Editorials

Autism: One face of the child with developmental disabilities

Christina M. Iyama, MD

You may recently have seen that Governor Doyle’s 2007-2009 budget proposal would require group health insurance plans to cover treatment for autism. Now that autism is a household word, and affects upward of 1/150 children in Wisconsin, everyone has been touched by someone who has this diagnosis. But I think the attention to autism, to the exclusion of other disabilities, misses an important point—that autism is but one aspect of complex neurodevelopmental disorders.

Author Affiliations: Madison, Wis

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

Why can’t a man be more like a woman?

John J. Frey, III, MD

When I graduated from medical school in 1970, I had 9 women classmates out of 145. However, for over a decade, women have been the majority of medical students in the United States, joining many other countries where women have been the majority of doctors. Two-thirds of all medical students in the United Kingdom are women.1

Author Affiliations: Medical Editor, Wisconsin Medical Journal

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

Improving care in physician offices

Jay A. Gold, MD, JD, MPH and Shanin Pepple

Physicians strive to deliver the best possible care to their patients. However, data measurement reveals a surprising number of missed opportunities to deliver care in line with widely accepted clinical guidelines.



Author Affiliations: Authors are associated with MetaStar, Inc. Doctor Gold is senior vice president and principal clinical coordinator; Pepple is a communications specialist. This material was prepared by MetaStar, Inc., the Quality Improvement Organization for Wisconsin, un

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

Protecting Children from Agricultural Injuries

Barbara C. Lee, RN, PhD

Across the United States, an estimated 100 children die and 33,000 are seriously injured each year from agriculture-related trauma.1,2 Wisconsin is among the states with the highest numbers and population-based rates of childhood agricultural injuries and fatalities.2 These injury events should not be referred to as “accidents” because they are not “acts of God” or “freak events.” The pattern is clearly identifiable. While many people believe that the benefits of living and/or working on farms far outweigh the risk of injuries, these beliefs are now being challenged by injury prevention specialists who are concerned about the slow reduction in childhood agricultural injuries when compared to other types of injuries.



Author Affiliations: Dr. Lee is a senior scientist of Marsh-field Medical Research Foundation, Marshfield Clinic where she directs the National Children’s Center for Rural and Agricultural Health and Safety.

Corresponding Author: Address correspondence to Dr. Barbara Lee, National Children’s Center, 1000 N Oak Ave, Marshfield, WI 54449.

New Ways to Define Conditions Related to Pain and Addiction

Michael Miller, MD

Pain, substance use, and addiction are all health conditions that are receiving increasing attention as we enter the 21st century. This is a good trend, particularly because of the disproportionately small amount of attention these conditions received in medical education in the 20th century compared to their prevalence in clinical settings. Addiction to alcohol and drugs other than nicotine, for instance, has been estimated to have a lifetime prevalence of 10% in every adult in America, of 20% in every adult who receives outpatient medical care in America, and of 30% or more in every adult hospitalized in America—but the proportion of medical and nursing school curricula devoted to addiction is closer to 1%. Clinical responses to these conditions have been suboptimal, therefore, not only because of disinterest or even scorn (deriving from the widespread stigma in our culture that these topics carry), but because of ignorance on the part of some caregivers. Many clinicians have not had the undergraduate or continuing medical education in these topics to provide them with adequate clinical tools or even adequate theoretical constructs. In an attempt to improve clinicians’ basic understanding of concepts, and to address some of the complexities clinicians face when pain and addiction may co-exist, 3 professional societies have come together to prepare a joint statement entitled “Definitions Related to the Use of Opioids for the Treatment of Pain.”1 Acting as the Liaison Committee on Pain and Addiction, representatives from the American Pain Society (APS)—a multidisciplinary organization, the American Academy of Pain Medicine (AAPM)—a medical specialty society, and the American Society of Addiction Medicine (ASAM)—another medical specialty society, developed this joint statement. The statement addresses the tolerance and physical dependence that may result from the use of potentially addictive substances in patients with chronic pain, while acknowledging that tolerance and physician dependence are not identical to addiction.



Author Affiliations: Doctor Miller is the director of Behavioral Services and medical director of Adult Addiction Services at Meriter Hospital in Madison. An assistant clinical professor at the University of Wisconsin Medical School, Dr. Miller is also an AMA Alternate Delega

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Commentaries

Wisconsin Medical Society launches DRconnection: a new resource designed to help patients and physicians

Susan L. Turney, MD, MS, FACP, FACMPE

The Wisconsin Medical Society launched its redesigned Web site last month, featuring an updated look, an improved search function, easier usability, and additional improvements and features. But perhaps the most exciting aspect of the new site is that it serves as an entry point to DRconnection, the Society’s new physician information repository.

Author Affiliations: Wisconsin Medical Society

Corresponding Author: Susan L. Turney, MD, Wisconsin Medical Society, 330 E Lakeside St, Madison, WI 53715; 866.442.3800.

Original Research

Is That Your Pager or Mine: A Survey of Women Academic Family Physicians in Dual Physician Families

Sarina Schrager, MD, MS; Anne Kolan, BS; Susan L. Dottl, PhD

Objective: This study explored the unique challenges and strategies of women in academic family medicine who are in dual physician families.

Methods: An e-mail survey was sent to all female physician members of the Society of Teachers of Family Medicine (STFM) who were listed in the on-line database. The survey collected demographic information, details of job descriptions and family life, and included 3 open-ended questions about the experiences of dual physician families.

Results: Over 1200 surveys were sent to women physicians in academic family medicine. One hundred fifty-nine surveys were returned. Half of all women worked full time compared to 87% of their partners. Most women reported benefits of having a physician partner including support and having an understanding person at home, though scheduling conflicts and childcare responsibilities contributed to the need for job compromises. Women prioritized finding work-life balance and having supportive partners and mentors as most important to their success as academic family physicians.

Conclusion: Dual physician relationships involve rewards and conflicts. More research should explore the competing demands of family life with success in academic medicine.


Author Affiliations: University of Wisconsin School of Medicine and Public Health, Department of Family Medicine (Schrager); University of Wisconsin School of Medicine and Public Health (Kolan, Dottl).

Corresponding Author: Sarina Schrager, MD, MS, University of Wisconsin, Department of Family Medicine, 777 S Mills St, Madison WI, 53715; phone 608.241.9020; fax 608.240.4237; e-mail sbschrag@wisc.edu.

Perspectives of Female Physicians Practicing in Rural Wisconsin

Erin B. Kimball, MS, IV; Byron J. Crouse, MD

Background: While approximately 30% of the Wisconsin population lives in rural areas, only 11% of physicians practice in these areas. More women are entering medicine today and some studies have raised concerns that women are less likely to practice in rural areas. The intent of this study was to identify which factors influenced female physicians to enter rural practice and to look at the issues they are confronting.

Methods: Ten female physicians practicing in rural Wisconsin towns agreed to participate in 30- to 60-minute semi-structured interviews. Transcripts of the interviews were analyzed to identify common themes in answers to the questions.

Results: The physicians had been in practice between 2-26 years, with an average of 13 years. Seven of the 10 had rural backgrounds, which influenced their decisions to practice in rural areas. The physicians cited other factors, such as professional satisfaction, the ability to be engaged with and serve one’s community, and having a good place to raise one’s family, that made practicing and living in a rural community attractive. However, these physicians also found some drawbacks to rural practice, including too few providers, too much call, and finding a balance between professional and family life. Despite this, all plan to stay in their current practices indefinitely and recommend rural practice to female medical students and residents.

Conclusions: These female physicians find the value of being in rural practice overcome the challenges. The participants provided insight into motivating women to enter rural practice, finding a balance between the challenges and benefits of rural medicine, and promoting the future of rural health care.


Author Affiliations: University of Wisconsin School of Medicine and Public Health (Kimball, Crouse).

Corresponding Author: Byron J. Crouse, MD, UW School of Medicine and Public Health, 4117 HSCL, 750 Highland Ave, Madison, WI 53705; phone 608.265.6727; fax 608.262.7823; e-mail bjcrouse@wisc.edu.

Review Articles

Women Residents, Women Physicians and Medicine’s Future

Karen Serrano, MD

The number of women in medicine has increased dramatically in the last few decades, and women now represent half of all incoming medical students. Yet residency training still resembles the historical model when there were few women in medicine. This article reviews the issues facing women in residency today. Data suggest that the experience of female residents is more negative than that of males. Unique challenges facing female residents include the existence of gender bias and sexual harassment, a scarcity of female mentors in leadership positions, and work/family conflicts. Further research is needed to understand the experience of female residents and to identify barriers that hinder their optimal professional and personal development. Structural and cultural changes to residency programs are needed to better accommodate the needs of female trainees.

Author Affiliations: Karen Serrano, MD, 4913 Flad Ave, Madison, WI 53711; phone 608.442.9164; e-mail karenserrano@mac.com

Corresponding Author: Karen Serrano, MD, 4913 Flad Ave, Madison, WI 53711; phone 608.442.9164; e-mail karenserrano@mac.com

Case Reports

Extrahepatic Portal Hypertension Following Abdominal Surgery

Ajit Singh Ahluwalia, MD, MHA; Joseph J. Mazza, MD, MACP; Steven H. Yale, MD

We present a case of non-cirrhotic extrahepatic portal hypertension in a 31-year-old woman following extensive abdominal laparotomy for the drainage of multiple retroperitoneal and liver abscesses following a perforated appendix. Chronic portal, splenic, and mesenteric vein thrombosis with portal hypertension was caused by a hypercoagulable state due to the abdominal infection and abdominal surgery. Various etiological aspects of chronic extraheptic venous thrombosis have not been documented due to the low incidence of these events. We discuss these aspects in the context of our patient.

Author Affiliations: Marshfield Clinic, Marshfield, Wis (Ahluwalia, Mazza, Yale); Clinical Research Center, Marshfield Clinic Research Foundation, Marshfield, Wis (Yale).

Corresponding Author: Steven H. Yale, MD, Clinical Research Center, Marshfield Clinic Research Foundation, 1000 N Oak Ave, Marshfield, WI 54449; phone 715.387.9110; fax 715.389.3808; e-mail yale.steven@mcrf.mfldclin.edu.

Penile Oleogranuloma Among Wisconsin Hmong

Philip M. Zickerman, MD; Chirasakdi Ratanawong, MD

Injection of viscous or semisolid materials into the penile shaft to increase its size, to correct erectile dysfunction, and/or to satisfy a sexual partner has only been sporadically reported in Eastern and Western European and American men. However, this practice appears to be more widespread in the countries of Southeast Asia. We present 3 cases of Hmong patients seen in a urology clinic in Wausau, Wis. We describe the presentation, correction, and difficulties experienced in convincing patients to undergo adequate treatment.

Author Affiliations: Marshfield Clinic–Wausau Center, Wausau, Wis (Zickerman); Marshfield Clinic–Weston Center, Weston, Wis (Ratanawong).

Corresponding Author: Philip M. Zickerman, MD, Department of Urology, Marshfield Clinic–Wausau Center, 2727 Plaza Dr W3C, Wausau, WI 54401; phone 715.847.3351; fax 715.847.3045; e-mail zickerman.philip@marshfieldclinic.org

Basal Cell Carcinoma of the Sole: Possible Association with the Shoe-Fitting Fluoroscope

Michael J. Smullen, MD; David E. Bertler, MD

Basal cell carcinoma of the sole is very rare. This report describes an occurrence in which a basal cell carcinoma may have developed in relation to radiation exposure from a shoe-fitting fluoroscope. The obvious limitation is that there is no record or means to measure any amount of radiation that a person may have received from this primitive fluoroscope. We conclude that radiation very likely did induce this lesion in this individual.

Author Affiliations: Michael J. Smullen, MD, 1239 W Mason St, Green Bay, WI 54303-2047

Corresponding Author: Michael J. Smullen, MD, 1239 W Mason St, Green Bay, WI 54303-2047

Your Practice

Per-click, under arrangement, mark-up, and other dirty words

Lisa A. Lyons, JD; Alyce C. Katayama, JD

CMS Proposes Important Changes to the Stark Regulations
On July 2, 2007, while we were all busy looking for the Stark II Phase III regulations, which were due out a few months ago but have now been postponed indefinitely, the Centers for Medicare and Medicaid Services (CMS) released proposed revisions to the Medicare Physician Fee Schedule for 2008. Tucked within those 924 pages are 50 pages proposing major changes to the regulations under the Stark self-referral law.


Author Affiliations: Health Law Group, Quarles & Brady LLP (Lyons, Katayama)

Corresponding Author: Lisa Lyons, JD, Quarles & Brady LLP, 411 E Wisconsin Ave, Milwaukee, WI 53202

Get organized for retirement planning

Claire Walmer, CFP®, SVA Wealth Management, Inc.

Collecting and organizing your personal financial information is the first step in retirement planning. The following is a list of the documents you may or may not receive throughout your working years. Create a file for each of the following categories and you will not only tame the paper tiger, but you will have the information you need to build a successful retirement plan.

Author Affiliations: Claire Walmer is a Certified Financial Planner® with SVA Wealth Management, Inc., based in Madison, Wis

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

Your Profession

National trend indicates women’s growing representation in medicine

Michael J. Dunn, MD

The Medical College of Wisconsin’s first class composed of 50% women just finished their M1 year. Our experience is a microcosm of the nation as a whole, with the Association of American Medical Colleges (AAMC) reporting that 48% of first-year students in the United States were women in 2005-2006, the most recent year statistics were tabulated.

Author Affiliations: Dean and Executive Vice President, Medical College of Wisconsin

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