From the Director
We are getting down to the wire! Second to last Med Res News of the year! We had our first intern present at Chair’s last week (nice job, Linda Koshy!), and it is T-7 days until the new interns show up for GME orientation.
Thanks so much to Dr. Corey, Jon Bae, Matt Crowley, Tom LeBlanc, Brian Griffith, Joel Boggan and Ryan Schulties from the Chief Resident Society for the Chief Picnic on Saturday Night! Very glad to hear that we are welcome to return to Elodie Farms next year. Hopefully it won’t be 95 degrees at 10 pm! Be sure to thank your chiefs this week for an awesome year….Jenn, Armando, Chris and Lindsay start on Monday.
iCompare is in full swing on the gen med services. Many thanks to everyone for their patience and suggestions as we iron out the kinks on Duke Gen Med. I got to do my Charity Auction day on Sunday, so thanks to Anne Weaver, Bill McManigle, Jenny Van Kirk and Stephanie Li for helping me figure out how to manage my day as an intern, and to Rania Kazan for being a great attending! Other kudos this week go to Lauren Ring from a patient on the lung transplant service for excellent care, and to Murat Arcasoy from Adva Eisenberg for covering the Heme pager so she could come to the picnic.
Big kudos to Nilesh Patel for his amazing grand rounds, and also to our award winners — LeCoq Award for best Chair’s Conference to Jim Lefler; Favorite Fellow to Stephen Bergin (Nominees – Aditya Mandawat, Neha Pagidipati, Carter Davis, and Anne Mathews); DRH Teaching Award to Chris Jones (Nominees - Tracy Setji and Tim Scialla) and Outstanding Service Award to Diana McNeill (Nominees – Joe Govert and Joseph Moore). Make sure to join us this week for your favorite VA Chief Coral Giovacchini for her grand rounds!
In case you missed it, Nilesh introduced our upcoming procedure and simulation curriculum for interns and JARS, which will be led by Cara O’Brien, with help from Nilesh, Chan Park, Coral, Bill Hargett and Jenny Van Kirk. Finally, please welcome to the newest member of our Duke Family! Madi Smith starts TODAY as our recruitment coordinator and staff assistant. Please come by the 8th floor and welcome Madi to the team!
This week’s Pubmed from the Program goes to Marc Samsky for his abstract that has been accepted for presentation at the 19th Annual Scientific meeting of the Heart Failure Society of America "Elevated total bilirubin on admission is a marker of worse 30- and 180-day outcomes for patients with acute HF: Insights from ASCEND-HF"
Have a great week!
Aimee
What did I read this week?
(Submitted by: Aaron Mitchell, MD)
What did I read this week?
Reference:
Stacie Dusetina, Ethan Basch, and Nancy Keating. For Uninsured Cancer Patients, Outpatient Charges Can Be Costly, Putting Treatments Out of Reach. Health Affairs. 34 (4) 2015: 584-591.
Why did I read this:
Cancer treatments are really expensive. As I anticipate trying to make a career in oncology and health services research, this is going to be a big problem facing this field, and one that I will need to know a lot more about. I’ve been searching for a better quantification of this problem, and so as I was catching up on an issue of Health Affairs from a few months back, this paper caught my eye.
Background:
In the ongoing transition from cytotoxic chemotherapies to targeted agents to immunotherapies, the price tag on treatments for cancer has been skyrocketing in recent decades. Many chemotherapies now cost many tens of thousands of dollars per month, and patients are getting priced out and/or going bankrupt. In reference to the physical toxicities long associated with chemotherapy, the new, popular term for this “financial toxicity” – first coined by Duke’s own Yusuf Zafar.
However, the amount of financial toxicity that patients suffer is going to depend on what kind of insurance they have. Different insurance will have different levels of “cost sharing” – ie, how much of the cost lands on the patient’s shoulders through copays and co-insurance. These authors set out to determine the cost burden on patients for a variety of different cancer treatments and insurance types.
Results:
The authors calculated the out-of-pocket cost to the patient for different chemotherapies, depending on the type of insurance. Important to note is that this is the cost for each individual infusion – what the patient has to pay every time he/she comes into the office for a round of chemo.
As you can see, the charges to anyone without health insurance are completely untenable; even wealthy people would be feeling the pinch after a few cycles. However, it is also important to point out that Medicare coverage leaves patients open to significant costs as well. Nearly $1,000 per infusion of bevacizumab or rituximab is going to be more than a lot of seniors are going to be able to afford.
Discussion:
On the one hand, having some level of “cost sharing” may be an effective way to hold down health care costs, as it may cause patients to shy away from unnecessarily expensive treatments. On the other hand, in the case of chemotherapy, there may not be more cost-effective alternatives. This leaves patients and families with no choice but to face extremely high out-of-pocket costs. As providers, we need to remember that having insurance (especially Medicare) often isn’t enough to make treatment affordable. As a health system, we need to prioritize the development and use of lower-cost treatments, or ways to pay for them that do not involve our neediest patients having to break the bank.
QI Corner
On behalf of myself, Lish Clarke, and Jon Bae, a HUGE congratulations to you on Internal Medicine's performance on this year's GME incentive program!
The results are in! As you may remember, two of the measures are institution wide (meaning us, gen surg, OB/GYN, plastics, etc. are all lumped together), and two of them were broken down by individual programs. As it turns out, you guys hit the target for the two measures that we had direct control over - these were the ED consult times (yay 1010!) and the SRS report submissions. Unfortunately, Duke GME as a whole failed on the two other measures - the 30 day readmission rate and the patient satisfaction survey.
As a whole though, I'd say that's a huge win for us as a program. The measures we had the most control over, you guys really went into high gear for this year and totally crushed. You can look for an extra $400 in an upcoming paycheck - enjoy it! You earned it!
Clinic Corner
Lots of changes here at Pickett. As we say good bye to our 5 SARS we will be welcoming our new 7 interns. We celebrate our SARs at our their graduation dinner next week with the faculty and staff. I am looking forward to intern orientation and the new 4 +1 system for the interns where I can meet with them 1:1 during administration time to help with mastering tasks outside of the patient.
We also welcome a new faculty member Dr. Michael Meredith who is a practicing physician at Sutton Station. Dr. Meredith had precepted residents at the Duke Outpatient Clinic and we welcome him to the Pickett Road clinic. He trained down the road at UNC for medical school and completed Internal medicine residency at Mary Imogene Bassett Hospital in Cooperstown, NY (that also where the Baseball Hall of Fame is located!) He will be precepting Tuesday afternoons.
We are rolling out the Transforming Primary Care a few changes at a time to help improve clinic flow and efficiency. The first steps has been printing medication lists and having patients reviewing the list, correcting the list in the waiting room. This has greatly helped rooming staff and providers. Next our rooming staff will be assisting the doctors address health care maintenance items that are due (at least sparking the discussion).
Sincerely
Sharon Rubin, MD, FACP
From the Chief Residents
Grand Rounds
Fri., June 19: Dr Coral Giovacchini, Chief Resident
Noon Conference
| Date | Topic | Lecturer | Time | Vendor |
| 6/15/15 | Outpatient Management of CHF | Zubin Eapen | 12:00 | Nosh |
| 6/16/15 | MED-PEDS Combined | 12:00 | Domino's | |
| 6/17/15 | Final Fun Lunch with the Chiefs | Chiefs | 12:00 | China King |
| 6/18/15 | QI Patient Safety Noon Conference | 12:00 | Chick-Fil-A | |
| 6/19/15 | Chair's Conference | Chiefs | 12:00 | Saladelia |
From the Residency Office
First Annual Summerfest
The Duke Medical Alumni Association is delighted to host this year’s First Annual Summerfest, an event for all Duke residents and their families. We want to welcome Duke’s newest house staff and celebrate with all residents that they are part of the Duke medical alumni family.
Book Club Event
Hello, residents!
Congratulations on being so close to the end of another year! We have one more Dept. of Medicine book club event scheduled before this academic year comes to a close, and would love to see as many of our residents there as possible! This time we’ll be reading The Immortal Life of Henrietta Lacks by Rebecca Skloot, a tremendously popular read that highlights important issues in medicine like access to care, informed consent, and more.
The event will be held on Monday, June 22nd, from 7-9 pm in the Searle Center Faculty Lounge. As always, we have a limited supply of FREE BOOKS to the first residents to RSVP, and there will be plenty of wine and food to go around. Please email laura.caputo@duke.edu if you would like to attend! We can’t wait to see you all there!
Thank you!
Laura M. Caputo, MD
SARs
Please know there is an excellent opportunity to hone your interviewing skills. Dr. Kathryn Pollak who is a communication coach and faculty member in the SoM will provide 4 1-hour sessions from which you can choose. In the session, Dr. Pollak will cover tips to finesse interviewing skills as well and give some a chance to role play. She also will be available for practice for their interviews in September and October.
The four sessions will be held the following dates and times:
Monday, August 17th: 12:00 noon to 1:00pm
Tuesday, August 18th: 4:00 to 5:00pm
Wednesday, August 26th: 12:00 to 12:00pm
Thursday, August 27th: 4:00 to 5:00pm
Each session will be 10 people or less, that way it’s more personalized. Please let me know as soon as possible which session you would like to sign up for. This is a very valuable tool being offered!
You’re Invited..
Please save the date for the 1st Annual Duke University Transplant Infectious Diseases Symposium.
The focus of this program will be building Transdisciplinary training programs in Transplant ID for physician scientists and exploring new frontiers in transplantation, with a special focus on HIV and HCV-infected populations.
A world-renowned panel of experts will be leading an afternoon of rich discussion and multidisciplinary exchange.
Full details are included in the attached brochure. Please contact Kelly Stanly @ k.smith@dm.duke.edu with any questions and to register for this NIH sponsored event.
We hope you can join us. Please forward this information along to any medical students, residents, fellows, or faculty who may be interested in attending.
Date: Friday, June 19, 2015 from 12:30pm-5:00pm
Location: Great Hall, Trent Semans Center, Duke University
http://medschool.duke.edu/about-us/trent-semans-center
Upcoming Dates and Events
June 19 - Dr. Coral Giovacchini, Chief Resident Grand Rounds
June 19 – 1st Annual Transplant Infectious Disease Symposium
June 26 - Intern Orientation
Useful links
https://intranet.dm.duke.edu/influenza/SitePages/Home.aspx
http://duke.exitcareoncall.com/.
Main Internal Medicine Residency website
Main Curriculum website
Ambulatory curriculum wiki
Department of Medicine
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