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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF March 24, 2017 | Archived Issues

Meetings and Events


Grand Rounds


Upcoming CME Conferences

Click below to view a complete list of all scheduled Continuing Medical Education conferences.

CME Newsletter - March 2017 (PDF)


Milestones

Do you know of a significant event in the life of a medical staff member? Please let us know, and we'll post these milestones in Medical Staff Pulse. Also, feel free to submit comments on milestones, and we'll post the comments in the next issue.

Submit your milestones and comments.

Who Gets to Observe Physician-Patient Encounters?

Hospitals frequently receive requests from educators, reality show producers and other outside parties to observe physician-patient encounters. Joel M. Geiderman, MD, co-chair of the Emergency Department, examined the sensitive privacy issue in a recent article in the Annals of Emergency Medicine.

» Read more

Here Is Your Chance to Honor a Deserving Nurse

In Hollywood, actors are nominated for an Oscar. At Cedars-Sinai, the best nurses are nominated for a Maggie. Online nominations for the 2017 Maggie Stempson-Carter Excellence in Caring Award for eligible nurses are open through Monday, April 3.

» Read more

Topics Sought for Morgenstern Debate

Morgenstern

The 14th annual Dr. Leon Morgenstern Great Debates in Clinical Medicine Resident Competition will convene on Friday, June 2. The debate committee is soliciting topics that are timely and relevant to all specialties.



» Read more

Delivering Prescriptions for Student Success

Cedars-Sinai faculty members recently shared their expertise and enthusiasm for medicine during Career Day at John Burroughs Middle School in Hancock Park, interacting with nearly 500 students. Their visit was the first public-outreach initiative coordinated by the newly minted Cedars-Sinai Faculty Diversity Ambassadors group.

» Read more

New Forums Give Caregivers an Emotional Outlet

Cedars-Sinai held its first-ever Schwartz Rounds last month. The multidisciplinary forum provides caregivers with an outlet to talk about social and emotional issues that arise at work. More than 200 employees attended the February hourlong discussion in Thalians Auditorium on the theme "Caring for the Caregiver." Participants shared their stories, perspectives and emotions.

» Read more

Psychosocial Oncology Society Honors Wolcott

Deane L. Wolcott, MD, former director of Supportive Care Services at the Samuel Oschin Comprehensive Cancer Institute, recently received the American Psychosocial Oncology Society's 15th Holland Distinguished Leadership Award. The award recognizes leadership and outstanding contributions to psychosocial oncology.

» Read more

Staff, Provider Buttons on Mycslink.org Removed

The staff and provider buttons on mycslink.org were removed this month. Physicians and staff are asked to bookmark the links below if they have not done so already.

» Read more

New Correction Factor for AST Coming in Core Labs

The Core laboratories in the Department of Pathology and Laboratory Medicine will be implementing a new correction factor for aspartate aminotransferase run on Ortho Vitros analyzers in April.

» Read more

Cortisol Announcement

The Core laboratories in the Department of Pathology and Laboratory Medicine will discontinue separate test codes for AM and PM cortisol (i.e., CORTAM, CORTPM) beginning Monday, April 10.

» Read more

Pharmacy and Therapeutics Updates

A product information update from February has been issued by the Pharmacy and Therapeutics Committee.

» Read more

Medical Library Has New Database

Do you need to find articles on healthcare administration or management? Want to read Harvard Business Review articles online? The publications can be accessed in Cedars-Sinai Medical Library's new database, Health Business Elite.

» Read more

CS-Link Tip: Try UpToDate Feature

cs-link logo

You can navigate from CS-Link™ to UpToDate, which is accredited by the Accreditation Council for Continuing Medical Education. UpToDate is a point-of-care tool that allows clinicians to research clinical problems and earn credit for continuing medical education, continuing education and continuing professional development.

» Read more

Who Gets to Observe Physician-Patient Encounters?

Joel M. Geiderman, MD, co-chair of the Emergency Department

When a Michigan woman gave birth to her fourth child in 1880, her physician brought a friend to witness the event. Upon learning that the stranger was not a medical professional but a jeweler and "tinker of watches," the mother sued them both — and won.

The case marked one of the first times the judiciary recognized a patient’s right to privacy in a medical setting. But since then, there’s been surprisingly little guidance about the observation of the physician-patient encounter.

These days, emergency departments and operating rooms commonly field such inquiries from medical educators and reality show producers. But with a lack of clear policies, how should providers evaluate the requests?

Joel M. Geiderman, MD, co-chair of the Emergency Department, examined the issue in a recent article published in the Annals of Emergency Medicine. He explored the identity of potential observers, their motivations and the ethical and legal concerns that accompany their being present.

"I have said 'no' many times, but I could find little direct guidance," Geiderman said. "When I wrote another article on commercial filming, some chairs with less authority in other departments told me it was good to have something to refer to."

In his most recent article, Geiderman described a range of observers, noting there are frequently valid requests from students seeking a medical career or people involved in the chaplaincy. Of lesser weight are appeals from pharmaceutical employees or artists seeking to enrich their work, Geiderman said. On the dubious end of the scale are reality TV shows, he added.

When considering potential observers, Geiderman suggested viewing them through the lens of patient privacy. When patients feel their privacy is respected, they tend to speak more honestly and openly about their health. This dynamic helps build a valuable bond of trust between physician and patient.

Patients, however, may be willing to forgo privacy for the sake of a social good like medical education. Some patients might even get a psychological boost participating in a documentary film. But physicians should be aware that some patients might consent to an observer out of fear of receiving lesser treatment if they refuse, Geiderman said.

From a legal standpoint, a patient’s privacy is safeguarded by federal law, and providers who knowingly violate privacy rules face stiff penalties. Federal law also mandates swift, unfettered treatment of emergency department patients.

In one striking privacy violation, New York Presbyterian Hospital agreed to a $2.2 million settlement after allowing a reality show to film a man’s death without consent. His wife learned about the footage only after watching it on television, according to news reports.

The American Medical Association also has developed policies to prevent unnecessary intrusions upon patients. The AMA policy states that if an outsider is privy to a patient encounter, the patient must be told of that person’s role and given the power to exclude them. If a patient lacks decisionmaking ability, the AMA policy adds that observation by a nonhealthcare professional represents a
"substantial invasion of privacy and generally should not be permitted."

The AMA also recommends distinguishing between observers who will contribute to patient care from those who won’t. It also warns against accepting payments in exchange for permitting observers.

Geiderman recalled a company that offered to pay up to $1,000 for a monthlong observership of foreign medical students. He cited research that showed even small gifts could influence physician behavior and have the potential to wrongly place an observer’s interests above a patient’s needs.

"The solicitation was pretty egregious," Geiderman said. "It felt like a payoff."

Ultimately, Geiderman advises that it is acceptable to seek patient consent for an observer only when the request will lead to discernible societal benefit. (Surrogates can consent on behalf of incapacitated individuals.)

If there is no clear benefit, he added, patients shouldn’t be asked.

Here Is Your Chance to Honor a Deserving Nurse

In Hollywood, actors are nominated for an Oscar. At Cedars-Sinai, the best nurses are nominated for a Maggie. Online nominations for the 2017 Maggie Stempson-Carter Excellence in Caring Award for eligible nurses are open through Monday, April 3.

Only members of the medical staff may submit a nomination for this award, which recognizes nurses who exemplify professionalism, clinical excellence and caring. Originally known as the Excellence in Caring Award, this annual recognition was renamed in 2005 in honor of the late Maggie Stempson-Carter, RN, who won the award in 2004.

Other award recipients include:

  • Peachy Hain, RN
  • Jean Eskenazi, RN
  • Bernice Coleman, PhD, ACNP
  • Betty Nersesian, RN
  • Paula Anastasia, RN
  • Tess Constantino, RN
  • Naomi Tashman, RN
  • Monette De Leon, RN
  • Raji Gandhi, RN
  • Rema Pendon, RN
  • Grace Romulo, RN
  • Joan Kirschner, RN

Nominations can be submitted via the intranet or the internet.

The award recipient will be selected by the Excellence in Caring Award Medical Staff Selection Committee and will be announced at the annual Nursing Awards Ceremony on May 3.

If you submitted a nomination last year and would like your nominee to be considered again this year, email chris.ng@cshs.org.

Topics Sought for Morgenstern Debate

The 14th annual Dr. Leon Morgenstern Great Debates in Clinical Medicine Resident Competition will convene on Friday, June 2. The debate committee is soliciting topics.

The chosen topic must cut across all specialties and must be of timely importance to the Cedars-Sinai community.

Please send suggestions to Leo Gordon, MD, Morgenstern Debate coordinator, at leo.gordon@cshs.org.

Last year's debate is available for viewing. Contact Gordon for access.

Delivering Prescriptions for Student Success

Sixth-graders raise their arms in "power poses" led by Zuri Murrell, MD, during Career Day at John Burroughs Middle School.

Zuri Murrell, MD, stood before a classroom of bright sixth-graders at the school that he attended decades ago. The Cedars-Sinai faculty member could still recall the childhood hopes and dreams of many of his former classmates at John Burroughs Middle School.

"Anybody want to go into sports?" he asked the class. Several hands shot up.

In fact, Murrell told the honors class, numbers suggest they would have a better chance of becoming brain surgeons than NBA or NFL players. There are about 3,500 U.S. brain surgeons, versus 2,200 total NBA and NFL players.

"I love what I do," Murrell told the class.

Murrell was one of seven Cedars-Sinai faculty members who shared their expertise and enthusiasm for medicine during Career Day at the Hancock Park school, interacting with nearly 500 students in 16 classrooms.

The March 3 visit was the first public-outreach initiative by the newly minted Cedars-Sinai Faculty Diversity Ambassadors. Backed by the Office of Faculty Development, the ambassadors support underrepresented groups in medicine and science, on campus and in the surrounding community.

Murrell has strong roots in the Hancock Park community, having graduated from John Burroughs in 1989. "Coming to this school was the beginning of what made me successful in life," he told the sixth-graders, crediting caring teachers for his success. It was during this period that he decided to become a doctor after his mother was first diagnosed with breast cancer. Years later, the disease took her life.

"I wanted to be a superhero," Murrell said. "I was that kid that kept breaking his arm jumping off the roof because I didn't learn I couldn't fly. Two broken arms later, I finally realized I couldn't fly. But I still wanted to try to save people's lives."

Today, Murrell is achieving his childhood goal by serving as a colorectal surgeon and medical director of the Colorectal Cancer Program at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute. "I love what I do," he told the students. "Every day I wake up, after I send my kids off, it's an adventure."

He urged the students to take the same attitude. "Come to school with a good breakfast and an open mind," he said. Throughout the day, he added, eat foods full of fiber and vitamins — like vegetables, fruits and oatmeal — which can help prevent colorectal cancer.

Students peppered Murrell with questions about junk food, smoking, drinking, obesity and other health issues. "It was good to see kids participate who don't usually raise their hands," said their teacher, Eurie Kim. "Dr. Murrell was talking about something they could relate to: their health."

At the end of class, Murrell led the students in "power poses," with arms high and fists clenched like racers on a victory lap, to charge up for the day.

In another classroom, filled with eighth-graders, Christopher Harris, MD, associate professor and director of Pulmonary Pediatric Medicine at Cedars-Sinai, was cataloging the enormous variety of healthcare professionals, from occupational therapists to pharmacists. "For anybody in this classroom, succeeding in life is possible," he said.

Harris was inspired to help organize the Faculty Diversity Ambassadors by Sarah Kilpatrick, MD, PhD, associate dean for Faculty Development and professor and chair of the Department of Obstetrics and Gynecology. Kilpatrick sent an email to faculty suggesting such a group about a year ago. "We know there is bias in the healthcare field, as it relates to underrepresented groups, and this is something we want to address," Harris said.

One way to fight this bias is to encourage more Latinos, African-Americans and other young people from diverse ethnic and racial groups to pursue medical careers. "You can't be what you can't see," Harris said. "Children need to have a complete understanding that medical providers come from backgrounds like theirs and that they can succeed in this profession."

Besides Harris and Murrell, faculty members who participated in Career Day were Rodrigo Alban, MD; Miguel Burch, MD; Ruchira Garg, MD; Nicolas Melo, MD; and Ueli Rutishauser, PhD.

"Cedars-Sinai's participation was priceless," said Steve Martinez, EdD, principal at John Burroughs, where most of the nearly 1,800 students are from groups that are underrepresented in medicine.

In the future, Harris said, the Faculty Diversity Ambassadors would like to extend their work with the school to include science classes and other endeavors. "It is vitally important that we, at Cedars-Sinai, show our commitment to our neighbors," he said.

In that regard, Melo pointed the way: He went straight to John Burroughs for Career Day after completing his overnight shift as a trauma surgeon at Cedars-Sinai.

For more information about the Faculty Diversity Ambassadors, or to participate in future events, contact denise.gallagher@cshs.org or 310-248-8642.


"For anybody in this classroom, succeeding in life is possible," Christopher Harris, MD, said during his Career Day talk to eighth-graders.

New Forums Give Caregivers an Emotional Outlet

Cedars-Sinai held its first-ever Schwartz Rounds last month. The multidisciplinary forum provides caregivers with an outlet to talk about social and emotional issues that arise at work.

More than 200 employees attended the February hourlong discussion in Thalians Auditorium on the theme "Caring for the Caregiver." Participants shared their stories, perspectives and emotions. Linda Burnes Bolton, DrPH, RN, FAAN, health system chief nursing executive, vice president for Nursing and chief nursing officer, and Chris Ng, MD, are executive sponsors of the event.

One of the panelists was David Hoffman, MD, a partner at Tower Hematology Oncology Medical Group, a Cedars-Sinai affiliate. He found the conversation a humbling and unifying experience.

"I was honored to be included among the panelists for the inaugural Schwartz Rounds," Hoffman said. "It was cathartic to express some of my feelings that are usually kept closely guarded from others. More profound, however, was the chance to hear from colleagues. The trust and empathy were astonishing and revelatory, and helped remind me why we do such impossibly difficult things every single day."

Survey results from the event showed that more than 90 percent of employees felt more open expressing their feelings about patient care with colleagues, and plan to attend future Schwartz Rounds.

Jennifer Poole, DO, MS, palliative care consultant, who facilitated the forum, saw it as an opportunity to voice the concerns, frustrations and joys experienced while caring for patients.

"I had an aha moment — I am not alone in having these feelings," said Jennifer White-Gellar, assistant nurse manager. "Other people have these feelings, just from different perspectives. It was very brave and very inspiring to hear colleagues be so vulnerable."

Schwartz Rounds will be held bimonthly, with the next event scheduled for Friday, April 7, from noon to 1 p.m. in Harvey Morse Auditorium. Lunch will be provided for the first 100 attendees. Continuing medical education and continuing education unit credits are available for clinical staff. All employees and medical staff members are welcome to attend.

"Schwartz Rounds provide another way to support physicians, clinicians, nurses and staff with the challenges faced in providing care," said Chris Gomberg, director of Work and Life Matters. "For all of us who provide such support, it is wonderful to see the openness and the compassion participants are willing to show."

For more information, please contact Peachy Hain at patricia.hain@cshs.org, Anna Lotakov at anna.lotakov@cshs.org or Jennifer Poole at jennifer.poole@cshs.org.

Psychosocial Oncology Society Honors Wolcott

Deane L. Wolcott, MD

Thirty-seven years ago, when a multidisciplinary team dedicated solely to the care of patients with serious diseases was first conceived of at Cedars-Sinai, the program was considered revolutionary. The practice focuses on relieving suffering and improving quality of life for patients and their families.

Today, the Cedars-Sinai Supportive Care Services model still is considered "very advanced," said Deane L. Wolcott, MD, former director of those services at the Samuel Oschin Comprehensive Cancer Institute.

Wolcott arrived at Cedars-Sinai in 1990 and dedicated himself to "marrying the best treatment with the best human care," he said.

"Cancer impacts every aspect of patients' lives, from diagnosis on," he added, "so that marriage is critically important to patients and family members."

In recognition of his leadership and outstanding contributions to the field of psychosocial oncology, the American Psychosocial Oncology Society bestowed its 15th Holland Distinguished Leadership Award to the psychiatrist at the group's recent annual conference in Orlando.

"Deane's award is great recognition for his outstanding vision and work over many years on behalf of the needs of patients with cancer," said Steven Piantadosi, MD, PhD, director of the cancer institute. "It is well deserved."

Psychosocial oncology is a specialty in cancer care concerned with understanding and treating the social, psychological, emotional, spiritual, quality-of-life and functional aspects of cancer, from prevention through bereavement.

When Wolcott assumed his Cedars-Sinai post 27 years ago, cancer survivors had access to social workers, which was helpful, he said. Through his input, the program added a range of services, including dietitians and cancer-pain management specialists.

Wolcott said that he's deeply gratified that he met his goal of "embedding the human aspects of cancer care" into one program.

"This award is a great personal and professional honor," Wolcott said. "While the award honors me, it also honors the comprehensive patient-centered care model that we implemented at Cedars-Sinai."

Staff, Provider Buttons on Mycslink.org Removed

The staff and provider buttons on mycslink.org were removed this month.

Physicians and staff are asked to bookmark the links if they have not done so already.

To bookmark a web page, type Ctrl D on a PC or Cmd D on a Macintosh.

Mycslink.org now is only for patients — including employees who are patients — and other users of My CS-Link™.

New Correction Factor for AST Coming in Core Labs

The Core laboratories in the Department of Pathology and Laboratory Medicine will be implementing a new correction factor for aspartate aminotransferase (AST) run on Ortho Vitros analyzers in April.

The move, which impacts medical staff in the Emergency Department and the Samuel Oschin Comprehensive Cancer Institute, is designed to produce results that better match the primary method used in the main laboratory that are run on Roche P modules.

AST on Ortho Vitros runs about 15 percent higher than AST on Roche Modular. While the difference may often not be clinically significant, especially for more elevated values, the goal is to provide results that are as consistent as possible across all three labs.

As such, a correction factor to better match Vitros to Roche values will begin Monday, April 10. The graph below shows that the correlation between both AST methods is strong despite this small, but persistent bias.

If you have questions, please contact Kimia Sobhani, PhD, at kimia.sobhani@cshs.org, or Holli Mason, MD, at holli.mason@cshs.org.

Cortisol Announcement

The Core laboratories in the Department of Pathology and Laboratory Medicine will discontinue separate test codes for AM and PM cortisol (i.e., CORTAM, CORTPM) beginning Monday, April 10.

The move is being undertaken due to low usage and potential confusion in ordering. The single test code for serum cortisol will be (CORT), which includes both morning and evening ranges:

Cortisol Reference Intervals (CORT)
Morning: 6.0 — 18.4 mg/dL
Afternoon: 2.7 — 10.5 mg/dL

If you have questions, please contact Kimia Sobhani, PhD, at kimia.sobhani@cshs.org, or Holli Mason, MD, at holli.mason@cshs.org.

Pharmacy and Therapeutics Updates

A product information update from February has been issued by the Pharmacy and Therapeutics Committee. The updates are summarized in the PDF link below:

P & T Approvals - February 2017 (PDF)

Medical Library Has New Database

Do you need to find articles on healthcare administration or management? Want to read Harvard Business Review articles online?

The publications can be accessed in Cedars-Sinai Medical Library's new database, Health Business Elite. There you can find full-text journal and trade articles from more than 500 publications that cover business-related health care topics. Individual journals are listed in the library's A-Z list and catalog.

CS-Link Tip: Try UpToDate Feature

You can navigate from CS-Link™ to UpToDate, which is accredited by the Accreditation Council for Continuing Medical Education.

UpToDate is a point-of-care tool that allows clinicians to research clinical problems and earn credit for continuing medical education, continuing education and continuing professional development.

To get to UpToDate, go to "Web Activities," then click "UpToDate." If you have not signed up yet, you can do so by clicking the link to register.

If you have questions, email groupeisphysicians@cshs.org.