Physician Self-Care Physician Heal Thyself… and in the Process Improve Patient Health the Depressed Physician the Importance of Spiritual Health Burned…?

winter 2015

Physician Self-Care Physician Heal Thyself… And in the Process Improve Patient Health The Depressed Physician The Importance of Spiritual Health Burned…?

Also… • Welcome to MAFP’s New President: Kisha N. Davis, M.D. • Dr. Linda Walsh Receives 2014 AAFP Humanitarian Award • Health is Primary: Family Medicine for America’s Health • Don’t Miss Special February Events – Advocacy, MC-FP, CME!

This Edition Approved for 2 CME Credits. Complete and Return Journal CME Quiz at www.mdafp.org. The Maryland familydoctor / winter 2015 • 1 2 • The Maryland familydoctor / winter 2015 THE MARYLAND familydoctor Winter 2015 Volume 51, Number 3 contents

FEATURES

Physician Heal Thyself…And in the Process Improve Patient Health 8 by Kathryn A. Boling, M.D.

The Depressed Physician 11 by Ansu M. Punnoose, D.O.

The Importance of Spiritual Health 13 by Matthew Loftus, M.D.

Burned…? 15 by Samyra Sealy, M.D.

Welcome to MAFP’s New President: Kisha N. Davis, M.D. 16 by Jocelyn M. Hines, M.D.

Dr. Linda Walsh Receives 2014 AAFP Humanitarian Award 18 by Katherine J. Jacobson, M.D.

Health is Primary: Family Medicine for America’s Health Mission Statement 20 by Patricia A. Czapp, M.D. To support and promote Maryland family physicians in order to improve the health of Don’t Miss Special February Events – our State’s patients, families and communities. 22 Advocacy, MC-FP, CME! departments

5 President 25 Residency Corner Strengthening Family Medicine in Maryland – Together! Happenings at the University of Maryland by Kisha N. Davis, M.D. and Franklin Square Medical Center Family Medicine Residencies 14 Calendar 27 Membership 15 CME Quiz Page

The Maryland familydoctor / winter 2015 • 3 President Western Kisha N. Davis, M.D. [email protected] Niharika Khanna, M.D. [email protected] President-Elect Central Patricia A. Czapp, M.D. [email protected] Mozella Williams, M.D. [email protected] Treasurer At Large

2014-2015/2016 Nancy B. Barr, M.D. [email protected] Ramona G. Seidel, M.D.* [email protected] Kevin P. Carter, M.D. [email protected] Secretary Shana O. Ntiri, M.D. [email protected] Matthew A. Hahn, M.D.* [email protected] Marc E. Wilson, M.D. [email protected] Vice presidents AAFP Delegates Central Adebowale G. Prest, M.D. [email protected] Jocelyn M. Hines, M.D. [email protected] Yvette L. Rooks, M.D. [email protected] Eastern AAFP Alt. delegates Kim Herman, M.D. [email protected] Eugene J. Newmier, D.O. [email protected] Southern Yvette Oquendo-Berruz, M.D. [email protected] Trang M. Pham, M.D. [email protected] Immediate past president Western Yvette Oquendo-Berruz, M.D. [email protected] Kristin M. Clark, M.D. [email protected] Resident Director Directors Richard A. Bruno, M.D. (R2, FSq) [email protected]

officers & directors & officers Eastern Jennifer A. Hollywood, M.D. [email protected] Student director Southern Sarah Britz (UM-4) [email protected] F. George Leon, M.D. [email protected] *Member of Executive Committee

Executive Committee of Board of Directors Donald Richter, M.D. (PCMH) [email protected] Kisha N. Davis, M.D. , President [email protected] Vivienne A. Rose, M.D. (obesity) [email protected] Patricia A. Czapp, M.D., President-Elect [email protected] Casey Rice Scott, M.D. (immunizations) [email protected] Ramona G. Seidel, M.D., Treasurer [email protected] Tobie-Lynn Smith, M.D. (underserved) [email protected] Matthew A. Hahn, M.D., Secretary [email protected] Bernita C. Taylor, M.D. [email protected] Yvette Oquendo-Berruz, M.D., Imm. Pst Pres. [email protected] Commission on Legislation & Economic Affairs Commission on Membership and Member Services Vice President Southern District Vice President Central District Trang M. Pham, M.D. [email protected] Jocelyn M. Hines, M.D. [email protected] Governmental Advocacy Committee Bylaws Committee Matthew T. Burke, M.D. ** [email protected] Yvette Oquendo-Berruz, M.D. ** [email protected] Neka Anyaogu, D.O. [email protected] Adebowale G. Prest, M.D. [email protected] Meenakishi G. Brewster, M.D. [email protected] Kevin P. Carter, M.D. [email protected] Finance Committee Patricia Czapp, M.D. [email protected] Ramona G. Seidel, M.D. ** [email protected] Kevin S. Ferentz, M.D. [email protected] Kristin Clark, M.D. [email protected] Robert S. Goodwin, M.D. [email protected] Patricia A. Czapp, M.D. [email protected] Kim R. Herman, M.D. [email protected] Kisha N. Davis, M.D. [email protected] Katherine J. Jacobson, M.D. [email protected] Kevin S. Ferentz, M.D. [email protected] William P. Jones, M.D. [email protected] Eugene J. Newmier, D.O. [email protected] Niharika Khanna, M.D. [email protected] Yvette Oquendo-Berruz, M.D. [email protected] F. George Leon, M.D. [email protected] Trang M. Pham, M.D. [email protected] Yvette Oquendo-Berruz, M.D. [email protected] Nominating Committee Naeha Quasba, M.D. [email protected] Yvette Oquendo-Berruz, M.D. ** [email protected] Donald Richter, M.D. [email protected] Richard Bruno, M.D. [email protected] Roxanne Richards, M.D. [email protected] commissons &commissons commmittees Matthew T. Burke, M.D. [email protected] Yvette L. Rooks, M.D. [email protected] Patricia Czapp, M.D. [email protected] Neil M. Siegel, M.D. [email protected] Kisha N. Davis, M.D. [email protected] Tobie-Lynn Smith, M.D. [email protected] Kevin S. Ferentz, M.D. [email protected] Elizabeth Wiley, M.D. (PGYI, UM) [email protected] Eugene J. Newmier, D.O. [email protected] Joseph W. Zebley, III, M.D. [email protected] Member Support Committee Commission on Education Yvette Oquendo-Berruz, M.D. [email protected] Vice President Eastern District Kisha N. Davis, M.D. [email protected] Kim R. Herman, M.D. [email protected] Eugene J. Newmier, D.O. [email protected] Education Committee RH = Rural Health Shana O. Ntiri, M.D. ** [email protected] Donald Richter, M.D.** [email protected] Neka Anyaogu, D.O. [email protected] Matthew A. Hahn, M.D. [email protected] Nancy Beth Barr, M.D. [email protected] Jennifer A. Hollywood, M.D. [email protected] Kristin M. Clark, M.D. (SAM) [email protected] F. George Leon, M.D. [email protected] Rebecca Johnson-Paben, MS III (JHU) [email protected] Andrea L. Mathias, M.D. [email protected] Heather M. Kearney, M.D. [email protected] Eugene J. Newmier, D.O. [email protected] Niharika Khanna, M.D. [email protected] Adebowale G. Prest, M.D. [email protected] Yvette Oquendo-Berruz, M.D. [email protected] Roxanne Richards, M.D. [email protected] Adebowale G. Prest, M.D. [email protected] SC = Special Constituency Vivienne A. Rose, M.D. [email protected] Matthew T. Burke, M.D. (New Phys) [email protected] Ramona G. Seidel, M.D. [email protected] Sarah Connor, M.D. (Women) [email protected] Netra Thakur, M.D. [email protected] Jocelyn M. Hines, M.D. (Minority) [email protected] Howard E. Wilson, M.D. (SAM) [email protected] F. George Leon, M.D. (IMG) [email protected] Marc E. Wilson, M.D. [email protected] Santhia A. Matthew, M.D. (GLBT) [email protected] Joseph W. Zebley, III, M.D. [email protected] Technology Committee Publications Committee Richard Kolodrubetz, M.D.** [email protected] MFD = MFD Editorial Board Kristin Clark, M.D. [email protected] Joyce Evans, M.D. ** [email protected] Matthew Hahn, M.D. [email protected] Kathryn A. Boling, M.D. [email protected] Jennifer A. Hollywood, M.D. [email protected] Matthew T. Burke, M.D. [email protected] Eugene J. Newmier, D.O. [email protected] Erkeda L. DeRouen, M.D. (R3, UMD) [email protected] Neil M. Siegel, M.D. [email protected] F. George Leon, M.D. [email protected] Commission on Health Care Services and Public Health Matthew Loftus, M.D. [email protected] Vice President Western District David McClure, M.D. [email protected] Kristin M. Clark, M.D. [email protected] Ansu M. Punnoose, D.O. (R3, FSq) [email protected] Saif Usman, M.D. [email protected] Public Health Committee Joseph W. Zebley, III, M.D. [email protected] Niharika Khanna, M.D.** [email protected] EB = E-Bulletin Nancy Beth Barr, M.D. (CV/Stroke) [email protected] Joseph W. Zebley, III, M.D. ** [email protected] Kisha N. Davis, M.D. [email protected] Jocelyn M. Hines, M.D. [email protected] Judy B. Davidoff, M.D. (HIV, onc, w hlth) [email protected] Kisha N. Davis, M.D. [email protected] Lauren Gordon, M.D. (women’s hlth) [email protected] Eugene J. Newmier, D.O. [email protected] Amanda P. Guzman, M.D. (domestic violence) [email protected] Yvette Oquendo-Berruz, M.D. [email protected] Jocelyn M. Hines, M.D. (underserved) [email protected] Kenny Lin, M.D. (screeng tsts, lifestyle couns) [email protected] Public Relations Committee Christine A. Marino, M.D. (oncology) [email protected] Kevin S. Ferentz, M.D. ** [email protected] Ariana M. Martin, D.O. (minority/women’s hlth) [email protected] Kevin P. Carter, M.D. [email protected] Yvette Oquendo-Berruz, M.D. [email protected] Joseph W. Zebley, III, M.D. [email protected] James P. Richardson, M.D. (geriatrics) [email protected] **Chair

4 • The Maryland familydoctor / winter 2015 THE MARYLAND president familydoctor Winter 2015 Strengthening Family Medicine Volume 51, Number 3 in Maryland – Together! Editor-in-Chief Joyce Evans, M.D. the number of students matching in to Edition Editor our specialty has been increasing. There Kathryn A. Boling, M.D. is still a ways to go to meet this country’s Managing Editor primary care shortage, but we are reaching Esther Rae Barr, CAE the point where the number of slots for primary care won’t meet the need. The AAFP Editorial Board Kathryn A. Boling, M.D. is helping to start the conversation on GME Matthew T. Burke, M.D. reform to reexamine how this country Erkeda DeRouen, M.D. (R3 UM) thinks about assigning residency and fel- F. George Leon, M.D. lowship funding. The current system often Matthew Loftus, M.D. Kisha N. Davis, M.D. ties GME funding to large academic insti- David W. McClure, M.D. I am so excited to be serving as your tutions which are usually situated in major Ansu M. Punnoose, D.O. (R3, FSq) Saif Usman, M.D. new president of the Maryland Academy metropolitan areas. Studies have shown Joseph W. Zebley, III, M.D. of Family Physicians. I come to you after a that doctors tend to stay close to where year on the Board of Directors of the Amer- they train and as a result there are short- ican Academy of Family Physicians and I ages of primary care doctors especially hope to bring some of that knowledge to in rural areas. Maryland experiences this our Maryland chapter. with two medicine residency programs, There are many challenges that some- both located in Baltimore. I am excited times make it difficult to be a doctor but to learn about the opening of our new- pcipublishing.com there are many things on the horizon that est Family Medicine residency affiliated Created by Publishing Concepts, Inc. David Brown, President • [email protected] make me optimistic about the future of with Prince Georges Hospital. However, For Advertising info contact Family Medicine. The first is the Family our eastern and western colleagues are at Tom Kennedy • 1-800-561-4686 [email protected] Medicine for America’s Health campaign a loss. There are some bright spots with that was launched during the AAFP Assem- the University of Maryland’s rural health EDition 19 bly in October. This national campaign track. In addition Johns Hopkins School aims to put primary care in to the fore- of Medicine has a thriving Family Medi- Publisher front. All developed countries that have cine Interest Group despite not having a Maryland Academy of Family Physicians made primary care a priority have better department of Family Medicine. 5710 Executive Dr., Suite 104 health outcomes. This campaign seeks to Our chapter is doing great things. We Baltimore, MD 21228-1771 410-747-1980; 410-744-6059 Fax; reeducate patients, the government and had a significant presence at the AAFP Con- [email protected] providers on the importance of primary gress of Delegates where our own Dr. Linda care and serves to remind everyone that Walsh was recognized with the 2014 AAFP The Maryland Family Doctor is published four times annually and is the official publication of Health is Primary. Go to the website www. Humanitarian Award for her annual medi- the Maryland Academy of Family Physicians. healthisprimary.org to learn more informa- cal missions to the Dominican Republic The opinions expressed herein are those of the tion and stay tuned for more buzz starting (see p.18). Dr. Jos. Zebley, Chair of the AAFP writers and not an official expression of Academy policy. Likewise, publication of advertisements in January 2015. Delegation to the American Medical Asso- should not be viewed as endorsements of I recently returned from speaking at the ciation (AMA), shared his report and encour- those products and services by the publisher. California Family Medicine Summit for stu- aged family physicians to join and influence Readership: over 10,000. Copyright: All contents 2003 MAFP. All rights reserved. dents and residents. Their enthusiasm and the AMA. In addition, Maryland was high- Contributions and Deadlines passion for Family Medicine was encourag- lighted as our Senator Ben Cardin, MD Those interested in submitting articles for ing and inspiring. For the past few years continued on page 6 publication can view the Author’s Protocol Sheet by clicking on News and Publications at www. mdafp.org or contacting the headquarters office. Deadline schedule for submitting articles: May 15, August 15, November 15, February 15. The Maryland familydoctor / winter 2015 • 5 President (continued) addressed the crowd at the AAFP Political cacy in Annapolis. Be sure to save the date nization like the MAFP supporting us and Action Committee (PAC) Reception. Maybe (February 5, 2015) to come meet your state fighting for the issues that are important the most significant activity was our chapter legislators and help inform them about the to us. Secondly, I’d like to see the voice of leading a movement asking the AAFP to end issues that are important to our patients the family physician be even stronger in its alliance with the Coca-Cola Company. and our profession. Maryland and the MAFP is already start- While the measure did not pass, it was a val- Lastly I’m encouraged by all of you. ing to lead that charge. Being so close iant effort that was organized by our own Many of you have come to me and said to Washington, DC, we are uniquely able resident member of the Board Dr. Richard that you want to get involved. I hope you to help push forward issues important to Bruno who co-authored the resolution. meant it because I’m going to come call- Family Medicine both at home and nation- We have renewed energy and ability to ing. The Maryland chapter is on the move. ally. In order to achieve these goals we will advocate for Family Medicine at the state My goals over the next couple years are need your voices and your support. legislature with the addition of our lobby- first to increase member engagement and I hope you join us over the next year ist Eric Gally. Our 2014 Advocacy Day was connection to the MAFP Board and with with several opportunities to learn, net- so successful that our own Dr. Matt Burke each other. As family physicians we often work, and advocate (details on p.22). presented on it at the 2014 AAFP State work in isolation, striving every day to do February 5, 2015 – Legislative Conference in New Orleans this what is best for our patients. What is best Maryland State Legislature Advocacy Day past November. Participation in advocacy for our patients is to have a strong network February 21, 2015 – Winter Conference helps to make sure our voice is heard in of family physicians who can support each June 25-27, 2015 – Summer Conference Maryland and around the Nation. We are other. Even more, we as family physicians already well in to planning our 2015 Advo- need to know that there is a strong orga- Stay tuned and get involved! ■

6 • The Maryland familydoctor / winter 2015 8 DISEASES AND HEALTH PROBLEMS LINKED TO SMOKING

OUT 1 OF 3 LUNG CANCER DEATHS COULD BE KIDNEY PREVENTED SMOKING CAUSES CANCER —IN THE— PANCREAS LUNGS l TRACHEA BRONCHUS l ESOPHAGUS ORAL CAVITY l LIP NASOPHARYNX NASAL CAVITY l LARYNX STOMACH l BLADDER PANCREAS l KIDNEY LIVER BLADDER COLON LIVER l UTERINE CERVIX COLON AND RECTUM AND CAUSES LEUKEMIA The Health Consequences of Smoking can cause cancer Smoking — 50 Years of Progress: almost anywhere in the body. A Report of the Surgeon General, 2014

Double your patients’ chances of quitting tobacco! 1990Refer them to the FREE Maryland Tobacco1990 Quitline (1-800-784-8669). 1990 Twenty-six percentFAX refer of American patients and a Quit CoachR.J. Reynolds makes ends athe marketing first call.test targeting Congress makes domestic airline adults smoke. Visit smokingstopshere.comAfrican for more Americans information. in response to protests flights smokefree. 26% organized by Uptown Coalition. The Maryland familydoctor / winter 2015 • 7 editor

Physician Heal Thyself…And In The Process Improve Patient Health

independent, competitive, high-achieving got, the more they exercised. After age 61, a and neglectful of their own health needs.5 whopping 72% are exercising twice a week As a result, they are often noncompliant or more. Of the almost 300,000 surveyed, and over-controlling as patients, with little only 7% of female and 8% of male physi- trust in the medical system. Physicians tend cians did not exercise at all.9 to view illness as personal failure and many dread becoming patients. A 2001 study Nutrition published in the British Medical Journal A 2013 survey by Medscape found that revealed that general practitioners (GP) feel 62% of physicians who were normal or pressured to act as if they are well, even underweight reported eating a diet rich Kathryn A. Boling, M.D. when sick. That pressure stems from a fear in fruits and vegetables. The same sur- Beginning immediately with the onset that patients and colleagues will view the vey found that 44% of heavier doctors ate of medical school, the practice of medi- GP’s health as an indicator of his/her medi- higher carbs, more meat and fat, or “on the cine is all consuming. Risks to a physical competence.6 Given these risks, how go” meals. A mere 16% of overweight or cian’s health begin from day one and does physician health and lifestyle compare obese doctors were on a calorie-restricted include sleep deprivation, excessive work to that of the general population? diet meant to help them lose weight. demands, financial stressors (high loan Although about half of all doctors surveyed repayments, low residency salaries), fear of A Snapshot of Physician go out to eat once a week, only 15% of over- litigation, exposure to contagious illness, Health and Lifestyle weight and obese doctors eat fast foods. proximity to human trauma and suffer- Among normal weight physicians, 10% ing, and severe time limitations that cause Obesity admit to eating fast food. Nationwide, only deficits in nutrition, exercise and preven- The CDC statistics on U.S. health report 32.5 percent of U.S. adults consume the rec- tive health treatments. Surveys have con- that in 2008, 40% of all American men ommended amount of fruit and 26.3 the sistently documented that physicians work were overweight and 37% were obese.7 suggested number of vegetable servings.10 many hours, averaging 50-60 hours per Male physicians fared somewhat better week when not on call.1 Resident physi- here than the general population with 37% Vitamins and Supplements cians routinely work 80 hours a week. Fur- overweight and only 5.3% obese. For Amer- More than 60% of physicians forty-six thermore, female physicians – who in 2010 ican women, 28.6% were overweight and and older, and 50% of younger physicians, made up 46.1% of residents and fellows2 – 35% obese. Female physicians came down take a form of dietary supplement. The face greater challenges than do their male on the slimmer side as well with only 26% most common supplements consumed counterparts in finding balance between being overweight and a much lower 6.2% were multivitamin, vitamin D, calcium, work and family responsibility, resulting in classified as obese. 8 omega-3 fatty acids and antioxidants. increased family conflict and stress.3 Compounding the problem, those who Exercise Alcohol and Cigarettes enter the profession tend to have similar The CDC also reported on exercise hab- Approximately 18% of Americans still personality traits. At the American Medical its. In the general U.S. population about smoke.11 Physicians are much healthier Association/Canadian Medical Association 22% of adult men meet federal aerobic and when it comes to smoking. Only 2% of male (AMA/CMA) 2002 International Confer- muscle strengthening guidelines. Physi- physicians and 1.28% of female physicians ence on Physician Health, delegates heard cians engage in physical exercise more than smoke. American drinking habits as a whole repeatedly that the very traits that make the average American. Of all physicians sur- have stayed steady since the late 1930s with for good physicians make for bad patients.4 veyed under 30 years of age, 48% exercised 67% of adults reporting they drink alco- In general, physicians are more likely to be at least twice a week, and the older they hol. Male physicians report that they drink

8 • The Maryland familydoctor / winter 2015 Physician self-care, however, is much like than twice as likely as the general population to kill themselves.17 Put into perspective, the the safety instructions given on a plane: yearly number of physicians who kill them- first put the oxygen mask on yourself, then selves is equal to approximately two average size graduating classes of medical school assist others. Many studies are now looking students annually. Female physicians appear at the way that physicians’ personal health to be especially vulnerable. Suicide rates for women physicians are approximately four practices affect their patient populations. times that of women in the general population.18 The rates for male and female physi- more than the average person, with 73.4% Americans believe in some type of Univer- cians are roughly equal, whereas women in reporting that they drink alcohol – however sal Spirit or God.14 Similarly, a full 83% of the general population are much less likely a large percentage drink less than once physicians believe in God, with over 40% than men to complete suicide. a week. Female physicians are closer to actively practicing their faith. the national average with about 65% who Sleep report alcohol consumption – again, many Mental Health Physicians frequently are not getting drinking less than one drink a week.12 Physician depression is at least as com- enough sleep. Healthy adults typically mon as in the general population, affect- require 6 to 10 hours of sleep in a 24-hour Marriage and Relationships ing an estimated 12% of males and 18% of day. The average person needs just over Physicians are more likely to be mar- females. Medical students and residents 8 hours of sleep each night. Adults who ried than the general population. A 2011 screened for depression have even higher get fewer than 5 hours of sleep will show Pew research report found that only 51% rates: 15-30%. Depression in U.S physicians a decline in peak alertness. After only one of Americans were married. The Medscape has not been well studied, but a 2011 survey night of missed sleep, a significant cogni- Physician Lifestyle survey found that 85% of 50,000 practicing physicians and medical tive decline may occur. In fact, twenty-four of male physicians were married followed students in Australia demonstrated a dra- hours of wakefulness produces impairment closely by their female counterparts, at 71%. matically increased incidence of severe psy- equivalent to having a blood alcohol level Being married contributed greatly to physi- chological distress and a twofold increased of 0.1%. In addition to the cognitive and cian happiness. Physicians of both sexes incidence of suicidal ideation in physicians motor impairment seen in physicians with who were married reported higher levels compared with the general population.15 sleep deprivation, the emotional effects are of happiness then those who were single, Unfortunately, when depression exists, considerable. A partial list includes family divorced, or separated. But the picture is physicians face increased barriers to care: and marital discord, depression, cynicism, not all rosy. Physicians have a divorce rate both self-imposed and organizationally.16 lack of empathy for patients, and suicide.19 that is 10-20% above that of the national Over half of all doctors felt that their pro- average. According to a 1997 US study, psy- fessional reputation would suffer and they Medical Care and chiatrists have the highest rate at around would be seen as less competent if col- Treatment 50%; surgeons are next at 33%; the profes- leagues knew they were depressed. In addi- Physicians are notoriously bad patients. sion as a whole has a divorce rate of 29%. tion, Physicians are concerned about main- One-third of Australian residents do not The study also found an elevated divorce taining confidentiality, fear recrimination or have a primary care physician and an equal rate among female physicians and those discrimination by employers or colleagues, number of Irish physicians had not been to who married while still in medical school.13 and worry about the impact on obtaining see a physician (either their own primary and keeping a medical license. care physician or a walk-in clinic) in the past Spirituality The overall physician suicide rate cited 5 years.20 Multiple research studies across Physicians are remarkably homog- by most studies has been between 28 and several different countries including Eng- enous with the general population 40 per 100,000, compared with the overall land, Australia, and Hong Kong indicate regarding their spiritual lives and beliefs. rate in the general population of 12.3 per that a large proportion of doctors engage According to a 2008 Pew Report 88% of 100,000. Overall, then, physicians are more continued on page 10

The Maryland familydoctor / winter 2015 • 9 in self-treatment with a significant number sician, but they are likely to benefit the making healthy lifestyle choices. A survey of physicians admitted to self-prescribing patient population as well. Getting enough of 1,000 primary care physicians found that medications, a practice that is considered sleep, exercising, eating more fruits and those who exercised at least once a week unethical by all medical associations and vegetables, getting appropriate preventa- or didn’t smoke were about twice as likely has been prohibited by legislation in cer- tive medical care and treatment are all inte- to recommend five lifestyle changes to tain jurisdictions.21 Rates of compliance gral to good health. Setting appropriate patients with hypertension. Those changes: for screening tests such as blood pressure limits and pursuing meaningful life relation- eat a healthy diet, reduce salt intake, attain measurement, mammography, Pap smears, ships and activities outside of work are also or maintain a healthy weight, limit alcohol cholesterol checks, and prostate examina- important for physicians to have balance, use and exercise regularly tion varied from 60% to 85% among Cana- emotional support, and buffers against the Much of the research on physician health dian physicians. These studies indicate that stresses of medical practice. Thus, physi- behaviors is recent, but interest in the topic is not all physicians follow recommended cians themselves benefit most by incorpo- growing. Progressively more articles about screening practices.22 rating self-care into their routines. professional well-being, physician health Even so, the practice of medicine often behaviors, personal growth and life balance Alternative Therapy requires self-sacrifice, and many physicians can be found in the literature. As recent as More than 33% of physicians utilize are reluctant to put their own needs above 1996, An International Conference on Physi- alternative or complementary medicine the calling of their work. Physician self-care, cian Health was started as a joint effort of the for themselves. Back pain, joint pain, neck however, is much like the safety instruc- AMA and the Canadian Medical Association. pain and arthritis are the most common tions given on a plane: first put the oxygen Their conferences are held every 2 years and reasons physicians report receiving alterna- mask on yourself, then assist others. Many specifically address the unique health chal- tive medicine treatments. The most popu- studies are now looking at the way that lenges of physicians; the last conference was lar treatments: massage, acupuncture, and physicians’ personal health practices affect 2014, in London, England. chiropractic or osteopathic manipulation. their patient populations. Not surprisingly, As we move forward, individual physi- physicians can be role models for good cians must strive to find a balance between The Good News health and their own health practices influ- work responsibility and personal health. But Physicians as a whole avoid risky behav- ence patient counseling. physicians as individuals cannot do this alone. ior, have very low rates of smoking, rarely Physicians who practice healthy behav- There needs to be a culture shift in medicine drink, exercise more and more as they age, iors have more confidence and are more - institutional commitment to examine the have lower incidence of obesity and thus willing to counsel patients about those barriers to physician well-being and a sys- lack many of the obesity-related chronic ill- healthy behaviors. For example, one study temic change in the attitudes and expecta- nesses that are threatening to overwhelm revealed that doctors who exercise are tions that have defined the profession. ■ the country’s health-care system. more likely to counsel their patients to do the same, and that patients are more will- Dr. Boling, a former family nurse practi- The Bad News ing to try exercising when their doctors dis- tioner, graduated in June, 2014 from the Physicians are reluctant to admit to ill- close their own personal workout habits.23 Franklin Square Family Medicine Residency ness or submit to care from other physi- Another study conducted at the University in Baltimore. She practices at Lutherville cians (many self-treat). They have higher of British Columbia and subsequently pub- Personal Physicians, one of Mercy Medical divorce rate, higher suicide rates, and get lished in the Canadian Medicine Association Centers’ community practice sites. New less sleep than what is considered healthy. Journal revealed that patients were more member of the MAFP Editorial Board, she likely to follow a recommended vaccination edits this, her first edition of The Maryland Physician Health practice that their own doctor follows, com- Family Doctor. Practices: Who benefits pared to those who don’t. The Fall 2010 issue of Preventive Cardiology concluded Note: References for this article are posted First, it is important for physicians to that doctors who exercised regularly and at www.mdafp.org; Publications tab. CME practice what they preach. Healthy life- maintained a healthy weight were most questions for this article are posted at www. styles not only benefit the individual phy- comfortable talking with patients about mdafp.org; CME Quiz tab, Winter 2015.

10 • The Maryland familydoctor / winter 2015 The Depressed Physician four times more likely to commit suicide than females in the general population. Depressive Physicians’ health is disorders often start in earlier years, causing reduction in people’s functioning and is the as important as their second leading cause of disability worldwide. patients and they Depression in medical students and residents range from 15-30%, although only 22% of deserve the same those screened positive for depression use quality of care that mental health services. they provide others. Ansu Punnoose, D.O. Depression during Training Years Introduction Physicians thrive on a competitive Predictors of Depression Physicians have a long tradition of being nature, which starts early during their Physicians tend to minimize their own considered different from the rest of soci- medical school years. Prospective medi- health concerns and often fail to seek ety. They have an attitude of perfection- cal students and residents, competing for treatment. They tend to recommend their ism, which studies have shown, starts from hard to attain spots, are extremely unlikely patients a sick day without taking time off childhood, with the perfect child trying to to report a history of depression during the for themselves. Table 1 shows predictors become the perfect physician. Physicians interview process. Once they enter the field of depression in general practitioners, with refuse to believe that the illnesses that they of medicine, the stressors only increase. their relationships with doctors and patients come across on a daily basis could affect Long hours, frequent shifts in schedules, as the main stressor. While these stressors their own lives, giving truth to the phrase fear of error in decision-making and risking increased risk of depression, they did not “doctors make the worst patients.” Self-care patients’ lives, while learning to deal with increase suicide risk in physicians if there was among physicians is not a topic generally the sick and dying, being belittled by those no underlying psychological difficulty. In fact, discussed in professional practice. However, above them in the chain of command, and a psychological autopsy study conducted by for those physicians suffering from depres- being estranged from their family and sup- Hawton of doctors who committed suicide sion, self-neglect along with the stressors port network often contributes to their noted that mental illness and alcohol and/ of professional practice can take a heavy mental distress. A recent study in JAMA or drug abuse were the most common fac- toll. These physicians believe that they are noted that students who discussed their tors. According to Silverman, a workaholic supposed to be the strong ones who care mental health felt that their opinions were white male age > 50 or female age > 45, who for the sick, often forgetting that they are less respected, coping skills considered less is divorced, single or currently experienc- also human, requiring help and support. adequate and were viewed by faculty as ing marital disruption and suffering from unable to handle their responsibilities. depression, with history of substance abuse Burden of Depression problem or risk-taking behavior is most likely Table 1: Predictors in Depression Although the rate of depression among at high risk for suicide. Additional risk fac- in Physicians physicians is comparable to that of the gen- tors include history of chronic pain or illness, eral population, physicians’ rate of suicide is Difficult relationships with senior recent change in occupational or financial doctors, staff and/or patients markedly higher than any other profession. status, increased work demands, personal An estimated average of 400 physicians com- Lack of sleep losses, diminished autonomy and access to mit suicide each year and physicians are more Dealing with death lethal means such as medications or firearms. than twice as likely as the general popula- Making mistakes tion to kill themselves. Lifetime prevalence Barriers to Care Loneliness for self-reported clinical depression in physi- Depression in physicians may be under- 24-hour responsibility cians is rated as 12.5% in men and 19.5% in recognized due to the stigma that physi- women. In fact, female physicians are three to Self-criticism continued on page 12

The Maryland familydoctor / winter 2015 • 11 Depressed Physician (continued) Table 2: Risk of caring for “VIP” patients be aware of health programs that provide confidential treatment and assistance to Caregivers, family and the patient may deny the possiblity of alcohol and substance abuse physicians with mental illness and/or sub- Caregivers may avoid or poorly handle discussions of death and “do not resuscitate” orders stance abuse problems. The patient may suffer from emotional isolation when protected from the normal As witnessed in the recent death of hospital culture actor Robin Williams, depression can be a The patient’s feelings of shame and fear in the sick role can go uncomforted silent killer, veiled behind a smiling, con- Caregivers may overlook neuropsychiatric symptoms because they do not wish to “insult” fident, competent face. However as noted the patient by an intern in a recent article in the New Staff may neglect or poorly handle the patient’s toileting and hygiene York Times about doctors committing Ordinary clinical routine may be short-circuited suicide, “we masquerade as strong and untroubled professionals even in our dark- Caregivers may avoid discussing issues related to the patient’s sexuality est and most self-doubting moments.” In cians associate with the diagnosis. Physi- ing with other physicians, we should be able order to best understand and treat depres- cians’ mental health is given a low priority, to pay attention to colleagues who seem sion in their patients, physicians need to therefore it is inadequately treated due to troubled and look for warning signs. These first acknowledge and address depression reluctance in seeking treatment, causing signs could include change in behavior in themselves and seek help. them to self-diagnose and self-treat. For toward co-workers and patients, less inter- some, while there is shame in revealing est in people and activities, more isolated, Helpful Resources: one’s mental health status to a colleague change in appearance, physical deteriora- • American Foundation for Suicide due to fear of receiving “VIP treatment” tion, mood swings, longer work hours with Prevention (www.afsp.org) (see Table 2), for others it is the distrust of less efficiency, repetitive tardiness to work • Federation of State Physician Health other physicians and fear of being discrim- and alcohol or drug abuse. Programs (www.fsphp.org) inated by colleagues or licensing boards. It is time that physicians acknowledge • For physicians suffering with depression Because patient safety is in question, that they are human. Their health is as (www.black-bile.com) medical licensing boards and credential- important as their patients and they deserve • Personalized litigation stress support ing bodies can solicit information about the same quality of care that they provide for health professionals (www. serious mental illness that could affect a others. It is imperative that physicians stop mdmentor.com) physician’s ability to practice. Other barri- diagnosing and treating themselves. Self- • Struggling in Silence: Physician ers to care include lack of time, cost, fear care does not mean self-diagnosing. In Depression and Suicide (video for of documentation on academic records fact, in physicians whose thought process physicians) and possible affect on future prospects in is clouded with depression, self-treatment • Out of the Silence: Medical Student career opportunities. could result in more harm than good. They Depression and Suicide (video for need to make lifestyle changes such as exer- medical students) ■ Self-care for Depression cise, sleep, eat healthy, make regular doctor In recent years, physician wellness is visits, and go on vacations – essentially prac- Dr. Punnoose is a R-3 at the Franklin Square emerging as an area of interest. In 2002, the tice what they preach. In addition, for those Medical Center Family Medicine Residency American Foundation for Suicide Preven- who are suffering from depression, they in Baltimore. She joins the MAFP Editorial tion came up with a consensus statement need to consider using cognitive behavioral Board last year as a Resident Editor. See intended to encourage depression treat- therapy and practice relaxation training. her additional contribution to Residents ment and to shift professional attitudes and Physicians need to seek additional educa- Corner on p.25. policies to support doctors seeking help. tion and training that allows them to distin- Starting from medical schools, programs are guish the difference among stress, burnout, Note: References and resource websites for this being put into place where students could poor boundaries, poor coping mechanisms, article are posted at www.mdafp.org; Publica- speak confidentially without it reflecting on depression, risk of suicide, substance abuse tions tab. CME question for this article are posted their academic record. As physicians work- and substance dependence. They need to at www.mdafp.org; CME Quiz tab, Winter 2015.

12 • The Maryland familydoctor / winter 2015 The Importance of Spiritual Health CE), whose attributed oath captures the gated in order to address spiritual concerns relationship between God, a physician, and – although African-American patients and patients in its opening: “The eternal provi- patients of low socioeconomic status were dence has appointed me to watch over the more likely to say this at rates of 10-15% – life and health of Thy creatures. May the which still represents at least one or two love of my art actuate me at all times; may patients a day for most of us in office-based neither avarice nor miserliness, nor thirst practice. Thus, there is evidence that prayer for glory or for a great reputation engage with patients – like many other psychoso- my mind; for the enemies of truth and cial interventions – is appropriate when philanthropy could easily deceive me and judicious clinical reasoning is applied to Matthew Loftus, M.D. make me forgetful of my lofty aim of doing spiritual inquiry. The greatest mistake in the treatment of good to Thy children.”2 Spiritual practices often flourish best diseases is that there are physicians for the One of the most important aspects of in a religious community. The individu- body and physicians for the soul, although prayer for ourselves and for our patients is alistic approach to personal spirituality, the two cannot be separated. ~Plato that it helps us to center us – we recognize while quite popular today, does not reflect that our role as physicians plays out in the all of the health benefits that accompany Family physicians are well-known for larger context of life and that there are a the fellowship, encouragement, and sup- their appreciation and practice of a holistic great number of things beyond our control port that can be provided within a church, approach to the human body – that is, we affecting our patients’ health. Prayer is also synagogue, mosque, or other religious recognize that good health is dependent a weapon against whatever forces harm our body.5 Frequent attenders of religious on mind, body, and soul working together efficacy and integrity – Maimonides men- services are noted to have a decreased in the context of a community. Most phy- tions “miserliness” and “thirst for glory” overall mortality compared to infrequent sicians assent to these ideas, but evidence but one could just as easily add “people attenders; reasons that have been eluci- suggests that half of all primary care physi- pleasing” or “compassion fatigue” to his list! dated for this include increased rates of cians don’t address prayer or other spiritual When we pray, we are not only calling on smoking cessation and more stable mar- topics with patients and more than half of more resources to heal our patients – we riages.6 The demands of medical practice patients report that spiritual issues haven’t are acknowledging that our work is part on physicians are well-known to readers of been brought up in clinical encounters.1,2 of something bigger and we are humbling this journal; qualitative (though not quan- We have to study the biomedical model ourselves to shape that work into efforts titative) research suggests that religious of human health in order to become phy- that fit into that larger context. practice, especially in its communal forms, sicians, but we recognize that many of The question of prayer with patients helps to reduce burnout and sustain doc- the health outcomes are shaped by our is not always a simple one. Many patients tors through the stressful situations that patients’ cultural values, learned behaviors, would like to have their spiritual needs our work brings us. and beliefs – even (and sometimes espe- addressed directly by a provider or by a Participation in a religious community cially) their spiritual beliefs. Thus, the prac- consultant chaplain – though as one would is also a great way to address public health tices of engaging in spiritual disciplines and expect, they are more likely to want these issues and engage in community devel- participating in religious communities are issues addressed when more serious health opment work. There is robust evidence not only essential taking our own rhetoric issues are at hand. It is not just at death, that health programs within faith-based about holism and wellness seriously, but either – according to one study of several organizations are effective at improving they are also a means by which we can grow hundred outpatients at six different sites, 1 a variety of health outcomes, from self- in mutual understanding with our patients. in 5 patients would like to be prayed with identified knowledge and increased fruit/ One of the most prominent and instruc- during a routine office visit!3 This same vegetable consumption to blood pres- tive examples of physician spirituality study, however, found that less than 10% sure and weight.7 Most of these studies comes from Moses Maimonides (1138-1204 of patients would want clinical time abro- continued on page 14

The Maryland familydoctor / winter 2015 • 13 calendar Spiritual Health (continued) have been done within communities of low 2015 socioeconomic status, speaking to the cru- February 5 April 30-May 2 cial role that faith and communal spirituality MAFP Advocacy Day AAFP Annual Leadership Forum play within poorer places. My own experi- Physicians for Patients in Annapolis and National Conference of Special ence of living and worshiping in the disad- Westin Hotel Constituencies vantaged Sandtown-Winchester neighbor- Annapolis Sheraton Crowne Center Kansas City, MO hood of West Baltimore has brought me February 20 into contact with so many wise community SAM Group Study May 12-13 advocates and leaders who have taught me Care of the Vulnerable Elderly AAFP Family Medicine Congressional much about engaging and caring for people Sheraton Baltimore North Conference different from me. As inequality and self- Towson Washington, DC segregation by class has grown in America, maintaining our connections with others February 21 June 25-27 outside of our narrow social circles is all the MAFP Winter Regional Conference MAFP 2015 Annual CME Assembly more important – and worship services are Topics in Family Medicine: From Here Essential Evidence 2015 to There and In-Between! Clarion Resort Fontainebleau Hotel a great opportunity to fellowship, learn, and Sheraton Baltimore North Ocean City participate in community life. Towson Addressing the challenges of spiritual self-care requires discipline and reflection, but the benefits can affect nearly every area AAFP Scientific Assembly Schedule of our practice and life. Our training as fam- National Conferences of Family Medicine Residents and Medical Students: ily doctors has given us a framework for rec- 2015 July 30-Aug. 2, Kansas City (dates/location are tentative) ognizing spirituality as a vital component 2016 Aug. 3-6, Kansas City (dates/location are tentative) of health and it is only fitting that we apply Congress of Delegates (CoD) and Scientific Assembly (SA): this understanding to ourselves as we cen- 2015 Sept. 28-30 (CoD); Sept. 29-Oct. 3 (SA), Denver ter ourselves in the universe. We can use this 2016 Sept. 19-21 (CoD); Sept. 20-24 (SA), Orlando framework to challenge the temptations that Annual Leadership Forum (ALF) and National Conference of steal our joy, meet the needs of our patients Special Constituencies (NCSC): in times of great distress, and actively work 2015 April 30-May 2, Kansas City to root ourselves in communities that we can 2016 May 5-7, Kansas City give to and receive from. ■

Dr. Loftus graduated in June 2014 from the CME Author Disclosure Statements Franklin Square Family Medicine Residency in The authors of CME articles in this publication, except for any listed below, disclose that neither they Baltimore. He practices at a community health nor any member of their immediate families have a significant financial interest in or affiliation with center in Baltimore City and is currently raising any commercial supporter of this educational activity and/or with the manufacturers of commercial support to practice and teach at a maternity products and/or providers of any commercial services discussed in this educational material. and pediatrics hospital in South Sudan. He is MAFP receives no commercial support to offset costs in the production of The Maryland Family releasing a novel about health and community Doctor Publication. chapter-by-chapter; you can read it at http:// trousseausyndrome.wordpress.com/ Correction Fall edition, p. 8: The name of the 2003 MAFP Lifetime Achievement Award Winner is Rose Mary Hatem Bonsack, M.D. Note: References and resource websites for this article are posted at www.mdafp.org; Publications tab. Next Edition CME question for this article are posted at www. □ Focus on Difficult Patients mdafp.org; CME Quiz tab, Winter 2015.

14 • The Maryland familydoctor / winter 2015 Burned…? tional testing Mr. Xavier is diagnosed with and are more likely to treat patients as tumor in his chest that was pressing against objects or diagnoses. The number of doc- a nerve in his arm. Mr. Xavier reports that tors suffering from burnout is staggering. “The first doctor couldn’t be bothered by One study, performed by Tait Shanafelt, what I was trying to say.” M.D. and colleagues, found that almost half of the study participants reported Could the ER doctor have emotional exhaustion, feeling detached been suffering from from patients and work, or suffering from physician burnout? low sense of accomplishment. The high- To address this question lets first look at dif- est risk factor was being in a specialty that Samyra Sealy, M.D. ferent question…What is Physician Burnout? offered front line access to care including Mr. Xavier is a 45 year old store clerk who Burnout is a constellation of symp- Family Medicine, Emergency Medicine, awoke one morning with a tight pain in his toms characterized by a state of emotional, and Internal Medicine. right shoulder that traveled down his arm. mental, and physical exhaustion caused by What can be done to address physician He presented to the local ER because his excessive and prolonged stress. It occurs burnout is an ongoing debate. Strategies arm became so weak that he was not able when you are overwhelmed and unable to include reducing the stigma associated with to grip a glass at his job as a store clerk. The meet constant demands. Over time burnout asking for help for emotional problems, ER physician, a 37 year old male, diagnosed reduces productivity, saps your energy, and increasing awareness about physician burn- a pinched nerve after a 15 minute visit with leaves you feeling resentful, cynical, hope- out, providing education, and encouraging Mr. Xavier. He prescribed a muscle relaxant, less and helpless, and reduces your sense self care. These strategies must occur at a Ibuprofen, and a few tablets of a narcotic of personal accomplishment. Although we personal level and at an organizational level. pain medication. The patient was advised all have days when we are overloaded, over- Ultimately reducing physician burnout is to follow up with his primary care provider worked, and unappreciated, the difference good for the doctor, great for the patient, in the next 1-2 weeks. between stress and burnout is the ability to and essential for the health care system. ■ Two weeks later when Mr. Xavier finally recover in your time off. gets in to see his primary care provider he Doctors who are suffering from burnout Dr. Sealy is a Maryland Family Care Physi- is even more debilitated. After some addi- are more prone to errors, less empathetic, cian at Mercy Hospital in Baltimore. journal CME quiz

Obtain CME Credit via The Maryland Family Doctor Articles 1. Physician Heal Thyself.. And in the Process ONLINE COMPLETION AND SUBMISSION OF MAFP JOURNAL Improve Patient Health p. 8 CME QUIZZES AT WWW.MDAFP.ORG The process for completion and submission of MAFP Journal CME quizzes is fully automated. Read 2. The Depressed Physician p. 11 the CME articles in this edition (listed above) either from your mailed version or the online version. Each 3. The Importance of Spiritual Health p. 13 “live” version is posted online at the Publications and News tab. Access the quiz by clicking on the CME The Maryland Family Doctor has been reviewed and Quiz tab at www.mdafp.org. is acceptable for Prescribed credits by the American Once on the CME Quiz page (where quizzes for each “live” edition are posted), follow the directions. Upon sending, you will receive an immediate confirmation that your quiz has been received by MAFP. Academy of Family Physicians (AAFP). This Winter, 2015 The confirmation will list the edition and the amount of credits earned. edition (vol. 51, No. 3) is approved for 2 Prescribed Those unable to complete/send the quiz using the automated system can get a hard copy of the quiz by Credits. Credit may be claimed for two years from contacting the MAFP office. Once completed and returned to MAFP, the sender will be sent a confirmation the date of this edition (expiring July 31, 2016). AAFP by MAFP staff. Quiz answers for each edition are posted at www.mdafp.org; Publications and News tab. Prescribed Credit is accepted by the American Medical Readers are responsible for reporting credits directly to AAFP or other entities. Confirmation of quiz Association (AMA) as equivalent to AMA PRA Category 1 submission will suffice for verification. Credit toward the AMA Physicians Recognition Award. Questions? Contact the MAFP office via email to [email protected] or call 410-747-1980.

The Maryland familydoctor / winter 2015 • 15 Welcome to MAFP’s New President: Kisha N. Davis, M.D.

from 2000-2004. It quickly became clear HIV/AIDS orphanage. After medical school, to me, as well as to her colleagues, that she returned to Maryland to complete her she was a “superstar.” Dr. Davis is not only residency, serving as Chief Resident during an intelligent and compassionate clinician her final year. but a poised and diligent professional. We After completing residency, Dr. Davis have remained friends since those years in worked at the Columbia, MD location of training and I have had the opportunity to Chase Brexton Health Services where she get to know her wonderful family and to was able to fulfill her professional dreams witness her numerous personal and pro- of seeing patients from birth to death from fessional accomplishments. a broad range of ethnic and socioeconomic Jocelyn M. Hines, M.D. Kisha grew up in Gaithersburg, MD backgrounds. She was able to focus on work Dr. Kisha Davis is the 62nd president where she lived with her parents and 2 with the underserved populations, diabetes, of the MAFP and will be added to a long siblings. She got her Bachelor’s Degree women’s health and HIV. She later went on list of accomplished leaders and clinicians in Biological Anthropology and Anatomy to complete her Masters of Public Health who have helped guide the course of Fam- from Duke University and then completed at Johns Hopkins University where she was ily Medicine, both in Maryland and on the her Medical Doctorate at the University part of the Delta Omega Honor Society. Cur- national stage. Kisha and I met while com- of Connecticut. During medical school, rently, she lives in Gaithersburg with her pleting our Family Medicine Residency at she participated in numerous student run very supportive husband, Everett, a middle the University of Maryland Department of medical clinics, as well as a mission trip school principal, and their two young sons Family and Community Medicine program to Zimbabwe where she volunteered at a Spencer and Byron, ages 7 and 4.

AAFP President Dr. Robert Wergin installs Dr. Davis MAFP President on October 23, 2014 at MAFP’s Celebration of Maryland Members event during New MAFP President Davis with her family (l-r) parents Gerard & Rita Green, the 2014 AAFP Assembly in Washington, DC sons Byron and Spencer, husband Everett and sister Maya Green.

16 • The Maryland familydoctor / winter 2015 During 2011-2012, Dr. Davis had the In Dr. Davis’ Words… found a lot more ways to be active within prestigious honor of being 1 of 15 individ- Why become a family doctor? the Academy. uals selected to receive the White House I loved OB and didn’t want to give up Fellowship Award. The recipients are indi- men and old people. I love being able to What are some of the biggest viduals from various backgrounds with see people at all ages and all stages. I’m challenges and potential exceptionally high potential who spend one of those people who actually likes rewards currently for Maryland a year learning the governmental process answering those medical questions that family doctors? from the inside. The fundamental goals you get from your family during the holi- I think the biggest challenged is that with of the fellowship are to promote leader- days. It is one of the specialties where you all the change, doctors may not feel settled ship, education, and service. While it is dif- actually get to make a difference. You get with all the regulations of ACA, ACO, PCMH ficult to summarize the myriad of unique to be with people over the entire course etc. There are so many things diverting your experiences, as well as the educational of their lives. While it is not heart surgery, attention from patient care, including not and growth opportunities, she feels the when people think about [what doctor] knowing how and what we are going to be program enhanced her leadership skills has been there for them, they usually think paid. At the same time, there is excitement by helping her become a better advocate of their family doctor. because we get an opportunity to write the for both patients and family physicians (Dr. story. We get to be at the table and part of the Davis’ article “My Year as a White House What made you want to get conversation so that when things do settle, it Fellow” appears in the Winter 2013 edition involved with the MAFP? works out in the best interests of our patients of this publication). I got involved because Dr. Yvette and ourselves. It is easier for us, Maryland After completing her White House Fel- Rooks (MAFP President 2008-10), who doctors, to get to DC than others; I think we lowship she became the Medical Direc- was my residency director asked me to have more opportunity to take some time off tor and Director of Community Health at go to a meeting and I liked it. Initially, I to meet our officials. Maryland family doctors Casey Health where she currently works didn’t have a great ambition to be part of have had a positive relationship with the leg- with an integrative medicine team to pro- the MAFP. So now when I see people who islature and the previous Governor’s adminis- vide patient centered care. may want to get involved, or even those tration. That is reassuring. She has held multiple leadership posi- who don’t think they want to be involved, tions within MAFP, as well as within the I invite them. They might surprise them- What do you want to accomplish AAFP. Most recently she was elected by selves. Then Dr. Rooks asked me to go to as President of MAFP? her peers to be New Physician Director the National Conference of Special Con- Some of the few things I’d love to see on the AAFP Board. In that capacity, she stituencies as the Minority representa- include a Department of Family Medi- made sure the voice of new physicians tive. While there, someone asked me to cine at Johns Hopkins, or a presence at was heard as the academy conducted run for New Physician American Medical the state level where Family Medicine is business including: approval of AAFP pol- Association Representative… I did and turned to for answers. What would make icies and turning the issues and concerns I won. I ended up in positions I never me most proud would be to see more of of it members into reality. She had the would have imagined. I was present at the our members actively engaged in our honor of being on the Board when that AMA when they brought up the patient Academy by attending conferences, par- body approved funding for the Family centered medical home initiative. At the ticipating in Advocacy Day, or even joining Medicine for America’s Health Campaign. various conferences, I see a lot of people a committee. I hope that people can feel She would tell you that her primary getting excited about Family Medicine connected to the MAFP, and that they feel responsibility as a board member of the and looking to get connected. One life their practice and their patients are better MAFP and AAFP, is to advocate on behalf lesson has been to step up when asked; off because they are a member. ■ of family physicians and their patients. you never know where it will lead. At the With the completion of her service on conferences, I also enjoyed the opportu- Dr. Hines, MAFP Central District Vice Presi- the AAFP Board in October, 2014, she was nity to network and meet other people; dent, practices at University of Maryland installed by AAFP President Robert Wer- to get away from just practicing and see- Midtown, Department of Emergency Med- gin as MAFP President. ing patients. In attending conferences, I icine, Baltimore.

The Maryland familydoctor / winter 2015 • 17 Dr. Linda Walsh Receives 2014 AAFP Humanitarian Award

Since 2003, Dr. Walsh has lead medi- More directly addressing public health cal teams of physicians, PAs, nurses, EMTs, concerns, she has worked with community physical therapists, dental hygienists, medi- leaders to train community health work- cal students, and pharmacy students. Much ers. These workers go on to teach others of Dr. Walsh’s work has indeed been relief- concerning matters such as storage of oriented-- under her leadership thousands clean water to reduce incidence of para- of people have received relief in their suf- sites and decreasing salt intake to lower fering. Yet, however extraordinary that sur- blood pressure. face story might be, it pales in comparison Dr. Walsh’s work has spurred many oth- to the year-round work in America that Dr. ers to work to better the situations of oth- Katherine J. Jacobson, M.D. Walsh does for the communities she serves ers. Several individuals who served with Even as interest in foreign medical mis- in the Dominican Republic. her in the Dominican Republic trace their sions grows, there seems to be a growing Responding to the lack of education decisions to pursue careers in medicine awareness among healthcare providers available to the neediest children, Dr. Walsh to their time working alongside Dr. Walsh. that foreign medical mission work is itself established and now administers a child Within her own family, both of her daugh- plagued with pitfalls. Perhaps this makes sponsorship program. The children and ters chose to become physicians follow- it all the more noteworthy that there are young adults who receive sponsorships are ing their work in the Dominican Republic, individuals who are persevering, in the face becoming doctors, dentists, and community and her husband and son-in-law worked of the challenges, to provide long-term sus- leaders, working to change these commu- with Dominican partners to install a high- tainable growth in communities desperate nities from the inside. Similarly, Dr. Walsh is output water filtration system, providing for immediate relief. Many, including myself, helping to equip a trade school in a needy clean water to a community of several have had the privilege of learning how to community to teach computers, hairdress- thousand people. navigate this difficult terrain by the example ing, baking, and plumbing. She also coordi- When Dr. Walsh first saw the com- of Dr. Linda Walsh, who practices most of the nates support for teacher salaries and school munity of ‘Esperanza’, the name (which time in Jarrettsville, Maryland, but also a sig- breakfast and lunch programs for primary means ‘hope’) seemed sadly ironic. Now, nificant amount in the Dominican Republic. schools in two communities. more than a decade later, there seems to

Then AAFP President Dr. Reid Blackwelder presenting the 2014 AAFP Dr. Walsh with her family (l-r) son-in-law David Jacobson, daughter MAFP Member and Humanitarian Award to Dr. Walsh our author Dr. Kate Jacobson (holding Caleb), and husband Jeff Walsh

18 • The Maryland familydoctor / winter 2015 be more hope with each passing day. This have helped me truly understand that it is is certainly due in part to the medical relief more blessed to give than to receive.” ■ that has been provided, but the signs of hope are even more clear in the lives of Dr. Jacobson, current member of the MAFP those in whom Dr. Walsh and others have Foundation Board of Trustees, is a new phy- facilitated a holistic healing. This healing sician who has been an active MAFP leader provides opportunities for lasting, pro- during her student and resident years. She found community development. practices at the MedStar Franklin Square Dr. Walsh with medical student interview a young patient For this work, the American Academy Medical Center Department of Family Med- during her recent medical mission to the Dominican Republic of Family Physicians has honored Dr. Linda icine in Baltimore. She readily accepted this Walsh with the 2014 Humanitarian Award, assignment when asked to author an article which was presented to her in a special about her mother. ceremony during the AAFP Congress of Delegates in Washington, D.C. on October Note: Dr. Walsh will be a featured speaker for 22, 2014. the “Symposium on International Medicine,” “I appreciate all I have learned from the at MAFP’s Winter Regional Conference “Top- people of the Dominican Republic,” said ics in Family Medicine, From Here to There Dr. Walsh. “I have been forever changed by and In-Between” on February 21, 2015 at the the way I have been welcomed into their Sheraton Baltimore North in Towson, MD. Dr. Walsh and a patient outside her medical clinic in the DR. homes, schools, and churches…. They Details at www.mdafp.org and on p.23.

Johns Hopkins Johns Hopkins Community Physicians – one of the most trusted names in medicine – is growing! We are hiring family practitioners/primary care providers for our Baltimore, Community Physicians central Maryland, and greater Washington, D.C.-area outpatient locations. is the largest primary and specialty care health care organization in the area. We Enjoy practicing high-quality medicine while earning a competitive salary and the have nearly 40 practices throughout benefits as a Johns Hopkins Health System team member. Night call is less than once Maryland and the Washington, D.C. area per month with no inpatient or OB obligation. offering comprehensive health care for patients in all stages of life. We are Visit hopkinsmedicine.org/jhcp to learn more about Johns Hopkins Community affiliated with The Johns Hopkins Hospital, Physicians, our practices, and careers (click “Explore Career Opportunities”). Johns Hopkins Bayview Medical Center, Howard County General Hospital, Sibley Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants Memorial Hospital and Suburban Hospital. will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.

The Maryland familydoctor / winter 2015 • 19 Health is Primary: Family Medicine for America’s Health

lations. A per-member, per-month (PMPM) fee that is age- and risk-adjusted and nego- tiated with third party payers is one model of health care coverage. Another model is direct primary care, which takes the third party payer out of the equation and requires consumers to pay primary care physicians directly for their services, with or without a monthly membership fee. Who is a health care consumer? In the Patricia A. Czapp, M.D. commercial market place, health care con- New Orleans hosted the annual AAFP State is not surprising, some of AAFP’s core strat- sumers are both individuals and employ- Legislative Conference (SLC) this past Novem- egies are. For one, the AAFP is promoting ers. Despite an earlier image of “concierge ber. Four Maryland family physician leaders comprehensive primary care payment. care” being affordable only by wealthy indi- attended and enjoyed soaking up the Deep Comprehensive primary care payment is viduals, increasingly, direct primary care is an South ambience, rubbing elbows with col- a move away from traditional fee-for-service attractive option for the largest health care leagues from other states as well as nationally medicine. Proponents of comprehensive pri- consumers, employers and unions, as well as renowned experts in health care and politics. mary care payment maintain that “insurance” individuals and families who can only afford The conference took place shortly after should cover catastrophic care, hospitaliza- high-deductible insurance plans. Access two major events: 1) a national midterm tions, expensive testing/treatment, whereas to affordable primary care is appealing to election with the lowest voter turnout since payment for primary care should be admin- them, and they reward it, often dipping the 1940s, and 2) the AAFP Assembly in istered differently, because everybody needs into their health savings accounts or flexible Washington, DC. Both of those events fea- primary care services. Primary care done spending accounts. tured some surprising outcomes which were well means that preventive care is provided, Comprehensive primary care payment is discussed and examined at the SLC. health is promoted and chronic diseases are a departure from the 1990s era of capitation The national election resulted in a Repub- managed within a patient-centered medical when primary care physicians were the hired lican sweep, with the GOP notably winning home, longitudinally and comprehensively, in “gatekeepers” for payers. In the new model their largest share of state legislative seats an equitable fashion for an entire population. we are seen as trusted advisors, accessible in history and, federally, the largest House There are different models of compre- by phone, text, email or in person, telling majority since 1928. What does that mean hensive primary care payment that could patients what we will do for them instead of for health care? Continued challenges for the be promoted, depending upon state regu- what we won’t do for them. Affordable Care Act can be expected. A market that seeks value, however, doesn’t care whose party is in office. React- ing to current economic reality, the AAFP at its annual meeting this October launched “Health is Primary” and “Family Medicine For America’s Health.” The former is a PR campaign and the latter is a strategic mission. Both are designed to promote the value of a strong primary care workforce in achieving the Triple Aim: better care experience for individuals, improved population health, The Maryland Chapter was well represented at the 2014 AAFP State Legislative Conference (l-r) Drs. Matthew Burke, and controlled costs. Whereas the concept Pat Czapp, Jos. Zebley and Tobie-Lynn Smith.

20 • The Maryland familydoctor / winter 2015 The Delaware Breast Cancer Coalition Presents Beyond issues of payment and promotion of primary care in gen- THE 18TH ANNUAL BREAST CANCER UPDATE eral, “Health is Primary” and “Family Medicine for America’s Health” focus the on reducing health care disparities, improving access to care and ensuring thePresent, primary care workforce development. If we are to maintain a competitive theFuture edge in the market place, our train- of Breast Cancer ing and expertise must distinguish us from non-physicians so that we Wednesday, April 22, 2015 can prove our value sustainably. We must also embrace technology, but 8:00 a.m. – 2:00 p.m. not simply to report outdated pro- Dover Downs Hotel & Casino, 1131 North Dupont Highway, Ballrooms B/C, Dover, Delaware cess measures. Rather we must use it to improve access to care and deliver Featuring leading medical experts and speakers discussing the better health outcomes. Ultimately, most up-to-date information on breast cancer treatment and practice conditions must evolve away survivorship. The event is free and open to the public. from the model of primary care physi- Agenda and registration TM cian as data gatherer and scribe for the information coming soon at health care system and instead restore www.debreastcancer.org Wilmington Dover Lewes the joy of taking care of patients. Considerable brainpower, exper- Contact Telephone: 866-312-DBCC Website: www.debreastcancer.org tise and know-how have been gathered from around the nation to launch “Health is Primary” and “Family Medi- cine for America’s Health.” Six major areas will be addressed: practice, payment, workforce education and Family Medicine with Sentara Medical Group development, technology, research, and engagement. To learn more, visit Live On The Shores of the Atlantic in Virginia and North Carolina healthisprimary.org or fmahealth.org Sentara Medical Group brings together more than 650 providers to care for patients across Virginia and to offer your opinions and hear others. Northeastern North Carolina – a vibrant and temperate region of the Atlantic Ocean and Chesapeake Bay. If you would like to participate locally, We are a division of Sentara Healthcare, one of the most progressive and integrated health care organizations in the Nation employing over 25K. The region boasts exceptional well-planned community join our chapter’s governmental advo- living, breathtaking waterways, safe cities and endless entertainment. cacy committee. Our Advocacy Day, a visit with state legislators during Urgent Care, New Practice and Growth Outpatient Family Medicine Opportunities In Virginia… Virginia Beach, Gloucester, Suffolk, Yorktown, Newport News, Hampton and Williamsburg. Annual Assembly, will be February 5, In North Carolina… Elizabeth City. 2015. All are welcome and CME credits • Competitive Compensation and Benefits • Reduced Individual Risks are awarded. ■ • Administrative Support • Access to Innovative Tools and Technologies • Excellent Schools and Communities Dr. Czapp, MAFP President-Elect and member of the Government Advocacy Committee, writes this, her 5th con- Can you see yourself here? secutive report as a Maryland Chapter We do. Contact Us Today. delegate to the AAFP SLC. She is Chair Lisa Waterﬁeld at of Clinical Integration, Anne Arundel [email protected] or call 757.252.3025. Medical Center, Annapolis. www.sentara.com

EOE, M/F/D/V. Drug-Free Workplace

The Maryland familydoctor / winter 2015 • 21 Don’t Miss Special February Events Advocacy, MC-FP, CME!

2015 MAFP ADVOCACY DAY IN ANNAPOLIS MARYLAND FAMILY PHYSICIANS FOR PATIENTS THURSDAY, FEBRUARY 5, 2015 WESTIN HOTEL ANNAPOLIS, MD

Westin Hotel, Annapolis, MD

YOUR ACADEMY NEEDS YOU to provide solutions to legislators to benefit you and your patients: • Advocate for Family Medicine • Approved for 6 CME Credits • Meet with elected representatives to lobby for our patients NOTE: There is no fee to participate. Breakfast and lunch are included. Questions? Contact MAFP at [email protected] or 410-747-1980. Let us know if you will participate!

22 • The Maryland familydoctor / winter 2015 MAFP WINTER REGIONAL CME CONFERENCE TOPICS IN FAMILY MEDICINE: FROM HERE TO THERE AND IN-BETWEEN SATURDAY, FEBRUARY 21, 2015 SHERATON BALTIMORE NORTH HOTEL, TOWSON, MD APPROVED FOR 7.75 CME CREDITS! Shana O. Ntiri, M.D. Program Chair and Moderator

Pre-Conference SAM Study Hall Module: Care of the Vulnerable Elderly Friday, February 20, 2015 Pre-Registration is Mandatory at www.mdafp.org or call 410-747-1980 • meet part II requirement for ABFM MC-FP • go through the 60 core competency questions • 12 CME credits upon completion of the Clinical American Board Simulation of Family Medicine • dinner included

Conference Topics and Faculty

Amanda P. Guzman, M.D. John J. Strouse, M.D., PhD Robert J. Ancona, M.D. Ashok C. Jacob, M.D. Matthew T. Burke, M.D.

Eric Gally B. Wayne Blount, M.D., MPH Nancy Beth Barr, M.D. Y. Veronica Pei, M.D., Med, MPH Linda A. Walsh, M.D.

Family Violence Symposium & Panel Discussion Lunch and Learn: Turning our Attention to Amanda P. Guzman, M.D. Advocacy Member, DHMH IPV Advisory Council Matthew T. Burke, M.D. Tania Araya Eric Gally, Gally Public Affairs Mercy Family Violence Response Program Colleen Moore, SAFE Domestic Violence Program GBMC AAFP Chapter Lecture Series: Adolescent Immunizations, Barriers That Exist Sickle Cell Disease and Other Hemoglobinopathies B. Wayne Blount, M.D., MPH John J. Strouse, M.D., PhD Impact of Work/Occupation on Pregnancy Illnesses Our Grandparents Treated: None Gone, Nancy Beth Barr, M.D. Many Forgotten Robert J. Ancona, M.D. International Medicine Symposium & Panel Discussion Lupus, MS and Other Autoimmune Diseases Y. Veronica Pei, M.D., Med, MPH Ashok C. Jacob, M.D. Linda A. Walsh, M.D. CONFERENCE AND SAM DETAILS, REGISTRATION MATERIALS, HOTEL INFORMATION REGISTRATION OPTIONS AT WWW.MDAFP.ORG OR CONTACT 410-747-1980

The Maryland familydoctor / winter 2015 • 23 The Core Content Review of Family Medicine

Why Choose Core Content Review?

• CD and Online Versions available for under $250! • Cost Effective CME • For Family Physicians by Family Physicians • Print Subscription also available • Discount for AAFP members • Money back guarantee if you don’t pass the Board exam • Provides non-dues revenue for your State Chapter

North America’s most widely-recognized program for: • Family Medicine CME • ABFM Board Preparation • Self-Evaluation

• Visit www.CoreContent.com • Call 888-343-CORE (2673) • Email [email protected]

24 • The Maryland familydoctor / winter 2015 residency corner

Happenings at the FM Residency Programs Franklin Square Medical Center by Ansu Punnoose, D.O., R-3 Winter is here, which in their own communities through health As our interns adjust marks the midway point of fairs. As a member of the Maryland Breast- to residency life, the year and beginning of feeding Coalition, Dr. Punnoose has been em- our third years look transitions. As our interns phasizing the importance of breastfeeding adjust to residency life, our third years look education during prenatal period to patients, towards the light at towards the light at the end of the tunnel as providers and staff. Dr. Amanda Guzman, R3 the end of the tunnel they prepare their CVs for interviews for jobs continues to serve as the resident liaison for as they prepare their and fellowships. the DHMH Intimate Partner Violence Task We are excited to work with a number of Force and is preparing a curriculum to in- CVs for interviews for new faculty members who have joined the crease DV awareness within residents at the jobs and fellowships. Department, including Dr. Martha Johnson, Family Health Center. Dr. Kendal O’Hare, Dr. Uchenna Emeche, and Our FM/Preventive Med resident Dr. Rich- Drs. Dan Gold, Fatmatta Kuyateh, Ansu our recently graduated alumnus Dr. Sharon ard Bruno, R2 led a planning meeting for the Punnoose and Arifuz Zaman along with Chung. They have all stepped into various National Conference of Students and Resi- faculty members attended the 33rd Annual roles as preceptors, OB faculty and commu- dents in Kansas City, developing the theme FMEC Region Meeting held at the Crystal City nity health liaison, and have been a great and programming for the 2015 conference Marriott in Arlington, VA, where our team source of learning for our residents. in July. He also attended the Congress of Del- won the Best Residency Fair Group Costume As always, our residents have been keep- egates in DC, supporting the Maryland chap- for our recruitment booth, costumes and ing busy. Drs. Jay Chung, R2 and Crystal Per- ter’s resolution to end the alliance between the song on “Gridlock in Healthcare,” written for alta, R2 and the rest of the AMA-JHM BP Ini- AAFP and Coca Cola. His colleagues and he re- us by our recently graduated alumnus and tiative team flew to Chicago for the AMA-JHM served a booth at the exhibit hall and gathered editor of the Winter edition of the Maryland Blood Pressure Initiative meeting, where they hundreds of signatures from physician mem- Family Doctor, Dr. Kathryn Boling. provided an overview of the home BP moni- bers concerned with the Coca Cola alliance. Please stay tuned for more at the Med- toring pilot and shared success stories. Drs. They published an article on the Union of Con- Star Franklin Square Family Medicine Resi- Fatmatta Kuyateh, R3 and Ansu Punnoose, R3 cerned Scientists’ website and the DC journal dency…. and don’t forget to “like” us on have been involved in promoting health care Politico published a story about their efforts. FaceBook!

(l-r) Drs. Punnoose, Zaman, Kuyateh and Gold work the Franklin Square Faculty and Residents from Franklin Square entertain in costume at the Residency Booth at the October, 2014 FMEC Conference in Arlington, VA FMEC Conference

The Maryland familydoctor / winter 2015 • 25 Residency Corner (continued) University of Maryland by Erkeda DeRouen, M.D., R-3 Wedding Transgender Care was recently re-elected to serve on the World Announcement Mali Zuses, PGY-3, attended the inaugural Medical Association (WMA) Junior Doctors The UMD residents would Gender Conference East in Timonium Mary- Network Executive Board. Dr. Wiley assisted like to send a warm CON- land in November 2014, which focused on with the organization of a physician well-being GRATULATIONS to our very own, Dr. Jenni- the care of transgender patients. mini-conference at WMA General Assembly in fer Christie (PGY-2) who married her long- Durban, South Africa. She also co-authored a time love, Daniel Gourdin in Florida on World Medical Journal article entitled, “Junior November 15th. Doctors’ Work Hours: from regulations to reality. ” Kudos to this hard working resident!

Mali Zuses and her son, who is a little doc-in training, Bear Zuses. Physician Wellness The blushing bride with two residents, Elizabeth Wiley, PGY-2, has been diligently Erin Jones (PGY-2) and Cynthia Calixte (PGY-2). working to change the culture of medicine. She Liz Wiley is above (Likely planning something AWESOME!)

POSITIONS AVAILABLE IN: The Myrtle Beach area is a wonderful place to live with its FAMILY MEDICINE warm weather, beautiful wide sandy beaches, and laid back INTERNAL MEDICINE southern atmosphere. The area also offers diverse cultural and PEDIATRICS educational interests, entertainment venues, an array of restaurants, over 100 golf courses, excellent schools, and an Little River Medical Center, Inc., is a Federally impressive university influence. These are just a few of the Qualified Health Center (FQHC) with 6 sites and over reasons that make living and working here so great! 200 employees located in the Myrtle Beach, SC area.

LRMC Offers: Contact Rick Warlick, • Stable Professional Work Environment [email protected] or • Dedicated Leadership 843-343-6956 • FTCA Malpractice Insurance Coverage • Competitive Compensation And Benefits Package 4303 Live Oak Dr • Federal Student Loan Payment Program Little River, SC 29566-9138 • NHSC Scholars Program www.lrmcenter.com

26 • The Maryland familydoctor / winter 2015 members

News For and About MAFP Members Maryland Proud in DC! Just under 200 MAFP members from Maryland made the short trip complete rundown on happenings can be viewed at www.aafp.org over to Washington, D.C. to participate in AAFP’s 2014 Congress of Let us show you in photos, the many ways Maryland Chapter mem- Delegates (COD) and Scientific Assembly this past October 20-24. A bers made us proud in DC.

Incoming and Outgoing MAFP Presidents Drs. Kisha Davis MD Chapter representatives were front and center at the AAFP PAC Reception where Senator Ben (l) and Yvette Oquendo-Berruz with their likenesses at Cardin was special guest. MAFP’s Celebration of Maryland Members Event

Dr. Eugene Newmier makes a point at the COD Town Hall Meeting about “the difficulty of New AAFP Fellow Dr. Shana Ntiri accepting her award meeting quality measures… when patients don’t Spotted at The Party were MAFP Past Presidents from AAFP President Dr. Robert Wergin. take responsibility for their own health.” Drs. Howard Weeks (l) (1974) and J. Richard Lilly (1973)

Drs. Adebowale G. Prest (l) an Yvette Oquendo-Berruz represent MAFP members Celebrating MAFP were (l-r) Drs. Jocelyn Hines, Kindra Smith, Danielle Jean at the 2014 AAFP COD (holding her door prize) and Mozella Williams

The Maryland familydoctor / winter 2015 • 27 Members (continued) Congratulations for Special Appointments, Honors, Features, Achievements! Kisha N. Davis, M.D. of N. Potomac, Matthew Loftus, M.D. of Baltimore au- The following MAFP members were MAFP President, was keynote speaker at thored “Medicaid should cover hepatitis-C awarded the degree of Fellow of the Ameri- the California Academy of Family Physi- prescriptions by primary care docs,” an Op can Academy of Family Physicians at the cians Family Medicine Summit for Stu- Ed piece in the September 26, 2014 edition 2014 Fellowship Convocation in Washing- dents and Residents on November 1, 2014 of The Baltimore Sun (see Dr. Loftus’ article ton DC in October: in Los Angeles, CA. in this publication on p.13). John Michael Brooks, M.D. Matthew Thomas Burke, M.D. Louis Kovacs, M.D. of Baltimore was The following MAFP members were Michael W. Costello, M.D. featured in “Medicine & Science On The among 510 physicians named from 102 spe- Eugene J. Newmier, D.O. Move” in the October 26, 2014 edition of cialties named in the 2014 Top Docs edition Shana O. Ntiri, M.D., MPH The Baltimore Sun for having joined the Ar- (November 2014) of Baltimore Magazine: Mercy Obamogie, M.D. nold Palmer Sports Health Center at Med- Jason Black, M.D. Donald R. Richter, M.D. Star Union Memorial Hospital. Tracy Gutierrez, M.D. Ariel J. Warden-Jarrett, M.D. Joyce King, M.D. J. Richard Lilly, M.D. of Hyattsville, a James R. Richardson, M.D. MAFP Past-President (1973) was named “Best Yvette L. Rooks, M.D. Doctor in Washington for 2014” by Washing- Jacqueline Shepard-Lewis, M.D. tonian Magazine, March 2014 edition.

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ICD-10 Educational Series ICD-10 Flashcards • Developed by coding experts, this 11-module voice-guided • Created to help physicians, practice managers, PowerPoint series offers a comprehensive map to a coders, and those who work on office dictation easily smooth ICD-10 conversion. transition from ICD-9 to ICD-10.

ICD-10 ICD-10 ICD-9 Region ICD-9DESCRIPTION K59.00 ICD-9 A60.04 DESCRIPTION UNSPECIFIED 278.00 ICD-9RIGHT LEFT ICD-9 DESCRIPTION 843.9 Unspecified sprainsObesity, of unspecifiedK59.01 unspecifi314.00 A63.0 hip S73.109–DESCRIPTION 054.11 Herpetic vulvovaginitis ed Attention deficit disor681.00S73.101– S73.102– ICD-9 Strain of muscle,Other fascia, obesity andK59.02 tendon due314.01 to of ex the hip B37.3 DESCRIPTION ICD-9 Anogenital warts (condyloma acuminatum) 278.01 cessAttention calories deficitS76.019– disorderderS76.011– withoutw mentionS76.012– of 078.11 Strain of quadriceMorbidps muscle, (seveK59.09 fascia, and tendon A56.2 493.00 DESCRIPTION ICD-10 Constipation, unspecified re) obesity due to excessS76.119– c Cellulitis AAFPand abscess of finger ICD-9 S76.111– 564.00 Candidiasis of vulva and vagina Attention-deficit hyp S76.112– hyperactivityExtrinsic asthma, unspecified 112.1 Straint, adductor unspecified Drug-inducedmuscle, fascia, obesity and tendon A53.9 ith hyperactivity Acute493.10 lymphangitis of fingerE66.9 • Put the 823 top primary care Slow transit constipation 278.03 aloriesUse additional code (B95-B97) to 269.9 of thigh eractivity disorder, predominan Intrinsic asthma, unsp ICD-10 • Access the top 50 diagnosis 564.01 099.55 Chlamydial infection of genitourinary trac Morbid (severe) Attention-deficitS76.219–A59.03 hyperact S76.211– S76.212–493.90 E66.09 278.02 obesity with alveolar hyp681.10 280.0 NutritionalDESCRIPTIONRIGHT deficiency, unspecified Outlet dysfunction097.9 constipationSyphilis, Unspecified Strain of muscle,Overweight fascia, and tendon of Attention-deficitth hyp Unspecified asthma,E66.01 uncom F90.0 ICD-10 564.02 TIP Hip e A60.9 ivityCellulitis disorder, and predominantabscess of toetly inattentive type posterior muscle group at thigh level S76.319–oventilation ICD-9ecified280.8 Iron deficiency L03.011to anemia secondaryLEFT to ICD-10blood loss (chronic) Other constipation Trichomonal urethritis Other obesity (endocri Attention-deficit hyp eractivityS76.311– disorder, combinedS76.312– Mild intermittent ast 564.09 131.02 erse effects column of the Table of DrugsR19.7 N34.1 Acute lymphangitis of toe ly hyperactiveidentify typeinfectiousE66.1TIP agent when reporting codes L0 UNSPEC StrainV77.8 of other specified muscles,799.51 fascia,ne, endogenous) and 682.3 281.0 Other specifiedL03.021 iron deficiencyL03.012 anemias 054.10 Genital herpes, unspecified Screening for obesityK52.9Attention and conce eractivityCellulitis disorder, of axilla other ty Mild persistent asthma,E66.2 plicated F90.0 DESCRIPTION tendonsspecified at thigh level S76.819– type 266.2hma, uncomplicatedPernicious anemia (VitaminL03.022 B12 due to intrinsicL03.019 factor deficiency) 783.1 AcuteS76.811– lymphangitisS76.812– of axillaModerate persistent 099.40 Other nongonococcal urethritis, un TIP Abnormal weight gainA09 ntration deficit E66.3 F90.1 L03.029 For drug-induced constipation, see the adv 843.0 Iliofemoral ligament sprain of hip dition pe Referential281.9 Deficiency of other specified BFlash group vitamins (folate, Vitamin Cards B12) 783.21 Codes within categorS73.119– Cutaneous abscess ax uncomplicated ICD-10 and Chemicals. Loss of weight S73.111– 493.02S73.112–Severe persistent asE66.8 F90.2 843.1 Ischiocapsular783.22 (ligament) sprain of K59.1hip nce when 282.5asthma, uncomplicatedUnspecified L03.031deficiency anemia (nutritional) Educational Diarrhea Underweight iesS73.129– F90 throughCellulitisS73.121– of F98 upper m limb Extrinsic asthma S73.122– Z13.89 787.91 Use additional code for any associated843.8 Other resistance sprain of hip and nonresponsivenessK52.2 of a con 493.12TIP illa F90.8L03.041 L03.032 0-L08. S73.199–Acute lymphangitis of upper limb 282.61thma, uncomplicatedSickle cell trait diagnoses at your fingertips. Chronic diarrhea S73.191–493.92S73.192–Intrinsic asthma withR63.5 L03.039 558.9 to antimicrobial drugs (Z16.–)844.9 if the infectionUnspecified code sprain does of knee not identify drug resista Cutaneous abscess ayof upper be used limb regardless with282.62 (acute) Sickleexacerbation cell diseaseR41.840L03.111 without crisisL03.042 codes for family physicians. Code first obesit 682.4S83.90X– J45.909 S83.91X– Unspecified asthma withR63.4 Infectious diarrheareporting codes A00.0 through B99.9.Sprain of unspecifiedy collateralcomplicating ligament preg of TIP S83.92X– 517.3 L03.121 L03.112 L03.049 ICD-10 009.2 tis-Vulvovaginitis.(O99.21-) when knee 682.6 Cutaneous abscess of hand (includes finge (acute)of the Sickleexacerbationage ofcell a crisis patient. with acute chest syndrome Functional diarrhea S83.409– S83.401– S83.402–Mild intermittent asthmaR63.6 J45.20 See additional codes at Vagini844.1 SprainUse additional of medial collateral codereporting ligamen codes fromnancy, childbirthCellulitisN30.00 ofand lower th limb Top282.62 823 primaryL02.411 L03.122care Diagnoses E63.9 564.5 TIP t of K52.89knee S83.419– Allergic and dietetic595.0 gastroenteritisAcute cystitis and colitis categoryAcute E66.N30.01 lymphangitisS83.411–e ofpuerperium, lowerS83.412–Mild limb persistent if app asthma289.52 w (acute)Sickle exacerbationcell crisis L03.113with splenic sequestrationL02.412 J45.30 558.3 844.0 Sprainor sixth of characterlateral collateral for ligament adverse of knee effect, if D50.0 Series Acute cystitis withoutd allergy hematuria (Z91.01-Z91.02). 5) when reportingA08.4 c S83.429– S83.421– 282.62licable, L03.123 L03.114 J45.40 with (acute) exacerbation 844.2 UseSprain additional of unspecified cod cruciate ligament of knee682.7 applicable,Cutaneous to abscess ide of lowerModerateS83.422– limb persistent asthmars) w D50.8 Knee cified Acute cystitis with hematuriacategory E66. e to identify body ode E66.1.S83.509–Cutaneous abscessS83.501–ntify of foot drugS83.502– (includes (T36-T50 to 284.19 wit Sickle cell crisis, unspecifiedL02.413 L03.124 J45.50 844.8 Sprain of anterior ligament of knee 682.0 N30.10493.01 Severe persistent as ith (acute) exacerbation D51.0 Use additional code to identify type of foo mass indexS83.519–Cellulitis (BMI), of face i h fifth L02.511 L02.414 595.1 Chronic interstitial cystitis V85.21 K58.0 N30.11S83.511–ExtrinsicS83.512– ast 285.1 Other pancytopenia Noninfective gastroenteritis and colitis, other844.2 speSprain ofBMI posterior 25.0-25.9, cruciate adult ligament of knee 493.11f known (Z68.-) when re ith (acute) exacerbation E53.8 558.9 S83.529–Acute lymphangitisS83.521– of face thma Acutewith (acute) posthemorrhagic exacerbatL03.115 anemia (acuteL02.512 blood loss) Interstitial cystitis (chronic)844.3 V85.22 without hematuriauria K58.9 IntrinsicS83.522– asthmahma with285.21 with status asthmaticus D53.9 Viral enteritis, not otherwise specified Sprain ofBMI superior 26.0-26.9, tibiofibular adul joint and ligament 493.91 es) porting L03.125 L03.116 L02.519 Interstitial cystitis (chronic) with hemat 682.1 CutaneousS83.60X– abscessS83.61X– of face 285.22 Anemia in chronic kidney disease 008.8 844.8 V85.23Sprain of otherTIP specified partst of K57.30 Asthma,S83.62X– unsp J45.901 D57.3 Irritable bowel syndrome BMI 27.0-27.9, adult knee CellulitisS83.8X9– of neck L02.415 L03.126 564.1 V85.24 reporting codes fromS83.8X1– S83.8X2–285.29 statusAnemia asthmaticus in neoplastic diseaseion J45.21 845.09 Strain ofBMI Achilles 28.0-28.9, tendonr bleeding a K57.32Acute lymphangitis of neckMild intermittentecified asthma type, w Z68.25with status asthmaticusL02.611 L02.416 D57.1 Irritable bowel syndrome with diarrhea identify infectious agent (B95-B97) when S86.019– S86.011– • Reach for this manageable V85.25Strain of muscle(s) and tendon(s)dult of anteri N34.1 S86.012– Anemia of other chronic disease L02.612 J45.31 Use additional code to BMI 29.0-29.9, a K57.10Cutaneous abscess of Mildneck persistent asthma with statusZ68.26 asthmaticus • Gain in-depth knowledge of Irritable bowel syndrome without diarrhea 682.2or Code first neoplasm (C00-D49) when reporting code D63.0 D57.01 V85.30muscle group at lower legdult level S86.219– L02.619 category N30. ration,BMI abscess, 30.0-30.9, or bleeding adult K57.12Cellulitis of trunk N34.2S86.211–Moderate persistentS86.212– asthm ithZ68.27 status asthmaticus J45.41 Diverticulosis of largeUrethritis, intestine unspecified without perforation,Strain of abscess, other muscle(s) o and tendon(s) at ASTHMA Code first underlying chronic kidney disease (CKD) (N18.-)L03.211 when reporting code D63.1 562.10 597.80 V85.31ation,BMI abscess, 31.0-31.9, or adu bleeding Cutaneous abscessN34.3 ofSevere abdominal persisten wall J45.51 D57.02 s, or bleeding K57.50 493.81 ANEMIA Z68.28 L03.212 Diverticulitis597.89 of largeOther intestine urethritis without (eg, postmenopausal)perfoV85.32lower leg level lt CellulitisS86.819– of abdominalN39.0S86.811– wall S86.812–Code first underlying disease, such as: hypothyroidism (E00.0-E03.9), symptomatic late 562.11 edBMI 32.0-32.9, adul ess, or bleeding Exercise inducedsyphilis bronc (A52.79),a with andZ68.29 status tuberculosis asthmaticus (A18.89) when reporting code D63.8 845.00OBESITY–WEIGHT K57.52493.82 t asthma with status asthmatic L02.01 D57.00 Diverticulosis597.81 of smallUrethral intestine syndrome, without V85.33unspecifi perforStrain of unspecified musclet and tendon atAcute lymphangitis of abdomina 562.00 withoutBMIpecified 33.0-33.9, perforation, adult absc s, or bleeding Cough variant asthm Z68.30 L03.221 SPRAINS–STRAINS Ankle lower leg levelATTENTION DEFICIT 285.3 D61.818

GENITO–URINARY Urinary tract infection,V85.34 site not s CutaneousS86.919– abscess of backS86.911– (except buttocS86.912– TIP

Diverticulitis599.0 of small intestine without perforation, absces TIP s hospasm J45.902

th small and large intestine BMIthout 34.0-34.9, perforation, ad absces Othern asthma L03.222

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Start mastering ICD-10 today aafp.org/coding-toolkit *(ICD-10 Educational Series and ICD-10 Flashcards sold separately.)

ICD-10 Ad_5.14_CMYK.indd 1 6/10/14 11:48 AM 28 • The Maryland familydoctor / winter 2015 Welcome New and Transferred Members August 1, 2014 - October 30, 2014 Active Resident Kathy Dunning Vasilios Mavrophilipos Hanan J. Aboumatar, M.D. Charles A. Olaleye, M.D. Richard Edgar Moche Meister Zoe L. Ajebon, D.O. Ekenesenarienrein C. Sarah Evans Matthew J. Mulligan Diana N. Carvajal, M.D. Omokaro, M.D. Sara Francomacaro Stefano Muscatelli Katherine A. Cook, M.D. Christopher Riley, M.D. Gregory Fu Khadijatou L. Njimoluh Justin Cross, M.D. Ivan Gonzalez Nolan O’Dowd Melissa Denham, M.D. Student Adam Graeber Payal Patel Dorita C. Egudu, M.D. Julian Amin Hallie Green Priya Patel Lindiwe F. Greenwood, M.D. Garrick Anderson Andrew Hanna Bennett Peterson Kathleen G. Hill, M.D. Brenton Andreasik Solomon Hayon Christopher Petruccelli Anugeet Kaur, M.D. Rochelle Arbuah Padmini D. Herath Manoj Racheria Aysha Khan, M.D. Ashley Barnes Allison Herring Nadira Ramnarain Sarah S. Kin, M.D. Nisha Basappa Atheeth Hiremath Jennifer Reid Anupama S. Khandare MBBS Samuel Black Tahreem Iqbal Kenneth Rosenberg Susrutha Kotwal, M.D. Alexandra Blaes Genna A. Jerrard Michael Rouse Barbara A. Levin, M.D. Nicole Bouchard Rahel Kebede Ragina Saylor Frank Malinoski, M.D. Shawnecca Burke Xavier D. Kee Samuel A. Schiff Tiffany Mapp, D.O. Ian H. Bussey Andrew Kim Alexandra Simpson Karin Mirkin, M.D. Sarah Chang Stanley Kim David Spivey Natalie Moore, M.D. Chris Charock Stephen Klepfer Claire Staley Mercy Obamogie, M.D. Yifei Chen Grace Koo Stephanie Steinweg Immirne M. Ouwinga, M.D. Amy Cheng Tim Lancaster Catherine Varnum Gerren Perry-Fabrizio, M.D. Nubal Cherian Jon David Landon Alex Wang Sophia A. Purekal, M.D. James Cometto Melissa Langer Huan Wang Birju H. Ringwala, D.O. James Comotte Gloribel Le Annie Weber Courtney K. Ryan, M.D. Timothy Cox Grace Lee Jeremy Wines Mona Sarfaty, M.D. Gordon Crews Megan Lee Steven G. Woodward Lisa Singletary, M.D. Johathan Danquah Steven D. Leydorf Swabena Yamoah Salvador Sylvester, D.O. Valerie Dawson Johathan Lim Serena Yin Debra A. Vereen Clare DeLaurentis Diamond Ling Tiffany Yu Heather E. Walker, M.D. Taylor T. DesRosiers Michael Lu Jackie Zhang Samantha Dizon Joseph Mansfield

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30 • The Maryland familydoctor / winter 2015 Your “No obligation” Consultative review includes the Insurance Review following: Employee Benefits: Med Chi Insurance Agency was • Group Medical, Dental, and Vision Coverage established in 1975 “by physicians • Group Life & Disability for physicians” to satisfy the needs of • Voluntary Benefits doctors and medical practices. Property & Liability: • Medical Malpractice • Workers Compensation Contact Keith Mathis at 800.543.1262, ext. • Medical Office Insurance • Employment Practices Liability 4422 or [email protected] today to • Directors & Officers Liability schedule your “no obligation” review at no cost! • Privacy/Data Breach Coverage • Bonds (Fiduciary/Fidelity/ERISA) 1204 Maryland Avenue Personal: • Life Insurance Baltimore, Maryland 21201 • Disability (Individual/Pension/ 410.539.6642 or 800.543.1262 Business Overhead) • Annuities 410.649.4154 fax • Long Term Care • Estate Planning/Retirement Planning www.medchiagency.com • Auto/Homeowners/ Umbrella Coverage The Maryland familydoctor / winter 2015 • 31 Presorted Standard MARYLAND Academy U.S. Postage Paid of Family Physicians Little Rock, AR Permit No. 2437 5710 Executive Dr., Suite 104 Baltimore, MD 21228-1771

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32 • The Maryland familydoctor / winter 2015