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Washoe County Medical Society

Silver Sage Medical Center Expands Travel Medicine Capabilities

Nevada Travel immunizations at Silver Sage

Silver Sage Family MedicineInternational adventure is now easier than ever before, but it still has risks — malaria and yellow fever, to name a few.

Silver Sage Travel Medicine is one of the few medical offices in northern Nevada that stocks the vaccines travelers might need to stay healthy on their international journeys, whether for business or pleasure. They can also make sure travelers have any medications they need for their trip.

“We stay informed on outbreaks around the world, so we’re ready to educate and prepare patients for their next adventure,” said Peggy Franklin, RN, who is heading up the travel department at Silver Sage. She is available to discuss travel plans, make recommendations and administer the appropriate vaccines.

Dr. Andrew Pasternak is an avid traveler and a member of the International Society of Travel Medicine (ISTM), which promotes healthy, safe and responsible travel for all people crossing international borders.

Silver Sage subscribes to Shoreland Travax, the leading travel medicine resource, which monitors and updates travel health and safety information in real time. This allows them to quickly create reports customized for travelers.

Recommendations will vary depending on the country and specifics of the travelers’ situations (pregnancy, chronic disease, children, etc.). Many vaccines don’t take effect immediately, so it is recommended that travelers take care of this four to six weeks before their trips begin.

For more information, visit or call 775-853-9394.

Medical Assistants and Injections in 2017

In December 2014, I wrote about the delegation of administration of certain cosmetic substances to medical assistants. The laws regarding this issue have substantially changed recently and it is recommended that physicians, and physician assistants review these laws to ensure they are familiar with legal requirements for the proper supervision and delegation of tasks to medical assistants.

NRS 630.0129 defines a medical assistant as an individual who “ (a) performs clinical tasks under the supervision of a physician or physician assistant; and (b) does not hold a license, certificate or registration issued by a professional licensing or regulatory board in this State to perform such clinical tasks.”1 In the case of cosmetic procedures, medical assistants are often referred to as “medical aestheticians”. This term does not exist in Nevada law. An individual who performs a clinical task is a medical assistant, regardless of the location of the individual.

NAC chapter 630 was amended in 2013 to better define what tasks may be delegated and the level of supervision required for medical assistants. In 2016, NAC 630.810 which sets forth the criteria for when a task may be delegated to a medical assistant was further amended. A task may be delegated only (by a physician or physician assistant) if the practitioner knows the medical assistant has the training and skill required; a certificate or license is not required to perform the task; the medical assistant is employed by the practitioner or the two share the same employer; and the employer must document in the medical assistant’s employment record that they have been appropriately trained and are competent to perform the delegated task. Practitioners should review the regulation in full.

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NJ Designs, Wins National Graphic Design Award for the WCMS Communicator

Graphic Design USA (GDUSA) has awarded NJ Designs’ founder and creative director Natalie Ede with an award for her outstanding design work on the Washoe County Medical Society’s bi-monthly publication the WCMS Communicator and will be featuring her award-winning design in their latest publication GDUSA.

“I am honored to receive such high praise for my work,” said Natalie. “My goal as a designer is and has always been to make sure my clients are happy. To also receive national recognition for my work for the fourth time in my career is truly icing on the cake.”

“We have a much more engaging newsletter with this new design,” said Mary Ann, WCMS executive director. “This national recognition is a great testimony to Natalie’s talent.”

This year there were over 1,000 entries; a highly selective 15 percent were selected for recognition.

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One Student’s Journey

The first months of medical school have been a learning process. Week 1, I was prepared to do whatever it took to get through the mountains of material, no matter the time required. Week 2, I learned that I need to sleep enough if I want to function. Week 3, I found a tentative sleep/study balance. Week 4, as I prepared for my first exam, I began to see that my studying efforts were fruitful—I remembered far more than I expected to!

Many describe the medical school workload as “drinking from a fire hose”, but as a first-year medical student, I find that the pancake metaphor is much more encompassing. For those of you that are not familiar with it, the metaphor goes a little like this.

Every day in medical school, students are served four to five pancakes (four to five lectures). It’s manageable. But the trick is that if one does not eat all her pancakes for any given day, they get added to the next day’s stack. If a student is not diligent about eating her pancakes, she may find herself 60 pancakes deep with only three days before an exam.

I have found that these pancakes come in many flavors. Some lectures are exciting and enticing, while others are more difficult to swallow. Telling friends, the day’s pancake flavors has actually become a pretty effective way to communicate a day’s difficulty. Telling a friend that medical school is hard will typically elicit responses along the lines of, “You are a great student! It cannot be too bad” or “you are the best student I know!”. However, when I tell my friends or family that I just ate three mushroom and liver pancakes, they immediately understand my plight and are more able to empathize with the unique struggles of medical school.

With the first block of medical school behind me, I have settled into what is at present a doable rhythm of learning—that is still supremely challenging.

Note from Dean Schwenk: Now that we are a fully northern Nevada-based medical school, patients throughout the community will see more and more medical students working with their private physicians—in the exam room and in the hospital.
I’m going to turn my column over to Timothy Baker, M.D., UNR Med alumnus (’04), Associate Dean of Medical Education and practicing general internist on the UNR Med faculty. Dr. Baker reflects on his experiences as both learner and educator as well as the patient’s role in the education of our developing physicians.

From Dr. Baker
The process of medical school is more than making sure our students leave their fourth year knowing something. We’re asking them to become something special: physicians. Moments like this one are how we go from student to doctor. It’s a special relationship in which both physician and patient play important parts.

I could drive to the very office and find the exact exam room where I diagnosed pneumonia for the first time during my first-year preceptorship.

In my first semester, I learned what it was like to be a doctor. I learned the responsibility that came with my white coat. I learned where my stethoscope was supposed to go, how to take a history and how to use my otoscope without puncturing the eardrum. After countless hours of studying, exams, lectures and labs, I was out in the community for my preceptorship. It was now time for me to see what being a doctor was all about.

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In the Homestretch

As some of you know, I enjoy running, cycling and cross-country skiing. When I’m in a race, there is always a point near the end when you can decide to back off a bit and just cruise into the finish or crank it up a notch and sprint in. As we come into the end of the year, I can proudly report that the WCMS board and staff are definitely in the “crank it up” mode.

One of the biggest challenges we face is getting providers up to speed on NV 474, the new law that affects how physicians prescribe narcotics AND other controlled prescriptions! WCMS and NSMA are working with state licensing boards as well as the Nevada Dept. of Health and Human services to give our providers the tools the need to comply with the law and still provide our patients the care they need. Make sure to check your e-mails and the NSMA website for more updates and tools.

We’ve also decided to take on the task of revising the WCMS bylaws and board structure. In the past few years, we’ve had some committees that are doing some incredible work. We’re finding a few areas, however, where we need to change the structure, eliminate redundant committees and merge committees where possible. This includes creating a permanent membership committee that we hope will help propel membership.

Part of our changes includes bringing UNR Med students, residents and fellows on to the board and committee positions. As I write this, I’m flying out to a primary care research meeting. Many years ago, I was fortunate to serve on the board of this organization as a fellow and I’ve kept up my membership and involvement because of those early experiences.

With WCMS, we’re hoping by getting more  young physicians involved early, we’ll help to develop the next generation of leaders in organized medicine.

In addition, I’ve had opportunities to talk to some of the students and residents about many of the issues where politics meets medicine and have been impressed with their knowledge and dedication to their communities. It’s critical that we get their input, as many of these decisions will affect them for their entirety of their careers.

Finally, at the federal level, where healthcare is headed is still incredibly unclear. This obviously impacts us, our practices, and our hospitals. Most importantly, it may affect many of our patients. As you talk to your patients, if you hear stories good or bad about how federal changes is impacting their healthcare, please let us know so we can make sure to relay those messages to our federal legislators.

Taking a Fresh Look at the Mini-internship Program

By Mary Ann McCauley

I’m delighted to have Kelly Wranik joining the WCMS team this fall to help us assess our mini-internship program so that we can make it even better. Kelly is a senior in UNR’s Community Health Sciences program where she’s majoring in public health.

During her internship, she will be interviewing past participants and physicians, local and state leaders and other key community leaders who can influence health care in our community. Our objective is to identify ways we can adapt or revise the program in order for it to obtain participation from those who influence legislation, regulations and policies concerning health care and the practice of medicine.

The outcomes will be an assessment and recommendations that our public relations committee will use to update and revise our mini-internship program for 2018.

Handling Subpoenas

The great majority of requests for medical records that are received by healthcare providers are requests which included a properly executed HIPAA compliant release. However, on occasion a record request may be received through a subpoena duces tecum, a subpoena requesting only the production of documents, not testimony.

In Nevada the issuance of subpoenas is governed by the Nevada Rules of Civil Procedure. Non-compliance with a properly issued and served subpoena could potentially result in the party issuing the subpoena seeking a court order for compliance with the subpoena and/or to find the non-responding party in contempt of court. While there are some legal challenges that may be raised to a subpoena, in general, compliance with the subpoena, to the extent legally allowed, is required. However, the disclosure of any records constituting Protected Health Information (“PHI”) must be done in compliance with HIPAA.
45 C.F.R. § 164.512(e) governs the disclosure of healthcare records pursuant to a subpoena. While the full contents of this section is too extensive to discuss here fully, two of the main points are summarized below.

  • “Covered entities” (which includes various healthcare provides) may disclose healthcare records pursuant to a subpoena if it receives satisfactory assurance (defined by 45 C.F.R. § 164.512(e)) that the party seeking the information has made reasonable efforts to notify the individual of the request or that the party has made reasonable efforts to request a qualified protective order.
  • If the covered entity does not receive satisfactory assurance from the party seeking the information, it may still disclose the records if the covered entity makes reasonable efforts to notify the individual whose records are being sought of the request or to seek a qualified protective order.

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Speak Up: There is Help and Support

Speak Up: There is Help and Support

Suicide can be Prevented

Suicide is an unfortunate reality that takes the lives of an estimated 400 physicians in U.S. every year. Fortunately, depression, suicidality, mental health and distress are responsive to proper intervention. Doctors too.

Nevada regulations now require physicians to earn two CME credits every four years in an effort to promote physicians’ abilities to recognize a patient who might be in danger of harming himself or herself. However, the regulation doesn’t address suicide prevention for physicians.

It raises the question: “While we’re looking out for our patients, who’s looking out for us?”

At the Nevada State Medical Association annual meeting in late August, the first CME program about suicide prevention was presented. A few days later, one of our own members took his life.

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The Sigh of Relief

By Bruce Knowlton
National Certified Chi Kung/Tai Chi Teacher

A Sigh of Relief is one of the most powerful self-healing tools we have. Unfortunately, most people do not use it until they are frustrated and angry. It is always preferable to release rather than to store anger, frustration, anxiety and worry. Science has proven that those emotions actually sabotage the immune system and other self-healing mechanisms by producing poisonous chemicals within the body.

If one practices the Sigh of Relief 25 to 30 times a day, it creates a tool the body will use whenever any stress arrives. One will find themselves doing the Sigh of Relief without thinking about it.

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