Improve the health of the people of Wisconsin by supporting and strengthening physicians' ability to practice high-quality patient care in a changing environment.

Volume 107, Issue 6 (September 2008)

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Treating oneself, one’s family and one’s colleagues is an issue that certainly is not new to physicians, but one many have faced. Yet it is not often taught or even discussed. In this issue of the Wisconsin Medical Journal, 3 physicians discuss what is acceptable and what is not when it comes to this aspect of medicine.


A comprehensive journal, and the opportunity for discussion

John J. Frey, III, MD

A general journal should be general enough to include most areas of medicine. The Wisconsin Medical Journal is noteworthy because it covers the major clinical disciplines and includes information about the health of the public, important trends in chronic and acute illnesses, and occasional pieces such as that by Krall in this issue, which crosses all of the disciplines by raising important questions about professional behavior. Feedback from readers and authors are encouragingly showing us that we are going in the right direction by including something for everyone, but not so exclusively narrow as to render articles inaccessible. We are able to do this in great part because of the participation of authors—you think of the Journal for your work and write about what you do in an interesting and direct fashion. Thank you.

Author Affiliations: Medical Editor, Wisconsin Medical Journal

Corresponding Author: Address correspondence to the Wisconsin Medical Society, 330 E. Lakeside St. Madison, WI 53715; e-mail wmj@wismed.org.

The two-physician family and the medical treatment of our children

Thomas Meyer, MD

Plaudits to Edward, J. Krall, MD, and his incisive manuscript dealing with the thorny problems surrounding the diagnosis and management of one’s own ailments and those of family, good friends, and, on occasion, neighbors. I wish that I had read it many years ago, for it contains wise advice for the unwary on how to handle these incidents.

Author Affiliations: Thomas C. Meyer, MD, is a retired pediatric cardiologist from Madison who served as Medical Editor of the Wisconsin Medical Journal for more than 10 years.

Corresponding Author: Address correspondence to the Wisconsin Medical Society, 330 E. Lakeside St. Madison, WI 53715; e-mail wmj@wismed.org.

Lessons in objectivity: As a physician’s daughter and now a physician mother

Leandrea Lamberton, MD

I have been surrounded by physicians treating themselves my entire life. My father was a physician, I am now a physician, and I work with medical students and residents who are struggling with the dilemmas of treating themselves. My thoughts have evolved over time, and I have made a very concerted effort to not repeat the pitfalls of my parents and to help others avoid or recover from pitfalls of self-treatment.

Author Affiliations: Doctor Lamberton is an assistant professor of psychiatry and behavior medicine at the Medical College of Wisconsin, Milwaukee, Wis.

Corresponding Author: Address correspondence to the Wisconsin Medical Society, 330 E. Lakeside St. Madison, WI 53715; e-mail wmj@wismed.org.

Original Research

Doctors Who Doctor Self, Family, and Colleagues

Edward J. Krall, MD

Treating one’s self, treating one’s family, being a physician-patient, and taking care of colleagues and their families are aspects of the practice of medicine that are not often taught or discussed in any type of venue. They are not new issues. They have been considered since the earliest days of medicine. They are sometimes controversial issues, since physicians have been reluctant to set standards for themselves. This article reviews the prevalence of physicians’ treatment of self and their families and the problems that may arise, as well as the regulations that have been developed. It also examines the reluctance of physicians to seek care and the consequences and the special needs of physician-patients. Finally, guidelines for providing care to self and colleagues are suggested. Further education for students and house staff is needed to enable physicians to appreciate the risks of self treatment and to know how to best care for themselves and their colleagues.

Author Affiliations: Department of Behavioral Health, Marshfield Clinic, Marshfield, Wis.

Corresponding Author: Edward J. Krall, MD, Department of Behavioral Health, Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449; phone 715.387.9005; fax 715.389.3808; e-mail krall.edward@marshfieldclinic.org.

A Comparison of Open and Laparoscopic Techniques in Elective Resection for Diverticular Disease

Stephen B. Shapiro, MD, FACS; Pamela J. Lambert, RN; Michelle A. Mathiason, MS

Introduction: This study examines the outcomes of patients who underwent elective sigmoid resection for diverticular disease during the transition period from open to laparoscopic surgery.
Methods: The medical records of patients who underwent elective sigmoid resection from July 1, 1993 to June 30, 2005 at a community-based teaching hospital were retrospectively reviewed. Data collected included age, sex, duration of surgery, estimated blood loss (EBL), postoperative day of diet, length of stay (LOS), postoperative complication rate, and readmission rate. Data were compared using Wilcoxon rank sum and chisquare tests. Recurrence rates were evaluated.
Results: The medical records of 246 patients who had elective sigmoid resections were reviewed. One hundred sixty-six of the procedures were planned open operations, and 80 were initiated with laparoscopy. Of these 80 procedures, 10 were converted to open surgery. Overall, laparoscopic surgery was associated with shorter LOS (median: 4 days versus 8 days, P<0.001; mean: 4.8 days versus 9.3 days), less EBL (median: 100 cc versus 200 cc, P<0.001; mean: 167 cc versus 255 cc), and longer operative time (median: 185 minutes versus 153 minutes, P<0.001; mean: 201.4 minutes versus 157.1 minutes). No mortalities occurred in either group. Readmission and recurrence rates were similar in the open and laparoscopic groups. Subset analyses to adjust for changes in practices over time did not account for improved LOS, EBL, or recurrence rate.
Conclusion: Compared with open surgery, laparoscopic surgery for elective sigmoid resection is associated with a significantly shorter hospitalization and similar safety and recurrence rates.

Author Affiliations: Department of Surgery, Gundersen Lutheran Health System, La Crosse, Wis (Shapiro); Department of Research, Gundersen Lutheran Medical Foundation, La Crosse, Wis (Lambert, Mathiason).

Corresponding Author: Stephen B. Shapiro, MD, FACS, Department of Surgery, Gundersen Lutheran Health System, 1900 South Ave, C05-001, La Crosse, WI 54601; phone 608.775.2345; fax 608.775.4460; e-mail sbshapir@gundluth.org.

Exploring the Effect of the Referring General Surgeon’s Attitudes on Breast Reconstruction Utilization

D. Heath Stacey, MD; Michelle A. Spring, MD; Tara M. Breslin, MD, MPH; Venkat K. Rao, MD, MBA; Karol A. Gutowski, MD

Background: Breast reconstruction rates remain low, at 5%-15% of mastectomy patients, despite the safety and high patient satisfaction of these procedures. Reasons for this are multifactorial, including the attitudes and biases of the referring breast surgeon, as well as patient factors. The purpose of this study was to explore attitudes of general surgeons towards breast reconstruction.
Methods: We surveyed 369 general surgeons in Wisconsin with questions about breast surgery. Responses from 135 (36%) surgeons were analyzed.
Results: Seventy-three percent of the respondents performed at least some breast surgery and were eligible for the study. For a little over 50% of the general surgeons surveyed, breast surgery made up less than 10% of their practice. Fifty-one percent never performed a skin-sparing mastectomy. A large number of breast surgeons (40%) did not refer all mastectomy patients for reconstruction. Reasons cited for not referring patients included the concerns over cancer recurrence and advanced patient age. Reasons for patients not undergoing reconstruction included patient’s refusal, need for radiation therapy, delaying adjuvant oncologic treatment, patient factors, and having no plastic surgeon available locally.
Conclusions: The decision by a patient to undergo breast reconstruction involves many complex factors. As a specialty, we should focus on improving the availability of breast reconstructive surgeons and educating referring surgeons and patients about reconstructive indications and options in order to positively affect the utilization of breast reconstruction.

Author Affiliations: Division of Plastic and Reconstructive Surgery, University of Wisconsin-Madison, Madison, Wis (Stacey, Rao, Gutowski); Division of Surgical Oncology, University of Michigan, Ann Arbor, Mich (Breslin).

Corresponding Author: D. Heath Stacey, MD, University of Wisconsin, Division of Plastic Surgery, 3334 Bradbury Rd, Madison, WI 53719; phone 608.274.6083; fax 608.265.9695; e-mail dheathstacey@gmail.com.

Case Reports

Fulminant Myopericarditis from Phenytoin-Induced Systemic Lupus Erythematosus

Brett D. Atwater, MD; Zhaowei Ai, MD, PhD; Matthew R. Wolff, MD

Myocarditis and pericarditis are identified at autopsy in up to 50% of patients with systemic lupus erythematosus. However, clinical symptoms of heart failure are unusual, occurring in only 5%-7% of patients. Drug-induced lupus is rare and typically causes classic lupus symptoms of rash, fever, pleuritis, renal insufficiency, and arthritis. We present an unusual case of drug-induced lupus from chronic phenytoin use in a man who presented with symptoms of fulminant myopericarditis. To our knowledge, this is the first such case reported in English.

Author Affiliations: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Wisconsin Hospitals and Clinics, Madison, Wis (Atwater, Wolff); Department of Internal Medicine, St. Agnes Hospital, Fond du Lac, Wis (Zhaowei).

Corresponding Author: Brett D. Atwater, University of Wisconsin Hospital, 600 Highland Ave, Madison, WI 53705; phone 608.345.1230; fax 608.263.0405; e-mail bd.atwater@hosp.wisc.edu.

Your Practice

Another round of Stark law changes coming your way as early as October 1, 2008

Alyce C. Katayama, JD; Sarah E. Coyne, JD; Kerry L. Moskol, JD

Sweeping changes to the Stark regulations will force many arrangements between physicians and hospitals, particularly hospital/physician joint ventures, to undergo significant restructuring.

Author Affiliations: Alyce C. Katayama, JD, Sarah E. Coyne, JD, and Kerry L. Moskol, JD, are from the Health Law Group, Law Firm of Quarles & Brady, Milwaukee and Madison, Wis.

Corresponding Author: Address correspondence to the Wisconsin Medical Society, 330 E. Lakeside St. Madison, WI 53715; e-mail wmj@wismed.org.

Seven reasons to consider a trust

E.G. Schramka, JD, CPA, PFS, CVA

Depending on your estate planning objectives and the individual characteristics of your intended beneficiaries, you may want to consider forming a trust. A trust is a contractual relationship between an individual, a trustee and a beneficiary for the trustee to hold legal title to property, formerly owned by the individual, for the benefit of the beneficiary.

Author Affiliations: E.G. Schramka, JD, CPA, PFS, CVA, is vice president of the SVA Trust Company, LLC, an affiliate of Suby, Von Haden & Associates, SC.

Corresponding Author: Address correspondence to the Wisconsin Medical Society, 330 E. Lakeside St. Madison, WI 53715; e-mail wmj@wismed.org.

Your Profession

Talent, teamwork give rise to best kidney transplant outcomes in Midwest

Jonathan I. Ravdin, MD

When compassionate care convenes with substantial clinical experience, scientific innovation, and progressive leadership, you achieve the level of success garnered by the Froedtert & The Medical College of Wisconsin’s (College) kidney transplant program. The program was identified in 2008 as having the best outcomes in the Midwest by the Scientific Registry of Transplant Recipients (SRTR).

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

Corresponding Author: Address correspondence to the Wisconsin Medical Society, 330 E. Lakeside St. Madison, WI 53715; e-mail wmj@wismed.org.

Your Society

New reporting requirements for nonprofit organizations

Robert J. Foulks, Jr., CPA, CAE

Tax-exempt organizations, including county medical societies and not-for-profit hospitals, will be facing many changes when they file tax returns for 2008 due to a redesigned Form 990. Last month, the Internal Revenue Service (IRS) released revised instructions to Form 990, the informational tax return required for tax-exempt organizations. The form was redesigned following draft releases and comment periods that began more than a year ago. Previous to this redesign, Form 990 had not been rewritten since 1979. A final revision of the instructions for the new Form 990 will be released later this year, but the IRS has indicated there will not be significant changes at this point.

Author Affiliations: Chief Financial Officer, Wisconsin Medical Society

Corresponding Author: Address correspondence to the Wisconsin Medical Society, 330 E. Lakeside St. Madison, WI 53715; e-mail wmj@wismed.org.