THE BULLETIN

A PUBLICATION OF THE MUSCOGEE COUNTY MEDICAL SOCIETY

ERUDIRE ET DELECTARE

V O L U M E 6 0 • N U M B E R 2

FEBRUARY 2015

Manoj Shah, M.D., President MAG and Jim Majors, M.D., President MCMS

Photo by Jim Cawthorne

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THE BULLETINSociety Office: 2300 Manchester Expressway, Suite F-7 • Columbus, GA 31904

706-322-1254 • FAX 706-327-7480 • www.muscogeemedical.org

C o n t e n t sPresident’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Hospital News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Editor: David H. Levine, M.D. • Associate Editor: Casey Geringer, D.O.Managing Editor: Lisa Venable

Officers 2015:

President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . James D. Majors, M.D.

President-Elect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .W. Frank Willett, III, M.D.

Past President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Glenn E. Fussell, M.D.

Secretary-Treasurer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Glenn E. Fussell, M.D.

Director to MAG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fred Flandry, M.D.

Alternate Director to MAG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W. Frank Willett, III, M.D.

Executive Committee: James D. Majors, M.D., W. Frank Willett, M.D., Glenn E. Fussell, M.D.,Fred Flandry, M.D., Michael Borkat, M.D., Ryan Geringer, D.O., Kurt Jacobson, M.D., David H. Levine,M.D., Ken Smith, M.D., Karen Stuart, M.D.

Delegates: Michael Borkat, M.D., Benjamin Cheek, M.D., Fred Flandry, M.D., Glenn E. Fussell, M.D.,Ryan Geringer, D.O., James D. Majors, M.D., Folarin Olubowale, M.D., Karen Stuart, M.D., W. FrankWillett, III, M.D., Joseph Zanga, M.D.

Alternate Delegates: Larry Brightwell, M.D., Casey Geringer, D.O., James Hagler, M.D., KendallHandy, M.D., A. J. Jain, M.D., David Levine, M.D., Henry Ngo, M.D., Kenneth Smith, M.D., TimothyVillegas, M.D., John D. Watson, M.D.

Ad position is at the sole discretion of the Editorial Board.

Members are urged to submit articles for publication in The Bulletin. Deadline for copy is the 11th of the month preceding date of issue.The Bulletin of the Muscogee County Medical Society is the official monthly publication of the Muscogee County Medical Society, 2300Manchester Expressway, Suite F-7, Columbus, GA 31904. All material for publication should be sent to the Managing Editor not laterthan the 11th of the month. Advertising requirements and rates upon request. Opinions expressed in The Bulletin, including editorials,are those of the individual authors and do not necessarily reflect policies of the Society unless stated. Advertisements in this magazinedo not necessarily represent endorsement or support by the Muscogee County Medical Society.

Muscogee County Medical Society State of the Union

2015 may prove to be a lean year for the Muscogee CountyMedical Society. Though physicians were invoiced in October2014, we have received only 75 member renewals for 2015. Lastyear we had 249 memberships that were paid for 2014.

The benefits of MCMS membership are numerous. First, anypatient who calls St. Francis Hospital for a new physician referral

inquiry is referred to the MCMS office. Lisa Venable recommends that these patientscall a paid MCMS member and also sends out lists of MCMS member primary carephysicians to patients who need a primary care physician. She receives several ofthese phone calls daily. She often has to contact me for subspecialty informationand again, these patients are directed to physicians who are MCMS members.Patients are often referred to our website for resource information on memberphysicians. Our membership directory is also available to MCMS members in theform of free mailing labels for medically oriented correspondence to colleagues.

Second, the MCMS annually produces a “Yellow Card” with a complete listing of allarea physicians, hospitals, and local pharmacies. Though all physicians are listed,paid MCMS members are listed in BOLD. It is distributed to all area physicians butmembers receive ten free copies to place at every conceivable office workspace.

Third, most MCMS members enjoy our four yearly meetings. For the past threeyears, our signature event has been a wine and food pairing at the swank Epicrestaurant. This event is so popular that the leadership of the Medical Associationof Georgia attends each year. Prior years have seen events hosted at the River MillEvent Center and at the Columbus Infantry Museum. The feedback from theseevents has been fantastic. The events are designed to be fun for physicians andspouses. My wife and I consider them “date nights” and look forward to them. Itis fun to see physicians in a social setting.

The MCMS plays a legislative role with the Medical Association of Georgia. We havea slate of ten or eleven delegates who attend the MAG House of Delegates each year.This meeting sets the MAG agenda for the Georgia state legislature. Without MAGinvolvement, Georgia would never have passed Tort Reform in 2005 or the morerecent prompt insurance pay laws. The size of our delegation and thus the numberof votes we have at House of Delegates is determined by the number of paidmembers in our Society. MCMS involvement in MAG is critical. We also inform youabout these events through Muscogee County Medical Society’s “The Bulletin” whichis published monthly and in which members can write articles. It is a great way tofind out what is going on in the society and the medical community in this area.

P R E S I D E N T ’ S M E S S A G EJames D. Majors, M.D.

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With the current reported financial duress of both local hospital systems, there hasbeen a paucity of renewals from hospital-employed physicians. St Francis aloneaccounted for 49 of the 249 hospital employed physician MCMS members in 2014.Only some of the dues have been received for 2015 (not including mine). Ashospitals struggle to balance their budgets, society membership renewals (paid onbehalf of employed physicians) have been postponed. We need our physicians torenew their memberships for 2015. Without members, events supported by theMCMS will have to be curtailed.

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Stan Hickson Named President of Northside Medical Center Stan Hickson, MHA, FACHE, joined Columbus RegionalHealth Jan. 21 as President of Northside Medical Center.Mr. Hickson comes to Columbus Regional Healthfollowing leadership positions in Washington, D.C., SouthCarolina and Virginia. He previously served as ExecutivePartner for Crimson, the D.C.-based Advisory BoardCompany’s data analytics product for clinical quality andcost efficiency. Prior positions included Acute CareExecutive/Executive Vice President and Chief OperatingOfficer for Palmetto Health Richland in Columbia, S.C., and Chief OperatingOfficer for HCA-Montgomery Regional Hospital in Blacksburg, Va. Mr. Hicksonholds an undergraduate degree from the College of Charleston and Master ofHealth Administration from Medical University of South Carolina. He is a Fellowin the American College of Healthcare Executives.

Columbus Regional Health Earns AwardsOnce again, Columbus Regional Health’s commitment to quality and patientsafety has earned recognition at the state level. Because our patients are at thecenter of everything we do, we strive to ensure we deliver safe, effective andcompassionate care. Toward that end, we benchmark ourselves against andparticipate in a variety of state and national initiatives including the GeorgiaHospital Engagement Network, the Partnership for Health and Accountability(PHA) Quality and Patient Safety Award program and the national qualityreporting program, to name a few. Columbus Regional Health received multipleawards during a recognition ceremony held Jan. 7 at the Ritz Carlton Lodge atReynolds Plantation in Greensboro, Ga.

The Josh Nahum Special Achievement Award The Josh Nahum Special Achievement Award for Infection Prevention and Controlwas established in 2007 by Victoria and Armando Nahum, in partnership withKimberly-Clark and the Georgia Hospital Association, in memory of their sonJosh, who died from a health care-associated infection. Midtown Medical Centerwon first place and was recognized for its Antimicrobial Stewardship initiative toreduce rates of Clostridium difficile Colitis. Team members included AmyPoloncic, Deanne Tabb, Dr. Valerie Fletcher, Dr. Saeed Baloch, Melonie Boatner,Susan Harp, Mandy Mock, Freya Gilbert, Dan Cullison and Pam Stokes.

Partnership for Health and Accountability (PHA) Quality and Patient Safety AwardNorthside Medical Center won first place in the category of hospitals with 100-299 beds and was recognized for its falls initiative, “Falls: A Journey of Discovery.”Team members included Michelle Breitfelder, Kendra Sermarini, Bernice Hardin,Tami Hobson, Patti Graulich, Amy Poloncic, Su Langroth, Darlene Glass, DebbieWhitley, Freya Gilbert and Lynn Kelly.

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Partnership for Health and Accountability (PHA) Quality and Patient Safety AwardMidtown Medical Center won first place in the category of hospitals with 300+beds and was recognized for addressing perinatal mood disorders in “You are NotAlone.” Team members included Jamie Evans, Kelly Hunter, Jennifer Osborne,Latisha Walker, Astrid Wightman, Chris Cannon, Dawn Hurst, Natalie Heath,Mariah Pritchett, Dr. Kendall Handy, Albert Eaton and Tonia Russell.

Circle of Excellence AwardThis special award is given to hospitals that have demonstrated a sustainedcommitment to quality and patient safety as evidenced by earning three or moreGeorgia Hospital Association annual awards within the previous five years.Northside Medical Center received the Circle of Excellence Award and hasbeen honored for the past five years.

Georgia Antibiotic Stewardship Honor RollMidtown Medical Center was recognized for demonstrating excellence ininitiating an antibiotic stewardship program, which can improve patient care andprevent the spread of antimicrobial resistance. Team members includedDr. Valerie Fletcher, Dr. Saeed Baloch, Dr. Aileen Huynh, Dr. Scott Hannay,Deanne Tabb, Susan Harp and Dan Cullison.

Georgia Hospital Engagement Network (HEN)The Hospital Engagement Network (HEN) is a national contract awarded by theCenters for Medicare & Medicaid Services (CMS) which engages hospitals acrossthe country to improve patient safety and quality, and achieve lower costs. Thegoal of the HEN is to reduce unnecessary readmissions by 20 percent andavoidable harm by 40 percent. Midtown Medical Center, Midtown MedicalCenter West and Northside Medical Center were recognized for participatingin the Georgia Hospital Engagement Network for continuing excellence andcommitment to quality and patient safety.

Columbus Regional Health Calls for Nominees for Physician Recognition ProgramColumbus Regional Health is seeking nominations for its Physician of the Yearrecognition. The recognition program, established in 2014, salutes a Physician ofthe Year in each of three categories – Clinical Care, Teaching and Leadership. Anymedical staff member, patient, family, Board member or Columbus RegionalHealth employee may nominate a physician. To nominate someone whoexemplifies excellence in Clinical Care, Teaching or Leadership, please goonline to columbusregional.com/greatdocs or email to Amy.Massey@columbusregional.com. Listed below are the criteria for the Physician of theYear in each category. If you know a physician who meets one or more of thecriteria, please list that person’s name and their specialty and cite specificexamples why this physician deserves to be one of Columbus Regional Health’sPhysicians of the Year.

Clinical Care• Demonstrates clinical expertise in assessment, diagnosis and plan of care for patients

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• Uses evidence-based practices in care delivery• Demonstrates consistent use of safety practices• Demonstrates quality patient outcomes• Serves as a role model in interactions with all members of the healthcare teamand lives the ACE-IT values of Attitude, Commitment, Enthusiasm, Innovation andTeamwork

Teaching• Inspires staff, students and colleagues to pursue critical thinking, achievetechnical skills and maintain competence in the practice of medicine and patient care• Is recognized as an expert in field of specialty• Proactively and constructively shares knowledge• Provides a creative and supportive environment for learning• Is seen as a mentor and role model in interactions with all members of thehealth care team and lives the ACE-IT values

Leadership• Is recognized by colleagues as a role model for physician practice/behavior andlives the ACE-IT values• Demonstrates constructive advocacy for medical staff/medical staff departmentin interactions with Medical Executive Committee and hospital administration• Participates on medical staff committee(s)• Actively participates as a member of his/her medical staff department• Advocates for patient care quality and safety practices• Evidences membership in professional organizations, community volunteerorganizations and/or pursues educational endeavors to enhance skills

CME Opportunities Offered for PhysiciansEach of the following Continuing Medical Education (CME) opportunities forphysicians has been approved for one hour of CME credit:

Pediatric Grand Rounds: Every Thursday, 8:15 a.m., Columbus RegionalConference Center at Midtown Medical Center. Open to any physician or otherhealth professional providing care for children. For more information, call LoriSitch at 706-571-1220.

Cancer Conference: Every Monday, 12:30 p.m., Conference Room at the John B.Amos Cancer Center, except for first Monday which is held at Columbus RegionalConference Center at Midtown Medical Center. (Approved as a series.) For moreinformation, call 706-571-1102.

Thoracic Oncology Conference: 1st and 3rd Friday, 7 a.m., Conference Room atthe John B. Amos Cancer Center. For more information, call 706-571-1102.

Midtown Medical Center is accredited by the Medical Association of Georgia toprovide continuing medical education for physicians. Midtown Medical Centerdesignates this live activity for a maximum of 1 AMA PRA Category 1 Credit™.Physicians should claim only the credit commensurate with the extent of theirparticipation in the activity.

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A R T I C L E O F I N T E R E S TBy Karen A. Stuart, M.D., FACOG

Morcellate Me!

I just returned from a lovely city in Canada, Vancouver,British, Columbia. If you've never been there, I highlyrecommend it. Vancouver and Toronto are largemetropolitan Canadian cities that remind me of largeAmerican cities only with less crime, less trash, lesshomeless, and better manners. I was there for the recentAAGL annual meeting. The AAGL, which stands for AmericanAssociation of Gynecologic Laparoscopists, was formed in1971 by a gynecologic surgeon to promote interest in

minimally invasive gynecologic surgery(MIS). As interest in MIS grew, so did themembership of the AAGL, which quickly expanded to include members from over110 countries. I relish going to this annual meeting now more than the ACOGmeeting (American College of Obstetricians and Gynecologists), because it's likethe Consumer Electronics Show of Gyn surgery! Everything that is new andamazing shows up here first. This meeting almost a decade ago, was where I gotmy first glimpse of the da Vinci robot system. It took that long for Columbus toget two robots. There are a lot of other new and fabulous devices out there thatwould make my life much easier in the OR, but given the current financial crunchthat the hospitals are experiencing, well let's just say it might be a while beforethey get here.

This meeting is packed with videos, and videos, and more videos, from people allacross the globe demonstrating all of their procedures, tips, tricks, and newinnovations of gyn MIS. However, the hottest topic this year was of course, thecontroversy over the use of the power morcellator. For those of you who have notheard of this device, or seen the commercials by opportunistic lawyers on TV, letme just explain what this device does. The power morcellator, which wasdeveloped back in the early 1990s, is used to reduce soft tissue such as uteri anduterine fibroids into smaller pieces so they can be extracted through a 12 mmlaparoscopic trocar incision. As Gyn surgeons adapted laparoscopic hysterectomyand laparoscopic myomectomy for even larger pelvic pathology, the dilemma wasalways how to extract these large masses from the abdomen without having toenlarge your incision, if they didn't fit through the vagina, or if there was novaginal incision. The power morcellator allowed us to be able to performminimally invasive surgery on women who, here to fore, would've had to havehad an abdominal procedure. It allowed the woman with 20 week fibroids to nowhave a laparoscopic hysterectomy, and walk out of the hospital on the same day.It has already been well-established by A Cochrane review of 27 randomizedclinical trials comparing laparoscopic or vaginal hysterectomy to abdominal

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hysterectomies. Significantly shorter hospital stays, speedier return to normalactivities, as well as less blood loss and less postop complications were achievedin women who had vaginal or laparoscopic surgery. Following this study bothACOG and the AAGL issued position papers on the route of hysterectomy forbenign disease. Their recommendation was that " most hysterectomies for benigndisease should be performed either vaginally or laparoscopically, and thatcolleagues who do not have the requisite training and skills required for the safeperformance of vaginal or laparoscopic hysterectomy should enlist the aid ofcolleagues who do, or should refer patients requiring hysterectomy to suchindividuals for their surgical care"1. Things were going well with this device untila female anesthesiologist in Boston had a laparoscopic hysterectomy using apower morcellator. It turns out she did not have benign disease as was previouslyexpected. She had a leiomyosarcoma, the prognosis for which is poor under anycircumstance. It was even more devastating because the way we previously usedthe device was to morcellate the tissue uncontained in the abdominal cavity. Thismeant fragments and chips of myometrium and endometrium went flyingeverywhere. This upgraded her disease to a stage 4 iatrogenically. Her husband,who happens to be a thoracic surgeon, went on a one-man campaign to have thisdevice and the procedure completely and utterly banned forever from ourarmamentarium. He used all of his powers including social media, Internet,daytime television, and powerful print media such as the Wall Street Journal toget his message across. Had this happened, it would have been a deathblow or atleast a huge setback for minimally invasive gynecologic surgery. The procedurehas not been banned, but he was successful in having the FDA put out a warningwhich has caused hospitals all across the country to reevaluate the use of thedevice. Some hospitals did ban the device completely, and others put restrictionson its use. The data that was used to come up with these restrictions was basedon an FDA review which quoted the incidence of uterine leiomyosarcoma inwomen who are undergoing hysterectomy or myomectomy for fibroids, to bearound one in 350. In residency we were taught that the incidence was aroundone in 10,000. The AAGL recently performed their own retrospective review, andfound that the FDA's data was flawed. The FDA only looked at nine studies, allwere in English, they did not consider any foreign papers at all, and three of thepapers that were included should've been excluded for various reasons. This newreview of the incidence of leiomyosarcoma based on over 1000 papers concludedthe incidence of uterine leiomyosarcoma to be closer to one in 8330. Althoughthis reaffirms our previous knowledge that leiomyosarcoma is still indeed a raremalignancy, it did not make us any less cautious.

This has now spurred a furious endeavor to find ways to morcellate in acontained environment. There were numerous videos at the AAGL annualmeeting where people were demonstrating their inventions of how to morcellatefibroids in a contained bag. The biggest problem is that there is no such bag thatis indicated or approved by the FDA for such a process. But we adapt as always,until someone comes up with something specifically for that task. It will probablytake several months or even a year before the FDA approves such a device. In themeantime, off label use of various bags such as isolation bags and ripstop tissue

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collection bags are being used for this purpose. One has only to Google"morcellation in a bag", or search for it on YouTube to find numerous videosposted by individuals demonstrating their techniques. I have recently adapted myown surgeries to include such a procedure. I can also tell you that patients arewatching the media and are intelligent enough to ask, as one recently did, " areyou going to use a power morcellator and a bag?"

So in just about 18 short months, one patient has single-handedly changed theway the entire GYN community has been performing a very common surgicalprocedure, probably for the better. But it comes at a price, as now we will have toincrease the cost of our preoperative evaluation of patients to include arecommended pelvic MRI for every patient undergoing hysterectomy where thepower morcellator or any type of morcellation that matter will be used( ACOGand AAGL recommendation). Will these extra measures help save the life of onein 8000 patients who has the disease? Leiomyosarcoma is extremely difficult todiagnose preoperatively as there are no specific or sensitive tests for detection.Patient symptoms are vague and nonspecific.

But this is the new society. The society that determines how we as physicianspractice medicine rather than the other way around. We are powerless and wemust obey, or be punished. Punished in that we may have our hospital privilegestaken away, we will not be reimbursed by insurance companies for theseprocedures. And we will be sued. I'm glad that we have an organization such asthe AAGL who is willing to fight tooth and nail to retain the ability to practicemedicine in the way we see is optimal for all patients. Organized medicine is notdead and should be revived at all costs. It starts at the grassroots. So pay your duesto Muscogee County medical Society, to MAG, to your specialty society, to somemedical organization, and get active. Certainly if one voice can change an entirenation of surgeons and their practices, think of what thousands of physicianvoices could do for all of healthcare.

1. AAGL Position statement, May 2014, Morcellation During Uterine Tissue Extraction

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A R T I C L E O F I N T E R E S TBy Juan Ayerdi, MD, FACS

Evolving Paradigm in Treatment of Pulmonary Embolism

There is a killer in our town. In fact there is a well-recognized but poorly treatedkiller in the world. According to the American Heart Association, up to 2 millionAmericans are affected annually by venous thromboembolic events, out of these200,000 suffer from pulmonary embolism (PE) and more than 60,000 dieannually from its. This is more than the number of people that die annually fromaids or breast cancer.

Over the past few decades great advancements have been made in almost allaspects of medicine. However, up until now the management of PE had remainedstagnant. Traditionally, PEs are treated with systemic anticoagulation and rarelywith systemic thrombolysis. Systemic thombolysis has been reserved for patientsin extremis due to the high risk of unwanted bleeding complications. Whilesystemic anticoagulation effectively reduces the formation of new clot, it does notdissolve the existing clot, relaying on the endogenous fibinolitic system, whichhas been proven to be highly ineffective at lysing large burdens of clot.Therefore, with the traditional approach patients remain at high risk for shortand long term complications named right heart failure and chronic pulmonaryhypertension respectively.

Newer data has come to support the use of catheter guided thrombolysis. Thisapproach offers the advantages of a prompt resolution of the thrombotic processand minimal risk of bleeding complications. The following is an illustrative case.The patient is a Middle age morbidly obese male. He had a history for prior DVTand PE off anticoagulation. He presented with sever shortness of breath and apre-syncopal episode secondary to a recurrent submassive PE and extensive rightlower extremity DVT. His condition was promptly recognized and initiallytreated with a traditional approach using systemic anticoagulation, neverthelesshe had a prolonged hospital stay due to inability to wean off oxygen. He hadclinically significant hypoxia with minimal activities despite being on oxygensupplementation. His diagnostic CT scan had demonstrated signs of cardiacstrain (figure). Repeat ECHO demonstrated persistent pulmonary hypertension(figure). Catheter guided thrombolysis was offered. The procedure consisted ofselective placement of multihole thrombolytic infusion catheters into bothaffected pulmonary arteries at low-dose tPA, for approximately 24 hours. Shortlyafter, the patient had satisfactory clinical and radiographic responses. His exercisetolerance improved to not require oxygen supplementation for his daily activitiesand CTA demonstrated significantly reduced pulmonary clot burden resolutionand no further evidence of right cardiac strain (figure). He was promptlydischarge to home on a Novel anticoagulation agent. He has been back for

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reassessment at 2 weeks. His activity level is back to baseline and he has enrolledin an active exercise program.

Low-dose catheter guided fibrinolysis is now accepted as a therapeutic alternativefor patients suffering from massive PEs (defined as syncope, systemic arterialhypotension, cardiogenic shock, or resuscitated cardiac arrest) and submassivePEs (defined as normotensive patient with PE and evidence of RV dysfunctiondocumented by CT, ECHO or cardiac markers). This approach improves rightventircular function and decreases pulmonary hypertension at a minimal risk forunwanted bleeding complications.

IMAGES:

CTA demonstrated significant dilationof the right ventricle as compared tothe left with diameters of 62:25mm.

Arteriographic exam of the rightpulmonary circulation

demonstrating only mild amountof flow to the right upper

pulmonary segment with no flowto the mid and lower segments.

Thrombolytic catheter was placedwithin the occluded mid andlower pulmonary segments.

Trans-thoracic ECHO demonstratedright ventricular septum displacementon diastole. This is a pathognomonic

sign of pulmonary hypertension.

Pre Intervention demonstrated largeamount of segmental thrombus

bilaterally. Sub occlusive on the rightpulmonary upper branch and leftbranches. Right lower and middle

lobe branches completely occluded.See arrows.

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Almost complete resolution of rightpulmonary thrombus with only

moderate amount of residual upperpulmonary thrombus.

Complete resolution of left pulmonary thrombus.

Post procedure CTA demonstratednormalization of right to left ventricular

diameter ratios at 46:49mm.

Arteriographic exam of the leftpulmonary circulation demonstrating

subocclusive thrombus within allarterial segments, see arrows.

Thrombolytic catheter was placed intothe left main and lower pulmonary

artery segments.

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A R T I C L E O F I N T E R E S TBy Chetan R. Patel, M.D., PGY1 Family Medicine

“A Tale of Two Interns"

If you talk to any physician and mention the experience of intern year,undoubtedly a flash of understanding, empathy and nostalgia is reflected inhis/her eyes, perhaps accompanied by a bittersweet smile. To quote CharlesDickens (from A Tale of Two Cities), "It was the best of times, it was the worst oftimes, it was the age of wisdom, it was the age of foolishness, it was the epoch ofbelief, it was the epoch of incredulity, it was the season of Light, it was the seasonof Darkness, it was the spring of hope, it was the winter of despair, we hadeverything before us, we had nothing before us, we were all going direct toHeaven, we were all going direct the other way – in short, the period was so farlike the present period, that some of its noisiest authorities insisted on its beingreceived, for good or for evil, in the superlative degree of comparison only.” Andit faithfully remains so to this day.

For those who went through residency in a different time, the modern era mayseem like a dream. It may even seem too easy. Fear not however, the Dickensianaspect of residency has not changed. The pay is still a pittance; the hours are stilllong (I average 74 hours a week); the patients are still demanding and unnaturallyill, perhaps even more so; and we are still eternally on the prowl for a morsel offood and a few spare moments. This is all while trying to not harm patients orembarrass ourselves too greatly.

Consequently, the skill most important to surviving residency is adaptation. Theamount of change during intern year is both personally and professionallystaggering. It is a metamorphosis on par with the caterpillar molting superficialand vestigial parts of it. As interns we must adapt to the ever increasingresponsibility, scrutiny, pressure, sleep deprivation and expectations we now findourselves facing. Piece by piece we uncover our inner physician. In a few shortyears, we will shed the trainee label to become fully-licensed providers ourselves.We will break free of the protective cocoon that is residency just in time to beswept up by the swirling winds of change that will surround the medical field forthe foreseeable future.

For us residents this is a boon. Rather than hatching into an era of continuousdecline, we are born into an epoch of change that raises the hope of real,meaningful reform. We of the internet age have been raised in a period definedby sea change. We know nothing if not progress. Our mantra: Harder, Better,Faster, Stronger. Forward. This tints the lens through which our generation seesthe world neither grey nor rose, but multicolored. Equally applicable in ourpersonal lives and professional careers, we strive to learn from our predecessorswhile seeking to improve upon their knowledge and experience. We strive forbalance.

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Despite the qualms of many of our elders and betters, the 80-hour work week isa blessing. Let's move past the idea that it is bad for training, as studies are nowshowing similar patient outcomes for physicians who trained with the duty-hourcap verses those who trained without. The real blessing, then, is not in patientoutcomes, but in the stability and continuity added to our hectic day to day lives.While trying to adapt to our new duties, having a steady schedule and the abilityto sleep every night is critical to both our mental and physical wellbeing, and ofcourse our sanity.

In addition to this ever changing milieu, the body of medical knowledge doublesevery 5-7 years. It is Moore’s Law of Medicine. This means that interns today mustcommand between 16 and 32 times the amount of medical knowledge of ourpredecessors who began residency 30 years ago. The individual physician oftoday is no longer a demigod, but an interchangeable part in the medicalindustrial complex. A part that can easily be replaced when business consultantsstate that our pay is not worth our production. As if these weren’t enough to beworried about, new residents are entering medicine at a time of financialcontraction. Physician incomes are decreasing with respect to costs and medicaleducation debt is at an all time high. Medical school costs have increased morethan five fold in the last twenty years alone, far outstripping inflation. Today’senvironment, while not the same as when you began your career, is still far froma utopian dreamscape.

All in all, the residency of the past is only modestly different from ours today. Andwhile the accreditation requirements may continue to change, the challenges foryoung physicians will not. We stolidly fight alongside you, our heroes andmentors, in a battle against father time and mother nature. Fear not for thefuture of medicine, for with your help and guidance we will be worthy successorsand stewards.

(Let's hope that Dr. Patel and the other "interchangeable cogs in the medical-industrial complex" read my column in last months Bulletin. --Ed.)

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NEW PHYSICIAN MEMBER

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W E L C O M E N E W M E M B E R

Shaun Ray Williams, M.D. earned his medical degree fromThe University of Alabama in Birmingham Medical School.He completed his internship at Baptist Health System, inBirmingham, Alabama and his residency and fellowship atEmory University, Atlanta, GA. He is certified inanesthesiology by the American Board of Anesthesiology.Dr. Williams practices at Anesthesia Associates, 2300Manchester Expressway, Suite F-2, Columbus, GA 31904.His office phone is 706-324-7146. We welcomeDr. Williams to Muscogee County Medical Society!

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