Internal Medicine Residency News, September 15, 2014

Monday, September 15, 2014

From the Director

DUKE.RESEARCH.NIGHT.03 (1)Happy Monday! Hope you all had a good weekend - turkey bowl practice, Duke win over Kansas, Gen Med, etc!

The Duke team had a great time in DC at the APDIM/CDIM meeting and have brought back lots of information and ideas to share. And it is the first official day of the recruitment season - ERAS opens for fourth year med students today! Time flies, that's for sure. Looking forward to a special noon conference on 9/25/14 when we can hear a telecast of the Nigerian health minister discuss the response to Ebola in Africa! Details to follow soon and a special thanks to Deng Madut for rescheduling his SAR talk so that we could take advantage of this great opportunity.

Kudos this week to our SAR talks from Laura Musselwhite, Katie Broderick and John Wagener, to Adrienne Belasco from Sneha Vakamudi for filling in in Duke Gen Med, to Sarah Nelson and Olinda Pineda also from Sneha for great work on Gen Med and to Olinda Pineda, Ryan Jessee and Nick Rohrhoff for gold stars this week. Gold stars are given when a patient mentions your name on a patient survey sent to the hospital!

Had a great time at JAR dinner with Titus Ng'eno, Myles Nickolich, Gena Foster and Brian Sullivan. Signups for October coming soon. Dr Klotman is starting her SAR lunches, so look for an email from Erin and Donna Salvo to sign up.

This weeks pubmed from the program goes to Joy Bhosai who just presented at the TedMED conference. Spotted there was former chancellor Dr Victor Dzau!

Have a great week




What Did I Read This Week?

submitted by: Aaron Mitchell , MD

Hsia RY, Akosa Antwi Y, Nath JP. Variation in charges for 10 common blood tests in California hospitals: a cross-sectional analysis. BMJ Open. 2014 Aug 14;4(8):e005482

[caption id="attachment_16361" align="aligncenter" width="121"]Aaron Mitchell, MD Aaron Mitchell, MD[/caption]


Why did I read this:

Health services research (HSR) is my game. That term applies to most research that studies health care delivery, but does not investigate specific new treatments per se. Think of it as “clinical trials for the health care system.” I encountered this particular article in assembling my weekly email summary of health care policy articles. Let me know if you want to subscribe!


The United States has a serious problem with health care costs. We spend about 18% of our GDP on health care, compared to 9-12% for most other developed countries. As the Baby Boom generation ages and we docs continue to discover new and expensive treatments, the public financing of medical care is putting an increasing strain on federal coffers.

One feature of American health care that contributes greatly to the cost of care is our lack of “price transparency.” Hospitals do not publically release their prices, so it is well-nigh impossible to know how much your bill will come to ahead of time. This contributes to a related problem – the lack of standardization of care. Imagine trying to shop at a grocery store or a clothing store where no prices were on display. How could you possibly hunt for bargains? As long as health care prices remain hidden, providers can charge whatever they want and patients are unable to “shop around” for better deals.

To investigate the extent of this problem, the authors of this study simply looked at the variation in the prices of basic lab tests at different hospitals.


The primary outcome measure in this study was “the average charge at each hospital for the blood test…the total dollar amount billed by the hospital to the patient or to their insurance provider.” They found a HUGE amount of variation. The prices between different hospitals for the same test (a lipid panel, say) differed not just by multiples, but by orders of magnitude. The main figure in the study reports the 95% price range for the lab tests they examined.

Just how large were the price differences?

As an example, a single comprehensive metabolic panel cost anywhere from $35 to $7,303 (yes, over seven thousand dollars!) depending on which hospital you went to.

read image


The lack of price transparency in US health care is a big obstacle for health care reform and cost control.

In many other countries, there is some level of top-down price setting. Patients can expect to pay the same price for the same test or procedure no matter where they go. This may be one contributing factor to how other countries are able to control overall costs so much better than we are.

In the USA, though, we tend to prefer free-market solutions to our problems, rather than government mandates. In a functioning free market, consumers (ie, patients) seek out the best deals for their money, forcing sellers (hospitals, doctors) to compete on prices and thus keep their prices low. However, when prices are invisible to the consumer (as they are for health care), this mechanism cannot work, and prices are higher than they would be if hospitals truly had to compete.

It is time to “shed some light” on health care prices!


Clinic Corner


PICKETT Clinic Corner, 2014 September

Changes at Pickett Road
Welcome Lauren our new CMA and Yolanda our Lab Tech (picture below). Nicole will be changing job role from Service Access Manager to Patient Service Agent. Sadly Dr. Wolf will be leaving Pickett Road for Signature Care. He is going to leave end of December 2014. Thursday Afternoon resident clinic will be on hold until March when Dr. Audrey Metz will be taking over! (she starts January 1, 2015).

lab tech

If your templates are not defaulted to ARIAL and you have to print a patient note, it will not be legible! So note to self, change arial as default font!

Good luck on your in-training exams!

I have complied the first lunch time topic. Due to so many of you completing the In-training exam, clinic is very light with residents for the first 3 weeks. I think Vaccines can cover that time and next topic to begin 9/22/14.

This is the original article printed and posted in the resident room

Interns: please remember to CC your notes to your attendings. In the FOLLOW UP Box there is an area to ROUTE your note to the attending. PLEASE do this even if your note is not finished. Please try to fill out the forms that come in the black box and not put them in other resident's boxes. They may not be here for months and if pts needs medical forms filled out, please do your best to help them.

All pts need to check out at the front desk (no more fly bys). This is due to the number of patients who do leave, who do not get their vaccines or labs or xrays done.

The order for Rapid Flu testing is LAB7959, please add this to your favorites!!

Process for getting access to NC Controlled substances (Thank you Julia Cupp!)
Through NC Medical Board:

Go to the medical board website

1) Look under the "Quick Links" menu and click on the second option, "Update Licensee Info Page".

2) Scroll down to the bottom of this page and sign in using your File ID# and DOB. If you have forgotten your File ID#, just click the box that says "Recover File ID" to retrieve this information. All you need to retrieve is the last 4 digits of your social security number and your DOB.

3) Once you have successfully logged into the licensee page you will look for the menu option "Training and CSRS". Once you click this option scroll down to the section on the CSRS. There will be a blue "Click Here" button to register for the NC CSRS.

4) Fill out the required information and submit. You will need your full DEA number. The password must be exactly 8 characters with one capital letter and one number. Do NOT use any symbols.

*Health Information Designs, Inc. will notify you by e-mail with your confirmation login information. Please be sure to add to your email contacts or acceptance list to prevent your notification emails from being rejected or sent to your spam folder.


Sharon Rubin, MD, FACP


QI Corner

[caption id="attachment_16361" align="aligncenter" width="127"]Aaron Mitchell, MD Aaron Mitchell, MD[/caption]

First, a reminder this week that Wednesday noon conference will be our monthly Morbidity and Mortality conference. We are trying something different this month, and will be focusing on procedure-related “learning opportunities,” presented by your fellow residents! Come learn about some of the easy pitfalls of doing procedures, and how to protect both your patients and yourself while doing them.

Next, and update on the GME incentive program. We now have 2 months of data on the ED consultation time measure. Just as a reminder, this is being tracked according to department, and the goal for each department is a 10% decrease from its 2013-2014 average. Check out the data below!

QI image

The “goal” for each department is the green bar. Gen Med (that’s us!) is over on the far left. As you can see, we are not at our goal yet, but we are heading in the right direction! We are at 36 minutes from 38 in July, down towards our goal of 30! Our median consult time in August is on the way down from July – not many of the other programs have been able to achieve that.

And then for the SRS reporting, here are the numbers:

SRS reports by trainees in July:          23

SRS reports by trainees in August:     45

Total remaining needed for goal:        1,904

That’s still a lot of ground to cover, but SRS reporting is very easy! Did your patient miss a dose of a medication? Did they have a fever or another event that you weren’t informed of? Those are all reportable events.

From the Chief Residents

Grand Rounds

Fri., Sept.19, 2014: GI, Dr. Alastair Smith

Noon Conference

Date Topic Lecturer Time Vendor
9/15/14 ITE No conference- lunch only 12:15 Nosh
9/16/14 MED-PEDS Combined: ADHD Richard D'Alli 12:15 Dominos
9/17/14 Resident M&M QI Team 12:15 Cosmic Cantina
9/18/14 IM-ED Combined Conference: HVCC Intro Jon Bae  12:15 Rudinos
 9/19/14  Chair's Conference  Chiefs  12:00  Chick-Fil-A

From the Residency Office

Flu Vaccination Blitz Starts September 18!

As you know, Duke University Health System (DUHS) requires all healthcare workers who perform their duties in a DUHS facility or a community home-based setting to be vaccinated annually against the flu. This is in alignment with our core value of “caring for our patients, their loved ones and each other.” Annual vaccination against influenza, or policy compliance through a granted medical or religious exemption, is a condition of employment for all DUHS employees. Annual vaccination or policy compliance is also a condition of access to Duke Medicine facilities for those holding clinical privileges in a Duke Medicine facility and learners who wish to train in our facilities.

With this in mind, please note these key dates for this flu vaccination season:

  • Start of Flu Vaccination Season: Thursday, September 18, 2014
  • Applications for Medical or Religious Exemption should be submitted before Friday, October 17, 2014.  This will allow sufficient time for review and for communication of the review decision. Please note: Due to the availability of an egg-free formulation of the flu vaccine, egg allergy will no longer be a valid reason for a medical exemption.
  • Policy compliance through vaccination or granted exemption by Monday, November 17, 2014

We will kick off our annual flu vaccination campaign with a 24-hour Duke Medicine Mass Flu Vaccination drill. The drill will begin on Thursday, September 18, 2014. Mass vaccination clinics will be available at each of the hospitals with peer vaccination available throughout DUHS. Following the drill, we will begin our annual flu vaccination program, during which time we will provide many additional opportunities for you to get vaccinated. A schedule of vaccination clinics is posted on the employee intranet at  This list will be updated throughout the flu season. Vaccination is also available at Employee Occupational Health and Wellness (EOHW) during business hours.

If you have questions about the flu vaccine or its availability, please visit the DUHS Influenza Resource Guide or, ask your manager or contact EOHW.

Together, we can stop the flu. Thank you for your commitment to keeping our patients, and our community, safe and healthy.

Register Now for BLS Blitz - November 10-14, 2014

Use the Swank system to register for BLS classes.  If you do not have an account in Swank contact the DHTS Service Desk 919-684-2243 to establish an account.  You may register for one session.  Detailed Registration Instructions and Informational Flyer
When you attend class, arrive 15 minutes before session begins and you must have your:

  • Class Registration Confirmation
  • Duke ID Badge
  • AHA BLS Healthcare Provider Manual 2010

All sessions are held at Hock Plaza - G07 Auditorium.
Parking is not available at Hock Plaza.
No one will be admitted to the session after it starts or if you do not have your AHA BLS manual.


Women In Medicine Event

The Duke Medical Alumni Association invites you to join us for the inaugural Women in Medicine Luncheon and Program

Friday, October 17, 2014  |  11:45am-1:45pm

Great Hall, Trent Semans Center for Health Education

The luncheon program features a panel discussion of Duke Medicine alumnae followed by roundtable conversations on issues specific to women in medicine.


Maestro Care Update

As part of the continuing commitment to advance patient safety throughout Duke University Health System (DUHS), Beaker, the lab application for Maestro Care, will be implemented at on September 20, 2014.  The Beaker implementation will impact all trainees who collect specimens (of any type) and print labels.

Provider Education

  • It is recommended that all providers in inpatient and ambulatory settings complete a WebEx  that includes videos outlining the process for collecting, labeling and sending specimens to the lab. The WebEx is located on the Physician Concierge website or by accessing the following:
  • Resources

To access and self-register for these required modules, employees may visit the DUHS Intranet (, click on “Duke LMS” under the Quick Links menu, and then perform a Catalog Search using the term “Specimen Collection – Beaker Rollout.”

Call for AbstractsClinical Science DayDeadline Extended to September 22nd

Duke University School of Medicine’s Clinical Science Day will be held on Saturday, November 8, 2014, in the Great Hall of the Mary Duke Biddle Trent Semans Center. This half-day event features five Duke University School of Medicine faculty speakers, a keynote speaker, and a poster session for residents, fellows, and health professions students. Clinical Science Day is an annual event that brings together faculty, staff, trainees, and students to celebrate clinical research and the vast and diverse array of activities taking place across our medical campus, and to facilitate collaborations.

We strongly encourage all residents, fellows, and health professions students to participate in the Clinical Science Day poster session by submitting an abstract.  The benefits of presenting at Clinical Science Day are to teach others about your work, gain experience presenting your work in a format similar to national meetings, and receive input and feedback from faculty members.  ALL submissions will be accepted, and monetary awards will be presented to the first, second, and third place winners of the competition. Dean Nancy Andrews will be the honorary poster judge.  For those residents and  fellows participating in the poster session, their presence at the event is required from 10 a.m. to 12:30 p.m. 

The deadline for the abstracts has been extended to September 22, 2014. Please submit abstracts to

New System for Requesting Interpreters

Duke University Health System has implemented a new, web-based system to request the services of medical interpreters. Duke University Hospital, PDC and hospital-based clinics that are currently being serviced by interpreters from International Patient Services (919-681-3007) can use a website to request an interpreter via an icon on PIN and non-PIN workstations.

The system, called ServiceHub, simplifies and streamlines requests for language assistance and enables users to track the process, including making medical interpreter requests and monitoring the status of requests to know when interpreters arrive on-site and complete the assignment. This system also enhances the ability to monitor how interpreters are deployed, enabling users to better estimate response times and International Patient Services to provide additional support to areas in high demand for interpreter services.

ServiceHub is intended to replace the language assistance request calls that are made to 919-681-3007.

While the system is designed to be user-friendly, training is mandatory to be granted access. Training materials are available through the Learning Management System (LMS), accessed by logging onto Duke@Work or via the following URL: 

After logging in, search the LMS for “ServiceHub Interpreter Request System - Requester Training.”  

Hospitals that use ServiceHub to dispatch interpreters report dramatic improvement in response times and improved efficiency by an average of 30 percent.  

The International Patient Services team will be ready to assist and support you while we transition to this new dispatching system. 

For questions regarding the new ServiceHub interpreter request system, please contact:

International Patient Services

919-681-3007 or 919-668-2431

Nouria Belmouloud

Pager: 919-970-0387


ETHOS for Noon Conference Attendance Tracking!

AS of 9/8/14 we now ONLY use ETHOS for tracking attendance.  Most of you should already have an ETHOS account which you use for tracking your attendance at Grand Rounds, but EVERYONE should read the following instructions carefully, as it applies to new and current account holders.  You MUST have your Duke Unique ID entered in to you ETHOS account in order for the system to work properly!  Please make sure that you enter your Duke Unique ID and NOT your Net ID!  If your unique ID is entered incorrectly, you will not get credit for attending the conference!

How do I Set up an ETHOS account for the first time?

How to register with Ethos

  • Go to the Duke Continuing Medical Education home page.
  • In the upper right corner, click Join. The Account Information page opens.
  • Complete the fields on the screen. A field with an asterisk is required.
  • NOTE:  Please make sure you include your Duke Unique ID– even though it does not show as a required field.
  • Be sure to include your mobile phone number; you will use this number to send a text message with a code supplied at each event and get credit for CME events you attend.
  • At the bottom of the account information form, click Create New Account. A green feedback message near the top of the screen informs you that a confirmation has been sent to the email address you provided.
  • Open the email (from and click the top link in the body of the message.
  • In your browser window, enter a password of your choice in both fields and note your user name. Click Save at the bottom of the page.
  • In the same window, click the Mobile settings tab in the gray menu bar at the top of the page. If you entered your mobile number when you registered, it should appear on this page. Click confirm number. You will receive a text message to that mobile number with a confirmation code from DCRI CME.
  • Enter the confirmation code in the box in your browser window and click Confirm Number. A message will appear below your number saying “Your number has been confirmed.”
  • Now when you attend an event for CME credit you can use your registered mobile phone to text the provided event codes and earn CME credit.

To record your CME attendance via text message, follow these steps

  • The 6-character SMS code will be provided on a slide during your CME event.
  • Begin a new text message on your registered mobile phone. Note: The provided code is only good for eight hours. You must text the code the day you attend Medicine Grand Rounds.
  • In the To field, enter the Duke CME phone number: 919-213-8033. Tip: Add this number to your mobile phone contacts.
  • In the message area, type the 6-character SMS code that was provided during the session (note: this code is not case sensitive).
  • Press send.
  • If you have set up your Ethos account, you will receive the successful confirmation text message, “Your attendance has been recorded for “[Name of Session].”

To add your Duke Unique ID to your account

  • Log into Ethos by visiting the Duke Continuing Education home page and click Log In at the top right of the page.
  • Enter your username and password. Click My Account in the upper right corner.
  • Under My Profile, click Edit
  • Scroll down until you see Duke Unique ID filed.  make sure it is correct
  • Save the changes to you My Profile page


Now Accepting Applications for Global Health Elective Rotations




Developing the next generation of globally educated, socially responsible healthcare professionals dedicated to improving the health of disadvantaged populations.

Accepting Applications for Global Health Elective Rotations

The Hubert-Yeargan Center for Global Health (HYC) is now accepting applications for Global Health Elective Rotations for July 2015 and March 2016. Application is open to residents from Departments of Medicine: Internal Medicine (PGY 2); Med-Peds (PGY 3) and Med-Psych (PGY 4). Access the application form and FAQ at or submit online

(Application addendum is available by request –

Application deadline is September 30, 2014. Interviews held during October. We strongly encourage you to speak with past participants to get a better idea of what daily life is like on the wards of your top sites. For more information, contact Tara Pemble, Program Coordinator at or 668-8352.



ITEs Are in Full Swing!

Friday, September 5th marked the first testing date for the ITEs!  House staff - please check your Amion to know what date you are scheduled to take the exam.  As a reminder, the exams are being administered electronically this year!  Please be sure to review the information below and contact Jen Averitt in the MedRes office if you have any questions.  Good luck!!

The following is important information – PLEASE REVIEW CAREFULLY BEFORE your test date!

  • Please take a few minutes to take a practice test at  Please try and practice BEFORE 9/2/14 as the test may become unavailable after the national testing window opens
  • The testing center is located at 406 Oregon St, Lab 101, Durham  There is free parking in front of the building
  • Please be at the testing center NO LATER THAN 8:00 am on test day!!
  • There is no food allowed inside the testing room, but a boxed lunch will be provided for you in the building.  You will be allowed a 30 minute lunch break.




September 14 Resp Fit Testing-T-Dap-TB Skin Testing Flyer2

Duke Headache Specialist

Practice Link Career Fair - 9/23/14


Upcoming Dates and Events

September 18: Internal Medicine In-Service Training Exams Testing Window - Last Day

September 26 - "The G-Briefing" with Dr. Galanos

October 27, 2014 - Recruitment Kick-Off Event

Useful links