Spring 2012 - Maryland Academy of Family Physicians

Transcription

SPRING 2012
SPOTLIGHT ON
INFECTIOUS DISEASE
The URI, Still a Challenge
Pets and Zoonotic Infection: Understanding the Risks
Dermatologic Sequelae of Infectious Disease - Viruses
Also…
• On the Road to
Transformation to
a Patient Centered
Medical Home • MD Tech: Take Back
Control!
• Essential Evidence
Update 2012 Annual CME Assembly
in June… New
Format, New Location!
The Maryland
This Edition Approved
for 2 CME Credits.
Complete and Submit
Journal CME Quiz at
www.mdafp.org.
familydoctor / spring 2012 • 1
Maryland’s largest medical professional
liability insurer is always on call for you.
In today’s heated legal environment, even
the best Doctors feel the constant threat
of litigation. That’s why there’s Medical
Mutual, the company created and directed
by Doctors to safeguard your practice and
professional reputation. Day in and day out,
we’re here for you, providing high quality
professional liability insurance, the most
proactive claims defense, and the most
dependable financial strength and stability
in Maryland. With just one call, we’ll rush in—
and put your worries out. It’s no wonder why
more Maryland Doctors are protected by
Medical Mutual than any other insurer.
225 International Circle | Hunt Valley, Maryland 21030
410-785-0050 | 800-492-0193
2•
The Maryland
familydoctor / spring 2012
THE MARYLAND
familydoctor
Spring 2012
Volume 48, Number 4
contents
F EA T U RES
12
14
16
19
21
24
by William R. Sonnenberg, M.D.
by Rafael Lefkowitz, M.D., Lisa A. Conti, DVM, MPH, Peter M. Rabinowitz, M.D., MPH
Dermatologic Sequelae of Infectious Disease - Viruses
by Ryane A. Edmonds, M.D.
On the Road to Transformation to a Patient Centered
Medical Home
By Nihaika Khanna, M.D.
MD Tech: Take Back Control!
by Matthew Hahn, M.D.
Mission Statement
To support and promote Maryland family
physicians in order to improve the health of
our State’s patients, families and communities.
Essential Evidence Update 2012
Like Maryland
Academy of Family
Physicians on
Facebook
d e p a r tm e n t s
4
Board of Directors, Commissions and Committees
5
President
Farewell, Thanks… And Keep Up The Good Fight!
by Eugene J. Newmier, D.O.
8
Editor
Spotlight on Infectious Disease
by Joyce Evans, M.D.
10
Executive Director
The Passing of a Family Medicine Pioneer
by Esther Rae Barr, CAE
22
Residency Corner
26
Membership
27
Calendar
The Maryland
officers & directors 2011-2012/2013
commissons & commmittees (new structure as of 6/24/11)
President
Eugene J. Newmier, D.O.*
President-Elect
Yvette Oquendo-Berruz, M.D.*
Treasurer
Christine L. Commerford, M.D.*
Secretary (acting)
Eva S. Hersh, M.D.*
Vice presidents
Central (acting)
Jocelyn M. Hines, M.D.
Eastern (acting)
Andrea L. Mathias, M.D.
Southern
Trang M. Pham, M.D.
Western
Kari Alperovitz-Bichell, M.D.
Directors
Central (acting)
Nancy B. Barr, M.D.
Mozella Williams, M.D.
dr.yvetteoquendo@gmail.com
ccommerford8@gmail.com
evastephanie@ymail.com
jhines001@live.com
amathias@dhmh.state.md.us
trangmpham@gmail.com
kbichell@chasebrexton.org
nancy.b.barr@medstar.net
mowilliams@som.umaryland.edu
COMMISSIONS AND COMMITTEES
Executive Committee of Board of Directors
Eugene J. Newmier, D.O. (President)
Yvette Oquendo-Berruz, M.D. (Pres-E)
Christine L. Commerford, M.D. (Treas)
Eva S. Hersh, M.D. (Acting Secretary)
Yvette L. Rooks, M.D. (Immediate PPres)
Commission on Membership and Member Services
Vice President Central District
Jocelyn M. Hines, M.D. (acting) docnewmier@rosehillfp.com
yrooksmd@yahoo.com
jhines001@live.com
Bylaws Committee
Yvette Oquendo-Berruz, M.D.**
Adebowale G. Prest, M.D.
aprest@surfree.com
Finance Committee
Christine L. Commerford, M.D.**
Kevin S. Ferentz, M.D.
Eugene J. Newmier, D.O.
Yvette Oquendo-Berruz, M.D.
Joseph W. Zebley, III, M.D.
kev107@aol.com
docnewmier@rosehillfp.com
josephzebley@mac.com
Nominating Committee
Yvette L. Rooks, M.D. **
Kevin P. Carter, M.D.
Eugene J. Newmier, D.O. Yvette Oquendo-Berruz, M.D. Trang M. Pham, M.D.
yrooksmd@yahoo.com
kcart006@gmail.com
kev107@aol.com
Member Support Committee
Charles P. Adamo, M.D.
RH = Rural Health
Matthew A. Hahn, M.D. (RH)
Andrea L. Mathias, M.D. (RH)
Eugene J. Newmier, D.O. (RH)
Adebowale G. Prest, M.D. (RH)
Donald Richter, M.D. (RH)
SC = Special Constituency
Kisha N. Davis, M.D. (New Phys) Jocelyn M. Hines, M.D. (Minority)
Julio Menocal, M.D. (IMG)
Shana O. Ntiri, M.D. (Women) Technology Committee
Kwame Akoto, M.D.
Kristen Clark, M.D.
Matthew Hahn, M.D.
Neil M. Siegel, M.D.
Commission on Health Care Services and Public Health
Vice President Western District
Public Health Committee
Niharika Khanna, M.D.**
Kisha Davis, M.D.
Judy B. Davidoff, M.D. (HIV, onc, w hlth)
Lauren Gordon, M.D. (women’s health)
Jocelyn M. Hines, M.D. (underserved)
Kenny Lin, M.D. (screeng tsts, lifestyle couns)
Christine A. Marino, M.D. (oncology)
Donald Richter, M.D. (PCMH)
Vivienne A. Rose, M.D. (obesity)
Richard Safeer, M.D. (cardiovascular)
Bernita C. Taylor, M.D.
Sara A. Vazer, M.D. (immunizations)
4•
The Maryland
cpadamo@verizon.net
mhahn@oxbowemr.com
docnewmier@shorenet.net
aprest@surfree.com
don@mtnlaurel.org
kishagreen@hotmail.com
jhines001@live.com
jmenocal@fmh.org
sntiri@som.umaryland.edu
kwameakoto@gmail.com
kc@wellbeingmedicalcare.com
mhahn@oxbowemr.com
nsiegel@umm.edu
nkhanna@som.umaryland.edu
kishagreen@hotmail.com
jdavidoff@chasebrexton.org
lauren.gordon@medstar.net
jhines001@live.com
kwl4@georgetown.edu
cmarino3@jhmi.edu
don@mtnlaurel.org
vrose@som.umaryland.edu
richardsafeer@gmail.com
bctaylor14@hotmail.com
saravazer@gmail.com
Eastern
vacant
Rosaire M. Verna, M.D.
Southern
Patricia A. Czapp, M.D.
Ramona G. Seidel, M.D.
Western
Kristen M. Clark, M.D.
Matthew A. Hahn, M.D.
AAFP Delegates
William P. Jones, M.D.
Howard E. Wilson, M.D.
AAFP Alt. delegates
Yvette L. Rooks, M.D.
Immediate past president
Yvette L. Rooks, M.D.*
Resident Director
Kevin P. Carter, M.D. (UM)
Student director
Meghana Desale (JHU)
*Member of Executive Committee
Commission on Legislation & Economic Affairs
Vice President Southern District
Trang M. Pham, M.D. Legislative Committee
William P. Jones, M.D.**
Howard H. Bond, M.D.
Patricia Czapp, M.D.
Natelaine E. Fripp, M.D. Robert S. Goodwin, M.D.
Kim R. Herman, M.D.
Katherine J. Jacobson, M.D. (PGY II, FSHC)
Kenneth B. Kochmann, M.D.
Yvette Oquendo-Berruz, M.D. Ben E. Oteyza, M.D.
Yvette L. Rooks, M.D.
Neil M. Siegel, M.D.
Gregory H. Taylor, M.D.
Rosaire M. Verna, M.D.
Commission on Education
Vice President Central District
Andrea L. Mathias, M.D. (acting)
Education Committee
Eva S. Hersh, M.D.** Nancy Beth Barr, M.D.
Raygan Harris-Lofton, M.D.
Tracy Jansen, M.D.
Niharika Khanna, M.D. Eugene J. Newmier, D.O.
Shana O. Ntiri, M.D. Yvette Oquendo-Berruz, M.D. Trang M. Pham, M.D.
Vivienne A. Rose, M.D.
Ramona G. Seidel, M.D. Marc Wilson, M.D.
Tracy A. Wolff, M.D., MPH
Publications Committees
MFD = MFD Editorial Board
Richard Colgan, M.D.** (MFD)
Joyce Evans, M.D. (MFD)
Jasmine Chen Gatti, M.D. (MFD)
Trang M. Pham, M.D. (MFD)
Jessica M. Stinnette, M.D. (FSR, MFD)
Tracy A. Wolff, M.D., MPH (MFD)
Joseph W. Zebley, III, M.D. (MFD)
EB = E-Bulletin
Jocelyn M. Hines, M.D. (EB)
Eugene J. Newmier, D.O. (EB)
Yvette Oquendo-Berruz, M.D. (EB)
Yvette L. Rooks, M.D. (EB)
Joseph W. Zebley, III, M.D. (EB)
PRA = Public Relations & Awards
Kevin S. Ferentz, M.D. ** (PRA)
Charles P. Adamo, M.D. (PRA)
Michael J. LaPenta, M.D. (PRA)
Joseph W. Zebley, III, M.D. (PRA)
**Chair
vernar@georgetown.edu
pczapp@aahs.org
rgms01@verizon.net
kc@wellbeingmedicalcare.com
mhahn@oxbowemr.com
wpj@georgetown.edu
hwilny@aol.com
aprest@surfree.com
yrooksmd@yahoo.com
yrooksmd@yahoo.com
kcart006@gmail.com
mdesale@gmail.com
wpj@georgetown.edu
bondhh@aol.com
pczapp@aahs.org
kev107@aol.com
nfripp@umm.edu
drrgoodwin@verizon.net
kimherman2@gmail.com
jacobsonkj@gmail.com
kbkochmann@comcast.net
boteyza@msn.com
yrooksmd@yahoo.com
nsiegel@umm.edu
gtaylor@umaryland.edu
vernar@georgetown.edu
nancy.b.barr@medstar.net
rharris002@yahoo.com
tadjansen@aol.com
nkhanna@som.umaryland.edu
sntiri@som.umaryland.edu
aprest@surfree.com
vrose@som.umaryland.edu
rgms01@verizon.net
emnluv@aol.com
wolffta@hotmail.com
rcolgan@som.umaryland.edu
pczapp@aahs.org
joycespeaks@yahoo.com
jasmine.gatti@fda.hhs.gov
jessica.m.stinnette@medstar.net
tracy.wolff@gmail.com
jhines001@live.com
yrooksmd@yahoo.com
kev107@aol.com
cpadamo@verizon.net
mlapenta@hospicechesapeake.org
president
THE MARYLAND
Farewell, Thanks…
And Keep Up The Good Fight!
Spring 2012
Volume 48, Number 4
familydoctor
Editor-in-Chief
Richard Colgan, M.D.
Even though we
sometimes feel that we
are under siege, I still
believe in my heart that
each one of us does a great
service to our patients,
state and country.
As my term as MAFP president
enjoyed working closely with her over the
comes to a close, I’ve been thinking about
last 2 years.
events over the last two years since I was
While I have great optimism for our
installed as President in Annapolis. It has
Academy and for the future of Family
been a whirlwind and I’ve truly enjoyed every
Medicine, there are a few things that I feel
moment of my term. I’ve had the opportu-
require persistent diligence. Over the last
nity to increase my understanding of issues
couple years, I have expressed my concern
affecting family docs throughout the Nation,
about potential threats to our specialty.
not just in Maryland. I’ve had the good for-
One obvious threat comes from the insur-
tune to meet and befriend my counterparts
ers and government. I don’t think any of
from different State Chapters. I’ve also met
us feel they have our best interest at heart,
many of our constituent members in Mary-
however, we must continue to watch out
land. I have to say that I’ve learned so much
for assaults on our specialty. The best way
from everyone and I think it will help me in
to do this is to work with each other and
my post-presidential career.
our Academy. DO NOT BECOME COMPLA-
I am truly grateful to the members of
CENT! We have a strong organization that
our Board and to the staff at the Mary-
has a strong voice in Annapolis and Wash-
land AFP. We have a wonderfully dedi-
ington. We must continue to use that voice
cated group of people on the Board. Their
to make ourselves heard!
energy and devotion to the membership
My greatest concern, however, is the
is what makes this Academy a very strong
erosion of Family Medicine from “within.”
one. Our staff does an exceptional job at
What I mean by this is the increase in the
handling the day to day operations and
number of family physicians who are not
keeping the Board apprised of the issues.
doing what they were trained to do. By
The Nominating Committee has proposed
this, I refer to the increasing incidence
a slate of great candidates (see p. 26), many
of practicing only outpatient medicine,
of whom are new to the Board. We should
urgent care or not doing procedures. By
be excited about what lies ahead.
My
becoming “referralists,” “outpatientists” or
successor, Dr. Yvette Oquendo will bring
hospitalists, we are allowing our specialty
great enthusiasm to the presidency. I have
to erode.
Our subspecialty colleagues
Edition Editor
Joyce Evans, M.D.
Managing Editor
Esther Rae Barr, CAE
Editorial Board
Zowie S. Barnes, M.D.
Ryane A. Edmonds, M.D.
Joyce Evans, M.D.
Jasmine Chen Gatti, M.D.
Trang Mai Pham, M.D.
Jessica M. Stinnette, M.D.
Tracy A. Wolff, M.D., MPH
Advertising Sales and Production
ED.8
Publishing Concepts, Inc.
Virginia Robertson, Publisher
vrobertson@pcipublishing.com
14109 Taylor Loop Road
Little Rock, AR 72223
501.221.9986
For advertising information contact:
Tom Kennedy
501.221.9986 or 800.561.4686 ext.104
tkennedy@pcipublishing.com
www.pcipublishing.com
Publisher
Maryland Academy of Family Physicians
5710 Executive Dr., Suite 104
Baltimore, MD 21228-1771
410-747-1980; 410-744-6059 Fax;
info@mdafp.org
The Maryland Family Doctor is published four
times annually and is the official publication of
the Maryland Academy of Family Physicians.
The opinions expressed herein are those of the
writers and not an official expression of Academy
policy. Likewise, publication of advertisements
should not be viewed as endorsements of
those products and services by the publisher.
Readership: over 10,000. Copyright: All contents
2003 MAFP. All rights reserved.
Contributions and Deadlines
Those interested in submitting articles for
publication can view the Author’s Protocol Sheet
by clicking on News and Publications at www.
mdafp.org or contacting the headquarters
office. Deadline schedule for submitting articles:
May 15, August 15, November 15, February 15.
The Maryland
and, more importantly, the insurers and
are trained to do, then we are no different
reason that we find ourselves in our current
Government will think that we are no dif-
from a mid-level who refers to the hos-
health care situation is because we did not
ferent from Mid level providers.
Nurse
pitalist. Conversely, if we continue to go
speak up or defend ourselves in the past. I
practitioners have been telling insurers
into urgent care or hospitalist work, then
would beseech each member to become
and the Government that they can provide
the continuity of care that is the hallmark
active with the AAFP and the MAFP. Our
primary care at the same level in a less
of Family Medicine will erode. If that hap-
Academy is in great shape but we need
expensive manner for quite some time.
pens, then the foundation of our health
YOU to keep it so!
As the need for more family physicians
care system will crumble.
I hope my words in these columns
in Maryland increases, the mid-levels are
A word of warning to our residents who
have given you food for thought. Even
positioning themselves to “fill the gap.” My
are reluctant to go into private practice
though we sometimes feel that we are
concern is that the Government will even-
because they would prefer an employed,
under siege, I still believe in my heart that
tually decide they are right. If we do not
9-5 job. Watch out, there may come a time
each one of us does a great service to our
distinguish ourselves, then our specialty
when jobs become scarce because a man-
patients, state and country. As I finish my
will be in serious trouble. I can foresee a
aged care group or hospital run group
term, I would like to thank one more group
time in the future when insurers, employ-
realizes that a nurse practitioner can see as
for trusting me to lead the Academy over
ers and the Government will develop a
many patients in a day at ½ the salary of a
the last two years. Thanks to our MAFP
model where a small group of physicians
fresh graduate from residency. The older,
members. I have appreciated your letters,
will oversee a larger group of mid-levels
more experienced docs could see the same
emails and calls during my term. I hope
who provide the bulk of primary care. If
threat as employers use the same model
that you, your families, patients and prac-
we, as a group, do not continue to see our
and eliminate the older doc who doesn’t
tices continue to thrive. Best Wishes to all
patients in the hospital and do what we
meet a daily “quota” of patients. Part of the
of you! Auf Wiedersehen!
family medicine
U T E R I N E F I B R O I D E M B O L I Z AT I O N
A SAFE AND EFFECTIVE ALTERNATIVE FOR FIBROIDS
Uterine fibroid embolization (UFE), also known as uterine artery embolization, is a
non-surgical treatment for symptomatic uterine fibroids performed by an interventional
radiologist. Using a catheter and guidewire, the physician injects tiny microspheres into
the vessels that feed the fibroids, blocking the blood supply, shrinking the fibroids, and
relieving symptoms.
After the UFE procedure
and appropriate
follow-up care, your
fibroid patient
returns to you
for continued care.
6•
The Maryland
Unlike myomectomy and endometrial ablation, which either address one fibroid at a
time or only bleeding symptoms respectively, UFE is a global procedure that effectively
addresses all fibroids and related symptoms at once.
UFE offers your patients another option:
• Resolves ﬁbroid symptoms
• Potential for maintaining reproductive ability
• Doesn’t require a lengthy hospital stay or recovery time
ENCOURAGING REFERRALS ENHANCES PATIENT CARE
Many physicians may not be fully educated about UFE and as a result, may not be
discussing it with many patients who will find it to be an attractive treatment option.
To locate an experienced Interventional Radiologist (IR) in your area and to order your
free supply of patient pamphlets, please call 866-275-7498.
■
888-680-4900
Security Alarms
CCTV
Card Access & Door Control
FREE PRICE QUOTES & BEST PRICES GUARANTEED
888-680-4900
www.ProtectedSec.com
Nationwide Sales & Service
24/7/365 Service
The Maryland
editor
Spotlight on Infectious Diseases
cases and mild cases were not reported.
Edmonds gives an update on the derma-
Haiti in the last 2 years has been rav-
tologic sequela of viruses. I am hopeful
aged by an ongoing cholera epidemic.
that these articles will not only educate
Recent CDC statistics note over 470,000
you but also serve as a reminder that
cases and 6,631 deaths.
Indeed, our
the book on infectious diseases is most
battle against these infectious agents is
definitely open and we should remember
never-ending. The book on infectious
prevention is often the best approach to
diseases is not closed. However, we are
limit many infectious diseases.
4
■
making progress.
Joyce Evans, M.D.
Note: references for this article are posted at
led to a reduction of many infectious
www.mdafp.org; publications and news tab.
“The time has come to close the
diseases.
book on infectious diseases.”
We only need to look at the
There is
impact of the use of vaccines on smallpox
debate as to whether this quote is accu-
and polio prevalence. At the same time,
rately attributed to former US Surgeon
the need for continual vigilance persists.
General, William Stewart in 1967. How-
Despite the availability of a measles vac-
ever, as any family physician can attest,
cine, the year 2011 was a particularly
our war against infectious disease con-
active year for measles infections. There
tinues on.
were over 100,000 cases in Africa, over
Mankind’s
battle
with
infectious
agents dates back to centuries ago. The
Black Death (Bubonic Plague) in the 14th
26,000 cases in Europe, over 700 cases in
Canada and over 200 cases in the U.S. 5
So the spotlight is on Infectious Dis-
century led to the death of over a third
eases.
of the European population.1 Despite all
important area of medicine makes up
efforts and strategies, this epidemic was
a significant component of our medi-
not quelled.
It maintained its impact
cal encounters. The presentations are
on society until the 16th century, when
diverse – for example, the common
cases decreased. Additional pandemics
cold, gastroenteritis, sexually transmit-
followed.
ted diseases, urological infections and
Yellow fever outbreaks were
It is an appropriate topic as this
common in the US and southern Europe
various skin infections.
in the 18th and 19th centuries and the
that the physician remains abreast of the
disease currently remains active in Africa
most current approaches to prevent and
and Latin America.
effectively manage the myriad of infec-
According to the
World Health Organization (WHO), yellow fever infections total 200,000 cases a
year and 30,000 deaths annually. 2
The 21st century has also seen its
8•
Advances in vaccines and drugs have
It is important
tious diseases.
In this edition of Maryland Family
Doctor, our authors will provide practical information to help you in your day
share of pandemics. In 2009, the H1N1
to day practice.
pandemic impacted countries through-
berg reviews the challenges in treating
out the world.
According to WHO, in
the upper respiratory tract infection.
2009, there were over 500,000 cases of
In their article, Drs. Lefkowitz, Conti
H1N1 infection and over 11,000 deaths. 3
and Rabinowitz provide a comprehen-
This estimate is felt to be low, as many
sive overview on pet-related infections.
countries failed to consistently report
Finally, our Resident Editor, Dr. Ryane
The Maryland
Dr. William Sonnen-
Are you looking for a satisfying career and a life outside of work?
Enjoy both to the fullest at Patient First.
Founded and led by a physician, Patient First has been a regional healthcare leader in Maryland
and Virginia since 1981. Patient First has 38 full-service neighborhood medical centers where our
physicians provide primary and urgent care 365 days each year. In fact, over 240 physicians have
chosen a career with Patient First. We are currently looking for more Full and Part-Time Internal
and Family Medicine Physicians in Virginia, Maryland and Pennsylvania. At Patient First, each
physician enjoys:
• Unique Compensation
• Malpractice Insurance Coverage
• Flexible Schedules
• Team-Oriented Workplace
• Personalized Benefits Packages
• Career Advancement Opportunities
To discuss available positions please contact Eleanor Dowdy,
eleanor.dowdy@patientfirst.com or (804) 822-4478. We will arrange
the opportunity for you to spend time with one of our physicians to
experience firsthand how Patient First offers each physician an
exceptional career.
• Generous Vacation & CME Allowances
Established by Physicians
for Physicians
We know how to
diagnose and treat
your insurance &
financial needs.
Property & Liability:
✤Medical Malpractice
✤Workers Compensation
✤Medical Office Insurance
✤Employment Practices Liability
✤Directors & Officers Liability
✤Bonds (Fiduciary/Fidelity/Erisa)
✤Personal Insurance (Home,
Auto, Umbrella)
Employee Benefits:
✤Medical, Dental &
Vision Coverage
✤Group Life & Disability
✤Section 125/Flex
Spending Accounts
Find out if your
medical practice is
adequately insured.
Call us today to schedule your
“no obligation” insurance and financial review.
410-539-6642 | 800-543-1262
1204 Maryland Avenue
Baltimore, Maryland 21201
www.medchiagency.com
The Maryland
executive director
The Passing of a Family Medicine Pioneer
Pending approval of the MAFP mem-
was the son of Charles Wilbur Stewart,
bership in June, the Maryland Chapter
M.D. and Elsie Hendrix Stewart. He was
will submit a Resolution of Condolence
married to Esther (Penny) Evans Stewart
for Dr. Stewart to the 2012 Congress of
of Westminster, his beloved wife of 58
Delegates of the AAFP.
years, who died in 2008.
William Stewart, who graduated with
his M.D. from Johns Hopkins in 1951, was
one of the pioneers in the establishment
of Family Practice as a medical specialty.
He built up a general practice in West-
Esther Rae Barr, CAE
minster from 1952 through 1968 with a
In late January I got a call from
couple of years spent as a Captain in the
Dr. Dean Griffin (MAFP President 1984)
U.S. Army Medical Corps’ Occupational
informing me of the passing of Dr. Wil-
Health Laboratory in Edgewood, MD. He
liam Stewart, a prominent figure in the
recognized that the medical schools in
history of Family Medicine who was the
Maryland were not graduating enough
first Chairman of the University of Mary-
general practitioners to meet the state’s
land Department of Family Medicine and
needs and approached the State Legis-
President of MAFP in 1969. I was sorry to
lature about the problem. As a result, he
hear the news. I have heard Dr. Stewart’s
was asked to serve as the first Head of the
name come up through the years, when
Division of Family Medicine at the Univer-
the early days of the specialty are still
sity of Maryland School of Medicine. In
oftentimes discussed. His contemporary
1971, he left Maryland for the opportunity
and colleague, Dr. J. Roy Guyther (also
to help build a new medical school from
a pioneer in the specialty) wrote of Dr.
the ground up at Southern Illinois Uni-
Stewart’s contributions in his article “ His-
versity School of Medicine in Springfield,
tory of the Department,” appearing in the
IL. He served as Professor and Chairman
Special Supplement to this publication
of that Department of Family Practice for
(Fall, 2007) marking the 35th Anniversary
almost a decade and implemented many
of the University of Maryland Department
innovative teaching techniques for medi-
of Family and Community Medicine (see
cal students interested in becoming Fam-
p. 29 for an update on Dr. Guyther’s cur-
ily Physicians. Dr. Stewart retired in 1991
rent activities).
as the Chairman of the Dept. of Commu-
Drs. Griffin and Stewart were colleagues
nity Health and Family Medicine at the
in Westminster, remaining in touch after
University of Florida College of Medicine.
Dr. Stewart left Maryland. Dr. Griffin gave
When he retired, he continued to volun-
me the contact information in Colorado
teer in a free clinic for several years.
Over the course of his career, Dr.
for Dr. Stewart’s daughter Cindy Murphy.
I contacted her to gather information
for this column, the intent of which is to
Stewart was a member of dozens of medical societies, residency review commit-
honor his memory and to acknowledge
William L. Stewart, M.D., formerly of
tees, editorial review boards and foun-
his continuing legacy. The following is an
Westminster, MD, and recently of High-
dations and wrote numerous articles and
abridged version of the obituary which
lands Ranch, CO, died November 18, 2011.
speeches – all with the goals of attract-
she wrote for The Carroll County Times.
10 •
Obituary by
Cindy Stewart Murphy
The Maryland
Born in Baltimore in 1925, Dr. Stewart
ing more students and promoting the
highest standards for the education of family physicians. He was
awarded the Thomas W. Johnson
Award for Outstanding Family
Practice Educator of the Year in
1978 by the American Academy of
Family Physicians.
Surviving are his daughters and
sons-in-law Cindy Stewart Murphy
and Keith Schrum of Highlands
Ranch, CO and Erin Stewart and
Curtis Martin of Bothell, WA, as
well as granddaughter Erica Mur-
•
•
•
•
•
phy Jones of Columbus, OH.
I’ll Show You a Green Horse
While Dad was a medical student at Johns Hopkins, he was
stumped by a question on an
exam. He wrote on the examina-
The top law enforcement
agencies and corporations
in the world use Shred-it!
Mobile Paper Shredding & Recycling
Est.
1988
Security-cleared personnel
Offices coast to coast
Locked containers supplied
Shredded in our truck at your location
Call for a free estimate
ON-SITE PAPER
SHREDDING
410-796-1500
1-800-697-4733 (1-800-69-SHRED)
www.shredit.com
tion paper, “If you can show me
one practicing doctor in a thousand who can answer this question, I’ll show you a green horse.”
Dad’s medical school buddies
were sure he’d be thrown out of
Hopkins for the remark. Instead,
the professor wrote back, “Stewart
- you’ve now shown us a horse’s
ass.” Dad’s medical school friends
got such a kick out of this that for
the rest of his life, whenever one
of them saw a green horse in a gift
shop, they’d buy it and send it to
Dad! We even have a few green elephants and green dogs that were
Accelerate your patient-centered
medical home practice transformation.
Connect with PCMH peers and thought leaders.
Share best practices and access resources.
Stay up-to-date on accreditations.
Delta-Exchange® is an award-winning collaborative
online network offering PCMH resources, such as:
sent. Dad kept his green horse
Online seminars, live and on demand
collection and I made sure that it
How-to articles on practice improvement topics
went with him at the assisted liv-
“Ask an expert” feature
ing facilities where he lived after
developing Parkinson’s Disease.
The collection (probably about 25
horses of all sizes and materials)
Knowledge and document sharing
Free to AAFP members
Practice tools and support
Learn more at
www.aafp.org/deltaexchange
was a great conversation starter
and Dad never tired of telling the
story behind it!
■
The Maryland
the symptoms are caused by the immune
Bradykinin produces local
Rhinovirus causes 50% of colds and
symptoms including sore throat, nasal
90% of colds in the fall. There is a large
congestion, watery eyes and cough.
amount of antigenic types, thus large
Cytokines cause systemic symptoms like
number of reinfections. Rhinovirus repli-
chills and fever, headache, fatigue, mal-
cates best at 33° to 35°C which is a little
aise, anorexia, nausea and depression.
cooler than core body temperature. Thus
Nearly all the symptoms of the common
it seldom goes into the lower respiratory
cold come from the immune response
tract. It can withstand drying on the skin
rather than the virus itself.
and a variety of temperatures.
response.
William R. Sonnenberg, M.D., FAAFP
Other
common viral causes include adenovirus,
parainfluenza, RSV, human metapneumo-
Even though the viral URI is seldom a
virus, and bocavirus.
cause of morbidity or mortality, the typical patient will spend five years of life
Methods to prevent the spread of
suffering from the common cold and one
colds include healthy diet, low stress,
year bedridden. This common problem
frequent hand washing and disinfect-
is responsible for 40% of lost time from
ing surfaces. Special antimicrobial soaps
work and 100 million office visits per
do not appear to be better than plain
year.1 The child in kindergarten can get
soap. 4 Increasing fluids is routine advice
up to twelve colds per year and the ado-
to help fever, loosen mucus and correct
lescent and adult will get seven. Women
fluid loss but the Cochrane fails to show
get more colds than men, but less if they
a benefit. 5 Lately it seems that there is
work outside the house.
little that vitamin D can’t do, and the
Colds are mostly spread by hand to
hand contact i.e. touching nose then
Rhinovirus
common cold is no exception. A study
in 2009 6 looked at almost 19,000 partici-
touching someone else. Coughing and
The initial symptom is a dry scratchy
pants comparing number of URI’s versus
sneezing are poor ways to spread a
throat accompanied by malaise and low
serum vitamin D levels. Results were
cold. Patients are most infective during
grade fever. This is followed by cough,
adjusted for BMI smoking, asthma and
early symptoms. Risks for cold include
rhinorrhea, and nasal congestion. The
COPD. (Results are shown in the chart on
poor nutrition, especially low vitamin D,
rhinorrhea comes from stimulation of
next page.)
crowding, day care, poor sleep, and low
the trigeminal nerve by the bradykinin.
Exercise has varible benefits with
humidity. Heavy exercise seems to be
Initially the discharge is clear, but after
URI’s. Moderate exercise has been shown
a risk factor while moderate exercise is
one to two days it becomes green. The
to result in a 50% reduction in sick days
helpful. Smoking can extend the dura-
green color is not a sign of bacterial
and 30% fewer URI’s. Exhaustive exercise
tion of a cold by 3 days. 2 Sleeping less
infection nor is it a sign necessarily of
seems to suppress immunity and increase
than 7 hours per day increases the risk
involvement of the sinuses. The green
severity and frequency of infections.7
2.94 fold above those that sleep 8 or
comes from involvement of leukocytes
more hours per day. Those with poor
which release myeloperoxidases.
sleep efficiency had 4 times more colds3
in the sinus areas come from pressure
to withhold dairy products.
changes from the congestion.
Pain
Treatment of the URI has shown little
changes over the years. There is no need
Smoking
The
should be decreased or stopped. Mod-
the nose or eyes by touching. It then
patient can also have sinus pain with
erate exercise is allowable. Humidifica-
replicates in the nasal epithelial cells.
patent ostia from inflammatory media-
tion via vaporizer or humidifer is benefi-
Damage to the mucosa is slight; most of
tors. The pain can worsen with postural
cial. There may be a modest benefit to
The virus enters the victim through
12 •
changes or air pressure variations.
The Maryland
interleukin- 8 , nor viral titers9 Zinc is sug-
<10 ng/ml
10 to <30 ng/ml
≥30 ng/ml
40.0
30.0
gested and did show a benefit in a trial
in 198410, but subsequent trials failed to
show benefit. There was a concern over
20.0
financial bias.
10.0
human affliction. Higher primates such
0
even have an increase in mucous pro-
The common cold is a uniquely
as chimps can be infected but they don’t
Winter
Spring
Summer
Fall
duction. This lack of an animal model is
part of the research problem. In some
respect, little has advanced since the
dextromethorphan and antihistamine/
spite of no evidence for faster nor greater
time of Benjamin Franklin who said,
decongestant combinations. Non-sedat-
effect. 8 There is no safety assurances for
“People often catch cold from one
ing antihistamines are ineffective. There
the combination. The dosing schedule is
another when shut up together in small
is no effective medication treatment for
also confusing with dosing of either every
close rooms, coaches, etc. and when sit-
coughs in children.
4 or 6 hours.
ting near and conversing so as to breathe
The FDA recently
in each other’s transpiration.”
issued a warning to stop the use of cough
Since conventional treatment options
and cold preparations in children under 4.
for the common cold fail to impress,
It was noted that there were 123 pediat-
patients often resort to complimentary
Dr. Sonnenberg is a family physician in
ric deaths between 1969 and 2006 due to
medicines. $300 million per year is spent
private practice in Titusville, PA. He is the
decongestants and antihistamines with-
on Echinacea. It is claimed to help WBC
current Vice President of the Pennsylva-
out a benefit.
function.
nia Academy of Family Physicians.
One sudy tested 3 different
■
Half of pediatricians recommend alter-
preparations on 437 volunteers exposed
nating ibuprofen with acetamnophen for
to rhinovirus type 39. There was no dif-
fever reduction. This advice is given in
ference in secretion volume, PMN’s,
journal CME quiz
Articles
1. The URI, Still a Challenge
p. 12
ONLINE COMPLETION OF MAFP JOURNAL CME QUIZZES AT WWW.MDAFP.ORG
2. Pets and Zoonotic Infection: Understanding the Risks
p. 14
3. Dermatologic Sequelae of Infectious Sisease – Viruses p. 16
The process for completion and submission of MAFP Journal CME quizzes is fully automated.
Read the CME articles in this edition (listed above) either from your mailed version or the online
version. Each “live” version is posted online at the Publications and News tab. Access the quiz by
clicking on the CME Quiz tab at www.mdafp.org.
Once on the CME Quiz page (where quizzes for each “live” edition are posted), follow the directions. Upon sending, you will receive an immediate confirmation that your quiz has been received
by MAFP. MAFP will report the credit to AAFP for posting on your member record at www.aafp.org
Those unable to complete/send the quiz using the automated system will be able to print the quiz
for manual completion then sending to MAFP. Quiz answers for each edition are posted at www.
mdafp.org; Publications and News tab.
Questions? Contact the MAFP office via email to info@mdafp.org or call 410-747-1980.
The Maryland Family Doctor has been reviewed and is acceptable for
Prescribed credits by the American Academy of Family Physicians
(AAFP). This Spring, 2012 edition (vol. 48, No. 4) is approved
for 2 Prescribed credits. Credit may be claimed for two years from
the date of this edition (expiring April 30, 2014). AAFP Prescribed
credit is accepted by the American Medical Association (AMA) as
equivalent to AMA PRA Category 1 credit toward the AMA Physicians Recognition Award.
The Maryland
Rafael Y. Lefkowitz, M.D.
50% of US households have a cat, dog, or
woman is infected during pregnancy, the
other pet. Therefore, when a physician is
fetus can develop congenital toxoplasmo-
caring for a family, it is more likely than
sis with serious developmental defects.
not that the family includes at least one
Other notable parasitic infections from
pet. The timely diagnosis, treatment, and
household animals include toxocariasis/
most importantly, prevention of the broad
ocular or visceral larval migrans (round-
range of pet-related zoonotic disease all
worm, from dogs, cats) leading to cases
require awareness on the part of the fam-
of preventable blindness in children or a
ily physician. At the same time, physicians
factor in asthma (Hotetz et al), cutaneous
must keep in mind that the psychosocial
larvae migrans (hookworm, from dogs,
benefits of owning pets and the “human
cats), and echinococcosis (tapeworms,
animal bond” are thought to outweigh
from dogs). It is equally important to be
the risks of pet-related zoonotic infection
aware of infections that are not zoonotic
in most cases (Friedman). This article will
but often erroneously attributed to pets;
review characteristics of pet associated
an example is pinworm infection due to
zoonoses. In addition, simple measures
(Enterobius spp; dogs and cats are not carri-
such as handwashing and proper disposal
ers of this roundworm.
of pet feces can reduce risk.
Scabies mites have adapted to different species, and while dogs can infect
Lisa A. Conti, DVM, MPH
Internal and External Parasitic
infections
humans with S. scabiei canis, usually such
zoonotic scabies infections resolve spon-
Common pet-related infections are due
taneously as the mites fail to reproduce on
to internal and external parasites. Perhaps
the human host. Ticks may enter a house
the most well known pet-related parasitic
on a dog or a cat, and removing a tick
infection is toxoplasmosis, caused by T.
from an animal is a risk factor for infection
gondii. The parasite undergoes sexual
with Lyme disease, Rocky Mountain Spot-
reproduction in cats and is fecally excreted
ted fever or other tickborne disease. Flea
as oocysts by newly infected cats. The
infestation on cats has been a risk factor
oocysts become infective to other animals
for transmission of Cat Scratch disease
after one to five days, therefore promptly
(Klotz) as well as plague to nearby humans.
disposing cat feces reduces infection risk.
While contact with cat feces is a risk fac-
Peter M. Rabinowitz, MD, MPH
14 •
Bacterial infections
tor for human infection, perhaps a more
The most common bacterial disease
important risk factor is eating under-
related to pet ownership is probably gas-
While most emerging infectious dis-
cooked meat (source 17 from original
troenteritis due to campylobacter (from
eases are zoonotic (shared between ani-
article). Dogs may serve as mechanical
cats and dogs) and salmonella (from rep-
mals and people) in origin, you don’t have
vectors of toxoplasmosis due to rolling in
tiles, ducklings, chicks, cats, and dogs)
to travel to exotic locations to contract
cat feces. Acute human infection in adults
infection. Other bacterial zoonoses from
zoonoses. If precautions are not taken, the
is usually either asymptomatic or a self-
pets include leptospirosis (from dogs, cats,
family dog or cat as well as other house-
limited mononucleosis-like illness. Immu-
multiple others), Chlamydophila pneumo-
hold pets can be a source of human expo-
nocompromised individuals are at risk of
nia (psittacosis) (birds), brucellosis (breed-
sure for a wide range of zoonotic patho-
more severe infection with neurological
ing dogs) and rat bite fever (streptobacil-
gens (Rabinowitz and Conti). More than
complications. If a previously unexposed
lus) (rodents). Fish aquaria can be a source
The Maryland
of infection with M. marinum. In plague-
ratory or diarrheal disease. Red flags in
disposal. Infants and children younger
endemic areas, infected cats have been
the history include the patients’ expo-
than age 5, older individuals, the immu-
reported to have passed the infection to
sure to high risk pets such as kittens,
nocompromised, and pregnant women
humans. Dogs and cats can be colonized
puppies, ducklings, chicks, reptiles, or
should avoid puppies and kittens younger
with Methicillin resistant Staphylococcus
other exotic animals, immunocompro-
than six months, baby chicks and duck-
aureus ( MRSA) , and transmission of MRSA
mised pets, or pets with diarrhea or
lings, reptiles, and pets with diarrhea.
acute respiratory infection.
Pregnant women should avoid handling
can occur between humans and pets.
(Manian)(Bender et al)(Morris et al).
Fungal infections
• Exotic pets carry increased risk of exotic
cat litter, keep cats indoors, and not feed
pathogens, an example being a recent
cats uncooked meat to reduce the risk of
outbreak of monkeypox in the Midwest
toxoplasmosis.
Fungal dermatophytosis (ringworm)
traced to imported African rodents.
is one of the most common pet-related
Wild animals kept as pets may pose a
infections. There are an estimated 2 mil-
greater infection risk.
One Health
There is a growing awareness of link-
lion human cases per year caused by expo-
• Pets that roam outdoors may have
ages between the health of humans,
sure to animals, especially dogs and cats
greater contact with wildlife and the
animals, and their environment. The con-
which may or may not have associated
pathogens they carry.
cept of “One Health” stresses the need for
lesions (Stehr).
Viral infections
While rabies is rare among vaccinated
• People at increased risk of zoonotic
close collaboration and communication
infection include infants and small
between human health providers and vet-
children, elderly, and immunocompro-
erinarians to prevent zoonotic infections
mised persons.
and balance the risks of infection with the
US dogs and cats, cat cases outnumber
• Not surprisingly, the particular habits
positive benefits of pet ownership (Rabi-
dog cases and both pose a risk to humans.
of pet ownership may play a pivotal
nowitz and Conti). Public health practitio-
Other
zoonoses
role governing transmission of pet
ners can help inform these collaborations.
choriomeningitis
pathogens. Sleeping with pets has
Ensuring pets receive regular preventive
virus (from pet rodents such as hamsters,
been linked to cases of the plague, cat-
veterinary care including de-worming and
guinea pigs, and mice) which can cause
scratch disease, and Chagas disease
vaccinations is a key part of reducing zoo-
fatal disease in immunocompromised indi-
(Chomel). Close animal contact, includ-
notic risk.
viduals. Pet rodents have been sources of
ing biting, scratching, licking, and
human cases of monkey pox and cowpox
kissing, has resulted in transmission
Dr. Lefkowitz is a clinical fellow in occupa-
(Nivone, Campe). During the H1N1 influ-
and infection from Capnocytophaga
tional and environmental medicine, Yale
enza pandemic, household cats and fer-
canimorsus
School of Medicine, New Haven, CT
rets became infected with the flu, appar-
choriomeningitis and Pasteurella spp
ently by humans (“reverse zoonosis”), but
(Kimura).
pet-associated
include
lymphocytic
viral
(Valtonen),
lymphocytic
son et al)
Dr. Conti is Courtesy Associate Professor,
Department of Infectious Diseases and
transmission from pets to humans has not
been reported.(Campagnolo et al, Swen-
■
Prevention
Prevention of zoonotic infections have
been outlined in consensus guidelines
Pathology, College of Veterinary Medicine,
University of Florida; Principal, One Health
Solutions, Tallahassee, FL
Key Points in the History
(CDC 1, CDC 2), and include routine vet-
• Many pet-related infections go undi-
erinary care for all pets, hand-washing,
Dr. Rabinowitz is Associate Professor of
agnosed or unreported. To detect pet-
proper hygiene in disposal of animal
Medicine, Director of Electives, Yale Uni-
related infections, the physician must
waste, appropriate diet for the pets, and
versity School of Medicine, Yale Occupa-
carry a high index of suspicion. One way
timely treatment for diseased pets. Spe-
tional and Environmental Medicine Pro-
is to ask questions about the patient’s
cific recommendations for all patients
gram, New Haven, CT
exposure to and health of these ani-
include hand-washing after handling pets
mals as part of the medical history,
and pet dishes, and avoiding contact with
especially for a patient with fever, respi-
animal feces and vomitus through proper
The Maryland
Dermatologic Sequela of Infectious Disease-Viruses
tions can have preceding prodromal symptoms of pain, burning, or itching prior to
outbreaks.
Experienced clinicians can usually properly diagnose these infections by visual
examinations, however there are confirmatory tests. Only primary infections may be
confirmed by serology. A viral culture can
help to confirm the diagnosis. The direct
fluorescent antibody (DFA) is less-specific
Ryane A. Edmonds, M.D.
test but useful. The Tzanck smear can be
Viruses are everywhere! These infec-
valuable in the rapid diagnosis of herpes
tions present in many different ways. Some
virus infections, but it is less sensitive than
of them are visible. In this article we will
culture and DFA.
discuss some of the top dermatologic infec-
The gold standard of HSV treatment is
tions caused by viruses, their prevalence,
Acyclovir; however other antivirals, such as
pathophysiology, signs & symptoms, diag-
famciclovir and valacyclovir, are also quite
nosis and treatment. Some are quite contagious, some are dangerous, and some are
just irritating. Let’s talk about what to do
when our patients present with them.
Table 1: Treatment of Herpes Simplex
Indication
Valacyclovir
200 mg PO 5×/day
or 400 mg PO tid
for 10 days
500 mg PO bid or
250 mg PO tid for
7 days
1 g PO bid for
10 days
Recurrent HSV
400 mg PO tid for
5 days
750 mg PO bid for
1 day
2 g PO bid for
1 day
Recurrent HSV
400 mg PO bid
250 mg PO bid
1 g PO or 500 mg
PO qd
a mucocutanous infection affecting the
orofacial areas (HSV-1) and genital areas
Famciclovir
Primary HSV
Herpes Simplex Viruses
Herpes simplex virus (HSV) is typically
Acyclovir
(HSV-2). Lesions are typically painful and
16 •
self limited. They may present as small
mucosa, and/ or palate. Common symp-
effective.
grouped vesicles on an erythemetous base
toms of viral syndromes may be associated,
ranted, for patients with recurrent infec-
Suppressive treatment is war-
and can be recurrent. Approximately 80%
such as cervical adenopathy, fever, malaise
tions (more than six episodes per year).
of the population has antibodies to HSV-1
and myalgias.
Immunosuppressed individuals with severe
and HSV-2 causes genital ulcerations in up
The terms cold sores or fever blisters
disease or complications require weight
to 50% of sexually active people. Infection
refer to Herpes labialis and characterize
based treatment with Acyclovir 10 mg/kg
of the virus is caused by direct contact of
reactivated HSV-1. They are demonstrated
IV every 8 hours for 7 days. Table one dem-
mucosal sites or areas of abrasion on the
as grouped vesicles on erythematous
onstrates other treatment options.
skin. The virus can remain dormant and
denuded skin, usually the vermilion border
become active during periods of illness,
of the lip. Genital herpes infections, HSV-2,
stress, menses, etc.
appear as erosions or ulcers on the exter-
Herpes Zoster
Definition and Etiology
Oral mucocutaneous lesions present as
nal genitalia occurring 7 to 10 days after
Herpes zoster, commonly known as
acute herpetic gingvostomatitis and her-
primary exposure. This rarely presents as
shingles, can affect up to 10% to 20% of
pes labialis. Children are generally affected
intact vesicles. Patients affected commonly
adults. Underlying immunosuppression is
by the former displaying vesicles, erosions,
have recurrent genital disease (40%). Both
common and the virus presents as an acute,
and erythema of the lips, tongue, buccal
herpes labialis and genital herpes infec-
painful dermatitis in a dermatomal pattern.
The Maryland
Table 2: Treatment of Herpes Zoster
Indication
Acyclovir
Herpes zoster
800 mg 5×/day x
7-10 days
Disseminated
zoster
10 mg/kg IV q8hr
x7 days
In Herpes Zoster, the varicella virus initially invades the skin or mucosal surfaces
and travels to the sensory ganglia, lying
dormant for the lifetime of the patient.
Trauma, surgery of the spine, radiation therapy, stress, and immunosuppresion can all
lead to its reactivation and presentation as
HPV Types
Famciclovir
Valacyclovir
500 mg tid x
7 days
1 g tid x 7 days
1, 2, 4
Common warts
1, 2, 4, 26, 27, 29, 41, 57
Flat warts
Herpes zoster,
commonly known as
shingles, can affect
up to 10% to 20% of
adults. Underlying
immunosuppression
is common and the
virus presents as
an acute, painful
dermatitis in a
dermatomal pattern.
3, 10, 27, 28, 41, 49
Genital warts
6, 11, 30, 40-45, 51, 54
Cervical cancer
16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58
Precancerous changes
16, 18, 34, 39, 42, 55
Laryngeal papillomas
6, 11, 30
Warts
Definition and Etiology
a dermatomal dermatititis. This primarily
Human papillomavirus virus (HPV) is
affects adults. It begins as pain and para-
the virus that causes Warts. As you know,
sthesias in a dermatomal pattern followed
it’s also the virus that causes cervical can-
by grouped vesicles in the same area days
cer, but that is another discussion. Warts
later. Patients may have some viral pro-
are common and typically benign, affect-
drome of malaise and fever but this is not
ing 10% of the population. This virus is
typical. About 50% of cases present in tho-
easily spread by casual touching or sexual
racic level dermatomes but it can present at
contact (anogenital warts). Direct contact
any level. Symptomatic treatment of pain
through broken epidermis facilitates inoc-
and dysesthesia is the norm. Immunocom-
ulation of the infection, which may take
promised patients may actually have dis-
anywhere from 2-9 months to emerge.
seminated zoster. It’s less common in the
Those who are immunocompromised can
immunocompetent. A good physical exam
develop persistent fulminant warts evi-
is appropriate to diagnose Herpes zoster
dent on physical exam.
but it can be confirmed with an HSV viral
There are over 100 different HPV strains
culture or direct fluorescent antibody. If it’s
and many other diseases occur due to this
caught by a physician within 24-72 hours
infection. Greater than 30 strains are sexu-
of its onset, antiviral therapy is warranted.
ally transmitted, making HPV the most
Outside of that, rest, pain management,
common sexually transmitted disease.
and warm compresses should be used. Dis-
Regarding warts, the common wart (ver-
seminated Herpes Zoster and Ophthalmic
ruca vulgaris), and the most common type,
Zoster must be treated with IV acyclovir.
Plantar warts
continued on page 18
The Maryland
There are over 100 different HPV strains
and many other diseases occur due to this
infection. Greater than 30 strains are sexually
transmitted, making HPV the most common
sexually transmitted disease. Regarding warts,
the common wart (verruca vulgaris), and the
most common type, presents as a generally
painless, hyperkertotic, flesh colored papule or
plaque, with overlying tiny black papules.
Table 3: Treatment of Warts
Destructive Methods
• Cryosurgery*
• Electrodessication
• Curettage
• Laser therapy
Chemotherapeutic Agents
• Podophyllin
• Canthacur
• 5-fluorouracil
Caustics and Acids
• Salicylic acid*
• Trichloracetic acid
Immunotherapies
the number of sexual partners. Gardisil
• Imiquimod
• Candida antigen
Vaccine is the newest approach to preventing genital warts (and cervical cancer in
*First line therapy
women). Available since 2006, it is safe and
presents as a generally painless, hyperker-
recommended as a 3 part vaccine for males
totic, flesh colored papule or plaque, with
and females ages 9-26.
overlying tiny black papules. Other types
of warts include, plantar warts, flat warts
The Poxvirus causes Molluscum conta-
loma acuminatum). Diagnoses is via visual
giosum. It’s common in children, especially
inspection. If the examination is not diag-
those with atopic dermatitis, sexually active
effective. Children can be treated with topi-
nostic, biopsy can be obtained.
adults, and patients with human immuno-
cal cantharidin, which is very effective and
deficiency virus (HIV) infection. Prevalence
well tolerated.
The treatment of warts is quite variable
Destruction
is about 5%. Transmission is facilitated via
So, as you can see, the viral form of
is the most common approach. Methods
direct skin contact, mucous membrane
infectious disease can affect the skin in
include: cryosurgery, electrodesiccation,
contact, or via fomites (inanimate objects
many different ways.
curettage, and application of topical med-
or substances capable of carrying infec-
can diagnose them with a good history
ications such as trichloroacetic acid, sali-
tious organisms). Once contact is made by
and physical exam.
cylic acid, topical 5-fluorouracil, podophyl-
the virus, it will replicate in cell cytoplasm,
ties are variable so it’s important than we
lin, and cantharidin. One very useful, non
inducing herperplasia, and forming its
properly recognize and diagnose these
medical therapy, is actually the use of duct
distinctive appearing lesion.
Classically,
illnesses. Always think of immunosuppre-
tape. It’s an old wives tale, but it works.
it appears as a pink, or flesh-tone, dome-
sion in those who present uncommonly
More stubborn warts may warrant treat-
shaped, umbilicated papule with a central
or in extremely difficult to treat patients.
ment with laser therapy , injection with
keratotic plug. The intertriginous sites; axil-
As family physicians, we treat the whole
candida antigen, or
imiquimod cream
lae, popliteal fossae, and the groin, are the
body. Remember to always, think of dia-
(Aldara- an immunomodulator). Aldara is
most common sites of infection. Again, like
betes, HIV, cancer, and other ailments that
proven to treat condyloma acuminatum,
the other viral dermatologic infection, clini-
may be associated with your patient’s der-
and some clinicians have see it’s beneficial
cal presentation and/or biopsy are diagnos-
matologic presentation.
effects as an adjunctive therapy with com-
tic.
mon warts.
and frequently challenging.
18 •
Molluscum Contagiosum
(verruca plana), and genital warts (condy-
Fortunately, we
Treatment modali-
■
Resolution is typically spontaneous;
however, immunocompromised patients
Dr. Edmonds is a PGY-II at the University
There are not any documented meth-
may have persistant infection. The treat-
of Maryland Family Medicine Residency.
ods to prevent common wart transmission.
ment modalities are similar to that of warts,
This is her 2nd clinical article for The
Genital wart transmission is associated with
cryosurgery and curettage being the most
Maryland Family Doctor publication.
The Maryland
On The Road to Transformation to a
Patient Centered Medical Home
Niharika Khanna, MBSS, M.D., DGO
of their patients. The family practitioners
surers and Medicaid supports transforma-
are convinced that they are providing ex-
tion process implementation, including
cellent medical care. From the patient and
care management integration into primary
staff picture on the walls, the evidence from
care practices. The MLC is supported by the
the practice; we agree. Is there a vulnerabil-
Health Information Exchange (HIE) and the
ity in this practice to the winds of change;
Regional Extension Centers (REC) for Mary-
or could it be that there is a health system
land.4 The MLC team hosts large and re-
that needs to change its values to recognize
gional collaborative learning events where
true everyday heroes in our society? What
practice transformation is the sole focus
would happen if we allow a practice like this
area and each of the 53 practices is held
to close because they just cannot afford to
up to the most rigorous National Council
On the road with the Maryland Learn-
keep their doors open? How would we
on Quality Assurance (NCQA) recognition
ing Collaborative Practice Transformation
measure this loss: in human terms, in sta-
standards as PCMH.5 The MLC core team of
Coaches to visit a practice in a rural com-
tistical terms, in quality assurance terms or,
practice coaches and lead physicians also
munity that is transforming to a patient
will we say there is no measure and let this
travel the state to visit the 53 practices to
centered medical home, we drive through
one go? In this practice, we know that prac-
support their transformation. These im-
tree lined narrow lanes. The homes are
tice transformation using the coaching/
pressions are gained from having had the
small, scrubbed clean porches, neat front
learning collaborative model is not only
privilege of being part of this team (not the
yards, lots of trucks and potholes in the
impossible and unsustainable; but there
official report).
driveways. Crossing a large transformer
may be minimal practice reserves that can
Going into Maryland communities to visit
station we reach a small, single story, brick
tolerate this change. There is clearly a need
primary care physicians who take care of the
building that is labeled ‘Medical Practice’.
for additional resources if transformation is
old, the infirm, the vulnerable populations is
It is 7:30 am, the door is open and the sign
to occur, and there may be a need to re-visit
a true privilege. These visits are the begin-
says, ‘OPEN’. We walk through the door to
our measures of success to map the change
nings of true insight and opportunity for our
a brightly lighted clinical space; we real-
that this practice undergoes towards be-
team to see firsthand how primary care is de-
ize immediately that this is a very special
coming a patient centered medical home.
livered around the State of Maryland. Sitting
practice. There are two family physicians
In response to the national movement
in waiting areas of these practices watching
and two staff members who care for the
towards newer and advanced models of
patients come into and leave from practices
rural community that surrounds them. The
healthcare, the patient centered medical
gave us an understanding of the patients’
community is aging and there is increas-
home model was selected by the State of
joy at having their own physician in their
ingly higher utilization of the practice and
Maryland as its building block towards
community who cares for them and who is
a lot of admissions to surrounding hospi-
achieving higher quality patient centered
available for their needs. The road to prima-
tals. Sometimes the hospitals inform the
care, improved population health and to
ry care practice transformation is a journey
primary care physicians about the care
moderate per capita costs.1,2 The Mary-
towards healthcare efficiency, cost savings
that was rendered; sometimes there is no
land Healthcare Commission (MHCC) and
and improved quality measures for disease,
communication whatsoever. Every visit by
Community Health Resource Commission
patients, physician and health care system.
a patient to their practice becomes a fact
(CHRC) jointly supported the creation of the
Being on this road with the 340 primary
finding mission for the staff and the phy-
Maryland Learning Collaborative (MLC) to
care physicians and practitioner colleagues
sicians as they try to piece together what
educate, advise and consult for 53 primary
within the Maryland Learning Collabora-
happened at any specialty consultations,
care practices in their transformation jour-
tive, supported by the State of Maryland
hospitalizations and new events that have
ney to patient centered medical homes.
3
and health insurance carriers is an incredible
relevance to bio-psychosocial functioning
Fiscal support from commercial health in-
The Maryland
documentation, and be sure to tell medical
students and residents that!” There is no
doubt in my mind that great medical care is
our goal, and we know that the precedents
of the past lay heavily on our minds when
we recreate some of the structural elements
of the old general practices. On the road it
seems clear that the training of future physicians of the next generation, medical students and residents, must include time to
observe transformed practices and possibly those in transition to becoming patient
centered medical homes. The varieties of
practice adaptation in each family practice,
internal medicine and pediatric practices
leads us to believe that young learners will
benefit from direct observation of this process of change that ultimately forms the
building blocks of healthcare reform. Our
task is to ensure that everyone, including
Going into Maryland communities to visit
primary care physicians who take care of the
old, the infirm, the vulnerable populations
is a true privilege. These visits are the
beginnings of true insight and opportunity for
our team to see firsthand how primary care is
delivered around the State of Maryland.
students, government, insurance carriers,
policy makers and stakeholders remember
that physicians and practices taking care of
one patient at a time is exactly what healthcare is about. We know that the value of primary care to the health care system will be
measured by an existing yardstick. Developing new yardsticks to measure change
and demonstrating the positive effects on
health systems, disease, patients and physicians will take rigorous and systematic
journey. Health care reform has reenergized
all our supporters have presented and we
process of query. At the MLC, we know that
the primary care community in Maryland to
know that our primary care colleagues are
the privilege to share the day to day lives
achieve the goals of improved health care
looking for the tools needed to educate,
of primary care practitioners in Maryland
quality and cost savings. It is also clear that
advise and consult with them. I know that
comes with a great responsibility.
one size cannot fit all!
we collectively recognize the challenges
6
20 •
■
There are unique challenges to deliv-
and the pitfalls in transforming our most
Dr. Khanna, Associate Professor, Depart-
ery of optimal care for patients who have
vulnerable practices into patient centered
ment of Family and Community Medicine,
higher bio-psychosocial burden of multi-
medical homes and we also recognize that
University of Maryland, Baltimore, is Pro-
morbidities. It is true that health care is
peer learning and change management is
gram Director for The Maryland Learning
harder to streamline and to stratify when
a large part of primary care transformation.
Collaborative. Learn more at http://med-
the population served is so diverse in its
An elder physician at one of our practic-
school.umaryland.edu/familymedicine/
burden of disease, its level of health literacy
es gave me some advice while visiting with
and socio-ecological predictors of health.7,8
his practice: “don’t forget that we have pro-
The Maryland Learning Collaborative team
vided great medical care to an entire gen-
knows that we are rising to a challenge that
eration before medical care became good
The Maryland
mdlearning/
MD Tech
Take Back Control!
Matthew Hahn, M.D.
When we initially conceived of a technology column for physicians, I thought the sub-
are being pushed, because of increasing ad-
the system, to see and feel how you can ac-
ministrative costs and shrinking payments,
complish your work. If this does not happen,
to higher productivity standards. Ironically,
then the system likely isn’t the right choice for
it is the very administrators who are largely
you. I have yet to meet a non-physician who
responsible for those (non-medical) high
understands and values the important details
costs, and who chose the clunky EMR, who
of patient care to the extent that they can
are demanding that physicians see more
provide the answers to these questions. Not
patients. One physician described an im-
a surprise because they did not go to medi-
age that continues to haunt me...of admin-
cal school, do not see patients and, therefore,
istrators going on long lunches, and leaving
don’t really know what makes an EMR clinical-
at 5pm, while the physicians work through
ly useful or useable. Only you, the physician,
lunch, remaining late into the evening.
can do that...and should do that.
This sad state of affairs stems from two
I remember the comments of a state Re-
ject matter I would be writing about would
misconceptions:
gional Extension Center (REC) employee at
primarily relate to rating and reviewing new
1. Physicians do not have the expertise to
an EMR demo (to be fair to our friends at the
gadgetry and cutting edge “apps.” As it turns
out, however, this MD Tech series has focused
Maryland REC, this was in Pennsylvania). Af-
evaluate and select an EMR.
2. Administrators, IT staff and various
ter viewing the demo, the REC staff concen-
more on issues peripheral to the technology
consultants are more capable, and bet-
trated on the EMR’s ability to interface with
itself, like obtaining government IT incentive
ter suited than physicians to make these
the state’s HIE. At the time, I said, “what’s
payments and how to make EMR purchase
decisions.
an HIE?” My next question was, “why is that
decisions. I come back to these issues time
Neither is true… nor has to be true! Taking
important?” I know now that HIE stands for
and again because, when I speak with my
control of these decisions is one of the keys to
health information exchange. Not that HIE
physician colleagues or read of their experi-
rescuing modern medicine, as well as to en-
interfacing isn’t important but it was not,
ences, these are the issues that appear to be
hancing your career satisfaction.
and should not be, the basis of an EMR pur-
the most important.
Here’s how you decide if an EMR is right
chase decision.
This current column will focus on who
for your practice. Use it! Before considering
The more we cede control of the practice
should make decisions about an EMR pur-
a product, get on the computer, start up the
of medicine and the important decisions that
chase… an incredibly important aspect.
software, pull up a test patient record, and
affect our careers and our ability to deliver
Just to be clear, the answer is that physicians
give it a try… to do what you do all day,
medical care, the worse it will become. Physi-
should make those decisions! What I often
which is documenting your care.
Docu-
cians must overcome their fear of the business
hear from physicians is their sad lament that
ment a patient’s past medical history. Write
of medicine and of making decisions about
because they relied on others...experts, so to
a SOAP note. Create and send a prescription,
health information technology. Instead, we
speak, they ended up in trouble.
refill prescriptions. Order tests and view test
must embrace, excel at and teach to others
The story goes something like this, “I took
results. Communicate with colleagues and
these aspects of practice management which
a job with this large organization so that I
other staff. Is it fast or slow? Is it simple to
are now integral to being a doctor.
could just be a doctor again. Then, the orga-
use or is it cumbersome? You must take the
nization purchased an EMR and, even after
time to go through this process in order to
Dr. Hahn is co-owner of Hahn and Nelson
months of use, it is so cumbersome, I have to
adequately evaluate an EMR. You must in-
Family Medicine in Hancock, Maryland. A
stay an extra 2-3 hours every evening just to
sist that EMR vendors allow this process, or
MAFP Western District Director and mem-
complete my notes.”
do not consider their product.
ber of MAFP’s Technology Committee, he
Then comes the worst part, “I’m not sure
how much longer I can do this.”
To make matters worse, many physicians
■
With a good EMR, as with any other
writes this, the 4th of a series of articles
software, within a relatively short time, you
about various aspects of technology and
should be able to understand the bulk of
practice automation.
The Maryland
residency corner
MAFP resident editors bring news of important happenings at Maryland’s two civilian Family Medicine residency programs, as well as
update us on activities and accomplishments among the residents.
Inside the Square
by Jessica Stinnette, M.D., PGY-2 ,
Franklin Square Hospital Center
Starting next academic year, we will see
exciting changes in our program. We will
be welcoming 2 additional residents to
our 8-8-8 program, as we are introducing
a combined family medicine-preventive
medicine dual program. These residents
will complete their residency and MPH
within four years.
This development leads to curriculum
Starting next academic year, we will see
exciting changes in our program. We
will be welcoming 2 additional residents
to our 8-8-8 program, as we are
introducing a combined family medicinepreventive medicine dual program.
These residents will complete their
residency and MPH within four years.
changes, where all residents participate in a
22 •
four week practicum of their choosing. The
on home visits with her panel of patients
practicum experience is allowing us to get
with chronic illnesses and mental illness co
U of MD Family Medicine
Residency Updates!
creative in knowing our patients, so that we
morbidities, with an emphasis on medica-
by Ryane A. Edmonds, M.D., PGY-2,
can better serve our community. Matthew
tion reconciliation. Joseph Nichols, M.D.
University of Maryland
Loftus, M.D. (PGY-1) has focused on high-risk
(PGY-1) is currently working on analyzing
Now with more than half of this aca-
patients who are defined as those frequently
the impact that palliative care consultation
demic year in residency complete, our
admitted to our inpatient team, noncompli-
has on hospital readmission rates on pa-
residents at the University of Maryland
ant with medications and treatment, or who
tients seen in the ICU. I am currently work-
continue to strive for excellence. In this
have been identified as having high-risk
ing on a collaboration with the Maryland
Residents Corner, I sing the praises of my
behaviors. When he was successful in con-
State Department of Education and a local
fellow residents, a group truly commit-
tacting them personally, conversations re-
middle school health teacher, assessing the
ted to Family Medicine and the commu-
vealed their understandings of their health,
comprehensive health curriculum, in an at-
nity. Check out how these new family
what their goals were to help improve their
tempt to improve health literacy.
physicians are changing the world!
health, and what they felt that they needed
The practicum experience is allowing
The third year residents (PGY 3s) are
from their primary care physician and our of-
us to reach out to our patients in a unique
going out with a bang! This year, Dr.
fice to meet their healthcare goals. Dr. Loftus
way that bonds us with the community in
Binetou Fall completed an internship at
then communicated this information to the
which we serve. As the focus on primary
the National Institutes of Health focused
primary care physician. Dr. Loftus viewed his
care medicine and the patient centered
on Health Policy. Chief Resident Dr. Car-
experience as a way to learn “creative prob-
medical home evolves over the next
los Duarte has an interest in pursuing a
lem solving and addressing broader issues in
several years, this practicum experience
master’s in public health. In his words
medicine…we are encouraged to help our
will provide our residents with a better
he would like to “learn more about the
patients in whatever way best helps them to
understanding of
role that the environment, social and
live a healthy life.”
how we need to
cultural factors, and access to care play
Courtenay Morrow, D.O. (PGY-2) is cur-
view a patient’s
in determining outcomes in healthcare.
rently involved in a project to analyze
health as being
Also, how primary care physicians be-
pediatric immunization data and pat-
an integral part
come can more knowledgeable about
terns, a study which she will broaden to
of school, work,
these variables and deliver optimal, cul-
involve adult immunization rates in our
and home;
not
turally sensitive and cost effective care
local Healthcare for the Homeless popula-
just what we see
along the entire care continuum.” Chief
tion.
in the office.
Resident, Dr. Leoni Prao matched as the
Ruth James, M.D. (PGY-3) focused
The Maryland
next Sports Medicine Fellow at
the University of Maryland. She
Our government gives you
new standards.
is very involved in the world of
sports medicine and will be presenting a case report at the American Medical Society for Sports
Medicine (AMSSM) Conference
later this year in Atlanta.
Payers give you
new requirements.
Happy newlywed Chief Resident Dr. Kevin Carter is on several
Family Medicine committees including Resident Director on the
Maryland Academy of Physicians
Board of Directors.
In addition, check out Dr. Michael Pitzer’s
(PGY-2) monthly
“Sideline Report” in the American
Medical Society for Sports Medicine
newsletter
(www.amssm.
org). Also, Dr. Marshala Lee (PGY1), has hit the ground running in
Annapolis Billing Services billing and account management services
guide you through all of these new standards and requirements.
Returning your staffs focus to patient care and practice enhancement.
621 Ridgely Avenue, Suite 404, Annapolis, MD 21401
Tel: 410-266-1588 • Fax: 410-266-6931
www.annapolisbilling.com
residency. She is very interested
in childhood obesity and is quite
involved in writing and implementing a grant for the “Better
My Identity” program to promote
wellness among 5th grade students in Baltimore who attend
the University of Maryland Family
Medicine Residency clinic.
The
program is designed to increase
physical activity, healthy eating
and emotional well-being for
these children and their families.
These are just a few of the
great things residents are doing at
University of Maryland. Residency is a time of
intense training
and these physicians are to
be commended
for their many
achievements.
Family Docs do
it all!
■
The Maryland
ESSENTIAL EVIDENCE
UPDATE 2012
Annual CME Assembly & Trade Show
Thursday-Saturday • June 21-23, 2012
Turf Valley Conferences • Ellicott City, Maryland
Learn and Network in Scenic Howard County
Experience a New Learning Format
16.75 CME Credits
SEE POSTED AT WWW.MDAFP.ORG
Event Brochure Includes Schedule, Registration Options, Facility Information
Program Faculty
Register Early for Discounted Fees
Questions?
Contact MAFP at info@mdafp.org or 410-747-1980.
New Learning Format!
From the Program Chair
Dear Colleagues:
Join us for “Essential Evidence Update 2012” pre-
The MAFP Education Commmittee learned of this
sented in a NEW learning format! The format is dif-
educational opportunity a couple of years ago after it
ferent than what many of you have come to expect
was used successfully by another AAFP chapter. With
in group CME events. A nationally reknowned fac-
the positive responses received from that chapter, the
ulty of four presenters will deliver a comprehensive
MAFP Board’s decision was to proceed.
2½ day program consisting of shorter 30-minute
Are we on the cutting edge? Will this set the course
topic segments covering a broad field. Each learner
for live MAFP CME in the future? Your responses will
will receive a 261-page syllabus (yes, real paper) to
help us decide. Take a look at the materials posted at
be used during the presentations and afterwards as
www.mdafp.org We look forward to seeing you at
a handy desk reference. Course Director Dr. Mark H.
the conference and to having your feedback!
Ebell and his team have put together a unique and
truly evidence-based program for Maryland Academy members and guests.
24 •
The Maryland
Eva S. Hersh, M.D.
2011 Assembly Program Chair
Program Faculty
Mark H. Ebell, M.D., MS,
Course Director
Associate Professor
University of Georgia
Deputy Editor, American Family Physician
Editor-in-Chief, Essential Evidence
Gary S. Ferenchick, M.D.
Division Chief
Department of Internal Medicine
Michigan State University
Special Assembly Participants and Events
John M. Hickner, M.D. MS
Outgoing MAFP President
Welcome to One and All!
Professor and Chair
Department of Family Medicine
The Cleveland Clinic
Incoming MAFP President
Embarking On A New Journey
Jeffrey M. Cain, M.D.
Michael Wilkes, M.D.
Professor and Vice-Dean,
Department of Internal Medicine
University of California at Davis
President-Elect, AAFP
Presenting Keynote Address
Perspectives on Maryland and National Health Reform Initiatives
Presiding at Installation of MAFP Officers
The Maryland
members
News For and About MAFP Members
Members to Vote for Officers & Directors and Change in Board Structure
Nominations Slate
The MAFP Nominations Committee recommends the following
June 22, 2012 at Turf Valley Conferences in Ellicott City, MD. Newly
slate. Nominations from the floor will be accepted. Elections will
elected officers will be installed later that day by AAFP President-
take place at the Annual Business Meeting Luncheon on Friday,
Elect Jeffrey Cain, M.D. at the Installation Luncheon.
2012 MAFP Nominations Committee
Yvette L. Rooks, M.D., Chair (Immediate Past President)
Trang Pham, M.D. (Vice President)
Eugene J. Newmier, D.O. (President)
Kevin Ferentz, M.D. (Committee Chair & Member-At-Large)
Yvette Oquendo-Berruz, M.D. (President Elect)
Kevin Carter, M.D. (Resident Director)
2012 MAFP Nominations Slate
PRESIDENT-ELECT
DIRECTORS
2012-13; one year terms
IN MID-TERM
PRESIDENT-ELECT
2012-2014; two year
Central District
2010-12; two year term
Kisha N. Davis, M.D., Gaithersburg
Nancy B. Barr, M.D., Baltimore
Yvette Oquendo-Berruz, M.D
(assuming office 9/1/12)
Mozella Williams, M.D., Baltimore
Eastern District
TREASURER
SECRETARY
Andrew S. Ferguson, M.D., Chestertown
2011-13; two year term
2012-2014 ; two year
Rosaire M. Verna, M.D., St. Michaels
Christine L. Commerford, M.D., Baltimore
Eva S. Hersh, M.D., Baltimore
Southern District
Trang M. Pham, M.D., Pasadena
DELEGATE TO AAFP
VICE PRESIDENTS
Patricia A. Czapp, M.D., Annapolis
2011-13; (two year terms, 2-terms limit)
2012-14; two year terms
Western District
William P. Jones, M.D.
Central District
Kevin P. Carter, M.D., Silver Spring
Jocelyn M. Hines, M.D., Baltimore
Kristin M. Clark, M.D., Ellicott City
Southern District
ALTERNATE DELEGATE TO AAFP
Ramona G. Seidel, M.D., Annapolis
DELEGATE TO AAFP
Eastern District
2012-13; one year to complete term
Howard E. Wilson, M.D., Bowie
Andrea A. Mathias, M.D., Snow Hill
Western District
ALTERNATE DELEGATE TO AAFP
2012-13; one year to complete term
Matthew A. Hahn, M.D. , Hanover
Yvette L. Rooks, M.D., Baltimore
Draft Bylaws Change
26 •
In accordance with the Bylaws of the
ument. Subsequent to the Board meeting
2012 at Turf Valley Conferences in Ellicott
on November 13, 2011 where the changes
City, Maryland. Any MAFP member wish-
(MAFP) CHAPTER X-AMENDMENTS, this
were initiated, the MAFP Bylaws Commit-
ing a copy of the current Bylaws docu-
will serve as notification that the MAFP
tee submits the following changes which
ment may view it at www.mdafp.org or
Board of Directors recommends the fol-
will be voted by members present at the
contact the MAFP office at info@mdafp.
lowing changes to the MAFP Bylaws doc-
MAFP Annual Meeting on Friday, June 22,
org or 410-747-1980.
The Maryland
calendar
MAFP Bylaws Committee
Yvette Oquendo, M.D., Chair
Eugene J. Newmier, D.O. ex officio
Excerpt from the Board of Directors Meeting Minutes 11/13/11: After detailed discussion and due consideration, upon proper motion, second and
2012
May 3-5
AAFP Annual Leadership Forum and AAFP National Conference of
Special Constituencies
Kansas City, MO
www.aafp.org/leader
unanimous favorable vote, the size of the MAFP Board of Directors will remain
June 21-23
the same with 4 VPs and 4 Directors each representing one of the 4 districts of
the state. In addition there will be 4 at-large Directors who will be nominated
based on qualifying criteria as determined by the nominating committee.
The Bylaws committee will draft a change in language to accommodate
the modified structure which will be presented to the Board at the Winter or
Spring meeting and voted at the Annual Business Meeting in June, 2012. If approved, the new Board structure would take effect with nominations for 20122013 at-large directors.
Key: box = delete, bold underline = new language
CHAPTER VIII - OFFICERS AND DIRECTORS
The officers… shall be a President, President Elect, Secretary,
Treasurer, four (4) Vice Presidents (one from each geographical district as defined in the Bylaws), eight (8 four (4) Directors (two one
MAFP Annual CME Assembly & Trade Show
Turf Valley Resort
Ellicott City
www.mdafp.org
July 26-28
AAFP National Conference of Family
Medicine Residents and Medical Students
Kansas City, MO
http://www.aafp.org/online/en/home/cme/
aafpcourses/conferences/nc.html
2013
February 23
MAFP Winter Regional Conference
Sheraton Baltimore North
Towson
June 27-29
MAFP Annual CME Assembly & Trade Show
Clarion Fontainebleau Hotel
Ocean City
from each geographical district as defined in the Bylaws), four (4)
at-large Directors, …
AAFP Scientific Assembly Schedule
CHAPTER XVI - ELECTION OF OFFICERS
2013 Sept. 25-29 San Diego
Section 1. Nomination Procedure. At least ninety (90) days prior
2014 Oct. 22–26 Washington D.C.
to the annual meeting, the President shall appoint a Nomination
2015 Sept. 30 - Oct. 4 Denver
2012 Oct. 17-21 Philadelphia
Committee… The committee’s duty shall be to present nomina-
2016 Sept. 21-25 Orlando
tions for the following offices:
2017 Oct. 18-22 Phoenix
A. For a term of one year:
2018 Sept. 26-30 Boston
eight (8) four (4) Directors (two one from each of the geographi-
2019 Oct. 23-27 Las Vegas
cal districts as defined in Section 4) four (4) At-Large Directors …
2020 Oct. 14-18 Chicago
Section 4. Geographical Districts. Geographical districts in the
State of Maryland are:
2021 Sept. 29 - Oct. 3 San Francisco
A. Central - Baltimore City and Baltimore County
CME Author Disclosure Statements
B. Eastern - Cecil, Harford, and all counties east of the Chesapeake Bay
The authors of CME articles in this publication, except
for any listed below, disclose that neither they nor any
member of their immediate families have a significant financial interest in or affiliation with any commercial supporter of this educational activity and/or with the manufacturers of commercial products and/or providers of any
commercial services discussed in this educational material.
C. Southern - Anne Arundel, Calvert, Charles, Prince George’s and
St. Mary’s Counties
D. Western - Allegheny, Carroll, Frederick, Garrett, Howard, Montgomery, and Washington Counties.
CHAPTER XVII - DUTIES AND TERMS OF OFFICERS
Section 2. President Elect. …The office of President Elect shall
MAFP receives no commercial support to offset costs in
the production of The Maryland Family Doctor Publication.
rotate annually to each geographical area as defined in the Bylaws,
depending upon the availability of a suitable candidate.
Next Edition
□Focus on Long Term Care
The Maryland
CHAPTER XXII TAKING EFFECT OF THE BYLAWS
Section 6. Directors. The term of office
next Annual Meeting or when a successor
of Director shall be for one (1) year and
is seated. There shall be eight (8) Direc-
shall begin at the conclusion of the An-
tors, two (2) one (1) from each Geographi-
These bylaws shall take effect immedi-
nual Meeting of the Maryland Academy
cal District as defined in these Bylaws and
ately upon their adoption, June 24, 2011
of Family Physicians at which the election
four (4) At-Large Directors. who shall be
22, 2012.
occur and expire at the conclusion of the
elected each year....
Time Limit for Board Eligible Status
The term ‘board eligible’ has never
the credentialers and the patients, all mem-
During this seven-year period, these
been recognized by member boards of
ber boards of the ABMS agreed to establish
board eligible physicians will have to con-
the American Board of Medical Specialties
parameters under which non-certified phy-
tinue to meet the ongoing requirements
(ABMS), including the American Board of
sicians could actually be recognized as be-
to sit for the examination and must main-
Family Medicine (ABFM) but the term con-
ing board eligible and to further define the
tain a full, valid and unrestricted license.
tinues to be used by credentialing organi-
time limit for such board eligible status.
After this seven-year period, the physi-
zations and others to recognize non-certi-
The ABFM Board of Directors decided
cian will lose the ability to refer to himself
fied physicians as having equivalent status.
at its meeting in October, 2011 that it
or herself as board eligible and will need
In practice, no limit exists on how long a
would define board eligibility as the first
to re-enter training and complete at least
non-certified physician could remain board
seven years after loss of certification or
one year of additional training in an ACG-
eligible. The abuse of the board eligible
the completion of an ACGME accredited
ME accredited Family Medicine residency
term and status perpetuated the ability of
residency training program. Therefore,
before he or she will be allowed to reap-
poorly qualified physicians to practice out-
beginning January 1, 2012, a physician will
ply to sit for the examination. This rule will
side of their initial certification with a risk to
have seven years in which to successfully
be effective January 1, 2012, and as further
patients and resulted in a lack of relation-
complete his or her initial certification ex-
details of the program are developed they
ship between the initial certifying examina-
amination after completing training or, if
will be published. For questions regarding
tion and training as a concurrent/synergis-
previously certified, will have seven years
the board eligibility, Diplomates may con-
tic measure of physician competency.
after the loss of certification to success-
tact the Support Center at 877-223-7437 or
fully complete the examination.
help@theabfm.org.
In an effort to resolve this confusion for
Lower Your Vaccine Costs with Atlantic Health Partners!
Atlantic Health Partners is pleased to announce a new program with TransactRx that
enables physicians to provide vaccines to
• Ability to get fairly reimbursed for vaccines covered under Part D
• Real-time out-of-pocket (copay) cost
most Medicare Part D patients. As you may
and reimbursement information
know, Atlantic offers our members the low-
• Electronic claims submission for vac-
forget these additional Atlantic benefits:
• Discounted medical, surgical and office
supply programs
• Discounts on a patient recall program
• Immediate customer service to ad-
est prices on vaccines, and now with Trans-
cines covered under Part D
dress any vaccine related issues
actRx your practice can provide vaccines to
MAFP is an Atlantic Health Partners
Contact Jeff or Cindy at info@atlanti-
Medicare patients. The TransactRx program
participating organization (click on the
chealthpartners.com or 1-800-741-2044
endorsed by Atlantic provides you:
AHP icon at www.mdafp.org). There is no
to find out how your practice can benefit
• Easy online access to patient specific
cost to join Atlantic Health Partners or to
from Atlantic Health Partners Savings and
benefit from this new service. Also, don’t
TransactRx.
Part D vaccine coverage
Congratulations to MAFP Members for Special Appointments, Honors, Features, Achievements!
28 •
Smaldore Family Practice Celebrates
then and now was to serve families who re-
Osteopathic Medicine, St Joseph’s Hos-
20 years in Bel Air: Twenty years ago,
side in Harford, Baltimore and Cecil coun-
pital and the Family Practice Residency
Smaldore
Associates
ties. Drs. Kellie and Steve Smaldore, are
Program at Franklin Square Hospital. Their
opened in Bel Air, Maryland. Its mission
both graduates of Philadelphia College of
partner, Dr. Gregory Dohmeier, joined the
Family
The Maryland
Practice
dren for care. On the 20th anniversary
of Smaldore Family Practice Associates,
accolades came from many colleagues,
hospital personnel, practice staff and
patients. The doctors were surprised
and moved by a special video presentation at the celebration luncheon on April.
Excerpted from an article by Julie SirganyGreen, Office Manager.
Patricia A. Czapp, M.D. of Annapolis has
been appointed to the AAFP Commission
on Health of the Public and Science, a 3-year
term. She joins Dr. Yvette L. Rooks of Ellicott City who is is mid-term on that Commission. Dr. Czapp has also been appointed to
L-R Drs. Steve Smaldore, Kellie Smaldore and Gregory Dohmeier.
the Board of Directors of the Mid-Atlantic
Business Group on Health (www.mabgh.org )
practice in 1975 after graduating from
Smaldore Family Practice Associates
J. Roy Guyther, M.D. of Mechanicsville
Kirksville College of Osteopathic Medicine,
currently has 5 practitioners on staff, see-
was featured in “St. Mary’s Storyteller Pub-
Community Hospital of Lancaster, and the
ing close to 100 patients a day. Many of
lishes Eighth Book” appearing in the Janu-
Family Practice Residency Program at the
the original patients have grown with the
ary 26, 2012 edition of The Washington Post.
University of Maryland.
practice and are now bringing their chil-
The Maryland
Dr. Guyther, a MAFP Past President (1958),
in the Special Supplement to this publica-
in “The Reader’s Issue” (Volume 12, Issue 4)
a Past President of MedChi (1982) and a
tion (Fall, 2007) marking the 35th Anniver-
of Maryland Medicine:
Past AAFP Family Doctor of the Year (1979),
sary of the University of Maryland Depart-
• Matthew Loftus, M.D., “Life Can
now retired at age 91, continues to be as
ment of Family and Community Medicine.
Unexpectedly Change in a Moment!”
• Richard Colgan, M.D. and Mozella
active as he is able. Of late, he has been
James R. Richardson, M.D. of Ellicott
quite prolific in writing stories about life in
City wrote “Myths and Misses About Al-
Williams, M.D., “University of Maryland
his Southern Maryland Community where
zheimer’s Disease” appearing at the social
School of Medicine Increases Medical
he was born and returned to practice med-
media site for physicians KevinMD.com The
Student Education in Primary Care”
icine in beginning in 1951.
link to the article:
http://www.kevinmd.
Student member Max Ramano, of Balti-
p.10 in the piece on his colleague Dr. Wil-
com/blog/2012/01/myths-misses-alzheim-
more, authored “The right to birth control:
liam L. Stewart, Dr Guyther was a pioneer
ers-disease.html
Politics aside, access to contraception is
As noted on
in Family Medicine. His longtime position
Donald R. Richter, M.D. of Oakland
basic to good health care,” an Op Ed piece
on faculty at the University of Maryland
and Ramona G. Seidel, M.D. of Annapolis
published in the February 15, 2012 edition
School of Medicine continued to the year
were featured in “FPs Share Their Experi-
of The Baltimore Sun. Contributing to the
of his retirement in 1995. He has written
ences With PCMH Pilot Projects,” lead ar-
article were student members Meghana
oftentimes on a variety of topics for MAFP
ticle in the December 1, 2011 edition of
Desale, Naomi Rios along with others
publications, the most recent of which was
AAFP News Now.
attending the Johns Hopkins University
“A History of the Department” published
The following have articles published
School of Medicine.
Welcome New and Transferred Members (November 1, 2011-January 31, 2012)
Barry M. Magnus, M.D.
Active
Kathryn A. Boling, .D.
Yaqian Liu
Dani S. Boulattouf, M.D.
Asia T. McDonald, M.D.
Georgia A. Bromfield, M.D.
Natasha Loving
Amanda K. Combs, M.D.
Victor McGlaughlin, Jr., M.D.
Brian D. Mancke, M.D.
Sherie McDonald
Lorren M. Donmoyer, M.D.
Jennifer M. Nelson, D.O.
Anne Savarese, M.D.
Karezhe Mersha
Timothy O. Ehiabor, M.D.
Contah Nimely, M.D.
John Foxen, M.D.
Monika Schlamminger, M.D.
Student
Christina M. Ramirez
Paulette L. Grey, M.D.
Anna Stuart McCall, M.D.
Armond Allkanjari
Evan Richards
Andrea D. Hulse, D.O.
Alan R. Weinstock, M.D.
Laura Andersen
Christopher Sardon
Yalda Jabbarpour, M.D.
Kimberly Zawistoski, D.O.
Amal Chaudhry
Brett A. Shannon
Ijeuru Chiteka
Payal D. Soni
Yvonne Whitelaw
Arman Janloo, M.D.
Brian Neuman
Zahra Kiran, M.D.
Resident
Melyssa K. Hancock
Dhirendra Kumar, M.D.
Ashley S. Blackledge, M.D.
Soo Yong Jung
list of advertisers
■
In Memory
The Maryland Academy of Family
Physicians is saddened by the passing of its
30 •
Medical Mutual Insurance....................... 2
Shred-it............................................................ 11
past member
Merit Medical.................................................. 6
Annapolis Billing Services ....................23
William L. Stewart, M.D.
Protected Security LLC ............................. 7
Kolmac Clinic.................................................23
formerly of Westminster who was MAFP
Patient First .................................................... 9
Righttime Medical Care..........................29
Med Chi Insurance Agency Inc.�� 9
Washington Open MRI ...........................32
The Maryland
President in 1969 (see p. 10). A memorial
contribution has been made in his honor to
the MAFP Foundation.
■
The Core Content Review
of Family Medicine
Why Choose Core Content Review?
• CD and Online Versions available for under $200!
• Cost Effective CME
• For Family Physicians by Family Physicians
• Print Subscription also available
• Discount for AAFP members
• Money back guarantee if you don’t pass the Board exam
• Provides non-dues revenue for your State Chapter
North America’s most
widely-recognized program for:
• Family Medicine CME
• ABFM Board Preparation
• Self-Evaluation
• Visit www.CoreContent.com
• Call 888-343-CORE (2673)
• Email mail@CoreContent.com
The Maryland
MARYLAND Academy of Family Physicians
5710 Executive Dr., Suite 104
Baltimore, MD 21228-1771
Presorted Standard
U.S. Postage Paid
Little Rock, AR
Permit No. 2437
DON’T TAKE YOUR MRI LYING DOWN!
THE BEST CHOICE FOR BODY AND MIND
For an appointment or for more information
Call 301-424-4888
Take control of your healthcare and choose the best your
body can get. At Washington Open MRI, you’ll get the
personal and professional care you deserve. You
won’t have to wait unnecessarily for an
appointment or your results – and your MRI
experience will be relaxed, comfortable and
hassle-free. Our centers allow you to choose
between standing up, lying down or sitting
down depending on your needs. You can even
watch a baseball game during your procedure.
Washington Open MRI has six convenient
locations offering state-of-the-art technology,
including the world’s first Stand-Up Open MRI.
You don’t have to take your MRI lying down.
Take charge, take control and take comfort in
your decision. Tell your doctor you choose
Washington Open MRI. Your body and your mind
deserve nothing less than the best in preventive and
diagnostic healthcare.
Visit us online at
washingtonopenmri.com
Please visit one of our 7 convenient locations
32 •
Rockville • Chevy Chase • Greenbelt • Oxon Hill
Clinton • Prince Frederick• Owings Mills
The Maryland

Spring 2012 - Maryland Academy of Family Physicians

Transcription

Similar documents

Gift Basket. - Lauren Monroe

Celebrates Year-Round - Leisure Group Travel

High Technology

maryland division of financial regulation

ProArgi-9+ and the Physicians` Desk Reference

2016 Maryland Ice Cream Trail Passport

Space Human Factors and Life Support

Arundel Mills Mall

Is Social Security a Ponzi Scheme

Program for Grey Rock 2015-06 - Maryland Society Sons of the