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Washoe County Medical Society

COVID19

Changing the Practice of Medicine

COVID-19 illustration

Jay K. Morgan WCMS PresidentCOVID19 has changed the way we practice medicine. We face the dual challenges of embracing procedures that provide optimum protection against the spread of the disease while also reassuring our patients and their families that with the proper precautions, there is no immediate cause for alarm or panic.

This is a tough situation since the protective measures appear to be dramatic causing greater concern by the very appearance of parking lot screenings, restricting visitors at our medical centers and clinics, masks and segregated waiting rooms to isolate those suspected of being affected by the virus.

Many of our family members and friends either will be working from home or temporarily laid off. Non-essential businesses are closed. Parents are helping their children adapt to online learning. Key events statewide have been canceled, including Match Day, at the medical schools. While we help our patients cope, we also need to help our families and friends manage with a minimum of stress. Being kind and patient has never been more important.

Our staff began working remotely March 18 for the next 30 days but remain accessible to you through emails and the office phone—825-0278. Mary Ann tells me you are welcome to reach her by cell: 952-292-8130. Our meetings have gone virtual. The business of WCMS continues, just not quite “business as usual.”

Daily, WCMS and NSMA are evaluating the new information being issued by the Washoe County Health District, the CDC, AMA and other expert health sources. Members of WCMS’ Allied Public Health Commission and NSMA’s Public Health Commission are working closely with the health district to interpret recommendations from all the COVID-19 sources to help our members make informed decisions about how they manage patients at their facilities. The information is being shared through emails and posted to the NSMA Coronavirus Resource Center. (https://nvdoctors.org/coronavirus-resource-center/).
One of the leaders in this effort is Kevin Murphy, MD, an infectious disease specialist with Saint Mary’s Regional Medical Center, and chair of our Allied Public Health Commission. Dr. Murphy is continually monitoring and synthesizing the vast amount of data coming from multiple resources. His regular updates provide us with guidelines for managing patients and protecting staffs. His updates and recommendations are being distributed frequently with other critical information. They also can be found at https://nvdoctors.org/public-health-advisory-on-covid-19/.

With the situation changing daily, we are committed to ongoing assessment of the data available and providing prompt access to updated recommendations and support resources. We are striving to be a highly reliable clearinghouse of the current information that will guide your practice procedures until the virus had ceased to be community health concern.

One Student’s Journey

Navigating Medical School in Uncertain Times


 

coronavirus covid-19 infected patient

 

Anita-savell-medical-student

By the time this article is published there will have been many updates and changes to the circumstances surrounding COVID-19 and the medical school experience, but today I’ll offer you a perspective from a moment in time as a 3rd year medical student navigating the spread of the novel coronavirus.

By mid-March all inpatient rotations were canceled for medical students. All clinical rotations for 3rd and 4th year students--inpatient and outpatient---were canceled until at least March 31 in a nationwide decision by the AAMC and LCME.

The impacts of the spread of this virus on medical education began slowly percolating. I remember first learning about the virus during my inpatient pediatric rotation when it was primarily in China. The floor was full of RSV patients and the whole team would put on their masks, gowns, and gloves and speak to the patients as we rounded. My colleagues on that same rotation now more than a month later have a very different experience. Medical students are barred from seeing patients on droplet precautions in order to preserve the hospital’s supply of PPE.

Hospitals in the region have completely restricted student access. And a source of anxiety for myself and my classmates is if we will be able to complete our clinical rotations and maintain our current timeline for graduation. At the same time that we are applying to 4th year away rotations in our desired specialties, we are getting notified of away rotation cancellations across the country.

There are different impacts felt at every level of medical school.

Our MS1s are trying to complete their anatomy requirements in an online capacity as UNR has made the decision all classes--graduate and undergraduate--will be online for the foreseeable future.

Our MS2s are in their dedicated study period, which is traditionally completed off campus, but they too are impacted as they wonder if the testing sites will be postponing Step 1 exams as they have Step 2 CS exams.

Our MS4s completed their rotations and interviews before travel restrictions and rotation cancellations began, but the culmination of medical school will look very different for their class than those who came before them. There wasn’t the traditional match day celebration. Many students feel uncertain of whether they will have a graduation ceremony.

Medical students have a unique position in this pandemic. While we want to be a resource in a potentially overwhelmed healthcare system and learn for future pandemics when we will be providers, we also recognize that we could become a burden to the system.

Students and providers alike--thank you to all those working to care for our community during this uncertain time.
By Monday night all inpatient rotations were canceled for medical students. By Tuesday all clinical rotations for 3rd and 4th year students--inpatient and outpatient---were canceled until at least March 31st in a nationwide decision by the AAMC and LCME.


 

Nevada Physician Wellness Coalition logo

 

Help During These Challenging Times…

Our community’s physicians and healthcare workers are navigating the challenges of the COVID-19 outbreak with courage and compassion. They are facing unprecedented circumstances in their work & home environments and are being tasked with exceptional demands.

Founded by local physicians, the Nevada Physician Wellness Coalition (NPWC) works to provide resources to physicians & their families to address burnout and to prevent suicide. We want to remind you that our resources are in full force to support those who are working so hard during this difficult time.

NPWC’s Physician & Family Resource Line provides free and confidential information and links to resources for physicians, medical students, and their families.

The Physician & Family Resource Line...

  • Operated by licensed psychologists with expertise in physician stress
  • Monday through Friday, 9 am - 5 pm
  • Calls returned within 24 hours

775-404-3307

The Physician & Family Resource Line serves non-urgent, non-crisis calls. If you or someone you know is in crisis, please call:

Crisis Call Number: 1-800-273-8255

NV Suicide Hotline: 1-800-992-5757

ABOUT NPWC

NPWC is volunteer physician led non-profit organization. It is operated independent of any health system, physician employer, licensing body, or organized medicine body. NPWC offers a range of programs including community and workplace education programs, seminars, and the Physician & Family Resource Line.

For more information, contact: info@nevadaphysicianwellnesscoalition.com, or visit: www.nevadaphysicianwellnesscoalition.com.

 

Observations from the Legal Trenches

The thorny issue of discharging a patient from a practice

Lyn Beggs

One the most common questions asked by physicians is how to properly discharge a patient from a practice. Sadly, there is little direct guidance regarding this issue.

AMA Ethics Opinion 1.1.5 states in part that when contemplating whether to terminate a physician-patient relationship a physician must:

  1. Notify the patient (or authorized decision maker) long enough in advance to permit the patient to secure another physician.
  2. Facilitate transfer of care when appropriate.

Similarly, NRS 630.304(7) states that a physician (MD) is subject to disciplinary action for “terminating the medical care of a patient without adequate notice or without making other arrangements for the continued care of the patient.” NRS 633.511(1)(n), applicable to DOs, reads almost identically.

These statements lack any definition of what defines “adequate notice.” There is a general notion that thirty days is appropriate, but this is not set forth in state law. Thirty days is typically considered adequate notice and is the notice period most practices follow. However, if you practice in an underserved specialty or care for patients in remote areas of the state, thirty days may not be sufficient; try to give as much notice as reasonably possible in these circumstances. In some cases you may be able to help the patient transfer to a new provider, if not, encourage them to contact their insurance carrier as quickly as possible for a referral. Regardless of the amount of notice, if the patient requires on-going medications, ensure that the patient has the necessary refills to last until they are able to see a new provider. In some cases, such as prescriptions for schedule II-controlled substances, this may not be feasible so early notice is crucial.

Administrator looking at medical record

If you are discharging a patient for any reason other than you are leaving the practice, be sure to document in relative detail the patient’s chart as to why the patient is being terminated from the practice; this may protect you should the patient file a complaint with the state board or other entity regarding the discharge. Regardless of the reason you are discharging a patient, provide written notice to the patient, even if you have verbally informed the patient. In most circumstances you should notify the patient of the final day that you will be providing medical care for them but offer to provide interim care during the period between providing the notice and the final day of care.

Discharging a patient does not discharge your duties to retain the patient’s medical records. Also, the patient is entitled to a copy of the chart pursuant to NRS 629. 061; while it’s fairly standard to transfer the patient’s chart to a new provider, if the patient asks for their own copy of the chart, you may legally charge up to $.60 per page for the copy.

Finally, while it is recommended to provide as much notice as reasonably possible to a patient being discharged, neither you nor your staff should ever be placed in a situation which may result in physical harm or other danger; in those circumstances immediate termination is certainly justified. Under such circumstances be sure to document in detail the circumstances resulting in immediate termination; if appropriate, you may notify the patient that one refill has been made for their medications to avoid disruption of needed medications.

In unusual discharge situations, you may want to consult with counsel, however most physician-patient relationship termination should not require legal advice if proper notice is given and good documentation is made.

Ms. Beggs, principal of the Law Offices of Lyn E. Beggs, PLLC, focuses her practice primarily on assisting clients with administrative and professional licensing board matters in addition to representing healthcare providers on a variety of issues. Ms. Beggs may be reached at 775-432-1918 or at lyn@lbeggslaw.com. This article does not constitute legal advice and should not be considered a substitute for retaining counsel for advisement in legal matter.

Check Your Sources!


 

Check cdc.gov for the latest information on the Coronavirus Disease.


 

Check washoecounty.us/health for the latest information from Washoe County Health District on the Coronavirus Disease.


 

Check Nevada Health Response for the latest information from the Nevada Health Response on the Coronavirus Disease.


Understanding the important work of the Nevada State Public Health Laboratory

Dr. Thomas Schwenk Dean of the School of Medicine and VP of Health Science

Dr. Thomas Schwenk Dean of the School of Medicine and VP of Health Science

Most of you probably know little about the work of the Nevada State Public Health Laboratory (NSPHL). You should know more, because the lab scientists and technicians are literally working around the clock to protect you and all Nevadans from a wide range of potential infections, food-borne illness, and unsafe water, as well as providing emergency response to biological and chemical terrorism, and testing every Nevada baby for more than 30 hereditary diseases.

Established in 1909, the NSPHL serves as Nevada’s centralized lab, representing a first line of defense in the rapid detection of a public health threat. The laboratory is part of the University of Nevada, Reno School of Medicine and located on the University campus.

Here are a few facts to help you understand the important work of the NSPHL and how it serves the entire state, so well. The laboratory performs over 550,000 tests each year to help keep Nevadans safe and healthy—that’s more than 2,000 tests each day. Over 400,000 of those tests are conducted on newborn babies, with each baby being tested twice in the first 10-14 days of life for conditions ranging from cystic fibrosis to congenital hypothyroidism to sickle cell disease to severe combined immunodeficiency disease. Every day, the NSPHL is confronted with questions and challenges, ranging from the safety of water in the Truckee River to outbreaks of whooping cough in local schools to whether the West Nile virus has come to Nevada.

The NSPHL is staffed by over 30 scientists and technicians, with a budget of over $7m/year. But, the cost per Nevada resident has dropped over the years, with state funding per capita declining from $644 in 1998 to $564 in 2018 due to an increasing level of efficiency and success by the laboratory management in seeking grants and contracts from other sources.

The NSPHL also has a new Director, Mark Pandori, Ph.D. Dr. Pandori has over 15 years of high-level experience in public health laboratory leadership, most recently as Director of the Alameda County Public Health Laboratory in Oakland, California. He earned his Ph.D. from the University of California, San Diego, completed a fellowship at Harvard University, and holds several certifications in diagnostics and public health microbiology. He will serve as a faculty member in the Department of Pathology and Laboratory Medicine at UNR Med where he will teach medical students and residents, in addition to his laboratory leadership responsibilities.

Dr. Pandori will continue the outstanding tradition of public health leadership that the state has enjoyed with Dr. Trudy Larson, professor and dean of the School of Community Health Sciences, who has served as NSPHL director since July 2014.

The NSPHL is an example of community service and engagement that characterizes the core mission of UNR Med at its best, to serve the state, to improve the health and quality of life and to contribute to a Healthy Nevada. Nevada residents can be confident that their public health is in good hands with the leaders and scientists at the Nevada State Public Health Laboratory.

Trust!

If you’re not at the table, you’re on the menu

Physicians are busy and need representation in a myriad of legislative, professional and community forums. Our priority forums are the places where we practice medicine and interact with our patients. They trust us to provide the best possible care.

This is why WCMS and NSMA are so important to us as professionals. They provide a critical forum for physicians to set priorities that lead to optimum healthcare in our community. Together, our collective voices will be loud and strong before the legislative and regulatory bodies that shape how we practice medicine. We are present and active with other professional associations in enhancing the quality of care and influencing regulations that affect us and colleagues.

My goals for 2020 are to:

  1. Increase our members by 20%
  2. Work even more closely with the UNR Reno School of Medicine
  3. Work closely with AWCMS
  4. Develop closer relationships with our younger generation physicians
  5. Work to improve the health of our patients in Washoe County

To achieve these goals:

  1. Each of us to bring one new member this year. The endorsement of a peer is far more valuable than any ad, email or brochure that may cross your desk. So, please bring in a member and help that person get engaged. As an added incentive, the first member to enroll seven new members will be awarded with a wine weekend for two in Sonoma County. My challenge is for one of you to beat me to it!
  2. Collaboration is key to our success. It enables WCMS to tap resources and talents with a wide range of healthcare expertise in this community without duplicating efforts. We will continue to strengthen our community partnerships, with special emphasis on the medical school, and seek one or two new ones.
  3. One of the most important partnerships is with the Alliance of WCMS, an awesome yet unrealized resource for recruiting and retaining members. We plan to work more closely than ever with the Alliance in enhancing both organizations.
  4. We must find successful ways to engage young physicians and new physicians coming to Reno. I welcome any and all ideas.

Finally, thanks to all who have been or are engaged on the board, a committee or commission. Your contributions are what makes this a great organization. I invite those of you who are not engaged, to get involved. Join a committee, attend the events and share you story through our newsletter.

I’m excited about the year ahead and look forward to leading the 2020 board.

WCMS Year in Review

Reed Dopf awardA busy year is winding down. Many gave your time, expertise and passion during an intense legislative year. Thank you for the hours spent formulating strategies around our legislative priorities, participating in our weekly Legislative Core Group and attending the NSMA House of Delegates in fall. A full listing of our legislative successes is available.

I thank our NSMA commissions and Committee Members for their time and wisdom. You helped to move the practice of medicine forward and you paved the way for continued representation by the House of Medicine in this emerging world of corporate practice.

Special thanks to Amanda VanderClay, MD, completing her board term; Vijay Aluru, MD, our resident board member now in graduate training, and Jackie McBride, our third-year medical student.

Our member database is live. Now, it is your responsibility to help keep it updated. If you haven’t done so, go to nvdoctors.org and click “log in.”
Please check our refreshed newsletter and website and consider joining us for the networking Happy Hour every Third Thursday at the Renaissance Shore Bar.

It has been a great experience serving as you president. I appreciate the encouragement, counsel and support. Let’s make 2020 visionary.

Please join us in welcoming NSMA’s new Executive Director, Jaron Hildebrand.

Headshot - Jaron HildebrandPrior to joining NSMA, Jaron has served as the director of government affairs for the Nevada Trucking Association since October 2012. Jaron has an extensive background in government affairs and has lobbied five sessions of the Nevada Legislature. He also has political and campaign experience working as field director for Congressman Mark Amodei where he coordinated and promoted events, established grassroots relationships and oversaw logistical operations for campaign materials sent throughout the state.
Jaron is a native of Reno, Nevada. He graduated from the University of Nevada in 2010, with Bachelor of Political Science and Communications, while minoring in European History. Jaron is an adventurous traveler, a sports enthusiast and enjoys spending time with his wife Kaitlin and eight-month-old son, Calvin.
You can contact Jaron at the NSMA office at (775) 825-6788 or email him directly at Jaron@nvdoctors.org

Changing of the Seasons

Anita-savell-medical-student

It is that time of year again — July 1 is here and along with it, the changing of the medical season. It is time for all of us to transition from the roles we grew comfortable with into a new position with new responsibilities and expectations.

Some residents are graduating and embarking on fellowship or new jobs—with at least 11 years of education under their belts.

Interns are steadier on their feet in the hospital. For some, just 2 years until graduation. For others, they are finally moving into the specialty training.

Former fourth year medical students have graduated and taken the Hippocratic oath. They are falling from the top of the medical school food chain to getting lost in the corridors of a new hospital.

Our new fourth year medical students are preparing to apply to residencies and are happy to waive goodbye to the grueling MS3.

Newly minted MS3’s — like myself—are anxiously awaiting board score results and the first days of rotations. We have climbed the mountain that was step 1 only to realize it was just a foothill and the steepest slopes are still to come.

Our incoming MS2’s spent the last several months watching the upperclassmen stress about Step 1 and are enjoying “the last summer of their lives” before they too start the step 1 climb.
And our incoming MS1’s are excited, hopeful, and in preparation for the start of their medical education.

Good luck to everyone in their transitions and congratulations on another year of progress towards your goals—whatever they may be. And if you have already made your full metamorphosis into a provider, look for the students finding their footing and give them a hand during this change of seasons.