florida doctor - north virtual edition january 2011

january 2011

6 1 4 4 G a z e b o P a r k P l a c e S o u t h , S u i t e 1 0 2 , J a c k s o n v i l l e , F L 3 2 2 5 7 I 9 0 4 . 8 8 0 . 6 5 6 5 I j o s i e f i p m @ a t t . n e t

his year, on September 25, Jacksonville pain medicine

physician, Bernard Canlas, MD, Medical Director of the Florida Institute of Pain Medicine, honored National Pain Awareness Month by hosting a free seminar at the Memorial Hospital auditorium entitled, “Current Clinical Concepts in Pain.” The event, designed for physicians, pharmacists, physician assistants and nurses, qualified for eight hours of continuing medical education credits. Sponsors included Memorial Hospital, Orange Park Medical Center, Florida Medical Association, Philippine Medical Society of Northeast Florida, Department of Health Florida Board of Nursing and Pharmacy.

Over 200 guests registered to attend the seminar, which was also timed to acknowledge the end of the Decade of Pain Control and Research bill signed into effect in 2000 by then President Bill Clinton. The bill recognized the debilitating effects of chronic pain and was intended to raise awareness of the medical treatment of pain, foster research and education, decrease morbidity rates associated with untreated pain

and achieve better pain control through appropriate treatment.

Now, ten years later, much has been learned about chronic pain and pain management. The ability to better assess pain and where it originates has changed the treatment approach. “We have a much better understanding of the mechanisms of pain, not just symptom control,” says Dr. Canlas. Board-certified in anesthesiology and the subspecialty of pain medicine, Dr. Canlas uses an interdisciplinary, multimodal approach that includes targeting pain at various sites from the periphery to the brain. “When it comes to pain control, there’s no silver bullet,” he says. Medication, interventional procedures, rehabilitation (both physical and psychological) and surgery all play a role in rational pain management.

The daylong seminar emphasized the need to respect the uniqueness of each patient and the importance of a multidisciplinary approach to pain control. Pain Management experts provided updates on topics like headache management, (presented by neurologist, Dr. Erin Doty),

the importance of sleep and its effect on pain (discussion lead by Dr. Rahul Kakkar) and the expanding role of neuromodulation (Dr. Bernard Canlas was the presenter). New information was also presented on rendering appropriate pain management and upholding the dignity of patients with end-of-life pain (presented by Dr. Stephen Clark, CEO of Community Hospice), as well as integrative pain medicine (lectured by Dr. Marla Golden) and the diagnosis and management of neuropathic pain (lectured by Dr. Vic Maquera). The event was finalized in presentation on the topic of Chronic Pain Rehabilitation/Bringing it all together (by Virgil Whittmer, Ph.D., co-director of Brooks Comprehensive Pain Program). Another key focus of the event was a legislative update and review of a new Florida State law (2272) implemented in October of this year. The new law requires all pain clinics in Florida to be registered with the state. It also mandates clinics be physician owned and disallows advertising the use, sale or dispensing of narcotics. An ongoing challenge for reputable pain specialists has been the lack of regulation for pain clinics in Florida, and the abuse of narcotics due to inappropriate prescribing and dispensing. According to Dr. Canlas the need for opiates requires careful evaluation, documentation and proof that

T

other options have been exhausted. “Prescription pain medications are effective for the patients who need them, but if they make their way to the streets, society, and our own families are affected. When prescribing these medications, the responsibility is on the physician to make sure those receiving them are appropriate patients.” By continuing to work closely with physician colleagues and pharmacists, as well as law enforcement and other non-medical individuals in the community. This is the principal reason this event is being held free of charge. The goal is for Physicians and allied Health Professionals to update themselves with current knowledge on the science and laws governing the field of pain medicine. Dr. Canlas hopes to ensure those suffering from chronic pain receive adequate and professional care. And the stigma of being a patient in pain will be diminished.

4 f l o r i d a d o c t o r •••• j a n u a r y 2 0 1 1

e d i t o r ’ s n o t e

Florida Doctor is published 12 times per year by Beson4 Media Group. Reprints are available — 13500 Sutton Park Drive South, Suite 105, Jacksonville, FL 32224. Content of the contrib-uting advertisers does not reflect the opinions of the publishers. Advertisers have proofed respective articles, and content is assumed true and correct. Florida Doctor is not responsible for the care given by its advertisers. Florida Doctor is for informa-tional purposes only and is not meant as medical advice. ©2011 Florida Doctor. All rights reserved. The contents of this publica-tion, including articles, may not be reproduced in any form without written permission from the publisher.

For questions or comments or to receive reprints, call 904-992-9945 or fax 904-992-9907.

PublisherA.J. Beson

business develoPment directorMichael E. Hicks

editorVanessa E. Wells

Art directorChristine Tarantino

oPerAtions mAnAgerStacey Cotner

mArketing consultAnts

Stephanie Autry

Lori Robinson

mediA relAtions mAnAger

Michelle Jacobs

mediA relAtions sPeciAlist

Katie Whiteman

grAPhic designerSummer R. Morris

contributing Writers

Laura Capitano

Priscilla Goudreau-Santos

Virginia J. Pillsbury

PhotogrAPher

Keith Moody

Send story ideas to [email protected] or call 904-992-9945.

Vanessa E. [email protected]

I’ve been the editor of Beson4 Media Group for the past year and it’s been the best year of my life. I love my job and truly enjoy the incredible stories from doctors, patients and others in the commu-nity. I am incredibly lucky to go to work everyday and find inspiration waiting for me. That being said, things sometimes get hectic, we’re always up against deadline and sometimes it takes a little perspec-tive to realize how blessed we really are.

It seems there are less and less hours in the day and while the New Year is the perfect time to pause and reflect on the year that’s passed, sometimes it feels like there is hardly a moment to catch our breath.

That’s how I felt this past week as I was rushing off to a photo shoot. Everything was going according to plan and I was right on schedule. Traffic on the interstate, however, was not cooperating and I was frustrated and wondered what was holding everything up. Then I saw a woman in a broken down car in the middle lane. When you come upon something like that, time stops, frustration subsides and you realize appointments can wait.

I pulled my car in front of her vehicle and walked to her driver’s side door. She was on the phone with 911. I flagged down another car and we were able to stop traffic and get her vehicle to the side of the road. The entire process took less than 15 minutes; the woman was grateful (and safer), and as for my photo shoot…I was the first one to arrive. (Everyone else was tied up in traffic too).

This month instead of AJ’s letter from the publisher, we’ll have a guest letter from the editor. Stay tuned for AJ’s regular letter next month.

That experience got me thinking about how incredibly easy it is to help someone everyday. Whether it’s helping someone with a broken down vehicle, or buying someone a cup of coffee or stopping to ask an elderly or disabled person if they need some assistance, paying it for-ward is an easy investment to make.

This year, let’s take a minute to sweat the small stuff so others don’t have to. And helping them reminds us how small our own frustrations are when we gain a little perspec-tive and take a moment to focus on someone else.

Until next month…

Call us at: 904.619.1966

13500 Sutton Pk Dr South, Ste 105, Jacksonville, FL 32224www.brightlinktech.com

overview of services

Managed IT Services and 24/7 Lights-On Support• Infrastructure Security• ServerandDesktopSupport• SecureLocalandRemoteAccess• DisasterRecovery

Technology Administration and Management• HardwareandSoftwareManagement• NetworkandDataAccessProvisioning• SoftwareLicensingManagement• EnvironmentReportingandDocumentation

Strategic IT Planning• InformationFlowAnalysisandAutomation• ServerandApplicationVirtualization• CloudComputing

Doctors’officeshavethesameneedsashospitalsandarejustasconcernedabouttheapplicationoftechnologyaspartoftheiroverallbusinessplan.Technologyshouldalwaysbeviewedasatooltocreateandmodifysolutionstothechallengesofbusiness.Doctorsandmedicalstaffalikeshouldbeconcernedwithhowtousetheirskillstocreatenewandbetterwaystoservetheirpatients,notwithtroubleshootingtimeconsumingtechnologyissues.

HowdoesBrightLinkTechnologyprovidethis?Withacomprehensivelistofservicesthataredesignedtoproactivelypreventissuesbeforetheyariseand,asissuesinevitablydoarise,providequick,professionalandreliableresolutions24/7.


f l o r i d a d o c t o r n o r t h

Features I january 2011 Issue 81 ••••

doctor proFIle:

Easing Suffering & Trepidation 20

donald twiggs, M.d., who serves as associate medical director at community Hospice, also volunteers in Juarez, Mexico.

covEr profilE

dr. John r. Whittaker has practiced at McIver clinic since 1976.

Cover photo by Keith Moody

Plus:

What’s Happening 8

Fun & Games at the

doctor’s office 28

What’s Your New Year’s

resolution 35

Doctors Get The Message 32

assessing patient expectation when it comes to electronic communication.

Taking control of your Schedule 24

a well-run schedule equates to happy patients and a healthy practice.

f l o r i d a d o c t o r i c o n n e c t i o n s


Visit Florida Doctor – North on Facebook to learn more about local medical events in the Northeast Florida community. http://www.facebook.com/FLDoctorNorth

L to R: Angela Mason, CST; Craig Acosta, PA; Christie Griffin, CST; Erica Kirkland, RN, Mgr. of Heart Service; Hannah Denton, RN; John Doyle, M.D.; Nathan Bates, M.D., Cardiothoracic Surgeon; and Tim Hiler

Larry J. Freeman endowment For education wiLL Be estaBLished By the women’s Board oF woLFson chiLdren’s hospitaL

This past December, The Women’s Board of Wolfson Children’s Hospital established the Larry J. Freeman Endowment

for Education to enhance the care of chil-dren in the region. The endowment honors Larry J. Freeman, who retired in December after serving for 34 years as administrator of Wolfson Children’s Hospital.

The Larry J. Freeman Endowment for Education will be used to assist with the continuing education needs of Wolfson Children’s physicians, nurses and ancillary medical personnel, ensuring that the chil-dren and adolescents of Northeast Florida,

Southeast Georgia and beyond who are served by the hospital will continue to receive high-quality care well into the future.

“It seems very appropriate for us to establish an educational endowment in Larry Freeman’s name as he is a man who has done so much to further the quality of care for children in our region,” said Susan Smathers, president, The Women’s Board of Wolfson Children’s Hospital. “It is our hope and prayer that the endowment will reach our goal of $1 million, thus sustaining educational needs at Wolfson Children’s Hospital for generations to come.”

orange park medicaL center hosts riBBon cutting and names medicaL director For cardiovascuLar surgery

On December 7, 2010, Orange Park Medical Center hosted its “Open House for Open Heart.” The festive event, to recognize the hospital’s new Open Heart surgery program, was held next to the hospital’s new cardiovascular operating rooms and cardiac catheterization labs. There was a ribbon cutting and dedication of the new facilities followed by tours.

The hospital has named Nathan Bates, M.D., as Medical Director of Cardiovascular Surgery. Dr. Bates, a cardiothoracic surgeon, will lead OPMC’s new open heart surgery program. The Heart & Lung Center at OPMC performed its first open heart sur-gery case in December.

“I’m looking forward to bringing state-of-the-art cardiovascular and thoracic surgery to the Orange Park area,” Dr. Bates says.

“Right now, patients have to go outside of the area for these pro-cedures. We will offer all that along with a stellar array of ancil-lary services.”

In addition to performing coronary bypass graft surgery for those having a heart attack or those at risk, Dr. Bates will also perform thoracic and vascular surgeries.

st. vincent’s heaLthcare hires new vice president oF revenue cycLe

St. Vincent’s HealthCare has hired Sarath Degala as Vice President of Revenue Cycle. The position is part of a new orga-nizational leadership structure within the system’s finance division.

Degala will be responsible for managing, analyzing, reporting and ensuring proper reimbursement from third party payers for St. Vincent’s HealthCare.

Degala began his career as a Financial Analyst for Orlando Regional Medical Center. He has also worked for Emory Healthcare in Atlanta and with large for-profit systems like Kaiser Permanente and HealthSouth. His Catholic healthcare experience includes work with the Sisters of Saint Francis Health System based in Indiana. Degala’s most recent position was in Philadelphia where he

Larry J. Freeman

Sarath Degala

w w w . b e s o n 4 m e d i a . c o m •••• j a n u a r y 2 0 1 1 9

served as the Director of National Revenue Cycle Practice Leader for IMA Consulting.

“It is an exciting time for St. Vincent’s HealthCare. I am extremely honored and blessed to serve in this position. I will be an active participant in each of our hospital’s communities and intend to provide every facility with sound financial direction. My family and I look forward to getting to know the SVHC team and become active members of the local community,” said Degala.

Joseph mignone eLected as chair, department oF medicine at memoriaL hospitaL

Joseph Mignone, M.D., medical oncologist with 21st Century Oncology of Jacksonville was elected by his peers as the Chair, Department of Medicine at Memorial Hospital. His term began January 1, 2011.

kevin douLens, m.d., was one oF two u.s. surgeons seLected For traveLLing FeLLowship program

Kevin Doulens, M.D., with First Coast Orthopedics, was selected by the European Federation of Sport Traumatology (EFOST) as one of two U.S. orthopedic surgeons who participated in the organization’s 2010 DJO Team Physician Travelling Fellowship.

The travelling fellowship program creates the opportunity for two orthopedic surgeons to travel to Europe and learn first-hand about the role of team physicians and the medi-cal organization of sport clubs on the continent. As some popular sports are not similar in the U.S. and Europe, fellows benefit from sharing experiences with high level sport medical teams.

During the two-week fellowship, Dr. Doulens, who is also the medical director for the Jacksonville Bank Marathon, visited the medical departments of professional and amateur teams, attended practices and games, and attended and assisted in giving medical care to athletes.

The travelling fellowship program also included academic ses-sions with local physicians, which included clinical case studies and scientific lectures related to sport injuries presented by the fellows and their hosts. These sessions addressed topics such as team coverage, athletic care, rehabilitation and injury prevention.

Dr. Doulens visited Tel Aviv, Barcelona, Paris, London and Brussels during the fellowship.

whitney dunLap, m.d., Joins nemours chiLdren’s cLinic

Whitney Dunlap, M.D., has joined the Division of Pulmonology and Allergy at Nemours Children’s Clinic as an allergy attending physician.

“Dr. Dunlap will be a tremendous asset in delivering the highest level of specialized care for allergic and immune system condi-tions for children,” stated Michael Erhard, M.D., medical direc-tor, Nemours Children’s Clinic, Jacksonville. “Her knowledge and

background will positively impact the lives of children.”

Dr. Dunlap most recently completed a fellowship in allergy and immunology at the University of Michigan in Ann Arbor, MI. She is board certified in general pediat-rics. Dr. Dunlap earned her medical degree from the Eastern Virginia Medical School in Norfolk, VA.

ava parker named to Baptist medicaL center Board

Ava Parker, president of Linking Solutions, Inc. and a partner in the law firm of Lawrence & Parker, PA., has been named to Baptist Medical Center’s Board of Directors. Linking Solutions, Inc. (LSI) is a management consulting, administrative support and com-munity outreach/education firm that provides services throughout the Southeast in both the public and private sectors.

Prior to developing LSI and Lawrence & Parker, Parker worked as a lawyer for Edward Waters College, the Florida Department of Transportation and an aide at the Florida Public Service Commission.

Parker also serves as chair of the Board of Governors of the State University System and chair of the Jacksonville Transportation Authority. She is a member of the Adoption Council for Broadband for America, the Board of Directors of the Cathedral Foundation, and the Board of Directors of the AME Housing Agency. She is a member of the Jacksonville Civic Council, Perkins Bar Association, Jacksonville Chapter of the Links and Alpha Kappa Alpha Sorority. Parker also founded FISH Kids, a non-profit organization that encourages youth to develop a strong spiritual foundation, eat healthy and exercise.

“We look forward to Ms. Parker’s contributions as a board mem-ber of Baptist Medical Center,” says Baptist Health President and CEO Hugh Greene. “Her business acumen and community service will make her an invaluable resource to our tertiary care hospital.”

Frank martire, president and ceo oF Fis, named to Baptist heaLth Board oF directors

Baptist Health has named Frank Martire to its board of directors. Martire is president and CEO of FIS. Martire joined FIS in October 2009 with the company’s acquisition of Metavante Corporation.

Previously, Martire served as chairman of the board for Metavante Technologies, Inc. and as CEO for Metavante Corporation, the principal subsidiary of Metavante Technologies, Inc.

Prior to moving to Jacksonville in 2009, Martire held a variety of leadership roles in the community. He served as chair of the board of directors of Aurora Healthcare, a pre-eminent health system serving Wisconsin and Illinois. In addition, he served as a board member for several organizations, including the Children’s Hospital and Health

System Foundation, the Greater Milwaukee Committee and the Metropolitan Milwaukee Association of Commerce. He also par-

Joseph Mignone, M.D.

Kevin Doulens, M.D.

Whitney Dunlap, M.D.

Ava Parker

Frank Martire

1 0 f l o r i d a d o c t o r •••• j a n u a r y 2 0 1 1

ticipated on the Business Advisory Council of the University of Wisconsin-Milwaukee’s Sheldon B. Lubar School of Business. In 2007, Martire was named by Bank Technology News to its “Innovators’ Hall of Fame,” and was recognized as one of the magazine’s 2007 Innovators.

“We are honored and fortunate to have such an experienced and committed leader to guide the development of our health system,” says Baptist Health President and CEO Hugh Greene.

mayo cLinic achieves nationaL recognition For hospitaL perFormance in saFety and QuaLity

For the third time in 2010, Mayo Clinic in Jacksonville received national recognition for scores of excellence in safety and quality.

The Leapfrog Group named Mayo Clinic among its annual class of top hospitals – 65 from a field of almost 1,200. The selection is based on the results of the Leapfrog Group’s national survey that measures hospitals’ per-formance in crucial areas of patient safety and quality.

“Our core value and primary mission is to provide our patients with the highest quality medical care,” says Dr. William C. Rupp, chief executive officer of Mayo Clinic in Florida. “Quality takes into account the whole patient experience. At Mayo Clinic, our goal is to deliver evidence-based medicine in a safe environment with compas-sion, integrity and respect for our patients.”

st. vincent’s heaLthcare Foundation to host 30th anniversary red rose BaLL

The St. Vincent’s HealthCare Foundation will host its 30th Anniversary Red Rose Ball Friday, February 11, 2011 at the Jacksonville Marriott at Southpoint.

The glamorous gala features a gourmet dinner and this year special entertainment from Denny Leroux and His Orchestra. Following dinner, plan to dance the night away to the music of KTG.

Proceeds from the 2011 Red Rose Ball will benefit the pedi-atric emergency waiting area of St. Vincent’s new Clay County Hospital. Construction on the new hospital will begin next year. Architects from HKS are working with leaders from St. Vincent’s to ensure a warm, comforting, child-friendly space for pediatric visitors.

The St. Vincent’s Red Rose Ball is well known for its live and silent auctions. This year the live auction will feature a trip for four to Paris for one week including airfare and a two bedroom apartment ideally located between “Madeline” and the famous “Champs-Elysees.”

The Title Sponsor of the 2011 Red Rose Ball is Wachovia – A Wells Fargo Company. Presenting Sponsors are Bacardi and Premier Beverage.

2011 Red Rose Ball Chairs include Dr. and Mrs. Brett B. Cantrell; Mr. and Mrs. Lee S. Haramis; Mr. and Mrs. William R. Howell, II; and Honorary Chairs, Mr. and Mrs. Robert T. Shircliff.

initiative oF Baptist heaLth, the Baptist heaLth Foundation and the aetna Foundation is “enhancing heart heaLth For seniors”

Residents age 55 and older of some of Northeast Florida’s most vulnerable com-munities are receiving the gift of better health through “Enhancing Heart Health for Seniors,” a partnership of Baptist Health, Baptist Health Foundation, the Aetna Foundation and several area faith-based organizations.

The Aetna Foundation awarded a $25,000 grant to Baptist Health Foundation for car-diovascular health screenings and health information for more then 1,000 people ages 55 and older in an area of Jacksonville particularly hard-hit by heart disease.

“Baptist’s Community Health department conducted a health needs assessment in congregations of New Town [an economical-ly- and health-challenged area of Jacksonville’s urban core] in 2010 to see how we might assist them, and these assessments con-firmed the need for a heart health program,” said Lynn Sherman, director of Community Health for Baptist Health.

Lewis J. oBi, m.d. pLastic surgery cLinic weLcomes dr. John d. murray

On December 9, the Lewis J. Obi, M.D. Plastic Surgery Clinic formally welcomed John D. Murray, M.D., renowned plastic and reconstruction surgeon, who recently joined the Jacksonville practice. Dr. Murray made enormous strides in breast health research and education at the Susan Komen/University of Illinois College of Medicine in Peoria. He received his doctorate in med-icine at the Emory University School of Medicine where he also completed his postdoctoral training in general surgery, plastics and reconstructive surgery.

The welcome reception featured an informal meet-and-greet with Drs. Obi and Murray, formal address regarding the impact of

the new alliance on the Jacksonville community and tours of the plastic surgery clinic. Many mem-bers of Jacksonville’s medi-cal community were in attendance to welcome Dr. Murray and his family.

north FLorida FamiLy psychiatry ceLeBrates First anniversary

Jared Gaines, M.D., and Lindsay Israel, M.D., recently celebrat-ed the first year anniversary of opening the doors of North Florida Family Psychiatry. The Orange Park-based practice prides itself on the mission of providing quality, compassionate and consistent psychiatric care, for people of all ages in the community.

Dr. William C. Rupp

Lynn Sherman

Drs. Murray and Obi with the Lewis J. Obi, M.D. Plastic Surgery Clinic team.

w w w . b e s o n 4 m e d i a . c o m •••• j a n u a r y 2 0 1 1 1 1

“We are very happy to serve the Clay County area, “ said Dr. Israel.

Dr. Gaines, who is also the Medical Director of the Psychiatric Unit at the Orange Park Medical Center, says, “Our working relationship with Orange Park Medical Center has allowed for continuity of care for our patients, which is so important for successful treatment.”

Both physicians are graduates of the University of Florida, and both specialize in Child and Adolescent Psychiatry as well as Adult Psychiatry, treating all psychiatric disorders, including Autistic and Developmental Disorders in children.

Joi partners with soLes4souLs® For third annuaL event at the suLzBacher center

On November 20, Hiram A. Carrasquillo, M.D., and Jacksonville Orthopaedic physicians (JOI) and staff participated in the national Soles4Souls® Conti Project (a merged volunteer orga-nization formerly known as Our Hearts to Your Soles) national campaign by providing more than 130 men and women residents at The Sulzbacher Center with free foot screenings, socks and shoes.

Foot screenings were provided by JOI physicians and staff. New socks were provided by Dignity U Wear and shoes were provided by Red Wing Shoes. Representatives from Hanger’s Prosthetics, Boger’s Shoes and First Coast Orthotics & Prosthetics, fitted the new shoes on clients.

“It is a privilege and honor to participate in the Conti Project,” states Dr. Carrasquillo. “We have more than 70 volunteers com-

ing to work on this annual project, which we give our time and exper-tise as a labor of love to the men and women clients at Sulzbacher, as clean and healthy feet, a clean pair of socks and new shoes can provide dignity and hope to those in need.”

Brooks rehaBiLitation ceLeBrates spinaL cord inJury awareness week

Brooks Rehabilitation celebrated the fifth annual Spinal Cord Injury Awareness Week November 15 through 21 with a variety of events.

On November 16, they held an Adaptive Sports Demo & “Meet and Greet” providing a demonstration of the many adaptive sports available to those with a spinal cord injury or other dis-ability. On November 17, they held a presentation called Chronic Spinal Cord Injury: Personal and Professional Stories of Resilience hosted by Bernie Jorn, M.Div., M.Ed., BCC and H. S. Keels Jorn, M.D. In his late teens, Bernie Jorn, the chaplain at Brooks Rehabilitation Hospital, dove into a body of water that was too

Lindsay Israel, M.D, and Jared Gaines, M.D.

Hiram Carrasquillo, M.D., helping staff as screening begins

shallow leaving him with quadriplegia. He and his wife, Dr. Jorn shared their personal story. On November 18, they had an air-port outing where spinal cord injury patients learned safe travel-ing procedures and helpful tips. On November 19, they held the Think First Presentation at Chimney Lakes Elementary where fifth grade students learned about brain and spinal cord injury preven-tion. Former SCI Patient and Current Peer Mentor, Tim Connor, attended the event.

movemBer shaving party heLd to commemorate men’s heaLth

On December 1, local sportscaster, Sam Kouvaris, hosted a Movember Shaving Party. Men around the First Coast donned mustaches during the month of November to raise money and awareness about men’s health, particularly prostrate cancer. Kouvaris hosted a shaving party at Bold City Grill to celebrate Movember’s success.

Barber Studio, Bold City Grill and the Sheraton Jax helped with the event and 21st Century Oncology of Jacksonville and HealthSource Magazine were sponsors. Proceeds were donated to the Lance Armstrong Foundation.

proton therapy may reduce risk oF treat-ment compLications For pancreatic cancer patients

One of the challenges in treating pancreatic cancer effectively with radiation therapy is the potential of harming surrounding healthy organs such as the small intestine, stomach and kidneys. Researchers at the University of Florida Proton Therapy Institute have early evidence that proton therapy may significantly reduce this risk.

As recently reported at the 52nd Annual Meeting of the American Society for Radiation Oncology, a study from UF in conjunction with investigators from the University of Maryland compared treatment plans for a type of x-ray radiation called intensity modulated radio-therapy, or IMRT, with proton therapy plans for a series of pancreas cancer patients using established radiation guidelines. The study demonstrated that proton treatment plans reduced normal tissue radiation exposure. The most significant reductions were seen for the small intestine, right kidney and stomach.

“The advantage of proton therapy is clear,” said R. Charles Nichols, M.D., an assistant professor of radiation oncology and radi-ation oncologist at the UF Proton Therapy Institute. “Our best IMRT treatments for pancreatic cancer can be improved upon by proton therapy. With protons we can both deliver the optimal dose to the targeted treatment area and reduce the risk of treatment complica-tions without compromising the chance for cure.”

Paul Kerns, Emmitt Grandy, AJ Beson, Mike Hicks; Stacey Cotner, Sam Kouvaris and Stephanie Autry

Frederic Porcase, D.O. Family Practice

James Fetchero, D.O. Family Practice

Rebecca Renault, A.R.N.P. Family Practice

Carly Strickland, A.R.N.P.

William Bosworth, D.O. Family Practice

Benjamin Goh, D.O. Family Practice

Kent Braeutigam, D.O. Family Practice

Mary Jo Sutherland, P.A. Family Practice

Robert Dajac, M.D. Family Practice

Gene Harris, D.O. Family Practice

Casey Meaker, A.R.N.P.

Mary Ray, D.O. Family Practice

M. Hassan Aboushaar, M.D. Pediatrician

T. Michael Hardin, D.O. Pediatrician

Jaime Revollo, M.D. Family Practice

Francis DeCandis, M.D. Family Practice

Edward Secunda, D.O. Family Practice

Jorge Caballero, D.O. Family Practice

Anthony Hamaty, M.D. Pediatrician

Barbara Trunzo, A.R.N.P. Pediatrics

Brittney Schmidt, A.R.N.P.

Douglas Pennington, D.O. Family Practice

Georgia Doyle, D.O. Family Practice

Darlene VonTobel, A.R.N.P. Pediatrics

Gloriosa Antiporda, M.D. Internal Medicine

Marc Berger, M.D. Pediatrician

Tia Sea, A.R.N.P.

John A Fetchero, D.O. Otolaryngology

Michelle Mendez, D.O. Family Practice

Zenaida Lavina, M.D. Pediatrician

Nicole Avens, A.R.N.P.

Laura Triola, A.R.N.P.

Maria Mora, M.D. Pediatrician

Ayumi Cardoza, P.A. Pediatrics

Celeste Soberano, M.D. Internal Medicine

Michael Soberano, M.D. Pediatrician

Joseph Stillword, M.D. General Surgeon

Samuel Walters, D.O. Family Practice

Chitra Kuthiala M.D. Allergist

Steven Simmons, A.R.N.P.

Tina Voisin, A.R.N.P.

Anthony J. Pacitti, M.D.

Ashley Southwick, A.R.N.P.

Family Medical Center/Argyle7855 Argyle Forest Blvd. Ste. 601

Jacksonville, FL 32244778-3389

Family Medical Center/Mandarin9765 San Jose Blvd. Suite 4


Family Medical Center/Middleburg3839 Country Road 218Middleburg, FL 32068

282-5474

Family Medical Center/Norwood5445 Norwood Ave.


Family Medical Center/Orange Park1409 Kingsley Ave. Suite 6A

Orange Park, FL 32073264-7517

Family Medical Center/Pediatrics1555 Kingsley Ave. Suite 601


Family Medical Center/Riverside2726 St. Johns Ave. Suite 101


Family Medical Center/San Pablo14011 Beach Blvd. Suite 120


Family Medical Center/San Pablo Pediatrics

14011 Beach Blvd. Suite 120Jacksonville, FL 32250

223-6400

Family Medical Center/Southside1906 Southside Blvd.Jacksonville, FL 32216

724-3083

Normandy Medical Center8225 Normandy Blvd.Jacksonville, FL 32221

378-8520

Riverview Medical Center2040 Riverview StreetJacksonville, FL 32206

713-8074

Marc S Berger7855 Argyle Forest Blvd. Ste. 302


John A Fetchero1542 Kingsley Ave. Ste. 140


Mendez Family Care14444 Beach Blvd. Ste. 315


Middleburg Pediatrics3839 County Road 218 Ste. C

Middleburg, FL 32068861-1034

Normandy Pediatrics10250 Normandy Blvd. Ste. 201


Celeste Soberano8833 Perimeter Park, Ste. 401


Michael Soberano1301 Plantation Island Dr. Suite 608

St. Augustine, FL 32080824-5437

Michael Soberano493 Prosperity Lake,

Suite 201 & 202St. Augustine, FL 32092

461-8906

Joseph Stillword800 Zeagler Drive, Ste. 320

Palatka, FL 32217386-328-9977

Samuel Walters6531 103rd Street


Chitra Kuthiala9765 San Jose Blvd.


Coastal Surgical Associates205 Zeagler Dr., Ste 203

Palatka, FL 32177386-312-8519

There’s strength in numbers. With 50 providers and 25 locations, you can bet that Family Medical Centers & Affiliated Physicians is going the distance with our patients and their families. If you’re interested in joining our ever-growing group of professionals please contact Jeff Burkhart at 904.699.0218 or email him at [email protected].

Physician Opportunities:

904.699.0218Sponsored by PCP Financial.

Participation with all hospitals.1 2 f l o r i d a d o c t o r •••• j a n u a r y 2 0 1 1

f l o r i d a d o c t o r i e v e n t s

1) Jim Burkhart, Jay Millson, John Compton; 2) (L to R) Dr. Pat Foster, Dr. Malcolm Foster, Mrs. Elaine Kilkenny and Dr. John Kilkenny; 3) Attendees at the event; 4) Robert Harmon, M.D.; 5) Harriet and John Lovejoy, M.D.; 6) Kevin Donovan, M.D., and Shar Donovan; 7) Brad Hollett and AJ Beson

duvaL county medicaL society (dcms) meeting

Duval County Medical Society (DCMS) held its 158th Annual Meeting, December 1, 2010 at the Hyatt Regency Jacksonville-Riverfront.

Malcolm T. Foster, Jr., M.D., an internal medicine physi-cian specializing in infectious diseases and rheumatology, was inaugurated as the 124th DCMS President. Dr. Foster is the Karl B. Hanson Professor of Medicine at the University of Florida/Jacksonville Department of Medicine and Professor, Division of

General Internal Medicine at the University Health Science Center, Jacksonville. He is especially committed to the DCMS and has been an active member for nearly 33 years, on the DCMS Board of Directors since 2007 and served as treasurer in 2008 and 2009 and President-Elect in 2010.

Dr. Foster believes organized medicine “is more important now than ever. Medicine must speak with one clear voice, and I feel a

responsibility to help make sure that voice is heard. It is especially important that DCMS speak up for Duval County physicians.” His goal as DCMS president is to make sure the Society is a “voice for medicine to the public and is a way for patients to know their doctors better.”

Annual elections and presentation of awards also took place during the meeting. Ashley Booth Norse, M.D., was elected as DCMS President-Elect. Rui Fernandes, M.D., received the 2010 Philip H. Gilbert Young Physician Leadership Award. John Lovejoy, Jr., M.D., received the 2010 Clyde M. Collins Humanitarian Award for giving of his time, resources and exper-tise to deliver free orthopedic care to Haitian patients, most recently earthquake victims. Jeff Goldhagen, M.D., MPH, received the 2010 DCMS Community Service Award.

Malcolm T. Foster, Jr., M.D.

1.

2.

3.

4. 5.

6.

7.

Frederic Porcase, D.O. Family Practice

James Fetchero, D.O. Family Practice

Rebecca Renault, A.R.N.P. Family Practice

Carly Strickland, A.R.N.P.

William Bosworth, D.O. Family Practice

Benjamin Goh, D.O. Family Practice

Kent Braeutigam, D.O. Family Practice

Mary Jo Sutherland, P.A. Family Practice

Robert Dajac, M.D. Family Practice

Gene Harris, D.O. Family Practice

Casey Meaker, A.R.N.P.

Mary Ray, D.O. Family Practice

M. Hassan Aboushaar, M.D. Pediatrician

T. Michael Hardin, D.O. Pediatrician

Jaime Revollo, M.D. Family Practice

Francis DeCandis, M.D. Family Practice

Edward Secunda, D.O. Family Practice

Jorge Caballero, D.O. Family Practice

Anthony Hamaty, M.D. Pediatrician

Barbara Trunzo, A.R.N.P. Pediatrics

Brittney Schmidt, A.R.N.P.

Douglas Pennington, D.O. Family Practice

Georgia Doyle, D.O. Family Practice

Darlene VonTobel, A.R.N.P. Pediatrics

Gloriosa Antiporda, M.D. Internal Medicine

Marc Berger, M.D. Pediatrician

Tia Sea, A.R.N.P.

John A Fetchero, D.O. Otolaryngology

Michelle Mendez, D.O. Family Practice

Zenaida Lavina, M.D. Pediatrician

Nicole Avens, A.R.N.P.

Laura Triola, A.R.N.P.

Maria Mora, M.D. Pediatrician

Ayumi Cardoza, P.A. Pediatrics

Celeste Soberano, M.D. Internal Medicine

Michael Soberano, M.D. Pediatrician

Joseph Stillword, M.D. General Surgeon

Samuel Walters, D.O. Family Practice

Chitra Kuthiala M.D. Allergist

Steven Simmons, A.R.N.P.

Tina Voisin, A.R.N.P.

Anthony J. Pacitti, M.D.

Ashley Southwick, A.R.N.P.

Family Medical Center/Argyle7855 Argyle Forest Blvd. Ste. 601


Family Medical Center/Mandarin9765 San Jose Blvd. Suite 4


Family Medical Center/Middleburg3839 Country Road 218Middleburg, FL 32068

282-5474

Family Medical Center/Norwood5445 Norwood Ave.


Family Medical Center/Orange Park1409 Kingsley Ave. Suite 6A


Family Medical Center/Pediatrics1555 Kingsley Ave. Suite 601


Family Medical Center/Riverside2726 St. Johns Ave. Suite 101


Family Medical Center/San Pablo14011 Beach Blvd. Suite 120


Family Medical Center/San Pablo Pediatrics

14011 Beach Blvd. Suite 120Jacksonville, FL 32250

223-6400

Family Medical Center/Southside1906 Southside Blvd.Jacksonville, FL 32216

724-3083

Normandy Medical Center8225 Normandy Blvd.Jacksonville, FL 32221

378-8520

Riverview Medical Center2040 Riverview StreetJacksonville, FL 32206

713-8074

Marc S Berger7855 Argyle Forest Blvd. Ste. 302


John A Fetchero1542 Kingsley Ave. Ste. 140


Mendez Family Care14444 Beach Blvd. Ste. 315


Middleburg Pediatrics3839 County Road 218 Ste. C

Middleburg, FL 32068861-1034

Normandy Pediatrics10250 Normandy Blvd. Ste. 201


Celeste Soberano8833 Perimeter Park, Ste. 401


Michael Soberano1301 Plantation Island Dr. Suite 608

St. Augustine, FL 32080824-5437

Michael Soberano493 Prosperity Lake,

Suite 201 & 202St. Augustine, FL 32092

461-8906

Joseph Stillword800 Zeagler Drive, Ste. 320

Palatka, FL 32217386-328-9977

Samuel Walters6531 103rd Street


Chitra Kuthiala9765 San Jose Blvd.


Coastal Surgical Associates205 Zeagler Dr., Ste 203

Palatka, FL 32177386-312-8519

There’s strength in numbers. With 50 providers and 25 locations, you can bet that Family Medical Centers & Affiliated Physicians is going the distance with our patients and their families. If you’re interested in joining our ever-growing group of professionals please contact Jeff Burkhart at 904.699.0218 or email him at [email protected].

Physician Opportunities:

904.699.0218Sponsored by PCP Financial.

Participation with all hospitals.


f l o r i d a d o c t o r i e v e n t s

1) Attendees at the event; 2) Attendees with panel-ist, Richard Brock; 3) Panelist, Richard Brock; Moderator, Jay Millson and panelists Dan Dieterle, Delena Howard, CPC, CPC-H; AJ Beson and Douglas Malie; 4) Britt Stephens, Ansley Butsch, Jeremy Miller and Dan Dieterle; 5) Cynthia Anderson, M.D., Vanessa Wells, Linda Sylvester, M.D.

2.

1.

3.

4. 5.

new decades, new strategies eventOn November 11, Beson4 Media Group, LBA, Harden and

Point of Care Solutions hosted a panel discussion at Ruth’s Chris. Topics included Tax Planning Strategies, Asset Protection, Practice Management, Physician Credentialing, Chart Audits and EHR and Marketing Strategies. Panelists included A.J. Beson, President and CEO, Beson4 Media Group; Richard Brock, Chairman of the Board, LBA Certified Public Accountants; Delena Howard, CPC, CPC-H, Director of LBA Healthcare Consulting Services, LLC; Douglas Malie, MBA, Majority Shareholder, Point of Care Solutions, LLC; and Daniel P. Dieterle, Senior Vice President, Healthcare Practice Unit, Harden. Jay W. Millson, Executive Vice President, Duval County Medical Society, moderated the discus-sion. More than 50 doctors were in attendance.

ot only does McIver’s historic presence and heritage reflect its roots in the Jacksonville community, it

continues to be favored by the men and women it has so dutifully served by providing excellence in medical services as well as a continued commitment to provide state-of-the-art urologic services in the future. As a cutting-edge group of dedicated urologic specialists embrace McIver’s past, their collective focus is to provide the latest treatment options for each patient.

McIver offers 12 board-certified medical doctors who believe in the Clinic’s mission of providing current and innovative urologic techniques in a sensitive and compassionate environment.

The continuity of care within McIver’s long-standing history provides a foundation that has paralleled the growth in the field of urology, especially in this time of an aging population. Its strong past provides the segue to a powerful future, as McIver Clinic leads the way in urologic care in the Northeast Florida and Southeast Georgia regions.

The clinic was opened in 1921, by Dr. Robert McIver, a visionary and early leader in the South in the development of urology as a major surgical subspecialty. In the early history of the Clinic, Dr.

McIver helped to found and define the Florida Urologic Society and demonstrate proper urologic techniques for his colleagues and aspiring urologic surgeons at St. Vincent’s Hospital.

That dedication to expertise, education and technique has carried through over these nine decades as the McIver physicians follow in the footsteps of Dr. McIver’s pioneering spirit. For example, in recent years, McIver physicians were the first in the area to offer innovative, minimally

invasive surgeries, such as laser and robotic prostatectomy, laparascopic and robotic renal surgery, and many other procedures. Attention to a patient’s specific needs remains an essential component of the clinic’s caregiving, a hallmark of their delivery of premier medical and surgical care.

Board certification by the American Board of Urology is a minimal requirement for a McIver physician, many have fellowships. Each physician has been specially recruited to join the McIver team. Because the field of urology and urologic surgery


f l o r i d a d o c t o r i c o v e r p r o f i l e

McIver TodayBy Virginia J. Pillsbury

In 2011, McIver Urological Clinic – now McIver Clinic – celebrates 90 years of providing excellence in

urological care to generations of families in this region – a great time to reflect on its impressive past

as Jacksonville’s urological pioneer, celebrate its current success, and look into its bright future as the

preeminent leader in the field of Urology.

Attention to a patient’s specific needs remains an essential

component of the clinic’s caregiving, a hallmark of their

delivery of premier medical and surgical care.

has evolved into so many subspecialties, McIver recruits physicians with the most highly specialized training, expertise and experience possible in order to treat all aspects of men and women’s health, including specific prostate and continence issues, as well as cancers.

One key concept of the McIver philosophy is to ensure legacy of staff by varying the ages, thus building a solid foundation of experience and new knowledge. The Clinic’s respected heritage and reputation of current and leading-edge practice remains a strong reason for referring physicians to entrust their patients to McIver doctors.

McIver offers three convenient locations, each providing multiple levels of integrated services:

The main Riverside office is the 18,000 square foot ‘hub’ of the practice. Riverside provides on-site diagnostic and therapeutic urology, advanced radiological services, including PET, CT, MRI and sonography. It also houses a complete pelvic floor and continence center, including Northeast Florida area’s only videourodynamic suite, and a rapid diagnostic laboratory.

The site also houses the McIver pathology lab, which

N

Innovators in urological Care since 1921

John R. Whittaker, M.D.


through a unique partnership with Bostwick laboratories, provides the highest level of urologic pathology expertise. Finally, the site is home to the brand new Siemans Artiste linear accelerator (one of only three in the country) providing on-site IMRT/ IGRT for the treatment of prostate cancer.

The San Marco location provides diagnostic and therapeutic urology on a daily basis.

McIver’s Mandarin office provides state-of-the-art diagnosis, treatment, and management of urologic disorders, complete with a continuum of care.

While McIver boasts the latest in innovative care and treatment, it also provides some old fashioned, and very appreciated, courtesies for patients. When a patient calls the Clinic, there’s no “automatic response system” – rather, McIver staff answers each call and extends a personal touch. One appointment line serves all three locations, and McIver maintains a policy of direct transfer to physician for doctor-to-doctor phone calls.

The relationship with primary care physicians is vital to each McIver physician, as well. Primary care physicians also know the importance of early detection of urologic problems, and know early referral to a specialist is critical – and may save a life. McIver physicians can be trusted to quickly respond to referrals because time matters when urological care is required in order to maintain the highest quality of life possible for each patient.

In 2008, McIver Clinic became part of ICON (Integrated Community


Oncology Network), which includes FROG (Florida Radiation Oncology Group) and FOA (Florida Oncology Associates). This multidisciplinary partnership further bolsters McIver Clinic’s role as the leader in urologic cancer merging advanced surgical techniques such as laparascopic and robotic kidney, prostate and bladder surgery with radiation and chemotherapy, as needed.

McIver provides the highest level of service to diagnose and treat male and female health issues. The door is always open for the discussion of erectile dysfunction, infertility, abnormal bleeding, genital pain, kidney stones, infections, and, as mentioned above, any cancer of the urinary tract. In addition, the Clinic has two specialty centers – the Jacksonville Prostate Center and the Jacksonville Continence Center.

The Jacksonville Prostate Center is dedicated to the management of benign (BPH) and malignant prostate disease. All men eventually develop BPH, and many suffer in silence. Utilizing both non-surgical and minimally invasive surgical techniques, BPH is a disease that can effectively be treated. One in six men will develop prostate cancer and once diagnosed, treatment options must be individualized, explains Dr. John R. Whittaker, a McIver urologist since 1976, and currently president of the group practice. Dr. Whittaker says, “We look at the grade, stage, patient age, and personal limitations that the patient perceives for his lifestyle and his quality of life. Each option is discussed in detail in a special ‘non-timed’

appointment with the patient and family members.

“Prostate cancer treatment is THE signature service of McIver Clinic,” states Dr. Whittaker. Since prostate cancer treatment has the potential to affect so many functions, expert treatment is a must. Robotic prostatectomy via the da Vinci robot provides for excellent cancer control while, in the right hands, minimizing the chance for urinary and sexual dysfunction. Dr. Apoorva Vashi has been performing robotic prostate removal since 2005, and is a leader in the field. He has served as a training site and proctor for Intuitive Surgical since 2007. In 2010, he was selected as one of only five US surgeons to lead an effort to bring robotic surgery to Southeast Asia.

Prostate seed implant or seed implant combined with IMRT radiation is another common treatment modality. McIver has one of the country’s five largest seed implant programs. The on-site IMRT linear accelerator is one of the finest in the U.S. Dr. Douglas Swartz presented the Clinic’s data at several national meetings in 2010. Prostate cryosurgery is headed by Dr. Richard Lewis and Dr. Paul Crum. Finally, watchful waiting strategies are discussed with the patient in detail.

The Jacksonville Continence Center is another center of excellence at McIver

Clinic. This Center provides comprehensive management of male and female voiding dysfunction and female urogynecology services. Dr. Sagar Shah and Dr. Charles Cobb head the Continence Center and oversee the extensive urodynamic laboratory, including the new videourodynamic suite. Dr. Whittaker states, “The Center offers full diagnostic and therapeutic options for non-operative management, as well as minimally invasive and standard surgical correction.” Among the innovative procedures offered are botulism injections, interstim therapy, robotic repair of pelvic prolapse, minimally invasive vaginal surgeries, and pelvic floor training. Since the surgeons are well versed in multiple operations, patient age, lifestyle and sexual and urinary function are taken into account when surgical correction is warranted.

McIver Clinic physicians practice at St. Vincent’s HealthCare (St. Vincent’s and St. Luke’s) and Baptist Health (Downtown and Baptist South), and several currently serve as chief of their specialty group at each of these hospitals. They work closely with primary care, family practitioners, internists, and all subspecialty groups.

McIver Clinic – 90 years of service. Congratulations!

Jacksonville Prostate center at Mciver clinicExcellence in Medical and Surgical treatment of benign and malignant prostate disease

signature services include:• Office-based Microwave therapy for BPH• Green Light Laser Vaporization of the Prostate for BPH• Robotic Prostatectomy for treatment of Prostate Cancer• Brachytherapy for Prostate Cancer• On-site IMRT for convenient radiation treatment of Prostate Cancer

Jacksonville continence center at Mciver clinicExcellence in Medical and Surgical treatment of female and male voiding disorders

signature services include:• Individualized treatments based on patient specific symptoms• Advanced diagnosis with video- urodynamics• Advanced treatment options for overactive bladder refractory to medications• Minimally invasive anti-incontinence procedures• Pelvic organ prolapse repair

MiniMally invasive surgery for all urologic Disease

advanced surgical options include:• Robotic Prostatectomy for Prostate Cancer• Brachytherapy for Prostate Cancer• Robotic Cystectomy for Bladder Cancer• Robotic Renal Surgery for benign and malignant Kidney disorders• Advanced Laparoscopic Renal Surgery for Kidney Cancer• Laparoscopic and Robotic Surgery for Incontinence• Minimally Invasive Stone Treatment

“The Clinic offers full diagnostic and therapeutic options for non-operative management as well as minimally invasive and standard surgical correction.”

— John R. Whittaker, M.D.


Dr. Twiggs began traveling to Juarez with his church, Memorial United

Methodist Church, which is located in Fernandina Beach.

Photo credit: Photos of Dr. Twiggs were taken at the Jacksonville Zoo and Gardens.


f l o r i d a d o c t o r i d o c t o r p r o f i l e

By Virginia J. Pillsbury

ecause of the high crime and escalating homicide rates and particularly a high incidence of violence

against women, Juarez has been called a lawless city. Violence affects every part of the area from tourist trade, to toll booth traf-fic from El Paso and all forms of local commerce.

Contrast that scenario with the tranquil, traditional, quaint com-munities of Callahan and Fernandina Beach, FL, and you might wonder why Donald Twiggs, M.D., feels called to leave his safe neighborhoods – where he provides great care and service – and venture into such dangerous territory.

It’s simply because Dr. Twiggs is invested in people. He has a heart for patients – and that spreads from his

Fernandina Beach-based family practice, where he served for 25 years, to Community Hospice of Northeast Florida, where he cur-rently serves as an associate medical director, to Juarez, where he travels on medical mission trips.

His desire is simply to interact with families and help make a contribution to their well-being.

ThE roaD To juarEz When Dr. Twiggs’ church, Memorial United Methodist Church

in Fernandina Beach, started going to Juarez on mission trips, they built homes and provided Bible school. “My wife went with them a couple of times before I went,” says Dr. Twiggs, who then became interested in the medical care in Juarez.

“There is a small medical clinic in Tierra Nueva, a suburb of Juarez,” Dr. Twiggs, age 66, explains. “I talked with a minister who is also a nurse and who runs the clinic. He was the only

Juarez, Mexico is entrenched in drug war-related violence that comes with devastating results

for the community itself. Turf wars between the rival Juarez and Sinaloa cartels are one reason

for escalating brutal violence, and Norte de Ciudad newspaper has called Juarez “the most vio-

lent zone in the world outside of a declared war zone.”

one there and the need for medical care is great.” So Dr. Twiggs knew he needed to go there. He has been there four times now and spends a week each time.

He takes a nurse prac-titioner and a Community Hospice psychosocial special-ist, Kelly Racine. “Kelly has gone on almost every trip I’ve made to Juarez. She speaks Spanish and interprets and teaches me Spanish,” he says.

The living conditions for his Juarez patients are primi-tive. “They are very, very poor and many live in card-board homes,” Dr. Twiggs describes. To keep the clinic running, patients are charged three dollars per visit. “When we come to care for them, it is free,” he says. “The people I see are much like those I would see in my family practice – babies, children and a combination of people.

It keeps me up on the fam-ily practice that I miss with hospice care,” he adds. While there, these medical mission-aries stay in a compound that is also quite primitive.

hElpinG a coMMuniTy STanD on iTS own

In one day at the Tierra Nueva clinic, Dr. Twiggs has seen as many as 125 patients between 8 a.m. and 8 p.m.

B


“The people are so apprecia-tive because they want to see the American doctor,” he says. “The children are very respectful and have beautiful brown eyes. The babies might cry, but the children never do. They just do what you ask them to do. Their culture is like that,” he says.

And he sees everything from diabetes to cancer to pregnancy. “You never know what you are going to see with the patients,” he says.

“You practice medicine a little differently here because there aren’t pharmacies and the people can’t afford the meds anyway.” Supplies are limited, the pharmacy that they do have is small and most medi-cations are donated.

“Each year I see some patients who return and fol-low up, but many don’t. One of the biggest disappoint-ments is that there is little continuity of care,” he says. With diabetes, for example, Dr. Twiggs says that most diabetics don’t take care of themselves. “In general, they just don’t check their blood sugar,” he explains. “There is a national health system, but most of the people don’t have the transportation to get there. Government hospitals are available for those who can afford to go to them.”

But the good news is that Dr. Twiggs has seen the small clinic grow. “They now have a Mexican physician and a den-

tist, and they may be getting an OB/GYN,” he says. “My dream is to someday organize a team of American physi-cians who rotate for a week each month so they would have a continuity of care.”

That dream is now on hold due to the current violent crime situation in Juarez. “The situation is pretty des-perate, and it’s not the fault of the people there; they have no control. But this year we had to cancel our trip – even

the people in Juarez agreed it was best that we not come,” says Dr. Twiggs. “We still support them financially as best we can, and with the doctor and dentist at the clin-ic, it is still functioning.”

Local Jacksonville churches also have set up a scholarship fund for students in Juarez. “Public schools there are not free. They need books, uni-forms and other supplies, and my wife interviews students for the school scholarships,” he says.

While he is not sure if the church mission trips to Juarez will ever include taking youth group members again, Dr. Twiggs hopes that he and his wife will be able to return. “Hopefully I can convince Kelly to go on another trip, too,” he says.

“We have developed a close relationship with Juarez,” he says. “That is potentially both good and bad. We want to enable them

and not be enablers – that’s what this is all about. We don’t want them to rely on us but to move on and do their own thing with their clinic and patients,” he says.

proviDinG EnD-of-lifE carE

Dr. Twiggs, currently an associate medical director for Community Hospice of Northeast Florida, was prac-ticing as a family practice physician in Fernandina

Beach when he started work-ing part time for Community Hospice. “I found that I had more and more interest in end-of-life care,” says Dr. Twiggs, who eventu-ally crossed over to fulltime

at Community Hospice. His Fernandina Beach practice has stayed in the family, however; his daughter-in-law is now the physician there.

With Community Hospice of Northeast Florida, Dr. Twiggs does home care and nursing home care. “I have found that spending time in homes is like the practice that I used to have many years ago, when people real-ly liked having you there and were very appreciative of what could be done for their loved ones,” he says. “There is a lot of fulfillment in that.”

Community Hospice of Northeast Florida has several fulltime medical directors, such as Dr. Twiggs, who work alongside interdisciplin-ary teams. Dr. Twiggs works with two home care teams and a nursing home team, and coordinates the care for patients living in Nassau County, North Jacksonville and Arlington.

“I like to meet people and interact with the families to provide a service that the families really need,” says Dr. Twiggs, who also appreci-ates the fact that he has the leeway to spend as much or as little time as a family or patient needs. He recently helped care for a young fam-ily; the husband and wife had only been married a short time, and the wife was dying. “I was able to give comfort and be there for the husband when he needed it,” says Dr. Twiggs. “This is one of the few places when at work you can give family members a hug,” adds the doctor for whom the comfort of such physical touch is very impor-tant. “Sometimes the most important thing I can do is just hold a hand.”

Community Hospice of Northeast Florida’s mission is “to improve the quality of life for patients and families and be the compassionate guide for end-of-life care in our community.” Currently Community Hospice cares for about 1,100 patients daily, and they serve patients with any illness – including end-stage dementia, conges-tive heart failure, end-stage Parkinson’s disease, chronic obstructive pulmonary dis-ease, ALS, cancer and AIDS. Care is available in a variety of settings as well, including patients’ homes, long term care and assisted living facili-ties, hospitals and in five inpatient centers.

Patients with symptoms of advanced illness or with a life prognosis of one year or less are eligible for hospice care from Community Hospice. To receive that care, the patient needs to obtain physician consent, have an available caregiver and reside in Baker, Clay, Duval, Nassau or St. Johns County.

“It is an honor to be with families during the end stage of life. Providing comfort, relief and quality time for patients is very gratifying. I get as much out of this as the families do. I

am very blessed.”

— Donald Twiggs, M.D.


“It is an honor to be with families during the end stage of life,” he says. “Providing comfort, relief and quality time for patients is very grati-fying. I get as much out of this as the families do. I am very blessed.”

While he doesn’t expect it, he always finds it rewarding to hear from a family after a loved one’s death. “I don’t see the families much after a death, so it is always nice to hear that the family was helped by our care,” he says.

“I enjoy it so much that it’s not really work for me,” he says of Community Hospice. “The interaction between the nurses, social workers and physicians is like a close-knit family.”

TranquiliTy in faMily His own family and home

life provide a soothing sanc-tuary away from work and mission trips. Dr. Twiggs and his wife Linda have been married for 42 years. Originally from Ohio, they met when she was a student nurse. When they decided to move south, they fell in love with Fernandina Beach. Over the years, Linda has worked in his office. Now she serves as the parish nurse for their church.

Their 20-acre farm in Callahan, complete with horses, goats, sheep and chickens, is their refuge. “I get on my tractor and plow the fields and can’t hear the phones or get interrupted,” Dr. Twiggs explains. Such work gives him a chance to mull things over. “When I am on the tractor riding around, I work things out in my mind.” Their daugh-ter and her family live next door, and their son and his family live in Fernandina. The Twiggs have five grand-children.

Dr. Twiggs hopes to one day orga-

nize a team of American doc-

tors who can rotate one week each month at

the clinic in Juarez.


rmed with good practice management software,

dedicated and knowledgeable staff and a commitment to keeping appointments on-time, physicians are finding that con-trolling scheduling is not only profitable but increases patient satisfaction.

SySTEMS ThaT STrEaMlinE SchEDulinG

With 12 office locations, over 50 gastroenterologists and more than 400 employees, the Borland-Groover Clinic has a centralized system for scheduling appointments, billing, coding and col-lections so as to perform the same func-tions almost the same way every time.

According to Tom Birdsong, Executive Director of Operations, Borland-Groover Clinic uses practice management sched-uling and a call center with 15 to 20 operators who all have the entire sched-ule for each doctor within the practice.

“It’s a real-time system so that there’s no delay and everyone’s aware of it,” said Birdsong. “As the day progresses, we’ll monitor each physician’s schedule and try to limit appointments so there aren’t too many but at the same time we’ll do a little bit of an overbook in case a patient cancels.”

Every Borland-Groover office is also equipped with a ticker sign in the wait-ing room that lets patients know if their doctor is on time. “What we’ve learned is that if you talk to the patient and let

them know that there may be a wait, then give them options for rescheduling, they’re much happier than if you ignore them.”

He continued, “It’s a matter of paying attention to patients and our staff really attends to their needs. We’re also using Electronic Health Records (EHRs) and are about 70 percent online now and want to be 100 percent online by sum-mer. Another goal is to be paperless by beginning of 2011. Paper charts create more chaos and now, just as with our scheduling software, staff at any location around the world can access this EHR.”

The systems, he says, save time, space and money, and allow everyone to be a little more accurate at what they’re doing.

“Knowing who your patients are, their demographics like age and income, and anticipating their needs is crucial to pro-viding good service,” he said.

Carol Mosley, director of operations for medical management company PCP Financial Services, agrees. “One of the best ways to keep appointments run-ning smoothly is to ask patients what they’re coming in for when they call in to make the appointment,” Mosley said. “If they’re a new patient we ask them to be here 30 minutes earlier to fill in paperwork. They also have the option of filling out the forms online and some patients ask us to mail the paperwork to them.”

f l o r i d a d o c t o r i t i m e m a n a g e m e n t

Tom Birdsong, MBA

By Priscilla Goudreau-Santos

a


“Knowing who your patients are, their demographics like age and income, and anticipating their needs is

crucial to providing good service.”— Tom Birdsong, MBA


The practice management software used by PCP Financial Services’ member practices including the nine-location Family Medical Centers, also verifies a patient’s insurance before they come in.

“We don’t really set a window or parameter for each patient to be seen but internally we try and make sure that patients see the doctor within 15 to 20 minutes of signing in. And, if the doctor is running late, we let them know and give them an option to reschedule their appointment. That means the world to patients because you’re giving them con-trol over their own schedule,” she said.

Patients are also given the option to be the first in the morning or the first after lunch. New patients are scheduled either one or two per hour so the doc-tor can spend time going over their past history and answering questions. Some pediatricians will meet with parents free of charge to see if they’re a good fit.

“Each location has an office man-ager,” said Mosley. “We work with staff on phone etiquette and greet-ing – initially with new hires and then once annually as a refresher. One of our issues is controlling staffing due to vacations and illnesses so we also cross train our medical assistants so that we can borrow from other locations where needed, and the majority of our paper-work is identical for all locations.”

EffEcTivE STaff iS KEy coMponEnT

Keeping good staff over the long term is another key to keeping doctors on schedule. “They know ahead of time what the doctor expects and antici-pate what tests or supplies she might require. We look back every month at what’s been ordered and next look at what’s coming up. When the patient makes the appointment the receptionist puts the reason into the system so that the MA knows what the patient needs in terms of room and supplies.”

Patients who are coming in for an annual Pap smear, for example, will need a Pap table and someone coming in for an annual physical may need an EKG,

she said. Diabetics always need their shoes and socks off and their glucose lev-els are measured. Staff is proactive even with needed testing such as a chest X-ray that will be in-hand when the doctor comes into the examination room.

“They know the doctor’s protocol and that’s what they follow. They’ll also check the schedules throughout the day so that they know what’s coming up,” Mosley said.

She continued, “We’ve found that the person who answers the phone is critical to patient satisfaction and we’ll have someone randomly call to make an appointment to find out if the per-son answering the phone is helpful, friendly and committed to getting the patient in to see the doctor at the ear-liest possible date.”

PCP Financial Services also offers an incentive program for filling the doctors’ schedule. Staff members receive a cer-tain amount of the receipts each month that might be $25 to $100 based on the size of the office. Mosley suggests monitoring schedules to assure that they’re legitimate and also to randomly call several patients once a month and ask whether they were happy with the scheduling.

“I’ve actually had some really good ideas come from the calls – it’s a win-win,” she said.

According to Periodontist, Gary D. Perlman, D.D.S., who specializes in perio-dontics and implantology, taking control of scheduling is all about the people who are responsible for helping you.

Because personnel are so important to his seven-member practice (eight including him), Dr. Perlman uses psy-chological testing to find the right fit. “You want someone who can speak to people, be outgoing and detail-oriented. I haven’t used it in a number of years but I do think it’s helped me find and keep the right people.”

“You have to be able to trust them and give them the freedom to do their jobs,” he said. “In my case, these people have been with me for years and in a medical specialty, if I’m not back

Gary D. Perlman, DDS

“We don’t really set a window or

parameter for each patient to be seen

but internally we try and make sure

that patients see the doctor within 15 to 20 minutes

of signing in. And, if the doctor is

running late, we let them know and

give them an option to reschedule their appointment. That

means the world to patients because

you’re giving them control over their

own schedule.”— Carol Mosley


treating patients, then I’m not making money and all bets are off.”

Dr. Perlman and his staff utilize a software system that gives an over-view of each day and throughout the week. At the end of each day, his staff accesses the software and sets up all the needed instrumentation for the next day. “If I’m not doing surgery but see-ing new patients, they need to know that, too.”

“Nicole and Cindy know how long a procedure will take and it’s up to them to make that flow,” he said. “There’s supply management, too. We try not to keep a backlog of supplies but instead order for each day or week. Surplus supplies are like money sitting on a shelf. My staff accesses the schedule, makes a list of needed supplies and runs it by me. I’m in a luxury situation because people have been with me for a long time so I don’t have to go back to basics.”

The basis for the practice, Dr. Perlman says, is that the patient has a nice experience and isn’t kept wait-ing. “In this type of specialty, we see one patient at a time – we don’t pride ourselves on volume but on quality. And, if we’re running late, we’ll call the patient and let them know and offer the option to reschedule. People appreciate that you respect their time.”

Mosley agrees and says that while the basics of great patient service haven’t changed, technological tools that help streamline scheduling make the process simpler and more effective.

• Class“A”MedicalOffice Condos• AffluentMarketwith 3GolfCourse CommunitiesNearby• SurroundedbyScenic NaturePreserve• IdealforMedical,Dental, RehabilitationorSurgery Center• Min.UnitSize1,700SF• Max.ContiguousSpace is10,000SF• DeliveredinShell Condition

sales Price: $180.00 Psflease Price: $12.00 Psf

“In this type of specialty, we see one patient at a time – we don’t pride ourselves on volume but on quality.”— Gary D. Perlman, DDS


A giant tree is the cen-terpiece in Dr. Reddy’s waiting room.


ust ask Dr. Prasanthi Reddy’s young patients about their

experience at Rainbow Pediatric Center. Dr. Reddy specifically designed and built the office two years ago with children in mind. Her goal: not only to make the atmosphere comfortable and appealing but also to make it safe for her patients.

DESiGn ElEMEnTS incorporaTE a BlEnD of fun anD SafETy

“Our waiting room is colorful, bright and open, and I designed a sick room and a well room which was the trend but [preventing infection] also boils down to how clean the office is,” said Dr. Reddy whose goal for the children is to create an environment where they look and think but don’t touch. “There’s a giant tree in the middle of the waiting room and on the roof we have panels with images of animals looking down so that the children can’t put their hands and mouths on them.”

There are also activities for children attached to the wall so that they can play and look around, and books. Not only do the little patients love the huge tree grow-ing out of the center of the waiting room but also the half-door entryway to get to the exam room.

“The half-door says ‘VIP’ and the check-in area looks like a little hut,” said Dr. Reddy. “The room where they have their vitals taken is also a fun space – it’s open and covered with Mr. and Mrs.

Potato Head displays. These keep them occupied and we allow the whole fam-ily to stay with them throughout the visit. We try to make everything fun for them so that they’re much more receptive and happy when they come back.”

Exploring the office and the giant tree that’s as large as a real, full-size tree is all part of the fun. Built by a local artist, the trunk is fiberglass and the limbs are real. Children lie underneath the branches and gaze up looking for animals and butter-flies.

“All the rooms have different themes like the deep jungles of Africa and the animals there,” Dr. Reddy said. “And, when the patient goes home, they leave with smiles and fists full of prizes and stickers and lollipops.”

a rollinG rEnovaTion on caMpuS

With its huge, sprawling campus, UF&Shands Jacksonville is undergo-ing a “rolling renovation” throughout its Emergency Department (ED) and most recently renovated its waiting room, making it more comfortable and appeal-ing, according to David Vukich, M.D., Department of Emergency Medicine pro-fessor and Chair, and senior vice president for Shands.

“Two years ago, we essentially annexed an outside space between two buildings and made it into an atrium space with lots of glass, living plants and a huge,

f l o r i d a d o c t o r i p r a c t i c e m a n a g e m e n t

Better technology, brighter waiting rooms and stellar customer

service are making a visit to the doctor a pleasant, if not a

downright fun, experience. Flat screen televisions, Game Boys

and laptop computers complete with wireless connections are

all part of the “new” patient experience and it’s only getting

better from there.

By Priscilla Goudreau-Santos

David Vukich, M.D.Prasanthi Reddy, M.D., FAAP

J

Top: Dr. Reddy’s check-in area; Bottom: UF&Shands revamped

ER facility.


in their mission statement - “Many Hands, One Vision, One Patient at a Time.” It’s obvious that patients are the number one priority here.

With over 50 gastroenterologists, 400 employees and 12 office loca-tions, Borland-Groover Clinic central-izes appointments, billing, coding and collections so that staff can perform the same functions virtually the same way every time, says Tom Birdsong, Executive Director of Operations.

“We’re patient-centric in everything we do and have one standard way of prac-tice,” he said.

The Clinic provides individual comput-ers with wireless connections, DVDs and water, coffee and snacks for patients in waiting rooms. Front office staff greets patients and asks them what they’d like to drink or eat, just as if greeting a guest in their own home.

“Our front staff is really aware of their surroundings and what’s going on,” Birdsong said. “Every morning, we have an employee line-up where we go over the “20 basics” and three steps of service to keep reminding them that our custom-ers are first and foremost. Every employ-ee is provided a laminated card with this information and every morning, we all read from this card. We also use the time to let the staff know how the day will unfold such as the number of scheduled appointments.”

Borland-Groover also requires stan-dardized office attire. All of its employ-ees wear a uniform, office personnel wear office dress and clinical staff members wear scrubs. Using a similar approach to customer service as The Ritz-Carlton in Amelia Island, the prac-tice stresses the three steps of service: first, a warm and sincere greeting using the patient’s name whenever possible; second, anticipating and complying with the patient’s needs; and third, offering a fond farewell and again, using the patient’s name.

All staff also carries a laminated card with the Borland-Groover Clinic motto,

“Many hands, one vision, one patient at a time.”

“Our daily line-up and employee cards keep our patient-focused mission in the top of our employees’ minds. Do people forget? Absolutely. That’s why we go over it each and every day. This training starts to stick with them. They remember it and begin to use it without thinking about it, and I believe it becomes part of their lifestyle.”

DiffErEnTiaTE your pracTicE wiTh GrEaT SErvicE

Helping its clients consistently deliver great customer service is also the goal for Signature Worldwide, a national com-pany that specializes in customer service and sales skills across many industries including healthcare, says Barry Himmel, senior vice president.

“Certainly, healthcare involves so much customer/patient interaction and as people continue to scrutinize those interactions this is becoming more promi-nent and service is becoming more and more important,” he said. “There are so many changes in the healthcare industry and the only one they [physicians and practice administrators] might be able to control is customer service.”

“For example,” he continued, “you can control whether you smile and whether you thank the customer for being patient, and also if you’re empathetic. So many industries have done their best to elimi-nate or decrease the amount of human interaction – so much is now online -- but not in healthcare. You’re going to have a minimum of four or five interac-tions with people as a patient and one of the ways you evaluate your experience is how long you wait and whether people are pleasant.”

When contracted to evaluate and elevate customer service at a practice, Signature Worldwide conducts “mystery phone shopping” with current patients to find out about their physician experience. “Usually, receptionists just take the order and don’t delve further to problem solve

Barry HimmelTom Birdsong, MBA

45-foot vertical volume,” he said. “We’re making the new waiting room beautiful with artwork provided by art students at LaVilla School of the Arts and Douglas Anderson School of the Arts. Music stu-dents from the schools will sometimes come over and play the grand piano in the atrium. Everyone loves it – patients and staff alike. The kids are prolific, their work is outstanding, and they’re fun and entertaining.”

Shands has also installed small electron-ic games like Game Boys in the ER wait-ing room and LCD flat screen TVs that broadcast commercial shows and short, patient-focused public service announce-ments. “Our primary care offices have similar setups. We just installed 30 TV screens and recently developed a central-ized call center that’s greatly reduced wait times for patients on the telephone. Soon, possibly within the next year, we’ll have the option to book appointments online and will then likely roll it out to certain clinics,” Dr. Vukich said.

And, as technology gets less expensive, he forecasts that patients will begin reg-istering with hand-held, wireless devices and that doctors will fill out charts with similar devices like iPads. “They might fill out their patient questionnaire and describe their condition and this informa-tion would then link to their electronic medical record (EMR) much like using an ATM,” he said.

“Many hanDS, onE viSion, onE paTiEnT aT a TiME”

The Borland-Groover Clinic’s approach to patient experience can be summed up

“Certainly, healthcare involves so much customer/patient interaction and as people continue to scrutinize those interactions

this is becoming more prominent and service is becoming more

and more important.”— Barry Himmel


or probe. We find those types of things in our analysis and they often become our mission,” Himmel said.

Signature will next do a full day of training that’s very interactive, positive and customized to each practice. “We’ve had good response. Some practices are experiencing a lot of competition and we can help with that. Patients choose people that they’re comfortable with and this attitude is often opinion based on wait times. There’s so little time with the physician so how that time is managed becomes very important.”

“It’s all about the relationship and it should be a very trusting relationship,” said Himmel. “We’ve certainly seen more requests for our service in healthcare and physicians are getting more sophisticated in reaching patients and getting their feedback. Physicians shouldn’t compro-mise on the service being delivered. They need to set high standards and be sensi-tive to people’s time. No one is looking forward to going to the doctor and you want to do what you can to minimize that anxiety.”

After staff training, Signature conducts a second round of mystery calling as a follow-up to see whether customer service is improved and sometimes does patient surveys and follow-up. “I think it’s a growing trend in healthcare because product differentiation isn’t as great as it once was and one way to dif-ferentiate yourself is with great service,” said Himmel. “You need a sharp man-agement team to keep that standard of service high.”

corporateheadshotsportraitsengagementsessionsfamilyandchildrenfashionportfolios

Askaboutour:

Ego Stimulus Package

asseeninJacksonvilleMagazineandFloridaTimesUnion

1951nmarketstreet#6,jacksonvilleflorida32206904.236.5337 I www.reneeparenteauphoto.com

Borland-Groover Clinic provides indi-vidual computers with wireless con-

nections, DVDs and water, coffee and snacks for patients in waiting rooms.


elying exclusively on telephone and face-to-face communication in a business environment is a

thing of the past, and an increase in Internet communica-tion at healthcare facilities is the reality. With broadband land being of such complex and unprecedented terrain in regard to maintaining patient privacy, how can your office ensure it has developed and implemented an effective email policy?

Scot Ackerman, M.D., a radiation oncologist and Medical Director for First Coast Oncology, said he sees Internet com-munications supplementing telephone and face-to-face com-munications as a very recent development, gaining attention in the past couple years. He notes that physicians in general don’t too easily embrace direct communication with their patients, long utilizing staff to answer phone calls, pagers and answering services to filter call volume, and the concern over inbox content is not too different.

“We prefer to focus our time with patients who need us now, but not at the expense of people who are in the office and sick,” Dr. Ackerman said. “Because of that physicians are late adopters of these new technologies relative to other pro-fessions because we are used to the buffer.” He is concerned that email communication could bring patient frustration because messages might not get replied to immediately, or information might be misconstrued. When he receives patient email he recognizes the person’s need for information and

assumption that he or she will get a quick response. “I can’t always get to it right away. It’s best to lateral those [messages] to my sup-port staff. I’ll look at the email and forward it to the appropriate person: nursing staff, social worker or billing department,” Dr. Ackerman explained.

Dr. Ackerman’s digital age approach is to try and make himself more accessible than most physicians. “My phone number has always been in the phone book. I don’t use caller ID to block anything. Even so, I get very few direct calls and emails from patients. A lot of physicians are afraid patients would abuse the access, but I find the opposite and patients respect it,” Dr. Ackerman noted.

“People expect to see an email address on our busi-ness cards,” offered Daniel Kantor, M.D., Medical Director for Neurologique and President-Elect of the Florida Society of Neurology. He agrees that expectations regarding response rate can be hard to manage. “With email nowadays, people expect communication imme-diately. They write you a text and they want a text back. If they email, they expect an email back fast,” Dr. Kantor explained. The reality is that having an office staff that is sitting around checking emails is not the ideal model for a physician practice.

BEnEfiTS of ThE inBoxBesides the relative ease

of accessibility email pro-vides, Human Resource Consultant Jamie Lynn Ferguson spoke to the addi-tional benefits of increased Internet communication between patient and physi-cian office.

f l o r i d a d o c t o r i t e c h n o l o g y

Within a professional relationship, it is tough to pull off a,

“I prefer you didn’t contact me by email,” communication

stance these days. While the healthcare realm has been

slower to adopt digital age communication demands than

some other industries, physician practices can no longer

ignore patients’ interest in and even expectation of having

email access to their doctors’ offices, if not to their physi-

cians personally.

By Laura Capitano

Scot Ackerman, M.D.

R

“Email presents a con-venient, fast, efficient and green way to engage in two-way communica-tions between physician and patient,” Ferguson said. “Some of the benefits include the ability to send a response at any time of the day and having a record of the conversation content — no need to take notes or keep paper docu-ments. With the increase in usage of mobile devices, patients could have access to their email regardless of where they are currently located,” Ferguson contin-ued.

Dr. Ackerman sees ben-efits of online communica-tion when it comes to getting patient information to the practice ahead of time. “When we have new patients to be seen, we call them up and tell them they can go to website for directions, or to download forms to have filled out for the appointment,” Dr. Ackerman said. He likes the ability to give patients a choice of filling out their paperwork at home to save time or at the office prior to the appointment.

For simple things, Dr. Kantor sees email as a pri-mary communication method. “When patients want, say, a copy of their labs after it has already been interpreted for them, then why not save paper? Simple questions or appointment changes work; email should not be high-priority things,” Dr. Kantor continued.

What types of information does it make sense to send via email, as opposed to the traditional communication channels? As a supplement to a face-to-face appoint-ment, Ferguson had the fol-lowing recommendations for physician practices emailing

“My phone number has always been in the phone book. I don’t use caller ID to block anything. Even so, I get

very few direct calls and emails from patients. A lot of physicians

are afraid patients would abuse the access, but I find the opposite and

patients respect it.”— Scot Ackerman, M.D.


patients: Share non-confiden-tial information, follow-up questions, appointment con-firmations or reminders for patients to schedule a follow-up appointment. “As long as the content of the email is kept relatively generic, just in case their email account is ever compromised. In cases where healthcare pro-viders are able to provide a secured website for physi-cians and patients to interact, I believe it would make sense to share more details once the patient consents to share those details electronically,” Ferguson explained. Email is also a convenient way to transmit addresses or phone numbers to referral offices, instructions on how to take prescriptions, preoperative or postoperative recommen-dations and links to further education or information on areas of patient interest.

a GuiDE To GuiDElinESAccording to Dr. Kantor,

his patients interested in Internet communications have been given informed consent forms regarding the electronic transfer of information. And often times, as Ferguson added, an email account may be shared between spouses, or patients using a work email account may have an assistant who screens it first. For these reasons, she recom-mends requesting approvals from patients before sending email.

American Medical Association guidelines for patient-clinician email com-munication suggest discuss-ing an informed consent agreement with each patient that is documented in the patient’s medical record. The agreement should con-tain details about security, encryption, non-sharing of patient email address or other information, backups and storage of electronic forms.

Outside the patient realm, and among the healthcare staff, it’s important to edu-cate on privacy concerns related to email. Ferguson suggested physician offices regularly remind staff of email protocol. “I would urge the staff to only include details in the email that are absolutely necessary, and omit as much non-relevant personal information as possible. Additionally, the staff should understand security protocols such as encryption and know how to encrypt data they are sending electronically,” Ferguson explained. From an office perspective, the facil-ity should hire an Internet and email security expert to ensure the office has adequate firewall protection to reduce the possibility of compromised patient data,” Ferguson continued.

How can practices deter-mine if now is the time to develop an email policy?

Ferguson suggests a survey of the patient base to gauge interest in electronic com-munications. “This could be done simply by asking a sam-ple of patients their thoughts on using email, or conduct-ing a pilot test. Once you are certain that email com-munications would be used by your patients, consult with an IT professional if you do not have any on staff to learn more about encryption and Internet security. From there you can begin work on your policies and develop any email templates that you wish to use,” Ferguson said.

Ferguson further recom-mends that practices looking to develop or amend their email policies for safety and effectiveness should outline what is appropriate to send electronically and what isn’t. “There needs to be clear guidelines as to what is elec-tronically transmitted, so that when a patient agrees to use email they understand exactly what information will be contained in the messaging,” Ferguson offered.

For larger healthcare facilities, Ferguson suggests that the human resource or Information Technology Manager is best suited to implement and monitor the email policy. “For smaller facilities it should be the responsibility of the lead physician to uphold the policies. Regular audits are recommended to verify that emails being sent to patients are following the policies and guidelines and a disciplin-

ary action plan should be in place to manage any mis-use,” Ferguson added.

looKinG ahEaDAs the population requir-

ing healthcare services continues to become more Internet savvy, experts pre-dict the demand for email communication to increase. “I predict that the number of patients willing to com-municate through email will continue to rise. Younger generations have been raised with email addresses and consider it the replacement of standard mail,” Ferguson said.

When considering the future of physician-patient email, Dr. Ackerman notes that people see doctors more often as they get older, and so as Americans age, each generation is more tech-savvy. “My kids in their 20’s are texting all day long, and they have learned how to bring nuance into a five word text message. I don’t get it and that’s okay. I think as that group of Americans gets older and starts utiliz-ing medical services more, emailing and electronic com-munications with the medi-cal professional is going to increase.

“Like it or not, it’s here and it’s happening more and more,” Dr. Kantor said of patient-physician email communication. “Other busi-nesses are moving away from phones entirely. Try and call someone at Google. You can’t.”

Daniel Kantor, M.D. Jamie Lynn Ferguson

“There needs to be clear guidelines as to what is electronically transmitted, so that when a patient agrees to use email they understand exactly what information will

be contained in the messaging.”— Jamie Lynn Ferguson


what inspired you open Blissful wellness?

“As an internist, I see so many cases of diabetes, heart disease, infertility, asthma, cholesterol, you name it… and a large

majority of these ill-nesses are related to obesity. When you take care of the obesity issue, you can correct and even avoid many of these other issues. When I started diagnosing patients with diabetes two

to three times per week, I knew some-thing had to be done. I couldn’t watch diabetes take control of half my patient population. I needed to make a differ-ence. It started out as a passion to help my patients and then I realized I needed to find a way to reach the public. We opened Blissful Wellness to help the rest of the community and we’ve come a long way in the last year. By helping patients lose weight and keep it off, they overcome so much; it helps patients suf-fering from diabetes to heart disease and hypertension to depression. They feel good about themselves again and that’s what the New Year is all about.”

what’s your new year’s resolution?

“We want to reach more people, we want to get out there and help people become who they really want to be. We’d like to expand to six, maybe seven, clinics by the end of this year so we can reach the entire [Northeast Florida] popu-lation. We want to help patients all inclu-sively this year; at the clinics, through educational seminars and by providing psychologists to help with the mental

florida Doctor – north asked local doctors what their new year’s resolutions were and here’s what some of them had to say.

and emotional aspects that impact weight loss and exercise physiologists so patients can learn the proper exercise regiments that will work for them. I also want to reach out to the pediatric population and work with children and their families to help get the 30% obesity [rate] in children under control.”

what’s your biggest message to doc-tors who are diagnosing patients with obesity-related illnesses?

“We are reaching out to area doctors and letting them know we are there for their patients. We aren’t there to take their patients; we are here to help them and send them right back. I believe as physi-cians, we need to reach out to obese patients and help them lose the weight. Everyday I tell patients who are struggling with weight issues and weight-related ill-nesses, ‘You do not need diabetes, heart disease, asthma, vascular disease, renal disease or hypertension.’ I believe it is up to us, as physicians, to make the differ-ence in the lives of our patients.”

how do you promote health and well-ness in your own office?

“All of our staff members can participate in our weight loss program free of charge. Most of my staff is fit; they want to be part of this process. We give them the tools to do that. They want to maintain a healthy weight because they are talking to the patients about it everyday. Just by educat-ing our staff, we have made a big differ-ence. We’ve had quite a few employees lose 20 to 30 pounds. We’ve also hired former patients who’ve been successful with the process since they are able to talk to the patients about their own experi-ence.”

Since weight loss tops plenty of people’s New Year’s resolution lists, we

spoke with Eylssa Blissenbach, M.D., P.A., owner of Blissful Wellness

and asked for her insight on weight loss and the New Year.

Eylssa Blissenbach, M.D., P.A.

WhaT’s youR NeW yeaR’s ResoluTIoN?

“1/1/11 is very special for me as I am opening my own practice – Jax Kidney Center. My New Year’s resolutions are to get more organized at the office and at home, spend more time with my family and spend more time giving back to the community.” — Esha Kancha, M.D.

“My New Year’s resolution is to grow in my relationship with Christ. I would like to spend more time getting closer to God and ministering to more people. That’s what’s in my heart and I would like to actively pursue ministry in my life whether it’s through my office, my church or the community.” — Ivis Alvarez, DMD

“My New Year’s resolution is to travel less and stay at home more. My wife has been busy this summer mov-ing our college-age children to California and Virginia. We also had an extended trip in Europe. Returning home, we realized that we are lucky to live in a great area with the beach as our backyard that matched or exceeded any of the places we visited. Our resolution is to stay home next summer and enjoy the beach!”— Shyam B. Paryani, M.D., MS, MHA, FACRO

“My New Year’s resolution is to win a gold medal in the Florida Senior Games in tennis singles. In 2009, I won the gold at the Jacksonville Senior Games and the silver at the Florida Senior Games.” — Robert Harmon, M.D.

Prsrtd stdU.s. Postage

PAIDso Florida FlPermit #375

FloridA doctor13500 sutton park drive south, suite 105Jacksonville, Fl 32224

The caring and compassionate physicians and staff at The Borland-Groover Clinic provide early diagnosis and prevention through the use of the most advanced medical technology available, giving you your best chance at a healthy life.

contact the physicians at the Borland-groover clinic to schedule your consultationtoday – and get back to life!

In the Jacksonville region 904.398.7205 Including: Fernandina Beach, st. augustine, Macclenny

In Port Orange (386) 788-1242 I In Ormond Beach (386) 677-0531 I In Delray Beach (561) 245-4550 www.borland-groover.com

...thanks to the physicians at the Borland-Groover Clinic, highly trainedexperts in research and education in the field of digestive health.