+++++++++++++ +++++++++++++ +++++++++++++ +++++++++++++ [ ] +++++++++++++ v2n1 2013 +++++++++++++ A PHYSICIAN PUBLICATION FROM +++++++++++++ +++++++++++++ THE NORTH SHORE-LIJ HEALTH SYSTEM +++++++++++++ +++++++++++++ +++++++++++++ +++++++++++++ +++++++++++++ +++++++++++++ +++++++++++++ +++++++++++++ Advancing Medicine Shedding New Light and more ON PROSTATE CANCER Page 14 DEVELOPING Medical Leaders Page 16 ROLE REVERSAL: Doctors as Patients Page 23 Favorite FICTIONAL PHYSICIANS Page 33 > accelerating the Leadership Message Advancing: growth or progress of I came of medical school hungry for the basics of medicine: the on-your-feet age when the computed critical thinking that leads one young doctor to tomography (CT) scan diagnose carbon monoxide poisoning by asking the debuted. I watched all right mix of questions about a Thanksgiving dinner. sorts of scans follow — You’ll read about doctors who save lives outside ultrasound, magnetic hospital walls ­­— whether it’s on an ambulance, at resonance imaging (MRI), the scene of a fire or in a small village on the other side then positron emission of the world that has very limited opportunities tomography (PET) — and I for healthcare, these doctors can’t take medicine learned at the hands of my sitting down. mentors that clinical exams I have witnessed a lot of important changes in were somehow taking a backseat to these promising medicine. After my medical training, I spent years technologies. In short order, the glamour of the image in general internal medicine practice. Diabetes was on a screen, which offered a window into the body, was so prevalent among my patients that I knew I could thought to say more than the touching, questioning not possibly have enough time to treat and educate and churning of the mind under fire that drew many all of them. A nurse practitioner answered the of us into medicine in the first place. calling and trained to become a specialist in diabetic Yes, this ability to get under the skin, through the management. She helped so many people learn bone and inside the brain added dramatically to the the skills of staying healthier — and I learned that science of medicine, but this infatuation with gadgets medicine is a team sport. seemed to replace critical thinking. Today, the refrain, We are now training medical students to become “I don’t know what’s wrong; let’s order a scan,” has critical thinkers and to put technology behind a careful led to patient frustration, runaway costs and very and thorough assessment of their patients. We don’t average doctoring. want doctors to lose trust in their clinical skills, only Medicine has to change, and there are advances in to feel they need to rely on technology for an accurate science that are game-changing and necessary. As you diagnosis. Even when technology is necessary to help will see in this issue of Doctoring, there are better ways make a diagnosis or manage treatment, it is my hope to diagnose prostate cancer and detect tumors earlier, that physicians use it together with deep thinking on and melding two imaging technologies may be just what their feet. That is the art and the science of medicine. the doctor needed to be able to tell patients when a tumor is present and requires attention. You’ll see how physicians and hospitals are challenged Sincerely, by the issues of modern medicine in a story on medical Lawrence G. Smith, MD errors and another on rehospitalization soon after PHYSICIAN-IN-CHIEF AND DEAN, discharge. You’ll meet the latest resident generation NORTH SHORE-LIJ HEALTH SYSTEM NORTH SHORE-LIJ EDITORIAL BOARD TRUE NORTH CUSTOM MEDIA R se ecy Terence Lynam Charlie Milburn a c e l Vice President, Public Relations e Senior Account Manager l P Doctoring is published three R g e n m li Brian Mulligan Ashlea Roark ov yc times annually as a service of the e ec Ins R Assistant Vice President, Public Relations Art Director/Designer North Shore-LIJ Health System. erts Before Maria Conforti Ed Lammon Director of Editorial Services Managing Editor Jamie Talan Science Writer TO SUBSCRIBE OR UNSUBSCRIBE, call 800-624-7496. DOCTORING : V2N1 V2N1 DRDOCTORING . contents GADGETS & GEAR Look inside for 04 ... A View from Above ....... Showcasing Science tablet edition exclusives. ....... Brainy Books Locate these icons throughout Doctoring magazine to learn where you can enjoy ....... Beyond Paper and Ink supplemental content in the tablet edition: Tablet-Exclusive Photography ON CALL:RESIDENT PROFILE Tablet-Exclusive Podcast 5 05 ... Siblings in Residence Tablet-Exclusive Video CHART NOTES 07 ... From Loss Springs Life 21 ... Reducing Readmissions CULTURE HEY DOC, 10 ... Q & A: Curbside Consults DO YOU 16 ... Moving into Management: HAVE AN Doctors as Administrators iPAD? 33 ... Doc in the (Electronic) Box: Who’s Your Favorite? Get your tablet edition OUTREACH subscription to 12 ... Transforming Lives Doctoring from the 12 a World Away App Store today. 36 ... Dual Roles: Doctor FoLLow theSe Steps: and Firefighter NEWSSTAND (1) Download our app from the App Store. (2) Open your newsstand app. (3) Subscribe to Doctoring. (4) Download issues and enjoy! BREAKING GROUND 14 ... Bringing Prostate Biopsies Out of the Dark FINANCE & INSURANCE 19… ACO: Embracing a New Model 26 WELLNESS 23 ... Healers Humbled: When Physicians Become Patients IN PROFILE 26 ... Branching Out: Neurosurgeon Doc Doubles as Olive Farmer 38 ... Fostering a Culture of in the Accountability (ELECTRONIC) ART & SCIENCE 28 ... Finding the Melody in Medicine TUTORIAL BOX 30 ... Learning from Medical Errors: 33 36 A Path Less Taken V2N1: DOCTORING g gadgets & gear > A roundup of medical office and/or personal equipment and other products of interest to physicians. by Jamie Talan 1 A VIEW FROM ABOVE /// While small, unmanned aerial vehicles (UAVs) can be as simple as a remotely controlled model plane or helicopter with a GoPro camera attached, Lehmann Aviation (LehmannAviation.com) has developed what may be the ultimate eye in the sky. The Lehmann LV580 is a full-auto-pilot-capable, auto-take-off, eagle-sized UAV. It features a day and night vision two-axis motorized camera and a ruggedized ground control system enabling full flight and camera control, plus live viewing of what the camera sees. Lehmann Aviation flew a UAV over the Palace of Versailles. Watch the video at http://bit.ly/castlevideo. 2 BEYOND 4 PAPER AND INK /// SHOWCASING SCIENCE /// What would it take to build a medical device? It all starts with an idea, of PBS NewsHour recently introduced two new regular science features: Science Wednesday course. But savvy inventors might and Lunch in the Lab. The Science Wednesday segments, which began this winter as part of also need to get acquainted with the PBS Exploration Wednesdays, explore science and engineering. The biweekly Lunch in the new world of 3D printing. By using Lab column covers offbeat and fun science news Mondays and Fridays at pbs.org/newshour. digital models to create solid, three- dimensional objects, 3D printers break through the limitations of the 3 two-dimensional printed page. Used in a wide range of fields, including space BRAiny BOOKS /// exploration and the aerospace industry, the possibilities are nearly unlimited. Researchers at the Wake Forest Annie Murphy Paul had a brilliant idea — many of them, for that matter. A science writer, Institute for Regenerative Medicine Ms. Paul fills The Brilliant Blog (AnnieMurphyPaul.com/blog) with insights into learning, have combined a traditional inkjet creativity and the path to brilliance. She has written several books, among them The Cult of printer with an electrospinning machine Personality, a cultural history and scientific critique of personality tests, and Origins, a book to create a 3D printer that produces about the science of prenatal influences. Crown will publish her latest book, Brilliant: The tissue constructs with properties typical New Science of Smart, later this year. of elastic cartilage. The scientists have already implanted these printed structures — made from synthetic and natural materials, including cartilage cells from a rabbit ear — into Want to Learn More? mice; and mechanical force testing Use your smartphone to scan these QR codes for easy access. has demonstrated the potential for implanting 3D printed structures in people. Although the technology is still in its infancy, 3D printers are already used to create dental fixtures and prosthetic limbs. The printers start at $1,000 and can cost as much as $500,000. Learn about the Wake Forest 1 2 3 4 team’s research at http://bit.ly/cartilageprinter. Lehmann Aviation PBS Annie M. Paul 3D Printing DOCTORING : V2N1 5 resident profile resident on call: call: on in Residence Siblings by Jamie Talan SEAN HOWSE, A THIRD- YEAR resideNT at LIJ MEDICAL CENTER, walKS THROUGH THE EMERGENCY DepartmeNT (ED) WITH HIS SISTER ELIZABETH. “HEY, DR. HOWSE,” IS THE COMMON REFRAIN AS THE DUO passes. BOTH TURN THEIR HEADS. THEY ARE A BROTHER-SISTER TEAM IN THE ED. he first brother-sister residents in emergency medicine derbird School of Global Management and worked in finance at the hospital, they don’t talk much medicine at home. for several years before heading to medical school. He always T Although the two entered college with different aspirations wanted to become a doctor but understood that he needed roots — Sean was interested in economics, Elizabeth in law — they ended in business to guide his practice in medicine. Even though his up following their parents’ paths into medicine. Their sister is also family is stacked with physicians, he said he didn’t know a lot of pursuing a medical career by training to become a psychiatrist. The doctors who knew the business aspects of medicine. two siblings’ penchant for solving puzzles in a hurry drew them to Dr. Sean’s business acumen helps during weekly ED staff meet- emergency medicine. ings that cover cases that could have gone better. The ultimate goal “Every patient is a mystery — and for each one, you have is to create a more efficient experience for both patients and staff.