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Memphis Medical news Oct 13

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December 2009 >> $5 PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357 ONLINE: M.MEMPHIS MEDICAL NEWS.COM ON ROUNDS PRINTED ON RECYCLED PAPER October 2013 >> $5 Catholic Charities Launches a New Outreach Program for Veterans In spite of the fact that his arms were completely full, the gentleman exiting the building held the door open for me and smiled. “Thank you, sir,” I said. “You’re welcome, m’am. Feeling blessed this morning!” .... 5 Devising Strategies for Healthful Sleep Merrill Wise calls the issue especially important in Memphis Problems with sleep are so common, it’s not surprising that one of the nation’s most prominent experts in the treatment of sleep disorders has had one himself ... 8 FOCUS TOPICS WORKFORCE IMPROVEMENT MENTAL HEALTH SLEEP STUDIES For Physicians Struggling With Demons, PHP Can Save Careers, Even Lives BY JUDY OTTO Out of tragedy emerges progress – and po- tential respite for those suffering from mental ill- ness. That’s the belief of Joy Golden, CEO of Lakeside Behavioral Health System. Many sufferers and their families have been reluctant to seek help because of the stigma and misconceptions commonly associated with mental illness. Now, however, Lakeside is seeing an increase in its patient population, reflecting a heightened sensitivity to mental health issues that Golden attributes to high-profile national disasters where in some cases underlying mental illness was an issue with the perpetrators. “We have worked desperately hard to re- duce the stigma of mental illness and have stressed seeking help early enough so that we can help the patient and the family have a normal life (CONTINUED ON PAGE 12) HealthcareLeader Joy Golden, RN, MSN CEO, Lakeside Behavioral Health System MEMPHIS on the MEND BY PAMELA HARRIS BY GINGER H. PORTER His wife knew the truth. His life and practice seemed perfect, but it was far from it. He was known as the doctor who “worked hard and played hard.” A Saturday afternoon DUI arrest with his twin daughters in the car did not surprise her, but it shocked everyone else. She had been concerned since his residency about his weekend use of pot and alcohol. The arrest mortified her, but she felt relieved to end the late-night arguments the children would overhear. His partners insisted he get help and called in assistance from the Physician’s Health Program (PHP). After meeting with the program’s medical director, the doctor entered the treatment he now credits with saving his life and marriage. He is grateful to be alcohol and drug free, and he enjoys the fellowship he has found with other recovering physicians. Somewhere within the span of their careers, more than 20 percent of physicians may become impaired by alcohol, drugs or other health problems to the point that their ability to practice medicine is affected, according to Roland Gray, MD, medical director of the Tennessee Medical Foundation’s Physician’s Health Program. Lifetime incidence of substance abuse disorders for doctors ranges from 8 to 15 percent, with alcohol the most commonly abused substance. Delores DiGaetano, MD PAGE 3 PHYSICIAN SPOTLIGHT (CONTINUED ON PAGE 10) InCharge Healthcare 2014 AD SPACE DEADLINE: FRIDAY, NOVEMBER 15 MATERIALS DUE: WEDNESDAY, NOVEMBER 20 Highlighting the who’s who in the Memphis healthcare industry.
Page 1: Memphis Medical news Oct 13

December 2009 >> $5







October 2013 >> $5

Catholic Charities Launches a New Outreach Program for VeteransIn spite of the fact that his arms were completely full, the gentleman exiting the building held the door open for me and smiled.

“Thank you, sir,” I said.“You’re welcome, m’am.

Feeling blessed this morning!”

.... 5

Devising Strategies for Healthful SleepMerrill Wise calls the issue especially important in MemphisProblems with sleep are so common, it’s not surprising that one of the nation’s most prominent experts in the treatment of sleep disorders has had one himself ... 8


For Physicians Struggling With Demons, PHP Can Save Careers, Even Lives


Out of tragedy emerges progress – and po-tential respite for those suffering from mental ill-ness. That’s the belief of Joy Golden, CEO of Lakeside Behavioral Health System.

Many sufferers and their families have been reluctant to seek help because of the stigma and misconceptions commonly associated with mental illness. Now, however, Lakeside is seeing

an increase in its patient population, refl ecting a heightened sensitivity to mental health issues that Golden attributes to high-profi le national disasters where in some cases underlying mental illness was an issue with the perpetrators.

“We have worked desperately hard to re-duce the stigma of mental illness and have stressed seeking help early enough so that we can help the patient and the family have a normal life



Joy Golden, RN, MSNCEO, Lakeside Behavioral Health System




His wife knew the truth. His life and practice seemed perfect, but it was far from it. He was known as the doctor who “worked hard and played hard.” A Saturday afternoon DUI arrest with his twin daughters in the car did not surprise her, but it shocked everyone else. She had been concerned since his residency about his weekend use of pot and alcohol.

The arrest mortifi ed her, but she felt relieved to end the late-night arguments the children would overhear. His partners insisted he get help and called in assistance from the Physician’s Health Program (PHP). After meeting with the program’s medical director, the doctor entered the treatment he now credits with saving his life and marriage. He is grateful to be alcohol and drug free, and he enjoys the fellowship he has found with other recovering physicians.

Somewhere within the span of their careers, more than 20 percent of physicians may become impaired by alcohol, drugs or other health problems to the point that their ability to practice medicine is affected, according to Roland Gray, MD, medical director of the Tennessee Medical Foundation’s Physician’s Health Program. Lifetime incidence of substance abuse disorders for doctors ranges from 8 to 15 percent, with alcohol the most commonly abused substance.

Delores DiGaetano, MD





Highlighting the who’s who in

the Memphis healthcare industry.

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Sometimes the simplest thing can start a person down a career path. For Dolores DiGaetano, it had something to do with fresh produce.

“My uncle was a doctor,” she said, “and I was impressed that his refrigerator always had out-of-season fruit, like green grapes.”

That and the fact that her uncle and aunt were able to be generous to her family and her other aunt’s family, young Dolores liked the things a doctor could do for others.

“I felt medicine would be a good way to help people, plus provide for my loved ones,” she said.

After her family moved from near Chicago to Forrest City, Arkansas, when she was 15, DiGaetano set her sights on a medical career. Today she is one of Mem-phis’ top psychiatrists – or the best, accord-ing to a survey of her peers in “best doctor in Memphis” surveys in 2011 and 2012.

She has been president of the Cham-berlin Clinic since 1988 and has her private practice there. She added a day per week at CNS Healthcare in 2005 to do research.

DiGaetano originally envisioned her-self becoming a family physician, “but I loved my psychiatric rotations.” After grad-uating from Southwestern (now Rhodes), she earned her medical degree at UTHSC. But, like many medical students, she had some struggles along the way.

“It was very competitive, and I had to study smart and study a lot,” she said. “There was definite sexual harassment, which I hope women don’t face today. It was difficult to balance home life with work. I worked throughout my clinical years to avoid a huge debt and at times would be up for 36 hours. It is what doctors do.”

After her residency, she interviewed for a job with the U.S. State Department when it created a psychiatric division after the Iran hostage crisis. That didn’t pan out, so she stayed in Memphis to be near her family and has been here ever since… And without regrets.

“Coming from Chicago,” she said, “I have loved the flowers that grow nearly all year round, the mild winters, the summer heat, the warm people and ethnic diversity. I also love our water!”

DiGaetano joined Barbara Chamber-lin and David Daugherty at the Chamber-lin Clinic in 1985, and those two eventually moved on. In 25 years under DiGaetano’s leadership, the clinic has evolved in several ways.

“We grew our group with psycholo-gists and social workers,” she said. “We ex-panded our hospital practices from Lakeside to Baptist Central and Baptist DeSoto and some nursing homes. However, Barbara and David moved back to Mayo Clinic in 1996. Since then we have had a number of reorganizations, and I have gradually made the transition to total outpatient services at

one location site in Cordova, working with a number of mental health providers over the years.”

As for whether mental disorders are treated better today than when she started, DiGaetano answered “yes and no.”

“While there are new, effective medi-cations that have fewer side effects, there are too many providers prescribing medi-cines outside of their range of expertise,” she said. “Extensive history taking is es-sential to making an accurate diagnosis. Commonly used symptom checklists are for screening purposes only. There is still stigma concerning psychiatric treatment, and unfortunately many people are reluc-tant to seek help, especially if having to go through referral sources or EAP services.”

DiGaetano listed major depressive disorder, anxiety disorders and bipolar spectrum disorders as the primary reasons patients come to see her.

She is known to be conservative in pre-scribing medication.

“I try to get people on the least amount of medicine possible for full functioning,” she said. “Acute illness will usually need more medicine at first and often for a 6 to 24-month period. I can usually taper medi-cine to lower maintenance levels after a per-son has done well for two years.”

In particular, she said, anti-depressants are over-prescribed, “as are stimulants, benzodiazepines and narcotics.”

The doctor leans toward psychother-apy over medication.

“I spend a lot of time separating medi-cal from social issues,” she said. “I favor psychotherapy but realize many people have biologically based diseases.”

Some of the major issues facing so-ciety today in terms of mental health are, she said, “Not enough sleep. Too little exercise. Poor conflict resolution. Poor self-care skills. Violence within families. Alcohol and drug abuse.”

On her website, www.chamberlin-clinic.com, DiGaetano is described as “a firm believer in diet, exercise and good sleep hygiene as a basis for good health.”

When asked to elaborate, she said, “You are what you eat. If you eat food that

is bad for you, you will get sick. Our bodies are built to move, so get moving. Most of us really need eight hours of sleep at night. Daytime sleep is half as efficient and leads to poor health. I encourage folks to work in the day. Don’t sleep with snorers, dogs or cats that need to go out. Get children to sleep in their own rooms. Don’t sleep with the TV on. Sound, uninterrupted sleep is essential to good health.”

Among her activities in high school, DiGaetano ran track and was a class vice president, and she hasn’t abandoned those interests. Married and a mother of three sons, she remains physically active with bi-cycling, yoga and pilates, and she’s training for a 5K run in November with some family members.

Beyond that, she has become active in local politics and has served as president of the Tri-County Republican Women for the past two years. She also is vice chair of the Fayette County Republican Party.

“Having had immigrant grandparents, I know from their experience that America is a wonderful country,” she said, “and that everyone has an opportunity to achieve whatever they are willing to work and sac-rifice for.”

Delores DiGaetano, MDUncle’s full fridge helped set talented psychiatrist on course


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Page 4: Memphis Medical news Oct 13

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Delta Medical Center is pleased to announce the opening of two additional Outpatient Programs:


A Day Program specializing in the treatment of older adults experiencing mental health and substance abuse problems, including depression, anxiety,

panic attacks, memory problems and prescription drug abuse.


This is a new addition to the continuum of substance abuse services offered at Delta. This

day program allows the patient to participate in both group and individual therapy and to return to their

normal living environment in the evening.


For information regarding these or any other Behavioral Health Programs at Delta,

please contact the Behavioral Health Admissions Department at



On the wall lead-ing to the poetry room at City Lights Book-store in San Francisco, there is a corkboard cov-ered with hundreds of color-ful post-it notes. Each note includes a per-sonal response to the question, “What book scared you the most as a kid?” The post-it note, although anonymous, gives the community a look into the hearts and minds of its customers, their friends and themselves.

Each note is part of a conversation. One that is carried on between those who stop to read the responses. One that takes place between the employee who posted the questions and those who gather them. Heck, even one between those who decide which books to stock! And these are the kinds of conversations that you could be having with your patients if you only had your own wall.

But you do.Today’s corkboard wall is social

media. There are several platforms. And there are lots of opportunities to ask good questions, gather responses and better un-derstand those who rely on you to reach their healthcare objectives.

Okay, so the responses aren’t anony-mous. But they are voluntary. The right question doesn’t ask someone to give away personal health information but could give them an opportunity to share information on the periphery that might help you de-velop a strategy for meeting their needs.

It’s this simple. You’re a cardiologist. The post on your practice’s Facebook page asks this, “What’s your favorite car-dio exercise?” Or, maybe it’s broader like, “Who inspires you to get off the couch and take a walk?”

By asking, “What’s your favorite?” you’re learning what most find doable and can share that with others. They’ll even share ideas with one another. And you may even find some new exercises that your particular audience is comfortable performing.

By asking, “Who inspires you?” you’re learning about motivations. Is it family? Is it sports heroes? Is it that hot new contestant on “Dancing with the Stars”? And with this information you’re learning more about what moves your patient to, well, move. It’s better than a lecture like, “Exercise now or die soon.” Oops. I’m sorry for the dramatic lecture title. I get a little excited about the topic of connecting you with your patient.

Dr. Bubba Edwards is a pediatrician

in Memphis, Tennes-see. On a wall at his

office are the hand-prints of kids who have

successfully (and heroically) received all of their shots. It’s just a handprint and a first name. But it’s a great encouragement for the anxious child being walked to the exam room in nervous anticipation of his school shots. And well, it’s just plain fun.

Okay, maybe your patients are too grown up for that. But they’re not too grown up to have fears of their own. They are not so grown up that we can’t encour-age them to pursue the treatments that can improve and perhaps even save their life.

So you don’t have a wall for the handprints of your grown up patients? Sure you do. It’s called Instagram. The free picture and, dare I say, inspiration sharing smartphone app has nearly one billion users. Each user is posting pictures of everything from what they’re eating to where they’re spending the day with friends. Imagine your challenge, or en-couragement, to a patient is that he posts pictures of his meals as a sort of account-ability to eat well. There’s no mention of a condition that demands it. It’s merely a celebration of “I can do this.” Heck, with the plug-ins for your website that sort or encouragement can be shared with every-one who interacts with you there. It’s sort of like a handprint on Dr. Bubba’s wall.

And so, maybe there are things be-yond prescriptions that can improve the quality of life for your patients. Maybe there are things beyond office visits that can help us stay connected. And maybe, just maybe, we can have some fun doing it.

By the way, what book scares you now?

Hey Doc, The Writing is on the Wall

Tim C. Nicholson is the President of Bigfish, LLC. His Memphis-based firm connects physicians, clinics and hospitals to patients and one another through healthcare social media solutions, branding initiatives and websites. His column, “Hey Doc”, appears here monthly. Find him on twitter @timbigfish or email [email protected]

Page 5: Memphis Medical news Oct 13

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Catholic Charities Launches a New Outreach Program for Veterans



In spite of the fact that his arms were completely full, the gentleman exiting the building held the door open for me and smiled.

“Thank you, sir,” I said.“You’re welcome, m’am. Feeling

blessed this morning!”I knew this man felt blessed because

he had come to the Catholic Charities of West Tennessee (CCWTN) offices at 1325 Jefferson in Memphis in need, and he walked out with a bag of food and a few clothing items. There were others there hoping for the same thing.

Most of us take for granted basic things such as food, shelter and clothing, so it doesn’t hurt to be reminded that there are those who, for whatever reason, live among us whose daily struggle is to secure these simple basic necessities for one more day.

CCWTN is one of the largest multi-social service organizations there to serve

people in our community who are doing without. According to Michael Allen, the President and CEO of CCWTN, “We’re here to give both a ‘hand-out’ and a ‘hand-up’ with the goal of helping those in need become more self-sufficient.”

CCWTN is fortunate to have Allen at its helm. Allen transferred to Memphis from Chicago three years ago to work for International Paper. A devout Catholic, he began volunteering his time to help CCWTN and eventually left Interna-tional Paper to lead CCWTN on a full-time basis.

CCWTN has many established pro-grams for people with various needs. It helps homeless individuals with mental illness through Genesis House. It offers emergency services that include the “Fig Tree” Food Pantry (In partnership with the Midsouth Food Bank) and Clothes Closet at its Jefferson Avenue location. There’s a mobile-food pantry that serves outlying areas in need, immigration ser-vices for those seeking US Citizenship, In-ternational Adoption services, and Camp Love and Learn – an eight-week summer camp for at-risk children.

Program for VetsIn October, CCWTN is launching

the most significant program that it has undertaken in the past eight years – a program to assist local homeless veterans. Called Saint Sebastian Veteran Services, the program will help veterans who are either homeless or at imminent risk of homelessness with case management sup-

port focusing on housing, employment and financial counseling.

Saint Sebastian is the patron saint of soldiers whose medal is often worn by sol-diers today.

On any given day, there are several hundred homeless veterans in Mem-phis. War-related disabilities often lead to homelessness for these individuals, whether it be a physical disability, mental anguish or post-traumatic stress syndrome (PTSD). There is noted difficulty in re-ad-justing to civilian life and these problems often lead to unsafe behaviors such as ad-diction, abuse and violence.

Veterans often end up in Memphis because VA Hospital is a resource for them. According to the US Department of Veterans Affairs website www.va.gov/homeless, the VA is committed to ending Veteran homelessness by the end of 2015, but it also admits to needing community organizations (such as CCWTN) to make it happen.

A Mission of HelpThe mission of CCWTN is, “Follow-

ing the teachings of Jesus Christ, we pro-vide help to those facing chronic poverty and bring hope, through intervention,


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Nearly half the health insurance exchange plans in 13 states (Tennessee included) with early filings will be of the narrow-network type according to an unpublished McKinsey & Company analysis of 955 plan offerings. Enrollees in such plans will have limited or no coverage if they seek care outside their plan network. In exchanges, subscribers will see lower premiums than they would pay for plans with broader networks, insurers say. These narrow panels will also reduce provider reimbursement because it will reduce completion and set prices.

In the large-employer market, Aetna’s narrow panels are 15 percent to 35 percent smaller than its standard preferred provider panels. Blue Cross Blue Shield of Illinois says its exchange plans using narrow networks will cost 20 percent to 30 percent less than its exchange plans with bigger networks.

Is this the definition that payers have been waiting on when they discuss quality of care? Some physician groups, hospitals, and patient advocates are concerned that many of the insurers’ networks have not yet publicly announced. (At least by the time you read this article.) Open enrollment begins October 1, 2013.

They fear that patients, particularly those who need specialized providers, may not have adequate access to care. Last year the Obama administration issued a rule that insurers “must maintain a network of a sufficient number and type of providers…to assure that all services will be available without unreasonable delay.” It also requires that “essential community providers” be included in all plans.

Please allow me to express my opinion as to why this will fail. Although enrollment begins October 1, many of the insurers’ networks have not yet publically announced their networks. This major flaw in apparent design, or no design, in the Affordable Care Act failed to fully realize the lack of state acceptance and/or lack of information coming out of Washington, caused a rush to throw out something and did not consider present obstacles to achieve transformational change which must be considered when designing a “new program.”

In Greg Butler and Chip Caldwell’s book, Top-Performing Health Organizations, they discuss seven proven steps for accelerating and achieving change. I want to discuss one barrier that always seems to be ignored, yet by not realizing it and paying attention to it, we doom the program before it even gets started. “Human Nature and the Barriers to Change”:

• Acceptance of the need to change is an admission of guilt. Before change can occur, mangers must acknowledge

that change is needed (and not to increase the bottom line of the insurers) and their current performance and work processes are not optimal. Thus the perception of failure.

• Fear of failure and rejection trumps the desire for change. For many individuals, the personal risk involved in change outweighs its potential rewards. Healthcare is a risk-averse culture. It fosters an environment that demands error-free performance and does not reward risk taking. Fear of failure appears to be a part of healthcare’s DNA.

• Comfort with the familiar leads to avoidance of change. Human nature’s first response to changes is to evaluate the risk and run though endless scenarios of possible negative outcomes.

• Complicated projects create the Mt. Everest syndrome. When considering a complex task in totality, people become overwhelmed. The reference to Mt. Everest analogy is; “Imagine yourself as a mountain climber facing a difficult slope. If you sit at the base of the mountain and contemplate the climb, trying to envision every step of the journey to the summit, you will become overwhelmed with the magnitude of what you must accomplish. (Sounds similar to our own personal lives, doesn’t it?)

Breaking the climb into achievable phases, it becomes a series of small climbs rather than an insurmountable challenge. (Sounds like it might be a good plan for our personal lives, doesn’t it?)

• Discomfort with ambiguity leads to avoidance. Most human beings are uncomfortable with even small amounts of ambiguity and uncertainty. They seek a proven map before they take the first step of a journey. Ambiguity is the root cause of many anxieties. This desire for certainty can prevent progress. Fear and protection of the status quo can masquerade as due diligence. Ambiguity can invoke a perpetual call for more data, more analysis, and examination of more alternative solutions.”

This is one of the problems I have with academia with their “publish or perish.” Many times these publications turn out to be a blueprint for perish or failure. A guiding vision is important, but seldom does one have the luxury of knowing all the answers and details before starting a transformational initiative.

Less Choice, Lower Premiums?

by Bill Appling

Bill Appling, FACMPE, ACHE is founder and president of J William Appling and Associates. He serves on the Medical Group Management board of directors. He is a national speaker, presenter and a published author. He serves as an adjunct professor at the University of Memphis and Chair of Harrah’s Hope Lodge board, and serves on the board of Life Blood. For more information contact Bill at [email protected].

Page 7: Memphis Medical news Oct 13

m e m p h i s m e d i c a l n e w s . c o m OCTOBER 2013 > 7


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Page 8: Memphis Medical news Oct 13

8 > OCTOBER 2013 m e m p h i s m e d i c a l n e w s . c o m

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Problems with sleep are so common, it’s not surprising that one of the nation’s most prominent experts in the treatment of sleep disorders has had one himself.

Merrill Wise, MD, of Mid-South Pul-monary Specialists, P.C., and Methodist Healthcare Sleep Disor-ders Center, was elected in June to a three-year term as president of the American Sleep Medi-cine Foundation. He also serves on the board of di-rectors of the American Academy of Sleep Medi-cine.

His issue with sleep is a common one: insomnia.

“I have struggled with insomnia from time to time, and I find that it’s not very fun,” he said. “I sometimes have trouble falling asleep on Sunday night because I’m thinking about all that I have on my plate for the week ahead.”

Wise’s strategy for achieving restful sleep?

“You try to plan and think about things that are on your mind several hours before bedtime,” he said, “to make lists and develop an action plan so you can then put those ideas out of your mind around bed-time.”

Devising strategies to treat sleep disor-ders is what Wise and the other specialists at Methodist Sleep Center do. With some 85 sleep disorders having been identified, treatment plans vary widely and are highly individualized. Developing the right plan is an invigorating challenge for the sleep spe-cialist.

In his practice Wise sees patients of all ages, from children to adolescents and adults. But as a child neurologist by train-ing, he is especially pleased with advances in treating pediatric sleep disorders.

“The most exciting development in re-cent times is the realization that untreated sleep disorders in children affect emotional and behavioral regulation and academic performance,” he said, “and that effective therapy often has a dramatic impact on im-proving day-to-day function.”

Overall, Wise is happy to see a rising awareness of the importance of healthful sleep.

“We now have much greater recogni-tion and appreciation for the central role that sleep plays in health and overall quality of life,” he said, “and that sleep is really at the crossroads of many aspects of how we feel and function during the day, including our cogni-tive functioning – for example our memory and attentiveness as well as our emotional regulation and our work productivity.

“We know that sleep and sleep prob-lems interface with our cardiovascular health, mood, and pain control for those with chronic pain and also with metabolic

function, including diabetes. Many people assume that sleep medicine only involves evaluation of snoring and the diagnosis of sleep apnea. But in fact it’s a very broad, multi-disciplinary field that spans pediatrics and adult medicine, and which includes a variety of respiratory, neurological and psy-chological processes.”

Wise said insomnia is a problem for at least 40 million Americans, and restless leg syndrome is thought to affect about 10 per-cent of the adult population and 2 percent of the pediatric population. Sleep apnea oc-curs in 8 to 24 percent of adult men and 4 to 8 percent of adult women.

“There’s a misconception that sleep apnea is a man’s disease, but it clearly can occur in women, and after menopause the incidence is almost equal between men and women,” he said.

The Methodist Sleep Center, with lo-cations in Memphis and Olive Branch, is the largest accredited sleep center in the re-gion, with seven board-certified sleep medi-cine specialists.

“Here in Memphis we’re especially focused on the importance of achieving ad-equate sleep as it relates to job performance and safety,” Wise said, “because we’re a transportation and shipping hub with the world headquarters of FedEx and a lot of trucking, rail and barge traffic. So we’re es-pecially attuned to ensuring that pilots, air traffic controllers, truck drivers and public transportation workers are well rested and fit for duty.

“There has been a growing aware-ness at both the governmental level and at the employer level that a well-rested, alert worker is a safer worker, and this is ex-tremely important in areas such as the air-line and trucking industries. So we have a large panel of patients from those groups.”

Wise describes his practice as family-centered. As an example, he cited the case of a 6-year-old girl who was brought to the sleep center because she’d been sleepwalk-ing. Wise found that she had been sleep-ing between her parents. Both were loud snorers and were ultimately diagnosed with sleep apnea.

“The child’s sleepwalking is a parasom-nia, or partial arousal, related to the intru-sive snoring that she was exposed to every night,” Wise said. “When we diagnosed and treated the two parents, which mark-edly improved their snoring and breathing during sleep, the child was also able to get a better night’s sleep and the sleepwalking resolved.

“I’ve seen a number of families where multiple family members had a sleep prob-lem, and by tackling each issue, family member by family member, we create an opportunity for healthy, restorative sleep for everyone. In the end, everyone is happier and functions better during the day. As a sleep specialist, that’s very rewarding to see. Can you imagine what our world would be like if everyone slept well every night?”

Devising Strategies for Healthful SleepMerrill Wise calls the issue especially important in Memphis

Dr. Merrill Wise

Page 9: Memphis Medical news Oct 13

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“When we began the Physician’s Health Program in 1978 and probably until about 10 years ago, almost every physician in the program had ei-ther an alcohol or sub-stance abuse disorder,” Gray said. “Now, we get a fair number of dis-tressed physicians who are acting in a manner or behavior that causes intimidation or people feel threatened by them. Some have mood disorders, stress and burnout, depression or bipolar disor-ders, some have not maintained appropri-ate boundaries with patients, some have overprescribed, and there are a few aging physicians with problems.”

Even the physicians with addiction problems have layers of health problems to be addressed, such as the comorbidities accompanying hard addictions, and other

behavioral issues the addictions may be self-medicating.

Radwan Haykal, MD, DLFAPA, di-rector of the Bipolar Spectrum Program at Lakeside Behavioral Health, explained that the alcohol and drug problems can be overly presented among doctors, who – known for their self-suffi ciency – tend to take matters into their own hands. “The root may be anxiety, depression, or bipolar illness,” he said. “They tend to deny they have a problem, and as a result, they self-medicate. In other words, when you think of alcohol and drugs, you think of this as a primary problem, but it can be a secondary problem to another disorder.”

A thorough evaluation must be done to determine the underlying causes of a distressed or addicted physician. Angry outbursts can happen because of burnout, depression, bipolar disorder or chemical dependency, fostering an abusive environ-ment with co-workers or subordinates and creating a setting not conducive to good patient outcomes.

One of the best alternatives for these doctors in crisis is a PHP, according to the Ethics Group of the American Medical As-sociation in an article published last year. It cites a 2008 study of 904 doctors who had entered physician health programs in 16 states for alcohol or substance abuse. In that study, 72 percent returned to the practice of medicine with unrestricted li-censing and were drug and alcohol free at

a fi ve-year follow-up.PHPs are nondisciplinary – providing

evaluation, support and re-entry program-ming. The fact that help can be received without reporting to a hospital creden-tials committee or a state licensure board means there is more likelihood of self-reporting. According to Gray, between 150 and 200 Tennessee physicians are identifi ed to the state program each year. Not all of those will be recognized as need-ing some type of assistance or treatment. Only 10 percent going through the Ten-nessee program relapse, and just over 3 percent cannot get to persistent recovery. Over 97 percent are able to complete their careers after this program. There are sup-port groups in 12 places across the state, two of those in Memphis.

Gray said the “physician health” movement got a late start. In 1955, state boards realized there was no physician rehabilitative track, and they called on states to create programs for doctors in-stead of just disciplining them. Even so, the movement did not really get going until the late 1970s when physician crises, once shrouded in secrecy, began making headlines.

It was 1978 when the Tennessee Phy-sician’s Health Program was instituted, the fi rst one in the United States. Shortly thereafter, a 1980 article in the Journal of

the American Medical Association titled “An Epidemic of Suicide Among Physicians on Probation,” reported an investigation by the Oregon Board of Medical Examin-ers. Over about a year and a half, 10 of the doctors being investigated attempted suicide, and eight of them were successful.

“Unfortunately, the medical pro-fession is well represented in the suicide ranks – we have a higher rate of suicide than most other professions,” Gray said. “Over the last 12 years, I have picked up nine survivors of various suicide attempts personally.”

Referrals to the Tennessee Physi-cian’s Health Program come from family, employing hospitals and medical groups. Over 25 percent are self-referred. PHP literature says “the mission of the Physi-cian’s Health Program is to protect pa-tients through identifi cation, intervention, rehabilitation and the provision of advo-cacy for the physicians impaired by addic-tive disease, mental or emotional illness.”

“If someone refers an alcohol or drug problem to us,” Gray said, “that’s kind of a turnkey operation, but for a distressed physician, the family, hospital or medical group needs to be a part of the process to get help. We want physicians to know that if you are in distress, if you are in trouble, there’s help available. It’s confi dential, and we are there for you.”

For Physicians Struggling with Demons, PHP Can Save Careers, continued from page 1

To contact the Tennessee Physician’s Health Program, call 615- 467-6411.

Dr. Roland Gray

Memphis Medical News

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Page 11: Memphis Medical news Oct 13

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The Tennessee Medical Founda-tion’s Physician’s Health Program (PHP) is a 501(c)3 organization funded by grants and contributions from hospitals and indi-viduals. A full-time staff of seven people, primarily case managers, follows a casel-oad of more than 200 doctors throughout Tennessee. A lot of the support group work is done by volunteers; two groups meet in Memphis.

“We have had doctors doing volun-teer work for us for 30 years,” said Roland Gray, MD, medical director of Tennes-see’s PHP. “Generally, these are physicians who have gone through some experience themselves. As they go through the process of recovery, a big part of that is reaching out and helping others.”

Gray, a pediatrician for 25 years, be-came interested in addiction medicine in the 1990s and received certification in it in 1997. He worked in addiction part-time until he began as medical director in 2002 after retiring from pediatrics.

He explained that any family mem-ber, patient or colleague can confiden-tially report concerns about a physician by phoning 615-467-6411 or at the TMF website at www.e-tmf.org. After a case is identified, case managers try to verify the reported behavior. If the report is not veri-fiable, the process is halted or the informa-tion is held for further inquiry.

If the need for help is present, the phy-sician is asked to make an appointment for an interview with PHP personnel for eval-uation. In exchange for support, the doctor is invited to follow the recommendations of the PHP in seeking specified treatment at his or her own expense. All treatment is done in approved hospitals and treatment facilities. The length of treatment is based on the physician’s individual needs and can include prescribed inpatient and/or

intensive outpatient therapy.Gray and case managers work in con-

cert with the treatment center’s recom-mendations to establish contractual ground rules for re-entry into the workplace. “Dur-ing this period, the PHP is often the phy-sician’s strongest — and sometimes only — ally,” Gray said.

Follow-up consists of a minimum five-year process of ongoing monitoring by the Tennessee Medical Foundation, guided by an individualized contract consisting of recommendations of the PHP and treat-ment facility. The success rate of the pro-gram is 97 percent.

“Probably the most difficult cases for me are the cases I receive late — whether the problem is alcohol or drugs or sex or prescribing or behavior,” Gray said.

Getting a physician’s issues resolved early can also mean intervention as early as medical school. Around the same time the Tennessee PHP was created 30-plus years ago, a student organization was founded at UT called AIMS: Aid for the Impaired Medical Student. Herschel “Pat” Wall, MD, was dean of students at the University of Tennessee Health Science Center when he got a call about an addicted student.

“At the time, we had nothing here to deal with that,” he said. “As it turned out, there was no program in the United States to deal with impaired students. I quickly pulled together a group of individuals in the college of medicine, some of them recovering physicians, and we came up with a program that started with medical students and then reached all students on campus.”

A classmate could call the AIMS council to report that a student was im-paired in some way, and everything was confidential. The program gained such credibility that it worked. Wall took the AIMS program “on the road” to other

While Doctors Have PHP, Med Students Can Turn to AIMS


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The American Psychological Association (APA) has honored a Memphis psychologist. Ed-ward A. Wise, Ph.D., is the 2013 recipient of the Award for Distinguished Professional Contributions to Clinical Psy-chology, presented by Society of Clinical Psychology at the APA’s 2013 convention in Honolulu, HI.

In presenting the award to Dr. Wise, the Society commented on his long-standing commitment to the integration of clinical and re-search productivity. He was nominated for this honor by numerous colleagues, including two former APA Presidents, as well as profes-sors and practitioners affiliated with the University of Toronto, Bay-lor College of Medicine, Emory University, University of Wisconsin, University of Washington School of Medicine and Palo Alto Univer-sity, literally ranging from coast to coast.

Dr. Wise is the founder and President of Mental Health Resourc-es, PLLC, a multi-disciplinary private practice, operating in Mem-phis since 1987. MHR pioneered Intensive Outpatient Treatment Programs in this area.

MHR’s programs are designed as hospital diversion programs that treat acutely distressed clients in the least restrictive setting. On-going research studies conducted by Dr. Wise monitor their treatment effectiveness and each individual’s treatment progress. Results of this research are shared internationally with practitioners and professors through frequent peer reviewed publications in professional journals. MHR is the only outpatient treatment facility in this region, and one of a few in the country, that has published data on their treatment effectiveness in peer reviewed journals.

During his 30+ years in private practice, Dr. Wise worked on numerous inpatient units treating adults and adolescents with severe mental illness, substance abuse, eating disorders, dual diagnosis dis-orders, and mood disorders. He has maintained an active forensic practice, serving on the Capital Defense Team, consulting with the Attorney General’s Office and performing hundreds of court ordered psychological evaluations.

Throughout his career Dr. Wise has worked with medical col-leagues in med-surg hospitals, provided consultation services to a pain management program, an extended care hospital, a local PPO, and regional as well as national MCO’s. In 1996 he developed the first freestanding psychiatric intensive outpatient program (IOP) in Memphis and added a substance abuse/dual diagnosis IOP in 2006. Both IOP’s are based on manualized treatment protocols developed by Dr. Wise and have been the subject of six outcome and satisfaction studies. He has published over 30 peer-reviewed publications related to practice, served as consulting editor for the Journal of Personality Assessment and is a reviewer for many prestigious journals. In rec-ognition of his numerous professional and scientific achievements he received the Award for Distinguished Professional Contributions to Clinical Psychology.

Dr. Wise is a Fellow of the APA, SPA, Distinguished Practitioner in the National Academies of Practice and a past recipient of the APA Award for Distinguished Contributions to Independent Practice in the Private Sector.

Dr. Wise received his Bachelor’s degree with Honors from Wash-ington University, St. Louis, in 1975. He completed his Ph.D. in Clinical – Community Psychology at the University of Wyoming and his internship at the University of Tennessee Internship Consortium at UTCHS in Memphis in 1980.

The American Psychological Association, founded in 1892, is the largest scientific and professional organization of psychologists in the United States and Canada, with a membership of a nearly 140,000.

– long before you get to a high-risk situa-tion where there’s a tragedy,” Golden said.

There is no stigma associated with get-ting a broken leg fi xed, she points out; yet seeking mental health assistance is a dif-ferent story. “We’re trying to reduce that stigma. We’d love to eliminate it entirely.”

One popular misconception is that those who seek help will be admitted; in fact, Lakeside sees hundreds of people each month who receive no-cost assessments completed by a masters-prepared therapist or counselor. Approximately only half of those are admitted; others are referred to a professional, as needed, for appropriate follow-up care.

Golden is familiar with the challenges of destigmatizing mental health treatment. She joined Lakeside in 1997 as a part-time nurse on the weekends while still fi lling an executive position as human resources director at Methodist Healthcare-Mem-phis. She continued to juggle a Monday-through-Friday executive job and her weekend staff nurse job at Lakeside for more than 10 years until 2007, when she was invited to join Lakeside full-time as chief nursing offi cer.

Although it’s an unusual career choice to “backtrack” from an administrative po-sition to become a staff nurse, Golden’s original objective was to gain the creden-tials of registered nurse (RN) and use that in her executive role.

“To my surprise, I fell in love with nursing,” she said. “I started here, picking up part-time hours just to keep my nursing license current. But then I started working every weekend because I loved it. It has ab-solutely been a joy in the journey!”

From nurse to chief nurse to COO, and ultimately to CEO for Lakeside, Golden acknowledges with pride the added insight and capability her unusual career path has given her. “I think being able to be a clinician and have that clinician foun-dation is incredibly important to managing a hospital,” she said.

It has guided her in developing a man-agement philosophy that her executive staff shares, and which contributes to her suc-cess in minimizing staff turnover:

“Our managers have ‘boots on the ground,’” she said. “We are not offi ce people. I model that, and they follow that model. I am on a unit every single day, and the perception of the staff is that we are doing this together. I think it’s helpful to employees to understand that leader-ship doesn’t come from some administra-

tive staff sitting in a different building who don’t have a clue what’s going on. If they’re having a diffi cult day on the unit, we show up – literally. And we’re qualifi ed to pitch in and help.”

Lakeside has been through a number of changes since its opening in 1969, many of which Golden has witnessed and/or implemented. Universal Health Services bought the hospital more than 10 years ago, and it is the largest of the 200 behav-ioral health facilities that Universal owns nationwide, including Puerto Rico.

Lakeside’s patient census also includes overfl ow from the Veterans Administration hospital, many of whose patients are suf-fering from post traumatic stress disorder (PTSD), Golden said. “We have a trauma resolution group led by a masters-prepared therapist who includes eye movement de-sensitization and reprocessing (EMDR) therapy, which has been very successful in helping to release internal trauma.”

An acknowledged trailblazer, Lakeside has adopted other treatment methodolo-gies that represent the state of the science. “If there’s a new treatment, we want to do it fi rst and best,” Golden said. “We are the only hospital in the area that has the equip-ment to administer trans-cranial magnetic stimulation (TMS), an FDA-approved therapy for major depressive disorder. It is a non-invasive outpatient treatment that has been successful in our experience.”

The prefrontal cortex of the brain – the mood center – is essentially jump-started by magnetic pulses released into that portion of the brain. No medication or sedation is given and no pain is involved; patients can drive themselves home after a 37-minute treatment. Treatments are usu-ally administered fi ve days a week for four to six weeks.

“Those we have treated have expe-rienced improvement in their mood,” Golden said.

Another effective treatment option – electroconvulsive therapy (ECT) – is ad-ministered by experienced physicians and also produces impressive results.

The most prevalent conditions that Lakeside treats are major depressive dis-order, bipolar disease and schizophrenia, although the range of care covers many other conditions, such as Asperger’s syn-drome, autism and Alzheimer’s disease.

“Sometimes all patients need is somebody to listen to them and to instill confi dence and hope that with treatment options and medications they can have a better life,” Golden said. “Unfortunately, there’s a lot of non-compliance in mental health patients, who stop taking necessary medicines because they feel better. Educa-tion is a continuing challenge for us.”

Golden spends her leisure time enjoy-ing her two granddaughters – competitive cheerleaders – and participating with her husband in shows sponsored by the Mem-phis Chevy Classic Club, for which he is the events director. The shows raise funds that benefi t the Tennessee Baptist Chil-dren’s Home or the Burn Center at The MED.

Healthcare Leader: Joy Golden, RN, MSN,continued from page 1

Read Memphis Medical News Online:


Page 13: Memphis Medical news Oct 13

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For 55 years, the Tennessee Associa-tion of Mental Health Organizations has served as the voice for community mental health centers and nonprofi t organizations that provide behavioral health services to some of the state’s most vulnerable residents.

Founded in 1958 as the Tennessee Association of Mental Health Centers, the statewide trade association changed its name in 1995 to better represent the changing organizational structure of its members.

“The purpose of the organization is to advocate for people who need services,” said Ellyn Wilbur, executive director for TAMHO. To achieve that goal, the association promotes the advance-ment of effective be-havioral health services, advocates for access to care, and works to serve its 21 member organiza-tions, which include com-munity mental health centers, specialty providers, and substance abuse experts. To carry the behavioral health agenda forward, working commit-tees, task forces, and professional member-ship sections bring together more than 400

staff from TAMHO member organizations on a regular basis to identify problems and issues from a provider perspective and to develop recommendations to effectively ad-dress them.

As the primary provider network for the state’s Medicaid waiver program, Wil-bur noted, “The majority of the people our centers serve are TennCare-eligible, al-though that number has decreased slightly, and there are more uninsured people now than in years past.” She added some cen-ters also serve those with private insurance and Medicare.

“We see, on average, about 90,000 people a month,” Wilbur said of the pro-vider network, noting many people access the system multiple times a year. “The community mental health centers see, by and large, those with severe mental illness or substance abuse disorders, which means repeat visits. We typically see more adults than children … roughly two-thirds adults to one-third children.”

Every county has at least one provider and some have multiple providers, she said of the network’s reach. In addition, there are 13 crisis providers across the state avail-able around the clock, seven days a week, 365 days a year; and eight crisis stabiliza-tion units (CSUs) spread across Tennessee. Wilbur explained a CSU is a short-term

unit staffed by a range of professionals and paraprofessionals where an individual typi-cally stays two to four days to get past the point of crisis.

“When you have this type of system in place, you can often stave off the need for hospitalization,” Wilbur said. “The sooner you can return someone to their commu-nity with the supports they need, the better the outcome often is.”

Wilbur, who has worked in commu-nity behavioral health and social services for more than 30 years, said she has seen the science behind behavioral health mark-edly evolve. “From my perspective, we’ve seen a tremendous increase in the knowl-edge base of what actually works for people with severe illness,” she said. “There’s been a pretty dramatic increase in the number of effective medicines that are now available,” she added. “At the same time, we’ve seen a pretty dramatic increase in demand over the last four or fi ve years.”

Wilbur said there are multifactorial reasons for the increased demand includ-ing stress brought on by economic con-cerns, mental health parity laws making services more accessible, and a lessening of the social stigma of seeking help. “We have worked hard as an industry to decrease the stigma and impress upon people that men-

TAMHOThe Voice for Behavioral Healthcare in Tennessee

Ellyn Wilbur

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Ellyn Wilbur, executive director of TAMHO, said integrated care is a main theme for the 2013 meeting, which includes a full slate of keynote, public policy and educational sessions, plus an awards and recognition celebration, annual business meeting and installation of the new board. On Dec. 4, Charles Good, CEO of Frontier Health, will pass the presidential gavel to Bob Vero, EdD, CEO of Centerstone Tennessee, as the 2014 board of directors is seated.

Wilbur is particularly excited about the broad appeal of this year’s keynote speakers. TAMHO has partnered with the Tennessee Department of Health to bring Nadine Burke Harris, MD, MPH, to attendees. Harris is CEO of the Center for Youth Wellness in California. “Her expertise is in adverse child experiences as a risk factor for adult disease,” said Wilbur. “I think we’ve not always made the connection between those two things.” Wilbur added, “She understands when children have been exposed to trauma or


Page 14: Memphis Medical news Oct 13

14 > OCTOBER 2013 m e m p h i s m e d i c a l n e w s . c o m

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counseling and case management.” They help people in all walks of life, “regardless of religious beliefs, socio-economic status or ethnic background.”

So CCWTN is not just for Catholics. In fact, it’s a gift to Memphis and West Tennessee from the local Catholic com-munity.

And all it takes to witness that gift is to meet the local volunteers who staff the food pantry and clothes closet at the Jef-ferson Avenue location. They’re there for one reason only: to serve those less fortu-nate than themselves.

West Tennessee OutreachIn addition to the Jefferson Av-

enue office and local Catholic churches, CCWTN also works through St. Mary’s Catholic Church in Jackson, Tennessee, and St. John’s in Brownsville, Tennessee.

How Can You Help?

DonateCCWTN is a 501(c)3, non-profit or-

ganization. Your donations can help in many ways:

$25.32 will support a homeless vet-eran’s overnight stay at the Genesis House

$60.00 will feed five people for one month from the CCWTN food pantries

$125.00 will send a child in need to summer camp for one week!

$1000.00 will sponsor one child for eight weeks of summer camp!

$2000.00 will be used for the most ur-gent needs of the CCWTN!

Volunteers WelcomeVolunteer medical professionals can

help out with health education and screen-

ings.Case managers are needed to work

with veterans and their families.Outreach specialists are needed to

identify veterans in need of CCWTN ser-vices.

Attend the ConcertCCWTN offers a beautiful fund-

raising event that will get your 2013 holi-day season started in a meaningful way! On December 7, 2013, at The Cannon Center, CCWTN welcomes back Chris-tian artist, John Angotti. 100 percent of ticket proceeds go to benefit CCWTN programs. Tickets, which start at $15, are only on sale through CCWTN during No-vember. Mark your calendar to call then. The ticket line is 901-722-4701. Leave a message if necessary and someone will call you back within 24 hours.

To preview a John Angotti per-formance, visit http://ccwtn.org/An-gotti2012.html

For more information about CCWTN, call Michael Allen at 901-722-4747 or visit their website at www.ccwtn.org.

CorrectionIn our September issue in the Mem-

phis on the Mend column titled FORCE: Facing Our Risk of Cancer Empowered, we incorrectly listed the website address and email for Irene Rodda. You can see Rodda’s blog on www.facingourrisk.org/Memphis or email her at [email protected].

To nominate a local non-profit or charity to be spotlighted in Memphis on the Mend, please email Pamela Harris at [email protected].

Catholic Charities Launches a New Outreach Program, continued from page 5

schools around the country so that they could model it and develop their own stu-dent programs for addiction and behav-ioral problems.

“I was pleased and proud of our stu-dents and the initial committee for helping set up the national model,” he said.

Jay Mattingly, MD, an anesthesi-ologist, ophthalmologist and director of clinical affairs for the UT department of anesthesiology, has been chair of the AIMS committee for the past four years. He has worked with the program for 10 years.

Today, the AIMS committee con-sists of half students and half faculty. Two students per class (a total of eight for the four-year program) are elected at the start of every year. The committee students can then refer a problem student to the program, but other resources are in place as well. The first recourse is University Health Services, where students can self-refer and confidentially receive help for a substance abuse problem, depression or a psychiatric problem. Then there are times when that does not work out and a situa-tion rises to the level of the committee’s

attention.“If there’s an incident that occurs, like

they get arrested at a frat party for getting drunk and fighting, or there’s a DUI, then that’s serious,” Mattingly said. “Sometimes it’s as simple as chit chat with our commit-tee and an ‘I’m concerned about so and so.’”

If necessary, a student then gets evaluated for treatment. If therapy or a treatment program is indicated, therapy is supplied for free and arrangement for repayment of the cost of treatment is made. This whole process is confidential. However, if the student demonstrates poor compliance with treatment and all resources have been exhausted, the AIMS committee has to evaluate the possibility of reporting the student to the dean of his or her college as a last resort.

“For a long time, the populace has avoided reaching out for help because it was regarded as a sign of weakness rather than a sign of strength,” Mattingly said. “Now there are more resources available, and people are availing themselves of those resources.”

While Doctors Have PHP, continued from page 11

Page 15: Memphis Medical news Oct 13

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An incisionless procedure first per-formed in St. Louis at Washington Uni-versity’s 7th Annual GI Live Conference in July may very well represent a new gold standard for treating esophageal achalasia.

“This is the closest we’ve gotten to the Holy Grail dream of incisionless surgery, where the patient goes to sleep, wakes up, feels no pain and has no side effects or complications,” said surgeon Michael Awad, MD, PhD, FACS, associate dean of medical student education, pro-gram director of general surgery, and director of the Washington Univer-sity Institute for Surgi-cal Education. “We’re not totally there yet, but we’re very, very close.”

Awad and interven-tional gastroenterologist Faris Murad, MD, as-sistant professor of medi-cine, and director of endoscopic ultrasound at Washington University, performed the area’s first POEM (Per Oral Endoscopic Myotomy) procedure on July 19, on a 54-year-old female who awoke early the next morning ready to go for a run. “We said, ‘no, you can’t do that yet,’” recalled Murad, with a laugh.

Immediately after completing the pro-cedure, Murad and Awad could see how well the patient’s esophagus opened.

“Other than minor bleeding and some CO2 that leaked into her abdomen, the case went great,” said Murad. “We’d practiced it and really understood the game plan.”

When checking on the patient postop-eratively that evening and the next morn-

ing, Awad was pleased to learn the patient had zero pain from the procedure. She only expressed slight discomfort from the postoperative barium swallow study and the IV in her arm.

“We wrote her (a script for) IV pain medication,” he said. “She didn’t use it once. We’d also written (a script) for Tyle-

nol, but she didn’t take even one Tylenol. That’s almost unheard of after a procedure like this.”

Within a couple of days, the patient re-turned to her daily routine. “She’s noticed a huge difference,” said Murad. “We’re thrilled with her outcome so far.”

The Long PreparationMurad and Awad began preparing for

the introduction of the incisionless proce-dure to St. Louis two years ago, when they first heard about POEM being introduced in the United States. Worldwide since 2010, some 1,400 POEM procedures have

A New Gold Standard?Washington University team performs first incisionless procedure for treating esophageal achalasia in St. Louis

Dr. Michael Awad

Dr. Faris Murad


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InCharge HealtHCare 2013

Y o u r P r i m a r Y S o u r c e f o r P r o f e S S i o n a l H e a l t H c a r e n e w S


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InCharge Healthcare 2014In December 2013, the 2014 edition of InCharge Healthcare will once again showcase the leaders who have risen to the top of one of Memphis’ most lucrative industries. This is Memphis’ resource guide for who’s who in the healthcare sector and provides a strategic opportunity for your brand to align itself among the healthcare elite who subscribe to Memphis Medical News.

Please contact Pamela Harris at [email protected] or 501-247-9189.

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Dr. Patrick Sullivan


An insidious condition, schizophrenia is estimated to occur in about 1 percent of the population worldwide. Character-ized by a breakdown in thought processes, the mental illness has been described for centuries through accounts of individu-als suffering from delusions, paranoia and hallucinations.

The chronic, debilitating disorder takes a heavy toll not only on affected indi-viduals but also on their families and society as a whole. An early onset disorder, many patients are first diagnosed dur-ing the late teens or early adult years and struggle throughout their lifetime to manage symptoms.

“It’s a horrible disor-der,” stated Patrick Sullivan, MD, director of the Center for Psychiatric Genomics at the University of North Carolina School of Medicine. “It’s a huge, huge public health problem, and it’s one where the scientific discussion has been dominated on partial information.” He added, “Peo-

ple have done the best they can with what information they have. We’ve been de-bating the cause of schizophrenia for the better part of a century now.”

On Aug. 25, Sullivan and colleagues helped move that conversation forward with the online publication of a new

genome-wide associa-tion study (GWAS) in the journal Nature

Genetics. “This is the larg-est published study we’ve done in the field,” noted the lead author who also serves as a professor in the departments of Genetics and

Psychiatry and UNC. Collabora-tors in the study include co-authors from the Karolinska Institutet in Sweden, the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard, and the Mount Sinai School of Medicine in New York.

“We discovered there were 22 places in the genome, 13 of which to our knowl-edge had never been described before, and each is a clue about the cause of schizophrenia,” Sullivan said of identi-fying nearly two dozen locations in the human genome that are involved in the disorder, including one that has previ-ously been implicated in bipolar disorder.

“If finding the causes of schizophre-nia is like solving a jigsaw puzzle, then these new results give us the corners and some of the pieces on the edges,” he stated, adding the number of genetic vari-

ants probably numbers in the thousands. “These 22 are the tip of the iceberg.”

The study was based on a multi-stage analysis that began with a Swedish national sample of 5,000 schizophrenia cases and 6,200 controls followed by a meta analysis of previous GWAS studies and then a replication of single nucleotide polymorphisms (SNPs) in 168 genomic regions in independent samples for a total of more than 59,000 people included in the research. The results underscored two takeaways for Sullivan. The first, “We need to do more studies urgently. We’re actually quite encouraged and believe larger studies of this type will lead to more knowledge,” he said. The second, “The early results we have here certainly indi-cate two different biological processes are involved.”

The research uncovered two distinct pathways that might be associated with the disorder — a calcium channel and micro-RNA 137. Calling the calcium channel, which includes the genes CACNA1C and CACNB2, the ‘queen of the channels,’ Sullivan explained there are a number of FDA-approved calcium channel blockers


Research Uncovers New Clues to the Causes of SchizophreniaGenome-wide study discovers new variants, pathways

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If the workforce ain’t happy … ain’t nobody happy.

This spring the Lucian Leape Insti-tute at the National Patient Safety Foun-dation (NPSF) released a report, Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care, that underscored the fundamental importance the workplace environment plays on patient safety. The result of two roundtables on the topic, the report contends patient safety is inextri-cably linked to healthcare workers’ own sense of safety and well being since provid-ers who feel disrespected or threatened are more likely to make errors and less likely to follow institutional protocols.

Julianne Morath, RN, MS, president and CEO of the Hospital Quality Institute based in Sacramento, Calif., co-led the roundtables with former U.S. Treasury Secretary Paul O’Neill, now CEO of Alcoa. A founding member of the

Lucian Leape Institute, Morath was the inaugural recipient of the John M. Eisen-berg Award for Lifetime Achievement in Patient Safety from NPSF and is a noted author and speaker on the topic of safety and workforce improvement.

Going into the roundtables, Morath said the working hypothesis was, “A work-force, no matter how committed and skilled, cannot create a culture of safety unless they themselves are free from harm and disrespect.”

This hypothesis was borne out during the discussions that included the experi-ences and opinions of frontline practitio-ners, leaders of healthcare organizations, scholars, and representatives of govern-ment agencies and healthcare professional societies. Morath said, “It became very evident through the course of the round-tables that we have a long way to go in healthcare workforce safety.”

When workers live in a constant state of risk, they become blind to that risk and resigned to their situation, Morath said. “It’s a dangerous place to be if you think this is as good as it’s going to get no matter what you do,” she noted.

When a workforce reaches this state,

Morath continued, the workers won’t speak up or speak out. Yet, the evidence clearly shows having a culture that allows for effective assertion … or a ‘stop-the-line conversation’ … is a prerequisite for pa-tient safety.

Morath, who served as chief quality and patient safety officer at Vanderbilt University Medical Center at the time of the roundtables, said her co-leader O’Neill has often made the statement that every person in a workforce should be able to answer affirmatively to three essential questions:

1. Am I treated with respect and dig-nity by everyone?

2. Do I have the support and training tools to do my job?

3. Am I recognized and thanked for my contributions?

Unfortunately, ‘no’ is too often the answer to those questions. “It was jarring to find not only was there a lack of respect … but even worse, there was a culture of disrespect in many of our healthcare orga-nizations that was tolerated,” she said of the group’s findings. “We have a somewhat his-toric and toxic culture where the hierarchy has to do with positional titles and the num-

ber of degrees,” Morath added.Vulnerabilities in the system include

accepting emotional abuse, bullying and learning by humiliation as ‘normal,’ per-forming demanding tasks under severe time constraints due to the production and cost pressures that dominate today’s healthcare landscape, and having a higher rate of physical harm than such high-risk industries as mining, manufacturing and construction. This culture of fear and in-timidation takes away the joy and meaning from work that most healthcare employees chose for the very purpose of helping oth-ers and making a difference.

“While this report is concerning, it’s also hopeful,” said Morath, noting there were also examples of healthcare work-places that are getting it right … at least most of the time. New healthcare models that rely heavily on teamwork are also helping make cooperation part of the landscape. “It really requires an apprecia-tion and respect for everyone’s contribu-tion in a team to deliver high quality, safe care in this complex environment in which we work today,” she noted.

The report asserts joy and meaning

Happy, Safe Workforce Prerequisite for Patient SafetyReport Emphasizes Impact of Workplace Culture on Patient Outcomes

Julianne Morath


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tal illness is an illness. It’s a brain disease just like diabetes or another chronic disease.”

With the health insurance exchanges launching this month, Wilbur said her member organizations anticipate the mar-ketplace plans will enable even more people to come through the doors to seek services.

“I think we’re concerned that if the state of Tennessee does not agree to ex-pand Medicaid, there will be a signifi cant group of people with no payer source for services at all,” she said, referring to the group of people caught in the gap between TennCare eligibility and qualifying for health exchange subsidies. Wilbur added the hope would be for an increase in state funding from the Department of Mental Health. “Right now about 33,000 people are served through that fund every year.”

TAMHO members are also dealing with more medically complex cases as pa-tients present with co-occurring disorders … either a physical/behavioral health combination or a mental health diagnosis plus substance abuse. “Many of our provid-ers are doing more integrated care,” Wilbur said, adding the new reality means provid-ers have begun to meet a range of physical and behavioral health needs and to collabo-rate and connect with each other to better coordinate care and improve outcomes.

TAMHO, continued from page 13

Annual Conference, continued from page 13

violence, that exposure changes the way their brains develop and leads to more physical issues later.”

Kathleen Reynolds, a consultant with the National Council for Behavioral Health, is an expert on bidirectional integration between behavioral health and primary care. Kenneth Minkoff, MD, a clinical assistant professor at Harvard, is another nationally renowned speaker and consultant. “He is considered one of the nation’s leading experts on integrated treatments for individuals with co-occurring psychiatric and substance abuse disorders,” Wilbur noted. A fourth expert on integration speaking at this year’s conference was found a little closer to home, she continued. Jeff Howard with Cherokee Health Systems, which is headquartered in Knoxville, will discuss his organization’s more than 30 years experience blending primary care and behavioral health services. Cherokee staff members have provided technical assistance on integrated care to more than 100 organizations nationwide.

Although always open to those outside the TAMHO membership, Wilbur said this year’s meeting with its focus on integrated care should be especially appealing to a range of providers and encouraged anyone interested to attend. For more detailed program information and to register, go online to www.tamho.org.

on the market today that are used for a variety of conditions ranging from hyper-tension and angina to migraines.

Stressing that it was much too early to draw conclusions, Sullivan said the fi nd-ings at least indicate the calcium channel might be an area that deserves further at-tention from those studying schizophre-nia. Hypothetically, he continued, calcium channel blockers might be found to have unexpected effi cacy in schizophrenics. “That’s something that needs to be evalu-ated in a careful, rigorous way,” he said, again cautioning against jumping too far ahead.

The second pathway includes its namesake gene MIR137, which is a known regulator of neuronal develop-ment. Sullivan noted more than a dozen other genes are also known to be regulated by MIR137, as well.

Schizophrenia has long been known to have a strong genetic component. While it occurs in about 1 percent of the general population, the disorder is found in about 10 percent of people with a fi rst-degree relative diagnosed with schizo-phrenia. The National Institute of Mental Health notes the highest risk for develop-ing the illness — 40 to 65 percent — oc-curs in an identical twin of an individual with schizophrenia. Yet, most scientists believe genetics is only one component in developing the disorder, which probably has environmental triggers, as well.

While Sullivan said each different approach to solving the enigma of schizo-phrenia is important, he noted the genetic approach offers a strong foundation for discovery. “We can measure the DNA part of people particularly well these days,” he said. “Our study is a step forward in under-standing the genetic basis of the disorder. This is really, truly nice progress.”

He added the new fi ndings provide “a couple of good strides forward” even though an endpoint isn’t yet in sight. “But for researchers and scientists, it shows us a bunch of things we’ve never seen before … and that’s pretty cool.”

And Sullivan expects more informa-tion to be forthcoming. “What’s really ex-citing about this is that now we can use standard, off-the-shelf genomic technolo-gies to help us fi ll in the missing pieces,” he said. “We now have a clear and obvious path to get a fairly complete understand-ing of the genetic part of schizophrenia. That wouldn’t have been possible fi ve years ago.”

Research Uncovers Clues,

continued from page 16

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By LyNNE JETER ORLANDO – When leaders at

the Florida State University College of Medicine (FSU COM) began crunching numbers, they were pleasantly surprised to learn that roughly two of three medi-cal graduates are practicing medicine in-state, even if they completed residencies elsewhere.

“We were con-cerned it was a fluke and hoped the trend kept up,” said Michael Muszynski, MD, dean of the FSU COM Orlando regional campus, and associate dean of clini-cal research. “Five years later, it’s holding steady between 60 and 64 percent.”

State lawmakers approved the open-ing of the FSU COM in 2000, after the Board of Regents denied requests in the late 1990s, stating more doctors weren’t needed. The charter class graduated in 2005.

As of May, 82 of 135 FSU COM graduates who have completed residen-cies are practicing medicine in Florida (61 percent). Of those, 70 percent (57) are in-state primary care providers (PCPs) and

16 percent (13) are practicing in rural, medically underserved areas of the state.

“The reasons why our statistics are much better than the standard 30/60 per-cent split – that is, 30 percent of graduates from traditional-based medical schools typically return to the state after complet-ing residency and 60 percent stay where they did their residency – is because of the foundation we laid with our mission state-ment, which was created by us from the very start,” said Muszynski. “We wanted the foundation firmly established so that whoever inherited the program from the pioneers who started the school wouldn’t be able to vary from the mission.”

First, FSU COM stacks the deck on the front end through a holistic applica-tion approach, focusing on applicants who want to live and practice medicine in Florida. Second, the college follows a community-based medical school model during students’ clinical years, where they connect one-on-one with physicians in the community.

And third, medical school faculty makes it fun and interesting to be a com-munity-based doctor with a mentoring system that maintains contact with stu-dents during school and afterward.

“We put a great deal of thought into how our approach might work,” said

Muszynski. “We knew we had to make an impression on medical students when they were making choices about their ca-reers. And it’s working. The only thing that surprised us was how well it’s worked. We would’ve been happy with a 40 to 50 percent return, but 60 to 65 percent is as-tounding.”

Deck Stacking Rather than reviewing only grades

and scholastic ability, the FSU COM ap-plication review board selects students with attributes that mirror the school’s mission.

“We quickly discovered that students who stated upfront their agreement with our mission had experience supporting that mission alignment,” said Muszynski. “For example, we noted that many ap-plicants from smaller towns and smaller high schools were involved in a meaning-ful way with their community and seemed more likely to maintain that mission. We made no apologies for those identifying descriptors.”

For several years, FSU COM only accepted in-state applicants. Now, ap-proximately 5 percent of approved appli-cants cross state lines to attend. Still, the board remains very selective.

All factors considered equal between

two applicants – one from a rural area and an urban applicant – the rural appli-cant may be get a slot above the urban applicant, said Muszynski.

“A student from a rural area is more likely to align with our mission just be-cause of their setting,” he explained. “But the rural applicant who didn’t do much extracurricular-wise, where the urban applicant worked with the underserved, then it’s different.”

Middle GroundTo keep the in-state return mindset

strong, the FSU COM uses a commu-nity-based curriculum to place third and fourth year medical students in the field.

“Community-based curriculums have been talked down by some schools,” said Muszynski. “We contend its equal worthiness. We focus on producing phy-sicians who can care for patients in com-munity settings, and a community-based curriculum is central to the process.”

For example, FSU COM has a unique apprenticeship model. Students aren’t assigned to hospitals, wards or resi-dency teams. Instead, they’re assigned to a physician practicing in the community who has been trained to be an educator. That physician typically receives $2,000

Stacking the Deck Part 1COM’s winning approach to retaining medical graduates

Dr. Michael Muszynski


Page 20: Memphis Medical news Oct 13

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been performed. Nationally, there have been only 200 POEM cases, mostly at two locations. The largest POEM center in Portland, Ore., accounts for roughly half of them. Awad trained with Lee Swanstrom, MD, FACS, of The Oregon Clinic in Port-land, who was the fi rst doctor to perform natural orifi ce surgery in the United States. The second largest center is Chicago; roughly 35 POEM procedures have been performed at NorthShore Hospital, and perhaps 25 cases at Northwestern Memo-rial Hospital.

“One of the fi rst times POEM came up in the U.S. was two years ago at a So-ciety of American Gastrointestinal and En-doscopic Surgery (SAGES) conference in San Diego,” said Murad. “I was presenting at the conference and had heard discussion about POEM, but it was the fi rst time I’d seen video and learned more about it. A consensus meeting discussing the best ap-proach to POEM with preliminary data and other details was very enlightening. POEM has been slow to take hold in the U.S. because so much goes into it, and the procedure takes highly skilled people.”

In St. Louis, a collaborative approach was taken with minimally invasive surgery and interventional endoscopy. This collab-oration paired surgical experts in perform-ing laparoscopic Heller myotomy, with interventional endoscopy and an esoph-agologist. Awad and Murad co-directed the start of the POEM program at Wash-ington University.

Because the POEM procedure pairs specialists in surgery and GI, Murad and Awad began concentrated efforts to expedite bringing the POEM procedure to St. Louis.

“POEM is a convergence of disci-plines, with both specialties focusing on the GI tract,” said Awad. “Traditionally, the approach to those disorders has come from different angles. GI approached it through use of medications and limited therapeutic maneuvers (injection of Botox and balloon dilation). On my end, we usually approach disease of the GI tract with keyhole surgery. We’ve been trying for years on a national level to make our procedures less invasive, and a huge jump was made 20 years ago with the advent of laparoscopic and mini-mally invasive surgery. It was a huge ad-vance toward less pain, faster recovery, and fewer complications for patients.”

LagniappeDuring the preparation phase, Awad

and Murad connected with Haruhiro Inoue, MD, a professor at Showa Univer-sity Northern Yokohama Hospital and Di-

gestive Disease Center in Japan, who has performed 423 POEM procedures. The timing worked well for Inoue (pronounced “in-you-way”) to keynote the July 19 St. Louis Live Endoscopy Conference and also proctor the fi rst POEM case at Wash-ington University. “It’s too early for us to know long-term outcomes, but right now they’re matching laparoscopic outcomes,” said Murad. “As our understanding of the procedure improves, it might lead to better long-term outcomes.”

Is the POEM procedure the new gold standard for esophagus achalasia?

“That’s the hope,” said Murad. “We don’t have quite enough evidence yet to say that, but it’s emerging, and very prom-ising. However, this particular procedure requires a great deal of technical expertise and a lot of specialized training. It won’t be done in all corners yet.”

A New Gold Standard? continued from page 15

Current Gold Standard for Treating Esophageal Achalasia

The Heller myotomy is most commonly used to treat achalasia, a dysfunction of the lower esophageal sphincter (LES), which fails to relax properly, making passage to the stomach diffi cult for food and liquids. Initially performed by Ernest Heller in 1913, the procedure, now performed laparoscopically, involves cutting the LES muscles. The myotomy only cuts through the exterior esophagus muscle layers that are squeezing the muscle, leaving the inner mucosal layer intact.

POEM Procedure for Esophageal Achalasia

Symptoms: Weight loss, chest pain/heartburn, regurgitation.

Preoperative examination: Esophageal manometry, barium swallow study, blood test, and x-ray exam of chest and abdomen.

POEM surgical steps: 1. With the patient in the operating

room under general anesthesia, an endoscopy of the upper gastro-intestinal tract is performed to determine the length of the required incision of the muscle layer.

2. After the injection of a saline solution is made under the mucosa, a “mucosal incision is created which allows the endoscope to enter the submucosal space”.

3. A submucosal dissection is then performed down the esophagus to the top of the stomach. After creating the tunnel in the submucosa, the inner muscle layer is cut along its length.

4. The mucosal entry is closed by clips that will eventually fall off.

Possible postoperative symptoms:Fever up to 101 degrees, chest pain due to the muscle layer incision performed, and throat discomfort.

Day after surgery: A barium swallow study to confi rm that the mucosal incision is tight and not leaking.

SOURCE: Showa University Northern Yokohama Hospital.

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are created when the workforce feels val-ued, safe from harm and part of the so-lutions for change. The Mayo Clinic and Virginia Mason Medical Center are two examples that Morath said stood out for their culture of respect. She also said Hos-pital Corporation of America (HCA) has an exemplary employee safety and secu-rity initiative.

To create safe, supportive work en-vironments, healthcare facilities must be-come high-reliability organizations with a fundamental precondition that employees are their most valuable assets and that the health and well being of those employees is a non-negotiable priority. The report outlined seven strategies to move the nee-dle toward becoming this type of an effec-tive organization.

1. Develop and embody shared core values of mutual respect and civility; transparency and truth telling; safety of all workers and patients; and alignment and accountability from the boardroom through the front lines.

2. Adopt the explicit aim to eliminate harm to the workforce and to patients.

3. Commit to creating a high-reli-ability organization and demonstrate the discipline to achieve highly reliable per-formance.

4. Create a learning and improve-ment system.

5. Establish data capture, database

and performance metrics for accountabil-ity and improvement.

6. Recognize and celebrate the work and accomplishments of the workforce regularly and with high visibility.

7. Support industry-wide research to design and conduct studies that will ex-plore issues and conditions in healthcare that are harming the workforce and pa-tients.

“It sounds deceptively simple, but it’s about and individual and collective commitment to continual learning, con-tinual improvement, and continual en-gagement,” said Morath. “When you start, you’re never fi nished. This is a com-mitment … a long term commitment.”

The Process of Discovering New, Effective Chemotherapy DrugsDiscovery of new effective chemotherapy drugs is essential to the progress of cancer therapy. There is a complex legal organization behind this pursuit, with the goal being to protect the patient and make participation in these studies voluntary, with information derived structured to be accurate, informative, and compelling. This organization is the roadmap to conducting studies, and is legally defined in the code of federal regulations of the Food and Drug Administration (FDA), an organization responsible for the safety of food, drugs, medical devices, cosmetics, vaccines, radiation emitting products, and tobacco. A successful pursuit of clinical research requires strong physician commitment, high levels of financial commitment (a research staff/team), and compelling studies with exciting new agents.

The new agent in question (drug, antibody, toxin, vaccines, or radionuclides) is generally developed by a pharmaceutical company, referred to as the trial sponsor. The study is typically designed by the sponsor and vetted through the FDA, subsequently being approved and possibly modified and conducted by a physician referred to as the “principal investigator” who assumes responsibility for the legal conduct of the study. He must closely supervise the conduct of the trial and ensure patient protection at all times. Other physicians conducting the study are called “sub-investigators,” who enroll eligible patients and treat them according to the study protocol. To activate a study, there is initial determination of whether the practice has the appropriate patient population (feasibility) followed by an extensive contractual negotiation and subsequent approval by an independent institutional review board (IRB).

Once open, all new potential cancer patients are screened by nurse study coordinators to determine whether they are eligible for the trial. If they are, a process referred to as “informed consent,” explains potential dangers of the study treatment, is discussed at great length with the patient and family, and then signed by both the patient and physician. Subsequently, a detailed care plan is scheduled and the nurse coordinator closely follows the patient’s progress. To proceed, a research pharmacist sends the study agent to the clinic/hospital, treatment is administered, and the data is meticulously recorded. All along the way the sponsor, study monitor, FDA, and IRB require proof of close compliance with the study protocol and rules governing the conducts and assurance of patient safety. Upon completion and post-treatment follow-up, if the study is “positive” (where the new agent results in meaningful and statistically significant improvement in patient outcome), the sponsor asks the FDA for breakthrough, accelerated, priority, or fast track approval and the drug is evaluated by the FDA/subcommittees (ODAC in the case of cancer drugs) and approved for sale and marketing for a very specific, and sometimes, narrow indication.

This entire process is laborious, complex and slow, sometimes taking upwards of five years to complete. It is extremely expensive; this cost needs to be recuperated in the price of drugs. While there are currently more than 4,000 active intervention cancer clinical trials presently open, less than five percent of adult cancers are treated on any study, despite free innovative new agent drug, as well as increased personal attention the patient may get. Patients often dislike the term “experimental.” Among the reasons that might explain this unacceptably low accrual rate are: the physician may not be committed to research or just doesn’t do a good job at recruitment, or the appropriate clinical trial may not be available.The Family Cancer Center Foundation is part of the Baptist Memorial Group (BMG) Baptist Cancer Center network, a 32-physician medical oncologist group. BMG has devoted the time, commitment, and generous financial resources to the development of a clinical research organization addressing all of the above steps. We have active disease-specific groups and clinical trials in the areas of malignant hematology, breast cancer, lung cancer, digestive and urogenital malignancies, as well as supportive care. Our research network extends from Columbus, Mississippi, to Memphis to Jonesboro, Arkansas, and will hopefully fill in all practice sites between. We are committed to the advancement of medical knowledge, excellence in patient care, and passionately believe that we can accomplish both through a cutting edge cancer research clinical trials program.


Memphis Bartlett Dyersburg Southaven Oxford

Donald S. Gravenor, MD

Happy, Safe Workforce, continued from page 17

Through the Eyes of the Workforce

To download the full report and related materials, go online to www.npsf.org. Click on “About Us” and select the Lucian Leape Institute at NPSF. From there, choose the LLI Reports and Statements link under “Related Pages.”

a month on a contract basis. As a result of this model, the FSU COM has no full-time faculty for years 3 and 4, with the exception of the campus dean.

The approach also includes a ge-riatric rotation component to spark interest in caring for older patients. FSU COM has also established a strong student advisor network. Each student is assigned to a community advisor on an 8-to-1 ratio. Students are counseled not only about their careers, but also life in general, volunteerism, and the delicate yet very important work/life balance that perplexes many physicians. Advisors are overseen by a dean or associate dean, depending on the campus, on a 20-to-1 (students-to-dean) ratio.

“That low of a ratio in the U.S. rarely exists,” emphasized Muszynski.

Stage 3To further strengthen community ties

and the job placement network, Florida Hospital recently provided a $2 million gift to establish the Florida Hospital En-dowed Fund for Medical Education to help the FSU COM support its educa-tional mission.

“Our mission aligns strongly with Florida Hospital’s except that we’re not a faith-based school; we’re public,” said Muszynski. “These students are highly sought after, and relationships end up being life-long. We have 16 graduates al-ready practicing in Central Florida. You might think: only 16? But it’s impressive when you consider the number of gradu-

ates during our ramp-up years between 2005 and 2010, and those who are just fi nishing 5-year residencies. We’ve now created a number of scholarships to en-courage students to return.”

Stacking the Deck Part 1, continued from page 19

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Communicating: A Professional Courtesy

By Ralph Berry, Executive Vice President, Public Relations, Sullivan Branding

We live at a time where there have never been more communication tools at our disposal. We have the tools at our fingertips virtually every waking hour. We can be as direct, or as broad as we want. We can be alerted for instant responsiveness. We can be scheduled and regimented. We can communicate all the time without ever actually interacting. We can use technology to ensure that our timing is either intrusive or non-intrusive, or we can use that technology to avoid an immediate response.

The result? We live in a time where true communication skills and practices are poor, bordering on atrocious.

Good communication runs on a continuum that should begin with professional courtesy and extends all the way to strategic business advantage. I would wager that the leadership at many medical practices has no idea where they fall on that continuum. Whether a small family practice or a giant hospital system, your patients and vendors have insatiable communication expectations. The question is how far do you need to go to be positively judged as a communicator?

Some may say, “Let our work speak for itself. People will overlook a little communication blip if they get what they want from a treatment perspective.” Perhaps. These same people would be surprised how much value patients place on the way they are treated from a communication standpoint, and how much that communication colors their view of the “treatment.”

For example. We are all inundated with emails and spam every day. Rather than separate those unsolicited requests/spam from legitimate requests or follow ups, some people seem to resort to an ignore everything philosophy. After all, if it is really important, people will get our attention.

Or, another common practice, -- if you request a meeting with someone to discuss doing business and that meeting takes place and there is follow-up communication required, even if the requesting party decides to “go in a different direction,” shouldn’t it be a standard professional courtesy to respond and say so? Isn’t that better than leaving the person you requested to meet with “hanging” or “in limbo” not knowing whether to continue following up or forget it ever happened?

No logical business person would let this discourteous behavior occur. Yet because we have so much communication in so many forms, these kinds of professional discourtesies have become the norm rather than the exception.

What is an overworked, message-inundated, over-communicated, time-challenged person or office to do?

First, you need to diagnose the problem. Begin with a full office communication practices exam. What hurts? Is there any bleeding? Is there any referred or reflective pain that needs to be sourced? Are there asymptomatic communication issues growing undetected? You should poke, prod, measure and monitor with the same diligence you would for a patient exhibiting chest pains.

Second, after you diagnose the issue, prescribe a strict communication protocol for the office going forward. Approach this protocol with the seriousness of diabetic lifestyle change. To be a strong communicator is going to mean attention to some highly intrusive and potentially monotonous regular activities.

Because we have so many communication choices; communication policies and procedures are necessary for a successful business. Effective communication with your internal and external audiences is a big part of your overall reputation that goes beyond the business at hand – health. This is the time we live in.

I apologize for the medical metaphors I stooped to in this column. Humor me, it is as close as I will ever get to practicing medicine.

— Ralph Berry, Executive Vice President, Public Relations, Sullivan Branding,[email protected]

To learn more about Ralph Berry or Sullivan Branding, visit www.sullivanbranding.com

Your Practice – Your Brand

Campbell Clinic Adds Two Physician Assistants

Danielle Mollere and Tasha Sabino have recently joined the staff at Camp-bell Clinic as physician as-sistants. Mollere received her master of medical sci-ence degree in the phy-sician assistant program from Our Lady of the Lake College in Baton Rouge, La. Sabino received a mas-ter of physician assistant studies degree from the University of Utah in Salt Lake City, Utah.

UnitedHealthcare’s New Online Service Lets Consumers Pay Their Medical Bills Online

UnitedHealthcare has introduced a secure, online electronic bill-payment service that enables consumers to pay their medical bills and manage their health care claims and related expenses all from one location. The online service, known as myClaims Manager, is available to more than 21 million UnitedHealthcare plan participants nationwide.

The bill-pay feature is the latest en-hancement to UnitedHealthcare’s plan participant portal www.myuhc.com. The new service enables consumers to pay medical bills electronically by entering their credit card, debit card or bank ac-count information, adding convenience for consumers while helping health care providers get paid faster and easier.

UnitedHealthcare is the first national insurance carrier to offer plan participants online bill-payment capabilities that are fully integrated with their online claim information. Such services are becoming increasingly important as consumers con-tinue paying a larger percentage of their medical bills, according to a recent report from the American Medical Association. Currently, only about two-thirds of physi-cian practices accept credit cards, accord-ing to a recent report from SK&A Informa-tion Services.

Designed in collaboration with In-staMed, the leading health care payments network company, the online system is available to UnitedHealthcare employer customers of all sizes and to their employ-ees. UnitedHealthcare’s entire network of physicians and other health care provid-ers are eligible to register and receive on-line payments through InstaMed.

myClaims Manager is the latest in-novation introduced by UnitedHealthcare that empowers consumers to make more informed health care decisions. Other examples included Health4Me, a mobile application that puts an array of person-alized health information at people’s fin-gertips, and myHealthcare Cost Estima-tor, which enables people to comparison shop for health care services based on quality and cost.

Saint Francis Hospital Behavioral Health Services Offers New Mobile Mental Health Assessment Service

Saint Francis Hospital-Memphis now offers a mobile mental health assessment program. The assessor is available to go out into the community and provide on-site mental health evaluations, in con-sultation with Saint Francis psychiatrists. Psychiatrists may be consulted from on-site to determine the best intervention for the patient.

Barbara Harris, the mobile mental health assessor, comes to Saint Francis Hospital with over 25 years of experi-ence, much of it in geron-tology. She is available to provide mental health as-sessments in acute care settings, medical offices, independent living, assisted living, and nursing care facilities. This service pro-vides the flexibility of visiting and evaluat-ing clients in their own environment.

This new program augments the 24-hour/ seven day a week service provided by the Clinical Assessment Center at Saint Francis Hospital. If inpatient care is warranted, Barbara can assist in the ad-mission process to the hospital, providing a smooth transition. The inpatient Behav-ioral Health program serves patients with a variety of mental health issues, includ-ing depression, anxiety, dementia and psychoses. There are specialized pro-grams for children, adolescents, adults and geriatric patients.

Saint Francis Healthcare Inks Pact With Community Heath Alliance

Saint Francis Healthcare has signed a three-year agreement with Community Health Alliance (CHA), Tennessee’s health insurance Consumer Operated and Ori-entated Plan (CO-OP) developed for Tennesseans enrolling in health insurance beginning in October. The agreement brings Saint Francis Hospital facilities and physicians into CHA’s preferred provider network.

This agreement provides CHA’s West Tennessee members with coverage at Saint Francis Hospital-Memphis and Saint Francis-Bartlett, Saint Francis Ambulatory Surgery Center, and all employed physi-cian locations, which will further bolster CHA’s preferred provider network in the region. The newly formed insurance Community Health Alliance CO-OP be-gan offering health coverage plans on the exchange October 1.

Saint Francis has served the Mem-phis region for almost 40 years and through partnering with 133 health insur-ers, continues to work closely with local healthcare organizations to provide care to 183,431 patients each year. Saint Fran-cis recently agreed to renewed partner-ships with United Healthcare and Cigna.

Community Health Alliance (CHA) is Tennessee’s health insurance CO-OP, cre-ated as part of the Affordable Care Act. Enrollment opportunities begin on Oct.1.


Danielle Mollere

Tasha Sabino

Barbara Harris

Page 23: Memphis Medical news Oct 13

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Dr. Ben CarsonEmeritus Director of Pediatric Neurosurgery

at Johns Hopkins Hospital

Trumbull Laboratories, LLC Norm and Dale Hill

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THANK YOU to our Lead and Premier Sponsors for making

this year’s Scholarship Banquet a success!

The Bank of Jackson with Gary and Susan Grisham

Experienced Physician and Nurse Leaders In Place at Methodist Olive Branch Emergency Department

With the opening of the Methodist Olive Branch Hospital on August 26, each department at the hospital is busy. One of the busiest departments is the emer-gency room where Michael Washington, M.D., M.B.A., FACEP is medical direc-tor. Donna Adams, BSN, RN, will serve as the Emer-gency Department Clinical Services Director

Washington has been an emergency medicine physician for 27 years, the last 22 of which have been spent at Methodist Hos-pitals of Memphis. He is Board Certified in Emergency Medicine by The American Board of Physician Specialties since 1998 and an Assistant Professor of Medicine at the University of Tennessee Health Science Center. In preparation for the revolutionary chang-es in healthcare, Washington enrolled in graduate school in 2010, earning his MBA from Auburn University in May of 2012.

Most recently, Washington was an attending emergency medicine physi-cian at Methodist University Hospital in the Memphis Medical Center. He is a member of the Board of Directors of Methodist Extended Care Hospital, The Tennessee College of Emergency Physi-cians and Lamplighter Montessori School in Cordova, TN. He is a member of the Southern Medical Association and serves as a member of its Leadership and Pro-fessional Identity Committee, and is a member of the Family Life Committee and serves on the Advisory Board for St. George’s Independent School of Collier-ville, TN.

Adams graduated from Methodist Hospital School of Nursing in Memphis in 1984. She has worked in various clinical roles at Methodist and other hospital sys-tems including 16 years in the emergency department and a previous clinical servic-es director of an emergency department. She received her BSN from the University of North Alabama and is currently work-ing on a master’s degree in Nursing Ad-ministration at the University of Memphis.

ORTHOMEMPHIS Kicks Off Friday Night Football Clinic

ORTHOMEMPHIS, a division of MSK Group, P.C., has kicked off their Friday Night Football Clinic. This clinic is the only one of its kind and the destination for football players, cheerleaders, and band members across the Midsouth. Our Fellowship Trained Sports Medicine Or-thopaedic Surgeons began this clinic to provide injured athletes with the highest quality orthopaedic care on game night. The clinic will be open during football season every Friday Night ending on No-vember 8. The clinic allows athletes to be-gin their road to recovery and hopefully

return to their sport before the end of the season.

The Sports Medicine Outreach Pro-gram at ORTHOMEMPHIS provides hands-on assistance to lessen the possi-bility of athletic trauma by providing certi-fied athletic trainers (ATCs) and/or team physicians to our partners. Our partners include Christian Brothers High School (CBHS), Evangelical Christian School (ECS), St. George’s Independent School (SGIS), St. Agnes Academy (SAA), St. Dominic School (SDS), White Station High School, Collierville High School, East High School, Overton High School, Memphis Kickball League (MKL), Dynasty Women’s Football Team, and Greater Memphis Soccer Association (GMSA). These part-nerships will allow athletes to optimize their sports performance through injury prevention, treatment, and rehabilitation.

During Football Season, you will find ORTHOMEMPHIS Drs. Krahn, Weiss, Deneka, Giel, Brown, and Dowling along with ORTHOMEMPHIS certified athletic trainers, Marty Scruggs, David Dabbs, Hannah Koraly, John Michael Leppert, Reagan Drake, Todd Price, David Smith, and Jennifer Dorman on the sidelines tak-ing care of players.

tnREC Helps Medicaid Providers Achieve Meaningful Use

The Tennessee Regional Extension Center (tnREC), a division of Qsource, is offering health information technology adoption support services to Tennessee healthcare providers who participate in TennCare, Tennessee’s Medicaid pro-gram. Eligible providers will receive state subsidized support in achieving Mean-ingful Use of an electronic health record (EHR) and help qualifying for incentive funding of up to $63,750.

In the current healthcare environ-ment, providers are being asked to do more with less says Jennifer McAnally-Ride, tnREC Director. This can be particu-larly challenging for those who care for a significant number of Medicaid patients. tnREC uses its extensive expertise in health IT to help providers adopt technol-ogy that can improve their practices and make them eligible for financial incen-tives.

Healthcare providers who qualify for assistance and financial incentives from tnREC include physicians of any spe-cialty, dentists, certified nurse-midwives or nurse practitioners with a 30 percent TennCare patient volume. Physician as-sistants practicing at a federally qualified health center (FQHC) or rural health clin-ics (RHS) led by a physician assistant also qualify. Pediatricians with a 20 percent minimum TennCare volume are eligible as well.

In addition to assisting healthcare providers in adopting an EHR and achiev-ing Meaningful Use status, tnREC can help them securely exchange informa-tion with patients, hospitals, home health agencies, nursing homes and other set-tings.

Dr. Michael Washington

Donna Adams

Page 24: Memphis Medical news Oct 13

24 > OCTOBER 2013 m e m p h i s m e d i c a l n e w s . c o m

Eye Specialty Group is pleased to introduce our newest colleague, Dr. Anne Rowland, Aesthetic and Reconstructive Oculoplastic Surgeon.

Dr. Rowland joins us from California where she completed fellowship training in Oculofacial Plastics and Orbital Diseases. She received her undergraduate education at Dartmouth College and her medical degree from the University of Vermont College of Medicine. Dr. Rowland then called New Orleans home as she completed her residency in Ophthalmology at Louisiana State University.

Dr. Rowland is a leading expert in aesthetics, lasers, and cosmetic and reconstructive surgery. She also offers her own line of exclusive doctor-directed cosmetic facial products.

Areas of Focus Aging changes of the eyelids and face Allergic eyelid problems Blepharospasm/Hemifacial spasm Eyelid and facial skin lesions/cancers Thyroid eye disease Eyelid malpositions (ptosis, ectropion, entropion, lagophthalmos) Nasolacrimal duct obstruction

Orbital tumors Cosmetic surgeries (upper and lower blepharoplasty, brow lift, midface lift) Cosmetic injectables (Botox®, Juvéderm®, etc.)

825 Ridge Lake Blvd. 901.685.2200www.esg.md


UT Medical Group Adds Glaucoma Specialist

Dr. Brian M. Jerkins has joined UT Medical Group’s Department of Oph-thalmology Hamilton Eye Institute and been named assistant professor at the University of Tennessee Health Science Center.

Jerkins earned his medical degree and com-pleted ophthalmology residency at the UT Health Science Center College of Medicine, fol-lowed by fellowship training in glaucoma at Louisiana State University/Ochsner Clinic Foundation.

He cares for patients at the Hamilton Eye Institute.

UT Medical Group Adds High Risk Pregnancy Specialist

Dr. Mauro Schenone has joined UT Medical Group’s Department of Obstet-rics and Gynecology and been named assistant pro-fessor at the University of Tennessee Health Science Center.

Schenone earned his medical degree at the University of Carabobo in Venezuela and completed OB/GYN residency at Wayne State Uni-versity in Detroit. He furthered his training

with a fellowship in maternal-fetal medi-cine at the University of Tennessee Health Science Center College of Medicine. He has a special interest in preeclampsia, fetal therapy, and intrauterine growth re-striction.

He cares for patients at UT Medical Group’s Center for High Risk Pregnancies in the Memphis Medical Center.

Campbell Clinic Welcomes Three Physicians To Staff

Campbell Clinic has announced the hiring of three new medical doctors who began working at the 104-year-old or-thopaedic practice in August. Two of the physicians will primarily work from Camp-bell’s Southaven location, while the third will be based in Germantown.

Dr. Gregory D. Dabov rejoins the Campbell Clinic family af-ter one year of practice in Montana. Dabov, a knee, shoulder and total joint specialist, was previously employed by Campbell Clinic from 2000-12, and he will practice in South-aven. A Board Certified surgeon, the California native attained his degree in medicine from The University of Tennes-see-Memphis, where he also completed an orthopaedic residency and internship with Campbell Clinic. Dabov also served as an assistant professor of orthopaedic

surgery with The University of Tennessee-Campbell Clinic program during his pre-vious tenure. He is a member of several national and local professional organiza-tions, including the American Academy of Orthopaedic Surgeons.

Dr. Douglas T. Cannon is a fellow-ship-trained physical medicine and re-habilitation physician who joins the clinic after serv-ing for 13 years at the Pain and Spine Medicine Cen-ter of the Central Coast in Templeton, CA. Can-non is a 1993 graduate of the Washington Univer-sity School of Medicine in St. Louis, and he completed his residency in physical medicine and rehabilitation at the North-western University Medical School’s Re-habilitation Institute in Chicago. Like Dr. Dabov, he will practice in Southaven. He is certified by the American Board of Physical Medicine and Rehabilitation.

Dr. Benjamin J. Grear, a foot and ankle specialist, begins with Campbell Clinic after completing a fellowship in Foot Surgery at Baylor University Medi-cal Center. He earned his Doctor of Medicine in 2007 from The University of Tennessee-Memphis. He completed his residency in orthopaedic surgery with Campbell Clinic

in 2012, where he was elected Chief Resi-dent. During his previous time in Mem-phis, he served as a volunteer physician with The University of Memphis, Rhodes College, the Memphis Redbirds and area high schools. He is a member of the American Medical Association and Ten-nessee Orthopaedic Society. He will prac-tice primarily at the company’s clinic on S. Germantown Road.

Methodist North Hospital welcomes new chief executive officer

Gyasi Chisley was recently named chief executive officer at Methodist North Hospital.

Prior to joining Meth-odist North, he was the president and site admin-istrator at Mercy Health, Anderson Hospital in Cin-cinnati, Ohio. In that role he was responsible for all business, financial, HR, nursing and op-erations transactions. Additionally, he was the corporate service line executive for orthopedics, facilities and food & dietary.

Chisley earned dual bachelor’s de-grees in psychology and biology from Morehouse College in Atlanta, Georgia and a master’s degree in health services/business administration from the Univer-sity of Michigan in Ann Arbor, Michigan.

Dr. Brian M. Jerkins

Dr. Mauro Schenone

Dr. Gregory D. Dabov

Dr. Douglas T. Cannon

Dr. Benjamin J. Grear

Gyasi Chisley

Page 25: Memphis Medical news Oct 13

m e m p h i s m e d i c a l n e w s . c o m OCTOBER 2013 > 25


UTHSC and Methodist Hospice Respond to Growing Need for Hospice and Palliative Care Physicians

A pivotal study “America’s Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation’s Hospitals” conducted by the Center to Advance Palliative Care and the National Palliative Care Research Cen-ter demonstrated that about 90 million Americans are currently living with a se-rious, life-threatening illness. The study’s authors project this group will more than double over the next 25 years as the num-ber of aging baby boomers increases.

Foreseeing a serious gap in health care, the University of Tennessee Health Science Center and Methodist Hospice and Palliative Care have worked together to make the Hospice and Palliative Care Fellowship Program at UTHSC an creden-tialed program through the Accreditation Council for Graduate Medical Education (ACGME).

Physicians who complete the Hos-pice and Palliative Care Fellowship Pro-gram at UTHSC will be eligible to take the exams to become board certified in Hos-pice and Palliative Care as a sub-specialty.

W. Clay Jackson, M.D., DipTh, medi-cal director for Methodist and Palliative Care, says that ACGME accreditation has allowed the Hospice and Palliative Care Fellowship Program to expand so that more adult and pediatric specialists will be trained in the field of hospice and palliative care. The UTHSC program can now train a total of four Hospice and Pal-liative Care Fellows – two adult and two pediatric.

Hospice and palliative care is a grow-ing field. Just 10 years ago there were vir-tually no palliative care programs in any of our country’s hospitals. Today, 63 percent of hospitals with 50 or more beds provide a palliative care team.

Deena Levine, M.D., a quality of life and palliative care physician with St. Jude Children’s Research Hospital and the first graduate of the accredited program, says the Hospice and Palliative Care Fellow-ship Program offered by UTHSC is help-ing her achieve her career goals.

After completing her fellowship, Dr. Levine will work at St. Jude as a qual-ity of life and neuro-oncology physician. She says there are only a handful of other universities in the country that offer a pe-diatric fellowship program in hospice and palliative care.

St. Jude Children’s Research Hospital CEO announces retirement

St. Jude Children’s Research Hospi-tal has announced that its director and CEO, Dr. Wil-liam E. Evans, has decided to retire from his executive post in July of 2014. Evans has been with the organi-zation for more than 40 years and has served as

CEO for the past 10 years.An expert in pharmacogenomics, Ev-

ans came to St. Jude as a student in 1972.The St. Jude Board of Governors will

conduct an international search to select Evans’ successor, and the process will in-clude potential internal and external can-didates. While Evans is expected to leave the CEO position next summer, he has agreed to serve until his successor is on board.

During Evans’ service as CEO, St. Jude announced the best worldwide cure rate for the most common form of child-

hood cancer, acute lymphoblastic leuke-mia. St. Jude also was the first to remove cranial radiation from standard treatment of this disease, reducing harmful long-term health risks.

The largest-ever investment in whole-genome sequencing of childhood cancers was launched by St. Jude under Evans’ leadership. This initiative has pro-duced significant research advances in aggressive childhood leukemias, brain tumors and common solid tumors in children. All of the resulting genome se-quence data is made available for free

access by the global scientific community.St. Jude has been a consistent pres-

ence on the Fortune Magazine list of the annual “100 Best Companies to Work For,” as well as the top 10 “Best Places to Work in Academia” as ranked by The Scientist magazine.

Evans’ expertise in developing indi-vidualized approaches to childhood can-cer treatment will continue to benefit St. Jude. He will continue to lead his research laboratory at St. Jude after his retirement from the CEO position.

Dr. William E. Evans

Page 26: Memphis Medical news Oct 13

26 > OCTOBER 2013 m e m p h i s m e d i c a l n e w s . c o m

Memphis Medical News is published monthly by Medical News, Inc., a wholly-owned subsidiary of SouthComm, Inc. ©2013 Medical News Communications. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Medical News will assume no responsibilities for unsolicited materials. All letters sent to Medical News will be considered Medical News property and therefore unconditionally assigned to Medical News for publication and copyright purposes.

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GrandRoundsDr. Wise Named President of ASMF

Merrill S. Wise, M.D., a neurologist and sleep medicine specialist with Mid-South Pulmonary Special-ists, P.C. and the Method-ist Healthcare Sleep Dis-orders Center, has been elected to a three year term as President of the American Sleep Medicine Foundation (ASMF).

The Methodist Sleep Center is one of the largest and most active accredited sleep centers in the country. Its medical staff provides evaluation and manage-ment of the full range of sleep disorders in children and adults.

The ASMF is the leading foundation promoting sleep research and education. Its mission is to enhance sleep health for all through research, education and hu-manitarian projects.

Methodist Le Bonheur Healthcare, UTHSC and UT Medical Group Create UT Methodist Physicians

Methodist Le Bonheur Healthcare (MLH) has partnered with UT Medical Group, Inc. (UTMG) and the University of Tennessee Health Science Center (UTH-SC) to create a new academic physician practice group that will enhance the de-livery of specialty care and hospital-based medical services in the Memphis area.

The new group, called UT Methodist Phy-sicians (UTMP), launched in September and includes UTMG physicians who have a strong history of affiliation with Method-ist.

UTMP specialties include urology, surgical oncology, and most adult medi-cine specialties, such as internal medi-cine, pulmonology and endocrinology. As of Aug. 30, 53 UTMG physicians in those areas and 80 supporting staff mem-bers joined UTMP and became MLH as-sociates. Most physicians joining UTMP will continue to care for patients at their current UTMG locations. UTMP will also include other physicians from the Mem-phis area. Initially, seven doctors from other practices will join the group, with more to be added in the coming months.

The UTMP collaboration is similar to the successful formation in 2011 of UT Le Bonheur Pediatric Specialists (ULPS) by UTMG, MLH, and UTHSC. The creation of that group strengthened the pediatric practices at Le Bonheur Children’s Hospi-tal, supported recruitment of additional outstanding sub-specialists, and helped it achieve national recognition.

Chris Jenkins will serve as adminis-trative director for UT Methodist Physi-cians. He was previously an administrator at Methodist University Hospital. Jessica Harrison, formerly clinic administrator at UT Medical Group, will be UTMP’s direc-tor of operations.

UT Medical Group Expands Dermatology Staff

Dr. Emily Jones has joined UT Medi-cal Group’s department of dermatology and been named assistant professor at the University of Tennessee Health Sci-ence Center.

Jones earned her medical degree and com-pleted dermatology resi-dency at the UT Health Sci-ence Center. She is board certified by the American Board of Dermatology. Jones cares for both children and adults at UT Medical Group’s dermatology office at 930 Madison Avenue in the Memphis Medical Center.

Two Physicians at Women’s Health Specialists Achieve New Board Certification

Robert L. Summitt, Jr., MD and Val Y. Vogt, MD of Women’s Health Specialists are the first urogynecolo-gists in the Mid-South to be Board Certified in Fe-male Pelvic Medicine and Reconstructive Surgery. Summitt and Vogt are two of the founding partners of the private practice OB/GYN group in German-town.

Summitt focuses on urogynecology, recon-structive pelvic surgery, and primary care of wom-en. Vogt focuses on uro-gynecology, reconstructive pelvic surgery, and primary care of women.

Dr. Merrill S. Wise

Dr. Emily Jones

Dr. Robert L. Summitt, Jr.

Dr. Val Y. Vogt

Page 27: Memphis Medical news Oct 13

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Medical Protective internal data 2002-2011. Product availability varies based upon business and regulatory approval and differs between companies. All products administered and underwritten by Medical Protective or its affiliates. Visit medpro.com/affiliates for more information. ©2013 The Medical Protective Company.® All Rights Reserved.

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Page 28: Memphis Medical news Oct 13

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