SGIM Forum Template Library/SGIM/Resource Library/Forum/2002... · 31-08-2002 · 13 accepted for...

SGIM

FORUMSociety of GeneralInternal MedicineTO PROMOTEIMPROVED PATIENTCARE, RESEARCH,AND EDUCATION INPRIMARY CARE

Volume 25 • Number 7 • July 2002

2002 ANNUAL MEETING: A LOOK BACK

SGIM CELEBRATES 25THANNIVERSARY IN ATLANTAEllen Yee, MD, MPH, and Jeff Jackson, MD, MPH

continued on page 13

Contents1 SGIM Celebrates 25th Anniversary

in Atlanta

2 Southern Region Meets in New Orleans(Again!)

3 President’s Column

4 Remember, Welcome, Anticipate

5 General Internal Medicine: Evolution of aDisipline

6 Glaser Award Goes to Lee Goldman

6 Jack Feussner Receives Eisenberg Award

7 Education Award Goes to Robert C. Smith

7 Carole M. Warde Receives Rhodes Award

8 Nickens Award Goes to David Satcher

8 Passing the Torch

8 SGIM Inaugurates Electronic Bulletin

9 2002 Annual Meeting: A Photo Album

20 Classified Ads

The celebration of our Society’s 25thanniversary at the 2002 AnnualMeeting in Atlanta was a spectacu-

lar opportunity to recognize the work ofpast, present, and future pioneers in gen-eral internal medicine. For three days inMay, members came from all across thecountry and the world to share ideas, gainknowledge, meet old friends, and makenew ones. The contributions and work ofthe founding pioneers of SGIM haveshaped the landscape of general internalmedicine, and their work continuesthrough the efforts of present and futureleaders. The theme of the meeting, “TheNext 25 Years: Emerging Issues for Gen-eralists,” offered us the chance to reflecton the impact of past events on the fu-ture. Multiple venues highlighted thetheme and promoted values embraced bySGIM: excellence in patient care, re-search, and education, as well as diver-sity, social responsibility, collegiality, col-laboration, mentorship, innovation, andcreativity.

Though the Annual Meeting itselfmade history, with new records set forattendance (1,612) and submissions(1,266), the real story came from themembers and the events of the meeting.SGIM reflects the passion and dedica-tion of its members. The AnnualMeeting was a wonderful reminder ofwhat can be accomplished with a dreamand an opportunity. From the firstAnnual Meeting in San Francisco in1978, SGIM, formerly the Society for

Research and Education in PrimaryCare Internal Medicine (SREPCIM),has experienced tremendous growth. Aretrospective published in JGIM in1994 noted that SREPCIM, an organi-zation with “no board, no mailing list,no tradition, and almost no money,”drew 178 physicians, “including severaldepartment chairs,” to its first meeting.1

The one-day meting included work-shops, plenary papers, and a meal. Forthe second meeting, Paul Griner’s callfor abstracts drew 38 submissions with13 accepted for presentation. Bycontrast, this year there were 1,226submissions, 44 precourses, 134 work-shops, 675 scientific abstracts, 68innovations in medical education, 22innovations in practice management,and 266 clinical vignettes. With only ahandful of exceptions (the clinicalupdates and two workshops), allpresentations at this year’s meeting wereselected by committees of volunteersthrough a largely blinded process. Morethan any other national meeting, theSGIM Annual Meeting is by and for itsmembers.

A Wednesday evening, pre-meetingreception at Grady Hospital featured apoignant presentation by Jordan Messleron the history of this once-segregatedpublic hospital. Though change hasoccurred in the form of integration,emerging issues from the early 1900’sstill remain: concerns about staffing

2

SGIM FORUM

Southern Region Meets in NewOrleans (Again!)Jane M. Geraci, MD, MPH


It is universally acknowledged thatSGIM’s Southern Region meets inNew Orleans for the food and

atmosphere. Yet this year there was stillabundant scholarly activity available forperiodic relief from the more basicoverindulgence. The 2002 meeting washeld at the Hyatt New Orleans fromThursday, February 21, to Saturday,February 23. It began on Thursdayafternoon with a workshop entitled“Resource and renewal: recognizingphysician burnout, promoting physicianwellness.” This workshop was sponsoredjointly by SGIM’s Southern Region andthe Southern Section, AmericanFederation for Medical Research(AFMR). Don Brady led the workshopwith assistance from Susan Ray(AFMR), Elisha Brownfield, and EricaBrownfield.

Friday’s activities included concur-rent workshops and oral scientificabstract and clinical vignette presenta-tions throughout the day. The PlenaryScientific Abstract Session was heldSaturday morning. Two abstracts tiedfor the Best Abstract Award: “Residentsmoking cessation therapy” by AmandaGreen and colleagues from Duke and“Health profile of an urban, low-incomeclinic” by Keith Winfrey and colleaguesfrom Tulane. Dr. Winfrey also receivedthe Southern Region’s award for

Resident Presentation of the Year,which included presentation of his workat the SGIM Annual Meeting inAtlanta and financial support to attendthat meeting. At the Business MeetingDon Brady of Emory hit a double,winning the position of President-Electand the Southern Region’s Clinician-Educator Award for 2002. Also an-nounced was the winner of the BestClinical Vignette Award, AnupamaKewalramani of Tulane for “Diabetes,thyromegaly, and acute weakness.”

The meeting closed Saturdayafternoon with the final clinicalvignette and workshop presentations.There was a general sense of pleasureand satisfaction with the meetingoverall. Registration reached 129, a gainof more than 10% over 2001. Fifteeninstitutions from eleven southern stateswere represented by attendees and/orpresenters.

I would like to take this opportu-nity to thank the many individuals whomade this meeting possible: SamCykert, Program Chair; Carlos Estrada,incoming President; Terry Shaneyfeldt,Treasurer; Ron Shorr, Abstract Selec-tion Chair; Mark Parkulo, AbstractSelection Co-Chair; Erica Brownfield,Workshop Chair; Nathan Flacker,Workshop Co-Chair; Karen DeSalvo,

EBM Task Force Seeks Member InputThe Evidence-Based Medicine (EBM) Task Force is developing a Web site to meet theneeds of members who are interested in learning and teaching about EBM. To learn moreabout those needs and how the Web site might address them, the EBM Task Force hasprepared a brief survey that we invite you to complete. We understand how busy all of youare, but we would appreciate it if you could take a few minutes to complete the survey.Your input will help us develop a resource that will be useful in your daily activities. Foryou convenience, we are mailing the survey with this issue of the Forum. Members whocomplete and return the survey by August 31, 2002, will be entered into a drawing for aPalm Pilot. Thanks for your help!

SOCIETY OF GENERAL INTERNAL MEDICINEOFFICERS

PRESIDENT

Martin F. Shapiro, MD, PhD • Los Angeles, [email protected] • (310) 794-2284

PRESIDENT-ELECT

JudyAnn Bigby, MD • Boston, [email protected] • (617) 732-5759

IMMEDIATE PAST-PRESIDENT

Kurt Kroenke, MD • Indianapolis, [email protected] • (317) 630-7447

TREASURER

Eliseo Pérez-Stable, MD • San Francisco, [email protected] • (415) 476-5369

SECRETARY

Ann B. Nattinger, MD, MPH • Milwaukee, [email protected] • (414) 456-6860

SECRETARY-ELECT

William Branch, MD • Atlanta, [email protected] • (404) 616-6627

COUNCIL

Christopher Callahan, MD • Indianapolis, [email protected] • (317) 630-7200

Kevin Covinsky, MD, MPH • San Francisco, [email protected] • (415) 221-4810

Susana R. Morales, MD • New York, [email protected] • (212) 746-2909

Eileen E. Reynolds, MD • Boston, [email protected] • (617) 667-3001

Gary E. Rosenthal, MD • Iowa City, [email protected] • (319) 356-4241

Harry P. Selker, MD, MSPH • Boston, [email protected] • (617) 636-5009

EX OFFICIORegional CoordinatorJane M. Geraci, MD, MPH • Houston, [email protected] • (713) 745-3084

Editor, Journal of General Internal MedicineJournal of General Internal MedicineJournal of General Internal MedicineJournal of General Internal MedicineJournal of General Internal MedicineEric B. Bass, MD • Baltimore, [email protected] • (410) 955-9868

Editor, SGIM ForumSGIM ForumSGIM ForumSGIM ForumSGIM ForumDavid R. Calkins, MD, MPP • Boston, [email protected] • (617) 432-3666

HEALTH POLICY CONSULTANT

Robert E. Blaser • Washington, [email protected] • (202) 261-4551

EXECUTIVE DIRECTOR

David Karlson, PhD2501 M Street, NW, Suite 575Washington, DC 20037

[email protected](800) 822-3060(202) 887-5150, 887-5405 FAX

3

PRESIDENT’S COLUMN

SGIM

FORUM

Published monthly by the Society of General Internal Medicine as a supplement to the Journal of General Internal Medicine.SGIM Forum seeks to provide a forum for information and opinions of interest to SGIM members and to general internists andthose engaged in the study, teaching, or operation for the practice of general internal medicine. Unless so indicated, articles do notrepresent official positions or endorsement by SGIM. Rather, articles are chosen for their potential to inform, expand, andchallenge readers’ opinions.SGIM Forum welcomes submissions from its readers and others. Communication with the Editorial Coordinator will assist theauthor in directing a piece to the editor to whom its content is most appropriate.The SGIM World-Wide Website is located at http://www.sgim.org

SUMMERMEDITATIONSMartin F. Shapiro, MD, PhD


EDITOR

David R. Calkins, MD, MPP • Boston, [email protected] • (617) 432-3666

EDITORIAL COORDINATOR

Stacy A. McGrath • Boston, [email protected] • (617) 432-3667(617) 432-3635 FAX

ASSOCIATE EDITORS

James C. Byrd, MD, MPH • Greenville, [email protected] • (252) 816-4633

Joseph Conigliaro, MD, MPH • Pittsburgh, [email protected] • (412) 688-6477

Giselle Corbie-Smith, MD • Chapel Hill, [email protected] • (919) 962-1136

David Lee, MD • Boise, [email protected] • (208) 422-1102

Mark Liebow, MD, MPH • Rochester, [email protected] • (507) 284-1551

P. Preston Reynolds, MD, PhD, FACP • Baltimore, [email protected] • (410) 283-0927

Valerie Stone, MD, MPH • Providence, [email protected] • (401) 729-2395

Brent Williams, MD • Ann Arbor, [email protected] • (734) 936-5222

Ellen F. Yee, MD, MPH • Los Angeles, [email protected] • (818) 891-7711 Ext. 5275

We live four score summers orso. That is about 5,000 days ofJulys and Augusts. As a kid,

those were the best days. Summersseemed endless. After the middle ofAugust, of course, there was the aura ofimpending doom associated with theirreversible slide towards the start of theschool year. Prior to that, it was a timein which a kid could have a lot morecontrol over his or her life—for a while.

In high school and college, summermeant summer jobs for many of us, butthe labor was a new experience and wasa lot of fun. As a relatively newlylicensed driver, I drove a pick-up truckand delivered auto parts at 18, andreally got to know my hometown ofWinnipeg. At 19, I was a taxi driver. (Onmy first day, one customer asked where tofind a prostitute; another wanted to makean illegal alcohol purchase. I had littleexpert advice to proffer.)

In medical school, summer fun canbe attenuated by growing involvementin things medical. For me, one summerwas consumed by a health policy job,and another with beginning my fourth-year clinical rotations. The breakbetween medical school and residencywas rather short for my cohort. Thoseweeks were filled with nervous anticipa-tion of what lay ahead. To the houseofficer, of course, the first months ofinternship and the similar period at thestart of each subsequent training yearbear little resemblance to the summersof youth. They are a time of immenseprofessional challenges. When I was anintern, hours were long, even on daysoff. Wandering out into the humidMontreal summer night felt a bit otherworldly, given my lack of sleep and needto be up early the next morning. I don’tthink that I ever considered summer tobe a carefree time when I was a resident.

I moved to California for myfellowship and was determined to

experience thejoys of the season.For a while, Iwent down toMalibu Beachevery Sunday andsat on the beach,reading. I finallyconcluded thatthat was ratherboring and haverarely been back to a beach since.

I joined the faculty and wasencouraged to do inpatient rotationsearly in July when you could have thegreatest impact on the new interns. Iloved it. The interns ranged from thebrash to the terrified, but it was prettymuch impossible to predict which onewould overlook the potentially lethallow potassium value. It was great to get

to know the trainees andfeel that you had helpedthem towards indepen-dence as doctors. It wasgratifying to realize thatyou were making a differ-ence in quality of care at atime when patients arerather vulnerable. But itsure was a long way fromthe summers of my youth.

I decided to start taking summervacations again a few years later. Ofcourse, long summer vacations were noteven on the table. A week or two or twoand a half was the limit, often following agrueling ward rotation with new interns.

Those vacations afforded anopportunity to catch up on the readingof fiction. Doctors tend to read a lot,

4

SGIM FORUM

PRESIDENTIAL ADDRESS

Remember, Welcome, AnticipateKurt Kroenke, MD


Talking with Tom Inui a fewmonths ago, I remarked that notsince my eighth grade graduation

speech have I delivered a talk morepersonally important to me. Now, 37years later, it’s a real privilege giving avaledictory address to my closestcolleagues. I will be speaking aboutsomething past, something present, andsomething future. This seems particu-larly relevant given our theme for thisAnnual Meeting. “The Next 25 Years”implies we have witnessed a past 25years, and “Emerging” suggests thatthings are just beginning to percolate tothe surface, faintly present now butready to burst onto our landscape.

Regarding past, present, and future,I have picked three verbs that, if notstrictly failings for me, neither are theystrengths. With respect to remembrance,my family background is pretty stoical.In terms of welcome, I am not by naturevery outgoing. And as to anticipating thefuture, I’ve always had to ward off aslightly pessimistic streak. However,our advice is sometimes best informedby those things that inadequacy hastaught us.

Not surprisingly, there is an Oslerstory that illustrates this point. Whenarriving as Chair at Johns Hopkins,Osler was already an acclaimed diagnos-tician. One afternoon, he examined anew patient who had a large, suprapubicmass. He proceeded to counsel both thepatient and family about the graveprognosis, preparing them to acceptwhat was obviously a terminal condi-tion. The next day, a surgeon wasconsulted to evaluate potential pallia-tive options, and he proceeded to inserta urinary catheter, drain a distendedbladder, and “cure” what Osler hadmisdiagnosed as probable cancer. Foryears afterwards, Osler openly sharedthis story with his students. Indeed,medical educators tell us that acknowl-

edging our own limitations is a powerfulmeans of enhancing the learningclimate. This is true also in research andpatient care. After all, why is scienceoften advanced through “trial anderror”? And in clinical practice, medicalerrors are not simply a phenomenon ofan Institute of Medicine report or thefunding this has triggered.

RememberOf my three themes, I will talk most onremembrance, touching first on indi-viduals, and then on the significance ofnames, as reflected in the following fewphotographs. John Eisenberg and MarkMoskowitz were well known to manyhere today. Sarah Stone and SteveGlidden were a University of Massachu-setts faculty member and an SGIMmember’s son, respectively. September11th needs no recounting. These were afew of our great losses this past year. Ialso know that a number of you haveexperienced other losses as well. Thesemay have been inside or outside ofSGIM, professional sorrows or personalones. During the next 15 seconds, Iwould like us to silently remember andmourn those represented by these emptycircles.

A predecessor is not always some-one older than us. It literally means“pre-deceasor.” Our predecessors have

simply departed first, sometimes toosoon. They are part of our lives as familyor friends or, in the few photographsI’ve shown, our SGIM community. Thiscommunity is cumulative.

If you visit Barcelona, there is afascinating museum, built around anexcavation site. At the street level, youare surrounded by 16th century archi-tecture. Inside the museum, you take anelevator down one floor, and, when thedoors open, you enter the remains of amedieval city. After visiting this 1,000-year-old site, you re-enter the elevatorand descend one more floor to visit theruins of a Roman village from the firstcentury AD. Each higher level is builtupon the lower one, and even incorpo-rates remnants of ancient walls into thenew city. At the street level, you wouldhave never guessed this history. You hadto enter the museum and push the downbutton. In the same way, we build ontop of. While our predecessors may havephysically left us, they surround us inevery wall. Because of the JohnEisenbergs and the Mark Moskowitzs,the Sarah Stones, Steve Gliddens, andthose circles we silently honored, wecontinue to build a new city. Remem-bering these predecessors is our corner-stone.

What’s in a Name?Think of medicine a century or two ago.Physical findings, diseases, basicmechanisms were often prefaced by aperson’s name: Babinski reflex,Parkinson’s disease, the Starling curve.This linkage of a person’s name with athing or place is called an epoynym. Likemany societies, SGIM honors individu-als through its own eponyms, linked toawards, lectures, or endowments.

Acronyms are another type oflabel—formed from the initial letters ofwords. For example, WACs belonged to

5

PLENARY ADDRESS

GENERAL INTERNAL MEDICINE:EVOLUTION OF A DISIPLINERobert M. Centor, MD


Before I start, I think it’s veryimportant that I give you somecaveats to prevent too many

attacks afterwards. These are mypersonal opinions. I got to choose whatissues I included and excluded. My goalis to stimulate discussion throughoutthe meeting and throughout the years. Ihope to emphasize the hypothesis thatgeneral internists desire complexity. Wedon’t often have time to address this inour outpatient practice. This leads to alot of discontent. And if we could goback to focusing on complexity, perhapswe could better define ourselves.

I’d like to acknowledge the follow-ing, among many other people, whohave helped me develop my thoughtsabout general internal medicine. TomHuddle is a medical historian in ourdivision who has tried to put the historyin some context for me and who seemsto include my thoughts on a regularbasis. I’ve had ongoing, long discussionswith Gustavo Heudebert at my institu-tion, and this presentation is really theresult of probably five to eight years ofus wrangling about what generalinternal medicine really is. Jim Byrd is along-time colleague and friend at EastCarolina, and most of our discussionsoccur on golf courses. Karen DeSalvo,the Division Chief at Tulane, sharedsome very interesting things about howshe redefined her division at Tulane,which really got me thinking about someof the fine points of this talk. And JackPeirce. For those of you who don’t knowJack Peirce very well, try to find him, talkto him. He will make you think.

What I’m going to do is reviewwhat academic general internal medi-cine was prior to the 1970’s, when Istarted medical school; how it emergedduring the 1970’s, while I was inresidency; how we expanded ourresponsibilities in the 1980’s and 1990’s;and then what I see as some challenges

for this century.In the early stages of the 20th

century, all internists were generalinternists (or, as they were often known,“academic consultants”). The leadinginternists of the time were strongbelievers in the value of generalism.William Osler once said, “There are, intruth, no specialties in medicine, sinceto know fully many of the most impor-tant diseases, a man must be familiarwith their manifestations in manyorgans.” And Tinsley Harrison, thefounder of the Department of Medicineat the University of Alabama atBirmingham, and our local hero, noted,“The true physician has aShakespearean breadth of interest inthe wise and the foolish, the proud andthe humble, the stoic hero and thewhining rogue. He cares for people.”

How did general internal medicinefirst wane? How did subspecialtymedicine grow? And then, how did were-emerge? Well, this is a very shortstory of a complex set of societal issues.

The 1950’s and 1960’s marked thefirst boom in federal research support.Departments of medicine over thatperiod of time slowly reorganized alongsubspecialty lines. This trend wasechoed in community practice, withgrowth in the number of board-certifiedsubspecialists. And the AccreditationCouncil for Graduate Medical Educa-tion (ACGME) gave all this even morestanding.

By the 1970’s many departments ofmedicine had no general internists. Thiswas the situation at my own medicalschool. When I was a medical student,it was impossible for me to have a rolemodel.

However, during the 1970’s, thingsbegan to change. The key events will befamiliar to those who were in medicalschool or residency during that era.

Several prominent institutions

started divisions of general internalmedicine. This stimulated otherinstitutions to take similar actions.

The Residency Review Committee(RRC) for Internal Medicine added arequirement for a continuity clinic forall internal medicine residents. When Iwas a resident, I did not have to have acontinuity clinic. RRC requirementschanged in about 1977 or 1978, if Irecall correctly. Once there was arequirement for a continuity clinic,someone had to run those clinics. Thechairs got a little nervous, because theyknew they couldn’t run it, and theydidn’t have anybody else who could runit. So they had to hire some generalinternists.

The Health Resources and ServicesAdministration (HRSA) began to offerfunding for training in primary care.The new divisions of general internalmedicine grabbed on and said, “This is away for us to build our divisions.” Chairsweren’t so sure about this primary carething that was going on, but it wasmoney, and chairs never turn downmoney.

We started to develop academicleaders through The Robert WoodJohnson Foundation’s (RWJF) ClinicalScholars Program, the Kaiser Fellowship,and other training programs for generalistphysicians with an academic focus.

6

SGIM FORUM



At the recent Annual Meeting inAtlanta, the Robert J. GlaserAward was presented to Lee

Goldman, MD, MPH, Professor andChair, Department of Medicine, andAssociate Dean, Clinical Affairs,School of Medicine, University ofCalifornia, San Francisco. The GlaserAward is SGIM’s highest award. It isgiven to an individual for outstandingcontributions to research, education, orboth in generalism in medicine. Theaward is supported by grants from theHenry J. Kaiser Family Foundation, theCommonwealth Fund, and individualcontributors.

Lee was nominated by a group ofcolleagues from UCSF, who noted hismany contributions to generalism, toacademic medicine, and to SGIM. Theywrote in part:

“Lee is one of the best-knowngeneralist physician-investigators in theworld. Beginning as a resident, when hedeveloped the cardiac risk index forassessing perioperative risk, he has had aremarkable knack for identifyingessential clinical questions, conceivinga creative research plan, executing andanalyzing the study with skill, andpresenting the results in a lucid andcompelling manner. Lee’s contributionsto the medical literature are extraordi-nary: he has first-authored 13 articles inthe New England Journal of Medicine,JAMA, or the Annals of Internal Medi-cine, and he has senior-authored another25 articles in these journals with histrainees or junior colleagues. In additionto his research in non-cardiac surgery,he has made unique contributions aboutthe triage of patients with chest pain,the usefulness of autopsies, the roles ofobservation units and hospitalists,health policy for coronary heart disease,and physician-patient communica-tion….

“Lee’s contributions to academic

Glaser Award Goes to Lee GoldmanDavid R. Calkins, MD, MPP

on how we teach, or on health policy.Although not required for this award,successful candidates also may have had

Jack Feussner Receives Eisenberg AwardRussell S. Phillips, MD

Fellowship program at the Brigham andWomen’s Hospital, serving as itsDirector and Co-Director of Harvard’sProgram in Clinical Effectiveness forover a decade, Lee developed a genera-tion of academic generalists…. As amentor, Lee has always been known forhis instant availability. He still has aremarkably short “turn-around” time formanuscript drafts; within a few days,and sometimes even sooner, he providesa detailed list of helpful suggestions andcomments….

“Lee is a leader in Americanmedicine. He served SGIM as ProgramDirector of the National Meeting,Secretary-Treasurer, and President, andhe has been elected to the Institute ofMedicine, the American Society for

Iwas pleased to serve this year as Chairperson of the Selection Committee for

the John M. Eisenberg National Awardfor Career Achievement in Research.This award was named for John M.Eisenberg, MD, MBA, because of hisunique role as a researcher and mentorand because of his national role as Direc-tor of the Agency for Healthcare Researchand Quality (AHRQ). As Director ofAHRQ, John was a strong advocate forresearch in general medicine. With John’spassing, this award becomes a part of hislegacy. The Eisenberg Award will help usto recognize those among us who sharesome of John’s inspiring qualities as a re-searcher.

The Eisenberg Award is given to amember of SGIM who has made majorcontributions conducting research thathad an important impact on how we doresearch, on how we care for patients,

Nicole Lurie presents the GlaserAward to Lee Goldman. (FOSTER ASSOC.)

DD Eisenberg prevailed over foulweather to join Russ Phillips (center)in presenting the John M. EisenbergNational Award for Career Achieve-ment in Research to Jack Feussner.

(FOSTER ASSOC.)

general internal medicine as a teacherperhaps have been greater than hisaccomplishments as an investigator. Inbuilding the General Internal Medicine

7

EDUCATION AWARD GOES TOROBERT C. SMITHCatherine R. Lucey, MD


SGIM established the NationalAward for Career Achievements inMedical Education in 1996 to

recognize individuals whose lifetimework has had a major impact on medicaleducation. This year’s award recognizesthe outstanding contributions of RobertC. Smith, MD, from Michigan StateUniversity. Randall Barker noted thatDr. Smith has “studied, conceptualized,operationalized, and disseminatedmethods that are of fundamental valueto medical educators involved inteaching interviewing skills and theprovider-patient relationship.” Hisbook, The Patient’s Story, uses a stepwise,prioritized, behavioral approach toguide new students of basic communica-tion and doctor-patient relationshipskills. Additionally, Dr. Smith hasdeveloped a teaching monograph andillustrative videotapes to facilitate thework of faculty charged with teachingabout interviewing. He is known forbeing an approachable expert—willingly taking calls from facultydealing with this tremendously impor-tant subject. Dr. Smith’s randomizedcontrolled trial of the methods outlinedin his book led not only to publicationsin the medical literature but to a secondbook, appropriately titled Patient-Centered Interviewing: An Evidence-Based Method.

On a parallel track, Dr. Smith hasused his skills in the medical interviewto identify and recommend strategies fordealing with patients with somatizationdisorders in primary care practices. Atthis meeting, he is presenting innova-tive work on a new syndrome ofpatients who rely on the health caresystem for evaluation of multiple simplesymptoms.

Dr. Smith has been recognized inthe past by the Association of AmericanMedical Colleges with the Thomas HaleHam Award and by the American

Robert C. Smith accepts the NationalAward for Career Achievements inMedical Education from EducationCommittee Chair CatherineLucey. (FOSTER ASSOC.)

Academy on Physician and Patient withthe George Engel Research Award forDistinguished Research in Doctor-Patient Relationships. He has presentedaward-winning workshops at theAssociation of Program Directors inInternal Medicine and SGIM and isrecognized as an outstanding teacherand mentor at his home institution.SGIM is delighted to add its voice inrecognition of Dr. Smith’s majorcontributions to the field of medicaleducation with the National Award forCareer Achievements in MedicalEducation. SGIM

The Elnora M. Rhodes SGIM ServiceAward was established in 1997 to

honor Elnora Rhodes’ tremendouscontributions to the Society during her10 years as Executive Director. Theaward is given to individuals foroutstanding service to SGIM and itsmission of promoting patient care,research, and education in generalinternal medicine. The award issupported by contributions from SGIMmembers and from friends and family ofElnora Rhodes. Previous RhodesAwardees include Elnora Rhodes(1997), Annie Lea Shuster (1998),Oliver Fein (1999), Shirley Meehan(2000), and Mark Linzer (2001).

Before reviewing nominations, thisyear’s Rhodes Award Committee firstbrought to mind some of the strongattributes that Elnora brought to SGIM,including love, commitment, zest,support for members, vision, connected-ness, good cheer, expertise, wisdom,perseverance, joy and optimism,

generosity, and a “can-do” attitude—with Elnora, anything was possible!

This year’s Rhodes awardee isCarole M. Warde. In making the award,the Committee noted that Carole

Carole M. Warde Receives Rhodes AwardRhodes Award Committee

Rhodes Award winner Carole Wardeshares a celebratory moment withaward presenters Richard Rhodes(Elnora Rhodes’ brother, who alsopresented a donation to the award onbehalf of the family) and Tom Inui.

(FOSTER ASSOC.)

8

SGIM FORUM

Passing the TorchDavid R. Calkins, MD, MPP

For the past three years and 36 issues,I have had the pleasure of serving as

Editor of the Forum. With the comple-tion of this issue, my term as Editor willend. Missy McNeil, University ofPittsburgh, will begin her three-yearterm as Editor with publication of theAugust 2002 issue of the Forum.

From my perspective, the positionof Editor of the Forum is one of themost enjoyable roles one can have inSGIM. It offers regular interaction withmembers throughout the country, whocontribute to the production of eachissue. It provides frequent contact withstaff in the SGIM National Office, agreat bunch of folks! And it includes aposition on the Council as an ex officiomember, an honor and a privilege.

My job as Editor has been madeeasier by the enthusiastic work ofAssociate Editors and other SGIMmembers who have written nearly 300articles over the past three years. Whilespace does not permit me to list all ofthese individuals, I would like to thanka few.

� Seth Landefeld, Sankey Williams,Kurt Kroenke, and Martin Shapirosubmitted monthly Presidents’Columns that were always thoughtfuland frequently thought provoking.

� The Annual Meeting ProgramCommittees provided frequent reports

SGIM’s Herbert W. Nickens Awardwas established in 2000 to honoran individual who has demon-

strated exceptional commitment tocultural diversity in medicine or toimproving minority health. The awardis named in memory of the late HerbertW. Nickens, MD, the former director ofthe Office of Minority Health of theDepartment of Health and HumanServices and the first Vice President ofthe Division of Community andMinority Programs, Association ofAmerican Medical Colleges (AAMC).During his tenure at the AAMC, Dr.Nickens established groundbreakingprograms designed to address the criticalneed to train more minority physiciansand to improve minority health status,including Project 3000 by 2000 and theMinority Health Services ResearchInstitute. Dr. Nickens died suddenly andunexpectedly in 1999. This award wasestablished to honor his memory and hisgroundbreaking work in increasingdiversity in medicine and improvingminority health. The members of thisyear’s Nickens Award Selection Com-mittee were Giselle Corbie-Smith,JudyAnn Bigby, Eric Whitaker, OlveenCarrasquillo, David Campa, and myselfas Chairperson.

We are very honored and incrediblyexcited to present this year’s Herbert W.Nickens award to David Satcher, MD,PhD, who until February 2002 was theSurgeon General of the United Statesand until February 2001 was theAssistant Secretary of Health of theDepartment of Health and HumanServices. We are honoring Dr. Satcherfor his enormous contributions in thearea of improving minority health.

Upon being appointed SurgeonGeneral and Assistant Secretary ofHealth, Dr. Satcher immediately beganto bring attention to disparities inhealth status, health care, and quality of

care by race/ethnicity via numerousspeeches, conferences, and targetedprogrammatic initiatives. In 1998, withsubstantial input from Dr. Satcher,President Clinton set forth the goal ofeliminating racial and ethnic disparitiesin seven major clinical areas by the year2010. This resulted in several newinitiatives, including the Racial andEthnic Approaches to CommunityHealth Reach (REACH) grant programof the Centers for Disease Control andPrevention (CDC) and the ExcellenceCenters to Eliminate Ethnic/RacialDisparities (EXCEED) grant program of

Nickens Award Goes to David SatcherValerie E. Stone, MD, MPH

Valerie Stone presents the NickensAward to former Assistant Secretaryfor Health and Surgeon General DavidSatcher. (FOSTER ASSOC.) continued on page 17

SGIM InauguratesElectronic BulletinLorraine Tracton

Did you receive the inaugural editionof SGIM E-News? Volume 1, Issue 1

of this new, biweekly electronic bulletinwas sent directly to members on June11. If you did not receive the transmis-sion, the SGIM National Officeprobably does not have a current,accurate e-mail address for you. Pleasecontact Katrese Phelps, Director ofMember Services (e-mail: [email protected], telephone: 800-822-3060), toupdate your records. SGIM


9

2002 ANNUAL MEETING: A PHOTO ALBUMMembers Arrive Early for Reception, Precourses, Interest Groups

Members gather for a group photo outside the original Grady MemorialHospital building. (L.TRACTON)

Bill Branch,Director, Division of

General InternalMedicine, Emory

University School ofMedicine, and

Secretary-Elect,SGIM, welcomes

members to thereception at Grady

Memorial Hospital.(L.TRACTON)

Past-President Stephan Fihn (second from left) offersadvice on the transition from fellow to faculty during theprecourse “A General Internal Medicine FellowshipSurvival Course.” (L.TRACTON) Members network at the opening poster session. (L.TRACTON)

Council member Susana Morales (top) joins the crowd atthe Students, Residents, Fellows, and First-Time Attend-ees Reception. (L.TRACTON)

Session Coordinator Carole Warde (second from right)listens attentively to a discussion at the Personal-Profes-sional Balance Interest Group meeting. (L.TRACTON)

10

SGIM FORUM

Opening Plenary Session, Award Presentations Highlight Second Day

JGIM Editor Eric Bass sitsatop copies of the AnnualMeeting Supplement at thepublisher’s booth. (L.TRACTON)

Past-Presidents gather to celebrate the 25th Annual Meeting. Left to right are EricLarson, Kurt Kroenke, Wishwa Kapoor (back), Bill Tierney, Stephan Fihn (back),Wendy Levinson, Sankey Williams (back), Lee Goldman, Sheldon Greenfield, and SethLandefeld. (L.TRACTON)

Julie Machulsky, Director of Regional Services (left), joins JaneGeraci, Regional Coordinator (second from right), in celebrat-ing Regional Resident Presenters of the Year Award winnersEleanor Bimla Schwarz, Samer Sader, Judy Zerzan,Varalakshmi Venkatachalam, and Keith Winfrey, who wererecognized during the Opening Plenary Session. (L.TRACTON)

Jim Sosman (left) congratulates Lawrence S.Linn Award recipients Gwen Davies andShawn Fultz, who were recognized during theUpdate in HIV Care. (FOSTER ASSOC.)

Eric Holmboe (left) describes his Innovations in MedicalEducation project to Lisa Rubenstein (right), one of theleaders of the 1998 SGIM Innovations Task Force. (L.TRACTON)

Wit playwright Margaret Edson (left) and SelectionCommittee Chair Anderson Spickard, III (center), joinwinners of the National Clinician-Educator Award forInnovation in Medical Education Karl Lorenz, KennethRosenfeld, and Eric Holmboe. M. Jillisa Steckart andNancy Rigotti (not pictured) also received this award.(L.TRACTON)

11

Theme Plenary Session Opens Final Day

Gregg Rouan, Chair, Communications Committee (left),chats with Past-Presidents Bill Tierney and Mack Lipkinduring a break in the meeting. (L.TRACTON)

Regional Coordinator Jane Geraci, keynote speaker BobCentor, and moderator Judith Walsh (left to right) join JeffJackson (at the podium) to open the Theme PlenarySession. (FOSTER ASSOC.)

Bob Wigton (left) congratulates Mack Lipkin, Sr.Associate Award winners Eleanor Bimla Schwartz, LisaKorn, and Michael Steinman. (FOSTER ASSOC.)

Bob Wigton (second from right) joins Milton Hamolsky JuniorFaculty Award winners Matthew Davis, ChristinaNicolaidis, and Jeffrey Wiese. (FOSTER ASSOC.)

Past-President Tom Inui leads a discussion during the workshop “TheIOM Report of Racial/Ethnic Disparities: Findings, Recommendationsand Concrete Next Steps.” (L.TRACTON)

Past-President Lee Goldman offers“Strategies for Future Success in Aca-demic General Internal Medicine” duringhis Meet-the-Professor session. (L.TRACTON)

12

SGIM FORUM

Meeting Closes with Awards Banquet, Peterson Lecture

Judy Tsui (second from right) and her quartet play against abackdrop of posters created by Special Programs Chair LindaPinsky, illustrating events that shaped SGIM’s developmentover the past 25 years. (L.TRACTON)

Adesuwa Olomu charts the “Under Use of Beta-BlockersFollowing Acute Myocardial Infarction in CommunityHospitals.” (L.TRACTON)

Council meets with members to discuss the recommendations ofthe External Funds Task Force. (FOSTER ASSOC.)

Selection Committee Chairs Hal Sox (left) and SaidIbrahim (right) congratulate Brian Gage, who wonboth the Outstanding Junior Investigator of theYear award and the Best Published Paper of theYear award. (FOSTER ASSOC.)

President-Elect JudyAnn Bigby (left) connectswith Deborah Prothrow-Stith after the latter’sPeterson Lecture. (L.TRACTON)

Kurt Kroenke passes the presidential gavel to MartinShapiro at the conclusion of the Awards Banquet. (FOSTER ASSOC.)

13

SGIM CELEBRATES 25TH

continued from page 1

continued on next page

shortages, pay, and working conditions(reinforcing the old adage that the morethings change, the more they stay thesame). Refreshments, music by Judi Tsui(SGIM member and talented Julliard-trained cellist), and a tour of thefacilities all helped to make this amemorable start to the meeting. (Judialso played with the Emory StringQuartet at dinner three days later. Wethank them for sharing their talentswith us.)

Jeff Jackson opened the PlenarySession by noting the passion anddedication of SGIM members andappealing for the continuation of thispassion in the work we love. ChristinaNicolaidis (“Could we have known? Anin-depth look at the stories of womenwho survived an attempted homicide byan intimate partner”) and Lisa Korn (“Isscreening for osteoporosis associatedwith fewer hip fractures?”) began thescientific program with their incisive,thought-provoking abstracts. Theseoutstanding presentations would go onto win Hamolsky and Lipkin awards,respectively.

During his inspirational andhumorous Presidential Address, KurtKroenke reminded us of the five P’sSGIM needs to include as we look tothe future: Patients, Pupils, Physician-colleagues, Payors, and the Public.During one point in his address, theattendees were asked to introducethemselves to others in the audience.We were struck by the notion that wewere sitting next to past, current, andfuture leaders: SGIM members who, intheir own way, were, or would be,architects of change. It was a wonderfulway to break the ice and reflected Kurt’smuch-appreciated leadership style:warm, inclusive, and member-focused.Indeed, keen insight, a gift of handlingcontroversial issues with grace, andhigh-quality accomplishments werehallmarks of his presidential abilities.

The Theme Plenary session openedwith remarks by Ellen Yee on thetransition of general internal medicine.General internal medicine’s rise to

prominence and into mainstreammedicine is mirrored in the move ofgeneral internal medicine divisionslocated in B-level basements andtrailers, up to A-levels and bettertrailers. Much work has been done butmore still remains! The featuredspeaker, Robert Centor, gave aneloquent history of academic generalinternal medicine and the forces thathave shaped general internal medicineas we know it now. Following his talk,four abstracts on emerging issues werepresented: “Implementation of avoluntary hospitalist system at acommunity hospital,” “The prevalenceof physician participation in pharma-ceutical-sponsored activities,” “Physi-cian specialization and antiretroviraltherapy for HIV,” and “A randomizedtrial of primary intensive care to reducehospitalization in high utilizers.”

The theme was continued throughprecourses and workshops, with “Emerg-ing Issues for Generalists” added as acategory. Through the leadership ofAnderson Spickard and Dawn DeWitt,Chair and Co-Chair of precourses, andGiselle Corbie-Smith and EricHolmboe, Chair and Co-Chair ofworkshops, an outstanding selection ofpresentations were offered.

Deborah Prothrow-Stith gave apassionate and inspirational PetersonLecture, discussing violence as a publichealth mandate. Is there an epidemic?What is behind this violence? Did werealize that violence is increasingamong adolescent girls? This was atimely and moving lecture, especiallyfollowing the events of September 11.Dr. Prothrow-Stith connected withmany in the audience when she spokefrom the heart about trying to reconcileher emotional “gut” reaction to thisviolence (Why aren’t we getting back at“them”? Drop the bombs!) with herintellectual, rational reaction (violenceis not the solution).

This year’s Annual Meetingincluded several memorials. D.D.Eisenberg gave a moving tribute to herlate husband, John Eisenberg. Alvan

Feinstein was remembered at theSydenham Society Dinner. The spirit ofElnora Rhodes, SGIM’s beloved firstExecutive Director who passed away lastyear, was felt in the hearts of thosegraced by her guidance and friendship.

Several novel innovations met witha warm reception. The newly inaugu-rated Lipkin and Hamolsky Awardfinalist sessions were a grand success,hosting overflowing audiences andbringing prominence to the work of thetalented associate and junior facultyfinalists. There was definitely a tensionin the air not felt during other scientificabstract presentations! Kudos to RobertWigton for chairing the Lipkin andHamolsky Awards Selection Committeeand to all the volunteer judges for theirtime and effort. An International PosterSession featured 38 presentations bymembers from Argentina, Canada,France, Sweden, Switzerland, and theUnited Kingdom. Incoming PresidentMartin Shapiro, who hails from Canadaoriginally, has noted that next year, allUnited States submissions might beconsidered International, as themeeting will take place in Canada.

Thanks to the vision of RegionalCoordinator Jane Geraci, eight Re-gional Resident Presentation AwardWinners received a scholarship to themeeting, a poster presentation (at aminimum), and recognition at theplenary session. Donald Brady and LisaInouye developed a special track forstudents, residents, and fellows (SRF)and creative touches, including a SRFlounge, interest group, and workshop.Linda Pinsky and Eric Whitakerenhanced Special Programs by conceiv-ing the idea of historical posters andassembling a distinguished Meet-the-Professors panel. The wisdom andknowledge of these esteemed professorswas the vital core of these sessions.Linda demonstrated that she is not onlya gifted educator but also an artist andmaster of visual elements. Her montageof posters (integrating presidentialwisdom and history), placards on

14

SGIM FORUM

SGIM CELEBRATES 25TH

continued from previous page

SUMMER MEDITATIONScontinued from page 3


medicine and literature, and a videoclip, featuring images of physicians andmedicine in film, were stunning. Otherhistorical touches at the meetingincluded silent slide shows giving SGIM“factoids” and distribution of copies ofSGIM’s history printed in a JGIMsupplement.1

Under the leadership of JudithWalsh and Robert Centor, the scientificabstract submission categories werereconfigured and leading researchersassembled for abstract sessions. The twoplenary sessions highlighted outstandingabstracts. Art Gomez, Marilyn Schapira,Janice Barnhart, and James Heffernanorganized the well attended Innovationssessions. New awards were instituted forthe highest-rated Innovations inMedical Education and Innovations inPractice Management presentations.

JudyAnn Bigby and Marshall Chincoordinated One-on-One Mentoring,an important element of the AnnualMeeting. Michael Green and ChristineLaine made several innovative changesto the evaluation forms, and their inputhelped to shape this meeting. TariqMalik and Preetha Basaviah orches-trated Clinical Vignettes, which had thelargest increase in submissions.

Eight Clinical Updates werepresented. Topics included GeneralInternal Medicine, Minority Health,Community-Based Preventive Services(CDC), Women’s Health, HIV Care,Geriatrics, Clinical Crossroads (Spiritu-ality), and the U.S. Preventive ServicesTask Force.

SGIM is about family and friends,diversity, advocacy, teaching, research,and patient care. SGIM is by and for itsmembers, and many of us consider it“home.” The 25th anniversary meetingwas a labor of love and reflected thehard work and dedication of many folks.Our thanks go out to the truly outstand-ing 2002 Planning Committee, KurtKroenke, volunteers, SGIM staff(especially Sarajane Garten and DavidKarlson), and most of all, to you, themembers of SGIM. Your accomplish-ments, passion, and vision inspire us.

Planning for the 2003 Annual Meeting,to be held April 30–May 3, 2003 inVancouver, is already underway. If youwould like to volunteer, contactSarajane Garten at the National Office(telephone: (800) 822-3060, e-mail:[email protected]), or Helen Burstin orLinda Headrick, Program Chair and Co-Chair. We give our best wishes to them

Vignettes Chair; and Sameh Basta,CME Coordinator. Lori Orlando wasindispensable in helping many of theresidents who presented clinicalvignettes. We are happy to note she isstaying in the Southern Region as ageneral internal medicine fellow atDuke next year! Many other individualshelped with judging awards. I alsowould like to thank the senior SGIMmembers and division chiefs who have

SOUTHERN REGIONcontinued from page 2

but most of the doctors whom I knowdevote much of their reading to theprofessional literature. Yes, we need toknow a lot, but something is lost whenwe ignore the world of literature. Foryears, I would pick out those books thatI believed that I had to read (Dr.Faustus, Ulysses, Remembrance of ThingsPast, and the like). They were greatbooks. I regularly got one-third to halfway through, then got bogged down.The books would rest on my night tablefor a year or two before working theirway back to a bookshelf. Ultimately, Iresigned myself to less stellar, but solidfiction. I was much more successful incompleting the books. I have not yetdescended to the level of Ludlum.

When I married and had children,summer became even more compellingas a time to vacation. Family vacationsas I have experienced them fall intothree categories.

The big family trip. Children

supported this meeting over the years:Bill Branch, Jim Byrd, Bob Centor,Dennis Cope, and Andy Diehl. Thank-fully, Karen DeSalvo has agreed to chairnext year’s meeting, guaranteeing yetanother successful program. And weshould never forget Julie Machulsky,SGIM Director of Regional Services,who makes meeting planning andregistration smooth and enjoyable.Thank you to you all! SGIM

and hope that they have as much funworking on the meeting as we did. SGIM

References1. J Noble, L Goldman, SL Marvinney,DC Dale. The Society of GeneralInternal Medicine from conception tomaturity: 1970’s to 1994. JGIM1994:9(Suppl 3):S1-44.

appropriately consume much of our freetime. My wife and I were determinednot to let child-rearing stand in the wayof exploring global vistas. We took our16-month old to Europe. The plane tripwas adventuresome (the child had greatfascination with the stairs in the 747and vomited between planes in Londonwhen we had no change of clothes inthe carry-on luggage.) We got to see alot of parks and zoos and took turnsgoing to the theatre. Another such tripfollowed with a one and six year old,which took us to France during WorldCup 1998. The sporting spectacleproved to be a thrilling distraction forthe children. The older child made a bitof a scene at a gathering at the home ofsome French friends on the night of thefinal, when he came to the realizationlate in the game that he really wantedBrazil to win!

The family motor trip. There is a

15

wonderful tradition of such travel, but Imust report that it has been completelyupended by the in-vehicle DVD player.We traveled to the Grand Canyonwithout a complaint from either child.Of course, they didn’t look at thescenery very much, either.

Family camp. This is a really fineinnovation. The kids do their thing,and the parents do their thing. For me,it is golf, as well as time with my wife.In a week, I can bring my scores downfrom the 120s to the upper 90s, and stillhave time for Ludlum… I mean Joyce.

The other day, I chatted with my10 year old about summer vacation. Iasked him to try and not get toobummed out when his 73-day breakended. That may have been unfair. Partof the process is the liberation from theregimentation of the school year. In anyevent, he did not commit to that courseof action!

I now have lived through about twothirds of my summers. Each one seemsprecious. There is much to do. What ismost important?� Spend more time with the children.

They won’t be wanting to spendsummers with you forever.

� Read some good books, if not somegreat books.

� Get some momentum in outdooractivities. Run, swim, golf (and don’tforget the sunscreen).

� Visit some places that you have neverseen.

� Get together with family and friendswho live at a distance.

� Take a little time to think. We stopbeing creative if we are overwhelmedwith busy work. The summer is agreat time for reflection.

� Realize that life is precious, thatsummer days are among the mostprecious, and that they should beinvested in renewal and nurturing ofrelationships and friendships, instimulating and challenging one’svalues and ideas, in improving oneselfintellectually, emotionally andphysically.

Of course, there are some other

wonderful things to do in the summer.� Take some nervous, anxious, unsea-

soned interns and walk them throughtheir first rotations as a physician.

� Meet with some newly anointedfellows and instill in them passion foryour vocation.

� Care for a patient in need.

SUMMER MEDITATIONScontinued from previous page

EVOLUTION OF A DISIPLINEcontinued from page 5

� Put down on paper ideas that havebeen percolating within you.

� Decide what you really want to dowith the next phase of your profes-sional life.

Summer days are long, but theirnumbers diminish rapidly. Use themwell. SGIM

Funding sources for primary careresearch started to emerge. The Na-tional Center for Health ServicesResearch (NCHSR)—which begat theAgency for Health Care Policy andResearch (AHCPR), which begat theAgency for Healthcare Research andQuality (AHRQ)—started to havesome funding, and general internistsstarted submitting to that fundingsource. RWJF was a funding source, aswere a variety of other foundations.

And, most importantly, the Societyfor Research and Education in PrimaryCare Internal Medicine (SREPCIM)was founded in 1978, which gave us anacademic home.

Once divisions were there, a varietyof things occurred. Many institutionsdeveloped general medicine consulta-tion services. There are some institu-tions where that became a major focusof research, a major focus of ideas.

At many institutions, the general-ists slowly have grown into being theprimary ward attendings. More andmore subspecialists are uncomfortablebeing an attending on a generalmedicine ward. If you’re a rheumatolo-gist—and I’m picking on them atrandom — and someone has lupus,you’re great. But as soon as they havediabetes also, many rheumatoloigstsstart to feel uncomfortable. And if theyalso happen to have coronary arterydisease, they actually tremble. This, insome way, led to the hospitalist move-ment. And distinguishing betweenhospitalists and general internists whodo a lot of inpatient care is often

difficult. But it is certain that generalinternal medicine represents bothinpatient and outpatient medicine.

More recently some generalinternists have begun to limit theirpractice to outpatient medicine. All thegeneral internists that I knew in the1970’s did both inpatient and outpa-tient medicine. But that is no longer thecase.

And then, especially in the 1990’s,we have seen the influence of managedcare on the growth of many divisions.And I’m going to suggest that this hasbeen a very disruptive force.

And finally, we have what, for lackof a better phrase, we’ll call the “cyclic”appeal of primary care. We were thekings in the early 1990’s. Everybodywanted to be in primary care. I remem-ber an ophthalmologist once telling methat he was a primary care ophthal-mologist. I was at a party with a radiolo-gist. He told me he did primary careradiology. That doesn’t seem to be quitein vogue this week.

Our divisions changed a lot in the1990’s. Research units benefited fromgreater funding and more fellowship-trained faculty. Just look at this meetingand the evidence of increased researchproductivity.

Many divisions took on a leader-ship role in the educational activities oftheir departments. Divisions of generalinternal medicine often started outfocusing just on the clinic. Slowly butsurely, many have taken on more andmore major responsibilities in the


16

SGIM FORUM

REMEMBER, WELCOME, ANTICIPATEcontinued from page 4

the Women’s Army Corps, and radarstands for radio detecting and ranging.Medicine is filled with acronyms fordiseases (COPD), clinical trials(GUSTO), and professional organiza-tions (ACP-ASIM, APDIM, AAMC).

Let’s look at our own Society’sacronyms. First there was the Societyfor Research and Education in PrimaryCare Internal Medicine, or the tongue-twister, SREPCIM. During his Presi-dency, Tom Delbanco led the charge fora simpler moniker, which brought us toSociety of General Internal Medicine.However, the acronym may not have auniversal pronunciation. Let me take aquick poll. How many pronounce it Sig-em? How many call it S-G-I-M? Lookslike we don’t have a consensus. Somesay “tomayto” while others say“tomahto.”

Legacy, however, is greater than anyeponym or acronym. Impact—or, as ahealth services researcher might say,“outcomes”—are one’s true footprints inthe sand. It may be an institution likeAHRQ. It may be a division of generalinternal medicine. It may be a genera-tion of residents and students andfellows, who have been recipients ofpriceless teaching or mentorship. It maybe the countless patients one has curedor comforted, the child who gifted uswith a dozen years, or the parent. ForSGIM, it has been addressing disparitiesin health care, quality in the doctor-patient relationship, respect for medicaleducation, and parity for primary careand health services research. Theseactions speak louder than our Society’sname—or its acronym, however youpronounce it.

Now for the counterpoint. Namesare not unimportant. Let’s take our ownspecialty. The discipline of “internalmedicine” originated in Germany in the19th century as “Innere Medizin.” Withrapid advances in pathology, it soonbecame apparent that diagnosis andunderstanding of disease relied not onlyon external manifestations (e.g.,physical findings) but also on investiga-tion from the “inside” (e.g., tissue

specimens). These origins over a centuryago might explain why we as internists arefascinated by objective tests that explorethe “interior” of a patient—bloodwork, x-rays, angiography.

Yet the public does not alwaysunderstand us. Explaining internalmedicine to the passenger next to meon an airplane—or, for that matter, mymother—is partly framed by what I don’tdo: I don’t take care of kids, deliverbabies, do surgery. I do take care of mostadult medical problems, but I’m not aspecialist. To clarify things, the ACP-ASIM has contemplated a namechange, like “Adult Medicine.” How-ever, if our specialty becomes “AdultMedicine,” does that mean we arecalled “Adultists”?

Many of us here proudly callourselves general internists. Onememorable image from Lee Goldman’sPresidential Address was a slide thatunfolded something like this. I couldalmost hear the cheer: “GIM… GIM…General Internal Medicine… U–rah–rah.” Besides communicating this to theAmerican public, however, we must alsoclarify to physicians in other countrieswhether we are more like their inter-nists (who are primarily hospital-basedconsultants) or their general practitio-ners (or GPs). In fact, we are both, andthat is what’s special. “Primary carephysician” is another of our labels, butthe realignment between hospitalismand office-based practice, reimburse-ment, and shifting career choices makethe definition of primary care a work inprogress. Still, how we define and labelourselves is essential to the five P’s: ourpatients, pupils, fellow physicians,payors, and the public.

WelcomeMy second message, focusing on thepresent, is simple: Welcome thenewcomer. One of the special thingsabout our SGIM Meeting (capital “M”)are the innumerable one-on-onemeetings (small “m”). On the way to aworkshop, I am sidelined by encounterswith friends, and I choose to be late in

order to reconnect. As I meanderthrough poster sessions, I juggle mydesire to see the science with my needto reconnect with friends I bump into.What I have just described is sort of a“personal-professional balance” withinthe meeting itself. Like when youdecide to skip a hospital meeting inorder to catch your child’s soccer game.

I am not asking you to forgo any ofthis networking. In fact, I’m asking thatwe each do just a little bit more. Wehave hundreds of first-time attendees. Anew meeting can be disorienting at first.Just this spring, I attended a professionalsociety meeting I usually don’t go tobecause of an invited symposium. It wasa strange feeling wandering through theposter sessions, recognizing no one. ButI felt most ill at ease at the finalbanquet. The tables were filled, I lookedself-consciously for a seat, and wasnearly ready to leave (after all, I toldmyself I wasn’t that hungry). As I walkedtoward the exit, one person came up tome and invited me to their table. Thisbroke the ice, and the rest of the eveningwas a rather easy conversation withpeople I had met for the first time.

Let’s do a practice run now. I wanteach of you to introduce yourself to oneor two individuals either next to you, orin front of or behind you. Tell themyour name, where you’re from, and onething about yourself (e.g., level oftraining, or which SGIM meeting this isfor you). Get on your mark, get set, go.

Your assignment is to repeat thisexercise at least five times in the nexttwo days—in abstract sessions andworkshops, during breaks, and atmealtimes. If someone is searching for atable, offer them a seat. This willguarantee that our Annual Meeting,historically one already of Brownianmotion and individuals eagerly collid-ing, will be the most user-friendly ever.

AnticipateMy third message, also brief, is future-oriented. “Anticipate” is a proactiveverb—not a “wait-and-see” part of our


17

REMEMBER, WELCOME, ANTICIPATEcontinued from previous page

vocabulary. Definitions include: “to actin advance; to feel or realize before-hand; to foresee.” For a geographicalmetaphor, I like promontory. A promon-tory is a tiny piece of land jutting outinto the breakwaters, surrounded bypounding waves. A promontory is notsafely inland, remote from the hurri-canes. Neither is it an island, isolatedfrom the mainland.

Some members appreciate in SGIMthe feeling of “sanctuary,” a “haven”from things we may not like happeningin other parts of the medical world.Here I say—be cautious. It is not refugewe seek. Talk to other organizations inmedicine, influence them, form partner-ships, negotiate, advocate, demonstrateif necessary. But avoid monasticism.While an oasis can be a wonderfulplace, remember that it is surrounded bydesert. The territory outside SGIM ishuge, and to keep it fertile, we must bein constant communication.

The good thing about a promontoryis that it’s on the edge, the vanguard,not a safe place really, but a brave place.However, the promontory is tiny, and itsdistinctness is that it is juxtaposed to agreater land mass with which it remainsconstantly connected. Are these biggerneighbors Goliaths that we struggleagainst? Or are they the seven-footcenter of our team, with us playingpoint guard? In fact, they are sometimesone and sometimes the other. Sortingout our battles from our alliances is bothour challenge and responsibility.

Finally, don’t move inland. Remainthe promontory. Reflecting on hisPresidential address more than a decadeago, Robert Fletcher recently said, “Iexpressed hope that SGIM would notbegin to act old just because it hadbecome established and had somethingto lose. With time and success, profes-sional societies tend to become lesstrusting, flexible, democratic, anddaring than SGIM was at the time.Fortunately, SGIM has so far retainedmany of the advantages of youth,though it is now certainly well estab-lished.” Establishment is a two-edged

word. Let’s take advantage of ourquarter century of establishment but, inso doing, not become the establishment.

Past SGIM Presidents were asked toreflect on our 25th anniversary, whichyou will see displayed throughout thismeeting. Let me close with whatSuzanne Fletcher shared: “As JohnGardner said, ‘We are constantlysurrounded by golden opportunitiescleverly disguised as insoluble prob-lems.’ SGIM is good at recognizing theopportunities and figuring out thedisguises.”

Remember our predecessors.Welcome those present, sitting next toyou, or looking for a seat at your table.Anticipate the future outside thesehalls, the next 25 years. Issues areemerging that you will hear about atthis meeting. As generalists, it is ourprivilege to be the promontory.

It has been my privilege to be yourPresident. Thank you. Have a wonderfulmeeting. SGIM

NICKENS AWARDcontinued from page 8

the Agency for Healthcare Researchand Quality (AHRQ). As a result of Dr.Satcher’s leadership, the new HealthyPeople 2010 document is much broaderthan its predecessors, with a focus uponeliminating disparities by race/ethnicityin health status and health care by2010. Dr. Satcher’s efforts also werecritical to the passage of the MinorityHealth and Health Disparities Researchand Education Act of 2000 (P.L. 106-525), which was signed into law inNovember 2000. This new legislationaims to improve minority healththrough research by establishing aCenter for Research on Minority Healthand Health Disparities within theNational Institutes of Health (NIH)and increasing funding in this criticallyimportant area.

In summary, SGIM is honored topresent the 2002 Herbert W. NickensAward to Dr. David Satcher for hisunparalleled contributions to improvingminority health. SGIM

on their plans for the AnnualMeeting and related items of interest(e.g., restaurants and other localattractions). Special thanks goes tothe Chairs and Co-Chairs: GaryRosenthal and Carol Bates (2000),Eileen Reynolds and CarolMangione (2001), and Jeff Jacksonand Ellen Yee (2002).

� Jas Ahluwalia and Joseph Conigliaroprovided monthly updates on grantopportunities through the ResearchFunding Corner.

� Brent Williams offered regular reportson matters of interest to clinician-educators, such as faculty develop-ment, teaching about professionalism,and interdisciplinary education.

� Mark Liebow provided updates onhealth policy, ably assisted by SGIM’shealth policy consultants, mostrecently Rob Blaser and JennJenkins.

� Valerie Stone, Giselle Corbie-Smith,

and Joe Betancourt wrote multiplearticles on topics related to minoritiesin medicine and disparities in healthand health care by race/ethnicity.

� Preston Reynolds authored columnson a diverse array of subjects, includ-ing SGIM’s mentorship program,health and human rights, andgenetics and primary care.

� David Lee provided reports onimportant developments within theVeterans Health Administration.

� Jane Geraci solicited reports onregional meetings (all of them!) andeven wrote a few reports herself.

� Bob Centor contributed severalarticles on matters of interest to theAssociation of Chiefs of GeneralInternal Medicine (ACGIM).

I have been assisted in the produc-tion of the Forum each month by StacyMcGrath at Harvard Medical School,Mary Stone at Blackwell Science, and

PASSING THE TORCHcontinued from page 8


18

SGIM FORUM

department. At many institutions theyare an integral part of the entireteaching program.

The clinical enterprise became alarger concern for many divisions.According to prevailing views of thehealth care system in the early 1990’s,primary care physicians were to be thefront door. Academic institutionsneeded to have a bunch of people outthere, doing primary care, bringingpatients in, so that the institution couldstay rich.

Now, in my mind, managed carehas had a very questionable influenceon general internal medicine. My viewof this matter has been influenced byseveral articles published in JGIMearlier this year. These articles havehelped shaped my thoughts about thedoctor-patient relationship, and aboutthe time pressures we face. And Ipersonally am very concerned aboutwhere we’ve gone: the pressure to seemore patients, the impact that that hashad on career satisfaction, the increas-ing number of general internists who doprimarily outpatient medicine, thedecreased satisfaction of patients. Whatis managed care doing to the doctor-patient relationship?

So let me give you my hypothesisabout how we got to where we are.None of my advisors bear any responsi-bility for my hypothesis. I think thatgeneral internal medicine embraced theconcept of primary care to emphasizecontinuity and comprehensive care, andthat’s what we meant in the 1970’s and1980’s. But that embracing of primarycare did not mean that we wanted toabandon the complexity of secondarycare.

In my opinion, the phrase “primarycare” has become distorted to oftenexclude complexity, and that has led togreat dismay among general internists. Ibelieve many of our subspecialtycolleagues look at those of us in primarycare as “simple docs,” not complex docs,and I know the insurers view us that way.

We don’t want to abandon com-plexity. That’s why I chose internal

medicine. I chose internal medicinebecause I liked the clinical complexity. Ilike the patient with five medicalproblems and 15 medications to figureout. I like the complexity of trying tofigure out the interaction between thedisease and the underlying psychosocialissues. I like the complexity of figuringout how to manage patients in theinpatient setting and then helping themtransition back to outpatient care—andmaking all that smooth and without error.

So these are my questions for thiscentury. Will research funding continueto grow? Will we be able to support theimportant research that members of thisSociety do?

How will we pay for education? Atmany institutions, the viability ofeducational programs in general internalmedicine divisions is threatened becauseno one will pay them to teach.

We have to decide whether generalinternal medicine is primary care and/orcomplex care, and how to define it, andhow to present ourselves to the rest ofthe world. We’re struggling withwhether we can be both inpatient andoutpatient physicians, and how do webalance that, not just in academics, butalso out in our practicing communities.

We have to focus on how healthcare is funded, and how that affectsgeneralists. Right now, it makes general-ists depressed. Who’s going to pay forcomplex continuity care? Who’s goingto pay generalists to see the patient whohas diabetes, hyperlipidemia, coronaryartery disease, congestive heart failure,and hypertension? And they’re trying todo that in fifteen minutes while they’redepressed. It can’t be done well. We aredoing so much more, we should do somuch more for our patients than we did25 years ago. We know so much betterhow to do secondary prevention. But itdoes take time.

Let me focus on one or two otherrecent trends. There was a very goodarticle in the New England Journal ofMedicine recently on concierge primarycare. When I was at the ACP-ASIMmeeting, going through the exhibits,

MDVIP had a booth. MDVIP is one ofthe concierge care companies. Now, youmay think what you want of conciergecare, but try to remember what theunderlying forces were that have causedthis to emerge and that have attractedboth patients and physicians to theconcept. A lot of it’s about time. A lotof it’s from the physician wanting to beMarcus Welby, really be able to go visitthe patient at home, really go visit thepatient and accompany them to thespecialist. Now, some of us may not behappy morally with the concept, but tryto understand why it has emerged. It’snot just about money.

We have physicians refusing newMedicare patients. Why are theyrefusing new Medicare patients?Because the overhead is greater thanyou get for seeing the patient, and youcan’t make it up in volume.

We have alternate practice struc-tures. If you have not read the recentarticle on this subject in the U.S. Newsand World Report, a link to the articlewill be on the SGIM Web site. You canactually read it on line. It’s very inter-esting to see how different people aretrying to approach practice in 2002.

I’d like to close with a quote frommy favorite CD. It’s from a song called“Reservations.” It’s written by JeffTweety of Wilco. How many people inthe audience—raise your hands—arefamiliar with Wilco? We’ve got about 10percent. That’s pretty good. Half ofthem have heard me talk about it in thelast two days. The name of the CD isYankee Hotel Foxtrot, and I’m not goingto explain why it’s called that. But thisis what he said:

“I’ve got reservations about so many things, but not about you.” SGIM

Editor’s Note—Bob Centor is thefounding President, Association of Chiefsof General Internal Medicine. He isDirector, Division of General InternalMedicine, and Associate Dean for PrimaryCare, University of Alabama School ofMedicine. He has a golf handicap of six.

EVOLUTION OF A DISIPLINEcontinued from page 15

19

success as mentors, as advocates forresearch funding, or as leaders ofresearch-related organizations.

SGIM is blessed to have manymembers who are terrific researchers.The Committee was fortunate to have avery strong group of candidates nomi-nated for this award. After carefulconsideration, we selected John R.(Jack) Feussner, MD, MPH, as thisyear’s winner of the Eisenberg Award.

Jack was nominated by 15 individu-als. In their nomination letter, theystated that Jack’s lifetime contributionshave had a national impact by virtue ofhis own research; his training andmentoring of general medicine research-ers; his leadership of a health servicesresearch program in Durham, NorthCarolina; and, most recently, hisleadership of a national researchprogram at the Department of VeteransAffairs (VA).

Jack’s early research focused onclinical trials of treatments for chronicmedical conditions. He is one of theearliest and most effective advocates forthe use of randomized, controlled trialsin health services research. In 1983,Jack was named Director of the VAHealth Services Research and Develop-ment Field Program in Durham, NorthCarolina, a position he held until 1996.He served as a primary mentor togeneral internists who subsequentlyestablished their own national reputa-tions. Jack also served as Chief of theDivision of General Internal Medicineat Duke between 1988 and 1996.

In 1996 Jack became the ChiefResearch and Development Officer,Veterans Health Administration,Department of Veterans Affairs. Underhis watch, the VA research appropria-tion has grown from $251 million to$409 million. Jack’s responsibilitiesinclude setting VA research prioritiesand managing all aspects of a nationalresearch program, which includes morethan 3,900 VA researchers. His accom-plishments include determining thefocus and priorities of VA medicalresearch and creating a new career

development program that supportsclinician-investigators. Jack expandedthe VA health services research andcareer development program to supportalmost 70 clinician-investigators, mostof whom are general internists. TwelveVA health services research anddevelopment centers are affiliated withmajor medical schools. Most of the

EISENBERG AWARDcontinued from page 6

clinician-investigators associated withthese centers are general internists.Together the operating budgets for thesecenters total more than $100 million.

The Eisenberg Award Committeeapplauds the work of Jack Feussner, andwe are pleased to present him with thisspecial award. SGIM

exemplifies, in her professional andpersonal activities, a balanced, tripartitecommitment to clinical care, teaching,and parenting. Her SGIM nationalactivities have included initiator,Personal-Professional Balance InterestGroup, and member, Development andPresidential Nomination Committees.Carole championed the MaryO’Flaherty Horn Scholars Program—and worked successfully to endow it!Her SGIM Regional activities haveincluded serving as President andProgram Chair, California Region, andas Southern California Chair, Treasurer,and Secretary. As a clinician-educatorshe has been Director, Long BeachMemorial Medical Center InternalMedicine Residency, and member,Graduate Medical Education Policy,Medical Education Liaison, ContinuingMedical Education, and Critical CareCommittees. Her group practice has

RHODES AWARDcontinued from page 7

been in the Southern California KaiserPermanente Medical Group, where shehas held many committee responsibili-ties.

In her personal and family life,Carole has held multiple responsibilitiesfor the Westerly School of Long Beach:Advisory Board, Annual Fund Co-Chair, Development Committee, BookFair Promotions Chair, Soccer TeamMother, and Room Mother. At the AllSaints Episcopal Church of Long Beach,she has served as a member of the YouthAdvisory and Youth Task Force SteeringCommittees and as a Sunday SchoolTeacher. With Carole, all things havebeen possible! SGIM

Editor’s Note—Members of the 2002Rhodes Award Committee were MarkLinzer (Chair), Tom Inui, MarthaGerrity, and Mark Schwartz.

Clinical Investigation, and the Associa-tion of American Physicians. He was aDirector of the American Board ofInternal Medicine for four years. He iscurrently Editor-in Chief of the Ameri-can Journal of Medicine….

“Lee has been an exemplary rolemodel for many of us in SGIM. Heattained his accomplishments whilebeing an active participant in hiscommunity, and a devoted husband andfather. For example, while a youngfaculty member building a career in a

then-nascent area of medicine, he alsoserved as the first president of his localsynagogue, and coached his children’ssports teams.

“For all of these reasons, LeeGoldman is eminently qualified for, anddeserving of the Glaser Award.”

The Selection Committee con-curred in this assessment, which wasechoed in letters of support from severalformer SGIM leaders, and named Leethe recipient of the 2002 Robert J.Glaser Award. SGIM

GLASER AWARDcontinued from page 6

Society of General Internal Medicine2501 M Street, NWSuite 575Washington, DC 20037

SGIM

FORUM

CLASSIFIED ADS

Positions Available and Announcements are$50 per 50 words for SGIM members and $100per 50 words for nonmembers. These feescover one month’s appearance in the Forumand appearance on the SGIM Website athttp://www.sgim.org. Send your ad, along withthe name of the SGIM member sponsor, toSGIM Forum, Administrative Office, 2501 MStreet, NW, Suite 575, Washington, DC20037. It is assumed that all ads are placed byequal opportunity employers.

ACADEMIC GENERAL INTERNIST. We seekoutstanding clinician/academician committed totraining internal medicine residents for primary carepractice. New faculty to join strong division of gen-eral medicine at a university-affiliated, communityhospital-based program. The general medicine fac-ulty consists of eleven full-time and part-time gen-eralists. The milieu emphasizes skill in teaching,role modeling of excellence, educational creativ-ity, independent scholarship and interpersonalwarmth. Primary responsibilities include residentand medical student education in inpatient andoutpatient settings plus direct patient care in com-bined resident-faculty practice with state-of-the-artinformation systems and an electronic medicalrecord. Send CV to Marian Hodges, MD, MPH,

Section Head, General Internal Medicine, Depart-ment of Medical Education, Providence PortlandMedical Center, 5050 NE Hoyt, Suite 540, Port-

land, OR 97213. Telephone 503-215-6600; fax 503-215-6857. Applications will be reviewed immedi-ately and accepted until position is filled.

Judy Davison at Odyssey Press. Theyhave done their best to keep theForum—and me—on schedule, notalways an easy task. I also have receivedenormous help from Lorraine Tracton,Director of Communications in theSGIM National Office. Lorrainecontributed numerous articles to theForum and provided many of the photo-graphs that have appeared in its pages(especially this issue). These folks deserveconsiderable credit for assuring that theForum has arrived in your mailbox eachmonth for the past three years.

When I took on the role of Editorthree years ago, I told Brent Petty (thenChair of the Communications Commit-tee) that my vision for the Forum wasthat “it should serve as a vehicle forsharing information and ideas among

SGIM members [and]… allow us tocontinue the exchange of ideas whichtakes place at the Annual Meetingthroughout the rest of the year.”Because of the contributions of theindividuals listed above and others, Ibelieve that we have been able toachieve this goal. Over the past threeyears, the Forum has published numer-ous articles about the work of SGIM’sCouncil and our many task forces (e.g.,AIDS, Clinician-Educator, Evidence-Based Medicine), committees (e.g.,Communications, Health Policy,Membership), and interest groups (e.g.,Geriatrics, Minorities in Medicine,Physicians Against Violence). TheForum has informed members about newprograms sponsored by SGIM (e.g.,Research Mentorship, Horn Scholars,

Increasing Education and ResearchCapacity to Improve Care of OlderAmericans). And it has served as avehicle for debate about SGIM policy,in particular, the matter of acceptanceof funds from external organizations.

I have enjoyed immensely theopportunity to serve as Forum Editor. Itis with great confidence that I pass onthe responsibilities of this position toMissy McNeil. Please help her bysubmitting articles, letters, and ideasabout how we might strengthen thispublication. The Forum is your newslet-ter, and it needs your continued support.Thanks for the support so many of youhave given me over the past threeyears. SGIM

PASSING THE TORCHcontinued from page 17

Geriatric Educational Tools18 Resources for Primary CareResidency Programs �

• Consultation services• Stand-alone teaching aids• Geriatric curriculum manuals• Faculty development programs• Packaged methods for teaching geriatric skills

Developed by �

• Baylor College of Medicine • Harvard University

• Johns Hopkins University • Stanford University

• University of California, Los Angeles

• University of Chicago • University of Connecticut

• University of Rochester

• American Academy of Family Physicians

The John A. Hartford Consortium forGeriatrics in Residency Training

Stanford University Geriatric Education Resource Centerphone: 650.723.8559 fax: 650.723.4312order from �

Now Available

http://sugerc.stanford.edu

�

Online Orderingand

Digital Distribution

SGIM Forum Template Library/SGIM/Resource Library/Forum/2002... · 31-08-2002 · 13 accepted for...

Documents

Transcript of SGIM Forum Template Library/SGIM/Resource Library/Forum/2002... · 31-08-2002 · 13 accepted for...