The Leg.Up - Richmond Academy of Medicine

The Leg.Up
Local, state and national news of interest to the
physician community
June 29, 2016 VCU Hospitals' Chief John Duval Steps Down, Deborah Davis Steps
Up
John Duval, Chief Executive Officer of VCU Hospitals
and Clinics and vice president for clinical affairs,
announced his retirement at the end of September,
reports the Times­Dispatch.
His successor will be Deborah Davis, who has served
as the organization's Chief Operating Officer for the
past nine years. "The care that has been taken to
groom her for this position results in a visionary and
John Duval strategic leader who will accelerate our momentum
toward a preeminent academic health center," wrote Dr. Marsha
Rappley, CEO of VCU Health System and Vice President, VCU Health
Services. Among Davis' accomplishments cited by Dr.
Rappley: "Superb financial management,"
oversight of the successful move into the
new Critical Care Hospital and the successful
design and occupancy of the Children's
Pavilion.
Davis told the TD yesterday that her
proudest accomplishment has been the STAR
service initiative to enhance the patient
experience.
She also noted the need "for community
engagement, and to create different kinds of
partnerships that may have never been
thought about." Duval, a RAM member, will remain with the
university through next March as a policy
advisor during the 2017 General Assembly.
During Duval's 13 years at the helm, VCU
brought on several major facilities, including
the Critical Care Hospital and the Children's
Pavilion. He also led the health system's
mergers with the Children's Hospital of
Deborah Davis Richmond in 2010 and with Community
Memorial Hospital in South Hill in 2014.
Duval, 63, and his wife of 37 years, Valli Duval, are moving back to
their hometown of Tucson, Ariz. "The west is home for me," said
Duval, who worked at the University of Arizona Health Sciences
Center for 16 years before coming to VCU.
Dr. Walter Lawrence Writes Future Physicians Click here to read Dr. Walter
Lawrence's column to future
medical school students in the
June/July "Discover Richmond"
in the Richmond Times­
Dispatch.
In "A seasoned doc shares a
message," the TD notes the
surgeon's participation in RAM
for than 50 years: "At age 90,
Dr. Walter Lawrence Jr. of
Richmond ­ who entered med
school during World War II ­ is
still seeing patients. Through
our friends at the Richmond
Academy of Medicine, we
asked him to write a letter to
aspiring doctors today."
Dr. Lawrence is professor of
surgery emeritus and director
Making the human connection!
emeritus of the Massey
(photo by Mary Beatty­
Cancer Center at the VCU
Brooks/McGuire VA Medical Center) School of Medicine. He also
treats fellow veterans at the McGuire Veterans Affairs Medical
Center.
"What is it about treating other human beings that's so fulfilling? It
starts with that aspect of medicine that seems as powerful now as
when I was a medical student: the patient," he writes. "Many call this the doctor­patient relationship, but I like to think of it
as the human connection." Dr. Lawrence served for many years on
the VCU School of Medicine Admissions Committee and said that
was always a reminder that "even though medicine has greatly
progressed over the years, we still need compassionate physicians,
with a talent for science, who will both love and seek the opportunity
to serve others in need."
Dr. Lawrence's column is also posted on RAM's website, so click here
for a good print version. Dinner (and family fun) on us!
Please join your fellow Academy members at Lewis Ginter Botanical
Garden on Wednesday, July 13th for RAM's Annual Family Night. We'll have live music by River City Band, waterplay in the Children's
Garden, face painting, balloon animals and a family­friendly dinner! Drop by from 5:00 ­ 8:00 p.m. for a night of family fun! CLICK HERE to register, call Lara at 804­622­8137 or email her at lknowles@ramdocs.org
Be sure to let Lara know the number of adults and children attending and the ages of those children.
We hope to see you there! Help Shape MSV/RAM's Legislative Agenda
Do you have suggestions for new health care policy in the
Commonwealth? Are there rules, laws, studies or other fair business
practice issues that you would like to see the Medical Society of
Virginia address?
If so, RAM invites you to offer resolutions for the consideration of our
38 delegates who will represent Richmond­area physicians at the
MSV Annual Meeting, October 14­16, 2016. These resolutions may
end up as proposed legislation for the 2018 Virginia General
Assembly or as a part of the MSV legislative package for 2018.
Please describe the problem, define the issue and propose a possible
solution. Submit your work by fax to 788­9987 or by e­mail to
lknowles@ramdocs.org. All resolutions must be received by
WEDNESDAY, AUGUST 17, 2016 to be considered.
Please consider serving as a delegate to the MSV Annual Meeting. If
interested, contact Lara Knowles at 622­8137 or
lknowles@ramdocs.org.
Goodbye Fan Free, Hello Health Brigade!
After operating for nearly a half century as the Fan Free Clinic, the
organization has rebranded itself as the Health Brigade, reports the
Times­Dispatch.
Executive Director Karen
Legato said the name better
reflects what the organization
provides to the community,
including "this sense of a
fighting spirit that we've
always had, because we've
been strong in our advocacy
work and social justice for the
people we serve."
"We really took a look at who we've been and what our core values
are to get to the essence of what Fan Free Clinic has been all these
years and how we want to position ourselves moving forward," she
said.
Legato noted that the "free" part of the clinic's name may have
limited the organization because it is considering implementing a
sliding­scale payment option that's tied to a patient's income.
Click here to read how the
rebranding occurred. The
name change name should be
completed by December, with
temporary signage already in
place. When Fan Free was
founded in 1968, it was the
first free clinic in Virginia and
one of the first in the country,
Legato said.
Bon Secours Taps Virtual App
Bon Secours
Richmond is rolling
out a new virtual
app/telemedicine
product, "Bon Secours 24/7." An ad in the July issue of Richmond
magazine shows a woman in bed holding a tissue against her nose:
"Don't 'Self' Diagnose," the ad declares. "Real Diagnosis. Real Time.
Real Simple."
It goes on to ask, "Is it just a cold or is it allergies? Now there's a
whole new way to see the doctor* (or let the doctor see you). With
the new Bon Secours 24/7 app you can video chat with one of our
medical providers in real time, giving you the convenience and
access you need to take charge of your health. And with virtual visits
for only $49, you can get a real diagnosis, a prescription if needed,
and get back to real life in record time."
Click here to learn more! (The * in the ad notes: "Patients may see a
doctor or nurse practitioner depending on availability.") Holy MACRA! One Doc's Take(down) On Medicare Payment Plan
Even as the head of CMS recently sang the praises of the Medicare
payment plan (MACRA) that replaced the bad old one (SGR), one
doctor was singing the blues about what lies ahead.
Blogging on KevinMD, Dr. Don Read says he was cheering last year
when Congress passed the Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA), which promised "to simplify
and improve Medicare's costly and complex programs that purport to
measure the quality of care we provide to our patients."
Unfortunately, "It appears that the net results will be neither
simplified nor improved."
In particular, he says, it's "disappointing... to learn that CMS
proposes to design a program that is stacked against solo physicians
and small group practices in its first year of implementation."
Despite promises by CMS Acting Administrator Andy Slavitt that
MACRA will "put physicians back in control," Read has a number of
concerns, from "costly reporting and compliance," to "arbitrary
incentives to create massive changes in physician practice." Click
here to read more about his concerns that run counter to the current
messaging and massaging from Washington. Treating Pain w/out Rx Slow to Gain Acceptance
Federal and state agencies & officials are urging docs to first treat
pain without using opioids ­ including some plans to restrict how
many pain pills a doctor can prescribe. "But getting the millions of
people with chronic pain to alternative treatments is a daunting task,
one that must overcome inconsistent insurance coverage as well as
some resistance from patients and their doctors, who know the ease
and effectiveness of medications," reports The New York Times. Alternate pain relief regimens may include chiropractic and
osteopathic manipulation, meditation, massage, acupuncture and
cognitive behavioral therapy, "which helps people cope with pain by
changing how they think about it."
But many state Medicaid programs for the poor, while eager to
reduce opioid use among their members, are just starting to grapple
with whether or how to cover non­drug treatments for pain.
One exception is physical therapy, which Medicaid is required to
cover for members who gained coverage under the Affordable Care
Act. But the coverage varies by state.
Click here to read more about ongoing research.
And click here to read how nearly 1 in 3 patients on Medicare ­ some
12 million people ­ "got at least one prescription for an opioid
painkiller last year. The bill? $4.1 billion.
One of the authors of the study said "this raises concerns about
abuse. This is serious problem facing our country."
Supreme Court Overturns Bob McDonnell's Convictions
The U.S. Supreme Court
unanimously reversed former
Virginia Gov. Bob McDonnell's
11 corruption convictions this
week. "Although there is a chance
that federal prosecutors could
seek to retry McDonnell,
Monday's decision marked an
end of a lengthy period of
legal limbo for a man was
once a rising star in the
Republican party," reports The
Washington Post.
Gov. McDonnell and daughters after
his conviction. Presumably, they're
happier now! Click here for a statement by the former governor. And here for a list
of who made donations to his legal defense fund. "Lawyers for Maureen McDonnell, whose separate appeal of her own
conviction had been put on hold as her husband's case played out,
said his victory means she should also be vindicated."
For the former governor, it could be months or even next year
before he learns whether or not he will be tried again in light of the
high court's decision overturning his corruption convictions, reports
the Times­Dispatch, "Or if the government throws in the towel, he
could find out much sooner."
USA Today reports that "public­corruption cases just got harder to
prove" by "saying that helping a wealthy benefactor gain access to
state officials, though 'distasteful,' does not necessarily prove illegal
quid pro quo."
Click here for another account from The New York Times.
UVa political analyst Larry Sabato
­­ the keynote speaker at RAM's
Sept. 13 General Membership
meeting ­­ said the court's decision
could magnify voter cynicism. "The
elites are saying this is
understandable behavior," he told
RTD columnist Jeff Schapiro. "But
average people were outraged by
this. That's where the jury verdict
came from." Click here to read more. UVa's Sabato: Average folks
will be "outraged" What Can You Say When a Patient Asks About Dying?
Click here for a thoughtful blog by a physician in KevinMD that
explores how "the path to becoming a physician is not easy."
As she reflects on her own growth over the years, Dr. Angella
Woodman recalls her own quest to retain her humanity while
controlling her emotions. "Love becomes blunted. Compassion is
muted at best. In building that wall to escape the pain, you run the
risk of closing yourself off from happiness as well."
Her struggle came to a head one day when a family member of a
dying patient asked her, "Why would God do this to her?"
Dr. Woodman's response ­­ and its aftermath ­­ taught her, "I could
not save their mother, and I could not take away the family's pain.
But I could acknowledge it, I could speak, and I could be human."
Click here to see what she said.
"Alert Fatigue" Got You Down?
While many people have set
their smartphones with various reminders, it's a whole
different story for doctors and
nurses who keep getting pings
and popups on computers and
iPhones.
"The electronic patient records
that the federal government
has been pushing ­ in an effort
to coordinate health care and
reduce mistakes ­ come with a
host of bells and whistles that
may be doing the opposite in some cases," reports Kaiser Health
News.
"What's the problem? It's called alert fatigue."
After Orlando Massacre, Many Confront a Long, Painful Recovery
As the viewings, funerals and candlelight
vigils tapered off after the June 12
massacre that killed 49 and wounded 53,
"The reality is setting in that many
people will be struggling ­ emotionally,
physically and, often, financially ­ for a
long time to come," reports The Wall
Street Journal.
Meanwhile, up to 1 in 5 people may be dying unnecessarily from car
crashes, gunshots or other injuries, "a stark conclusion from
government advisers who say where you live shouldn't determine if
you survive," reports The Washington Post. "The findings take on
new urgency amid the increasing threat of mass casualties like the
massacre in Orlando."
The Orlando massacre happened just blocks from a major trauma
care hospital, "an accident of geography that undoubtedly saved
lives," the Post reports. But the recent study "found that swaths of
the country don't have fast access to top care, and it urges
establishing a national system that puts the military's battlefield
expertise to work at home."
The ultimate goal: Zero preventable deaths after injury, and
minimizing disability among survivors, said the National Academies
of Sciences, Engineering and Medicine report. Click here to read it! There's no single organization in charge of trauma care in the U.S.,
but the study's authors said local and state improvements could
begin immediately. "The meter is running on these preventable
deaths," said Dr. Donald Berwick of the Institute for Healthcare
Improvement, who chaired the NAS committee.
Trauma is the leading cause of death for Americans 45 and younger,
killing nearly 148,000 people in 2014 alone, costing an estimated
$670 billion in medical expenses and lost productivity.
The biggest opportunity to save lives occurs well before reaching a
doctor, with about half of deaths occurring at the scene of the injury
or en route to the hospital. Here's an article about advances in
stopping bleeding from traumatic injuries. Click here to read more from Kaiser Health News about promoting
the lessons of the military to advance national trauma care.
Zika Funding Squashed after Senate Spat
Senate Democrats yesterday
"blocked a federal bill that
would have provided $1.1
billion to fight the mosquito­
borne Zika virus, saying
Republicans had sabotaged
the legislation with politically
charged provisions," reports
The New York Times. "The
move raised the possibility
that no new money would be
available soon to fight the disease as Southern states brace for a
summer outbreak."
After Republicans added provisions to the spending bill "that would
hinder access to contraception for women and weaken
environmental restrictions on pesticide use," health officials worried
that the in­fighting ignores "the urgency of this threat."
Meanwhile, click here for a report on some promising research that
could lead to vaccine to protect against the Zika virus.
For Docs in Training, a Dose of Health Policy Can Help the
Medicine Go Down
We treasure RAM's medical
students, residents and
interns who get involved early
in organized medicine! Click
here to learn more about the
special membership
opportunities the Academy
offers. Stay tuned for more
info about upcoming summer
socials for students, residents,
interns and fellows. Learn to
dig organized medicine in our
Digital Age ­­ and how RAM
helps you link in with our
medical community!
And click here to read how
RAM's future leaders at the
VCU School of Medicine are
outpacing their peers around the country where "many are taught
next to nothing about the workings of the health care system."
Lit's Healing Power Click here to read about a Georgetown U.
Medical School class that starts with an
Emily Dickinson poem about the isolating
power of sadness:
I measure every Grief I meet
With narrow, probing, eyes ­
Poet with probing
I wonder if It weighs like Mine ­
eyes
Or has an Easier size.
"It's a strange sight," writes Daniel Marchalik, MD, in The New
York Times. "...me, a surgical resident, reading poetry to 30
medical students on a Tuesday night. Some of us are in scrubs,
others in jeans; there are no white coats."
But over the past four years, this has become his routine, and a
feature of medical education at Georgetown, reading books like
Haruki Murakami's novel, "Colorless Tsukuru Tazaki and His
Years of Pilgrimage." It's the story of a depressed middle­aged
man who's trying to retrace his past in order to understand how
life became so empty.
There are many other books and discussions in GU's literature
and medicine track, all in an effort to "slow down and explore
human lives and thoughts in a different, more complex way...
Reading attentively and well, we hope, will become a sustaining
part of our daily lives and practice."
Happy summer reading! (If you're looking for a recent great
novel, try "My Brilliant Friend" by Elena Ferrante, the first of
her Neapololitan trilogy about two precocious girls growing up in
Naples.) We Love to Hear from You!
We draw from a wide range of print, online and medical journals to
bring you information we hope is relevant to your practice of
medicine.
But as a former journalist
and nonfiction author, I
recognize that mistakes do
happen. So please contact
me if you have any concerns,
complaints, or ideas/articles
you'd like to share by clicking
here or calling 622­8136.
Click here if you'd like to see
some of my other writing.
THANK YOU for being part of
the Academy and its
continuing conversation
about the best practice of
medicine.
And please check out some
back issues!
Chip Jones RAM Communications &
Marketing Director Seeking inspiration at the Temple of
Confucius in Beijing
The Richmond Academy of Medicine, 2821 Emerywood Pkwy,
Ste 200, Richmond, VA 23294
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