NH Medical Society

7 North State Street

Concord, NH 03301

(603) 224-1909

(603) 226-2432 fax

nhmed@nhms.org www.nhms.org

Charles Blitzer, MD….... .President

Palmer P. Jones………….EVP

Catrina Watson…………..Editor

NHMS New President..................... 1 It has Been a Good Journey .......... 2 Legislative Update ......................... 3 Adult Emergency Care................... 4 Rx Law ........................................... 6 Q&A................................................ 6 CME, Meetings, Events.................. 7 Inauguration................................... 8

Opinions expressed by authors may not always reflect official NH Medical Society positions. The Society reserves the right to edit contrib-uted articles based on length and/or appro-priateness of subject matter. Please send correspondence to “Newsletter Editor” at the above address

Physicians Bi-Monthly

NEW HAMPSHIRE MEDICAL SOCIETY NEWSLETTER NH Medical Society; For The Betterment of Public Health Since 1791

January/February 2009

Do you or a colleague need help?

The New Hampshire Professionals’ Health Program (NH PHP) is here to help!

The NH PHP is a confidential resource that assists with identification, intervention, refer-ral, and case management of NH physi-cians, physician assistants, dentists, and dental hygienists who may be at risk for or affected by substance use disorders, behav-ioral/mental health conditions, or other is-sues impacting their health and well-being. NH PHP provides recovery documentation, education, support, and advocacy – from evaluation through treatment and recovery.

For a confidential consultation, please call Dr. Sally Garhart @ (603) 491-5036

Charles Blitzer, MD Thank you to those who were able to at-tend my Inaugural dinner. It is very hum-bling and quite daunting to be the 177th president of the New Hampshire Medical Society. Many of you have shared with me that I have a tough act to follow – I became acutely aware of that fact a year ago when Oglesby Young, MD, (Oge), described a true passion of his in his inau-gural address entitled “Saving the Soul of Medicine.” Oge put great energy into that effort this past year in his work with the Medical Society emphasizing what we, as physicians, seek to accomplish and what we need from society – to provide us with a reasonable working environment. I became somewhat more comfortable with taking on the Presidency of the New Hampshire Medical Society when I spent a working weekend with Oge in November at the AMA interim meeting. I want to touch not on the soul of medicine but, rather, on what an Orthopaedist might call the skeleton of medicine, that upon which we rely to accomplish our healing art: Communication.

It is quite fitting that we are gathered for my inauguration in an art museum as, cer-tainly; much of what art does is to commu-nicate about human feelings and emo-tions, hopes and worries. It gave me great pleasure to have had most of my family with us. My Mom, an artist, gave us all an appreciation of the skills of visual communication. My Dad, who died in 2004, made a career in a field of medicine known to rely heavily on communication, Psychiatry. He clearly conveyed to my brother, a radiation oncologist, my sister, who works in medical faculty development and myself, the satisfaction of a career in medicine. As an Orthopedic Surgeon, a field not known for its practitioner’s stellar communication skills, I hope to encourage all members of the Medical Society to work to improve both our individual and our collective skills in this area. This is critical for all physicians and for medicine for many reasons:

With clearer communications our patients will better understand their diagnosis and, hopefully, improve their ability to manage their condition. Improved communication can improve patient satisfaction and pa-tient safety – something I have seen re-peatedly at the medical liability claims re-view committee I serve on. Poor commu-nication can have devastating conse-quences as discussed by the cardiologist and Nobel laureate, Bernard Lown, who wrote about “words that maim.” Good communication improves physician satis-faction as well.

NHMS Welcomes New President

Continued on pg. 9

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It has been a great privilege to serve as your New Hampshire Medical Society President. I have been honored to represent the doctors of this state as one of your advocates with lead-ers of both our federal and state govern-ments. Like presidents before me, I have en-joyed the unique position of trying to make better both the lives of physicians and our patients. With our capable medical society staff and the support of other active physi-cians, we have fought to protect the environ-ment in which we work- the environment in which we as physicians care for our patients.

This job has been a rich educational experi-ence and deeply gratifying. Time from my practice has given me many moments to re-flect. One of the benefits of a long career is there being plenty to look back on.

Medicine has been good to me in more ways than I could have imagined when I applied to medical school. It has taught me discipline, empathy and a fullness of heart when con-necting with other human beings from all walks of life. We experience human emo-tions to another depth- great joy, deep sor-row, frustration and fear, and certainly love from which all emotions take root. To para-phrase the famous German poet, Maria Rilke, as physicians we have many occasions “to look into ourselves and find how deep is the place from which life flows.”

The other day I saw a four year old girl, Melissa, with her mom who is about to have another daughter. I said to Melissa “I hope your baby sister comes out as smart and as healthy and as pretty and as kind as you.” And she looked up to me and added “and, and, and, and with no cavities like me.”

Just before Christmas I saw a three year old boy, Paul, with his mom who is having an-other son. I asked Paul if he had named his

baby brother, and he said “Yes.” His mom quietly smiled, sheepishly covering her face. So I asked Paul “what is his name going to be?” And he proudly announced, “Santa Claus.” Oh, how deep is the place from which life flows.

Medicine continues to transform more rapidly than ever before. We are able to do consid-erably more for our patients than when many of us started. Who could have imagined that in-vitro fertilization would be such a viable option today when I saw infertile couples years ago? Our profession was dominated by primarily middle-class, white males when I joined. It has since become greatly enriched by the full acceptance of women and the em-bracement of those from diverse ethnic and socioeconomic backgrounds. My son’s sec-ond year Dartmouth Medical School class presently has 55% women and 45% minority students.

So much of what is wondrous in medicine is communal. I am grateful for the presence of others who have shared my journey. A high-light of this year has been traveling the state to speak with medical staffs and to meet phy-sicians from many communities. I am im-pressed that we are a faithful, compassionate and uncompromising lot when it comes to caring for our patients. Despite the growing complexities in medicine today, it is apparent that most of us have not forgotten why we chose to be physicians.

You sacrifice much for the privilege to do great work. You help many, far more than you can know. Please accept my admiration and my gratitude.

As I leave this position as President of our Medical Society, I have three simple but im-portant thoughts. First, there has never been a more critical time for physicians to engage in

It Has Been a Good Journey

Continued on pg. 3

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the legislative process. We have a health-care crisis with costs steeply rising, grow-ing uninsured and aging populations and limited access to primary care. For this rea-son, there are many forces outside of medi-cine wanting to change the way we prac-tice. Let us be mindful that those of us who really understand patient care should be at the lead of any health care reform.

Second, as physicians I hope that we never underestimate the meaning of our support for one another– physically, intellectually and spiritually. Although there are mo-ments in medicine that feel very lonely, knowing that we are on this journey to-gether should always be a comfort.

And finally, we should never let anything or anyone compromise our relationships with our patients. Technology is exciting and our expanding base of medical knowl-edge is truly gratifying, but it is our rela-tionships with patients that will keep us going on our journey in medicine. I worry that we are reading MRI reports and not listening to our patients’ stories. I fear that we are looking into the screens of com-puters more than we are looking into their faces– missing expressions which tell us far more about the human condition. It is this soul of medicine that makes our pro-fession so special. Let us always fight to preserve this soul.

Thank you for the opportunity to have served you and to have known you better.

Oge Young, MD

Legislative Update

Déjà vu all over again ….

The trial lawyers have introduced several bills to repeal or weaken RSA519-B, the pre-trial panel law. Personal injury/trial lawyers are also attempting to change the current appor-tionment of damages law, which would un-fairly and financially, burden defendants who end up in court after others, in a multi-defendant law suit, have settled out of court (HB197). Two years ago, Governor Lynch successfully vetoed a previous attempt.

Expansion to HIPAA privacy provisions for electronic medical records (EMR) is back in HB580. The bill would require health care providers to give patients audit trials of their EMR, upon request. (Current HIPAA law re-quires audit trials as an internal security tool.) The bill also requires that, as of Jan. 1, 2010, all EMR systems would have to have the abil-ity to segregate certain patient information and segregate certain providers within an EMR system.

There are also some unusual bills this year …

HB495, requiring physicians to get a signed statement from a patient disclosing that the doctor does not make hospital visits.

SB81, requiring the Board of Medicine to es-tablish a bill of rights for urology patients.

HB249, prohibiting hospitals to have rules governing paramedics. (Hospitals don’t do that now – there is a state board that regulates EMTs.)

HB359, requiring health care providers to state the portion of payment covering costs of the

uninsured.

Janet Monahan

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Patients and visitors commonly assume that if an unexpected medical event occurs while at a physi-cian's office, the physician and staff members will respond with expertise and appropriate equipment to take immediate action. Being prepared to man-age a medical emergency in the office setting in-volves evaluation, preparation and planning.

Evaluation

Adequate preparation begins with a thorough of-fice system evaluation to determine the unique characteristics of the office setting and the pa-tients served. Based on this evaluation, a focused plan can be developed that uses strategies de-signed to meet the specific needs of your patient population based on your resources.

A retrospective look at emergencies that have pre-sented or developed will assist in formulating a profile of trends for which the office can prepare. Determine the average response time for EMS. Once you have completed your evaluation, prepa-ration and planning can begin.

Office Preparation

Based on the evaluation of the office setting, pa-tient population and available resources, determi-nation of appropriate equipment can be made. If definitive advanced life support is readily avail-able (such as the practice is located in an urban area), then a minimal amount of equipment and supplies may be necessary. In more rural areas where transport times can be delayed it may be necessary to insure the availability of adequate supplies to support the patient. Providers and staff must maintain competency in the equipment that is available in the office. At a minimum, all prac-tices should have staff trained in basic life support (BLS) present when patients are at the office.

Planning

Key to an emergency response is a coordinated plan. A written protocol insures that staff mem-bers have an understanding of their respective roles during an emergency event.

Ideally, the plan should delineate specific respon-sibilities of each staff member. Once the plan has been developed conduct drills to practice the office’s response to a medical emergency. These drills provide staff the opportunity to learn their roles, evaluate the plan, implement changes and develop the confidence and skill needed to re-spond effectively when an emergency does oc-cur.

Ongoing monitoring of supplies is important to insure that they are not outdated and are in proper working order. On a monthly basis the emer-gency equipment and medication should be evalu-ated. A log of this review should be maintained.

Lack of appropriate training and equipment may result in an adverse outcome. Do not wait for an emergency event to discover that you are ill-prepared.

Medical Mutual of Maine's "Practice Tips" are offered as reference information only and are not intended to establish practice standards or serve as legal advice. MMIC recom-mends you obtain a legal opinion from a qualified attorney

for any specific application to your practice.

NHMS Members

The New Hampshire Medical Society offices at 7 North State Street Concord,

New Hampshire are your offices

You are welcome to stop by anytime to:

• Catch your breath when in Concord

• Meet with colleagues (call ahead to reserve meeting space)

• Use wireless to check your email or search the net.

• Enjoy a cup of your coffee, use the micro-wave

• Put your feet up and read Usual hours 8-4:30 Monday through Friday

603-224-1909

Adult Emergency Care in the Office Setting

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New Hampshire’s citizens are well on their way to becoming the most successfully immunized people in the nation. According to the National Immunization Survey (NIS), in 2007 New Hamp-shire had the second highest immunization rate nationally for children ages 24 and 35 months. Not only that, over 77% of our 65 and older popu-lation have received an influenza vaccination in the last year and 72% have received a pneumo-coccal immunization. That’s great for our chil-dren and seniors, but what about our pre-teens and adolescents? There is no reason why New Hampshire shouldn’t have high childhood and adolescent immuniza-tion rates. After all, New Hampshire is one of the few states that provides all childhood and adoles-cent vaccines to health care providers at no cost. This unique program is possible through a part-nership with New Hampshire insurance compa-nies, the State legislature, and federal funding from the Centers for Disease Control and Preven-tion. New Hampshire health care providers may obtain any childhood and adolescent vaccine from the current immunization schedule without having to pay out-of-pocket. Now is the time to focus attention on pre-teens and adolescents. Every New Hampshire pre-teen and adolescent child should enter into adulthood fully immunized with all vaccines recommended on the adolescent immunization schedule. The Advisory Committee on Immunization Prac-tices (ACIP) recommends that pre-teens get sev-eral vaccines at their 11- or 12 year-old check-up .

• Tetanus-diphtheria-acellular pertussis vaccine (Tdap)

• Meningococcal conjugate vaccine (MCV4)

• Human Papillomavirus (HPV) vaccine, for girls

• Influenza (flu) vaccine (annually from September through January and beyond

Please place pre-teen and adolescent immuniza-tions on your priority list. Consider special initia-tives and outreach campaigns to either get these children immunized and, in the case of HPV vac-cine, to ensure they complete their immunization series. The New Hampshire Immunization Program (NHIP) will work with you to make sure that you have all the vaccines to meet this challenge. Please contact the NHIP at 271-4482 or 1-800-852-3345 x4482 if you have questions or would like to begin a pre-teen and adolescent immuniza-tion outreach initiative in your practice or com-munity.

• Let’s work together to ensure that all of New Hampshire’s pre-teens and adoles-cents are protected from vaccine-preventable diseases.

Please see Immunization Schedule on p.12.

Pre-teens and Adolescents – Now is the Time

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Amended NH Rx Law Changes to The New Hampshire Controlled Drug Act, effective January 1, 2009. Note that the “100 dosage units” (maximum) is de-leted and the amended law allows up to a 34-day supply of Schedule II and III controlled substances to be dispensed.

RSA 318-B:9, IV was amended as follows (the bold print represents new sections and strike-outs represent sections removed from the cur-rent law).

RSA 318-B:9, IV. No prescription shall be filled for more than a 34-day supply [or 100 dosage units, whichever is less,] upon any sin-gle filling for controlled drugs of schedules II or III; provided, however, that for controlled drugs, in schedules II or III, that are com-mercially packaged for dispensing directly to the patient, such as metered sprays and inhalers, liquids packaged in bottles with calibrated droppers, and certain topical preparations packaged with metered dis-pensing pumps may be filled for greater than a 34-day supply, but not more than 60 days, utilizing the smallest available product size, in order to maintain the dosing integ-rity of the commercially packaged contain-ers; and, provided that with regard to am-phetamines and methylphenidate hydrochlo-ride, a prescription may be filled for up to a 60-day supply if either such prescription speci-fies it is being used for the treatment of atten-tion deficit disorder, attention deficit disorder with hyperactivity, or narcolepsy.

Retired Ob./Gyn available for part time (Gyn. only) office/ clinic

position: contact JATMD@OPTONLINE.NET

Frequently Asked Questions

Q : Now that we are only required to send Continuing Education reports

every year what should we do? Do you want us to send in records for New Hamp-shire Medical Society or New Hampshire Osteopathic Association to keep track or would you prefer that we wait and send all the records in when we file?

A : Please only send in CME reports with your reporting form when you are

asked to file.

Q : When are my New Hampshire Medi-cal Society membership dues due?

A : The invoices generally go out in De-cember for the upcoming year, they are

payable upon receipt. A second billing will go out in February.

Q : Is there a penalty if I don’t get my CME report in by February 28th?

A : No but please get them in as soon as possible.

National Healthcare Decisions Day will be recognized again in NH this year on Thurs., April 16. Gov. John Lynch will sign a proclamation that day and we are urging health care providers to do an educational event on that day (or some-time that week) to encourage your em-ployees to talk about/do their own ad-vance care planning. More info. is at www.healthynh.com/fhc/initiatives/ performance/eol/endoflifecare.php and www.nationalhealthcaredecisionsday.org

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CME, MEETINGS & EVENTS

SEASIDE CME New Hampshire Academy of

Family Physician’s

Continuing Medical Education

Conference

March 27-29, 2009

For information call 603-224-1909

or email: catrina.watson@nhms.org

Sheraton Portsmouth Harborside Hotel

250 Market St. Portsmouth, NH

For room reservations call: 603-431-2300

Keynote Speaker:

Richard Roberts, MD

Additional speakers include:

Phil Lawson, MD,

Steve Schwartz, MD,

Aaron Geller, MD,

Matt Norman, MD,

Robert Lanney, Esq,

Peter Grasso, Pharm. D.

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President’s Inauguration

Paul Bergeron, MD, F.B Dibble, MD, Mr. Bergeron, Renata Dutton, Mary Pyne, Joy Potter, Mae Bradshaw

Pam Young, Meg Blitzer, Jeanne Shaheen, Charles Blitzer, MD, Sandy Blitzer, Att. Bill Shaheen, Oge Young, MD, Mrs. Blitzer

Winter Garden at Currier Museum of Art

Oge Young, MD, Charles Blitzer, MD

Jeanne Shaheen, Charles Blitzer, MD

Amanda Leese, Beth Smith, MD, John Robinson, MD, Janet Monahan, Stuart Glassman, MD, Anne Smith, Marianne

Glassman, Richard, Melanie Ferrell

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President continued from page 1 Our communication skills can always be practiced and improved. When I was skiing as a child we would take turns being the one to ride up the chair-lift as the single paired with a stranger. My family was always impressed that whenever Dad got off a ski lift after riding up with a stranger he would have that person’s entire life history! Wouldn’t it be nice if each of us could develop such an ability to have our patients openly share their stories? With better communication we physicians will be able to provide higher quality care more efficiently. Technology has been touted as a wonderful solu-tion to the difficulties of communication. We have seen spectacular evolutions of the technology. Some of us remember when the beeper, now go-ing the way of the eight track tape, was a signifi-cant advance. Now we have elaborate HIT, which is Health Information Technology for those of you thought I was talking about heparin induced throm-bocytopenia. At the Currier, there were several members of the Health Information Technology Working Group. This committee of the New Hamp-shire Citizens Health Initiative was established by executive order of Governor Lynch with the objec-tive to assess the status of Health Information Technology in New Hampshire and to make rec-ommendations to improve access to care, safety of care and efficiency of care. Those of us who utilize PACS, EHR, and cell phones can attest to the improvement these have brought (vs. lost films, difficulty finding notes and test results and being tied to a house phone when on call) but we also see difficulties with proprietary EHR’s which don’t talk to each other, long, standardized notes in which relevant content is extraordinarily difficult to find, and particularly, patient complaints of the physician paying more attention to the computer than the patient. We need to focus on the patient and make sure our communication is effective in order to appropriately diagnose the patient and educate them on the care of their problem. We also have trouble communicating with our col-leagues. More and more of our colleagues are not

getting involved with medical staff affairs or poli-tics.

Only 20% of physicians nationwide are members of the AMA. About 60% of New Hampshire physi-cians are members of the New Hampshire Medical Society. Increased physician participation with these organizations improves our ability to com-municate to society as a whole the New Hamp-shire Medical Society’s continuing goal since 1791 of working “For the betterment of the public health.” As attributed to Pericles, “Just because you don’t take an interest in politics doesn’t mean politics won’t take an interest in you,” so please take a little time when you are back at your prac-tice or hospital to urge your fellow physicians to join our Medical Society. I hope, that working together, we can improve many aspects of our communication and help to keep the soul of medicine healthy. I also want to thank my wife, Sandy, for encourag-ing me to take on the challenge of being NHMS President and putting up with the burdens it will place on our time.

Charles Blitzer, MD

Charles, Sandy Blitzer

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The New Hampshire Medical Society Corporate

Affiliates Offer the following services

Accounting

Apparel & Services

Billing Services

Business Management

Credit Card Processing

Dental Insurance

Document Scanning

Electronic Medical Records

Financial

Health Insurance

Malpractice Insurance

Legal Services

Office Supplies – Printing

Pharmaceutical

Quality Improvement

Staffing Solutions

Technical

Telecommunications

Transcription

Vaccine programs

NHMS CAP is a paid membership program whose members meet criteria as posted at www.nhms.org

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SAVE THE DATE!!!!

SUICIDE PREVENTION CONFERENCE

Presented by the Suicide Prevention Council, the Youth Suicide Prevention Assembly and the Geriatric Education Center

Friday, November 6, 2009 at the Waterville Valley Conference Center

A variety of plenaries and workshops will be offered, including:

- Community based approaches to suicide prevention

- Depression across the lifespan

- Clinical workshop on addressing the needs of older adults

- CALM : Counseling on Access to Lethal Means

This conference will focus on:

what we have learned about suicide prevention over the years

what strategies have been demonstrated to be effective and

how these can be implemented in these challenging times

The registration cost will remain at $50 including meals and materials.

Contact hour certificates will be available. CEUs, CMEs will be pursued.

For more information, contact: Cindi Lapointe at 603-653-8360 or cindi.lapointe@dartmouth.edu

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NH Medical Society Welcomes New President Charles Blitzer, MD

F.B. Dibble, MD, Gary Woods, MD, Oge Young, MD, Charles Blitzer, MD, Seddon Savage, MD, Mark Sadowsky, MD, Albee Budnitz, MD, David Charlesworth, MD, Gary Sobelson, MD

New Hampshire Medical Society

7 North State Street

Concord, New Hampshire 03301-4018 RETURN SERVICES REQUESTED

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