summer 2012

SUMMER 2012 SAN JOAQUIN PHYSICIAN 1SUMMER 2012 SAN JOAQUIN PHYSICIAN 1SAN JOAQUIN PHYSICIAN SUMMER 2012 SAN JOAQUIN PHYSICIAN SAN JOAQUIN PHYSICIAN

PLUS: 2012 Young Physician Award Recipients

Have Legal Issues? Contact the CMA Legal Information Line

Dr. Bryant Williams receives the Lifetime Achievement Award

YEARS, THOUSANDS OFPATIENTS

Summer 2012

2 SAN JOAQUIN PHYSICIAN SUMMER 2012

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SUMMER 2012 SAN JOAQUIN PHYSICIAN 3

{FEATURES}

30

1217

44

NOT SURE ABOUT THE LAW?Contact the CMA Legal Information Line

EMBRACING MEDIAIn your Practice

CUT THE CORDAnd you could be cutting your safety line

LIFETIME ACHIEVEMENT AWARD50 years, thousands of patients

YOUNG PHYSICIANS AWARDJerry and Susan McDonald heal hearts

{DEPARTMENTS}25 CMA FOUNDATION CMA Foundation Helps Physicians Improve Diabetes Care

29 DOCBOOKMD Case Study

38 IN THE NEWS New Faces and Announcements

54 2012 LEADERSHIP ACADEMY San Joaquin incoming president has already adopted the best practices of health reform

67 IN MEMORIAM

68 AT A GLANCE

VOLUME 60, NUMBER 2 • JUNE 2012

58


MEDICAL SOCIETY STAFF

EXECUTIVE DIRECTOR Michael Steenburgh

DEPUTY DIRECTOR Nikki West

OFFICE COORDINATOR Debbie Pope

ADMINISTRATIVE ASSISTANT Jessica Wilkerson

COMMITTEE CHAIRPERSONS

MRAC F. Karl F. Karl Gregorius, MD

DECISION MEDICINE Kwabena Adubofour, MD

ETHICS & PATIENT RELATIONS to be appointed

COMMUNICATIONS Moris Senegor, MD

LEGISLATIVE Jasbir Gill, MD

COMMUNITY RELATIONS Joseph Serra, MD

AUDIT & FINANCE Marvin Primack, MD

MEMBER BENEFITS Jasbir Gill, MD

NOMINATING Hosahalli Padmesh, MD

MEMBERSHIP Ramin Manshadi, MD

PUBLIC HEALTH Karen Furst, MD

SCHOLARSHIP LOAN FUND Eric Chapa, MD

NORCAP COUNCIL Thomas McKenzie, MD

CMA HOUSE OF DELEGATES REPRESENTATIVES

Robin Wong, MD, Lawrence R. Frank, MD,

James R. Halderman, MD, Patricia Hatton, MD,

James J. Scillian, MD, Peter Oliver, MD, Roland Hart, MD

Kwabena Adubofour, MD,

Gabriel K. Tanson, MD, Ramin Manshadi, MD

SAN JOAQUIN PHYSICIAN MAGAZINE

EDITOR Moris Senegor, MD

EDITORIAL COMMITTEE Moris Senegor, MD,

Kwabena Adubofour, MD, Mike Steenburgh

MANAGING EDITOR Michael Steenburgh

CREATIVE DIRECTOR Sherry Roberts,

sherrylavonedesign.com

CONTRIBUTING WRITERS James Noonan,

Elizabeth Zima, William West

THE SAN JOAQUIN PHYSICIAN MAGAZINE

is produced by the San Joaquin Medical Society

SUGGESTIONS, story ideas or completed stories

written by current San Joaquin Medical Society

members are welcome and will be reviewed by

the Editorial Committee.

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:

San Joaquin Physician Magazine

3031 W. March Lane, Suite 222W

Stockton, CA 95219

Phone: 209-952-5299 Fax: 209-952-5298

Email Address: [email protected]

MEDICAL SOCIETY OFFICE HOURS:

Monday through Friday 9:00 AM to 5:00 PM

PRESIDENT George M. Khoury, MD

PRESIDENT-ELECT Raissa Hill, DO

PAST-PRESIDENT James Halderman, MD

SECRETARY-TREASURER Thomas McKenzie, MD

BOARD MEMBERS Lawrence R. Frank, MD, Moses Elam, MD, Peter Drummond, DO, Ramin, Manshadi, MD,

Alan Kawaguchi, MD, James J. Scillian, MD, Karen Furst, MD, Kwabena Adubofour, MD, Kristin M. Bennett, MD

SUMMER 2012 SAN JOAQUIN PHYSICIAN 5SUMMER 2012 SAN JOAQUIN PHYSICIAN 5

Get More

Practices affiliated with Hill Physicians Medical Group retain their independence while enjoying the support of a large, well-integrated network of providers. Hill’s advantages include: • Fast, accurate claims payments • Free eReferrals, ePrescribing and online doctor-patient communications • Experienced RN case management for complex, time-intensive cases • Deep discounts on EPM and EHR solutions to help you meet the federal mandate • Easy preventive care and disease management reminders for patients • Extensive health resources that boost patient engagement • High consumer awareness that builds practice volume That’s why 3,700 independent primary care physicians, specialists and healthcare professionals have made Hill Physicians one of the nation’s leading Independent Physician Associations. Get more for your practice and your patients by affiliating with Hill Physicians Medical Group.

Get more information at www.HillPhysicians.com/Providers or contact:

SupportSupport

Hill Physicians’ 3,700 healthcare providers accept commercial HMOs from Aetna, Alliance CompleteCare (Alameda County), Anthem Blue Cross, Blue Shield, CIGNA, Health Administrators (San Joaquin), Health Net, United Healthcare WEST and Western Health Advantage. Medicare Advantage plans in all regions. Medi-Cal in some regions for physicians who opt in.

San Joaquin and Stanislaus: Paula Friend, regional director, (209) 762-5002, [email protected] area: Doug Robertson, regional director, (916) 286-7048, [email protected]

Bay Area: Jennifer Willson, regional director, (925) 327-6759, [email protected]

Craig Bobson, M.D.Hill Physicians provider since 2004.Uses Hill inSite, RelayHealth and Ascender for eligibility, eClaims processing, electronic health records, practice management, secure online communications, ePrescribing, eReferrals and preventive care reminders.


With a new five-year strategic plan in place, the staff is embarking on a number of new and exciting projects which will impact our physician community and

the general community as well.

You have the opportunity to hear about several of these projects firsthand by reading our president’s column on page 8. Not wanting to steal any of his thunder, I have to mention the excitement of our staff over our involvement in the community-wide effort to promote better diabetes care, as well as the future expansion of our

society website to serve as a “hub” for many community resources for both medical professionals and the general public. Be sure to read Dr. Khoury’s column for all the details and the call to action by Dr. Kwabena Adubofour for the creation of a specific county-wide Diabetes Hospital Task Force to improve the care of hyperglycemic patients.

Understanding that our current and prospective members, as well as the public, often choose to go online in search of information, we have just completed a substantial upgrade to our website. In addition to moving the site to a much more robust platform for future growth, we have seamlessly connected our site to CMA’s site in a number of ways which allows several new features to work. Check out our website ad on page 36 for more details, or better yet: go to www.SJCMS.org and see it for yourself!

Lastly, I want to encourage you to quickly send in your reservation for our upcoming Annual Membership Dinner on Sunday, June 24th. As our beautiful cover illustrates, we will be honoring Dr. Bryant Williams for his amazing career spanning over 50 years. We will also be recognizing Drs. Jerry and Susan McDonald as our 2012 Young Physician Award recipients. It’s going to an exciting evening for all in attendance so we hope you’ll join us.

All the Best,

STAFF REPORT

NEW PROJECTS BRING NEW FOCUS

{ IN ADDITION TO MOVING THE SITE TO A MUCH MORE ROBUST PLATFORM FOR FUTURE GROWTH, WE HAVE SEAMLESSLY CONNECTED OUR SITE TO CMA’S SITE IN A NUMBER OF WAYS WHICH ALLOWS SEVERAL NEW FEATURES TO WORK.

MIKE STEENBURGH

letter from the executive director


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Recognizing a need for

people with diabetes

to have easier access

to diabetes self-

management classes,

the San Joaquin Medical

Society is developing an

online resource to keep

track of available classes

in one place.

It seems only yesterday that I was given the responsibility to be the

president of the Medical society. My goal was to do something that would make the Medical Society a brand name and be an integral part in our communities’ health. With the direction of our board, the Medical Society staff and physician volunteers worked at defining the Local health care problems we are facing and finding solutions that are workable. This is part of a greater movement that has been slowly developing in the San Joaquin County. The San Joaquin County Public Health department presented to the Board “The Community health status report of 2011”. The data is quite discouraging. The SJ Public Health Department has established a five year plan to effect change in regard to chronic diseases: Asthma, Obesity, Hypertension, Diabetes, Congestive heart failure etc…

The Medical Society chose to target Diabetes first. Managing Diabetes is a quest our community has to tackle

together. The Patient, Physician, and Community have to work as one unit. To reach that goal the medical society has embarked on a quest that is achievable and without re-creating the wheel.

Recognizing a need for people with diabetes to have easier access to diabetes self-management classes, the San Joaquin Medical Society is developing an online resource to keep track of available classes in one place. The online resource, best described as the Unite for Diabetes San Joaquin County Resource Hub, will list diabetes self-management classes, screening locations, no cost or low-cost medical care options and support services available throughout the region, along with their location, providing organization, and cost. Health care providers will be able to access the Hub and help patients locate the classes they need. Rather than just telling patients to go to diabetes self-management education, a doctor or medical assistant will be able to look at the Hub and find a

ABOUT THE AUTHOR Dr. George M. Khoury is President of the San Joaquin Medical Society and practices at Stockton Diagnostic Imaging as a Radiologist.

Managing Diabetes First

a message from your president - George M. Khoury, MD


specific class that meets their patient’s needs and schedule. This will make it much more likely that patients attend the classes and learn the skills they need to manage their diabetes and help avoid serious complications. The Hub will also feature links to online diabetes self-management services and downloadable educational materials that can be printed for patients to take home.

In its first stage, the Unite For Diabetes San Joaquin County Resource Hub will be directed

at health care providers and will focus on diabetes standards of care and self-management, but the Medical Society hopes to expand the Hub by including other healthy living resources and allowing community members to have direct access to the site in the future. The Hub is being developed in collaboration with the California Diabetes Program and the California Medical Association Foundation. In addition, it supports the San Joaquin County 5-Year Chronic Disease Prevention Strategic Plan goal to decrease the incidence and prevalence of obesity, chronic disease and the related risk factors. The Hub emerged as a product of the Medical Society’s goal to improve the health of the community and to provide support to those in need while working with Diabetes Work Group of the San Joaquin County Obesity and Chronic Disease Prevention Task Force.

The Unite For Diabetes San Joaquin County Resource Hub will go live in November in recognition of American Diabetes Month.

a message from your president - George M. Khoury, MD

SAN JOAQUIN COUNTY HOSPITALS

diabetes special interest groupWorking to improve care of hospital hyperglycemia through countywide collaboration

The San Joaquin County Hospitals Diabetes Special Interest Group (H-DSIG) is being formed with the mission to MONITOR, EDUCATE and ENHANCE diabetes care in the hospitals of San Joaquin County. The H-DSIG will operate/function under the auspices of the county medical society with the executive director of the county medical society as its convener.

Background:Beginning in July 2012, a consortium of physicians, nurses, certified diabetes educators, pharmacists and dietitians plus other allied health professionals from each local hospital in San Joaquin county will begin meeting on a monthly/bi-monthly basis to formulate a plan to enhance the care of hospitalized patients with hyperglycemia.

This consortium is being formed in response to the unacceptable high morbidity and mortality associated with diabetes in San Joaquin county.

We are faced with the escalating cost of rising infection rates leading to sepsis with multi-organ dysfunction

Increased lengths of stay in both the ICU and medical-surgical floors setting with increased morbidity and mortality.Increased time spent on ventilatorIncreased incidence of heart or renal failure

We are first and foremost clinicians and as the importance of glucose control in the hospital setting has become increasingly recognized, we must be leaders in finding ways to apply the results of various clinical trials to real world hospital environments.

Immediate Goals:Identification and organization of other interested stakeholders.Development of consensus sample clinical guidelines aimed at evidence-based management of inpatient hyperglycemia.Dissemination of information/Best practices.Sponsorship of workshops.Construction of a website (– link to the medical society website - ) for guidelines and other relevant information.Members of H-DSIGTracy Sutter Medical CenterDoctors MantecaKaiser MantecaSan Joaquin General HospitalDameron HospitalSaint Joseph’s Medical CenterLodi Memorial Medical Center

Representation:Each hospital to be represented by a team consisting of:Physician – “hospitalist” plus or minus “traditionalist”, Nurses – administration plus first line supervisorClinical pharmacistCertified diabetes educatorDietitian/Nutrition services

The Unite For Diabetes

San Joaquin County Resource Hub will go live in

November

Written by: Kwabena Adubofour, MD


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“There was new leadership at the facility,” explained Dr. Arévalo, a board-certified family physician and Senior Medical Director of Sutter Independent Physicians since 2003. “The patient was told that she would only be able to see the medical director for the facility, instead of her established physician.” Dr. Arévalo called the California Medical Association (CMA) Legal Information Line because he was uncertain about what rights the patient had in choosing a doctor in a skilled nursing facility and had concerns about continuity of care.

A CMA member for 20 years, Dr. Arévalo had used the Legal Information Line before. “This is a tremendous resource. I knew they would have an answer for me.”

The Legal Information Line and its staff will research and provide information to address

just about any legal-related question from a CMA member.

A WEALTH OF INFORMATION Every day, CMA member physicians and their staff contact CMA’s Legal Information Line with a wide range of legal issues they face in their practices, such as the formation of physician practice models, medical staff and peer review, managed care, reimbursement and office staff issues. The Legal Information Line is staffed by CMA’s Center for Legal Affairs, which assists members by providing them with resources and information on applicable laws.

Many of the inquiries can be answered with information available in CMA’s health law library, CMA ON-CALL. CMA ON-CALL is a comprehensive legal resource that is

Contact the CMA Legal Information Line

NOT SUREABOUTTHE LAW?

WE ARE HERE TO HELPBy listening to member inquiries, asking questions, doing research and contacting outside resources, including other health organizations and government agencies, the Legal Information Line staff works hard to address members’ questions. Whether the questions are simple or complex, “We always try to find the right information to best address our members’ questions,” Pellón said. “Do they need to talk to their professional liability carrier or a state agency? We try to direct them to the right resource if we cannot address a question.” Pellón adds that should a member need specific legal advice about a particular situation, “we also maintain contact information for physician-friendly attorneys” in various physician-related legal issue areas. The CMA Legal Information Line is a free resource for members. You can access this member benefit by calling (800) 786-4262 or e-mailing [email protected].

HELP

When a patient’s family member asked José A. Arévalo, M.D., to intervene at the skilled nursing facility where his patient was living, he wasn’t quite sure what the patient’s rights werea under the law.


updated annually by CMA attorneys and available free to members at the CMA website, www.cmanet.org/cma-on-call. It contains information on current laws, regulations and court decisions related to medical practice.

For example, a common question on the Legal Line is: “How long do I have to keep a patient’s medical record?” CMA staff can e-mail or direct a member to a CMA ON-CALL document that discusses statutory record retention requirements, recommended retention periods, options for record management, as well as record destruction requirements. See CMA ON-CALL document #1160, “Retention of Medical Records.”

Some Legal Line inquiries, however, are more complex.

“Many of these questions are not straightforward,” said Samantha Pellón, CMA’s health law information specialist who has staffed the Legal Information Line for the past four and a half years. “I will often ask a lot of questions to get enough information about a certain situation so I can refer members to the right resource or do more in-depth research.” Pellón, who is set to begin a Masters in Public Health at the University of California Berkeley this fall, adds that although CMA cannot give individual legal advice to members, “we try to research and provide enough information as possible to help members with their legal questions.”

This includes pulling in CMA attorneys with knowledge in a specific issue area to help locate the relevant law. When Dr. Arévalo asked about the legal rights of his patient at a skilled nursing facility, CMA legal counsel Alicia Wagnon got involved. Wagnon, who previously worked as a litigator in private practice defending doctors in medical malpractice and employment law, called her contacts at the California Association of Health Facilities (CAHF). Wagnon was able to get a clear answer from CAHF quickly and pass on useful guidelines to Dr. Arévalo. “Associations are always looking for trends (in their area of specialty), so they

were happy to provide information.” She said networking with other health associations in the state allows the associations to track issues that may affect their members.

ONLINE PHARMACIES AND THE LAWWith the ease of e-commerce and patients’ desires to save money, the Legal Information Line has received numerous questions about the use of foreign internet pharmacies.

When a county medical society contacted the Legal Information Line on behalf of a member physician about a patient who wanted to buy prescription medicine from an online pharmacy in Canada, CMA legal counsel Lisa

Matsubara not only provided the physician with a CMA ON-CALL document discussing the risks of obtaining drugs from a foreign country (CMA ON-CALL document #0511,

“Drug Prescribing: Drugs from Other Countries”), but she also researched several websites for Canadian pharmacies.

“On behalf of the patient, the Canadian online pharmacy faxed the physician a prescription form and asked that the physician fill it out and return the prescription form to the pharmacy,” Matsubara said. “The physician wanted information on the legality of prescribing and importing drugs from a Canadian pharmacy.” Matsubara, who has staffed the Legal Information Line for over two years, reviewed the websites and found policies and disclaimers that conf licted with federal and state laws.

Although she was unable to give individual legal advice, Matsubara provided the county medical society with pertinent information on the applicable laws, as well as guidance from the Food and Drug Administration and the California Board of Pharmacy about the potential liability risks associated with the importation of drugs from foreign countries.

CMA HELPS MEMBERS RECOUP THOUSANDS OF DOLLARS IN CLASS ACTION LAWSUIT

Inquiries to the Legal Information Line also inform CMA attorneys about the need for certain advocacy

CMA Legal Information Line

“We were recently updated that one member was able to get back over $20,000 from the

settlement fund after accessing and using our advocacy resources.”


resources. In 2000, the American Medical

Association along with other health care provider and patient groups, filed a class action lawsuit against UnitedHealth Group, alleging that United conspired to defraud consumers by manipulating out-of-network reimbursement rates and shortchanging physicians and patients by hundreds of millions of dollars over 15 years.

“We had a lot of questions from our membership about filing a claim for reimbursement after the settlement,” Pellón said. To help physicians understand the settlement and what they need to do to claim their share, CMA’s Director of Litigation, attorney Long Do, created a settlement guide for CMA members. The guide discussed key provisions of the settlement and provided information on how to qualify and submit claims to the settlement fund. In addition, the CMA legal center put together a resource page with links to settlement forms, the settlement claims administrator website, and AMA resources. See United/Ingenix Settlement Guide.

Pellón says that the settlement guide, resource page and staff assistance helped CMA member physicians recoup thousands of dollars. “We were recently updated that one member was able to get back over $20,000 from the settlement fund after accessing and using our advocacy resources.”

HOW TO RESPOND TO NEGATIVE ONLINE REVIEWSAnother issue that is the subject of numerous calls to the Legal Information Line is how to handle negative comments on consumer review and rating websites. Such websites are a concern for physicians because inappropriate negative comments can

damage a physician’s reputation and affect his or her practice.

“With more and more websites inviting patients and other members of the public to rate and review physicians, we were receiving phone calls from physicians asking about what their options were with regard to negative online reviews of their practice,” said Matsubara. In response, Matsubara

authored a CMA ON-CALL document addressing member concerns and providing information on identifying online reviews, responding to negative online comments and possible legal remedies for physicians who find themselves the subject of such reviews. See CMA ON-CALL document #0822, “Online Consumer Review and Rating Sites.”

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San Joaquin Medical Society and CMA Members Enjoy:

Vast CMA Resources:• Contract Analysis • Reimbursement Hotline • Legal Hotline• Legislative Hotline • HIPPA Compliance • Free Monthly Webinars on various topics• Extensive Online Resources including over 200 letters, agreements, forms, etc.• Plus – Free Legal Advice with CMA ON-CALL Documents

San Joaquin Medical Society Resources: • Online Prescriber’s Letter subscription• DocBookMD phone app• Annual Directory • Free CME Seminars • Cost Saving Benefits• Quarterly Publication • Website/Online Resources • Insurance Savings• Alliance Membership • Annual Social Events • Patient Referrals• Office Manager Forum and Practice Resources

Your Membership Investment supports our Advocacy efforts on your behalf in Sacramento and Washington DC

Phone: (209) 952-5299www.sjcms.org

Serving the counties of San Joaquin, Calaveras, Alpine, and Amador

“My Membership provides me a Voice in Sacramento and Washington DC.”

Thomas McKenzie, MD


In general, the practice of medicine has been dramatically affected by the state and federal budget problems. All this translates into a significant adaptation that physicians must implement in order to survive. Those physicians that can adapt quickly as the changes come their way are the ones that will succeed. It is survival of the fittest. Among these changes are taking advantage of the power of having your own website, using Electronic Medical Records

(EMR), plus implementation of social networking. As testament to this, the usage of social media grew 50 percent in the last year, particularly with doctors aged 45-54 where usage has tripled.

How does one get started? I feel the first question to ask yourself is what motivates you to create a website or involve your practice in social networking? Is it for marketing? For better patient-physician communication? Or both?

San Joaquin Medical Society and CMA Members Enjoy:

Vast CMA Resources:• Contract Analysis • Reimbursement Hotline • Legal Hotline• Legislative Hotline • HIPPA Compliance • Free Monthly Webinars on various topics• Extensive Online Resources including over 200 letters, agreements, forms, etc.• Plus – Free Legal Advice with CMA ON-CALL Documents

San Joaquin Medical Society Resources: • Online Prescriber’s Letter subscription• DocBookMD phone app• Annual Directory • Free CME Seminars • Cost Saving Benefits• Quarterly Publication • Website/Online Resources • Insurance Savings• Alliance Membership • Annual Social Events • Patient Referrals• Office Manager Forum and Practice Resources

Your Membership Investment supports our Advocacy efforts on your behalf in Sacramento and Washington DC

Phone: (209) 952-5299www.sjcms.org

Serving the counties of San Joaquin, Calaveras, Alpine, and Amador

“My Membership provides me a Voice in Sacramento and Washington DC.”

Thomas McKenzie, MD

With implementation of the Affordable Care Act (ACA) right around the corner, along with tumultuous times currently in the practice of medicine, physicians are left with a grim outlook for the future.

by: Ramin Manshadi, MD

Practice Medicine

in your practice

embracing


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My goal in establishing a website was to better serve my patients and to keep up with the changing times. Initially, I hired a marketing company that thoroughly interviewed me to learn my strengths, and establish a brand based on my unique background. This information was then incorporated into the establishment of my website. Just as with building a house, the process is quite detail oriented and each step must be reworked thoroughly until it satisfies your needs. Within the website, I not only have provided information about my practice, but also educational information to help patients better understand their disease process. I knew I had done a good job with this when a nutritionist at a local hospital told me that when searching for optimum diabetic care and education, she was able to find it on my website.

Such a website can also be used by patients to schedule appointments, as well as send confidential information to their providers. All of this can be interfaced with the practice’s EMR to better serve the patients. Forms can be filled out by potential patients prior to consultation, thus reducing wait time at the office. With Accountable Care Organizations just around the corner and the government pushing for more transparency, the EMR is becoming a must for all practices to such a degree that if a practice does not implement

EMR within next couple of years, they risk losing bonus money from the government.

In addition, my website has links to my practice on Facebook, Twitter, LinkedIn, and in blogs – all of which I am presently in the process of developing. Let us examine these four social networks that could be used for medical social networking. Each functions in its own unique way to keep the line of communication open between

provider and patients, or provider and the general population.

Facebook is a social networking service and website launched in February 2004. Users may create personal profiles, add other users as friends, and exchange messages, including automatic notifications when they update their profile. One can have a professional Facebook account in addition to the personal account.

Twitter is a website owned and operated by Twitter Inc., which offers a social networking and microblogging service, enabling users to send and read messages called tweets. Tweets are text-based posts of up to 140 characters displayed on the user’s profile page.

LinkedIn is a business-oriented social networking site. Launched in May 2003, it is mainly utilized for professional networking. It can be used to find jobs, people, and business opportunities that are recommended by someone in one’s contact network. This is a nice way to be connected not only to medical professionals, but also to professionals across many disciplines.

A blog (a blending of the term web log) is a type of website or portion of a website. Blogs are usually maintained by an individual, with regular entries of commentary, descriptions of events, or other material such as graphics or video. An external blog is a publicly available blog where company employees, teams, or spokespersons share their views. Corporate blogs may be written primarily for consumers (business-to-consumer, or B2C) or primarily for other businesses (B2B). In the medical arena, one can use this to repeatedly remind patients to quit smoking, not to overindulge in eating, or to encourage they do their evening walks.

Besides using these four social networks, a provider can also send monthly newsletters

Practice Medicine

I knew I had done a good job with this when a nutritionist at a local

hospital told me that when searching for optimum

diabetic care and education, she was able to

find it on my website.


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e help you succeed.WIn today’s challenging business climate it’s more important than ever to have a bank and a team

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...every life is a gift

At St. Teresa Comprehensive Cancer Center, we believe that in order to treat the disease, you must begin by caring for the entire patient. As a result, our staff is equipped to offer many services designed to care for the patient and their friends and family.

Our compassionate team provides customized and highly specialized patient-centered care.

St. Teresa Comprehensive Cancer Center4722 Quail Lakes Dr., Suite B

Stockton, CA 95207Phone: (209) 472-1848

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www.stteresascancercenter.com

St. Teresa Comprehensive Cancer Center

electronically to the email addresses of all their respective patients. This is more of a proactive approach to keep the patient, and at the same time remind them about their appointments. The four social networks employ a somewhat less direct approach.

Beyond marketing the practice, implementing social networking can translate into better care for the patients. It can open the line of communication between provider and patients, while at the same

time help the busy practitioner stay informed of the latest developments in his or her particular field. Medical information is ever rapidly changing such that by ten years, what you once knew can be obsolete. Social networking can also provide information to patients on various applications that can be used on smart phones. One such application is the Diabetic Connect application provided by Alliance Health Network, Inc., where diabetics can go on and have a social support group. Community Health Network has an application called Pillbox that helps patients and their families keep track of their medication list on their iPhone and iPod touch. There are also physician- only networks such as Sermo, OZmosis and iMedExchange. Sermo allows doctors to share clinical information, do case studies, explore job opportunities and even earn honoraria. Sermo has 112,000 physician members across 68 specialties. OZmosis is also physician exclusive with the same characteristics as Sermo, but on a smaller scale.

The Medical Social Network comes with its


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own legal issues of which physicians should be aware. Doctors must be very careful not to post particular names of any patients on the net. If a physician is describing a patient scenario in

detail, then the information “needs to be generic enough that nobody can identify a patient in the course of reading a post.” Moreover, on many occasions, I have had some patients

asking to be my Facebook friends. We should ignore these requests and draw a fine line between physician and patient relationships. Physicians should set up a practice Facebook account and allow

their friends to be the fans of the practice. On this page, patients can follow your updates.

In addition to this, those physicians using Sermo should be careful not to use the curbside consultation as gold standard, since accepting consultation outside of the standard of care can be thought of as malpractice. Further, anything that one writes on Twitter or in a blog is discoverable. Thus, be careful never to say anything derogatory about the hospital where you work, other doctors, or patients. Like anything else in life, always pause and think before posting any tweets or Facebook updates. In fact, because of this, the AMA has published guidelines for the use of Social Media. It emphasizes for us to be aware of patient privacy issues and maintain personal-professional boundaries.

Just as medicine continually changes and evolves, so does our practice of it. All that I am addressing here is no longer “the future.” It is right now and should become part of any physician’s practice.

Practice Medicine


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cma foundation news

CMA Foundation Kicks Off New Project to

Help Physicians Improve Diabetes Care in San Joaquin CountyThe California Medical Association (CMA) Foundation is pleased to announce a new project, Teaming Up for Healthy Hearts, which addresses the ongoing concerns with diabetes and cardiovascular disease in San Joaquin County. San Joaquin County has the 3rd highest diabetes-related mortality rate and the 4th highest mortality rate attributed to coronary heart disease according to 2011 data from the California Department of Public Health. The CMA Foundation, the San Joaquin Medical Society and the California Diabetes Program have teamed up with several partners in efforts to reduce the burden of cardiovascular disease and improve outcomes among underserved patients with type 2

diabetes in the County. Teaming Up for Healthy Hearts is a multi-year project that aims to strengthen the capacity of the care team to improve the delivery and management of diabetes care. The project encourages the formation of multidisciplinary teams based on existing, local resources to support patient self management efforts. Training and technical assistance will be provided to approximately 20 solo and small group practices that provide care to Medi-Cal patients. Physicians will be provided with opportunities for clinical education to improve adherence to diabetes standards of care. Medical assistants will receive training to assist physicians in the care of patients with diabetes. Finally, the project will identify and strengthen patient referrals to self-care services provided by certified diabetes educators, case managers, pharmacists and other care team members in the community.For more information please contact, Julie Vedolla-Fuentes, Diabetes Coordinator, at [email protected]

Diabetes Care Guidelines Flow Sheet Updated

The Diabetes Quality Improvement

Project has updated the Diabetes

Care Guidelines Flow Sheet

with the newest additions to the

American Diabetes Associations

2012 Standards of Medical Care

in Diabetes. The flow sheet was

initially developed with the assistance

from several frontline medical

practitioners in an effort to improve

the way in which patients with

diabetes receive quality care.

The flow sheet along with many

other valuable diabetes resources can

be found on the Diabetes Quality

Improvement webpage at http://

www.thecmafoundation.org/projects/

APED/ NewPatientResouces.aspx

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Federally insured by the NCUA.

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Clinical Priorities

Parameters Frequency Goal/ Recommendation

Date/Results:

Date/Results:

Date/Results:

Date/Results:

History, Physical and Mental Health

Blood Pressure Every Visit <130/80 mm Hg

Weight Every Visit BMI <25 kg/m2 ; reduce weight by 5%-10% if overweight

Foot exam Every Visit Inspect skin; teach protective foot behavior if sensation diminished

Foot exam-monofilament Annually Prevention of ulceration and amputations

Dilated Eye Exam Annually Retinopathy prevention

Dental Bi-Annually Assess oral symptoms/ refer to dentist

Depression Annually Assess for mood disorders; suggest support groups/counsel/referral

Medication Review

(diabetes meds, statin,

ACE/ARB and/or aspirin)

Every visit Optimize glycemic control and for the primary or secondary

prevention of CVD and/or management of HTN and

hyperlipidemia; reconcile medication list; discuss adherence issues

Tobacco Status: ________ Never ________ Former_______ Current Quit Date: ____________

If current smoker, refer to California Smokers’ Helpline at 1-800-NO-BUTTS

General Care

Periodic H&P/ Pap or

Prostate

As indicated Early detection of cervical and prostate cancer

Mammogram Every 1 - 2

years

Early detection of breast cancer; screening to begin at age 40 or 50†

Colorectal Cancer After age 50 Early identification of colorectal cancer

Lab A1C

Quarterly <7% for most patients*

Albumin/Creatinine Ratio Annually Check spot urine for albumin and creatinine, calculate ratio ≥ 30 µg

alb/mg creatinine is abnormal

Serum Creatinine for

eGFR

Annually Estimate glomerular filtration rate (GFR) to stage the level of

chronic kidney disease (CKD)

LDL Annually < 100 mg/dL; <70 mg/dL (optional goal)

Triglycerides Annually <150 mg/dL

HDL Annually >40 mg/dL in men; > 50 mg/dL in women

Non-HDL Annually <130 mg/dL; <100 mg/dL (optional goal)

Total Cholesterol Annually < 200 mg/dL

Vaccine Flu Vaccine Encourage vaccination annually upon availability of vaccine

Hepatitis B Administer to unvaccinated adults with diabetes mellitus aged 19 through 59 years

Pneumovax Once if over 2 years old. (Then revaccinate when > 65 years old if more than five

years since initial vaccine.)

Tetanus/ PPD Vaccination against tetanus; determine exposure to TB

Tdap/ Pertussis Vaccination against tetanus, diphtheria & pertussis

Self Management

Goals

Patient Goals

Self-Glucose Monitoring

Pt. to monitor glucose as necessary to minimize risk of hyper/hypo

glycemic episodes; review and check patient log book for accuracy

Physical Activity

150 minutes of moderate to vigorous exercise a week

Nutrition

refer to dietician/MNT; Advise weight reduction if BMI ≥25;

Foot Exam

Review foot inspection instructions with patient

Medication Management/Adherence Discuss barriers/solutions to adherence; reconcile medication list;

Refer to DSME/ DSMS

Diabetes Care Guidelines/Flow Sheet

Name __________________________________________ MR # ______________ D.O.B. _______________

Language_________________ Race/Ethnicity _______________

† For women at average risk of breast cancer, the US Preventive Services Task Force recommends mammograms every 2 years beginning at age 50 while the American Cancer Society recommends yearly mammograms beginning at age 40.

* More or less stringent A1c values may be appropriate dependent on individual history, risk factors and length of disease, among other considerations.

Sources: American Diabetes Association, Standards of Medical Care in Diabetes, 2012 and the American Association of Clinical Endocrinologists Medical Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan, 2011

Notes: 1) Any application of these recommendations should be made in consideration of the needs, conditions and circumstances of each individual patient. 2) This flow sheet is included in the CMA Foundation’s Diabetes and Cardiovascular

Disease Provider Reference Guide (2nd ed.), 2011

Patient Goals

at age 50 while the American Cancer Society recommends yearly mammograms beginning at age 40.

Medical Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan, 2011

2) This flow sheet is included in the CMA Foundation’s Diabetes and Cardiovascular

In the News 7

I N S I D E T H I S I S S U E :

CMA Foundation Kicks Off New Project to Help Improve Diabetes Care in San Joaquin County

1

Thank You Daiichi Sankyo Incorporated

2

Diabetes Care

Guidelines Flow Sheet Updated 2

Diabetes Care Coordination: A Team Based Guide

3

Save the date: NEPO Summit 4

CMA Foundation’s Medical Student Community Leadership Grant Program

5

CMA Foundation is now on Facebook 6

Help us improve the health of California! Click here to donate.

A Newsletter of the Diabetes Quality Improvement Project

Help us improve the health of California! Click here to donate.

The Diabetes Dose

Volume 2 Issue 3 April/May 2012

CMA Foundation Kicks Off New Project to Help Physicians Improve Diabetes Care in San Joaquin County The California Medical Association (CMA) Foundation is pleased to announce a new project, Teaming Up for Healthy Hearts, which addresses the ongoing concerns with diabetes and cardiovascular disease in San Joaquin County. San Joaquin County has the 3rd highest diabetes-related mortality rate and the 4th highest mortality rate

attributed to coronary heart disease according to 2011 data from the California Department of Public Health. The CMA Foundation, the San Joaquin Medical Society and the California Diabetes Program have teamed up with several partners in efforts to reduce the burden of cardiovascular disease and improve outcomes among underserved patients with type 2 diabetes in the County.

Teaming Up for Healthy Hearts is a multi-year project that aims to strengthen the capacity of the care team to improve the delivery and management of diabetes care. The project encourages the formation of multidisciplinary teams based on existing, local resources to support patient self management efforts. Training and technical assistance will be provided to approximately 20 solo and small group practices that provide care to Medi-Cal patients. Physicians will be provided with opportunities for clinical education to improve adherence to diabetes standards of care. Medical assistants will receive training to assist physicians in the care of patients with diabetes. Finally, the project will identify and strengthen patient referrals to self-care services provided by certified diabetes educators, case managers, pharmacists and other care team members in the community.

For more information please contact, Julie Vedolla-Fuentes, Diabetes Coordinator, at [email protected]

The Diabetes Dose is a monthly newsletter of the CMA Foundation’s Diabetes Quality Improvement

Project. To receive the Daily Dose automatically every month, send us an email and include your first and last name, title, organization and email address to [email protected]


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Challenge: The ER physician verbally describes the wound and what is shown in the X-rays to the orthopedic surgeon. The orthopedist is unsure having just had a patient who lost his toe due to necrosis as a result of getting lost to follow-up. He must determine whether to accept the ER diagnosis or drive to the ER and see the patient in person.

Solution using DocBookMD: Due to his recent experience with a patient losing a toe, the orthopedist requests X-rays and photos of the wound be sent to him on his smartphone using the iPad that the ER had recently purchased for DocBook use. Within a few minutes, the orthopedist determines the wound was as reported by the ER physician and did not require that the patient be seen by the specialist.

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30 SAN JOAQUIN PHYSICIAN SUMMER 201230 SAN JOAQUIN PHYSICIAN SUMMER 2012

By Fran Cain l Information Technology Department NORCAL Mutual Insurance Company and the NORCAL Group

Have you considered introducing a wireless network to your practice? Commonly known as WiFi, which is a reference to the WiFi Alliance, wireless access to the Internet may be a boon for tech-savvy, iPad-toting patients waiting to be seen. Office staff may also benefit from a WiFi network. But before you install that wireless access point, or even if you already have, there are some risks to be aware of. >>

and you could be cutting your safety line

SUMMER 2012 SAN JOAQUIN PHYSICIAN 31SUMMER 2012

T H E G O O D : W I F I I S A G R E A T T O O L .With WiFi it becomes possible for physicians and other healthcare providers to operate a laptop or mobile device such as an iPad or smart phone from many locations without needing Ethernet cables. The result is untethered freedom to access the Internet or local network. In the home or office, it is inexpensive and easy to set up. WiFi is becoming a standard for Internet access at coffee shops, parks, hotels and airports. Public areas with WiFi are known as hotspots.

WiFi is fast compared to the stodgy cellular network. Your smartphone or iPad can tap into the home or office wireless router, or a local hotspot, to increase the speed of Internet browsing.

WiFi is convenient because most laptops and mobile devices, smartphones, and even printers come pre-equipped with wireless cards. In the home or office, Internet service from a provider such as Comcast or AT&T is required for Internet access. But there is no extra charge for adding WiFi, beyond the purchase price of the router.

Coffee shops, airports, etc., with hotspots may charge for WiFi access. Simply enter a credit card number at the prompt to log on for a specified time period, usually an hour or a day.

T H E B A D : W I F I C A N B E R I S K YHotspots are generally not encrypted. While connected to an unencrypted hotspot, your laptop or mobile device becomes relatively easy to hack. Therefore, protected health information and personal health records stored on the hard drive or transmitted over the WiFi connection can be accessed by intruders, as can such information as your credit card number. Similarly, WiFi in the home or office network which is not properly configured renders computers vulnerable to hacking and viruses.


T H E U G L Y : W H A T C A N H A P P E N I F Y O U A R E C O M P R O M I S E D

Free hacking tools are readily available to anyone desiring to compromise a WiFi connection. An ingenious hacker who has gained access to your computer might insert viruses such as trojans just because it’s possible. A hacker could make private, sensitive or legally protected information public, in the way the hackers known as Anonymous published confidential government papers. Or they can plant a key logger to collect keystrokes, transmit them to an overseas collection center, and pick out names, passwords, birth dates and credit card numbers. The data collected could then be used for identity theft against you, your employees, your patients, or other associates when sensitive information is shared electronically.

Eavesdropping, Denial of Service, and Man in the Middle attacks are common hacks. Eavesdropping could happen at the airport when you logon to the WiFi and someone sitting near you has tools to view your data. Even at home, a neighbor can access your data if your router is not secured. Denial of Service occurs when a hacker floods your connection with meaningless data making it impossible for you to access the network. A Man in the Middle can intercept communications and data flowing between the device being hacked and the intended destination. This can be very damaging if, for example, a credit card number is being transmitted.

W H A T Y O U N E E D T O K N O W T O P R O T E C T Y O U R S E L F A N D Y O U R P A T I E N T S

Start with the assumption that all WiFi connections are insecure. If you are using a public WiFi hotspot, avoid transmitting confidential data such as protected patient information, or credit card or Social Security numbers, across the Internet via a browser, unless you are sure the web site uses SSL, a secure tunnel that is established to encrypt data as it travels across the Internet. Always type the address to a website yourself instead of clicking on a link from another web page or email message. If you have a device such as an iPad or iPhone that supports SSL for email, be sure SSL is enabled in the device settings.

If you employ a technician or firm to install WiFi in your office or home, here are some pointers to use in discussing whether the configuration is secure.

R O U T E R C O N F I G U R A T I O N A N D S E T U P :Be sure that the router supports WPA2, the strongest encryption currently available. It will encrypt communications between the device (e.g., laptop) and the router.

Never use a router that relies only on WEP. If your router is old, replace it with one that uses WPA2.

Do not broadcast the SSID (name) of the wireless network.

Change the password of the router when you install it, and use a complex password. Don’t shortcut this step.

E A V E S D R O P P I N G , D E N I A L O F S E R V I C E , A N D M A N I N T H E M I D D L E A T T A C K S A R E C O M M O N H A C K S .

Risk Management > WiFi – The Good, the Bad, the Ugly


P R E M I E R L E V E L S P O N S O R S

Member Physicians and Spouse/Guest $35 per person Non-Members and Invited Guests $60 per person

You can register online through our website at www.SJCMS.org or by calling Jessica at the

San Joaquin Medical Society: (209) 952-5299

Annual Membership Dinner

Dr. Bryant B. Williams2012 Young Physician Award RecipientsDrs. Jerome M. and Susan B. McDonald

honoring our

2012 Lifetime Achievement Award Recipient

Please join us for the

G O L D L E V E L S P O N S O R S

S I LV E R L E V E L S P O N S O R S

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Sunday, June 24, 2012Cocktail Reception 6:00pm / Dinner 7:00pm


The longer the password, the harder it is to hack. A mix of 11 characters and numbers is a good rule of thumb.

Users who need to connect to the wireless router must be given a login name and password. Make the password hard to guess, and change it periodically.

If your home or business network can be accessed via the wireless router, use the Guest account for visitors to access only the Internet and prevent access to the business network where your data is stored.

If you have a very small network, consider using MAC filtering. A MAC address is a unique identifier for every piece of hardware. Locate the MAC address for each device connecting to the wireless network. Enter those specific addresses in the router’s MAC Filter. Then deny access to any device not listed. If you use dynamic (DHCP) IP address assignments, consider limiting the number available to the actual number of devices in use. You could also assign static IP addresses in a small office.

B E S T P R A C T I C E S F O R S E C U R I N G D A T AWhether or not you use WiFi, there are best practices for securing data: • In the office, institute formal written security policies on the handling of protected health information and update them annually or more often.

• Invest in security systems to monitor logs from firewalls, servers and routers for intrusions.• Keep computer operating systems updated monthly or more if necessary.• Use antivirus software and update it daily or more often.•Be aware of social engineers. These are imposters seeking to pry private information from you or your staff.• Use firewall software on all computers.• Use intrusion detection/prevention software or services.

This article is a high level overview of some of the risks involved in using wireless in the office. It is intended to raise awareness and not to be a comprehensive technical article. Additional technical detail is available from a variety of resources.

NORCAL Mutual Insurance Company provides extensive information to assist policyholders in understanding information security risks and formulating policies and procedures. Policyholders enjoy full access to state-specific information through the DataShield™ Learning Center, located in MyNORCAL, the policyholder-only section of HYPERLINK “http://www.norcalmutual.com” www.norcalmutual.com. For example, the learning center includes detailed sample policies which can easily be adapted to your practice, regular newsletters, up-to-date information on compliance, and training.

T H E L O N G E R T H E P A S S W O R D , T H E H A R D E R I T I S T O H A C K . A M I X O F 1 1 C H A R A C T E R S A N D N U M B E R S I S A G O O D R U L E O F T H U M B .

Risk Management > WiFi – The Good, the Bad, the Ugly


Pictured Above: AMR Cardiac ResponseTeam Members;Greg Garcia - EMT, FTO and

Brent Tindle - Paramedic, FTO

Combined with advanced medical and a quickresponse emergency staff, the San Joaquin CountyEmergency Medical Services Agency has namedDameron Hospital as a designated STEMI (heartattack) receiving center in San Joaquin County.A STEMI or (ST segment elevation myocardialinfarction) is a common type of heart attackcaused by a blocked coronary artery that can betreated through cardiac catheterization or clot bustingdrugs to restore blood flow to the heart. The longer ittakes for a patient to get treatment generally the worsethe outcome. Because of Dameron’s LifeLine Technologyand its cardiac prepared ER staff, emergency responseteams will automatically take patients suffering aSTEMI to Dameron Hospital.

Dameron Hospital cardiaceducation and preparedness results

in better lives for the residentsof San Joaquin County.


San Joaquin Medical Society’s website just got an upgrade……get the resources & help you need at SJCMS.org.


The all new website offers a

member only physician finder,

member resources, association

programs, up-to-date CMA

news, upcoming events, patient

resources and more. Make sure to

stop by and take a look around.

San Joaquin Medical Society’s website just got an upgrade…

www.sjcms.org

…get the resources & help you need at SJCMS.org.

SJCMS.org provides a member physician finder. Search by name,

specialty, zip code, and more.

Physician finder results provide you with info such as contact info, mapped

locations, and even photos.

Get info on all of your SJCMS member benefits plus your CMA

benefits at SJCMS.org.

Physician Magazine and archived issues are available online with the

SJCMS.org bookshelf.


IN THENEWS

Providing staff, physicians and patients with relevant & up to date information

ST. Joseph’s Auxiliary Members Recognized for Volunteer ServiceSt. Joseph’s Auxiliary recently honored 58 members for their volunteer service to St. Joseph’s Medical Center during an awards luncheon at Stockton Golf & Country Club. Service recognition levels ranged from 100 to 8,000 hours, and three members received service awards for 10 or 20 years of service. In 2011 alone, 115 Auxiliary members served 25,350 volunteer hours in 12 service areas, including three Information Desks, Gift Shop, Medical Library, Flower and Coffee Delivery, Fundraising, Welcome to Life, Radiology Transport, Doctor’s Conference and Sewing. Through its volunteer efforts, the Auxiliary donated $97,000 to the Medical Center last year.

“It is so rewarding to truly help someone. The genuine appreciation from those I help keeps me coming back,” said Escort and Information volunteer, Linda Acton.

Honored for their years of volunteer service are: 20 years – Helen Hori, Jim Shuck; 10 years - Andrea Helchinger. Due to their history of extraordinary service, three members were granted honorary lifetime membership including: Marion Carlson, Peggy Johnson and Aileen Maderos.

Members honored for hours of service include: 8,000 hours – Aileen Maderos and Wilma Romero; 7,000 hours – Jim Shuck; 5,500 hours – Joy Clem; 5,000 hours – Patti Hogue; 4,500 hours – Tess Aberle and Rick Tipton; 4,000 hours – Betty Marino and Grace Nishimura; 3,500 hours - Bill Adams and Joan Sternecker; 3,000 hours – Susan Mah, Judy Mullins and Marlene Selna; 2,500 hours – Mary Minard; 2,000 hours – Louise Andermahr, Norma DePauli, Joan Franco and Judy Torre; 1,500 hours – Judy Bonfilio, Donna Goyette, JoAnn Henderson, Pat McMillan, Judy Rafert and Harumi Tanaka; 1,000 hours – Linda Acton, Kay Cole, Virginia Fortuny, Leonard Gonzalez and Mary Jane Tisher; 750 hours – Mary Anderson, Helen Click and Marie Shane; 500 hours – Michele Cortez Gallego, Don Knudsen, Bill Service and Ron Stock; 250 hours – Linda Biancalana, Judy Canclini, Sharon Chinchiolo, Rose Coronado, Linda Dillon, Pat Gustorf, Rosie Jimenez, Joan Mattheisen, Toni Mussi, Eleanor Oto, Barbara Pereira, Maria Phillips, Kate Williams and Michele Zaragoza; 100 hours – Kathy Baba, Shannon DeJesus, Carmen Eversman, Mary Lou McMillan and Mary Pennini.

The Auxiliary, founded in 1957, provides important volunteer services to patients, families and visitors throughout the Medical Center. For more information about how to make a difference by helping others at St. Joseph’s Medical Center, call 467-6527, visit StJosephsCares.org, or e-mail the volunteer office at [email protected].

Sutter Gould Medical Foundation Receives Visit from Healthcare Value NetworkFor over 64 years, Gould Medical Group physicians at the Sutter Gould Medical Foundation (SGMF) have been providing health care for Central Valley residents. During that time, there have been multiple methods for evaluating and improving the services provided, making Gould and SGMF one of the leading health care providers in the area. For the past two years, SGMF has been on a new journey – to improve their patient care practices in a unique way – applying lean principles of continuous improvement and process redesign. These practices have produced remarkable quality and productivity improvements for North American manufacturers over the last 30 years, but are relatively new to the health care industry. SGMF has named this patient-centric, lean management system the “Gould Practice System.”

Due to successful outcomes from these lean process improvements, SGMF (part of the Sutter Health network) was selected to host a two-day site visit for the Healthcare Value Network (HVN), March 15 and 16. The HVN is made up of health care organizations from across North America all of which are on a lean journey. The visit involved structured learning and interaction at the work site or “gemba” (a Japanese term for the place where the work is actually done).

“Our visitors gained a better understanding of the importance of lean practices and how they improve SGMF performance,” said Paul DeChant, MD, Sutter Gould’s chief executive officer. “We showed how we have enhanced our patient experience by enabling a culture of front-line problem solving, working on projects to reduce wait times for laboratory draws and to standardize and simplify our exam rooms so our staff can better and more effectively care for patients during appointments. We are constantly looking for ways to involve everyone in our organization to help systematically identify and eliminate waste in all of our care processes.”

in the news


Sound Physicians Enters Partnership to Provide Hospitalist Services at Dameron HospitalLeading Hospitalist Organization Focuses on Improving Quality and Reducing Cost of Inpatient CareSound Physicians, a leading hospitalist organization focused on driving improvements in quality, satisfaction and financial performance of inpatient healthcare delivery, announced today an agreement to provide hospitalist services at Dameron Hospital in Stockton, Calif.

The team of hospitalists at Dameron Hospital will join Sound’s 60 hospitalist physicians and partners serving patients in Northern, Central and Southern California for more than five years.

“We look forward to serving patients and community providers at Dameron Hospital,” said Robert Bessler M.D., chief executive officer of Sound Physicians. “We have had a long-standing practice of making a meaningful difference in the communities we serve with our hospitalist teams. We’re excited to begin a collaborative partnership with Dameron Hospital and provide high quality, patient-centered care to patients in the Stockton community.”

Nick Arismendi, Chief Operating Officer at Dameron Hospital, stated “Sound Physicians is a proven partner with a track record of delivering exceptional patient care. We welcome them to our community and our team at Dameron.”

Working with Dameron Hospital’s leadership team, Sound Physicians will introduce its SoundConnect™ workf low and informatics platform and processes to drive improvements in inpatient care outcomes, as well as financial performance. Sound Physicians will also apply its expertise in building high-performing hospital practices, including strong physician leadership, revenue cycle management and a track record of physician recruiting success.

About Sound PhysiciansSound Physicians is a leading hospitalist

organization focused on driving improvements in quality, satisfaction and efficiency of inpatient health care delivery. By investing deeply in outstanding

physicians, clinical process excellence and its proprietary workf low and informatics technology, Sound Physicians improves the delivery of inpatient care. Sound Physicians aligns with healthcare providers to measurably enhance patient outcomes and strengthen its partners’ financial performance. The organization is the practice of choice of more than 500 hospitalist and post-acute physicians. To learn more visit: www.soundphysicians.com

Dr. Prasad Dighe to Serve as St. Joseph’s Medical Staff ChiefStockton hematologist-oncologist Prasad Dighe, MD, has been appointed St. Joseph’s Chief of Staff for 2012. In this position, he is responsible for leading the medical staff, which meets to review patient care and safety issues and set policy for the medical care provided at the medical center.

“It is an honor to serve as Chief of Staff at St. Joseph’s Medical Center,” said Dr. Dighe. “St. Joseph’s is a leader in promoting good health in San Joaquin County. I look forward to ongoing opportunities to enhance our leadership in heart and cancer care, as well as our collaboration with the greater Stockton community.”

Dr. Dighe completed college and his medical education at the M.S. University in Baroda, India. He completed his residency in internal medicine and a fellowship in hematology/oncology at St. Francis Hospital in Evanston, Illinois. Practicing at St. Joseph’s Medical Center since 1981, Dr. Dighe is also board certified by the Diplomat American Board of Internal Medicine.

Dr. Dighe is a member of the San Joaquin Medical Society, the California Medical Association, the Association of Northern California Oncologists and the American Society of Clinical Oncology.

The Medical Staff works in partnership

with hospital leaders to ensure continued growth and expansion of current services in addition to overseeing the development of future services through the clinical research and development program at St. Joseph’s. The Medical Staff also works with the hospital to ensure there are a sufficient number of physicians – both primary care and specialists – to serve the Stockton community.

Officers for 2012 include David Jensen, M.D., past chief of staff; Michael Herrera, M.D., chief of staff-elect; Raghunath Reddy, M.D., secretary; Purushottama Sagireddy, M.D. and Alan Kawaguchi, M.D., members at large to the Executive Committee; Timothy Bechtel, M.D., member at large to the Emergency Department; and Amrik Sidhu, M.D., member at large to the Medicine Department. Department chairs are Robert Stump, M.D., Anesthesia; George Charos, M.D., Cardiovascular; Daniel Terry, M.D., Diagnostic Imaging and Radiology; Michael Herrera, D.O., Emergency Medicine; Venkata Emani,

Dr. Prasad Dighe


M.D., Internal/Family Medicine; Kevin Rine, M.D., Obstetrics and Gynecology; Stephen Connolly, M.D., Pathology; Steven Billigmeier, M.D., Pediatrics; and Charles Johnson, M.D., Surgery.

St. Joseph’s Receives Prestigious STEMI Center Designation for Heart Attack Emergencies St. Joseph’s Medical Center has been awarded STEMI Center Designation from San Joaquin County Emergency Medical Services for meeting or exceeding national standards in diagnosing and treating heart attacks. This prestigious designation means that St. Joseph’s Medical Center is specially equipped and trained to care for patients experiencing an ST-elevated myocardial infarction (STEMI) heart attack, which is caused by a sudden, total blockage of a coronary artery.

The St. Joseph’s STEMI Team is a collective group of staff and physicians in the Emergency Department and Cardiac Catheterization (Cath) Lab, and they have created a process to immediately alert all necessary medical professionals to the needs of these heart attack patients, rapidly transporting them to the cath lab for

definitive heart muscle-saving treatment.

“St. Joseph’s has always been at the forefront of technological advances

and cardiac patient care,” says Michael R. Ricks, Chief Operating Officer, St. Joseph’s Medical Center. “This designation

recognizes our commitment to excellent patient care and quality outcomes. We are pleased to offer more heart attack patients this life-saving treatment.”

While the national standard to open a blocked artery (a.k.a. door-to-balloon time) is 90-minutes, St. Joseph’s targets 65 minutes or less, and has a best ever time of 28 minutes. 90 minute door-to-balloon time is one of the many guidelines established by the American College of Cardiology in order to earn a STEMI designation title. Other requirements include licensure as

a cardiac catheterization laboratory, availability of a communication system for notification of appropriate personnel of an incoming STEMI patient - a dedicated team of cardiologists, cath lab staff, emergency department physicians and skilled clinical staff who within moments of STEMI notification are readily available to the incoming patient.

St. Joseph’s Partnering with St. Jude Medical to Expand Cardiac CapabilitiesElectrophysiology (EP) is a specialized branch of cardiology in which extremely complex heart rhythm disturbances may be diagnosed and treated. In January, St. Joseph’s began a year-long partnership with St. Jude Medical in an electrophysiology training program specifically for educating physicians on the safe and effective patient

practices for placement of implantable cardiac devices. California-licensed physicians will train on leading edge St. Jude Medical technologies with Walter Chien,

IN THENEWS

in the news

Mock Stemi


MD, and James Morrissey, MD, in the St. Joseph’s/St. Jude Medical program.

“An EP study can diagnose complex arrhythmias and help us plan treatment options. These would include medical therapy, ablation, or device implantation,” said Walter Chien, MD, Board Certified Electrophysiologist.

Over the past three years, board certified electrophysiologists at St. Joseph’s Medical Center have implanted over 400 Automatic Implantable Cardiac Defibrillators (AICD), which are electronic devices used to treat severe abnormal rapid heart rhythms. There is a need for new therapies for heart patients, and St. Joseph’s is proud to be able to provide this advanced level of care and utilize the innovative product portfolio from St. Jude Medical.

St. Joseph’s Medical Center has been chosen as a training center due to the expertise and knowledge of its physicians. Drs. Chien and Morrissey have been chosen as mentors for the program based on their eagerness to share their knowledge and proctor other physicians in the safe and effective use of implantable devices. After completing the training, visiting physicians will be able to perform these procedures at their home facilities.

“St. Joseph’s is honored to have been chosen as a partner in this program, which promotes the positive impact of EP services in helping to improve local cardiac patient care,” said Joann Marks, RN, Cardiovascular Service Line Leader, St. Joseph’s Medical Center. “This training will allow more physicians to implant devices for the needing population in areas where there are currently only a few specialists.”

Dameron’s Emergency Room Earns Cardiac Care Receiving Center Designation. Dameron Hospital has been approved by County Emergency Medical Services, and the State of California

to apply as a Designated STEMI Receiving Center. STEMI is an acronym for a severe type of heart attack. Key conditions of earning the right to apply is having an emergency room that has demonstrated the ability to save lives through speed and accurate stabilization of cardiac incidents. Dameron’s emergency cardiac care has been measured from the field to a hospital bed. The Hospital has worked diligently to have processes in place for rapid treatment and intervention for lethal heart attacks within the community of Stockton. The hospital’s emergency department has cardiac ER physicians combined with a skilled nursing staff specifically trained to deal with dangerous STEMI type conditions. Dameron has also teamed with local ambulance service AMR to dramatically improve cardiac response with its new mobile LifeLine Technology. LifeLine is an emergency communication system that connects paramedics in the field with a reviewing physician located at Dameron Hospital’s emergency department. This new communication translates to critical timesaving analysis during transport.

The designation process for receiving the Designated Receiving Center designation requires a two to three year history of efficiency. Strict requirements must be met prior to a hospital’s emergency department gains the right to have an application placed with local and state agencies.

What is commonly referred in hospital emergency departments as a STEMI is when the coronary artery is completely blocked off by a blood clot, and as a result, virtually all of the heart muscle being supplied by the affected artery starts to die. This type of heart attack is the more serious type because of the large amount of heart muscle being damaged. Earning the application process, Dameron’s emergency department has demonstrated the speed and accuracy to vastly improve a patient’s chances of surviving a serious

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STEMI. One key element is the quickness of the Dameron team, which translates to a patient’s chance of surviving with as little coronary muscle loss as possible.

“Local residents can feel more secure knowing that Dameron Hospital is staffed

and prepared for emergency cardiac care with the most modern state-of-the-art response procedures.”,

says Cheri Shirey R.N. Director of Emergency Services. “This puts Dameron on a par with any major-market hospital in the Nation”.

Diego Ferro M.D. opens new medical office at 420 West Acacia Street, across from Dameron Hospital.Dr. Diego Ferro is a board certified, internal medicine, physician specializing in serving both the English and Spanish language residents of San Joaquin County. Fluent in Latin American language and culture, Dr. Ferro plans to assist both physicians and residents in need of bringing modern healthcare to under served segments of the County. Diego was born in Colombia and grew up in Southern California and moved to New York to attend Saint Johns University to study biology. Dr. Ferro returned to Colombia to finish his medical education and then returned to California for a

preliminary residency position at King/Drew hospital in Los Angeles in the Internal Medicine Program. As Dr. Ferro states: “To my advantage the program went through some difficult times and closed down and all the residency programs were distributed to other programs and I was sent to USC General where I finished my preliminary year taking advantage of all of their educational resources. The other good thing about it was that it was also located in an under served population area of LA and took care of a major Hispanic patient population. This is where I started noticing that my bilingual proficiency was greatly appreciated and that it made a great difference in patient outcomes.” Dr. Ferro moved to Stockton in 2007 where he joined the Internal Medicine program at San Joaquin General Hospital where he completed his categorical residency.

Dr. Ferro currently sees patients at Dameron Hospital’s Employee medical Clinic. Dr. Ferro’s new Internal Medicine office is located at 420 West Acacia Suite #6. His office phone is Ph: (209) 944-5472 and Fax: (209) 944-5478. Dr. Ferro is actively seeking new patients and cooperative relationships with local physicians.

IN THENEWS

in the news

HAVE SOMETHING TO SHARE? We welcome submissions to our In-the-News Section from our community healthcare partners. We prefer Word files and .jpg images and may edit for space restrictions. Send your files to

[email protected] one month prior to publication (Aug 1 for the Fall issue, Nov 1 for the Winter issue, Feb 1 for our 2013 Spring issue and May 1 for our 2013 Summer issue).

Dr. Ferro


At its annual meeting, Wed., Apr. 25, members of the LMH Association and their guests celebrated the hospital’s 60th birthday at Wine & Roses. The association is the “owner” of the hospital, and membership is open to all. Each year at its annual meeting, reports are provided by board chair Cecil Dillon and LMH President and CEO Joe Harrington on LMH accomplishments and plans for the future.

Results of the board’s annual election were announced.Re-elected were Liz Aguire, Galt’s city clerk and public information

officer; Steve Crabtree, attorney at Herum Crabtree; Bill Cummins, pastor of Bear Creek Church; and Christeen Ferree, administrative-services and human resources director at the Port of Stockton. Newly elected to the board were Pat Patrick, executive director of the Lodi Chamber of Commerce; and Mona Shulman, vice president and general counsel at Pacific Coast Producers.

Because it was the hospital’s 60th birthday, this particular meeting took on a different look. Community members whose lives are intertwined with the hospital spoke and reported on hospital milestones and activities. They also paid tributes to the hospital, its boards and staffs.

Tom Moffitt, gift-shop volunteer, reported that in a few short weeks he is off to medical school. He hopes to serve in the U.S. military as a physician once he completes his training. He thanked the hospital for the learning experiences and, in particular, Michael Catz, MD, and the surgery staff for allowing him to shadow them and sit in on surgeries. Tom also thanked Richard Yee, DO, a family

medicine practitioner, for allowing Tom to shadow him. Tom reported that since the volunteer program began in 1968, volunteers have donated 653,892 hours of service to LMH.

Soon-to-be UC Berkeley graduate Ashley Bedi wants to be a pediatrician. She was born at LMH, her mom, Monique Bedi, RN, has spent her career at the hospital, and Ashley spent her high-school years volunteering at LMH.

Her favorite spot was the Walter E. Reiss Outreach Clinic.

Ashley’s degree is in integrative biology and global poverty and practice. After her May graduation, Ashley

will head to India for the summer to work on a health organization’s mobile van serving rural communities without access to care. She’ll also be applying to medical schools. Ashley thanked the LMH Foundation for their support of her education with a scholarship. She noted that since its inception in 1980, the foundation has directed $19 million to LMH for capital projects. Just last year, their contribution was $611,000.

Up third was a woman whose young birth mother presented herself to the LMH ED in 1979. The young mother delivered a daughter, and then determined it was best to allow her daughter to be adopted. Then serendipity took over.

Because the young mom delivered at LMH, the evening’s speaker was adopted by the physician who delivered her – Ken Mullen, MD. Dr. Mullen was on call for Dr. McFarlane and was jogging when he got the call to handle the delivery.

Kimberly Mullen then told of her loving and exceptional life in the Mullen clan. She is the beloved granddaughter of the late Robert Mullen, one of the hospital’s founders, and the daughter of recently retired schoolteacher Nancy Mullen.

Kimberly went on to become partner to Bryan and mother to Jackson.

Together she and Bryan own, publish and edit Herlife Magazine, a women’s magazine for the Central Valley.

Kimberly reported that since its first day, Mar. 30, 1952, LMH has admitted 305,189 patients and delivered 47,040 newborns. She counts herself among the luckiest of those deliveries.

Lodi Memorial Hospital celebrates 60 years of care

Ken Mullen, MD, Nancy Mullen, Kimberly Mullen and Bryan Smith

44 SAN JOAQUIN PHYSICIAN SUMMER 201244 SAN JOAQUIN PHYSICIAN SUMMER 2012

2012 Lifetime Achievement Award


Inside his Stockton home, Bryant Williams, M.D. thumbs through a mountain of memories.Here, the retired pediatrician who has spent the past 50 years providing care to three generations of Stockton residents sifts through a stack of photos that could easily be mistaken for a “who’s who” for the bustling delta community.

Occasionally, Williams will stop to comment on a particular image, one of the many strewn across the table before him.

He pauses, briefly, to point out patients who had been carried through the doors of his South Madison Street office for their newborn care and then, roughly two decades later, walked in on their own for a pre-college physical. Several of the images in Williams’ stack capture mothers proudly clutching their newborn children.

For f ive decades, Dr. Bryant Wil l iams served as one of Stockton’s most honored and trusted pediatricians. For f ive decades, Dr. Bryant Wil l iams served as one of

YEARS, THOUSANDS OFPATIENTS

By James Noonan


Recalling names and family histories with the greatest of ease, Williams happily points out that he had administered childhood checkups to both the mother and her child over the course of his long career. He stops momentarily on another photo, pointing his finger toward a man named Matt. Decades ago, Williams performed the care for Matt on the day he was born. It wasn’t long ago, Williams recalls with a chuckle, that Matt, now a practicing anesthesiologist, sought Williams out to introduce his former pediatrician to his new fiancé. “I didn’t know a single person when I first got here,” Williams said. “I ended up knowing

thousands.” It might be difficult to imagine a time when Williams, who over the course of his career, became so in tune with the Stockton community that he was once immortalized in the comic section of the local paper, was a stranger in the city he now calls home. Before 1960 however, Stockton was just another name on the map for Williams. Originally from San Antonio, Williams attended Meharry Medical College, a historically black institution in Nashville, Tenn. After wrapping up his time in medical school, Williams and his wife Janice moved to Oakland, where he completed his pediatrics residency. When a colleague suggested that Williams set up shop in Stockton and join his practice, the reaction, he recalls, was as straightforward as they come. “Where in the heck is Stockton?,” he asked at the time. “I had never heard of it.” Upon arriving, however, Williams sensed the fit immediately. Coming to a community like Stockton, which at the time possessed only six “extremely overworked” pediatricians, meant immersing himself in the sort of underserved area that his medical education and residency experience had encouraged him to seek out.

Inspired by the prospect, Williams set down roots in the community he would go on to serve for the next 50 years. It wasn’t overnight, however, that “Dr. Williams” became a household name in Stockton’s medical world. For his first few years in the community, Williams worked part time with the San Joaquin County Public Health Department to help acquaint himself with his new home. “The world didn’t exactly beat a path to my door when I first got here,” he said. “I had to introduce myself to the community.” It was his work with the county’s public health department that would eventually lead to Williams’ involvement with the “Su Salud”

community health clinic, an effort that would annually provide care and health screenings to thousands of county residents lacking access to reliable care. Glancing at a

poster advertising Su Salud’s success that dates back to the mid-1970s, one that happened to prominently feature a photograph of Williams providing care to one of the county’s many farm workers, he proudly recalls the years of good work put forward by the physicians behind the effort. The advertisement, on the other hand, wasn’t defended as readily. “I don’t know who thought it wouldn’t be a good idea to make me the poster boy that year,” he jokes. In addition to his work with the county’s public health department, much of Williams’ introduction to the Stockton community came after he was asked to serve as the team physician for Edison High School. For a self-admitted football fanatic who was raised in the heart of Texas, the opportunity to help serve young athletes while immersing himself in the competitive spirit of high school athletics was one too good to pass up. “That high school produced some tremendous athletes,” he said, adding that over the years he would find himself “vicariously coaching” and getting wrapped up in the emotions of the game. “I’d be heading out to celebrate a victory and my wife would say ‘O.K., coach,’” Williams

Dr. Bryant worked tirelessly for so many years taking care of his pediatric patients in South Stockton. Over the many years he cared for , loved and motivated so many of his patients who eventually contributed to society as Teachers, Doctors, Attorney’s and many other professions. His patients became parents and even grandparents and brought their beloved offsprings to him because they trusted him to care for them .” - Dr. George Khoury



CMA Center for Economic Services

Photo Caption: Color photosDr. Williams with some of his patients.Black and white photos: Dr. Williams in his earlier years with schoolmates and with his mother as child


chuckled. “She was calling me coach.” His role at Edison embedded Williams in the Stockton community in a way that some physicians can spend an entire career trying to match. As the years went on, generation after generation began to turn to him for care. “They became patients, and their children became patients and their children’s children became patients,” he said. “That’s just the way it went.” In addition to becoming parents themselves, Williams’ patients went on to become doctors, lawyers, soldiers and a variety of other professions that continue to make their childhood physician beam with pride. “My patients have done all sorts of things in life – teachers, physicians, attorneys, the whole gambit,” he said. “I’ve always been very proud to see these people evolve and grow over the years.” Within this pride, however, is also rooted a deep sense of humility, as Williams will be the first to admit that his role was but a small piece of the overall development of the men and women for whom he cared. “I don’t want to imply that I take credit for any of that, because I don’t,” he adds. While he’ll never shoulder responsibility for the accomplishments of his many patients, the idea of watching young children develop into successful members of society was part of the reason Williams embarked on a career as a pediatrician to begin with. “People like to say that children are our future,” he said. “I always looked at this as me putting a down payment on my own future.” Having the benefit of Williams’ 50-year career as a physician to look back on, it seems natural to think that the man who touched and helped shape so many lives was destined to assume a role in medicine. When he was young, however, a career in medicine was far from a guarantee. “Before I got to high school, my mind was on just about anything other than academics,” Williams quipped. After leaving junior high, Williams’ surroundings changed rapidly. He was entering high school at the same time that many veterans of the Second World War were returning home. Taking advantage of

the newly-penned GI Bill, many of these veterans were seeking an education at the university level, while others, who had left high school prematurely to join the war effort, were suddenly sharing a classroom with Williams. “When I got to high school, I was intimidated. These guys were disciplined and real sophisticated.” he said. “By the time I got to college, most of my classmates were veterans.” Adding to the challenges Williams faced early on was the fact that the Texas neighborhood in which he was raised, as well as much of the southern half of the country, was segregated during his youth. Despite this fact, Williams said he found the means, and people, to help him f lourish. “Even in spite of that, there were so many people who came into my life and inspired me,” he said. “Over the years, I can say I’ve learned one thing, and that’s to keep the faith, work hard and let the chips fall where they may.” While this simple axiom may have been an early breakthrough in Williams’ worldly education, it was far from the only piece of wisdom he would pick up over his long and fruitful career. Looking back, he’s quick to think of advice he would offer to young physicians just now cutting their teeth in the field of medicine. “It’s hard work,” he said. “Pediatrics, and not just pediatrics but medicine as a whole, is hard work.” For young physicians, after spending years tuning their minds through school and the arduous residency process, one of the most difficult aspects of the profession to learn is also perhaps one of the most important to have, Williams added. “Humility,” he said. “There’s is no place for egos in this profession, I’ll tell you that much.” Over the course of his career, Williams learned that other decision makers within the medical profession were just as passionate about what they did as even the most enthusiastic and experienced physician. In some cases, he added, successful care would be impossible without them. One such example occurred years into Williams career, when he found himself, a

“People l ike to say that children are our future, I always looked at this as me putting a down payment on my own future.” - Dr. Bryant Wil l iams



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pediatrician, to be the only doctor passing through an OB/GYN ward when a familiar call went out. “Is there a doctor on the f loor?,” he recalls hearing, answering with a slight bit of anxiety that he was, indeed, nearby. It having been years since he last staffed an OB/GYN ward during his residency, Williams instinctually approached the patient and prepared to ask some basic questions to assess the situation. Almost immediately, a nurse who was more

in tune with the rigors and routine of an OB/GYN ward chided Williams for his approach. “Doctor! she cried, “This end,” directing Williams toward the soon-to-be-crowning child. “You see, doctors aren’t always the ones calling the shots,” Williams joked after recalling the situation. While some scenarios can inspire laughter years after the fact, Williams notes that this type of adaptability is a very serious requirement for anyone hoping to be a

successful physician. “Every patient is different,” he said. “Just because one is successful with one patient doesn’t mean he’ll be successful with every patient.” It was perhaps this adaptability and willingness to provide personalized care that made Williams exactly the type of physician that would become synonymous with the term “doctor” in the hearts and minds of generations of Stockton residents. In fact, for a large portion of many Stockton residents’ lives, Williams was the only doctor they had ever known, and the only one they could think to turn to when it came time to find care for their own children. It was that bond that made the decision to retire so difficult on Williams, as well as the thousands of community members that had come to him for care over the decades. “For some of my patients it was almost traumatic,” he said, adding that, although he would sometimes do his best not show it, the transition was equally difficult on him. In the final days before closing up shop, however, the emotions began to spring forth. “I’d go into a room to see a patient and they would start bawling. Then I would start bawling,’” he said. “Eventually I’d clean up and head to the next room, where it would happen all over again.” Since finally closing the doors of his office back in 2010, life has changed for Williams. His days are no longer filled by the demands of providing regular checkups, hunting down medical records or managing the day-to-day operations of solo practice. The transition, he admits, has been a difficult one. “I still miss the activity,” he said. “I’m just happy to have been able to do it at all.” While the South Madison Street office may no longer be providing care, the generations of Stockton residents who looked there for their medical needs will likely always view Williams as their doctor, despite the fact that the 82-year-old is now well into his retirement. Likewise, judging from the way he carefully sifts through the mountain of photos while rattling off memories and anecdotes with an ear-to-ear grin, for Williams, these members of the Stockton community will forever be thought of as his patients.



20 TO 40 POINTSYou are doing well.

41 TO 60 POINTSYou are okay if you take preventative action.

61 TO 80 POINTSYou are a candidate for burn-out.

81 TO 100 POINTSYou are burning out.

I feel tired ___________________________________ My job performance is not up to par ______________I only feel dissatisfied _________________________ I use alcohol and drugs to feel better ______________I feel sad for no apparent reason _________________ Communicating with others is a strain _____________I’m forgetful _________________________________ I can’t concentrate ____________________________I’m irritable and snap at people __________________ I’m easy bored _______________________________

I’m withdrawn _______________________________ I work hard but accomplish little _________________I have trouble sleeping _________________________ I feel frustrated _______________________________I get sick a lot ________________________________ I don’t like going to work _______________________My attitude regarding work is “why bother?” ________Social activities are draining ____________________I get into conflicts with others ___________________ Sex is not worth the effort ______________________

1 Rarely 2 Sometimes 3 Frequently 4 Usually True

1. Take a vacation or mini-breaks.2. Learn to leave the office work behind.3. Maintain a perspective.4. Use humor. 5. Indulge in yourself-- watch TV, take short trip, have a message, etc. 6. Don’t sweat the small stuff. 7. Learn to delegate tasks and responsibilities.

8. Make some time and spoil yourself.9. Close your eyes, relax, and visualize pleasant scenery like the beach, ocean, etc. 10. Engage in exercise-- like tennis, gym, or walking. 11. Think of setbacks as challenges. 12. Maintain a positive attitude.13. Eat a balance diet.

14. Stay away from alcohol and drugs. 15. Always take time to have fun.16. Learn a technique to lower your frustration such as transcendental meditation, yoga, etc.17. Seek counseling and psychotherapy. 18. Balance work and family.19. Start a new hobby.

There is a Physicians’ Confidential Line available 24 hours a day at (650) 756-7787. www.cmanet.org/resources/confidential-assistance

SOLUTIONS TO BURN-OUT

Mood swingsAnxietyAnger and

resentmentIrritableExcessive use of

nicotine DepressionOversensitive

Overuse of alcohol and illicit drugsPoor concentration

EMOTIONAL SYMPTOMS


2012 Education Series

APRIL 18JUNE

-JUL

Y

APRIL 18JUNE

-JUL

Y

APRIL 18

JUNE 7

JUNE 20

June 6: A Manager’s Guide to Lowering Practice CostsDebra Phairas • 12:15 – 1:15 p.m.There are only three ways to realize increased net income: raise fees, increase productivity or decrease overhead. With managed care, and particularly capitation, increased fees are difficult to achieve. The doctor may already be working at maximum capacity, so increased productivity may not be an option. In many areas of California, practices have higher overhead costs than national norms. The only way to assure profitability is to control and reduce overhead expenses.

June 7: California Workers’ Comp eBill Part 4: First-Time SubmissionJopari Solutions & CA Division of Workers Comp • 12:15 – 1:45 p.m.Part 4 of an extended 4-part California eBill Webinar Educational Series. Learn how physician practices can experience increased success in sending workers’ compensation eBills and attachments correctly the first time, by understanding common reasons for eBill rejections. This webinar is free to all attendees.

June 13: CMA and the Courts/Accessing CMA’s Legal LibraryCMA Center for Legal Affairs • 12:15 – 1:15 p.m.Learn about CMA’s role in important litigation in California and nationwide, and learn how to navigate CMA’s health law library. The Legal hotline staff will provide an overview of the wide array of topics covered CMA’s online library.

June 20: Writing Effective AppealsMary Jean Sage • 12:15 – 1:15 p.m.It is inevitable that occasionally some of your insurance claims will be denied or your reimbursement will be whittled down significantly. The appeals process will require you to make explanations, submit documentation and follow up with additional information as requested. A proper appeal will either get a denial reversed or give you exact reasons as to why the claim was denied. Knowing how to write a effective appeal letter that will get positive results from the insurance company is an essential part of any medical practice.

July 11: 2012 Legislative UpdateCMA Center for Government Relations • 12:15 – 1:15 p.m.This webinar will provide physicians and their staff with the latest information on the bills that made their way through the State Legislature this year. Topics being discussed include immunizations, children’s health, physical therapists, physician health and more. This webinar is free to all attendees.

JUNE 13

JUNE 6

JULY 11


AUGUST-NOVEMBER

The above webinars are being hosted by the California Medical Association. Please register at www.cmanet.org/events. Once your registration has been approved, you will be sent an email confirmation with details on how to join the webinar. Questions? Call the CMA Member Help Line at (800)786-4262.

Please note that this calendar does not include CMA’s ICD-10 training courses to be offered in 2012.

July 18: Preparing for a Medicare and/or Medi-Cal AuditMary Jean Sage • 12:15 – 1:15 p.m.All third-party payers, including government health plans, have stepped up their audit activity. It is no longer a matter of “if” you go through an audit, but “when” you are selected for an audit. It is always preferential to be prepared.

Aug. 1: Coding for Medical NecessityArthur Lurvey, M.D. • 12:15 – 1:15 p.m.Medicare and private payers all recognize medical necessity as a deciding factor for claims payment and it is important that all practices know the rules.

Aug. 15: Program Integrity in Medicare and Medi-Cal – The Physician’s RoleBruce Tarzy, M.D. • 12:15 – 1:15 p.m.This session provides physicians with information about the risks of becoming a victim of fraud and how to take preventive action. It also covers compliance with Medicare and Medi-Cal documentation requirements.

Aug. 16: California Workers’ Comp eBill Part 1: Are You Ready?Jopari Solutions & CA Division of Workers Comp • 12:15 – 1:45 p.m.Part 1 of an extended 4-part California eBill Webinar Educational Series. This webinar will provide you with an overview of what eBill is, how it works, and the benefits and tools to help you evaluate your practice’s eBill readiness. This webinar is free to all attendees.

Aug. 23: California Workers’ Comp eBill Part 2: ImplementationJopari Solutions & CA Division of Workers Comp • 12:15 – 1:45 p.m.Part 2 of an extended 4-part California eBill Webinar Educational Series. This webinar will provide an overview of the eBill compliance requirements

and focus on electronic claims and attachment submission requirements including acknowledgement transactions. This webinar is free to all attendees.

Aug. 30: California Workers’ Comp eBill Part 3: Understanding Remittance Advice RulesJopari Solutions & CA Division of Workers Comp • 12:15 – 1:45 p.m.Part 3 of an extended 4-part California eBill Webinar Educational Series. This session will provide an overview of the eBill electronic remittance advice rules and how to use these rule as a tool to help automate your back office workflow processes. This webinar is free to all attendees.

Sept. 5: A Guide to Reviewing Payor ContractsKris Marck • 12:15 – 1:15 p.m.Kris Marck from CMA’s Center for Economic Resources will offer you tips to maximize success in negotiating with a high-level review on contract terms and provisions. She will identify top provisions practices should be aware of prior to signing or renewing an agreement, because a contract is so much more than just reimbursement rates.

Sept. 6: California Workers’ Comp eBill Part 4: First-Time SubmissionJopari Solutions & CA Division of Workers Comp • 12:15 – 1:45 p.m.Part 4 of an extended 4-part California eBill Webinar Educational Series. Learn how physician practices can experience increased success in sending workers’ compensation eBills and attachments correctly the first time, by understanding common reasons for eBill rejections. This webinar is free to all attendees.

Sept. 19: Creating and Implementing Financial and Office PoliciesDebra Phairas • 12:15 – 1:15 p.m.In the medical office, office policies and procedures are handed down verbally

from one staff person to another. Inevitably, important elements of policies are lost in translation. Creating written financial and office policies and procedures help staff learn their jobs faster, with greater accuracy, and relieves physician and manager frustration!

Oct. 3: Protect Your Practice From Payor AbuseMark Lane • 12:15 – 1:15 p.m.CMA sponsored legislation (AB 1455 - The Health Care Provider Bill of Rights) includes many protections against unfair payment practices by health plans and insurers. Mark Lane from CMA’s Center for Economic Resources will discuss important California laws that protect physicians and their practices from payor abuse.

Oct. 17: Establishing Expectations for High Performance from Medical StaffDebra Phairas • 12:15 – 1:15 p.m.Superstar staff members are made, not born. Staff usually rise to the owner or manager’s level of expectations. This webinar will teach physicians/managers how to set high expectations for performance, create monitoring tools to evaluate and reward staff who achieve stellar performance.

Nov. 7: Understanding ARC and CARC Revenue CodesDavid Ginsberg • 12:15 – 1:15 p.m.The use of remark codes and claims adjustment reason codes became standardized under HIPAA. The recent introduction of the 5010 standards further emphasizes use of these codes on remittance advices and payments made to medical offices by health insurers. Understanding the codes can assist medical practices in more effective payment posting and follow up on denials or payment reductions.


Leadership Academy

Leadership Academy 2012


San Joaquin incoming president has already adopted the best practices of health reformRaissa Hill, D.O., a board-certified family practitioner and incoming

president of the San Joaquin County Medical Association, says she feels

very well prepared for the uncertainties of health reform. “A lot of the talk

about health reform [and the Affordable Care Act (ACA) ] may seem new

to specialists,” but as a family practitioner she has already been an active

participant in the patient-centered medical home, a centerpiece of the

pioneering Accountable Care Organizations (ACO), she said during a break

in the California Medical Association (CMA) 15th Annual California Health

Care Leadership Academy..

Dr. Hill was one of 600 attendees and other health care stakeholders who

attended this year’s Leadership Academy, April 27-29 in Anaheim. The

program focused on the transformation of the health care marketplace,

which is being driven in large part by federal health reform.

One of the major changes in health care delivery Dr. Hill is looking forward

to is that family practitioners will be at the center of patient care. Family

practitioners, she says, are uniquely prepared to serve in this role. “[We]

have had to manage patient care all along,” said Dr. Hill, referring to her

experience treating a broad range of illnesses and working with a broad

range of payors.

Dr. Hill, who has been in practice for the past 12 years, sees a mix of

health plan (Hill Physicians IPA) and Medi-Cal patients. She speaks

Spanish and relishes the fact that in Stockton, where she practices, is

made up of a diverse population. “Thirty percent of my Medi-Cal practice

is Hispanic.”

Leadership Academy2012

Academy2012

AcademyStory by Elizabeth ZimaPhotography by David Flatter


Leadership Academy 2012

She says her experience in seeing Medi-Cal patients has put her in a good position to meet health reform head on. For example, Medi-Cal already requires that she collect health improvement data on her patients. “Medi-Cal has had pay-for-performance reimbursement for a long time. I have already been collecting the rate of immunization for children under the Healthy Families program,” she said. Under the ACA “this will be expanded to adults,” she said.

“For a lot of physicians, (collecting health improvement data) maybe new, but this has been a part of my practice for a long time.”

The past reflects the futureDr. Hill graduated with a D.O. from Western University of

Health Sciences in Pomona, CA, and completed her residency at the University of California in Davis Satellite Department of Family and Community Medicine. This March, she was honored as the Alumni of the Year by the University of California, Davis, Network of Affiliated Family Medicine Residency Programs for her achievements and contributions to family medicine.

After graduation, she started her practice with the help of her father. “My father was a pediatrician in private practice. I started in his office, in the closet. I had three exam rooms and a bathroom.” A year later she moved into a larger office.

In her 12 years of practice, she has seen many fluctuations in health care. “I am having a hard time forming an opinion” about how health care will look under health reform, she said. Perhaps this is because she finds herself already practicing the type of medicine that would be termed “new” under health reform. The fact that family practitioners will “direct” the care of most people newly enrolled under ACA seems like a dream.

If all these things come to pass, she says, it could be like going back to the future. A long time ago, “when IPAs started, they folded because of the conflicts between specialists and family practitioners.” Many of these first experiments failed because the incentives for all doctors were not well-aligned. She wonders if history will repeat itself.

S E R V I N G C E N T R A L V A L L E Y F A M I L I E S S I N C E 1 9 9 6C

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CALPAC needs your help to support candidates and legislators who understand and embrace medicine’s agenda.

Our top priorities are: 1. Protect MICRA 2. Preserve the ban on the corporate practice of medicine3. Provide solutions to our physician shortage crisis!

California Medical AssociationPolitical Action Committee

Please visit www.calpac.org for more information

Fighting for you!


“Cor Sanare.” For Jerry and Susan McDonald, it’s more than just a catchy Latin phrase that adorns every bottle of their homegrown Meritage wine. To them, this simple phrase, meaning to heal the heart, has become a way of life.

Glancing over the meticulously crafted label affixed to a bottle of 2007 Cor Sanare Meritage, one can’t help but ponder the meaning of it all.

heartBy: James Noonan

Beneath the text displaying the blend’s Latin title and an image of a raven-haired women delicately balancing a wine glass in the palm of her hand, the unmistakable leaves of the vitis vinifera plant twist and bend before coming to rest in the familiar shape of a crimson heart. For some, the label might look to be just a creative and appealing way to package what happens to be an equally appealing bottle of wine, but for Jerry and Susan McDonald, the imagery and name itself couldn’t be more apt. “Cor Sanare,” Susan, who was a Latin major in college, explains. “To heal the heart.” From the land surrounding their Lodi home, Jerry and Susan have produced the grapes used to make the Cor Sanare blend, and together have proudly made “healing the heart” something of a family business. Since first arriving in the Stockton area in 2007, Jerry has been practicing as one of the Central Valley’s top cardiothoracic surgeons, while Susan specializes as a cardiac anesthesiologist at St. Joseph’s Medical Center in Stockton.

Simply put, the McDonalds are “heart people,” and it’s easy to see why their quick to introduce themselves as such. Even the vines of the McDonald Family Estate, which surround their home in California’s Lodi appellation and bore the fruit used to make the blend in question, were grown with the aim of healing the human heart. Each year, bunches of cabernet sauvignon, merlot, petit verdot, malbec and cabernet franc grapes are plucked from their respective blocks and trucked out to a Napa Valley vintner. From there, the Meritage blend, modeled after those made famous in the Bordeaux region of France, is crafted and set aside to age in a collection of French Oak barrels. It’s a delicate process, as winemaking tends to be, but despite the complexities, the McDonalds never sought to earn a profit from the process.

giving from the

2012 Young Physician Award


“The wine was never meant to be a money making thing,” Jerry said. “It was just a way to give back.” While viticulture tends to be a finicky art, one in which weather and the skill of the grape grower can combine to make or break a year’s crop, it can be said that in at least one sense, the McDonald’s vines have produced exactly as they were supposed to. For each bottle of Cor Sanare sold by the McDonalds, the proceeds are donated directly to the American Heart Association’s Go Red for Women campaign, a project which hopes to curb the prevalence of heart disease in

women. “We’ve always been supporters of the American Heart Association,” Susan said, so using the vines that surround their home to further the AHA’s cause was an easy choice. In addition to their professional interest in the cause, the McDonalds are also personally vested in the fight against heart disease. Recently Susan’s mother underwent a major bypass operation, something that brought the threat of heart disease a little closer to home. “I fully believe in the cause,” she adds. “Anything to help get the message

out there.” Even the label itself is used by the McDonalds as a way to give back to the surrounding community. Beginning with the 2007 vintage, the pair have left the design process up to students at the University of the Pacific. The winning entry finds itself applied to every bottle of Cor Sanare made from that year’s vintage, as well as into the student’s fledgling professional design portfolio. “It’s just a way to try and better tie us to Stockton,” Jerry said. While their efforts with the Cor Sanare brand have garnered the

Caption: “Cor Sanare.” For Jerry and Susan McDonald, it’s more than just a catchy Latin phrase that adorns every bottle of their homegr



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McDonalds attention within the Lodi appellation’s budding wine community, the pair have also become noted philanthropists in the greater San Joaquin area. For some time, the McDonalds have been donating funds to a variety of different causes throughout the area, as well as dedicating a significant amount of time to their parish at the Cathedral of the Annunciation in downtown Stockton. “We’ve always been very fortunate in a number of ways in our lives,” Jerry said, explaining the motivation behind the

couple’s charitable activity. “There’s a fair amount of people in our community who aren’t doing as well.” While those who know them well would be quick to praise the couple for their history of giving, the McDonalds themselves remain characteristically humble about such activity. In fact, when the pair first heard that they were being honored with the San Joaquin County Medical Society’s Young Physician Award, their focus immediately shifted to peers they felt would be more deserving of such an honor. “We were surprised. We don’t feel like we do anything that other doctors in this area weren’t already doing,” Susan said, adding that Jerry’s first reaction was to run through a list of roughly a dozen physicians

that were equally entitled to the award. “There are a lot of people who do more for the community,” he said.It’s perhaps this humility that makes the McDonalds more deserving of such an honor than they themselves can realize.The selfless nature of their work, and the nonchalant manner in which they discuss these contributions, suggests that, for them, any other way of going about things just wouldn’t feel right. Even when discussing the vital work they perform within Stockton’s health care community, the pair radiates a sense of

service and enjoyment that demonstrates that “healing the heart” is more of a passion than simply a job. In the backyard of their sun-drenched Lodi estate, Jerry reflects on the complex task of heart surgery as if it were an incredibly intimate task shared between surgeon and patient, something akin to taking the afflicted by the hand and guiding them toward a better, healthier life. “I really enjoy getting people through the most stressful points of their lives,” he said. “It’s a fairly satisfying experience.”In a similar fashion, Susan, who in addition to her role as an anesthesiologist also serves as the vice president of medical affairs for St. Joseph’s Medical Center, discusses her craft as a way shepherding patients through a potentially traumatic experience.

What has been impressive is the way they literally hit the road

running in terms of their commitment to this community. They

have shown a commendable degree of kindness and warmth

and have been unwavering in support of causes linked to their

specialty of cardiovascular surgery. - Dr. Kwabena Adubofour““What has been impressive is the way they literally hit the road “What has been impressive is the way they literally hit the road What has been impressive is the way they literally hit the road “What has been impressive is the way they literally hit the road

“and have been unwavering in support of causes linked to their

“and have been unwavering in support of causes linked to their

specialty of cardiovascular surgery. - Dr. Kwabena Adubofour

“specialty of cardiovascular surgery. - Dr. Kwabena Adubofour



“I look at is as being an advocate for the patient as a whole,” she said, explaining that surgeons are allowed to focus on the heart itself, while she ensures the rest of the patient’s body makes it through the experience safely. For a pair of individuals who seem so inclined to care for others, it makes sense that decision to pursue a career in medicine came with little hesitation.“Well, my brother got me,” Jerry said, noting that the guidance of having a physician for an older sibling made a career in medicine something of an inevitability. “I was pretty sure I wanted to be a heart surgeon since about 10th or 11th grade,” he adds. For Susan, the decision to practice medicine was rooted in a desire to better the lives of those around her. “I just wanted to be of use,” she said. “I wanted to help people, and be around people.” Between all of their successes, it is perhaps in this area – a desire to help – that the McDonalds have had their greatest impact. Together, the husband and wife team have become leaders in the Central Valley’s medical field, luminaries in the arena of philanthropic service and invaluable resources to the community that they only recently started to call home. “We felt so fortunate to be embraced by the community when we first got here,” Susan said. Judging by the manner in which the McDonalds have been giving back, it would appear that they’ve been equally quick to embrace the Stockton area as their own.

64 SAN JOAQUIN PHYSICIAN SUMMER 2012 SPRING 2011 SAN JOAQUIN PHYSICIAN 21

Therapeutic Research Center, 3120 W March Ln, Stockton, CA 95219

TEL: 209.472.2240, FAX: 209.472.2249

TherapeuticResearch.com

Dear SJMS member,

Only the physicians in a

few select metropolitan areas can boast of having a national

medical publication originate in their town. When we think of the head

quarter cities

for well‐regarded medical publications, most physicians think of Boston, Philadelphia,

NYC, and Chicago. But if you live in Stockton, you

might like to know that your

hometown is also headquarters for a respected medical publication.

Prescriber’s Letter and re

lated publications originate right here. We occupy

the 20,000‐square‐foot Therapeutic Research Cen

ter building in Brookside (across

the parking lot from the St Joseph’s Medical Office – and across the street from your

SJMS office on March Lane). About 60 members of our staff work in our Stockton

headquarters building and the rest are spread thr

oughout the U.S. and Canada.

Therapeutic Research Ce

nter has been in Stockton for 26 years. It is uniq

ue in that it is

one of the only remaining medical publishers that refuses to accept any form

of

advertising or support. Almost every other publishe

r now lives off of revenue streams

that can taint the objectivity of the publication.

The majority sell advertising. Many

publish supplements paid for by sponsors. Many sell reprints of speci

fic articles that

are favorable towards a specific product. More and more gather data from physicians’

clicks on websites and mobile devices and sell tho

se data to commercial suppliers.

We create unbiased clinica

l recommendations, databases, analyses of drug studies,

CME programs, and live webinars.

Prescriber’s Letter’s evide

nce‐based objectivity has earned it the highest a

ccreditations

from the major CME accrediting agencies and subscriptions from physicians and

medical institutions worldwide. We have long‐standing rel

ationships to provide our

unbiased recommendations or accredited CME to such institutions as

Kaiser

nationwide, MD Anderson, Johns Hopkins, Medscape, WebMD, National Library of

Medicine, National Institutes of Health, FDA, Health

Canada, physicians employed by

the governments of Australia and the U.K., plus many others – and now SJ

MS.

We’ve always had high reg

ard for your Executive Director, Mike Steenburgh, so when

he initiated a conversation to provide a benefit f

or San Joaquin physicians, we were

pleased to do so. We appreciate the many San Joaquin physicians who have been

integral in our publishing for so many years as Members of our Board: Robe

rt Browne,

Jerry Jones, John Connolly, Daren Primack, Raymond Wong, Ted Lee, Darius Noo

ri,

Sheela Kapre, David Stadtner and years ago, Guey

Mark, John Morozumi, and Russ Steele.

Thanks to Mike’s work, and the contr

ibutions of these San Joaquin physicians, all San

Joaquin physicians will now be able to get the un

biased Prescriber’s Letter

recommendations, plus over 25 CME credits each year, as pa

rt of membership in SJMS.

We’ve been neighbors for

a long time. I am pleased that we will get to know each

other even better. Feel free to contact us anytim

e we can help.

Jeff Jellin, PharmD, Editor‐in‐Chief

Prescriber’s Letter Is Now a Member Benefit of the

Welcome!

Search: (Help)

Advanced SearchUnbiased Evidence and Advice You Can Trust on New Developments in Drug Therapy

Prescriber's LetterSome experts are backpedaling on aspirin

to prevent heart disease.We know that aspirin is beneficial for

SECONDARY prevention...to preventrecurrent cardiovascular events.... readmore...Table of Contents of Current IssuePrevious Issue

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Ob/Gyn

SJMS Is Proud to Announce an Exclusive Benefit for Its Membership – Prescriber’s Letter Online, Mobile Access, and 25+ hours of CME...Dear SJMS member,

Your board members and I are always looking for ways to improve the value of your SJMS membership – constantly on the lookout for benefits that can help you practice your profession, or save your time, or your money.

We’ve had our eye on Prescriber’s Letter for some time now. We have often thought how great it would be to get this for SJMS members.

And now I am so pleased it is a reality. Not only that, but we were able to get our members the highest level of service Prescriber’s Letter offers – its VIP Member level. VIP stands for “Very Informed Prescriber” and that speaks volumes about the special nature of this member benefit. Other physicians throughout the nation pay $250 for this service, and it is now included in your SJMS membership, at no additional fee to you.

You now get online access to each and every Prescriber’s Letter drug therapy recommendation as soon as they are posted. You also get all the evidence-based details behind each recommendation, and other practice tools such as the PL Drug Formulary Comparison tools, PL Patient Handouts in English and Spanish, Treatment Guidelines, and all the other PL Detail-Documents. You can access all of this on your computer, or mobile device of your choosing, including iPhones and Android phones.

We were also able to reserve every SJMS member a space on the monthly webinars where the Prescriber’s Letter Editorial Board deliberates and decides upon the Recommendations to be published. Plus, if your schedule does not allow you to listen to these sessions when they are offered live, you will have access to listen to the archived recorded sessions whenever you want. Through this new arrangement with Prescriber’s Letter, your SJMS membership now includes more than 25 CME credits per year at no fee to you. You can get these CME credits from reading the Recommendations – from getting your clinical questions answered online at the Prescriber’s Letter website – and by participating in the live webinars or listening to the recorded webinars.

To begin taking advantage of this members-only benefit, visit our website at www.SJCMS.org and click on the Prescriber’s Letter logo located on our homepage, or you can just call our office (209-952-5299) and we’ll handle the entire subscription process for you.

All the Best!

Mike Steenburgh Executive Director

SJMS Is Proud to Announce an Exclusive Benefit for Its Membership – Prescriber’s Letter Online, Mobile Access, and 25+ hours of CME...

SJ Physician 2011 Spring.indd 21 2/23/11 10:33:24 PM

SUMMER 2012 SAN JOAQUIN PHYSICIAN 65SPRING 2011 SAN JOAQUIN PHYSICIAN 21

Therapeutic Research Center, 3120 W March Ln, Stockton, CA 95219

TEL: 209.472.2240, FAX: 209.472.2249

TherapeuticResearch.com

Dear SJMS member,

Only the physicians in a

few select metropolitan areas can boast of having a national

medical publication originate in their town. When we think of the head

quarter cities

for well‐regarded medical publications, most physicians think of Boston, Philadelphia,

NYC, and Chicago. But if you live in Stockton, you

might like to know that your

hometown is also headquarters for a respected medical publication.

Prescriber’s Letter and re

lated publications originate right here. We occupy

the 20,000‐square‐foot Therapeutic Research Cen

ter building in Brookside (across

the parking lot from the St Joseph’s Medical Office – and across the street from your

SJMS office on March Lane). About 60 members of our staff work in our Stockton

headquarters building and the rest are spread thr

oughout the U.S. and Canada.

Therapeutic Research Ce

nter has been in Stockton for 26 years. It is uniq

ue in that it is

one of the only remaining medical publishers that refuses to accept any form

of

advertising or support. Almost every other publishe

r now lives off of revenue streams

that can taint the objectivity of the publication.

The majority sell advertising. Many

publish supplements paid for by sponsors. Many sell reprints of speci

fic articles that

are favorable towards a specific product. More and more gather data from physicians’

clicks on websites and mobile devices and sell tho

se data to commercial suppliers.

We create unbiased clinica

l recommendations, databases, analyses of drug studies,

CME programs, and live webinars.

Prescriber’s Letter’s evide

nce‐based objectivity has earned it the highest a

ccreditations

from the major CME accrediting agencies and subscriptions from physicians and

medical institutions worldwide. We have long‐standing rel

ationships to provide our

unbiased recommendations or accredited CME to such institutions as

Kaiser

nationwide, MD Anderson, Johns Hopkins, Medscape, WebMD, National Library of

Medicine, National Institutes of Health, FDA, Health

Canada, physicians employed by

the governments of Australia and the U.K., plus many others – and now SJ

MS.

We’ve always had high reg

ard for your Executive Director, Mike Steenburgh, so when

he initiated a conversation to provide a benefit f

or San Joaquin physicians, we were

pleased to do so. We appreciate the many San Joaquin physicians who have been

integral in our publishing for so many years as Members of our Board: Robe

rt Browne,

Jerry Jones, John Connolly, Daren Primack, Raymond Wong, Ted Lee, Darius Noo

ri,

Sheela Kapre, David Stadtner and years ago, Guey

Mark, John Morozumi, and Russ Steele.

Thanks to Mike’s work, and the contr

ibutions of these San Joaquin physicians, all San

Joaquin physicians will now be able to get the un

biased Prescriber’s Letter

recommendations, plus over 25 CME credits each year, as pa

rt of membership in SJMS.

We’ve been neighbors for

a long time. I am pleased that we will get to know each

other even better. Feel free to contact us anytim

e we can help.

Jeff Jellin, PharmD, Editor‐in‐Chief

Prescriber’s Letter Is Now a Member Benefit of the

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Ob/Gyn

SJMS Is Proud to Announce an Exclusive Benefit for Its Membership – Prescriber’s Letter Online, Mobile Access, and 25+ hours of CME...Dear SJMS member,

Your board members and I are always looking for ways to improve the value of your SJMS membership – constantly on the lookout for benefits that can help you practice your profession, or save your time, or your money.

We’ve had our eye on Prescriber’s Letter for some time now. We have often thought how great it would be to get this for SJMS members.

And now I am so pleased it is a reality. Not only that, but we were able to get our members the highest level of service Prescriber’s Letter offers – its VIP Member level. VIP stands for “Very Informed Prescriber” and that speaks volumes about the special nature of this member benefit. Other physicians throughout the nation pay $250 for this service, and it is now included in your SJMS membership, at no additional fee to you.

You now get online access to each and every Prescriber’s Letter drug therapy recommendation as soon as they are posted. You also get all the evidence-based details behind each recommendation, and other practice tools such as the PL Drug Formulary Comparison tools, PL Patient Handouts in English and Spanish, Treatment Guidelines, and all the other PL Detail-Documents. You can access all of this on your computer, or mobile device of your choosing, including iPhones and Android phones.

We were also able to reserve every SJMS member a space on the monthly webinars where the Prescriber’s Letter Editorial Board deliberates and decides upon the Recommendations to be published. Plus, if your schedule does not allow you to listen to these sessions when they are offered live, you will have access to listen to the archived recorded sessions whenever you want. Through this new arrangement with Prescriber’s Letter, your SJMS membership now includes more than 25 CME credits per year at no fee to you. You can get these CME credits from reading the Recommendations – from getting your clinical questions answered online at the Prescriber’s Letter website – and by participating in the live webinars or listening to the recorded webinars.

To begin taking advantage of this members-only benefit, visit our website at www.SJCMS.org and click on the Prescriber’s Letter logo located on our homepage, or you can just call our office (209-952-5299) and we’ll handle the entire subscription process for you.

All the Best!

Mike Steenburgh Executive Director

SJMS Is Proud to Announce an Exclusive Benefit for Its Membership – Prescriber’s Letter Online, Mobile Access, and 25+ hours of CME...

SJ Physician 2011 Spring.indd 21 2/23/11 10:33:24 PM

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DR. YIN YAN CHENGAugust 20, 1940 - April 23, 2012

Dr. Yin Yan Cheng, prominent Stockton cardiologist, died at his home in Morada, on April 23, 2012. Born to the late Wai Yat Cheng and Chi Ngai Hau, in Guilin, Guangxi Province, China, Dr. Cheng emigrated to the United States in steerage in 1957.

He landed in California, with only $20 in his pocket, which was stolen from his duffel bag at the YMCA, where he stayed temporarily. Penniless and alone, in a country far from home, he found his way to San Francisco’s Chinatown, locating family friends from China, who helped him find a job as a restaurant dishwasher, working 14-hour days and earning very little money.

He attended the University of Montana, earning Bachelor degrees in History and Biology. He completed medical school at the top of his class at University of Indiana, Indianapolis, where he met and later married Jeanne Gauthier. He returned to California as an M.D.

He began his career, at a medical clinic for migrant workers in Salinas. As he said, “After years of struggling to find employment, I found myself continuously working, seeing 30 to 40 patients a day and working from 7 a.m. to 10 p.m. Life is difficult, but leads to goals being achieved.” In addition to be a life-time member of the San Joaquin Medical Society and CMA, he later became certified as a member of the American College of Cardiology, and was elected to the fellowship of the American College of Interventional Cardiology. He practiced medicine throughout California, as well as in Pennsylvania and Illinois. His practice in Stockton spanned more than 20 years, and included serving as Chief of Cardiology at Dameron and Lodi Memorial Hospitals.

He was nominated for national top physician honors, recognized by Who’s Who, and won numerous awards from professional medical organizations. He presented papers on interventional cardiology at national and international conferences, and stent procedures in China, where he was an adjunct professor at Tianjin University. His patients were the center of his life.

He was a self-taught photographer, using photography to document his travels. As a world-traveler, he believed there wasn’t anything quite like the lessons learned while traveling. On medical and scientific missions, he worked internationally, on all seven continents. In Africa, he practiced in small clinics, without proper medical supplies, electricity or running water.

He is survived by his brother, Yin Ming Cheng; and his children, Chi Ming Cheng, Chi Ling Cheng, Chi Wan Cheng (Julie), Chi Pak Cheng (Kari), Chi Sing Cheng, Chi Mae Cheng, Chi Lan Cheng, Chi Ching Cheng (Yen Jie) and 12 grandchildren. He was pre-deceased by his parents, sister, Yin Shun Cheng and two sons, Chi Yin Cheng and Chi Tien Cheng.

In MemoriamDr. Yin Yan Cheng

In Memoriam


at a glance


Physicians from across the state, including 9 from the San Joaquin Medical Society, met on April 17 at the California Medical Association’s 38th annual Legislative Leadership Conference. For the second year in a row, Governor Jerry Brown addressed the crowd or more than 500 physicians, speaking about issues that will make California healthier. “You in the medical community have authority. As professionals, people listen to you” said Governor Brown. “It’s very important that all of us in California rise to the occasion and consider what our state ought to look like. With your help we can get this state back on track.”


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