Editorials

Milestone sparks reflection

Thomas C. Meyer, MD, Wisconsin Medical Journal Medical Editor

When the Editorial Board met in the fall of 2003 we were surprised to hear that the Wisconsin Medical Journal had been around for a century. I’m not sure that any of us had given thought to the longevity of the publication. We were firmly lodged in the present: meeting to review what feedback we had had from the readers, add our personal perceptions, select themes for 2004 and get along home to our various cities across the state.


Author Affiliations: Medical Editor

Corresponding Author: Wisconsin Medical Society

Commentaries

Working poor have friend in Dr. George Schneider

Steve Busalacchi

When the physician introduced himself to a new patient, her response caught him off guard. “I’m sorry that I had to come here,” she said. George Lange, MD, assured her that no apology was necessary and that he was sorry she fell through the holes in our health care safety net. Doctor Lange is among 40 physicians recruited by George Schneider, MD, and his wife Kathleen Schneider to volunteer at the Greater Milwaukee Free Clinic in West Allis. “Inspiring” is the word Lange uses to describe Schneider, who he trained under as a medical student.


Author Affiliations: Wisconsin Medical Society

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Original Research

The Wisconsin Medical Journal Year One: 1903

Earl Thayer

The Wisconsin Medical Journal exists today because two Milwaukee physicians had both keen business acumen and political savvy. Whether out of envy at a colleague’s journal, simple competitive instincts, pure desire for professional excellence, or some of each, they launched the Wisconsin Medical Journal as a private business venture in January 1903.



Author Affiliations: Mr Thayer was Secretary and General Manager of the Wisconsin Medical Society from 1971-1987. He joined the Society in 1947 as Director of Public Information and served in various roles thereafter.


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Medical care in “Old Milwaukee”

J. M. Cerletty, MD

During the early decades of settlement in Wisconsin, no disease took a greater toll than malaria, commonly called ague. In the summer of 1830, three-fourths of the men stationed at Fort Crawford in Prairie du Chien became infected with malaria, which killed 80 of the 600 residents of Lake Muskego in 1841.1



Author Affiliations: Doctor Cerletty is an archivist with the Medical College of Wisconsin, and professor emeritus of the Department of Medicine there

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Our heritage: Medical education in Milwaukee

J. M. Cerletty, MD

Solomon Juneau was the first permanent white settler in Milwaukee, arriving in 1818 as an agent for the American Fur Company. A few years after his arrival, his wife Josette became ill, and the couple had to travel to Chicago for health care because there were no physicians in Milwaukee. Within 15 years after Juneau’s arrival, Milwaukee began to grow rapidly, thanks to land speculation and the extensive influx of immigrants. By 1841, there were 2000 people in the city, including eight physicians.



Author Affiliations: Doctor Cerletty is an archivist with the Medical College of Wisconsin, and professor emeritus of the Department of Medicine there.


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St. Madison, WI 53715

The Medical College of Wisconsin: A brief history

Norman Engbring, MD

The first successful medical schools in Wisconsin were located in Milwaukee: the Wisconsin College of Physicians and Surgeons, established in 1893, and the Milwaukee Medical College, established in 1894. By the end of the century, each school occupied an impressive building, with adjacent hospital facilities. St. Joseph’s Hospital was across the street from the Wisconsin College of Physicians and Surgeons; Trinity Hospital was in the same building as the Milwaukee Medical College.



Author Affiliations: Doctor Engbring is professor emeritus of the Medical College of Wisconsin. He is also the author of the book An Anchor for the Future—A History of the Medical College of Wisconsin, 1893-1990, from which much of this article was taken.


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

The history of neurology in Wisconsin: The early years, 1907-1957

Phiroze Hansotia, MD; Norman C. Reynolds, Jr, MD

The history of neurology in Wisconsin is best appreciated by reviewing the early development of clinical neurology in Europe in the late 19th century, the practice of medicine in Wisconsin in the beginning of the 20th century, and finally the beginning and growth of neurology in Wisconsin in the 20th century. Brief biographies of the pioneers of neuropsychiatry at the University of Wisconsin and the work they did give insight to the final separation of neurology from psychiatry.



Author Affiliations: Doctor Hansotia is an emeritus physician with Marshfield Clinic, Department of Neurology, Marshfield, Wis. Doctor Reynolds is Professor of Neurology with the Medical College of Wisconsin, Milwaukee, Wis.

Corresponding Author: Phiroze Hansotia, MD, Marshfield Clinic, 1000 N Oak Ave 1R1, Marshfield, WI 54449; phone 715.389.3443; fax 715.389.3808; e-mail: hansotia@tznet.com

Academic anesthesiology in Milwaukee: A personal history

Richard Foregger, MD, FRCA England

After World War II, I returned to Madison where, from 1939 to 1942, I had been a resident physician in the University of Wisconsin’s Department of Anesthesia. In the spring of 1946, I was sitting in the office of Department Chair Ralph Waters, MD, when in walked Dr Herman Schumm, Professor and Director of Marquette University Medical School’s Department of Orthopedic Surgery. He was also Professor of Orthopedic Surgery at the University of Wisconsin and a member of the Dean’s Committee at Marquette. He said Marquette was looking for an anesthesiologist to head up its Department of Anesthesia and to serve as Senior Consultant in Anesthesia at the Veterans Administration Hospital in Milwaukee. Waters pointed to me and said, “There’s your man.”



Author Affiliations: Doctor Foregger was a practicing anesthesiologist for 46 years as well as an author of scholarly articles in medical science and history. While carrying on a medical practice, he was also a student at Marquette University School of Engineering, 1952-1953,

Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53715

The Class Mentor Program at the University of Wisconsin Medical School: A Unique and Valuable Asset for Students and Faculty

William E. Scheckler, MD; Gordon Tuffli, MD; Don Schalch, MD; Archie MacKinney, MD; Edward Ehrlich, MD

There is a paucity of published data on mentor programs for medical students. The University of Wisconsin Medical School has 19 years of experience with a unique Class Mentor Program. A single mentor is dedicated to each class of incoming medical students. The mentor attends all classes in the first 2 years and varied clinical venues in later years, following the class all 4 years through graduation. The mentors appointed have been experienced physicians who tend to be in the later years of their careers. As of 2003, 16 such mentors have been appointed. One mentor has taken 2 classes. Available survey data from students who have graduated demonstrate that most graduates recall their own mentor to have been a positive influence to student medical training. A recent accreditation review commended the Class Mentor Program as a unique help to students and to medical school curriculum evaluation. Five of the more recent mentors describe herein their own assessment of the Class Mentor Program and they encourage other medical schools to consider such a program for their own institutions.



Author Affiliations: All authors are former Class Mentors at the University of Wisconsin Medical School

Corresponding Author: William E. Scheckler, MD, Professor Emeritus, University of Wisconsin Medical School, Department of Family Medicine, 777 S Mills St, Madison, WI 53715; phone 608.263.4550; fax 608.263.5813; e-mail wes@fammed.wisc.edu.

Quality of Work Life of Family Physicians in Wisconsin’s Health Care Organizations: A WReN Study

John W. Beasley, MD; Ben-Tzion Karsh, PhD; François Sainfort, PhD; Mary Ellen Hagenauer, BA; Lucille Marchand, MD

Problem Considered: Most family physicians in Wisconsin are employed by large health care organizations. Because of its impact on physician recruitment, retention, commitment to the organization, and patient care, the quality of physician work life is an important problem. Methods: A survey was designed based on a literature review and augmented by focus group data. It was sent to all 1482 members of the Wisconsin Academy of Family Physicians in 2000. Results: Overall response rate was 47%. Three hundred ninety-seven of the respondents were employed by 18 different health care organizations having 10 or more respondents. There were significant differences among Wisconsin’s health care organizations in terms of physicians’ satisfaction with their organization. There was a strong significant negative correlation between satisfaction with one’s organization and turnover intention and a strong positive correlation between satisfaction with one’s organization and ability to achieve one’s professional goals. There were also significant, though less strong, correlations between satisfaction with one’s organization and satisfaction with being a physician and perceived quality of care delivered. Conclusions: Some of Wisconsin’s health care organizations are doing better than others at working with their family physicians to maximize these physicians’ satisfaction with the organization, reduce the likelihood of turnover, and enable them to reach their professional goals.



Author Affiliations: Doctors Beasley and Marchand are faculty of the University of Wisconsin Department of Family Medicine. Dr Karsh is faculty of the University of Wisconsin Department of Industrial Engineering and a member of the University of Wisconsin Systems Engineering

Corresponding Author: John W. Beasley, MD, University of Wisconsin Department of Family Medicine, 777 South Mills St, Madison, WI 53715; phone 608.263.7373; e-mail: john.beasley@fammed.wisc.edu.

The Milwaukee General Assistance Medical Program: Patient Perspectives on Primary Care in an Urban Safety Net

Staci Young, MS; Marie Wolff, PhD; Paula Lucey, RN, MSN, CNAA; Cheryl A. Maurana, PhD

Purpose: The General Assistance Medical Program (GAMP) is a managed care model that provides a network of services through community-based clinics and area hospitals. An evaluation of the program included patient focus groups to determine the effectiveness of this safety net.

Methods: Focus groups were conducted with patients at various hospital and community-based clinics. Researchers identified patterns and themes that emerged from the data.

Results: The focus groups had the following themes: (1) eligibility and enrollment policies, (2) patient advocacy, (3) primary care access, and (4) patient recommendations for improving GAMP.

Discussion: Patient feedback allowed for several improvements in the GAMP system, including an overview seminar and health education materials for new enrollees. Future research could include studying similar safety nets and public insurance programs to compare to GAMP. GAMP still faces many challenges as the “safety net” providing care to these populations in Milwaukee.



Author Affiliations: Ms Young is a Community and Student Program Coordinator, Medical College of Wisconsin. Dr Wolff is an associate professor at the Medical College of Wisconsin. Ms Lucey is the former director of the Milwaukee County Department of Human Services. Dr Maurana

Corresponding Author: Staci Young, MS, Community and Student Program Coordinator, Center for Healthy Communities, Department of Family and Community Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226; phone 414.456.8868; fax 414.456.6524; e-ma

Colposcopic Proficiency-Disease Spectrum in a Single Family Practice Colposcopists’ Clinic

Gregory L. Brotzman, MD; Kenneth G. Schellhase, MD, MPH

Purpose: We sought to assess colposcopic proficiency in a family practice teaching clinic. Methods: Subjects were a prospective cohort of women age 13 to 68 who were colposcopy clinic attendees from 1991 to 2002. Data recorded on each subject included demographic variables, sexual history, history of sexually transmitted diseases, reason for referral to colposcopy, Pap smear results, colposcopic impression, colposcopic biopsy results, and diagnoses. The Kappa statistic was used to measure agreement between clinical colposcopic assessment and biopsy results. Results: Eight hundred twenty-six patients were enrolled. Compared to biopsy, colposcopic impression overall correctly predicted normal cervical biopsy in 55.8% (95% CI: 45.8%, 65.8%) of cases, and predicted abnormal biopsy 84.9% (95% CI: 81.6%, 88.1%) of the time. Colposcopic impression of low-grade squamous intraepithelial lesion (LSIL) correctly predicted LSIL on biopsy in 64.6% of cases, and correctly predicted the absence of LSIL 74.2% of the time. Colposcopic impression of high-grade squamous intraepithelial lesion (HSIL) correctly predicted biopsy results of HSIL in 70.05% of cases (Kappa = 0.544, P<.0001). There was a 12.7% error rate in discriminating normal from LSIL (Kappa -.258, with P<.0001). Conclusion: Family physicians perform colposcopy with good correlation between colposcopic impression and subsequent histology.



Author Affiliations: Doctor Brotzman is a professor and Doctor Schellhase is an assistant professor with the Department of Family and Community Medicine, Medical College of Wisconsin.

Corresponding Author: Gregory L. Brotzman, MD, CSM Family Health Center, 1121 E North Ave, Milwaukee, WI 53212; phone 414.267.6500; fax 414.267.3892; e-mail brotzman@mcw.edu.

Cocaine-Induced Renal Artery Dissection and Thrombosis Leading to Renal Infarction

David A. Edmondson, DO; Jonathan B. Towne, MD; Dennis W. Foley, MD; Majed Abu-Hajir, MD; Mahendr S. Kochar, MD, MS

We present the case history of a 40-year-old man who developed renal artery dissection and thrombosis, probably due to cocaine use. The patient underwent exploratory laparotomy and thrombectomy. He remained asymptomatic and cocaine-free, and warfarin was discontinued 9 months after discharge. Approximately 12 months after discharge he returned to the hospital with symptoms very similar to previous episodes. He was found to have recurrent clot formation in the right renal artery. Further workup revealed a double heterozygous methyltetrahydrofolate reductase A1298C/C677T thermolabile polymorphism with an elevated serum homocysteine.



Author Affiliations: All authors are with the Medical College of Wisconsin, Milwaukee, Wis. Doctor Edmondson is a fellow, allergy and immunology; Doctor Towne is a professor of surgery; Doctor Foley is a professor of radiology; Doctor Abu-Hajir is an assistant professor of me

Corresponding Author: Mahendr S. Kochar, MD, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226; phone 414.456.4575; fax 414.456.6528; e-mail kochar@mcw.edu

Proceedings from the 2004 Wisconsin Primary Care Research Forum

Edited by John O’Connor, MD, MS

The 17th Annual Wisconsin Primary Care Research Forum was held January 30, 2004 in Waukesha, Wis. A 1-day conference sponsored by the Wisconsin Academy of Family Physicians, the Forum included presentations of invited work and original research by students and faculty from both the Medical College of Wisconsin and the University of Wisconsin Medical School. Plenary speaker Bernard Ewigman, MD, Professor and Chair of the Department of Family Medicine at the University of Chicago, discussed “Integration of Research Evidence and Clinical Experience.” An open meeting of the Wisconsin Research Network (WReN), a statewide network of primary care physicians interested in practice-based research, followed the research presentations. Abstracts of original research presentations are included here.



Author Affiliations: John O’Connor, MD, MS, Department of Family and Community Medicine, Medical College of Wisconsin


Corresponding Author: WIsconsin Medical Society 330 E. Lakeside St Madison, WI 53715

Your Practice

Laying the groundwork for managing an inheritance

Van Westmoreland, Registered Investment Advisor

You’ve worked hard for your money, and now you want it to work for you. If you are like most Americans, you understand the importance of an estate plan. You’ve mapped out your financial future, including how your wealth will finally be distributed, and you are at ease with the notion that your final bequests will guarantee a financially successful future for your children. But have you taken the extra steps necessary to protect your children and grandchildren from the burdens that come with inheriting wealth?



Author Affiliations: Working out of the firm’s Brookfield, Wis office, Van Westmoreland is a fee-only financial consultant with SVA Planners Inc., Registered Investment Advisor.

Corresponding Author: Wisconsin Medical Society Insurance and Financial Services, Inc. toll free at 866.442.3810

Your Society

The Increasing Prevalence of Pneumonia

Arthur J. Patek, AB, MD, Editor

Much has been written of late concerning the increased prevalence of pneumonia and the increasing ratio of deaths from this disease. We see this not only in the medical journals of the day but also see references to the fact in the lay press.



Author Affiliations: Editorial Comment excerpted from Wisconsin Medical Journal, 1905;(3)8:472-473


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St. Madison, WI 53715