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DECEMBER 2005

Richard Payne, MD, Editor • Images of Katrina • Candidate Bios • Immunization Update • New Website

Within 100 feet you can get a tetanus shot, an eye exam and an HIV test. Walk a little more and you can see a doctor, dentist, get a prescription filled, get a chair massage, and even get your hair done. Beyond the armed guards, there are a sea of beds and newly acquired personal possessions. Upstairs, break-fast is served by volunteers wearing yellow t-shirts reading “Operation Compassion.”

These are images of the shelter located at the George Brown Convention Center in Houston two weeks following Hurricane Katrina. After watching the devastation on TV, my mother and I found our way to a clinic at the shelter sponsored by the University of Texas-Houston Medical School. Generosity was abundant. “Just write ‘Katrina Relief’ at the top of the prescription,” I was told, and up to a month of medication would be provided, courtesy of Walgreens. Patients were flown by Continental Airlines all over the country. Physicians came from near and far to volunteer, some brought a sleeping bag in case there were no hotel rooms.

It felt good to be a family doctor. Each day a team was sent out to a local church where FEMA checks were being handed out. Family practitioners were always asked to go. As evacuees waited for hours in the smoldering heat, an elderly lady fainted. A G7P6 at term went into labor. Reassurance was given to parents of infants who missed their well child appointments. Hypertensive emergencies were commonplace. I received hugs of gratefulness for listening to patients’ stories of loss and for treating their hypertension and anxiety.

It was refreshing to be reminded what’s important in life, why I choose medicine, and why I became a family physician - to help those in need and as the saying goes, “to cure sometimes, to relieve often, to comfort always.”

P.O. Box 910144 San Diego, CA 92191

Images of Katrina Elaine Chong, D.O.

SDAFP Gets a New Website Stephen Daquino, D.O.

Some of you may have noticed a few changes to the San Diego Academy of Family Physicians website over the past few weeks. After a long stint of downtime, we are pleased to inform you that the SDAFP has taken over ownership of the site from the CAFP. This will allow us to make more timely updates and have the site better reflect the needs of our San Diego constituency. We are now directly responsible for making our own changes and no longer need to wait for changes to be made. Our first action was to give the site a facelift. This has involved experimenting with new ways to use the web to communicate to our large number of active members. This newsletter represents our first electronic version, of which this and future versions can be archived on the site. Events important to our members are able to be updated quickly and more easily on the “events” page. New links to online registration for upcoming CME events are also in the works. Soon you will also find a new bulletin board which will prove useful for both board members and general members as a place to have open discussions on any topic we wish. The site can now truly be called our own, and because it is meant for our members we would love for you to become an active part of it. Check out the site at www.sandiegoafp.org. Email us with any suggestions you may have or features you would like to see. Members wishing to contribute to the site may also submit articles to be published on it. Our hope is to develop the site into the first stop on the web for all our members. Your input and suggestions are the first step toward seeing it grow, so please visit often.

Immunization Update Mark H. Sawyer, MD Medical Director, San Diego Immunization Partnership

Much has recently happened in the world of immunizations! The FDA approved 7 new vaccines or vaccine indications, although at this point we don’t have specific recommendations from CDC/AAP/AAFP for the use of many of these new indications. The table below summarizes the new vaccine/indication and the status of recommendations. The prices are the CDC contract price and CDC data on typical private sector prices. Stay tuned for more updates. For additional information, go to http://www.cdc.gov/nip/home-hcp.htm. or to the San Diego Immunization Branch web site http://www.immunization-sd.org/.

Celestial Medicine! - Forwarded by Joseph Leonard, M.D. Medical offices, particular high volume primary care practices, struggle under the increasing requirements of providing care in this informational age. Everyone has more needs to be met. Of course, reimbursement of service constantly trails the increased demand for more service. Is office medicine economically sustainable??? Advances in the processing of data spawn the hope of the paperless office. But down on earth, that hope may seem as inapproachable as “google”. Yet, there are steps to get to “paper-lite” that are now within our grasp. An exemplary practice is that of Skyline Family Physicians in Royal Gorge, Virginia. This small office has a fully functional informational portal that has partial links with their electronic medical record. Patients can send in requests for appointments, pay their bills, and communicate electronically with the office in a HIPAA-compliant manner. Patients can have “e-visits” with their physicians, and the physicians can be reimbursed for the visit. (www.skylinefamilypractice.com). Mayo Clinic in Rochester also has a system that enables e-visits with physicians, and receives reimbursement from some payors (https://www.mayopatients.org/wps/portal/!ut/p/.scr/Login) Electronic portals imbedded within proprietary EMRs on a hypersecure websites (“https”) can enable specialists a “read only” view of the primary care physician’s medical record on a mutual patient, in accordance with HIPAA regulations. This certainly could diminish repetitive diagnostic testing. Patients themselves can be enabled to see selected portions of their charts, and can have results sent to them via the portal, instead of by mail. E-visits have great clinical potential. All of us are surprised at how some patients with severe chronic disease avoid office visits for extended periods. Also, we understand the cost to the employed patient of an office visit in terms of time off from work and transportation costs. A reimbursable e-visit, coupled with periodic office visits, could lead to better care, and hopefully, more attention to health maintenance issues (some of which will have extra reimbursement attached).

Vaccine (manufacturer) Recommendations? Comments Price

Conjugated meningococcal vaccine-MCV4-Menactra (Sanofi Pasteur)

Routine use in 11-12 year olds, kids entering high school, and high-risk groups including college freshman

Already experiencing shortage CDC-$68 Private-$82

2nd dose of varicella vaccine (Merck)

None Evidence of waning immunity has led to consideration of a 2nd dose

CDC-$52 Private-$67

Tdap-Adacel (Sanofi Pasteur)

Routine use in 11-12 year olds Recommendations for adults pending CDC-$31 Private-$36

Tdap-Boostrix (GlaxoSmithKline)

Routine use in 11-12 year olds Only approved up to age 18 years at this time

CDC-$29 Private-$35

Hepatitis A vaccine at 12 months of age (VACTA-Merck)

None yet Only one of two Hepatitis A vaccines approved for younger age at this time

CDC-$12 Private-$30

Fluarix-a new influenza manufacturer (GlaxoSmithKline)

Standard influenza vaccine recommendations

Should help prevent a shortage this year

MMRV-ProQuad

None yet This may be the way to give a second dose of varicella vaccine

CHECK OUT OUR UPCOMING EVENTS!!! • February 10th, 2006: Annual Installation Dinner - Admiral Kidd Club • April 6-9, 2006: California Academy of Family Physicians Annual Scientific

Assembly in Collaboration with the San Diego Academy of Family Physicians

Presenting… the 2006 Candidates for the SDAFP Board of Directors All SDAFP members will soon be receiving a ballot to elect candidates for board of director positions. Here’s a rundown on the excellent group of individuals running for office: Lee Remington-Boone, MD: Dr. Remington-Boone graduated from UCSD School of Medicine in 2000. She completed her residency in the UCSD Department of Family Medicine in 2003. She is currently in her 3rd year of private practice in the La Mesa area where she lives with her husband and two children. She is interested in bringing the perspective of a ‘new’ physician to the SDAFP Board of Directors. She would also like to foster more cooperation between our local organization and the medical school in order to encourage more students to join the field of Family Medicine. She states, “I am a family physician today because of my primary care clerkship preceptor—we can all make an impact on our local students!” Patrick Yassini, MD: Dr. Yassini attended West Virginia University where he earned his BS, MS and MD Degrees. Following two years of postgraduate training in General Surgery at LA County Hospital, he moved to San Diego and completed his residency with the UCSD Department of Family Medicine. After being in private practice for several years in the San Diego metro region, Dr. Yassini recently opened his own completely paperless office in Coronado. He was recently nominated to chair the Department of Medicine at Coronado Hospital. Dr. Yassini also sits on the CAFP Practice Affairs Committee. He is especially interested in the use of technology to improve quality of care. His father who still practices Family Medicine in Wheeling, West Virginia, showed him first hand the meaning of being a home town doctor. This inspired his vision to provide a broad scope of medical care to a community of families. However, the changing landscape of healthcare has made bringing this vision into reality more difficult than ever. Dr. Yassini still believes Family Medicine physicians play a critical role in maintaining the health of our nation’s population, although he is concerned that the scope of practice seems to be shrinking. He is optimistic that the Future of Family Medicine, as charted by national leaders, will provide great change for the better. He states, “I am honored and excited about the opportunity of contributing to this leadership as a SDAFP board member”. Phil E. Yphantides, MD: Dr. Yphantides is a full-time family physician and also serves as Outpatient Medical Director for Neighborhood Healthcare, a community clinic network with sites in North and East San Diego counties. He went to medical school and also trained as a resident at the UCSD Department of Family Medicine. Dr. Yphanitides was chief resident his final year. He has an interest in advancing the field of family medicine as a discipline and attracting highly qualified applicants into leadership positions within broad-based community clinic practice settings.

A Great Loss We regret the sudden passing of a dear friend and colleague. Dr. Mike Hart of Sharp Grossmont Family Medicine Group died unexpectedly on Thanksgiving following a bike accident near Jamul. He leaves behind his wife Emily and three young children. A memorial fund is being set up for the Hart family.

The address to send donations to is: Grossmont Family Medical Group, 5525 Grossmont Center Dr, Ste. 200, La Mesa, CA 91942

Please make checks out to the Michael Hart Memorial Fund

A CALL FOR CASES! - Bradford Stiles, M.D.

Do you have an interesting case, clinical finding or pearl? Share it with us! We are looking for presenters for the ‘2 Minutes, 2 Slides, 2 Questions’ section at the next California Academy of Family Physicians Annual Scientific Symposium, which will be right here in San Diego at the Sheraton Harbor Island Hotel. The talk will be held on Friday, April 7th, 2006. The session is informal and fun. You will have only 2 minutes to present your case, clinical finding or pearl and may use only 2 slides for the presentation. You then must field 2 questions from the audience. This session has been done for the past two years at the San Diego Academy of Family Physicians Annual Scientific Symposium and has been very well received. If interested, please e-mail a brief description of the presentation to Brad Stiles, M.D. at: tunaboy@san.rr.com. We do have a limited number of spots, so get your case in early. We will notify you if yours is chosen. It’s really amazing how much information can be presented in just 2 minutes!

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Don’t Miss the 2006 California Academy of Family Physicians Annual Scientific Assembly in Collaboration with the San Diego Academy of Family Physicians!!!

By Steve Green, M.D.

Get ready for the first combined CAFP/SDAFP scientific assembly April 7-9, 2006. This is our first project combining the successful meetings of the CAFP and the SDAFP and will be at the Sheraton Harbor Island hotel. The SDAFP will be in charge of the Exhibit Hall and will also be arranging the CME program for the afternoon of April 7, 2006. We are hopeful that this joint effort between the SDAFP and CAFP will offer benefits to both groups and their members. In 2007, the SDAFP will once again have it's own CME conference, this time at the San Diego Marriott hotel on August 3-5, 2007.

For more information, please contact Sabrina Bazzo at the SDAFP office Phone: 858-458-9439, Fax: 858-458-9467, e-mail: sbazzo@sandiegoafp.org, website: sandiegoafp.org