January 2012

Meet our new president

S MB O

P i m a C o u n t y M e d i c a l S o c i e t y • J a n u a r y 2 012Home Medical Society of the 17th United States Surgeon-General

2 SOMBRERO–January2012

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SOMBRERO–January2012 3

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Official Publication of the Pima County Medical Society Vol.45No.1

PublisherPimaCountyMedicalSocietySteveNash,ExecutiveDirector5199E.FarnessDrive,Tucson,AZ85712Phone:(520)795-7985Fax:(520)323-9559E-MAIL: [email protected]: pimamedicalsociety.org

SOMBRERO (ISSN 0279-909X) is publishedmonthlyexceptbimonthlyJune/JulyandAugust/September by the Pima County Medical Society,5199E.Farness,Tucson,Ariz.85712.Annualsub-scriptionprice is$30.PeriodicalspaidatTucson,

Arizona.POSTMASTER: send address changestoPimaCountyMedicalSociety,5199E.FarnessDrive, Tucson, Arizona 85712-2134. Opinionsexpressedarethoseoftheindividualsanddonotnecessarily represent the opinions or policies ofthepublisheror thePCMSBoardofDirectors,ExecutiveOfficersor themembers at large,nordoesanyproductor serviceadvertisedcarry theendorsementofthesocietyunlessexpresslystated.Paid advertisements are accepted subject to theapprovaloftheBoardofDirectors,whichretainstherighttorejectanyadvertisingsubmitted.

Copyright©2012,PimaCountyMedicalSoci-ety.Allrightsreserved.Reproductioninwholeorinpartwithoutpermissionisprohibited.

EditorStuartFaxonPhone: 883-0408E-mail: [email protected]

AdvertisingBillFearneyhoughPhone: 795-7985Fax: 323-9559E-mail: [email protected]

Art DirectorAleneRandklev,CommercialPrinters,Inc.Phone: 623-4775Fax: 622-8321E-mail: [email protected]

PrintingCommercialPrinters,Inc.,AndyCharlesPhone: 623-4775E-mail: [email protected]

Pima County Medical Society OfficersPresident Alan K. Rogers, MD

President-ElectCharles Katzenberg, MD

Vice-PresidentTimothy Marshall, MD

Secretary-TreasurerJohn Curtiss, MD

Past-President Timothy C. Fagan, MD

PCMS Board of DirectorsDiana V. Benenati, MDR. Mark Blew, MD

Neil Clements, MDMichael Connolly, DOBruce Coull, MD (UA College of Medicine)Alton “Hank” Hallum, MDEvan Kligman, MDMelissa D. Levine, MDLorraine L. Mackstaller, MDClifford Martin, MDKevin Moynahan, MDSoheila Nouri, MDJane M. Orient, MDGuruprassad Raju, MD Scott Weiss, MDVictor Sanders, MD (resident)

Members at Large Kenneth Sandock, MDRichard Dale, MD

Board of MediationBennet E. Davis, MDThomas F. Griffin, MDCharles L. Krone, MDEdward J. Schwager, MDEric B. Whitacre, MD

Arizona Medical Association OfficersGary Figge, MD, past president

Thomas Rothe, MD, vice-presidentMichael F. Hamant, MD, secretary

At Large ArMA Board Ana Maria Lopez, MD,

Pima Directors to ArMATimothy C. Fagan, MDR. Screven Farmer, MD

Delegates to AMAWilliam J. Mangold, MDThomas H. Hicks, MDGary Figge, MD (alternate)


6

D E P A R T M E N T S Membership................................... 8PCMS.Alliance.News..................... 22Conferences.&.Seminars................26Members’.Classifieds.....................26

CONTENTS

24

23

14

9

On the Cover

Dr. Alan K. Rogers is 2012 PCMS president (Photocourtesyhimself ).

President’s.Page.HelpDr.AlanRogershelpyou!

PCMS.News.Ourelectionresults;usingsocialmediainyourpractice.

Time.Capsule.AspecialmemoirbythelateDr.BudSimons.

Reality.Check.Dr.MikeSmithontouchingothersthroughpassionfornature.

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Reflection

Meet our new president

S MB O

P i m a C o u n t y M e d i c a l S o c i e t y • J a n u a r y 2 012Home Medical Society of the 17th United States Surgeon-General



Helpmehelpyou!TomCruise’sJerryMcGuirecharacter

screams,“Helpmehelpyou!”atadiffi-cultclientinafamousmoviescene.SoIam shouting the same thing to you asPima County medical providers—don’tbedifficult!

Physiciansmustbeactiveinorganizedmedicineorsuffertheconsequences!ItisnotO.K. to sit out andwatch thedra-maticchangesoccurringinmedicinefromthesidelines.

Ournation is indebateoverprovisionofhealthcare.Rationingofscarcemedicalresources,healthcarefinanc-ing indifficulteconomic times,dealingwith inadequatenumbersofprovidersforburgeoningnumbersofpatients,potentiallycompound-edbynationalhealthinsurancecoverage,arejustsomeoftheissues.

Physiciantraininghaslaggedbehinddemand.Costandlifestyleconsiderationsdrivemedstudentstohigh-incomesub-specialties.NowcomesWalmartwithawarplan to takeover the“relativelyhealthy”primary careofficevisitmarket.Doyou thinkWalmartintendstotakecareofthesickestandmostdifficultpatients?Asaprovideryoumusttakeapositiononthisissue.

Thelistgoesonandon.Doctorsarebecomingdividedandlesseffective in influencingthedebate.Physiciansarebeingsplit intooffice-based, hospital- based, academics, and specialists, all ofwhomseldommeet.Iamastrangerfrommostofthehospitalistswhocareformypatientsduringtheirsickestmoments.Gonearethedaysofhangingoutwithcolleaguesinthedoctors’ loungetodiscussthepoliticsofmedicineonafirst-namebasis.Nowonderitisdifficulttogetphysicianstohaveacommonvoiceintheissuesfacingus.Andyetit’snosecretthatmembershipinorganizedmed-icinehasbeendeclining,justwhenitismostneeded.

Whatcanyoudotohelp?Orbetter,howcanyouhelpushelpyou?Before Ipropose someanswers, I chargeyouwith thedutythatyoumusttakeaction.Youmustlead,follow,orgetoutoftheway!Ignoringallthisisnotanoption.

Ifnothingelse,jointhePimaCountyMedicalSocietyandpayyourdues!Ittakesmoneytodefendmedicineatthestatelegisla-ture.Justgiveustheresourcestocontinuethefight.

Contactlegislatorsandvoiceyouropinion.Bewillingtoreachconsensus.Evenamongourownmembershipthereiscontroversyover policy. So express your opinions, listen to others, and thenagreeonthebestcourseofaction.VoteforyourPCMSBoardofDirectorsmemberscarefully—theyaremakingdecisionsforyou!

Lobby with patients one-on-one in the office about medicineandthecontroversiesinhealthcare.Mypatientsaskaboutmedicalmarijuana.Doyoureallythinkmedicalmarijuanaisagoodidea?Well,thentellyourpatients!

Read our communications. Educate yourself on our positionsontheissuesandproposedlegislation,bothstateandfederal.Make

Dr. Alan K. Rogers

yourself ready for that chance discussion with people that couldmakeadifference.Maybeyourpatientisastatelegislator!

Attendsocialfunctionsandknowyourcolleagues.Yes,evenfunsocialeventslikethePCMSStarsontheAvenue“medicineball.”Youneedtoplaceafacewiththatradiologistwhocallsyouwithreports!

Mentorastudentandshareapositiveattitudeaboutmedicine.Medicineisandwillalwaysbeagreatcareerforbrightyoungpeo-pletoenter.Wejustneedtopromoteit.

AttendPCMSandArMAmeetings.SteveNashorIwillputyoutowork.BeDoctoroftheDayattheArizonaStateLegislature.Membership inyourspecialtyorganization isfine,but theydon’thavethecloutorconnectionswithstateandlocalissuesasPCMSdoes.Tobeeffective,weneedtosayPCMSrepresentsthemajorityofphysiciansinPimaCounty.Bynotjoining,youareundermin-ingourabilitytobeheardandhaveinfluence.

But here is a practical problem: If you are reading Sombrerorightnow,youareprobablyalreadyaPCMSmember.Sogetyourpartners,colleagues,referringphysiciansandfriendstojoinPCMSandpaytheirdues.

Your colleagues have greatly benefited from the efforts of thePCMSandArMAwhethertheyknowitornot.ManydebatethereasonsforthedeclineinmedicalliabilityclaimsandpremiumsinArizona,butIdirectlycreditourstepwiseeffortsattortreformasthemajor factor. Ifyoudonotunderstandwhy“majorityofevi-dence”vs.“predominanceofevidence”makesadifferenceincourtcases,thenyouhaven’tbeenreadingourcommunications!

Steve Nash and I have deemed membership as the theme for2012. Iamthrowingdownthegauntletandsettingagoalof90newmembers.Helpushelpyouandmakethisgoal!

MeetDr.RogersBy Stuart Faxon

Everyoneseemstoberunningforpresidentthesedays,fromtheglibtothedoltish.Evenaphysician,thoughhe’sbeenintheU.S.HouseofRepresentativesforyears.

Ournewpresident isDr.AlanKeithRogers,who can’t run forU.S.presidentbecauseheisn’ta“naturalborncitizen,”inourFram-ers’phrase.Thoughhewasbroughthereatage5andisacitizennow,hewasborninMaricaiboinwhat’sbecomedictatorHugoChavez’ssocialistparadise,Venezuela.Thatwasin1954,whenDr.Rogers’fa-therworkedinVenezuelaforanoildrillingsupplycompany.

HeearnedhisM.D.atBaylorCollegeofMedicineinHouston,anddidhisIMinternshipandresidencyattheUniversityofArizo-naCollegeofMedicineandUniversityMedicalCenter.HejoinedPCMSasaresidentin1983.HepracticeswithPCMSmembersE.LuisAguilar,NormanR.EpsteinandLeslieWillingham,withtwoNPs and one PA, at El Dorado Family and Internal Medicine,1500N.WilmotRd.,No.A110,infrontoftheformerElDoradoHospital.ThepracticeispartofArizonaCommunityPhysicians.

PrESidENT’S PagE


Dr.andSusanRogershavebeenmarriedsince1985.SusanhasbeenactivewiththePCMSAlliance,servedasitspresident,andre-ceived the1998MarilynHaasAward.She isalsoactivewith theParseghianFoundationandservedontheplanningcommitteefortheTMCFoundationgalainNovember.Susanis“themaster”ofchildmanagement,”Alansays.“She’sgreatwiththekids.”

The Rogerses have four children, who constitute a kind ofhealthcarefamily.AlexanderisanR.N.andworksforTheUniver-sityofArizonaHealthNetworkatUniversityofArizonaMedicalCenter—University Campus (most of us are still used to sayingUMC).MichelleisascrubtechatUMC.StephanieworksforKai-serPermanenteinLosAngelesasaprojectmanager.Amyisase-niorattheUniversityofSouthernCaliforniaandisinvolvedwithGlobal Medical Brigades, an international volunteer sponsor ofmedicalclinics.

Infact,Dr.RogershasgoneononeofGlobalMedicalBrigades’missions,andisgoingononeagainthismonth.Hejokes,“MyfirstactasPCMSpresidentwillbetoleavetown.”He’llbeheadedtoHondurastodoalotofpediatricsandallkindsofregularoutpa-tient checks such as for diabetes, colds, and parasites for peoplewhohavelittleornoregularmedicalcare.

Dr.Rogerswasthefirstinhisownfamilytogointomedicine,andunlikemanyphysicians,hehasneversouredontheprofessionandfindsdaily joy in it. “I found it tobeaniceblendofpeopleskillsandscience,”hesaid,whileadmittingthatpeopleskillsareatleastasmuchacontinuingcontinuumasCME.“IthankGodeveryday that Iwent intomedicine,”he said. “Thepeopleare sonice.Thepatientsarenicetoyou,andtheyappreciatewhatyoudo.”

IfthatsoundsthePollyanna,he’sknowsthat,too.“IamalwaysthePollyannaoptimistaboutmedicine.I’mgladIwentintoit,andI’mgladtoseemykidsgo into it. It’salwaysgoingtobeagreatprofession.Ifyougointoitsolelytomakemoneyorforsomeoth-erreason,you’regoingtobedisappointed.”

Dr.Rogershasbeenaheadof the trend infitnessandpreven-tion.Hehasusedapersonal trainer twiceweekly for threeyears,andhehasalwaysbeenabicyclistandhasparticipatedinElTourdeTucson.Soasyoumightexpect,heendorsestheshiftintopre-ventivemedicine,but“aslongasit’sscientificallyvalid.”Heoffersthecounter-exampleofgreenteaashaving“noproofthatitactual-lydoesanything.”

Dr.RogersdescribeshimselfasacommittedChristianandisamemberofCatalinaFoothills[Presbyterian]Church.

Lastandcertainlynotleast,heisatesticularcancersurvivor.Hehadsurgeryforanaplasticseminomain1996plussixweeksofradi-ationtherapy.Hedownplaysitsseriousnesscomparedtoothercan-cers,butwe’recertainlygladhistreatmentwassuccessfulanyway!

Communicate!In order to be an effective organization, PCMS must be

able to communicate quickly with its members. We need your e-mail address! I promise we won’t abuse it.

Tonight when you get home, send an e-mail to [email protected]. No need for a message. But do use the e-mail return address you prefer for communications.

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MEMbErShiP

OurnewestmembersBy Bill Fearneyhough

Pleasewelcome thesephysicians to thePimaCountyMedicalSociety.Physiciansneedtobeheardmorethanever,andmember-shipisourstrength.

Thomas Boyer, M.D.Dr.BoyerpracticesatTheUniversityofArizonaMedicalCen-

ter—UniversityCampusonCampbellAvenue,Tucson.Hisclini-cal/research interests include hepatitis treatment; treatment ofcomplicationofcirrhosis;diagnosisandmanagementofallformsofliverdiseases;mechanismsoflivercellinjury;andtreatmentofviralhepatitis.

Hegraduated fromUSC’sKeckSchoolofMedicine in1969.HealsoservedhisresidencyandfellowshipatUSC.Dr.Boyer iscertifiedbytheAmericanBoardofInternalMedicineandGastro-enterology.Hisofficephoneis626.5952.

Alexander Chiu, M.D.Dr. Chiu currently practices OTO and Facial Plastics at

UMC—UPH Surgery Clinics. His affiliations include BrianLabSurgical Navigation (National Consultant) and Medtronic ENT(NationalConsultant).

He graduated from medical school at Albany (N.Y.) MedicalCollegein1997.HeservedhisresidencyatGeorgetownUniversityHospital,Washington,D.C.andafellowshipatStanfordUniversi-tyMedicalCenterPaloAlto,Calif.HeiscertifiedbytheAmericanBoardofOtolaryngology.HemaybereachedattheUniversityofArizonaat626.6673.

Conrad Clemens, M.D., M.P.H.Dr. Clemens practices at The University of Arizona Medical

Center—UniversityCampusonCampbellAvenue.Hisaffiliationsinclude theCouncilonMedicalStudentEducation inPediatrics,AmbulatoryPediatricAssociation,AmericanAcademyofPediatricsandInternalClinicalEpidemiologyNetwork.

HegraduatedfromJohnsHopkinsUniversitySchoolofMedi-cine in 1990. He served his pediatric residency Johns HopkinsHospitals,Baltimore,andaresearchfellowshipattheUniversityofWashington(Seattle)SchoolofMedicine(MedicalGenetics).Hisofficephoneis626.6303.

Susan Dickson, M.D.Dr.Dicksonhasapersonalizedmedicine(concierge)IMpractice

at5210E.FarnessDrive.Sheisa1995graduateofTheUniversityofArizonaandservedher IMwith theTucsonHospitalsMedicalEducationProgram.atTHMEP.Herofficephoneis795.1661.

Steve Goldschmid, M.D.Dr.GoldschmidcurrentlypracticesatTheUniversityofArizo-

naMedicalCenter—UniversityCampusonCampbellAvenue.His

clinical/research interests include inflammatoryboweldisease,GImalignancy,andendoscopictherapyforGIdisorders.

Heisa1980graduateofWayneStateUniversity,Detroit.HeservedhisIMresidencyandGEfellowshipatUniversityofSouthFloridaCollegeofMedicine,Tampa.Dr.GoldschmidiscertifiedinbothInternalMedicineandGastroenterology.HemaybereachedatTheUniversityofArizonaat626.0993.

Stephen Goldstein, M.D.Dr. Goldstein’s practice is at UPH Surgery Clinics, UMC.

His affiliations include the AMA, American Academy of FacialPlasticandReconstructiveSurgery,andtheAmericanAcademyofOTO-HNS.

Heisa1996graduateofStateUniversityofNewYork(UpstateMedicalUniversity).HeservedhisOTOresidencyatThomasJef-fersonUniversityHospital,Philadelphia,andafellowshipatBuck-headFacialPlasticSurgery,Atlanta,Ga.He isOTOboardcerti-fied.Hisphonenumberis626.6673.

Nicole M. Gullick, M.D.Dr.Gullickisa1994graduateofUSC’sKeckSchoolofMedi-

cine.Her family practice is at 268E.RiverRd., Suite 130.Herclinicalinterestsincludeweightlossandaesthetics.

Dr.GullickiscertifiedbytheAmericanBoardofFamilyPrac-tice.Heofficephoneis495.0151.

Francisco Moreno, M.D.Dr. Moreno practices at The University of Arizona Medical

Center—University Campus on Campbell Avenue. His clinical/researchinterestsincludebiologyandtreatmentofmoodandanxi-etydisorders; improvingourunderstandingof thebrainbasis formentalillness;andactionmechanismsofpharmacologicalandde-vice-mediated treatment and treatment resistance.His affiliationsincludetheAmericanBoardofPsychiatryandNeurologyandtheAmericanPsychiatricAssociation.

Hegraduatedin1988fromtheAutonomousUniversityofBajaCalifornia,Mexico.Heservedhispsychiatryresidencyandfellow-shipatTheUniversityofArizona.HeisABMSboard-certifiedinpsychiatry.Youmayreachhimat626.5198.

Richard Van Rhoads, M.D.Dr.BoyercurrentlypracticesatTheUniversityofArizonaMed-

icalCenter—SouthCampus.His clinical interests include adultinpatientpsychiatryandhisaffiliationsincludetheAmericanPsy-chiatricAssociation.

He graduated from University of Massachusetts MedicalSchool in 2001 and serviced his residency at The University ofArizona.He isboard-certified inpsychiatry.Youmaycallhimat874.4105.


PCMS NEwS

ElectionresultspostedBallotswerecountedDec.12,andtheresultsofthePCMSelec-

tionsmadepublicduringtheRegularMembershipMeetingDec.13.ElectedtotheBoardofDirectorswereDianaBenenati,M.D.;

NeilClements,M.D.;Alton“Hank”Hallum,M.D.;ScottWeiss,M.D.;EvanKligman,M.D.;andSoheilaNouri,M.D.

VictorSanderswaselectedastheresidentmembertotheBoardofDirectors.

Edward Schwager, M.D. and Charles Krone, M.D. were re-electedtotheBoardofMediation.

AidingtheNominatingCommitteenextsummerwillbeKen-nethSandock,M.D.andRichardDale,M.D.,whowere electedMembersatLarge.

RegularMembershipMeetingJan.10

ThenextPCMSRegularMembershipMeetingisTuesdayJan.10,andwillcoincidewiththeyear’sfirstPCMSBoardofDirectorsmeeting.

The meetings begin at 6:30 p.m. Light refreshments will beserved.PleaseRSVPat795.7985,[email protected].

RockyMountainspottedfeverspotted

Rocky Mountain spotted fever is now endemic in rural PimaCounty, the Pima County Health Department told the PCMSPublicHealthCommitteeDec.5.

Ifyoususpectthedisease,goaheadandtreat,thenreporttothehealthdepartmentat443.7797.

‘Healing’displayruns’tilFeb.26

Theexhibit“HealinginTucson—theHealingResponsetotheViolenceofJan.8,2011”openedDec.1intheBehavioralHealthPavilionGalleryinthelobbyoftheBehavioralHealthPavilionatTheUniversityofArizonaMedicalCenter—SouthCampus,2800E.AjoWay,theorganizationreported.

As theone-year anniversaryof themass shootingapproached,TheUniversityofArizonaMedicalCenter—SouthCampushostedtheartexhibittofocusonthehealingprocessandresponsetothemurdersof sixpeopleand injuryof13, includingRep.GabrielleGiffords(D-8).TheexhibitfeaturespiecescreatedbyvisualartistsinSouthernArizona.

The exhibit will remain on display through Sunday, Feb. 26.TheBehavioralHealthPavilionGalleryisopenforviewing8a.m.-7p.m.MondaythroughFridayand1:30-4p.m.onweekends.

So.Az.IndoorSportsCentercoming

AspartofPCMS’snetworkingwithotheragenciesinvolvedintheobesityfight,thesocietylearnedTucsonisgettinganewindoor

activity space atRiverRoad andLaChollaBoulevard thathas amarketingopportunityforlargedonors.

TheSouthernArizonaIndoorSportsCenterwillstartconstruc-tioninJulyandopeninearly2013.The40,000-square-footfacili-ty accommodates five basketball courts or eight volleyball courtsand will be available for regular exercise classes. It will not be a“drop-in”place,butmoreofaresourceforleagues,fortheyoung,andforthenot-so-young.

Areaschoolsdiscourageuseoftheirgyms,eitherbysayingnotoallcomers,orbymakingthepricetoohigh.

PimaCountywillbuildandcontinue routinemaintenanceoftheSouthernArizonaIndoorSportsCenterandaprivatecharitableorganization,SouthernArizonaCommunitySports,willfundpartoftheconstructionandrunthebuilding.

TucsonConquistadorshasprovidedhalftheprivatefundbud-get,andthereisabout$200,000neededtofinishthepublicpartofthefunding.Courtscanbesponsored,andtherearemessageop-portunitiesonthewallstoencouragekidstocontinueactivityalltheirlives.Individualdonationsarewelcome.

Todonate,learnmore,orfindoutaboutmarketingopportunities,pleaselogontowww.soazcommunitysports.org,orcall797.2585.

TwitterandFacebookinyourpractice

By Lucien W. Roberts, III, MHA, FACMPEand Barbara Brownlee, MT (ASCP)

Wewillnever followcelebrities’ escapadesonTwitterorFace-book,butwe think theybothhave aplace in amedicalpractice

Because Dr. Peter Crowe was at his ranch during our Stars on the Avenue event last September, Dr. Rock Jackson accepted Dr. Crowe’s award for him. Dr. Jackson, left, was finally able to catch up with Dr. Crowe in early December to give him the plaque noting that he is our 2011 Lifetime Achievement Award winner (Steve Nash photo).


whenusedjudiciouslyandinmoderation.Evenifusedjustforfill-ingopenslotsintheappointmentschedule,thesesocialmediacanhelptoday’smedicalpracticerunmoreefficiently.

BothofushaveFacebookaccounts,butneitherofus look atthemdaily,nordowegive“friends”aminute-by-minuteaccountofouractivities.ManylovetodrinkfromtheFacebookwelleveryday,butthat’snotourcupoftea.

Wedon’ttwitter,whichusedtobeaperfectlyserviceableadverb,and we’re not on anybody’s twit list, whether or not we thinkthey’retwits.Withallduerespecttotwitsandtwitterers,weneednoplay-by-playofyourday.Happyyoustoppedbythecleaners,sorryyouoverslept10minutes,butwedon’treallyneedtoknowabouteither.Nothingpersonal;wejustdon’tgiveatwit.Andwiththe140-characterlimitforeach“tweet,”we’renotsurewecansayanythingthatmattersin140characters,muchless140words.Infairnesstothosewhotweetwell,oftenatweetwillincludealinktoapageonyourwebsitewherethereareno140-characterlimits.

Filling your schedule—Hadituptoherewithpatientscancel-lingtheirappointmentsonshortnotice?Twitteringisagreatwaytoletpatientsknowyouhavejust-openedspotsinyourschedule.Firstcome,firstserved—patientslikeit,yourfrontofficewilllikeitbetterthancallingtenpatientstofilloneslot,andyourbottomlinewillloveit.

Facebookisawaytoletpotentialpatientsknowthatyourprac-ticehasappointmentsavailable.Postsomethingtoyourpractice’sFacebookpage about same-dayor same-week appointment avail-ability,andyournumberofunfilledappointmentswilldropinthenextyear.

Specialists shouldconsiderusing this approach to let referringphysiciansknowthatyouhaveopenings.Letthereferralcoordina-tors at thePCPofficeknow thatyou sendoutupdatesviaFace-bookorTwitterwhenslotsopen.

Clinical research studies—Tryingtoenrollpatientsforanewclinicalresearchstudy?Twitteralinktotheclinicalresearchpageofyourwebsite.Makeitpartofyourpatientrecruitmentstrategy.Youwon’tknowifitworksuntilyoutryit.SeveralpracticeshaveusedFacebookasaneffectiveportal.

Just arrived: flu vaccine—Wannabeasuperhero?Influseason,twitterpatientsabouttheshipmentoffluvaccinethatjustarrived.Itworks.Andifyouareoutofvaccineanddon’texpectanyship-ments, twitter awebsite linkof places that still haveflu vaccine.Yourpatientswillbemostappreciative.AFacebookpostabouttheavailabilityoffluvaccinemayevenbringyounewpatients.

New, new, new—Twitteryourpatientsaboutanewprovider,anewoffice,newextendedhours,oranewservice.Includealinktoyourwebsiteformoredetails.ThesamegoesforFacebook,whichengagesyourpracticewiththosewholiveandbreatheasteadydietofFacebook.

Patient education—Promote coming seminars or webinars toyourpatients.Offeralinktotheregistrationpage.Remindpatientsofthepatienteducationpagesonyourwebsitewhileyou’reatit.

Job posting—Thiscanbetricky;youmaynotwantoneofyourpatientstobeyouremployee.Butifyourpatientstelltheirfriendsthatyourpracticehasanopeningandisagreatplacetowork,youjustmightstrikegold.WeneverthoughtFacebookwouldbeanef-fectivemeansofrecruitment,butitworks.Anotherfreeandeffec-tive recruitmentvenueyoumight try isCraigslist,whichmedicalpracticesinsomecitiesroutinelyusetofindnewemployees.

In conclusion—BarbaraconfessesthatsherecentlyusedFace-booktopostapictureofherdogwearingagraduationcaponthe

lastdayofobedience school, andher statusupdatemusedabouthowthedoggotthecertificatebutBarbaralearnedallthelessons.Sometimeswecan’thelpbutshareourlittlesuccesseswithfriendsandfamily.ButtherestoftheaboveishowweenvisionFacebookorTwitteruseinthepracticeenvironment.

Lucien W. Roberts, III, MHA, FACMPE, is vice-president, and Barbara Brownlee, MT (ASCP) is sales executive of Pulse Systems, Inc., a provider of practice management software, EHR, and revenue cycle management applications for medical practices. For more infor-mation, call 1800.444.0882 ext. 1286, or visit www.pulseinc.com.

RaytheondonationtargetsUofAtrauma

RaytheonMissile Systemshasdonated$100,000 to theDivi-sionofTrauma,CriticalCareandEmergencySurgeryintheUni-versityofArizonaDepartmentofSurgery,theuniversityreportedin December, saying the gift will fund research on treatment ofwoundedsoldiersonthebattlefield,andtraumavictimshereathome.

“The Raytheon donation will fund advancements in care forwoundedwarfighters,”theysaid.“Potentialadvancementsthatcanbeimplementedthequickestwillgetthehighestpriority.Specificresearch areas will include developing devices to detect and treatchest injuries, new human-based resuscitation fluids, and newtreatments to stop bleeding. Studies also will focus on traumaticbraininjury,tissuetransplantationandsuspendedanimation.”

“Advancementforwarfightersalsowillhaveanimmediateimpactathomeasitwillbejustasapplicableforciviliantrauma,”saidPeter Rhee, M.D.,chief,UADivisionofTrauma,CriticalCareandEmer-gencySurgery.“WeareexcitedtopartnerwithoneofTucson’slargestemployers through their support in trauma research. Research is asystematicwayofimprovinghumanlifenowandforever.”

“Raytheon isproud toprovide theUA traumadivisionwith thisdonationtohelpfurthertheword-classworkthatisalreadyunderwaythere,”saidRMSPresidentTaylorW.Lawrence,Ph.D.“Becauseourtwoorganizationshaveafocusonthewarfighter,weseetremendoussynergybetweenRaytheonandtheUATraumateaminthisarea.”

“The tragic shooting in January [2011] exemplifies why we

On the UofA Mall near Old Main, manning the booth at the Tucson Marathon Festival Dec. 10 were Dr. Carol Henricks and Dr. Paul Gee, who instructed kids and their parents about the diseases caused by obesity, and what levels of activity and nutrition are needed to avoid the fat trap (Steve Nash photo).


needanexcellenttraumaprograminTucsonandSouthernArizo-na,” saidRainer W.G. Gruessner, M.D., chairman,UADepart-mentofSurgery.“Excellencecomesfromnotonlyprovidingout-standingclinicalcareforpatientsinourcommunity,butalsofrominnovativeresearchtodiscovernewtreatmentsandcuresandtore-tainthehigh-caliberacademictraumaandsurgicalteamswehaveattheUniversityofArizona.”

Raytheon,headquartered inWaltham,Mass., employs72,000peopleworldwideandprovidesstate-of-the-artelectronics,missionsystemsintegration,andothercapabilities intheareasofsensing;effects; and command, control, communications and intelligencesystems,aswellasabroadrangeofmissionsupportservices.

UACC,St.Joe’sPhoenixcollaborate

UniversityofArizonaCancerCenterhasenteredanaffiliationagreementwithSt.Joseph’sHospitalandMedicalCenter/CHWinPhoenix“fortransformationalcancercare,”theUofAreportedinDecember.TheUACCistheonlyNationalCancerInstitute-desig-natedcomprehensivecancercarecenterheadquarteredinArizona.

“Thevisionistocreateanaffiliationthatleveragesthestrengthsofbothorganizations,incollaborationwithcommunity-basedon-cologists,totransformthedeliveryofcancercareandtoestablishapremiercenterforambulatoryandinpatientoncology,withanem-phasisonhigh-quality,patient-centered, evidence-basedmultidis-ciplinarycareandclinical/translationalresearch,”theysaid.

“WeenvisionouroperationsinPhoenix—atSt.Joseph’sandatour future outpatient facility—as a national and internationalmodelofintegratedhealthcaretofightcancer,”saidUACCDirec-torDavid S. Alberts, M.D.

Theuniversity reports that since1976,UACChas conductedresearchtowardcuresforandthepreventionofcancer.Itisoneofjust40NCI-designatedcomprehensivecancercentersintheUnit-edStates.

“St.Joseph’salsohasalonghistoryofcancerresearchandinno-vativecareforsomeofthemostchallengingpatientsinthecoun-try. Itwill serveasUACCatPhoenix’sprimary inpatientclinicalsite.St.Joseph’salsowillprovideoutpatientclinicalfacilitiesatitscentralPhoenixmedicalcentercampus,witheventualexpansionofCancer Center outpatient activities to a multi-story, 250,000-square-footoutpatientcentertobeconstructedonthedowntownPhoenixBiomedicalCampus.

“TheArizonaBoardofRegentshasendorsedtheaffiliation,andatitsDec.2meetinginTucsonapprovedtheconstructionofaUACancerCenterfacilityonthePhoenixBiomedicalCampus.Con-structionwillbeginthisyear.”

PCMS2012meetingsTheArMA Legislative Reception isJan.23inPhoenix.Tryto

attend;it’sworthit.TheArMA Annual Meeting (delegatesonly)isJune1-2.

OurRegular Membership MeetingsareTuesdayJan.10,6:30p.m.whenmembersareinvitedtotheBoardofDirectorsmeeting;TuesdayNov.8,7p.m. including readingof thenominees slate;andTuesdayDec.11aftertheBoardofDirectorsmeets,forballotcountanddeclarationofelectionwinners.

Pima County Medical Foundation’s Evening Speaker Series is on the secondTuesdays inFebruary,March,April,May, June,September,October,andNovember,oftenincludingCME.Watchfortopicannouncementsinthe“betweenSombreros”newsletter.

ThePCMS Board of Directors andExecutive Committee (of-ficersonly)meet:

Often you never know who or what will roll into the PCMS parking lot, and Nov. 29, 2011 was no different. Stephen Jones, a volunteer for Physicians for Civil Defense, left Martha’s Vineyard Sept. 23 bound for San Diego, stopping at 10 first-responder offices per day to distribute tiny radiation stickers and a 60-second training. ‘Most fire guys and patrolmen, as well as Homeland Security folks, welcome the information,’ Jones said. ‘Every 1950s schoolkid knows what to do if there is a nuclear blast, but most young guys and women don’t get any training.’ He said he wants first responders to be able to detect spikes in radiation and know how to calmly react during a nuclear accident or terror attack. ‘With these small RadStickers, we have a net of detectors all the way back to New England,’ he said. Jones, 61, owns a successful business in Salt Lake City and has not ridden this far since he rode across the U.S. when he was 14, and from Alaska to Mexico when he was 16 (Steve Nash photo).

Kids lined up for the one-mile run during the Tucson Marathon Festival at the UofA Mall Dec. 10 (Steve Nash photo).


BOARD: EXECS:Tues.Jan.10,6:30p.m. Tues.Jan.10,5:30p.m.Tues.Mar27,6:30p.m. Wed.Feb155:30p.m.Tues.April24,6:30p.m. Tues.Mar27,5:30p.m.Tues.May22,6:30p.m. Tues.April24,5:30p.m. (MemorialDayMay30) Tues.May225:30pmTues.Aug.28,6:30p.m. Tues.June26,5:30p.m.Mon.Sept.24,6:30p.m. Tues.Aug.28,5:30p.m. (YomKippurstartsSept.25) Mon.Sept.24,5:30p.m.Tues.Oct.23,6:30p.m. Tues.Oct.23,5:30p.m.Tues.Dec.11,6:30p.m. Tues.Nov.13,5:30p.m. Tues.Dec.11,5:30p.m.

PCMS2012infoPimaCountyMedicalSociety,foundedin1904,isat5199E.

Farness Drive,Tucson, Ariz. 85712, inTucson Medical Park offRosemont Avenue from Grant Road. Office hours are 8 a.m.-4p.m.Monday throughFriday.Phone is795.7985; fax323.8558.Afterhours,anansweringservicecanputyouthroughtoseeifany-oneisanswering,oryoumayleaveamessage.Ourbacklineforaf-terhoursis795.7986.E-mail:[email protected].

OurholidayclosingsthisyearareNewYear’sDayJan.2,Me-morialDayMay28,IndependenceDayJuly4,LaborDaySept.3,Thanksgivinghalf-dayNov.21throughNov.23,ChristmasDec.24-26,NewYear’sEveDec.30,andJan.1.2013NewYear’sDay.

NovembermonthlyreportReferrals to physicians:103Meeting rooms occupied:20.9percent(8a.m.-10p.m.,seven

daysperweek)Executive Committee: PCMS PresidentTimothy Fagan MD

presidedNov.8,5:37-7:05p.m.Several disability programs for physicians were evaluated and

recommendationswillbemadetotheboard.Theexecs resolvedapersonnelmatter,andexaminednominees

forhonorarymembership,meetingdates,andbudgetideasfor2012.Bennet Davis MD gave an overview of progress with business

entitieswiththeobjectofajointefforttoreformhealthcarelocally.TheBoard of Directors,chairedbyPCMSPresidentTimothy

FaganMD,didnotmeetinNovember.Board of Mediation: ChairmanEdwardSchwagerMD.AnappealfromaBoardofMediationdecisionwasgiventothe

PCMSpresident.Public Health Committee: Sky Hilts MD presided Nov. 7,

12:25-1:31p.m.Bikefatalitystatswerestudied.Therewere25deathsin2009.ObesityplansnowincludeaboothatahealthexpoontheUni-

versityofArizonaMallDec.10.Bioethics Committee: Chairman David Jaskar MD presided

Nov.15,12:40-1:34p.m.The committee discussed the call for reconsideration of liver

transplants for alcoholics, and a note that Carondelet St. Mary’sHospitalhadthethirdhospiceintheU.S.

RevisionsweremadeinanewcasetobeofferedforpublicationinSombrero.Aletterfromamemberaboutthelastpublishedcasewasreviewed.

History Committee:ChairmanJamesKleinMDpresidedNov.8.ThecommitteemetandmadefinalplanstotheNov.12tourof

theFlorenceHighway.Thattourwasagreatsuccess,withstopsataTitanMissilesite,whereaformercommander,JerryFreund,gaveafeel for what manning this ColdWar facility was all about.Thepropertyownersaidthatthesilowasblownup,butthattherestofthe site is still underground and a great place for rattlesnakes tolive.ThetourclimbedPostonButte,stoppedattheprisonerstore,andhadawonderfultourofthemuseum.Lookforthecommit-tee’sfutureguidedtoursinvolvingArizona’spast.

Pima County Medical Foundation, Inc.: President JamesKleinMDpresidedNov.14.

EveningSpeakerSeriestopicsfor2012weresetandDr.Krem-penwenttoworkontheCMEdocumentation.

Regular Membership Meeting: President-Elect Alan RogersMDpresidedNov.8,7:05-7:55p.m.

Dr.BennetDavisoutlinedeffortssofartoengagebusinesslead-ersintheoperationsoflocalhealthreform.Hemadeitclearthatbusiness leaders want physician leadership. A subcommittee of

PCMS will work to articulate a vision andprinciples for local healthcare reform, andPCMS members will continue to work withtheArizonaBusinessCoalitiononHealth.

Theslateofnominationswasreadandaddi-tionalnominationsinvited.

Odds & Ends: PCMS attended meetingswith the Pima Community Access Program,the National Disaster Medical System, theHealth Information Network of Arizona, theJointTechnical Education District (health ca-reereducationinhighschools),andtheExer-cise is Medicine Conference Planning Com-mitteemeetingsinNovember.

OnNov.8PCMSwasonhand to see thehandwashing ordinance defeated at the PimaCountyBoardofSupervisors.

OnNov.17,PCMSattendedacasualbreakfastwith state Sen. Al Melvin (R-26-NW Tucson),state Sen. Frank Antenori (R-30-E Tucson), andstate Rep. Ted Vogt (R-30-E Tucson) at KVOIradiostudios.

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Talkaboutadvances!By Bernard W. “Bud” Simons, Jr., M.D.

Editor’s note: In retirement the late surgeon Dr. Bud Simons was known in these pages as an engaging raconteur, memoirist, and chronicler of Tucson medical history. Because he encom-passed so much history, we did not always have space to print his pieces while doing them justice. We are pleased to present this one, from 2006, in his memory.

Whilehavingsomeblooddrawnrecentlyforaspectrumoftests,IwasstruckbythenumberofchangesI’veseen inmedicineover50years.Sit-ting there—in a specially designedchair,no less—and lookingaround,Icouldseenothingthatwouldhavebeenavailable tomycolleaguesandmeinthepast.

I’m pleased to report that whilethe objectives were the same, thematerials, equipment, and methodswere all different. I began to com-

The late Dr. Bernard W. “Bud” Simons, Jr. in 1984.

parethisworldwiththeoneIlivedinbackthen,intheSanFran-ciscoBayarea.

The “phlebotomists” caught my attention. They are “still”young,bright-eyed,andpleasant—asIhopewewere—butdiffer-entinmanyrespects.Theyareeithertheproductofformaltrain-ing, or in a formal trainingprogram,with their sole function inmanyhospitalsandlargelabs,justtodrawblood!Nosuchpersonexisted50-60yearsago.Usuallythejobfelltojuniormembersofthelab,andwasjustastepabovewashingequipmentandmakingsolutions.IfyouwereaspecialfriendoraVIP,theseniorlabper-sonwouldusehisexpertise todrawblood.Somestates thenhadlawssayingonlydoctorsand“speciallytrained”peoplecoulddrawblood,andthefewmedicallabswereafavoritesourceofemploy-mentformedandpre-medstudents.

Inthemidstofhighschool,Iwaseagertoswiminthemedicalstream and thought working in a medical lab would be a goodstart.Fortunately,asmall,one-manlabintheValleyBankbuildingatStoneAvenueandCongressStreetdowntownacceptedmyoffertodomenial chores around the lab in exchange forwhateverhehad time to teach me. Soon I was very much involved with the

fewprocedureshedid, and I found thisnewworldvery interesting.Weneverdrewblood;it arrived in vials, each having been filled inoneofthemanydoctors’officesinthebuild-ing. Most of my excitement came from myintroduction to using a high-power micro-scopeaswellaslearningaboutthecomponentsofbloodandurine.

Thenextyear, Ifinagleda jobasanassis-tant—a “gopher”—at the Southern PacificHospitallabonWestCongress.Thelabwasabusy, moderate-sized unit with two techni-cians. It turned out one of my female class-mateswasoneofthetechnicians,whohades-sentially been taught the procedures by anolderfriendwhoworkedinanotherofthelo-cal labs.These two people were fine teachersandnotonlytaughtmehowtouseandcleantheequipment,butalsomadesureIsawwhat-everwasinteresting,whichincludedseeingmyfirstintestinaltapeworm.

Thislabwasalsomyintroduction,bymanyhours at the sinks and scrub brushes, to thelargeamountsofglasswarelabsused.Nothingwasdisposable!

Mynextstintinalabwassixyearslaterasasecond-year med student, working the over-nightshift ina large,privatehospital labasa


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secondjob.Thatwasnotmuchfun,notonlybecauseofthehours,but because the heavy responsibilities included doing a lot ofblood-typingandcrossmatchingforpatientsinsevereshock.ThiswasmyintroductiontotheleadenmantleofmedicalresponsibilitythatIworeuntilIretiredatage60.

Upintothe1960sinmanymedicalofficesthroughouttheU.S.,thedoctorhimselforanofficenursedidmanyofthemorebasictestssuchasCBCs,hemoglobins,urinalyses,andevenafewsimplechemistries. Small, independent labs, staffed and run mainly byoneortwowell-trainedtechnicians,wereoftenlocatednearwher-evermedicalofficesclustered.

Formanyyearstherewerenoethicalorlegalrestraintsondoc-tors’ owning, or investing in these labs. While many physicianstooksomefinancialadvantagefromthis,itshouldberememberedthatthesedoctorswerealsodoingtheirpatientsandcommunityabigfavorinsavingtime,investingtheirownmoney,andprovidingconsiderableconvenience.Veryfewsickpeoplewanttobemovedaboutinabuilding,ordrivenmanymilesforlabwork.

Atone timemany“mailorder” labsadvertised in themedicaljournalsorinthemail.Theseoutfitsofferedawiderangeoftests,includingwaterandfoodanalysis.Theirchargeswereverycompet-itiveandmostdidverygoodwork.Whencontacted,thesebiglabssenttoone’sofficealargeassortmentofspecimenandmailingcon-tainers with adequate instructions on collecting and sending thebloodserumorwhatever.Resultswereusuallyavailableinaweekto10days.Theselabsweremosthelpfultophysiciansinverysmalltowns,andalwaysprovided themsomefinancial incentive topa-tronizethem.Theywouldbillthedoctor,whointurnwouldpass

thischargetothepatientinwhateveramountheconsideredappro-priate.Inthe1960ssolicitationsfromtheselabscametomyofficefromasfarawayasChicago.

Intheearly-to-mid-’60s,Arizonapassedlawsorregulationsthatmadeitverydifficultforaphysiciantohavehisownofficelab.Ire-call considerable anger among a few doctors who lost their labsduringthattime.Irecallthatbeforethelegalchanges,morethanoneofthesedoctorsurgingmetousetheir“private”labsfor“rou-tine”tests.Itriedtodothisafewtimes,butitledtoawkwardmo-mentsandquestions frompatients, suchas,“WhoisDr.…andwhydidhesendmeabill?”(insteadofbillingforlabprocedures!)

AnotherbigproblemthatcameuparoundthattimewasalaworregulationthatpreventedanM.D.frombillingforthelabworkdonebyalaboutsidethedoctor’soffice.Strangely,adoctorcouldchargefordrawingtheblood,butnotforthetest!

Priortothis,manydoctors,orsomeoneonstaff,drewthebloodandsentittoalabthatwouldbillthedoctormonthly.Thedoctorsin turn billed individual patients for a “lab fee” for whateveramount the practice deemed appropriate. The doctor paid themonthly labbill just like anyother.Thismade for simplebook-keeping for all concerned. But this setup did confuse some pa-tients,particularlyaboutthe“variation”inlabcostsamongdiffer-entofficesforthesametests.Asmorepeoplewerebeingmedicallyinsured in the ’60s, the insurance companies became more in-volved. Many did not pay for any kind of laboratory work notdoneinahospitalaspartofanadmission.

Withthelaboratoriesbeginningtobillpatientsdirectly,thelabshad tobuymoreofficeequipmentandhiremorepersonnel,and

subsequently had to raise their charges. Somepeopletothisdayclaimthatitraisedthecostofcaretothepatientsfarmorethanthefewdol-larsitmighthavesavedfrombeingcollectedbythe fewdoctorswhohad labs. Itwascertainlynotwhollytothepatient’sbenefitthateveryoneinvolved had to write more checks, do moremailings,andspendmoretimeontheprocess.

Many physicians, myself included, quitdrawing blood in their offices, as it becamemoretroublethanitwasworthintime,capitalinvestment, billing, etc. especially since insur-ancedidnot cover it.There are stories sayingthe insurance companies and authorities soonrealized the absurdities of the regulations andconsideredareturntotheoldersystem.Butitwasbroughttotheirattentionthatitwastheirideainthefirstplace,andthatwewereallcer-tain to get bad publicity when the new officepersonnelwerefiredandnewofficeequipmentpayments were defaulted upon. There couldhardlybeabetterexampleofbureaucraticstu-pidity and interference. Some believe the up-wardspiralofmedicalcostsbeganwithsuchill-advisedmaneuversbytheinsurancecompanies.

Whiletherewasafinancialincentivebehindthe development of many physicians’ labs, it’s


Creating value in Physician practice’s since 1987

important to realize thatmanyof these“office” labswere runbyphysicians who were highly trained, and maintained very highstandards.Thiswasespeciallypertinent to someoffices thatweretreatinglargenumbersofpatients,orthosewithspecialconditionssuchaskidneyandliverproblems,ordiabetesandblooddyscrasias.Theconveniencetothesickanddisabledwasenormousinallow-ingquickchangesincareandmedications.Ibelievethatthebasisofmostoftheselabswasagreatdesireonphysicians’partstogivethebestandfastestservice.Therewasconsiderablecompetitionforpatientsbackthenbecauseitwasallword-of-mouth,withnoad-vertisingandnocompanyororganizational“deals.”

TheaforementionedspeciallydesignedchaircontrastswiththeordinarychairalongsidethewoodormetaltablesweusedtouseIfthebloodwastobedrawnfromtherightarm,thechairwasturnedtoplacetherightarmonthetable,andforthereverseofthatforthe leftarm.Todaythe“chair”maybe likeanexpensiverecliner,anditwillhavepaddedextensionsonbothchair-armsonwhichtoplacethearmselectedforthephlebotomy.Sincesomanypeoplegetfaintorlight-headedatblood-drawings(thathasn’tchanged!),havingatableorcouchonwhichtoreclinewasalwayspartofourlives.Onecannothelpbutbeimpressed,inthislitigiousage,withthecurrentpracticeofdrawingbloodwiththepatientinsomeout-of-the-way cubicle or closet, with NO facilities for the faint ofheart—exceptanampouleofammonia!

Andtheequipment!Itseemsnowlikeeverytechhasaspecialthinstripoflight-coloredrubbertouseasatourniquet.Sometimestheyuseabloodpressurecuff—andtheybothworkwiththesameolddiscomfort.


BothcontrastwiththepilferedPenrosedrainsoroldgumrub-bertubingthatweused.Whenweneededtoreplaceatourniquet,weusuallydroppedinat“centralsupply”andstatedwhatweneed-ed, or theproblemwehad to address.Whomeverwas in chargewouldusuallyreferustoamonstrouscoilofgumrubbertubingona shelf, with instructions to cut off what you needed. Penrosedrainswerehardertocomeby,astheywereavailableonlyinsur-gery. If you were on good terms with the scrub-nurses, during“takedown”onemightbeslippedanunuseddrain.Remember,inthosedaystheORsusuallyrecycledeverythingtheycouldpossiblyuseagain,includingthosedrains.

Fiftyyearsago,labtestsrequiredwhatwouldtodaybeconsid-eredlargeamountsofapatient’sblood.Todaywecananalyzedriedblooddrops! Itwasnotunusual forvery illpatients—whocouldleast tolerate blood loss—to sometimes become almost exsangui-nated from multiple phlebotomies. In turn, these unfortunatepatients had to be given transfusions, further complicating theirdiagnoses.Back then, aCBCrequired at least5cc,but if a sedi-mentationrateandhematocritwerealsoneeded,onewithdrewatotalof10cc.Bloodsugarsrequired10-15cc,andmosttypeandcross-matches needed 20-30. It was a rare chemical test that didnotneed10-20.Whena“liverpanel”ofanybatteryoftestswasor-dered,itwasnotunusualtodraw100-150ccofblood.

I recall that when I was an intern, we had a special cart forblood-drawing rounds. While all the syringes were surgicallywrappedinsortedbysizes intoboxes,theneedleswere inspecialmetalracks,orstucklikeroundsofammunitioningauzepadsinenameledtrays.Aspecialboxheldthecollectionof50-100ccglass

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syringes (I can testify that they broke into many pieces whendropped). A few tourniquets were attached around the sides ofthecart.

Alcoholspongesweresoakedwithpink-coloredisopropylalco-hol.A jar of themwas centeredon top layer, alongwith labeledboxesofsmallvials,color-codedaccordingtowhichanti-coagulanttheycontained.Thechartforwhichanti-coagulanttouseforeverytesthungonthecart,encasedinclear,oldX-raysheets.Oneusedgreasepencil, alsooften attachedon a long string to the cart, tomark the vials with the patient’s name. It was standard to use aNo. 18 needle for drawing any amount of blood over 25-30 cc,to diminish the clotting that invariably occurred when using aNo.20.

Clotting in the needle or small syringes when drawing bloodwasquitecommonforavarietyofreasons.Asarule,bothneedlesand syringes were washed and “sterilized” on the ward, with thesterilization standardbeingboilingwateror soaking inabacteri-cide.Personnelwereoftentoobusytogiveneedlesthecarethere-quired to stay sharp, freeof clots, skinplugs, and residues.Theybluntedeasilyfromslidingaboutinenameltraysfilledwiththosebactericidalsolutions,andthisoftengaveakindof“hook”totheneedletips,whichinterferedwithinsertionaswellaswithdrawalifnotdetectedbeforehand.

Usingglasssyringes,onebecameawareoftheirfrequent“freez-ing,”orthestickingandlossofthebarrel’sabilitytoslideinsidethecylinder.Twoverycommonreasonsthatsyringesstuckor“froze”were that they were not cleaned well to begin with, or were notthoroughlyrinsed indistilledwaterbeforedryingandpackaging.

While5ccsyringeswerekeptontheunit,largephlebotomy syringes of 20cc or more camefrom“centralsupply.”

Wegotallourneedlesfromthefloornurs-es.Everycylinderandplungercamewrappedseparatelyingauzeinsideoneortwolayersofsurgical, sterile cotton clothwrap.Thewrapswerealwayssavedtobeusedagain!Afterun-wrapping,itwasimportanttochecktheserialnumbersormarkingonthetwopartstomakesuretheyweresupposedtofit.Eachplungerorpistonwasmadeforaspecificcylinder.Someofthebetter-qualitybrandsusedanumberingsystem.

There was no one-size-fits-all, or inter-changeabilitybetweenthetwopartsofsyring-es. One always pulled the plunger back andforth a few times to make sure it slid easily.Then, and only then, did one use the sterilepick-upstopickaneedleoutofthepan—curi-ously,alwayswhiteenamelwithbluetrim—toattach it tothesyringe.Thenyouhadtotestthe setup again to make sure the needle wasnotpluggedandthatthesyringewouldeasilyslide.Itwasnotuncommontohavetostopinthe middle of drawing blood and get a newsetupwhentheplunger“froze”inplace.


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Alltoooftenthistime-consumingritualwentonatbedsideinfull viewof thepatient. Imagine their distressupon seeing thosehuge—wecalledthem“horse”—syringes!Thephysicaldifficultyofdrawingbloodwitha50-200ccsyringewasthattheneedleadapterwascentrallyplacedattheendofthebarrel,acentimeterormorefromtheedge.Itwasalwayseasieronbothpatientanddoctor ifneedle adapterson these syringeswereplacedon the edgeof thebarrel.Thesesyringesweremoreexpensivetobuy,sotheywerenottoocommonlyavailable.Usingoneofthesebettersyringesallowedeasierinsertionintothevein,lesschanceofactuallytransactingthevein,andmorecomfortableaspirationofalargeamountofblood.

Whileweallhadsomeinstructioninphlebotomy,itwasbriefandwewereexpected to“learnbydoing,”as itwasOURhousestaff job! Phlebotomy was usually regulated to the most juniormemberofanyteam,unlesstheveinsinquestionwere“collapsed”orbadlydamaged.Then,a“moresenior”teammemberwouldtrytoobtaintheblood.

Asyoucanimagine,manyveinsweredamagedandtransactedbyusneophytes,andmorethanoneofusweresurprisedandupsettofindoursyringesfilledwithARTERIALblood!Thoseofuswithsurgical aspirations were expected to learn how to do arterialpunchesaswellasthoseofdeepveinsandthoseinawkwardplaces.Thiswasimportantincasesofdismembermentandmassivetrau-ma.Inonesevereburncase,afriendofmineactuallydrewbloodfromthevictim’spenis!

Around 1950 individually packaged, disposable needles cameonthemarketandeveryoneenthusiasticallyadoptedthem.Thencamedisposable syringes,greetedwith the sameenthusiasm.Notonlywerebothproducts safer andmorepleasant for thepatient,buttheyalsoeliminatedalotoftimelostthroughoutallhospitalsandofficesfromtheonerous,dangerous,andtime-consumingjobsofcleaning,sharpening,andpackagingofthesetwoitems.Needlepunctures alone cost thousands of dollars in losttime and cost of care. A nurse or doctor, finally,couldbesurethatonewouldalwaysgetasterilesy-ringeandneedlethatworkedanddidsosmoothly.Needlesthatwerealwayssharpandfreeofobstruc-tions?Wow!

The glass syringe was a great invention, but youcanseeithaditscomplicationsanddangers.Itoften“froze” in use and often broke when being washed,tested,andevenused.Iparticularlyrecallhowthisup-setnurseswithsevereallergiestosubstanceslikepeni-cillinandhorseserum.Theydidn’tappreciatespottingor damaging their uniforms, either! Breakage occa-sionallyinflictedsomemiserablehandlacerations.

Thenextlogicalandmostwelcomestepwasthecompletepackageofadisposablesyringewithanat-tacheddisposableneedle,bothinabroadvarietyofsizes.Nowherewastrueadvancement!Itwasagiantleap forward to those of working on the hospitalfloor. I must admit, however, that the sterilizableglass syringewasahugeadvanceover thehard-to-clean metal, or glass-and-metal syringes granddadhadtouse!

Thinkingofneedles, Imust includeoneofmy immunizationexperienceswhenIjoinedtheArmyduringwhatwenowcalltheKoreanWar.Asweheadedoverseas, a rapid series of immuniza-tions was in order for about 600 of us physicians and dentists.Onmore thanoneoccasion,we actually got two immunizationssimultaneously—oneineachdeltoidareaaswefiledbytheseveral“shotstations”!

BecauseIthoughtIneededtoknowhowtheArmydidthis,Ipaidcloseattentiononeafternoontoourtyphoidinoculation.Thetechnicianuseda10or20cc syringewitha longNo.23needleandanalcohollamp.Aftereach5ccinjection,hewouldpasstheneedle through theflame (theglass syringewouldbeheldbelowflamelevel),giveittwoorthreesecondstocooloff,andtheninjectthenextman!Obviouslytheyneverpulledbackthepiston,andIhadneverheardofmultipleimmunizationsfromthesamesyringeandneedlebefore—orsince!Someofuswerestunnedtoseethis.Fortunately, Inever encountered that again.After that, Ibelieve,theairgunscameonlineformassinoculations.

Theinventionofthedouble-endedneedleintheplasticcupforphlebotomy,andhavingavacuuminthespecimenreceptaclewerebigadvances.Inourtime,wedidsomethingofajugglingactthatwasalmostimpossibleforthosewhowerenottoodexterous.Oneheld theblood-filled syringe inonehand,and in theotherhandthespecimenvial,andusedthatthumbandforefingertoremovetherubberplug,injectthebloodintothevial,re-plugthevial,andthenrock itbackandforth.Thiswasoftenrather slow,as itnotonlyrequiredsomedexterity,butthebloodoftenprematurelyclot-tedinthesyringebeforeallthevialscouldbefilled.Ofcourse,thismeantanotherveni-puncture!Oneoftenheardcausticcommentsaboutthesemaneuvers,somesayingtheywerea“test”requiredtoenterasurgicalprogram!Obviouslyitisquickernowand,withoutadoubt,muchsaferandpleasanttobothpatientandtechnician.


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Present-day marvels don’t stop with just the act of drawingblood; they extend to the small amount of blood necessary formodernlabstodotheirtests.Atmid-20thcentury,manylaborato-riesdidnotdoabroadrangeofanalysesandtestsbecauseelaboratepreparations and considerable timewerenecessary.Commonly, atechnicianbutoneortwoofthemorecomplicatedtestsatatime.Serumanalysesdeterminationswerenotevendoneatmosthospi-tals inSanFrancisco.Bloodgasesandmanyother testswerenotreadilyavailable,andwhentheyweredone,ittook24-36hourstogetresults—whichthenwereratherequivocal.

Fasterwerebloodsugars,whichtook1-3hoursonanemergen-cybasisfromthelabinthecountyhospitalwhereItrained—ifthelabwasopenandnotover-committed.However,asweconsideredspeedtobemoreimportanthere,wesetupanillegalmini-labonthemedicalfloortodoourowntestsinlessthan30minutes,nightorday, and especially overweekends.Those of usdoing intrave-nousfluidtherapyhadNOtestforK+bloodlevels,andthosedoneforNa+tookafullday.Theflamephotometerwasjustnewonthemarketbut,asIrecall,theSanFranciscocityfathersfeltiswasjustanexpensive“toy”fordoctors!

Most liver and kidney tests were done two-to-three days perweek,andittookthesameamountoftimetogetresults.Forallpracticalpurposes,thechemistrylabswereclosedonweekendsex-ceptforbloodsugarsandBUNs.

Therewasnowaytogetblood levelsonpoisonsandmedica-tionsunless itwas sent to a state lab,with results taking at leastweekortwo.AttheSanFranciscoCountyHospitalallCBCs,sedrates, Hct, platelet counts and urinalyses were done in the wardlabsbyinternsormedicalstudentswhocarriedasmallcaseofequip-

mentandsolutions.Iunderstandthiswascommonpracticeinmanyteachinghospitals.Notonlydidourinternsandstudentsdoallrou-tineCBCsandurinalyses;theydidallthefollow-upandemergencylabwork.Alllabworkhadtobecompletedforallpatientsbydaily8a.m.rounds.Whennomedstudentswereavailable,twointernsdidthison100-personwardsatSanFranciscoCountyHospital.

The“case”theycarriedwasasmallblackboxthataccompaniedaninternthewayariflegoeswithaMarine.Itcontainedahemato-cytometerwithcoverslipsaswellasslides forbloodandexudatesmears.Allthenecessarypipettesforbloodworkwereinaspecialrackinthelid.Belowinfittedcompartmentsweresmallbottlesofthesolutions—suppliedgenerouslybythehospital!—necessaryforcounts(WBC,RBC,platelets, smears,hemoglobometry), includ-ingWright’sandGram’sStain.

The urine specific gravity hydrometer and its cylinder werethere,andthetestingmaterials forurinesugar,acetone,andpH.Tapetestshadjustcomeoutandsomepeoplehadthem,whileoth-ersdidnot.Stuckinapieceofrubberorcorkineveryone’skitwasaNo.11Bard-Parkerbladeforfingerandearsticks,whichwereacommonwaytodotheserialcountsorhemoglobinchecks.Thesebladeswerereplacedeveryfewweeksandwereusuallywipedwithan alcohol sponge before use. Alcohol sponges were occasionallyavailableinpackets,butweremostoftenfoundinspecialglassjarsatthenursingstations.Asstudentswewoulddothepneumococcaltyping,butthiswasnolongernecessaryby1950.That“blackbox”costuseachabout$75-100fromourownpockets,andwepaidforanybrokenorlostcomponents.

IntheprivatehospitalsinSanFrancisco,andprobablyinmostother hospitals then, technicians did all the blood counts “by


hand,”throughamicroscopeusingaspecialruledslideandspecialsolutions,thoughafewmachineswerebecomingavailable.Bloodcount processing took up to eight hours, unless marked EMER-GENCY.Mosthospitalstriedveryhardtohaveallbasiclabworkofeveningadmissionsinthechartsthenextdayby7a.m.,especial-lyforthesurgicalcases,butoftendidnotsucceed.Itwascommonforsurgicalfloornursestobecallingphysiciansat4-6a.m.aboutlowhemoglobinsandsuchwhenthelabtechnicianputtingthelabworkintothechartsbroughtittothenurses’attention.

Obviouslyincasesofmassivebleedingthetestswouldbedonein minutes and everyone contacted. While a technician or twomightbeavailableallnighttodobloodcountsandcross-matches,itwasarareprivatehospitalthathadin-housetechniciansabletodobloodchemistriesafter5p.m.The“oncall”techwouldhavetocomeinforthosecases.

Since most bacteriological studies were done during the day,bacteriologicalnightproblemswererare.Whenexudatesandsuchweretobestudied,asterileswabwasusedandplacedinaculturemedium.Thiswaswelllabeledwithgreasepencilandimmediatelytakentothelabforincubation.Blooddrawnforsepticstudieswasbasicallyhandledinthesameway,andofteninvolvedaduplicateor“backup”tube.

Itmightbeeasyforsometolookbackatthosetimesasmoreleisurely,butwehousestafferswereverybusy.Veryfewprivatehos-pitalshadERsor24-houremergencyservices.Thenationhadfew-erpeopleandconsiderablylessviolence,butthesecannotexplainitall:Peopleweredifferentthen.

People were far less demanding.They understood that we weredoingoutbest.Theyevenseemedappreciative!Commonly,theyalsounderstood that a doctor’s office could handle most of their needsmorequicklyandeconomicallyduring thecourseof regularhours.Therewerenoneofthe“mytimeisasvaluableasanydoctor’s”com-ments.Therewerenoneofthe“IwantorneedthisorthatbecauseIheardof someonewith this or thatwhodroppeddead,”orpeoplewhoneededsomethingdonebecausesomemediapersonalitysaidso.

Oneneversawapatientwithordersfromalawyerurgingcer-tainexamsortestsnomatterhowabsurdorexpensive.Oneneverheardthethreatofalawsuitifthepatientdidnotgetwellorfullyrecover.Commentslike,“thecostisnoproblemsinceIhaveinsur-ance”—oramonMedicare—nevercameup.

BeforeIretired,Iwasimpressedtohearpeopledemandtobetreated “like when we were younger,” to be “normal,” to “feelgood”—whateverallthatmeans.IhadpeoplesharplychallengemyestimatesofrecoverytimebecauseTHEYplannedtobe“well”andbackatworkadayor twoaftermajor surgery.Peoplewere evensayingthatsincetheaccidentwasnottheirfault,theydidnotfeelanobligationtopaymybill—orthehospital’s!

Weworkedlong,demandinghoursinthe1940sand’50s,butbasicallywerehappy,andproudofourresults.Wehadnoseriousproblemswithourequipmentandlabsbecauseweknewthatitwasallsomuchbetterthanwhatpreviousgenerationshad.

Iwouldliketobelieve,however,thatourcollectivecontributionwasconstructiveandimprovedthesystemforfuturepatientsandstaffs.Weallsawtheneedforimprovements,andquickerresults.But I will never be convinced that all of our medical advanceswould not have occurred without all the new harsh, almost un-bendable,difficult-to-understandlawsandrules.

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PCMS alliaNCE NEwS

An out-of-sight ‘step-out’By Tyna Callahan

A sellout crowd step-ped into Fleming’s Dec.7, 2011 for the themed“Step-Out for MobileMeals,” Pima CountyMedicalSocietyAlliance’sMobile Meals HolidayLuncheon.

Nearly 120 peoplejoinedeventchairAnas-tashaLynnandtheAlli-ance in support of Mo-bile Meals as Fleming’sopened their doors tothe event off-hours forthesecondyearrunning.Members and friends of

theAlliancewerewelcomedintothewarm,festivelydecorateddin-ing room for their signature steaks and famous cheesecake (withtheflexibilitytoaccommodatenon-meateaterswithfishandvege-tarianchoices).

The numbers weren’t in at our timeof publication, but given the selloutcrowd and tables full of beautiful raffleandauctionitems—andMrs.A’sApplesfor sale—it’s safe to say that Alliancemembersonceagaincamethroughwhentheystepped-outforMobileMeals2011.

PCMSA’s tradition of supportingMobileMealsofTucsonismorethan40years strong, and members and friendsof the Alliance always look forward tothiseventtokickofftheholidayseason,and to kick off holiday shopping andgiving.

MobileMealsofTucsonprovidesoneessential service: the delivery of specialdietmeals tohomebound individuals tohelp keep themhealthyandindependent.Theydeliveredmorethan96,000mealsthispastyeartomorethan670clients,55percentofwhomcouldonlypay$3orlesstowardthealmost$11costofthesemeals.Tomakeado-nation,visitwww.mobilemealsoftucson.org.

Attendees entered to the sounds of the fabulous Tucson JazzQuartet,andheadedfortheauctionandraffleroomwheretableswere loadedwithbeautiful gifts andgift certificates fromTucsonmedicalpractices, restaurants, andotherbusinesses, including re-peatdonorsEclecticCafé,Fleming’s,Gadabout,ImagenSalon&DaySpa,J.EliseDesigns,J.GilbertFootwear,Pastiche,Perfection

From left, PCMSA ‘chiefs’ are Kynn Escalante, Kay Dean, and Anastasha Lynn.

Plastic Surgery, TucsonDermatology and more.Of course, Dr. PhilipFleischman’s pepper millhad a prominent place,too. New businesses alsopitched in this year,among them, IronwoodDermatology,PrettySweetDesserts, Renee’s Organ-ic Oven, and SabinoArtisanChocolates.

PCMSA membersthemselvesmadecreativedonationsthatdrewalotofinterest—andraisedsubstantialdona-tionsbythesilentauction.HallaMoussa,famedwithintheorgani-zationforheroutstandinghummusandbaklava,offeredcookinglessons;JaniceLeffdonatedapaintingthatsoldat its“buynow”pricebefore it evengot in thedoor, anda setof cardsdecoratedwithherartwork.Morethanhalfadozenwreathoriginalscrafted

anddonatedbymembersunderthedi-rectionofinteriordesignerandmemberJoyChapeskie,weresnappedupatauc-tion(onewasspottedlastweekhangingintheBenettonshopatLaEncantada).Thanksgo, too, toAskrens for thedis-counts they offered our wreath-makingmembers.

PCMSAmembersoutdidthemselveson the event this year, and those whoputtheirowntime,money,andcreativi-ty into the event made it truly special.Community-building fund-raising ac-tivitiesleadinguptotheeventbenefitedfrom the talents of two PCMSA past-presidents:JoyChapeskie,whoseleader-ship brought us beautiful wreaths for

auction,andMrs.Aherself,KathyArmbruster,whowentall-outonceagain,leadingthetraditionalMrs.A’sApple-making.

Otherever-presentandtirelessvolunteersincludedTraceyGee,whoorganizedandcollecteddonationsforraffleandauction;KayDean, who managed reservations and seating; Apples second-in-commandSusanRogers,yetanotherpastpresident;TynaCallahan,pasteventchair;andPCMSAPresidentKynnEscalante.

Mosttirelessofallwasourchairwoman,AnastashaLynn,whosteppedintoleadershipthisyear,bringingnewideasandkeepingoldtraditionsalivewithherownuniqueflair.Andthegoodnewsis,shehasagreedtodoitagainnextyear!

Kristin Ashdown shows the creative wreath donated by Michelle Grantham.

The Tucson Jazz Quartet entertained at the event.


Touchingothers

rEaliTY ChECK

Dr. Michael S. Smith

I never knew Jamalee Fenimore, orStephne “Stevie” Staples. No one whowillreadthisknewthem,either.

Both of them loved the Sandhillcranes(Gruscanadensis),asdoI.Aview-ing blind is named for them at RoweSanctuaryinGibbon,Neb.,atthePlatteRiver’ssouthernend.

Everyspring,theSandhillandWhoop-ing cranes, respectively the most andleast common of the 15 crane species,begin their 5,000-7,000-mile migration

tothesubarcticinNorthAmericaandSiberia.TheirfinalstagingareaisonthePlatteRiver.

They go to thePlattebecause there is foodnearby—formerlysmallanimals,butnowmostlycorn—andbecauseofthesafetythatoneofthelargestbraidedriversinNorthAmericaaffords.Theyfeedintheadjacentfieldsbydayandroostintheriveratnight,wheretheshallowwaterallowsthemtohearpredatorsapproach.Beforethe Platte was dammed and water used for irrigation, recreationanddrinking, itwasamilewideandaninchdeep,“toothicktodrink,toothintoplow.”

NowthePlatte inmanyareascontains lesswater,has invasivespeciesandmanytreesnearby,reducingthesuitablehabitatto50milesfromtheformer200.RoweSanctuarymanagesfourmilesofriver and owns 1,900 adjacent acres, preserved as habitat. Everynight for six weeks in March and April, up to 600,000 Sandhillcranes, 90 percent of the world’s population, roost in the river.Everymorningthey leavetogotothefieldstoeat.JaneGoodallhascalledthisoneofthetop10spectaclesinnature.

I’vebeenfortunatetohaveseenmuchinnature.Thismigrationisinmytopthree;seeingasolareclipseandawolfinthewildarethe other two. I love the cranes so much that I volunteer at thesanctuary,alongwithdozensofothers,helpingthefull-timestaffoffour—that’s right, four—show visitors the cranes from viewingblinds,forcranesareshybirdsandwillnotletpeoplenearthem.

ManytalkaboutthecranesthatmigratetoArizona.Isimplyre-ply,“Youdon’tunderstand.”Andyoucan’tuntilyouwitnesstheaflockof50,000cranesdarkeningthesky.

StevieStaplesmentoredoneoftheRoweStaffandlived74yearsbeforedying in2006 fromcancer. Shewas a former canoe racerandarealcharacter.Ionceracedcanoes,andIwouldhavelovedtohavediscussedracingwithher.ShetouchedthestaffatRowe.Sheknew it, for she did live to see a beautiful picture of a Sandhillcraneinflightwithhervolunteertagwith“nineyearsofservice”onit.ThepicturehangsonthewallinthehallwayofRowe.ApictureofSteviereceivingthepicturefromtheRowestaffhangsinKeanna

Leonard’soffice.ThedynamicKeannaistheeducationaldirectoratRowe.

JamaleeFenimoregrewupinNebraskaandpracticedveterinarysurgery inWashingtonState.Shediedofcancerfartooyoungat49,donatingherestatetoRowe.NooneatRowekneworremem-beredherbeingthere.Butobviouslyshewastouchedbytheriver,the cranes, and the sanctuary. We volunteers learn that we maytouchvisitorsinwaysweneverknowatthetime.

When I volunteer atRowe, Iwork17-hourdays, sleepingonthefloor in thegift shopsoIcanhear thecranesontheriveratnight.Iguidepeopletotheviewingblinds,andIcanteachthemeverything I know about cranes. Mostly, however, I let peoplewatch,remainingsilent,sotheycanhearthebirds.Icleantoilets,paint, greetpeople,build a sundial, carpentry,whateverneeds tobedone.

Ononetour,ItookadisabledmantoStevie’sblindinanelec-tricgolfcart.Hadhebeenabletowalk,allofthegroupwouldhavegonetoStrawbaleblind,whichhadbetterviewsatthattime.Butwe still saw many cranes, American white pelicans, and unusualcranebehavior.

Myriderlovedtheviewandtriedtotipme,whichIofcourserefused,askinghimtoputthemoneyinthecontaineratthesanc-tuary.Iplannedtotalktoothervisitors,becauseastheleadguide,Ihadn’tspenttimewiththem.ButIspenttimewiththisman.Hewasoriginally fromSingapore;whenItoldhimIhadbeentheretwice,hisfirstcommentwas,“Thankyouforsavingmycountry.”I’veneverheardthatbefore,anditdidmegood.IhopeIandRowedidhimgood.

Wetoucheachotherinwayswemayneverknow.Goodpeoplespread kindness throughout their world. The lucky ones receivethatkindnessandlivelongenoughtodiscoverthattheirkindnesswasdeeplyappreciatedandhonored.Butallwhospreadkindnessarefortunatethattheydoso.

Stevieknew inherfinaldays thatherkindnesswasappreciat-ed.IhopeJamaleeFenimoredid,too.Butifnot,Iknowsheknewshe did the right thing. I deeply appreciate what she did. EverytimeIguidepeopletoeitherofthetwoblinds,Itellthemthestory,forbothdeservetoberemembered.

TohaveaviewingblindnamedforyouonariverwhereahalfmillioncranesvisiteveryMarchisawonderfulhonor.Ireallycan’timagineabetterone.

Sombrero columnist Dr. Mike Smith’s blog is http://michaelspinnersmith. com, where there are previous RealityCheck columns, outdoor writing, descriptions and pictures of National Parks, Alaska hikes, eclipse- chasing, mental arithmetic, op-eds, and two non-technical neurology articles that physicians might enjoy.


PErSPECTivE

ThetwoAmericasBy Dr. Michael Hamant

IhaveaverydifferentperspectivefromthatofDr.GeorgeMakol[Perspective,December2011Sombrero].Dr.MakolfirstgavePCMSreaders a nice story about his family’s immigration to America in1903andthequintessentialAmericansuccessstorythatfollowed.

ItisinterestingthattwoTucsonphysicians,fromthesamegen-eration,practicingonlyafewmilesapart,couldhavesuchdifferentworldviews.Itisimpossibletoillustrateallourdifferencesinafewparagraphs,but Iwould like tooffer adifferentperspectiveonafewofDr.Makol’spoints.

Dr. Makol’s family history is certainly inspiring. He states,“ThiscouldhappenonlyintheAmericainwhichIgrewup.”ButDr.MakolandIgrewupinthe1950sand’60sinaneraofgreatfreepubliceducationandinexpensivehealthcare.

Myparents’generationwenttoexcellentfreepublicschoolsin1930sChicago,filledwithethnicimmigrants.Itoohadonegrand-fatherwhowasamillionaire,buthe losthis fortune inthe1929stockmarketcrashandchangedfromaRepublicantoaRooseveltDemocrat. My other grandfather only finished the eighth grade,buthis sonobtainedaprofessionaldegreeon theGIbill.Somyfamilylegacywastoappreciatethepositiveeffectofgovernmentoneducation and on financial regulation. These family history vi-gnettesareas important inshapingmyworldviewasDr.Makol’sfamilyhistoryisinshapinghis.

Wedivergeonmanyotherpointsaswell,especiallyouropin-ions on “global warming, a.k.a. climate change.” As evidence,Dr.Makolcitessomeexamplesofunusuallocalweatherconditionsasskepticismaboutwhetherglobalclimatewarmingisoccurring.Infact,themodelsofglobalclimatewarmingpredictthewildfluc-tuations in local weather, just as Dr. Makol reports.The globalmeantemperature,however,isdeterminedbybillionsoftempera-turemeasurements,notafewspotreadings.Itisincumbentuponphysician-scientists to use the scientific method and statistics topresentdata in ameaningfulway insteadof repeating inaccurate“talkingpoints.”

Dr.Makolhadmanystatementsandthemesthatwerenotclearand illustrations thatdon’t sustain close inspection.For example,there was a contention that the globe is 95 percent uninhabitedandthattheworld’spopulationwouldfit intoTexasatapopula-tiondensityofManhattan.Iamnotsureifthisisacommentonpotentialunlimitedresourcesthatexist,orthatpopulationcontrolisnecessaryornot.But70percentoftheglobeisoceanandunin-habited. Of the remaining 30 percent, probably half is arctic ordesert.AndcanyouimaginewhatdamageatornadoliketheonethathitJoplin.Mo.orahurricanelikeKatrinawoulddotoTexaswith 7 billion people?This would be a silly speculation since itwouldbephysicallyimpossibletotransportthewaterintoTexasor


thefecesoutfor7billionpeople.WecanbarelyaccomplishthisinthelimitedspaceofManhattanwithafewmillionpeople!Regard-less,theplanet’sresourcesarefiniteandcannotsupportunlimitedpopulationgrowth.

“Thethoughtthatman’sactivitycouldwarmthewholeatmo-sphereisnarcissistictosaytheleast”isquiteashockingstatement.Certainlyourcivilization’seffectontheatmosphereisvisible every-whereasaworldwidehazeatbest,andasfilthysmoginmostcitiesatworst.Mostofoureffectsontheenvironmentaremuchmoresubtlethansmogandquiteinvisible.Theprofoundeffectwehaveontheplanet’senvironmentisnotnarcissism,butisstronglysup-portedbythescientificevidence.

There was an evocative, yet false, statement about the ArcticNationalWildlifeRefuge that read, “If youmadea footballfieldsizedmapofAlaska,ANWRwouldbethesizeofapostagestamp.”Infact,theANWRis19millionacres(aboutthesizeofSouthCar-olina) and is 4.477 % of Alaska’s land mass. This computes toabout2,578squarefeetona360-by-160-yardfootballfield,orthesizeofagood-sizedhome.Certainlyquiteabitbiggerthanapost-agestamp.

Dr.Makolspendsagoodpartofhisessayaddressingthecurrentpolitical debate over the size of government and the taxes usedto support it. We can certainly disagree about these issues, butmany of his supporting facts are not accurate. For instance, theG.W.Bushbudgetdeficitwasnotonly$161billionin2007“after9/11andtwowars”becauseBushnever includedthewars inthebudget.Itmightbeaneataccountingtricktokeepthewars“offbudget,” but the reality is that two unfunded wars at $2 trilliondollarsandcounting,whilesimultaneouslygivingataxratereduc-tion,broughtusfromtheClintonerabudgetsurplustoourcur-rentdebtproblems.

TheBush-erataxcutswereatotalfailureincreatingjobs.Thecurrentmantraaboutnottaxingthe“jobcreators”simplyhasnofactualbasis.Wearenottalkingaboutreturningtothe1950seraof70percentmaximumtaxrate,butProgressivesareaskingforare-turntotheClinton-eramaximalrateof3-4percenthigherthanthehistoricallylowcurrentrates.Reaganraisedtaxesseventimesandtheeconomygrewjobs.CorporationslikeGeneralElectricpaynotaxes,yetshipjobsoverseas.Solet’sberealisticabouttaxpolicyandjobcreationandnotpandertoAmericansforTaxReform’slobbyistGroverNorquist.

Yes,Itotallyagreethat“wearerapidlybecomingtwotypesofAmericans.”NotDr.Makol’stypes,butrathertheveryrichandev-eryoneelse.AverageCEOsalaryincreased27percentin2011andcorporationsaresittingontrillionsincash,yetunemploymentisatnear-historic highs, the median annual income is $27,000, andnearlyathirdofthepopulationisinpovertyorverynearit.Mid-dle-classincomehasbeenstagnantfornearly20years.Itisthelackofbuyingpowerofthemiddleclassthatisthecruxoftheeconom-icproblems,notexcessivetaxationofthewealthy.Whenthemid-dleclassdoeswell,everyonedoesbetter,includingthewealthy.

It is trickle up, not trickle down. So yes, if you are fortunateenoughtobeinthetop1percent,youneedtopayslightlyhighertaxestobringAmericatoaprosperouseconomicfutureforall.Ifnot, the future looks a lot like Marie Antoinette’s 18th-centuryFrance’sincomedistribution.The99percentneedmorethan“letthemeatcake”asaneconomicmodelforsuccess.

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SHELVING SYSTEM FOR SALE: Original purchase price $20,000. Exceptional condition. 20 ft X 9 ft, 7 levels high. Asking $5,000 or best offer. Please contact Cindy, 327-9573, ext. 245. (12-11)

PCMS member, certified physician assistant with alternative medicine background, seeks 32-36 hours of employment in an internal medicine practice starting January 1. Contact PCMS, 795-7985, if interested.

OFFICE SPACE FOR LEASE: Free-standing single-story building with Grant Road frontage. Ample on-site covered parking. Move-in ready; currently configured as medical office space of approximately 4,100. sq. ft. Ideally located across the street from Costco between Tucson Medical Center and St. Joseph’s Hospital. Contact Ted Kalota, 250-5040. (11-11)

CONfErENCES & SEMiNarS

JanuaryJan. 29-Feb. 4: Mayo Clinic EMG EEG and Neurophysiology

in Clinical Practice isattheWestinKierlandResort&Spa,6902E.GreenwayPkwy.,Scottsdale85254;phone480.624.1000.CME:60AMAPRACategory1credits,andself-assessment8AMAPRACategory1.

TopicsincludefundamentalbasisforCNPtestsincludingphysiol-ogy,pathophysiology,clinicalcorrelation,andappropriateuseofthesetechniques. Specific procedures include EEG, EMG/nerve conduc-tion studies, evoked potentials, movement disorders studies, auto-nomic studies, polysomnography, and intraoperative monitoring.Clinical correlation with sleep and neurologic- based diseases arestressed. Newer techniques for this year’s course include vestibulartesting.Alsotakeaway“pearls”oncoding,billing,andproposedqual-ity metrics for managing the person with epilepsy. Website: http://www.mayo.edu/cme/neurology-and-neurologic-surgery-2012s508

Contact:StaciKing,MayoSchoolofContinuousProfessionalDevelopment; phone 480.301.4580; fax 480.301.8323. E-mail:[email protected]

FebruaryFeb. 10-11: Latino Health Promotion Summit: A Focus on

Prevention & Community Collaboration. The University of Arizona College of Medicine’s Office of

Outreach and Multicultural Affairs, and the Hispanic Center ofExcellence,incollaborationwiththeNation-al Hispanic Medical Association (NHMA),

theArizonaLatin-AmericanMedicalAssociation(ALMA),andtheLatinoMedicalStudentAssociation(LMSA)arepleasedtoinviteyoutoattendthe2012LatinoHealthPromotionSummit.

The goal of the summit is to bring together community physi-cians, residents, medical students, pre-health students, promotoras,andcommunitymemberstoincreaseawarenessaboutLatinohealthandco-developcommunitybasedhealthpromotionsolutions.

ProgrambeginsFeb.10withacommunitylecturebyElenaRios,M.D.,M.S.P.H.,presidentandCEOoftheNationalMedicalAsso-ciation(NHMA),whowillalsogivethekeynotetalkonFeb.11.

Online registration:www.diversity.medicine.arizona.eduRegis-tration and lunch are free of charge. Please e-mail questions [email protected],orcall520.626.7146.

Feb. 15-18: The Mayo Clinic Department of Gynecology’s23rd Annual Advanced Techniques in Minimally Invasive Pel-vic Surgery: The Leading Edge and Hands-on Cadaveric Work-shop, is at the Fairmont Scottsdale Princess, 7575 E. PrincessDrive,Scottsdale85255.CMEcredits:27.5AMAPRACategory1;27.5AOACategory2-A.

Symposium’sgoalisawell-balancedprogramtrulyreflectiveofapractice committed tominimally invasive surgery. “The attendeewillwalkawayfromourcourseunderstandingthemanyaspectsofMISandtherolesofvaginal,laparoscopic,androboticapproachesinasurgeon’spractice.”

Phone480.301.4580;fax480.301.8323.Website:http://www.mayo.edu/cme/[email protected]

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One Area of Focus:

Radiology Ltd. has focused on providing radiology services in the Tucson community for over 70 years. Each of our physicians is a specialist in their area of expertise. They, and the rest of our staff, are dedicated to providing quality patient care with an emphasis on both patient comfort and safety. Our imaging is now entirely digital, providing the highest image quality and quick turnaround of results.

There Is A Difference

radltd.com733-SCAN (7226)

Radiology

Radiology Ltd also provides:

RadVision The clear choice for immediate viewing of digital imaging and patient reports via a secure online connection. Images are also available on CD and high resolution paper.

To get connected to RadVision, please call 901-6747.

Convenient scheduling– centralized scheduling for all sites by phone or fax– ability to accommodate STAT requests – accept all major insurance plans– insurance verification and appointment confirmation– a bi-lingual staff

Easy access to reports– accurate reports with rapid turnaround time– faxed preliminary and/or final reports – recent and remote study reports always available online

Professional Relations Team– rapid staff responses to your needs– dedicated phone line for physician to physician consultation– full-time couriers deliver studies/reports to you quickly

Radiology Ltd. is locally owned and operates ten imaging centers in Southern Arizona to serve you and your patients.

Consider working with the radiology specialists at Radiology Ltd.


(602) 956-5276, (800) 352-0402 www.mica-insurance.com

The dividend declared for any give year reflects MICA’s financial performance during the year.

Past performance does not guarantee future dividends.

Mutual Insurance Company of ArizonaMedical Professional Liability Insurance

Through a true partnership of efforts,

MICA's Board of Trustees is pleased to

announce a $50 million dividend for

2011 - our 7th consecutive dividend.

Thanks again, MICA members.

Great News!

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January 2012

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