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Wisconsin Medical Journal PDF

948 Pages·1996·82.1 MB·English
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3 ESE OF PHYSICIANS /} A jftN<2 2'l9|6 ****** digit 191 SERIALS LIBRARY COLLEGE OF PHYS OF PHIL. 19 SOUTH 22ND ST. REET PHILADELPHIA PA 19103-3001 We Treat Groups. .Like People . Whenyou’repartofalargeinsurancegroup, servicecanbecome SMS InsuranceServicesoffersoneofthemostcomprehensive prettyimpersonal. Youcanloseyouridentity. Andendupfeeling groupinsuranceprogramsaround. Group coverageincludes likepartoftheherd. programsforliability, health,life, dental, disability, property, andevenretirement. Foryourpractice, clinic, orhospital. At At SMSInsuranceServices, wetreatgroupsandtheirmembers extremelycompetitivegroup rates. likepeople. Asindividuals. Wecandothisbecausewe specialize inservingoneveryspecialgroup ... the 7000-plus StateMedical With SMS InsuranceServicesyouget allthebenefitsofgroup Societyphysician-members, theirfamilies, andemployees. Sowe participation withoutfeelinglikeyou’repartoftheherd. . . . canfocus allourattentiononyou. Andyoualone. Formore information about SMS InsuranceServicesgroup insuranceprograms, contact: INSURANCE SERVICES, INC. Wisconsin based-physician owned-committed to servingyou. P.O.Box 1109 • 330E.LakesideStreet • Madison,WI53701 • (608)257-6781 • (800) 545-0631 • FAX(608)283-5402 Wisconsin Medical Journal TheWisconsinMedicaljournal(ISSN0043-6542)istheofficialpublicationoftheStateMedicalSocietyofWisconsinandisdevotedtotheinterests ofthemedicalprofessionandhealthcareinWisconsin.Themanagingeditorandeditorareresponsibleforoverseeingtheproduction,business operationandcontentsofthejournal.Theeditorialboard,chairedbythemedicaleditor,solicitsandscreensallscientific,specialandsoundings articles;itdoesnotscreensocioeconomicororganizationalarticles.Thechairprovidesleadership fortheeditorialassociatesandcommentson botheditorialsandletterstotheeditor.Althoughletterstotheeditorarereviewedbythemedicaleditor,allsignedexpressionsofopinionbelong totheauthor(s)forwhichneithertheWM/northeSMStakeresponsibility.TheWMJisindexedinIndexMedicus,HospitalLiteratureIndexand CambridgeScientificAbstracts. ThomasC. Meyer,MD,Madison Staff year single copies, $3 each. Previous years MedicalEditor Betty-Lou Pellicore, Madison single copies, when available, $4 each. For- Director,Communications eignsubscriptions,$40peryear. Editorial Board ShariHamilton,Madison ThomasC. Meyer,MD,Madison ManagingEditor SecondclasspostagepaidatMadison,Wise. Chair CherylMcCollum,Madison SusanF. Behrens,MD,Beloit ContributingEditor Published monthly JCKMehaefarsfrtraleiveynasHnD.C.K.uLHCtaoatmfynof,vnmeMtar,D,n,,MMDMDM,Di,l,WMwaaMaudiusilkswaeoauenukee VLiyDPcnrekniosediLug.BcnjMtoAeirsyogsenoir,sA,tsMasManiadtsditiasnsotonn Abadercgrecese3psp,rto1aal9vnl1ic7dce.eofdArourrfteomhrsaopiirnolinSizdenecegdtnaictAoesunpg1teu1ocs0i3att,lheA7r,catWt1ei9os1of8cf.OopcnoAtssdiot-n-- DonaldS.Schuster,MD,Madison MarthaGaie Medical Journal, PO Box 1109, Madison, WI BenjaminC.Wedro,MD,LaCrosse CommunicationsIntern 53701.Streetaddress:330E.Lakeside. VictorS.Falk,MD,Edgerton MedicalEditorEmeritus Telephone Postmaster 608-257-6781 ortoll-free 1-800-362-9080 Editorial Associates Send address changes to: Wisconsin Medical RussellF. Lewis,MD,Madison Advertising Journal,POBox 1109, Madison,WI53701. JohnP.Mullooly,MD,Milwaukee Advertisinginformationappearsintheclas- KennethI.Gold,MD, Beloit sifiedsectionatthebackoftheJournal.Fora ISSN0043-6542 JohnD.Wegenke,MD,Madison rate card or sample issue, please call 1-800- Established 1903 MaxwellH.Weingarten,MD,Milwaukee 362-9080. CharlesW.Schauberger,MD,LaCrosse Copyright1995 Subscription rates Members,$12.50peryear(includedinmem- StateMedicalSocietyofWisconsin bership dues); non-members, $35. Current Createdby theTerritorial Legislature in 1841 and now representing nearly8,500 memberphysicians, theSociety's purpose is to "advancethe scienceandartofmedicineandthehealthofthepeopleofWisconsin;ensurethatphysiciansareequippedtodealeffectivelywiththeeconomic andpoliticalaspectsofpractice;andserveasthepatientandphysicianadvocatetogovernmentandotherrelevantpublics."Themajoractivities oftheSocietyconcernmedicaleducation,peerreview, legislation,communityhealtheducation,scientificaffairs,socioeconomics,healthplan- ning,servicetophysicians,operationoftheCharitable,EducationalandScientificFoundation,andpublicationoftheWisconsinMedicalJournal. OfficialsoftheSociety District 1 District4 MarciaJ.S. Richards,MD,Milwaukee Clarence P.Chou,MD,Mequon RobertJ.Jaeger,MD,StevensPoint President TimothyG.McAvoy,MD,Waukesha JamesR.Keuer, MD, Minocqua RichardH. Ulmer,MD,Marshfield MarvinG.Parker,MD,Racine RobertE. Phillips,MD,Marshfield PresidentElect JohnE.Ridley, III,MD,Milwaukee RichardG.Roberts,MD,Madison JayF.Schamberg,MD,WestAllis District5 PastPresident GeorgeR.Schneider,MD,WestAllis TerryL. Hankey,MD,Waupaca ThomasL.Adams,CAE,Madison FrankH.Urban,MD,Brookfield Harry Zemel,MD, Fond duLac J. ExecutiveVicePresident RobertF.Purtell,Jr,MD,Milwaukee KevinF.Quinn,MD,Neenah HarryJ.Zemel,MD,FondduLac CassandraP.Welch,MD,Milwaukee Treasurer RaymondC.Zastrow,MD,Milwaukee District6 SandraL.Osborn,MD,Verona David Matteucci,MD,Kenosha David Deubler,MD,Kiel J. J. Speaker StephenD. Hathway,MD,GreenBay MichaelC. Reineck,MD,WestBend District2 AnthonyR. Mars,MD,Marinette ViceSpeaker AndrewB.Crummy,Jr,MD,Madison CyrilM. Hetsko,MD,Madison District7 Board ofDirectors JerryM.Ingalls,MD, Monroe CharlesV. Ihle,MD,EauClaire RaymondC.Zastrow,MD,Milwaukee AyazM.Samadani,MD,BeaverDam DouglasM. DeLong,MD, Ladysmith PaulA.Wertsch,MD,Madison Chair MarkH.Andrew,MD,Viroqua BradleyL.Manning,MD,Madison District8 ViceChair RobertL.Sellers,MD,Superior District3 MarkH.Andrew,MD,Viroqua gr - ’ JackM.Lockhart,MD, LaCrosse olLlGE OF PHYSICIAN. Or PHILADELPHIA JAN 2 2 3896 Contents January 1996 Vol. 95 No. 1 Opinions 5 President'spage Carpe Diem byMarciaJ. S. Richards,MD,Milwaukee 7 EVP report: Theviewfrom here Guiding the wanderers byThomasL.Adams,CAE,Madison 8 Guest editorial Understanding where we are, where we want tobe, and how to get there byJohn Frey,MD,Madison J. 10 Letters to theeditor The physician-assisted suicide debate byJosephR Gibes,MD,Darlington 11 Bedside teaching byRodSorensen,DO,Marshfield 12 Hearsay Jammin'withthejournals Focus on family practice 13 Family practice residency training capacity in Wisconsin: current status and future projections byWilham Hueston,MD,andRalphSuechting,MA,EauClaireandMadison J. 17 Graduates comment on issues related to the decline ofWisconsin family physicians providing maternity care byNickTurkal,MD,andCarrolChristman,MA,MilwaukeeandMadison 22 Acurriculum in managed care for family medicine residents byLorenA. Leshan,MD,Milwaukee Public health 27 Over-the-counter sales of cigarettes to children: results ofcompliance checks in Wisconsin, 1992-1995 byMaryGothard,JohnFox,MD,ThemisFloresdePierquet,CindyMusial,andRichardYoast,PhD, Madison WAPC 30 Position Statement Human Immunodeficiency Virus (HIV) education and testing in the perinatal period Contents Socioeconomic 37 Oneofa kind Combining sports medicine, rehabilitation and family clinical care makes physical UW and fiscal sense for Clinics byMichaelMuckian 42 A wordfrom WIPRO Warfarin encouraged for stroke prevention in atrial fibrillation byJayA. Gold, MD,JD, MPH, Madison 44 CD Rom review Clinical Reference Software—Patient Handouts byR.ZorbaPaster,MD,Oregon 46 Videoconferencing Technology in medicine by Douglas Turecek, Management Information Systems director 47 Tenants insurance LIBRARY 0 bvMichaelJ. Dolan,CLU,ChFC,Madison JQl I F(2jZ nr rn Organizational 2 2 1996 49 Physicians keep medical practice in the family byCherylMcCollum, WMJcontributingeditor ^ 52 Family practice: the call for more generalists continues byMarthaGaie,SMScommunicationsintern 54 ADA is changing the way physicians practice medicine byKalisaBarratt,JD,SMSstaffattorneyandMarkL.Adams,JD,CAE,SMScorporatecounsel 57 Third in a series Practical considerations regarding ethical questions in the daily practice of medicine byMariaVanCleve,SMSCommissiononMedicineand Ethicsstaff 59 Obituaries 60 County society news 61 Physician briefs 63 Bayfield County to have model program 65 Classified ads Our cover: Partnerships in familymedicine. This issueexplorespartnerships and trends in family medicine, from inside residency programs, within our medical schools, between disciplines and, even, among family members. Theme articles are in the index. Photo of Dr BenGrafatUW Clinics-Research Parkby Bob Rashid (related storv, p. 37). The Doctors Advisory Network You make the We make the connection. call. Free referrals. A free phone call. What The Doctors Advisory Network has could possibly be better? How about made more than 4,000 referrals across a choice oftop-line, managed care the country. experts in your neck ofthe woods? You’ll receive a Network starter kit — One call to the Doctors Advisory including a complimentary booklet Network is all it takes to access A Physician's Guide to Selecting physician-friendly lawyers, business and Working with a Managed Care consultants and actuaries. As a Attorney or Consultant. member ofthe American Medical Calltollfree800AMA-1066, andpress2. Association (AMA), you can use this The Doctors Advisory Network. — service any time you need it free! Your direct line to managed care Nonmembers pay a nominal fee. solutions. American Medical Association PhysiciansdedicatedtothehealthofAmerica Opinions President's page Carpe Diem "It is a paradox that in our timeofdrastic change, when thefuture is in our midst devouring thepresent before oureyes, ive have never been less certain about what is ahead ofus." —Eric Hoffer am sitting in my hotel room, in I AMA attendanceatthe interim meeting,asIwritethismonth. While traveling to DC, on "thebestairline in the air." I picked up a magazine and started to read a report on BusinessWeek's "Health Care Sum- mit," a futuristic conference for top business management. I was taken aback by what I read. The consensus of the business leadersinattendancewasaclearrec- ognitionofthecriticalrolethatphy- sicians should play in the ongoing health transformation. They voiced frustration at having to wait for us toabandonourcurrentresistanceto change. Indeed, a note of disap- pointment in the dearth of leader- ship by physicians was communi- MD cated. Commentswere madeon the Marcia J. S. Richards, apparent lack of organization of physicians,an ironicstatementcon- sideringmycurrentparticipation in business,theycannotallow thecur- the problem themselves. a meetingoftheAMA,anorganiza- rent situation to persist and they Theleadersofindustryfeelmuch tion thatisthoughttobestrepresent have assumed the leadership role. like many ofus. They would prefer the collective voice of medicine. Most see thebill for medical care of working on their primaryvocation, Hope was expressed that we, as their employees as a cost of doing but will take on others for the sur- physicians,willseizetheleadership business. We are a necessary sup- vival of their business. Notice the roleinreformingthehealthcaresys- plier for their industry to continue. parallel, as most ofuswould rather tem.ManyCEOsindicated thatthey But, like a third partyvendor, ifour care forpatientsthannegotiatecon- really didn't want to lead the costsare toohigh, or thequality too tracts.Yes,thebusinessleaderswant changes in health care. But because low, (notice the middle ground be- us to seize the day. And I had be- ofthefinancialconsequencestotheir ing value) they will step in to solve Continuedon nextpage WisconsinMedicalJournal•January 1996 5 Continuedfrom precedingpage the Japanese cars arrived on the ation will be temporary. lieved that businesses wanted the westernshoresoftheUS. Wedonot Butfortunatelyformostinmedi- lead dog position. They said, if accept, or truly believe, that the fu- cine there is a deep concern about medicine can run parallel with us, ture will be dramatically different. the future of our profession. Many ata reasonablepaceand inasimilar Therefore, we have not yet re- of us are still in training and ex- direction,thenphysiciansandother sponded with the needed vigor to tremely anxious about the current providersofhealthcareservicescan the tides of change that wash on situation. I appreciated this even set the rest of the game plan. medicine's shores. Remember the more after talking with the student Yes, many of us will have addi- ensuing years when the percentage and residentphysician leaderswho tional constraints under new medi- ofAmerican-made cars on the road attended this AMA meeting. Addi- cal practice styles, but so do most dropped, and "Made in America" tionally, with the increased output other professions if they are to sur- was often second best. How times of our training programs (half) of vive in a world-based society. Little have changed with innovative de- physiciansareunder50yearsofage room is left for cottage industries, a sign, new manufacturing tech- andhaveatleast15-20yearstoprac- style of business that many small niques,and attention toqualitycon- tice. practices have more in common trol. The best value in cars are now ThisNewYear-whetheryouplan with than with large corporations, made at home. Perhaps this is why many years of medical practice or who purchase our services. Look wehaveseensuchattentionpaidby are concerned about the future- around you. Medicine is taking on the foreign auto makers to luxury even if you are graying at the the corporate model. That is not to cars.Theyareattemptingtobecome temples (or experimenting with say that cottage industries can not like the physicians of Harley Street other colors as I am)—resolve to ac- often flourish and grow. They do, in the area ofauto sales. cept the challenge put forth by but usually if successful, they ulti- For others of us, we see the Americanbusinessleaders. Become mately integrate or are acquired. changesoccurringinmedicineasan involved, demand or accept leader- Againnotetheuncannysimilarities. intrusion,andonlyhopethatwecan shiprolesinthereformofhealthcare Perhapsasphysicians,thesesimi- survive until we cash in our retire- delivery. larities are parallel to the situation ment chips. Yet others, blindly be- Yes, seize the day. Carpe diem. oftheauto makers in Detroit, when lieve (orwish) that the current situ- 6 Wisconsin Medical Journal •January 1996 EVP report: The viewfrom here Guiding the wanderers Teacher— One whokindlyguides thewandereron his way. —Quintus Enniuse WASDEEPLYSADDENEDlast month (NCMS) as director ofGovernmen- I to receive a telephone call in- tal Affairs. I was 29 years old and forming me of the passing of my fresh from 3 yearsofwork onCapi- friendWilliamB.A.J.Bauer,MD (See tol Hill in Washington, DC, where 1 obituary by Russell King on page had been "lobbied" many times. 59). As he lay dying of cancer. Dr While I had never done any lob- Billcalled andasked metovisithim bying myself, the NCMS had for athishomeinLadysmith. Ifirstmet many years retained John Huske Dr Bill when he was honored at the Anderson, Esq., as its lobbyist and StateMedicalSociety's50YearClub advocate with the Legislature. luncheon in 1989. From that meet- When I met and worked with John ing we developed a delightful pen he was 74 years old and going pal friendship thatopened my eyes strong. During our year together, to so many thoughts and ideas. John was my mentor, teaching me During my occasional travels in whatIneeded toknowtoeffectively northern Wisconsin, would take represent the medical profession. I time from my schedule to drive to Among other things, he taught me Ladysmith to spend an enjoyable never to quit, never give up on an evening, laughing and talking with issue until the last possible vote in a friend. thelastpossiblevenuehasbeencast. Thomas L. Adams, CAE Duringmylastvisitwith him,Dr That advice has served me and the Bill reflected on his life and the organizations where I have worked mentoring role that so many other well during the past 18 years. gram. The program is run through physicians had played in his own In my conversation with Dr Bill theSMS'sYoungPhysiciansSection life. With all the changes medicine he frequently referred to what he (YPS),which includesphysicians40 is experiencing he was hopeful that had learned from others. years and younger. the role of mentoring, which he He related to me how much his Nearly50YPSphysiciansinvari- deemed a critical part of medicine, father, who also was a physician, ous specialities are mentors to resi- would not disappear. It's amazing, influenced his medical career. His dents. Theprogramallowsresidents hetoldme,howmuchyoucanlearn father often told him, and he later intheirlastyearofresidencytocon- from shadowing another physician learned himself, that so much of tact a young physician in an area of fora day. Listeninghow they teach your practice will not be what you thestateorintheirspecialityandask a diabetic patient healthy diet learned in medicalschool, butwhat them questionsabouttheirpractice. choicesorwatchinghowacolleague youlearnfromyourcolleagues. (For Thisallowsresidentstogeta feel for performs a delicate procedure are a look on the influence of a parent what the physician climate is like justtwoexamplesofhowphysicians inachild'scareerchoiceofmedicine, beforetheymakeanymajordecision can absorb information from their please see our story this month on on where they would like to prac- colleagues. You can learn many three family physician parent-child tice. It's an excellent program de- wonderful things, he said, from teams in Wisconsin). velopedbyourYPSand it's thefirst watchingandlisteningtootherphy- Through Dr Bill's writings, step for residents of what we hope sicians, no matter what their age. whether in the form ofa syndicated will includea lifetimeof mentoring That conversation got me think- monthlyadvicecolumnorhisbook. experiences. ingaboutthementorsinmylifeand OutofDr. Bill's Black Bag, he strived Forthoseyoungphysiciansinter- how much we all rely on the pass- to help others and to teach through ested in getting involved in ing ofknowledge from one genera- his wealth ofexperiences. mentoring a resident, please call tion to the next. My discussion with Dr Bill re- SMS Field Representative James Eighteen years ago I joined the mindedmeofoneoftheStateMedi- Reuter, who staffs the program, at North Carolina Medical Society cal Society's own mentoring pro- Continuedon nextpage WisconsinMedicalJournal•January1996 7 Continuedfrom precedingpage bers, Jackie Millar, was shot in the records, she was shot in the back of 1-800-362-9080, (608)257-6781 orvia back of the head by two teenagers. theheadbytwoteen-agecarthieves. e-mail [email protected]. Since that column, both of the boys Both face charges, including at- Dr Bill Bauer was a special man. whoallegedlyshotJackiehavebeen tempted homicide, in adultcourt in Those of us lucky enough to have waived into adult court. Jackie re- Sauk County. Jackie works as a been his students will miss him mainsinfairconditionatUniversity meeting planner at Lakeside Asso- greatly. Hospital where we've been told by ciationServices,Inc.,asubsidiaryof familymembersthatshe'smadetre- SMS. Shehastwosonswhoarestu- An update onJackie's condition mendous progress. She's talking, dents at the University of Wiscon- Mylastcolumndiscussed a tragedy smiling and in physical therapy. sin-Platteville. Wecontinueto pray that hit a little too close to home Jackie was visiting a friend in for her and her family.*:* when one our own SMS staffmem- Reedsburgwhen,accordingtocourt Guest editorial Understanding where we are, where we want and how to be, to get there JWohn Frey, MD, Madison J. isconsinhasbeen a remark- past 20 years has tried to hit what what motivates young doctors to ably supportive environ- seems like a moving target, at first train as family physicians in the ment for family practice, both recommending thetrainingofmore state. A personal tie to the state is through themandateoftheLegisla- physicians and then years later ap- among the most important reasons ture which helped bring family pearing to retrench and say thatwe that medical graduates choose to medicine education to the medical might be training too many - or come here, or stay here after medi- schools and through the develop- training the wrong types of physi- calschool,asresidents.Thestatehas ment of large multispecialty group cians. Learning how to notspin out flourished in filling residency posi- practiceswhich havevalued family on an icy road, I was instructed 30 tionsinpartbecauseithasbeenable physicians as members. This envi- years ago by my father, was learn- toattractresidentsfromotherstates. ronmentcannotbeignored. Healthy ing to not jerk the wheel hard but Since historically two thirdsoffam- plants grow in healthy soil. turn into the spin and accelerate ily practice residency graduatesbe- However,familymedicineeduca- yourwaybacktothestraightahead. gin practice within one hundred tion has not been immune to the American medical education has milesofwhere they train,attracting changing funding and organization appeared not to have learned how students from other states to train of health care. The search for the to drive on icy roads and as a result here as residents will net a large rightmixofgeneralistsand special- feels likeweare outofcontrol, orat number of future family doctors. istscontinuestobea search forboth least threatening to be if we aren't Should the number of graduates of the proper ratio and theproperdis- clear about where exactly we want theUWand MCWwhochoosefam- tribution of physicians for the to go. Whereweshould goiswhere ily practice residencies increase, as peopleofthestate.Aseriesofwhite we always should be heading and those of us involved with student papersandnationalreportsoverthe that is to keep our eyes clearly on education feel it must, it may de- the needs of all types of communi- creasesubstantiallytheimmigration ties and the needs ofour patients. of non-Wisconsin medical school Dr Frey is chair of the Dept of Family HuestonandSuechting1pointout graduates who train here. Medicine for theUniversity ofWiscon- thattheplanningfortraininginWis- On theotherhand, ifthenumber sinMedicalSchool. consinrequiresanunderstandingof of graduates choosing family prac- Wisconsin MedicalJournal •January 1996

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