sutures newsletter

PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY October 2016 | Archived Issues

Teaching Professionalism

By Bruce Gewertz, MD
Surgeon-in-Chief, Chair of the Department of Surgery

Residents learn from observing the exemplary behaviors of our large number of private physicians and faculty as they interact with patients and families in every inpatient and outpatient venue, on the telephone and, tellingly, even in conversation among themselves. This is the "hidden curriculum" of medical training, and it is our most powerful course.

» Read more

Focusing on Triple-Negative Breast Cancer

The team of Xiaogiang Cui, PhD, focuses on uncovering the biological basis and novel therapeutic targets for triple-negative breast cancer development and metastasis. The team is also exploring regenerative tissue engineering of the human mammary gland.


» Read more

Two Minutes With …

This question-and-answer feature will help you get to know some of the physicians in the Cedars-Sinai Department of Surgery. This month's installment features Neel Joshi, MD.



» Read more

Clinicians Should Be Partners in Value Revolution

By Jonathan Warsh, PhD, Harvard Business School
and Michael Nurok, MBChB, PhD, Cedars-Sinai Heart Institute

As conversations about how to control healthcare costs dominate the policy landscape, clinicians in hospitals often find themselves as pawns in an increasingly complex medical chess game. We believe that clinicians, as the providers of frontline care, can be essential players in driving value from the bottom up.

» Read more

Figlin to Lead Initiative to Integrate Cancer Care

Figlin

In an effort to standardize cancer care and ensure optimal treatment of patients, Cedars-Sinai has appointed Robert A. Figlin, MD, to integrate research and clinical strategies across the organization. Figlin will serve as deputy director of the Integrated Oncology Service Line at the Samuel Oschin Comprehensive Cancer Institute.

» Read more

Central Processing Is Now Sterile Processing

Central Processing, which helps make sure operating rooms have clean and sterilized surgical instruments, has a new name — Sterile Processing Department. It’s now a department within Perioperative Services.

» Read more

Cedars-Sinai Wins National Award for Patient Care

Cedars-Sinai has earned a top award for the quality and efficiency of its patient care. The health system received a 2016 Bernard A. Birnbaum, MD, Quality Leadership Award by ranking eighth out of more than 100 academic medical centers participating in a study by Vizient Inc., a healthcare performance improvement company.

» Read more

Presidential Health Is Topic of Nov. 4 Lecture

Leo Gordon, MD, will discuss "When Your Patient Is the President: Vignettes in Presidential Health." Gordon is a longtime member of the medical staff in the Department of Surgery. The event will take place Friday, Nov. 4, at noon in Harvey Morse Auditorium.

» Read more

Circle of Friends Honorees for September

The Circle of Friends program honored 92 people in September. Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai.

» Read more

Training Available for Nov. 6 CS-Link Upgrade

The new CS-Link™ upgrade begins Sunday, Nov. 6. Physician training sessions have been scheduled.

» Read more

CS-Link Tip: Listing Common Diagnoses

CS-Link™ can help you avoid the sometimes-cumbersome task of picking from a long list of specifics when typing in a common diagnosis. Instead you can add the diagnosis to a common diagnoses button list.

» Read more

Teaching Professionalism

Bruce Gewertz, MD

By Bruce Gewertz, MD
Surgeon-in-Chief, Chair of the Department of Surgery

Pretty much every week, I receive a written compliment about the care and dedication of one of our house staff. These comments are originated by patients, families of patients and staff. On occasion, I hear from attending physicians or residents from other departments who want to be sure a good deed is recognized. Indeed, these positive and unsolicited tributes outnumber any complaints by a factor of more than 10.

Patients commonly write about the time and effort residents take explaining a complicated condition or being certain the patient's diet is advanced with the next meal — not waiting until tomorrow's breakfast. The actions range from the most important to less critical aspects of medical care and life.

In the current evaluation of residents, the teaching staff is required to evaluate a wide range of behaviors often grouped under the broad category of "professionalism." While we might all agree professionalism is important, one could ask when are these behaviors taught? It is true that we have few if any didactic sessions centered on the topic.

Still, any experienced physician can identify, often with great passion, how these attitudes and practices are developed.

The answer is role modeling. Residents learn from observing the exemplary behaviors of our large number of private physicians and faculty as they interact with patients and families in every inpatient and outpatient venue, on the telephone and, tellingly, even in conversation among themselves. This is the "hidden curriculum" of medical training, and it is our most powerful course.

The good examples are prominent in our memories. I can still remember the experienced endocrine surgeon at the University of Michigan who taught me that sitting down in a patient's room, even for one minute, sends a strong signal that you are there and engaged and willing to spend whatever time is needed. Paradoxically, once so assured, patients pose few extraneous questions or comments, rarely prolonging the visit beyond what is needed.

The actions of an esteemed gastroenterologist I met in medical school illustrated two key factors in gaining patient trust — maximizing eye contact and the laying on of hands. He often remarked that he tried to be doing one of those two activities the entire time he was with a patient. I can't imagine how he would react to our modern necessity for electronic medical recording of information, which too often offers patients a turned back during minutes of furious documentation.

We all likely have favorite stories of equanimity and compassion. My surgical idol in medical school allowed me to spend a month with him in the O.R. and his office. Once, a patient, cured of lung cancer by a pneumonectomy, bitterly complained, "How could you send me such a large bill? Have you no compassion?" Instead of responding with hostility to the questioning of his character — after all, the patient had sailed through a big operation and it was successful — the surgeon offered to reduce the bill to what the patient thought was reasonable and consistent with his resources.

The surgeon's composure and willingness to waive part of his fee (even in the face of an aggressive inquiry) taught me more than watching the elegant operation.

In sum, senior physicians and senior residents alike have a great responsibility to pass on these lessons. Our students will profit from us pointing out our successes and, even, our occasional shortcomings in these areas.

Based on my experience here, the good news is that the lessons are getting through.

Focusing on Triple-Negative Breast Cancer

Xiaogiang Cui, PhD

By Xiaojiang Cui, PhD

The team of Xiaogiang Cui, PhD, focuses on uncovering the biological basis and novel therapeutic targets for triple-negative breast cancer (TNBC) development and metastasis. The team is also exploring regenerative tissue engineering of the human mammary gland.

TNBC is one of the most aggressive types of breast cancer and has the highest mortality rate among all breast cancer subgroups. It is generally diagnosed based upon the absence of three "receptors" known to fuel most breast cancers — estrogen receptors, progesterone receptors and human epidermal growth factor receptor 2. These tumors generally do not respond to common receptor-targeted treatments. Unlike other breast cancer types, it frequently metastasizes to the brain, the most feared complication of systematic cancer.

Currently, the only systemic treatment option for these breast cancers is chemotherapy. The development of effective targeted therapies for this devastating disease depends on our elucidation of its molecular and genetic mechanism.

The team, in collaboration with clinicians at the Cedars-Sinai Saul and Joyce Brandman Breast Center - A Project of Women's Guild, is pursuing several innovative research projects in this direction. One such project examines the FOXC1 gene, identified by gene expression profiling of human breast tumors as a critical biomarker for TNBC. Team members revealed that the FOXC1 gene controls TNBC cell growth and invasion and that its expression levels predict brain metastasis in human breast cancer. The group is testing whether FOXC1 regulates the seeding and growth of breast cancer cells in the brain.

Another project is related to therapy resistance in breast cancer treatment targeting cancer stem cells. Hedgehog (Hh) proteins are key regulators of cancer stem cells and are considered promising targets for cancer treatment. But results of ongoing clinical trials show anti-Hh drug resistance is common.

These drugs target an Hh-interacting protein called SMO, which transmits Hh signals to gene expression and cell function changes. Cui's group revealed that FOXC1 can activate the genes, normally activated by Hh and SMO, in an Hh/SMO-independent manner, thereby inducing resistance to anti-Hh drugs in breast cancer cells. This work demonstrates a novel resistance mechanism for anti-Hh drugs in cancer cells and allows for designing strategies to more effectively kill cancer stem cells in cancer treatment.

Xiaojiang Cui, PhD, is associate professor in the Department of Surgery and research scientist in the Women's Cancer Program at the Samuel Oschin Comprehensive Cancer Institute.

Two Minutes With …

This question-and-answer feature will help you get to know some of the physicians in the Cedars-Sinai Department of Surgery.

Neel Joshi, MD

Where did you grow up?

I was born in Phoenix and grew up in a suburb called Mesa. The greater Phoenix area has undergone incredible population growth and development during the past few decades, and now bears little resemblance to the sleepy Southwestern town I remember from childhood.

Why did you decide to specialize in general surgery?

I considered pursuing different subspecialties during my residency training. Ultimately, my interest in laparoscopy led me to complete a fellowship in minimally invasive surgery at Cedars-Sinai. I enjoy treating patients with diverse problems ranging from cancers to benign gastrointestinal conditions and abdominal wall hernias. There are very few boring days in the life of a busy general surgeon.

What is the most rewarding aspect of your job?

The best part of being a surgeon is the opportunity to help people with serious health conditions during times when they are emotionally and physically vulnerable. It's intensely satisfying to know that you have done your best for patients during some of the most difficult periods in their lives. Getting to do cool technical stuff in the operating room is pretty sweet, too.

Outside the O.R., where do you find inspiration?

I've always been a bit of a sports nut. I played on my college golf team, and I still greatly enjoy weekly golf games with my buddies. I am also an on-again, off-again long-distance runner, and I have completed several marathons. I believe it's important to maintain hobbies and interests outside of medicine. These activities provide welcome relief from the pressures and responsibilities of a surgical career.

What's at the top of your bucket list?

I'd say it's a tie between qualifying for the Boston Marathon and playing golf at Augusta National Golf Club (site of the Masters tournament). Thankfully, my chances of qualifying for Boston actually improve as I get older, since the qualifying standards become progressively less rigorous.

Clinicians Should Be Partners in Value Revolution

By Jonathan Warsh, PhD
and Michael Nurok, MCBhB, PhD

As conversations about how to control healthcare costs dominate the policy landscape, clinicians in hospitals often find themselves as pawns in an increasingly complex medical chess game. Under pressure from payers, chief financial officers and department chairs increasingly task clinicians with finding ways to decrease costs.

Clinicians struggle to respond, often feeling overwhelmed by growing public scrutiny of their outcomes in a setting in which care delivery is becoming ever more complex. Clinicians and policymakers will remain at loggerheads unless we develop new approaches to engage clinicians as partners in the value revolution. We believe that clinicians, as the providers of frontline care, can be essential players in driving value from the bottom up.

Reports about bends in the cost curve have provided some cause for optimism that cost containment in healthcare is possible, although the unwieldiness of the American healthcare system and the institutional barriers standing in the way of delivery system reforms have tempered that enthusiasm. Medicare experiments around bundled payments, accountable care organizations and other value-based payment schemes have shown some success, yet the movement of private payers away from legacy fee-for-service schemes has been slow going. Hospital administrators routinely talk about impending budget shortfalls and thin operating margins as hospital consolidations continue to dominate the landscape.

Pressure on providers

Against this backdrop, doctors and other care providers feel pressured from above, with payers and hospital management viewing them as passive subjects upon whom behavioral and economic incentives need to be forced. The assumption seems to be that the interests of payers and providers are not aligned and that, left to their own devices, providers are not interested in efforts to control cost.

This assumption leads to a system in which payers and administrators reason, "If doctors aren't willing to be responsible custodians of the healthcare system, we must force them to act conscientiously by changing how they're paid."

It would be naïve, of course, to underestimate the role that payment incentives play in our system; the impact, for example, of fee-for-service schemes on utilization trends is exceedingly well-documented. But it is our contention that, in specific ways, hospitals and payers can do much more to engage clinicians as partners in helping to control costs. Indeed, if long-term cost control is to be successful, clinicians must not just have a seat at the table but be leaders in driving reforms from the ground up.

Why is it, then, that those who are delivering frontline care so often feel left out of conversations around how to control healthcare costs? To be sure, many providers may be uninterested in this type of work, while others may bristle at the notion that clinicians should even consider cost, positing that there is a conflict between providing optimal patient care and thinking about the financial implications of their decisions.

Although there is growing recognition among many providers that attentiveness to value may actually lead to higher-quality care, the chasm between clinical teams and their management and finance counterparts has only grown over time. A failure to empower clinicians with the tools that they need to be champions for higher-value care constitutes a major blind spot for the healthcare system.

Measuring productivity by volume, not quality

Understanding the nature of this divide is important. First, hospital finance systems are almost always indecipherable to clinicians (or indeed, to anyone without an accounting degree), relying on arcane concepts like relative value units and cost-to-charge ratios that don't make intuitive sense. In an inpatient setting, the costs of care may be assigned to literally dozens of "cost centers," but exactly how those costs are assigned remains opaque.

Moreover, clinician productivity is often measured on the basis of metrics that incentivize the volume, but not necessarily the quality, of care. Indeed, while a clinician's focus on maximizing professional fee billing may make sense from the perspective of a department chair, such efforts drive up the total cost of care. Perversely, efforts that result in decreased lengths of stay while maintaining or improving outcomes may negatively impact both professional and facility fee revenues.

Second, clinicians are rarely given specific guidance on what they can do to help lower costs — in cases in which costs are growing too rapidly, department chairs are often given instructions to simply lower their costs, which can lead to decisions (e.g., across-the-board cuts) that actually compromise high-value care. If there is no effort to understand the potential savings in addressing "fixed" costs, then even heroic efforts to lower such costs may have no impact on cost savings.

For example, if clinicians focus on decreasing lengths of stay in the ICU, but the hospital does not flex the ICU staff when there are fewer patients, then cost savings will be minimized and ICU costs will remain "fixed." Alternatively, if ICU staffing is reduced when there are fewer patients in the ICU, or if the open beds in the ICU are used to accommodate other patients who need beds, then the hospital system would realize cost savings.

Third, hospital finance systems still exist in very discrete silos aimed largely at ensuring the economic viability of the organization. Department chairs are frequently given their own budgets to "manage" and may be subject to negative feedback or other consequences when they exceed those budgets. Highly reimbursed programs invariably end up subsidizing necessary but money-losing programs in other departments.

But patients and diseases have little regard for those neat silos. Sometimes, the same procedure is performed by different departments within the same hospital, which invariably results in redundancy of capital expenses.

In other situations, guild-like referral patterns may steer a patient to one type of therapy in a situation in which they could benefit from a very different intervention. For example, depending on the referring doctor, a patient with coronary disease may be sent to see either an interventional cardiologist or a cardiac surgeon.

Finally, clinicians are often in the dark when it comes to understanding practice variations both inside and outside the walls of their own institutions. Many clinicians talk anecdotally about how one colleague always uses expensive implants or diagnostics, but hospitals have not shown continued success in helping clinicians understand the ways in which particular clinical decisions affect cost. Patients and payers may have little control over cost either, as referrals generally are made through established social networks with no regard for the cost of care.

Turning clinicians into partners for reform

What can be done to engage clinicians as genuine partners in reforming care delivery? First, educational initiatives that demystify concepts in healthcare financing and accounting can start to break down the psychological barrier between clinical and finance teams. Programming in both business and medical schools as well as continuing education has been instrumental in educating practicing clinicians and executives, but as more medical schools mandate courses in ethics, sociology and health policy, they would do well to also give future doctors the tools to understand the microeconomics of healthcare delivery.

For example, a series of executive education courses offered through Harvard Business School attempts to engage clinicians and finance personnel together in an effort to have them unite in improving value. In the realm of medical education, organizations like Costs of Care are working on curriculum development to bring courses on value into medical schools and residency programs.

Second, hospital finance departments can partner more closely with clinical leaders in an effort to better understand how clinical decisions affect cost within different disease categories. While we know, for example, that patients with longer stays are more expensive, the factors that drive that longer stay will be different depending on the medical condition being addressed.

At Cedars-Sinai, for example, physicians along with teams from finance have created an alternative cost model for our extracorporeal membrane oxygenation program that allows clinicians to predict the financial implications of decision-making in real time. Dashboards that measure these clinical metrics can be of much greater use to clinicians than general financial reports that use the language and parlance of accounting to break down costs.

Also, through a partnership with a commercial analytics company, clinicians in the Cedars-Sinai Heart Institute are provided with easily interpretable data on their costs of care; these data can then be compared with those of other clinicians performing the same procedure and can also be broken down into clinically actionable components.

In addition, as healthcare systems move toward interdisciplinary team-based approaches to delivery, convening those same interdisciplinary groups to lead cost reduction and process improvement measures can ensure that we begin to think about costs from the perspective of the patient rather than that of the individual department or cost center. As an example, the clinical transformation group at Cedars-Sinai provides support teams to work with clinicians across specialties in developing and implementing cost-reduction strategies.

Getting away from the guild structure

In some instances, it will be necessary to create financially and clinically aligned administrative structures that support a patient- and disease-centered approach to care. The creation of such structures may mean transitioning away from the traditional departmental guild structure on which hospitals have relied for decades and toward more patient- and disease-oriented institutes or centers.

For example, Cleveland Clinic has largely shed the traditional department-based medical infrastructure in favor of disease centers that integrate care around the patient's medical condition rather than the physician's medical specialty. As a result, the clinic has seen substantial domestic and international growth driven not just by reputation but by superior outcomes and lower costs.

In addition, hospital finance representatives should be embedded in the transformation of clinical care to enrich conversations about the financial implications of clinical decision-making. For example, at Cedars-Sinai, a standing High Value Care Committee that includes finance representatives and frontline clinicians regularly convenes to explore and implement approaches to value-based opportunities across the hospital system.

Other hospitals, like the MD Anderson Cancer Center and the Hospital for Special Surgery, have established "value management" offices that coordinate these activities and serve as umbrella entities to promote value-based care.

Finally, armed with an understanding of the clinical drivers of cost, clinicians can be empowered and incentivized to work together to reduce unwanted sources of variation in care delivery. Although the health policy community has given considerable attention to the well-studied issue of geographic variation in healthcare spending, there has been much less of a focus on how to drive down variation within individual hospitals and healthcare systems.

We do not mean to discount the vital work being done around payment reform — the economic incentives at play in healthcare continue to exert influence over clinical behavior. But a conceptual shift toward seeing clinicians as allies — and not adversaries — is badly needed in the value revolution.

As costs continue to rise, it makes good sense to directly engage those who have the greatest ability to effect change. Provided with the right tools, clinicians can be essential partners in leading the value revolution.

Jonathan Warsh, PhD, is senior researcher and senior project leader at Harvard Business School.

Michael Nurok, MBChB, PhD, is medical director of the Cardiac-Surgical Intensive Care Unit at the Cedars-Sinai Heart Institute and a Cedars-Sinai faculty member.

Figlin to Lead Initiative to Integrate Cancer Care

Robert A. Figlin, MD

Robert A. Figlin, MD

In an effort to standardize cancer care and ensure optimal treatment of patients, Cedars-Sinai has appointed Robert A. Figlin, MD, to integrate research and clinical strategies across the organization.

Figlin will serve as deputy director of the Integrated Oncology Service Line at the Samuel Oschin Comprehensive Cancer Institute. Previously, he was director of the Hematology Oncology Division at the institute. He will remain in this position until a successor can be found.

In his new role, Figlin will work with clinicians and investigators to unify the health system’s approach to treating cancer. The integration of cancer care means that patients will get the same level of quality services whether they’re treated at Cedars-Sinai’s main campus or at one of its highly regarded affiliates, including Tower Hematology Oncology and The Angeles Clinic.

"Dr. Figlin was tailor-made to do this," said Steven Piantadosi, MD, PhD, director of the Samuel Oschin Comprehensive Cancer Institute and professor of Medicine at Cedars-Sinai. "He’s an experienced leader who knows cancer care in the Cedars-Sinai system, throughout Los Angeles and beyond."

A kidney cancer specialist, Figlin will continue working to develop clinical trials, translate research findings from the laboratory to the clinical setting and lead initiatives such as Cedars-Sinai’s effort to contain the high cost of cancer drugs.

Figlin, who joined Cedars-Sinai six years ago, is the Steven Spielberg Family Chair in Hematology Oncology. Since his arrival, he has established the Experimental Therapeutics Program and successfully recruited clinical and research faculty in critical specialty areas such as breast cancer, bone marrow transplant, gastrointestinal oncology, genitourinary oncology, survivorship and cancer biology, among many other achievements.

His new position, he says, will provide additional opportunities to enhance the lives of cancer patients, while advancing significant research goals.

"This position presents an opportunity to improve cancer care for our patients at Cedars-Sinai," Figlin said. "Contributing to cancer science allows me to wake up each day and feel as though I’m making an important difference."

Central Processing Is Now Sterile Processing

Central Processing, which helps make sure operating rooms have clean and sterilized surgical instruments, has a new name — Sterile Processing Department. It’s now a department within Perioperative Services.

While the name is new, the department continues to be an integral part of the world-class healthcare team that supports the delivery of high-quality care to Operating Room Services, Labor and Delivery and procedural areas.

The realignment within Perioperative Services is designed to enhance cross-functional collaboration between all areas.

Cedars-Sinai Wins National Award for Patient Care

Cedars-Sinai has earned a top award for the quality and efficiency of its patient care.

The health system received a 2016 Bernard A. Birnbaum, MD, Quality Leadership Award by ranking eighth out of more than 100 academic medical centers participating in a study by Vizient Inc., a healthcare performance improvement company. The 13 highest-rated hospitals earned the recognition.

Thomas M. Priselac, president and CEO, accepted the award at the recent Vizient Clinical Connections Summit in Dallas.

"This honor reflects our deep commitment to delivering the best-quality care to the diverse populations Cedars-Sinai serves," Priselac said. "We strive to give our patients the high-value healthcare they deserve while meeting our own rigorous standards."

The Quality Leadership Award honors academic medical centers that meet high standards for mortality, safety, efficiency, effectiveness, patient centeredness and equity. Vizient noted that the 13 award winners consistently demonstrated a shared sense of purpose, hands-on leadership, vertical and horizontal accountability, a focus on results and interdisciplinary collaboration.

Vizient's annual study analyzes a year's worth of data from a variety of sources, including its own databases, the Hospital Consumer Assessment of Healthcare Providers and Systems survey, and the Centers for Disease Control and Prevention's National Healthcare Safety Network.

Presidential Health Is Topic of Nov. 4 Lecture

Leo Gordon, MD, will discuss "When Your Patient Is the President: Vignettes in Presidential Health." Gordon is a longtime member of the medical staff in the Department of Surgery.

The event will take place Friday, Nov. 4, at noon in Harvey Morse Auditorium.

Gordon has served as the associate director of Surgical Education, coordinator of the Cedars-Sinai physician re-entry program and physician adviser to Community Relations and Development.

He is the senior consultant in Clinical Surgery for the Surgery Group of Los Angeles, a multispecialty surgical group based at Cedars-Sinai. Gordon has had a careerlong interest in the health of U.S. presidents.

His talk, the Dr. Edward Shapiro/Dr. Leon Morgenstern Memorial Lecture, is sponsored by the Cedars-Sinai emeritus society. Gordon was a colleague and a friend of Shapiro and Morgenstern.

Circle of Friends Honorees for September

The Circle of Friends program honored 92 people in September.

Circle of Friends allows grateful patients to make a donation in honor of the physicians, nurses, caregivers and others who have made a difference during their time at Cedars-Sinai. When a gift is made, the person being honored receives a custom lapel pin and a letter of acknowledgement.

Click here for more information about the program and for a list of past honorees.

  • Michael J. Alexander, MD
  • Daniel C. Allison, MD
  • Maria C. Alvarado
  • Tina G. Ban, RN
  • Sylvia C. Bendimez
  • Valerie Betley
  • Keith L. Black, MD
  • Gene Howard Booth, MSN, RN, CNL
  • Neil A. Buchbinder, MD
  • Linda Burnes Bolton, PhD, RN, FAAN
  • Brendan J. Carroll, MD
  • David H. Chang, MD
  • Susan B. Clark, RN
  • J. Louis Cohen, MD
  • Myles J. Cohen, MD
  • Stephen R. Corday, MD
  • Nicole Cutidioc, BSN, RN
  • Catherine M. Dang, MD
  • Jeannie M. Decuir
  • Alice R. Dick, MD
  • Naomi Drucker, RN
  • Cheryl L. Dunnett, MD
  • Shervin Eshaghian, MD
  • Blake S. Feldman
  • Edward J. Feldman, MD
  • Randy Feldman, MD
  • Louis S. Fishman, MD
  • Dorothy Forneris, RN
  • Larry Froch, MD
  • Gerhard J. Fuchs, MD
  • Bruce L. Gewertz, MD
  • Raisa N. Gimpelman
  • Eli Ginsburg, MD
  • Judy R. Glover, RN
  • Jaime Hope Goldberg
  • David B. Golden, MD
  • Sherry L. Goldman, RN, NP
  • Catalin I. Grigore
  • Omid Hamid, MD
  • Shibisha M. Hegwood, RN
  • David M. Hoffman, MD
  • Steven Joseph Hsu, MD
  • Marney Jakubowicz, LVN
  • Jametrice James
  • J. Patrick Johnson, MD
  • Stanley C. Jordan, MD
  • David Y. Josephson, MD
  • Ali Khoynezhad, MD, PhD
  • Michelle M. Kittleson, MD, PhD
  • Honore G. Kotler, NP
  • Caroline Lee, MD
  • Shannon Lee, RN
  • Madeline S. Lerman, BSN, RN
  • Yuliya Linhares, MD
  • Cynthia A. Litwer Schwieger, MD
  • Rajendra Makkar, MD
  • Tina M. Marque, RN
  • Blanca S. Martinez
  • Guy S. Mayeda, MD
  • Michael Casey McGuire
  • Troy D. McLeod
  • Gil Y. Melmed, MD, MS
  • Amin Joseph Mirhadi, MD
  • Monica M. Mita, MD, MDSc
  • Esther Morrison, RN
  • Nicholas N. Nissen, MD
  • Paul W. Noble, MD
  • Guy D. Paiement, MD
  • Natasha Panenko
  • Robert S. Pashman, MD
  • Edward H. Phillips, MD
  • Elinor Pullen, PA
  • Danny Ramzy, MD, PhD
  • Sonja Louisa Rosen, MD
  • Barry E. Rosenbloom, MD
  • Jesica R. Salguero, LVN
  • Nancy Salinas, RN
  • Amar J. Shah, MD
  • Stuart L. Silverman, MD
  • Andrew Ira Spitzer, MD
  • Andrea D. Sutherland, RN
  • Charles D. Swerdlow, MD
  • Alfredo Trento, MD
  • Elizabeth Rose Tria
  • Timothy Tsui, MD
  • Robert A. Vescio, MD
  • Xunzhang Wang, MD
  • Jonathan M. Weiner, MD
  • Janet Y. White, MD
  • Sandra K. Wilson, RN
  • Marcianne Windbiel, RN
  • Hong Zhou, NP

Training Available for Nov. 6 CS-Link Upgrade

The new CS-Link™ upgrade begins Sunday, Nov. 6. Physician training sessions have been scheduled for the following dates:

Inpatient user group:

  • Thursday, Oct. 27, 7:30-9 a.m., Harvey Morse 4-5
  • Thursday, Dec. 22, 7:30-9 a.m., Advanced Health Sciences Pavilion, PEC 8

Outpatient user group:

  • Thursday, Nov. 10, 7:30-9 a.m., Advanced Health Sciences Pavilion, PEC 8

For more information, please visit the Service Center site.

CS-Link Tip: Listing Common Diagnoses

CS-Link™ can help you avoid the sometimes-cumbersome task of picking from a long list of specifics when typing in a common diagnosis.

Instead you can add the diagnosis to a common diagnoses button list. For example, you could add "Type 2 diabetes without complication, without insulin" and "Type 2 diabetes with unspecified complication." You can click the wrench to give the button an easier name to remember such as "DM 2 w comp." This is patient specific, and the information will be there for the next visit.

Learn to be more efficient by attending a Physician Efficiency Training session. The classes are held in Cafeteria Conference Room C. The schedule:

  • Tuesday, Nov. 8, 7:30-9 a.m.
  • Thursday, Nov. 10, noon-1:30 p.m.
  • Wednesday, Nov. 16, 5-6:30 p.m.
  • Thursday, Dec. 8, noon-1:30 p.m.
  • Tuesday, Dec. 13, 7:30 a.m.-9 a.m.

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