2019 Fall Newsletter

Governor’s Corner

Matt Hollon, MD MPH FACP

 

On my e-bike (affectionately called ‘Treehugger’) on my way to the Global Climate Strike! I love talking about e-bikes!

I hope you all had a wonderful summer and are enjoying the start of fall.  The start of fall was exciting for me as it began with the Global Climate Strike and my younger son’s 18th birthday!  I must say that in the face of ongoing news about the health of our planet, I am inspired by both the exuberance of my son (who also participated in the strike) and the outpouring of activism across the globe for an environmental, economic, and critical public health issue that has been wrongly and unfortunately politicized. Sadly, a few days after the Global Climate Strike, the United Nation’s Intergovernmental Panel on Climate Change released the third in a series of special reports they produced this year, this one on the oceans and cryosphere, with distressingly worrisome news.  As the BBC concluded in their reporting, it is, “red alert on ‘Blue Planet’”.  I hope you all will join me in continuing to raise awareness that the health of our planet is vitally important to the health of our patients, our families, and ourselves.

I value my membership in the College for many reasons – as I am sure is true for most of you.  Perhaps first among these reasons for me is that the College remains the conscience of American medicine.  Whether that is advocating for a reasoned approach to tackle the public health challenges of firearm violence and climate change, working to reduce the administrative burden on physicians through their Patients Before Paperwork initiative, or drafting deliberate, comprehensive policy to provide direction on health system reform through the Better Health Care System for All Initiative (which you will hear a lot more about in the coming months), the College is the voice for our patients and internal medicine across the country and in our state.  A recent example of our chapter’s efforts was our amazingly attended educational session on September 26th in collaboration with the Washington Coalition of Healthcare Professionals to Prevent Firearm Injury and Death entitled “Firearm Violence Prevention – Conversations for Clinical Practice”.

Our chapter continues our work to engage all facets of our membership.  On September 12th we hosted our first ever “Resident Career Forum” covering topics that included finding a first job and negotiating a contract.  Also on the resident and medical student front, we look forward to our annual abstract competition embedded within our amazing annual chapter meeting (you can register for the meeting here).  Dr. Ananth Shenoy, profiled below, continues to direct this competition for us.  He organized the review of the more than 60 submitted abstracts and for this we owe him heartfelt thanks!  The resident winner of the oral abstract competition will represent, all expenses paid, our Chapter at Internal Medicine 2020 in Los Angeles!

Also on the member engagement front, we look forward to an upcoming focus group with our Council of International Medical Graduates (IMGs) to better elucidate how we can engage and support the more than 20% of our membership who graduated from a medical school outside the U.S. or Canada, such as executive council member Jennifer Balde MD FACP whose profile is below.  The focus group for IMGs will take place over the lunch hour on the phenomenal pre-course day, October 31st, of our chapter meeting.

Speaking of the pre-course day, morning attendees will have the option of earning 20 ABIM Maintenance of Certification points in our facilitated SEP module sessions or attendees can pair a SEP module (outpatient or inpatient) with 2 hours of outstanding, case-based point-of-care ultrasound training (also outpatient focused or inpatient focused).  In the afternoon sessions, this year’s pre-courses also continue to have outpatient and inpatient themes – these sessions feature some of the most renowned speakers from prior Washington Chapter meetings, including Drs. Doug Paauw and Paul Pottinger.

Dr. Doug Paauw, National ACP Jane F. Desforges Distinguished Teacher Award Winner

Dr. Thomas Gallagher, our newest Master Member

Speaking of Dr. Paauw, we enthusiastically announce that he is this year’s winner of the College’s prestigious national Jane F. Desforges Distinguished Teacher Award.  The award is bestowed upon a Fellow or Master of the College who has demonstrated the ennobling qualities of a great teacher as judged by the acclaim and accomplishments of former students who have been inspired and have achieved positions of leadership in the field of medical education, primarily as teachers.  We also are excited to share with you that Dr. Thomas Gallagher is our Chapter’s newest Master in the College.

Last on the news front, we are happy to share with you that, thanks to the work of so many of you, our chapter has been awarded the highest level of “Chapter Excellence” this past year – Gold Level!  The Gold Level recognizes truly extraordinary chapters that surpass excellence in chapter management. Our chapter met all Bronze (21 criteria) and Silver criteria (15 criteria) and completed 13 additional Gold criteria.

We are committed to making the Washington Chapter among the best ACP chapters out there, if not the best.  We also know that “many hands make light work” and often the best ideas come from our general membership.  As such, we are evolving our strategy for creating and supporting initiatives within our Chapter.  We have a diverse set of Councils charged with member engagement and Committees charged with completing the work of the chapter.  Our intention going forward is to set aside money to support proposals from our chapter membership – from you all – for events and initiatives across the state.  If you have a great idea for your internal medicine community and need Chapter support to pull it off, please let me know at mhollonmdfacp@gmail.com. Also please be sure to complete your Member Engagement Profile to let us know how you would like to be more involved with our Chapter and ACP.  There are many opportunities to volunteer for the College both locally and nationally.

I truly appreciate your membership in ACP and our Chapter.  I always welcome suggestions for how the College can be of value to you so please reach out.  I hope to see many of you at our extraordinary Annual Chapter Meeting October 31 through November 2 – PLEASE DON’T FORGET TO REGISTER.

Best,

Matt Hollon, MD MPH FACP

Governor || Washington Chapter – American College of Physicians


Strategies for Clinicians to Prevent Firearm Injury & Death

By Carrie Horwitch, MD MACP

 

The Washington Chapter of ACP and the Washington Coalition of Healthcare Professionals to Prevent Firearm Injury and Death, and the King County Medical Society co-sponsored a CME event to provide clinicians with strategies for use in the clinic to identify patients at risk for firearm injury (focusing on suicide prevention), engage patients in conversations about firearm safety, and how Extreme Risk Protection Orders can be used by family members and law enforcement to temporarily transfer firearms for safe storage when appropriate.

The data presented noted that 67% of gun owners cite self defense or protection as the primary reason for ownership.  In order to facilitate immediate firearm access for protection, many of these owners may keep their guns unlocked and loaded at home.  Most (75% in Washington) fatal firearm injuries are due to suicide (not accidents <4% or homicide 17%).  Adolescents with access to firearms are 2.6 times as likely to die by suicide as adolescents without access.  93% of suicide attempts with a firearm are fatal.

Changes in firearm storage can reduce the risk of youth and adult suicide and unintentional firearm injury.

Brett Bass (Program Coordinator for Safer Home, Suicide Aware program) and Dr Jeffrey Sung (psychiatrist at University of Washington, Pioneer Square Clinic) presented information on strategies to understand the culture of firearms ownership  and data on the reasons for firearm ownership. They also spoke on clinical skills to help clinicians talk to their patients about firearm safety.

Some of the clinical skills recommended are: Understand and respect patients’ beliefs and perspectives on firearm ownership (cultural competence); screen for risk factors for firearm injury – especially suicidal ideation or behavior; focus on voluntary and temporary interventions for suicide prevention;  engage the patient in conversations leading to safer firearm storage practices; be aware of resources in the community and processes to help temporarily transfer firearms out of a home when the patient is at high risk of harm to self (suicide) or others.

Kim Wyatt, a senior deputy prosecuting attorney spoke about the Extreme Risk Protection Orders – a civil protection in Washington state for firearms and a concealed pistol license.

For more information:  https://www.kingcounty.gov/depts/health/violence-injury-prevention/violence-prevention/gun-violence.aspx

Information about the Washington Coalition of Healthcare Professionals to Prevent Firearm Injury and Death:
https://depts.washington.edu/hiprc/new-public-health-collaboration-seeks-to-reduce-firearm-injuries/

https://www.kingcounty.gov/~/media/depts/health/violence-injury-prevention/documents/firearm-injury-death-public-health-problem.ashx

http://depts.washington.edu/saferwa/


2019 Resident Career Forum

 

With hundreds of internal medicine residents in our state, our chapter successfully planned and executed our first ever “Career Forum”.  The evening, attended by nearly 40 members, featured a series of panels and speakers covering topics from finding a job to negotiating contracts to managing finances successfully.  First up was a wonderful panel of recruiters including Jason Dulin, Michele Chacon, and Jana Mastandrea, who highlighted the role of the recruiter in finding a job.  Next up was an awesome panel of early career physicians including Drs. Natalie Talbott, Arthur Bagabag, Elissa Poorman, Leah Marcotte, Laura Bovee, and Ananth Shenoy, who shared lessons they learned from previous job hunts.  The evening finished with two amazing sessions.  Avi Lipman, an attorney in Seattle, discussed employment contracts and upcoming changes in Washington State regarding non-compete clauses.  Gigi Brannan, a financial advisor in Seattle, provided guidance on managing the money that comes with that first job.  Panelists and speaker shared numerous important pearls including:

  • A cover letter is extremely important in introducing yourself to recruiters and explaining your interest in the position and your fit with the organization.
  • Shadowing a physician in the practice setting you are looking at for a job can provide valuable insights into the practice environment.
  • Employers hire attorneys to write employment contracts so you should strongly consider having an attorney review the offered contract.
  • Commit yourself to a financial plan and stick to it – that commitment pays off!

All in all, the evening was a great success.  Deepest thanks to our exhibitors, panelists, and speakers for making the event possible.  The College and our Chapter are committed to being a wonderful resources for our resident and fellow members.  For more career guidance from the College see the College’s resources online – Resident Career Counseling, Guidance, and Tips.


Member Spotlight: #1 – Ananth Shenoy

By Rahaf Baker, MS4, MPH

 

Dr. Shenoy grew up in the Bellevue and Renton area, attended college at UW as a biochemistry and biology major. Initially he was interested in research in the health sciences, particularly gene therapy. However, after volunteering in the Overlake emergency room, he found that the acuity and interactions with patients he saw there pulled him away from research and in the direction of clinical medicine. He changed gears to pursue medicine and was admitted to the UW School of medicine. His greatest mentors in medical school were the internal medicine residents all of whom were passionate about teaching, intelligent, and prepared for anything. His considered his role models to be his chief resident at the VA (Dr. Tristan Osborne) and his attending (Dr. Moe Hagman). He vividly remembers caring for a cystic fibrosis patient over multiple hospitalizations as medical student, as well as caring for lung cancer patients at the VA, and how his experiences with these patients shaped his career. He loved the way internists think about clinical problems, the breadth of knowledge, and the demand for internists everywhere.

Dr. Shenoy went on to train at Virginia Mason for residency, where he greatly enjoyed the feel of a community hospital and the program’s dedication to embracing change, then stayed on as chief resident. He loved the diversity of primary care, the intellectual side of IM, the problem solving and the continuity of outpatient IM. He particularly enjoys seeing his patients on their good days in clinic. He currently teaches Virginia Mason residents, UW medical students, and NP’s and finds teaching particularly satisfying and regenerative.

Dr. Shenoy is currently involved in the two ACP conferences and serves on the abstract committee and medical education committee, spearheading the medical student competitions in May and in the fall. He enjoys the camaraderie of the ACP and hopes to become involved with legislative events in Olympia and DC in the near future. On the toughest days, Dr. Shenoy looks to the enthusiasm of his students and developing the next generation of physicians as well as the meaningful patient interactions when they share news of having grandchildren or quitting smoking. His advice for students is to not be afraid to give feedback to attendings and residents so that they will learn what they need. At times the journey can feel overwhelming, but you will come out feeling more confident and prepared in the end. In his free time, Dr. Shenoy enjoys playing tennis, ultimate frisbee, board games, watching Sci Fi, Game of Thrones, and Scrubs.


IMG Council – Focus Group!

By Deepthi Mani, MD

 

The newly formed Washington Chapter International medical graduate (IMG )council  is hosting an in person focus group with IMGs to chart a course forward for next steps for creating a vibrant, participatory membership group. This focus group session with lunch provided will be on Thursday, ACP meeting pre-course day –  October 31st, 2019. The session will be at Bell Harbor for 15 physicians during  12:00 – 1:00 pm time when lunch would be delivered. One can easily rejoin the precourse session after the lunch. It’s not mandatory that you sign up for the precourse, just attending the lunch session would be fine. This would be an invitation only event, RSVP by October 18th , 2019 if you would like  to attend the session. Also, if you have an IMG colleague/friend who might be interested,  we will be happy to extend them the invitation.  Please email Liz Truong, executive director  of WA- ACP (Liz@aminc.org) or Deepthi Mani, IMG council chair (deepthim1@gmail.com) if interested.


Member Spotlight: #2 – Dr. Jennifer Balde

By Nathan Maris, MS3

 

Dr. Jennifer Balde, MD, FACP grew up loving to argue. As someone who thrived questioning rote answers and getting to the true root of problems, Dr. Balde first considered a law career before her love of physiology, desire to help others, and inspiration from a surgeon uncle pushed her towards medicine. She developed “grit and tenacity” working 34-hour shifts as an intern in the Philippines before moving to New York City, where she completed her internal medicine residency and geriatrics fellowship.

On being both an internist and a geriatrician, Dr. Balde notes that “getting old is not fun when your friends and family are not there to support you. I let [my patients] know that I do care about them; it is a privilege for me to be entrusted as their doctor.” Dr. Balde particularly enjoys her specialty’s emphasis on creatively approaching complex patient problems from a variety of different angles. She also highlights the role that technology will play in the future of outpatient internal medicine, particularly regarding ambulatory diagnostic devices and patient education opportunities.

A pillar of the Tri-Cities medical community, Dr. Balde has served as both the president of the local Benton Franklin County Medical Society and as a representative of southeast Washington to the WSMA. An ACP member and officer, she credits the organization’s Women in Medicine advocacy branch for helping her “know what [she] is worth, deal with uncomfortable situations, and support other” women physicians in their own careers. When asked what advice she would offer current trainees, Dr. Balde gave the following counsel: “be grateful, be smart about finances early, live simply, enjoy life.”


POCUS Highlights – Pre Course Day

By Kang Zhang, MD

 

The use of point-of-care ultrasound (POCUS) in general internal medicine has grown exponentially in the last several years. POCUS has proven its ability to deliver affordable, safe, and real-time imaging at the bedside. Additionally, internists can use POCUS to augment their physical exam, add accuracy to their patient assessments in clinics/hospitals, and improve shared understanding between physicians and patients about their diagnosis. The enthusiasm for general internal medicine POCUS is reflected in the growing number of workshops offered at regional and national society meetings. In 2019, the POCUS pre-course at the national ACP meeting in Philadelphia was attended at capacity. This year at the ACP Washington Chapter meeting, the POCUS pre-course will offer separate inpatient and outpatient tracks taught by regional and national experts. The major emphasis is to equip learners with a systematic and hypothesis-driven approach of evaluating patients in the clinic or hospital. I equate this to learning the FAST exam for the general internist. While there will be some lecture-based learning, the majority of the workshop will be hands-on experience in a small-group setting, while scanning standardized patients. At the end of the workshop, we will provide additional tools to further advance your POCUS journey. This is an exciting time in general internal medicine. I hope to see you this year at the ACP Washington Chapter Meeting!


Outpatient Pre-Course Highlights

By Kavita Chawla & Leah Marcotte, Co-Chairs

 

With the aging U.S. population, increasingly general internists are responsible for managing geriatric care. At the WA Chapter Meeting Ambulatory Pre-course, we will focus on diagnoses common in older adults which can often be challenging to manage. Dr. Barak Gaster will discuss how to diagnose and care for patients with dementia in primary care. Dr. Susan Ott will review updated management guidelines for osteoporosis. Dr. Doug Paauw will cover medications to avoid and de-prescribe in older adults. We will end with a session on Medicare billing and documentation, focusing on codes that increase reimbursement for work you already do in providing comprehensive, coordinated and patient-centered care.

Schedule:

1:00-3:00PM:      Dementia: Diagnosis and Management in Primary Care
3:00-3:15PM:      Break
3:15-3:45PM:      Osteoporosis – Updates in Diagnosis and Management
3:45-4:15PM:   Medication prescribing in the elderly
4:15-4.30PM:     Q&A with Dr. Ott and Dr. Paauw
4:30-5:00PM:     How to get paid for the work you do: Medicare care coordination codes, advance care planning codes, and more


Inpatient Pre-Course Highlights

By Anna Hagan & Audrey Young, Co-Chairs

 

This year’s inpatient pre-course takes a fresh look at conditions hospitalists manage every day. The session kicks off with critical care innovator Dr. David Carlbom, who developed the sepsis early warning system, discussing key management points in resuscitating septic patients. Next up, Dr. David Likosky, a local and national neurohospitalist leader, delivers pearls for the care of intracranial hemorrhage, a condition with which hospitalists are increasingly involved. Infectious disease and global health specialist Dr. Paul Pottinger tackles the critical issue of antibiotic stewardship in the hospital. Patient communication experts and palliative care physicians Dr. Susan Merel and Dr. Katy Hicks coach us through more effective code status conversations with patients and their families. And finally, we’ll hear from medicine consultation authority Dr. Divya Gollapudi about the latest in perioperative evaluation. This promises to be a dynamic, relevant, and practical session and we look forward to seeing you there!

Schedule:

1:05 – 1:40PM: Resuscitation Keys in the Management of Sepsis – David Carlbom, MD
1:50 – 2:25PM: Update in the Management of Intracranial Hemorrhage – David Likosky, MD
2:35 – 3:10PM: Antibiotic Stewardship in the Hospital – Paul Pottinger, MD DTM&H FACP
3:30 – 4:10PM: Facilitating Effective Code Status Conversations – Susan Merel, MD FACP & Katy Hicks, MD
4:15 – 4:50PM: Perioperative Evaluation of the Hospitalized Patient – Divya Gollapudi, MD


Calling on Early Career Physicians, Medical Students, Residents and Fellows

 

The Council of Early Career Physicians (CECP), the Council of Resident/Fellow Members (CRFM), and the Council of Student Members (CSM) are currently seeking candidates to fill vacant seats for 2020-21. Nominations are due by November 1, 2019 and details for submitting are included in the links below. Each Council meets during the ACP Internal Medicine Meeting, once a year in Philadelphia, and several times via webinars. The Councils are responsible for responding to requests for review of programs, products and services; advising the College regarding ways to increase the value of ACP membership among their constituency group; and strengthening activities and relationships at the ACP chapter and local levels. For more information on eligibility and nomination material requirements please see the CECP Call for Nominations, the CRFM Call for Nominations, and the CSM Call for Nominations. If you have any questions please contact ACP staff at acpgovernance@acponline.org and if you are interested in serving please let our Governor, Matt Hollon know at mhollonmdfacp@gmail.org


2019 Annual Commercial Supporters Featured at the Annual Chapter Meeting