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SOMBRERO

Pima County Medical Society
Home Medical Society of the 17th United States Surgeon General

FEBRUARY 2014

Jewish History Museum at 104 You’re invited: Mix-at-Six coming March 1 MRCSA teaches emergency response Feb. 22

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SOMBRERO – February 2014

SOMBRERO
Pima County Medical Society Officers
President Timothy Marshall, MD President-Elect Melissa Levine, MD Vice President Steve Cohen, MD Secretary-Treasurer Guruprasad Raju, MD Past-President Charles Katzenberg, MD

Official Publication of the Pima County Medical Society Members at Large
Donald Green, MD Veronica Pimienta, MD

Vol. 47 No. 2

PCMS Board of Directors
Eric Barrett, MD Diana Benenati, MD Neil Clements, MD Executive Director Bill Fearneyhough Phone: 795-7985 Fax: 323-9559 E-mail: billf 5199@gmail.com Advertising Phone: 795-7985 Fax: 323-9559 E-mail: dcarey5199@gmail.com

Michael Connolly, DO Michael Dean, MD Howard Eisenberg, MD Afshin Emami, MD Randall Fehr, MD Alton Hallum, MD Evan Kligman, MD Kevin Moynahan, MD Soheila Nouri, MD Wayne Peate, MD Scott Weiss, MD Leslie Willingham, MD Gustavo Ortega, MD (Resident) Snehal Patel, DO (Resident) Joanna Holstein, DO (Resident) Jeffrey Brown (Student) Jamie Fleming (Student) Editor Stuart Faxon Phone: 883-0408 E-mail: tjjackal@comcast.net Please do not submit PDFs as editorial copy. Art Director Alene Randklev, Commercial Printers, Inc. Phone: 623-4775 Fax: 622-8321 E-mail: alene@cptucson.com

At Large ArMA Board

R. Screven Farmer, MD

Pima Directors to ArMA
Timothy C. Fagan, MD Charles Katzenberg, MD

Board of Mediation
Timothy Fagan, MD Thomas Griffin, MD George Makol, MD Mark Mecikalski, MD Edward Schwager, MD

Delegates to AMA
William J. Mangold, MD Thomas H. Hicks, MD Gary Figge, MD (alternate)

Arizona Medical Association Officers
Thomas Rothe, MD   president Michael F. Hamant, MD   secretary Printing Commercial Printers, Inc. Phone: 623-4775 E-mail: andy@cptucson.com Publisher Pima County Medical Society 5199 E. Farness Dr., Tucson, AZ 85712 Phone: (520) 795-7985 Fax: (520) 323-9559 Website: pimamedicalsociety.org
SOMBRERO (ISSN 0279-909X) is published monthly except bimonthly June/July and August/September by the Pima County Medical Society, 5199 E. Farness, Tucson, Ariz. 85712. Annual subscription price is $30. Periodicals paid at Tucson, AZ. POSTMASTER: Send address changes to Pima County Medical Society, 5199 E. Farness Drive, Tucson, Arizona 85712-2134. Opinions expressed are those of the individuals and do not necessarily represent the opinions or policies of the publisher or the PCMS Board of Directors, Executive Officers or the members at large, nor does any product or service advertised carry the endorsement of the society unless expressly stated. Paid advertisements are accepted subject to the approval of the Board of Directors, which retains the right to reject any advertising submitted. Copyright © 2014, Pima County Medical Society. All rights reserved. Reproduction in whole or in part without permission is prohibited.

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Inside
 5 Membership: Tucson’s 104-year-old Jewish  8 Milestones: Some personal and some
institutional achievements. can do. History Museum is a labor of love for the slightly younger Dr. Barry Friedman.

10 Neurology: Dr. Carol Henricks on what HBOT 11 Emergency Medicine: Dr. Sheldon Marks on the
Medical Reserve Corps of Southern Arizona and its emergency medicine training event Feb. 22. when the wrong side of the road is right. coming March 1.

13 Behind the Lens: Dr. Hal ‘Travelin” Tretbar knows 17 PCMS News: The new Society event Mix-at-Six is 23 Perspective: Dr. David Ruben on American
medical eduction. Clinic Scottsdale. On the Cover
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Membership

Tucson’s Jewish History Museum at 104
Story and Photos by Dennis Carey

D

r. Barry A. Friedman, celebrating his 40th year of PCMS membership this year, is also in his ninth year serving as president of the Tucson Jewish History Museum Board of Directors, which celebrated its centennial in 2010. What’s more, three months ago Dr. Friedman opened the new Holocaust History Center. “I’m the jerk of all trades,” Dr. Friedman self-deprecated about his role at Arizona’s only Jewish history museum. “I give tours, answer questions, sweep the floors, help raise funds. It’s a nonprofit, so who else is going to do it besides the president?” But it is obviously this “jerk’s” labor of love. The exhibits have never looked better, and there is so much Jewish history to preserve in Southern Arizona. The efforts have not gone unnoticed: The JHM was named Fifth Best Western Museum by True West magazine in 2013. “I’ve always loved history, but never really considered myself a historian,” Dr. Friedman said. “I went to medical school because my father made me go to medical school. But this is a job I love doing every day I am here—even sweeping the floors.” Dr. Friedman’s medical career was accomplished for someone who was pushed into practice. He was born in Dayton, Ohio and graduated in 1969 from Ohio State College University College of Medicine in Columbus. Later that year he came to Arizona for his internship and two residencies. He had a fellowship in infectious disease at the University of Arizona in 1972, and was involved in the Pima County medical community throughout his career.

Dr. Barry Friedman in the courtyard of the Jewish History Museum, where he has served nine years as president of its board of directors.

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The Holocaust History Center houses this representative quilt created by Holocaust survivors. SOMBRERO – February 2014

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photos of Southern Arizona survivors of the Holocaust. Names of hundreds more have been submitted to the center. There are photos of the time period and a quilt created by Southern Arizona survivors. There are no explicit scenes from concentration camps or of holocaust victims. “We want the center to be friendly to visitors of all ages,” Dr. Friedman said. “We don’t want to frighten children. The purpose of the center is to remember the Holocaust and to honor the survivors. It is something that should never be forgotten, but it does not take horrific images to do the job. I think we have done a good job in getting that balance.

The building that houses the Jewish History Museum, 564 S. Stone Ave., has served many purposes since it was built in 1910.

Besides his practice in infectious diseases, he was appointed to the Arizona Board of Medical Examiners in 1990. He then moved into administrative medicine, serving as medical director for Health Partners Health Plans and UnitedHealthcare from 1997 until his retirement in 2001. He admits he gets a big charge when a school plans a field trip to the museum. “I’m not sure young people in general have as much love for preserving history as my generation and the generations before me did,” Dr. Friedman said. “Even in my own family, we buy furniture and other items in our home with the idea to eventually hand it down to our children, but they are not interested in keeping it and don’t want them. That’s one reason why donations to the museum keep coming in.”

The new Holocaust History Center opened next door to the Jewish History Museum in October 2013.

“It is amazing to see how much presence the Holocaust has in Southern Arizona. It is evident by the amount of donations in photos and artifacts we received after we announced were creating the Holocaust History Center.” Dr. Friedman said he looks forward to seeing both the Jewish History Museum and Holocaust History Center grow as more is learned about the artifacts and donations given to the museum over the years. Expansion will also depend on availability of additional funds. The museum itself is a survivor. The building was built in 1910 at 564 S. Stone Ave., a lot that is today on the south edge of

This time-capsule box was pulled from the museum’s corner four years ago in celebration of its centennial.

A good example is the Ketubah and Wedding Dress Exhibit that opened Jan. 1 and will run until March 30. The exhibit includes some magnificent dresses as old as the 16th century, and others that were recently donated and worn in the 21st century. Dr. Friedman said they don’t make too many long-term plans for special exhibits. However, one permanent addition is the new Holocaust History Center. It’s in a 2,300-square-foot building next door to the museum. It opened on Oct. 20, 2013 with more than 100
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Timeline displays support artifacts on permanent exhibit at the Jewish History Museum. SOMBRERO – February 2014

a major multimedia event. Memorabilia from the time capsule are on display in the museum. “I love this neighborhood,” Dr. Friedman said. “People are surprised about how wide the streets are, and how quiet it is. And it is one neighborhood in Tucson where you will find trees. I have been called a ‘tree hugger’ more than a few times. I don’t consider it an insult.” The museum showed its appreciation of Dr. Friedman’s service by giving him the Jewish Heritage Award in 2012. He is in the company of former Rep. Gabrielle Giffords, who received the same award in 2013. “I just don’t think they could find anyone else who would accept it when they gave it to me,” Dr. Friedman mused. “Really, it is an honor to be able to do this for a job. It is important to preserve Jewish history in Southern Arizona. “I am concerned [that] future generations may not be as interested in preserving history, so I am doing my part.” The museum’s heaviest attendance periods are now, during Tucson’s high tourist season in the winter months. It is open Wednesday, Thursday, Saturday and Sunday, 1-5 p.m., and Friday 1-3 p.m. The museum is searching for a new executive director, as Eileen Warshaw retired at the end of January after serving a decade in the position. Dr. Friedman and the Jewish History Museum have faced daunting tasks in the past, so just add one more to the list. Dr. Friedman served as a delegate to ArMA and on the PCMS Board of Directors from 1988-1990. He has been an Associate member since 2001. Dennis Carey is PCMS Associate Director. n

These dresses are part of the Katubah and Wedding Dress Exhibit on display until March 30.

downtown Tucson. It served as the first Temple Emanu-El from 1910-1949. After the Jewish congregation moved out, the building has been 11 different churches, a theater, and a Mexican radio station. It fell into disrepair and was condemned. At times it was no more than a roof for the homeless and it faced the wrecking ball. Local citizens generated enough interest to save the building. Volunteers were able to restore the building and a new cornerstone was installed in 2001. A 1910 time capsule was removed from the original cornerstone at the centennial celebration and it was as close as Tucson gets to

SOMBRERO – February 2014

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Milestones

Center for Neurosciences adds Dr. Rivero
The Center for Neurosciences recently welcomed the addition of Sergio Rivero, M.D. as a new neurosurgeon at the practice.  “We are delighted to welcome Dr. Rivero into our group of neurological specialists,” said Center for Neurosciences President Abhay Sanan, M.D. “Dr. Rivero has extensive experience in all aspects of neurosurgery including brain and spine surgeries, traumatic brain injuries, spinal trauma and neurosurgical emergencies.” Dr. Rivero earned his medical degree at the Autonomous University of Guadalajara, Mexico. He completed his multidisciplinary internship at the Hospital Español in Mexico City, and his neurosurgical residency and fellowship at the University of Arizona. He also completed a masters degree in Medical Science at the University of Arizona with a focus on pain management. He was a clinical neurosurgeon at Humboldt Medical Specialists in Eureka, Calif. prior to returning to Tucson in 2011. “Dr. Rivero is deeply involved in the Tucson community as a member of many different boards including the Tucson Surgical Society, National Hispanic Medical Association and Arizona Latin-

American Medical Association,” the practice reported. “From 2001-2005 he worked with the Southern Arizona Border Health Career Opportunity Program, volunteering his time to provide assistance to students from economically and academically disadvantaged backgrounds with the opportunity to develop skills needed to compete successfully, specifically entering into and graduating from health profession areas of study. Dr. Rivero is fluent in written and spoken Spanish.” He is also involved in research and has been included in publications and numerous presentations including the Southern Arizona Trauma Network, Arizona Neurosurgical Society and the University of Arizona Neuroscience Grand Rounds.  The Center for Neurosciences, 2450 E. River Rd., was established in 1950 and is “Southern Arizona’s largest and longest-standing group practice dedicated to the treatment of neurological disorders,” they said. “Five neurosurgeons, seven adult neurologists, four pediatric neurologists, a neuro-oncologist, an interventional pain management specialist and a radiation oncologist, along with three PAs, four NPs and a certified clinical research professional offer complete neurological care to patients of all ages, from infancy through adulthood.” For more information please visit www.neurotucson.com .

Welcome to Dr. Spark’s neighborhood
Tucon Mayor Jonathan Rothschild recently asked Dr. Ronald P. Spark to serve as volunteer Neighborhood Outreach Coordinator.

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SOMBRERO – February 2014

“Ron is a past-president of his neighborhood association,” Mayor Rothschild noted, “and is on the steering committee of the Neighborhood Support Network, Broadway Coalition, and Dowtown Neighborhood and Resident Council. “He also has had a long-term interest in urban recreation and open space, and has served as president of the Pima Parks Alliance. Ron will be reaching out to each of you and I ask that when he does, you work with him to find ways to make our neighborhoods clean, safe, and vibrant. You can reach Ron at rpsparkmd@yahoo.com.” Dr. Spark tells us you can join the mayor’s “One Can a Meeting” program. Just bring a non-perishable food item to your meeting. There’s a Community Food Bank collection box right in the conference room.

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CHVI renovations complete
Hybrid operating suite called first of its kind
After a year of renovation and construction, the Carondelet Heart & Vascular Institute celebrated its official opening in January with an open house for community members, donors, physicians, and healthcare providers. “The $17 million dollar project is part of a major expansion of Carondelet Health Network’s heart program on both the Carondelet St. Mary’s and Carondelet St. Joseph’s hospital campuses,” CHN reported. “Nine of the 20 cardiac and vascular specialists employed by Carondelet have joined the Network this past year. “CHVI is on the first and third floors of Carondelet St. Mary’s Hospital. The institute includes a dedicated Cardiovascular Intensive Care Unit; a 21-bed, all private room progressive care unit; a 34-bed telemetry unit; two cardiac catheterization labs; three dedicated operating suites, an electrophysiology suite with cardiac arrhythmia ablation capability; and an endovascular surgical suite for complex aneurysm repair.”

ROC #278632

CHN reports that a highlight of the new institute is hybrid operating suite seen in this photo. It combines a cardiac cath lab and cardiothoracic operating room, with ambient lighting, hightech equipment that “dramatically reduces radiation exposure for patients and physicians, and video streaming—making it the only hybrid OR of its kind in the nation.” Design of this OR “streamlines workflow and creates a more relaxing environment,” CHN reported. “It offers clear sightlines and open spaces, reducing a patient’s potential sense of isolation. Clinical studies have shown that, in this specific environment, patients who remain awake during surgery require less medication for anxiety than in traditional surgical environments. “The hybrid OR is also equipped with the highest quality X-ray imaging for optimal visualization during complex surgical procedures. Lastly, this modern surgical environment will serve as a remote classroom, producing streaming video that will allow physicians and medical students anywhere in the world to observe and learn new techniques and procedures.” “The vision of Carondelet Heart & Vascular Institute is to be nationally recognized as a premier destination for modern cardiovascular care through clinical excellence, research, and physician education,” said Michael Hecht, M.D., CMO of Carondelet Specialist Group. “Our expert medical team has formed a unique collaboration to provide the highest quality, most comprehensive and compassionate care to our patients.” n
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“We are so proud to offer Southern Arizonans the very latest in cardiac and vascular care technologies, coupled with one of the most highly skilled teams of physicians, surgeons and nurses,” said Dr. Amy Beiter, president and CEO of Carondelet St. Mary’s Hospital. “Carondelet Heart & Vascular Institute is truly an extraordinary combination of high-tech and high-touch care.”
SOMBRERO – February 2014

Neurology

HBOT activates healing mechanisms
By Dr. Carol Henricks

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ou probably know hyperbaric oxygen therapy or HBOT, and its use in treating “the bends” of divers, but you may not know that more recently it has become known for treating nonhealing diabetic foot ulcers. By enhancing oxygen delivery, HBOT stimulates healing processes that are relevant across many disease states. Since hemoglobin molecule binding sites are maximally saturated with oxygen at atmospheric pressure, enhancing the oxygen- carrying capacity of

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blood depends on dissolving oxygen molecules in plasma. Under hyperbaric (increased pressure) conditions, a hyperoxic state is achieved which initiates healing processes. HBOT triggers release of stem cells. [1] Stem cells are necessary for the continuous renewal and repair of all organs throughout our life. This includes our brain. A recent article in Neurology Today presented work with Down’s syndrome patients and correlates the early dementia that is part of the symptoms complex with a failure in the process of releasing stem cells. [2] In a hyperoxic environment, the chemistry of oxygen free radicals is different: oxygen radicals interact directly at a DNA level to up-regulate healing reactions and growth hormones, and down-regulate destructive pathways. More than 8,100 genes have been studied. [6] HBOT interrupts the cascade of injury following hypoxia / anoxia to minimize injury. Dr. Mathius made this discovery when studying patients with severe anoxic brain injury. [4,5] HBOT stimulates intracellular healing. Oxygen has a critical role in our metabolism, and an injured/diseased cell may rejuvenate in an oxygen-rich environment. [5] The hyperoxia in HBOT stimulates angiogenesis and is one of the ways that permanent healing is achieved. [3] HBOT should not be viewed as a disease specific treatment, but instead as a healing treatment modality. Dr. Henricks’ practice is Northstar Neurology, 7598 N. La Cholla Blvd. A PCMS member since 2004, she graduated in 1991 from Hahnemann University Medical School, Philadelphia. She did her internship and neurology residency at Hahnemann University Hospital, Philadelphia, and had a Fellowship in neurology at University of Michigan.
REFERENCES 1. Thom SR et al. Stem cell mobilization by hyperbaric oxygen. Am J Physiol 290: 1378-1386, 2006. 2. Talan J. Stem cell defects associated with Down syndrome. Neurology Today, Nov 7, 2013, Vol 13, Issue 21 p1, 13-16. 3. Goodman CA et al. Hyperbaric oxygen induces a cytoprotective and angiogenic response in human microvascular endothelial cells. Original paper. Cell Stress Society International 2009. 4.Mathieu D et al. Hyperbaric oxygenation in acute ischemic encephalopathy (near-hanging ) . Eur J Neurol 7 (Suppl 3):151.

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5. Jain KK. HBOT therapy in global cerebral ischemia / anoxia and coma. In “Textbook of Hyperbaric Medicine,” Hogrefe & Huber, 2004. 6. Thom SR. Oxidative stress is fundamental to hyperbaric oxygen therapy. J Appl Physiol 106:988-995, 2009. n

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SOMBRERO – February 2014

Emergency Medicine

Are you prepared?
By Dr. Sheldon H.F. Marks

Capt. Blume has taught military TCCC to Navy SEALs, and this Active Shooter/Mass Casualty course to government leaders. Dr. Marks taught wilderness/austere/trauma medicine to Special Operations Command members as well as TCCC to operators to be deployed to high-threat regions of Afghanistan. Both are active with the Tucson Police SWAT team. Don’t choose to be helpless. Remember, it is a choice. Call 520.445.7035 or e-mail MRCSA@outlook.com and register for this or future TECC classes. Medical Reserve Corps of Southern Arizona Want to know more or get involved? The Medical Reserve Corp of Southern Arizona is a nonprofit that is seeking like-minded physicians, active and retired, to join and participate, train and teach fellow physicians, physician extenders and nurses, as well as non-medical personnel in all aspects of community preparedness, not just trauma or world-changing disasters but mass immunizations, bio, nuclear, and chemical hazard risks, and other serious health issues that threaten the wellness and health of our community. MRCSA works to strengthen public health, prepare for and respond to emergencies and improve resiliency to any challenge to the health of our community. Resolve to be ready, through training and education of our medical community, to act if and when we are needed for a local, regional, or national event! We know that community decisions made now affect the lives and investments of everyone in the community for decades. For mor information or to join MRCSA,contact Tim Siemsen, MRCSA coordinator, at MRCSA@.outlook.com . Dr. Sheldon H.F. Marks serves on the PCMS Public Health Committee. His urology practice is Arizona Center for Vasectomy and Urology, 850 N. Kolb Rd. n

A

n emergency by definiton is now. Not later. Now’s the time for TECC—Tactical Emergency Medical Care. Don’t choose to be helpless. After all, it is your choice. If you are like most of us, you will have spent hours upon hours learning to use a new EMR system, or sat through lengthy, hospitalmandated courses on ethics or medical records. But when it comes to knowing what to do in an emergency—if you are the first on the scene of a serious automobile accident with multiple injuries; or your neighbor falls off the roof; or a teen at the local baseball game takes a line-drive to the face—and knowing you’re a doctor they rush over to ask you for help until the medics arrive… Are you prepared? If there is a terrorist attack on a school, shopping center or sports event, do you know what to do or not do? If there is a radiation alert because of a terrorist nuclear detonation elsewhere, are you knowledgeable or are you going to become part of the mass hysteria based on misinformation? As your medical field is constantly evolving with new knowledge, it’s probably not well-informed to assume that the basic first aid and trauma care you learned decades ago are still valid. Will you feel helpless when you are needed the most? Then continue to do exactly what most of us are doing to prepare: nothing. The world is different today. It’s time to get our heads out of the sand. The good news is that now you have a quick and painless way to learn and prepare. The Medical Reserve Corp of Southern Arizona (MRCSA) is offering a fast-track “Active Shooter/ Mass Casualty/TECC” course for healthcare providers to survive and save lives in an accident, violent situation, or disaster. TECC (Tactical Emergency Casualty Care) is the civilian equivalent of battlefield- proven, lifesaving trauma training taught to every U.S. soldier. Learn what to do and, just as important, what not to do. Understand your role to save lives and not become a victim. Find out what should be in your personal trauma kit at home, in your car, and at work. This MRCSA course teaches the newest advances in lifesaving trauma care from lessons learned in the field treating the injured in Iraq and Afghanistan, and will give you practical, realworld information and skills that you can use to save lives in those first critical seconds. Join us for this limited-seating TECC training on Saturday, Feb. 22 from 8:30 a.m. to 12:30 p.m. at the PCMS HQ. RSVP is mandatory. The training will be led by Capt. Kris Blume of the Tucson Fire Department, a senior paramedic responsible for Tucson’s emergency/disaster preparedness, and Dr. Sheldon Marks, PCMS past-president, and MRCSA board member.
SOMBRERO – February 2014

To refer a patient, please call (520) 396-1370.

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SOMBRERO – February 2014

Behind the Lens

When wrong is right
By Hal Tretbar, M.D.

W

hen is wrong right? When is left right? When you’re driving on your own “wrong” side of someone else’s road, that’s when. Dorothy and I were on our honeymoon in 1955. We were on a Caribbean cruise that stopped at Jamaica every 10 days. So we jumped ship there until the liner came around again. We were met at the ship by taxis and chose the driver with a mid-1930s convertible sedan, probably a Buick, just the thing for tropical Jamaica. I told the driver, whom I will call Leroy, that I wanted to rent a car. He said, “Sure Mon, but do you know how to drive on the left side of the road?” So there we were with me behind the wheel of an ancient taxi creeping around the side streets of Kingston. Apparently I was O.K. because Leroy said, “Now you need to get a visitor’s drivers license.” It took a good part of the day to have an ID photo taken and then apply for the temporary permit. With the papers in hand Leroy took us to the best car rental place. Apparently he approved when I rented a 1954 MG TD. The MG is a lowslung two-seater British sports car with a rack on back for luggage. There is a folding canvas top in case of foul weather. We took a few pictures and thanked Leroy with a nice tip for all of his pleasant help and attentiveness. Since about the time of Napoleon, the French, their colonies, and the rest of Europe have driven on the right side of the road. Great Britain and her colonies have always driven on the left side of the road. Perhaps this speaks for the age-old political enmity between the Anglophones and the Francophones. Driving on the left side of the road isn’t so hard—until you meet an English roundabout. There you are, confidently zooming along, feeling comfortable with the steering wheel on the right side of the car and maybe a manual shift for your left hand. Then instead of an easy intersection you face the task of circling around until you turn out on to the desired street, only to find yourself facing oncoming traffic. It’s devoutly to be wished that this is only briefly before you overcome the old reflex of driving on the right side of the road. We have driven in the British Isles several times. The first was when we took our new 1959 Porsche 356 A through England and Scotland. Dorothy remembers seeing Queen Elizabeth II close-up when the monarch got
SOMBRERO – February 2014 13 Dorothy and I roamed around Kenya on our own safari in this right-hand-drive Suzuki.

Dorothy recovers after our harrowing 300-kilometer drive from Masi Mara to Amboseli.

Our local guide shows Dorothy the remains of the cheetah’s lunch that we were watching.

out of her Rolls-Royce at Edinburgh Castle. I remember that she was guarded by the Royal Archers in their resplendent uniforms and armed with longbows. Formed in 1676, the Royal Company of Archers is the official guardian of British royalty when they are in Scotland. When we visited Kenya in 1984 we rented a four wheel drive Suzuki in Nairobi. Right-hand drive of course because Kenya was once a British colony. It had a pop-open top that was ideal for photography. We had made reservations at several safari lodges and camps in both Masi Mara and Amboseli parks. I bought maps and we took off on our own. Before we left Tucson we had picked up a used gastroscope that TMC was donating to the Friends Lugulu Mission Hospital near the

Ugandan border. One of their docs had come to Tucson to learn how to use it, but arranged for us to deliver it. We had no trouble getting to the hospital. We drove on the left side a new smooth, wide, empty highway that the president had built in his home district. When we stayed at a safari lodge we would hire a local person as our guide. I would do the driving and he would take us to the remote areas where the game was. We avoided all of the other safari vehicles that would cluster around the “animal of the day.” There was one small problem. When we were off the road going crosscountry, the guide, sitting on the left side, would frequently wave for me to go left. Finally I decided he was just swatting flies. We did get lost a few times. It turned out that the maps were far from accurate, and if you just followed the vehicle tracks it would lead to the next camp. One day we had to drive 300 kilometers to get to Amboseli National Park. We left Masi Mari at sunrise because we knew the gate at Amboseli closed at 6 p.m. The drive was challenging. The main roads were horrible. Inches of fine gritty dust covered even the corduroy ridges. Traffic dodged from one side of the road to the other to miss the knee-deep potholes. The suffocating dust in the car mixed with the fumes from our leaking extra can of gas. Finally Dorothy had had it: “Stop this car! I won’t go another inch. Take me back to Nairobi.” These are times that test true love. After we sat for awhile and she was able to breathe some clean air we were able to proceed. We got to the gate just before it closed. I have a photo of Dorothy sitting on our deck at the Amboseli lodge with three empty beer bottles in front of her. We had a great time during our honeymoon in Jamaica. We stayed in an old English guest house that served High Tea every afternoon. We covered the island from Kingston to Montego Bay in our MG TD. I don’t remember the weather causing us to put that top up. One time we were up in the
SOMBRERO – February 2014

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520.544.9890 | www.casahospice.com
Hospice services are paid for by Medicare

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Center for Neurosciences Welcomes
Sergio Rivero, MD Neurosurgeon
As a native Arizonan who was born and raised in Nogales, Dr. Rivero looks forward to serving our Southern Arizona community. He is fluent in Spanish.
Our rental ’54 MG TD is behind Leroy’s taxi in Kingston, Jamaica.

mountains when Dorothy asked, “Do you think they grow strawberries here?” And there they were around the next corner. The curves on the little winding mountain roads were lots of fun in the low-slung MG. When I turned the car in, before catching the liner for the rest of the cruise, my left thigh was covered with bruises. It seems that every time I took a mountain curve at speed, Dorothy would gasp as the road rushed past her seat just inches off of the ground. Then without thinking she would grab my left leg with her right hand. That was because, for her, we were driving on the wrong (left) side of the road. n

To schedule an appointment with Dr. Rivero, please call

(520) 795-7750.
Learn more about our physicians and services at

www.neurotucson.com

2450 E. River Road, Tucson, AZ 85718

Superior medical care, right in your neighborhood!
Valley ENT is proud to offer Southern Arizona residents the most comprehensive treatment of the diseases of ear, nose and throat (ENT).
Our services include:  Effective, minimally invasive in-office procedures, geared to improve your quality of life  Standard and no-shot allergy treatment  State of the art services in audiology and hearing aids  Standard and at-home studies for sleep apnea
Steven J. Blatchford, MD

A.J. Emami, MD, FACS

Call our office today to schedule an appointment!

James D. Gordon, MD

(520) 792-2170
OFFICES LOCATED AT:

Adam D. Ray, MD

David T. Miyama, MD

SOMBRERO – February 2014

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Diet of Hope Institute

Dr. Gann’s Diet of Hope©
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Dietmar Gann MD Elizabeth Gann CNC

DIET OF HOPE YOUR PARTNER IN YOUR PATIENTS CARE
WE THANK OUR COLLEAGUES IN THE MEDICAL COMMUNITY FOR THEIR STRONG SUPPORT OF OUR PROGRAM OVER 4,000 PATIENTS HAVE SUCCESSFULLY FINISHED OUR 6 WEEK (PHASE 1) PROGRAM PATIENT SATISFACTION 99% WEIGHT LOSS 5-17% OF BODY WEIGHT ON PHASE 1 807 DIABETIC PATIENTS LOWERED THEIR AVERAGE A1c LEVEL FROM 7.7% TO 6.26%

520-696-3438
268 E. River Suite 130, Tucson Arizona 2096 N. Kolb Suite 107 Tucson, Arizona Gene Powers, FNP Sierra Vista, Arizona Dr. Michael Laux, San Carlos, Mexico Www.dietofhope.org
Hippocrates: Let Food Be Your Medicine And Medicine Be Your Food
16 SOMBRERO – February 2014

PCMS News

Late last year the Board of Directors voted to underwrite the events with funds traditionally used to publish and mail the PCMS monthly bulletin. The newsletter ended in November last year. “One thing that has been sorely missed these past years is the opportunity for physicians to socialize in a casual setting without any agenda hanging overhead, Dr. Marshall said. “The mixers will also be a great opportunity for members to introduce nonmember docs to the Society.” PCMS Executive Director Bill Farneyhough said Mix-at-Six socials will be given at restaurants, hotels, and other venues around Tucson, making it convenient for every member to attend at least one or two of the events. Spouses and significant others are encouraged to attend. Announcements about upcoming Mix-at-Six gatherings will be in Sombrero, on the website pimamedicalsociety.org, and e-blasted. If you have not provided the Society your e-mail address, Mix-at-Six is one good reason to send it along to Dennis Carey at dcarey5199@gmail.com

Members must send PCMS their e-mail addresses
As of this month, the Society transitions to e-mail, a speedier, low-cost means of distributing our bulletin, legislative news and alerts, social announcements, and educational opportunities for physicians and staff. Other than mailings required by Society bylaws, including Sombrero magazine, ballots, bylaws changes, etc., we are going strictly electronic. For our physician e-community to work, each member must provide the Society an e-mail address to add to our membership e-distribution list. So, please email your address to Assistant Director Dennis Carey at dcarey5199@gmail.com. Once we’ve verified or added your address, you’ll start to receive all our announcements and news via your iPhone, iPad, laptop, or desktop computer.

MICA declares 2013 dividend
Mutual Insurance Company of Arizona Board Chairman, President, and CEO James F. Carland, M.D. reports that for the ninth consecutive year, MICA’s Board of Trustees declared a policyholder dividend of $30 million for 2013. This brings the nine-year cumulative dividend total to $319 million, he said. The 2013 dividend will be allocated among participating policyholders who are current MICA members as of Dec. 31, 2013. Member dividends will be processed early this month. “Each member’s share of the dividend is calculated based on the threeyear period 2011-2013,” Dr. Carland said. “The $30 million dividend is allocated using each member’s proportion of uninterrupted earned premium relative to the company’s total earned premium over the same preceding 36 month period ending December 31, 2013. “For policyholders who have been insured by MICA for the full 36 consecutive months as of year-end 2013, the dividend represents approximately 25 percent of their 2013 annual premium.”

Mix@6 debuts
No, not another e-mail address, it’s Mix-at-Six. No matter how you write it, PCMS President Timothy Marshall, M.D. and his wife Denise, will host the Society’s Mix-at-Six Social on Saturday March 1 at their home, 6-8 p.m. It will be the first of six such events this year. Mix-at-Six is an opportunity for physicians to gather in a relaxed, informal setting to discuss anything they want. It will be open to all Society members and invited non-members. Physicians can interact with colleagues and meet other physicians they may refer to, but rarely see or meet. Member physicians are encouraged to invite non-members as a chance to showcase the Society and the advantages of membership. Dress is Arizona casual. Hors d’oeuvres, wine, beer and nonalcohol drinks will be served. Spouses and significant others are welcome. RSVP to the event by Feb. 15 by calling the Society at 795.7985. Attendees will be provided the address and phone number of the location. Future Mix-at-Six socials will be announced through the PCMS website, e-mail blasts, and Sombrero. Photos from the events will be published in these pages.
SOMBRERO – February 2014

Dr. Friese on the run
Dr. Randall S. Friese, University of Arizona College of Medicine Associate Trauma Medical Director since 2008, recently announced that he is running for Arizona House of Representatives Dictrict 9 in the November election. A Democrat, Dr. Friese will oppose Reublican state Rep. Ethan Orr for a two-year term. Orr, Democrat Victoria Steele, and Democrat Sen. Steve Farley represent District 9. The district is north and central Pima County and northwest Tucson metro areas east of I-10 and south of the Santa Catalina Mountains.
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While seeking political office is far from unique among physicians, we nevertheless asked Dr. Friese why a perfectly good doctor would want to do such a thing. “It is precisely because I have a good job that I want to do this,” he said. “I received a full, four-year undergraduate scholarship. Without my great public school education, plus the scholarship and low-interest loan opportunities made available to disadvantaged kids like myself, I would not have been able to become a physician and surgeon. Developing and maintaining a robust public education system for the people of Arizona should be the highest priority of the state government. “Another issue that I am deeply concerned about is Arizona’s precedent-setting anti-choice policies” for reproductive rights. “ I am firmly pro-choice. “Finally, it’s impossible for me to honestly answer the question, ‘Why are you running?’ without reflecting on Jan. 8th. The more I learned about these people, and the more I studied the issues that they were fighting for, the clearer it became to me that I could not stand by. I had to become part of the group that worked daily to find solutions to the issues that are important to hardworking Arizonans.” Baltimore-born Dr. Friese graduated from the University of Maryland in 1986, majoring in biochemestry. He went on to graduate from the UofM School of Medicine in 1990. He did two surgical residencies at University of Colorado School of Medicine, Denver, and a critical care fellowship at University of Texas Southwestern, Dallas. In 1997 he served with the U.S. Navy Medical Corps as a surgeon in Okinawa, Japan, and Camp Pendleton, Calif. Dr. Friese serves on the PCMS Public Health Committee. His website is drfrieseforhouse.com .

PCMS 2014 President Timothy Marshall, M.D. presents the traditional presidential service plaque to Dr. Charles Katzenberg at the Board of Directors meeting Jan. 7 at PCMS (cell phone photo).

UofA neurologists begin public lectures
The University of Arizona Department of Neurology, College of Medicne, and Pima Council on Aging continue their partnership this month with a second annual Brain Matters in Neurology

monthly lecture series that runs Feb. 12 through April 9 at Tucson’s Jewish Community Center, the university reports. The lectures are free and open to the public. Organizer Jenny Chong, Ph.D., UofA associate director of neurology research, said the first Meet Your University Neurologist lecture in February 2012 drew more than 400 attendees. Speakers include David Labiner, M.D., chair, UofA Department of Neurology, professor of Neurology and director of the Arizona Comprehensive Epilepsy Program; Scott Sherman, M.D., Ph.D.,

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SOMBRERO – February 2014

director, UofA Movement Disorders Clinic, medical director of the American Parkinson’s Disease Association—Arizona Chapter, and director of the Parkinson’s Disease Program at the HealthSouth Rehabilitation Institute of Tucson; and Alex Hishaw, M.D., who provides neuropsychiatric and polytrauma treatment services at the Southern Arizona Veterans Administration hospital and UAMC. Jenny Chong said she started both lecture series because, “In my outreach efforts to recruit people/subjects, I found we did not have a ‘community face’ and, yet, there is a lot of hunger for information. One hopes that, with this, there will be more interest in research participation when they see our neurologists and become ‘familiar’ with them.” The first Brain Matters lectures were held last fall with topics that included Alzheimer’s and Parkinson’s Diseases with participation of UA neurologists and local chapters of related associations. Discussions cover latest therapy innovations and available support services. Topics for the upcoming Brain Matters series at the JCC include Headaches and Migraines presented by Wendi Kulin, M.D., M.D. Wednesday Feb. 12 at 9 a.m.; Neuropathies presented by Holli Horka, M.D. Wednesday March 19 at 9 a.m.; and Stroke presented by Kendra Drake, M.D. Wednesday April 9 at 9 a.m.

American College of Radiology’s accreditation for Mammography, Stereotactic Breast Biopsy, Computed Tomography and Magnetic Resonance Imaging.”

UofA College of Medicine— Tucson awarded Reynolds grant
The University of Arizona College of Medicine—Tucson recently announced that is has been awarded a “prestigious grant from the Donald W. Reynolds Foundation to strengthen physician training in geriatrics. “With the rapid growth of the American elderly population, especially in Arizona, an urgent need exists to assure that all physicians are prepared to provide the best of care for older adults,” they said. “This $1 million grant—the University of Arizona Health Network provided an additional $847,845 in matching—provides much-needed support to train Arizona’s physicians in geriatric care, with an emphasis on hospitalists and surgical and medical specialists.” Founded in 1954, headquartered in Las Vegas, Nev., the Reynolds Foundation is a national philanthropic organization that has committed more than $245 million to its Aging and Quality of Life program. “The grant program will support and extend the successes of the Arizona Reynolds Program of Applied Geriatrics, founded in 2006 by a previous Reynolds grant, which built an infrastructure of excellence in geriatric education and training,” the university reported. “This generous grant from the Reynolds Foundation will ensure

ACR rates The Breast Center at Carondelet St. Mary’s
The Breast Center at Carondelet St. Mary’s has been designated a Breast Imaging Center of Excellence by the American College of Radiology, Carondelet Health Network reports. The designation is given to breast imaging centers that have earned accreditation in all of ACR’s voluntary, breast-imaging accreditation programs, in addition to the mandatory Mammography Accreditation Program, they reported. “This designation demonstrates that our breast center meets the highest standards for quality patient care set by an independent professional organization,” said Amy Beiter, M.D., president and CEO of Carondelet St. Mary’s Hospital. “It is a rigorous process that is voluntary and shows our commitment to women’s health.” “Imaging services at the center are fully accredited in mammography, stereotactic breast biopsy, breast MRI, MRI-guided breast biopsies, breast ultrasound, and ultrasoundguided breast biopsy. Peer-review evaluations conducted by board-certified physicians and medical physicists who are experts in the field, have determined that The Breast Center at Carondelet St. Mary’s has achieved high practice standards in image quality, personnel qualifications, facility equipment, quality control procedures, and quality assurance programs,” they reported. They described the center as “a center without walls” featuring a “multi-disciplinary team of professionals focused on the prevention, early detection and prompt treatment of breast diseases, such as breast cancer. The ccnters has also earned the
SOMBRERO – February 2014

To refer a patient, please call (520) 396-1370.

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that hospitalized older adults will be cared for by specialists who have been trained to meet the unique health-care needs of older adults,” said Principal Investigator Mindy Fain, M.D., division chief of geriatrics, general internal medicine, and palliative medicine at the UofA College of Medicine–Tucson, and codirector of the UofA Center on Aging. Targeted specialties are those for acute care or older, frail adults, the university reported: emergency medicine; pulmonary/critical care; hospital medicine; orthopedics; and surgery. “In addition to training key specialists in geriatric principles, the program will develop high-value, team-based models of geriatric care for older, frail adults, such as a Senior Emergency Room, and an Acute Care of Elders program.

Diego R. Martin, M.D., Ph.D., The Cosden Professor and chairman of the UA Department of Medical Imaging and UAMC Medical Imaging. He said he expects greater research and research funding opportunities with the BMR Lab improvements now complete. “It will support innovation and ongoing studies and collaboration locally, nationally and internationally for important clinical centers, including the Arizona Cancer Center, Sarver Heart Center and Arizona Arthritis Centers.” “This 3T MRI facility serves to jump-start our research activities with a dedicated research scanner that is the same as the new clinical scanners just installed in our hospital and outpatient facilities,” Dr. Martin said. “Now, we can truly focus on accelerating innovation that leads to important developments from bench to bedside. Even though we’ve just begun, we have already seen benefits that have improved delivering healthcare to our patients.” The total project cost was about $3.2 million. The renovated lab will be run as a core support facility with financial oversight by Interim UA Vice-President of Research Jennifer Barton, Ph.D., and operational oversight by Dr. Martin. This project is also supported through a research agreement with Siemens Medical Systems. Renovations began in fall 2012 and included gutting the previous lab, which housed nuclear magnetic resonance (NMR) spectrometers used in studying peaks and markers in cellular growth and change. The spectrometers are slated to go to the UA Department of Chemistry and Biochemistry to serve its research needs, according to Scott Squire, the UA senior MRI research specialist who oversaw BMR Lab renovations. The new 3T MRI was installed in January 2013, but saw limited action until now due to that work. The MRI Lab at UAMC— University Campus includes another 3T Skyra scanner as well as two 1.5T MRI scanners, one from GE and another from Siemens. The new 3T Skyra scanner will open up more time for those scanners to be used in clinical applications. Dr. Martin noted that imaging sciences represent a major component of medical practice and science across an array of specialties in today’s healthcare. Magnetic resonance imaging in particular has revolutionized our capacity to study tissues and diseases that affect patients, from structure to function, in ways inconceivable before. Providing in-depth, non-invasive analysis, MRI is a remarkably safe technology and does not use potentially harmful X-rays. Over two decades use of MRI to make diagnosis of most major diseases—including solid cancers and diseases affecting the heart and vasculature, brain, abdominal and pelvic organs, the bones and joints—and to safely study children or even the unborn fetus has developed at a very rapid pace.

Coming PCMF CME dinnermeets
Pima County Medical Foundation has scheduled these CME events for its Tuesday Evening Speaker series. Dinner is served at 6:30 p.m. and the presentation is at 7. Feb. 11: Medical Marijuana presented by Sue Sisley, M.D. This is our annual physician homecoming event. March 11: Treatments of Obesity presented by Jeffrey Monash, M.D. April 8: Alzheimers and Other Degenerative Brain Diseases presented by Geoffrey Ahern, M.D. Also at this meeting, Timothy Fagan, M.D., Hector L. Garcia, M.D., and Jane Orient, M.D. will receive the Foundation Award for Lifetime Achievement in the Furtherance of Medical Education. May 13: Healthcare Update 2014 presented by Timothy Fagan, M.D. Other likely speakers are Marc Leib, M.D. and Bill Mangold, M.D. June 10: Rheumatoid Arthritis presented by Michael Maricic, M.D. Sept. 9: Dermal fillers and Fat Stem Cells in Plastic Surgery presented by plastic surgeon Dr. John Pierce. Oct. 14: New Medical and Surgical Treatments for Prostate Cancer presented by Rick Ahmano, M.D. and Mitch Sokoloff, M.D. Nov. 11: Newer Anticoagulants and Their Role in A-Fib, DVT, and Pulmonary Embolism presented by Tmothy Fagan, M.D.

Updates expand funding potential for UofA Biomedical Research Lab
A grand opening event was given in January for renovations and the new Siemens 3T Skyra MRI scanner installed in the University of Arizona Biomedical Research Lab at 1609 N. Warren Ave., Tucson, adjacent to UAMC—University Campus, the university reported. Acquisition of the MRI unit was made possible through a collaborative effort between the UA Office of Vice-President for Research, UA College of Medicine, UA Department of Medical Imaging (formerly Radiology) and the University of Arizona Health Network, the university reported. “This marks the culmination of a two-year project involving a coalition of support from the University of Arizona, the colleges, departments and BIO5 collectively investing in this project,” said
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UofA-based program called model ‘telehealth technology innovation accelerator’
 A number of outstanding telemedicine programs, owned by different healthcare organizations, work together on telemedicine challenges ranging from legal and regulatory issues,
SOMBRERO – February 2014

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SOMBRERO – February 2014

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to telecommunications technology, to reimbursement, The University of Arizona reports. “Investments by state governments in their own state universities can yield large returns and help create new industries. In Arizona, telemedicine is a good example of a success story. “The Arizona Telemedicine Program’s Telehealth Technology Innovation Accelerator (TTIA) supports the development of telemedicine programs in independent healthcare delivery systems throughout Arizona. The Arizona Telemedicine Program (ATP) operates one of the largest broadband healthcare telemedicine service networks in the United States, delivers federally funded distance education and training programs throughout the Southwest, and supports clinical studies on innovative healthcare delivery systems. “Headquartered at the University of Arizona College of Medicine– Tucson, ATP began in 1996, when then-state representatives Robert “Bob” Burns (R-Glendale) and Lou Ann Preble (R-Tucson) championed the creation of an eight-site telemedicine program. Ronald S. Weinstein, M.D., a pioneer in telemedicine and telepathology, was recruited as its founding director. Since then, the eight-site Arizona Telemedicine Rural Network has grown 20fold, and now extends to 160 sites in 70 communities.”

include creating and operating a shared broadband telecommunications network; developing inclusive training programs that address the telemedicine training needs of personnel across the entire healthcare industry in Arizona; and promoting telemedicine, telehealth and mobile health (or mHealth).” “Today, a number of nationally recognized telemedicine programs are affiliated with ATP. Personnel in these programs have received telemedicine training and technical assistance from ATP in Tucson and Phoenix, or online. “The Yuma Regional Medical Center (YRMC) signed on with ATP in 2006. Greg Warda, M.D., and his YRMC staff now have daily access to pediatric cardiologists led by Daniela Lax, M.D., at The University of Arizona Health Network (UAHN) in Tucson. Doctors in YRMC’s 20-bassinet Neonatal ICU have immediate access to UA telecardiologists in Tucson over the Arizona Rural Telemedicine Network. Immediate medical decisions can be made about transferring babies born with life-threatening congenital heart defects to Tucson or Phoenix hospitals with world-class pediatric cardiothoracic surgery specialists on their staffs. “I can’t say enough about the cardiologists in Tucson. They’ve all been wonderful,” Dr. Warda said. “Each week, the UAHN cardiology group consults on four to five YRMC cases by telemedicine video conferencing and UA cardiologists also spend a day and a half each month in Yuma following up on the babies and children they have diagnosed. ATP engineers are available 24/7 to provide technical support for this pediatric service, which has handled more than 400 expedited cases in the Gpast five years. “The ‘granddaddy’ of telemedicine services in Arizona is teleradiology, the most commonly used telemedicine application in the U.S. Faculty in the UA Department of Medical Imaging (formerly Department of Radiology) pioneered the development of digital radiology, the foundational technology for teleradiology. Today, teleradiology services like those developed at the UA a decade ago are offered by hundreds of teleradiology companies in the United States. Since 1998, UA radiologists have diagnosed more than 1.3 million radiology cases for patients in 25 communities in Arizona and adjacent states.” “Today a number of our outstanding telemedicine programs, owned by different healthcare organizations, work together on telemedicine challenges ranging from legal and regulatory issues to telecommunications challenges to reimbursement issues of mutual concern,” Dr. Weinstein said. “ATP is proud that the Arizona Legislature had a strong sense of ownership of ATP at the time of its creation 17 years ago, and is engaged in these activities of ATP more than ever today. “Telemedicine is everybody’s business.” n

“Our goal from the start was to use state funding as seed money for something far greater,” Dr. Weinstein said. “Our University of Arizona physician faculty members and basic scientists saw an opportunity to create a new type of federation of telemedicine programs, in which the UA would have multiple roles for an Arizona statewide consortium of telemedicine programs. These roles now BUZZIN

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SOMBRERO – February 2014

PerspecƟve

How American medicine can succeed
By David A. Ruben, M.D., M.B.A.

In “Why American Education Fails,” by Jal Mehta in the May 2013 Foreign Policy magazine, the author discusses why America is in the middle in tallied international education ratings. Mehta posits that our problems lie in lack of support and emphasis on human capital, core knowledge, and effective organizational structures, and he faults over-emphasis on accountability at the expense of the first three. He then touts the medical profession as doing better in achieving its goals. Although by some measures American medicine has achieved much, by others it rates no better than education when compared to other countries on such issues as infant mortality, longevity, and the prevalence of chronic illness. It may be of value, then, to look further at what Mehta sees as the issues for improvement in education, and considering how they may also be issues for the larger success of American medicine. Physicians agree when Mehta states that the bar for entering the medical profession and developing a broad knowledge base, as opposed to what is standard in educational profession, is high. But I am less confident that physicians continually revisit their training, set targets, make sure those targets are met, and that “no patient is left behind.” Mehta goes on to list Canada, Finland, Japan, Singapore, and South Korea as showing high student success. This is through not only good selection and training of teachers, but also by providing them with opportunities to collaborate with peers to improve their practices, external supports to do their work, and a strong welfare state. This has resulted in less need for the kind of external monitoring of performance which has failed to improve the system here. He suggests that education needs to borrow ideas from countries that do better, to “build a new system from the ground up—an expert profession that can consistently deliver high levels of performance.” Some of this applies to medicine. Mehta notes that education transformed from one-room schoolhouses, with the teacher in charge, to a district system around 1900. Teachers then worked under superintendents, but here was yet little organizational direction or control. Later, as demands for equality and To refer a patient, please call (520) 396-1370. an educated work force combined with a worsening economy that did little to improve poverty, education did not measure up. Medicine also evolved from a cottage industry to now individual practitioners and institutions joining to form the ACA’s Accountable Care Organizations. To date, however, medicine has done no better at addressing the health of patients than education has done in addressing their level of scholarship.
SOMBRERO – February 2014

Mehta explains that good teachers need to have three kinds of knowledge: “substantive knowledge” of the subjects they teach, “pedagogical knowledge” about how to teach, and pedagogical content knowledge about “how students are likely to understand the subject, what errors or preconceptions they may harbor, and how to respond to these misunderstandings.” He quotes research that say teachers make more than one 1,000 decisions per day in “real and fast-changing situations.” This is a familiar process in what physicians are called upon to do in diagnosing, educating, and treating patients in their daily work. That medicine does well on the front end of recruiting and training, as well in some areas of developing better and new specialized knowledge, is not enough. Improvement is needed in support for the growth and development of practitioners and their learning how to better work with patients in applying knowledge to increase their health. “Isolation is the enemy of improvement,” Mehta says. Teachers— and doctors as well—need to work together in their professions to discuss and reflect on performance and develop new and better approaches. In Japan teachers “regularly come together to study one another’s lessons and refine them …” Teachers in the U.S. spend 40 percent more time in the classroom than in Japan and Korea, with poorer student outcomes. The opportunities for shared collaboration are seen as essential for educational professionals, while those opportunities for the medical profession have shrunk. Economics have weakened medical societies and hospital memberships. Legal restraints have eliminated vendor-sponsored meetings where physicians use to gather to gain new information while enjoying and benefiting from association with their peers. The office is devoted to face-to-face rapid and intensive patient contact with little support for consultation, on the phone or even with the colleague down the hall.

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The price of this is isolated practices and practitioners who are accountable only to themselves and the threat of the punitive regulatory bodies. There is little attention paid to the hierarchies of clinical skills and accomplishment. Physicians who do better jobs are not recognized or paid more for patient satisfaction, or their patients’ good outcomes. Learning communities and learning laboratories are not common, while they should be the rule rather than the exception in this highly educated and dedicated profession. Mehta says, “Micromanagement, more requirements, regulation and accountability in hopes of improving these professions is not the answer.” Change will come from a re-ordering of the medical system that focuses on the value of the profession to its practitioners and patients, and enlists all actors in a common mission and focus of improved health. Re-establishing the core ideals of the profession, the shared professional identity and mutual support, better knowledge of how to work with patients as partners in their healthcare, and support of government that believes that more is gained in a civil society that nurtures all its members, is required. Dr. Ruben is director of Healthcare Southwest (HCSW), providing clinical services in adult and child psychiatry, chronic illness, and pain and addiction medicine. HCSW is a member of the Health Modeling and Consulting Group (HMCG), consulting in development of integrated delivery systems for institutions and practices, and for the modeling and measurement of patient health outcomes  They are also developing a “social perspectives in medicine” course for health students and professionals. Jal Mehta, the author to whom Dr. Ruben refers, is an assistant professor at the Harvard Graduate School of Education. His recent book is “The Allure of Order: High Hopes, Dashed Expectations, and the Troubled Quest to Remake American Schooling.”

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Become a member of the Pima County Medical Society
Pima County Medical Society is one of Tucson’s oldest institutions. It was in 1903 that the American Medical Association made it a “responsibility of professionalism” to belong to a county medical society. If one did not exist, then physicians were charged with starting one. In 1904 Yavapai and Pima counties complied and established societies. Other counties (except Maricopa which had started in 1891) started societies before 1910. Since 1904, the 1,000-plus member physician organization has been the gathering place for doctors to discuss, address and remedy medical and health care delivery concerns. To this day, the Pima County Medical Society continues to: • Preserve and protect the physician-patient relationship, a cornerstone of the U.S. health care delivery system; • Work towards and secure unity and harmony in the medical profession in Pima County; • Bring together in one organization all reputable, ethical and competent physicians of Pima County for the purpose of maintaining high standards in the medical profession in Pima County; • Promote the respected high reputation to which the medical profession’s history and achievement entitle it; • Promote the science and art of medicine; • Promote ethical practices among its members; • Conserve and promote the public health The benefits of membership are many! Please contact Executive Director Bill Fearneyhough or Associate Director Dennis Carey at (520) 795-7985. You can make application right over the phone. We fill out the paperwork for you or you can download a membership form by logging onto pimamedicalsociety.org, click on “How to Join” on the right hand side of the home page and download an application. Either way, your membership will make a tremendous impact for both patient and physician in Tucson and throughout Southern Arizona.

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CME

February
Feb. 20-22: The 36th Annual Tucson Hospitals Medical Education Program Winter Conference is at The Peaks hotel during Rodeo Week in Telluride, Colo. Program features speakers from Tucson on a variety of topics relevant to practicing physicians. “This is an excellent way to get CME credits in a beautiful mountain setting with excellent skiing,” said course organizer Robert Berens, M.D. “Kids will enjoy the winter sports and activities, so be sure to bring the whole family.” The Peaks features first-class facilities with deluxe accommodations. Please check the meeting website www. tucsonmedicalgroup.com for meeting details and sign-up. Register now to get exclusive meeting room rates at The Peaks. Contact Sue Corcoran at sue.corcoran@tmcaz.com, or meeting organizers Robert Berens, M.D. at robertrjb@gmail.com, Richard Dale, M.D. at rdale9136@aol.com, or Alan Rogers, M.D. at arogers@azacp.com.

Course addresses needs of female patients and their physicians for “comprehensive insight into relevant medical problems uniquely found in women, as well as a basic approach to addressing and improving common health concerns.” Website: http://www.mayo.edu/cme/women-s-health-2014s307 Contact: Mayo School of Continuous Professional Development Registrar, 13400 E. Shea Blvd., Scottsdale 85259; phone 480.301.4580; fax 480.301.9176. mca.cme@mayo.edu http:// www.mayo.edu/cme March 27-29: Tackling Problematic Chronic Rhinosinusitis: A Conclave of Global Experts is at Mayo Clinic Education Center, 5777 E. Mayo Blvd., Phoenix; phone 480.301.8000. Accreditation AMA, AOA, AAFP. Mayo Clinic presents “the first symposium on managing your most challenging sinusitis patients.” Global leaders in otolaryngology-rhinology, allergy-immunology, and basic sciences brainstorm in highly interactive sessions. Symposium goal is to synthesize its information into innovative strategies and tips on medical and surgical management of the recalcitrant chronic rhinosinusitis (CRS) patient. Bring together your challenging cases to discuss. Website: http://www.mayo.edu/cme/otorhinolaryngology2014s378 Contact: Mayo School of Continuous Professional Development Registrar, 13400 E. Shea Blvd., Scottsdale 85259; phone 480.301.4580; fax 480.301.9176 mca.cme@mayo.edu http://www.mayo.edu/cme

March
March 6-8: The 10th Annual Mayo Clinic Women’s Health Update is at FireSky Resort, 4925 N. Scottsdale Rd., Scottsdale 85251; phone 480.945.7666 or 800.528.7867. Accreditation AMA, AOA, AAFP, ACOG.

Members’ Classifieds
PHYSICIAN NEEDED: HealthySkin Medical and Cosmetic Dermatology is seeking a dedicated professional to join our growing practice! We are a team of 9 providers committed to our patients, staff and each other. We’re looking for a compassionate, personable BC/BE Dermatologist interested in practicing clinical dermatology. Our group consists of 4 general dermatologists, 1 Mohs Fellowship trained surgeon, 4 physician assistants, an on-site radiation therapy department, clinical and cosmetic lasers, and a fully staffed skin care department. HealthySkin Dermatology has been established in Southern Arizona for over 20 years with 4 main practice locations. We offer a 4-day work week (no nights, no weekends), a competitive guaranteed salary, production bonuses, comprehensive benefits including insurance, disability, 401(k), profit sharing, CME time and allowance, vacation time, and an opportunity for partnership. You will enjoy instant success with our EMR, established patient base and new offices encompassing over 20,000 sq. ft. of state of the art facilities. Call today for details, Samantha Marques, Practice Administrator (520) 293-5757, ext. 7113 or smarques@healthyskinderm.com. Visit our website at www.healthyskinderm.com. (1-14) SEEKING NP FOR PAIN MANAGEMENT PRACTICE: The Integrative Pain Center of Arizona is currently recruiting a Nurse Practitioner. We are Arizona’s only pain clinic to be designated by our specialty society as a Center of Excellence. If you are interested in working in a patient centered environment where the goal is to help patient’s find their way to wellness, whatever it takes, this is for you. Candidates are urged to review the IPCA website www.ipcaz.org. Job duties include intake evaluation; assessment of physical activity, diet, health risk factors and screening for mental health/behavioral risk factors; ongoing management of patients that includes pain treatment, diet and exercise, oversight of the integration of behavioral health treatment into the care plan, use of complementary and alternative medicine consultants, use of procedures to treat pain including routine injections, minimally invasive techniques and referral for surgical evaluation, and more. You will be working closely with experienced pain medicine practitioners. Successful candidates must have a current Arizona license and unrestricted prescribing privileges. Interested applicants please send resumes to bdavis@ipcaz.org. (11-13)

To refer a patient, please call (520) 628-1400.

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M I C A

A N N O U N C E S

CONSECUTIVE YEARS OF DIVIDENDS
At its December Board Meeting, MICA’s Board of Trustees approved a $30 million dividend to be distributed to qualifying members as of December 31, 2013. This is MICA’s ninth consecutive year of dividends, and our nine-year total of dividends distributed to policyholders is $310 million. Contact MICA to learn more about the benefits of membership in a physician-owned mutual insurance company.
Dividends declared for a policy year reflect the Company’s financial performance during that year. Past performance does not guarantee future dividends.

Medical Professional Liability Insurance (602) 956-5276 (800) 352-0402 www.mica-insurance.com

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