking on all the bookkeep
ing?
* Make certain office duties are
segregated. Have one employee
open the mail, photocopy the
checks, and another make out Uie
deposit slip. Make sure more than
one person understands your
accounting system.
* The person who posts payments
and adjustments into the computer
system should never see the actual
checks. That person should post
from photocopied checks and
EO B s.
* Require all employees to take
annual vacations.
* N ever, ever have a signature
stamp available to employees. Sign
everything yourself, personally.
* R eview contractual adjustments.
O ccasionally review montli-end
reports that list each posted adjust
ment.
* R eview appointment schedules
and follow several patients through
your system , making sure payments
arc received for services
provided. Compare cash receipts
posted in your accounting system
with cash deposits in the bank.
* R eview bank deposit slips to see
i f the “less cash” part is ever used.
Investigate why.
* H ave your bank statement
mailed directly to your home. Take
five minutes each month to review
each processed check to make sure
none has a forged signature, or a
payee's name has been changed.
* Make sure all important reports
and documents (bank statements,
month-end reports, financial state
ments, appointment schedules, fee
tickets) are saved. D on’t allow
em ployees to shred documents
unless you have approved it.
* Approve all accounts sent to a
collection agency and written off as
bad debt expense.*
P u g e t S o u n d Area, WA: You know how you want to set up your practice.
se e k s BC/BE Family Practitioners. Flexible financial p ack ages and
m anagem ent to full em ployment. C onvenience, quality 225-bed hospital
and excellent location in fast-growing, family community. C lose to Seattle
em ployer. Contact Kathy Guy, Administrative Director of Clinics, Good
Samaritan Community Healthcare, 407 - 14th A venue SE, Puyallup, WA
98371, (253) 848-6661, Ext. 1865.
June General Membership Meeting
Tuesday, Jun e 8, 1999
Social Hour:
Dinner:
Program:
L a n d m a rk C o n v e n tio n C e n te r
Temple Theatre, Roof G arden
Tacom a
6:00 pm
6:45 pm
7:45 pm
C are a t th e
en d
o f life
opportunities
for
improvement
fe a tu rin g
Marilyn Pattis on, M D
Stuart Farber, M D
(Registration required by June 4. Return this form to: PCMS, 223 Tacom a Ave S, Tacom a 98402; FAX to 5 7 2 -2 4 7 0 or call 572-3667)
Please reserve________ dinner(s) a t $20 per person (tax a n d tip included)
□
Visa
□
Master C a rd
or m y cre d it c a rd # is ______________
Signature
I will be bringing m y spouse or a guest. N am e for na m e t a g : __________
Signed:_____________________________________________________________
Thank you!
News briefs
Wall Street Journal provides interactive m utual-fund tips
Reprinted fro m the Wall Street Journal,
5/5/99
C h a rle s Schw ab
w w w .sc h w a b .c o m
T ools/T oys: I f y o u ’re an accounllioldcr, you can custom ize a home
page and use the A sset A llocation
Tool Kit. A nybody can try out the
M utual Fund Screening Tool w hich
so rts funds by ices, size, perfor
m ance.
R csources/U sability: Stack
together as m any as 50 funds o f the
thousands sold by or through
Schw ab to com pare them. B ut
th e re 's lim ited charting capability.
A ccount-holders can get indepen
dent research in the A nalyst
C enter, plus daily updates on the
status o f fund holdings.
T ransactions: Yes. w ith one o f
the biggest m utual-funds “super
m ark ets” around, site is one o f m ost
heavily used for buying/selling
funds.
E * T ra d e
w w w .e t r a d e .c o m
Tools/T oys: Invest an im aginery
$ 100,000J o in discussion groups.
R csources/U sability: Conduct
research on thousands o f funds. A
“pow er search” allow s investors to
use ever-narrow er criteria. E x p la
nations are clear, concise, easy to
read.
T ransactions: Y es, lots o f buying
opportunities. Site has one o f the
w idest selections o f funds - around
4,300.
F id e lity In v e stm e n ts
w w w .fid e litv .c o m
T ools/T oys: H elpful, interactive
retirem ent section. T h ere’s a Roth
IRA presentation and planning tools
for funding college education, plus
tax -p rep aratio n help.
R csources/U sability: T he site
contains inform ation from fundtracker M orning star Inc. ab o u t
more than 3,000 funds from over
300 com panies. T he best tilings are
reserved for Fidelity custom ers,
including real-tim e stock and
m utual-fund quotes an d the ability
to extensively ch art the perfor
m ance o f funds. W hen we
searched the site in late M arch
w ithout account-holder privileges,
results for funds w ere only through
February 28. B u t funds snapshots
are quite good, detailing fund fees,
expenses and volatility. The site
also offers annual/sem iannual fund
reports.
T ransactions: Yes
M o r n in g s ta r
w w w .m o rn in g s ta r.n e t
Tools/Toys: O ffers a few nifly
tools, including 40 l(k ) and indi
vidual retirem ent account calcula
tor, as well as a fund selector. Pul
the cursor on “ Q uicklakes” to get
snapshots o f a fu n d ’s risk, return,
expense ratios, plus news and
analysis. Investors can track up to
10 portfolios w ith as m any as 50
funds or stocks in each.
R csources/U sability: C an 295,000
free users be w rong? “ Prem ium ”
users, w ho pay $9.95 a m onth or
$99 a year, get daily m arket
updates, tw o portfolio updates daily
and news alerts on holdings via email. D ay-trader alert: W ho says
you have to be a long-term owner?
This site gives you daily m utual
fund leaders and laggards, based on
the previous d ay ’s perform ance
data. M ost experts w riting the
site’s analytical pieces are surprise! - M orningstar analysts,
but the fund track er is know n for
its consum er-friendly and indepen
dent approach.
Transactions: N one
8
PCM S
B U L L E T IN
M ay, 1999
M u tu a l F u n d In v esto r’s
C e n te r
w w w .m fe a .c o m
T ools/T oys: T h ere’s a retirement
w orksheet an d “ M y Personal
P ortfolio” track s perform ance of as
m any as 9 ,000 m utual funds.
F undC enter locates category
leaders, low est-cost funds and
those w ith the low est invesUnent
minimums.
R esources/U sability: The Educa
tion, Planning and Retirement
C enters are good places for the
novice to start. Funded by no-load
fund com panies, this is a gateway
to 42 other sites. B ut while tliis site
isn ’t p lastered w ith advertising, as
som e are, fund firm s do conspicu
ously p o st articles on the home
page ab o u t their own sites, funds,
m anagers, perform ance, etc. What
som e m ight like about this site:
A nonym ity. Y ou can download and
p rin t educational m aterials without
registering, as is required on some
oilier sites, notes Michelle Smith,
m anaging director o f the Mutual
Fund E ducational Alliance, a
co nsortium o f no-load fund compa
nies th at run the site.
T ransactions: N one
S cu d d er K em per Invest
m e n ts
w w w .s c u d d e r.c o m
Tools/T oys: IR A calculator, retire
m ent planning tools, asset-allocation
w orksheets. A n online financial
“concierge” takes w ritten questions
an d directs visitors to the proper
are a w hen asked such questions as.
“ W h at is a grow th fund?” But don t
expect sophisticated answers to
m ore conceptual questions. “Why
should I care ab o u t a Rind’s risk
level?” sent us to a list o f daily
prices o f S cu d d er’s funds.
See "tips" page 10_____________________
T PC H e a lth D e p a rtm e n t
m
. -■ i'SS*'
HEALTH
D E P A R T M E N T
Over the next few months, the
Tacoma-Pierce County H ealth D e
partment will publish articles about
the health status o f Pierce County
residents. W e hope physicians and
other medical providers will find the
reports interesting and useful to
their practice.
In addition to engaging private
providers’ interest in Pierce County
statistics on mortality and morbidity,
the data should provide a fram e
work for understanding the health
department’s priorities for preven
tion strategics. Over the next sev
eral years, our goal is to reduce ill
ness and death related to smoking,
alcohol abuse, violence and HIV/
AIDS. These areas are related to
behaviors which we believe health
promotion campaigns, carefully
crafted and targeted, should be able
to change. The charts and narra
tives we include in the Bulletin are
baseline statistics against which we
can compare numbers in the future
to determine the effectiveness o f
our strategies.
A ccess to C are
What happens when someone
does not have medical insurance?
What are the impacts on the indi
vidual and on a family when health
coverage is inadequate to their
needs? W ithout insurance or with
only partial coverage, individuals
make choices not to see a physi
cian, even when they believe they
should. W ithout insurance, individu
als and families receive neither
T he h ealth status o f Pierce C ounty
health care nor inform a
tion that helps prevent
medical problem s. The
H ealth D epartm ent has
collected data on levels o f
insurance coverage and
on their impacts. Some o f
those figures are shared
in this article.
Recency of Blood Pressure
Checks
In Pierce County:
♦ H a lf (50% ) o f the unin
sured adults w ho said
they probably needed to
see a doctor during 1998
did not do so. They said
cost prevented it. By
com parison, only eight
percent (8%) o f the in
sured adults did not see a
doctor when they felt it
w as necessary.
♦ Uninsured adults are
less likely to have re
ceived routine medical
checkups in tw o or more
years, com pared to medi
cally insured adults (see
chart). This is according
to the Behavioral Risk
Factor Survey, developed
by tlie Centers for D is
ease Control and com
pleted by tlie health de
partm ent in 1995.
♦ Almost twenty percent
(20%) o f uninsured
women have not had a
pap smear, to detect cer
vical dysplasia and earlystage cervical cancer, in
more than two years.
♦ Among county adults
who have been diagnosed
with hypertension, those
without insurance are less
likely to have had a blood
pressure checkup than
P e rc e n t D ia g n o se d with H y p e rten sio n
Time Since Last Medical
Checkup
■ Insured
□ Uninsured
c 60<
<D
O
CD
a
40% - *
20%
0%
Jl
n , -n ,.J
<1
1 -2
2 -5
5+
Never
Time S in ce Checkup (years)
P e rc e n t of A dults
W ithin E ach R acial/E th n ic G ro u p
W ho A re M edically U n in su red
[IJ I I ■
-u
B lack
eCouniyAdults
:e OCA8RI:SM996)
Mai. Am.
O the r
W h ite
Asian
H ispanic
R acial Group
See "Health"page 14_________
May, 1999
PCM S B U LLET IN 9
News briefs
Tips
S tr o n g F u n d s
w w w - s t r o n g - f u n d s .c o m
fro m page 8
R esources/U sability: W ell-geared
lo r the inexperienced user. C reate
an on-line profile and after a few
queries ab o u t age. retirem ent plans
and such. S cudder divines your
interests and sends m essages 011
subjects o f possible interest.
Fund data from both M om ingstar
and L ippcr Inc. are available to
analyze Scudder funds, but not rival
funds. W hile investors c a n 't buy
riv als' funds on this site, Scudder
will track and price them inside its
“ Personal Investm ent O rganizer.”
W e discovered this oddity as we
tried out the retirem ent planner: By
m odestly increasing inflation and
interest rate assum ptions, we three
tim es w ere told we need lo save a
negative num ber each m onth to
reach retirem ent goals. (S u rp ris
ingly enough, there w as an alloca
tio n strategy suggested to m eet that
goal!)
T ransactions: Yes
S m a r tM o n e y
w w w .s n n a r t n io n e v .c o m
Tools/T ovs: Interactive perfor
m ance com parisons, and investors
can com pare two Hinds over one,
three or five years. A n asset
allocator helps figure out retirem ent
incom e, college plans. T here's
“A sk Sm artM oney” for specific
questions. (Sm artM oney is p u b
lished by Dow' Jones & Co. in a
jo in t venture w ith H earst Corp.
D ow Jones also publishes The W all
S treet Journal.)
R esources/U sability: Content is
refreshed often during the day,
usually w ith analysis. Fund profiles
are tagged in green, red and yellow
to denote w h at’s good, bad or
otherw ise notable. Some tasks take
longer, such as having to go to a
different screen lo find out w hat a
fu n d ’s sym bol is.
T ransactions: N one
T ools/T oys: Lots o f interactive tools
- retirem ent an d college calcu la
tors, portfolio planners, a quiz to test
your m utual-fund know ledge. (If
you fail a question, y o u ’re au to m ati
cally linked to a section that con
tains inform ation you m issed.)
W atch fund-m anager interview s
online, live o r taped. A nd th e re’s a
quiz th a t gives investors ideas on
portfolio stru ctu rin g , custom ized to
your age and risk tolerance.
R esources/U sability: E asy-to-use
charts (pow ered by D onaldson
Lufkin & Jen rette’s online trading
unit, D LJdirect) th a t allow com pari
sons o f S trong funds w ith indexes
and rival funds over various periods,
up lo 10 years. A lso, there is
extensive daily m ark et com ment,
courtesy' o f D LJ. Lots o f helpful
docum ents are available.
T ransactions: Yes
V angu ard G roup
w w w . v a n g u a r d .c o m
T ools/Toys: Interactive quizzes help
investors determ ine risk tolerance,
proper investm ent m ixes and how
m uch lo stash into an IRA, am ong
other features.
R esources/U sability: Full o f
objective, educational m aterial th at
d o esn 't push V anguard products.
(It even m akes a case against
IRA s.) Extensive explanations o f
recent lax laws. Portfolio sum m a
ries can track V anguard and nonV anguard investm ents. Extrem ely
easy for the novice to navigate.
Provides investors w ith free
N avigator Plus softw are for
financial planning. (M any people
buy such softw are from stores.)
The Learning C enter has 10 indepth, step-by-step tu to rials on
m utual-fund investing. T here is
even a library w ith V anguard found
John B ogle’s speeches, am ong
m any selections.
Transactions: Yes
iO
PCM S
B U L L E T IN
May, 1999
A lso o f N ote:
w w w .fu n d a la r m .c o m
I f th e m u tu al fund W eb-site world
had a gossip colum n, this might be
it. H ighlights include “ 3-Alarm
F unds,” w hich is a list o f portfolios
regularly lagging behind their
benchm arks, plus news o f fund
m anager changes and sassy
com m entary' on the industry.■
Approved
Interpreters for
Medicaid changed
as of April 1, 1999
T o satisfy the sta te ’s purchasing
requirem ents, W ashington is
changing its contracts with inter
p reter agencies for Medicaid
effective A pril 1. The Medical
A ssistance A dm inistration (MAA)
recom m ends that physicians’
offices confirm th at any interpreter
agency they use has a contract with
the state. O therw ise, the interpret
ers m ay look to the physicians'
office fo r paym ent o f their services
to M edicaid patients.
A list o f th e participating agencies
can be obtained by contacting
P C M S at 572-3666, or check die
S tate G eneral Administration
o ffice’s w ebsite at http://
w w w .g a .w a .g o v /D ca /D ca co n t.h tm .
an d enter contract #15398.■
J
ji
th in k
I
o f us.
ji
-A fte r
bread t
S u y p
|
Union Avenue Pharmacy & |
Corset Shop
|
Formerly Smith's Corset Shop j]
2302 S. Union Ave 752-1705..... I
Feature
A C a reer W ell S p en t
by J.D . Fitz, M D
On the occasion o f my friend Bob
K allsen’s retirement. I’d like to
celebrate with you w hat I have
come to find out about his personal
and professional life. M any o f the
members o f the PCM S have
known and loved Bob for longer
than I, but I feel a special claim to
his friendship, having shared offices
and support sta ff w ith him for the
past several years. I have always
admired and tried to emulate B ob’s
dedication to his patients, his uni
formly positive outlook on life, his
professionalism in regards to his
stalf relations. I will always trea
sure the role modeling he has pro
vided me in so many areas.
Bob was bom and grew up in
Pipestone County, located in south
west Minnesota near the South D a
kota and Iowa borders. He at
tended the University o f M innesota
- both undergraduate and Medical
Schools. His medical school was on
the fast track during W orld W ar II.
In order to satisfy his draft board,
Bob enrolled in the V-12 program
and entered active naval service
during his senior year o f medical
school.
After graduation, he was trans
ferred to the N aval Hospital. W hile
there, still during the war, he met a
young lady named M avis at the
University o f W ashington. She was
studying Chinese languages there in
order to become a “spy” for the US
government. M avis says she first
met Bob when she had to throw
him out o f the w om en’s dormitory
at the UW (acting in her role as
Resident Associate) one evening.
He will only adm it to “playing
bridge” with another young lady at
tile time.
Bob was subsequently assigned
to the naval fleet in the South Pa
cific. The w ar ended during this as
signment and Bob had the privilege
o f representing the US N aval fleet
and meeting with the Chinese com
munist physicians at the occasion
o f the Japanese surrender. After
the W ar he found M avis and the
two were m arried in 1946. They
returned to M inneapolis where he
completed his Internal Medical
Residency. A fter this he took a po
sition at the Scripps Research
Clinic in San Diego. W hile there he
had the opportunity to meet two
little known gentlemen named D r.’s
M erck and Upjohn on the develop
ment o f obscure pharm aceuticals
such as H ydrochlorothiazide and
antidiuretic hormone. Bob then was
asked to start the San Diego blood
bank but was soon thereafter re
called into active duty during the
Korean Conflict. By this time Bob
and M avis had three o f their even
tual 5 children.
After returning from active duly
at the N aval Hospital in San Diego,
Bob and several friends decided to
return to their rural roots and began
a practice o f Internal Medicine in
northern M innesota on the “ Iron
Range.” Bob says that Mavis only
had to see the first snowfall to real
ize that she w as not going lo live in
the tundra. H e began to peruse the
classifieds and found a practice in
Tacom a for sale due to the un
timely death o f its’ owner, a Dr.
Quevli. They bought the practice
(note that I did not say “They re
viewed the benefits package and
negotiated a contract to include a
moving allow ance”) and moved
their family to their present home in
the N orth End. Thus began B ob’s
Robert A. Kallsen, MD
44 year Tacom a career in 1955.
M avis decided that afler their m ul
tiple moves that “this w as il” and
she w as right!
Bob initially practiced in the
M edical Arts Building and subse
quently in the building on 5"' and L
which is now occupied by the
Rainier Surgical Associales. After
many years o f practice in these lo
cations. Bob moved to Jackson Hall
lo make room for (lie expanding
T acom a Family Residency pro
gram, which began its existence in
his building on L Slreel. And more
recently, he has moved his practice
inlo the Residency building in order
to facilitate the R esident's contin
ued participation with his patients.
B ob’s practice has been an integral
part o f the teaching focus for the
TFM Residents in the areas o f In
ternal Medicine and Geriatrics. And
since its’ inception. Bob has always
taken an active role in the Resi
dency, beginning his involvement as
a member o f its’ initial Board with
Dr. Roy Virak and others. Over the
years he has been one o f Uie major
supporters through his committed
volunteer teaching services and his
active participation in the confer
ences and rounding activities. Bob
still has the distinction among all the
residents or faculty o f having the
best attendance al M orning Report
and lire daily teaching conferences.
Because o f his dedication to his p a
tients and his devotion to the pro
fessional elements o f practice (onSee "Career"page IS
May, 1999
PC M S B U LLET IN
11
Andy Dolan advised members
about effective physician
organizations at April General
Membership Meeting
A ndy D olan offered valuable advice and optim ism fo r
tlie fu ture o f m edicine w hen he spoke to tlie crow d at
tlie A pril G eneral M em bership M eeting.
H e noted there are currently external factors that
have added to difficult tim es fo r physicians and th a t is
tw o other groups vying for the sam e health care dollars
as physicians - hospitals and alternative medicine
providers. This increases tlie com petition for the money
an d w ill force physicians to becom e m ore involved and
active in their careers and in politics.
H e explained one o f the biggest m istakes physicians
have m ade is signing any contract th a t is given to them.
O nce you learn how m uch it costs you to provide
m edical carc, then you will know w hat price you can sell
it for. The day will com e w hen physicians w ill have to
say. no.
He advises everyone to get into larger groups. "It is
essential fo r contracting w ith carriers as it provides
m ore clout. T he little office w ill have a difficult tim e
surviving."!
P ictured at right:
Top: Dr. Joe IVeani (right), Tacoma pediatrician, visits with speaker
A ndy Dolan after the meeting
Center: Dr. Tim Schubert (center), gastroenterologist, and his wife
Arlene, smile f o r the camera while neurologist Dr. George Delyanis
looks on
Bottom: Dr. Alark Yuhasz (left), radiologist, visits with Dr. M atthew
White, Lakew oodfam ily practitioner after the meeting
P e r so n a l P ro b lem s
M e d ica l problem s, drugs, alcohol, retire
ment, em otional, o r oth er su ch difficulties?
* R o b e rt .Sands, C h a ir
7 5 2 -6 0 5 6
Bill D ean
2 7 2 -4 0 1 3
F. D ennis W aldron
2 6 5 -2 5 N 4
Confidentiality Assured
12
PC M S
B U L L E T IN
M ay, 1999
Allenmore
Psychological
Associates, P.S.
■752-7320 .--------Do you have pa tien ts w ith difficult emotional
----------------- 1530 Union Ave. S.. Ste. 16. Tamma
Feature
In M y O p in io n
I'm D e p r e s s e d
"H ell I'll be hanged."
Juilas Iscariot, when he fou n d out his SSRI11X was changed
bv Nichol Iverson, M D
I’m depressed. I received a letter
from one o f the local insurance
companies that stated that I was
over prescribing a certain green and
creain colored capsule to treat de
pression. I have been living in this
delusional world that tailoring medi
cines to a patient’s specific needs
and side effects is good medicine.
Wrong. A carefully penned letter
on glossy paper with pie graphs and
numbers and letters on the back
identifying me as the guilty party in
a crime against society snapped me
back to reality. Radier than sending
my patients to the health food store
to get St, John’s W ort, chew on a
Chinese herb, or drink 17 lattes be
fore breakfast, I prescribed effec
tive prescription drugs! On careful
perusal o f the pie graph, my
“wedge o f pie” usage o f the afore
mentioned capsule was actually less
than my peers. Confused? Y ou bet.
Impulsively I began singing, “You
can get anything you want, at
Alice’s R estaurant,” until my phar
macist wife dragged my limp body
to the sofa.
Scanning the literature about de
pression can be depressing. M ost
experts agree that this debilitating
malady creates all sorts o f grief,
and has now been linked to many
“physical” ailments such as coro
nary deaths, accident rates and
plain old run o f the mill suicide.
Practicing critical care medicine
has allowed me to observe multiple
suicide attempts by the same pa
tients, fortunately rarely successful.
Consecutive successful suicides ap
pear to be rare. M ost psychiatric literature and conferences (one’s_____
N O T supported by an SSRI m anu
facturer) have, pounded into my
head the failure o f primary care
physicians to treat depression ad
equately. W hen I received my letter
from Dr. Ray Junts, MD, MA, JD,
my wife (the pharm acist) was quick
to point out that pharm acists have
prescriptive authority, and have
been allowed in many clinics to pre
scribe “equivalent” albeit cheaper
medicines “for better care o f Hie
patients” not to mention a larger
bottom line for the insurance com
panies. H ow much do the C E O 's
o f all these insurance companies
make anyway? How much are
these companies spending to keep
us from spending? How many
years did these morons spend in
medical school, residencies and
learning the art o f medicine in their
practice? I would love to see the
faces o f all these cost cutters when
they have a personal crisis and their
choices are limited by their own
system.
Since physicians and other health
care givers have taken a hammer
ing in incomcs and have been deal
ing with a huge pile o f paper to
treat insurance companies, the time
may have arrived to consider one
(ugh!) payer for health care in our
state. H ow about a system in which
there is only one middle person,
thereby eliminating the greatest
w aste in medicine - time. Consider
all the time we spend filling out
forms, changing prescriptions, get
ting approval for hangnail and w art
surgery, the consumers o f medicine
would wind up with much more o f
my time. Emotional energy units
N ichol T. Iverson, M D
"H o w about a sys
tem in which there is
only one middle
person, thereby
elim inating the
greatet waste in
medicine
time.
Consider al! the time
we spend fillin g out
form s, changing
prescriptions, getting
approval f o r hang
nail and wart sur
gery, the consumers
o f medicine would
wind up with much
more o f m y time. "
-
(E E U ’s) left over to carc for pa
tients and to improve record keep
ing would be spent improving the
health o f the community. Perhaps il
is time to take all the insurance
companies to task, eliminating all
their C E O ’s, bureaucrats and other
high school dropouts whose sole job
is to pester physicians lo death. The
vision statement for this insurance:
W e shall collect money to pay hos
pitals and physicians to care for p a
tients. Period. Can somebody
gimme a Prozac?? ■
May, 1999
PCM S BU LLET IN
13
N e w s b rie fs
"om page 9
Health />■
Applicants for membership
geons, 1207 South 5th Street,
T acom a 98405; 5 7 2 -8777
M edical School: R u sh M edical C ol
lege
Residency: P ark lan d M em orial
Hospital
Fellow ship: H arv ard M edical
School
N eu h a lfen , E liz a b e th A ., M D
F am ily P ra c tic e
P ractices a t G ood S am aritan C om
m unity H ealth. 16515 M eridian
E ast. #104A , Puyallup 98375; 2401859
M edical School: U niversity o f N e
b rask a
Internship: M adigan A rm y M edical
C e n te r
Residency: M adigan A rm y M edical
C en ter
S te w a rt, W illiam M ., M D
A n e s th e s io lo g y
Practices w ith P acific A nesthesia,
St. Joseph M edical C enter, P O B ox
2197, T acom a 9 8401; 591-6625
M edical School: U niversity o f U tah
Internship: U niversity o f U tah
Residency: U niversity o f A rizona
H ealth Sciences C enter ■
S m ith , W e n d a ll J ., M D
C a rd io th o ra c ic S u rg e ry
P ractices a t C ardiothoracic S u r
those w ith insurance (see chart),
m issing o ut on a sim ple mechanism
fo r preventing cardiovascular acci
dents an d deterioration.
♦ O verall, th ere seems to be pat
terns o f w ho is and who is not in
sured (see chart). A frican Ameri
cans lead tlie list o f populations with
uninsured adults; N ative Americans
are second. N ote th at in tlie survey
results, H ispanic people are under
represented, so tlie data on that
p o p u latio n m ay not be accurately
reflected in tlie chart.
F o r m ore inform ation on tlie data,
co n tact R ick M acC ornack, Senior
E pidem iologist and Public Health
M anager, a t 798-4788.■
T h e M edical Society
iA C O lU A R A D I O L O G Y
Detect and M onitor
Low Bone Density
TEM PORARY
P LA CEM EN T SERVICE
PROVIDES:
* A pool o f qualified clinical &
administrative applicants
& F e m u r (A x ia l D E X A )
Allenmore Medical Center on I
* Coverage for vacations, illness,
leaves o f absence
* Help for peak work loads
Low risk screening
W hen o n e o f the follow in g criteria are m et,
beneficiaries are covered by M edicare every 2 3 m onths.
1.
Estrnjjc-n deficient women at clinical risk
2.
Individuals with vertebral abnormalities.
1. Individuals receiving long term
foi osteoporosis.
HOW IT W ORKS:
* W e pay employees' salary, taxes
& benefits
* W e complete all payroll forms
fJiiCf-OCOrtoidtherapy.
* Y ou pay us a low hourly rate
Personal history of primary hyperparalhyroidism.
M onitoring of FDA approved osteoporosis druj.1
, therapy may a llow
frequency of examination or further baseline axial
tor greater
rriPrtSurernunl.
Call to schedule
CALL Deborah at 572-3709
fo r y o u r
Tacoma
14
Lakewood
Gig Harbor
(253) 383-2038
(253) 5 72-5174
(253) 588-6083
(253) 858-3200
A lle n m o re M ed ica l C en ter
Frank 5. -Baker C enter
Lakew ood Office
Point Fosdick Im aging
PCM S
B U L L E T IN
M ay, 1999
________
Employment Needs
same dav coverage in most cases!
Feature
Cost, Value and Price
Value is the most invisible and impalpable o f ghosts, and comes and goes
imthought o f while the visible and dense mailer remains as it was.
W . Stanley Jevons
Inv estig atio n s m C urrency a n d Finance, 1884
bv Andrew Statson, M D
When the California M edical
Association came out with its first
Relative Value Schedule, it was
based on actual charges. H ie
market had determined them as the
price for medical services, except
for surgical fees. The price o f
surgical services had been bid
higher than com parative medical or
obstetrical ones because insurance
covered hospital and surgical
charges.
As insurance coverage expanded
to the other fields, that distortion in
the market was factored into the
payment schedules o f Medicare,
Medicaid, the bureaus and other
payers. It became a source o f
animosity between procedural and
cognitive physicians, and eventually
led to the development o f the
Resource Based Relative Value
Schedule and lower paym ents for
all. The surgeons felt the squeeze
more acutely, because o f the earlier
distortion in the market.
The economic effect o f the
current payment squeeze has
already changed the practice o f
medicine. O ur hospitals and offices
are reducing overhead, while
increasing the workload. A t the
same time those o f us who can,
leave medicine for other fields.
0 tilers retire. The new physicians
who are going to replace us are
much less willing to w ork the long
hours we put in. The change in the
medical work force, not only
physicians, but also nurses and
other personnel, will reduce the
supply o f services. The m arket will
exact its n rice____________________
Even so, the main economic
problem for health care in this
country is not the squeeze we all
experienced, although it is a prob
lem. M uch w'orse is the economic
distortion brought about by the
resource-based reim bursement for
goods and services, better known
as “cost plus valuation”.
I don’t know whether cost plus
valuation originated with Karl M arx,
but according to him the value o f an
item is determined by the am ount o f
work required to produce it, specifi
cally the num ber o f work hours. He
had to adm it that no am ount o f
labor can make an essentially
worthless object valuable. He had
to skirt the issue o f a rt valuation.
Since he believed in equality, it did
not occur to him that some workers
m ight produce more value in a
given time than others. Another
economist, A lfred M arshall, wrote
in 1890: “W e might as well dispute
whether it is the upper or the under
blade o f a pair o f scissors that cuts
a piece o f paper, as whether value
is governed by utility or cost o f
production.
The labor theory w as at the basis
o fth e socialist economies and to
the extent that it was applied into
practice, it contributed to their
downfall. Cost plus valuation and
the labor theory o f value are
essentially the sam e tiling. They are
based on the fallacy that there is a
direct connection between cost o f
production and m arket value. If
such were the case, Beanie Babies,
that cost pennies to produce, would
not sell for hundreds o f dollars.
Value is determined by the price at
w hich the buyer would rather buy.
than keep his money; and the seller
w ould rather sell, than keep his
product. The cost o f production
comes into consideration only when
making the decision to produce
something. I f the cost is higher than
the expected market value there
will be no room for profit and the
item will not be produced. On the
other hand, if die value is much
higher than the cost o f production,
the volume ofproduction will
increase, either by the same
m anufacturer or by a competitor,
and the resulting surplus will bring
down the market price closer to the
cost o f production. For instance,
Visicalc and Lotus 1-2-3 sold for
over 300 dollars initially, but now7
entire suites o f program s can be
bought for about h alf that.
How' the m arket functions is
illustrated by the following example:
Slide rules were a valuable tool in
several fields, prim arily engineering.
WTien electronic calculators ap
peared, and as llieir price gradually
came down, the m arket value o f
slide rules dropped below their
m anufacturing cost. Production
ceased and the slide rules in the
pipeline were sold at huge dis
counts. Today there is no market
for them.
O ur government uses cost plus
valuation because it buys items,
such as tanks, submarines and
bombs, for which there is no market
___________________ Sec "Cost" page 16
May, 1999
PC M S B U LLET IN
15
Feature
"Cost"
fro m page 15
to price them mid determine their
value. Its purchases arc based on
political, not on econom ic consider
ations. This system o f payment ran
into (.rouble when (lie government
entered health care financing with
Medicare and Medicaid. The
hospitals were paid on a cost plus
basis. That resulted in a spending
spree, and eventually had to be
controlled with certificate o f need
requirements, then with the DRG
based prospective payment system.
For physicians HCFA brought
about the R BRVS. Right or wrong,
that is how the government oper
ates. Wc cannot expect anything
else.
Our patients are not concerned
about cost. They are concerned
about the value o f our services to
them. They assess it according to
whether we helped them deal with
their problems. 'They know w e
cannot always cure them, even
though they would like that, but they
expect w e w ill be there for them
tlirough hard times and we w ill do
our best to make tilings easier for
them. I don't know what the cost is
o f a warm smile, a gentle touch, an
expression o f concern and caring,
and all those little tilings patients
call our “bedside m anner’. These
are the tilings that give them the
nudge to keep going, to keep
fighting, to keep living. I wonder
what could be the resource based
value o f the human touch that is so
much a part o f clinical practice. I
could not find it in the CPT book,
there is no code for it. The man
aged care plans probably don’t
know it exists, or i f they did, they
don't care. Only the patients can
determine its value.
The m ost distressing tiling I see
today is the lack o f caring. It hit the
hospitals first, but it is infiltrating our
offices. W e are rushed. The burden
16
PCM S
B U L L E T IN
M ay, 1999
o f paperwork has increased tre
mendously. W e have less and less
time to devote to our patients and
their care suffers. They suffer. W e
see it, but w e are helpless. Our
protests have been largely ignored.
The powers that be don’t care what
we think.
The purchasers o f health care
insurance, that is the big employers,
and the insurance companies selling
the policies are cutting costs. It is
true that they have a lot o f money,
a lot o f lobbyists, a lot o f clout. Still
they have to face their employees
from time to time, and there is one
tiling they cannot do, they cannot
vote. Congress and the state
legislatures are concerned about the
cost o f health care. They are even
more concerned about getting
reelected. Government intervention
is best avoided, but mistreating
people is bound to bring about
retribution, one w ay or another,
sooner or later. Already people are
having to deal with the problems we
saw coming som e time ago, and
they are unhappy. The popular
discontent is growing. Our patients
will make tilings change. Our role in
this conflict is minor, but important.
It is to maintain our allegiance to
our patients and to remain their
ad v o ca tes.i
Two-tenant building
One side for lease: 1,580 sq. ft
7424 Bridgeport Way West
Two suites: 1,177 sq. ft
and 1,570 sq. ft.
New! Menlo Park Professional Center
Office space: 5 0 0-5,000 sq. fL
Contact Gary Crawford
(253) 272-9200
H+H
HEALTH CARE NETWORK
w w w .h ch n e t.o rn
S E A T T L E - E X C E L L E N T O P P O R T U N IT IE S fo r B E /B C p h ysicia ns in the areas of:
F A M IL Y P R A C T IC E a n d P E D IA T R IC S . E njoy pra cticin g in a progressive hospital
netw ork. M in u te s from do w n to w n S eattle , the sh o re s o f P uge t S ound and the Cascade
M o unta in s. W e o ffe r s ta te -o f-th e -a rt re so u rce s, e q u ip m e n t an d expertise to provide
ou ts ta n d in g c a re fo r y o u r pa tie n ts. F o r d e ta ils, call o r w rite us: P at T ennent, Highline
C o m m u n ity H ospita l H ealth C a re N etw ork, 16251 S y lv e s te r Rd SW , S eattle, W A 98166.
Phone (206) 439-5578 • Fax (206) 431-3930
____________________
e-m ail: p th c h rm @ a o l.c o m
____
Feature
A Mother's Tear
by Teresa Clabols, M D
The other nite
I could not sleep
I tossed and turned all nite,
My baby here
within my reach,
was also sleeping light.
Caressing and humming out loud,
my mom snag cradle songs,
A Mother Mary lullaby,
the other o f sweet Jesus.
She coaxed the infant to her sleep,
and calmed away her fears.
I went to feel
the ocean breeze,
and smell those memories,
that open doors up to the past,
and hold me in their spell.
I saw all this in clouds up high
as tears washed my many sins.
I called for her and shouted loud
yet she didn't turn my way.
The crying sea swelled
with every breath,
and groaned with every sigh.
I went to watch
the light reflected
off that silvery' moon.
A gently hanging
silver pendant,
on the night's bosom.
I saw the moon like a medallion disc
someone had bitten off,
It seemed serene, pristine, alone,
a host, a halfhost moon.
I saw my mother
up in the clouds,
her face a Pieta's smile.
Sweetly cooing at the child,
she cradled in her arms.
The babe in amis,
all fluffy and fat,
her fingers were pulling hair.
I saw my mother wince and smile
and gently kiss those fingers.
With eyes fixed on her mother,
and legs like pistons kicking,
she giggled, cooed and pulled again.
Teresa Clabols, MD
For as God reached out to take his
servant,
she was happy as could be.
For you see.....
SHE was content with her lot in life:
For the babe she nursed was me.
•k -k k k •k
I saw she was content, relaxed,
she'd had a full career,
for one could tell her sacrifice,
in the slow rhythm o f her sway.
(As a mother she'd spent
many a sleepless night
for the comfort on another.
In anger and pain I called again,
I wanted her full attention,
But all she cared f o r ...............
was the babe in her amis,
who had her full devotion.
Through her blood and milk
and sweat and tears
into that babe
she poured out her very essence.
For as the sun's gold rays reached
out to her
like the fingers o f God's own halo
the clouds were stretched much
thinner,
thru the haze I could see the
face....
...of the babe in her arms much
clearer.
I turned to the infant in my bed
as I put her to my breast.
My tear touched her cheek
as I realized.....
my mom's spirit was in MY babe.
And I thanked my God
that I had known this woman
who had taught me to be a mother.
How to love,
what was right,
how to help another
and also how to forgive.
As we shape each soul
that God has entrusted
in our circle o f love.
Dedicated to the memory o f Alicia
Garcia-Otero Gaston, 1924-1997
May, 1999
PCM S BU LLET IN
17
V.
News briefs
Career
fro m page 11
going study, participation in learning activities), he is a
valued and respected member o f tlie TFM family.
Dennis Waldron, MD to be
honored by the CCFA
But more than all o f these elements I have men
tioned, Bob is a real person with many active interests
in various areas. Bob and M avis are taking yearly trips
to fly-in BC fishing destinations, he is seen at Crystal
Mountain frequently, lie takes an active interest in his
landscaping and he maintains wonderful relations with
his 5 children. 12 grandchildren and 2 grcat-grandchildren.
F. D ennis W ald ron , M D w ill be
receive tlie 1999 Torch o f Friend
ship Award at tlie annual dinner o f
tlie Crohn's & Colitis Foundation
o f America, W ashington Chapter.
The meeting dinner w ill be held on
Saturday, M ay 22 at the Glendale
Country Club in Bellevue.
F. Dennis Wahhm, AID
A s Bob has been m y mentor, model and friend, I
wish him well in this next phase o f his life and career.
I’m quite sure I will be seeing him at conferences and
CME activities and I know he will be enlarging his al
ready fLill life outside o f medicine with tlie extra time
he will have available. Congratulations, Bob on a ca
reer well spent! ■
Dr. Waldron is being honored for
"his pioneering services in gastroenterology as tlie first
GI physician in Pierce County and for his commitment
to die fight for health for people with Crohn's disease
and ulcerative colitis.
Congratulations, Dr. Waldron.*
Fed eral W ay’s Fin est
A d d ress:
The Medical Pavilion
At St. F ran cis H ospital
34503 9 th A venue S.
F ed eral Way
5 2 ,0 0 0 Square Foot M edical/Professional Office Building
Available space up to 6 ,4 0 0 Sq ft. - divisable
Join These Tenants: M edalia H ealth Care • St Francis W omen’s
C enter • Pediactrics N orthw est • Digestive H ealth
N etw ork • P harm acy & Diagnostic Lab • Dr. B arbara Lev)-'
A
A lexander
Comm ercial Real Estate
/
18
PCM S
B U L L E T IN
Contact:
Kirsten Hayford
206-264-4594
Call for more information or to
schedule a tour.
M ay, 1999
•
•
•
•
Class “A ” Interiors
T. I. Allowance
Ample Parking
High Growth M arket
C O------L L
EGE
OF ---------------
MEDICAL
Surgical U pdate CM E, May 14 & 15
offers d issection s and lectu res
Law & M edicine
Sym posium set
for May 21, 1999
T he very p o p u la r
d issections, dem on
stratio ns an d lec
tu re s p resen ted
an n u ally by the
T aco m a S urgical
C lub are set fo r M ay
14 & 15. T he
p ro gram w ill be held
a t T aco m a C o m m u
nity C ollege in th e
L ecture H all,
B uilding 16.
EDUCATION
The very' p o p u lar L aw & M edicine
Sym posium offered by the M e d i
cal/Legal C om m ittee is scheduled
for Friday, M ay 21, 1999. T he
sym posium presen ts topics o f
common interest to both phy sician s
and attorneys.
This y e a r’s p ro g ram h as been
designed by Joseph Ju st, JD and
N icholas R a ja c ic h , M D an d w ill
be held in the L ag erq u ist C o n fer
ence C enter a t St. Joseph H o sp ital
in room s 1A & B.
The p ro g ram w ill offer p h y si
cians 6 C ategory I C M E credits for
A M A. T he schedule includes
addresses on the follow ing topics:
♦ B o u n d a ry V io la tio n s — S ex u al
M isc o n d u c t
♦ L eg alizatio n o f M a r iju a n a
O n F rid ay a fte r
noon, dissections a n d d em o n stra
tions o n c a d a v ers w ill be p erform ed
fo r h ealth care pro v id ers and
interested students. B eginning
S a tu rd a y m orning, several short
lectures featu rin g the latest devel
opm ents in su rg ery w ill be p re
sented by local p h y sician s and
A rm y M edical C o rp s doctors.
T h e 6 8 th an n u al p ro g ra m is
directed th is y e a r b y D r. D av id
M ag elsse n . T he S urgical C lub
A nnual D inner, open to Surgical
C lu b M em bers an d invited guests
w ill be held S atu rd a y evening, May15 beginning a t 6 :3 0 p.m . at
T aco m a C o u n try and G o lf C lub in
L ak ew o o d .
T he p ro g ra m ’s schedule is as
follows:
♦ U n io n izatio n o f P h y sic ia n s
❖ B lo o d & C o m p o n e n t R e
p la c e m e n t
❖ H y p o v o le m ia , S h o c k &
C e llu la r V essels
❖ D isse c tio n : T h o ra x , M a jo r
V essels
❖ D iss e c tio n : U p p e r A b d o m e n
& R e tr o p e r ito n e a l S p a c e
❖ P e n e tr a tin g I n ju r ie s o f th e A b
dom en
❖ P a n c re a s , S to m a c h & L iv e r
T ra u m a
❖ In tra a b d o m in a l V a s c u la r In
ju r ie s
❖ D is s e c tio n : F e m a le P elv is
❖ B u rn In ju rie s
F o r specific p ro g ra m scheduling
o r reg istratio n info rm atio n , please
call the C ollege a t 6 2 7-7137.■
♦Y 2K
♦ R e p r e s e n ta tio n B e fo re th e
M ed ical Q u a lity A s s u ra n c e
C o m m issio n
Dates
Program
Directors)
Saturday, May 15
Surgery Update 1999
David Magelssen, MD
Friday, May 21
Law & Medicine
♦ IIIV - N am es R e p o rtin g
R egistration rem ains o pen for the
program . P lease call the College,
627-7137 fo r reg istratio n in fo rm a
tion.*
Joseph Just, JD
Nicholas Rajacich, MD
May, 1999
PCMS BULLETIN
19
News briefs
1999 Physician D irectory changes
t
C o le n , J o h n , M D ( R e tir e d )
M e n d e ls o n , M a r t i n , M D
7310 A m ber L ane SW
M o v e d to G e o rg ia
AMERICAN LUNG ASSOCIATIONS
ofV febington
1-800-LUNG-USA
M o r r is , R o n a ld , M D
P h o n e: 5 8 2 -4 8 9 9
2 7 3 2 E a s t M a in A v e
P u y a llu p , W A 9 8 3 7 2
H a ll, J e r o m e , M D
L u n g In form ation
S e r v ic e L in e
2101 N o rth P e a rl S tre e t, # 3 0 0
T acom a, W A 98406
S a n f o r d , E liz a b e th , M D
P h o n e: 7 5 6 -5 1 0 0
1901 S o u th U n io n , # B 6 0 0 7
F A X : 7 5 9 -8 0 1 3
T acom a, W A 98405 ■
Providing patient
education materials
H o r v a t h , K im b e r ly , P A -C
1901 S o u th U n io n , # B 6 0 0 7
T acom a, W A 98405
Now
Open
Saturdays
20
PCM S BU LLETIN
May, 1999
_
_
_
PCMS Alliance
the P u l s e
P ierce C ounty M edical Society A lliance
P resident's M essage
The M arch 30 m eeting o f the
P C M S A w as held a t the hom e o f
Fran T hom as. T he m eeting
opened a l 10a.m . M inutes and
T reasurer reports w ere dispensed
as neither o f the officers wrere
present.
The p rim ary discu ssio n w as
nom ination o f officers fo r n ex t
year. W ith the cooperation o f all
present, a new slate w as co m
pleted.
The nom inated officers are as
follows:
President - Y olan d a B ru ce
P resident-elect - A lic e Y eh
R ecording S ecretary - Patty
K e s lin g
Dues T reasurer - Sue
W u lfe stie g
P h ila n th ro p ic fund
applications now
ships n ex t fall.
available
T he m eeting concluded at
11:30a.m .
O u r p ro g ra m w a s p rovided by
Ju lia M ueller. A co llection o f
C h a ra c ter W atc h e s w as presented,
w ith shadow b o x es o f m any
d ifferent ty p es o f w atch es, from
c arto o n c h a ra c ters to political
figures to fo o d p ro d u c ts an d m uch
m ore. W e th en sa w a slide show o f
th e m an y ty p es o f ch a ra c te r
w a tc h e s.
I f y o u r service an d h ealth related
P ierce C o u n ty o rg an izatio n w o u ld
like to b e considered by the P C M S
A lliance as a recipient fo r p h ila n
thro p ic funding, you m ay o b tain an
a p p licatio n form by w ritin g to: Fran
T h om as, 3 2 2 4 H o rseh ca tl B ay
D rive N W , G ig H a rb o r , 9 8 3 3 5 .
P ro o f o f 501 C (3 ) IR S ratin g is
required a n d all ap p licatio n s m u st
be req u ested directly fro m M s.
T h om as.
Installatio n fo r the new officers
w ill be held a t G ra z ie s’ in O ld T ow n
on the 4 th o f M ay a t 1 1 :30a.m . I f
y ou w ish to jo in u s, p lease m ake
reserv atio n s w ith N ikki C row ley
a t9 2 2 -7 2 3 3 .«
A p p licatio n deadline is S ep tem b er
1.1999.■
T reasurer - K ath y Sam m s
Further discussion w as regarding
comm ittees fo r the year. T h ere w ill
be a Philanthropy C om m ittee an d a
H oliday S haring C ard C om m ittee
w hich is in keeping w ith the
m em bership's preference to be
strictly philanthropic. M em b ers w ho
have not been involved in A lliance
activities and w ould like to be
included in th e p h ilanthropic effo rts
are invited to co n tac t F ran T h o
mas o r N ikki C row ley.
R eports w ere m ad e by P atty
K esling and K ris W h ite regarding
the W S M A A A lliance A nnual
M eeting held in L a C onner in A pril.
It w as suggested th a t w e try to
obtain e-m ail addresses fo r all
m em bers w hen renew ing m em b er
O
D
r g a n
O
N
S
A
T
T
is s u
I
O
e
N
^Co.ilniurt on Donation
Share Your Life.
Share Your D ecisio n r
For more information on organ and tissue donation
please call LifeCenter Northwest
t o l l free, 1-877-275-5269
May, 1999
PCMS BULLETIN 21
P r e p a r in g p h y sicia n o ffic e s for th e y ea r 2 0 0 0 (Y2K)
The A M A , W SM A and PC M S
h a v e a ll b e e n w o rk in g to p re p a re
p h y s ic ia n s fo r th e y e a r 2 0 0 0
p ro b le m b y p ro v id in g se m in a rs, a
g u id elin es m a n u a l, a Y 2 K W e b site
a n d p u b lic ity a b o u t H C F A sp o n
so re d Y e a r 2 0 0 0 A c tio n W e ek
e v e n ts .
T h e W S M A h a s p u b lish e d a
m a n u a l titled , "T h e Y e a r 2 0 0 0
P ro b le m : C o n c e rn s a n d S o lu tio n s
fo r P h y sic ia n s a n d M e d ic a l P ra c
tic e s."
T h e m a n u a l a d d re sse s th e
fo llo w in g to p ics:
♦
O v e r v ie w o f th e Y 2 K p r o b
lem , in c lu d in g th e h isto r y ,
sc o p e , co m p lic a tio n s a n d c o m
p lia n c e
r e n o v a tio n , v a lid a tio n , im ple
m e n ta tio n , in c lu d in g a checklist
a n d re sp o n d in g to Y 2 K inquir
ie s .
♦
T h e Im p a c t o f Y 2 K on
P h y sic ia n P r a c tic e s, in c lu d in g
p a tie n t sa fe ty an d p r a c tic e
c o n tin u ity . In c lu d e d h e r e a re
m e d ic a l d e v ic e s , c o m m u n ic a
tio n s and fa cility c o n tr o ls as w ell
as r e im b u r se m e n t and leg a l
c o n c e r n s and b u d g e t p r e p a r e d
n ess.
I t is h ig h ly reco m m en d ed that
e v e ry p h y sic ia n p a y attention to
th is im p o rta n t is su e a s it has the
p o te n tia l to se rio u sly im p ac t physi
c ia n s a n d th e ir p ra c tic e s. The
h e a lth c a re co m m u n ity is p articu
la rly v u ln e ra b le b e c a u se o f its
c o m p le x b u sin e ss a n d p atien t care
in te ra c tio n s.
♦
A d d r e ssin g th e Y 2 K P r o b
lem in P h y sicia n P ra c tice s
co v ers a w a r e n e ss, a ssessm en t,
I f y o u h a v e q u e stio n s a b o u t the
M ille n n iu m B u g , p le a se call PCM S.
572 -3 6 6 6 . ■
Professional Network Relations Representatives,
CALL 5 9 7 - 6 4 7 3 OR 5 9 7 - 7 9 8 2 .
22
PCM S BU LLETIN
May, 1999
^
C lassified A d ve rtisin g
M ed ical C o n s u lta n t P o s itio n s
A vailable. T he S tate o f W ash in g to n
Division o f D isability D eterm ination
Services seeks physicians w ith
clinical experience in p sy ch iatry ,
fam ily m edicine, general internal
medicine, o r orthopedic su rg ery to
perform co n tract services in tlie
O lym pia and R enton a re a offices.
C ontract services include th e ev a lu
ation o f physical o r m ental im p air
ment severity from m edical records
and other reports, utilizing Social
Security regulations an d rules.
M edical C onsultants function as
m em bers o f tlie adjudicative team
and assist s ta ff in determ ining eligi
bility for disability benefits. R E
Q U IR E M E N T S: C u rren t m edical
license in W ashington S tate. B oard
certification is desirable. R E IM
B U R SE M E N T : $ 5 1.83/hr. Inter
ested physicians should co n tac t
G uthrie L. T urner, Jr., M D , M P H ,
Chief M edical C o n su ltan t a t (360)
664-7361 o r tlie respective A rea
M anager: O lym pia, Jo y J u s tis (360)
664-7355; R enton, F rances Stine
(425)430-4811.
P e d iatrician . G r o u p H e a lth
Perm anente is cu rrently seeking a
full-time ped iatrician fo r o u r P o rt
Orchard facility. W e are a p h y si
cian-m anaged organ izatio n recently
affiliated w ith K aiser P erm anente
internationally know n fo r research
and clinical p ro g ram developm ent.
O ur facility is located n ear P u g et
Sound w ith m any recreational o p
portunities nearby. F or fu rth e r in
form ation, call 800-5 43 -9323 o r fax
CV and cover letter to (206) 4 4 8 6191.
T a c o m a /P ie rc e C o u n ty o u tp a
tient gen eral m ed ical c a re a t its
best. F u ll a n d p a rt-tim e positions
av ailab le in T a c o m a and vicinity.
V ery flexible schedule. W ell suited
fo r c a re e r redefinition fo r G .P .,
F .P ., I.M . C o n ta c t A ndy T soi, M D
(2 5 3 ) 7 5 2 -9 6 6 9 o r P au l D o ty (A llen,
N elson, T u rn e r & A sso c.), C linic
M a n ag er (2 53) 3 8 3 -4 3 5 1 .
L a k e w o o d , m e d ic a l sp a c e av a il
able 11/01/98. T w o su ites 750
sq u are feet each. O ne suite 2900
sq u are feet. M u ltiC a re U rgent C are
leaving sp ace w hich h as been o c c u
pied by a n u rg en t c are facility since
1980. B u ilding is a m edical-dental
facility next to A lbertsons. 8509
S teilacoom B lvd. C all D r. Ken R ing
a t 5 8 4 -6 2 0 0 o r 5 8 2 -5 8 5 6 .
N ew office s p a c e a v a ila b le . U p
to 4 5 0 0 sq. ft. W ill finish to suit. On
U nion A venue. C lo se to ho sp itals.
C o nvenient p ark in g , g ro u n d level.
C all R o b in a t 7 5 6 -2 1 8 2 .
P u y a llu p O ffice S p a c e F o r
L ease. 1800 sq. ft., five exam
room s, h earin g b o o th , lab, p riv ate
p h y sic ia n ’s office, b reak room , se
cu rity and fully furnished. L ocated
o n M eridian. P lease call Jess or
L ouise a t 6 2 7 -6 7 3 1 .
M e d ic a l office s p a c e to s u b
lease. A p p ro x im ate ly 1.000 sq. ft.,
th ree blo ck s fro m T ac o m a G eneral.
P riv a te p ark in g a n d p riv a te b ath.
C all 3 80-9743.
M E D IC A L W R IT IN G
S E R V IC E S
T ranscription Specialists
PUYALLUP
MEDICAL CLINIC
- Prompt, professional service
- Free daily pick-up and deliver}'
- Temporary and overflow work
gladly accepted
- Publication assistance available
- Outstanding references
4,000+ sf for le ase /fo r sale
in an ex cellent S outh H ill
location.
253-208-8072
Linda Robson, PhD - Owner
Steve O ffe n b e e h e r, C C IM
G atew ay C o m m ercial
(253) 840-5574
T A C O M A /P I E R C E C O U N T Y
VOLVO
O u tp a tie n t G e n e ra l M e d ic a l C are.
SERVICE & REPAm
a v a ila b le in T a c o m a a n d vicinity.
V ery flex ib le sc h e d u le . W ell su ite d
(253) 588-8669
w w w .volvorep air.com
fo r c a r e e r re d e fin itio n for
G P , F P , IM .
B oyle’s Foreign C ar R epair
C ontact Andy Tsoi, MD (253) 752-9669
or Paul D oty (Allen, Nelson, T urner &
May, 1999
PCMS BULLETIN 23
Physicians Insurance to help. In fact, o u r underw riting depart
ment processes more than 90 percent of all requests within two
dependable advice.
As physicians, clinics, and hospitals have know n since 1982,
needs quickly, efficiently, and with attention to detail.
Western Washington
1-800-962-1399
Eastern W ashington
1-800-962-1398
Physicians
Insurance
E X C H A N G E
ill.: WA©W5PIAJ99T
T acom a, W A 9 8 4 0 2
24
PCM S BU LLETIN
May, 1999
PRESORTED
STANDARD
US POSTAGE PAID
TACOMA, WA
PERMITN0605
PIER C E C O U N T Y M E D IC A L SO C IE T Y
B
ULLETIN
June, 1999
Retiring PCMS Physicians - Not Quite!!!
See story, page 3
Inside:
3
7
8
9
11
13
17
Six P C M S R e tir e d p h y sic ia n s s h a r e t h e i r liv es a s th e y le a r n to e n jo y th e i r "fre e d o m "
D rs. S tu a r t F a r b e r a n d M a rily n P a ttis o n w ill s p e a k o n "E n d o f L ife C a re " a t J u n e m e m b e r s h ip m e e tin g
M e d ic a l S o ciety a n d H e a lth D e p a r tm e n t w o rk t o g e t h e r to re c e iv e P ie r c e C o u n ty gi a n t fo r u n in s u r e d
"T he P ric in g M e c h a n ism ," h e a lth c a r e p r ic in g h a s b e c o m e p o litic a l, b y A n d rew ' S ta tso n , M D
H e a lth C a re : R e fo rm o r R e v a m p ? D a isy P u r a c a l, M D d e fin e s th e p r o b le m a n d o ff e rs so lu tio n s
T h e H e a lth S ta tu s o f P ie r c e C o u n ty : T o b a c c o k ills 1 ,0 7 2 r e s id e n ts e a c h y e a r
R e tir e d m e m b e r s t o "visit" A sia w ith D r. P e t e r M a r s h , M D a n d S u san B em is, A R N F a t J u n e lu n c h e o n
PCMS Bulletin
L a w re n c e A . L a rs o n , D O ............................. P re sid e n t
C h a r l e s M . W e a th e r b y , M D ............ P re s id e n t E le c t
P a t r ic e N . S te v e n s o n , M D ...... S e c r e ta r y /T r e a s u r e r
J a m e s M . W i l s o n , J r ., M D ............... P a s t P re s id e n t
Y o l a n d a B r u c e , P C M S A P re s id e n t
B
PIERCE COUNTY M ED ICAL SOCIETY
ULLETIN
June, 1999
P a s t P r e s id e n t: P e t e r K . M a r s h , M D
T ru s te e : D a v i d E . L a w , M D
AJVIA D e le g a te : L e o n a r d A J c n ic k , M D
E x e c u tiv e D ir e c to r : D o u g la s Ja c k m a n
A g in g , R ic h a rd W a ltm a n ; A ID S , L aw re n ce S ch w artz;
B y la w s , S tan ley T u e ll; B u d g e t/F in a n c e , P atric e
S tev en so n ; C o lle g e o f M e d ic a l E d u c a tio n , W . D ale
O v e rfie ld ; C r e d e n t i a ls , S u sa n S alo; E m e r g e n c y
J a m e s M . W ilso n ; L e g is la tiv e , W illia m M a rs h ;
M e d ic a l- L e g a l, P a t D o n ley ; M e m b e r s h ip B e n e fits ,
Inc... D re w D e u tsc h ; P e r s o n a l P ro b lle m s O f
P a ltiso n ; P u b lic H ealtli/S clio o fl H e a lth , Jo sep h
W e a m ; S p o r ts M e d ic in e , Jo h n Jig an ti.
T h e B u lle tin is p u b lis h e d m o n th ly b y P C M S
M e m b e rs h ip B e n efits, Inc. for m em b e rs o f the P ierce
C o u n ty M e d ic a l S ociety. D e a d lin e s for su b m ittin g
artic le s a n d p la c in g a d v e rtise m e n ts in T h e B u lletin
a re th e 15th o f the m o n th p re c e d in g p u b lic a tio n (i.e.
T h e B u lle tin is d e d ic a te d lo the art, sc ien ce an d
d eliv ery o f m e d ic in e a n d the b e tte rm e n t o f th e h ealth
a n d m e d ic a l w elfare o f the co m m u n ity . T he o p in io n s
h e re in are th o se o f the in d iv id u a l co n trib u to rs a n d do
n o t n e c e s sa rily re fle c t th e official p o sitio n o f the
M e d ical S ociety. A cce p ta n c e o f a d v e rtisin g in no
w ay c o n stitu te s p ro fe s sio n a l a p p ro v a l o r e n d o rse
m e n t o f p ro d u c ts o r se rv ices ad v ertised . T he B u lletin
a n d P ie rc e C o u n ty M e d ic a l S ociety reserv e the rig h t
to re je c t an y ad v ertisin g .
E d i t o r : D a v id S. H o p k in s M D
S ta n lc y T u e ll, W . B e n B l a c k c t t, R ic h a r d H a w k in s
A d v e r tis in g R e p r e s e n ta tiv e : T a n y a M c C la in
(2 5 3 )5 7 2 -3 6 6 6 , F a x 5 7 2 -2 4 7 0
E - m a ila d d r e s s : p c m s w a @ p c m s w a .o r g
2
PCM S BULLETIN
June, 1999
Features
The R etiring PCMS Physician - Not Quite! ..........
Ju n e GMM: C are a t th e e n d o f l if e .........................
"Health Care: R eform or R e v a m p ? .....................
Im m unization E ducation O u tre a c h ........................
State vaccine participants m ust do study...............
R etired m em bers L uncheon, June 1 8 ...................
3
7
11
12
12
17
D ep artm en ts
P ierce County applies for g ran t for u n in su re d ....
The Invisible Hand: T he P ricing M echanism .....
Tacom a Pierce County H ealth D e p a rtm e n t
PCMS New M em b ers..................................................
1999 D irectory c h a n g e s .............................................
C ollege o f M edical E d u c a tio n ..................................
PCMSA: The Pulse .....................................................
Classified A d v e rtisin g .................................................
8
9
13
15
15
16
19
21
23
News briefs
L&I C om plaint form av ailab le ................................. 18
H ea ltlilin k s.co m is w orth v is it in g ................................ 18
F e a tu re
The Retiring PCMS Physician
Not Quite!
r e .tir e d / 1 : se c lu d e d , q u ie t 2: w ith d ra w n fro m a c tiv e d u ty o r fro m on e's occu p a tio n
by Jean B o rst
There w as a tim e w hen retirem en t
meant leaving behind tlie hu stle and
bustle o f tlie w ork w orld, finding
time to relax, dispensing o f sch ed
ules, perhaps tak in g a trip , ca stin g a
line, or allotting a m orning (o r tw o
or three) for coffee w ith o th er re
tired friends. T im e, tim e an d m ore
time. Tim e to read all those u nread
books. Tim e to tack le all th o se re
vered hobbies.
B ut for to d a y ’s p hysicians, a p p a r
ently, retirem ent does not n e c e ssa r
ily mean an end to schedules, re
sponsibilities and com m itm ents. As
a m atter o f fact, th eir lives a p p e a r
busier than ever.
Six retired physicians w ere in ter
viewed for this articlc w ith tlie in
tent o f shedding light on tlie life o f
the retiree. W hat h as tlie tran sitio n
been like? W h at do you m iss m o st
and least about m edicine? H o w are
you filling your day? W h at advice
do you have fo r oilier physician s
contem plating retirem ent?
All agree th a t there has been little
free time since “official” retire
ment. They are all involved in v a ri
ous activities - recreational, p o liti
cal, social, business, sp iritu al, m edi
cal. H ands dow n, all em phatically
agree that w hat they m iss m o st are
their patients, th eir colleagues, a n d
the day-to-day interaction th a t
comes w ith being a physician. In
turn, all w ere in consensus a b o u t
what they don Y m iss ab o u t m edi
cine - the o verabundance o f p a p e r
work, increased w orkload, m idnight
awakenings, w eekends on call, a u
thorizations, delays, p h ysician a n d
patient dissatisfaction, an d m edical
m alpractice problem s.
T he w o rd “ freed om ” cam e up
frequently, as each said they en
jo y e d th e freedom to do tlie kinds o f
tilings they like m ost. A nd all en
co u rag ed oilier p h y sician s looking
ah ead to re tire m en t to keep active,
keep in to u ch w ith m edicine, and
keep healthy.
y o u r patien ts. Y ou have a relatio n
ship w ith every one o f them . N ow .
I look a t tlie p erson a s m y friend,
rath er than a h e art p ro b le m .” Dr.
E arly added th a t if he ever does
feel lonesom e, he ju s t goes to the
n eighborhood S afew ay. “ Invariably,
I’ll m eet five o r six fo rm er patien ts
w hile I'm th ere!”
Jim E arly , M D
retired in te rn ist
A b o u t 18 m onths before retiring.
Dr. E a rly said he felt like lie w ould
n ever leave m edicine. “ B u t a v ear
and a h a lf later, 1 said, ‘th a t's it.’ I
ju s t w oke u p one d ay an d realized I
d id n ’t have to do it an y m o re and I
d id n ’t w an t to do it an y m o re."
Since retiring, h e ’s h ad o p p o rtu n i
ties to retu rn to m edicine, and has
given it som e thought. “ It d id n 't
take me long to realize th a t it w ould
be stu p id !”
A djustm ent? W h a t ad ju stm en t? For
D r. Jim
Early,
w h o re
tired in
N ovem
b e r 1997,
th e re
h a s n ’t
been one.
“ I’m b u sy
all tlie
tim e,” he
noted. “A nd I’m enjoying every
m inute o f it.”
F am ily activ ities and events,
travel, m ain tain in g ren tal properties,
spending tim e w ith friends, hiking,
boating, fishing, singing in the
church choir. “ I never had tim e to
do all tlie th in g s I w an ted to. N o w I
can. F reed o m is tlie k ey .”
Dr. E arly said it too k a b o u t six
m onths to really m ake tlie tran sitio n
from m edicine to retirem ent. “ I
d id n ’t tu rn m y p rac tic e o v er to
som eone, so it to o k a few m onths to
co m plete c h a rt tra n sfe rs, p lace p a
tients, etc. I d id n ’t ju s t close up
sh o p .” F rom tim e to tim e, he still
gets p atie n t-re la te d calls, b u t th a t is
dim inishing. “W h en y o u ’re in solo
p ractice, y o u ’re really m a rried to
For o thers thinking o f retiring.
“you c a n ’t do it unless y o u ’re fin an
cially solvent. M ak e p ru d e n t invest
m ents. A nd d o n ’t get div o rced !”
H e also en co u rag es people to m ain
ta in th eir in terests and activities
th ro u g h o u t th eir careers, then keep
up w ith them w hen retirem ent
com es. “ L ook a t y o u r ow n personal
v alu es - fam ily an d sp iritu al
grow th. S ta rt v alu in g y o u r ow n
physical health. O ne o f m y p atients
en co u rag ed m e to exercise. N o w I
w o rk o u t three tim es a w eek. 1 feel
great. I’ve lo st w eight, and I’m able
to enjoy a lot o f o d ier activities
n o w .”
T he E arlys have tw o adopted
sons, one o f w hom recently m a r
ried. “ W e ’re very p leased to now
have a d au g h ter!” D r. E arly said.
T h e ir o th er son su ffers from
chronic m ental illness, so a g reat
_______ See "Retired" page 4___________
June, 1999
PCMS BULLETIN 3
F e a tu re
"Retired"
from page 3
d eal o f th e ir tim e is d e v o te d to him .
T h e y a re v e ry a c tiv e in th e m e n ta l
h e a lth sy ste m , su p p o rtin g o th e rs
w h o a re d ea lin g w ith s im ila r c ir
c u m s ta n c e s .
D r. E a rly re fle c ts o n h is m ed ic a l
p ra c tic e a n d h is life a n d w o n d ers,
“ I w a s c o m m itte d 100 p e rc e n t to
m ed icin e, 2 4 h o u rs a d a y fo r a ll
th o s e y e a rs . A t th e sam e tim e , I
w a s in v o lv ed a n d c o m m itte d to
o th e r a c tiv itie s a n d in te re sts. H o w
did 1 d o it? ” Q u ite w ell, one im a g
ines.
Dr. Early served as PCMS President in
1975. He also served as President o f St.
Joseph Hospital Medical Staff. He was a
PCMS Trustee in 1972-73 and a IVSt\L4
Delegate in 1974-1976.
D a v id H o p k in s , M D
r e t i r e d fa m ily p r a c t it io n e r
S in ce i t 's o n ly b e e n fo u r m o n th s
sin ce h is re tire m e n t, D r. D av id
H o p k in s
feels he
h a s n 't
had a
c h a n c e to
fu lly re
flect on a
tran sitio n
from
p ra c tic in g
m e d ic in e
to re tire
m ent. A s a m a tte r o f fa c t, h e ’s
been to o b u sy . F ro m m ed ical issu es
w ith in h is fam ily to d e alin g w ith a
c a r a c c id e n t, th e r e ’s h a rd ly been
tim e to th in k a b o u t it. “L ife h a s
been h e c tic ,” he said.
W h ile so m a n y p eo p le fro m all
p ro fe ssio n s sp e n d th e ir en tire c a
reers w o rk in g a n d p u ttin g o f f v a ri
o u s a c tiv itie s a n d p le a s u re s u n til re
tire m e n t, D r. H o p k in s w a s a d a
m a n t a b o u t e n jo y in g h im s e lf w h ile
h e w a s still w o rk in g . “ I ’ve k n o w n
to o m a n y p e o p le w h o w a n te d to
w a it u n til re tirin g to d o a n y th in g -
4
PCM S BU LLETIN
June, 1999
tra v e l, h o b b ie s , e tc . T h e n , o n c e th ey
d id re tire , th e y e ith e r b e c a m e ill o r
th e y o r th e ir s p o u s e d ied. I p ro b a b ly
d id n ’t se t a sid e fo r re tire m e n t a s
m u c h a s m a n y p e o p le w o u ld , b u t I
sp e n t m o n e y tra v e lin g a n d sp en d in g
tim e w ith m y fa m ily th r o u g h o u t m y
p ra c tic e . W h ile I re a liz e I h a v e to
b e c a re fu l n o w b ein g o n a fix e d in
co m e, I ’m g la d w e d id so m a n y
tilin g s th ro u g h o u t th e y e a rs .”
D r. H o p k in s m isse s h is p a tie n ts ,
a n d the d a y -to -d a y in te ra c tio n w ith
p eo p le. B u t, “ I d o n ’t m iss the
even in g ca lls, th e p a p e rw o rk a n d
th e b u sin e ss sid e o f m e d ic in e .” H e
h ad so ld h is p ra c tic e to M e d a lia
H e a lth S y ste m s a n d , a s p a rt o f d ie
a g reem en t, w o rk e d in th e clin ic a
y e a r b e fo re retirin g . “ I g o t a g o o d
look a t w h a t’s co m in g d o w n th e
p ik e ,” a n d w h ile it’s n o t all b ad ,
h e ’s reliev ed to b e a w a y fro m it.
H e d o es, h o w e v e r, still k eep in
to u c h w ith m e d ic in e a n d w ill c o n
tin u e to b e a c tiv e in th e A sso c ia tio n
o f F a m ily P ra c tic e a n d re tire d p h y
sic ia n s m e etin g s a t th e M e d ic a l S o
ciety.
“ I h a v e n ’t b e e n re tire d long
e n o u g h to k n o w y e t w h a t th e tr a n s i
tion an d a d ju s tm e n ts w ill b e ,” he
said. “ In co m e is a n issu e. T h e tilin g
a b o u t sa v in g fo r re tire m en t is th a t
y o u g et to th e p o in t w h ere y o u h a v e
to sp e n d it! T h e e n tire p ro c e ss is
rev ersed , a n d Ih at ta k e s so m e g e t
tin g u sed to .”
Dr. Hopkins was PCMS President in 1976.
He has served as Editor o f the Bulletin since
1972. He was a Delegate to the/WLi, 19811985 and an Alternate Delegate, 19 74-1976.
He has served as Chief o f Staffand as a
Board o f Trusteefa r St. Francis Hospital.
D u an e IIo p p , M D ,
r e t i r e d o r t h o p e d ic s u r g e o n
“ I d id n ’t re a lly retire , I ju s t
ch a n g ed o c c u p a tio n s ,” a c c o rd in g to
D r. D u a n e H o p p , w h o re tire d fro m
m ed icin e in Ju n e 1996. W h e n he
le ft h is fu ll-tim e p ra c tic e , D r. H o p p
h a d little tim e to re g a rd tra n sitio n .
H e a n d h is
w ife S u
s a n h ad
ow ned
a n d o p e r
a te d a
h o rs e b re e d in g
fa r m
(T h rift
R anch)
fo r 10 y e a rs.
“ I re a lly d o n ’t m iss m edicine,” he
sa id . “A c tu a lly , I ’m still using my
m e d ic a l sk ills o n d ie farm , and have
ev en d o n e so m e equ in e orthoscopic
s u rg e ry .” H e a d d e d th a t he espe
c ia lly d o e s n ’t m iss th e m alpractice
p ro b le m s th a t in v a ria b ly come with
p ra c tic in g m ed icin e. “A t least
h o rse s c a n ’t su e y o u . T h ey can
k ic k , b u t I ’d p re fe r th a t to a law
s u it!”
D r. H o p p d o es ad m it th at the
tra n s itio n fro m o rth o p ed ic surgeon
to h o rs e b re e d e r to o k planning. “I
le a rn e d fro m m y fa d ie r - a gyne
c o lo g ist - to b eg in p lanning retire
m e n t fro m d ie tim e y o u start prac
tic in g m ed icin e. W h en h e retired, he
d id n ’t h a v e a n y th in g to do. I really
b eliev e y o u h a v e to p la n carefully,
a n d d ie n w o rk to w a rd dial. Now
h e re I a m ...I re ally enjoy w hat I'm
d o in g , a n d I h o p e to do it as long as
I p o ss ib ly c a n .”
T h rif t R a n c h is a 70 acre farm.
C u rre n d y , d ie H o p p s have four
m a re s th e y b re e d to v ario u s stal
lions. W h ile d ie y a re prim arily
b re e d e rs (se llin g h o rse s worldwide),
d ie H o p p s a ls o k eep som e o f the
h o rs e s d ie m se lv e s to race. Two of
d ie ir h o rse s a re c u rre n d y running at
E m e ra ld D o w n s a n d ano th er is
tr a in in g a t C h u rc h ill D ow ns in Ken
tu c k y .
Dr. Hopp practied orthopedic surge/v in
Puyallupfrom 1975 until his retirement in
1996.
See "Retired" page 5
F e a tu re
"Retired"
from page ‘
Ken G raham , M D
retired fam ily p ractition er
“It has n o t been a to u g h a d ju st
ment,” said D r. G rah am , w h o retired
in M ay 1996. “I have alw ay s liked to
do a lot o f tilings, an d now I h av e tlie
time to do
them. W hen ."-r
y o u 're
practicing
fulltime,
you have to
really limit
your activi
ties - plan
1 I
around call
schedules
and delivery' dates. B u t now I have
tlie freedom to do tilings I like.” A nd
it’s easy to see w hy D r. G rah am
needed m ore tim e. H is interests in
clude fishing, hunting, hiking, biking,
tennis, and travel. H e also v olunteers
with A ssociated M inistries, an d gives
his time to the P ain t T aco m a project.
He said he’d also like to help o u t at
St. Leo’s neighborhood clinic. “ T here
are volunteer activities everywhere,"
he noted.
While he’s w elcom ed retirem ent
with open arm s, D r. G rah am does
miss his patients and colleagues an d
works to keep in touch w ith both. H e
still receives calls from p atien ts a sk
ing for advice. “I w ill alw ay s th in k o f
them as friends,” he said.
For others looking ah ead to re tire
ment, Dr. G raham offers th is advice:
“Stay a little involved in m edicine.
Keep your license, a t least until you
see how tilings go. M ain tain co n tac t
with your colleagues. C onsid er w h at
you like to do in y o u r sp are tu n e an d
cultivate those activities. K eep o r g et
involved w ith aerobic exercise an d
keep in good physical shape. P a rtic i
pate in outdoor activities an d sp o rts.
Make new friends an d find a n ac tiv
ity that will bring you in co n tac t w ith
younger people. Playing tennis a t P ac
W est has done ju s t th a t fo r m e .”
Dr. Graham was president o f PCMS in
1979. He was named Washington Family
Physician o f the yea r in 1988. He served
on the initial Board o f Directors and was
thefir st president o f Membership Benefits,
Inc.; the PCM Sfor-profit subsidiary. He
also served as Wilson High School team
physicianfor 25 years.
J oh n M cD o n o u g h , M D
r etired ca r d io lo g ist
D r. John M cD o n o u g h , w ho w ill
celeb rate one y e a r o f retire d life
July 1, fo u n d retirem en t to o k a
little g ettin g used to. “ I w orked 50
y ears in m ed icin e,” he said. “ S u d
denly, I
had lo
learn a
fe w
I
n ew
tric k s.”
For
sta rte rs,
he had
to o v er
co m e
w ak in g a t 5:30 a.m . an d reaching
fo r his beep er. “ It to o k m e five
m onths to g et o v e r th a t.” he said.
H e ’s also learning new skills like w ritin g checks an d b alan c in g
a checkbook, a ta s k his w ife p re
v io u sly to o k c a re o f a t hom e and
h is s ta f f h an d led a t tlie office.
W hile still in p ractice. D r.
M cD o n o u g h recalled talk in g to
retire d p h y sician s an d being p e r
p lexed w h en th ey to ld him there
w a s n ’t en o u g h tim e in tlie d ay to
do all tlie tilings they needed o r
w an ted to do. “ I ju s t d id n ’t b e
lieve th a t,” he said. “B u t now I
realize it’s easy to fill u p a sched
ule doing good, w orthw hile tilings,
an d still h a v e a list o f o th er tilings
to do tlia t’s to o long to acco m
p lish !”
D r. M cD o n o u g h fills his p e r
so n al schedule w ith a v ariety o f
activ ities, m an y related to his
ch u rch . F o r in stan ce, once a
w eek he ta k es com m union to
sh u t-in p a tie n ts (one o f w ho is a
retired p h y sician ), an a ctiv ity he
finds very rew arding.
H e an d w ife Jan e spend time
w ith th e ir children an d g ra n d ch il
dren, all o f w hom live in W ash in g
ton stale. In his “ sp a re ” tim e. Dr.
M cD o n o u g h even designed and
c o n stru cte d an o u td o o r g rill a t this
b each h o u se th a t cooks food upside
dow n, d ispensing fat drip p in g s into a
drip p an , avoiding flare ups an d ex
cess sm oke. T he a p p a ra tu s is also
c o n fig u red to bake, b roil an d rotisserie.
W hile extensive trav el is n o t on
tlie lo ng-range ag en d a, tlie
M cD o n o u g h ’s, a s a retirem ent cel
e b ratio n o f so rts, to o k a trip aro u n d
the sou d iem end o f S o u d i A m erica
in M arch and w ere a t se a fo r 32
d ay s.
“ I d early love an d enjoy re tire
m en t,” he said , “ b u t I do m iss my
p atien ts an d colleagues. O ccasio n
ally, I ’ll have a fam ily m em ber or
friend a sk advice a b o u t a cardiology
related issue, and I’m p leased lo be
able to offer advice o r g u id an c e .”
F or o th er p h y sician s co n tem p lat
ing retirem ent. D r. M cD onough o f
fers this: “ R ealize th a t it’s a
changed life, b u t a good one. Life is
Rill o f tran sitio n s, this is ju s t one o f
them . T hink w ell in ad v an ce a b o u t
y o u r retirem ent. W hile I d o n ’t think
it dem ands a lot o f detailed p la n
ning, you do need to pave the w ay.
R ealize th a t th e re ’s a transition
from h aving ail incom e, mid ex am
ine w ell in ad v an ce w h a t y o u r other
incom e sources arc. Keep som e in
tere st in m edicine. I t’s a m ajo r p art
o f o u r lives, a fte r all. A ttend m edi
cal m eetings, re a d jo u rn a ls, slay in
to u ch w ith co lleagues and su p p o rt
th em i f th ey need it. A nd stay
healthy!
Dr. McDonough practiced canliology in
Tacoma since 1975. He has served as chair
o f the PCt\ IS Personal Problems o f
Physicians Committee.
See "Retired"page 6
June, 1999
PCMS BULLETIN 5
V.
F e a tu re
___________________________________
"Retired" fro m page 5
D a v id S p a r lin g , M D
r e t i r e d p e d ia t r i c ia n
“ F m b u s ie r n o w th a n b efo re I re
tir e d ,” n o te d D r. D a v id S p a rlin g ,
w h o re tire d in Ju n e, 1997. “ I
h a v e n ’t h a d tim e fo r all th e tilings
I 'm in te re ste d in doing. T h e list o f
b o o k s I 'd like to re a d a n d h o b b ie s
I 'd like to
p u rs u e is
g ettin g
lo n g er, n o t
s h o r te r ! ”
A n d llie
list o f h is
a c tiv ities
a p p e a rs to
b e g ettin g
lo n g er, as
w ell. A l
p re se n t. D r. S p a rlin g is c o o rd in a to r
o f m e n 's m in istry a t h is c h u rc h , a
m e m b e r o f th e T a c o m a -P ie rc e
C o u n ty B o a rd o f H e a lth , a n d e x te n
siv ely in v o lv ed w ith p ro g ra m s a t
M a r y B rid g e H o sp ita l. D r. S p a rlin g
is th e U .S . p a rtn e rsh ip re p re se n ta
tiv e fo r th e M a ry B rid g eC h e ly a b in sk A ffiliatio n , a p a rtn e r
sh ip e sta b lish e d a n d m a n a g e d b y
th e A m e ric a n In te rn a tio n a l H e a lth
A llia n c e w h ich is fo cu sed o n n eo
n a ta l re su sc ita tio n . H e is a lso c h a ir
m an o f th e L eg al A d v o c a c y C o m
m itte e /M a ry B rid g e 2 0 0 0 , a jo b th a t
h a s ta k e n h im to O ly m p ia o n se v
eral o c c a sio n s to d eal w ith su c h is
su es a s g u n lo c k leg islatio n , th e c a r
d ia c su rg e ry p ro g ra m a t M ary
B rid g e, d is p ro p o rtio n a te sta te c o m
p e n sa tio n to M a ry B rid g e fo r a d is
p ro p o rtio n a te sh a re o f M e d ica id p a
tie n ts, a n d th e c h ild re n ’s h ealth in
su ra n c e p ro g ra m . H e re c e n tly v is
ited th e g o v e rn o r’s o ffice fo r sig n
ing o f le g isla tio n m a n d a tin g life
ja c k e ts fo r all ch ild ren o p e ra tin g in
p riv a te w a te rc ra ft, a c ru s a d e he
w a s v e ry inv o lv ed w ith.
B u t th e s e a re n o t sim p ly
n e w fo u n d ac tiv itie s b ro u g h t on by
6
PCMS
BULLETIN
June, 1999
retire m en t. D r. S p a rlin g is sim p ly
c o n tin u in g a n d e x p a n d in g a c tiv itie s
h e ’s b e e n in v o lv e d in th ro u g h o u t is
c aree r. “ I g u e ss I s h o u ld n ’t h a v e let
p e o p le k n o w I re tire d ,” h e lau g h ed .
“ T h e y m u s t h a v e th o u g h t I ’d h a v e a
lo t o f free tim e o n m y h a n d s. P e r
h a p s it’s tim e fo r m e to le arn to sa y
n o !”
H is d a y tim e r is fu ll, indeed, h i
a d d itio n to h is m e d ic a l-re la te d in
vo lv em en t, th e S p a rlin g s a ls o a tte n d
th e ir g ra n d k id s ’ t-b a ll a n d so c c e r
g am es, c o o rd in a te c h u rc h a c tiv ities,
tra v e l, g a rd e n , h ik e a n d c a m p , ta k e
in c u ltu ra l e v en ts, a n d p la n a n d p a r
tic ip a te in v a rio u s fa m ily a c tiv ities.
C h ec k o u t a ty p ic a l w eek fo r D r.
S p arlin g : a n ev en in g a t th e S e a ttle
O p e ra , a w eek ly bib le b re a k fa st,
w o rk in g o n a g ra n t re p o rt fo r a
B o a rd o f H e a lth p ro je c t, a M a ry •
B rid ge L eg al A d v o c a c y C o m m ittee
m eeting, ch o ir re h e a rsa l, m ee tin g a
friend v isitin g fro m M o sc o w , an
o pen h o u se fo r th e M a n 1 B rid g e
A d v o c a c y /C h ild A b u se P re v e n tio n
a n d S afe ty C e n ter, d in n e r w ith a
n ep h ew a n d v isitin g R u ssia n g u e sts,
a n ig h t a t th e s y m p h o n y ... all w h ile
p re p a rin g fo r a fa m ily trip to W h is
tle r. O h , D r. S p a rlin g a lso runs two
a n d a h a l f m iles, th re e to fo u r times
a w eek .
D o e s h e m iss m ed icin e? Does he
e v e n h a v e tim e to m iss medicine?
“ I d o n ’t m iss it. I h a v e o th e r chal
le n g e s n o w , a n d I ’m g la d to be
a w a y fro m th e p ro b le m s.”
H e still k e e p s u p o n m edical lit
e ra tu re a s h e d id w h ile still in prac
tic e . In 1 9 7 4 , D r. S p a rlin g began his
o w n a b s tra c ts o f p e d ia tric literature
h e re a d , a n d h a s d istrib u te d it to
frie n d s fo r th e la s t fe w years. Last
y e a r, a v o lu m e w a s tran slated to
R u s s ia n a n d sen t to colleagues
th e re .
S o w h a t c o m es n e x t fo r Dr.
S p a rlin g ? “ I still h a v e m y list o f
h o b b ie s I ’d lik e to p u rsu e. I still
h a v e tlia t lis t o f b o o k s th a t needs to
b e read . A n d I still h av e th at ham
m o c k in th e b a c k y a rd th a t hasn 't
b een u s e d .”
Dr. Sparling practiced pediatrics in
Tacoma beginning in 1960. He has served
as a m ember o f the Tacoma-Pierce Comity
B oard o f H ealth since 1994. He was chair of
thePnblicHealtli/SchoolHealthCommittee
and served as President o f the Pierce County
Pediatric Society’, 1966-1967. ■
Professional Compounding Center o f Tacoma, WA
Urethral Inserts
Sublingual Troche
IV Services
Capsules
Lip Balms
752-1705
June General Membership Meeting
Tuesday, J u n e 8, 1 9 9 9
Social Hour:
6 :0 0 p m
Dinner:
Program:
6 :4 5 p m
7:45 pm
L a n d m a r k C o n v e n t io n C e n t e r
47 St. Helens A v e n u e
Tacom a
C are a t th e en d
o f life -
opportunities for improvement
• Dying today - w hat is it really like?
• O pportunities fo r:
© physician education
© system changes
® com m unity p articipation
featuring
Marilyn Pattison, M D
Stuart Farber, M D
(Registration required by June 4. Return this form to: PCMS, 223 Tacom a Ave S, Tacoma 98402; FAX to 572-2470 or call 572-3667)
Please reserve________ dinner(s) a t $20 per person (tax a n d tip in clu d e d )
□
Visa
□
Master C a rd
or m y c re d it c a rd # is
Expiration Date
______________________________________
Signature
I will be bringing m y spouse or a guest. N am e for n a m e tag:
Signed:_______ _________________________________________
Thank you!
News briefs
Pierce County hopes to receive grant to assist uninsured
T h e T a c o m a -P ie rc e C o u n ty H e a lth
D e p a rtm e n t, in co n ju n c tio n w ith th e
P ie rc e C o u n ty M e d ic a l S o cie ty h a s
a p p lie d fo r a g r a n t fro m th e R o b e rt
W o o d Jo h n s o n F o u n d a tio n to
d e sig n , b u ild a n d im p lem e n t a
lo c a lly -m a n a g e d , u n iv e rsa l h ealth
in s u ra n c e p ro g ra m fo r u n in s u re d
P ie rc e C o u n ty resid en ts.
T h e p rim a ry o b jectiv es o f th e
p ro je c t a re to:
•
p ro v id e u n iv e rsa l co v e ra g e
•
im p le m e n t m o re cost-efF ective
p a tte rn s o f c a re
• d iv e rt e p iso d ic c a re fro m h ig h c o s t e m e rg e n c y ro o m s
•
re c o n c ile c o m m u n ity e x p e c ta
tio n s a b o u t th e sc o p e a n d s ta n d a rd
o f c a re w ith a v a ila b le re so u rc e s
• c o n sid e r e n a c tin g a lo c al
re q u ire m e n t fo r in d iv id u a l fin an cial
re s p o n sib ility fo r illn e ss c a re
•
se rv e a s a p ro je c t fo r (lie
c u rre n t sta te -s u b sid iz e d in s u ra n c e
plan
• b u ild c o m m u n ity a g re e m e n t
a b o u t th e n ee d fo r a n d fe a tu re s o f
th e p ro g ra m
T h e p la y e rs in th e p ro je c t w ill be
k ey m ed ica l p ro v id e rs (P C M S , fo u r
m a jo r h o sp ita l sy ste m s, T a c o m a
P ie rc e C o u n ty H e a lth D e p a rtm e n t
a n d th e c o m m u n ity -b a se d clin ics
c u rre n tly se rv in g m an y u n in s u re d
M E D I C A L W R IT IN G
S E R V IC E S
T ra n sc rip tio n Specialists
- Prom pt, professional service
- Free daily pick-up and delivery
- T em porary and overflow work
gladly accepted
- O utstanding references
p e rs o n s). T h e y w ill c a rry o u t a
c o m m u n ity -b a se d p ro c e ss for
te s tin g a n d fu r th e r m od ify in g the
fe a tu re s o f th e sy ste m an d define
m o re p re c is e ly th e n u m b er and
c h a ra c te ris tic s o f u n in su red in
P ie rc e C o u n ty .
P ie rc e C o u n ty is a p p ly in g for this
g ra n t b e c a u se p re v io u s efforts to
reso lv e p ro b le m s o f a ccess for low
in c o m e u n in s u re d p eo p le have not
b e e n a s su c c e ssfu l a s h a d been
hoped.
T h e p ro p o s a l is bold, bu t the
H e a lth D e p a rtm e n t p lan s to pro
ceed w h e th e r o r n o t th e grant
fu n d in g is a w a rd e d .*
T A C O M A R A D IO L O G Y
Detect and Monitor
Low Bone Density
S p in e
&
F e m u r ( A x in l D E X A )
A ll e n m o r e M e d i c a l C e n t e r O n ly
253-208-8072
Linda R obson, PhD - O wner
Two-tenant building
One side for lease; 1,580 sq. It
7424 Bridgeport W ay W est
Two suites: 1,177 sq. ft.
and 1,570 sq. ft.
(T-score)
New! Menlo Park Professional Center
H e e l ( P e r ip h
L o w r is k s c r e e n i n g
Call to schedule
O f f ic e s p a c c : 5 0 0 - 5 ,0 0 0 s q . fL
C o n tact G ary C raw ford
(253) 272-9200
8
PCM S BU LLETIN
June, 1999
Tacoma
Lakewood
Gig Harbor
(253) 383-2038
(253) 572-5174
(253) 588-6083
(253) 858-3200
Alle n m o re M ed ica l C enter
Frank S. Baker C e n le r
Lakew ood Office
P o in l F o s d ic k Im a g in g
Feature
The Invisible Hand.
T h e P ricin g M ech a n ism
We never know the worth o f w ater till the well is dry.
T h o m as F uller, M . d ! (1 7 3 2 )
bv Andrew Statson, M D
W e usually think o f the m ark et a s a
system that brin gs to its p artic ip a n ts
the goods and services th ey w a n t to
consume and carries a w a y w h at
they have produced. It does th at,
but it does m uch m ore. It is also a
system o f com m unication and reg u
lation. It functions as th e circu lato ry
and neuro-endocrine system o f so
ciety. In a m ulti-cellular organ ism
the cells secrete horm ones, kinins
and other active sub stan ces, w hich
inform others o f th e ir condition and
regulate local and system ic blood
flow. Sim ilarly, every day th e p a r
ticipants in the m ark et m ake m u l
tiple decisions based on th e in fo r
mation the m arket has given them ,
namely the price o f goods an d se r
vices. The inform ation o f th e ir a c
tions is in tu rn tran sm itted acro ss
the market to the other p articip an ts.
At the sam e tim e the m ark et reg u
lates production and consum p tio n by
adjusting the su p p ly and dem an d so
that they balance each other. It
does that th rough the pricing
mechanism .
The price o f an item is a signal o f
its relative scarcity o r abundan ce.
Fresh fruit, for instance, m ay v ary
in price three to five fold th ro u g h o u t
the year. W hen the price is low
buyers tend to consum e m ore o r
use the fruit to m ake preserv es and
jam s for fu tu re consum ption. T he
high price, on the o pposite, dam pens
demand to m atch the lim ited supply.
Once upon a tim e th ere w ere se r
vice stations. W hen w e p u lled into
one, an attendant w ould com e o u t
running, fill th e tan k , w ash the
w indshield, ch eck th e oil, etc. Then
the oil p ro d u cers raised th e p rice o f
crude. T he c o st o f p ro d u ctio n from
cians and die m edia cam e up w ith a
slo g an - “ S ave it fo r the b est!” P er
h ap s m an y patrio tic citizens heeded
th a t advice. I su sp ect m o st people
"The central control ofprices in the fie ld o f health care has
effectively destroyed the pricing mechanism. We no longer have
a way to measure value and to price the services accordingly.
The pricing o f health care has become a political process."
som e so u rces b ecam e h igher than
the going p ric e o f g as. U neconom ic
pro d u ctio n sto p p ed , a n d the su p p ly
becam e in ad eq u ate to m eet the d e
m and. T o b rin g those tw o b ack into
b alan ce th e m ark e t needed to raise
th e p rice o f g as h ig h enough and
fa s t enough in o rd e r to c u rtail de
m and an d stim u late supply. For p o
litical reaso n s w e decided not to let
th a t happen. Instead, w e resorted to
rationing. T he tw o im m ediate re
su lts o f th a t w ere th e alm o st co m
plete d isap p ea ra n c e o f service, and
a sig n ifican t m isallo catio n o f scarce
re so u rc e s.
T he gas statio n s w ere allotted
supplies a c co rd in g to tlieir previous
use. Since th e ratio n in g reduced
to u rism , m an y re so rt a re as saw a
dro p in th e n u m b e r o f visitors. They
experienced no g a s sh o rtag es a t all.
T hey g o t m o re th a n the local people
could use. A t th e sam e tim e tlie
m a jo r p o p u la te d a re a s w ere
squeezed harder.
. T o en co u ra g e con serv atio n , p o liti
th o u g h t o f it as a g o o d one lo r the
oth er guy. W h at really m ade people
use less g as w as the lack o f supply.
W illi o u r decision to control the
price o f gas w e did n o t foil the m a r
k e t W e still p aid the p rice, and
p ro b ab ly m ore. H ow ever, instead o r
p aying in cash a t the p u m p , w e paid
in w asted tim e on the road, becau se
o f the low er speed lim it, an d at the
pu m p , because w e had to w a it in
line, o r p a y som eone else to w ait for
us. W e p a id fo r it in inconvenience,
b ecau se w e could not go 011 long
trip s, w e could only b u y g a s on c e r
ta in d ay s, an d w e had lo drive
aro u n d tow n looking for an open sta
tion th a t had no t a in o u t ol' its allo t
m ent.
In cases o f n atu ra l d isasters, such
as flood and earth q u ak es, w hen the
w a te r is contam inated and the flow
o f supplies interrupted, the p rice o f
essentials, such as food, w ater and
gas, h as to rise in o rd er to limit the
u se o f these scarce resources only
See "Pricing”page 10
June, 1999
PCMS BULLETIN 9
News briefs
"Pricing"
fro m page 9
to th e m o s t im p o rta n t fu n c tio n s.
S o m e p e o p le h a v e c a lle d tills rise in
p ric e , g o u g in g . P e rh a p s , b u t it is a n
u n m is ta k a b le a n d u n e q u iv o c a l m e s
s a g e fro m tlie m a rk e t th a t g ets
e v e ry b o d y 's a tte n tio n a n d say s:
“ S a v e it fo r tlie b e s t!”
W h en tlie p ric in g m e c h a n ism is
n o t a llo w e d to fu n c tio n fo r p o litic al
re a s o n s, a n im b a la n c e b e tw een
s u p p ly a n d d e m a n d o c c u rs . W h e n
tlie p ric e is fix e d to o lo w , a s h o rt
a g e d e v elo p s. W h e n it is fix e d to o
hig h, it re s u lts in o v e rp ro d u c tio n an d
w a ste . T h e c e n tra lly co n tro lle d
eco n o m ie s o f tlie so c ia list c o u n trie s
su ffe re d c o n sta n tly fro m th o se
p ro b le m s. T lie la c k o f a p ric in g
m e c h a n ism , m o re th a n th e la b o r
theory' o f v a lu e, m o re th a n a n y
o th e r e co n o m ic fa c to r, w a s tlie re a
so n fo r th e fall o f co m m u n ism . T he
a c tiv e b la c k m a rk e t th a t ex iste d
th ere o n ly p ro lo n g e d tlie ag o n y , it
co u ld n o t p re v e n t tlie fall.
W h e n tlie M e d ic a re a n d M e d ic
a id p ro g ra m s b ro u g h t larg e am o u n ts
o f m o n ey in to th e h e a lth c a re m a r
ket. th e d em a n d e x p lo d e d , a n d so
d id p rices. N o w w c see tlie o p p o -
Puyallup, WA 98371-0192._______
10
PCM S
BULLETIN
June, 1999
site e ffect. T h e flo w o f m o n e y is
d ro p p in g . T h e f ir s t ste p in th e m a r
k e t re sp o n se is tlie re d u c tio n in s e r
v ices. S o fa r tlie p riv a te o ffices
h a v e n o t b e e n a ffe c te d v e ry m u c h ,
b u t tlie h o sp ita ls a n d tlie b ig g ro u p s
a re . T h e p e o p le w o rk in g th e re h a v e
a h ig h e r w o rk lo a d , less tim e to c a re
fo r p a tie n ts, tlie te n s io n is h ig h er,
tlie jo b sa tisfa c tio n is lo w er, a s is
p a tie n t sa tisfa c tio n .
h i a re c e n t A u d io d ig e st ta p e th e
s p e a k e r cite d a stu d y o f M a s s a c h u
se tts p h y sic ia n s p u b lish e d in JA M A
in 1993. A b o u t 3 6 % o f th e m sta te d
th e y w o u ld n o t h a v e g o n e to m e d i
c a l sch o o l i f th e y k n e w th e n w h a t
th e y k n o w n o w . O v e r 5 0 % w o u ld
n o t e n c o u ra g e th e ir c h ild re n o r
o th e r y o u n g p e o p le to g o in to m e d i
cine. T lie n u rs e s c h o se th e ir fie ld to
ta k e c a re o f p a tie n ts , b u t th e y a re
so o v e rb u rd e n e d w ith p a p e rw o rk ,
th ey h av e n o tim e left fo r p a tie n t
c a re .
T h e p a tie n ts th e m se lv e s believ e
th a t in tlie m a n a g e d c a re settin g tlie
p h y sic ia n s h a v e v e ry little tim e fo r
them . T h e y a re n o t sa tisfie d w ith a
b rie f ex a m in a tio n a n d a p re s c rip
tio n , so th e y g o to a lte rn a tiv e c a re
p ra c titio n e rs. T h e y w a n t so m eo n e
w h o c o u ld sp e n d tim e w ith th em
a n d listen to them .
T h e m a rk e t still is e x a c tin g its
p rice. W e p a y it n o t in c a sh , b u t in
lo w er q u a lity c a re , in w a ste d tim e,
in d elay ed tre a tm e n ts, in lo n g te rm
seq u elae. In su m , w e p a y it in h u
m an su fferin g . T h a t a lso is o u r p o
litical decisio n .
T h e p h y sic ia n s w h o tu rn e d o v e r
th e ir offices to tlie m a n a g e m e n t
g ro u p s a n d w e n t o n a sa la ry lo st
c o n tro l o f th e ir p ra c tic e s . W h e n
th eir c o n tra c ts w e re d u e fo r re
new al, th e y a ls o h a d to tak e a sig
n ific a n t c u t in p a y . N o w o n d er
u n io n iz atio n o f s a la rie d p h y sic ia n s is
beco m in g m o re p re v a le n t. W ith
p ric e s u n d e r c e n tra l c o n tro l, p a y
a n d w o rk in g c o n d itio n s a re no
longer economic issues, but have
become political ones. Unioniza
tion is a political response.
T h e c e n tra l c o n tro l o f prices in
th e fie ld o f h e a lth c a re h as effec
tiv e ly d e stro y e d th e p ricin g
m e c h a n ism . W e n o lo n g er have a
w a y to m e a s u re v a lu e and to price
th e se rv ic e s a c c o rd in g ly . The pric
in g o f h e a lth c a re h a s becom e a
p o litic a l p ro c e s s. T h e patients
h a v e n o w a y to d eterm in e tlie
re la tiv e a b u n d a n c e o f scarcity o f
re s o u rc e s. T h e m a rk e t has no
w a y o f te llin g them : “ S ave it for
th e b e s t!”
A s p o litic a l d e c isio n s direct the
flo w o f m o n e y in h ealth care, we
c a n e x p e c t th e m ed ical equivalent
o f p u ttin g a m a n o n tlie moon,
w h ile o u r ro a d s a re full o f pot
h o les. S o m e d a z z lin g projects will
b e fu n d e d j u s t to sh o w the world
h o w g o o d w e a re , w h ile tlie treat
m e n ts o f tlie p ro sa ic , boring, but
c o m m o n illn esses w ill be ne
g le c te d .
R e c e n tly o n e o f m y health plans
se n t m e a n a m en d m en t to their
c o n tra c t. T h e la s t p a rag rap h
c a u g h t m y atten tio n : “M em bers
a re free to c o n tra c t a t an y time to
o b ta in a n y h e a lth c a re services
o u ts id e Uhe h e a lth p la n on any
te rm s o r c o n d itio n s tlie members
c h o o s e .” T h e p la n ju s t will not pay
fo r th em . T h u s m an a g e d care as
su m e s tlie ro le o f a safety net, tlie
lo w e st tie r o f a m u lti-tiered health
c a re sy stem . A few y ears ago the
m ilita ry e sta b lish e d th e first multi
tie re d sy ste m w ith th e ir Tricare
p ro g ra m . T h is is n o w expanding to
M ed ic a re . T h e o p tio n s w ill be
co m e a v a ila b le to o th ers under
m a n a g e d ca re . T h o se w ho can af
fo rd to d o so w ill seek care out
sid e tlie sy ste m . P riv a te insurance
c o m p a n ie s w ill m o v e in and offer
p o lic ies w h ic h in su re ag ain st cata
stro p h ic e x p e n se s. A new cycle
w ill b eg in . ■
Feature
Health Care: Reform or Revamp?
by D aisy P u racal. M D
►
T h e P ro b le m
M edical care in A m erica is cap ab le
o f being the finest in the w orld, b u t
out o f 29 developed nations w e are
the only one w ho chooses n o t to
have a system o f N atio n al H ealth
Care Policy to cover all citizens.
We rank 19“' in longevity an d 2 7 “’ in
infant m ortality!! P atients a n d d o c
tors nationw ide a re show ing in
creasing d issatisfaction w ith the
current health care delivery sy s
tem. M anaged care h as created
difficulties, excessive pap erw o rk
and frustrations fo r all. D en ial o f
carc by health care plans poses
problems fo r doctors an d patien ts
alike. E xcept fo r a b rie f initial slow
ing, m anaged c are h a s n o t p ro v ed
effective in ongoing c o st co n tain
ment. N ational health care co sts
were back up to 10% last y e a r and
are still rising w ith m ore th a n 44
million people in A m erica w ith o u t
health care o r the m eans to p a y fo r
care in spite o f econom ic ex p an sio n
and decreased unem ploym ent.
There is no d o u b t a b o u t it ... h ealth
care is expensive! B u t other in d u s
trial countries have show n th a t it
can be done. So, w h a t can w e do
to maxim ize o u r reso u rces an d p ro
vide sim ilar coverage fo r all A m eri
cans?
T he F a c ts
Twenty percent o f p atien ts co n
sume 80% o f o u r h ealth c a re dollar.
These are the high risk patien ts
with m ajor m edical illnesses. A s a
corollary, 80% o f p atien ts consum e
only 20% o f health costs, b u t are
paying high p rem ium s fo r it. M ed i
cal care should be th e inalien ab le
right o f every A m erican. T h is right
is being denied to m an y b ec a u se o f
the m arket driven inflated co sts o f
our present system .
►
A P ro p o s a l
W h a t is o u r ex p ectatio n o f in su r
ance? S h ou ld in su rers be expected
to c o v er all h ealth c a re costs? O r
sh o u ld in su ran ce be p olicies o b
tain ed to indem nify a g a in st only
“ ex cessiv e” lo sses to fam ilies o r in
d ividuals? I p ro p o se a m ultitiered
sy stem to m eet the needs o f health
c a re .
►
T h e F ir s t L e v e l - O u tp a
t i e n t S e rv ic e s
O ffice visits to all providers
w h eth er it be to p h y sician s,
n atu ro p a th s, ch iro p ra c to rs and
m edications w ill be covered a l this
level. P atien ts w ill retain th eir
choice o f providers. A n arb itra ry
c ap (e.g. $ 2 0 0 0 p e r p erso n p e r a n
num ) is set fo r th is. P atien ts w ill
carry' a d eb it c a rd to p a y for se r
vices. A n a u to m atic read o u t a t the
p o in t o f serv ice keeps tra c k o f se r
vices u sed an d rem aining m onies
a v ailab le fo r th e y ear.
T h e m oney fo r this incom e
com es o u t o f a n ew ly created p e r
so n al social se c u rity a c co u n t (or
M edical S av in g s A cco u n t) b y ta x a
tion. Incentives w ill need lo be in
p lace to d isco u rag e excessive
spending o r ab u se o f th e system
(e.g. an individual m ay have th e o p
tio n to u se ex cess ca sh over a p e
rio d o f tu n e in h is/h er ac co u n t for
e d u catio n /h o u sin g im p ro v em en ts).
Incentives n eed to be placed for
u tilizing p rev en tiv e care (e.g. lax
d eductions fo r m am m o g ram s or
p ap tests). M ech an ism s fo r q uality
a ssu ra n c e an d c o st co n tain m en t a t
th e p ro v id ers end need also to be
im plem ented. P atien ts o r p roviders
w ho co n sisten tly ov eru se th e sy s
tem c a n be id entified a n d ed ucated
(i.e. m ax im izatio n o f $2 0 0 0 ).
W ith this m ethod, freedom o f
Daisy Puracal, M D
choice is m aintained. It elim inates
d iscrim in atio n am o n g st the rich, the
elderly^ an d th e po o r. P ro v id ers will
be able to o ffer ch arity care again
a t their ow n discretion. W itli o u r
c u rre n t system , th e differential in
d isb ursem en ts to p ro v id ers by M ed
icaid, M ed icare an d p riv ate insurers
creates social d iscrim inations.
►
T h e S e c o n d L e v e l - In p a
tie n t C a r e
S u rg ical and hospital co sts w ill be
covered th ro u g h in su ran ce - either
a sta te ru n single p a y o r o r p riv ate
insurance. H ow ever, stric t m ea
su res have to be in place to en su re
th a t there be no profiteering. A gain,
th ere should be a cap to th e ex
penses p e r p erson p e r y e a r (e.g.
$ 2 0 ,0 0 0 ). Insurance m ay b e bo u g h t
by the individual, em ployer o r M ed i
care. M edicare al th is level should
be age an d incom e b ased an d not
solely age based.
T he in su ran ce p rem ium should be
stan d ard ized an d equitable fo r all. A
universal prem iu m w ill b ring back
the b asic ten et fo r in su ran ce (i.e.
large pool to m inim ize risk). It d is
co u rag es exclu sio n s o f high risk
g ro u p s o r in dividuals an d e n co u r
ag es to ta l num bers. W ith o u t o u tp a
tien t c a re an d ex trao rd in a ry costs
o f th e th ird level (see below ) prem i
um s w ill b e m ore affordable.
People should be ab le to m ove from
one jo b to an o th e r o r from one state
lo a n o th er w ith o u t affecting the s ta
tu s o f th eir insurance. E very single
w orking p erso n w ill be insured.
Illness is no t p red ictab le an d no
See "Care"page 14
June, 1999
PCMS BULLETIN
11
Feature
State vaccine participants required to
participate in August study
Imm unization
Program
Educational
Outreach
In Ju n e , tlie T a c o m a -P ie rc e C o u n ty
Im m u n iz a tio n C o a litio n a n d tlie
T a c o m a -P ie rc e C o u n ty H e a lth
D e p a rtm e n t Im m u n iz a tio n P ro g ra m
w ill ofFer a n o ffic e b a s e d a s s e s s
m e n t a n d e d u c a tio n a l in -se rv ic e to
m e d ic a l p ro v id e rs a n d clin ics.
S e le c te d c lin ic s a n d o ffic e s w ill be
a s k e d to p a rtic ip a te . T h e g o a l o f
th e o u tr c a c h is to a s s e s s p r a c
tic e w id e im m u n iz a tio n r a te s
a n d o ffe r in f o r m a tio n a n d to o ls
to in c r e a s e th e p e r c e n ta g e o f
fu lly v a c c in a te d c h ild r e n in y o u r
p ra c tic e .
T h e p ro g ra m b eg in s w ith a
p ra c tic e -b a s e d im m u n iza tio n
a s s e s s m e n t u sin g C lin ic A s s e s s
m e n t S o ftw a re A p p lic a tio n (C A S A )
to see h o w m a n y o f th e clin ic's tw o
y e a r o ld p a tie n ts a re u p to d a te on
im m u n iz a tio n s. C A S A w a s d ev e l
o p ed b y tlie C D C 's N a tio n a l
Im m u n iz a tio n P ro g ra m . A ra n d o m
sa m p lin g o f c h a rts a re rev iew ed
a n d e n te re d in to th e C A S A c o m
p u te r p ro g ra m w h ic h c a lc u la te s
im m u n iz a tio n ra te s fo r th e p ra ctice .
B a se d 011 tlie re su lts o f tlie a s s e s s
m en t, a 3 0 to 45 m in u te in -serv ice
w ill be p re s e n te d w h ich w ill o ffe r
to o ls a n d reco m m en d atio n s fo r
in te rv en tio n s to in c re a se rate s.
A fte r on e y e a r, tlie C A S A a s s e s s
m en t w ill be repeated.
A ll re s u lts w ill b e sh a re d w ith
p ro v id e rs. I f y o u h a v e a n y q u e s
tio n s o r w o u ld like ad d itio n a l
in fo rm a tio n a b o u t tlie e d u c a tio n a l
o u tre a c h p ro g ra m , p le a se c a ll C in d y
M iro n a t tlie H e a lth D e p a rtm e n t,
7 9 8 -6 5 5 6 .■
In A u g u s t o f 1 9 9 9 , all p ro v id e r sites
e n ro lled in th e s ta te v a c c in e p r o
g ra m w ill b e re q u ire d to p a rtic ip a te
in w h a t is b ein g c a lle d a b e n c h
m a rk in g su rv e y . T lie su rv e y w ill
d o c u m e n t tlie elig ib ility s ta tu s o f all
c h ild re n u n d e r a g e 19 y e a rs re c e iv
in g im m u n iz a tio n s d u rin g tlie en tire
m o n th o f A u g u st. T h e d a t a
g a th e r e d t h r o u g h s ta te w id e
b e n c h m a r k in g w ill b e e s s e n tia l
to th e s t a b ility o f lo n g - te rm
v a c c in e fu n d in g in W a s h in g to n
S ta t e .
T h e s u r v e y in v o lv e s a simple
f o r m w h ic h y o u r p a tie n ts ' parent
o r g u a r d i a n w ill b e a sk e d to
c o m p le te . It a sk s tlie child's name,
b irth d a te , w h e th e r tlie child is
in su re d , u n in s u re d , underinsured (110
c o v e ra g e fo r im m u n izatio n s),
M e d ic a id en ro lled , o r A m erican
In d ia n /A la sk a N ativ e . T h e surveys
c a n th e n b e co lle c te d b y tlie office
sta ff, a n d tu rn e d o v e r to tlie
T P C H D im m u n iz a tio n program
s t a f f a t tlie en d o f tlie
b e n c h m a rk in g perio d .
T h e s ta te h a s b e e n o p e ra tin g o n
a n e stim a te th a t 4 3 p e rc e n t o f o u r
ch ild ren q u a lify fo r v a c c in e s u n d e r
tlie fed eral V acc in e s fo r C h ild ren
(V F C ) p ro g ra m . T lie C e n te rs fo r
D ise a se C o n tro l is n o w req u irin g
th a t th e se p e rc e n ta g e s u se d in th e
fu nd in g fo rm u la tio n b e b a se d on
a c tu a l d a ta . In re a lity , tlie p e rc e n t
a g e o f V F C elig ib le c h ild ren in o u r
sta te is p ro b a b ly h ig h e r th a n 43
p ercen t. W e b eliev e this to b e tru e
as W a sh in g to n h a s o n e o f tlie
lo w e st d o c u m e n te d p e rc e n ta g e s o f
V F C elig ib le ch ild re n b u t h a s tlie
h ig h e st M e d ic a id elig ib ility cap
(2 0 0 % o f fe d era l p o v e rty level),
one o f tlie h ig h e st p ro v id e r p a rtic i
p a tio n ra te s, a n d a h ig h p e rc e n ta g e
o f p u b lic -a ss iste d b irth s.
T h e T a c o m a -P ie rc e C ounty
H e a lth D e p a rtm e n t Im m unization
P ro g ra m w ill p ro v id e a supply o f
th e su rv e y s a n d in stru c t tlie office
s t a f f a b o u t su rv e y requirem ents.
W e w ill b e av a ila b le to answ er
q u e stio n s o r g iv e a ssistan ce as
n e c e ss a ry . A t tlie end o f tlie survey
p e rio d , o u r s t a f f w ill collect the
fo rm s a n d se n d th e m 011 to the
W a s h in g to n sta te Im m unization
P ro g ra m to b e com piled and
a n a ly z e d . A g g re g ate results will be
a v a ila b le u p o n request.
T A C O M A /P IE R C E CO UN TY
O u tp a ti e n t G e n e r a l M e d ic a l C a re .
PCM S
BU LLETIN
June, 1999
PUYALLUP
MEDICAL CLINIC
F u ll a n d p a r t- tim e p o sitio n s
a v a ila b le in T a c o m a a n d vicin ity .
4 ,0 0 0 + s f fo r lease/fo r sale
V e ry fle x ib le s c h e d u le . W e ll s u ite d
in an e x c e lle n t S outh Hill
fo r c a r e e r r e d e f in itio n fo r
lo cation.
G P , F P , IM .
12
T h e in fo rm a tio n y o u g ath er is
im p o rta n t in th e contin u atio n o f a
h ig h level o f im m u n izatio n services
f o r c h ild ren . Y o u r cooperation is
a p p re c ia te d , p a rtic u la rly during tlie
b u sy m o n th o f A u g u st.!
S te v e O ffe n b e c h e r, CCIM
G a te w a y C om m ercial
(253) 840-5574
T a c o m a - P ie r c e
C o u n ty
H e a lth
D e p a r tm e n t
The health status of Pierce County
-
#■
HEALTH
D E P A R T M E N T
This is a continuing segm ent
outlining the h ealth statu s o f P ierce
County residents. T he d a ta p re
sented should provide a fram ew o rk
for understanding th e H ealth
departm ent's priorities fo r p rev en
tion strategies. O ver the n ex t
several years, our goal is to
reduce illness and death related
to sm oking, alcoh ol m isu se,
violence, and H IV /A ID S . T hese
areas are related to behavio rs
which deserve com m unity w ide
attention an d efforts fo r change.
Here's som e o f th e statistics related
to smoking and to b acc o -related ill
ness and death in P ierce C ounty:
♦
T here are approxim ately
110,000 adults - or ap p roxi
mately 25% o f adults - in P ierce
County w ho sm ok e cigarettes.
♦
A s discussed in th e first ar
ticle in this series, a ge-a d ju sted
death rates from lun g cancer
have not changed over 15 y ea rs,
while rates from all oth er causes
of death have d ro p p ed sig n ifi
cantly.
♦
E very yea r in P ierce
County, 1,072 p eo p le die from
tobacco use. T w en ty p ercen t o f
all Pierce C ounty deaths are
smoking related. A b o u t h a lf o f
all regular sm okers w ill ev en tu
ally die o f to b acco-related ill
n esses.
♦ Across the seven health dis
tricts*, death rates for all respi-
ratory can
cers in m ales
in D istricts 4
and 5 and fe
m ales in D is
trict 1 are
sta tis tic a lly
sig n ifica n tly
high er than
in D istrict 7
w hich has
th e lo w e st
death rate
from this
c a u se (s e e
ch a rt).
Dca th s F r o m R e s p i ra t o ry Cancer.
1993-1997
♦
O ne
third o f all
h o sp ita l b e d s
and 5 3 ,0 0 0
o u tp a tie n t
visits are re
lated to to
b acco use.
♦
T o b a cco
use is the
num b er o n e
p r e v e n ta b le
cau se o f
death in this
cou n ty. S e v
en ty p ercen t
o f cu rren t
sm ok ers sa y th ey w a n t to quit a n d m o st o f them have m a d e m ore
than on e serio u s attem p t to do so.
B ecau se o f th is u n n ecessary to ll on th e h ealth a n d w ell-being o f Pierce
C ounty citizens, th e H ea lth d ep artm en t h as developed a com prehensive to
bacco p rev en tio n p lan w hich focuses on ad u lt cessatio n , p revention o f youth
u p tak e, en fo rcem en t o f law s b an n in g all o u td o o r ad v ertisin g , zero to lerance
o f y o u th p o sse ssio n a n d sales to m inors, an d sm oke-free w o rk p laces. D em o
g ra p h ic v a riatio n o f sm okers seen acro ss th e co u n ty h ighlight th e need to ta i
lo r com m u n ity -w id e prev en tio n an d in tervention effo rts to g ain m axim um ef
fects in b e h av io r change. AH plan s w ill be im plem ented in th e seven local
health d istric t a re a s a s well a s fro m th e cen tral office.
P h y sician s a n d o th er p rim ary c a re p rov id ers p lay a key role in assistin g
sm okers in quittin g . S tudies have sh o w n m ed ical s ta ff w ho provide b rie f
clinical interv en tio ns d u ring p atien t v isits achieve q u it rates u p to ten percent.
W hile th is ra te o f c e ssatio n m ay seem relatively low , co n sid er th a t tob acco
See "Health Status"page I ‘i______
June, 1999
PCMS BULLETIN
13
V
News briefs
"Care" fro m page 11
"H ealth Status" fro m page 13
o n e sh o u ld b e p e n a liz e d fo r g e llin g sick . D o c to rs c a n b e
h e ld a c c o u n ta b le fo r th e c a re th e y p ro v id e , b u t n o t fo r
th e fa c t th a t p e o p le g e t sick.
u se is a c h ro n ic d ise a se . Im a g in e a c h ie v in g a five per
c e n t ra te o f c u re fo r T y p e I d ia b e te s. T h e H ealth De
p a rtm e n t is p ro v id in g fre e tr a in in g fo r m ed ical office
s t a f f to le a rn h o w to im p le m e n t a sta te -o f-th e -a rt clinicb a se d to b a c c o c e ss a tio n in te rv e n tio n fro m th e National
C a n c e r In s titu te . T h e tra in in g c a n h a p p e n in y o u r office
a n d c a n r e d u c e y o u r s m o k in g p a ti e n t p o p u la tio n to
1 5 % o f y o u r g e n e ra l p a tie n t p a n e l w ith less th a t three
m in u te s o f s t a f f tim e.
►
T h e T h i r d L e v e l - E x c e p tio n a l C o s ts
E x tra o r d in a r y c o sts (e.g. tra n s p la n ta tio n s , o r “ e x p e ri
m e n ta l” p ro c e d u re s) w ill g o th ro u g h a b o a rd . F u n d in g
fo r th is sh o u ld b e th ro u g h sta te o r fe d e ra l reserv e. N o
o n e w h o fils c rite ria fo r th e se p ro c e d u re s n eed e v e r b e
d en ied care.
►
T h e F o u r t h L e v e l - N u r s in g H o m e C a r e
L o n g te rm c a re w ill b e ta k e n c a re o f b y M ed ic a re . In
c en tiv es a re g iv en to e n c o u ra g e in -h o m e c a re b y fam ily
m e m b e rs o r h o m e h e a lth n u rses.
In esse n c e e v ery o n e is g iv en a $ 2 ,0 0 0 d e d u c tib le a n d
the m e a n s to p a y fo r it, a n d w e w o n ’t h a v e to w o rry
a b o u t long te rm c a re crip p lin g a fam ily.
F o r q u e stio n s o r in fo rm a tio n a b o u t T o b a c c o Preven
tio n , c a ll N a n c y M c K in d s e y a t 7 9 8 -6 4 6 1 .
F o r m o re in fo rm a tio n fro m th e O ffic e o f Community
A sse ss m e n t (on s ta tis tic s q u o te d ), c all R ic k
M a c C o m a c k , P h .D . a t 7 9 8 -4 7 8 8 .1
* T h e sev en
tric t a n d
►
T h e F if th L e v e l - R e s e a r c h a n d D e v e lo p m e n t
F u n d in g fo r th is is to be u n d e rta k e n b y d ru g co m p an ies,
u n iv e rsitie s , c h a rita b le d o n a tio n s a n d m a y b e su b sid ize d
b y th e g o v ern m en t.
W h e n a c a p is re a c h e d , fu n d in g ro lls o v er to th e n e x t
level. C h e c k s a n d b a la n c e s a re p u t in p la c e to red u ce
a b u s e o f th e sy stem . M a n y d e ta ils w ill, o f c o u rse, h a v e
to b e w o rk e d o u t (e.g. w h a t a b o u t th e child o r the
h o u se w ife w ith n o so c ia l se c u rity ? ) B u t you c a n see th a t
w ith th is sy stem th ere c a n b e a d v a n ta g e s o v e r the c u r
re n t one. P ro fite e rin g a t th e e x p e n se o f a n o th e r 's sic k
n e ss is to ta lly u n c iv iliz e d a n d u n -A m erican . W ith w h a t
e v e r w e ch o o se, p ro fite e rin g h a s to go.
I w o u ld like to see m o re o p en d iscu ssio n s o n the f r u s
tra tio n s d o c to rs a re facin g . M a y b e the cre a tio n o f a
m a ilb o x a t the S o c ie ty w ill help. I u rg e y o u r th o u gh ts
a n d co m m en ts on the issu e so w e can w o rk to w a rd s a f
fo rd a b le h ealth c a re fo r all a n d d o c to rs c a n g o b a c k to
b e in g d o c to rs. ■
h e a lth
d is tra c ts a re
a p p ro x im a te
th e
s y n o n y m o u s w ith c o u n t y c o u n c il d is
fo llo w in g
a re a s:
1 ) E a s t P ie r c e C o u n ty , in
c lu d in g S u m n e r . O r tin g , E a to n v ille ; 2 ) P u y a llu p , F ife , E d g e w o o d ; 3 )
B e th e l, M id la n d , R o y . Y e lm ; 4 ) T a c o m a C e n tr a l a n d N o rth e a s t; 5 )
T acom a
S o u th ,
p a rt o f L ak ew o o d ; 6 )
U n iv e rs ity
P la c e , p a rt o f L a k e
w o o d , S te ila c o o m ; 7 ) G ig H a r b o r , P e n in s u la , N o r th T a c o m a .
A llenm ore
Psychological
Associates, P.S.
^ 752-7320 ■-----------D o you h ave p a tie n ts w ith difficult emotional
and stress-rela ted problem s? Psychiatric and
p syc h o lo g ica l con su ltation s are available.
------------------ 1530 Union Ave. S.. Ste. 16. Tacoma
Dr. Puracal is a fa m ily physician. She has practiced in Tacoma since
mo.
Personal Problems
o f Physicians
M e d ic a l pro b lem s, drugs, alcohol, retire
m ent, em otional, o r oth er st&ch difficulties?
'R o b e r t
S a n d s,
B ill
D ean
F.
D e n n is
C lu ifr
2 6 5 -2 5 8 4
:
Confidentiality Assured
14
PCM S BU LLETIN
June, 1999
A s s e t m a n a g e m e n t , in c .
R egistered In v e stm e n t Advisory
PtP.Sf. >NAL IN V [ STMENT
A D VIC E FROM Tl IE PRESIDENT
INDUS I PY-LEADINO LO W EEES
(NO COMMISSIONS)
7 5 2 -6 0 5 6
2 7 2 -4 0 1 3
W n ltlro n
to tal
Cali 8 5 8 - 2 7 4 5
w w w .4 - T A M -R IA
D u viii J. lloskoph, MBA, CFP
CALL OR VISIT OUR VEB POR A
CD\CASSETT£ INTRODUCTION
V ,
Feature
Welcome, new PCMS Members
A b d u llah , B ish e r A ., M D
P e d /P e d G a s tr o e n te r o lo g y
Practices a t 314 M L K J r W ay ,
#2 0 2 , T acom a 98405 ; 552-1511
M edical School: D am ascu s U n iv er
sity School o f M edicine
Residency: M edical C ollege o f Ohio
Fellowship: R iley H o sp ital fo r
Children
C h an , C h ris to p h e r Y ., M D
F am ily M e d ic in e
Practices w ith C ornerstone Fam ily
Physicians, 5922 10011' S t SW , # 2 6 ,
T acom a 9 8 4 99-2751; 5 8 8 -07 5 6
M edical School: U niversity o f
A lberta
Internship: U niversity o f A lb erta
Residency: U niversity o f A lb e rta
C lark , L y n n e P ., M D
G eneral S u rg e r y
Practices w ith M t. R ain ier S urgical
A ssociates, 419 S “L ” St, #1 0 1 ,
Tacom a 98405; 3 8 3 -5949
M edical School: E astern V irginia
M edical School
Internship: E astern V irginia School
o f M edicine
Residency: E astern V irg in ia School
o f M edicine
G inocchio, C h r is to p h e r J ., M D
N e u ro lo g y
Practices at 915 6* A ve, #2,
Tacom a 98405; 3 8 3 -5056
M edical School: U niversity o f
C alifornia School o f M edicine San D iego
Internship: G ood S am aritan /
Emanuel H ospital
Residency: O regon H ealth S ciences
University
Fellowship: D uke U niversity
M edical C enter
K a e le y , G u r ji t S ., M D
R h e u m a to lo g y /I n te r n a l M e d
P ra c tic es w ith P acific S ports
M edicine, 3 3 1 5 S 2 3 rd S t, # 2 0 0 ,
T a co m a 9 8 4 0 5 ;5 7 2 -8 3 2 6
M edical School: U niv ersity o f
L ondon
Internship: U niv ersity o f T ennessee
R esidency: U niversity o f T ennessee
F ellow ship: U niversity o f T ennessee
M o o n , M ic h a e l R ., M D
A n e s th e s io lo g y
P ractices w ith A llenm ore A nesthe
sia A sso ciates, 1901 S U nion,
T a co m a 98 4 0 5 ; 5 9 6-5131
M edical School: O regon H ealth
Sciences U niversity
Internship: D avid G ran t U .S. A ir
F o rce M edical C en ter
R esidency: W ilfo rd H a ll U .S . A ir
F orce M edical C en ter
S c h o e n ik e , S u m n e r L ., M D
P e d ia t r i c s
P ra c tic e s w ith L ak ew o o d P e d ia t
rics, 7 4 2 4 B rid g ep o rt W ay W . # 2 0 3 ,
T a co m a 9 8 4 6 7 ; 5 8 1-2111
M edical School: B ay lo r C ollege o f
M edicine
Internship: U niversity o f T ex as
R esidency: P h o en ix A ffiliated
H ospitals
R esidency: O reg o n S tate H o sp ital ■
Applicants for Membership
B e n ja m in , G . G o rd o n , M D
D ia g n o s tic R a d io lo g y
P ractices a t T aco m a R adiology;
3402 S 18th S treet, T a co m a 9 8405;
383-1099
M edical School: M edical C ollege o f
W isco n sin
Internship: V irg in ia M aso n H o sp ital
R esidency: U niv. o f W ashington
F ellow ship: U niv. o f W ashington
B le a u , B ria n L ., M D
G a s tr o e n te r o l o g y
P ractices a t T a co m a D igestive
D isease C en ter; 1112 S ixth A v
enue, # 2 0 0 , T a co m a 98 4 0 5 ; 2 7 2 8664
M edical School: U niv ersity o f
A lb erta
Internship: R oyal C olu m b ian
H ospital
R esidency: U niversity o f B ritish
C olum bia
Fellow ship: U niversity o f B ritish
C o lu m b ia an d tlie M ay o C linic
K h a n , S h ire e n E ., M D
D ia g n o stic R a d io lo g y
P ractices a t T aco m a R adiology;
3 4 0 2 S 18U| S treet, T a c o m a 9 8 4 0 5 ;
383-1099
M edical School; W ash in g to n
U niversity S chool o f M edicine
Internship: C o u n ty M edical C en ter
R esidency: U niversity' o f M innesota
Fellow ship: C h ild ren ’s H o sp ital
M ed ical C e n te r!
June, 1999
PCMS BULLETIN
15
Feature
C o le n , J o h n , M D ( R e tir e d )
C h a n g e a d d re s s to:
7310 A m ber L ane SW
P h o n e: 5 8 2 -4 8 9 9
C o m m u n ity H e a lth C a r e
( H e a l t h A g e n c ie s )
A d m in istra tio n O ffice
101 E 2 6 th S t, # 1 0 0
T a c o m a , W A 9 8 4 2 1 -1 1 0 8
D a v is , E d d ie , D P M
C h a n g e p h o n e to:
P u y a llu p O ffice: 8 4 1 -3 6 6 8
F r e e m a n , R o b e r t , M D (R e
tire d )
2 1 1 9 M ild re d S t W
T a c o m a , W A 9 8 4 6 6 -6 1 3 5
C h a n g e a d d re s s to :
2 1 0 2 N P e a rl S t, # 3 0 0
T acom a, W A 98406
P h o n e :7 5 6 -5 1 0 0
F A X : 7 5 9 -8 0 1 3
H o r v a th , K im b e r ly , P A C
C h a n g e a d d re s s to :
1901 S U n io n A v e, # B 6 0 0 7
T a c o m a , W A 9 8 4 0 5 -1 8 0 6
M o r r is , R o n a ld , M D
2 7 3 2 E M a in A v e
P u y a llu p , W A 9 8 3 7 2 -3 1 6 4
M u ltic a re
D rs . C o m b s , D e h lin g e r a n d
S tr in g f e llo w ;
C a th e r i n e D r o e g e , A R N P
A d d th e fo llo w in g p h o n e n u m b ers:
P h y sic ia n s only: 4 0 3 -6 0 5 9
F A X : 4 0 3 -6 0 2 8
F ed eral W ay’s F in est
A d d ress:
A t St. F ra n c is H ospital
F ed eral Way
5 2 ,0 0 0 Square Foot M edical/P ro fessional Office Building
Join These Tenants: M edalia Health Care • St Francis W omen’s
C en ter • P ediactrics N orthw est • Digestive H ealth
N etw ork • P h arm acy & D iagnostic Lab • Dr. B arbara Levy
A
A lexander
Commercial Real Estate
aJ ^
16
PCM S BU LLETIN
Contact:
Kirsten Hayford
206-264-4594
schedule a tour.
June, 1999
• Class “A ” Interiors
• T. 1. Allowance
•A m p le Parking
• High Growth M arket
O s t, M ic h e lle , M D
1 6 5 1 5 M e rid ia n E
P u y a llu p , W A 9 8 3 7 5 -6 2 51
S a n f o r d , E liz a b e th , M D
1901 S U n io n A v e, # B 6 0 0 7
T a c o m a , W A 9 8 4 0 5 -1 8 0 6
S t u a r t , R o b e r t, M D
4 7 0 0 P t. F o sd ic k D r N W , #310
G ig H a rb o r, W A 9 8 3 3 5
P h o n e :8 5 3 -2 1 5 0
W o h n s , R ic h a r d , M D
P u y a llu p O ffice
1 0 2 B -2 3 rd A v e S E
P u y a llu p , W A 9 8 3 7 l i
invites yo u a n d y o u r s p o u s e /g u e s t to the
Retired Physician Luncheon
S h en aniga n’s Restaurant
NEW LOCATION:
3017 Ruston Way, Upstairs
Friday, June 18,1 999
12:00 (noon)
Peter M arsh, MD
and
Susan Bemis, ARNP
ta k e you on:
A S I A T r a v e ls
Korea, China and Viei Nam
(Please clip and mail in the enclosed envelope to PCMS no later than Tuesday. June 15 or call 572-3667)
YES, I (we) ha ve reserved Friday, June 18 to join retired mem bers, (including spouses, guests, a n d widows) o f
the M e d ica l Society for lunch.
Please re s e rv e _____ lunch(es) for m e a t $18.00 p e r person (includes tax a n d tip). My c h e c k is a tta c h e d .
I will b e b rin g in g m y spouse or a guest. Nam e for n a m e t a g : _________________________________________
S ig n e d :_______________________________________________________
Thank you!
News briefs
L & I Complaint
r e p o r t available
T h e W S M A a n d tlie D e p a rtm e n t o f
L a b o r a n d In d u strie s h a v e d e v e l
o p e d a sy s te m to receiv e, reco rd ,
a n a ly z e a n d re sp o n d to c o m p lain ts
th a t p h y sic ia n s hav e co n c ern in g
th e ir in te ra c tio n s w ith tlie d e p a rt
m ent. T h e c o m p la in t fo rm a sk s fo r
in fo rm a tio n th a t w ill h e lp th e m
id en tify p ro b le m a re a s a n d w o rk on
m a k in g im p ro v em en ts.
T h e fo rm , w h ic h m u s t b e c o m
p le te d a n d fa x e d to W S M A , is one
p a g e a n d e a sy to co m p letc,
F o r m o re in fo rm a tio n o r a c o p y o f
th e fo rm , c a ll P C M S , 5 7 2 -3 6 6 7 .■
18
PCM S BULLETIN
June, 1999
H ea ltlilin k s.co m - a com p reh en sive
o n lin e lin k for h e a lth p rofession als
H e a ith lin k s .c o m is o n e o f tlie
m o st c o m p re h e n siv e o n lin e d ire c to
ries a v a ila b le sp e c ific a lly d esig n ed
fo r h e a lth c a re p ro fe ssio n a ls.
T h is m e d ic a l re s o u rc e c e n te r
p ro v id e s a w o rld o f in fo rm a tio n a t
y o u r fin g e rtip s.
C a te g o rie s in c lu d e m ed ical
p ro fe ssio n a ls, W e b T V p ro g ra m s,
c o n su m e r re s o u rc e s a n d se a rc h
options.
F o r m ed ical p ro fe ssio n a ls a
p lac e m e n t serv ice, o n -lin e p h a r
m acy , d is c o u n t p ro d u c ts, m ed ical
re s o u rc e s, d is p u te resolution,
m e d ic a l g ra n ts , c o n tin u tin g medical
e d u c a tio n a n d o th e r su ch services
a re a v a ila b le . A lso included is a
m e d ic a l b o o k sto re a n d m arketing
in fo rm atio n .
M e d ic a l p ro fe ssio n a ls can build
a n d m a in ta in th e ir o w n w ebsite by
u sin g tlie H e alth lin k s' M edDirectory
W e b W iz a rd .
W h ile y o u a re v isitin g
H e a ltlilin k s.c o m , b e su re to check
o u t tlie P C M S hom epage,
p c m s @ p c m s .v v a . ■
COLLEGE
----------------- DF ---------------
MEDICAL
EDUCATION
2000 W histler
CME Program
February 2-6
The dates fo r the an n u al ski C M E
program in W histler/B lackcom b
have been set fo r F eb ru ary 2-6,
2000. The dates are one w eek later
than Hie traditional p ro g ram w eek.
N ext year, the C ollege o f M edical
Education has co n tracted so th a t all
physicians can again stay in the
Aspens, also the site fo r the m eet
ings.
A program bro ch u re and m ore
details w ill be av ailab le in S ep tem
ber.
M ark your calendar now !*
ID Update first
Fall C ollege CME
The ninth annual Infectious D is
eases U pdate C M E p ro g ram w ill
start out th e C ollege’s F all sch ed
ule.
The very p o p u lar p ro g ram is
directed by A lan T ice, M D an d
involves Infections L im ited p h y si
cians. It is scheduled fo r F rid ay ,
October 1, 1999 an d w ill be held a t
llie T acom a S heraton H o tel.*
Hawaii CME dates and location set Spring, 1999 on the "Big Island"
W in ter sun,
beachcs, relax atio n ,
fam ily tim e, golf,
tennis, sw im m ing
A N D q u ality
C ateg o ry I C M E !
Join y o u r c o l
leagues an d their
fam ilies n ex t A p ril
on the b eau tifu l
island o f H a w a ii fo r
the C ollege o f M edical E d u c atio n ’s “ reso rt” conference A pril 10-14. 2000.
Like o th er C ollege C M E a t H aw aii p ro g ram s in 1992. 1994. 1996 and 1998.
this y e a r’s “ re so rt” conference will be held on th e b ig island o f H aw aii and
featu re a p o tp o u rri o f educational su b jects o f v alu e to all m edical specialties.
T he elegant H a p u n a B each H otel h as been selected as th e site for the
C M E a t H aw aii p ro g ram fo r a variety o f reasons b u t p artic u la rly fo r o ur
ability to secu re “a w o rld class reso rt” al greatly reduced rates.
U nlike larg e n atio nal C M E m eetings, this p ro g ram n o t only o ffers co n sid er
able savings a n d is cu sto m designed for local p hysicians, b u t allow s Pierce
C ounty p h y sician s a n d th eir fam ilies to m ix aw ay fro m the office and enjoy
one o f the m o st b eautiful sp o ts in the w orld.
A p ro g ram b ro ch u re highlighting th e conference p a rtic u la rs should be
m ailed in July. In addition to outlining th e C M E pro g ram (16 C ateg o ry 1
h o u rs), th e b ro ch u re discusses tran sp o rtatio n and en co u rag es ad v an ce
p lanning fo r th e lim ited flight options durin g the sp rin g v acatio n dem ands in
H aw aii. T he b ro ch u re also d iscusses the savings an d am enities o f the
H apuna.
F o r additio n al in form ation, call the C ollege a t 6 2 7 -7 1 3 7 . ■
C ollege Board to announce 1999-2000
CME program schedule in July
T h e C ollege o f M cdical E d u ca tio n ’s B o ard o f D irectors w ill an nounce its
C M E schedule fo r 1999-2000 a fte r th eir June m eeting. T he courscs are
offered in resp o n se to local physician interest an d arc designed and directed
by local phy sician s. A ll courses o ffer A M A an d A A F P C ateg o ry I C M E
credit.
A c o u rse cale n d ar identifying the co u rse title, dates, b rie f descrip tio n and
c o u rse d irecto rs w ill be m ailed in early July. F or additio n al inform ation on
n ex t y e a r’s offerin g s, p lease call the C ollege a t 6 2 7 -7 1 3 7 .*
June, 1999
PCMS BULLETIN
19
News briefs
M in im iz in g
lia b ility in th e
m e d ic a l se ttin g
P h y s ic ia n s In s u ra n c e E x c h a n g e is
o ffe rin g a th re e -h o u r w o rk sh o p fo r
m e d ic a l o ffic e p erso n n e l o n m in i
m iz in g liab ility . T h e w o rk sh o p w ill
h e lp to p ro te c t y o u r p ra c tic e b y
sh o w in g s t a f f th e c o rre la tio n
b e tw e e n g o o d d o c u m e n ta tio n a n d a
s u c c e s sfu l d efen se, a n d te a c h skills
th a t w ill lim it o r e lim in ate c o n ta c t
w ith p la in tif f atto rn e y s.
T h e p ro g ra m is o ffere d b o th Ju n e
9 a n d Ju n e 10 in T a c o m a a t th e
S h e ra to n H o tel. F o r m o re in fo rm a
tio n call 1 -8 0 0 -9 6 2 -1 3 9 9 .1
20
PCM S
BU LLETIN
June, 1999
O
D
r g a n
O
N
&
A
T
T
is s u e
I
O
N
S h a r e Y o u r L if e .
S h a r e Y o u r Decision.™
For more inform ation on organ and tissue donation
please call LifeCenter N orthw est
toU free, 1-877-275-5269
PCMS Alliance
¥
the P u l s e
P ierce C ounty M edical Society A lliance
Planning m e e tin g
sch ed u led
Please jo in us for a planning
meeting - T uesday, June 8th a t
11:00 a.m . at the hom e o f Y olan d a
Bruce - 4822 105* A ve N W , G ig
Harbor; 265-8190. B row n b ag
lunch - beverages w ill be prov id ed
by tire hostess.
The A lliancc needs an d w ants
your ideas for field trip s and y o u r email address. Y ou m ay send them
to: iebruce@ ,p tin e t.n e t.
Directions from T aco m a
Hwy 16 W est take G ig H arbor City
Center/Kopachuck State Park Exit.
Turn left at light oil Pioneer Way.
Turn right at light on Hunt, Turn
right at 46Ul Ave/Skansie Ave. Turn
left at Rosedale St N W . Turn left at
Raynash D r N W and proceed to stop
sign. Street changes name to
Kopachuck Dr N W . Proceed over
bridge and continue on Kopacliuck
Dr NW. Street changes names to
Artondale at State Park entrance.
Turn right on 105111 Ave N W
(Kopachuk Ridge Estates). It is the
second right after the park entrance.
Blue house with w hite trim in a culde-sac. Do not trim right on 105th
Ave Ct NW . ■
VOLVO
SERVICE & REPAIR
(253) 588-8669
Boyle’s Foreign C ar R epair
7202 Steilacoom B lvd SW
Congratulations 1999 graduates!
C a ris s a B o u rd e a u , d au g h ter o f E m ory and S hirley B o u rd eau will g rad u ate
fro m C h arles W rig h t A cadem y. S he w as selected to a tten d the 1999 N a
tio n al Y o u th L eadership F o ru m on M edicine in S an F ran cisco . She w ill be
attending th e U niversity o f A riz o n a w ith an eye to a care e r in m edicine.
T im o th y C a rg o l: son o f th e late Lai n an d B onnie C arg o l w ill receive his
B .S . in E lectrical E ngineering from M IT . H e w ill continue a t M IT n ex t year
to com plete his M aster's D egree.
P e te r J o h n K e slin g , son o f Pete an d P a tty K esling is g rad u atin g from
S eattle U niversity L aw School.
S te fa n K ric k , so n o f G eorge and P a tric ia K rick is g rad u a tin g from S tadium
H igh School.
D r. E d w ard J. P rzasn y sk i and w ife B a rb a ra h av e tw o g rad u ates this year.
N ik k i P rz a s n y s k i is g rad u atin g from C h arles W rig h t A cadem y and p lan s to
atten d the T isch S chool fo r the P erform ing A rts a t N Y U .
J e r e m y P rz a s n y s k i w ill receive his B .S. in C o m p u ter Science from W e st
ern W ash in g to n U niv ersity in B ellingham .
K e v in T h o m a s , son o f Bill and F ran T hom as is g ra d u atin g from G ig H a rb o r
H igh School. H e w as aw ard ed a sch o larsh ip to L ew is and C lark C ollege in
P o rtlan d , O regon, w here he w ill attend this fall.
R o d n e y Y eh , so n o f H su sh i an d A lice Y ell is g rad u atin g from F oss H igh
School. H e w o n a N atio n a l M e rit S ch o larsh ip an d is a sem i-finalist for
P resid en tial S ch o lars A w ard. H e w ill atten d H a rv a rd n e x t year.
A n n e Z o lta n i, d a u g h ter o f D r. an d M rs. J. G reg Z oltan i is g ra d u a tin g from
B ellarm ine H igh School. She w ill a tten d S eattle U niversity and plan s to m ajor
in In ternational S tudies *
Philanthropic fund applications now
available for non-profit organizations
I f y o u r serv ice an d h ealth related P ierce C o u n ty o rg an izatio n w ould like to be
considered by th e P C M S A llian ce as a recip ien t for p h ilanthropic funding,
you m ay o b ta in an ap p licatio n form by w ritin g to: F r a n T h o m a s, 3224
I lo r s e h e a d B a y D riv e N W , G ig H a r b o r , 9 8 3 3 5 .
P ro o f o f 5 0 1 C (3 ) IR S ratin g is req u ired an d all ap p licatio n s m u st be re
qu ested d irectly fro m M s. T hom as.
A p p licatio n deadline is S ep tem b er 1, 1999.*
June, 1999
PCMS BULLETIN 21
V
News briefs
A M A data: P h ysician in c o m e d ow n
F o r th e se c o n d tim e in fo u r y e a rs,
m e d ia n p h y sic ia n in co m e fell
slig h tly b e tw e e n 1 9 9 6 a n d 1997,
a c c o rd in g to th e m o s t rece n t
e d itio n o f th e A M A 's S o c io e c o
n o m ic M o n ito rin g S y ste m p h y sic ia n
su rv e y .
fa 19 97, llie m o s t re c e n t y e a r fo r
w h ic h c o m p le te d a ta w e re a v a il
a b le , th e m e d ia n n et in co m e fo r a
U .S . p h y s ic ia n w a s $ 1 6 4 ,0 0 0 , d o w n
1 .2 % fro m $ 1 6 6 ,0 0 0 in 1996.
T h e a n n u a l su rv e y p o lls a
re p re se n ta tiv e sa m p le o f a p p ro x i
m a te ly 4 ,0 0 0 d o c to rs. S in ce 1988,
su rv e y d a ta sh o w th a t p h y sic ia n
in co m e, a d ju s te d fo r in fla tio n , h a s
been e ss e n tia lly flat. B e tw een 1993
a n d 1997, m e d ia n n e t in co m e
a d ju s te d fo r in fla tio n fell a t a ra te o f
1 .4 % p e r y e a r.
T h e su rv e y a ls o fo u n d th a t a s o f
la s t y e a r, 6 2 .3 % o f th e n a tio n 's
p h y sic ia n s w e re self-e m p lo y e d ,
w ith 3 6 .1 % id e n tify in g th e m se lv e s
a s em p lo y ees a n d 1 .6 % listin g
th em selv es as in d e p e n d e n t c o n tra c
to rs. P h y sic ia n s w o rk e d a n a v e ra g e
o f 55 h o u rs a w e e k ; se lf-e m p lo y e d
d o c to rs a v e ra g e d 5 7 -h o u r w eek s,
w h ile e m p lo y ed d o c to rs a v e ra g e d
51*
t
AMERICAN LUNG ASSOCIATION*
ofVtojfv/jgion
1-800-LUNG-USA
L u n g Inform ation
S e r v ic e L ine
Providing patient
education materials
Reprintedfrom / IM News, M ay 2 4 /3 1 ,1999
of commission?
As you know , d isab ility in s u ra n c e policies fo r p h y sicia n s are ch a n g in g
rapidly— a n d n ot fo r th e better. H igh c la im s have c a u se d m a n y m ajo r
ca rriers to lim it th e m o st im p o rta n t b enefits.
At P hy sician s In su ra n c e Agency, th e re ’s still tim e to secu re th e specialtyspecific coverag e you need. In ad d itio n , w e c a n h elp you fin d superior life
a n d lo n g -te rm -c a re co verag e fo r you a n d y o u r fam ily.
To discuss th e w ays you c a n best p ro tec t y o u r fu tu re in co m e, call
P hy sicians In s u ra n c e A gency today: ( 206) 343-7150 o r 1-800-962- 1399-
r
PHYSICIANS
■ - INSURANCE
^ AGENCY
A W h o lly O w n e d Su b sid ia ry o f
P h y sic ia n s In su ra n c e E xc h an g e
Sjiit/isorec!bytheWashingtonStateMedicalskwciatioit
(DWSPIA W
22
PCM S BULLETIN
June, 1999
C la s s ifie d A d v e rtis in g
POSITIONS AVAILABLE
OFFICE SPACE
T a c o m a /P ie rc e C o u n ty o u tp a
tient general m edical c a re a t its best.
Full and part-tim e p ositions av ailab le
in T acom a and vicinity. V ery
flexible schedule. W ell su ited fo r
career redefinition fo r G .P ., F .P .,
I.M. C ontact A ndy T soi, M D (2 53)
752-9669 or P au l D oty (A llen,
Nelson, T u rn er & A sso c.), C linic
M anager (253) 3 8 3 -4351.
L a k e w o o d , m e d ic a l sp a c e a v a il
ab le 1 1/01/98. T w o su ites 750
sq u are feet each. O ne suite 2 9 0 0
sq u are feet. M u ltiC a re U rgent C are
leaving sp a ce w h ich h a s been
o ccupied b y a n u rg e n t c are facility
since 1980. B u ilding is a m edicalden tal fac ility n e x t to A lbertsons.
8509 S teilaco o m B lvd. C all D r. K en
R in g a t 5 8 4 -6 2 0 0 o r 58 2 -5 8 5 6 .
W A N TED F U L L -T IM E P E D IA
TRICIAN fo r established p ra c tic e in
a fast grow ing com m unity, so u th o f
Olympia. P lease send resum e to 193
S M arket B lvd., C hehalis, W A .
FAX 360-748-4577. C all 1-88 8-2651585.
N ew office s p a c e a v a ila b le . U p to
4 5 0 0 sq. ft. W ill fin ish to suit. O n
U nion A venue. C lo se to hospitals.
C onvenient p ark in g , g ro u n d level.
C all R o b in a t 75 6-2182.
P E D IA T R IC IA N S : G ro u p
Health Perm anente is cu rrently
seeking tw o full-tim e pediatrician s
for our P ort O rch ard an d E verett
facilities. W e are a p h ysicianmanaged organization recently
affiliated w ith K aiser P erm anente
internationally know n fo r research
and clinical p ro g ram developm ent.
Our facility is located n e a r P uget
Sound w ith m any recreational
opportunities nearby. F o r fu rth er
information, visit o u r w ebsite at
www.ghc.org o r call 800-543 -9 3 2 3 .
Fax CV and cover letter to: (2 06)
448-6191. E qual O pportunity
Employer.
M e d ic a l office s p a c e to s u b
lease. A p p ro x im ately 1,000 sq. ft.,
th ree blocks from T a co m a G eneral.
P riv ate p ark in g an d p riv a te bath.
C all 380-9743.
P u y a llu p O ffice S p a c e F o r
L e a se . 1800 sq. ft., five exam
room s, h earin g booth, lab , p riv ate
p h y sic ia n ’s office, b reak room ,
secu rity an d fully fu rnished, located
on M eridian. P lease call Jess o r
L ouise a t 62 7 -6 7 3 1 .
EQUIPM ENT
F R O M “R E T IR E D ” V A SC U
L A R LA B : U ltraso u n d m achines.
B W , w ith D o p p le r B iosound, A T L
U M -8. V ascu lab , c a rt m ounted
$ 2 ,0 0 0 - $ 1 2 ,5 0 0 . A T L U M -9
“ C o lo r D o p p le r” $ 5 0 ,0 0 0 . P ositional
g u m e y ca rts fo r u ltra so u n d exam s,
tra n sp o rt $ 1 ,2 0 0 . S p ectru m a n a
ly zer $500. O P G $ 2 5 0 . A u toclav e
$1 5 0 . T read m ill $ 2 5 0 . E conoline
v an w ith equipm ent lift $ 2 ,5 0 0 .
(2 5 3 )5 6 4 -8 4 1 2 a
Puget Sound Area, WA: You know how you want to set up your practice.
We can help you do it. Dynamic community-based healthcare organization
seeks BC/BE Family Practitioners. Flexible financial packages and
with year-round recreational opportunities. We are an equal opportunity
98371, (253) 848-6661, Ext. 1865.
PRACTICES AVAILABLE
T iretl o f o ffice/h o sp ital m e d i
cine? E xclusive long-term care
practice available im m ediately. G ood
income potential. C all 4 7 2 -2 0 1 1 .
H -tti
HEALTH CARE NETWORK
w w w .hchnet.org
S E A T T L E - E X C E L L E N T O P P O R TU N ITIE S for BE/BC physicians in the areas of:
F A M IL Y P R A C T IC E a n d P E D IA T R IC S . E njoy practicing in a progressive hospital
netw ork. M inutes from do w n tow n Seattle, the shores of P uget Sound and the C ascade
M ountains. W e offer state-of-the -art resources, equipm ent and expertise to provide
outstanding care fo r y o u r patients. For details, call or w rite us: Gail M umma, Highline
C om m unity H ospital H ealth C are N etw ork, 137 SW 154"’ Street, Seattle, W A 98166.
Phone (206) 619-9069 * Fax (206) 439-3939
e-m ail: pthchrm @ aol.com
June, 1999
________________________
PCMS BULLETIN 23
ment processes m ore than 90 percent of all requests within two
tives are here lo help you in person, by phone, and by letter.
reaction, you can call o u r local claims experts for quick and
dependable advice.
Western W ashington
1-800-962-1399
Eastern W ashington
1-800-962-1398
S T Physicians
^ Insurance
E X C H A N G E
Se.mle, WA©WSPIA199"
Tacom a, W A 98402
24
PCM S BU LLETIN
June, 1999
PRESORTED
STANDARD
US POSTAGE PAID
TACOMA. WA
PERMITN06()5
o M e d w a l'
-
BULLETIN
July, 1999
Dale Overfield, MD (left), President of the College of Medical Education
thanks Gary Taubman, MD for his years of service on the Board of
Directors including his service as president 1996-1998
See story page 15
INSIDE:
3
5
6
9
11
13
17
“C a r e a t th e E n d o f L ife ,” a r e c a p o f tlie J u n e G e n e r a l M e m b e rs h ip M e e tin g
“ T r a u m a i n P i e r c e C o u n t y ,” t o p i c o f S e p t e m b e r G e n e r a l M e m b e r s h i p M e e t i n g
P C M S m e m b e rs c o m p le te S o u n d to N a rro w s r u n
S w if t s u r e s a i l b o a t r a c e a p o p u l a r e v e n t w ith p h y s i c ia n s
A lc o h o l m i s u s e i n P i e r c e C o u n t y
D r. A n d re w S ta ts o n ta lk s a b o u t m e d ic a l s h o r ta g e s a h e a d
C o ll e g e o f M e d i c a l E d u c a t i o n B o a r d s e t s 1 9 9 9 - 2 0 0 0 c o u r s e c a l e n d a r
'v
B
u l l e t in
P C M S O f f ic e r s /T r u s te e s :
L a w re n c e A. L arso n . D O ............................ P re sid en t
C h a rle s M . W e a th e rb y , M D .......... P re sid e n t E le ct
P a tric e N . S tev en so n , M D
S e c re ta ry /T re a su re r
Ja m e s M . W ilso n , Jr., M D ............. P a st P re sid e n t
M ic h a e l J. K elly , M D
J. Ja m e s R o o k s, Jr., M D
S u sa n J. S alo , M D
Y o la n d a B ru c e , P C M S A P re sid en t
J«iy
W S M A R e p r e s e n ta tiv e s :
P ast P re sid e n t: P eter K. M arsh , M D
S p e a k e r o f th e H o u se: R ic h a rd H aw kins, M D
T ru ste e : D a v id E. L aw , M D
A M A D eleg ate: L eo n ard A len ick , M D
1999
E x e c u tiv e D ir e c to r : D o u g la s Jackm an
A g in g , R ic h a rd W altm an ; A ID S , L a w re n c e S chw artz;
B y la w s, S tan ley T u ell; B u d g e t/F in a n c e , P atrice
S tev en so n : C o lle g e o f M e d ic a l E d u c a tio n , W . D ale
O v erfie ld ; C r e d e n tia ls , S usan S alo; E m e rg e n c y
S t a n d a r d s O f P r a c tic e , D av id L u k en s; G r ie v a n c e ,
Ja m e s M . W ilso n ; L e g is la tiv e , W illiam M arsh;
M e d ic a l-L e g a l, P a t D o n ley ; M e m b e r s h ip B e n e fits ,
I n c ., D rew D eu tsch ; P e r s o n a l P ro b le m s O f
P h y s ic ia n s , R o b e rt S an d s; P r o g r a m . M arily n P attison;
P u b lic H e a lth /S c h o o l H e a lth , Jo sep h W earn; S p o r ts
M e d ic in e , Jo h n Jig anti.
T h e B u lle tin is p u b lish e d m o n th ly by PCM S
M e m b e rsh ip B e n efits, Inc. fo r m em b ers o f the P ierce
C o u n ty M ed ical S o ciety. D ead lin es for subm itting
articles an d p lacin g a d v ertisem en ts in T h e B ulletin are
th e 15th o f the m o n th p reced in g pu b licatio n (i.e.
O c to b e r 15 fo r the N o v em b er issue).
T h e B u lle tin is d ed icated to the art. scien ce an d delivery
o f m ed icin e and the b e tterm en t o f the health and
m ed ical w e lfa re o f the co m m u n ity . T h e o p in io n s herein
are those o f the in d iv idual co n trib u to rs and do not
n e c e ssa rily reflec t the o fficial p o sitio n o f th e M edical
S o ciety . A cce p ta n ce o f ad v e rtisin g in n o w ay
c o n stitu te s p ro fessio n al approval o r en d o rse-m en t o f
p ro d u cts o r se rv ices ad v ertised . T h e B ulletin and P ierce
C o u n ty M ed ical S o ciety reserv e the rig h t to reject any
ad v ertisin g .
Table of Contents
3
“C are at th e E n d o f L ife ”
5
“T ra u m a in P ie rc e C o u n ty ”
6
S o u n d to N a rro w s recap
9
S w iftsu re sa ilb o a t race
10 N ew M e m b e rs
1999 W S M A A n n u a l M eetin g
“C a stle o f S a n d ,” b y Jo h n M cD o n o u g h , MD
11 T a co m a -P ie rce C o u n ty H e alth D epartm ent
A le tte r fro m th e d ire c to r
A lcohol m isu se in P ie rc e C ounty
12 W eb sites d e v o te d to h ea lth
13 “T h e In v isib le H a n d ,” C au tio n : Shortages Ahead
E d it o r : D av id S. H o p k in s M D
M a n a g in g E d ito r : D ouglas Jackm an
E d it o r i a l C o m m itte e : D av id S. H o p k in s, (C hair)
S tan ley T u e ll, W . Ben B lac k ett, R ichard H aw k in s
15 C h ild D ea th R e v e w T eam m e ets m onthly
G ary T aubm an, M D h o n o re d fo r service
A d v e r tis in g R e p r e s e n ta tiv e : T a n y a M c C lain
S u b scrip tio n s: $50 p e r y ear, $5 p e r issue
16 C o lleg e o f M e d ic al E d u c atio n
B oard set p ro g ra m c a le n d a r fo r 1999-2000
M ak e all ch e c k s p ay a b le lo: M B I
223 T a c o m a A v en u e S outh, T a co m a W A 984 0 2
2 5 3 -5 7 2 -3 6 6 6 , F A X 2 5 3 -5 7 2 -2 4 7 0
18 P C M S D ire c to ry c h a n g e s
E -m ail ad d ress: pcm sw a<s>pcm sw a.org
H o m e P ag e: h ttp ://w w w .p c m sw a .o rg ____________________
19 C la ssifie d a d v e rtisin g
June General Membership Meeting Review
“Care at th e E n d o f L ife”
Drs. M im i P attiso n and Stu
Farber agree that there is a lot
happening around end-of-life care in
our county and in our country. With an
aging population and a focus on quality
of life, it is an issue that will not soon die
itself.
Dr. Pattison drew the landscape
for what our society and particularly,
Pierce County, has to look forward to
in terms of end of life care. “Tilings
have changed tremendously during
the last century,” she told the crowd at
the June General Membership
meeting. At the turn of the century the
average age of death w'as 46. Today it
is 78. Major causes of death used to be
infection, accidents and childbirth,
while today they are cancer, heart
attacks, stroke and dementia. Disability
- on average four years - has also
entered the picture. “There didn’t used
to be healthcare disability,-’ noted Dr.
Pattison, “but today we fin d w om en
req u iring an a v e ra g e o f five
years an d m en fo u r y e a rs of
care. T he a v e ra g e p e r s o n w ho
lives to life ex p ec ta n c y in th is
country can ex pect n o t to ta k e
care of th em selv es fo r f o u r o r
five y ears b e fo re th e y d ie .”
The reality is that we don’t have a
healthcare system that addresses this
issue. Financing has changed tremen
dously; while it used to be private, and
a very minor, out of pocket expense,
today most of it is public. And, thirty
percent of families who go through a
terminal illness of a loved one end up
financially devastated in some way.
This reality affects families and loved
ones of the 5,000 or so people that die
in Pierce County each year.
What do we know about dying and
what it is like? Dr. Pattison cited a
couple major research studies. One,
conducted by Catholic Health Care,
talked to patients,
families, bereaved
persons and comm u
nity people. They
found that Americans
believe that death is
really a natural part of
life and even people
with a chronic or
terminal illness see
themselves as living
and d o n 't acknowl
edge themselves as
dying. An organized
system for care at the
end of life generally
doesn’t exist unless the
patient has access to
hospice. And, on
average, only a b o u t
17% o f p e o p le w ho
d ie h a v e a c c e ss to
h o s p ic e .
The support
study, looked at patient
preferences and
outcomes regarding
treatment. This Robert
W ood Johnson study
looked at 9,000 patients
in various teaching
institutions. After twoyear baselines they
learned that doctors
believed that they
did n 't need more
information to treat
patients, honor their
directives, treat their
pain, etc. Then they
created a first-class
system o f communica
tion where physicians
got all the information
they needed. But,
see “ Care al the End o f Life "
page 4
Dr. M im i Pattison, left, talks with M elinda Rajacich
(N icholas) a fte r the m eeting
Dr. Slu F arber answ ers questions p o se d by Yasitko
Wada (Suiniho) a fter h is presentation
F rom left, Dr. P hillip Backup, M rs.Yctsuko Wada, D i.
Sum iho W ada and M rs. R uth B ackup enjoyed the
e v e n in g
July, 1999
PCMS BU LLE TIN
3
PAer-rr %ounlif Q-'Uedica/ ifoclettf
Swiftsure sailboat race attracts PC M S m em bers
Drs. Dave M cC ow en and
Chris Jordan once again sailed in
the very popular Swiftsure sailboat
race. The event, which actually has
three separate courses, starts in
Victoria B.C. and rounds Cape Flattery
for 100 nautical miles. Drs. McCowen
and Jordan, both veterans of the race,
did the middle course to Cape Flattery.
Dr. McCowen has sailed the Swiftsure
for 17 years. This was the 13th year for
his39’ Calsailboat, “Mystic.” PCMS
members crewing for him were D rs.
Phil Craven, Jim F ry and H en ry
Retailliau. The Mystic brought home
a 3rd place trophy.
Cardiovascular surgeon Ron
Knight was part of the crew on Chris
Iordan’s 37’ “Kahuna.” The “Kahuna”
took 2nd place in 1997 and was leading
their class this year but had to quit in
order to catch a ferry.
Dr. Jordan has done the Swiftsure
12 times and has always found it an
exciting race. The weather for the
May 29 event was a combination of
great winds and frustrating calm.
Personal Problems
of Physicians
Medical problems,
drugs, alcohol, retire
ment, emotional, or
other such difficulties?
Your colleagues want to help
*Robert Sands, Chair 752-6056
BiUDean
272-4013
F. Dennis Waldron 265-2584
ONE
to
P HYS I CAL
T H6 RBP V
ONE
(253) 396-9001
D e b o ra h K ris to v ic h , form er R ehabilitation D irector
for Franciscan H ealth S y stem ’s Elder Care, has opened
O n e -to -O n e P h y sic a l T h e ra p y .
Deborah Kristovich
MPT, ATC
•
O r t h o p e d i c R e h a b ilita tio n
•
G a it & M o b ility Tra in in g
•
B a la n ce a n d S a fe ty R e tra in in g
•
S p o rt & A c tiv ity A s se ssm e n t
C o n fid e n tia lity
A ssu red
z
2 3 1 2 N o r t h 3 0 th S t r e e t , S u i t e 101 ( I n O l d T o w n T a c o m a a c ro s s th e stre e t f r o m G r a z i e ’ s )
July, 1999
PCMS BU LLE TIN
9
B u l l e t in
“ Care at the E n d o f L ife ”
w hen they began to m easure out
com es, absolutely nothing changed.
F rom patient and family reports, 50% of
patients h ad experienced severe or
m oderate pain m ost o f the time.
“W e know an incredible am ount
about pain m anagem ent today in terms
o f physiology and pharm acology, but
yet there is a real disconnect betw een
w hat we know and w hat we do," noted
Dr. Pattison. In term s o f honoring
patient’s w ishes in decision making,
75% o f patients an dfam ilies had said
that after two w eeks o f serious illness in
the hospital, no physician had ever
discussed code status or CPR with
them.
T he inform ation gleaned from
these m ajor studies shows that there is
real need in four specific areas: pain
and sym ptom m anagem ent, advance
directives, patient and fam ily support,
continuity and transfers. And, there is
trem endous m ovem ent across the U.S.
from m ajor organizations in medicine,
both A M A and A CP, to begin to
address these issues. T here are also
m any private foundations that are
conducting research and program s.
“W hen w e talk about im proving
end o f life care, we m ake one m ajor
assum ption and that is that w e have
identified w ho is at the end o f life,” said
Dr. Pattison. “W hen we think about
dying patients, one o f the biggest
challenges for physicians is to deter
m ine w ho is dying.” And, she admitted,
it is difficult to determ ine w ho is dying.
V arious diseases and illnesses have
predictable courses, yet others have
gradual declines with episodic illness
that can m ean im m ediate death. These
types are m ost difficult to predict and
w ill rem ain a challenge.
Studies have show n that most
people w ill die o f a chronic illness that
is know n to be fatal. They will die
w ithin a few day or w eeks o f having
been relatively stable. T hey w ill die
having quite an uncertain prognosis.
A nd, in short, m ost people will die
4
PCMS B U L L E T IN
July, 1999
w ithout an active dying process.
People d o n ’t diink o f heart disease
as a term inal illness, yet it is the m ost
com m on cause o f death in o ur country.
Dr. Pattison shared a slide o f an
algorithm on how to treat heart failure
produced by the A m erican H eart
A ssociation. O ptions included m edical
launched by C om passion in Dying, an
organization that challenged the
constitutionality o f the laws against
physician assisted suicide in the state of
W ashington. They form ed a coalition,
now called the W ashington State End
o f Life Coalition, an active group with
broad com m unity representation.
“W e k n o w an in c re d ib le a m o u n t a b o u t p a in m an a g em en t today in
term s o f p h y io lo g y an d p h a rm a c o lo g y , b u t y e t th ere is a real
d isc o n n e c t b e tw e e n w h a t w e k n o w an d w h at w e d o .”
m anagem ent, various drugs,
revascularization, heart transplant, etc.;
but you could not die! N ot allowed.
Dr. Pattison explained a project at
her prim ary care clinic that she has
w orked on w hich identifies patients in
the last year o f life, offers advance
care planning, increased clinic contact,
and referrals to support services in the
com m unity. O utcom es have included
increased physician aw areness and
patient and physician satisfaction,
increased com m unity resource use,
decreased hospitalization and em er
gency room use, and increased
referrals to hospice. The length o f
service that hospice provides has
increased dram atically - to over 70
days. A n added benefit for patients is
that the decrease in hospitalization and
em ergency room visits has served to
facilitate people dying at home.
C ost data has shown that it does
increase costs at the end o f life, but the
program does im prove quality o f care
and it can be easily replicated at other
medical facilities, said Dr. Pattison.
Dr. Farber spoke to the group
about w hat’s happening at the local
com m unity level. PC M S and the
W SM A have both been involved in
end o f life care issues. Dr. Farber
served on the E nd o f Life task force,
form ed in 1997. The group w as form ed
in response to the Suprem e C ourt case
W hile initiated by WSMA, it has
developed as an independent body
and Dr. F arber serves on the steering
com m ittee. In addition to many health
care participants, also included is the
A CLU , A ARP, government officials,
senators, as well as two groups,
C om passionate Choices and Compas
sion in Dying. One advocates for
physician assisted suicide, while one
w orks to prevent the need for it.
“O ne o f the fruits of the coalition is
that these diverse groups came
together and agreed upon one ideal,
that all fam ilies and patients at the end
o f life deserve good care,” noted Dr.
Farber. The coalition will also be
sponsoring a series o f community
forum s across the state for the public
addressing end o f life care.
In Pierce County, Dr. Farber
chairs the H ospice Task Force, which
brings together the major hospice
organizations to discuss needs in
Pierce County. Originally, the task
force m et to consider the feasibility of a
free-standing, inpatient hospice in
Pierce County. The group has
determ ined that they need to ask the
com m unity fo r input. “They will be
w orking in the com ing year with
physicians and patients and families and
asking w hat we should be doing in the
area o f end o f life care,” said Dr.
F arber.
in v ite s y o u a n d y o u r s p o u s e /g u e s t t o th e
September General Membership Meeting
Tuesday, S e p te m b e r 14, 1 9 9 9
L a n d m a r k C o n v e n t io n C e n t e r
Social Hour:
Dinner:
Program:
T em ple Theatre, Roof G a rd e n
47 St. Helens A v e n u e
Tacom a
6 :0 0 p m
6 :4 5 p m
7:45 p m
Trauma
System
Update
(Registration required by Septem ber 10. Return this form to: PCMS, 223 Tacoma Ave S, Tacom a 98402; FAX to 572-2470 or call 572-3667)
Please reserve________ dinner(s) a t $20 p e r person (tax a n d tip in clu d e d )
□
Visa
□
Master C a rd
or my credit card # is______________
Signature
I will be bringing m y spouse or a guest. N am e for n a m e t a g : __________
Signed:_______________________________________________________
Thank you!
July, 1999
PCMS B U LLE TIN
5
B
u l l e t in
Sound to Narrows
. . . c l fun run
Tom Herron, MD, placed 7th in his age
division and was the 59th finisher
F or another year, D rs. John Jiganti, Tom H erron and Ron Taylor
finished in the top 200 o f the 4,163 runners that finished the 12K course
o f the 1999 Sound to N arrow s run. Dr. Jiganti finished 9th in his age
division and 54rd in the run w ith a time o f 46:45. Dr. Herron finished 7th
in his age division and 59th overall w ith a tim e o f 47:01. Dr. Taylor
finished 2nd in his age division with a tim e o f 50:08 m aking him the
145th finisher to cross the line.
O ther PCMS finishers:
Cordell Balm , M D w ho ran the event for the 27th consecutive year,
as long as it has been held and Bruce Baker, DO, both finishing at one
hour 26 minutes.
Drs. Loren Betteridge, ran a terrific 58:50, Tom Charbonnel
finished al 1:08. R obert C orliss, Sum ner internist, and M ark Craddock,
Gig H arbor fam ily practitioner bolh finished strong. Steve Elder, MD
finished in just 54:16 and Jim Furstoss, M D in 1:03.
Cordell Bahn, MD, has run in every Sound to Narrows
making this his 27th consecutive year at the event
Jack Tomow, MD, (right) PCMS applicant and medical
director fo r TriCare, hoping to soon see the finish line
John Lenihan, MD, ran an excellent 58:38, just 33 seconds
slower than last year
Ken Graham, MD, retired fam ily practitioner, feeling good
lm ! giad to be finished
6
July, 1999
/
R FR EE Training
Help y o u r p a tie n ts
and d o u b le y o u r d in t
11
L[0
jd ) j
This effective clinical intervention is based on
a tuuo-year evaluation of 3000 peer-revieuued
studies that addressed the assessment and
treatment of tobacco dependence, nicotine,
addiction and clinical practice. Seventy
percent of smokers see a physician each
year, fl physician's or other health care
provider’s advice to quit is a pouuerful
motivator.
The free training is conducted for you and your staff at your convenience
by a National Cancer Institute trainer. You mill learn houu to implement the
M-fl model, a clinic-based tobacco intervention program that takes little
time and has proven to be successful for you and your smoking patients.
Training objectives:
Techniques to help patients quit tobacco
Effective pharmacotherapy
Create a systematic clinical approach
©
*
T A C O M A -P 1 E R C E C O U N T Y
. ) HEALTH DEPARTMENT
CMEand CEUoffered
For information about this training nil
i $ ml 4 m
2ftrrce
Sforietij
Sound to Narrows
...a PCMS recap
Pediatrician Martin Goldsmith, M D, finished in 58:27 and
John Goodin, MD, Tacoma ophthalmologist completed the course
in one hour, 15 minutes.
Drs. Ken Graham, retired family physician, Jack Hill,
cardiologist and Patrick Hogan, neurologist. Charles Hubbell,
MD, Tacoma dermatologist finishing in one hour, 10 minutes. Peter
Krumins, MD and John Lenihan, MD both had excellent runs,
finishing at 57:33 and 58:38 respectively, as did Drs. Tim Lang,
Carlos M oravek, Todd N elso n , and A k sel N o rd estg a a rd ,
with finishing times of 1:07,1:01,1:04 and 57:33.
Tacoma general surgeon Jim Rifenbery, MD ran a 1:18,
Craig Rone MD, finished in just 57:13 and Jim Rooks, MD, 1:12.
Others were James Schopp, MD, Tacoma pulmonologist with a
time of 1:00, Darryl Tan, MD, Lakewood pediatrician 1:08, Jack
Tornow, MD, PCMS applicant and Hsushi Yeh, M D , 1:18.
John Jiganti. M D. ran an excellent
46:45, finishing in 54th place
Hsushi Yeh, MD, Tacoma ophthalm ologist com pleted the 12K
run while his wife ran the 5 K
Jim R ifenbery, M D, Tacom a general surgeon, glad to he at
the fin ish line
little slower than his last y e a r ’s time o f 58:17
thg event f o r a „olher yea r
B
u l l e t in
Sound to
Narrows...
family finishers
T w o top w om en finishers were
w ives o f PC M S m em bers. Lisbet
N ordestgaard (A ksel) finished the run in
L:01 and was 145th in the top 200 women
w hile M ary C rabb (Bill) finished 13
seconds later and was the 151 st woman
across the line.
O ther finishers included M ary
B aker (Bruce), Jinny Craddock (M ark).
H ilda E lder (Stephen), Jennifer Fulcher
(daughter o f Jim ), K im berly N elson
(Todd). Jenifer R ifenbery (Jim), Kathy
Sam m s (John), Jennifer Tobin (Rick),
and Sue W ulfestieg (Carl).
C ongratulations, runners.
Ron Taylor, MD looks strong as he
nears the finish line. He placed 2nd in
his age division, running a 50:08
Craig Rone, MD, ran an excellent
57:13 shaving 5 seconds off last year’s
time
Aksel Nordestgaard. MD ran an
excellent 57:13, finishing ahead o f his
wife, who's time was 1:01:22
Jack Hill, MD, happy at the finish line
after an excellent run
■V
*..• ■
i
■■.ill
Pat Hogan, DO, Tacoma neurologist,
finished in 1:00:04, bettering his 1997
time o f1:01:00
I f PCMS staff missed vour name or your spouse's name in compiling the results, we
apologize, but please let us know and it will be printed in the August issue.
B
u l l e t in
Physicians and patients taking control
1999 Annual WSMA House of Delegates meeting
T his y e a r’s A nnual M eeting is ju st around the com er. W SM A m em bers will
gather to set policy, exchange ideas and deliberate issues affecting the practice o f
m edicine and the profession Septem ber 30 through O ctober 2 at C avanaugh’s Inn at
the P ark in Spokane.
A ny m em ber of the H ouse o f D elegates may subm it a resolution. Proposed
resolutions m ust be received by Shannon Bell by A ugust SO01 or (July 30,h to be
printed in the D elegate H andbook). H er fax is 206-441-5863 and her em ail is
slb@ w sm a.org. If you are not a delegate but have a resolution y o u ’d like to propose,
contact PC M S, 572-3667 about having a delegate subm it your resolution.
C astle o f Sand
The boy upon the beach w ith scoop and hand,
did toil to make a city out o f sand.
From central parapet and scarp there rose,
a castle, mighty tow ers thrusting o ’er,
A fortress built to last foreverm ore.
B oy grew to youth and youth to man in time,
A nd tools changed while in the sandy grime.
Letters, num bers, science and the call,
To engineering, m edicine, the law,
O r business, clergy, or the public trough.
M oney, pow er, prideful selfish way.
Slow ly entered, and when in did stay.
A nd vice with its entrancing open maw,
With golden threads drew into unseen mesh,
Its victim s, circled, caught w ith no regress.
The sun reached apogee then started west,
As city shadows bode the coming test.
Sea breezes up, became a raging gale,
A nd restless w ave that swept the briny shore,
Left castle o f sand, once proud, astand no more.
The boy with trem bling and dismay did cry,
Father, M other, why are things awry.
Then a sound, clear, sweet, w ithout delay
Said: D earest child my voice at your behest.
Is muted till you com e with a request.
For answ er only truth will turn the key,
To free your soul from its chained misery.
Search deep with hum ble heart the depths inside.
T om orrow at the beach another day.
Finds the boy with pail and scoop at play.
John R. M cD onough, M D
10
PCMS B U L L E T IN
July, 1999
N ew Members
B e n a v e n te , M a r is s a , M D
F a m ily P ra c tice
Practices at U niversity Place Clinic;
4620 B ridgeport W ay W , Tacoma
98466; Phone: 564-0170
M edical School: U niversity of Illinois
Internship: R iverside Regional
M edical C enter
Residency: Riverside Regional
M edical C enter
Fellow ship: Eastern Virginia Medical
School
C a v a n a g h , M ich a el K ., PAC
Practices at 1802 S Yakima, #102,
Tacom a 98405; Phone: 272-7777
M edical School: Creighton University
Internship: U.S. Army Physician
A ssistant School
H a r r o u n , D o u g la s V ., M D
I n te r n a l M e d ic in e
Practices at N orth H ill Family
M edicine; 2748 Milton Way #102;
M ilton 98354; Phone:927-9772
M edical School: W ayne State Medical
School
Internship: U niversity o f Texas
R esidency. U niversity of Texas
M c A lliste r , D eb ra L ., M D
O b /G y n
Practices at 1408 3rd Street SE, #200,
Puyallup 98372; Phone: 848-2683
M edical School: St. Louis University
School o f M edicine
Internship: Southw estern Medical
School
R esidency: Southw estern Medical
School
S m e lse r, L y n n M ., PAC
P e d ia tr ic s
Practices at E vergreen C hildren’s
Clinic; 1910 M eridian Street S, #A,
Puyallup 98371; Phone: 848-2303
M edical School: Alderson-Broaddus
C o lleg e
Lî'etce 'ilomit)/ Q/iltdica/ (jfocidy
The Health Status of Pierce County
A letter from th e director o f health
TA C O M A -P IE R C E C O U N T Y
HEALTH
D E P A R T M E N T
As physicians, we are all aware of
the toll tobacco use has on the health
and quality o f life of our patients. I
would like to encourage you to con
sider taking advantage of a free clinicbased tobacco cessation training avail-
Alcohol m isuse in P ierce C ounty
Alcohol misuse is associated with
significant morbidity and mortality in
Pierce County and Washington state.
> We estimate that alcohol mis
use is associated with 275 deaths;
23,400 hospitalization days; and almost
50,000 outpatient visits every year in
Pierce County.
> From 1992-1996, an average
of over 100 youth under age 21 were
killed or injured in motor vehicle colli
sions per year in Pierce County.
>In a 1995 survey, one in four
men in Pierce County reported binge
drinking (consumption of five or more
drinks at any one time, two or more
times per month). There is a strong as
sociation between driving under the in
fluence and binge drinking.
►
In a 1998 survey of Pierce
County students; 48% of 12u’ graders
reported having used alcohol within the
last 30 days; 29% of 12lh graders re
ported at least one episode of having
five or more drinks in a row within the
last two weeks.
>•
In 1996, 46.5% of all traffic
fatalities in Washington State involved
drinking drivers; the economic loss
from drinking driver collisions was
$448.5 million.
► The prevalence of drinking
and driving increases substantially
among youth and young adults. A lco
hol use among youth is associated with
other unhealthy and risky behaviors,
such as unprotected sex, acquaintance
rape, and violence.
In 1998, school survey data indi
cated that 56% of Pierce County 12"'
graders surveyed said it would be very
easy for them to obtain beer, wine or
hard liquor. In November and Decem
ber, the Washington State Liquor Con
trol Board conducted compliance
checks of 176 grocery and convenience
stores in Pierce County to check for
sales of alcohol to minors. Nineteen
percent o f the stores checked failed to
check identification of youth attempt
ing to purchase alcohol. The Health
Departm ent’s “Keep Teens Alive” m e
dia campaign addressed adults who
would sell liquor to, or buy it for, un
derage persons.
The reduction of alcohol misuse
by 20% is one of the prevention priori
ties o f the Tacoma-Pierce County
Health Department. Reaching that goal
will translate into approximately 55
fewer deaths due to alcohol each year
in the county as well as fewer alcoholrelated hospitalizations and outpatient
visits. Health Departm ent prevention
specialists are now developing a cam
paign against binge drinking which will
target young adults, to be launched in
the fall o f 1999. For more information
about the plan, call John Britt at 7982881. For more information (about
health data), call Rick MacComack,
Ph.D. at 798-4788.
able to you and your staff from the
Tacoma-Pierce County Health Depart
ment. The training is tailored to your
needs, and the basics can be taught in
as little time as an hour in your office
setting.
W e all want to help our patients
with the number one preventable
cause of death - tobacco use. The Na
tional Cancer Institute and the Agency
for Health Care Policy have devel
oped an effective clinic-based smoking
cessation model. Research has refined
that model based on analysis of 3000
cessation research articles. The result
ing Smoking Cessation Clinical Practice
Guidelines (the 4-A model) are easy to
learn, fast to use, and effective. Imple
menting the briefest version of the
model takes no more than three to five
minutes and can result in doubling the
cessation rates for your patient popula
tion.
During the training, you and your
staff will learn a systematic process to
use with your patients and you will
learn simple and effective motivational
interviewing techniques that help your
patients move forward through the
quitting process. The model can be
readily incorporated into your current
patient education system so that every
member of your team is able to assist
patients with their quitting process.
W hile physician advice has the most
dramatic impact on patients’ behavior,
the model can also be effectively used
by non-physician members of the team.
The Board of Health has set the
goal of reducing tobacco use in the
county by 40% over the next ten
years. I hope that you will take advan
tage of the free training we offer and
play an important role in reaching that
goal.
Sincerely,
F ed erico C ru z-U rib e, MD
July. 1999
PCMS BU LLE TIN
II
B u l l e t in
Todays cybercraze is any website devoted to health or
maladies- check o u twww.doctorsmedicinesdiseasesgalore.com
by Anne Carrns
Reprinted from the Wall Street
Journal, 6/10/99
In the next big land rush on the
Internet, the target m arket is a juicy
one: cyberchondriacs. Fam ous medical
centers, unknow n online startups and
big m edia com panies are all jockeying
to create W eb sites w here consum ers
can find out about their health.
D rkoop.com Lie. raised $84.4
million in an initial public offering,
m aking its cofounder, form er U.S.
surgeon general C. Everett K oop. a
w ealthy W eb m ogul at the age o f 82.
On the sam e day. R upert M urdoch’s
N ew s Corp. em pire said it had made a
“significant investm ent” in
PlanetR x.com , an online pharm acy and
health-inform ation service. Silicon
Valley entrepreneur Jim Clark, who
founded Silicon G raphics and
N etscape, is trying for his third hom e
run with H ealtheon Corp., now about
to m erge w ith W ebM D Inc.
R o u g h ly 23.3 m illio n a d u lts,
o r n e a rly 4 0 % o f A m e ric a n a d u lts
o n lin e , u s e d th e I n t e r n e t to se e k
h e a lth r e la te d in f o rm a tio n in
1998, says New Y ork research firm
C yber D ialogue Inc. They surf the
W eb voraciously seeking inform ation
about diseases, treatm ents and drugs,
and chat with others who suffer from
similar maladies.
Art D oherty, a 58-year-old
retired engineer form Lom poc, Calif.,
contracted Lym e disease a few years
ago and now spends eight hours a day
searching the Internet for inform ation
about the illness. “I ’m pasty w hite,” says
Mr. D oherty, joking about spending his
days indoors at the com puter.
Brenda M cK aig, a 36-year-old
Pickering, O ntario, woman w ho
struggles with chronic sinus infections
and asthm a, says she spends about two
hours daily hunting for inform ation,
w hich she then discusses with her
doctor. “I really use the Internet to feel
I ’m not alone,” she says. “T h ere’s
hundreds o f other people suffering
from the sam e condition.”
A s th e y m u ltip ly lik e v i
r u s e s , th e n e w W e b v e n tu r e s a r e
ra c in g to s e r v e u p a ll th e s e
p a tie n ts to d r u g m a r k e te r s . L a s t
y e a r , d r u g c o m p a n ie s s p e n t $ 1 .5
b illio n a d v e r t is i n g p r e s c r i p t i o n
d r u g s d ir e c tly to U .S . c o n s u m e rs .
M ost o f that was for print and TV, with
less than J % going to online advertis
ing.
Everyone expects m ergers and
flam eouts to reduce the field to a few
players with pow erful brands. H e re 's a
field guide to som e o f the aspirants:
M ed scap e.co m : A serious
medical site. It offers original, peerreview ed reports as well as journal
articles organized by m edical specialty.
D espite its w eighty m aterial,
m ore o f its one m illion registered users
say they are consum ers (350,000) than
doctors (180,000). (Mr. Doherty, the
Lym e disease sufferer, is a frequent
user.) A dedicated consum er site is in
the works, as is an initial public offer
ing. Its editor is George Lundberg,
iconoclastic form er editor o f the
Journal o f the A m erican Medical
Association.
W eb m d .c o m : The pending
m erger o f privately held W ebM D with
publicly traded m edical-transaction
com pany H ealtheon, together with big
investm ents from M icrosoft and
D upont, is giving w ebm d.com a head
start in establishing itself as a brand
name.
Begun as a subscription service
for doctors, W ebM D is also beefing up
its free consum er site, w hich offers
health news and inform ation, a physi
cian directory and condition-specific
“com m unities,” or support groups.
Jeffrey A rnold, the com pany’s chief
executive, has cut m arketing and
distribution deals w ith outlets such as
T im e W arn er’s CNN , Lycos and
M icro so ft’s W ebT V Networks.
D rk o o p .c o m : W ith Dr. Koop
h im self as chairm an and spokesman,
the site claims six million individuals
visits since its launch nearly a year ago.
It offers m ore than 120 chat groups, as
w ell as advice from physician Nancy
Snyderm an, a popular radio and
television personality.
Plans call for drkoop.com to add
a personal m edical-record feature that
will invite consum ers to keep track of
their health history and expenses
w ithin a secure portion of the Web site.
A h n .co m : The site specializes
in “W ebcasting” m edical procedures,
such as angioplasty, so patients can see
the surgeries th ey 're about to undergo.
First to bring a live birth to your
com puter screen via the Internet,
alm .com w ill relaunch in July as
thehealthnetw ork.com , a joint venture
o f Fox Liberty Ventures and AHN Ltd.
P artners, featuring expanded offerings
and more coordination with its affiliated
cable-television station.
M ed ico n su lt.co m : Focusing
on patients with chronic ailments, the
publicly traded venture offers informa
tion on 60 com m on conditions. Roughly
85% o f its visitors are women. Consum
ers may pose questions to big-name
doctors for a $ 195 fee.
In te lih e a lth .c o m : The site is
the product o f a closely held, for-profit
jo in t venture betw een medical heavy
w eight Johns H opkins University
H ospital and Health System and Aetna
In c .’s A etna U.S. Healthcare unit.
Intelihealth.com offers whimsical
features such as a virtual picnic,
com plete w ith anim ated ants, where
See "craze"page 16
?ft(£¥-<x- 'fpountif '”=itedivo/
Tfo(Z I n v i s i b l e H & T lc l. . *
by Andrew Statson, MD
Caution: Shortages A head
The above sign has appeared
periodically over the year's. W hen the
unit is full we have transferred patients
to other hospitals. At times we also have
received patients from other hospitals
because they did not have beds
available. This shuffling of patients
around takes
advantage of
the redun
dancy in the
system. It is
an inconve
nience for
them, but it is
not critical.
Our B ritish
and C ana
dian
colleag u es
A n d rew N.
Statson, M D
have to
schedule their electives up to two
years into the future. We are nowhere
near that.
Unfortunately, things are going
to get worse, not better. The Tribune
recently ran a story on the plight of the
teaching hospitals. They are cutting
down on staff and beds. Their teaching
and research programs are under
funded. The closure of wards, and
perhaps even entire hospitals is a
possibility.
My first experience with medical
shortages in this country was at
Cleveland State Hospital. My resi
dency included a six month rotation
through the medical-surgical ward.
During three of those months, by the
25*, the pharmacist would call to tell us
we had spent our budget for antibiotics
and the only one he had available until
the first of next month was penicillin G.
In its war on drugs, the Nixon
administration convinced the Turkish
farmers (paid them enough) to plow
under their poppy plantations. The
“N1CU closed.”
A sign in our L & D suite
result was a temporary shortage of
morphine and codeine. More recently
our pharmacists stopped making the
Tacoma General house cream for
hemorrhoids. They couldn’t get the
ingredient with anesthetic and vaso
constrictive properties, cocaine.
There is a current shortage of
injectable droperidol and phenobarbital. According to the official explana
tion the manufacturers cannot get some
basic ingredients to make them. The
real reason is more likely to be that
they cannot make them at a profit.
When these products eventually do
come back to market, I suspect it will be
at a higher price.
The past few years we have had
rashes and other reactions was of the
order of 20%. Many people were
labeled then as allergic to penicillin.
However, when the pharmaceutical
companies improved their purification
process, the drug reactions almost
disappeared. Today, even in its
injectable form, ampicillin very rarely
produces a reaction. The problems we
observed in the past must have been
due to the impurities in the preparation,
not to the ding.
Drug manufacturing is an
exacting process. Purity is important,
especially for injectables. Absorbability
is important, especially for tablets. The
tablets need to be compressed well
enough so they don’t crumble, but not
so much that they don't dissolve in the
intestinal tract.
The price squeeze we experi
enced was also applied on the drug
companies, mostly on the manufactur
“A s in a n y o th e r p r ic e sq u eeze, th e fir s t to g o d o w n is
q u a lity th e n ex t is a v a ila b ility T he big p u rc h a se rs o f
d ru g s: th e in su ra n c e p la n s, h o sp ita ls , b ig d ru g store
chains, h a v e g o n e to th e lo w est b id d ers. A j a result, the
m a n u fa c tu re rs h a ve b een fo r c e d to c u t co rn ers. ”
a series of letters from the pharmacists,
reporting temporary shortages of a
variety of injectable drugs. I don’t
rem ember this happening with any
regularity in the past. It is a recent
development. Sometimes the shortages
may be due to the FDA, which has
required a change in the manufactur
ing process. In any event, however,
the price of the preparation will
probably need to rise, or it will not
become available at all.
During the first few years after
ampicillin came out the incidence of
ers of gencrics. Even though recently
they have been able to raise prices and
have shown some good profits, they
have had to reduce their costs too. As
in any other price squeeze, the lirst to
go down is quality, the next is availabil
ity. The big purchasers of drugs: the
insurance plans, hospitals, big drug
store chains, have gone to the lowest
bidders. As a result, the manufacturers
have been forced to cut corners.
My observations have no
scientific validity, it may be my para
noia. but 1 sense a recent trend that
See "shortages"page 14
July, 1999
PCMS BU LLE TIN
13
B u l l e t in
“ Shortages”
w orries me. It seem s there is an
increase in drug reactions, which may
or m ay not be allergic. The last few
patients I treated w ith cefazolin did not
d efervesce as expected, even though
the cultures show ed sensitive organ
ism s. Instead, the patients m aintained a
tem perature o f around 99 until the drug
w as stopped. T heir neutrophil and
lym phocyte counts were norm al, but
the eosinophils w ere up. C ould that
have been a reaction to an im purity?
C om pared to past experience
there is a decrease in the response to
som e drugs, alm ost as if the patients
w ere not taking the m edication, or
perhaps not absorbing it well. One of
my patients put it to me very bluntly:
‘"These generic pills are like taking a
placebo! They have absolutely no
effect!” She had been on a brand name
estrogen and her insurance company
had instructed the pharm acist to give
her a generic substitute. She requested
to go back on the brand name drag
even if she had to pay m ore to get it.
The price squeeze extends to
other products and services we use.
The supplies we use, such as gloves,
sutures, adhesive tape, dressings, etc.,
are of low er qualify. Laboratory
services have kept up reasonably well,
probably due to the introduction of
better technology, but the pressure to
cut costs is there. The problem s with
the reading o f Pap smears, the reduc
tion in the num ber o f cuts on pathology
specim ens, the low er quality of
reagents, the increased workload on
the staff, all com bine to produce an
environm ent where m istakes will be
m ade, and on a large scale. Perhaps
these problem s always existed, but in
the past w e had no-one else to blame.
One long term consequence o f
this squeeze is that pharm aceutical and
m edical supply com panies will have to
cut their expenses. U nless they can be
sure they will be able to recover their
costs, the first thing they will have to cut
is their research and developm ent
14
July, 1999
program s. T hey m ay continue those
they are currently operating, p articu
larly if close to com pletion, but they will
be very reluctant to em bark on new
research if they cannot be sure it will
be profitable.
There is no excuse o f p rofli
gacy. W e cannot justify using the m ost
expensive equipm ent and supplies
when cheaper products can do a good
job. H owever, cost effectiveness
im plies an equal stress on both cost and
effectiveness. W hen the stress is on
cost, usually because the people who
purchase the products are not the ones
who use them, the quality is so poor,
that the products are not effective. The
result is a higher level o f waste and
inefficiency, which ultim ately raises
costs. This is m isguided econom y.
One exam ple was the position of
m anaged care plans to require the use
o f ch eaper drugs fo r a specific prob
lem , even though the m ore expensive
ones m ay reduce the rate o f side
effects, com plications, office visits and
hospital adm issions. It took them a while
to accept that the SSR I are much better
than the tricyclics, for instance.
W hen we, as individual physi
cians, treating individual patients, select
a treatm ent, we can and do make
m istakes. W e do n o t always choose the
best, or the least expensive treatment.
U sually, how ever, our choices work
reasonably well, at a reasonable cost.
W hen the selection is made centrally
and applied equally to all patients, the
m istakes are still m ade, but on a much
larger scale. I shall end with the well
know n saying: “To err is human, but to
really foul things up you need a
com puter.”
H -4 4
HEALTH CARE NETWORK
w w w .h c h n e t.o ra
S E A T T L E , W A - E X C E L L E N T O P P O R T U N IT IE S fo r B E /B C F A M ILY P R AC TITIO N ER S.
E njoy pra cticin g in a p ro g re s s iv e ho sp ita l se ttin g w ith an e xte n sive ne tw ork o f health care
pro v id e rs and sp e c ia lists th ro u g h o u t S W K ing C oun ty. M in u te s fro m do w n tow n Seattle, the
sho res o f P u g e t S oun d and th e C a sca d e M o u n ta in s. W e o ffe r s ta te -o f-th e -a rt resources,
e q u ip m e n t and e xp e rtise to pro vid e o u tsta n d in g care fo r y o u r pa tients. C om petitive
pa ckage. F o r d e tails, call o r w rite us: G ail M u m m a , H ig h lin e C om m u n ity Hospital
H ealth C are N etw ork, 137 S W 154"' S tre e t, S e a ttle , W A 98166.
Phone (206) 619-9069 • Fax (206) 439-3939
______________________________ e-m ail: H M E G A IL @ a o l.c o m
T A C O M A /P IE R C E CO UN TY
O u tp a tie n t G eneral M edical Care.
Full an d part-tim e positions
available in T acom a and vicinity.
Very flexible schedule. Well suited
for career redefinition for
GP, FP, IM .
C o n tact Andy Tsoi, M D (253) 752-9669
or Paul D oty (Allen, N elson, T u rn er &
A ssoc.), Clinic M anager (253) 383-4351
________
M E D I C A L W R IT IN G
S E R V IC E S
T ra n sc rip tio n Specialists
- Prom pt, professional service
- Free daily pick-up and delivery
- T em porary and overflow work
gladly accepted
- O utstanding references
253-208-8072
Linda R obson, PhD - Owner
JPierce Comity Q'/'ledatl Society
Pierce County “Child
Death Review Team”
meets m onthly
College of Medical
Education thanks Gary
Taubman, MD
From 1995 to 1997, the W ashington legislature enacted
several bills to develop a statewide system to review child
hood deaths. Under the legislation, local teams were devel
oped to review deaths occurring in the county for the
purpose of identifying preventable strategies. In December
1998, the Pierce County Child Death Review Team
(PCCDRT) was formed pursuant to that legislation. Hosted by
the Tacoma-Pierce County Health Department, members of
the PCCDRT come from a variety of public and private
agencies and include physicians, nurses, CPS staff, law
enforcement detectives and prosecuting attorneys.
On average, 160 infants and children die annually in
Pierce County. Approximately 40 o f those deaths are due to
traumatic event (homicide, suicide or unintentional injury) and
another 15 are classified as SIDS. All of the injury and SIDS
deaths undergo a complete review. To date, 12 deaths have
been reviewed by the PCCDRT and prevention strategies
identified.
The reviews are not to place blame on any party.
Rather, the purpose is to identify factors which, if addressed
through system changes, would likely have prevented that
death or similar deaths. A subcommittee also screens the
medical or natural deaths for deaths that could have been
prevented through changes in the systems available in the
county. The reviews consist of abstracting information from
appropriate records including medical, CPS and law enforce
ment.
The team meets monthly to review the cases. At the end
of each year, the team will publish a report with its recommen
dations.
For additional information, please contact Riley Peters
at 798-6056 orMedori Hill at 798-7668.
At their June meeting, the College of Medical Education
Board of Directors awarded a plaque to G ary T aubm an, MD
for his service to the board of directors as well as serving as
president of the College from 1996 until 1998. Dr. Taubman
has served on the board since 1990.
The College is a subsidiary of the Pierce County Medical
Society and is responsible for accredited continuing medical
education. The College conducts numerous Category I
accredited CME courses each year. The courses are set by the
Board of Directors with input from the PCMS membership
compiled from interest surveys and course evaluations.
At their June meeting the board also approved the 19992000 course calendar which will feature eleven courses, one
in Hawaii and one in Whistler, with the other nine being held
in Tacoma at various locations. (See page 17 for a complete
list of courses.)
Dr. Taubman has also served as a course director for
several years as he has co-chaired. with Dr. Rick Tobin, the
Nuts, Bolts, & Innovation: Gastrointestinal Disease confer
ence for the last four years. The fifth annual course will be
held on Friday, June 2, 2000.
College board members leaving this year with Dr.
Taubman are D rs. Jo h n H au tala and M ark G ru b b . Board
members for 1999-2000 will be D rs. J.D . Fitz, B a rb a ra Fox,
Jo h n Jig an ti, Steve K onicek, Dale O verfield, B rad
P attison, Ju dy Pauw els, Cecil Snodgrass, Virginia Stowell,
R ich ard W altm an, and Tod YVursl. New members will be
D rs. W illiam H olderm an and R o b ert Alston. Other mem
bers of the Board include Rick Campbell. Good Samaritan
Hospital, Sister Anne McNamara, Franciscan Health System,
Victoria Fletcher, MultiCare Medical Center and Doug
Jackman, PCMS Executive Director.
djgj Allenmore
•ySsi Psychological
Associates, P.S.
...a multi
disciplinary
behavioral
health group
that works
with physicians
. 752-7320 ■
Do you have patien ts w ith difficult em otional
— —
1530Union Ave.S.. Ste. 16. Tacoma
July. 1999
PCMS BU LLE TIN
15
B
u l l e t in
‘Craze’
visitors can com pare the fat content of
sum m er foods. Its online H ealthy
H om e catalog sells item s like a
SnoreL ess pillow.
A m e ric a sd o c to r.c o m :
O ffering free, private chats with online
doctors, 24 hours a day, the site
receives sponsorship fees from partner
hospitals, w hich can provide local
contacts. Its M edical M all sells items
like a Super Tote C arryall ($36.80), a
purse that attaches to your walker.
Click on “A D octor in Y our H ouse” to
schm ooze with the stars and their
physicians. A ctor R oger M oore
recently chatted about skin cancer. Mr.
M oore, w ho first noticed his skin was
sun-dam aged while film ing
“O ctopussy,” offered his own special
advice on sun block and bronzing
cream s.
T h riv e o n lin e .c o m : A n
offering o f m edia mogul G eraldine
L aybourne’s Oxygen M edia Inc., the
site is also available through A m erica
O nline’s health channel. It features
alternative m edicines, diet and exer
cise tips. It also includes subject areas
like Serenity, w here users can click on
a photo o f “D ream D octor” Charles
M cPhee, w ho will interpret their
dream s. One w om an w rites to say she’s
about to get married, and is w orried
about a dream that “everyone I ’ve
ever known was hunting m e down to
kill m e.” She w onders if this is related to
prem enstrual syndrom e. C harles
M cPhee congratulates h er on her
w edding and then w onders, “H ow bad
is your PM S?”
O n h e a lth .c o m : A w ell being
site aim ed prim arily at women,
onhealth.com is operated by On H ealth
N etw ork Co., a onetim e p artner o f the
M ayo C linic that was relaunched last
sum m er as a publicly traded com pany.
On Health N etw ork has an alliance
with D rugstore.com for on-line
pharm acy purchases and offers guides
that rate the health quotient o f com m u
nities nationally.
AMERICAN LUNG ASSOCIATION.
ofWisNngton
1-800-LUNG-USA
L u n g In form ation
S e r v ic e L in e
Providing patient
education materials
TACOMA RADIOLOGY
Detect and M onitor
Low Bone Density
& F e m u r (A x ia l D E X A )
A lle n m o r e M e d ic a l C e n s e r o n ly
H e e l ( P e r ip h e r a l D E X A )
- ~ 's
L o w ris k s c re e n in g
When one of the following criteria are met,
beneficiaries are covered by Medicare every 23 months.
lifte r
1
E s tro j’ e n d e fic ie n t w o m e n a l c l i n i c a l ris k fo r o s le o p o r u s is .
2.
I n d iv id u a ls w i t h v e r te b r a l a b n o r m a lit ie s .
I rea st
3 . I n d iv id u a ls r e r c - iv in i; lon|< te rm g lu t C o c o r t o id th e ra p y .
5 u r ^ .e r ^
•1.
th in k
M o n it o r i n g o i I- D A a p p r o v e d o s te o p o ro s is d r u g th e r a p y m a y a l l o w fo r g r e a te r
P e rs o n a l h is to r y o< p r im a r y h y p e r p a r a th y r o id is m .
Call to schedule
fr e q u e n c y o f e x a m in a t io n o r fu r t h e r b e e l i n e a x ia l m e a s u r e m e n t.
of- u.-i.
Union Avenue Pharmacy &
Corset Shop
2302 S. Union Ave 752-1705
Tacoma
Lakewood
Gig Harbor
(253) 383-2038
(253) 572-5174
(253) 588-6083
(253) 858-3200
A lle n m o r e M e d ic a l C e n te r
F ran k S. B a k e r C e n te r
P o in t F c isd ic k Im a g in g
’
COLLEGE
Continuing Medical Education
_____________ O F ------------------
MEDICAL
EDUCATION
Watch for
Hawaii CM E
Brochure in July
The semiannual CME at Hawaii
program is set for April iO-14 on the
“Big Island” of Hawaii at the elegant
Hapuna Beach Hotel.
A brochure detailing the
program and information on course
registration, accommodations, and air
transportation should be out in early
July.
Those interested are encour
aged to plan ahead and make early
arrangements for the hotel and
particularly flight reservations.
For more information, call the
College at 627-7137.
C ollege Board announces CM E
schedule through June, 2000
The College of Medical Education’s Board of Directors announced its CME
schedule for 1999-2000 after their June meeting. The courses are offered in
response to local physician interest and are designed and directed by local physi
cians. All courses offer AMA and AAEP Category I CME credit.
A course calendar identifying the course title, dates, brief description and
course directors will be mailed in early July. For additional information on next
year’s offerings, please call the College at 627-7137.
D ates
Friday, O ctober 1
Friday, O cto b er 29
Friday, D ecem b er 3
F riday, Jan u ary 21
W ednesday - S unday
F eb ru ary 2-6
Friday, F ebruary, 11
CME Program
at Whistler,
February 2-6
The dates for the annual Whistler
CME program have been set for
February 2-6, 2000. The dates are one
week later than the traditional program
week.
The College of Medical Educa
tion has contracted so that all physicians
can again stay in the Aspens, also the
site for the meetings.
A program brochure with course
details and registration will be available
in September.
P ro g ra m
Infectious D iseases
U pdate
C om m on O ffice
M edicine & M ental
H ealth
C ardiology for P rim ary
C are
C M E @ W h istler
A dv an ces in W om en's
M edicine
Internal M edicine
M arch 9 & 10
R eview 2000
A p ril 9-15
S aturday, A pril 29
A lan Tice, M D
M ark C raddock, M D
P roblem s
T h u rsd ay -F rid ay
M o n d ay - Friday
D ire c to r^
D avid Law, M D
G regg O stergren, DO
R ich ard Tobin, IV1D
John L enihan, Jr., M D
R obert C orliss,M D
C M E @ H aw aii
Surgery U pd ate 2000
V irginia Stow ell, M D
A sthm a, A llergy &
F riday, M ay 5
P ulm o n o lo g y for
A lex M ihali, M D
P rim ary C are
N u ts, Bolts &
Friday, Ju n e 2
Innovation:
G ary Taubm an, M D
G astrointestinal
R ich ard Tobin, M D
D isease V
B
u l l e t in
,
,
V
......
.T ..
i f - r
;V : .
1999 Physician Directory changes
A r c h e r , B r y a n , M D (R etired )
C hange address to:
South Shore Lakes #1107
3805 FM 518 W est
L eague C ity, T X 77573
F r o e lic h , T h e r e s a , D O
C hange address to:
G yft Clinic
3582 Pacific Ave, 3rd Floor
Tacom a, W A 98408
Phone: 475-5433
FAX: 473-6715
K r isto v ic h , D e b , M P T
Change address to:
O ne-to-O ne Physical T herapy
2312 N 3 0 '1'S treet, #101
Tacom a, W A 98403
Phone: 396-9001.
FAX: 396-1231.
K u n k le , R o b e r t M D
Change address to:
4700 Pt F osdick D r N W , #206
Gig H arbor, W A 98335
Phone: 851-6075
Physicians only: 851 -6076
FAX: 858-5059
K e s lin g , P e te r , M D
C hange address to:
2703 Jahn A ve N W , #C -5
G ig H arbor, W A 98335
Pone: 851-6992
FAX: 858-3425
L a z a r u s, M a r le n e , M D
Change phone to:
Phone: 864-6848
FAX: 864-6851.
F ed eral W ay’s Fin est
A d d ress:
At St. F ra n c is H ospital
F ed eral Way
5 2 ,0 0 0 Square Foot M edical/Professional Office Building
Join These Tenants: M edalia H ealth Care • St Francis W omen’s
C enter • P ediactrics N orthw est • Digestive H ealth
N etw ork • P h arm acy & Diagnostic Lab • Dr. B arbara Levy
C o n ta c t:
A
Kirsten Hayford
A lexander 206-264-4594
C o m m e rc ia l R e a l E s ta te
/
18
JL .
July, 1999
for more information or to
schedule a tour.
C a ll
•
•
•
•
Class “A ” Interiors
T. I. Allowance
Ample Parking
High Growth M arket
R e y n o ld s , G le n , M D (R etired )
C hange address to:
8023 Shirley A ve, #B
G ig H arbor, W A 98332-1847
Phone: 858-6031
S tro m , J a n ic e , M D
Change physicians only to: 596-5158
T o th , E ile e n , M D
Change physicians only to: 596-5158
P A ew e 'ip cm rty Q 4 L d (c a l C rfocieti/
!
OFFICE SPACE
POSITIONS AVAILABLE
S i®
Tacoma/Pierce County outpatient
'i:
,. >iJliiLl...I’[■ L_L^
. . . . j.'
Lakewood, medical space
available 11/01/98. Two suites 750
square feet each. One suite 2900 square
feet. M ultiCare Urgent Care leaving
space which has been occupied by an
urgent care facility since 1980.
Building is a medical-dental facility
next to Albertsons. 8509 Steilacoom
Blvd. Call Dr. Ken Ring at 584-6200 or
582-5856.
WANTED FULL-TIME
PEDIATRICIAN for established
practice in a fast growing community,
south of Olympia. Please send resume
to 193 S Market Blvd., Chehalis, WA.
FAX 360-748-4577. Call 1-888-265-1585.
|
■; ;j
FROM “RETIRED” VASCULAR
LAB: Ultrasound machines, BW, with
Doppler Biosound, ATL UM-8.
Vasculab, cart, mounted $2,000 $12,500. ATLUM-9 “Color Doppler”
$50,000. Positional gumey carts for
ultrasound exams, transport $1,200.
Spectrum analyzer $500. OPG $250.
Autoclave $150. Treadmill $250.
Econoline van with equipment lift
$2,500. Oak waiting room chairs (12),
table, stools (2), secretary chairs (3)
$20-$50/item. (253) 564-8412.
^ l l ^ p i L ^ B
L p .,,:
Tired of office/hospital medicine?
Exclusive long-term care practice
available immediately. Good income
potential. Call 472-2011.
4500 sq. ft. Will finish to suit. On
Robin at 756-2182?
M edical office space to sub-lease.
Approximately 1,000 sq. ft., three
blocks from Tacoma General. Private
parking and private bath. Call
380-9743.
Office space available in new
multi-specialty three-story medical
building currently under construction in
Puyallup. Located within 3 blocks of
Good Samaritan Hospital with frontage
on Meridian. One suite is 2,575 square
feet, located on the 3rd floor and the
other remaining space is 2,075 square
fee, located on the 2nd floor. Excep
tional tenant improvement allowance.
Completion in late 1999. For informa
tion, call Larry W hite, MD or Lorna
Drees at 253-848-3000.
VOLVO
BMW
S E R V IC E & R E P A IR
(253) 588-8669
w w w .v o lv o rep air.co m
B o y le ’s F o re ig n C a r R e p a ir
7202 S te ila c o o m Blvd S W
are 12 noon to 9:30 pm MondayFriday, 10:00 am -7:30 pm
98371, (253) 848-6661, Ext. 1865.
July. 1999
PCMS BU LLE TIN
19
B u l l e t in
Congratulations
N I O N AVENUE
o
M RI
V
& - / P PEN
E
ne of twelve Hitachi open magnets in the Nation
to be Accredited by the Am erican College of Radiology
2502 South Union Avenue, Tacoma, WA 98405 (253) 2 7 6 -3 2 4 5 o r toll free 1 -(888) 2 7 6 -3 2 4 5
MiiltiCare Health System
Franciscan Health System
P ie rc e C o u n ty M edical S o c ie ty
2 2 3 T a c o m a A v e n u e S o u th
T a c o m a , WA 9 8 4 0 2
R etu rn s e rv ic e re q u e s te d
20
PCMS B U L L E T IN
July, 1999
D iagnostic Imaging N orthw est
Tacoma Radiology
PRESORTED
STANDARD
US POSTAGE PAID
TACOM A, WA
PERM IT NO 605
ôunfof oMediccU'■(Sfo-ddii
August, 1999
m
/
m
PHYSICIANS
& PATIENTS
WSMA
Annual
Meeting
September 30 October % 1999
Spokane, WA
TAKING
CONTROL
See page 12
CO -3
a> CJI
CO
INSIDE:
13
17
P r e s i d e n t ’s P a g e : “ S u m m e r t i m e A s s e s s m e n t”
“T r a u m a in P i e r c e C o u n ty ,” t o p i c o f S e p t e m b e r G e n e r a l M e m b e r s h i p M e e t in g
R e t i r e d m e m b e r s t r a v e l to A s ia w ith D r . P e t e r a n d S u e M a r s h
“ P r o f ili n g ,” b y A n d r e w S ta t s o n , M D
E d u c a t i o n f o r P h y s i c ia n s o n E n d o f L if e C a r e
L e t t e r to t h e E d i t o r : J o h n M c D o n o u g h , M D i n t e r p r e t s h is p o e t r y
F i r e a r m I n j u r i e s in P i e r c e C o u n t y 1 9 9 2 - 1 9 9 6
B u l l e t in
P C M S O f f ic e r s /T m s te e s :
L a w r e n c e A . L a r s o n , D O ............................ P r e s id e n t
C h a r le s M . W e a t h e r b y ,M D ............P r e s id e n t E le c t
P a t r ic e N . S te v e n s o n , M D
J a m e s M . W i l s o n , J r ., MLD............... P a s t P r e s id e n t
E d w a r d l . W a lk le y , M D
Y o l a n d a B r u c e , P C M S A P r e s id e n t
W S I V IA R e p r e s e n t a t i v e s :
P a s tP r e s id e n t: P e te r K . M a rs h , M D
S p e a k e r o f t h e H o u s e : R i c h a r d H a w k in s , M D
T r u s te e : D a v i d E . L a w ,M D
Table of Contents
E x e c u tiv e D ir e c to r : D o u g la s J a c k m a n
A g in g , R ic h a rd W a ltm a n ; A I D S , L a w re n c e S c h w a rtz ;
B y la w s , S ta n le y T u e ll; B u d g e t/F i n a n c e , P a tric e
S te v e n s o n ; C o lle g e o f M e d ic a l E d u c a ti o n , W . D ale
O v e rfic ld ; C r e d e n t i a ls , S u sa n S alo ; E m e r g e n c y
M e d ic a l S t a n d a r d s , T e d W a lk le y ; E th ic s /
Ja m e s M . W ilso n ; L e g is la tiv e , W illia m M a rsh ;
M e d ic a l- L e g a l, P a t D o n ley ; M e m b e r s h ip B e n e fits ,
I n c ., D re w D e u ts c h ; P e r s o n a l P r o b le m s O f
P h y s ic ia n s , R o b e rt S an d s; P u b lic H e a lth /S c h o o l
H e a l t h , J o s e p h W e a m ; S p o r t s M e d ic in e , Jo h n
Jig a n ti.
T h e B u lle tin is p u b lis h e d m o n th ly b y P C M S
M e m b e rs h ip B e n e fits , Inc. fo r m e m b e rs o f t h e P ie rc e
C o u n ty M e d ic a l S o ciety . D e a d lin e s fo r s u b m ittin g
a rtic le s an d p la c in g a d v e rtise m e n ts in T h e B u lle tin
are th e 15th o f t h e m o n th p re c e d in g p u b lic a tio n (i.e.
O c to b c r 15 fo r th e N o v e m b e r issu e).
3
President’s Page: ‘‘Summertime Assessmenf ’
4
4
Physician Data Income
Pierce County not selected for Robert Wood Johnson grain
5
September General Membership Meeting: Trauma!
6
Retired members travel to Asia at June luncheon
7
The Invisible Hand: “Profiling”
8
Register to vote
9
Education for Physicians on End of Life Care
10 Applicants for Membership
T h e B u lle tin is d e d ic a te d to th e art, s c ie n c e a n d
d e liv e ry o f m e d ic in e a n d th e b e tte rm e n t o f th e h e a lth
a n d m e d ic a l w e lfa re o f t h e c o m m u n ity . T h e o p in io n s
h e re in are th o se o f th e in d iv id u a l c o n trib u to rs a n d do
n o t n e c e s sa rily re fle c t the o ffic ia l p o sitio n o f the
M e d ic a l S o c ie ty . A c c e p ta n c e o f a d v e rtisin g in no
w a y c o n s titu te s p ro fe s s io n a l a p p ro v a l o r e n d o rs e
m e n t o f p ro d u c ts o r se rv ic e s a d v e rtise d . T h e B u lle tin
an d P ie rc e C o u n ty M e d ical S o c ie ty re se rv e th e rig h t
to re je c t a n y a d v e rtisin g .
E d it o r : D a v id S. H o p k in s M D
M a n a g in g E d it o r : D o u g la s Ja c k m a n
S u b s c r i p t i o n s : $ 5 0 p e r y e a r , $ 5 p e r is s u e
11 Letter to the Editor: John McDonough interprets his poetry
12 WSMA Annual Meeting, September 30 - October 2
13 TPCHD: Firearm Injuries in Pierce County, 1992-1996
14 MQAC Considers Rule Change
WSMA Contract Evaluation Service revamped
15 The Pulse: PCMSA plans next year’s meetings
16 AMA sets guidelines on health-related product sales
17 The College of Medical Education
M a k e a ll c h e c k s p a y a b l e to : M B I
2 5 3 -5 7 2 -3 6 6 6 , F A X 2 5 3 -5 7 2 -2 4 7 0
E - m a il a d d re s s : p c m s w a @ p c m s w a .o r g
H o m e P a g e : h ttp ://w w w .p c m s w a .o r g __________________
18
Y2K Workbook available
Sound to Narrows update
19 Classified Advertising
'£Pr'e/cc icountt]
President’s Page
Q - t b d i. c a / c V ‘o n c t tf
by Lawrence A. Larson, D.O.
Sum m ertim e A ssessm ent
The sum m er is a good tim e
to stand back and reassess w here
we are going, how w e got there,
and what adjustm ents m ight be
in order. U sually the sum m er al
lows a mini
break from
patient and
practice de
mands. This
is a good
time to re
new our en
thusiasm and
refocus our
direction.
I know that we participate
in the best of the professions.
We are afforded privileges that
most other professionals are not,
such as the jo y o f being a valued
part of patients’ life. In m edicine
we sit in the unique position of
helping people shape a m ore
positive direction through our
skill, education and caring. W e
participate as friend, m entor, and
example to our patients and com
munity. This all has its rew ards,
but also there is a paym ent. O ur
time, energy, and enthusiasm
can be drained by these p riv i
leges turning into dem ands. H ow
do we keep going in a fulfilling
and positive direction?
I believe that rem aining
productive, positive and content
with our m edical lives takes tim e
and thought. These are som e of
the tools I use to stay productive.
1) Take on new challenges.
T his could be as sim ple as or
ganizing y our d esk or as com
plex as o rganizing yo u r prac
tice. It is good to periodically
stand b ack and identify a new
p roject or goal. T hen it is im
p ortant that w e celebrate our
accom plishm ents along the
way. A fter all, the journey
m ay be m ore im portant than
the destination.
2) Don’t procrastinate. If only
I could avoid this. M y w ife al
w ays tells m e that perfection
ists tend to procrastinate - 1
guess this fits m e w ell. (If only
the b est will do then less than
the “b est” w ill surely not be
acceptable.) W hereas, we
strive fo r excellence and per
fection, som etim es w hat we
do is good enough and allow s
for m ore p roductive activities.
3) Forego the material for
the spiritual. I ’m rem inded
everyday w hen I listen to
p a tie n t’s concerns that m y so
lutions fo r their problem s
rarely involve m oney. M ore
o ften than not, answ ers rely
on em otional, spiritual, and
p ro fessional support. W e too
o ften ju d g e our success in
m onetary m easures and lucra
tive contracts. A fair return for
o u r services is im portant as
long as this is balanced w ith a
reco g n itio n o f o u r overall fa
vorable econom ic status.
4) Get exercise. I have alw ays
spent tim e participating in
sports. M y favorite pastim e is
playing “ratball” (a form o f dis
organized basketball) at the
Y M C A . This is a good release
for m e and a great w ay to stay
fit. I like sports that are physi
cal and com petitive. I think it
is im portant to participate,
w atch less and do m ore.
5) Enjoy today. This is the
only sum m er o f 1999 you will
ever have, so live it. D o n ’t put
o ff your enjoym ent o f life un
til retirem ent. This I have
learned from the advice o f my
senior colleagues. Plan to
w ork longer and pace your
self. M edicine needs experi
enced practitioners. D o n ’t re
tire com pletely from m edi
cine, but use your talent and
perspective to support your
colleagues, com m unity, and at
risk populations. Exam ples
abound in our “retired” physi
cians such as Dr. David
Sparling’s w ork in R ussia
and Dr. Dumont Staatz’s
w ork in Ethiopia.
I am certain that this sum
m er will find m ost of you talcing
advantage o f the Pacific N orth
west. M y w ish is for you to be
content w ith your profession and
position in Pierce County. I am
proud to be your colleague.
B u l l e t in
Physician
Income Data
The 1998 Socioeconom ic M onitor
ing System (SM S) survey o f physicians,
prim arily focused on physician income,
released their findings this spring.
Key findings o f the survey show
that m edian physician net incom e of all
surveyed physicians fell $2,000 or
1.2% in 1997. F rom 1993 to 1997, m e
dian net incom e adjusted fo r inflation
fell an average of 1.4% per year. The
share o f practice revenue from m an
aged care contracts increased to 52.4%
in 1997 from 44.2% in 1996.
The SMS survey is a telephone
survey o f a nationally representative,
random sam ple o f post-resident, nonfederal patient-care physicians. Som e
4,000 physicians, both A M A m em bers
and nonm em bers took part. Both office
and hospital-based physicians are in
cluded. The survey was conducted
from A pril-Septem ber, 1998.
A dditional findings show that
62.3% o f physicians were self-em
ployed; 36.1% w ere em ployees, and
1.6% were independent contractors.
O f .self-employed physicians, 41.5%
were in solo practice, w hile 43.4% of
em ployee physicians practiced in
groups of 9 or more.
Physicians w orked a median o f 48
w eeks p er year and 55 hours per
week. Self-em ployed physicians spent
57 hours per w eek in professional ac
tivities com pared to 51 hours for em
p loyed physicians. M edian patient visits
p e r w eek were 100 for all physicians.
For a com plete copy o f the survey
results, call PCMS at 572-3667.
Pierce County not selected for
“Communities in Charge” grant
The P ierce C ounty M edical
Society, T acom a Pierce C ounty H ealth
D epartm ent, the four m ajor hospital
system s and the com m unity-based
clinics currently serving m any unin
sured persons w ere recently disap
pointed w hen they w ere notified that
they w ere not selected to receive a
“C om m unities in C harge” grant offered
by The R obert W ood Johnson
Foundation. The com petition w as stiff,
as there were over 1,100 inquiries
regarding the proposal and ultim ately,
100 applications submitted. O f the 100
that applied, 26 w ere chosen for a site
visit.
The goal o f the grant project is to
design, build com m unity consensus for
and prepare to im plem ent a locallymanaged, universal health insurance
program for uninsured Pierce C ounty
residents. G rant organizers hoped to:
•provide universal coverage
•im plem ent m ore cost-effective
patterns o f care
•divert episodic care from highcost em ergency room s
•reconcile com m unity expecta
tions about the scope and standard o f
care with available resources
•consider enacting a local
requirem ent for individual financial
responsibility for illness care
•serve as a pilot project for the
current state-subsidized insurance
plan, and
•build com m unity agreem ent
about the need for and features o f the
Samaritan Community Healthcare, 407 - 14th Avenue S E , Puyallup, W A
98371, (253) 848-6661, Ext. 1865.
4
PCM S BULLETIN
August, 1999
p rogram
O rganizers plan to proceed with
the project despite losing the grant
funding. They plan to capture as many
dollars locally as possible, including
state m oney designed for county
control, design a prem ium that is
m eans-tested and create new expecta
tions for financial participation by those
w ith som e resources. W ithin con
straints o f funding, they will develop a
m anaged care system that assumes
universal coverage and responds to
each eligible person seeking care at
the appropriate level o f medical
expertise, regardless o f where one
enters the system. A m ajor goal is to
ration procedures, not people.
T he m otivation for this group
stems from the estimated 99,325
m edically uninsured persons of all
ages in Pierce County. There is an
additional 103,005 receiving Medicaid.
The Basic H ealth Plan, a statewide
effort to provide insurance for this
population, currently covers nearly
24,000 lives in the county but it is
under-funded, suffers from adverse
selection, and is losing providers.
U ltim ately, nearly 27% o f the county
population are people o f limited means
w ithout com m ercial medical insurance.
T he planning group will establish
a com m ission to serve as the entity for
the plan. The m em bers o f the commis
sion w ill include at least one represen
tative from each o f the m ajor health
system s, a representative from each
com m unity clinic system operating in
Pierce County, a representative from
each local governm ent unit that
provides substantial support for the
plan, a PC M S representative and three
consum ers. If the Legislature will
provide support, then the state would
also have representation.
W atch future issues of the
B ulletin for project progress reports
from the planning group.
...........
/A cr-t-e 'trW > t!tf Q 'ile d ic a l & < x< e tt(
in v i t e s y o u a n d y o u r spouse/guest to th e
Tuesday, S e p te m b e r 14, 1999
Social Hour:
Dinner:
Program:
6:00 pm
6:45 pm
7:45 pm
Tacom a
T raum a!
System update
Specialist support
Hospital support
Financial arrangem ents
(Registration required by Septem ber 10. Return this form to: PCMS, 223 Tacoma Ave S, Tacom a 98402; FAX to 572-2470 or ca ll 572-3667)
Please reserve_______ dinner(s) at $20 per person (tax and tip included)
□ Visa
□
Master Card
or my credit card # is_________________________________ _______
Expiration Date________ Signature___________________________
I will be bringing my spouse or a guest. Name for name ta g :_____________________________________
Signed: ______________________________________________________
Thankyou!
August. 1999
PCMS BULLETIN 5
Retired Members Travel to Asia5 at June luncheon
It w as all because of a barbecue at Senator M arilyn
R asm ussen’s house. T hat w as where the plan began, anyw ay,
o f an A sia trip to Korea, C hina and V iet Nam for Dr. Peter
Marsh and his wife Sue (ARNP). They had interesting travel
com panions as they were part o f the W ashington State Trade
D elegation that included other political leaders from W ash
ington state.
They shared m any hum orous stories about their travels
w ith PC M S retired m em bers at their June luncheon held at
Shenanigan’s R estaurant. O ver 50 people attended and not
one of them left early, for fear o f m issing out on one o f Dr.
M arsh’s entertaining tales.
T hey attended a K orean Econom ic B oard m eeting and
heard projections for K orea for the next few years. Dr.
M arsh noted that K orea has recently laid off many workers
and m ost others have taken a 40% pay cut due to the bleak
econom ic conditions. On the fun side, they toured K orea’s
open air m arket w hich is several square m iles, and, you could
buy a ‘fa k e ’ or ‘im itatio n ’ anything as there are no patents in
the country, they reported.
In Beijing they jo in ed 12 m illion people, and watched as
10 m illion o f them rode bicycles. “T here are dumpy bikes
everyw here,” noted Sue M arsh. N obody steals them they just
use any bike that happens to be convenient. And, the air
quality is very bad, but a breeze will com e and clear it out.
They did lots o f touring in B eijing and, o f course saw the
Forbidden City.
In China, the G reat W all was a favorite spot. It is 2500
m iles long and took 50 years to com plete. And, in Saigon they
m arveled at the beautiful french architecture.
In V iet Nam there was lots going on. “Billion dollar
projects are happening there,” said Dr. Marsh.
P eter M arsh, M D, and his wife, Sue, kept the crow d laughing
at the retired m em ber luncheon at Shenanigan's R estaurant
A ttendees adm ire the oeaitujul silk garm ent that Sue Marsh
brought back fr o m their trip
The crow d thoroughtly enjoyed the entertaining stories the
M arshes shared about their travels to A sia
D ennis W aldron, M D visits with M ian A nw ar, M D and his
wife P atty after the m eeting
6
PCM S BULLETIN
August, 1999
/
/ -----
iH m x if cutthf Q '/fedtra/ifvaeti/
T h e I n v i s i b l e H c in d ...
bv Andrew Statson. MD
“Profiling55
A few years ago King County
Medical came out with a profiling
system for physicians. They held
several meetings in the area to explain
what this system did and how' the
information could help us. In Pierce
County, we didn’t have many patients
insured by
King County
Medical, so
the numbers
were too low
to be of much
significance.
The
idea of
profiling is
interesting. It Andrew N. Statson, MD
is good for us
to know where we stand among our
peers on various parameters. We are
social creatures and have the innate
desire to fit in our group, to conform to
their expectations, to be accepted. At
the same time, however, we expect to
be recognized as individuals, as
different from everyone else, as having
something special to contribute.
At the informational meetings, a
problem came to light. The point of
view of the company officials was that
we must fit the mold they had designed
for us. We must strive to be average on
the chosen parameters. Instead of
pointing to our individual differences as
strengths to be cultivated for the benefit
of all, they were outlined as weak
nesses to be corrected.
As an example, they gave the
profile of a family physician, who was
more efficient than average (had a
lower per patient cost) in his office
visits, laboratory utilization and refer
rals of adult patients. However, he had
more referrals than average in the
pediatric age group. Instead of capital
izing on his skills to treat adults, the
Comparison is n o tp ra o f
F re n c h p ro v e rb
point of the presentation was that he
was deficient in treating children,
therefore he needed to get some
additional education in that area. The
medical director said he didn't need a
family physician who did only well
child care. He could get a nurse
practitioner to do that. He probably
didn’t realize that he was speaking as
the employer o f the physician, not as
the insurer of the patient. In fact, the
physician is employed by his patients,
not by their insurance company.
Another thing the medical
director didn't realize was that physi
cians are not clones o f one another.
feel comfortable handling. Forcing him
to do something he didn’t like would
not make him more productive. The
resulting increase in his work related
stress would adversely affect even that
part of his job he was doing well. Such
an effort would be counterproductive
and self-defeating. Physicians cannot fit
a mold any better than patients can.
My first year o f residency was a
total immersion in obstetrics. After a
few months I was amazed to discover
how closely the personality of the
patients matched that of their physi
cians. Patients need to feel comfortable
with their physicians. They need to be
able to communicate with them. To do
so, they have to be on the same w'ave
length. The net result is not only better
patient-physician communication, but
also better medical care.
" l suspect patients profile us when they ask their friends about a referral,
a n d certainly thev do so a t their initial visit. I f we d on't m easure up in their
expectations, they go to som eone else. The m anaged care p la n s use
profiling to select a p anel o f physicians who fit their mold. They hoped this
would reduce their costs. Perhaps, but il is m ore likely that ilw ouldn t. "
Some physicians are very good at
working with children. They can easily
establish a good rapport with them,
they can readily communicate at their
level, and as a result they are very
effective in treating them. Others don’t
have the heart for that. They may find
it emotionally too painful or taxing, or
their personality may be such, that
children don’t feel comfortable with
them.
W hatever the reason, this
example showed a physician who did a
good job in his field of interest. He also
knew when to refer the cases he didn’t
I suspect patients profile us when
they ask their friends about a referral,
and certainly they do so at their initial
visit. If we don’t measure up to their
expectations, they go to someone else.
The managed care plans use profiling
to select a panel of physicians who fit
their mold. They hoped this would
reduce their costs. Perhaps, but it is
more likely that it wouldn’t.
To reduce costs they would
need to use their people where they
are the most effective, where they
would give peak performance. To
S e c “ p ro filin g " p a g e 10
August, 1999
PCMS BULLETIN
t
Register to Vote
P erson al Problem s
o f Physicians
P h y sic ia n s h a v e a v ery p o o r r e c o r d fo r v o tin g in e le c tio n s at all
le v e ls o f g o v e r n m e n t. A v e r y e a sy w a y to im p r o v e y o u r v o tin g record
is to v o te a b se n te e . S ee b e lo w fo r in s tr u c tio n s o n h a v in g b a llo ts mailed
to y o u r h o m e fo r e v e r y e le c tio n . T o v o te is th e h ig h e s t fo rm o f good
c it iz e n s h ip .
M edical problem s,
ment, em otional, or
other such difficulties?
Y ou m ust be a citizen o f the U nited States; at least 18 years o f age by the date of
the n ext election; a resident o f Pierce County; and not presently denied your civil
rights as a result o f a felony conviction.
You may register at the Pierce C ounty A nnex, 2401 South 35th Street, Room
200, T acom a or you may use the form below . If you register by m ail, your applica
tion m ust be postm arked at least 30 days prior to an election to vote. You may
register in person at the A ud ito r's O ffice, 2401 South 35th Street, R oom 200, Tacoma
or at an A u d ito r's Satellite O ffice up to 15 days prior to an election
Bill Dean
272-4013
Address or Name Change
A ssu red
VOLVO
BMW
SERVICE & REPAIR
(253) 588-8669
If you m ove, be sure to notify the A u d ito r’s O ffice o f your new address - call
253-798-7439. If your nam e has changed, we w ill need to send you a form to update
your signature.
j
:|
j
-I
Cancellation o f Registration
Y ou will only be rem oved from the registration files if you fill out a cancellation
card o r register to vote in another country or state. I f a voter is deceased, another
voter may fill out a death card to cancel the deceased p erson’s registration.
!?i
I
If you want to vote by mail permanently, fill out this form and
send it in. If you alread y re ce iv e y o u r ballot by mail,
you do n ot need to fill this out.
B o y le’s F oreign C ar R ep air
7202 S teilacoom B lvd SW
P ie r c e C o u n ty A b s e n te e B a llo t R e q u e s t
ONGOING [X )
Send
Cathy Pâraall-Stipek.CFO Pfeerce Co. A u d i t o r
A y e a r-ro u n d
mailing
a d d re s s is re q u ire d
j
A M E R IC A N
LU N G
P rin t. N y m e
t1-800-LUNG-USA
L u n g In fo rm a tio n
S e r v ic e L in e
Providing patient
education materials
I
as R e g i s t e r e d
P r i n t A d d r e s s W h e r e Y o u U v -e
D iitij o f B i r t h
August, 1999
C ity T o w n
S o c ia l S e c u r ity N u m b e r
Z ip C o d e
H o m e P h o n e N u m b d i1
M a t t i n g A d d r e s s ( r e q u i r e d i f d i f f e r e n t f r o m a r i d r e j w w h e r e y * u lo v e )
C ity T T o v m
Zap C o d e
X
| S ig n a tu r e o f A p p lic a n t
PCM S BULLETIN
2401335thSt,R m 200, Tacoma, WA 96409
(253) 798-7430 * 1-S00-446-4979 (WA)
A S S O C IA T IO N ,
ofVUjsh/ngton
8
To:
D a te
__J
Education for Physicians
on
End of Life Care
A f o u r p a r t s e r ie s :
S e p te m b e r 16 a n d 3 0 ; O c t o b e r 14 a n d 2 8
7:00 - 9:00 a .m .
L a n d m a rk C o n v en tio n C e n te r
47 St. H elen s A venue. T aco m a
Registration
To register, please call Pierce County Medical Society, 5723667. Registration is required and open to physicians only.
There is no fee. Priority will be given to those registering for
the entire series.
Faculty
O b j e c t i v e s ; P articip an ts will:
Stuart Farber, M.D. is a Project on Death in America Scholar
and Assistant Clinical Professor in the Departm ent o f Family
Medicine, University o f Washington School o f Medicine. He
is board certified in family practice, geriatrics and hospice and
palliative medicine. EPEC* trained, 1999.
Mimi Pattison, M.D. is Medical Director, Palliative Care
Services and Chair, Medical Ethics Committee, Franciscan
Health System-West; Medical Director, Improving Care
Through End o f Life, Internal Medicine-Nephrology,
Franciscan Medical Group. EPEC* trained, 1999.
C o m m itte e to p r o v i d e c o n t i n u i n g
• u n d e rs ta n d
how
lo n e g o t i a t e g o a l s o f c a r e
and
id e n tify
re a s o n a b le h o p e
• be
a b le lo c o m m u n ic a te p r o g n o s is a n d id e n tif y /a s s e s s a s s e s s m e n t a r e a s
• be
a b le to d e f in e a d v a n c e c a r e p la n n in g
• le a rn h o w
• be
a n d e x p la in
lo c o m m u n ic a te b a d n e w s a n d k n o w
a b le to c o m p a r c a n d c o n tr a s t n o c ic e p tiv e
• b e a b le
to id e n t i f y
g e n e ra l g u id e lin e s
th e a s s e s s m e n t a n d
lo a p p ly
fo r m a n a g in g n o n -p a in
th e p r in c ip le s
• le a rn h o w
lo
• le a rn h o w
to a s s e s s a n d m a n a g e
• b e a b le
id e n tify a n d m a n a g e
to
p re p a re an d
its im p o r ta n c e
it i s i m p o r t a n t t o d o s o
a n d n e u ro p a th ic p a in
a d v e rs e e ffe c ts o f a n a lg e s ic s a n d
• b e a b le
w hy
th e ir m a n a g e m e n t
s y m p to m s
m anagem ent o f com m on
p h y s ic a l s y m p to m s
fo r w ith h o ld in g o r w ith d r a w in g
s u p p o rt th e
th e ra p y
p a tie n t, fa m ily , a n d c a re g iv e rs
th e p a th o p h y s io lo g ic a l c h a n g e s o f d y in g
in itia l g r i e f r e a c tio n
F o r M o r e In fo rm a tio n
Accreditation, 7 H o u rs
A s an o rg a n iz a tio n a c c r e d ite d b y th e
W SM A
M e d ic a l E d u c a tio n
m e d ic a l e d u c a tio n , th e C o lle g e o f
M e d ic a l E d u c a t io n c e r t i f i e s t h a t t h i s c o u r s e m e e t s t h e c r i t e r i a f o r 7
h o u rs o f C a te g o r y I C M E
S p o n so rs
This course is offered through the generous support of
Franciscan Hospice, Group Health Hospice, Good Samaritan
Hospice, Multicare Hospice o f Tacoma, Piercc County Medical
Society, PCMS Alliance, Three Cedars, Compassionate
Choices and the College o f Medical Education.
to s a tis f y
th e r e q u ir e m e n ts o f th e W a s h in g to n
S ta te M e d i c a l Q u a l i t y A s s u r a n c e C o m m i s s i o n
a n d fo r th e P h y s ic ia n s ’
Please call the Pierce County Medical Society, 572-3667. fora
program brochure. Additional registration information,
including directions to the Landmark Convention Center, is
available by calling the PCMS office.
R e c o g n itio n A w a r d o f t h e A M A .
August. 1999
PCMS BULLEI IN 9
V
B
u l l e t in
“Profiling”
C o n tin u e d fro m p a g e 7
achieve that, however, the managed
care plans have to treat physicians as
individuals, different from one another.
The officers of the managed care
plans, I am afraid, cannot understand
such a concept. To them physicians are
full time equivalents. So long as they
look on us as bodies, not as individuals,
they will get the performance of
bodies.
There is a Latin maxim: “The
surgeon cuts first with his mind, then
with his knife.” The Romans knew it.
Our modem insurance executives
have yet to discover it. They believe
they can do the thinking for us. They
expect us to do as their procedure
manuals tell us, to decide according to
their algorithms, to follow their guide
lines. to heed their protocols, to
practice within their parameters. They
are least interested in the best we have
to offer, our professional judgment.
They want from us the least valuable,
the work of our hands; and ignore the
most valuable, the work of our minds.
No wonder they are losing money,
even though they pay us so little.
Patients, however, see us as
individuals, and judge us as such.
When they have a choice, they select a
physician who matches their personal
ity, someone they can relate to. When
that choice is taken away from them,
patients are frustrated and unhappy. As
a result they come up with more
complaints, that require more office
visits and tests, more medications, and
in the long run their care ends up
costing more. Patients who are worried
can easily accept the word of a
physician they trust that there is
nothing seriously wrong with them, and
go away happy. When they don’t trust
the physician, they are not satisfied
until they have had multiple tests and
procedures to give them the reassur
ance they need.
Properly used, profiling can
direct patients to the physicians who
will best meet their needs. It can be like
a matching service, which allows the
patient to learn about the physicians
before the first interview. Of course
this assumes that the parameters of the
profiling match what the patients are
looking for in a physician. The system
will have to answer the questions the
patients have when they select a
physician. Is he a good listener? Does
he allow enough time for questions?
Does he feel comfortable discussing
the personal questions I have in mind?
Is he compassionate? Is he judgmental?
Is he patronizing? Will he accept me as
I am, with all my lumps and warts?
Such a profiling system would be
beneficial to both patients and physi
cians. If the parameters of profiling are
chosen by the insurance company to
cut costs, while the patients are looking
for someone able and willing to listen to
them, the service would not work.
K+H
H
IG
H
L
IN
EC
O
M
M
U
N
IT
Y
H
O
SP
IT
A
L
HEALTH CARE NETWORK
w w w .h c h n e t.o rn
S E A T T L E , W A - E X C E L L E N T O P P O R T U N IT IE S for BE/BC FAM ILY PR A C T IT IO N E R S
AND IN T E R N IS T S . Enjoy practicing in a progressive hospital setting with an extensive
network of health care providers and specialists throughout S W King County. Minutes from
downtown Seattle, the shores of Puget Sound and the Cascade Mountains. W e offer
state-of-the-art resources, equipment and expertise to provide outstanding care for your
patients. Competitive package. For details, call or write us:
Gail Mumma, Highline Community Hospital
Health Care Network, 137 S W 154th Street, Seattle, W A 98166.
Phone (206) 619-9069 • Fax (206) 439-3939
e-mail: [email protected]
Applicants for
Membership
L its k y , S te v e n H ., M D
P h y s ic a l M e d ic in e & R eh ab
Practices at NW Center for Integrative
Medicine; 2702 S 42nd Street, #310,
Tacoma 98409; 472-7844
Medical School: Sackler School of
Medicine, Tel Aviv University
Internship: Sinai Hospital, Wayne State
University
Residency: Sinai Hospital,Wayne State
University
R e a lic a , R o ss M ., M D
P la s tic S u r g e r y
Practices at Pacific Northwest Plastic
Surgery; 1530 S Union, Tacoma 98405
Medical School: University of
Phi lippines, College of Medicine
Internship: Boston University
Residency: St. Elizabeth’s Medical
C enter
Fellowship: Medical College of
G eorgia
W ym an , Ja m es J ., M D
O r th o p e d ic S u r g e r y
Practices at Tacoma Orthopedic
Surgeons; 2420 S Union, #300, Tacoma
98405, Phone: 756-0888
Medicine & Dentistry of New Jersey
Internship: University of CalifomiaDavis
Residency: Rhode Island Hospital
Fellowship: Rhode Island Hospital
Puyallup, W A 98371-0192._______
Letter to the Editor
Dear Editor:
Please note the omission of the
word “happy” in my poem “Castle of
Sand” which you published in the July
issue of the Bulletin. I think you will
agree that the omission changes the
tone, especially of the last stanza.
While attending an American
College of Cardiology meeting in
Castle o f Sand
T h e b o y u p o n th e b e a c h w ith s c o o p a n d h a n d .
D id to il to m a k e a c i t y o u t o f s a n d .
F ro m c e n tr a l p a r a p e t a n d s c a r p
th e re ro s e ,
A c a s tle , m ig h ty to w e r s t h r u s t i n g o ’e r,
A fo rtre s s b u ilt to l a s t f o r e v e r m o r e .
B oy g re w to y o u th a n d
y o u th to m a n
in tim e .
A n d to o ls c h a n g e d w h i le in th e s a n d y g r im e .
L e tte rs , n u m b e r s , s c i e n c e a n d t h e c a l l .
T o e n g in e e rin g , m e d ic in e , th e
la w ,
O r b u s in e s s , c le rg y , o r th e p u b l i c t r o u g h .
M oney, p o w e r, p rid e fu l s e lf is h w a y .
S lo w l y e n t e r e d , a n d w h e n i n d i d s t a y .
A n d v ic e w ith its e n tr a n c i n g o p e n
W ith g o ld e n th r e a d s d r e w
m aw .
in to u n s e e n m e s h .
I ts v i c t i m s , c i r c l e d , c a u g h t w i t h
no
reg ress.
T h e su n re a c h e d a p o g e e th e n s ta r te d
w e s t.
A s c ity s h a d o w s b o d e th e c o m i n g te s t.
Sea b re e z e s u p , b e c a m e a r a g in g g a le .
A n d re s tle s s w a v e th a t s w e p t th e b r in y s h o re .
L e ft c a s tle o f s a n d , o n c e p r o u d , a s t a n d
n o m o re .
T he b o y w ith tr e m b lin g a n d d is m a y d id
c ry ,
F a th e r, M o th e r , w h y a r e t h i n g s a w r y .
T hen a s o u n d , c le a r, s w e e t, w ith o u t d e la y ,
S a id : D e a r e s t c h i l d m y v o i c e a t y o u r b e h e s t ,
Is m u te d till y o u c o m e w i t h a r e q u e s t .
F or a n sw e r o n ly tr u th w ill tu r n th e k e y ,
T o f re e y o u r so is l f r o m
its c h a in e d m is e ry .
S earch d e e p w i t h h u m b l e h e a r t t h e d e p t h s i n s i d e .
T o m o rro w a t th e b e a c h a n o th e r d a y ,
F in d s h a p p y t h e b o y w i t h p a i l a n d
s c o o p a t p la y .
'M y wife, Jane, re a d it a n d said. “B u t John. I d on j u n d e r s ta n d
it. ” S e v e r a l sin c e h a v e asked, but w h at d o e s it m e a n 0 '
Hawaii in 1994, with afternoons free to
spend at the beach, my attention was
caught by a group of children digging
and building in the beach sand near the
w ater's edge. As the northeast trade
winds swept over Mauna Kea, bringing
the late afternoon cloud cover so
typical o f the Kona coast where my
wife Jane and I were staying, I began to
im agine the themes which later were
written down, and woven into what
became the poem, “Castle of Sand.”
Jane read it and said, “But John,
I don’t understand it.” Several since
have asked, "but what does it mean?''
The poem is allegorical and
makes heavy use of metaphor. The boy
represents every man (or woman). The
sand represents those materials used to
construct the edifices of our world.
Castle, parapet, scarp, and fortress
represent those structures which
enclose and isolate us from others.
Time is not treated solely as
elapsement, but variously: as perma
nence (a fortress built to last forevermore); as future treated as being
present (boy grew to youth and youth
to man in time, and tools changed
while in the sandy grime); and as the
past, treated as if it were the present
(the boy with trembling and dismay did
cry).
The evil influences o f life
(money, power, pride, selfishness, vice)
were used to emphasize the power of
these influences to victimize and
enslave.
With the metaphor of the sun’s
movement, apogee represents high
noon; sea breezes represent the
afternoon movement o f sea air upon the
land; and destruction of the sand castle
by gale and wave represent the
dissolution of material things by the
forces of nature.
Lengthening afternoon shadows
of the city are intended as a foreboding
of the coming test. This test is not the
ability of
city
i?......
^ ^
structures
to with
stand the
storm, but
rather, the
response of
the boy to
loss of the
material
things of
his life.
Jo h n M c D o n o u g h , M D
The
voice represents the Divine, or God,
who speaks to us if we ask and listen.
Truth is treated for its power to free
from spiritual bondage. Humility and
discernment are treated as enhance
ments to allow the light of truth lo
illuminate the interior spaces.
Happiness is treated as the result
of listening and responding to the voice
of the Divine and is alluded to in the
final line of the poem: finds happy the
boy with pail and scoop at play.
I wish lo thank you for publishing
this poem and especially my medical
colleague Dr. Teresa Clabots for
submitting it on my behalf.
i
i
John R. McDonough, MD
E d it o r 's n o t e : O u r a p o lo g ie s t v D r . M c D o n n u g h f o r
t h e o n x is a o n n ft h e \ v o r d ''h a p p y '’ m t h e o r ig m a l
p r in t e d v e r s io n q fh is p o e m “ C a s t le q f S im d ."
H o w e v e r , i r e a r e g r a t e f u l to D r . M c D o n o u g h f o r
p r o v id in g h is in t e r p r e t a t io n o f th e p o e m a lo n g u it li
th e c o r r e c t io n .
Bu L L E T I N
WSMA Annual M eeting will focus on solutions
109th meeting to be held in Spokane Septem ber 30 - October 2
“Physicians and Patients: Taking
Control,” is the theme of the WSMA
Annual Meeting scheduled for
September 30-0ctober 2 in Spokane.
Speakers at the opening session will
focus on:
1) how to build a statew id e
c o a litio n
2) h o w to id en tify sp e c ific p r o b
lem s w ith in the h ealth care
sy s te m
3) h ow to id en tify so lu tio n s and
e n su re th at th e so lu tio n s are
c a r r ie d ou t
Stuart Elway, president of Elway
Research in Seattle, will lead the way
with his analysis of two statewide
opinion surveys commissioned by
WSMA and Physician Insurance. H e’ll
review the state of the current health
care system as perceived by physicians
and the public.
The new WSMA and Physicians
Insurance public awareness campaign
will be introduced by Denise Passinetti,
vice president of public relations for
KNCB/Dave, a Seattle public relations
firm. Ms. Passinetti will explain how the
campaign will build statewide support
for changes in the health care system
that the survey research shows is
wanted by both the public and WSMA
members. She will explain the cam
paign messages and display the
creative materials and ads that will be
used.
Dan Monson, head coach for
Spokane’s Gonzaga University men’s
basketball team will also be a featured
speaker. He will reveal how teamwork
can power successful sports teams as
well as groups of physicians.
The annual meeting is free to
members, and will be held at
Cavanaugh’s Inn at the Park in
Spokane. Registration packets will be
sent in mid-July. Room reservations
should be made before August 31. To
reserve your room call 1-800-325-4000
or visit www.cavanaughs.com. Askfor
the WSMA room discount.
Watch your mail for registration
brochures.
W ill a disability p u t you out
of commission?
%
n
n
As you know, d isab ility insurance policies for physicians are ch an gin g
rap idly— and not lor the better. High claim s have caused m an y m ajor
carriers to lim it the m ost im portant benefits.
At P hysicians Insurance Agency, th ere’s still tim e to secure the specialtyspecific coverage you need. In addition, we can help you find superior life
and long-term -care coverage for you and yo ur fam ily.
w
To discuss the w ays you can best protect yo ur future incom e, call
P hysicians Insurance Agency today: (206) 343-7150 or 1-800-962-1399.
F ,
PHYSICIANS
INSURANCE
AGENCY
A Wholly Owned Subsidiary of
Physicians Insurance Exchange
; WSPIA IW
12
PCM S BULLETIN
Sptworecl by Ihe Washington Slab ,1kdiatl Association
August, 1999
The Health Status o f Pierce County
Firearm Injuries in P ierce C ounty
1992-1996
HEALTH
Suicides r e p r e s e n t t h e m a jo r ity o f fir e a r m -r e la te d in ju r y d e a th s
This article is part of a series from
the Tacoma-Pierce County Health
Department, illustrating the health
status of Pierce County residents. We
hope physicians and other medical
providers will find the reports interest
ing and useful to their practice.
The data presented should
provide a framework for understand
ing the Health Department’s priorities
for prevention strategies. Over the
next several years, our goal is to
reduce illness and death related to
smoking, alcohol misuse, violence, and
HTV/AIDS. These areas are related to
behaviors which deserve communitywide attention and efforts for change.
Firearms-related incidents across
the nation as well as locally continue to
sensitize health professionals, policy
makers and the general public to the
tragic consequences that occur when
firearms fall into the wrong hands.
Information for this brief summary was
obtained from the CHARS hospital
reporting system database. A recently
implemented statewide firearms injury
surveillance system will soon provide
information about firearms injuries that
are treated in emergency rooms. This
will allow for a more complete picture
of firearm injury prevalence and
patterns in our communities.
Although homicides and assault
receive a great deal of media attention,
suicides represent the majority of
firearm-related injury deaths. Females
attempt suicide at a much higher rate
than males, but male fatality rates are
about 4 times higher. The result is that
males represent over 80% of suicide
fatalities.
D E P A R T M E N T
Firearm injuries occur most
frequently to adolescents and young
adults. From 1992-1996, Pierce County
youth aged 15-19 experienced the
highest rate o f firearm homicide o f any
P ierce C ounty (5.9/100,000) was
84% higher than the rate for
W ashington S tate (3.2/100,000)
d u rin g th is fiv e-y ear p erio d .
The Health Department is prepar
N u m b er o f F ire arm -R e lated In juries to P ierce C ounty Y outh, 1992-1996
F atalities
H om icide
Suicide
U nin ten tio n al
T o ta l
H o sp italizatio n s
A ssault
S elf-in flicted
U ninten tio n al
T o ta l
U n d er 1
1
1-4
2
5-9
1
0
1
U nder 1
0
-----------
0
2
1-4
0
-----
0
1
5-9
0
10-14
4
7
0
11
10-14
7
1
1
0
0
0
0
4
11
age group (18.9/100,000) accounting for
22% of all firearm homicide victims.
Firearm homicide is the second leading
cause of injury death for this age
15-19
41
17
0
58
15-19
65
3
24
92
20-24
40
32
4
76
20-24
51
3
25
79
ing a plan for reducing injury and
death from firearms and other forms of
violence. More information will be
provided in the TPCHD column once
N u m b er o f F ire arm -R e lated In ju ries in P ierce C ounty, 1992-1996
Fatalities
H ospitalizations*
T otal
H om icide
190
A ssault
249
439
Suicide
277
S e lf -Inflicted
30
307
U nintentional
10
U nintentional
120
130
Total
477
399
876
* M ay in c lu d e so m e p a tie n ts w ho ev en tu ally died.
group. The vast majority of firearm
homicides (83%) occur to individuals
between the ages o f 15-44 years old.
The fire arm hom icide ra te in
those plans are finalized.
Contact John Britt, RN, MPH,
Prevention Coordinator, for more
information 798-2881.
M QAC
co n sid ers rule
change
W S M A con tract evalu ation
service rev a m p ed
A new two-year license renewal
cycle is being considered by the
Medical Quality Assurance Commis
sion, (MQAC) as of October 1,1999.
Physicians would renew their licenses
every two years instead of every year.
MQAC has scheduled a meeting
for September 24 to vote on the
change, which would also apply to
CME mles. A physician would need to
obtain 200 hours of CME every four
years rather than 150 every three
years as is currently required.
Also in keeping with the change
would be licence fees which would
reflect the new two year time frame.
The WSMA Board of Trustees
recently approved a plan to revamp
the WSMA contract evaluation
service. Among the upcoming
changes:
♦ more focus on the evaluation
by emphasizing contract
provisions most important to
medical practices
♦ more assertive and direct
characterization of contract
provisions and
♦ model language for key
provisions.
An advisory group of county
medical society executives and clinic
managers is advising on the re-design.
The board also approved transferring
the contract evaluation service to
WSMA-Representation Service
(WSMA-RS).
WSMA members requesting a
contract evaluation now will be asked
to authorize WSMA-RS to representa
tion if they have not already done so.
For questions about the WSMA
Representation Services call WSMA,
1-800-552-0612.
CALL 5 9 7 - 6 4 7 3 OR 5 9 7 - 7 9 8 2 .
B lu e S n ie l d
V
rfe w
The Pulse
ix.’0(( ill) j Q .(/ U (h m / rr)<‘- n ef‘.f
PCMS Alliance
June Planning M eeting Yields Ideas
The June planning meeting o f the PCMSA was held at
the home of Yolanda Bruce. Dates were set for member
ship solicitation, mailing and newcomers coffee. Membership
mailing will be held at the PCMS office at 223 Tacoma Avenue
South on August 10 at 9:30 a.m. Your help is greatly appreci
ated.
Ginny Miller has graciously offered to host the
Newcomers coffee at her home on September 23rJ. Child
care will be provided. Time and directions will be announced
in the September Bulletin. A Chinese Tea Ceremony will be
presented.
Suggestions for field trips were made. They include: a
cooking class, bowling, snow shoeing and hiking. The
cooking class will be held at the Peninsula Cooking School in
Canterwood on November 4“'. Cost is $30.00 per person for a
maximum of 12 people. Holiday hors d ’oeuvres is the topic.
RSVP to Yolanda Bruce al 265-8190.
Join us for bowling in January al the Narrows Plaza
Bowl & Entertainmenl. The date and time will be announced.
Information on snow shoeing and hiking will be provided in
the future.
It was suggested that three raffle items be offered at the
PCMS Joint Holiday Dinner this year. What are your
thoughts? E-mail them to [email protected].
Also, please note that philanthropy applications forms
are out and are due by September 1, 1999.
N e e d office h elp in a hurry?
I
Pierce County Medical Society/Medical Placement Sendee
th e so lu tio n f o r a ll tjm tr sta fp sig meeds
We pro v id e fo r you:
•
•
•
•
An available pool o f qualified clinical & administrative applicants
Coverage for vacations, illness, leaves o f absence, peak work loads, pregnancy, etc.
Employees without the hassle of salary, benefits, taxes and other such employee requirements
Temp to Perm: A unique opportunity to work with a potential employee on a trial basiswithout obligation to hire
F o r m ore information: call D eborah Pasqua: 5 7 2-3709
Allenm ore
Psychological
Associates, P. S.
...a m u lti
d is c ip lin a ry
be h a vio ra l
health g ro u p
that w o rk s
w ith ph ysicians
Do we have your e-mail address?
■752-7320 ■-------------
please send it to us at:
Do you have patients with difficult emotional
[email protected]
---------------- 1530 Union Ave. S.. Ste. 16. Tacoma
-------
August, 1999
PCMS BULLETIN 15
B u l l e t in
Organ STissue
A M A sets g u id e lin e s o n h ea lth related p rod u ct sales
D O N A
♦ Physicians should disclose to
patients the nature of their financial
arrangements with suppliers of
health-related products
♦ Physicians should provide literature
understandable to patients which
attests to the scientific validity of
the product being sold
♦ Physicians should not engage in
exclusive distributorships of healthrelated products.
The AMA House of Delegates, at
their annual meeting in June, adopted
the Council of Ethical and Judicial
Affairs Report 1 which addresses the
sale of health-related products in
physician offices. The report’s recom
mendations were:
♦ Health-related products which lack
scientific validity should not be sold
in physician offices
♦ Useful health-related products may
be distributed free of charge or at
cost
♦ Physicians generally should not sell
products when they can be obtained
elsewhere in the community
T I O N
S h a r e Y o u r L ife.
S h a r e Y o u r D ecisio n
For more information on
organ and tissue donation
please call
The WSMA Judicial Council is
expected to issue their report on this
topic at the WSMA annual meeting in
Spokane.
L ifeC enter Northwest
toll free 1-877-275-5269
Now
Open
Saturdays
NToN AVEfflpE
penm r
J
2502 South Union Avenue, Tacoma, W A 98405
f
i
,
16
PCM S BULLETIN
August, 1999
t
I M
1i
tre fp o m d f Q ilechca/
COLLEGE
CF
MEDICAL
EDUCATION
Common O ffice
Problems C M E
will be h eld
October 29
The topics are set for the
College’s Common Office Problems
CME scheduled for Friday, October
29,1999. The conference will be held
at St. Joseph Medical Center, Rooms
1A&B.
The program is again directed
by Mark Craddock, M D and will
offer 6 Category I CME credits. This
year’s course will cover:
•P ediatric V accin es
•Common Shoulder Problem
•U terine A rtery E b olizatin
for Treating Fibroids
•N ew D ia b etes T h era p ies
•P ed iatric H ead ach e
•H yp erten sion
•D erm atology
•Fibrom yalgia
ID U pd ate C M E set O ctober 1
Program will include physicians from other specialties
The annual Infectious Diseases
Update CME is set for Friday, October
1,1999 and will be held at the Sheraton
Tacoma Hotel. The program is again
directed by Alan Tice, MD and will
feature local specialists and sub-spe
cialists joining Infections Limited physi
cians as they give presentations on
D a te s
P rogram
D ir e c t o r ^
Friday, October 1
infectious Diseases
Update
Alan Tice, MD
Friday, October 29
Common Office
Problems
Friday, December 3
Medicine & Mental
Health
David Law, MD
Friday, January 21
Care
Gregg Ostergren, DO
Wednesday - Sunday
February 2-6
CME @ Whistler
Richard Tobin, MD
Friday, February, 11
Thursday-Friday
March 9 & 10
The course is designed for the
primary care clinician and focuses on
practical approaches to the most
common dilemmas faced in the daily
routine of medical practice. Look for
the registration brochure in the mail
jjist after Labor Day.
For more information, please call
the College of Medical Education, 6277137 between 7:30 a.m. and5:00p.m.
specific disease areas.
This year’s keynote speaker is
Alan Cross, MD from the University of
Maryland Cancer Center in Baltimore.
He will be speaking on Bio Terrorism.
The registration brochure will be
mailed in the middle of August. Physi
cians are encouraged to register early.
Mark Craddock, MD
Advances in Women's
Medicine
Internal Medicine
John Lenihan, Jr., MD
Robert Corliss,MD
Review 2000
M onday - Friday
April 10-14
CME @ Hawaii
Mark Craddock, MD
Saturday, April 29
Surgery Update 2000
Virginia Stowell, MD
Asthma, Allergy &
Friday, May 5
Friday, June 2
Pulmonology for
Primary Care
Nuts, Bolts &
Innovation:
Gastrointestinal
Alex Mihali, MD
Gary Taubman, MD
Richard Tobin, MD
Disease V
X
August, 1999
PC M S BU LLE I IN
1/
1999 Physician
Directory changes
F le tc h e r , B o b b ie , A R N P
Change address to:
920 Alder Avenue
Sumner, WA 98390
Phone: 891-0811
M eas, H ay S a n , M D
Change address to:
3716 Pacific Avenue, #H
Tacoma, WA 98408-7836
R a ja c ic h , N ic h o la s, M D
Change address to:
3 16 MLK Jr. Way, #312
Tacoma, WA 98405
Phone: 627-7143
FAX: 627-5006
R e y e s, M a ria R e g in a , M D
Change DSHS Billing # to: 1103829
Y2K W orkbook
for co n cern s
and solu tion s
available
“The Year 2000 Problem - Con
cerns and Solutions for Physicians and
Medical Practices,” is available to help
physician practices prepare for the
Millennium Bug.
The booklet, published by
WSMA, explains how to find out more
information about your particular
preparedness for Y2K, discusses
patient safety and practice continuity
and includes a checklist to help ensure
a smooth transition into the next
millennium.
For information, call the PCMS
office, 572-3667.
S o u n d to
N arrows update
PCMS
member
D a v id
M a g e ls s e n ,
M D com
pleted the
Sound to Nar
rows run on
June 12,1999.
He ran an excellent run, completing the
12 kilometer course in one hour and
four minutes (1:04:24).
Dr. Magelssen finished 1,386th out
of 4,163 runners in the 12K event.
PCMS apologizes for inadvertently
omitting him from the results listed in the
July Bulletin. Jim R ooks, M D, noti
fied PCMS that Dr. Magelssen had par
ticipated in the run.
Federal Way’s Finest
Address:
T h e M e d ic a l P a v ilio n
At St. F ra n c is H ospital
F e d e ra l Way
5 2 ,0 0 0 Square Foot Medical/Professional Office Building
Available space up to 6,400 Sq ft. - divisable
J o in T h e se T enants: M edalia H ealth Care • St Francis W omen’s
C en ter • P ediactrics N orthw est • Digestive Health
N etw ork • P h arm acy & D iagnostic Lab • Dr. B arbara Levy
A
A lexander
C o m m e rc ia l R e a l E s ta te
/
C o n ta c t:
Kirsten Hayford
206-264-4594
C a ll fo r m o r e in f o r m a tio n o r to
s c h e d u l e a to u r .
• C lass “A” In te rio rs
• T. I. A llow ance
• A m ple P arking
• High Growth M arket
M H S S jlS
W\erce % m n tf Q'fledica/ Society
P O SIT IO N S A V A ILA BLE
T acom a/P ierce C ou nty
outpatient general medical care at its
best. Full and part-time positions
available in Tacoma and vicinity. Very
flexible schedule. Well suited for
career redefinition for G.P., F.P., I.M.
or Paul Doty (Allen, Nelson, Turner
& Assoc.), Clinic Manager (253) 3834351.
Urethral Inserts
Sublingual Troche
IV Services
Capsules
Lip Balms
752-1705
O FFIC E SPACE
Lakew ood, m ed ical space
available. Two suites 750 square feet
each. One suite 2900 square feel.
Excellent location and visibility. Close
to many schools and residential areas.
B509 Steilacoom Blvd. Call Dr. Ken
Ring at 584-6200 or 582-5856.
rACOIHA RADIOLOGY
Detect and Monitor
Low Bone Density
New office sp a ce a v a ila b le .
Up to 4500 sq. ft. Will finish to suit. On
CallRobin at 756-2182.
Spine & Fem ur (A xial DEXA)
A llen m ore M ed ical C en ter O n ly
M edical office sp ace to su b
lease. Approximately 1,000 sq. ft.,
three blocks from Tacoma General.
Private parking and private bath. Call
380-9743.
TA C O M A /PIER C E C O U N T Y
Outpatient General M edical Care.
Full and part-time positions
available in Tacoma and vicinity.
Very flexible schedule. Well suited
for career redefinition for
GP, FP, IM.
Contact Andy Tsoi, M D (253) 752-9669
or Paul D oty (Allen, Nelson, Turner &
(T-score)
H eel (P eripheral DEXA)
Low risk screen in g
Call to schedule
Lakewood
Gig Harbor
(253) 383-2038
(253) 572-5174
(253)
588-6083
(253)588-6083
(253) 858-3200
A llen m ore M ed ical C e n te r
Frank S. B ak er C e n ler
Lakew o o d O ffice
Point Fosdick Im aging
Tacoma
B u l l e TIN
f f l m x Ypcumty- o M ed ka l (Sodetw
Policyholder Concerns Come First
“I appreciated the fa c t that Physicians
Insurance was really looking out fo r my
interest and not just their own.”
W h e th e r it's a claim, a lawsuit, or a risk management issue,
Physicians Insurance keeps customer concerns at the forefront.
Claims representatives work closely with insured defendants
and experienced attorneys to secure the best possible outcome
for our policyholders. Equally as dedicated, our risk manage
ment representatives conduct interactive seminars and respond
to questions in person, by phone, and by mail. Our goal, now
and in the luture, is to help physicians, clinics, and hospitals
remain successful.
Western Washington
Eastern Washington
Oregon
Cr^.i1<■,i jind .ji'-'tiii'r'.-i.l l>\ 1he
W:,islunjHon S'Moil- MAsspi mu:
1-800-962-1399
1-800-962-1398
1-800-565-1892
■T Physicians
Insurance
A M u tu a l C o m p a n y
Seaitlir. WA 0 Physicums Insurance 1999
PRESORTED
STANDARD
US POSTAGE PAID
TACOMA, WA
PERMIT NO 605
P ie rce C o u n ty M e d ica l S o cie ty
2 23 T a c o m a A v e n u e South
T a co m a , W A 98 40 2
."■V!
ll I !. 0
Lit n.,ii|,1
'
7.
ijj i
n;
.
H A U S591
T 9 2 2 0 1 3 0 2 4 359S 07
R E T U R N TO S E N D E R P O S T D U E =
H A U SE R
T E M P O R A R IL Y AWAY
R E T U R N TO S E N D E R
20
PCM S BULLETIN
August, 1999
PO ST
DUE
0 8 /1 3 /9 9
$
.7 7
September, 1999
M a k in g it to t h e to p , t o g e t h e r ...
See page 3
INSIDE:
3
5
7
9
10
U
13
B eyon d m e d icin e , p hysician s enjoy a th le tic ev en ts, a ctiv itie s
“T ra u m a in P ie rc e C ou n ty,” to p ic o f S e p te m b e r G e n e ra l M em b ersh ip M eetin g
E d u ca tio n fo r P hysician s on E n d o f L ife C a re
W SM A A n n u al M e e tin g , S e p te m b e r 3 0 - O c to b e r 2 ; P h y sician s/P atien ts T aking C o n tro l
New c h a rg e s fo r co p y in g a n d d u p lica tin g re c o rd s
S e p te m b e r is W o m en in M ed icin e m o n th
T h e In v isib le H a n d : “T h e H a m m u ra b i E x p e r im e n t”
Bu L L E T IN
i
PCM S
O f f i c e r s / T r u s te e s :
L a w r e n c e A . L a rs o n , D O ............................ P re s id e n t
C h a r l e s M . W e a th e r b y , M D ........... P r e s id e n t E le c t
P a t r ic e N . S t e v e n s o n , M D ......S e c r e ta r y /T r e a s u r e r
J a m e s M . W ils o n , J r., M D ............... P a s t P r e s i d e n t
J. J a m e s R o o k s , Jr., M D
E d w a rd 1. W a lk le y , M D
Y o la n d a B r u c e , P C M S A P re s id e n t
■V
ce ^G u n iif o 4 (edw cd (ffocm kp
—
B ulletin
v w
m
PHYSICIANS
& PATIENTS
S e p te m b e r
1999
W S M A R ep resen ta tiv es:
S p e a k e r o f t h e H o u s e : R ic h a r d H a w k in s , M D
T r u s te e : D a v id E. L a w , M D
TAKING
CONTROL
E x e c u t i v e D ir e c to r : D o u g la s J a c k m a n
A g i n g , R ic h a rd W a ltm a n ; A I D S , L a w re n c e S c h w a rtz ;
B y l a w s , S ta n le y T u e ll; B u d g e t / F i n a n c e , P atrice
S te v e n s o n ; C o l l e g e o f M e d i c a l E d u c a t i o n , W . D ale
O v e rfie ld ; C r e d e n t i a l s , S u sa n S alo ; E m e r g e n c y
M e d ic a l S t a n d a r d s , T e d W a lk le y ; E t h i c s /
S t a n d a r d s O f P r a c t i c e , D a v id L u k e n s; G r i e v a n c e ,
J a m e s M . W ilso n ; L e g i s l a t i v e , W illia m M arsh ;
M e d i c a l - L e g a l , P at D o n le y ; M e m b e r s h i p B e n e fits ,
I n c ., D re w D e u ts c h ; P e r s o n a l P r o b l e m s O f
P h y s i c i a n s , R o b e rt S a n d s; P u b l i c H e a l t h / S c h o o l
H e a l t h , J o s e p h W e a m ; S p o r t s M e d i c i n e , Jo h n
J ig a n ti.
T h e B u l l e t i n is p u b lish e d m o n th ly by P C M S
M e m b e rs h ip B e n efits, Inc. for m e m b e rs o f th e P ie rc e
C o u n ty M ed ical S o ciety . D e a d lin e s fo r su b m ittin g
a rtic le s an d p la c in g a d v e rtise m e n ts in T h e B u lletin
are th e 15th o f th e m o n th p re c e d in g p u b lic a tio n (i.e.
O c to b e r 15 fo r th e N o v e m b e r issu e).
T h e B u l l e t i n is d e d ic a te d to th e art, s c ie n c e and
d e liv e ry o f m e d ic in e an d th e b e tte rm e n t o f th e h e a lth
a n d m e d ic a l w e lfa re o f the c o m m u n ity . T h e o p in io n s
h e re in are th o se o f th e in d iv id u al c o n trib u to rs an d do
n o t n e c e s s a rily re fle c t the o fficial p o sitio n o f the
M e d ical S o c ie ty . A c c e p ta n c e o f a d v e rtisin g in no
w a y c o n s titu te s p ro fe s sio n a l a p p ro v a l o r e n d o rs e
m e n t o f p ro d u c ts o r se rv ic e s a d v e rtise d . T h e B u lletin
an d P ie rc e C o u n ty M e d ical S o c ie ty re se rv e th e rig h t
to re je c t an y a d v e rtisin g .
E d i t o r : D a v i d S . H o p k in s M D
S ta n le y T u e ll, W . B e n B la c k e tt, R ic h a rd H a w k in s
A d v ertisin g R ep resen tative: T an y a
S u b s c r i p t i o n s : $ 5 0 p e r y e a r , $ 5 p e r is s u e
M c C la i n
2 5 3 -5 7 2 -3 6 6 6 , F A X 2 5 3 -5 7 2 -2 4 7 0
E -m a il a d d re s s : p c m s w a @ p c m s w a .o r g
H o m e P a g e : h t t p : / / w w w . p c i n s w a . o r g __________________
Table of Contents
3
Beyond Medicine,Physidansenjoyathleticevents,activities
4
TPCHD: Firearm Practices in Pierce County
5
SeptemberGeneralMembeishipMeetingTraxama!
6
AppIicantsforMembership
6
1999Directory changes
7
Education for Physicians o n E n d of Life Care
8
Online phannacy sites explosionraises concemfor oversight
9
WSMAAnnualMeetrngPhysidare/PatimtsTakingChntol
10 NewCopyingChargesforDupKcatingPatientRecords
10 Advanced CodingSerninarofferedinTacoma
11 AnOpenLettertoPatientsabouttheM edicareProgram
11 W om eninM edidneM onth WomenPhysidansontheMove
12 Guides to Substance A buse Services available
13 TheInvisibleHand:TheHammurabiExperiement
15 H ie Pulse: PCM SANews
16 The College of Medical Education
17 The College of Med ical Education: Annual Calendar
18 Asthma: Crisis in inner'cities
HMGs: Red ink continues
Dr. Arroyo to participate in Orthopaedic Institute
19 QassifiedAdvertising
Beyond medicine, physicians enjoy athletic events, activities
M any en jo y p a r t i c i p a t i n g w ith t h e i r fam ily , p a r t ic u l a r ly t h e i r c h il d r e n
Athletic events abound in the
summer in W ashington State. Ever)'
weekend there is a ru n ning, biking, o r
some combination of, air athletic event.
And, you can alw ays do your ow n
tiring, like hiking kayaking, w ind
surfing, or even attem pting to scale one
of die infamous m ountain peaks.
Opportunities are as ab u n d an t as one's
interest or imagination.
Many PCMS m em bers take full
advantage of these opportunities, and
many as well, share the satisfactions of
such accomplishments w ith their
children.
Drs. P at Hogan, T aco m a
N e u ro lo g ist a n d David Law, T acom a
Internist, both have sh ared their
m ountain climbing accomplishments
w ith their children. Dr. H ogan, w ith
d au g h ter A drienne (Mt. Rainier) an d
son Patrick (Mt. St. H elens) a n d Dr.
Law w ith son Tad (Mt. Rainier and Mt.
Hood).
A very p o p u lar su m m er event for
families is die annual Seattle to Portland
bicycle rid e. Dr. Tim Schubert
completed the 190 mile ride w ith his
d a u g h te r, A lexa, a n d Dr. J. Greg
Zoltani enjoyed th e c o m p an y of his
Dr. Tim Schubert and daughter Alexa com pleted the Seattle
to Portland bicycle ride on a tandem. They pedaled to Long
view thefirst day (150 miles)
son, D an iel, w h ile Drs. Henry
Retailliau a n d Jim Fulcher ro d e
w ith their sons, D aniel and Tyler,
respectively.
D rs. Ja c k S tew art, Peter
K rum ins a n d Nick Iverson all
com pleted the RAM ROD (Ride
A ro u n d Mt. Rainier in O ne Day), a
rigorous, 160 m ile bike ride. It is a
tortuous course an d entry is limited.
E d it o r 's N o t e : If y o iih a v e p ic t io 'e s o f a n e v e n t o r
a c t iv it y th a t y o u h a v e u n d e r ta k e n w it h a n y o f y o u r
f a m ily m e m b e r s , p le a s e s u b m it th e m to th e P C A I S
B u lle t in f o r p u b lic a t io n
Dr. J. Greg Zoltani and son D aniel completed the Seattle to
Portland bicycle ride this summer
September, 1999
PCMS BULLETIN 3
B u l l e t in
S I 8 | J Health
Status of Pierce Countv
__________________________________________ ggg
T A C O M A -P IE R C E K O I IM TY
HEALTH
Firearm Ownership & Storage Practices
in Pierce County, 1996-1998
D E P A R T M E N T
T his article is p a rt of a series fro m
th e T acom a-P ierce C o u n ty H e a lth
D ep artm en t, re g a rd in g the health status
of P ierce C o u n ty resid en ts.
T h e d a ta p re s e n te d sh o u ld
p ro v id e a fram ew o rk for u n d e rs ta n d
ing th e H e a lth D ep artm en t's priorities
fo r p re v e n tio n strategies. O v e r th e
n e x t sev eral years, o u r g oal is to
re d u c e illness a n d d e a th re la te d to
sm oking, alcohol m isuse, violence a n d
H I V / AIDS. T h ese areas are re la te d to
beh aviors th a t deserve com m unityw id e a tten tio n a n d efforts fo r change.
E v ery y e a r the W a sh in g to n S tate
D e p artm en t of H ealth conducts a
statew id e h o u se h o ld survey. E very
e v e n n u m b e re d year, qu estio n s a b o u t
firearm o w n ersh ip a n d storage are
in cluded. T he co m bined 1996 a n d 1998
Pierce C o u n ty resu lts are sh o w n in th e
table above, alo n g w ith estim ates of
c h ild h o o d ex p o su re to h o u seh o ld
firearms.
H e a lth care p ro v id e rs sh o u ld be
a w a re th a tm a n y of their patients are
likely to possess firearm s a n d th a t som e
o f th ese firearm s are sto red un lo c k e d
a n d / o r loaded. E venfam ilies w h o d o
n o t o w n firearm s sh o u ld k n o w that
m o re th a n o n e o f e v e ry th re e h o u s e
h o ld s w ith children contains a firearm .
T h e sto rag e practices of th e firearm
o w n e r sh o u ld b e of co n cern to a n y
fam ily w h o se children visit o th er h o m es
in th e n eig h b o rh o o d .
T h e T aco m a-P ierce C o u n ty
H ea lth D e p a rtm e n t is d ev elo p in g a
c am p a ig n to en co u rag e h a n d g u n
o w n e rs to store th e ir g u n s in a lock
box. T h ese d ev ice s p ro v id e q u ick
4
PCM S BULLETIN
September, 1999
Firearm Ownership and Storage
Practices - Pierce County Households
with Children under 18 at Home 96/98
Firearm Ownership
(3 7 %
%
o f F ire a rm s
O w n e rs W h o :
E s t. # C h ild r e n u n d e r 18
E x p o s e d to H o u s e h o l d F ire a rm s
7 5 ,0 0 0
o f h o u s e h o ld s )
O w n H andguns
* O w n R ifle s /S h o tg u n s
62%
4 7 ,0 0 0
78%
5 1 ,0 0 0
Firearm Storage Practices
S to re F ire a rm s U n lo c k e d
57%
1 3 ,0 0 0
S to re F ire a rm s L o a d e d
22%
6 .0 0 0
S to re F ire a rm s L o a d e d a n d U n lo c k e d
14%
3 ,0 0 0
* M a n y fire a rm
o w n e rs re p o rt b o th h a n d g u n s a n d r ifle s /s h o tg u n s
access fo r th o se w h o h a v e g u n s fo r
protection w h ile k e e p in g th e g u n s o u t
of th e w ro n g h a n d s. In creasin g th e
n u m b e r of firearm s th at are safely
stored w ill red u ce u n intentional
firearm s injuries to children, re d u ce
d ie likelihood of y o u th carry in g fam ily
firearm s to school, re d u c e th e inci
d e n c e of th eft of fire arm s fo r u se in
s u b s e q u e n t v io len t crimes, an d reduce
th e accessibility of fam ily firearm s to
d e p re s se d a n d im pulsive adolescents.
If y o u a re in te re ste d in receiving
p a tie n t ed u catio n m aterials related to
fire a rm sto rag e o r w ish to be placed on
a m ailin g list fo r the safe storage
cam p a ig n , p lease contact W endy
W hite a t 798-6426.
O rgan & T issu e
D
O
N
A
T
I
O
N
Share Your Life. Share Your Decision.
For more information on organ and tissue donation
please call: LifeCenter Northwest,
toll free, 1-877-275-5269
Tuesday, S e p te m b e r 14, 1999
Social Hour:
6:00 pm
Dinner:
6:45 pm
Program:
7:45 pm
Tacom a
Trauma!
►System update
►Specialist support
►Hospital support
►Financial arrangements
(Registration required by Septem ber 10. Return this form to: PCMS, 223 Tacoma Ave S, Tacom a 98402; FAX to 572-2470 or call 572-3667)
Please reserve_______ dinner(s) at $20 per person (tax and tip included)
□ Visa
□
or my credit card # is________________________________________
Master Card
Expiration D ate________
Signature ___________________________
I will be bringing my spouse or a guest. Name for name ta g :____________________________________
Signed:_______________________________________________________
X
September, 1999
Thankyou!
PCM S BULLETIN
5
B u l l e t in
Applicants for Membership
C o w e ll, P a m ela D ., M D
O b s t e t r ic s /G y n e c o lo g y
K im , C h olw oo A ., M D
G en eral Su rgery
T a k a g i, B rian K ., M D
O p h th a lm o lo g y
Practices at Mt. Tahom a Gynecology,
4808112thStreet SW, L akew ood 98499;
582-5880
M edical School: W ayne State University
School of M edicine
Internship: G rady M emorial Hospital
Residency: Emory University Affiliated
Hospitals
Practices at M eridian Surgical
Sendees, 102-A 23rd AveSE, P u yallup
98372; 840-1999
Medical School: Univ of N orth
Carolina
Internship: Emory University Hospitals
Residency: Emory University
Hospitals Fellowship: Emory
University Hospitals
Practices at Valley Eye Clinic, 2622
M eridian Street S, Puyallup 98373; 8483545
M edical School: Univ of Pittsburgh
Internship: Cleveland Clinic
F oundation Residency: Cleveland
Clinic Foundation
Fellowship: M ason Eye Institute,
University of Missouri
K ihara, T odd K ., MD
V a sc u la r S u rg ery
Practices at Cascade V ascular
Associates, 1802 S Yakima, #204,
Tacoma 98405; 383-3325
Medical School: Univ of M aryland
Internship: G eisinger M edical Center
Residency: G eisinger M edical Center
Fellowship: H ershey M edical Center
P etrin, Jam es H., M D
D e r m a to lo g y
Practices at Puyallup Dermatology
Clinic, 1706 S Meridian, #140, Puyallup
98371; 841-2453
Medical School: Univ of W ashington
Internship: University of W ashington
Residency: University of W ashington
1999 Physician
Directory changes
B e r to z z i, P e te r , M D
P ierce C o u n ty M e d ic a l Society
M e d ic a l P la ce m e n t Service
M ailing address: 617 N "C" Street
Tacoma, W A 98403-2810
C o z a r t, J e n n ife r , PAC
The solution for all your staffing needs
W e provide for you:
► a n a v a ila b le p o o l o f q u a lifie d c lin ic a l &
a d m in istra tiv e a p p lic a n ts
► c o v e ra g e fo r v a c a tio n s, illn ess, leav es o f
a b se n c e , p e a k w o rk lo ad s, p r e g n a n c y , etc.
► em p lo y e e s w ith o u t th e h assle o f sa la ry ,
b e n e fits, ta x e s a n d o th e r su c h e m p lo y e e
re q u ire m e n ts
►
Tem p to Perm: A u n iq u e o p p o rtu n ity to w ork
w ith a p o te n tia l em ployee on a tria l basis
w ith o u t obligation to h ire
For more information:
Call D eborah Pasqua: 5 7 2 -3 7 0 9
6
PCMS BULLETIN
September, 1999
C hange address to:
2102 N Pearl Street, #405
Tacoma, W A 98406-2550
E h ly , J a y , M D (R etired )
C hange address to:
PMB1204
200 W 34thA venue
Anchorage, AK 99503-3969
M ic h e l, T e r r e l, M D
C hange address to:
336 21®Street SE
Puyallup, W A 98372-3220
S p a n g le r , R o n a ld , M D (Retired)
C hange address to:
19823 N W hite Rock Drive
S un City West, AZ 85375
U tt, T e r r ill, M D
Change m ailing address to:
PO Box 731009
Puyallup, W A 98373-0030
Education for Physicians
on
End of Life Care
A fo u r p a rt series:
Septem ber 16 a n d 30; O c to b e r 14 an d 28
7 :00 - 9 :0 0 a.m .
L an dm ark C on ven tion C en ter
47 St. H e len s A v e n u e , T a c o m a
Registration
S p o n so rs
To register, please call Pierce County Medical Society, 572-
This course is offered through the generous support o f
Franciscan Hospice, Group Health Hospice, Good Samaritan
Hospice, Multicare Hospice o f Tacoma, Pierce County Medical
Society, PCMS Alliance, Three Cedars, Compassionate
Choices and the College o f Medical Education.
3667. Registration is required and open to physicians only.
There is no fee. Priority will be given to those registering for
the entire series.
Faculty
O b je c ti v e s ; P articipants will:
Stuart Farber, M.D. is a Project on Death in America Scholar
and Assistant Clinical Professor in the Department o f Family
Medicine, University o f W ashington School o f Medicine. He
is board certified in family practice, geriatrics and hospice and
palliative medicine. EPEC* trained, 1999.
Mimi Pattison, M.D. is Medical Director, Palliative Care
Services and Chair, Medical Ethics Committee, Franciscan
Health System-West; Medical Director, Improving Care
Through End of Life, Internal Medicine-Nephrology,
Franciscan Medical Group. EPEC* trained, 1999.
a c c re d ite d
b y th e
C o m m itte e to p r o v i d e c o n t i n u i n g
W SM A
I CM E
M e d ic a l E d u c a tio n
m e d ic a l e d u c a tio n , th e C o lle g e
M e d ic a l E d u c a t i o n c e r t i f i e s t h a t t h i s c o u r s e
h o u rs o f C a te g o r y
how
to n e g o t i a t e g o a l s o f c a r e
• b e a b le
lo c o m m u n i c a t e p r o g n o s i s a n d
• b e a b le
to d e f i n e
• le a r n
how
advance
c a re p la n n in g
lo c o m m u n i c a t e b a d
• b e a b le
lo c o m p a r e
• b e a b le
lo
and
g e n e ra l g u id e lin e s
th e a s s e s s m e n t a n d
how
to p r e p a r e
• le a m
how
to
• b e a b le
and
e x p la in
know
and
assess and
to i d e n tif y
and
w hy
and
fo r m a n a g in g
hope
its i m p o r t a n c e
i t is i m p o r t a n t t o d o s o
n e u ro p a th ic
n o n -p a in
p a in
s y m p lo m s
m anagem ent o f com m on
th e p r in c ip le s fo r w ith h o ld in g
• le a m
id e n tify re a s o n a b le
e ffe c ts o f a n a lg e s ic s a n d th e ir m a n a g e m e n t
to a p p ly
new s and
c o n tra s t n o c ic e p liv e
id e n tify a d v e rs e
• b e a b le
and
id e n tify /a s s e s s a s s e s s m e n t a re a s
p h y s ic a l s y m p to m
o r w ith d ra w in g
th e ra p y
s u p p o r l th e p a tie n t, f a m ily , a n d c a r e g iv e r s
m anage
m anage
th e p a th o p h y s io lo g ic a l c h a n g e s o f d y in g
in itia l g r ie f re a c tio n
F o r M o re In fo rm a tio n
Accreditation, 7 H o u rs
A s an o rg a n iz a tio n
to s a t i s f y
th e
m e e ls th e
r e q u ir e m e n ts o f th e
S ta te M c d i c a l Q u a l i t y A s s u r a n c e C o m m i s s i o n
and
of
c rite ria fo r 7
W a s h in g to n
f o r th e P h y s ic ia n s ’
Please call the Pierce County Medical Society, 572-3667, for a
program brochure. Additional registration information,
including directions to the Landmark: Convention Center, is
available by calling the PCMS office.
R e c o g n itio n A w a r d o f t h e A M A .
September, 1999
PCMS BULLETIN 7
B u l l e t in
Personal Problems
of Physicians
M edical problem s,
d ru g s, alcohol, retire
m ent, em otional, or
other such d ifficulties?
*R o b ert Sands, C h a ir 752-6056
Bill D ean
272-4013
F. D ennis W aldron
265-2584
A s s u r e d
VOLVO
BMW
S E R V IC E & R E P A IR
(253) 588-8669
O n lin e ph arm acy sites explosion
raises co n cern s for oversight
Pharm acy w eb sites are a boom ing
business these days arid there is
concern regardin g h o w they are
policed. The actual n um ber of internet
pharmacies continues to grow rapidly
for both legitimate business an d not-solegitimate operators, as they both see
opportunities by selling prescription
drugs online.
Both the Federal Trade C om m is
sion and the Food and D rug Adm inis
tration are regulators of such busi
nesses and both have inform ed a
federal subcommittee that they are
w orking to fight illegal d ru g sales by
pharm acy w eb sites.
A lthough the FDA has outlined
their plan to double the num ber of
investigators from ten to 20, m any do n 't
feel this will m ake m uch difference and
continue to ask the question, "w here
are the cops on the Internet?"
It has been estim ated that the total
num ber of pharm acy w eb sites is
currently over 400. Everyone is
starting a site fearful of losing a
perceived business opportunity.
Hopefully, they operate legally by
filling written prescriptions from
physicians that they have verified.
H ow ever, som e sites offer easy access
to prescription drugs w ithout requiring
a prescription. M any anecdotes have
raised concerns in the medical profes
sion and the government.
The AM A has w orked with the
N ational Association of Boards of
Pharm acies (NABP) to develop a
program to identify legitimate sites. Hie
program will use a national seal to
identify the pharm acies that have been
licensed an d credentialed. Pharmacies
are licensed by the state in which they
do business.
The NABP also allows anyone to
rep o rt w h at they believe to be illegal
activities by a pharm acy web site. The
NABP has no authority to discipline,
but will tu rn over any information to the
appropriate authorities. Enforcement
activities are difficult and complicated
as m any transactions are conducted
across state lines or by foreign compa
nies. These difficulties have been
acknow ledged by the FTC and the
FDA.
Excerpts from AMNews, August 23/30,
1999. For a copy o f the complete
article, call PCMS, 572-3667
B o y le’s F o re ig n C a r R e p a ir
7202 S te ila c o o m B lvd S W
Allenmore
Psychological
H M Associates, P.S.
...a m u lti
discip lin ary
behavioral
health group
that w orks
w ith ph ysician s
----------------■752-7320 ■------------Do you have patients with difficult emotional
___________ 1530 Union Ave. S.. Ste. 16. Tacoma
PCMS BULLETIN
September, 1999
T otal Asset
m a n a g e m e n t , in c .
Registered In v estm en t Advisory
PERSONAL INVESTMENT
ADVICE PROM THE PRESIDENT
INDUSTRY-LEADING LOW EEES
(NO COMMISSIONS)
Giii 858-2745
4-TAM-RIA
WWW.
Duviil
1. Ro-sliopli, MBA. CF[’
C A L L O R VISIT OUR WEB TOR A
CD\CASSETT£ INTRODUCTION
WSMA Annual M eeting will focus on solutions
109th m eeting to b e h eld in Spokane S ep tem b er 30 - O ctober 2
"Physicians and Patients: Taking
Control," is the theme of the WSMA
Annual Meeting scheduled for
September 30-0ctober 2 in Spokane.
Speakers at the opening session will
focus on:
1) how to build a statew ide
coalition
2) how to identify specific
problems w ithin the health
care system
3) how to identify solutions and
ensure th a t the solutions are
carried out
Stuart Elway, president of Elway
Research in Seattle, will lead the way
with"Attitudes on Health Care," his
analysis of two statewide opinion
surveys commissioned by WSMA and
Physicians Insurance. He'll review
the state of the current health care
system as perceived by physicians
and the public.
The new WSMA and Physicians
Insurance public awareness campaign
will be introduced by Denise
Passinetti, vice president of public
relations for KNCB/Dave, a Seattle
public relations firm Ms. Passinetti,
whose talk is entitled "Moving
Awareness to Action," will explain
how the campaign will build statewide
support for changes in the health care
system that the survey research shows
iswanted by both the public and
WSMA members. She will explain the
campaign messages and strategies and
display the creative materials and ads
that will be used.
Dan Monson, head coach for
Spokane's Gonzaga University m en's
basketball team will also be a featured
speaker. He will reveal, in his talk,
“Leadership: Taking it to the Hoop
Takes Teamwork," how teamwork can
power successful sports teams as well
as groups of physicians.
PCMS m embers, Drs. Stu
F arber and Mimi Pattison will
present an educational session,
"Helping Families Prepare for the End
of Life Journey." Their session will be
held on Friday, October 1,1 - 5 p.m.
and is accredited for 3.75 hours of
Category 1 CME. Sessions will be
presented from the caregiver's and
physician's perspective. The
physician's perspective will include
techniques that physicians can learn
and incorporate into their discussions
w ith patients and their caregivers.
Other educational sessions
include:
D om estic V iolence
G enetics & Y our P ractice
M edical S trategies for T o
bacco C essation
M edicare C om pliance for
P h y sician s’ P ractices
A ddiction M edicine
Vaginal B irth after C esar
ean Section: Safe and
Sound S tra te g ies
A dvances in W om en’s
Health
MQAC: Pain M anagem ent
A llergy/A sthm a Sym po
sium
O phthalm ology
P sychiatry
Other highlights of the meeting
will be the President's Dinner which
will honor the outgoing president and
the N ew President's Inauguration and
Reception which will welcome the
new incoming officers and trustees.
M&Mt
PHYSICIANS
& PATIENTS
TAKING
CONTROL
Dr. Peter M arsh, Tacoma
Infectious Diseases physician, will be
stepping dow n from die sla te of
officers. He served as WSMA Presi
dent in 1997-98 and this past year as
Past-President.
The annual meeting is free to
members, and will be held at
Cavanaugh's Inn at the Park in
Spokane. To reserve your room call 1800-325-4000 or visit
www.cavanaughs.com. Ask for the
WSMA room discount.
If you have not received your
registration brochure, please call
PCMS, 572-3667 and one will be mailed
to you.
September, 1999
PCMS BULLETIN 9
B u l l e t in
New copying charges for duplicating patient records
The Health Care Information Act
of 1991 allows pa dents to obtain a copy
of their medical record, and also
allows physicians to charge a reason
able fee. Health care providers are
not required to honor an authorization
until the fee has been paid.
The procedure should include a
written requestfrom the patientto
examine or copy all or part of the
recorded health care information. The
health care provider should promptly,
but no later than fifteen working days
after receiving the request, make the
information available for examination
during regular business hours and
provide a copy, if requested, to the
Fees that providers can charge for
searching and duplicating records
increased as of July 1,1999. The new
fees, pursuant to WAC 246-08^400 and
RCW 70.02.070, cannot exceed:
Copy charges:
S .79 p e r page - first 30 pages
$ .60 p e r page - o th e r pages
Clerical fees:
$18.00 m axim um
Certification of Record:
$ 2.00
Editingbv the physician personally
(when required by statute-):
B asic office v isit c h a rg e
TACOMA RADIOLOGY
D etect and Monitor p
Low Bone Density
Comfortably, quickly, safely
and precisely
H e e l (P e r ip h e r a l D EXA )
L o w risk s c r e e n in g
Tacoma
Lakewood
Gig Harbor
(253)383-2038
(253) 572-5174
(253) 588-6083
(253) 858-3200
A lle n m o r e M e d ic a l C e n te r
Fran k S . B a k e r C e n te r
Po in t F o sd ick Im agin g
patient. If the
provider does
not maintain a
record of the
information, the
patient should be
given the name and
address ofthe health
care provider w ho
maintains the record.
Denial of examination and
copying of patient records can be
m ade if there is knowledge that the
heal th care information would be
injurious to the health of the patient or
expected to cause danger to the life or
safety of any individual.
For more information on patient
records and the Health Care Informa
tion Act, call the Society office, 5723667.
Advanced Coding
Seminar offered
in Tacoma
Washington State Medical Associa
tion is offering a new seminar on
Advanced CPT & ICD-9 Coding in
Tacoma on Friday, September 24 at the
LaQuinta Inn.
Morning sessions are from 8:30
a.m. to 12:30 p.m. and will address
coding for medical specialties, while
afternoon sessions (1:30 -5:30 p.m.) will
review coding for surgical specialties.
Obstetrics and Gynecology will be
covered as the last segment of both the
morning and afternoon sessions. Better
coding means better cash flow and
low er practice expenses.
Cost of each half day seminar is
$129 for WSMA members and their
staff ($258 for non-members). For
registration information call Kathy
Bimie at the WSMA office, 1-800-5520612
ffiesce ffownty q 41c<1(c<iI
An open letter to patients about the Medicare Program
Below is a suggested “open letter ’ to patients on Medicare fraud and abuse policies. It is intended to
show that physicians are concerned about “true”fraud, while educating patients about the. effects o f
burdensome Medicare regulations and overzealous fraud activities. The letter is a template. Physicians
may use it exactly as it is or modify it to suit their purposes. Plagiarism is encouraged.
As your physician, I w a n t y o u to
know that I ant concerned about M edi
care fraud. The A m erican M edical A s
sociation (AMA) has w orked diligently
over the years w ith C ongress an d
agencies of the federal go v ern m en t to
root out real fraud.
Physicians are concerned ab o u t
the simplistic approach the federal gov
ernment is currently taking tow ards a d
dressing M edicare fraud, h i press re
leases and policies, the federal govem mentfrequently lum ps honest billing
mistakes together w i th intentional
fraud. The result is that the patient-physician relationship is harm ed an d physi
cians are buried in paperw ork.
As you know , M edicare is ex
tremely complicated. Today, physicians
must comply w ith m ore th a n 100,000
pages of M edicare rules an d reg u la
tions. As a result of the com plexity of
the program, billing errors do occur.
My first and forem ost duty is to provide
you with the best m edical care.
Complying w ithfederal M edi
care requirem ents is forcing m e to
spend a great deal m ore tim e an d ex
pense on adm inistration This m eans
that I and m y office staff have less time
to spend on direct patient care. Al-
t
A M E R IC A N L U N G A S S O C IA T IO N ™
ofV&shington
1-800-LUNG-USA
Lung Inform ation
Service L ine
Providing patient
education materials
X
th o u g h this is a disservice to you and
m y other patients, I m ust go along w ith
these rules - or else d ro p o u t of the
M edicare p ro g ram for good.
A M A physicians are u rg in g the
federal governm ent to simplify M ed icare regulations a n d to educate p hysi
cians o n w h a t w e need to do to com ply
w ith the requirem ents. W e are hopeful
that the federal governm ent w ill tone
d o w n its rhetoric that labels honest
physicians as criminals, and instead lo
cus on identifying those individuals
w ho are truly committing intentional
fra u d and bilking the taxpayers.
In ad v e rte n t billing errors are
b o u n d to occur in a p ro g ram as com
plex as M edicare. Like m ost physi
cians, I am trying m y best to comply
w ith the extremely complicated M edi
care p ro g ram . If y o u believe y o u have
fo u n d an error, please b ring it to m y at
tention. 1w a n t to be helpful an d answ er
y o u r questions. You sh o u ld feel confi
d en t and comfortable about the medical
care th a t y o u receive from me. T hank
y o u for listening to m y concerns. I am
alw ays available to listen to yours.
Women Physicians on the Move Celebrating our History
S ep tem b er is W om en in M edicine M onth
This year com m em orates twenty
years of w o m en physician leadership at
the American Medical Association
(AMA). W hen the AM A created its first
formal comm ittee in 1979 to identify the
needs of the grow ing n u m b e r of
w o m en in medicine, only about 10% of
U.S. physicians w ere fem ale. By the
beginning of 1999, the n u m b er of
w om en phy sicians had m ore than
tripled. W om en now rep resen t 22% of
all U.S. physicians.
This celebration of the g ro w th
and accomplishments of w om en
physicians will serve as the fram ew ork
of the 1999 Septem ber W om en in
Medicine M onth campaign. 11also
presents a n o p portunity for y o ur
m edical society to herald its o w n
history of w om en physician leadership.
The dram atic g ro w th in the
n u m b er a n d influence of w om en
physicians, particularly over the past
tw o decades, has m ade the medical
profession an d the AM A stronger. Of
course, w e m u s t also recognize the
contributions of the m any outstanding
w om en physicians w ho paved the way.
For exam ple, in 1896, Dr. Sarah
H ackett Stevenson becam e the first
w om an m em ber of die AMA. The AMA
w elcom ed its first w om an delegate in
1915.
T his y e a r's S eptem ber W om en
in Medicine M onth cam paign is an
occasion to celebrate o u r pioneers, o ur
colleagues and the w om en physicians
of the future. As always, it is also a
chance to focus on yo u r m em bership
and program m ing effort on this
im portantphysician segment. W e hope
y ou will also help to prom ote m em ber
ship in the A M A and the W omen
Physicians Congress (WPC).
September, 1999
PCM S BULLETIN
11
B u l l e t in
G uides to Substance Abuse Services available
The Substance A buse and M ental
H ealth Services A dm inistration of the
Departm ent of H ealth and H um an
Services h as p u b lish ed A Guide to
Substance Abuse Services fo r Primary
Care Clinicians, w hich includes a
po ck et reference guide. The d o cu
ments are designed to transm it know l
edge on substance abuse treatment,
provide guidance on sound clinical
and administrative practices, and
thereby im prove alcohol and other
d ru g treatm ent. They are products of a
systematic an d innovative process that
b ro u g h t together clinicians, research
U
ers, program managers, policy makers,
an d other experts to reach consensus
on treatm ent practices.
The bo u n d book provides
practical information for identifying
indications of subs tance abuse an d
initiating a discussion of substance
abuse disorders, conducting brief
interventions for patients in the early
states of substance abuse, an d ap p ro p ri
ately referring m ore seriously affected
patients for in-depth assessment and
treatment. The docum ent includes
recommendations aboutpharmacotherapy and legal issues surrounding
privacy an d confidentiality.
The reference book summ arizes
essential inform ation on screening and
assessm ent of patients during the
clinical interview, an d "Identifying
Substance A buse in the Prim ary
Setting," a n accom panying brodiure
provides a quick an d easy-to-use-tool
for screening patients. The documents
rep resen t n ew efforts to provide
inform ation to practitioners in formats
th at are easily used in patient interac
tions.
For inform ation on receiving a
copy of the materials, call PCMS, 5723667.
NION
M RI
2502 South Union Avenue, Tacoma, WA 9840'
Locally owned, managed and committed to
support of our Puget Sound medical community.
Call (253) 761-9482 or 1 -(888) 276-3245
M ultiC are H ealth System
12
PCMS BULLETIN
Franciscan H ealth System
September, 1999
D ia g n o stic Im aging N o r th w est
Tacom a Radiology
Pharmacy Directory Federal W ay- K ing C ounty (All area codes a re 253)
Tacoma (all area codes are 253)
5 6 4 -0 0 8 8 F X : 5 6 4 -4 0 6 2
A l b e r t s o n ’s 3 3 6 2 0 - 2 1 s t A v e S W
5 6 5 -7 9 9 7 F X : 4 6 0 -0 4 4 0
C o s t c o 3 5 1 0 0 E n c h a n t e d P k w y .............................................................................. 8 7 4 - 4 4 3 1
’'- • A lb e r ts o n 's 2 4 0 1 N o r t h P e a r l S t ...........................................................................
7 5 2 -7 9 1 9 F X : 7 6 1 -7 7 3 0
D ru g E m p o riu m
i-t A lb e rts o n 's 8 6 1 1 S t e i l a c o o m B l v d ....................................................................
5 8 2 -4 1 4 9 FX : 5 8 2 -8 6 6 4
F a m ily P h a r m a c y 3 0 8 0 9 - 1 st A v e S o u th
#K
......................................... 8 3 9 - 3 1 0 0 F X : 9 4 1 - 4 3 1 0
>
A llenm ore M u l t i C a r e C l i n i c P h a r m a c y , S 1 9 t h & U n i o n ...........
4 0 3 -5 0 5 5 FX : 4 0 3 -5 7 9 4
F ra n c is c a n P h a rm a c y 3 4 5 0 3 - 9 th A v e S o u th
# 1 1 0 ............. ^ ) . ) . . 9 4 2 - 4 0 4 0 F X : 9 4 2 - 4 0 4 6
t"
A llenm ore P h a r m a c y 1 9 0 1 S o u t h U n i o n # A 2 5 2 ................................
3 8 3 -5 5 1 9 FX : 2 7 2 -9 3 2 4
F r e d M e y e r 3 3 7 0 2 - 2 1 s t A v e ................................................................................... 9 5 2 - 0 1 3 3 F X : 9 5 2 - 0 1 4 2
^
B r id g e p o rt P ro f P h a rm a c y 7 4 2 4 B rid g e p o rt W a y
\ & H P re sc rip tio n 2 6 0 3 B r i d g e p o r t W a y W
A l b e r t s o n 's 3 9 0 5 B r i d g e p o r t W a y W
....................................................................... 9 5 2 - 3 3 2 3 F X : 8 7 4 - 4 8 5 3
F X : 8 7 4 -5 7 7 3
2 0 3 0 S o u t h 3 1 4 t h .............................................................. . . . . 9 4 6 - 1 2 2 2 F X : 9 4 6 - 4 0 4 6
W .....................
5 8 2 -1 6 6 2 F X : 5 8 9 -9 6 9 8
L o n g s D r u g s 1 2 0 9 S o u t h 3 2 0 t h .............................................................................. 9 4 5 - 6 7 5 2 F X : 9 4 5 - 7 1 3 8
c en tru y P l a z a 1 7 0 8 S o u t h Y a k i m a .......................................................... 0 . ) .
5 9 1 -6 9 2 0 FX : 3 0 5 -6 4 2 0
R ite A id 2 1 3 1 S W 3 3 6 th
- i - Chung P h a r m a c y 9 1 2 2 S o u t h T a c o m a W a y # 1 0 4 .............................
5 8 4 -2 4 8 4 F X : 5 8 4 -6 0 9 4
R ite A id 3 1 0 0 9 P a c ific H w y S o u th
I,...' Cost L ess P r e s c r i p t i o n s 5 4 3 1 P a c i f i c A v e ..................................................
4 7 4 -9 4 9 3 F X : 4 7 4 -2 3 6 9
T o p F o o d s & D ru g
L ‘ C o s t L e ss P r e s c r i p t i o n s 1 1 0 9 R e g e n t s B l v d ( F i r c r e s t ) ..................
5 6 4 -5 2 0 0 FX : 5 6 4 -6 6 9 8
V i r g i n i a M a s o n S o u t h 3 3 5 0 1 - 1 s t W a y S o u t h .......................................... 8 7 4 - 1 6 5 0 F X : 8 7 4 - 1 6 6 5
1:1 Cost P lu s P h a r m a c y & F a m i l y C a r e C t r
2 0 4 N o r t h " I " S t ......
6 2 7 -1 1 8 8 F X : 6 2 7 -0 1 5 8
S t ......................................................................................... 9 5 2 - 2 8 0 3 F X : 9 5 2 - 0 3 8 7
...................................................................... 9 4 1 - 5 0 1 3 F X : 5 2 9 - 1 5 1 9
3 1 5 1 5 - 2 0 t h A v e S o u t h .......................................... 8 3 9 - 9 3 2 2 F X : 8 3 9 - 9 3 9 7
Costco P h a r m a c y 3 6 3 9 S o u t h P i n e S t ..........................................................
4 7 5 -2 3 7 6 F X : 4 7 5 -0 4 6 0
Fife (All area codes are 253)
;- t ; F ranciscan P h a r m a c y - T a c o m a S o u t h , 2 1 1 1 S o u t h 9 0 t h ..............
5 3 5 -5 6 1 5 F X : 5 3 5 -5 7 1 7
F ife U n ite d D ru g 5 3 0 3 P a c ific H w y E a s t .
. 9 2 2 -0 2 2 2 F X : 9 2 6 -2 5 4 1
Fred M e y e r 4 5 0 5 S o u t h 1 9 t h S t ..........................................................................
7 5 2 -9 1 1 0 FX : 7 5 6 -9 3 2 0
F i f e V a l l e y M a r t 5 3 0 6 P a c i f i c H w y E a s t ...
. 9 2 2 -8 7 2 2 F X : 9 2 2 -0 1 3 6
Fred M e y e r 6 9 0 1 S o u t h 19 t h S t ..........................................................................
5 6 5 -7 5 8 5 F X : 5 6 5 -7 9 7 1
Fred M e y e r 5 1 1 5 1 0 0 t h S t S W ( L a k e w o o d ) ............................................
5 8 9 -4 4 3 3
^
S ' Kmart 14 1 4 E a s t 7 2 n d ...................................................................................................
FX : 5 8 9 -4 4 4 2
5 3 7 -6 6 6 8 F X : 5 3 9 -8 4 6 1
3 8 t h .................................................................
4 7 3 -1 1 5 5 FX : 4 7 3 -1 1 5 8
Longs D ru g s 5 4 0 1 - 6 t h A v e ..................................................................................
7 5 2 -1 4 8 4 F X : 7 6 1 -9 4 3 0
Longs D ru g s 7 9 0 1 S o u t h I - i o s m e r ....................................................................
4 7 2 -7 4 8 8 F X : 4 7 2 -3 7 8 9
M ai L in h P h a r m a c y 1 2 1 1 S o u t h 1 1 th S t ....................................................
3 8 3 -2 5 7 6 F X : 3 8 3 -2 5 9 8
Lincoln P h a r m a c y 8 2 1 S o u t h
M ary B r id g e C l i n i c s P h a r m a c y 3 1 1 S o u t h L S t ..................................... 4 0 3 - 1 4 1 1
FX : 4 0 3 -1 7 4 5
G ig H arbor (All area codes are 253)
B a r t e l l D r u g s 5 5 0 0 O l y m p i c D r .................................................................
. 8 5 8 -7 4 5 5 F X : 8 5 8 -7 4 6 0
C o s t L e ss P re s c rip tio n s 1 4 2 1 8 - 9 2 n d A v e N W
(P u rd y ).
. 8 5 7 -7 7 9 7 F X : 8 5 7 -7 6 7 9
G i g H a r b o r R e x a l l 3 1 1 4 J u d s o n S t ........................................................
. 8 5 8 -9 9 0 8 F X : 8 5 8 -7 2 1 3
O ly m p ic P h a rm a c y 4 7 0 0 P t F o s d ic k D r N W
. 8 5 8 -9 9 4 1
# 1 1 0 . . . ..........
F X : 8 5 1 -9 9 4 2
R i t e A i d 4 8 1 8 P t F o s d i c k D r N W .............................................................
. 8 5 1 -6 9 3 9 F X : 8 5 8 -3 2 0 3
S a fe w a y 4831
. 8 5 1 -6 8 7 0 F X : 8 5 1 -6 8 7 0
P t . F o s d i c k D r N W ........................................................
M edical C e n t e r P h a r m a c y 1 2 0 6 S o u t h 1 1 th S t ....................................... 3 8 3 - 5 3 5 9 F X : 3 8 3 - 4 7 3 2
— M ega P h a r m a c y 7 9 1 1 S o u t h
H o s m e r .............................................................. 4 7 3 - 1 9 1 9
FX : 4 7 3 -6 5 2 8
M u ltiC are C l i n ic P h a r m a c y 5 2 1 M L K i n g J r W a y ............................... 4 0 3 - 4 9 2 0 F X : 4 0 3 - 4 8 5 6
P arkland M a r k e t p l a c e 1 3 3 2 2 P a c i f i c A v e .................................................... 5 3 1 - 3 7 1 1
|
F X : 5 3 7 -0 9 9 3
.......................................... 2 7 2 - 1 1 0 7 F X : 2 7 2 - 7 3 2 7
P uget S o u n d P h a r m a c y 1 1 1 2 - 6 t h A v e # 1 0 1
R ain ie r P h a r m a c y 1 9 0 1 S o u t h C e d a r # 1 0 4 ................................................. 2 7 2 - 2 2 9 3
FX : 2 7 2 -2 2 9 4
R ankos P h a r m a c y 1 0 1 N o r t h T a c o m a A v e ................................................. 3 8 3 - 2 4 1 1
F X : 5 7 2 -4 3 2 9
R iteA id 3 8 4 0 B r i d g e p o r t W a y W .......................................................................... 5 6 4 - 2 2 5 5 F X : 5 6 4 - 0 1 8 9
y | R iteA id 9 8 3 0 P a c i f i c A v e ............................................................................................. 5 3 1 - 6 5 3 3
M ilton (All area codes are 253)
A l b e r t s o n ’s 2 8 0 0 M i l t o n W a y .......................
. 9 5 2 -8 4 3 6 FX : 9 5 2 -8 4 7 8
R i t e A i d 9 0 0 E a s t M e r i d i a n ...............................
. 9 5 2 -2 6 8 0 F X : 9 2 5 -0 6 8 5
S a f e w a y 9 0 0 E a s t M e r i d i a n ............................
. 9 5 2 -0 3 9 0 FX : 9 5 2 -4 3 5 4
O rting (Area code 360)
C o p e 's O r t i n g P h a r m a c y
134 W a s h in g to n A v e .
. 8 9 3 -2 1 1 7 F X : 8 9 3 -8 8 8 8
F X : 5 3 9 -4 3 8 3
1‘ R iteA id 5 7 0 0 - 1 0 0 th S t S W # 1 0 0 ( L a k e w o o d ) ........................................ 5 8 8 - 3 6 6 6 F X : 5 8 8 - 1 9 2 2
R iteA id 7 0 4 1 P a c i f i c A v e ............................................................................................. 4 7 4 - 8 5 0 0 F X : 4 7 4 - 0 2 5 3
Puyallup (All area codes are 253)
RiteA id 6 8 0 2 S o u t h 1 9 t h ............................................................................................. 5 6 4 - 7 2 2 3
FX : 5 6 4 -0 2 0 6
A l b e r t s o n ’s 1 6 1 2 0 M e r i d i a n E a s t
R iteAid 15 8 0 1 P a c i f i c A v e .......................................................................................... 5 3 1 - 7 4 2 7
FX : 5 3 5 -9 2 7 9
A l b e r t s o n ’s 1 1 0 1 2 C a n y o n R d E a s t ..................................................................... 5 3 7 - 3 8 0 8 F X : 5 3 9 - 3 6 5 4
..................................................................
8 4 5 -9 6 1 7 F X : 7 7 0 -3 5 7 8
RiteAid 1 9 1 2 N o r t h P e a r l ............................................................................................ 7 5 6 - 6 7 0 7
F X : 8 7 9 -0 2 7 2
B e a l l ’s P h a r m a c y 6 1 8 S o u t h M e r i d i a n , S u i t e A
.................................... 8 4 5 - 8 4 4 4 F X : 8 4 5 - 7 1 1 4
RiteAid 4 5 0 2 S o u t h S t e e l e S t .................................................................................. 4 7 4 - 8 3 5 5 F X : 4 7 3 - 3 9 4 9
F r e d M e y e r 1 1 0 0 M e r i d i a n N o r t h .......................................................................... 8 4 0 - 8 1 8 3 F X : 8 4 0 - 8 1 7 7
....................... 8 4 6 - 0 5 4 2 F X : 8 4 6 - 8 7 1 6
F r e d M e y e r 1 7 4 0 4 M e r i d i a n E a s t ............................................................................ 4 4 5 - 7 8 7 3 F X : 4 4 5 - 7 8 6 7
RiteAid 2 2 3 1 1 M o u n t a i n H w y E
(S p an aw ay )
Safeway 7 0 7 S o u t h 5 6 t h S t ....................................................................................... 4 7 1 - 1 7 3 0 F X : 4 7 1 - 3 5 2 9
M e d i c i n e S h o p p e 1 2 1 0 E a s t M a i n ........................................................................ 8 4 8 - 1 5 9 7
Safeway 2 4 1 1 N o r t h P r o c t o r .................................................................................... 7 5 9 - 9 8 8 9 F X : 7 5 6 - 6 9 0 2
R i t e A i d 1 3 2 3 E a s t M a i n ..................................................................
FX : 8 4 8 -6 2 6 8
8 4 8 -3 5 6 4 F X : 7 7 0 -9 1 8 7
Safeway 1 0 5 0 7 G r a v e l l y L k D r S W .................................................................. 5 8 1 - 7 1 8 1
FX : 5 8 8 -3 6 5 8
R i t e A i d 3 7 1 7 M e r i d i a n ..................................................................................................... 8 4 8 - 1 5 4 4 F X : 8 4 1 - 4 1 1 9
Safeway 1 3 0 2 S o u t h 3 8 t h S t .................................................................................... 4 7 1 - 5 5 1 1
FX : 4 7 1 -9 6 7 3
R ite A id 1 1 0 1 2 E a s t C a n y o n R d
Safeway 1 6 2 4 7 2 n d S t E a s t ....................................................................................... 5 3 7 - 2 4 3 5
FX : 5 3 7 -3 0 1 9
S a fe w a y 4 301
Safeway 1211 S o u t h “ M ” S t ..................................................................................... 5 7 2 - 7 7 5 3
F X : 2 7 2 -9 3 1 5
S a f e w a y 1 0 1 0 5 - 2 2 4 t h S t E a s t ( G r a h a m ) ..................................................... 8 4 7 - 7 6 3 4 F X : 8 4 7 - 7 6 3 5
...................................................
5 3 5 -5 6 6 0 F X : 5 3 7 -2 2 0 1
S o u t h M e r i d i a n ................................................................................ 8 4 1 - 6 4 9 5 F X : 8 4 1 - 6 4 9 6
Sm indview P h a r m a c y 3 6 1 1 S o u t h “ D ” S t .................................................. 7 5 6 - 8 5 8 5 F X : 4 7 4 - 7 8 7 4
S a f e w a y 5 5 1 2 - 1 6 1 s t E a s t ( a t C a n y o n R o a d ) ......................................... 5 3 1 - 5 8 3 1
Spanaway D r u g 1 7 7 0 3 P a c i f i c A v e .................................................................... 8 4 6 - 0 5 1 1
F X : 8 4 6 -0 5 1 3
S u m m i t T r a d i n g C o 1 0 4 0 9 C a n y o n R d E a s t .............................................. 8 4 0 - 2 0 9 8 F X : 5 4 0 - 0 3 0 8
Tacoma P h a r m a c y 9 1 1 5 S o u t h T a c o m a W a y # 1 0 9 ............................. 9 8 4 - 9 5 8 0 F X : 9 8 4 - 1 2 9 4
T o p F o o d s & D r u g 2 0 1 - 3 7 t h A v e S E ............................................................. 7 7 0 - 7 7 2 0 F X : 7 7 0 - 7 7 3 8
Top F o o d s & D r u g 3 1 3 0 S o u t h 2 3 r d ............................................................... 5 9 1 - 3 1 1 0 F X : 5 9 1 - 6 2 7 8
W a lm a rt P h a rm a c y 3 1 0 - 3 1 s t A v e S E
.....................................................
FX : 5 3 6 -5 2 3 5
7 7 0 -9 8 8 9 F X : 7 7 0 -9 9 8 3
Union A v e P h a r m a c y 2 3 0 2 S o u t h U n i o n ..................................................... 7 5 2 - 1 7 0 5 F X : 7 6 1 - 9 3 1 5
W algreens 9 5 0 5 B r i d g e p o r t W a y S W ................................................... it 1
. })... 5 8 2 - 2 2 3 0 F X : 5 8 2 - 0 6 5 4
Sum ner (All area codes are 253)
W algreens 8 4 0 5 P a c i f i c A v e ......................................................................... !# ! .) .. 5 3 6 - 3 7 0 5
M a r k ’ s P h a r m a c y 1 1 1 9 M a i n ...................................................................................... 8 6 3 - 6 2 2 3
W algreens 4 3 1 5 - 6 t h A v e ...............................................................................
FX : 5 3 6 -4 6 5 9
7 5 6 -5 1 5 9 FX : 7 5 6 -5 0 8 6
N i c h o l s o n ’s P h a r m a c y 9 1 0 A l d e r A v e ............................................................. 8 6 3 - 8 1 4 1
F X : 8 6 3 -3 7 0 7
W algreens 7 4 5 1 C i r q u e D r W .................................................................................. 5 6 4 - 7 5 6 9 F X : 5 6 4 - 8 2 0 8
W algreen s 8 2 2 4 S t e i l a c o o m B l v d S W
............................. ............. 5 8 1 - 0 4 9 4 F X : 5 8 1 - 0 9 9 7
G o o d S a m a r i t a n H o s p i t a l ............................................................................................... 8 4 1 - 5 8 9 9 F X : 7 7 0 - 5 6 5 5
Fred M e y e r 2 0 9 0 1 H w y 4 1 0 ................................................
. 8 9 1 -7 3 3 3 F X : 8 9 1 -7 3 2 7
RiteAid 2 1 3 0 2 H w y 4 1 0 ......................................................
. 8 6 2 -2 8 2 2 F X : 8 6 2 -8 4 3 0
Z',',...,
B afe w ay 2 1 3 0 1 H w y 4 1 0 ....................................
. 8 6 2 -2 5 3 3 F X : 8 6 2 -2 1 7 3
M a r y B r i d g e C h i l d r e n ' s H o s p i t a l ............................................................................ 5 5 2 - 1 0 7 6 F X : 5 5 2 - 1 5 5 8
P u g e t S o u n d H o s p i t a l .......................................................................................................... 4 7 4 - 0 5 6 1 F X : 4 7 2 - 8 6 9 7
S t . C l a r e H o s p i t a l P h a r m a c y ....................................................................................... 5 8 1 - 6 4 1 0 F X : 5 8 9 - 8 2 9 4
S t . F r a n c i s H o s p i t a l P h a r m a c y ................................................................................. 9 5 2 - 7 9 6 6 F X : 9 5 2 - 7 9 2 4
Eatonville (Area code 360)
S t . J o s e p h M e d i c a l C e n t e r ................................................................................ { * ) . ) . . 5 9 1 - 6 6 8 3 F X : 5 9 1 - 6 9 5 6
0 r k ’s P h a r m a c y 1 0 4 M a s h e l l A v e N o r t h .
. 8 3 2 -4 7 0 0 F X : 8 3 2 -4 5 2 0
Pharmacy H otlin e ................................................2 5 3 -8 4 6 -0 5 1 1
lumbers in parentheses a
H ospital O utpatient P harm acies (All area codes are 253)
A l l e n m o r e H o s p i t a l .............................................................................................................. 4 0 3 - 5 1 5 0 F X : 4 0 3 - 5 0 9 2
IBonneyi ]Lake (All area codes are 253)
a t v o i c e m a il p r o m p t t o r c a l l s 'f io m p h y s i c i a n o f f i c e s o n l y
T a c o m a G e n e r a l H o s p i t a l ................................................................................................ 4 0 3 - 1 0 7 6 F X : 4 0 3 - 1 5 5 8
The ph arm acy h otline is f o r reportin g fra u d u len t ph arm acy activities
<5/99 P ie r c e C o u n ty M e d ic a l S o c ie ty ; p le a s e c a ll 5 7 2 - 3 7 0 9 f o r c h a n g e s / a d d itio n s
The Invisible Hand...
“The Hammurabi Experim ent”
Tyrants like to portray themselves
as the benefactors and the protectors
of the little people. Every tiling they do
is for our own good. Of course, they
are the best placed to know w hat is
good for us.
That did not
startwith
Hammurabi,
nor wall it
end with
Stalin. They
may debase
the coinage
to the point
where it is
Andrew N. Statson, MD
all copper
and no sold. The merchants, however,
are expected to give good m easure,
and the craftsmen are expected to do
solid work. They also are expected to
accept in payment the centrally deter
mined price and in the debased coin
age in circulation.
The laws of H am m urabi cover a
wide variety of topics. They mostly de
termine prices for good and services,
but also establish punishments for
crimes and mishaps. Several provisions
pertain to the practice of medicine.
Among them is the following "If a phy
sician has trea ted a freeman with a
bronze knife and has cured the free
man, he shall receive ten shekels of sil
ver. If a physician has trea ted a free
man with a bronze knife and caused
the man to die, his hand shall be cut
off." There are various translations of
this text, but the above is a reasonable
approximation
There are some indications that
the price fixing reduced trade and af
fected the prosperity of the city. There
are no documents from the city of
Babylon concerning the practice of
medicine under this law. A few clay
tablets dealing with the practice of
medicine were found in other cities in
i- Ainu
by name, Hammurabi, the rev wen I prinee who fear s the ;
i gods, to render good to the people, to m ake justice shine in the: land, to destroy the
evil and wicked, to ensure that the strong do n ot oppress the weak.
Tine I aw s of H aninuaabi ('19th Century BQ
Babylonia, but most of diem come from
Assyria.
We have an account on the city
of Babylon from the 5lhcentury BC by
Herodotus: "Next iningenuity to the
old marriage custom is dieir heatment
of disease. They have no physicians,
but bring their sick out into die street,
w here anyone who comes along of
fers the sufferer advice on his com
plaint, either from personal experi
ence, or observa tion of a similar com
plaint in others. Anyone will stop by
the sick man's side and suggest rem
edies, which he has himself proved
successful in whatever the trouble may
be, or which he has know n to succeed
with other people. Nobody is allowed
to pass a sick person in silence, b ut ev
eryone mustask him what is the mat
ter."
Present day assyriologists do not
believe Herodotus could be right.
They think he either invented the
story, or was misled. Possibly so, but so
far no docum ent from ancient Greek
or Roman sources has been discov
ered to prove H erodotus wrong, or
even to merely contradict him. Yet
Greeks and Romans had extensive
contacts with the Mediterranean and
the Middle Eastern worlds, which
Herodotus describes. In ancient
Greece and Rome, Herodotus was
considered not only a scholar, but also
a model of scholarship. It is easy to u n
derstand w hy by reading "The Histo
ries." In his narrative he clearly distin
guishes between the things he person
ally saw; the tilings told to him by reli
able sources, such as the priests and the
scribes of tire temples; and the stories
he heard from other people. W hen he
has heard different versions of the
same event, he relates all of them, giv
ing his sources. When he has an opin
ion, he states wliich version he thinks is
the most likely to be true. His descrip
tion of the customs of Baby Ion is based
on his personal observations during his
visit diere.
The assyriologists make several
points on this subject. The practice of
medicine in Mesopotamia had diree as
pects: surgical, expressed by the use of
a knife; medical, expressed by the ad
ministration of herbs and potions; and
psychosomatic, expressed by incanta
tions and spells. The laws of Hammurabi
deal only with die surgical aspect.
Therefore, even if the practice of sur
gery had ceased, die medical and psy
chosomatic prac ti tioners should not
have been affected. However, the texts
discussing the practice of medicine in
Babylonia and Assyria describe mainly
one type of physician, the "asu," imply
ing that he probably was a general
practitioner, using a bronze knife at
times, giving herbs and potions at other
times, and doing incantations and spells
as well.
A nother aspect of the above
point is that the stele widi die laws of
Hammurabi has areas that have been
rubbed off and are not legible. Consid
ering the am ount of detail diese laws
cover, it is possible that the other as
pects of medical practice were covered
Se e "E xperim ent" p a g e
September, 1999
PCM S BULLETIN
14
13
^ E x p e rin T e n f'fiD rn F a g e B
as well, at least regarding the prices of
services. This co u ld have been o n the
sam e stele, or p erh ap s on another one,
still bu ried u n d e r the silt of the
Euphrates.
T he severity of the law is an
other point. The assyrioiogists say the
law is so harsh, that it could not have
b een enforced. T hat m ay be so, b u t the
laws of H am m urabi also provide penal
ties forjudges, if they changed the law,
an d for civil servants, if they d id n o t ap
ply it. W hether the law s w ere enforced
or not w o u ld then depend on how long
w as the arm of the king.
It is tru e the law is very severe.
Unless the physicians of Babylon had
six arm s, like som e depictions of
Brahma, they w ere out after only two
strikes. D ocum ents from several cities
in Babylonia and also from Assyria,
suggest that m edicine continued to be
practiced after the time of H am m urabi.
There are no such docum ents from the
city of Babylon proper. This m ay be
because the city of Babylon has not
been d u g out. It is also possible that the
other cities of Babylonia d id n o t en
force the law an d d id n ot suffer the
sam e consequences. Even though his
torians speak of a Babylonian em pire, it
consisted of m any city-states w ith their
ow n kinds, w ho paid tribute to Babylon
but w ere autonom ous in their internal
affairs. So w hile it is likely that the laws
of H am m urabi w ere enforced in the
city of Babylon, it is unlikely that they
w ere heed ed elsew here.
Let m e transport y o u for a m o
m ent to tire city of Babylon d uring the
time of H am m urabi. W e are the physi
cians of the city and w e gather in the
hom e of one of ou r colleagues, the first
one to suffer u nder the new law. W e
look at the end of his arm, w here his
han d should be and see a stum p. Then
w e look a teach other. W e k n o w th a t
the questions about our turn to suffer
the same fate is not w hether b ut w hen.
O ne of the old-timers says: "I w as going
to retire last year, b u t the patients just
keep calling. N ow I'm going to quit for
Federal Way’s Finest
Address:
T h e M e d ic a l P a v ilio n
A t St. F ra n c is H ospital
riTTT
F e d e ra l Way
5 2 ,0 0 0 Square Foot Medical/Professional Office Building
Available space up to 6,400 Sq ft. - divisable
J o in T h e s e T enants: M edalia H ealth Care * St Francis W omen’s
C en ter • P ediactrics N orthw est • D igestive H ealth
N etw ork • P h a rm a c y & D iagnostic Lab • Dr. B arbara Levy
sure." A younger physician says: "I
have an uncle, w h o is a m erchant in Ur.
I' 11visit h im to see w hether he could
em ploy me." H ow m any of us do you
think will w ait around for the first
strike? H ow m any will stay after that for
the second?
I d o n 't know w hether Herodotus
is telling the truth. I don'tknow
w hether the la w s of Hamm urabi de
stroyed the m edical profession of
Babylon. The m ore surprising thing is
not that it could have happened, but
that the effect of the law w ould still
hav e been p resen t 14 centuries later.
O f course th at is ancient history. We
have com e a long w ay since then. To
day w e are m uch more civilized.
G ranted w e still have a central control
of prices, b u t at least in case of mishap
w e seldom h u rt our physicians physi
cally. W e only scar them emotionally
and sometimes ruin them economically.
T hat w ay, they w o n 't leave to do some
thing else, b u t will stick around for
more punishm ent
Sjfom/f Q/iLdic(d ffiociefy-
T h e
P u ls e
Presidents Message
The A m erican H eritage dictionary defines m em b er as a
distinct p art of a w hole or one th a t belongs to a g ro u p or
organization. Tire A lliance exists because of its distinct
members and will continue to be active in the com m uni ty as
long as there are m em bers.
There are cu rrently 135 active m em b ers in the PCMSA.
The Alliance m ailed 716 m em bership solicitations. If you have
already joined or renew ed y o u r m em bership, th an k you. If
you have forgotten to retu rn you m em bership, please d o so
today.
A special th a n k y o u to Mona Baghdadi, Brittany
and H ilary Bruce, Nikki Crow ley, F ra n Thom as, Kris
White, Sue Wulfestieg a n d Alice Yeh fo r h e lp in g w ith
the membership mailing.
Also, please accept this rem in d er th a t tire N ew com ers
Coffee will be held on T hursday, S eptem ber 23 at 9:30 a.m.
Child care will be provided. Please indicate if y o u w ill need
this service w h en y o u RSVP. A C hinese Tea cerem ony w ill
be presented. RSVP by S eptem ber 13thto G innie M iller a t
759-7434. G innie is hosting the coffee. H e r ad d ress is 4629
North Mullen, Tacoma. From 1-5, take Exit 132. Follow H w y
16 to the 611' Ave. Exit. T urn left on 6U’, im m ediately getting
into the right lane to tu rn right onto Pearl Street. C ontinue on
Pearl, turning right on N orth 46“'. T u rn left o n N . M ullen.
Ginnie's house is w hite brick w ith light g reen trim on the right
at the com er of N orth 47th a n d N o rth M ullen.
This coffee is for n ew com ers a n d its success d ep e n d s
on your participation. If y o u kno w of a m edical fam ily new to
the community, please consider inviting them. See y o u there!
Yolanda Bruce, PCMSA President
Do we have your e-mail address?
please send it to us at:
[email protected]
PCMS Alliance
Entertainm ent 2000
Update - W hat s New??
T his y ea r's b o o k is o u r b est ever. O u r m erch an t
sendees team has signed m an y great n e w offers in all areas,
especially in the greater O lym pia, B rem erton, an d Tacom a
areas.
C heck o u t so m e of th e H O T n ew offers: A riel's at
B ayview Inn, S a n d p ip er Steakhouse, T u m w ater Valley Bar &
Grill, N orthw est Grill at C avanaugh's, Rustica Ristorante,
T acom a Bar & Grill, A ltezzo a t the Sheraton, B alsano's West,
C lifford's Bistro, The Shoreline, Salish T odge, Beniliana,
Seattle Supersonics, Planet H ollyw ood an d TONS M O R E...
We are also pleased to ag ain offer som e of y o u r
favorite m erchants su ch as Johnny's Dock, G enoa's, C aptain
K's, M ary M cC rank's, M am a Stortini's, Space N eedle, Seattle
M ariners, Tacoma Rainiers, Victoria Clipper an d much, m uch
more.
The books will be available in m id-Septem ber. Call
Fran Thomas at 265-2774. C o st is $35 fo r the S o u th S o u n d
edition and $40 for the Seattle edition.
W SM AA & PCM SA
launch “SAVE” program
H ie Pierce C o u n ty M edical
Society Alliance an d the W ashington
State M edical Association Alliance have
recently launched a n ew pro g ram
called "SAVE," Stop A merican's
Violence Everyw here. N o w available
are "H A N D S ARE N O T FOR H IT
TIN G " activity coloring books for PreK to 3rd grades. If you w o u ld like to
introduce this to y o u r child's school or
c h u rc h class, p le a se c o n ta c t Alice Yeh
at 756-0578.
There are m any "SAVE"-related
projects in the w orks. If you w o u ld like
to get involved, p lease contact a
m em ber of the PCMSA.
September, 1999
gwimsn
M g E M lE ffi
ThElteaaiMaiffi
PCMS BULLETIN 15
Plans ready for C M E on "Big Island”
W inter sun, beaches, relaxation,
family time, golf, tennis, swimming
A N D quality Category I CME!
Join y o u r colleagues an d their
families for next year's spring vacation
on the beautiful island of H aw aii
d u rin g the College of M edical
Education's "resort" conference April
9-15,2000.
Like other College CME in
H aw aii program s in 1992,1994,1996
and 1998, this year's conference will
be held o n the big island and feature a
potpourri of educational subjects of
value to all medical specialties.
U nlike large national meetings,
this program not only offers consider
able savings and is custom designed
for local physicians, it allows Pierce
County physicians and their families to
m ix aw ay from the office and enjoy
one of the m ost beautiful spots in the
world.
P rogram brochures w ere
mailed in August. In addition to
outlining the CME program (16
C ategory I hours), the brochure
discusses transportation and encour-
Early air
reservations
essential
H aw aiian spring vacation flights
sell out m any m onths in advance. A
review recently suggested all flights
during this time are filling.
To assure you are able to secure
seats an d get a reasonable price, w e
u rge you to m ake your reservations
NOW. A small refundable deposit will
hold y o ur seats.
The College is w orking w ith
M arilyn at O lym pus Travel (565-1213).
O lym pus has booked som e seats at
group rates and has access to other
special options at the best rates. Call
Marilyn today.
ages advance planning for the lim ited
flight options during the spring
vacation dem ands in H awaii. Tire
brochure also discusses the savings
an d am enities of the H apuna Beach
H otel, th e conference site.
For additional information, call
the College at 627-7137.
Elegant Hapuna Hotel, with bargain
children rates, is site for CME
The H ap u n a Beach P rince Hotel,
on 32 acres edging on H a p u n a Beach
at the M auna Kea R esort,(hailed as
"one of the w orld's 10 best"), has been
selected as the site for the CME at
H aw aii program for a variety of
reasons, but particularly for the ability
to secure a "world-class resort" at
greatly reduced rates. Registrants m ay
benefit from our negotiated group
rates for ocean view room s at $180. A
second adjoining room for children
u n d er 18 is available at $50 below the
group rate.
Built in 1994, the H ap u n a is
located on the beautiful and sunny
Kona coast. The oversized, deluxe
guest quarters feature lou vered doors
that slide open to room y furnished
lanais. The sm art design of this hotel
ensures that all room s have at least
partial ocean views.
The hotel offers reduced green
fees at the M auna Kea course that
began the legend of H aw aii as a
golfer's paradise, and H apuna Golf
Course, 18 championship holes
designed by A rnold Palmer and Ed
Seay, w ith an ocean view from every
tee an d green.
To take advantage of these
savings, you m ust m ake your reserva
tions soon. THE COLLEGE'S RE
SERVED BLOCK OF ROOMS WILL
BE RELEASED AFTER FEBRUARY
9,2000. Reservations can be made by
calling the H ap u n a directly at (800) 8826060. You m ustidentify yourself as part
of the COLLEGE OF MEDICAL
EDUCATION group.
COLLEGE
C ontinuing M edical E ducation
OF
MEDICAL
EDUCATION
ID Update
CME set
October 1
The annual Infectious Diseases
Update CME is set for Friday, October
1, 1999 and will be held at the Sheraton
Tacoma Hotel. The program is again
directed by Alan Tice, MD an d will
feature specialists and sub-specialists
from the community joining Infections
Limited physicians as they give presen
tations on specific disease areas. The
course is designed as an updte on com
mon outpatient and inpatient infections.
This year's keynote speaker is
Alan Cross, MD from the University of
Maryland Cancer Center in Baltimore.
He will be speaking on Bioterrorism.
The registration brochure w as
mailed in August. If you did not re
ceive yours, please call the College
and one will be sent to you. Physicians
are encouraged to register early.
The program will feature joint
addresses on infectious diseases and
Whistler/Blackcomb CME
registration, reservations open
Registration is open for the
College's CME at Whistler/Blackcomb
program; brochures were recently
mailed. The conference is scheduled
for February 2-6,2000.
Reserva tions for the block of
condos, THIS YEAR AGAIN ALL
IN THE ASPENS, are available.
Reservations can be m ade by calling
D ates
Friday, D ecem b er 3
Friday, Jan u ary 21
W ednesday - Sunday
F eb ru ary 2-6
F riday, February, 11
Public health
M usculosk eletal in fectio n s
D iagnostic Im aging
Bioterrorism
Pulm onary d iseases
G astroen terology
For more information, please call
the College of Medical Education at
627-7317.
P ro g ram
D irecto rs')
Infectious D iseases
U pdate
C om m on O ffice
M edicine & M ental
H ealth
C ardiology for Prim ary
Care
C M E @ W h istler
A dvances in W om en's
M edicine
T h u rsd ay -F rid ay
Internal M edicine
R eview 2000
M o n d ay - Friday
S aturday, A pril 29
A lan T ice, M D
P roblem s
M arch 9 & 10
A pril 10-14
♦
♦
♦
♦
♦
♦
(800) 777-0185. You must identify
yourself as part of the College of
Medical Education to receive the
negotiated reduced rates. THE
C O L L E G E ’S BLOCK OF
ROOM S W ILL BE RELEASED
ON D ECEM BER 1, 1999.
D avid Law, M D
G regg O stergren, D O
R ichard Tobin, M D
John L enihan, Jr., M D
R o b ert C orliss,M D
C M E @ H aw aii
S urgery U p d ate 2000
V irginia Stow ell, M D
A sth m a, A llergy &
Friday, M ay 5
P u lm o n o lo g y for
A lex M ihali, M D
P rim ary C are
N uts, B olts &
Friday, Ju n e 2
In novation:
G ary Taubm an, M D
G astro in testin al
R ichard Tobin, M D
D isease V
September, 1999
PCMS BULLETIN 17
b U L L E T IN
Julian Arroyo, MD
will participate in
Orthopaedic
Summer Institute
D r. Ju lia n S. A rroyo, L ake
w ood orthopaedic surgeon, will be on
the faculty of the A m erican Academy
of O rthopaedic Surgeons' Sum m er
Institute, 1999. The Institute wi 11be
held in Seattle, Septem ber 22-26.
Dr. A rroyo w ill serve as an
Institute Lab Instructor and will also
present a lecture entitled, "M anage
m ent of Proximal H um eral Fractures."
18
PCMS BULLETIN
September, 1999
Asthma: crisis
in inner cities
HM Os: red ink
continues
African Americans and Hispanics
iii inner cities are two to six times m ore
likely to die from asthm a than are w hite
Americans, according to the N ational
Medical Association. Allergic triggers
such as dust m ites an d cockroaches of
ten proliferate in m ultiple or substan
dard urban dwellings, the Association
rep o rted in the A u g u st Journal ofthe
National Medical Association. A ller
gens from tobacco sm oke an d diesel
fum es m ay set u p the basis for chronic
airway inflammation.
Studies have show n tha t some Af
rican-American patients are treated dif
ferently and have poorer outcomes.
For the second year in a row,
m ore th an half of H M O s lost money. In
1998,56% of H M O s lost a total of $490
million, according to Weiss Ratings,
Inc. In 1997,57% of H M O s lost $768
million.
In addition, m any plans faced with
financial insolvency. The capital
reserves of 100 H M O s fell below
m inim um risk-based capital guidelines
established by the National Association
of Insurance Commissioners. One of
the plans w ith the low est level of capital
reserves w as H um ana Health Plan of
Texas, w ith only 18 % of the recom
m ended capital level.
—
^
W’l& m % o< m tif o M e d ic a lo fo c id f
POSITIONS AVAILABLE
PRACTICES AVAILABLE
T aco m a/P ierce C o u n ty
outpatient general medical care at its
best. Full and part-time positions
available inTacoma and vicinity. Very
flexible schedule. Well suited for
career redefinition for G.P., F.P., I.M.
Assoc.), Clinic Manager (253) 383^351.
T ired of office/h o sp ital
medicine? Exclusive long-term care
practice for an Internist/General
Practitioner available immediately.
Good income potential - no paperwork
hassle. Call 472-2011.
O pportunities for Full S er
vice Family Practice Physicians. Four
Family Practice Physician openings at
UW Physicians Network (UWPN)
clinics in the Puget Sound area:
Westwood (WestSeattle), Issaquah,
Auburn, and Federal Way. FPs m ust be
board certified or eligible, and practice
the full spectrum of family medicine
including obstetrics. UW PN is a
physician ru n organization of nine
clinics fully utilizing an electronic
medical record system. Affiliated with
the University of Washington Aca
demic Medical Center; resident/ studen t
teaching and research opportunities.
Excellent com p/benefitplan Submit
cover letter/cv to: Thomas E. Norris,
MD, Medical Executive and Executive
Director, UW Physicians Network,
1910 Fairview Avenue North, Suite
302,Seattle WA98102.Fax: (206) 5205587.
Puyallup, WA:
Hospital affiliated
openings for B C family practice
physicians to work 8-hour shifts.
Clinic hours are 10:00 am - 6:00
pm, 7 days per week, outpatient
only is $50/hr, or full service
salaried with benefits available.
Also seeking physician assistants
to work in urgent care center;
salaried position. Send letter of
introduction and C V to Urgent
C are Center Application, Good
Sam aritan Community Healthcare,
Attn: Kathy Guy, P O Box 1247,
Puyallup, W A 98371-0192.________
OFFICE SPACE
L akew ood m edical space
Ring at 584-6200 or 582-5856.
TA CO M A /PIER CE COUNTY
New office space av ailab le.
U p to 4500 sq. ft. Will finish to suit. On
Robin at 756-2182.
M edical office space to su b
lease. Approximately 1,000 sq. ft., three
blocks from Tacoma General. Private
parking and private bath. Call 380-9743.
seeks BC/BE Family Practitioners. Flexible financial packages and practice
positions available from independent to group settings, practice
Samaritan Community Healthcare, 407 - 14th Avenue S E , Puyallup, W A
98371, (253) 848-6661, Ext. 1865.________________________________________
O u tp a tie n t G e n e ra l M ed ic a l C a re .
available in T a c o m a a n d vicinity.
V eiy flexible sc h e d u le . W ell su ite d
fo r c a re e r re d e fin itio n fo r
G P , F P , IM .
C o n ta c t A ndy T soi. M D (253) 7 5 2-9669
o r Paul D o ty (A llen, N e lso n , T u r n e r &
A ssoc.), C lin ic M a n a g e r (253) 3 8 3-4351
lr e a .it
iu raeru
/ / •in k/
th
of u i.
|j Union Avenue Pharmacy &
Corset Shop
HI
2302 S. Union Ave 752-1705
September, 1999
PCMS BULLETIN
19
B u l l e t in
Policyholder Concerns Come First
“I appreciated the fa c t that Physicians
V
f;
W h e th e r it's a claim, a lawsuit, or a risk management issue,
Physicians Insurance keeps customer concerns at the forefront.
Claims representatives work closely with insured defendants
and experienced auomeys to secure the best possible outcome
for our policyholders. Equally as dedicated, our risk manage
.J k n t
ment representatives conduct interactive seminars and respond
to questions in person, by phone, and by mail. Our goal, now
and in the future, is to help physicians, clinics, and hospitals
remain successful.
F
m"
11i.l sport:-'
by iK'1
<<i Stair Mi'dicul /\v
P ie rce C o u n ty M e d ic a l S o c ie ty
2 2 3 T a c o m a A v e n u e S ou th
T a c o m a , WA 9 8 4 0 2
R e tu rn se rv ic e r e q u e s te d
20
PCM S BULLETIN
September, 1999
Western Washington
Eastern Washington
Oregon
1-800-962-1399
1-800-962-1398
1-800-565-1892
Physicians
Insurance
A M utual Company
Sc.mle, WA © Phvsiuans Insuunce lMO
PRESORTED
STANDARD
U SPOSTAG EPAID
TACOMA, WA
PERM IT NO 605
O c to b e r, 1 9 9 9
Members participate in many activities
LtoR: Drs. C harles W eatherby, Rob Roth, C hris Jordan,
Susan Salo and Steven Litsky before din n er at the
September General M em bership M eeting, "T raum a U pdate"
General S urgeon Bill M artin, and
ivaryl pack the
car- after com pleting the 180 mile C ourage Classic
Bicycle Ride loop that climbs three m ountain passes
I j j p p f f - f - -P
L to R: Jim M ullein, JaniceSack-O ry, Pediatricians, Drs.
R ichard O ry and P am LaBorde and Bill LaBorde looking
fo rw ard to the 12 m ile Blewett Pass descent just ahead
Dr. Kirk Rue, left, Tacom a anesthesiologist, visits w ith Dr.
Lawrence Larson, PCM S President, an d his wife, Mar}'
Larson while the crow d enjoys the social h o u r
S ee p a g e 5
See page 3
INSIDE:
3
5
7
9
11
13
16
“ S tate o f th e S ystem ,” a tr a u m a u p d a te given a t th e S e p te m b e r G e n e ra l M eetin g
M em b ers r id e in C o u ra g e C lassic B icy cle T o u r; ra is e funds lo r M a ry B rid g e
D e p a rtm e n t o f L a b o r & In d u s trie s - In d e p e n d e n t M ed ical E x a m in e r Panels
T P C H D : E a r ly In te rv e n tio n C a s e M a n a g e m e n t fo r H IV In fe c tio n
In M em o riam : Stevens D im a n t, M D pays trib u te to R o d g e r D ille, M D
T h e In v isib le H a n d : “ M ed icin e is a H a rs h M istre ss”
H aw aii & C M E - m ak e plan s now fo r n e x t spiring
B u l l e t in
f
P C M S O ffic e rs/T r us t e e s :
L a w re n c e A . L a rs o n , D O ............................ P re s id e n t
C h a r le s M . W e a th e r b y , M D ........... P r e s id e n t E le c t
P a tr ic e N . S te v e n s o n , M D ...... S e c r e ta r y /T r e a s u r e r
J a m e s M . W ils o n , J r ., M D ............... P a s t P r e s id e n t
M ic h a e l J. K e l l y , M D
J. J a m e s R o o k s , J r., M D
Y o l a n d a B r u c e , P C M S A P re s id e n t
^
■
fflcwee
oM edkai
=■
B u l l e t in
October
W S M A R ep resen ta tiv es:
P a s t P r e s i d e n t : P e t e r FC. M a r s h , M D
S p e a k e r o f t h e H o u s e : R ic h a rd H a w k in s , M D
T ru s te e : D a v i d E . L a w ,M D
1999
E x e c u t i v e D ir e c to r : D o u g la s J a c k m a n
A g i n g , R ic h a rd W a ltm a n ; A I D S , L a w re n c e S ch w artz;
B y l a w s , S ta n le y T u e ll; B u d g e t / F i n a n c e , P atric e
O v e rfie ld ; C r e d e n t i a l s , S u san S alo; E m e r g e n c y
M e d i c a l S t a n d a r d s , T e d W a lk le y ; E th i c s /
S t a n d a r d s O f P r a c t i c e , D a v id L u k en s; G r i e v a n c e ,
Ja m e s M . W ilso n ; L e g i s l a t i v e , W illiam M arsh ;
M e d i c a l - L e g a l , P at D o n le y ; M e m b e r s h i p B e n e fits ,
In c., D rew D e u tsc h ; P e r s o n a l P r o b l e m s O f
P h y s i c i a n s , R o b e rt S an d s; P u b l i c H e a l t h / S c h o o l
H e a l t h , J o s e p h W e a m ; S p o r t s M e d i c i n e , Jo h n
J ig a n ti.
T h e B u l l e t i n is p u b lish e d m o n th ly by P C M S
M e m b e rs h ip B e n efits, Inc. for m em b ers o f the P ierce
C o u n ty M e d ic a l S o c ie ty . D ea d lin e s for su b m ittin g
a rtic le s an d p la c in g a d v e rtise m e n ts in T h e B u lletin
are th e 15th o f th e m o n th p re c e d in g p u b lic a tio n (i.e.
T h e B u l l e t i n is d e d ic a te d to th e art, sc ie n c e and
d e liv e ry o f m e d ic in e an d th e b e tte rm e n t o f the h ealth
an d m ed ical w e lfa re o f th e c o m m u n ity . T h e o p in io n s
h e re in are th o se o f the in d iv id u al c o n trib u to rs an d do
n o t n e c e s sa rily re fle c t the o ffic ia l p o sitio n o f th e
M e d ical S o c ie ty . A c c e p ta n c e o f a d v e rtisin g in n o
w a y c o n s titu te s p ro fe s sio n a l a p p ro v a l o r e n d o rs e
m e n t o f p ro d u c ts o r s e rv ic e s a d v e rtise d . T h e B u lletin
an d P iercc C o u n ty M ed ical S o ciety re se rv e th e rig h t
to re je c t an y a d v e rtisin g .
E d i t o r : D a v id S . H o p k in s M D
M a n a g i n g E d ito r : D o u g la s Ja c k m a n
E d i t o r i a l C o m m i t t e e : M B I B o a r d o f D ir e c to r s
S u b s c r ip tio n s : $ 5 0 p e r y e a r , $5 p e r issLie
2 5 3 -5 7 2 -3 6 6 6 , F A X 2 5 3 -5 7 2 -2 4 7 0
E -m a i 1a d d r e s s : p c m s w a @ p c m s w a .o r g
H o m e P a g e : h ttp ://w w w .p c m s w a .o rg
1able of Contents
3
"StateoftiieSystem"anupdateonTrauma
5
M embers ride in Courage Classic Bicyde Tour
7
7
Labor& IndustriesTaskForceupdate
Pierce County Independent Medical Examiner Panels
9
H ealtliStatusofR eixeC ouniy/T P C H D N ew s
10
FrandcanMedicalGrouppartswithlaborurdon
H
tiMemoiiam;StevensDirnant,MDrernaribersRodgerDille,I'
12 Advanced CodingSeminarsrescheduled
13
ThelnvisibleHand:"M edidneisaHarshM istress"
14 ApplicantsforMembership
15
The Pulse: PCMSA N ew s
16 TheCollegeofM edical Education: Hawaii update
17 The College of Medical Education: A nnual Calendar
18
Dr. Lenihan reaps results o f several years of research
19
CiassifiedAdvertising
“State of the System” report on Trauma
A "State of the System" report on
Tacoma-Pierce C ounty L evel II A d u lt
Trauma w as given at the Septem ber
14s1General M em bership M eeting
held at Tacoma's L andm ark C onven
tion Center. Drs. Jim Rifenbery,
Chris Jordan a n d Alan W hite
along with Executive Barbara Y oung,
responded to m any questions an d con
cerns regarding the system that has
been scheduled to be im plem ented, b u t
been postponed, twice. "A traum a di
rector is crucial," n o ted Dr. R ifenbery
as he addressed the crow d. "W e need
a pilot," he responded, w h en asked of
reasons for the delays. U nfortunately,
two to three candidates have been of
fered the position b u t have declined
d u e to fam ily reasons.
Dr. R ifenbery rev iew ed the h is
tory, explaining the "sh u t do w n " of die
Pierce C ounty system in 1995, w hich
m any physicians felt w as operating
dangerously. Patients w ere dien
shipped to M adigan Army Medical
C enter o r H arborview in Seattle, just
30 miles north. Som e continue to su p
p o rt patients being sent to
H arborview , as it is an excellent
teaching facility that provides full-time
traum a staff an d equipm ent. However,
m an y m ore physicians in Pierce
C ounty believe d iatpatients should
n o t have to leave dieir o w n com m u
nity for care an d tha t Pierce C ounty
has die talent to p ro v id e excellent
trau m a care. A nd, currently, over
three-fourths of the traum a patients are
cared for at M adigan, w h o has stated
publicly th a t they cannot continue to
p ro v id e care for civilian patients.
The tw o years of toil an d efforts
by Drs. Rifenbery, Jordan a n d W hite
h ave p aid off. They have m anaged to
get b o th hospitals to agree to a system
of care th at w ill be rotated betw een
hospitals. Even though this system is
criticized by m an y doctors, it is a big
step for the tw o large competitors, only
a m ile apart, inTacom a. "W e n eeded to
b e involved," n o ted Dr. Jordan be
cause the big players in the county and
the state said "w e 're going to design a
S ee “T ra u m a ” p ag e 4
From left: Drs. Michael Regalado, Harold Boyd, and Bob
Stoecker, all ER physicians and David Judish, physical med
and rehab. Drs. Regalado and Judish practice in Puyallup
From left: Ralph Mitchell, PA-C, Dr. Jim Rifenbery,
Trauma Executive Barbara Young and Dr. Alan Write,
Dr. Rifenbery and White are Tacoma general surgeons
Dr. Asuquo Esuabana, left and Dr. Kelly Jones, new
PCMS member, both practice at Community Health Care
Left, new member and orthopedic surgeon, James Wyman
with pediatric surgeon George Noble and his wife, Martha
October. 1999
PCM S BULLETIN
3
B u l l e t in
'Trauma’
from page 3
system an d w e w a n t you to help us or w e will do it for you."
The fear of h av in g it fixed by others still exists. Pierce
County rem ains the last piece in a statewide plan that w as to
be com pleted last year.
In spite of differing opinions w ithin the physician com
m unity about the need for a local traum a system, it is h ard not
to recognize the hard w o rk and com m itm ent of the three sur
geons. Drs. Jordan, Rifenbery a n d W hite have dedicated
endless hours to developm ent of a traum a system for this
com m unity. They hope that a new traum a director can soon
take over their jobs.
Trauma: State o f t h e System
* * >1 A
From left, Dr. Rina Reyes and Dr. Patrice Stevenson;
both practice physical medicine and rehabilitation at
Good Samaritan Hospital in Puyallup
System s Operations:
►A ll three hospitals (Tacoma General and St. Joseph jointly,
Madigan separately) submitted proposals and completed site
reviewsfo r state trauma designation; provisional designation
granted
^ Tacoma General/MultiCare will contract and billfo r their
hospital sei-vices and all trauma-related professional physician
fees generated through SW WA Trauma Services, PLLC. St.
Joseph will contract and billfo r their hospitalfees. Madigan will
follow their own military/federal billing protocols
►Outreach efforts with the prehospital community are ongoing to
ensure triage and transport protocols reflect the presence o f
Level II trauma facilities in Tacoma
►Thejo in t multi-disciplinary Trauma Committee has completed
all required policy development, including clinical pathways and
a quality assurance/improvement plan
Dr. B radPattison (left), St. Joseph anesthesiologist and
Dr. M ark Yuhasz, Tacoma radiologist compare notes
after the meeting
*S W W ashington Trauma Services, PLLC:
•Engaged in national search fo r Trauma Medical Director
•Hired one trauma surgeon, recruiting fo r two more
•Hired three trauma physician assistants, recruitingfor one more
•Have signed contracts with subspecialists as follows:
8 general orthopedists, 5 ortho-hand surgeons
4 ortho-spine surgeons
3 vascular credentialed surgeons (includes one
Madigan moonlighter)
I plastic surgeon (plus one more pending arrival)
4 thoracic surgeons, 5 urologists
I I ob/gyn surgeons, 9 pulmonologists
6 craniofacial surgeons
•Have signed contracts with 5 community general surgeons plus
4 Madigan moonlighters
•Have commitments to participate fi'om 4 hospital-based specialty
groups; 2 emergency, 1 radiology, 1 anesthesia
4
PCM S BULLETIN
October, 1999
A llen m o re
P sy ch o lo g ica l
■ 3 A sso cia tes, P.S.
752-7320
Do you have patients with difficult emotional
U n ion A ven u e Professional Building
--------------------1530 U n ion A ve. S.. Ste. 16. T a m m a
VPievce ôu/niij. oM edical (Society-
Courage Classic Bicycle Tour benefits Mary Bridge
Childrens Health Center as well as participants
The Eighth A nnual Courage Clas
sic BicycleTour, held A ugust 21-23,
attracted 540 riders. The Classic is one
of the best-supported rides in the coun
try. Rest stops about every 20-25 miles
staffed by volunteers from the Pierce
County Rotary Clubs, compete with
each other to provide the best food
available. Banana splits, root beer
floats, bagels and cream cheese, all
types of fruits, even solid foods like
spaghetti, chicken,beef, etc. is served.
Mostriders gain w eight on the ride.
The ride originated three miles
west of North Bend and riders left the
parking lot in a wet mist that continued
most of the 26 miles to Snoqualmie Sum
mit. The route did escape 1-90 for a few
miles on side roads to relieve the ex
cessive noise of the traffic. The sun
came out on the summit and the riders
were greeted with music and a fantastic
lunch hosted by the Gig H arbor Ro
tary, where Dermatologist Bob M ar
tin, MD was volunteering. The next
rest stop would be 20 miles away at
Lake Easton, then on to Cle Elum
where they would finish their 60-mile
ride for that day. They w ere treated to
a barbecue dinner in the Sunset Cafe
parking lot with live music and a hyp
notist act that pleased the crowd.
After a Sunday breakfast buffet
riders headed north through the
Teanaway Valley horse ranches, w ith
beautiful meadows, toward Blewett
Pass. With the exception of the last 3A
miles, Blewett was found to be an
; easier climb than Snoqualmie. Dr. Ed
'PuUen, Puyallup family physician was
a Sumner Rotary volunteer on the
serving line for the terrific lunch and
leis that were given the riders. A bit of
a headwind prevented the nearly 20
mile downgrade from being exciting.
The temperature w as nearing 85-90 as
the riders entered Leavenworth for
the evening.
Day three of the ride daw ned
beautifully in
Leavenworth and
die riders found
themselves in
Sl<ykomish57
miles later where
the ride ended.
The first 23 miles
took them on the
back road to Lake
W enatchee
through beautiful
meadows and
woods and a
couple challeng
ing hills. At mile
23, the right turn
onto Hwy. 2
w ould lead the
riders to Stevens
Passsummitat
mile 43. At mile
39, Sumner Ro
tary volunteer
D r. P at Duffy,
Sumner family
physician and Past
President of
PCMS was hand
ing out drinks and
food to carry the
riders over the
top. Dr. Duffy had
togetupat3:30
a.m. to get to the
Pass to meet the
first riders.
It would be
easy to over dra
matize the last
four miles of the
climb, but they
were difficult and
for some people
they w ere prob
ably brutal. The
temperature
gauge read about
See"Courage"
Orthopedist Jack Stewart, MD, waitingfo r his banana split at
the Lake Easton rest stop. The Classic was a piece o f cake
fo r Dr. Stewart as he had done the infamous RAMROD
(Ride Around Mt. Rainier in One Day) a few weeks earlier
Anesthesiologist Marsden Stewart, MD and his wife, Leelee,
enjoying the summit o f Blewett Pass and a great lunch
provided by the Sumner Rotaiy. Leelee also did the
RAMROD in 1999, Dr. Stewart in 1998
MultiCare President/CEO Diane Ceccheittini and husband
Major General Frank Scoggins enjoy lunch after the
Snoqualmie climb. Diane has done all eight Courage Classics
October, 1999
PCMS BULLETIN 5
B u l l e t in
“C o u ra g e ”
from page 5
90 degrees and being so close to the pavement m ust have in
creased that a few degrees. But, after a few refreshments, the
seven-mile descent on new pavement made the climb all
worthwhile. Some riders gained speeds of up to 3540 miles
per hour on the ride down. It w as all-downhill to Skykomish
where buses awaited to take riders back to their cars in North
Bend.
All agreed that it w as a superb ride with great company,
food, weather and excellent organization by the Courage
Classic staff and Mary Bridge Children's Hospital. They esti
mated that nearly a quarter-million dollars was raised by the
riders.
PCMS Members riding the Classic were: Patty Kulpa,
P am ela L a b o rd e , Jo h n M cC loskey, Bill M a rtin /K a ry l,
R ic h a rd O ry/Jan, H e n ry R e ta illia u , Steve S ettle, Don
S h re w sb u ry , J a c k S te w a rt an d M a rsd e n S te w a rt /
Leelee. Volunteers included Drs. Pat Duffy, Bob M artin
and Ed Pullen.
Tacoma Internist Henry Retailliau, MD, visits with
Dermatologist Bob Martin, MD at the Snoqualmie Pass
Summit. Dr. Retailliau was about to devour a great spaghetti
lunch prepared by the Gig Harbor Rotary o f which Dr.
Martin was a volunteer andpast-president
Now
Open
Saturdays
'ii
ACR Accredited
NION
*8$
M RI
6
PCM S BULLETIN
October, 1999
'Mmm
in v ite s you an d you r sp o u se /g u est to a
com plim entary (FREE!)
November General Membership Meeting
Tuesday, N o v e m b e r 9, 1999
Social Hour:
6:00 pm
Dinner:
6:45 pm
Program:
7:45 pm
Tacoma
featuring:
The Media’s
Perceptions
of
Health Care in
Pierce County
► H e a lth ca r e a v a ila b ility an d access
► A d u lt T r a u m a C en ter
► P u b lic H ea lth con cern s
P le a s e r e s e r v e
dinner(s) a t N O CHARGE. COURTESY OF BAYER PHARMACEUTICAL
R E G I S T R A T I O N R E Q U I R E D by F rid a y , N o v em b er 5th
If you register and later find you are unable to attend, please call and cancel your reservation
I will be bringing my spouse or a guest. N am e for nam e t a g : __________________________
Return this form to: PCM S, 223 Tacoma Ave S, Tacom a 98402; FAX to 572-2470 or call 572-3667
Pharmacy Directory - 2000
Tacoma (all area codes are 253)
F e d e ra l
W ay -
K in g
C o u n ty
(A ll a r e a
co d es
a re
253)
F X : 5 6 4 -4 0 6 2
A l b e r t s o n ’s 3 3 6 2 0 - 2 1 s t A v e S W
................................................................ 5 6 5 - 7 9 9 7
F X : 4 6 0 -0 4 4 0
C o s t c o 3 5 1 0 0 E n c h a n t e d P k w y .............................................................................. 8 7 4 - 4 4 3 1
A lb e rts o n ’s 2 4 0 1 N o r t h P e a r l S t ............................................................................. 7 5 2 - 7 9 1 9
F X : 7 6 1 -7 7 3 0
D ru g E m p o riu m
A lb e rtso n ’s 8 6 1 1 S t e i l a c o o m B l v d ...................................................................... 5 8 2 - 4 1 4 9
F X : 5 8 2 -8 6 6 4
F a m ily P h a rm a c y 3 0 8 0 9 - 1 st A v e S o u th
A llen m o re M u l t i C a r e C l i n i c P h a r m a c y , S 1 9 t h & U n i o n
4 0 3 -5 0 5 5
F X : 4 0 3 -5 7 9 4
F ra n c is c a n P h a rm a c y 3 4 5 0 3 - 9 th A v e S o u th
A llenm ore P h a r m a c y 1 9 0 1 S o u t h U n i o n # A 2 5 2 .................................. 3 8 3 - 5 5 1 9
F X : 2 7 2 -9 3 2 4
F r e d M e y e r 3 3 7 0 2 - 2 1 s t A v e .................................................................................... 9 5 2 - 0 1 3 3 F X : 9 5 2 - 0 1 4 2
B rid g ep o rt P r o f P h a r m a c y 7 4 2 4 B r i d g e p o r t W a y
F X : 5 8 9 -9 6 9 8
L o n g s D r u g s 1 2 0 9 S o u t h 3 2 0 t h ............................................................................... 9 4 5 - 6 7 5 2 F X : 9 4 5 - 7 1 3 8
A & H P re s c rip tio n 2 6 0 3 B r i d g e p o r t W a y W
A lb e r ts o n 's 3 9 0 5 B r i d g e p o r t W a y W
...........................................5 6 4 - 0 0 8 8
W ....................... 5 8 2 - 1 6 6 2
........................................................................ 9 5 2 - 3 3 2 3 F X : 8 7 4 - 4 8 5 3
F X : 8 7 4 -5 7 7 3
2 0 3 0 S o u t h 3 1 4 t h ..................................................................... 9 4 6 - 1 2 2 2 F X : 9 4 6 - 4 0 4 6
# 1 1 0 ............. 9 4 2 - 4 0 4 0 F X : 9 4 2 - 4 0 4 6
C enffuy P l a z a 1 7 0 8 S o u t h Y a k i m a .........................................................5 9 1 - 6 9 2 0
F X : 3 0 5 -6 4 2 0
R ite A id 2 1 3 1 S W
Chune P h a r m a c y 9 1 2 2 S o u t h T a c o m a W a y # 1 0 4 ............................... 5 8 4 - 2 4 8 4
F X : 5 8 4 -6 0 9 4
R ite A id 3 1 0 0 9 P a c ific H w y S o u th
Cost L e s s P r e s c r i p t i o n s 5 4 3 1 P a c i f i c A v e .................................................... 4 7 4 - 9 4 9 3
F X : 4 7 4 -2 3 6 9
T o p F o o d s & D ru g
Cost L e s s P r e s c r i p t i o n s 1 1 0 9 R e g e n t s B l v d ( F i r c r e s t )
5 6 4 -5 2 0 0
F X : 5 6 4 -6 6 9 8
V i r g i n i a M a s o n S o u t h 3 3 5 0 1 - 1 s t W a y S o u t h ......................................... 8 7 4 - 1 6 5 0 F X : 8 7 4 - 1 6 6 5
Cost P lu s P h a r m a c y & F a m i l y C a r e C t r
2 0 4 N o rth " I” S t
3 3 6 th
# K . ......................................... 8 3 9 - 3 1 0 0 F X : 9 4 1 - 4 3 1 0
S t .......................................................................................... 9 5 2 - 2 8 0 3 F X : 9 5 2 - 0 3 8 7
...................................................................... 9 4 1 - 5 0 1 3 F X : 5 2 9 - 1 5 1 9
3 1 5 1 5 - 2 0 t h A v e S o u t h ........................................... 8 3 9 - 9 3 2 2
FX : 8 3 9 -9 3 9 7
6 2 7 -1 1 8 8
F X : 6 2 7 -0 1 5 8
Coslco P h a r m a c y 3 6 3 9 S o u t h P i n e S t ............................................................ 4 7 5 - 2 3 7 6
F X : 4 7 5 -0 4 6 0
F ife
F ranciscan P h a r m a c y - T a c o m a S o u t h , 2 1 1 1 S o u t h 9 0 t h
F X . 5 3 5 -5 7 1 7
F i f e U n i t e d D r u g 5 3 0 3 P a c i f i c H w y E a s t ...................................................... 9 2 2 - 0 2 2 2 F X : 9 2 6 - 2 5 4 1
F i f e V a l l e y M a r t 5 3 0 6 P a c i f i c H w y E a s t ................................................. .
5 3 5 -5 6 1 5
(A ll a r e a
co d es
253)
a re
Fred M e y e r 4 5 0 5 S o u t h 1 9 t h S t ............................................................................ 7 5 2 - 9 1 1 0
F X : 7 5 6 -9 3 2 0
Fred M e y e r 6 9 0 1 S o u t h 1 9 t h S t ........................................................................... 5 6 5 - 7 5 8 5
F X : 5 6 5 -7 9 7 1
Fred M e y e r 5 1 1 5 1 0 0 t h S t S W ( L a k e w o o d ) ............................................. 5 8 9 - 4 4 3 3
F X : 5 8 9 -4 4 4 2
G ig
K m art 1 4 1 4 E a s t 7 2 n d ..................................................................................................... 5 3 7 - 6 6 6 8
F X : 5 3 9 -8 4 6 1
B a rte ll D r u g s 5 5 0 0 O ly m p ic D r
H a r b o r (A H
a re a
co d es
a re
9 2 2 -8 7 2 2 F X : 9 2 2 -0 1 3 6
253)
.......................................................................... 8 5 8 - 7 4 5 5 F X : 8 5 8 - 7 4 6 0
3 8 t h .................................................................... 4 7 3 - 1 1 5 5
F X : 4 7 3 -1 1 5 8
C o st L e s s P re s c rip tio n s 1 4 2 1 8 - 9 2 n d A v e N W
L ongs D r u g s 5 4 0 1 - 6 t h A v e ..................................................................................... 7 5 2 - 1 4 8 4
F X : 7 6 1 -9 4 3 0
G i g H a r b o r R e x a l l 3 1 1 4 J u d s o n S t ....................................................................... 8 5 8 - 9 9 0 8 F X : 8 5 8 - 7 2 1 3
L ongs D r u g s 7 9 0 1 S o u t h H o s m e r ....................................................................... 4 7 2 - 7 4 8 8
F X : 4 7 2 -3 7 8 9
O ly m p ic P h a rm a c y 4 7 0 0 P t F o s d ic k D r N W
L incoln P h a r m a c y 8 2 1 S o u t h
(P u rd y )
#1 1 0
8 5 7 -7 7 9 7 F X : 8 5 7 -7 6 7 9
.......................... 8 5 8 - 9 9 4 1
F X : 8 5 1 -9 9 4 2
M ai L in h P h a r m a c y 1 2 1 1 S o u t h 1 1 th S t .....................................................- 3 8 3 - 2 5 7 6 F X : 3 8 3 - 2 5 9 8
R i t e A i d 4 8 1 8 P t F o s d i c k D r N W ............................................................................. 8 5 1 - 6 9 3 9 F X : 8 5 8 - 3 2 0 3
M ary B r id g e C l i n i c s P h a r m a c y 3 1 1 S o u t h L S t ..................................... 4 0 3 - 1 4 1 1
S a f e w a y 4 8 3 1 P t . F o s d i c k D r N W ....................................................................... 8 5 1 - 6 8 7 0 F X : 8 5 1 - 6 8 7 0
F X : 4 0 3 -1 7 4 5
M e d ic al C e n t e r P h a r m a c y 1 2 0 6 S o u t h 1 1 t h S t .....................................- 3 8 3 - 5 3 5 9 F X : 3 8 3 - 4 7 3 2
M ega P h a rm a c y 7 9 1 1 S o u th
253)
H o s m e r ............................................................. 4 7 3 - 1 9 1 9
F X : 4 7 3 -6 5 2 8
M ilto n
M u ltiC a re C l i n i c P h a r m a c y 5 2 1 M L K i n g J r W a y ................................ 4 0 3 - 4 9 2 0
F X : 4 0 3 -4 8 5 6
A l b e r t s o n ’s 2 8 0 0 M i l t o n W a y ...................................... ............................................ 9 5 2 - 8 4 3 6 F X : 9 5 2 - 8 4 7 8
P a rk la n d M a r k e t p l a c e 1 3 3 2 2 P a c i f i c A v e .................................................... 5 3 1 - 3 7 1 1
F X : 5 3 7 -0 9 9 3
Puget S o u n d P h a rm a c y 1 1 1 2 - 6 th A v e # 1 0 1
.......................................... 2 7 2 - 1 1 0 7 F X : 2 7 2 - 7 3 2 7
(A ll a r e a
co d es
a re
R i t e A i d 9 0 0 E a s t M e r i d i a n .................................................................................... .
9 5 2 -2 6 8 0 F X : 9 2 5 -0 6 8 5
S a f e w a y 9 0 0 E a s t M e r i d i a n ......................................................................................... 9 5 2 - 0 3 9 0 F X : 9 5 2 - 4 3 5 4
R a in ie r P h a r m a c y 1 9 0 1 S o u t h C e d a r # 1 0 4 ................................................ 2 7 2 - 2 2 9 3 F X : 2 7 2 - 2 2 9 4
R a n k o s P h a r m a c y 1 0 1 N o r t h T a c o m a A v e ................................................. 3 8 3 - 2 4 1 1
F X : 5 7 2 -4 3 2 9
R ite A id 3 8 4 0 B r i d g e p o r t W a y W . . . . . ................................................................. 5 6 4 - 2 2 5 5
F X : 5 6 4 -0 1 8 9
R ite A id 9 8 3 0 P a c i f i c A v e ............................................................................................. 5 3 1 - 6 5 3 3
F X : 5 3 9 -4 3 8 3
O rtin g
(A re a
co d e
360)
C o p e ’s O rtin g P h a rm a c y
1 3 4 W a s h i n g t o n A v e ...................................... 8 9 3 - 2 1 1 7 F X : 8 9 3 - 8 8 8 8
R iteA id 5 7 0 0 - 1 0 0 t h S t S W # 1 0 0 ( L a k e w o o d ) ......................... !* ? .).. 5 8 8 - 3 6 6 6 F X : 5 8 8 - 1 9 2 2
R iteA id 7 0 4 1 P a c i f i c A v e ............................................................................................... 4 7 4 - 8 5 0 0 F X : 4 7 4 - 0 2 5 3
R iteA id 6 8 0 2 S o u t h 1 9 t h
.................................. .................................................. 5 6 4 - 7 2 2 3 F X : 5 6 4 - 0 2 0 6
P u y a llu p
(A ll
a re a
co d es
a re
253)
A l b e r t s o n ’ s 1 6 1 2 0 M e r i d i a n E a s t ........................................................................... 8 4 5 - 9 6 1 7 F X : 7 7 0 - 3 5 7 8
R iteA id 1 5 8 0 1 P a c i f i c A v e ........................................................................................... 5 3 1 - 7 4 2 7 F X : 5 3 5 - 9 2 7 9
A l b e r t s o n ’s 1 1 0 1 2 C a n y o n R d E a s t ..................................................................... 5 3 7 - 3 8 0 8 F X : 5 3 9 - 3 6 5 4
R iteA id 1 9 1 2 N o r t h P e a r l
B e a l l ’s P h a r m a c y 6 1 8 S o u t h M e r i d i a n , S u i t e A
....................................................................... 7 5 6 - 6 7 0 7 F X : 8 7 9 - 0 2 7 2
R iteA id 4 5 0 2 S o u t h S t e e l e S t .................................................................................... 4 7 4 - 8 3 5 5 F X : 4 7 3 - 3 9 4 9
R iteA id 2 2 3 1 1 M o u n t a i n H w y E
(S p a n a w a y ) ....
..................... 8 4 6 - 0 5 4 2 F X : 8 4 6 - 8 7 1 6
.................................... 8 4 5 - 8 4 4 4 F X : 8 4 5 - 7 1 1 4
F r e d M e y e r 1 1 0 0 M e r i d i a n N o r t h .......................................................................... 8 4 0 - 8 1 8 3 F X : 8 4 0 - 8 1 7 7
F r e d M e y e r 1 7 4 0 4 M e r i d i a n E a s t ..............................................................( # ? .).. 4 4 5 - 7 8 7 3 F X : 4 4 5 - 7 8 6 7
Safeway 7 0 7 S o u t h 5 6 t h S t ........................................................................................ 4 7 1 - 1 7 3 0 F X : 4 7 1 - 3 5 2 9
M e d i c i n e S h o p p e 1 2 1 0 E a s t M a i n ......................................................................... 8 4 8 - 1 5 9 7 F X : 8 4 8 - 6 2 6 8
S afew ay 2 4 1 1 N o r t h P r o c t o r ..................................................................................... 7 5 9 - 9 8 8 9 F X : 7 5 6 - 6 9 0 2
R i t e A i d 1 3 2 3 E a s t M a i n .................................................................................................... 8 4 8 - 3 5 6 4 F X : 7 7 0 - 9 1 8 7
Safew ay 1 0 5 0 7 G r a v e l l y L k D r S W ................................................................... 5 8 1 - 7 1 8 1
R i t e A i d 3 7 1 7 M e r i d i a n ........................................................................................................ 8 4 8 - 1 5 4 4 F X : 8 4 1 - 4 1 1 9
F X : 5 8 8 -3 6 5 8
Safew ay 1 3 0 2 S o u t h 3 8 t h S t ..................................................................................... 4 7 1 - 5 5 1 1 F X : 4 7 1 - 9 6 7 3
R i t e A i d 1 1 0 1 2 E a s t C a n y o n R d ................................................................................. 5 3 5 - 5 6 6 0 F X : 5 3 7 - 2 2 0 1
Safew ay 1 6 2 4 7 2 n d S t E a s t ........................................................................................ 5 3 7 - 2 4 3 5 F X : 5 3 7 - 3 0 1 9
S a few ay 4301
Safew ay 1 2 1 1 S o u t h “ M ” S t ...................................................................................... 5 7 2 - 7 7 5 3 F X : 2 7 2 - 9 3 1 5
S a f e w a y 1 0 1 0 5 - 2 2 4 t h S t E a s t ( G r a h a m ) ...................................................... 8 4 7 - 7 6 3 4 F X : 8 4 7 - 7 6 3 5
S o u t h M e r i d i a n .................................................................................. 8 4 1 - 6 4 9 5 F X : 8 4 1 - 6 4 9 6
Soundview P h a r m a c y 3 6 1 1 S o u t h “ D ” S t ................................................... 7 5 6 - 8 5 8 5 F X : 4 7 4 - 7 8 7 4
S a f e w a y 5 5 1 2 - 1 6 1 s t E a s t ( a t C a n y o n R o a d ) ........................................... 5 3 1 - 5 8 3 1 F X : 5 3 6 - 5 2 3 5
S panaw ay D r u g 1 7 7 0 3 P a c i f i c A v e ..................................................................... 8 4 6 - 0 5 1 1 F X : 8 4 6 - 0 5 1 3
S u m m i t T r a d i n g C o 1 0 4 0 9 C a n y o n R d E a s t .............................................. 8 4 0 - 2 0 9 8 F X : 8 4 0 - 0 3 0 8
Tacom a P h a r m a c y 9 1 1 5 S o u t h T a c o m a W a y # 1 0 9 .............................. 9 8 4 - 9 5 8 0 F X : 9 8 4 - 1 2 9 4
T o p F o o d s & D r u g 2 0 1 - 3 7 t h A v e S E ............................................................. 7 7 0 - 7 7 2 0 F X : 7 7 0 - 7 7 3 8
Top F o o d s & D r u g 3 1 3 0 S o u t h 2 3 r d ................................................................ 5 9 1 - 3 X 1 0 F X : 5 9 1 - 6 2 7 8
W a lm a rt P h a rm a c y 3 1 0 - 3 1 s t A v e S E
Union A v e P h a r m a c y 2 3 0 2 S o u t h U n i o n ..................................................
.............................................................. 7 7 0 - 9 8 8 9 F X : 7 7 0 - 9 9 8 3
7 5 2 -1 7 0 5 F X : 7 6 1 -9 3 1 5
(A ll a r e a
co d es
a re
253)
W algreen s 9 5 0 5 B r i d g e p o r t W a y S W .................................................. f f . ' . L 5 8 2 - 2 2 3 0 F X : 5 8 2 - 0 6 5 4
S u m n e r
W algreen s 8 4 0 5 P a c i f i c A v e ........................................................................ H f .'.L 5 3 6 - 3 7 0 5 F X :
5 3 6 -4 6 5 9
M a r k ’s P h a r m a c y 1 1 1 9 M a i n ...................................................................................... 8 6 3 - 6 2 2 3
W a lg r e e n s 4 3 1 5 - 6 t h A v e ...............................................................................!? .).!.. 7 5 6 - 5 1 5 9 F X :
7 5 6 -5 0 8 6
N i c h o l s o n ’ s P h a r m a c y 9 1 0 A l d e r A v e ............................................................. 8 6 3 - 8 1 4 1
F X : 8 6 3 -3 7 0 7
W algreen s 7 4 5 1 C i r q u e D r W ................................................................................... 5 6 4 - 7 5 6 9 F X : 5 6 4 - 8 2 0 8
W alg re en s 8 2 2 4 S t e i l a c o o m B l v d S W .............................................................. 5 8 1 - 0 4 9 4 F X : 5 8 1 - 0 9 9 7
H o s p ita l
O u tp a tie n t
P h a rm a c ie s
(A ll
a re a
co d es
a re
253)
A l l e n m o r e H o s p i t a l .............................................................................................................. 4 0 3 - 5 1 5 0 F X : 4 0 3 - 5 0 9 2
Bonney Lake (All area codes are 253)
'Fred M e y e r 2 0 9 0 1 H w y 4 1 0 ...................................................................................... 8 9 1 - 7 3 3 3 F X : 8 9 1 - 7 3 2 7
’R iteA id 2 1 3 0 2 H w y 4 1 0 .................................................................................................. 8 6 2 - 2 8 2 2 F X : 8 6 2 - 8 4 3 0
S a f e w a y 2 1 3 0 1 H w y 4 1 0 .............................................................................................. 8 6 2 - 2 5 3 3 F X : 8 6 2 - 2 1 7 3
G o o d S a m a r i t a n H o s p i t a l ............................................................................................... 8 4 1 - 5 8 9 9 F X : 7 7 0 - 5 6 5 5
M a r y B r i d g e C h i l d r e n ’s H o s p i t a l ............................................................................ 5 5 2 - 1 0 7 6 F X : 5 5 2 - 1 5 5 8
P u g e t S o u n d H o s p i t a l ..........................................................................................................4 7 4 - 0 5 6 1
S t. F r a n c i s H o s p i t a l P h a r m a c y
Eatonville (Area code 360)
K ir k 's P h a r m a c y 1 0 4 M a s h e l l A v e N o r t h
F X : 4 7 2 -8 6 9 7
S t . C l a r e H o s p i t a l P h a r m a c y ....................................................................................... 5 8 1 - 6 4 1 0 F X : 5 8 9 - 8 2 9 4
............................................................................. 9 5 2 - 7 9 6 6 F X ' 9 5 2 - 7 9 2 4
S t . J o s e p h M e d i c a l C e n t e r ................................................................................( # 1 ) .. 5 9 1 - 6 6 8 3 F X : 5 9 1 - 6 9 5 6
....................................... . 8 3 2 - 4 7 0 0 F X : 8 3 2 - 4 5 2 0
Pharmacy H o tlin e ................... .............................. 2 5 3 - 8 4 6 -0 5 1 1
^’Limbers in p a r e n th e s e s a r e t o b e p r e s s e d a t v o i c e m a il p r o m p t f o r c a l l s f r o m p h y s i c i a n o f f i c e s o n l y
T a c o m a G e n e r a l H o s p i t a l ................................................................................................ 4 0 3 - 1 0 7 6 F X : 4 0 3 - 1 5 5 8
The pharmacy hotline is fo r reporting fraudulent pharmacy activities
8/99 Pierce County Medical Society; p h a se call 572-3709 fo r changes/additions
ty }iwca
PCMS Labor & Industries Task
Force brings collaboration
o4U<kc<U dfociefy
D epartm ent of
Labor & Industries
Introducing......
D ia n e Groves, R N C , B S N , M A
The L abor a n d In d u strie s Task
Force chaired by William Ritchie,
MD has been m eeting for nearly tw o
years attem pting to bring about a
smoother, m ore collaborative relation
ship betw een physicians and the
Department of L abor & Industries
(L&I). The m atter of in d e p e n d e n t
medical examinations w as again the
centerpiece of the ag en d a at the T ask
Force's Septem ber m eeting and
several issues w ere discussed that m ay
be of interest/benefit to PCMS m em
bers.
L&I does encourage a tten d in g
physicians to perform the rating
examination of the patient. This does
enhance the process a n d red u ce the
amount of paperw ork. The attending
physician need n o t provide a ten page
report to the D epartm ent. It is neces
sary, however, that the D epartm en t be
notified that you will be doing the
ratings and it is necessary for them to
load the code. A pre-authorization call
will greatly speed the account receiv
able time. It is im portant to distinguish
between IMEs and the im pairm ent
rating codes, w hich are different.
Physicians and / or their staff can
call (800) 848-0811 (provider toll-free
hotline) to determ ine if the code has
b e en lo ad ed . If y o u are experiencing
difficulty w ith a particular claims
m an ag er or specific claim, please d o n 't
hesitate to con tact any of the follow ing
claims m an ag er supervisors. They are:
Unit 9:
Kathryn Hudson
360-902-4742
Unit J:
W ayne S hatto
360-902-6445
U nit G:
Sherrilyn McClune 360-902-6413
O c c u p a tio n a l N u rse C o n su lta n t
T a c o m a S e r v ic e lo c a tio n
D iane has spent the last ten years in
O lym pia with the M edical Quality
A ssurance Com m ission as a Health
Care Investigator before jo in in g L & I
P h o n e : 253-596-3904
F A X : 253-596-3881
The claim m anagers' operations
m an ag e r for Pierce C oun ty is Carol
E ddinger. She m ay be reached at 360902-6601. If y o u fail to get a satisfactory
response from any of the above,
please call D o u g Jackm an at 572-3667.
E m a il: g r o e 2 3 5 .In i.w a .g o v
P lease call Diane i f y o u have
questions or n eed help
Pierce County Independent
Medical Examiner Panels
C orvel I ME Services
M edical Director: A lan Brobeck, MD
10828 G ravelly Lake D rS W #105
Tacoma, 98499
360-779-7488, Fax: 360-779-7636
Quality' Assurance Contact: Mary
Swindell, Dist Mgr, 360-336-9602
H aelan M edical E v alu atio n s (NHR
WA Inc.)
M edical Director: Bradley Billington, M D
535 Dock Street #114, Tacoma, 98402
253-627-0565,800-858-7040, Fax: 253-6275651
Q uality Assurance Contact: Patricia
Jackson, 800-858-7040
E xigere C o rp o ra tio n
TACOMA/PIERCE COUNTY
O utpatient G e n e ra l M ed ical C a re .
Full an d p a rt-tim e p o sitio n s
available in T a c o m a a n d vicinity'.
Veiy flexible sc h e d u le . W ell su ite d
for c a re e r re d e fin itio n fo r
GP, FP, IM.
C ontact A ndy T so i, M D (2 5 3 ) 7 5 2 -9 6 6 9
or Paul D o ty (A llen, N e lso n , T u r n e r &
Assoc.), C linic M a n a g e r (2 5 3 ) 3 8 3 -4 3 5 1
M edical Director: Edw ard DeVita,M D
1901S Union, B1012, Tacoma, 98405
888452-5582, Fax: 425452-5582
Q uality Assurance Contact: Jamie
Cheney, 425452-5581
F ra n cisc an In d ep e n d en t M edical
C onsultants
M edical D irector Kirk H an n o n , MD
1930 P ort of Tacom a Road
Tacoma, 98421
253-272-6686, Fax: 253-274-5525
Q uality Assurance Contact: Kristin
Shotsman, 253-272-6686
In d e p e n d e n t M edical E v alu atio n s
M edical Director: M ark Leadbetter, MD
10828 G ravelly Lk D r #110, Tacoma, 98499
360491-2558,800-876-2558, Fax: 360459-
019-1
Q uality A ssurance Contact: Sheila Melich,
360491-2258
In d e p e n d e n t M edical S ervices
M edical Director: Patrick H ogan, DO
1811 ML K ing Jr W ay, Tacoma, 98405
253-5724288, Fax: 253-5724608
Q uality A ssurance Contact: M aureen
Graves, 253-5724288
S e e “ P a n e ls ” p a g e
October, 1999
12
PCM S BULLETIN
7
B u l l e t in
Save
the
The Edwin C. Yoder Honor Lectures
Friday, November 19,1999
SP E C IA L P R E S E N T A T IO N by Susan Fish er-H o ch , MD and Jo se p h McCormick, MD
autho rs o f Level 4: Virus H u n te rs o f th e C PC. T h is husband and w ife team has sp en t two and a half
decades in rem ote co rn e rs o f th e world tra ckin g some o f th e m ost lethal d ise a se s known to mankind.
Now th e se d isea ses - th e deadly Ebola virus, Lassa F e v e r, H I V , Legionnaire's D ise a se and th e tick
borne Crim ean Congo H em orrh agic F e v e r have becom e th e s u b je c t o f in creased public concern. These
sp eakers will o f f e r a personal, insiders' account o f th e stru g g le to un d erstand and to cu rb the
d e stru c tiv e power o f th e s e viruses.
Location:
St. JcnepJv M e d ic a l Center
Physician Lectures:
This course is accredited for 2.0 Category 1 hours.
12:30 PM. -1:30 PM. C c n n p lim e n ta r y C a te red * L u n ch e o n /
c a fe te r ia ;
1:30 PM. - 2:30 PM- "EyYiej'Cf-vvu^- ’D l4€&4'&}-L-yvthe*'21‘'r C&ntlU'y-i^ciA/e^ W&L^trnedscivui'l'lJCll'W&Aytf.tcipcitti'?"
'Roomy 1A <5-£
Joseph sH cC orm C ch; M- V.
2:4-5 PM. - 3:4-5 PMR oom y lA&c'b
UU'u-id - Tropical*Ra,<U/i'froi''e4t~to-the.'HLgJ'isS&tx-u'Cty La.bot'citoiy"
Su$ari'F££iher-Hox^v, M. D.
Reservations required for lunch and each lecture - limited seating available
I iWLt~cvtLo-yv^ w u b be/ vncvded/ iw O ctober, f o r move/ CAafbrwicvtion/, cuU/
they Office/of A c a d e m ic / AffvUr^ a t ( 2 5 3 ) 2 0 7 - 6 0 3 5 .
"As an organization a ccre d ite d by th e W ashington S ta te M edical Association M edical Education Com m ittee to provide continuing medical
education. Catholic H ealth In itia tive s, W e ste rn Region c e rtifie s th a t th is course m eets th e c rite ria f o r 2.0 hours o f Category 1 CME to
s a tis fy th e relicen su re requirem ents o f t h e W ashington S t a t e M edical Q u a lity Assuran ce Commission and f o r th e Physician's Recognition
Aw ard o f th e Am erican M edical Association."
8
PCIvlS B U L L E T IN
October, 1999
C o m ity o4'icdica.I (S fo u d j
%
Early Intervention Case
Management for HIV Infection
HEALTH
D E P A R T M E N T
Health
Department
web site offers
wealth of info
Be sure to bookmark
w w w .h ea lthd ep t.co .p ierce.w a.u s
as one of your frequently visited web
sites. The active site offers options for
navigation. You can do a site search on
any page by topic or you can use the
site directory, a complete listing of
departments and progprams. All major
sections have their ow n site directory,
as well.
A sampling of listings include:
• Board Activities
• Board of Health
• Breast & Cervical H ealth
• Commercial Food Program
• Communicable Diseases
•Community/Health Groups
• Family Support Centers
• Food & Community Safety
• Domestic Violence
• Health News - W orldwide
•Help
• Human Resources
• Public Health Affairs
• Programs for Kids
• Services and Phone Directory
• Site Directory
• Source Protection
• Substance Abuse
The Tacoma-Pierce County
Health Department has begun a
program of case management for
people w ho are HIV positive. The
program will balance early treatment to
maintain health with strategies to
prevent the spread of the disease.
There are now medical therapies
which can help HIV-positive people to
live healthier, longer lives. The
development of highly active
antiretroviral therapy (HAART) means
w e can begin to look at HTV infection
as a chronic disease that can be
managed. Although die virus stays in
the infected person's body perm a
nently, early treatment can help the
body restore its immune system to near
normal levels.
While the new drugs have
remarkably improved tire health of
persons infected with HIV, there are
concerns. The regim ens are complex
and patients often have difficulty
adhering to the medication schedule;
people who miss doses may be at
increased risk for developing drugresistant strains of HTV, and HTVpositive persons on the HAART
therapy may believe they are less
infectious and relax their prevention
practices.
The H ealth Department's Early
Intervention Case Management
program will combine help in locating
resources for medical and other needs
w ith education on ways to prevent the
spread of the disease. Services will be
provided in a professional and thera
peutic manner; referrals, education and
counseling will be individualized to the
client's needs and risk factors. In
addition, staff will work the HIVpositive people to locate partners to
educate and support them in preven
tion behaviors. Research completed by
the Centers for Disease Control (CDC)
has shown that clients and their
partners are receptive to partner
notification services, and it is a standard
public health practice for preventing
sexually transmitted and other commu
nicable diseases.
The effectiveness of the
program relies on early notification of
HTV infection. Earlier this year the
Board of Health passed a resolution
that requires reporting of positive HIV
tests to the Health Department by
physicians and laboratories. Reporting
HIV infection, rather than waiting for
AIDS symptoms, means that individuals
can get the HAART and other medical
treatment in early stages of viral
infection and also prevent the spread
to others through education and followu p w ith partners. H ie CDC have
recently advocated for this kind of
early action, by using new technology
that helps to pinpoint w hen someone
first became infected. If those names
are thenforw arded to professionals for
follow-up, partnere can be identified
more quickly and accurately. In
U pdate #101, dated September 7,1999,
the CDC announced they w ant to "do
for HTV w hat has long been done for
syphilis and gonorrhea" by getting the
infected person treated and partners
notified early. Their message contin
ues: "While it's hard for many sexually
active people to recall the names and
addresses of all their partners, span
ning year's of activity, it is typically a
simple matter to conjure a list for the
past four months. The CDC want public
health authorities to use this information
to track down individuals who might
have gotten infected and interrupt the
chain of transmission on a large-scale
basis."
Please report HTV-positive tests
to the H ealth Department by calling tire
24-hour reporting line at 798-6534.
October, 1999
PCMS BULLETIN 9
B
u l l e t in
Franciscan Medical G roup Physicians No Longer
R epresented by L abor Union
The N orthw est Physicians
Alliance (NWPA), a p art of United
Salaried Physicians and Dentists labor
union, has chosen to no longer
represent physicians w ho practice w ith
the Franciscan Medical G roup, a
netw ork of eight clinics located
throughout south King and Pierce
counties. Franciscan Medical G roup
has received a letter from die union
stating they " unequivocally disclaim
interest in representing" the physicians
in the medical group.
Franciscan Medical G roup,
w hich has 52 physicians, began
operations in April 1999, after the split
up of M edalia H ealthcare, a network
of prim ary care clinics throughout
P uget Sound that w as co-sponsored by
the Providence and Franciscan H ealth
Systems. In June 1998, M edalia
physicians voted to be represented by
a labor union. After it w as form ed this
spring, Franciscan Medical G roup
recognized the union an d agreed to
bargain with it.
"W e are pleased to have the
opportunity to w ork directly w ith our
physicians to provide our patients the
best possible care," said Cliff
Robertson, MD, chief m edical
officer for Franciscan M edical G roup.
"O ur physicians have taken a strong
lead in m aking decisions locally as part
Fed eral W ay’s Fin est
A d d ress:
At St. F ra n c is H o sp ita l
3 4 5 0 3 9 t h A v e n u e S.
F e d e ra l Way-
5 2 , 000 Square Foot M edical/Professional Office Building
Join These Tenants: M edalia H ealth C are • St F ran cis W om en’s
C e n te r • P e d ia c tric s N o rth w e st • D igestive H ealth
N etw o rk • P h a rm a c y & D iagnostic Lab • Dr. B a rb a ra Levy
Contact:
A
K irsten H ayfo rd
206- 264-4594
A le x a n d e r
Commercial Real Estate
J -
10
PCM S BULLETIN
schedulea tour.
October, 1999
•
•
•
•
Class “A” Interiors
T. I. Allowance
Ample Parking
High Growth M arket
of this new organization. I interpret the
union s w ithdraw al to mean that our
doctors are optimistic about the
direction of our medical group. While
w e respect the right of our physicians
an d staff to seek representation, this
action suggests that our doctors don't
feel they need a u nion as a third-party
intermediary."
Since its form ation in April,
Franciscan M edical G roup has success
fully recruited five new physicians,
converted to a m ore effective com
pu ter system and installed anew phone
system tha t provides better access for
patients, while maintaining steady
patient volumes.
y o t m t y Q îiedicai <§foaety
IN M E M O R IA M
R O D G E R S. D 1 L L E , M D
It is an honor to be asked to celebrate the life of Dr. Rodger Dille. H e w as my firm friend and colleague
for 42 years. Rodger w as a great m an in every sense, in every sense. His hum or was no less than his goodness.
We enjoyed m any experiences together and apart from our one day fully spent at the races at Longacres where
my wife and I w ere his guests, all experiences were positive. H e had a profound
knowledge of internal medicine, having firs t received his degree in Pharmacy,
m agnum cum laude,attheUniversityofW ashingtonwithsubsequentmedical
p^s
training at the Mayo Clinic. Quickly one recognized his diagnostic skills, his intel-
4
"
'M
lect and his scientific know ledge. An article in a recent News Tribune by Ellen
Goodman emphasizes the importance of compassion in medical care. Rodger ex
emplified that quality. H e also had an unpredictable, very funny wit. A remark
that only he could make occurred when I sought his opinion about w hat to me
was a most puzzling, obscure disorder. His response was, "It's the worst case of
whatever it is that I have ever seen!" H e was an instinctively kind and warm person. He had an immense heart, one matelling his frame. In the hospital corridors
this big man seemed to trot rather than walk and one will always remember that diminutive black bag which held his
medical tools of trade. I heard that early every morning his day started w ith Journal reading. H e remained up to
date with a current know ledge of The N ew England Journal of Medicine, The Lancet and the other best publica
tions. H e was full of energy no less than wisdom. Moreover, I never heard him say an unkind tiling.
Despite his large practice and daily commitments to Internal Medicine, many of us will remember his participat
ing at surgery. In the operating room he would patiently assist for hours if necessary in order to see the disease
process, the pathology. W ho w as it that once said thatfor some surgical procedures a calendar w ould be more ap
propriate than a clock? Rodger w as unflinching.
Medicine and family w ere his life. With the pleasure of having been the treating physician for his wife
Vemetta, and his daughters Esther and young Vemetta there was ample evidence of these family bonds. He was
wrenched by the loss of Josephine in early days. H e w ept at the funeral of his beloved wife Vemetta not long ago.
He came with us to enjoy Jerry Miller and his son playing jazz at the Iron Horse. O n taking him home late at
night there of course w as the older Vemetta waiting for him at the gate. Most recently, at the age of 90, he regu
larly came to services I sometimes conducted through St. Luke's Church at the Weatherly Inn. This was always
followed by time cheerily spent in his apartment, reminiscing and still talking med icine. He was a merry m an at all
times. If, by H eaven is m eant leaving us with the best memories of a splend id person, Rodger has certainly gone
there.
S te v e n s D im a n t, M D
October, 1999
PCMS BULLETIN 11
B
u l l e t in
“Panels”
M ed ic a l C o n su lta n ts N etw o rk
Medical Director: Brian Grant, MD
3315 S 23rd #110, Tacoma, 98405
253-272-4556,800-636-3926, Fax 253272-4876
Quality Assurance C ontact Karen
Rothstrom, 800-443-6269
M e d ic a l D ia g n o s t ic S e r v ic e s
Medical Director: Michael Olejar, MD
1402 - 54th Ave E, Tacoma, 98424
800-8348334
Quality Assurance Contact: Jeannine
Austin, 425-451-3345
O b j e c tiv e M e d ic a l A s se ss m e n ts
(O M A C )
Medical Director: D hanvantM adhani
Allenmore Medical Center
PO Box 111266, Tacoma 98411-1266
800-331-6622
Quality Assurance C ontact Chris
Casper, 206-324-6622
P h y s ic i a n R e s o u r c e s N o r t h w e s t
Medical Director: M ark Holmes, MD
11318 Bridgeport W ay SW, #B
Lakewood, 98499
253-581-1913, Fax: 253-581-9358
Quality A ssurance Contact: Jeanete
Colberson, 253-581-9313
V a lle y I n d e p e n d e n t P h y s ic i a n s
S erv ice s
Medical Directors: Drs. Ma, Rerun and
Winegar
12303 Meridian S, Puyallup 98373
253-841-1378
201 - 15th Ave SW #D, Puyallup 98371
253-840-0598, Fax: 253-840-3352
Quality Assurance Contacts: Drs. Ma,
Renn and W inegar
Advanced
Coding Seminars
Rescheduled
The W SMA A dvanced Coding
S e m in a rs, A d v a n c e d C P T & IC D -9
C o d in g , h a v e b e e n rescheduled. The
Tacom a session will be held on
W ednesday, October 27 at the
LaQuinta Inn.
M orning sessions 8:30-12:30will
address codingfor medical specialties,
w hile afternoon sessions {1:30 -5:30)
will review coding for surgical special
ties. O b /G y n will be covered as the last
segm ent of both sessions. Cost is $129
for W SMA m em bers and $258 for non
members.
For m ore information, call Kathy
Bimie at WSMA, 1-800-552-0612.
of commission?
rapidly— an d not for the better. High claim s have caused m an y m ajor
carriers to lim it the m ost im p o rtan t benefits.
At Physicians Insurance Agency, th ere’s still tim e to secure the specialtyspecilic coverage you need. In addition, we can help you find superior life
and long-term -care coverage for you and your family.
lb discuss the ways you can best protect your future incom e, call
Physicians Insurance Agency today: (206) 343-7150 or 1-800-962-1399-
w \
PHYSICIANS
INSURANCE
AGENCY
A W h o lly O w n ed S u b sid ia ry of
P h y sic ia n s In su ra n ce E xch an ge
Sjionsan'd by /be W ashiuôu Stale Medical Association
12
PCMS BULLETIN
October, 1999
I
I
“Medicine is a Harsh Mistress”
This title was inspired by Robert
Heinlein, who wrote "The M oon is a
Harsh Mistress." The thoughts were
triggered by a letter from a high school
student,
working on
adass
assignment
"Obstetrics
sounds like
a nice
profession.
What do
you like
aboutit?
Whatdon't
you like? What made you go into it?"
What, indeed!
During the few spare moments in
medical school, between classes, lab,
night call, and studying for tests, we
admitted to one another that w e didn t
reallyknow what we were getting into
when we applied to medical school.
Thiswas not a complaint. It was a
statement of fact. No matter how much
wemay have known about medicine
before we started, the reality of it was
different. We could try to describe it,
butwe could not make someone else
understand it One had to live through
it, to know what it was like. Each one of
us probably experienced things
differently, but we all had our feelings.
When we were lined up to
register for the first year of school, one
secretary joked, "You w on't get to be
doctors until each of you has filled a
cemetery lot." Facing death w as one of
the strongest triggers of feelings. She
had differentfaces: the 27 year old m an
withrheumatic heart disease, on his
sixth episode of congestive heart
failure, whose heart refused to
respond to digitalis; the eight year old
girlwith leukemia, covered with
petechiae; the four month old boy with
True passion is aconsuming flame, and either it mustfind
fruition, or it will b u m the hum an heart to dust and ashes.
W illliam W inter
myocardial fibroelastosis; the 22 year
old woman with septic abortion. They
were al 1different, yet w hen death
finally took them, they looked
strangely alike, as if she had p ut her
ow n mask on their faces: the sunken
eyes, the pinched nose, the ashen
cheeks.
Facing death, after having
worked on patients for hours to keep
them going, brought the bitter taste of
defeat. We bowed to the inevitable, but
did not like it. We just had to accept it,
or it would not have been possible to
keep going.
savoring the last few moments of a
slumbering state, before stepping into
tine brightly lit opera ting room, sud
denly completely awake, ready to go.
Then followed the rush of action, like
resusci ta ting a newborn with no
heartbeat that was pulled out of the
abdomen of a woman with a ruptured
uterus, and getting him to the nursery;
like doing a hysterectomy on a patient
with postpartum hemorrhage who just
w ouldn't stop bleeding after replacing
some ten units of blood. We all have
many stories to tell like that, where we
are thrown into the picture of a
Something is missing. We used to be proud o f our art. now ive are
asked to paint by the mimhers. We had the respect o f the commu
nity. now »n? are bodies, full-time equivalents. Our patients still
respect us. somewhat. We are no longer their physicians o f choice,
we are one o f those names on their insurance panel.
O ther people also were affected
by death and needed help. Like the
baffled parents of the four month old
boy with fibroelastosis. "But he was
well until just two to three days ago!"
Like the bewildered husband of the 22
year old w om an with septic abortion,
who stood outside the room, holding
his 18 month old boy on his arm, and his
three year old girl by the hand, waiting
for us to get done so he could spend
some time with his wife. He didn't get to
her bedside until after she had died.
Then, there w ere the nights. Ah,
the nights! lik e walking through dim
halls of the hospital, half asleep,
complex pattern of human life, and
leave our mark on the canvas.
Last year, at the district meeting
of ACOG, I met a few friends from
California, now retired. We sat
together at lunch, and were joined by a
colleague recently out of training.
"Why do you still go to meetings?" she
asked them. The answer was: to get
CME credits to keep their license. Was
that the real reason? Why did they
w ant to keep their license? Certainly
not to practice. The truth is that
medicine is a way of life. You don't stop
S e e “ M is tre s s " p a g e 1 4
October, 1999
PCMS BULLETIN 13
B
u l l e t in
Misti ess
from page 13
being a physician just because you
retire. Som ehow giving u p the license
is like giving u p a p art of one's life. I
didn' task them w hat they did, thatthey
w ould not have been able to do w ithou t
their license, w hat m ade them spend
their retirem ent m oney going to
m eetings, keeping up. I think, very
simply, as long as they w ere still alive,
they were still physicians.
W hat m ade us go into medicine?
Some w ould say it w as the m oney. It
has been said doctors m ake too m u ch
money. T hat is no longer true, if it ever
was. Yes, w e earn a good living, but
those am ong u s w ho became rich did
so from other activities, not from tine
practice of medicine. People in other
fields, w ho w ork as hard as w e do, w ith
our intelligence and ability, make much
m ore money than w e could ever
expect to make.
Some w ould say it w as a role
model that inspired us. Perhaps, but
w hy did w e choose this role model,
rather than another? W hy did Presi
dent Clinton choose President
Kennedy as his role model, rather than
the local general practitioner? Why,
out of all the role m odels out there, w e
w anted to be like this one?
I have know n physicians, w ho at
some point decided medical practice
w as not for them. They w ent into public
health or administration. Well known
writers, like Michael Crichton, dropped
o u t of m edicine early in their careers
and never looked back. We stayed.
The sam e questions apply to
nurses. I have spoken w ith several,
w ho left nursing for other fields, but
came back. W orking on an assembly
line they m ade more money, had
regular hours, did not have to w ork on
w eekends and had better benefits.
H owever, they could not take tire
drudgery. There is some kind of
mental stimulation and emotional
feedback from w orking in medicine
that makes us p u t u p w ith the hours, the
m essy work, the blood and the gore of
medical practice. That is a soft spot
inside us w e try to cover u p w ith
14
PCMS BULLETIN
October, 1999
superficial detachment, an d even w ith
some degree of cynicism. After
w orking all night, trying to patch u p a
w retched body, w e m ay say, "There
m ust be a better w ay to earn a living!"
Yet w e keep going, because deep
inside w e know that there is nothing
else w e w ou ld rather be doing.
The insurance executives k now
that very well. They know w e will be at
our posts w hen called, no m atter w hat
they do to us. W e will continue to take
care of patients arid w e will be satisfied
w ith any crumbs they deign throw n us.
Physicians w ere w ell k now n to be the
best risk for disability insurance am ong
all professionals. We just could not stay
aw ay from our work. However, a
strange thing happened on the w ay to
the bank. To the h o rro r of insurance
executives, physicians suddenly
started filing claims for disability in
large numbers, so m uch so that
disability compensation of physicians
p u t a significant dent in the balance
sheets of insurance companies.
Something is missing. We used to
be pro u d of our art, now w e are asked
to paint by the num bers. We h ad the
respect of the com munity, no w w e are
bodies, full time equivalents. O ur
patients still respect us, somewhat. We
are no longer their physicians of
choice, w e are one of those nam es on
their insurance panel. We stand at the
gate to their medical care and hold the
key, so they resent us for that. They
also know they no longer have our
undivided allegiance, because w e are
beholden to their insurance com pany.
They know w e are in a bind, b u t they
are in a bind too, an d they are m ore
concerned about themselves than
about us.
So there w e stand, b u t one
cannot keep on giving, w ithout getting
som ething in return. Even the strongest
passion needs to be fed. It usually does
not require much, b ut it needs some
recognition, or it will b u m out. W hen
that happens, w hatever is done to
rekindle it, it usually too little, too late.
W hatrem ains is dust and ashes in the
heart.
Applicants for
Membership
C o w e ll, P a m e la D., MD
O b stetrics/G yn ecology
Practices atM t. Tahom a Gynecology,
4808112lhStreet SW, Lakewood 98499;
582-5880
M edical School: Emory University
School of M edicine
Internship: G rady Memorial Hospital
Hospitals
J o h n s o n , A n th o n y G., MD
F a m ily Practice
Practices at9332BridgeportW aySW ,
Lakew ood 98499; 403-4460 Medical
School: University of Califomia-Irvine
Internship: University of California at
Davis
Residency: University of California at
Davis
Personal Problems
of Physicians
M edical problem s,
m ent, em otional, or
o th e r su ch difficulties?
"Robert Sands, Chair
Bill Dean
F. Dennis Waldron
752-6056
272-4013
265-2584
A s s u r e d
PCMS Alliance
President s Message
Philanthropic Update
Now that school is back in session w e hope you will be
able to join us on November 4 from 11:00am to 1:00pm for the
Peninsula Cooking School class. The school is located in
Qinterwood. Robin Going will demonstrate how to prepare
and serve hors d'oeuvres for the holidays. The cost is $30 per
person with a maximum of 12 people. Please make checks
payable to PCMSA and mail to Yolanda Bruce, 4822105th
Ave NW, Gig Harbor 98335. Your check is your reservation.
RSVP by October 25 to Yolanda Bruce at 265-8190.
Directions to Peninsula Cooking School: The address/
phone is 12210 49“’ Ave Ct NW/858-2465. If the gates are
closed, dial 013. Take H w y 16 East to Gig Harbor. Exit at
North Rosedale. Turn right onto Rosedale. Turn left at
Canterwood Blvd. Turn right at 54thStreet, which turns into
49*Avenue.
Nikki Crowley is in charge of family support. Please
call her at 922-7233 for any individual needs, concerns or
support
The following organizations have requested funds. The
Philanthropic Commi ttee will meet in October to prioritize the
list. They have specified w hy funds have been requested.
The Holiday Sharing Card mailing will be held
on October 12 at 9:30am at the PCMS office. Your
help is greatly needed! Call Yolanda Bruce if you can help.
Tacoma Area Literacy Council for tu to r training and
support services
Prison Pet Partnership Program for electric wheelchairs
Neighborhood Clinic for a social w orker
Pierce County AIDS Foundation for their Basic N eeds
Program
YWCA for a W omen's Health Program
PLU Wellness Center for a First Step Program
Trinity Neighborhood Clinic for m edication and
malpractice insurance
Head Lice International for Pediculosis Treatm ent
Specialist
Sane/SARC Program atT acom a G eneral for training
additional nurse examiners for the Sexual Assault Program
American Lung Association for C am perships for two
children
Baby Think It Over Program for m ore dolls
Ten Things you can do to Reduce Violence
Education
• Invite a speaker on domestic violence to your faith organization, neighborhood meeting, or civic group.
• Encourage your pastor or Rabbi to provide spiritual leadership to your congregation that addresses family violence.
• Encourage your school to include violence prevention as part of the curriculum.
• Talk to your children about relationships that are healthy and foster mutual respect. Control over a partner is abuse.
•Self-examination means does your ow n vocabulary, attitude and actions reflect a tolerance for violence or a desire for peace
and respect?
VOLUNTEERS
NEEDED
Get involved
*Adopt a room at the W omen's Shelter or give your time as a volunteer.
*Attend court with a victim of domestic violence to provide emotional support.
*Sponsor a food drive for a w om en's shelter through your faith organiza tion, civic group or business.
ONE - TW O HOURS
*Donate or collect new clothing and toys for children living at the shelter.
1Donate 5 % of your income or 5 % of your time to a program benefiting the victims of family violence.
*Talk about it! The conspiracy of silence allows this to pass from generation to generation and people
are dying every day.
If you or someone you know needs help call 911 for emergency assistance or call the
Washington State Domestic Violence Toll Free Hotline for services nearest your at 800-562-6025.
Planforyour future safety.
October, 1999
Stop the Violence Fair
Satu rday, October 23
10a.m-5p.m.
South Hill Mall,
Puyallup
Contact: AliceYeh
756-0578 or
email: [email protected]
PCMS BULLETIN 15
B u l l e t in
C M E at H aw aii on "Big Islan d,”
H ap u n a Hotel on sunny, K o n a C o a st
The H a p u n a Beach Prince
Hotel, on 32 acres edging on H apuna
Beach at the M auna Kea Resort (hailed
as "one of the w orld's 10 best"), has
b een selected as the site for the CME
at H aw aii program for a variety of
reasons, but particularly for the ability
to secure a "world-class resort" at
greatly reduced rates.
Built in 1994, the H apuna is
located on the beautiful and sunny
K ona coast. The oversized, deluxe
guest quarters feature louvered doors
that slide open to roomy furnished
lanais. The sm art design of this hotel
ensures that all rooms have at least
partial ocean views.
The hotel offers reduced green
fees at the M auna Kea course that
began the legend of H aw aii as a
golfer's paradise and H apuna Golf
Course, 18 championship holes
designed by Arnold Palmer and Ed
Seay, w ith an ocean view from every
tee and green.
Registrants may benefit from our
negotiated group rates for ocean view
rooms at $180. A second adjoining
room for children under 18 is available
at $50 below the g ro u p rate.
To take ad v an tag e of these
savings, you m ust m ake your reserva
tions soon. THE COLLEGE'S RE
SERVED BLOCK OF ROOM S WILL
BE RELEASED AFTER FEBRUARY
9,2000. Reservations can be m ade by
calling the H apuna directly at (800) 8826060. You m ust identify yourself as part
of the COME group.
Program brochures w ere m ailed
in August. In addition to outlining the
CME p ro g ram (16 Category I hours),
the brochure discusses transportation
a n d encourages advance planning for
the limited flight options during the
springvacation dem ands in Hawaii.
The brochure also discusses the
savings and amenities of tire Hapuna
Beach Hotel.
For additional information, call
the College at 627-7137.
Z-TQ WAtUE* TOVJN - 10 Ml.
Air reservations
encouraged for
Hawaii CM E
To assure y ou are able to secure
seats and get a reasonable price for
CME at Hawaii, we urge y o u to make
your reservations NOW. A small
refundable deposit will hold your seats.
The Col lege is w orking w ith
M arilyn at O lym pus Travel (565-1213).
O lym pus has booked some seats at
special options at the best rates.
Call M arilyn today.
16
PCMS BULLETIN
October, 1999
COPYRIGHT ©'90?
BY THAVGl GRAPHICS
INTERNATIDNAUJ!
W ’leyce Tpotmtif- Q vd eJku i C Sfoatty
COLLEGE
□=
MEDICAL
EDUCATION
Common Office
Problems CME
set October 29
The topics are set for the
College's Common Office Problems
CME scheduled for Friday, October
29,1999 and planned for Rooms 1A &
Bat St. Joseph Medical Center.
The course is designed for the
primary care clinician and focuses on
practical approaches to the most
commondilemmas faced in the daily
routine of medical practice. Special
emphasis will be placed on quality, cost
effectiveness and practice parameters.
The program is again directed
by Mark Craddock, MD and will
offer 6 Category I CME credits. This
year's course will cover:
• Pediatric Vaccines
• Common Shoulder Problems
• Uterine Artery Ebolizatin
for Treating Fibroids
• New Diabetes T h e ra p ies
• Pediatric H eadache
• Hypertension
• Dermatology
• Fibromyalgia
Forregistrationinformation or a
course brochure, call the College at
627-7137.
Whistler/Blackcomb CME condo
reservations deadline December 1
College's CME at Whistler/Blackcomb
program; brochures were recently
mailed. The conference is scheduled
for February 2-6, 2000.
Reservations for the block of
condos, THIS YEAR AGAIN ALL IN
THE ASPENS, are available. Reserva
tions can be made by calling (800) 777-
Dates
Friday, October 29
Friday, December 3
Friday, January 21
Wednesday - Sunday
February 2-6
Friday, Februaiy, 11
0185. You must identify yourself as part
of the College of Medical Education to
receive the negotiated reduced rates.
THE COLLEGE'S BLOCK OF
ROOMS WILL BE RELEASED AF
TER DECEMBER 1, 1999.
For more information, call the Col
lege at 627-7137.
Program
Director^)
Common Office
M ark Craddock, MD
Problems
M edicine & Mental
Health
Care
CM E @ W histler
Advances in Women's
Medicine
Thursday-Friday
Internal M edicine
M arch 9 & 10
Review 2000
M onday - Friday
April 10-14
Saturday, April 29
David Law, M D
Gregg Ostergren, DO
Richard Tobin, MD
Robert Corliss,MD
CM E @ Hawaii
M ark Craddock, MD
Surgery Update 2000
Asthma, Allergy &
Friday, May 5
Pulmonology for
A lex M ihali, MD
Primary Care
Nuts, Bolts &
Friday, June 2
Innovation:
Gary Taubman, MD
Gastrointestinal
Richard Tobin, MD
Disease V
October, 1999
PCMS BULLETIN 17
B
u l l e t in
John Lenihan, MD reaps results of
several years of research and study
The lead an d second articles p u b
lished in the G reen Journal (OB/GYN)
w ere the results of tw o studies Dr.
Lenihan participated in as a co-investi
gator. ("Uterine Bleeding in Postm eno
pausal W om en on Continuous
Therapy w ith Estradiol and
N orethinadrone Acetate," Archer et al.,
OB-GYN, Vol 94, No. 3, Page 323,
September, 1999 and " A Randomized
Controlled Trial of Four Doses of
Transderm al Estradiol for Preventing
Postm enopausal Bone Loss," Weiss et
al., OB-GYN, Vol 94, No. 3, page 330,
September 1999.)
He also participated as a re
searcher for an article published in the
A m erican Journal of OB-GYN in July,
1999 w hich is entitled "Efficacy an d
Safety of Low, Standard, an d H igh
Dosages of an Estradiol Transderm al
System Com pared w ith Placebo on V asomotorSymptoms inHighlySymptomatic M enopausal W omen," Utian et al.,
Vol 181, No. 1, July, 1999. H e co
authored a pap er recently accepted for
presentation at the Am erican College
of Rheumatology A nnual Clinical
M eeting on N ovem ber 13,1999. The
paper is entitled "Alendronate vs. Intranasal Calcitonin for Treatm ent of Os
teoporosis in Postmenopausal W om en/'
by Rosen, et.al. Dr. Lenihan's patients
are now benefitting from several years
of research and study of n ew m eno
pausal treatmentregimens.
TACO M A RA D IO LO G Y
Detect and M onitor
Low Bone Density
1999 Physician's Guide to
Prevention and Treatment
of Osteoporosis
Star Chefs Auction
P r e s e n t e d b>y
Rainier Pacific
Benefiting the March of Dimes
Thursday, October 14,1999
6:30 to 9:30 p.m.
Tacoma's Landmark Convention Center
Plaza Grand Ballroom
Feast your eyes
and bid on spectacular dining
and entertainment auction packages
For Tickets or More Information
Contact The March of Dimes (253)752-9255
or Tamara Bolton (253)926-4511
VOLVO
BMW
S E R V IC E & R EPA IR
(2 53) 588-8669
B o y le’s Foreign Car Repair
D e t'c io /ju tl by lh e N a tio m ii O ste op oro sis
FoKrufaliim in collaboration u/Uli
A m e ric a n Accwiemy of <Jn/uifM ed ic Surgeons
A m erican Academ y a ( P / m fa i/ M edicine
and R cW ;i7 i[iitirm
A m e ric a n A s s o c m to ji o f C lin ic a l Endociinologi.su
Am e ric a n C ofic jjc o f O tafem cK m s
: A M E R IC A N L U N G A S S O C IA T IO N S
ofWtefnngton
and G y rie n ilfijjis h
A m e ric a n C olicgc of R tiAiobgy
A m erican C o fiq y o f R lw um itio/o^y
H e e ! (P e rip h e ra l D EXA )
L o w risk s c r e e n in g a v a ila b le a t a ll lo c a tio n s
A m e ric a n G e rw irrcs S mciciy
1 -8 0 0 -L U N G -U S A
A m erican Society fo r Bone an d M m e ra / Research
r/ie Endocrine
L u n g Inform ation
S erv ice L ine
Tacoma
18
Lakewood
Gig Harbor
(2 5 3 ) 3 8 3 -2 0 3 8
(2 5 3 ) 5 7 2 -5 1 7 4
(2 5 3 ) 5 8 8 -6 0 8 3
(2 5 3 ) 8 5 8 -3 2 0 0
Alle n m o re M edical C enter
Frank S. Baker C en ler
Lakewood Office
Pom I Fosdick Imaging
PCMS BULLETIN
October, 1999
Providing patient
education materials
POSITIONS AVAILABLE
Tacoma/Pierce County o u tp a
tient general medical care at its best.
Full and part-time positions available in
schedule. Well suited for career redefinitionforG.P., F.P., I.M. Contact
Opportunities for Full Ser-
viceFamily Practice Physicians. Four
FamilyPractice Physician openings at
UWPhysicians Network (UWPN) clin
ics in the Puget Sound area: W estwood
(WestSeattle), Issaquah, Auburn, and
FederalWay. FPs m ust be board certi
fied or eligible, and practice the full
spectrumof family medicine including
obstetrics. UWPN is a physician run
organization of nine clinics fully u tilizingan electronic medical record sys
tem Affiliated with the University' of
Washington Academic Medical Center;
resident/student teaching and research
opportunities. Excellent comp/benefit
plan. Submit cover letter/ cv to: Thomas
E. Norris, MD, Medical Executive and
Executive Director, UW Physicians
Network, 1910Fairview Avenue
North, Suite 302, Seattle WA 98102.
Fax:(206)520-5587.
OFFICE SPACE
PRACTICES AVAILABLE
multi-specialty three story medical building
currently under construction in Puyallup.
Located within 3 blocks of Good Samaritan
Hospital with frontage on Meridian. Last
available suite is 2,075 square feet and is
located on the second floor of a three
story building. All tenants are medical of
fices. Excellent parking and exceptional
tenant improvement allowance. Comple
tion in early 2000. For information, contact
Lawrence J. White, MD or Lorna
Drees at (253) 848-3000.
Tired o f olfice/hosp ital m e d i
cine? Exclusive long-term care practice
openings for BC family practice
introduction and CV to Urgent
Care Center Application, Good
Puyallup, W A 98371-0192.
for an Internist/General Practitioner avail
able immediately. Good income potential no paperwork hassle. Call 472-2011.
P uget Sound Area, WA: You know how you w a nt to set up your practice.
W e can help you do it. D ynam ic com m unity-based healthcare organization
seeks BC/BE Fam ily Practitioners. Flexible financial packages and practice
m a n ag em en t to full em ploym ent. C onvenience, quality 225-bed hospital
and exce lle nt location in fast-grow ing, fam ily com m unity. C lose to Seattle
w ith year-round recreational opportunities. W e are an equal opportunity
em ployer. C ontact Kathy Guy, A dm inistrative D irector o f Clinics, Good
S am aritan C o m m unity H ealthcare, 407 - 14th A ven ue SE, Puyallup, W A
98371, (253) 848-6661, Ext. 1865.___________
Lakewood medical space
each. One suite 2900 square feet. Ex
cellent location and visibility. Close to
many schools and residential areas.
8509Steilacoom Blvd. Call Dr. Ken
Ringat584-6200 or 582-5856.
New office sp ace a va ilab le.
Up to 4500 sq. ft. Will finish to suit. Qn
UnionAvenue. Close to hospitals.
Robinat756-2182
Urethral Inserts
Sublingual Troche
IV Services
Capsules
Lip Balms
October, 1999
752-1705
PC M S B U lL E lIN
19
B
~ '^ w k €
u l l e t in
t^C oclvcal $ c c id u
Policyholder C oncerns Come First
“I appreciated the fact that Physicians
interest and not ju st their own.”
W h e t h e r il’s a c la im , a la w s u it, o r a r is k m a n a g e m e n t issue,
P h y s ic ia n s I n s u ra n c e k e e p s c u s to m e r c o n c e rn s a t th e fo refro n t,
C la im s re p re s e n ta tiv e s w o r k c lo se ly w ith in s u r e d d e fe n d a n ts
a n d e x p e rie n c e d a tto rn e y s to s e c u re th e b e s t p o s s ib le o u tc o m e
fo r o u r p o lic y h o ld e rs . E q u a lly a s d e d ic a te d , o u r risk m a n a g e
m e n t re p re s e n ta tiv e s c o n d u c t in te ra c tiv e s e m in a rs a n d re s p o n d
to q u e s tio n s in p e rs o n , b y p h o n e , a n d b y m ail. O u r g o al, n o w
a n d in th e fu tu re , is to h e lp p h y s ic ia n s , c lin ics, a n d h o sp ita ls
r e m a in su c ce ssfu l.
Physicians
Insurance
W e s te rn W a s h in g to n
E a ste rn W a s h in g to n
O re eo n
223 Tacoma Avenue South
Tacoma, WA 98402
20
PCMS BULLETIN
October, 1999
1.-800-962-1399
1-800-962-1398
1-800-565-1892
A M utual Company
Seattle, W A © Ph ysicia ns In surance 1999
PRESORTED
STANDARD
US POSTAGE PAID
TACOMA, WA
PERMIT NO 605
WSMA Annual Meeting;:
o
Insurers/Universal Health Care
N ovem ber, 1999
okane
The Pierce C oum y delegation, 2 n d a n d 3 rd rows,
demonstrates their plea su re a t the conclusion o f one o f m anv
discussions on issues fa c in g p h ysicia n s
P eter Marsh, A!D (left) receives congratulations a n d thanks
from Dr. M ark Adams, outgoing WSMA President, for his
tenure on the B o a rd oj Trustees, a n d his service as President
Drs. Nick Rajacich, K eith D em irjian a n d C harles Weatherby.
(left to right) study one o f the m any resolutions discussed in
reference committee p rio r to the D e leg a te's m eeting
Kris IVhite. WSMA A lliance P resident (M atthew White, MD)
received the thanks o f Dr. John Coombs, VP, U o f W School
o f M edicine fo r A lliance contributions to the school.
Dr. C oom bs is a P C M S m em ber
M ore pictures an d story, page 5
INSIDE:
3
4
5
7
9
10
11
P re s id e n ts P age: “W SM A : W h a ts H o t an d W h a ts N ot”
In M em o riam : P C M S says good b ye to 6 3 y e a r m e m b e r, K e n n e th S tu rd ev an t, M D
W SM A A n n u al M e e tin g re c a p
New M e m b e r R e c e p tio n w elco m ed new m e m b e rs to th e m ed ical co m m u n ity
P C M S su p p o rts p ositive T B te s t re p o rtin g
A d m in istratio n o f o ra l m ed icatio n a t sch ool c re a te s confusion
K ris W h ite , W SM A A P re s id e n t, P ro m o tin g a Positive Im a g e o f P hysician s & th e ir Spouses
B u l l e t in
P C M S O fficers/T ru stee s:
L a w re n c e A . L a rs o n , D O ............................ P re s id e n t
C h a r le s M . W e a th e r b y , M D ...........P re s id e n t E le c t
P a tr ic e N . S te v e n s o n , M D .......S e c r e ta r y /T r e a s u r e r
J a m e s M . W ils o n , J r ., M D .............. P a s t P r e s id e n t
J. J a m e s R o o k s , J r., M D
S u s a n J. S a l o ,M D
Y o la n d a B r u c e , P C M S A P re s id e n t
W S M A R ep reseii ta t i v e s :
S p e a k e r o f th e I lo u s e : R ic h a r d H a w k in s , M D
T ru s te e : D a v id E . L a w ,M D
A M A D e le g a te : L e o n a rd A le n ic k , M D
C o m m i t t e e Chairs:
A g in g , R ich a rd W altm an ; A I D S , L aw re n ce S ch w artz;
B y la w s , S tan ley T u ell; B u d g e t /F in a n c e , P a tric e
S te v e n so n ; C o lle g e o f M e d ic a l E d u catio n , W . D ale
O v e rfie ld ; C red en tia ls, S u san S alo ; E m e r g e n c y
M ed ica l S ta n d a r d s , Fed W alk ley ; Eth ics/
S ta n d a r d s O f Pr actice, D av id L u k en s; G rie v a n c e ,
Ja m e s M. W ilso n ; L e gis la tiv e, W illiam M arsh;
M ed ic a l- L e g a l, P at D o n ley ; M e m b e r s h i p Benefits,
Inc., D re w D eu tsch ; P erson a l P r o b le m s O f
P hysicia n s, R o b e rt S an d s; Public H ea lth /S ch o o l
Health, Jo se p h W earn ; S p orts M ed icin e, Jo h n
Jig a n ti.
T h e Bullet in is p u b lish e d m o n th ly by P C M S
M e m b e rsh ip B en efits, Inc. fo r m em b ers o f the P ierce
C o u n ty M ed ical S o ciety . D ead lin es for su b m ittin g
articles an d p la c in g a d v e rtise m e n ts in T h e B u lletin
are the 15th o f th e m onth p re c e d in g p u b licatio n (i.e.
O c to b e r 15 for th e N o v e m b e r issue).
T h e Bulletin is d e d ic a te d to the art, sc ie n c c and
delivery' o f m ed ic in e an d the b e tte rm e n t o f the health
and m ed ical w elfare o f the c o m m u n ity . T h e o p in io n s
h erein are th o se o f the in d iv id u al c o n trib u to rs an d do
not n e c e ssa rily re fle c t the o fficial p o sitio n o f the
M e d ical S o ciety . A c c e p ta n c e o f a d v e rtisin g in no
w a y co n stitu te s p ro fe ssio n a l a p p ro v a l o r e n d o rse
m en t o f p ro d u c ts o r se rv ic e s a d v e rtise d . T h e B ulletin
an d P ierce C o u n ty M e d ical S o ciety reserv e the right
to re je c t any a d v e rtisin g .
E d i t o r : D a v id S . H o p k i n s M D
E d i t o r i a l C o m m i t t e e : M B 1 B o a rd o f D ir e c to r s
Table of C ontents
3
President'sPage: W S M A W hat' sH o ta n d W h a t'sN o t
4
4
4
IN M E M O R lA M K ennethSturdevant,M D
Dr. Boutry thanks colleagues
O PA T C M E andthe200001ym pics
5
W SM A A nnual M eetinginreview
7
R eceptiontow elcom enew m em berssuocessful
8
8
Applicants for M em bership
N ew M em bers
9
9
H ealth S tatu so fP ierceC o u n ty ,T P C H D N ew s
P C M S en d o rsesp o sitiv eT B testrep o rtin g
TO A dm inistration of oral m edication at school creates confusion
11
Kris White: W SM A Alliance President
13 The Invisible H an d ;" U ncertainty in A cadem ia"
15 T heP ulse:PC M S A N ew s
2 5 3 -5 7 2 -3 6 6 6 , F A X 2 5 3 -5 7 2 -2 4 7 0
E -m a il a d d re s s ; p c m s w a @ p c m s w a .o r g
H o m e p a g e : h ttp ://w w w .p c m s w a .o rg
16
IntemeL H u m o r H ealth InsuranceQ uestions
17 T he College of M edical E d u catio n
19
QassifiedA dvertising
Peart Place
W e e t g a te M e d ic a l B u i ld in g -
L o c a te d a t:
W e e tg a te & P e a rl S tr e e ts , T a c o m a , W a s h in g to n
> Suite Sizes up to 3,532+/Sq. Ft.
> Ready for Build-Out Based
On Tenant Needs and
Building Specifications
> Generous “On-Site”
Parking
> Another Quality Building by:
IE
RUSH
CONSTRUCTION
COMPANY, INC.
For More Information, Please Call:
Lisa Mitchell
F IR S T
W ESTER N
P R O
P E R T I E S
-
t a c o m a
,
&
in c
(2 5 3 )4 7 2 -0 4 0 4
.
‘Paid Advertisement’
®
Presidents Pag0
WSMA -W hats Hot and What s Not
The annual meeting of the WSMA
on the first weekend of October in Spo
kane proved to be a great review of
what's hot and what's not in Washington
state medicine. As usual, there was
more material and debate presented in
the three days than one could possibly
cover.
The Pierce Count}' delegates came
prepared thanks to the PCMS staff and
our caucus meetings. We had good
representation at all four reference
committees and the two House of Del
egates sessions.
What's hot this year included a va
riety of issues and resolutions. Dr. Pe
ter Marsh’s resolution urging organi
zations to refer to our profession as
"physicians" or"doctors" instead of the
more generic "provider" summed up
the tone of the meeting. We are profes
sionals and we expect to act and be
heated as such. The role out of the
CUREcampaign was done in a less than
positivemanner with an immediate pro
test from the House to project a more
professional approach. The initial ad
campaign, although truthful, came off as
trite and negative rather than forceful
and effective. This was a good re
minder (hat we have legitima te com
plaints with the insurance industry, but
that we will be more successful with our
message if we keep our patients con
cerns first.
We did approve a resolution to
develop a reimbursement and fee sur
vey statewide to provide physicians
with data. In addition, w e agreed to de
velop a Washington state model pro
vider agreement to use in a lawful man
ner for negotiation of provider con
tacts. This would allow physicians to
more effectively counter insurance
plans that aggressively pursue contracts
that disadvantage physician-patient rela
tionships and undermine quality care.
A resolution was passed to re
quire health plans to include in physi
cian and non-physician provider contractsa"compensalionschedule" that
provides a comprehensive compensa
tion schedule for each plan product
which clearly delineates the services
covered, reim bursement for each ser
vice and penalty charges for failure to
provide a compensation schedule.
This would allow us to better under
stand how we are reimbursed for ser
vices which now is often not possible
under current contracts.
The hottest debate of the meet-
Wliat
was "not
hot" this
year in
cluded
continu
ing "busi
ness as
usual"
with
heal tli
L aw rence A. Larson, D.O.
plans, ig
President, 1999
noring the
concerns
over access to adequate, affordable in-
"What was 'not hot ’ this y e a r in clu ded continuing ‘business
as usual ’ with health plans, ignoring the concerns over access
to adequ ate, a ffo rd a b le insurance an d excluding physicians
from the decision s o f p rop er, quality m ed ical care.
”
ing occurred in reference committee
"C." This concerned the Washington
State Health Care Financing Reform
Act of 2000. The debate raged on for
hours with a resolution to take a more
studied view of Health Care 2000
prior to drafting any final language.
The single payer system, medical sav
ings accounts, and use of discounted
fee for cash paym ent at time of service
w ere considered.
Several resolutions deal t with
access to care issues. Noting that we
have 600,000 individuals uninsured in
the state, 17 counties without indi
vidual health insurance plans available
and a rapid increase in basic health
plan premiums, one of the solutions to
this crisis was the Kids Care resolution
which would develop a system for uni
versal coverage of all children in the
state.
surance and excluding physicians from
the decisions of proper, quality medical
care.
Of course many more initiatives
w ere discussed and passed. The over
all tenor was to remain professional in
our advocacy for our patients and the
practice of medicine. We will need to
partner with our patients through such
vehicles as the CURE campaign for ef
fective and significant change.
I w ould hope that each of our
Pierce County physician has the op
portunity to participate in the develop
ment and/ or implemaitation of these
and future WSMA and PCMS initia
tives. H ie experience is worthwhile
and certainly educational.
I will remind PCMS members that
we have many effective avenues for
your involvement and I welcome your
ideas and efforts.
November, 1999
PCMS BULLETIN 3
B
u l l e t in
KENNETH STU RD EVAN T M D
1906 - 1999
Kenneth H. Sturdevant, MD died in P uy allu p on O ctober 15,
1999. H e was bom in Oklahom a City on N ovem ber 11,1906. He at
tended high school in Connecticut and Texas and college at the Univer
sity of Oklahoma prior to earning his doctor of medicine degree from
Loma Linda University in 1931. After interning at Swedish Hospital in
Seattle he practiced medicine in Friday H arbor for five years. In 1936 he
moved to Puyallup so he w ould have access to a hospital. He w orked
w ith Dr. Aylen, a local surgeon, learning additional surgical skills which
he used to provide more complete medical services to his patients. D uring W orld W ar II he spent
three years in the Army Air Force as a flight surgeon and then resum ed his practice in Puyallup.
Dr. Sturdevant was active in the community serving as a m em ber of the city council and the
school board, including a term as president. H e belonged to the Puyallup Active Club, and was a
m em ber of the K iw anis and PCMS until his death. Dr. Sturdevant was a PCMS member
for 63 years. After retiring he volunteered for three tours w ith the Am erican Red Cross in the
Cambodian refugee camps in northern Thailand. He assisted in many church sponsored missions
including visits to Zambia, Thailand, Sudan, Papua New Guinea and Malaysia.
Dr. Sturdevant is survived by Evelyn, his wife of 68 years, his daughter Marilyn, four grand
children and three great grandchildren.
PCMS extends condolences to his family.
OPAT and the
2000 Olympics
It is n ot too late to m ake plans to
attend the first international conference
on outpatient parenteral antimicrobial
therapy, Septem ber 17-22,2000, in
Sydney, Australia. The conference will
be u n d er the medical direction and
o rg an iz atio n of Alan Tice, MD.
The incredible Fairm ont Resort in
Leura has been secured for the
meeting. If you w ould also like to
attend the Olympics, you should make
plans for tickets SOON by contacting
M ary McManus a t274-0833 or by email
at [email protected]
4
PCMS BULLETIN
November, 1999
Dr. Boutry thanks colleagues
E d ito r 's Mote: Dr. B o u try w as in ju re d in a hit a n d ru n a c c id e n t near his
h o m e in north Tacom a. H e a sk e d P C M S to p u b lis h this n o te o f thanks
The concern and support of my colleagues have overwhelmed me.
Thank you so much for the cards, gifts and flowers. A special thanks
to Drs. Craddock, Pingrey an d Roes w ho hav e helped above
and beyond the call of duty to keep m y office open and to Drs.
Kovanda, Lenihan an d Cammarano for k eep in g m y call
coverage intact. Thanks to Drs. Yancy and Kunkel w ho p u t me
back together and have me on m y feet again!
Sincerely,
Don Boutry, MD
PCMS Delegates participate in setting WSMA policy
This year, at the WSMA Annual Meeting in Spokane,
delegates from Pierce County participated in many discus
sions of concern to physicians in our state. Of primary
concern was the insurance industry and the myriad of
difficulties both physicians and patients have in conducting
business with them.
Representing Pierce County at the meeting were PCMS
delegates, Drs. Lawrence A. Larson, James M. Wil
son, Charles W eatherb y , P atrice S tevenson, Susan
Salo, Nick Rajacich, Keith D emirjian, Don Russell,
Cecil Snodgrass, an d Federico Cruz-Uribe. WSMA
Representatives included Drs. Leonard Alenick, Rich
ard Hawkins, David Law an d Peter Marsh. Dr. David
BeMiller represented the American College of O b/G yn,
W ashington C hapter w hile Dr. Ken Graham represented
the Senior Physician Section.
A highlight of the meeting for many Pierce County
participants was attending the media training session spon
sored by the AMA featuring their med ia expert Pat Clark. Ms.
Clark gave an outstanding educational session on working
with the media, using audience members (incl uding Dr.
Charles Weatherby) as examples of w hat not to do. As always,
Ms. Clark's three hour session was informative and entertain
ing.
Another highlight of the session was an opening session
presentation by KIRO Radio personality Dave Ross. Mr.
See “W S M A ” page 6
'
From left, Drs. P atrice Stevenson, P uyallup p h y sic a l m e d a n d
rehab physician a n d Susan Salo, G roup H ealth fa m ily
practitioner visit after the early m o rn in g caucus m eeting
R ichard H awkins, MD, WSMA S peaker o f the H ouse (left)
chats with D a ve Ross, K IR O R adio perso n a lity a fter his
presentation to the H ouse o f D elegates at the opening session
£ to R: Drs. R ic h a rd H aw kins, L a w ren ce A. L a rso n a n d
Susan Salo, M D a n d L a rry Larson, D O f in d a fe w m inutes to
chat about the m a n y issues discussed at the m eeting
Federico C ruz-U ribe discuss an issue a fte r the P ierce C ounty
caucus breakfast m eetin g early S a tu rd a y m orning
November. 1999
PCMS BULLETIN 5
B
u l l e t in
“WSMA”
from page 5
Ross told the H ouse of Delegates that "it is your responsibility,
as medical professionals, to w ork w ith your patients and the
insurance com panies in a professional m anner to effect
change." Mr. Ross' presentation w as a welcome relief after
the introduction of the CURE cam paign that featured less than
professional media clips that took " potshots" at insurance
companies.
O ther actions taken include further study of the H ealth
Care 2000 initiative, w hich endorses a statewide, single
sponsored health care system and approval of a study of
system reform options, including advantages and disadvan
tages of different system models. The H ouse opposed further
health plan m arket consolidations, and supported legislation
J im W ilson, M D , P C M S P a s t-p r e s id e n t visits w ith WSM A P a stp re sid e n t N a n c y P urcell, M D , R e n to n g a stro e n tero lo g ist
that w ould require health plans to have adequate physician
netw orks in place prior to m arketing to employers and
patients.
Dr. Peter M arsh’s reso lu tio n is n o w W SM A policy and
says th at W SMA should direct that physicians be referred to
by their professional title of either'physician' or 'doctor'
instead of the umbrella term " provider," that is currently used
for any n u m b er of professionals th at provide a service to the
public from m essage therapists to naturopaths. Kudos to Dr.
Marsh!
If you w ould like a com plete listing of all the actions of
the H ouse of Delegates at the recent W SMA A nnual Meet
ing, please call the PCMS office, 572-3667 an d a copy can be
mailed or faxed to you.
A t right, D r. P a tric e S tev en so n , P C M S Secretary-Treasurer,
se rv e d as c h a ir o f R e fe r e n c e C o m m ittee B ; Dr. R ichard
H aw kins, S p e a k e r o f the H o u se, is in the background, presiding
D r. C h a rles W eatherby, P C M S P resid en t-elect, (center) a n d
P e te r D u n la p , S e a ttle a n e sth esio lo g ist, re c eive m ed ia tra in in g
fr o m A M A 's m ed ia specialist, P a t C la rk
6
PCM S BULLETIN
L e ft to right, D rs. C h a rle s W ea th er by, L a r ry L arson, Ken
G raham (hidden) N ic k R a ja c ich , P a tr ic e S tev en so n a n d D avid
L a w visit d u rin g o n e o f th e b re a k s
November, 1999
/
o M ed ica l (Scieiet^
'f
New m em ber reception welcomes colleagues
A new member reception held in September to welcome
new PCMS members to the organization and to the medical
community was a success. Many new members attended and
were welcomed by PCMS leadership.
The event was held at N orth Tacoma Winesellers and
was the first such event sponsored by PCMS. The early
evening reception was weU attended and provided an
opportunity for new members to meet colleagues and visit
with each other outside of the medical setting.
The event was hosted by Hoechst M arion Roussel.
Steven Litsky, M D, p h y sic a l m edicine a n d rehab p hysician
w ith his wife, Cynthia. Dr. L itsk y p ra c tic es in Tacom a
Family practitioners Drs. Steve D uncan, Puyallup, (center)
and Charles Weatherby, T a c o m a , visit with a H oechst rep.
Dr. Duncan sits on the M B I B o a rd o f D irectors a n d Dr.
Weatherby is P resident-elect o f P C M S
F rom left, R ich a rd Schroeder, MD, ob/gyn, his w ife Kirsten,
a n d M ichael M oon, MD, anesthesiologist visit with colleagues
Dr. Schroeder p ra ctices a t M ulticare a n d Dr. M oon at
A lle n m o re
From left, C. A nthony Kim , M D, g e n era l surgeon, his w ife
Kathy and Jeffrey Jacobs, M D, Tacom a pediatrician, enjoy
getting to know colleagues
Left, Dr. B ish er A bdullah a n d his w ife H ania, (center) with
M iem ie Yuwono, MD. Drs. A bdullah a n d Yuwono are both
pediatricians
November. 1999
PCMS BULLETIN 7
Applicants for
M em bership
New M embers
B e c k e r , N ic o le R ., M D
P e d ia t r i c s
B en jam in , G. G o r d o n , MD
D ia g n o s t ic R a d io lo g y
L its k y , S tev en H., MD
P h y s ic a l M e d ic i n e & Rehab
Practices at Pediatrics NW , 316 MLK
Jr. W ay, #212, Tacom a 98405; 403-1419
M edical School: U niversity of
Pennsylvania School of M edicine
Internship: Children's H ospital of
Philadelphia
Residency: C hildren's H ospital of
Philadelphia
Fellowship: University of W ashington
Fellowship: Rush Children's Hospital
Practices at Tacoma Radiology, 3402 S
18thSt., Tacoma 98405; 383-1099
M edical School: M edical College of
Wisconsin
Internship: Virginia M ason Hospital
Fellowship: University of W ashington
Practices at the N orthw est Center for
Integrative Medicine, 2702 S 42ndSt.,
#310, Tacoma 98409;472-7844
M edical School: Sackler School of
M edicine, Tel Aviv University
Internship: Sinai Hospital, Wayne State
University
Residency: Sinai Hospital, Wayne State
University
Blair, John M., Jr., MD
O r t h o p a e d ic s
Practices at 1515 MLK Jr. W ay,
Tacoma 98405; 572-2663 Ext. 230
M edical School: University of Chicago
Internship: University of California San
Diego
Residency: U niversity of California
San Diego
Fellowship: University of Minnesota
E d g o o s e , J e n n if e r , M D
F a m ily M ed icin e
Practices at Com m unity H ealth Care,
9112 Lakew ood D r SW, #203, Tacoma
98499; 589-7030
Medical School: Columbia University
B ou try, D o n a ld A., M D
O b/G yn /In fertility
Practices at 4700 Pt. Fosdick Dr. NW,
#205, Gig H arb o r98335; 581-8684
Califomia-lrvine
Internship: Santa Clara Valley M ed
Center
Residency: Stanford U niv M ed Center
C ow ell, P a m ela 1)., MD
O b stetrics/G y n eco lo g y
Practices at Mt. Tahom a Gynecology,
4808112thSt. SW, Lakew ood 98499;
582-5880
Medical School: Emory University
School of M edicine
Internship: Grady Memorial Hospital
Hospitals
Kihara, Todd K., M D
V a s c u la r S u r g e r y
Practices at MultiCare, 225 176thSt. S.,
Spanaway 98387; 552-4777
Medical School: Louisiana State Univ
Residency: Texas Tech U niversity
H ealth Science Center
Practices at Cascade Vascular, 1802 S
Yakima #204, Tacoma 98405; 383-3325
Maryland
Internship: G eisinger M edical Center
Residency: G eisinger Medical Center
Fellowship: H ershey Medical Center
R y n e s, R ichard I., MD
R h eu m atology
Kim, C Anthony., MD
G eneral Surgery
Practices a t 4905108thSt. SW,
Lakewood 98499
Pennsylvania
Internship: University of Michigan
Residency: U niversity of M ichigan
G raduate Training: H arvard
U niversity School of M edicine
Practices at M eridian Surgical
Sendees, 102-A 23rJ Ave. SE, Puyallup
98372; 840-1999
Medical School: University of N orth
Carolina School of Medicine
Internship: Emory University Hospitals
Residency: Emory University Hospitals
Fellowship: Emory University
H o e fle , S te p h a n ie F., MD
F am ily Practice
R ea lica , R o ss M ., MD
P la s t ic S u r g e r y
Practices at Pacific N orthwest Plastic
Surgery, 1530 S Union, North Pavilion,
Tacoma 98405
M edical School: Univ of the Philippines
Internship: Boston Univ M ed Center
Residency: St. Elizabeth's Med Center
Fellowship: Medical College of
Georgia
T ak agi, Brian K., MD
O p h t h a lm o l o g y
Practices at Valley Eye Clinic, 2622
M eridian St. S., Puyallup 98373; 8483545
Pittsburgh School of Medicine
Internship: Cleveland Clinic
Foundation
Residency: Cleveland Clinic
Foundation
Fellowship: M ason Eye Institute,
University of Missouri
W y m a n , J am es J., M D
O rth op aed ic Surgery
Practices at Tacoma Orthopaedic
Surgeons, 2420 S Union, #300, Tacoma
98405; 756-0888
M edical School: University of Medicine
& D entistry of N ew Jersey
Internship: Univ of California at Davis
Residency: R hode Island Hospital
Fellowship: Rhode Island Hospital
VPiewe % m U f oM edi& d tfo c ie tf
m
m
Tacoma Pierce C ounty H ealth
D ep artm ent updates Website
T A C O M A - P IE R C E C O U N T Y
HEALTH
D E P A R T M E N T
PCMS supports
positive TB test
reporting
Hie Pierce County Medical
Society Board of Trustees recently
agreed to support a regulation that
would ask physicians to report cases of
TBinfection to the Health Department.
The Health Department is cur
rently required by law to maintain a
register of individuals for whom
preventive therapy is being pre
scribed. But, as all clinical services for
TBscreening and prevention are
being delivered in the private sector, it
has become difficult to gather the
information that assures that all appro
priate disease control measures are in
place.
A health regulation which will
require private medical providers,
hospitals and clinics to report to the
Health Department positive TB skin
tests and for pharmacists to report the
dispensing of preventive medications
would allow the Department to collect
information about individuals in the
community who are screened and
treated for TB latent infection.
Dr. Federico Cruz-Uribe
explained to the Board of Trustees at
their October meeting that they are
successful working with patients that
visit the health centers but they are
missing an unknown number tested in
the private community. The Board of
Trustees voted unanimously to
support the Health Department's
efforts.
With the goal of preventing public
health problems, the Tacoma-Pierce
County Health Department (TPCHD)
looks for as many mechanisms as pos
sible for keeping people informed.
One of our newest attempts is an up
grade of our website. Originally focus
ing on tobacco prevention, the website
offers practitioners and the general
public lots of information.
To get to the TPCHD home
page, enter www.healthdept.co.
pierce.wa.us into the address line of
your internet main page. You'll see a
"table of contents" on the left side of the
TPCHD home page, which you can
click on with your mouse to move to ar
eas of interest. Here's a quick list to
pique your curiousity:
Communicable Disease
Control. This section has several sub
sections, of particular use to the practi
tioner. "Reportable Diseases" lists all
the diseases that medical providers are
expected to report to the health depart
ment. "Communicable Diseases" con
tains the monthly statistics of reported
cases in Pierce County of the diseases
caused by E. Coli or salmonella, ill
nesses carried by food or water, sexu
ally transmitted diseases (including
HIV), tuberculosis, measles and other
diseases avoidable if immunized, hepa
titis, and other diseases in the county.
The section on Medical Provider
information includes heal th alerts if
there are any recent outbreaks to be
aware of and a monthly newsletter with
useful information, such as the latest
news related to immunization, and
symptoms and new treatments of dis
eases.
There is also a list of Continuing
Medical Education opportunities for
physicians and their staff
Source Protection. This part
of the website is devoted to preventing
problems in and from the larger envi
ronment. The section on Safe Shellfish
contains a guide for safe harvesting of
shellfish and information to prevent
paralytic shellfish poisoning. The sec
tion on Household Hazardous Wastes
provides a lot of information about
toxic materials in the home. A particu
larly useful piece for people with
chemical sensitivities is a list of Less
Toxic Alternatives for Cleaning.
Food and Community
Safety. This part of the website con
centrates on information and resources
for preventing illnesses due to poor
techniques in storing and cooking
foods. There is also a list of smoke-free
restaurants in Pierce County.
A fun section for kids teaches
them how to wash their hands and why
that's important. Feel free to copy the
pictures of germs for young patients to
color or the maze for them to complete.
As they play, they also leam a very im
portant way to prevent the spread of
diseases.
On the home page is a list of new
topics and timely resources. Right now
there's a link to information on pre
venting head lice and treating individu
als with lice, for example. This informa
tion may be helpful to your patients.
This article is only a partial listing
of all the resources available through
the TPCHD website. We are continu
ally updating the information so that
you and your patients will have the
most up-to-date and valuable informa
tion possible. You can add your e-mail
address to our list of "subscribers" (look
for the button near the bottom of the
home page) to get health alerts and
other news as soon as we get it. If you
have ideas about other information
you'd like to see on the website, please
send an e-mail to our "Webster" using
I the link at the bottom of the home page.
November, 1999
PCMS BULLETIN 9
B
u l l e t in
Administration of oral medication at school creates confusion
H e a lth c a re p r o v id e r s , o th e r th a n
p h y s ic ia n s a n d d e n tis ts , m a y p r e s c r ib e
m e d ic a tio n s fo r s c h o o l c h ild r e n , b u t
o n ly s c h o o l n u r s e s a re le g a lly a llo w e d
to a d m in is te r th e m e d ic a tio n a t sc h o o l.
T h e y a r e n o t p e r m i tt e d to d e le g a te th e
r e s p o n s ib ility to a n u n lic e n s e d s c h o o l
s ta f f m e m b e r . H o w e v e r, th e y m a y d e l
e g a te th e r e s p o n s ib ility o f a d m in is te r in g
th e m e d ic a tio n to a n u n lic e n s e d s c h o o l
sta ff m e m b e r if th e o r d e r is fro m a p h y
s ic ia n (M D o r D O ) o r a d e n tis t.
R C W 2 8 A .2 1 0 .1 6 0 , P u b lic a n d p r i
v a te s c h o o ls - A d m in is tr a tio n of O ra l
M e d ic a tio n s b y - C o n d itio n s , s a y s, " P u b
lic s c h o o l d is tr ic ts a n d p r iv a te sc h o o ls
w h ic h c o n d u c t a n y of g r a d e s K -12 m ay
p r o v id e fo r th e a d m in is tr a tio n o f o ra l
m e d ic a tio n o f a n y n a tu r e to s tu d e n ts
w h o a re in th e c u s to d y o f th e s c h o o l
d is tric t o r sc h o o l a t th e tim e of a d m in is
tra tio n b u t a re n o t r e q u ir e d to d o so by
th is s e c tio n , s u b je c t to th e fo llo w in g
c o n d itio n s : (4) " T h e p u b lic s c h o o l d is
tric t o r th e p r iv a te s c h o o l is in r e c e ip t of
(a) w r itte n , c u r r e n t a n d u n e x p ir e d r e
q u e s t fro m a lic e n s e d p h y s ic ia n o r d e n
tis t fo r a d m in is tr a tio n o f th e m e d ic a tio n ,
a s th e r e e x is ts a v a lid h e a lth r e a s o n
w h ic h m a k e s a d m in is tr a tio n o f su c h
m e d ic a tio n a d v is a b le d u r in g th e h o u r s
w h e n s c h o o l is in s e s s io n o r th e h o u r s
in w h ic h th e s tu d e n t is u n d e r th e s u p e r
v is io n o f s c h o o l o ffic ia ls, a n d (b) w r itte n ,
c u r r e n t a n d u n e x p ir e d in s tr u c tio n s fro m
s u c h p h y s ic ia n o r d e n tis t r e g a r d in g th e
a d m in is tr a tio n o f p r e s c r ib e d m e d ic a tio n
to s tu d e n ts w h o r e q u ir e m e d ic a tio n fo r
m o re th a n 15 c o n s e c u tiv e w o r k in g
d a y s ."
T h e n u r s e p r a c tic e a c t r e q u i r e s
n u r s e s to e x e c u te th e m e d ic a l r e g im e n
as p r e s c r ib e d b y h e a lth p r o f e s s io n a ls ,
in c lu d in g p h y s ic ia n s a n d d e n tis ts . T h e
la w re la tin g to n u r s in g c a re lists th e fo l
lo w in g h e a lth p r o fe s s io n a ls as th o se th a t
a n R N m a y p r o v id e c a re a t o r u n d e r th
g e n e r a l d i r e c ti o n o f : lic e n s e d p h y siciai
a n d s u r g e o n , d e n tis t, o s te o p a th ic p h y si
c ia n a n d s u r g e o n , n a tu r o p a th ic p h y s i
c ia n , p o d ia tr ic p h y s ic ia n a n d su rg e o n ,
p h y s ic ia n a s s is ta n t, o s te o p a th ic p h y si
c ia n a s s is ta n t, o r a d v a n c e d re g is te re d
n u r s e p r a c t it i o n e r (A R N P ) a c tin g w ithin
th e s c o p e o f h is o r h e r lic e n se . Li
c e n s e d p r a c t ic a l n u r s e s a re re q u ire d to
c a r r y o u t s e le c te d a s p e c ts o f th e desig
n a te d n u r s i n g r e g im e n u n d e r th e direc
tio n a n d s u p e r v is io n o f a re g is te re d
n u r s e in a d d itio n to th e a b o v e -liste d
h e a lt h p r o f e s s io n a ls .
T h u s , n u r s e s (R N ,L P N ) m ay accepl
a n d c a rr y o u t o r d e r s fo r o ra l m ed ica
tio n s fro m h e a lth p ro fe s s io n a ls w ith p re
s c rip tiv e a u th o r ity o p e ra tin g w ith in their
s c o p e o f p r a c tic e , b u t th e y c a n d eleg ate
th e a d m in is tr a tio n o f o ral m ed icatio n s to
n o n - n u r s e s c h o o l s ta ff o n ly o n w ritte n
r e q u e s ts f ro m p h y s ic ia n s a n d d e n tists.
of commission?
rapidly— an d not for the better. H igh claim s have caused m an y m ajo r
carriers lo lim it the m ost im p o rtan t benefits.
—
At Physicians In su ran ce Agency, there's still tim e to secure the specialtyspecific coverage you need. In addition, we can help you find superior life
an d long-term -care coverage for you an d your fam ily.
To discuss the ways you can best protect your fu tu re incom e, call
P hysicians In su ran ce Agency today: (206) 343-7150 or 1-800-962-1399.
PHYSICIANS
INSURANCE
AGENCY
A wholly owned subsidiary
of Physicians Insurance
© Phvsicians Insurance 1999
10
PCM S BULLETIN
S p o n s o re d b y th e W a sh in g to n S ta te M e d ic a l A s s o c ia tio n
November, 1999
Special Feature
Kris White: WSMA Alliance President
Promoting a Positive Image o f
Physicians and Their Spouses
"I think there is a serious miscon
ception out in the community about
what physicians d o /' says Kris White,
president of the WSMAA, active
PCMSA member and wife of D r.
Matthew White, a Lakew ood family
physician. "The popular notion is that
physicians are 'full of themselves.'"
Through the projects of the Alliance,
she and other members w ant to show
communities that medical families care.
"Our role is to promote a positive
image of physicians and their spouses
by giving back to the community," she
explains. "Through our involvement,
we can show people that physicians are
not in the profession only to earn a
lifestyle. Our involvement can gener
ate tremendous positive publicity
throughout Pierce County."
Her past involvement with
PCMSA and her current leadership
role at the state level have done just
that. But her decision to be involved
was not predicated on needing
something to keep her busy. "I don't
have any more spare time than anyone
else," Kris said. "But I'm a good
example of someone with a full life who
can still be involved. I have num erous
interests and am well educated. I have
worked in my husband's medical
practice and have firsthand knowledge
ofwhatphysicians do."
Her agenda as WSMAA presi
dent is full, to say the least. D uring her
yearlong tenure, Kris travels to
Chicago three times, for an annual
meeting and two leadership training
conferences. In W ashington state, she
attends four board meetings and an
annual meeting, as well as retreats and
monthly meetings with the WSMA
Executive Committee. She also visits
active counties. There is a great deal of
administrative work that comes with die
job, she notes, and is grateful that
WSMA provides secretarial support.
Is her state leadership role a
stepping stone to the national level?
"Perhaps later," she says. "W hat I most
enjoy is being in the community and
working on projects in Pierce County,"
Kris says. "It's very rewarding and I'd
like to help mentor others to step
forward into leadership roles."
Kris praises the PCMSA for its
involvement on the local level,
particularly its role in placing 'Baby
Think It Over' dolls in schools. The
lifelike, computerized infant simulators,
the actual size of infants, are teacher
programmed and sent home overnight
with students to give them a very
realistic idea of w hat caringfor a baby
is like.
She also points to the accomplish
ments of other county All iances.
" Wonderful examples are being set
throughout the state," she says. In
Spokane, for example, Alliance
members built a Habitatfor Humanity
house. The Thurston-Mason County'
Alliance conducted a childhood
immunization program . "If one person
or a group has a good idea, it's fine to
copy it," Kris says. "I'd like to see our
county rise to the challenge and take
on a giant project, as in building a
Habitat home or funding a new shelter
for domestic violence victims."
Kris is one of a line of PCMSA
past presidents w ho have gone on to
head the WSMAA - Sharon Ann
Lawson, Suzy D uffy an d Helen
S e e “ W h ile ” p a g e
K ris White
P C M SA President, 1999-2000
W
S M
A
A
...
From 1931 to Today
The WSMA A lliance (once know n
as the Auxiliary), has been in
existence sin ce 1931 w hen Dr. A. E.
A nderson, WSM A president,
p re se n te d a resolution to the 42nd
a n n u a l m eeting o f their H ouse o f
D elegates asking f o r the fo rm a tio n
o f a " W omen s A uxilia iy " to the
A ssociation. The resolution p a ssed
unanim ously, a n d by F eb ru a iy 1932,
12 counties were organized. B y
Septem ber, A lm a Wluteacre, wife o f
Dr. H orace W hiteacre, then
p re sid e n t o f WSMA, becam e the fir s t
stale president.
M uch has cha n g ed over the years.
A t present, the A lliance is organized
in six active counties. A s p h ra sed in
the W SM 4 A lliance website, "It
really does not take a lot o f p eople to
h o ld fund-raising events, prom ote
health p ro jects a n d have a g o o d
time. " The organization is no longer
a w o m e n 's g ro u p a n d is actively
seeking m em bership fr o m men
m arried to physicians.
12
November, 1999
PCMS BULLETIN 11
B
u l l e t in
“W hite” from page 11
W hitney h av e also held the position.
H er involvem ent at die state level
cam e ab o u t because of h er interest in
health issues. Specifically, Kris
explains that one 'd ream health
project' w o u ld be to develop a series
of Public Service Television A n
nouncem ents related to the AM AA's
national project - Stop America's
Violence E veryw here (SAVE).
"There are num erous materials and
background information available,
specifically in regards to conflict
resolution for children. Participating in
the national project at a state level
w o u ld be very beneficial," she says.
Kris W hite brings to her position
as W SM AA president an extensive
and w ell ro u n d ed background. She
has a bachelor's and m aster's in
geography, geology an d science
education from W ashington State
U niversity and University of W ashing
ton. Kris gained extensive teaching
experience in science an d m ath, grade
five - college. In addition to her
involvement w ith PCMSA and
WSMAA, she has also been actively
involved in dom estic violence issues,
both as a m em ber of the Pierce
County Commission Against Domestic
Violence and W SM A PACE Violence
Advisory group. H er interest in
domestic violence stems from her
relationship w ith a good M end and
feUow teacher w ho w as involved in an
abusive marriage. "I vow ed then to do
som ething significant if I ever h ad the
chance." She has since w orked to pass
domestic violence legislation and
helped develop guidelines for
physician intervention w hen abuse is
suspected. "It's a difficult task," she
notes. "Domestic violence is still an
issu ew ed o n 't w an t to talk about. 11
brings w ith it a great deal of denial and
embarrassment"
W hile her plate is full w ith
WSMAA responsibilities, it's not all
business w ith Kris White. She prides
herself on having a variety of inter
ests. In addition to her Alliance
12
PCMS BULLETIN
November, 1999
commitments and w orking in her
h usband's office, Kris enjoys skiiing,
hiking, fishing, photography, gourm et
cooking and gardening. A lover of the
outdoors, Kris has m ade several ascents
of Mt. Rainier and w orked for the
N ational Park Service as a seasonal
na turalist at Mt. Rainier an d G rand
Teton N ational Parks. She hopes to
com bine her interest in photography,
w riting and the outdoors to do some
freelance w o rk for regional travel
m a gazines. She plays clarinet in local
concert bands, having played w ith
other medically related clarinetists Drs. R ay P lisk ow a n d Leslie Fox.
Kris is also a m em ber of the W ashing
ton State University Cougar Alumni
M arching Band.
Kris acknow ledges that it's
difficult for people to take on more
responsibility in their lives, but encour
ages Alliance members to find the time
to give back to the community. "Look at
the activities an d causes you're
involved in rig h t now, then take one
m o n th off. Call Yolanda Bruce
(PCMSA President) and find out what
y o u can do for the Alliance. It's
im portant for us to be out in the
community," Kris says, adding that
Alliance involvement also brings added
benefits. "T here are a lot of great social
an d recreational opportunities," she
notes. "The spouses are missing out on
alotof satisfaction.. .andfun!"
T A C O M A R A D IO LO G Y
Detect and M onitor
Low Bone Density
Com fortably, quickly, safely
and p recisely
D etect clinical chan ges
H e el (P erip h eral DEXA)
L o w risk scree n in g
1 <t|i; d 1 ,h!11
Tacoma
Lakewood
Gig Harbor
(253) 383-2038
(253) 572-5174
(253) 588-6083
(253) 858-3200
F ran k S . B a k e r C e n te r
P o in l F o s d ic k Im a g in g
P /te x e 'it'o u tih f Q 'M fdicai C jfoctehf
“Uncertainty in Academia”
A breeze of fresh air is blow ing
through the academic world. The
change is noticeable in the attitude of
the speakers at our meetings. It has
become
obvious
within the
pasttwo
years.
O ne of
m y atten d in g s
used to say:
"Ifyou
haven't had a
c o m p le tio n ,
it s b e c au se
you h a v e n 't
A n d r e w N S ,a t s o n M D
done enough cases." Before CME
became big business, speakers at a
meeting would present their series of
60or 80 patients and conclude by
saying: "We had no complications in
our series. So, if you did things our
way, you should have no complica
tions.'' The thinly veiled implication was
that if-we had a complication, it was
because we did not do things their way.
There still are a few speakers like that,
but now they tend to cover u p their
position with the legal implications of
not doing as they recommend.
As CME became a requirem ent
for license renewal and the speaker
circuit developed, the academics had to
meet their peers from other institutions
across the country and across the
world. They discovered that there is
more than one w ay of doing things.
The standard line they adopted w hen
expressing an opinion became "m y bias
istodothis."
It is only recently that speakers
have changed their tune to a better
one. At the meetings I have attended
thepast two years, m ost speakers said:
Don't take my w ord for it. H ere are
the studies, these are their strengths
'Life is the art of drawing sufficient conclusions from insufficient premises."
Sam uel Butler
and weaknesses as I see them. Look at
them and make your own decision."
Some w ent further by saying that the
patient population in private practice is
not the same as that at the university
clinics, on which the studies have been
done, and their conclusions do not
necessarily apply to all patients. The
management decision should depend
on the individual situation and on the
specific risk factors of every patient.
"Use your judgment," they said.
This new trend is very signifi
cant for the private practice of medi
cine. It is partly due to the recent stress
on evidence based practice. There is
intended for others. They discovered
that tliis system was not such a good
idea. The straitjacket they had
prepared for the private practitioners
was now wrapped around them as
well.
I don't know how many of our
professors have realized that aca
demic freedom and practice freedom
are two adjacent facets on the multifac
eted diamond of freedom. I don't
know how many of them realize that
marring any one of these facets dims
the sparkle of every other one and
dulls the brightness of the entire gem.
Freedom is indivisible. We cannot
"While the insurance companies are busy curtailing thefreedom
o f patients and physicians in their frantic effort to cut costs, other
forces at large are gradually eroding the freedom o f the insurance
companies themselves through government mandates. When
bullying is the game, there is always a bigger hullv around. "
another reason for it as well. In the
past our professors had no reluctance
to issue management protocols. They
felt that, since they wrote them, they
could change them at any time, and
were not bound by them. The proto
cols were for the local doctors, those
outside the ivory towers.
Managed care changed that.
The insurance companies picked up
the tilings they liked from the various
protocols and wrote their own guide
lines. They also had the pow er to
enforce them, since they held the
purse. The professors suddenly found
themselves bound by the rules they
deny it to some and expect that no-one
else will be affected.
This applies to insurance
companies as well. During the past
several years they have spent an
inord inate am ount of effort to establish
controls over patients and physicians,
to restrict patient access to care and
our ability to provide it. [n this effort
they were helped by our professors,
who designed the algorithms, wrote
the guidelines, and established the
parameters of medical practice. But
medicine does not stand still. The
insurance companies hoped that the
See "Academia" page 14
November, 1999
PCMS BULLETIN 13
B
u l l e t in
“A cadem ia” from page 13
protocols, once w ritten, w ould be valid
for a long tim e, if n o t forever. Yet they
w ere obsolete alm ost as soon as they
w ere published.
Several years ago the state of
M aine enacted a new malpractice law.
It provided that a physician w ho
followed an established protocol could
present it in his defense and w ould not
be liable for malpractice. Tine interim
rep o rt on the effect of this law for the
first five years cam e out recently.
D uring this tim e in only one case did a
defendant invoke this law. The original
protocols have never been updated.
The m alpractice insurers have discour
aged their physicians from relying on
this law for their defense. The interim
commission concluded that the law had
not achieved w h at it set out to accom
14
PCM S BULLETIN
November, 1999
plish
The professors, for th eir part,
thought that their algorithms w ould help
tire practice of medicine. H ow ever, as
new things are discovered, as experi
ence is gained, the algorithm s become
outdated and a hindrance, rather than a
help. They need such frequent
revisions that it becomes difficult at any
one time to know w hich is the latest
version and w hich one is obsolete. We
are swam ped with bulletins from
various agencies and companies w ith
their la test rules and requirements,
replacing the ones they issued ju st a
few months ago. H ow is it humanly
possible to keep up w ith all that, and
w ith the medical literature as well?
W hile the insurance com panies
are busy curta iling the freedom of
patients an d physicians in their frantic
effort to cu t costs, other forces at large
are gradually eroding the freedom of
the insurance companies themselves
through governm ent mandates. When
bullying is the game, there is always a
bigger bully around. Then, w hen the
biggest bully gets too big, w hat
happens is the disintegration of the
social structure, so brightly illustrated
by the events in the Soviet Union.
I suspect the change in academia
reflects the realization by our profes
sors that uncertainty is part of the
practice of medicine. I also hope that
this realization will be broad enough to
affect the entire academic community.
If so, the fu tu re of medicine and of our
health care system will be much
brighter.
The Pulse
PCMS Alliance
President’s Message
October Board Report
Thanks to Mona Baghdadi, Nikki Crowley, Judy
Donley, Sonya Haw kins, Ginnie Miller, Fran T h o
mas, Helen Whitney an d Alice Yeh for attending the
September meeting and to those of you that attended the
October meeting as well. We have many projects in the
works, including Violence issues, philanthropy decision, the
December Annual Meeting, and of course, our biggest fund
raiser of all, the Holiday Sharing C ard. We are also seeking
additional funding from the WSMAA Health Foundation for
our Baby Think It Over Dolls.
After our September meeting May Chen presented a
Chinese Tea Ceremony which w as fun.
Remember, mark your calendar for the PCMS/PCMSA
Annual Meeting that will be held onTuesday, December 14
attheSheratonTacoma Hotel.
Entertainment Books
2000 available now
This year's book is the best ever featuring m any great
new offers in all areas. Check out some of the HOT new
offers: Tacoma Bar & Grill, Altezzo at the Sheraton,
Balsano's West, Clifford's Bistro, The Shoreline, Salish
Lodge, Benihana, Seattle Supersonics, Planet Hollywood and
TONSMORE...
We are also pleased to again offer some of your
favorite merchants such as Johnny's Dock, Genoa's, Captain
K's, Mary McCrank's, Mama Stortini's, Space Needle, Seattle
Mariners, Tacoma Rainiers, Victoria Clipper and much more.
Call Fran Thomas at 265-2774. Cost is $35 for the
SouthSound edition and $40 for the Seattle edition.
The October Board meeting w as held at the PCMS office
on O ctober 12. A ttending the m eeting w ere Yolanda Bruce
(President), Alice Yeh, F rae T hom as, M ona
Baghdadi, Kathleen Sm ith, Helen W hitney, Nikki
Crowley and Kris White.
The Board approved funds to purchase a vinyl banner
and t-shirts w ith SAVE logos (STOP AMERICA'S VIO
LENCE EVERYWHERE). They will be used at functions
w here PCMSA members are representing the Pierce County
medical community.
Philanthropy requests were presented for discussion and
were prioritized. The final list will be published next month.
Raffle items for the PCMS/PCMSA Annual Meeting were
discussed and it was decided that two baskets will be made this
year, one featuring food items and the other non-food items.
The main agenda item for the meeting was the prepara
tion of the Holiday Sharing Card solicitation mailing.
P e r s o n a l P r o b le m s
© f F tiy s ie ia n s
M e d ic a l p r o b le m s ?
d r u g s , a lc o h o l, r e tir e
m e n t, e m o tio n a l, o r
o th e r s u c h d iffic ti (tie s ?
Y ou r c o l l e a g u e s w a n t to help
Allenmore
Psychological
Associates, P.S.
...a multi
disciplinary
behavioral
health group
that works
with physicians
* R o b e rt S an d s, C h a ir
Bill D ean
F. D en n is W a ld ro n
752-6056
272-4013
265-2584
--------------- ■ 7 5 2 - 7 3 2 0 r-------------Do you have patients with difficult emotional
_
C o r^yd erd id E ty
A ssu red
_
November, 1999
PCMS BULLETIN 15
B
u l l e t in
In tern et H um or - H ealth Insurance Questions
Q: W h at does H M O sta n d for?
A: This is actually a variation of the
phrase, "H ey, Moe!" Its roots go back
to the concept pioneered by Dr. M oe
H ow ard, w ho discovered that a patient
could b e m ade to forget about the pain
in his foot if he w as poked hard
en o u g h in the eyes. M o d e m practice
replaces the finger poke w ith hi-tech
equivalents such as voice mail and
referral slips, b u t the result rem ains the
same.
Q: D o all diagnostic procedures
require pre-certification?
A: N o. O nly those y ou need.
Q: I just joined a n ew H M O . H ow
difficult will it be to choose the doctor I
want?
MultiCare Health System
A: Just slightly m ore difficult than
choosing you r parents. Your insurer
will provide you w ith a book listing all
the doctors w ho were participating in
the plan at the time the information w as
gathered. These doctors will fall into
tw o basic categories: those w ho are no
longer accepting new patients and
those w ho will see you b ut are no
longer p art of the plan. But do n 't
w orry... the remaining doctor w ho is still
in the plan and accepting new patients
has an office just half a d ay's drive
away.
Q: W hat are pre-existing conditions?
A: This is a p h rase u sed by the
grammatically challenged w hen they
w ant to talk about existing conditions.
Unfortunately, w e seem to be pre
stuck ^with it
Franciscan Health System
Q: W ell, ca n I g et coverage for my
pre-existing conditions?
A: Certainly, as long as they don't
require any treatment.
Q : W h at hap p en s if I w ant to by
alternative form s of medicine?
A: You'll need to find alternative forms
of payment.
Q: I have an 8 0/20 plan with a $200
deductible an d a $2,000yearly cap. My
insurer reim bursed the doctor for my
outpatient surgery but I'd already paid
the bill. W hat should I do?
A: You have tw o choices: your doctor
can sign th e reim bursem ent check
over to y o u or y o u can ask him to
invest the m oney for you in one of
Diagnostic Imaging Northwest
See “humor” page
Tacoma Radiology
COLLEGE
CF
MEDICAL
EDUCATION
Condo reservation
deadline is
December 1
Reservations for the College's
block of condos, once again all in the
Aspens, are available. Reservations
can be made by calling (800) 777-0185.
You must identify yourself as part of
the College of Medical Education to
THE COLLEGE'S BLOCK OF
ROOMS WILL BE RELEASED
AFTER DECEMBER 1,1999.
Medicine and Mental Health
Conference set D ecem ber 3
A CME program focusing on the
diagnosis, treatment and management
of mental health complaints faced in
the primary care and internal medicine
practice is set for Friday, December 3.
The complimentary program,
directed by Drs. David Law and
Mark Craddock, offers 6 category I
CME credits. Topics include:
• Estrogen Deprivation & It's
Impact on Cognitive Function
Dates
Friday, December 3
Friday, January 21
Wednesday - Sunday
February 2-6
Hawaii Hotel/Air
reservations urged
Thursday-Friday
March 9 & 10
Monday - Friday
Although the dates for the
College's CME atH aw aii program are
six months away, it's not too early to
make necessary LOGISTICAL
arrangements including reservations
for the hotel, flights and registration for
the conference.
If you are planning to attend the
conference, set for April 9-15 on the
BigIsland, w e suggest you call the
Hapuna Beach Hotel at (800) 882-6060
AND Marilyn at Olympus Travel for
flight arrangements a t565-1213.
April 10-14
Saturday, April 29
• Dementia with Psychosis
• TreatmentResistant Depression
• Sleep Disorders
•Adult ADD
• Anxiety & Panic
• Addressing the Addictive Patient
• Geriatric Depression
A program brochure was ma iled in
late October. For additional informa
tion, please call 627-7137.
Program
Director fs)
M edicine & Mental
Health
Care
David Law, MD
Gregg Ostergren, DO
CME @ W histler
Richard Tobin, MD
Advances in Women's
Medicine
Internal Medicine
Review 2000
Robert Corliss,MD
CM E @ Hawaii
M ark Craddock, MD
Surgery Update 2000
Asthma, Allergy &
Friday, May 5
Pulmonology for
Primary Care
Alex Mihali, MD
Nuts, Bolts &
Friday, June 2
Innovation:
Gastrointestinal
Gary Taubman, MD
Richard Tobin, MD
Disease V
November, 1999
PCMS BULLETIN 17
B
u l l e t in
H um or
from page 16
those great offers that only doctors and
dentists hear about, like windmill farms
an d frog hatcheries.
Q: W hat accounts for the largest
portion of health care costs?
A: D octors trying to recoup their
investm ent losses,
P u g et S o u n d A rea, WA: You know how you want to set up your practice.
seeks BC/BE Family Practitioners. Flexible financial packages and practice
Samaritan Community Healthcare, 407 - 14th Avenue S E , Puyallup, WA
98371, (253) 848-6661, Ext. 1865.
________________________
Q: W h at sh o u ld I do if I get sick
w hile traveling?
A: Try sitting in a different p art of the
bus.
Q: No, I m ean w h at if I'm aw ay from
hom e an d I get sick?
A : You really shouldn't do that. You'll
have a hard tim e seeing your prim ary
care physician. It' bestto w ait until you
retu rn th en get sick.
ONE
to O N E
P H V S 1 C A I
T H 6 R A P V
(2 5 3 )3 9 6 -9 0 0 1
D e b o r a h K ristov ich , form er Rehabilitation Director
for Franciscan H ealth S y stem ’s E lder Care, has opened
O n e -to -O n e P h ysical T herapy.
Deborah Kristovich
MPT, ATC
•
O r t h o p e d i c R e h a b ilita tio n
•
G a it & M o b ility Tra in in g
•
B a la n c e a n d S a f e ty R e tra in in g
•
S p o r t & A c tiv ity A s s e s s m e n t
2 3 1 2 N o rth 3 0 th S tre e t, S u ite 101 (In O ld T o w n T a c o m a a c ro ss th e s tre e t from G ra z ie ’s)
W e are proud to continue our tradition of providing quality
H Regence
CALL 5 9 7 - 6 4 7 3 OR 5 9 7 - 7 9 8 2 .
B lu e S h ie ld
POSITIONS AVAILABLE
Tacoma/Pierce C ounty o ut
patient general medical care at its best.
Full and part-time positions available in
ANESTHESIOLOGIST N E E D E D
FOR DAY SURGERY - Anesthesia
locum tenens, B/ C or B / E, needed
immediately for outpatient surgery
center in south Seattle area. Minimum
of 24 weeks/year, working two to five
day/week Possible permanent parttime position available in the near
future. Contact Covington Day
Surgery Center at 253-639-8306.
PRACTICES AVAILABLE
Tired of office/hospital m ed i
cine? Exclusive long-term care
practice for an Internist/Genera]
Practitioner available immediately.
Good income potential - no paperwork
hassle. Call 472-2011.
OFFICE SPACE
Lakewood medical space
Ring at 584-6200 or 582-5856.
New office sp ace available. Up
to 4500 sq. ft. Will finish to suit. On
Call Robin at 756-2182
multi-specialty three story medical
building currently under construction
in Puyallup. Located within 3 blocks of
Good Samaritan Hospital with frontage
on Merid ian. Last available suite is
2,075 square feet and is located on the
second floor of a three story building.
All tenants are medical offices.
Excellent parking and exceptional
tenant improvement allowance.
Completion in early 2000. For
inform ation, contact Lawrence J.
White, MD or Lorna Drees at (253)
848-3000.
P enthouse office in Ja ck so n Hall
will be available for lease November 1,
1999. Jackson Hall is conveniently
located across the street from Tacoma
General Hospital and Mar}' Bridge
Children's Hospital. Suite 501 has 2,466
sq. ft., w ith updated lease-hold
improvements. Large front office space
as well as very Iarge exam rooms, two
of which are wheel-chair accessible,
m ake this suite special. The space is
ideal for 1-3 practitioners. There are
currently 4 exam rooms, and another
room can easily be converted. The lab
area is separate, and allows for clean
and dirty areas. Your staff will love the
lounge and the view of the water and
Olympics. For information call Dr.
Sandra Reilley at 383-1231.
| Union Avenue Pharmacy &
|
Corset Shop
%
2302 S. Union Ave 752-1705
Puyallup, W A : Hospital affiliated
openings for BC family practice
introduction and CV to Urgent
Care Center Application, Good
Puyallup, W A 98371-0192._______
VOLVO
BMW
SE R V IC E & R E PA IR
(253) 588-8669
T A C O M A /P IE R C E C O U N TY
O u tp atien t G eneral M edical Care.
Full and part-tim e positions
available in T acom a an d v ic in ity .
Very flexible schedule. W ell suited
lor ca reer redefinition for
C P, FP, 1M.
C o n ta c t A n d y T s o i, M D
( 2 5 3 ) 7 5 2 -9 6 6 9
o r P a u l D o t '.1 ( A l l e n , N e l s o n , T u r n e r &
B o y le ’s F o reign C ar R ep air
7202 S teila coo m Blvd SVV
A s s o c .), C li n ic M a n a g e r (2 5 3 ) 3 S 3 -4 3 5 1
November, 1999
PCMS BULLETIN 19
B
u ll
■ETIN
Policyholder C oncerns Come First
Insurance was really looking out for my
V
W h e t h e r i t ’s a c la im , a la w s u it, o r a ris k m a n a g e m e n t issue,
P h y s ic ia n s I n s u ra n c e k e e p s c u s to m e r c o n c e rn s a t th e fo refro n t.
C la im s r e p re s e n ta tiv e s w o r k c lo se ly w ith in s u r e d d e fe n d a n ts
a n d e x p e rie n c e d a tto rn e y s to s e c u re th e b e st p o ssib le o u tco m e
fo r o u r p o lic y h o ld e rs . E q u a lly as d e d ic a te d , o u r ris k m a n a g e
m e n t re p re s e n ta tiv e s c o n d u c t in te ra c tiv e s e m in a rs a n d re s p o n d
to q u e s tio n s in p e rs o n , b y p h o n e , a n d b y m ail. O u r goal, n o w
a n d in th e fu tu r e , is to h e lp p h y s ic ia n s , c lin ic s, a n d h o s p ita ls
re m a in su c c e ssfu l.
r4f" Physicians
^ Insurance
i r o a ir J a n d s p i/'ii-o rc d h v d'.c
"'A.nshin^Lon M ate M e d u u i A is o a n lio n
P ie rc e C o u n ty M e d ic a l S o c ie ty
2 2 3 T a c o m a A ve n u e So u th
Tacom a, WA 9 8 4 0 2
1 - 8 0 0 - 962-1399
1 - 8 0 0 - 9 6 2 -1398
A M utual Company
E a ste rn W a s h in g to n
O re g o n
1 - 8 0 0 - 565-1892
Seattle, W A © Physicia ns In surance 199 9
PRESORTED
STANDARD
US POSTAGE PAID
TACOMA, WA
PERMIT NO 605
D e c e m b e r, 1999
PCMS Celebrates No More Mortgage
D rs. J o e W e a m (left) a n d G o rd o n K la tt w atch th e p a p e r b u r n a t th e P C M S M o rtg ag e
B u rn in g P arty. D r. K la tt w as p r e s id e n t a n d D r. W e a m was s e c r e ta r y - tr e a s u r e r in 1990
w h en th e b u ild in g w as p u r c h a s e d by M B I, th e P C M S fo r-p ro fit s u b s id ia ry
M ore p ictu res a n d story, page 7
INSIDE:
3
5
7
8
9
11
13
P re s id e n ts P ag e: F C Y 2 K M S
The News Tribune E d ito rs a d d re ss m e m b e rsh ip a t N o v em b er m e e tin g
M o rtg a g e B u rn in g P a rty a h ap p y ev en t fo r PC M S
P a tie n t in fo rm atio n I n te r n e t re s o u rc e s
“A F am ily P h y sician ’s P ro m ise to H im self,” by R ic h a rd W altm an , M D
“T h e B u r d e n o f P ro o f,” by A n d rew S tatso n , M D
“E n d o f th e Y e a r P e rsp e ctiv e ,” by F e d e ric o C ru z -U rib e , M D
B
u l l e t in
P C M S O ffic e r s/T r u ste e s:
L a w r e n c e A . L a r s o n , D O .............................P re s id e n t
C h a r l e s M . W e a t h e r b y , M D ........... P r e s id e n t E le c t
P a t r ic e N . S t e v e n s o n , M D ....... S e c r e t a r y /T r e a s u r e r
J a m e s N4. W i l s o n , J r ., tv lD ...............P a s t P r e s id e n t
S u s a n J. S a l o , M D
Y o la n d a B r u c e , P C M S A P r e s id e n t
-
’W \w m
oM edtccd
=
B u l l e t in
W S M A Re p resen ta tiv es:
P a st P re s id e n t: P e te r K . M a rs h , M D
S p e a k e r o f t h e H o u s e : R i c h a r d H a w k in s , M D
E x e c u tiv e D irector:
December
D o u g la s Ja c k m a n
C o m m i t t e e C h a irs:
A g i n g , R ic h a rd W a ltm a n ; A I D S , L a w re n c e S c h w a rtz ;
B y l a w s , S ta n le y T u e ll; B u d g e t / F i n a n c e , P a tric e
O v c rfie ld ; C r e d e n t i a l s , S u sa n S alo ; E m e r g e n c y
M e d i c a l S t a n d a r d s , T e d W a lk le y ; E th ics/
S t a n d a r d s O f P r a c tic e , D a v id L u k e n s; G r i e v a n c e ,
J a m e s M . W ilso n ; L eg is la tiv e, W illia m M a rsh ;
M e d i c a l - L e g a l , P a t D o n le y ; M e m b e r s h i p B enefits,
Inc., D re w D e u ts c h ; P e r s o n a l P r o b l e m s O f
P h y s ic ia n s , R o b e rt S a n d s; P u b lic H e a l t h / S c h o o l
H e a lt h , J o s e p h W e a m ; S p o r t s M e d i c i n e , Jo h n
J ig a n ti.
T h e B u lle t in is p u b lis h e d m o n th ly by P C M S
M e m b e rs h ip B e n e fits , In c, lo r m e m b e rs o f th e P ie rc e
C o u n ty M e d ic a l S o c ie ty . D e a d lin e s fo r s u b m ittin g
a rtic le s a n d p la c in g a d v e rtis e m e n ts in T h e B u lletin
are th e 15th o f th e m o n th p r e c e d in g p u b lic a tio n (i.e.
O c to b e r 15 fo r th e N o v e m b e r issu e).
T h e B u lle t in is d e d ic a te d to th e art, sc ie n c e and
d e liv e ry o f m e d ic in e an d th e b e tte rm e n t o f th e h e a lth
a n d m e d ic a l w e lfa re o f th e c o m m u n ity . T h e o p in io n s
h e re in are th o se o f th e in d iv id u a l c o n trib u to rs an d do
n o t n e c e s s a rily re fle c t th e o ffic ia l p o sitio n o f th e
M e d ic a l S o c ie ty . A c c e p ta n c e o f a d v e rtis in g in no
w a y c o n s titu te s p ro fe s sio n a l a p p ro v a l o r e n d o r s e
m e n t o f p ro d u c ts o r s e rv ic e s a d v e rtise d . T h e B u lle tin
a n d P ie rc e C o u n ty M e d ic a l S o c ie ty re se rv e th e rig h t
to re je c t a n y a d v e rtisin g .
E d it o r : D a v id S. H o p k in s M D
E d it o r ia l C o m m i t t e e : M B I B o a rd o f D ire c to rs
S u b s c r i p t i o n s : S 5 0 p e r y e a r , $ 5 p e r is s u e
1999
Table of C ontents
3
P resident's Page: PCY2KMS
4
Applicants for M em bership
5
The N e w s Tribune E ditors offer PCM S collaboration
7
M ortgage B urning p arty a h a p p y event for PCMS
8
Patient Inform ation Internet resources
9
"A Fam ilyPhysidan'sProm isetoH im self"
11 The Invisible H and: "T he B urden of Proof"
13
TPCHD: "E nd of the Year Perspective"
15
The Pulse: PCMSA N ew s
16
17 The College of M edical E ducation
2 5 3 -5 7 2 -3 6 6 6 , F A X 2 5 3 - 5 7 2 -2 4 7 0
18 W hat do surgeons an d mechanics have in common?
E -m ail a d d ress: p c m s w a @ p c m sw a .o rg
19
PCY2KMS
Do we need a Y2K fix for medicine in Pierce County?
What is needed to make the practice of medicine compliant with
the demands of the new millennium, and how do we identify
L a w ren ce A. Larson.
those demands?
P resident, 1999
The physicians and hospitals of Pierce County can be proud
ei
of our excellent health care. However, there are signs that
problems await us in the near term. Marketplace forces, big business, insurance compa
nies, government and the legal system all present formidable obstacles to quality medical
care.
I know that 500,000 uninsured people in the state of Washington is a significant prob
lem that will need to be remedied. When citizens of our county and state no longer have
access to affordable medical insurance then our whole care system is in a precarious
position. There are no simple solutions to this health care crisis, but an alliance with our
patients would go a long way to finding workable solutions. The new WSMA CURE
program may help form an effective platform to iden tify the issues and create a positive
force for remedies.
In Pierce County we are fortunate to have an active and effective Medical Society.
We have an excellent and tireless administrative staff that is focusing on our issues. As
physicians we need to help the PCMS identify where its energies should be placed. This
year we have supported regional trauma care, end-of-life issues, public health issues,
community health clinics, immunizations, quality of care, communication links to insurance
plans, legislative reform, tuberculosis reporting, L&I reform, management of anaphylaxis
in schools, communication with our local press, and quality practice vehicles. We do this
work with mainly volunteer energy from tine Medical Society membership. This is your
body of work for 1999 and one of which we can be proud. The system of committees and
boards, CME and MBI does work. We enjoy our largest membership in the past decade
because we have been and are effective at improving medicine for Pierce County.
As I end this year as President of PCMS I want to thank all of the membership and
staff for your dedication and hard work. Yes, Y2K is upon us but we have the right organi
zation in PCMS to support excellence in health care in the new millennium. ■
1
,c e n
December, 1999
D.O.
'
PCMS BULLETIN 3
B
u l l e t in
Applicants for
M em bership
FOUND: Raincoat
K ie r n e y , P h ilip C ., M D
P la s t ic & R e c o n s t r u c t i v e S u r g e r y
M acb eth , Laura C., M D
P e d ia t r i c s
Practices atl7 0 8 S Yakima, Tacoma
98405; 404-1165
M edical School: UCLA
Internship: M ayo Clinic
Residency: M ayo Clinic
Fellowship: University of South H on d a
Practices at Pediatrics N orthw est, 4700
Pt. Fosdick D r NW , #103, Gig H arbor
98335; 851-5665
M edical School: N ew York U niversity
School of M edicine
Residency: University of W ashington/
Children's Hospital
K w o n , P e te r S., M D
N e u r o lo g y
Practices at 1322 3rd St. SE, #220,
Puyallup 98372; 848-9695
M edical School: Univ of M innesota
Internship: St. Joseph M ercy H ospital
Residency: U niversity of M ichigan
Fellowship: D uke University
D id Y ou
S oru m , R a n d y D., M D
R a d ia tio n /O n co lo g y
Practices atT acom a/V alley Radiation
O ncology Center, 1318 3rdSt. SE,
Puyallup 98372; 841^311
M edical School: U niv of South Dakota
Internship: University of South Dakota
Residency: St. M ary's Integrated
Radiation Oncology Program
A raincoat was left at the
L a n d m a r k C on ven tio n
C e n te r a fter the
N o v e m b e r 9th g e n era l
m e m b e r s h ip meeting.
T h e c o a t is a L on don Fog,
lo n g r a in c o a t, dark green
in co lo r.
I f yo u lost yo u r raincoat
a ft e r the m e e tin g , please
call P ie r c e C ou n ty
M e d ic a l S o ciety, 572-3667.
i
R em em b er?
Medical Placement Service
The solution for all you r staffing needs
W e p ro v id e fo r you:
/
WAMPAC
Washington Medical Political
Action Committee
► an available pool of qualified clinical &
administrative applicants
► coverage for vacations, illness, leaves of
absence, peak work loads, pregnancy, etc.
► employees without the hassle of salary,
benefits, taxes and other such employee
requirements
►
Temp to Perm: A unique opportunity to w ork
with a p otential em ployee on a trial basis
w ithout obligation to hire
ItiOO Cooper Point Road S\\
B lilff 7. Suite A,
O lym pia. WA f)B502
8 0 ( l - 5 ( ) 2 - 1.14(i ♦ (3H0) 3.)2-4848
4
PCM S BULLETIN
December, 1999
For m o re in fo rm a tio n :
C a ll D e b o ra h F a sq u a : 5 7 2 - 3 7 0 9
The News Tribune Editors offer collaboration with PCMS
Over 100 people attended the
November 9 General Membership
meeting eager to hear opinions of
Tacoma's major newspaper's senior
editorial staff. Representing The N ews
Tribune were D avid Zeeck, D avid
Seago and Patrick O'Callahan; Execu
tive Editor, Editorial Page Editor and
Chief Editorial Writer respectively.
And, as one w ould expect, all well
spoken and professional, and surpris
ingly honest.
They were explicit in their
distinction between editorials and
news, notingthat editorials are biased
because they are merely " opinions."
"We receive about one complaint per
monthregarding this issue," noted
Seago. People tend to forget that the
editorial page is not" news."
Each defined their distinct role.
Seagohas editorial responsibility for
two pages daily and four on Sunday
while Zeeck is responsible for the
news content O' Callahan writes
editorials, but, "I don't write all the
editorials," he quickly noted. H e was
previously a medical reporter and
remains intensely interested in medi
cine and it's role in society. "I follow
the profession and their concerns," he
added.
The routine is a ten a.m. meeting
eveiy morning and the job is to argue.
They review local and national news
and issues. They look for support and
information frombotii sides, w ith an
eye to what is good for the community.
"It is a challenging, exciting job, noted
Seago, but w hat is good for the
community is what drives our opinions."
Patrick O' Callahan said that he
sees two problems for the medical
community. People who have HMOs
and people who don't have HMOs.
'Medical care needs to be defined," he
said. "Is health
care a commod
ity, a human right,
an entitlement or
a public good?
Until w e can
define w hat
medical care is
w e don't know
what model to
follow."
W hen asked
about current
local issues such
as trauma care
and Initiative 695,
responses were
forthcoming. "It is
troubling that
trauma care for
Pierce County
has taken as long
as it has, but
medicine lias
internal politics
just as any
profession,"
responded
O'Callahan.
Seago added,
"There are smart,
credible people
w ho disagree
about trauma, so
it is hard to know
w ho is right." He
added thathe
believes the new
trauma director
will be a real
asset for the
system and if it
works for two
years he prom
ised to help with
S ee “T N T ” page
R ight, D a vid Zeeck, E xecutive E ditor, talks with Dr. R on
M orris after the m eeting. H e w elcom es input from the m edical
com m unity
V
1
D a vid Seago, E ditorial P age E ditor (left) visits with attendees
after the meeting. “We try not to be in an ivory tower, ” he sa id
6
Left, P atrick O 'Callahan, E ditorial Writer, thinks before
responding to a question. Technology’ and inflation have
vexed p o lic y m akers f o r a long time, he believes
December, 1999
PCMS BULLETIN 5
B
u l l e t in
“TNT’ftompageS
publicity for pennanent funding.
O n the 695 issue they felt the trend of the public is one of
anger an d frustration. "The governm ent has an angry
co n stitu en cy/' noted Seago. The w ave of anger could be
encom passed by stadium s, the N arrow s Bridge, property
taxes, etc., w ith Initiative 695 giving voters a perfect avenue
to let law m akers know how fed u p they are.
M oving on to direct questions about bad publicity for
m edicine, including a recent article questioning the safety of
childhood vaccinations, Zeeck apologized. "T hat has to be
the dum best article w e have ever run," he said, adding, "you
should have read it before it w as edited." H e adm itted that
the article w as a "big m istake" and tine editors do recognize
that w h en people read the n ew sp ap er they assum e the
inf orm ation is m ainstream . O ' Callahan expressed his concern
that the Am erican public is less literate scientifically than they
used to be an d ignorance is m ore pervasive an d the demand
for credibility has been lifted.
In closing, the guests expressed their interest and
willingness to w ork w ith the medical com m unity and their
desire to be m ore proactive an d less reactive. Suggestions for
collaborative efforts included guest columnists, op-ed articles,
a n evening forum on health care, as well as the invitation for
any PCM S m em ber to call the editors directly and express
their ideas or concerns.*
L e ft D r J im E arly, r e tir e d L a k e w o o d in te rn ist talks w ith
L e ft to right, C H C p h y s ic ia n s D rs. J o h n G ray a n d A suqito
E d ito ria l
E su a b a n a visit w ith a c o lle a g u e a fte r the m e etin g
6
Page
E d ito r D a v id S e a g o a fte r the m e e tin g
PCM S BULLETIN
December, 1999
Mortgage burning party a happy event for PCMS
In 1990, w ith PCMS facing a rental increase for office
space that w ould cost $150,000 over five years, the search
began for an office building to purchase. As luck would
have it, an ideal spot was found that could provide space for
PCMS and their two subsidiaries, Membership Benefits, Inc.
(MBI) and the College of Medical Education, as well as
additional offices that could provide rental income for the
Society.
On October 28, over 40 mem bers attended a celebra
tion in honor of PCMS now owning the building. In just nine
years, MBI has satisfied the mortgage.
Dr. Gordon K latt w as PCMS P resident and Dr. Joe
Wearn Secretary-Treasurer w hen the Board of Trustees
voted to invest in the real estate venture. It has been a good
decision. The building will now serve as a source of nondues revenue from rents paid by tenants. Current tenants
include the Pierce County Dental Society, Pierce County
Nurses Association, American Lung Association of Wash
ington, SW Washington Trauma Services and Chase
Economics.
The building has been recently remodeled including
new paint inside and out, new carpeting, lights and a
heating/ air conditioning system. Located on Tacoma
Avenue South, just one block east of W right Park, it offers
close proximity to both Tacoma General and St. Joseph
Hospitals. There is a conference room that will accomodate
about 15 people. Many smaller meetings are held at the
office including the Immunization and Hospice Task Forces,
MBIBoard, and Grievance, EMS, L&I and Medical-Legal
Committees.*
PCMS President, Dr. L a rry Larson, visits with Mrs. Lorna
Burt, wife o f re tired m em b er Dr. R obert B urt
F rom left, Dr. P eter M arsh, his w ife Susan, Drs. M ian Anwar,
Stephen D uncan a n d D a v id D ve w atch the p a p e r burn
From left, Drs. G eorge Tanbara, D ick Bowe a n d Tom
M iskovsky along with Dr. D oris P age t/ront row) helped
celebrate the happy occasion for P C M S
Drs. M ian A nw ar (center) a n d his w ife Patty, visit with Dr.
Tom M isko\'sk\‘ w hile Drs. Ron A nderson (left) and
G eorge Tanbara visit in the background
December, 1999
PCMS BULLETIN 7
B
u l l e t in
Patient inform ation internet resources
For patients w ho w an t to find
health information, there axe m any
options. The N ational N etw ork of
Libraries of M edicine offers the
following advice/ options:
T h e W o rld W id e W eb g iv e s
access to a w ealth of health information.
But, check th e source! W ho p u t that
inform ation on the w eb? N on-profit
health agencies and universities often
h av e excellent w eb sites. Be aw are of
the m any advertisem ents on the web.
M any reputable sites are listed below.
Y o u r public librarian does
have access to im portant indexes and
lists of health materials and can borrow
from am edical library. U sually the
inform ation can be acquired w ithout
charge.
H ospital and clinic libraries
serving consum ers are becom ing m ore
num erous. H ospital librarians are
specialists in finding the best health
information. Call ahead to find out
about h o u rs an d charges.
w w w .n n l m . n l m . n i h . g o v / p n r / d i r /
rep o rts/co n su m ers.h tm l
Consum er health information
services are often offered by m edical
school libraries and large hospital
libraries. Librarians specializing in
health inform ation can find exactly
w h a t you w ant, copy and send you a
com plete packet of information. Such
services cost m ore b u t m ay well be
w o rth it. O ne exam ple is H ealth
Inform ation for You:
w w w .h slib .w a sh in g to n .e d u /h sl/
h ify /
O ther online options include:
M E D LIN Epfus:
w w w .n lm .n ih .g o v /m ed lin ep lu s
The N ational Library of M edicine's se
lected resource for inform ation that will
h elp y o u research y o u r health ques
w w w . ig m . n l m .n i h .g o v
The w orld's m ost extensive bibliogra
phy of published medical information.
Free access to the N ational Library of
M edicine via P ubM ed an d Internet
Grateful M ed
h e a lt h fin d e r :
w w v v .h e a l t h f i n d e r .g o v
A m e r ic a n M ed ic a l A ssociation ’s
H e a lth In s ig h t Page:
w w w .a m a - a s s n .o r g /c o n s u m e r
C H ID O n lin e:
w w w .ch id .n ih .g o v
D esigned by the AM A to provide
online health inf onnation and to be pa
tient friendly. It includes links to a "Doctor Finder" and a "Hospital Finder"
Com bined H ealth Information Data
base, sponsored by health related
agencies of the federal governm ent
N IH H ealth I n fo r m a tio n Page:
w w w .n ih .g o v /h ea lth
Provides access to consum er health in
form ation of the National Institutes of
Health
d r k o o p .c o m :
w w w .d rk o o p .co m
A n Internet based consum er
healthcare com pany founded in p art by
the form er S urgeon G eneral C.
Everett Koop. It's stated purpose is to
"em pow er consumers to become ac
tive, well inform ed participants to better
m anage their health". There is inform a
tion for people of all ages, from new s,
health and wellness, disease topics and
more.
H e a lth W eb:
w w w .h ea lth w eb .o rg
Easy to use health specialty categories.
M aintained by medical school libraries
in the G reater M idw est region of the
N ational N etw ork of Libraries of M edi
cine
N etw elln ess:
w w w .n etw elln ess.co m
M EDLINE:
W eb-based consum er health inform a
tion service developed by the U niver
freem ed l
w w w .n c b i.n lm .n ih .g o v /P u b M e d /
8
PCM S BULLETIN
December, 1999
,
;
i
Federal governm ent's links to d ep en d
able consum er health information
tions
w w w .n lm .n ih .g o v /d a ta b a ses/
sity of Cincinnati Medical Center with
m ore th an 40 partners, including the
m edical centers at Case W estern Re
serve University, O hio State University
a n d O hio's libraries. They have all col
laborated to provide current and accu
rate health information. Try "Ask the
Expert"!
.
.
C ancernet:
w w w .c a n c e r n e t . n c i . n i h . g o v
Provides inform ation on cancer, and
cancer physicians and counselors. From
the N ational Cancer Institute.
'
C D C , th e C e n te r s for Disease
C on trol:
w w w .c d c .g o v
w w w .c d e /g o v /n ip
w w w .c d c /g o v /tr a v e le r s
H as answ ers to frequently asked ques- "
tions about childhood immunizations, in
ternational traveling, disease outbreaks,
recom m ended immunizations, etc. as
w ell as m yriad other resources for the
-•
public.
*
T h e A g e n c y fo r Health Care
P o lic y an d R e se a r c h :
w w w .a h cp r.g o v
1
The A gency for H ealth Care Policy
an d Research provides data to help
consum ers m ake decisions about specific h ealth concerns and prescriptions,
si
^
S u b s t a n c e A b u se and M ental
H ea lth S er v ic e Administration:
w w w .s a m h s a . g o v
■
Substance A buse and Mental Health
Service Administration's information on
treatm ent an d prevention
f
5
Special Feature
by Richard E.Waltman,M.D.
A family physicians promise to himself
A year ago, a very close friend,
godfather to my oldest son, died of
lung cancer caused by smoking. Bob
was 53, a devoted husband and father,
and a delightful
guy. He was a
doctor of phar
macy, smart
enough to
know about the
dangers of
smoking and
strong enough
toquitthe habit
several years
ago,unfortuR ichard IValtiiian, K4D
nately, too late.
After the funeral, I attended a recep
tion at his home, and found the caterer
and the waiters smoking in the back
yard during a break. 1m ade them put
out their cigarettes, eliciting a sarcastic
"Chill out, man!" from one of the young
men. I wondered if his family w ould be
having a similar reception after his fu
neral 30 or 40 years hence.
On the plane ride home, I resolved to
make a special effort throughout the
coming year to encourage smoking
cessation in my practice. It w ould be
my way to make some peace w ith Bob's
death
I tried. I read up on all the m ethods of
smoking cessation, and listened as the
pill and patch and gum reps gave me
their data and educational litera ture. I
made quitting an issue w ith every one
of my patients who smoked. I did per
suade a few patients to stop, but no t
many. And like so many of you, I spent
the year treating ram pant abuse related
illness.
I admitted my chronic lung pa tients
with infectious exacerbations of their
disease; several of them needed four
or five hospital stays in one year. I di
agnosed 12 patients w ith lung cancers
and three with nose and throat cancers
had the flu.) And, while doing ER
related to smoking.
backup, I admitted a 20-year-old
One of my saddest experiences in
w om an widi a mixed drug overdose.
volved a 51-year-old man whom I've
She w as intubated, got better, signed
followed for more than 10 years. At ev
out against medical advice, and was
ery visit, I urged him to quit smoking,
back on the streets in a few days. Ironi
starting exercising, and get his diabetes
cally, w e call a case like that a "save"!
I dealt w ith a num ber of patients with
under control. At his first follow-up of
chronic dependence on, and little in
fice visit after an acute MI and emer
sight regarding, the narcotics their phy
gency C ABG surgery, he and his wife,
sicians had prescribed. As Mrs. Gallo
said they were now " really working
hard" to quit smoking. They are both
w ay told me, "I wouldn'ttake the pills if
my pain w eren't so bad. Ican'tstop
dow n to less titan a pack a day.
now."
If the pain and shock of an Ml and
Sadly, Mrs. Galloway is severely
emergency cardiac surgery w on't
overweight, poorly conditioned, and
make you give up tobacco, I w on
dered, w hat will?
profoundly inactive at age 68. She'll
O ther abuse-related illnesses kept
never start the exercise and weight
me busy all
loss program
year. I admitted
that could re
patient after pa
duce the pain in
"I think toe can have substantial
tient with prob
those arthritic
impact on the lifestyles o jo u r
lems induced by
joints. A nd she'll
patients, and I believe its our
alcohol: Tom
continue to take
obligation to help them help
w ith another GI
more and more
themselves. Don’t you P”
bleed, Ralph
narcotic analge
wi tlr another
sia.
episode of pancreatitis, and Minnie
Domestic violence? I discovered
with hip fractures, two in one year, af
some cases, but had almost nothing to
ter falling while intoxicated. I recently
offer the victims except a sympathetic
admitted a 47-year-old man, the son of
shoulder. Our community has only two
a longtime patient, to a nursing home
shelters, always full, and very little in
with mental status changes that prob
the w ay of other support for victims. If
ably resulted from anoxia and alcoholthe statistics are correct, for every ca
related aspiration pneumonitis. He
sualty of domestic violence I identified,
I missed three or four others. It's prob
should be able to return to the commu
ably true that physicians don't look
nity soon, bu t I'm already anticipating
carefully for domestic violence, but I
the call from tire ER after he damages
think that's in part because we have so
himself again
little help to offer.
D rug abuse is well represented,
I lost several patients to drunk driv
even in my predominantly Medicare
ers in the past year, and now I have
and working-class practice. I admitted a
one teenage patient trapped in a
young m an with severe hepatitis from
w heelchair for the rest of her life be
IV drug abuse and saw a high school
cause of a friend's reckless driving.
student who had a dysphoric reaction
to marijuana. (His mother thought he
See “Promise" page 10
December, 1999
PCMS BULLETIN 9
B
u l l e t in
-L l O m i S 0
from page 9
Y esterday I paid m y m onthly visit to a
46-year-old form er teacher w i th a d ev
astating head injury. She w as struck on
h er w ay to school by a d ru n k driver. I
have seen her in the n ursing hom e for
11 years now , and I'll probably pass
h er care on to another physician w hen
I redre.
Fortunately, I have not lost a patient
to suicide in the past year. But I d id get
involved after a 16-year-old student at
m y son's school took his ow n life, and I
found h ow little w e have done to cre
ate suicide prevention program s in o u r
com munity. Sadly, a great m any suicide
victims h ad visited a health professional
w ithin a few m onths before their act. In
m ost cases, w e d id n 't recognize their
cry for help.
L ooking back over the year, I w as
bothered by one thing above all: I had
been b ro u g h t u p to believe th a t good
people w ere rew ard ed and bad people
punished. But that w asn't w hat I was
seeing. M y smokers, m y drinkers,
even m y d ru g users and victims of abu
sive husbands, w ere in alm ost every in
stance good people, nice people,
people w ho sim ply had m ade poor
choices or show n poor judgm ent. In no
w ay could I say that they "deserved"
w h at h appened to them. I really
couldn't blam e them, and frankly, I be
gan to blame myself. Perhaps I should
h av e d one a better job directing their
choices.
A s the anniversary of Bob's death ap
proached, I w asn't sa dsfied w ith w hat
I'd accomplished, and w anted to do
better. I w rote a letter to 35 of m y pri
m ary care colleagues and asked them
to join m e in a sm oking cessation effort.
Several w rote back to voice support,
b u t other responses disappointed and
saddened me.
Tw o physicians said they d id n 't think
anything w e could do w ould have
m uch of an im pact on smokers. A nother
felt it w asn't his responsibility, or his
right, to tell people to stop smoking. I
disagree w ith both. I think w e can have
substantial im pact on the lifestyles of
o u r patients, an d I believe it's o u r obli
gation to help them help themselves.
D on't you?
The m ost disturbing response came
from a doctor w h o said he agreed w ith
m e but had too m uch else going on
riglit now. Actually, w hat frustrated me
m ost of all w as the absence of any re
sponse from m ost of m y colleagues.
W hich leads m e to today. I've got to
start somewhere, so I' 11start w ith m y
self. I'm tired of trying to repair the car
nage and I d o n 't w an t m ore of the
same.
I do n 't w ant to find any m ore lung
cancer: I w an t to prev en t them. I d o n 't
w an t to "save" any d ru g overdoses: I
w ant them not to happen. A nd I don't
w a n t to provide em ergency care for a
domestic violence victim: I w ant to get
h e r to safety before the violence oc
curs.
I am making a com m itm ent to be more
aw are of and m ore responsive to
abuse-related illness. I am going to
w o rk harder, longer an d better to d e
feat this killer of fathers, mothers and
children, this destroyer of families and
communities.
H ow will I do it?
I will m ake it a priority to learn more
about abuse-related illness. I'll learn
w ha t m ethods and interventions are
m ost effective. I'll read m ore about
abuse-related illness, find some CME
courses and encourage our hospital to
sponsor program s on die subject.
I will m ake m y patients aw are of the
risks of abuse-related illness an d of my
interest in helping them modify their
behavior before it's too late. I'll start by
sending a letter to all m y patients, mak
ing them aw are of m y willingness to
help.
I will w ork m ore actively in our commu
nity to enhance resources available for
the prevention an d treatment of abuserelated illness. I'll m ake some financial
donations, but I'll also offer my time do
ing volunteer w ork and presentations.
I w ill alert m y colleagues and encour
age their support of programs aimed at
deeding w ith abuse-related disease and
the im portance and effectiveness of
physician intervention. That alert starts
w ith this essay. I'm asking doctors
throughout the country to join me in an
approach to patient care that empha
sizes the identification and treatment of
self-destructive behavior.
By m y w ords and actions, I will show
m y community and my profession that
physicians do care about the conse
quences of abuse-related illness, and
that w e can intervene to reduce the
losses to o u r society that abuse-related
illness brings.
I d o n 't h av e false expectations. I
w on't abolish smoking, alcoholism, or
substance abuse. I w o n 't bring an end
to dom estic violence, reckless driving,
or suicide. But perhaps I can change a
few m inds and save a few lives, and
that's a start. If I can save a few, and if
each m em ber of m y call group can save
a few, an d if every physician who reads
this essay can save a few ...
Will you join me? ■
ONE
to
PHVSI Cf l l
T H € R ft P V
ONE
(253) 396-9001
D e b o r a h K ristov ich , form er Rehabilitation D irector
for Franciscan H ealth S ystem ’s E lder Care, has opened
O n e -to -O n e P h y sica l T h erap y.
Deborah Kristovich
MPT, ATC
• Orthopedic Rehabilitation
•
Gait & Mobility Training
•
•
Sport & Activity Assessment
Balance and Safety Retraining
2 3 1 2 N o r t h 3 0 th S tre e t, S u ite
101 ( I n O l d T o w n T a c o m a a c r o s s t h e s tre e t f r o m G r a z i e ' s )
The Invisible Hand.
“The Burden of Proof ”
"Logic is not satisfied w ith assertion. It cares nothing for tire opinions of the great,
nothing for the prejudices of the many, and least of all for die superstitions of the dead."
Robert Ingersoll (1884)
A inlrew Statson, M D
At a meeting last year, a midwife
discussed her role in a group obstetri
cal practice. Then she said, "Preg
nancy is a natural process and should
be considered normal until proven that
itis not. Innocent until proven guilty."
Applying a dictum from one field
to another is a type of lateral reasoning
that Aristotle would probably have
called illogism. Imagine our armed
forces accepting our dictum "First do
no harm." You can see our soldiers tell
ing the enemy, "Gentleman, w e don't
want to harm you for any tiling in the
world, but we are about to shoot ex
actlywhere you stand."
Innocent until proven guilty is
the legal expression of the bill of rights.
It is the product of the American Re v olution An early hint of it is present in
the Magna Charta, but it acquired its
full meaning only in the constitutional
democracy of the United States. It is an
ever so tenuous a protection of the citi
zen from the exercise of arbitrary
power by the state.
In medical practice, the pow er is
in the hands that hold the purse. In the
past, that was the patient. In contempo
rary practice, it is the insurance com
pany. Since the patients will suffer from
the lack of care or from inappropriate
care, they should be protected from
the exercise of arbitrary pow er and the
burden of proof should be borne by
those who hold the purse.
There are many situations in
medicine where the condition of the
patient can become serious very fast.
Infants and pregnant w om en are two of
these. They m ay look healthy, under
going a natural process, but in die span
of a few hours, or even a few minutes
their condition may change from very
low risk to critical.
A simple example is the multiparous woman in labor, who has had an
uneventful pregnancy. She is pro
gressing well until sheruptures mem
branes and the cord prolapses. She
changes from a very low risk to a very
high risk in the span of a few seconds.
If this patient happened to be off moni
tor because she w as low risk and w e
checked fetal heart tones every 30
cumstances w e had to assume that the
patient had an ectopic until we could
prove that she did not. The patient did
not have to convince us she had an ec
topic. The burden of proof w as on us.
W hen a patient has a breast mass or an
abnormal mammogram, the burden is
on us to prove she does not have can
cer, ra ther than on her to demonstrate
that she does. Yet, w hen w e call the in
surance companies to get authorization
for tests or procedures, w e are asked
to prove to them that they should be
done, rather than have them prove to
"M uch has been sa id about the right to m edical care, i f there is
such a thing. H ow ever, the restrictions im posed on pa tients and
p h ysicia n s by the insurance com panies have been such that p a
tients have h ad to pro ve they sh o u ld get the care they want. "
minutes, or even every 15 minutes, the
time it would have taken to discover
the problem and to act on it might have
been too long. It w ould have been
even worse if the patient happened to
be in the hot tub at the time. We cannot
p u t the burden on the pa tient to prove
to us she is in trouble and expect to
avoid these types of situations. We
have to be able to prove from minute to
minute that the patient is not in trouble.
One of the admonitions where I
trained was "think ectopic". In the past,
before the sonograms and lab tests of
today, the diagnosis of ectopic preg
nancy was difficult. U nder certain cir
us that they shouldn t.
Fortunately, high risk situations
are not common, but when they occur
we usually cannot wait for the patient to
prove to us she is guilty. In laboring
patients w e have to be ready to act on
very short notice. We can prove she
was low risk only inretrospect, after
she is safely delivered, and the baby is
doing well. Up to that point anything
can happen, and has.
Years ago, a teenage couple
came to my office. They wanted to de
liver at home. What did I think about
See “ P ro o f' page
December, 1999
12
PCMS BULLETIN 11
B
u l l e t in
P ro o f
from page 11
that? She show ed m e a little paperback
book w hich discussed pregnancy, la
bor, delivery a n d th e care of the n ew
born. The illustrations show ed equip
m en t w hich people on the American
frontier probably h ad used. I told them
I did n ot do hom e deliveries. "But w hat
could possibly go w rong?" he asked. I
looked at m y textbook of obstetrics,
tw o inches thick, an d said nothing. H e
caught m y lo o k I d o n 't know w hether
he got th e m essage. I never saw them
again.
O ne p atien t cam e for a preg
nancy interview and told m e she did
n o t w a n t oxytocin after deli very be
cause after h er last delivery she had
too m uch cramping. Instead, she
w an ted to p u t the baby on the breast,
hoping that w ould m ake her uterus
contract just enough b u t not too much.
"W hat did they do before oxytocin?"
she asked. "They died," I answ ered.
Maternal mortality was m ore than 20%
in the nineteenth century an d hem or
rhage w as one of the major causes.
W e have m ade such progress in m edi
cal practice that people have forgotten
Death is still around to claim her due.
W e h av e been able to delay h e r so
m any times, that w hen she finally wins,
as inevitably she does, people think
w e m ust ha ve done som ething wrong.
It has to be o u r fault, n o t their reckless
ness. Fortunately for m y coronaries,
this patient decided to go someplace
else fo r care.
D eath does not care w ho is inno
cent an d w h o is guilty. She is never far
away. Sometimes a few seconds of inat
tention, as in a car accident, is all she
needs to claim her victims. She profits
from any lapse in our vigilance,
w hether it w as a Pap sm ear or a m am
m ogram delayed, a chest pain ne
glected, or an y other subtle sign of
trouble ignored, because the patient
w as assessed as low risk. Then som e
thing happens that gets our attention,
the equivalent of hitting us on the head
w ith a two-by-four, b u tb y then tire pa
tient m ay be in deep trouble.
12
PCM S BULLETIN
December, 1999
Sometimes a n ew patient m ay call
m y office to m ake an appointm ent and
give a list of reasons w h y she needs to
be seen. M y staff know she m u st have
h a d experience w ith one of the closed
panel program s w here getting an ap
pointm ent w ith a physician is a big
event.
The insurance executives w o u ld
have been incensed if an aircraft m a n u
facturer had p u t on the m arket a plane
w ith defective doors thatflipped open
in m idair e v e r y thousands flights or so.
Yet they had no qualm s asking w om en
w ith previous section to undergo labor,
w hen the risk of uterine ru p tu re is one
percent. Recently, our State M edical
Quality Assurance Commission felt
compelled to issue a statem ent on "the
dark side of VBAC" (vaginal birth after
cesarean). The only tiring w rong w ith
this statem ent is that it should have
b een m ad e fifteen years ago. I w onder
w h at kind of proof finally m ade the
Commission come out with it and who
bore the burden. H o w m any babies
h ad to die, or live w ith serious prob
lems, how m any w om en had to lose
their u teru s in order to prove that
VBAC has a d ark side?
M uch has been said about the right
to m edical care, if there is such a thing.
H ow ever, the restrictions imposed on
patients an d physicians by the insur
ance com panies have been such that
patients h ad to prove they should get
the care they w ant. U nder these cir
cumstances, no m atter w hat anyone
m ay say, the care is n ot theirs by right,
it is theirs by permission. They can
only beg for it, an d if they get it, it is
m uch m ore as alms, than as a right. ■
TA CO M A R A D IO LO G Y
Detect and Monitor
Low Bone Density
1999 Physician's Guide to
Prevention and Treatment
of Osteoporosis
Developed by t/ie National Osteoporosis
FotHwiatimi in collaboration -with
American Academy of Qnhof'acdic Surgeons
American Academy of Physical Medicine
dud Retafeifiiarinn
American Association of Clinical Endocrinologists
American CoMege of Obstetricians
and Gynecologists
American CoUege of Radiology
American College oj Rfieumaiotagy
American Geriatrics Society
American Society /or Bone and Mineral Research
The Endocrine Society
L o w risk s c r e e n in g a v a ila b le a t a ll lo c a tio n s
WM-.
Tacoma
Lakewood
Gig Harbor
(253) 383-2038
(253) 572-5174
(253) 588-6083
(253) 858-3200
F ra n k S . B a lte r C e n te r
P o in t F o s d i c k Im a g in g
VPie/Ke %
Q/dedieal &ociefaf>
m
“E n d o f t h e Y e a r P e r s p e c tiv e
by F e d e ric o C ru z -U rib e , MD
T A C O M A - P IE R C E C O U N T Y
HEALTH
D E P A R T M E N T
1999 has been a roller coaster year
recent election has resulted in painful
for us at the Health Department. On the
cuts to programs. With the passage of I"up" side, we accomplished some things
will have to eliminate 59 positions. Here
695, some of the department's services
that I consider
are the changes w e've planned:
will have to be limited or changed.
public health
Oui-focus will continue to be
Comm unicable Disease
milestones:
prevention. We w ant to create healthy
Control. M uch of the funding for dis
❖ The
communities, working in concert with
ease prevention is categorical, but
Board of Health
the residents and services currently
even here w e had to cut 7.4% of the
approved a
available, including private provider’s.
budget. In general, we will continue to
resolution to re
W hen the voters approved 1-695, dis
strive toward our goal of fully imple
quire reporting
cretionary funds to the department
menting a communicable disease con
ofindividuals
were cut by 50%. Faced with that level
trol system throughout Pierce Count)'.
who are HTVof budget reduction, we decided to do
This means staff will continue to collect
F ederico
positive, allow
two things: 1) Maintain tine Vision, Mis
data on diseases in the community and
Cruz-U ribe. M D
ing us to begin
sion and Strategic Directions set out
respond to outbreaks as they occur,
prevention ac
four years ago; and 2) Keep the overall
and work with physicians and o ther
tivitieswith the individuals and their
structure intact at a level where all com
providers, offering infonnation and re
partners sooner.
ponents could still function and be
sources on public health issues.
❖ In a related action, theH ealth
brought up to speed again as future
Public Health Service Sys
Department has begun a case manage
funding allows. However, to achieve
tem. This is the countrywide vehicle
ment system for people w ho are HIVtlie $4.2 million budget cu t required, we
for prevention efforts, including campositive. The program will balance
See " Y e a r " p a g e 1 4
early treatment to
maintainhealth
with strategies to
T he MVET C hallenge: R ed uce th e Y2K B u dget by $ 4 , 2 3 4 ,5 6 0
prevent the
spread of the dis
A c h ie v e b y :
ease.
M a k in g D r a s tic P ro g ra m C u ts - 1 5 % o f O v e ra ll B u d g e t
♦t* W e've
developed plans
R e ta in in g t h e In fr a s tr u c tu r e to A c c o m p lis h th e D e p a r t m e n t 's M is s io n
and begun cam
C u ts :
paigns to change
A d o le s c e n t H e a lth P ro g ra m s - $ 6 8 5 , 8 9 9 ( 4 2 . 1 % ) - 4 . 8 F T E
the public's behav
C o m m u n ic a b le D is e a s e C o n tr o l - $ 3 8 4 , 2 8 8 ( 4 . 7 % ) — 2 . 0 F T E
ior regarding to
F a m ily S u p p o r t C e n te r s - $ 8 2 4 , 0 1 6 ( 2 2 % ) - 8 . 0 F T E
bacco use, alcohol
P u b lic H e a lth S e r v ic e S y s t e m - $ 1 , 5 4 4 , 6 7 0 ( 4 0 % ) - 2 5 . 2 F T E
misuse, and do
S o u r c e P r o te c tio n P ro g ra m s - $ 4 7 1 , 3 3 2 ( 1 2 . 2 % ) — 6 . 0 FT E
mestic violence.
This is the start of
work to improve
thepublic's health
on a larger scale
than we have in
thepast
On the
"down" side, the
S u b s ta n c e A b u s e /O th e r S e r v ic e s - $ 1 8 0 , 1 0 5 ( 4 % ) - 4 . 0
FTE
A d m in is tr a tio n - $ 6 9 9 , 2 6 9 ( 1 7 . 3 % ) - 9 . 0 FT E
N O T E 1:
S o m e o f th e F T E s c u t, e s p e c ia lly in th e P H S S , w ill b e re s to re d
th r o u g h p o s itio n r e s tr u c tu r in g .
N O TE 2:
C u t s t o a d m in is t r a t io n , to ta llin g $ 5 5 6 , 0 1 9 a re d is tr ib u te d in c u ts id e n tifie d
f o r e a c h p r o g ra m as w e ll as in th e A d m in is tr a tio n lin e .
December, 1999
PCMS BULLETIN 13
B
u l l e t in
'Year
from page 13
paigns to lim it tobacco use, alcohol
abuse a n d violence. O ne of the hall
m arks of this program w as community
involvem ent activities that engaged
residents of a n area in assessing their
public health issues an d m aking plans
to deal w ith them. M uch of the funding
for these services is from MVET fu n d
ing. To achieve the req u ired 40% cut
iii this program , w e chose to restruc
tu re it. W e w ill reduce the n u m b e r of
sites fro m seven to three an d reduce
the size of staff in each of th e districts,
although staff will travel to an d be
available to the public in all seven dis
tricts in the county. W e w ill also re
lease m ore limited public cam paigns on
tobacco, alcohol a n d violence.
Family Support Centers
(FSC). T he FSC 's p ro v id e resources
to the families of yo u n g children, re
sources w hich include public nurses to
assess babies for developm ental
progress an d families for issues such as
substance abuse. The nurse a n d /o r a
Fam ily S u pport W orker can then cre
ate a p lan for each fam ily to achieve
goals to strengthen thatfam ily. The
program will continue, although this
will also be restructured, n o t only to
achieve a 22% reduction in the b u d
get, b u t also to rebuild a m ore seamless
service for children and families.
A dolescen t H ealth. T he
M iddle School an d M oderate O ffender
Program s w ork w ith adolescents to
prevent gang involvem ent by youth.
These program s will be cut by approxi
m ately 42%, although staff will continue
to w ork w ith you th in schools an d the
juvenile justice system to prevent risky
behavior.
Source Protection. W e w ill
be eliminating our compliance pro
gram, w hich will impact the w ork w e do
on monitoring and educating the public
about the environm ent. H ow ever, w e
will continue to w ork to improve
ground and surface water, septic sys
tems and the appropriate elimination of
hazardous/ infectious waste.
The bottom line here is th at the
H ealth D epartm ent has taken a dam ag
ing blow to it's budget and w e're doing
the best w e can to continue to offer this
com munity as m any key health prom ot
ing services as possible.
Thanks for y o u r cooperation in
1999. W e're looking forw ard to m ain
taining our relationship w ith the medi
cal com m unity and to w orking together
w ith you to strengthen Pierce County
in the year 2000. ■
Urethral Inserts
Sublingual Troche
IV Services
Capsules
Lip Balms
i/i
PHWIS BULLETIN
December, 1999
Personal Problercis
rsicians
M e d ic a l p ro b lem s, drugs,
a lc o h o l, r etir e m e n t, emotional,
or o th e r such difficulties?
Your colleagues
w ant to help
Bill Dean
272-4013
C o n fid en tiality
A s s u re d
VOLVO
BMW
SERVICE & REPAIR
(253) 588-8669
w w w .v o lvo re p a ir.co m
752-1705
Boyle’s Foreign Car Repair
VPiewe ffounfy. Q 'ib d ic a l S o c ie ty
The Pulse
PCMS Alliance
Presidents M essage - Holiday W ishes
Mark your calendar for the
PCMS/PCMSA Annual Meeting that
will be held on Tuesday, December '14
at the Tacoma Sheraton Hotel. Watch
your mail for your invitation. Please
be sure to bring an unwrapped
toy for a child or a wrapped gift
for a woman that will be donated
to the YWCA Shelter.
And, thanks to all of you for
sending in your donations for the
Holiday Sharing Card. We appreciate
your support and your donation. The
money will support our philanthropic
contributions to our community.
O u r Apology
A s bells ring out
on Christmas Day.
M ay j o y a n d la u g h ter
come yo u r way.
A n d m ay th e sea so n
leave behind
M em o ries o f th e n icest kin d!
The B ulletin apologizes to
Jo Roller (Gil) and JoAnn
Johnson (Ralph) for n ot
recognizing them in the
N ovem ber issue as Pastpresident's of the WSMA
Alliance (formerly known as the
Auxiliary).
Jo A nn Johnson served as
President in 1970-1971 and Jo
Roller in 1978-1979.
We apologize for the error.
A s bells rin g in
the new year, too.
M a y y o u f i n d th ey rin g in f o r y o u
D ays fille d with
special jo y and cheer
A n d h appin ess to la st a ll yea r!
Yolanda Bruce
I
u
Open
Saturdays
ACR Accredited
NION
M RI
Hi
■■
(2 5 3 ) 7ft i - 9 4 8 2 i»r 1
M u ltiC are H e a lth System
Franciscan H e a lth System
D ia g n o s tic Im ag in g N o rth w e s t
December, 1999
J " t. JJ-t
Tacom a R adiology
PCMSBULLEMN
15
B r e n n a n , M ic h a e l , D O
C hange all prefixes to 435
6002 N W estgate Blvd. #230
Tacoma, W A 98406-2527
D a y , L ila, M D
K o v a n d a , C aro l, M D
C hange address to:
3920 W T apps D r E
Sum ner, W A 98390
Phone:862-8001
Effective 12/1/99
C hange address to:
314 MLK Jr. W ay, #104
Tacoma, W A 98405
Pone: 272-5572
Physicians only: 272^4761
FAX: 272-5699
= fc
L u n (gj In form ation
S e r v ic e L in e
C hange address to:
515 S"M " St., #201
T acoma, W A 98405
Providing patient
education materials
S a n fo rd , E liza b eth , M D
C hange address to:
A S S O C IA T IO N ®
1 -8 0 0 -L U N G -U S A
M a th ew s, Paul, MD
H o r v a t h , K im b er ly , P A C
L U N G
ofWoshington
C hange address to:
3611S"D "St., #2
Tacoma, W A 98408
Phone:756-8570
FAX: 475-5531
A M E R IC A N
|
C hange address to:
6002 N W estgate Blvd. #230
Tacoma, WA 98406-2527
of commission?
rapidly— an d n o t for the better. H igh claim s have caused m an y m ajo r
carriers to lim it the m o st im p o rtan t benefits.
At P hysicians In su ran ce Agency, th ere’s still tim e to secure the specialtyspecific coverage you need. In addition, we can help you find superior life
an d lo n g-term -care coverage for you an d your family.
To discuss the ways you c a n best protect your fu tu re incom e, call
Physicians In su ran ce Agency today: (206) 343-7150 o r 1-800-962-1399-
PHYSICIANS
a INSURANCE
■ AGENCY
U
P
A wholly owned subsidiary
of Physicians Insurance
Sponsored by the Washington State Medical Association
16
PCMS BULLETIN
December, 1999
PPieytc b o u n ty Q 'i'led ica / (ffed -ety
COLLEGE
OF
MEDICAL
EDUCATION
Whistler CM E
reservations for
condos urged
College's popular CME at W histler/
Blackcomb program. The conference
is scheduled for February 2-6,2000.
Reservations for the College's
block of condos, again in the Aspens,
are available. Reservations can be
made by calling (800) 777-0185. You
must identify yourself as part of tine
College of Medical Education to
THE COLLEGE’S BLOCK OF
ROOMS WILL BE RELEASED
AFTER DECEMBER 1, 1999.
C ardiology C M E sc h e d u le d
for Ja n u a ry 21, 2 0 0 0
The College's fifth annual pro
gram featuring subjects on cardiology
for the primary care physician will be
held on Friday, January 21. The
course director is Gregg Ostergren,
DO.
The program will address the
following topics:
• Hypertension
’ Acute Coronary Syndromes
D a te s
Friday, December 3
Friday, January 21
Wednesday - Sunday
February 2-6
Got your Hawaii
air reservations?
The program brochure will be
available in early December. For
course information call the College at
627-7137.
P ro g ra m
D ir e c to r ^
Medicine & Mental
Health
Care
CME @ W histler
Advances in Women’s
Medicine
Thursday-Friday
Internal Medicine
March 9 & 10
Review 2000
M onday - Friday
To assure you are able to secure
seats and get a reasonable price for
CME atHawaii, we urge you to make
your reservations NOW. A small
refundable deposit will hold your seats.
The College is w orking with
Marilyn at Olympus Travel (565-1213).
Olympus has booked some seats at
special options at the best rates.
Call Marilyn today.
• Lipid Therapy
• Atril Fibrillation
• Congestive H eart Failure
• Stroke M anagement
• Managing the Diabetic with
Cardiovascular Concerns
April 10-14
Saturday, April 29
David Law, MD
Gregg Ostergren, DO
Richard Tobin, MD
Robert Corliss,MD
CME @ Hawaii
Mark Craddock, MD
Surgery Update 2000
Asthma, Allergy &
Friday, May 5
Friday, June 2
Pulmonology for
Primary Care
Alex Mihali, MD
Nuts, Bolts &
Innovation:
Gary Taubman, MD
Gastrointestinal
Richard Tobin, MD
Disease V
December, 1999
PCMS BULLETIN 17
B
V
u l l e t in
W hat do surgeons and mechanics have in common?
M orris w as rem oving som e engine valves from a car on the lift w h en he spotted the fam ous heart surgeon Dr. Michael
DeBakey, w ho w as standing off to the side, w aiting for the service manager.
M orris, som ew hat of a loud m outh, shouted across the garage, "Hey, DeBakey.. .is d at you? Com e over here a minute." The
fam ous surgeon, a bit surprised, w alked over to w here M om s w as w orking on the car.
M orris in a loud voice all could hear, said argum entatively, "So, Mr. fancy doctor, look at this w ork. I also take valves out,
grind 'em , p u t in new parts and w hen I finish this baby will p u rr like a kitten. So how com e you get the big bucks, w hen you and
m e are doing basically the sam e work?
DeBakey, very em barrassed, w alked aw ay and said softly to M orris.. ."Try doing your w ork w ith the engine running."
A
N E W
ERA
IN
MRI
T E C H N O L O G Y
VALLEY
DIAGNOSTIC
IMAGING
SERVICES
Olympic Building MRI
Offering your patients state-of-the-art 1.5 Tesla
imaging with high resolution short/large bore
*
magnetic resonance imaging.
Service
Highlights:
• Extended hours,
including Saturdays
• Priority scheduling
within 24 hours
• Comfortable, relaxed
atmosphere
• Highly qualified,
professional caring staff
For scheduling or
more information, call:
425.656.5550 Ph.
877.674.2674 Toll-free
18
PCM S BULLETIN
December, 1999
Olympic Building
400 South 43rd Street • Renton, WA 98055
(On Valley Medical Center Campus)
| Valley Radiologists Inc., P.S. ill association with Valley Medical Ctnler\
POSITIONS AVAILABLE
O FFIC E SPACE
Tacoma/Pierce C o un ty o u tp atien t
L ak ew ood medical space av ail
P en th ou se office in Jack son Hall
general medical care at its best. Full and
part-time positions available in Tacoma
and vicinity. Very flexible schedule.
Well suited for career redefinition for
G.P., F.P., I.M. Contact Andy Tsoi, MD
(253) 752-9669 or Paul Doty (Allen,
Nelson, Turner & Assoc.), Clinic
Manager (253) 383-4351,
able. Two suites 750 square feet each.
One suite 2900 square feet. Excellent
location and visibility. Close to many
schools and residential areas. 8509
Steilacoom Blvd. Call Dr. KenRing at
584-6200 or 582-5856.
will be available for lease November 1,
1999. Jackson Hall is conveniently
loca ted across the street from Tacoma
General Flospital and Mary Bridge
Children's Hospital. Suite 501 has 2466
sq. ft., with updated lease-hold
improvements. Large front office space
as well as very large exam rooms, two
of w hich are wheel-chair accessible,
m ake this suite special. The space is
ideal for 1-3 practitioners. There are
currently 4 exam rooms, and another
room can easily be converted. The lab
area is separate, and allows for clean
and dirt}' areas. Your staff will love the
lounge and the view of the water and
Olympics. For information call Dr.
Sandra Reilley at 383-1231.
PRACTICES AVAILABLE
N ew o ffice space available. Up
to 4500 sq. ft. Will finish to suit. On
Robin at 756-2182.
Tired of office/hospital m ed i
cine? Exclusive long-term care practice
for an Internist/General Practitioner
available immediately. Good income
potential-nopaperworkhassle. Call
472-2011.
GENERAL
Must sell surplus at reasonable price: 2
birthing beds (motorized), 2 exam
tables with storage space, and metal
tables for storage. Call Sieu or Teresa
253474-5715.
multi-specialty three story medical
building currently under construction
in Puyallup. Located within 3 blocks of
GoodSamaritanHospital with frontage
on Meridian. Last available suite is
2,075 square feet and is located on the
second floor of a three story building.
All tenants are medical offices.
Excellent parking and exceptional
tenant improvement allowance.
Completion in early 2000. For
inform ation, contact Lawrence J.
White, MD or Lorna Drees at (253)
848-3000.
dfiji Allenmore
Psychological
Associates, P. S.
-------------- . 752-7320 ,-------Do you have patients with difficult emotional
TACO M A/PIERCE CO UNTY
O u tp atien t G eneral M edical Caro.
F ull and p art-tim e positions
available in T acom a and vicinity.
Very flexible schedule. W ell suited
lo r career redefinition for
GP, FP, IM.
C ontact Andy Tsui, M D (253) 752-9669
or Paul D oty (Allen, N elson, T u rn e r &
Assoc:.), Clinic M anager (253) 383-4351
December, 1999
PCMS BULLETIN 19
B
u l l e t in
C oncerns Come First
Insurance was really looking out for my
interest and not ju st their own. ”
W h e t h e r it’s a c la im , a la w s u it, o r a ris k m a n a g e m e n t issue,
P h y s ic ia n s I n s u ra n c e k e e p s c u s to m e r c o n c e rn s a t th e fo refro n t.
C la im s re p r e s e n ta tiv e s w o r k c lo se ly w ith in s u r e d d e fe n d a n ts
a n d e x p e rie n c e d a tto rn e y s to s e c u re th e b e s t p o s s ib le o u tc o m e
fo r o u r p o lic y h o ld e rs . E q u a lly as d e d ic a te d , o u r r is k m a n a g e
m e n t r e p re s e n ta tiv e s c o n d u c t in te ra c tiv e s e m in a rs a n d re s p o n d
to q u e s tio n s in p e r s o n ,'b y p h o n e , a n d b y m a il. O u r g o al, n o w
a n d in th e f u tu re , is to h e lp p h y s ic ia n s , c lin ic s , a n d h o sp ita ls
re m a in su c c e ssfu l.
p w Physicians
a" Insurance
Crcisfed and :-p>>nv>red by ihc
\V,ishinyion Suuc Medial Association
223 Tacom a Avenue South
Tacoma, WA 98402
20
PCM S BULLETIN
December, 1999
1 - 8 0 0 - 9 6 2 -1 3 9 9
E a s te rn W a s h in g to n
1 -8 0 0 - 9 6 2 -1 3 9 8
O re e o n
1 -8 0 0 - 5 6 5 -1 8 9 2
A M u tu al C o m p an y
scaui*. wa ophvsicuins Insurance
PRESORTED
STANDARD
US POSTAGE PAID
TACOMA, WA
PERMIT NO 605

Pierce County Medical Society Bulletin 1999

Transcription

Similar documents

workshop - Westcoast Hot Yoga

High Technology

`Nothing naked,` but just enough

a folding CD cover, with complete notes and images.

ProArgi-9+ and the Physicians` Desk Reference

w ith Miss Muffin

Spend $25 • Save $500 Addison`s, Sophia`s, Bleu, Harpo`s, The

roup

Utilitarian Fiction

950 câu trắc nghiệm tiếng Anh