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Insides Winter Winter 1998/Volume 2 No. 1 table of contents Editors’ Comments Dr. Garfield; 29 2 Tom Janisse, MD; Arthur Klatsky, MD; Scott Rasgon, MD; Lee Jacobs, MD. Clinical Contributions 6 Ambulatory Open Shoulder Surgery. Raymond A. Sachs, MD; Jennifer Smith. 10Managed Genetic Care in the Largest HMO: The Challenge of Providing Genetic Services to 2.7 Million Members. Ronald Bachman, MD; Edgar J. Schoen, MD. 15Natural Rubber Latex Protein Allergy Prevention and Exposure Control. Enid K. Eck, RN, MPH; Eric Macy, MD; Wendy Huber, MD. 19A New Era in Colorectal Cancer Screening and Surveillance. Seymour Grossman, MD. 22Perspective—Kaiser Permanente Medicine 50 Years Ago. Morris Collen, MD; Elizabeth Anderson, MD. Soul Of The Healer On the Cover/”Sunset 14“Select-a-Nose.” Evany Zirul, DO, MFA. Reflection, Buda Castle, Budapest” by Stu Levy, 39“Punchbowl Falls, Oregon.” Stu Levy, MD. Toupees by Al; p. 53 MD. Dr. Levy is a family 53“Toupees by Al.” Evany Zirul, DO, MFA. practice physician for Northwest Permanente, 56Gracie in my Heart. Bob Randolph. PC, and studied photogra- Couplets to a Pre-Existing Condition. Ronald Louie, MD. Select-a-Nose; 14 phy with Ansel Adams. He Retirement. Gopal Nemana, MD. has taught many photography workshops and has had over 20 one- person shows of his work. The Lighter Side Of Medicine 29Life on the Sunnyside, and Dr. Garfield—Kaiser Physician; and a reprint of How to Use Humor to Stay Healthy. External Affairs 30Cultural Competence in Health Care: Another Aspect of Kaiser Permanente’s Commitment to Quality. M. Jean Gilbert, PhD. If you would like to 33Building and Delivering the Kaiser Permanente Promise. submit art for consider- Kathy Swenson; Vaughan Acton. ation for the cover of 37 The Presidential Commission and Health Care Reform. The Permanente Journal Donald W. Parsons, MD. please use the following guidelines… 40 Keeping Abreast of Permanente in the News. Send us a high-quality Tom Debley. color photograph of your art no smaller than 4x5 and no larger than 8x10. Brand Strategy; 33 Mission... The Permanente Health Systems Management Journal is published and 42 Systems Challenge for Primary Care and the Specialties: Relationships and Access. written by the clinicians A roundtable discussion with panelists Patricia Behlmer, MD; Tony Bianchi, MD; of the Permanente Andrew Golden, MD; William Caplan, MD; Steve Lieberman, MD; and Walid Sidani, MD. Medical Groups and KFHP to assist them in 48 Achieving Clinician Use and Acceptance of the Electronic Medical Record. delivering superior Michael A. Krall, MD. health care to our 54 The Coming Tidal Wave: Genetic Testing. Al Weiland, MD. members and our communities. Permanente Abstracts EpicCare; 48 58 ◆ Heritability of Longitudinal Changes in Coronary Heart Disease Risk Factors in Women Twins ◆ Epidemiology and Outcome of Patients Hospitalized with Acute Lower Gastrointesti- nal Hemorrhage: A Population-Based Study ◆ Specialty Differences in the Management of Asthma. A Cross-Sectional Assessment of Allergists’ Patients and Generalists’ Patients in a Large HMO ◆ Extending Health Maintenance Organization Insurance to the Uninsured. A Controlled Measure of Health Care Utilization ◆ Efficacy and Cost-Effectiveness of Multihole Fine-Needle Aspiration of Head and Neck Masses ◆ Heritability of Factors of the Insulin Resistance Syndrome in Women Twins ◆ Stanford-Kaiser Permanente G1 study for Clinical Stage I to IIA Where to find The Hodgkin’s Disease: Subtotal Lymphoid Irradiation Versus Vinblastine, Methotrexate, and Permanente Journal... Bleomcycin Chemotherapy and Regional Irradiation ◆ Marijuana Use and Mortality A full-text version is available at our Web site (www.kpnw.org/ A Moment In Time ~permjournal/ 61 Anesthetic Agents of the Forties and Fifties. Carl Fisher, MD. permjournal.html). In addition, copies of the Journal are available in Book Review Kaiser Permanente 63 “Color Atlas of Regional Dermatology.” Gary M. White, MD. Vincent J. Felitti, MD. libraries Programwide. Letters To The Editor 64 Your letters will link quarterly issues and create more dynamic exchange on the Internet. Announcements 65 ◆ Eighth Interdivisional Conference on Primary Care, Occupational Health, and Musculoskel- etal Medicine ◆ Health Plan Institute’s Core Program ◆ Second Interdivisional Educational Symposium for Nurse Practitioners, Physician Assistants, Certified Nurse Midwives, and Certified Registered Nurse Anesthetists ◆ Managed Care in Occupational Health ◆ Interdivi- How to Contact The sional Occupational Health Meeting ◆ KP Clinical Practice Exchange ◆ Editing Help with Your Permanente Journal… Manuscripts ◆ 1998 Nike World Masters Games ◆ Kaiser Permanente Clinical Best Practices in E-mail us at Otolaryngology Symposium [email protected] Call us at 503-813-2623 ? Instructions For Authors 67 We want you to submit your work; please look here to find out how. Fax us at 503-813-2348 The Permanente Journal, 500 NE Multnomah St, Suite 100, Portland, OR 97232 The Permanente Journal / Winter 1998/Volume 2 No. 1 1 Editors’ Comments Drawing Out the Modern Mind Visual Explanations Tom Janisse, MD, Editor-in-Chief To approach visualizing ideas from a different perspective, as an In this third issue of The Permanente Journal, I would editors’ comments editor I work to enhance the environment in which words appear. like to continue my comments on communication from For example, I encourage authors to include tables, graphs, and the second issue, but broaden the scope and context. We diagrams with their articles. Further enhancements include: plac- know how important communication is and how it often ing these articles in a more visually pleasing and diverse environ- could have been done better. We hear how we can’t communicate ment populated with drawings, photographs, icons, and borders; enough, how we communicate more by our actions than our words, the graphic use of white space; and attention to the format and and how we remember visuals better than words after a lecture. In type style of text. Through these methods pages don’t appear so the last couple of years I have been actively trying to draw “pictures dense with words. I believe that these efforts enhance communi- of ideas” to aid in explanation. These pictures are visual representa- cation. It gives the author and the reader the greatest opportunity tions of a concept or a process I am discussing with someone. (Box to connect with each other. Each is more highly stimulated by the 1: Pictures: desktop computer, mouse-generated drawing symbols. content and the context. Box 2: Pictures: palmtop, stylus-generated sketches.) Other pictures Because as editor of The Permanente Journal I oversee all aspects I use routinely are metaphors and stories. of each issue, I spend time with the production staff looking at the Physicians, patients, and other healthcare workers have responded layout, selecting the cover art and the visuals inside, as well as well. They seem to understand me better or feel a picture or dia- attending to the balance, tone, and order of articles—the “feel” of gram has clarified our discussion. This response has encouraged The Permanente Journal. To improve my graphic sensibility I have me to seek new ways to picture ideas to improve my communica- begun to read magazines like, Critique: The Magazine of Graphic tion skill and effectiveness. Because we increasingly understand Design Thinking, and books like Edward Tufte’s series, The Visual the value of innovation in health care delivery, tools to enable and Display of Quantitative Information, Envisioning Information, and diffuse innovations can benefit us. The Permanente Medical Groups Visual Explanations. It was an article in Critique that stimulated this will better define, clarify, and implement Permanente Practice in- editorial. It is called, “Drawing Out the Modern Mind.” The follow- novations if clinicians communicate more effectively with each ing comment introduces the article: “Contrary to old beliefs, the other. Drawing can complement other communication tools we human mind is not a computer: instead of working in a predictable, use—electronic, audio, video, oral, and written. logical, sequential way, our minds work in a flexible, perceptual, External and Circular views internal relations Feedback loops Direction and interacting levels Transition state A cloudy step ABCS XNZ -------- Three ways there Aligned communication Multiple off-shoots Box 1. Pictures: desktop computer, mouse-generated drawings 2 The Permanente Journal /Winter 1998/Volume 2 No. 1 “Contrary to old beliefs, the human mind is not a computer: editors’ comments instead of working in a predictable, logical, sequential way, our minds work in a flexible, perceptual, all-at-once way.” all-at-once way. The modern mind achieves power by combining can, and do, create pictures in the form of metaphors or sto- logic and intuition. And you can sharpen the perceptual skills that ries—two of the four tools of intuitive thinking along with im- underlie intuition by strengthening your drawing skills.” ages and symbols. These tools help to bring the elusive com- plexity of medical science to a common place for people—a What’s The Difference? description of the dilemma or the concept in everyday language You may be asking yourself at this point, how does this make or events. I hesitate using the following dark-side example; how- any difference to me? In the Health Systems Management section ever, I practice clinically as an anesthesiologist, and when people of this issue a roundtable discussion appears on “Primary Care come to surgery they are most afraid of not waking up, of dying and the Specialties: Relationships and Access.” When you read it under anesthesia. They come to the operating room on terms you will engage in a conversation with 6 physicians from across with the surgical procedure, but not with the loss of control of the country who discuss what they have learned from innovative unconsciousness. People often ask, “What are the odds?” Cur- practices they have implemented. You will hear and understand rently, death occurs from anesthesia in about 1 of 200,000 en- more about access to specialists than is present in the words on counters.
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