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This article from Medscape -- US on High Alert With Coronavirus Outbreak -- is the first in a series of education clinical briefs on the coronavirus outbreak. 

Wrapping Up 2019

The Pueblo County Medical Society 2019 got off to a great start with Dr. Greidanus at the helm and his three resolutions projected: good governance, clear direction and relevance. Some of the events and/or actions PCMS participated in this past year are worth noting.

Events

  • Presented 9 CME events where expert speakers brought their knowledge and expertise to membership.
  • Hand-delivered over 100 red carnations to members on Doctors Day in appreciation for their contributions to our local community and generous support of their 138-year-old medical society.
  • Board of Directors strategic planning retreat included onboarding three new board members, revising bylaws, reviewing mission and vision statements, and performing a SWAT analysis which led to an action plan and 5 subcommittees.

Advocacy

  • PCMS Director and CMS Board Representative Brad Roberts, MD, took an active part in identifying advocacy, a vital aspect of membership. Sharing regularly in our monthly online newsletter, he kept members informed of the challenges facing physicians throughout the legislative session, advocacy opportunities available to membership, and presented ideas how physicians make things happen locally and statewide.
  • Terry Lakin, MD, volunteered to be our PCMS representative and attended the CMS Council on Legislation throughout the year. Reviewing and deciding positions on multiple bills under consideration by the Colorado General Assembly, Dr. Lakin was a breath of fresh air for PCMS, taking time out of his busy schedule as a PCP in Pueblo to represent the best interests of membership.
  • Recognized Senate President Leroy Garcia with a special award presentation. An outstanding supporter of physicians’ health policy issues in the 2019 Colorado General Assembly, Senate President Garcia was privy to 4 physicians – 3 in white coats – representing PCMS and demonstrating appreciation for a work well done.
  • A letter was sent to Mayor Nick Gradisar and all City Council Members requesting a meeting to discuss the issue of Cannabis Lounges or Pot Clubs.
  • Met with Pueblo Mayor Nick Gradisar to discuss public cannabis lounges and other public use cannabis facilities. PCMS remains opposed and is concerned that this will jeopardize the health and safety of Puebloans.

Collaborations

  • Participated in Pueblo’s Food Project, a group effort supported and promoted by Pueblo Mayor Nick Gradisar, as a call to action for citizens, organizations and agencies to join forces to build community and strengthen economic development in local food systems.
  • Supported the Pueblo Department of Public Health, Substance Use Response Ecosystem (SURE), and school district 60 to promote  education regarding substance abuse and dependence to middle school students in district 60. There is still a need for health care providers (physicians or mid-level providers) to volunteer.
  • Collaborated with Interim HealthCare Hospice to locate a Hospice Medical Director who now provides oversight of the Hospice Physicians’ services and assist the Hospice Physician and IDG.
  • Created a partnership with Lumunos which specializes in creating and delivering well-being programs for providers. PCMS is exploring ways Lumunos’ work is relevant for our mission of supporting clinicians in our community.
  • Sponsored the free fundraising breakfast for Season of Change Fundraiser in an effort to support the Nature & Wildlife Discovery Center's mission to promote environmental stewardship and population health through nature education, wildlife rehabilitation, and outdoor recreation.
  • Collaborated with Pueblo Bank & Trust Company to recruit a member physician to serve as a committee member on the Pueblo City & County Foundation Committee. The foundation was established to provide grants for worthy causes throughout Pueblo County.
  • Partnered with Sangre de Cristo Hospice and Palliative Care to produce the creation and distribution of the 2019 Physician Directory. Sangre de Cristo Hospice & Palliative Care, a Legacy, Non-Profit Hospice, has been a pioneer in the hospice movement since 1985.
  • Submitted a letter in support of the Pueblo Department of Public Health and Environment’s application to the Colorado Department of Public Health and Environment’s Overdose Data to Action to request funding.
  • Participated in legislative breakfasts presented by the Greater Pueblo Chamber of Commerce.

Moving forward in 2020

  • Dr. Marcel Junqueira, MD,  became our new president and his 2020 plan is a roaring example of his passion to increase the relevance of your medical society, locally and statewide.
  • Working with the state medical society to implement MemberSuite, the premier technology provider of association management software and engagement solutions that will empower our societies to accomplish every activity we need to better serve our membership.
  • Partnering with Parkview Medical Center to facilitate meaningful collaborations of annual events to maximize members time and efforts.
  • Hosting our 4th annual membership and  community wide symposium
  • Regularly updating the PCMS website to make it more productive and the perfect place to house the great content we have to inform and engage membership and community members.
  • Continuing dialogue and communication with legislators in Pueblo, Pueblo Department of Public Health and Environment, and member physicians to oppose and campaign against public cannabis lounges and other public use cannabis facilities.
  • Visiting with the Southern Colorado Family Medicine Residency Program to discuss collaborations and what we can do for them.
  • Continuing participation in the Pueblo Food Project  to work on establishing  a recognized and sustainable organization.
  • Organizing a community service chapter, patient education chapter, physician education events, and award ceremony during annual general meeting and revisiting our mission and vision statements to narrow down target audience and add community involvement.

…and on the horizon

  • Planning to increase partnerships to provide better benefits and services for physicians, PAs and NPs.
  • Much more to come!

…and finally, hats off to our part-time staff member and our many sponsors who made it all possible.

 

 


 

The Colorado Medical Society Board of Directors held our first meeting of 2020 and there are many things to report. Top of the agenda is the 2020 Colorado General Assembly, which also convened last week. All eyes will be on health care costs, particularly as legislators consider policy on the public/state option, the Total Cost of Care initiative being promoted by the Colorado Hospital Association and pharmaceutical costs. In addition to health care costs, CMS will be monitoring any attempts by the trial lawyers to make it easier to sue providers, policy solutions to the opioid crisis, ways to reduce administrative burden and empower physicians, and any challenges to scope of practice.
 
In addition to public policy, the CMS operational plan that will drive our work in 2020 also focuses on communications – the dynamic exchange of information with members to ensure timely action on our priorities – and organizational excellence – continued innovation of CMS to increase membership value and make CMS meaningful and relevant to a diverse physician population. To achieve these goals, I invite you to get involved through one or more of CMS’s involvement opportunities. It is a strong and vibrant society because of our members and your membership and engagement can make a real difference for our patients. 
 
I urge all PCMS members to join CMS. Despite some things we don't agree on, a collective voice for the things we do agree on is a major asset to our region! Join or renew your membership at www.cms.org/join.

Substance use – legal and illegal – continues to be a big concern in our region and state. A new law passed in 2019, House Bill 1230, recently went into effect allowing cities and counties across Colorado to decide whether they will allow marijuana consumption in public spaces in so-called “marijuana hospitality establishments” or “marijuana lounges.” These lounges are being compared to bars that serve alcohol. The Pueblo County Medical Society recently adopted a position against marijuana lounges and has called upon the city and county to prohibit their operation.

Related is the physician community’s concern about the use of e-cigarette products, or vaping. As of Jan. 8, Colorado has experienced eight outbreak cases and eight hospitalizations of suspected e-cigarette or vaping associated lung injury (EVALI). We are not the hardest-hit state: as of Dec. 17, more than 2,500 hospitalized lung injury cases had been reported to the Centers for Disease Control nationally and 54 deaths had been confirmed.

A Jan. 3 bulletin from the Colorado Department of Public Health and Environment (CDPHE) asks physicians to follow updated CDC guidance if e-cigarette or vaping product use is suspected as a possible cause for a patient’s lung injury. The updated guidance recommends post-hospitalization outpatient follow-up, optimally within 48 hours of discharge, and emphasizes the importance of preparation for hospital discharge and post-discharge care coordination to reduce risk of rehospitalization and death among hospitalized EVALI patients. CDPHE asks all providers to report any suspected EVALI cases to the Disease Reporting Line: 303-692-2700 or 303-370-9395 (after hours). If the patient has the product in hand, safely collect and hold it, and contact CDPHE’s Disease Reporting Line so that the product can be collected by CDPHE for potential testing.

By Brad Roberts, MD, PCMS representative on the CMS Board of Directors

There are lots of important things currently being considered by CMS (the new Colorado public health insurance option, the continued opiate epidemic, the new and ever-increasing cannabis epidemic, managing cost of care discussions, evaluating and advocating in the current liability climate for physicians, scope of practice discussions, physician professional satisfaction… and the list could go on extensively).

That being said, this time of year is always a wonderful opportunity for me to pause and consider whether I am focusing on what is truly most important; to reevaluate goals and look forward to the future with plans to do better. I appreciate that this time of reflection also comes during a holiday season in which society focuses on giving and thinking of others. I hope you will allow me to pause to reflect for a moment with my article for the newsletter as well.

In true medical fashion, I went to the peer reviewed literature to find out if there were any studies done on the physiologic benefits of kindness (I had also just watched the Mr. Rogers movie, A beautiful day in the neighborhood, with Tom Hanks). Sure enough, I quickly found a paper titled ‘it’s good to be good: 2014 Biennial Scientific Report on health, happiness, and helping others by Stephen G. Post. In case it needs to be found on PubMed, the citation it came from is Int J Behav Med. 2005;12(2):66-77.

In the study, Post notes that volunteers have less trouble sleeping, less anxiety, less helplessness and hopelessness, better friendships and social networks, and a sense of control over chronic conditions. He then reviews a number of studies demonstrating improvements with serving others in a wide range of markers including improvements in cholesterol, lower BMI, decreased rates of HTN, and improvements in alcohol addiction treatment outcomes. There were improvements in chronic pain patients including decreased pain intensity levels, decreased degree of disability, and decreased depression when they began to serve as peer volunteers for others suffering from chronic pain.

He also cites changes seen on fMRI studies in the mesolimbic pathway and ventral striatum, the brain’s satisfaction and reward center, which is responsible for dopamine mediated euphoria, with giving.  Interestingly, he cites a cross sectional study of 2,682 medical students attending medical school in seven U.S. medical schools in 2009 that found that students experiencing burnout had considerably reduced altruistic attitudes about physician responsibility to society, including less desire to provide care for the medically underserved. A separate study found that health professionals who volunteered to go on medical mission trips scored lower on burnout scales following their return and continued to improve at a six-month follow up.

It may be crucial to solving the problems above for us to step back, pause and serve others. It is in serving that we develop the relationships needed to understand one another; it is there we gain ideas to look outside of the constant drum of our practices and gain new insight; and it is through service that we can regain the altruism that drove us to medicine.  And, apparently, as a biproduct, it helps us become healthier and happier as well. With that, I wish you all happy holidays!