INTERNATIONAL MISSION SERVICES Societies Continue Work in Key Focus Areas PAGE 12 Supreme Court May Weigh Medical Ethics and the Death Penalty PAGE 16 SPRING 2019 • VOL.10 • NO.1 A PUBLICATION OF THE WYOMING MEDICAL SOCIETY Tirelessly defending the practice of GOOD MEDICINE. We’re taking the mal out of malpractice insurance. By constantly looking ahead, we help our members anticipate issues before they can become problems. And should frivolous claims ever threaten their good name, we fight to win—both in and out of the courtroom. It’s a strategy made for your success that delivers malpractice insurance without the mal. Contact Susan Miller of The Doctors Agency of Wyoming at 800.451.9829, or [email protected], or join us at thedoctors.com Contents SPRING 2019 The Wyoming Medical Society (WMS) is the premier membership organization dedicated to promoting the interests of Wyoming physicians and PAs through advocacy, education and mem- ber services. WYOMING MEDICINE (ISSN- 2154-1681) is published bi-annually by WMS at 122 East 17th Street, Cheyenne, Wyoming 82001. Contact WMS at 307-635-2424 or [email protected]. WYOMING MEDICAL SOCIETY LEADERSHIP President Lisa Finkelstein, DO Vice President David Wheeler, MD, PhD Secretary/Treasurer Jasper James “JJ” Chen, MD Past President Joe McGinley, MD, PhD EDITOR’S PAGE Open Trustee Betsy Spomer, MD Pharmacy Partnerships Expand Care AMA Delegate Stephen Brown, MD 4 AMA Alt. Delegate Paul Johnson, MD FROM THE DIRECTOR WMS Executive Director Sheila Bush Fighting for What’s Right for Our Members 6 MAGAZINE EDITORIAL BOARD Editor in Chief Robert Monger, MD HEALTH OFFICER’S CORNER Publisher Sheila Bush Human Papillomavirus in Wyoming 8 Managing Editor Kandice Hansen Societies Continue Work in Key Focus Areas 12 SUBSCRIPTIONS To subscribe to WYOMING MEDICINE, write to Supreme Court May Weigh WMS Department of Communications, P.O. Box Medical Ethics, the Death Penalty 16 4009, Cheyenne, WY 82003. Subscriptions are $10 per year. ON THE COVER Articles published in WYOMING MEDICINE International Mission Services: represent the opinions of the authors and do not Helping Around the World 18 QHFHVVDULO\UHÀHFWWKHSROLF\RUYLHZVRIWKH:\RPLQJ Medical Society. The editor reserves the right to ::$0,6WXGHQW3UR¿OHV 26 review and to accept or reject commentary and advertising deemed inappropriate. Publication of an PARTNER MESSAGES advertisement is not to be considered an endorse- Wearable Medical Devices ment by the Wyoming Medical Society of the product or service involved. Give Abundant Data—and Risks 36 WYOMING MEDICINE is printed by PBR, BCBSWY Works to Streamline Cheyenne, Wyoming. Provider Services for Wyoming 38 POSTMASTER Ankle Arthritis: Management Send address changes to Wyoming Medical Society, P.O. Box 4009, Cheyenne, WY 82003. and the Role of Total Ankle Arthroplasty 39 ABOUT THE COVER Ovarian Cysts: Observation versus Dr. Jessica Kisicki (kneeling) of Cheyenne ispLFtured Surgery and When to Worry about Torsion? 40 with Guatemalan patients and a fellow volunteer on a 2018 volunteer mission trip to La Pila with Great Commission Outreach. WMS Member List 44 4 EDITOR’S PAGE Pharmacy Partnerships Expand Care BY ROBERT MONGER, MD ooking for a way to improve access to healthcare for your justed. For example, a patient could go to their pharmacy to have patients? The Centers for Disease Control (CDC) says their thyroid function tests checked and the pharmacist could L WKDWRQHFRVWH̆HFWLYHVWUDWHJ\WRLPSURYHWUHDWPHQWDF- then adjust their thyroid dose as needed. For many patients this cess and quality is for prescribers to form partnerships with is a much less expensive alternative to using hospital labs, and pharmacists through collaborative practice agreements that al- it frees up physicians from routine medication management to low pharmacists to expand their participation in patient care. focus on patients with more complicated medical issues. For the past two years I’ve served on a collaborative practice Collaborative practice agreements in Wyoming are governed oversight committee at the Wyoming Board of Pharmacy and by the Wyoming Board of Pharmacy, and as of early 2019 the during that time I have learned a lot about the rapidly changing landscape of pharmacy training and practice, but many people Board has now approved a total of eight collaborative practice are not aware of all the clinical services that pharmacists can agreements for providers around the state; it is anticipated now provide in collaboration with physicians. WKDWWKLVQXPEHUZLOOVLJQL¿FDQWO\LQFUHDVHRYHUWKHQH[WIHZ For example, most physicians are familiar with pharmacy led years. While some of these collaborative practice agreements clinics for patients taking chronic anticoagulation medications. take place at institutions such as the State Hospital in Evanston Typically, a patient taking warfarin will come to the clinic regu- and the UWFM residency program in Cheyenne, others involve larly to have their PT/INR checked, and the pharmacist will use individual primary care providers. the test result to adjust the warfarin dose and at the same time ,QWHUHVWHGLQ¿QGLQJRXWPRUHDERXWFROODERUDWLYHSUDFWLFH provide patient education regarding drug interactions, dietary agreements? The Wyoming Board of Pharmacy has a template concerns, etc. \RX FDQ XVH WR KHOS \RX GHYHORS VSHFL¿F DJUHHPHQWV ZLWK D In recent years, however, pharmacists have greatly expanded pharmacy, and the Board can also help you review the statutory their clinical care skills and now routinely help manage many rules that govern such arrangements. For example, it is impor- additional medical conditions including diabetes, hyperten- sion, smoking cessation, thyroid disorders, and hyperlipid- WDQWWRKDYHZHOOGH¿QHGSURWRFROVLQSODFHVXFKDVZKDWWRGR emia. A best practices guide* for cardiovascular disease preven- if a patient is noncompliant, or how to notify the physician in tion programs developed by the CDC documents that involving case of an adverse drug reaction. It is also important for the pa- pharmacy participation in patient care is linked to improved tient to continue as an active patient with the physician and for cardiovascular outcomes for patients. The CDC guide states the physician to closely collaborate with the pharmacist and to that, “collaborative drug therapy management (CDTM) en- VSHFL¿FDOO\OHWWKHSKDUPDFLVWNQRZZKDW\RXZDQWWKem to do. abled by a collaborative practice agreement (CPA) is a formal &ROODERUDWLYHSUDFWLFHDJUHHPHQWVDUHDQH̆HFWLYHZD\LPSURYH SDUWQHUVKLSEHWZHHQTXDOL¿HGSKDUPDFLVWVDQGSUHVFULEHUVWR clinical outcomes. Medication management provided through a H[SDQGDSKDUPDFLVW¶VVFRSHRISUDFWLFH&'70LVDFRVWH̆HF- pharmacy may often be less expensive and more accessible for tive strategy for lowering blood pressure, blood sugar, and LDL patients than similar services obtained through a hospital lab cholesterol levels; improving treatment quality; and increasing or medical clinic and can potentially be provided using tele- medication adherence” and goes on to say that strong evidence exists that CDTM enabled by a CPA is effective. medicine. For more information consider talking with your local Many pharmacies are open evenings and weekends and pa- pharmacist or contacting the Wyoming Board of Pharmacy. tients can often walk in without an appointment, which im- proves access to care, and pharmacists sometimes have more time than physicians do to educate patients regarding their *Citation: Centers for Disease Control and Prevention. Best medical conditions and medications. There is also the poten- Practices for Cardiovascular Disease Prevention Programs: tial for pharmacists to use telemedicine to improve access to $*XLGHWR(̆HFWLYH+HDOWK&DUH6\VWHP,QWHUYHQWLRQVDQG care especially for patients in rural areas. &RPPXQLW\3URJUDPV/LQNHGWR&OLQLFDO6HUYLFHV$WODQWD CLIA approved laboratory testing is now available in many *$&HQWHUVIRU'LVHDVH&RQWURODQG3UHYHQWLRQ86'HSW pharmacies, meaning that a patient may be able to go directly to RI+HDOWKDQG+XPDQ6HUYLFHVZZZFGFJRYGKGVS the pharmacy to have their lab tests done and medications ad- SXEVGRFV%HVW3UDFWLFHV*XLGHSGI 6 FROM THE DIRECTOR Fighting for What’s Right for Our Members BY SHEILA BUSH e often tout the WMS legislative successes to our a time in Wyoming where we can watch the coastal waters members and attempt to convey the degree to UHFHGHH[SRVLQJWKHRFHDQÀRRUDVDWVXQDPLDSSURDFKHV WZKLFKRXUDGYRFDF\WHDP¿JKWVWRVWUHQJWKHQDQG That tsunami will be legislation attempting to further erode bolster the physician voice in important state regulatory and WKHOLQHVGL̆HUHQWLDWLQJSK\VLFLDQVIURPDOOWKHRWKHUKHDOWK- legislative conversations. Likely at some point in time during care providers on the team, along with a myriad of other the discussions surrounding this topic of advocacy members ideas in healthcare cost transparency, data sharing and tech- have become fatigued and frustrated because our position nology innovation. While all of these ideas may have merit, on an issue wasn’t consistent with their personal opinions or the devil will forever be in the details. WMS will be charged triggered anger because WMS didn’t win on the bills of the with ensuring the light is shined on those details, warning of utmost importance to them. the unintended consequences that can come from the quick All of the positive responses, as well as the negative ones, ¿[HV of today. are appropriate and earned, as we win some battles and lose There’s no time to waste in getting the medical society others. WMS won’t get every front and center in key con- issue right every time,