Medicine

The President’s Podium: A Final Message

Posted in Medicine, Physician Health on May 4th, 2016 by MMS Communications – Comments Off on The President’s Podium: A Final Message

By Dennis M. Dimitri, M.D., President, Massachusetts Medical Society

Dr. Dimitri XIn my inaugural address a year ago, I spoke about something I consider to be one of the most important issues facing the medical profession today: physician (dis)satisfaction.

As the end of my presidency approaches, I believe it is important, not only to our colleagues in the profession, but to our patients as well, to reiterate some of what I said.

My remarks last May highlighted the fact that we physicians are privileged to have our patients come to us, sharing openly all of their own difficult circumstances, that they look to us to help them overcome these problems.

I urged my fellow physicians to remember that that privilege means we must put our patients’ interests before ours. I reminded colleagues that we should think for a moment about the impact we have on our patients’ lives.

Still, we hear much about physician burnout and the loss the joy in practice.

“Physician” still rates as one of the most respected professions in every public poll, yet many within the profession are less sure of that.

This increasing dissatisfaction within our profession provided the genesis for the annual education program at the 2016 MMS Annual Meeting – Sustaining Joy in the Practice of Medicine: Compassion, Innovation, and Transformation.

I have the privilege of moderating a program with national experts who share the love of practicing medicine and who are committed to helping physicians overcome these challenges and restore their passion for this profession.

Participants include Jeffrey J. Cain, M.D., Chief of Family Medicine at Children’s Hospital Colorado; M. Bridget Duffy, M.D., Chief Medical Officer of Vocera Communications; and Christine A. Sinsky, M.D., Vice President of Professional Satisfaction for the American Medical Association.

Among the topics to be addressed are lessons we can learn from patients, why caring for the caregiver is so important, how we can transform the practice of medicine, and how physicians can rediscover the joy in the practice of medicine.

My tenure as MMS president has been marked by many issues, most significantly the opioid epidemic, electronic health records, and the search for a new executive vice president of MMS.  Given the urgency of those subjects, I didn’t get as much opportunity as I would have liked to focus on the issue of physician satisfaction.

While I end my presidential year firmly believing that we have established our medical society as a leader in the Commonwealth’s fight against substance abuse, that we made an important contribution in easing the burdensome requirements of information technology, and that we have selected a new executive who will be a great partner of physicians for years to come, I wish to leave colleagues with the same message I imparted when I became president.

And that message is this: Physicians really are different, and what gives us the greatest satisfaction is providing good care to our patients. It’s what our patients expect, it’s what we like to be able to do, and it’s what we should remember on those days when the frustration mounts.

So when you are feeling dissatisfied about regulations, prior authorization, delays in payments, or searching for a course to fulfill your risk management CME’s, remember this: I helped some patients today.

The President’s Podium appears periodically on the MMS Blog, offering commentary on a range of issues in health and medicine.

 

The President’s Podium: Reducing Opiate Abuse

Posted in Department of Public Health, Health Policy, Medicine, opioids on February 18th, 2015 by MMS Communications – Comments Off on The President’s Podium: Reducing Opiate Abuse

By Richard Pieters, M.D., President, Massachusetts Medical Society

Governor Charlie Baker and Attorney General Maura Healey have each made opiate abuse one of their top priorities, and this week they will announce steps they will take to fight this public health crisis. That the state’s top elected official and top law enforcement officer have put this issue at the forefront of their agendas is good news, because even as Massachusetts ranks as one of the top four states in adopting strategies to curb prescription drug abuse by the Trust for America’s Health, prescription and opiate abuse remains a crisis in the Commonwealth.

MMS has reached out to both the Governor and Attorney General to offer our assistance as they address the problem. Their initial responses have been encouraging, and we look forward to hearing the specifics of their plans and working with them.

One of the keys to reducing the abuse, however, is a sustained effort in raising public awareness about the issue, and the Massachusetts Medical Society has long recognized the importance of communicating to both physicians and patients about prescription drug abuse.

We highlighted the topic in 2011 with our patient education television program that reaches communities across the state, and in subsequent shows addressed the topic of substance abuse in young people and how they can be treated.

Our current program revisits the subject of prescription abuse with experts in addiction medicine. Additionally, we have distributed articles to local media, to outline what both physicians and patients can do to prevent prescription abuse. This is especially important, as more than three out of four people who misuse prescription pain medicines use drugs prescribed to someone else.

My predecessor Dr. Ronald Dunlap last year outlined the physician’s perspective on prescription drug abuse and recommended additional steps that can be taken to reduce the abuse.

I have since provided my views and recommended improvements in the state’s prescription monitoring program, which the Society helped to create more than 20 years ago. We believe a well-run, real-time, robust monitoring program is a key element in the fight against prescription abuse and one in which every physician should participate.

MMS will continue its educational effort on opioids and prescription abuse on April 8 with our Annual Public Health Leadership Forum for physicians and health care providers. The Opioid Epidemic: Policy and Public Health, featuring local and national leaders in substance abuse and addiction medicine, will discuss a range of issues, including the basics of pain management, alternatives to opioids, communicating with patients about pain management and treatment, and advocacy for treatment programs for those with addictions. This forum will offer important information for those who prescribed opioids and treat pain and addiction, and I urge those who do so to attend.  Also, the MMS Ethics Forum at our annual meeting in May will explore the ethical and legal considerations in pain management by physicians.

As government and public health officials seek remedies to the opiate crisis, we urge them to recognize that physicians and their patients – the ones who treat the pain and take the medicines – can play critical roles in reducing the abuse.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Pieters’ commentary on a range of issues in health and medicine.

January Physician Focus: Chronic Kidney Disease

Posted in Health, Medicine, Physician Focus, Public Health on December 31st, 2014 by MMS Communications – Comments Off on January Physician Focus: Chronic Kidney Disease

The kidneys are vital organs in the human body, performing such critical functions as cleaning blood, removing waste, and controlling blood pressure. Yet more than 20 million Americans have chronic kidney disease, a serious condition that raises the risks of heart attack, stroke, and end-stage kidney disease.

To create awareness among patients about the condition, Physician Focus begins 2015 with a guest appearance by Martin Gelman, M.D., (photo, right) a board-certified internist and nephrologist who practices at Milford Regional Medical Center and St. Elizabeth’s Medical Center in Boston. He joins program host Bruce Karlin, M.D., (photo, left) a primary care physician in Worcester, in conversation about various aspects of the disease.

Among the topics discussed are the functions of the kidney in the human body, the major causes and effects of chronic kidney disease, who is most at risk for the condition, kidney dialysis and transplants, and a look at what the future might hold in renal replacement therapy with a bio-implantable artificial kidney that has just been approved for clinical trials.

Physician Focus, now in its 11th consecutive year of production, is available for viewing on public access television stations throughout Massachusetts. It is also available online at  www.massmed.org/physicianfocus, www.physicianfocus.org, and on YouTube.

September Physician Focus: Is Marijuana Medicine?

Posted in Medical Marijuana, Medicine, Physician Focus on August 28th, 2014 by MMS Communications – Comments Off on September Physician Focus: Is Marijuana Medicine?

Despite a ban by the Federal government, little clinical research into its effectiveness as a medicine, and lack of approval by the Food and Drug Administration, the use of marijuana for medical purposes has been approved by 23 states and the District of Columbia as of August.

In Massachusetts, voters in 2012 overwhelmingly approved a ballot question allowing the use of marijuana by patients with “debilitating medical conditions.” The vote represented a declaration of medicine by plebiscite, a major departure from the nation’s structured way of creating, testing, and approving medications through well-controlled, sanctioned clinical trials and review and approval by the U.S. Food and Drug Administration.

As the regulatory process of overseeing the marijuana program proceeds and marijuana dispensaries prepare to open in the Commonwealth, the September episode of Physician Focus examines a basic question: Is marijuana medicine?

Guests for the show are two physicians who presented at the MMS’s recent CME course on medical marijuana in June: Alan Ehrlich, M.D. (photo, center), Senior Deputy Editor of DynaMed, a clinical reference tool created by physicians that examines medical articles for clinical relevance and scientific validity, and Kevin Hill, M.D., M.H.S., (right), Director of the Substance Abuse Consultation Service in the Division of Alcohol and Drug Abuse at McLean Hospital in Belmont. Hosting the program is John Fromson, M.D., (left) Chief of Psychiatry at Brigham and Women’s Faulkner Hospital in Boston.

The three physicians examine the current evidence surrounding marijuana, the risks of using the drug, what conditions marijuana may help, and what patients should know about the drug if they are considering using it for medicinal purposes.

Physician Focus is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.massmed.org/physicianfocus, www.physicianfocus.org,  and on YouTube.

April Physician Focus: Health Care Disparities

Posted in Health, Health Policy, Medicine, Physician Focus, Primary Care on March 31st, 2014 by MMS Communications – Comments Off on April Physician Focus: Health Care Disparities

A dozen years ago, the Institute of Medicine released its groundbreaking report on health care disparities, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. That report concluded that wide differences exist between racial and ethnic minorities and whites in access to health, availability of insurance, and the quality of care they received.

The IOM report made public a topic that today still commands the attention of the medical community, and it’s the subject of the April episode of Physician Focus.

Guests for the show are Ronald Dunlap, M.D. (photo, center), President of the Massachusetts Medical Society, and Milagros Abreu, M.D., M.P.H. (right), Vice Chair of the MMS Committee on Diversity in Medicine and Founder and President of the Latino Health Insurance Program in Framingham. Alice Coombs, M.D., (left) past president of MMS and a member of the American Medical Association’s Commission to End Health Care Disparities, serves as host.

Among the topics of conversation by the physicians are the causes of health care disparities, their consequences on the health outcomes of patients, and the steps both physicians and patients can take to reduce these differences and improve care.

April’s Physician Focus is part of a renewed attention to the issue of health care disparities by the Medical Society, as outlined by Dr. Dunlap in his blog post of March 28 (below).

Physician Focus is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.massmed.org/physicianfocus , www.physicianfocus.org, and www.massmed.org/itunes.

The President’s Podium: It’s Time for Equal Treatment

Posted in Health, Medicine, Physician Focus, Primary Care on March 28th, 2014 by MMS Communications – 1 Comment

By Ronald Dunlap, M.D., President, Massachusetts Medical Society

When the Institute of Medicine published its groundbreaking report on DSC_0003 Dunlap 4x6 color 300 ppi_editedhealth care disparities in March of 2002, the topic touched a raw nerve in the medical community. Almost overnight, health care disparities became a top priority for medical professionals and policymakers alike.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care disclosed what all of us consider to be a distressing and unacceptable aspect of health care in America: that racial and ethnic minorities receive poorer quality medical care than whites, even when such factors as insurance coverage, ability to pay, and access to care were equal among the groups.  It is also quite clear that socioeconomic status and poverty contribute to health care disparities.

More than a decade after the IOM’s report, health care disparities still commands our attention, a topic increasing in importance, as our population continues to undergo demographic changes.

For years, the Massachusetts Medical Society has been one of the leading voices in the effort to reduce health care disparities in the Commonwealth. Our members have worked to educate our colleagues about the issue. We have testified before the state legislature in support of bills to reduce disparities in care. We have examined the ethical aspects of disparities, and our patient education efforts have focused on the subject.

I am proud to say we are continuing our efforts.

Our 2014 Public Health Leadership Forum, The Impact of Health Care Reform on Health Care Disparities (occurring Friday, April 4 from 9 a.m. to 1 p.m.) brings together some of the nation’s best health care experts to discuss how reform efforts may affect disparities in care. This forum, moderated by Lenny Lopez, M.D., Chair of the MMS Committee on Diversity in Medicine, adds a new dimension to our efforts on health care disparities, as it is being conducted in collaboration with the Commission to End Health Care Disparities.

The Commission was formed in 2004 by the American Medical Association and the National Medical Association, with the National Hispanic Medical Association joining soon thereafter, to respond to the IOM’s report. It has become the nation’s leading advocate to reduce disparities in care.  The MMS has had and continues to have a seat at the table: Alice Coombs, M.D., MMS past president and past chair of the Committee on Diversity in Medicine, has represented MMS on this committee for several years.

Among the scheduled participants in our Leadership Forum are Commission Co-Chairs Jeremy Lazarus, M.D., immediate past president of the American Medical Association, and Lawrence Sanders, M.D., president-elect of the National Medical Association. Besides looking at the effect of reform on disparities in care, participants will also address how changes in policy and practice and such areas as pay for performance and technology can reduce disparities in care.

Our continuing efforts also include a new dedicated web page on health care disparities that provides research and reports on the topic, resources and activities to identify and reduce disparities, strategies and tools to help eliminate them in the physician’s office, and information on the role of a diverse physician workforce in addressing differences in care.

And to bring the message beyond the medical profession, our April episode of Physician Focus, the MMS’s monthly patient education television program, discusses the issue in depth, describing the causes and consequences of health care disparities and what physicians and patients can do to reduce these differences and improve care. Hosting this show is Dr. Coombs, with Milagros Abreu, M.D., Vice Chair of the Committee on Diversity in Medicine, joining me as a guest. An accompanying print article is also being distributed to media across the state.

Twelve years after the Institute of Medicine’s report, we are making progress in reducing disparities, certainly more slowly than we would like, but making progress nonetheless. It is clear that reducing disparities will involve the efforts of everyone in health care – all physicians, providers, payers, and policymakers, and, yes, even patients.

My hope is that our upcoming efforts will signify a renewed commitment to equal treatment. It is a goal worth pursuing and achieving, and it’s time is long overdue.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine.   

  

 

February Physician Focus: Crohn’s and Colitis

Posted in Health, Medicine, Physician Focus on January 31st, 2014 by MMS Communications – Comments Off on February Physician Focus: Crohn’s and Colitis

Medicine in the 21st century constantly seeks answers, yet precise explanations can still be elusive. Such is the case with Crohn’s disease and ulcerative colitis, part of a group of chronic digestive disorders known as inflammatory bowel diseases.

For patients, Crohn’s and colitis can be frustrating. Their causes are unknown, they have no known risk factors (although they tend to occur in families), no preventive measures can be taken to avoid them, and because their symptoms are non-specific to the diseases, most cases are diagnosed months or years after symptoms first appear. Their effects on daily living, social and professional activities, can also be discouraging.

The February episode of Physician Focus provides a basic introduction to these digestive diseases. Both conditions afflict a total of nearly 1.4 million Americans, with men and women in equal numbers.

The special guest for this program is Andrew Warner, M.D., Chief of Gastroenterology at Lahey Health in Burlington and co-author of 100 Questions & Answers About Crohn’s Disease and Ulcerative Colitis. Hosting this edition is Lynda Young, M.D., Clinical Professor of Pediatrics at Children’s Medical Center at UMass Memorial Healthcare in Worcester and a past president of the Massachusetts Medical Society.

The conversation between the physicians covers details about the symptoms of the diseases; their similarities and differences; how they affect a patient’s health and quality of life; how the conditions are diagnosed; and how the diseases are treated, including dietary plans, medicines like steroids and biologics, and surgery.

Physician Focus is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.massmed.org/physicianfocus, www.physicianfocus.org, and www.massmed.org/itunes.

The President’s Podium: A Vote for Vaccines

Posted in Health, Medicine, patient safety, Primary Care, Public Health on September 4th, 2013 by MMS Communications – 1 Comment

If we need any reason to remind our patients about the value of vaccines, all we need do is look around our country and the world. Diseases once thought to be under control, even eradicated, are reappearing with disturbing frequency.

Measles and mumps outbreaks have occurred in Canada, Europe, and the Middle East. Polio has shown a fierce stubbornness, resurfacing in Somalia after six years. The disease has reached Israel, which is re-vaccinating one million children, from Pakistan, one of three countries, along with Nigeria and Afghanistan, where it remains endemic.

Those counties may be far away, but distance no longer offers the protection it once did.  A measles outbreak in Brooklyn earlier this year, brought back by an overseas traveler, is a stark reminder that an outbreak – or epidemic – can be just one plane ride away.

In the U.S., outbreaks have occurred coast to coast. According to the Centers for Disease Control, 2012 was the worst year in six decades for whooping cough with nearly 42,000 cases. The number of measles cases in the U.S., recently highlighted by an outbreak centered in a Texas church whose ministers reportedly questioned the value of vaccines, is on track this year to be one of the highest in 17 years. Mumps is returning as well, as evidenced by more than 100 cases in Virginia.

While immunization rates may be high for children, too many people appear to be losing sight of the importance of vaccines. More states (though our record in Massachusetts has been good) are granting medical and philosophical exemptions from childhood vaccinations, and the medical-conspiracy theorists are still at it – and even given potential platforms to air their misguided notions. ABC Television’s appointment of an outspoken childhood vaccine critic as a co-host of a widely-watched morning show, for example, has rightly caused outrage. It prompted a Boston Globe editorial, saying “the network shouldn’t let her use the show as a platform for her theories. Giving them even a moment’s notice would be a disservice to the public.”

The paper recognized an unfortunate truism: despite mountains of evidence on the safety of vaccines, scare tactics can still work with some people.

The irony – and frustration – of all this is that as more diseases become drug-resistant,  as new ones like MERS emerge, we continue to fight the old ones we can prevent.

The focus on vaccines must also encompass more than children. The vaccine for HPV, the most commonly sexually transmitted infection, has yet to gain widespread acceptance, and more than 50,000 adults die each year from vaccine-preventable diseases and their complications.

CDC Director Dr. Thomas R. Frieden, in urging the medical community to promote vaccinations, said recently that “The doctor is the single most influential factor that determines whether kids get vaccinated.”  It’s true for adults, too.

The message is clear: As with so many other areas in health care, physicians can make the biggest difference, one patient at a time.

The President’s Podium is a new feature that appears regularly on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine.   

September Physician Focus: The Physician-Patient Relationship

Posted in Health, Health Reform, medical homes, Medicine, Physician Focus, Primary Care on August 30th, 2013 by MMS Communications – Comments Off on September Physician Focus: The Physician-Patient Relationship

Since the days of Hippocrates, the physician-patient relationship has been regarded as the foundation of good health care, thus making the selection of a physician one of the most important medical decisions a patient will make.

The September episode of Physician Focus provides an in-depth discussion of this key element of health care with two experienced primary care physicians.

Special guest for this program is MMS Vice President Dennis M. Dimitri, M.D., a board-certified family physician in Worcester, Mass. with more than three decades of primary care experience.

Dr. Dimitri, (photo, seated) Clinical Associate Professor and Vice Chair of the Department of Family Medicine and Community Health at UMass Memorial Medical Center and UMass Medical School in Worcester, joins fellow family physician and program host Mavis Jaworski, M.D. for the conversation.

Focusing on primary care, the physicians examine a range of topics, including what factors patients should consider when seeking a physician, the elements that make up a good physician-patient relationship, the barriers that might negatively affect the relationship, what patients and physicians might do if the relationship doesn’t seem to be working, and the potential impact on the relationship of new models of care such as the patient-centered medical home and accountable care organizations.

Physician Focus is available for viewing on public access television stations throughout Massachusetts and also available online at www.massmed.org/physicianfocus , www.physicianfocus.org  and on iTunes at www.massmed.org/itunes.

The President’s Podium: Unhappy Doctors?

Posted in Health Reform, Leadership, Medicine on August 12th, 2013 by MMS Communications – 1 Comment

by Ronald Dunlap, M.D., President, Massachusetts Medical Society 

The headline shouted the news – 60% of Docs Wouldn’t Recommend Their Profession as a Career – recounting the sentiments of a nationwide survey of nearly 3,500 physicians. And while we may parse the responses – Is it a generational thing? Does specialty matter? – it’s likely most physicians aren’t surprised at the result. Changes to our profession have been fast and extensive in recent years, and we’re constantly adjusting to new demands.

When six out of ten doctors, however, suggest they’re unhappy, it prompts some key questions. What might patients think of this? Are discontented doctors affecting the physician-patient relationship? Or are survey respondents just blowing off steam out of frustration?  I think that it’s an important issue. Here’s my take on the reasons behind the survey results:

Mounting administrative and mandated requirements. Prior authorizations, certifications, complex billing, and the myriad of administrative tasks before us all steal time from the thing we most love to do: engagement in patient care. Ever-expanding oversight (though some, we’ll agree, is good and necessary) through more and more rules and mandates from insurers, legislators, and regulators, some duplicating the others, steal more time, and chip away at the control we have over how we practice medicine.

The imposition of information technology. Advocates say IT will lead to better quality care, but for many physicians, it’s been more of a disruption than an improvement to medical practice. Big investments of money and time, without appreciable return, along with lack of interoperability among systems, have soured many on computers, despite financial incentives. Computers have provided some benefits and may yet prove to improve health care, but the evidence so far is limited, and the transition is not complete.

The cost of educating physicians. Many young doctors avoid primary care or public health positions in favor of higher-paying specialties that may offer a more flexible lifestyle. It’s easy to understand why, when they’re coming out of medical school with hundreds of thousands of dollars in debt. The extraordinary cost and years of training are raising questions about the return on their investment of time and money.

Other issues weigh on our perspective. These include declining and changing reimbursements, the specter of liability, the uncertainty of reform, and imperfect rating systems from a host of sources telling us how well (or not) we practice medicine.

These are legitimate concerns. I suggest, however, that our discontent is not with the practice of medicine, but rather with the business of medicine – a fact borne out by the survey that prompted this post. I suspect, as those who conducted the survey do, that the disenchantment was prompted in part by colleagues letting off steam.

As my fellow MMS members and I work to fix what’s wrong, I remind myself that “physician” remains at the top of every poll ever taken of most admired professions and that, in the words of Dr. William Osler, we are distinguished from all other vocations by our unique ability to do good. I hope my patients feel the same way.

The President’s Podium is a new feature that will appear regularly on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine.