"A job well done"

Because of the Department of Health meeting in New York last Friday, I was not able to return to Syracuse in time for the annual Service Recognition Dinner for Community General employees and for recent retirees.

This was, I think, the first Recognition Dinner I have missed for Community. I am sorry to have missed it, it being a poignant evening as the last one under Community’s independent status.

My thanks to Sharon O’Neill, Human Resources Director, and her staff for organizing the event again this year, and thank you too to Vice President Dennis Trepanier and to Medical Staff President Dr. David Halleran who “did the honors” in saluting employees and retirees at this milestone event.

A highlight of the evening was an “ode” by Jan Filsinger, an Emergency Department Coding Data Analyst. Here's what she said:

ODE TO MY ADOPTED FAMILY
Jan Evans-Filsinger

When I was very young you took me in.

You had patience with me and showed me skills.

You watched me grow under your tutelage and there were expectations.

I worked hard over the years and in return you helped me provide for my family.

You paid for some of my education and most of my insurance.

You provided me with the means to save for my children’s education, Christmas club, and even my own separate retirement.

When my children were born, I came to you and you took care of me and the expense.

When I or my family were sick or injured we came to you and again you took care of us and the expense.

Just like any other family, we had our ups and downs but you always stuck by me; even in some really rough patches when I left you in the lurch you were still by me and helped work things out.

Oh sure we have some siblings that have felt you should have done more, given them more, but with the economy changes that got harder to do. Yet year after year you have recognized us, given us gifts, some free lunches and never forgot a Christmas.

But just like any other family member on a fixed income, you began to falter under the weight of the economy.

You made some changes and tightened your belt.

But at the end of the day it proved to be too much and now you need assisted living.

As we move forward I will do all that I can to help you transition with your dignity and self-respect intact.

Tonight we recognize you for 48 years of hard work and a job well done.

I will always look back with fondness and say thank you to Community General Hospital!

Wow, Fall Harvest Gala tops $300,000

The photo shows the lobby of the Hotel Syracuse yesterday evening. That's the logo of Community General Hospital, as ice sculpture, in the center. The occasion was the Community General Foundation's Fall Harvest Gala where three individuals and organizations were recognized for their service to community.

Dr. David Halleran (in photo below, at right) was honored for his service to Community General Hospital and its Medical Staff. Specifically cited were his work as a surgeon, his humanity in caring for patients, and his focus on collaboration as a physician leader.

Also recognized was Onondaga Community College and its President Dr. Debbie Sydow (third from right) for the excellence of OCC's School of Nursing and its important role in our community.

Saluted for corporate citizenship was Excellus BlueCross BlueShield of Central New York, which has long supported health education, health planning, and quality improvement initiatives within the community. Receiving the accolade for Excellus was Dr. Arthur Vercillo, Regional President (fourth from left).

A special gift of $56,000 was presented by the Auxiliary to Community General Hospital by its President. John Stafford (at left).

With the Auxiliary, the Foundation raised $302,000!

I sincerely thank all who made the 2010 Gala such a success:

Diamond Sponsor

IBEW/ NECA

Platium Sponsors

Laboratory Alliance of CNY LLC

Pepsi

Gold Sponsors

Advanced OB-GYN

Bond Schoeneck & King PLLC

Excellus

Upstate Medical University

Welch Allyn

Silver Sponsors

Colon Rectal Associates

ConMed Corporation

Crouse Radio9logy Associates

Dr. David Halleran

Onondaga Hill Pathology

Practice Resources LLC & FamilyCare Medical Group PC

Realty USA

Rural Metro medical Services

Dr. & Mrs. Edward Schoenheit

SOS Syracuse Orthopedic Specialoists

Visual technologies

Also much appreciated were the many Bronze, Copper, and Patron Sponsors, along with individual donors. Your generosity is greatly appreciated! Thanks also to Foundation Chair Scott Matukas, Byrne Dairy (second from left), and Gala Committee co-chairs Rebecca Norr-Hartman, Welch Allyn (third from left) and Mark Re, RealtyUSA (second from right).

Our fraying social contract

During his two years as medical staff president, Dr. Dave Halleran used the word “collegiality” in most meetings. "Collegiality,” in his lexicon, reflects a social contract between hospitals and their medical staffs. In recent years, that social contract has been in need of mending.

“Collegiality” refers to that combination of obligation and respect that exists among doctors within their medical groups, within their specialties, and among the departments at the hospitals where they have privileges. That combination is meant to serve patients well, supporting the availability of care as well as care that reflects experience, judgment and skill.

Today it is not uncommon for one or more hospitals in a given community to have gaps in specialty on-call schedules at their emergency rooms. There are not enough available (or willing) physicians to complete the roster. Nor is it unheard of for one specialist to assert it is really another specialist’s duty to respond to a patient’s specific need in this or that hospital at this or that time of the day. On-line educational credits have replaced in-hospital educational meetings for many physicians, and hospital department meetings are both less frequent and less well attended than they were, even ten years ago.

These are examples of a fraying social contract.

The acute care hospital used to be a more essential part of – indeed, the center of – a physician’s professional life. The hospital provided the 24-hour staff and services, the high-tech equipment, and the array of specialists a doctor needed to care for her patients. Today many physicians focus so much of their time in outpatient settings they may never come to the hospital, or rarely so.

Why?

Because the things for which patients used to be hospitalized can often be accomplished in the office or in an outpatient setting. Government-driven payment models have tended to reward outpatient and procedure-based care, more so than hospital care. Reductions in payments have encouraged doctors to form larger medical groups, and these groups have developed both the patient base and the capital base to provide outpatient services that were once a big part of the hospital world.

All this means that private doctors are less able – and less willing – to come to hospitals in the middle of the night to take care of an emergency patient they may have never met before. This may be a point of annoyance among medical specialists who may not know each other or, even if they do, whose collegiality may be tested since they haven't seen much of one another for some period of time.

At the medical staff meeting last week, Dr. Halleran, a colon-rectal surgeon, stepped down as staff president and handed the gavel to Dr. Richard Lockwood, a specialist in internal medicine. In his farewell remarks, Dr. Halleran recalled a time “when doctors used to talk about patient care with each other. Today our discussions,” he lamented, “seem to be more about insurance payments or government rules.”

During the meeting, Dr. Halleran paid tribute to his father, once an internist in midtown Manhattan, whom he affectionately called “a real doctor.” He explained that his father “had office hours five and one-half days a week, went to the hospital seven days a week, and still managed to visit patients regularly in their homes.”

Dr. Halleran served as a medical staff president before. About a decade ago, he performed that service for another medical staff where he is a member in good standing, at St. Joseph’s Hospital Health Center. That means Dr. Halleran has demonstrated his medical staff “good citizenship” twice.

You don’t get elected staff president two times and at two different hospitals, unless you are someone special.

Dr. Halleran is.

Two facts about a STAR doctor

At Dr. Halleran’s final meeting as medical staff president, Dr. Fred Goldberg, chief medical officer, recognized him with the STAR award for demonstrating the qualities of “Sensitivity, Thoughtfulness, Appreciation, and Respect”

A number of people nominated Dr. Halleran for the honor, and here is some of what they said:

▪ “It is not uncommon for Dr. Halleran to discuss sensitive issues with nurses and ask their input regarding patient care.”

▪ He “[w]ill support and intervene with difficult situations and patients.”

▪ “He is respectful to us as staff and always trying to make this a better place for all of us.”

▪ “He reminds me of the country doctor going door to door making house calls. More importantly, I believe he reminds all of us of what it means to truly ‘care’ for patients and each other. We are so fortunate to have him here at Community General Hospital and in our lives.”

Congratulations, Dr. Halleran. It has been a privilege to work with you in your leadership role.

Here are two facts about Dr. Halleran that may not be widely known:

▪ In October 2008 he was named one of the best doctors in Central New York by CNY Magazine.

▪ On December 8 1980, Dr. Halleran was a surgical resident at Roosevelt Hospital in mid-town Manhattan, when the police brought in a victim of four gunshots. As he cared for the patient, someone looked through the patient's wallet for identification. The driver's license read: John Lennon.

For 40 years...

Last week week (March 27) Community General honored 116 employees for a total 2,065 years of service.

That's Helen Banyas, Operating Room surgical technologist, pictured on my left. Beside her is Dolores "Dee" Doughtry, who recently retired as unit secretary on Two West. Both were honored for 40 years of service. Helping with the celebration was Dr. David Halleran, Medical Staff President, along with some 300 who attended the service recognition dinner.

My thanks and congratulations to all who, working together, provide extraordinary care and service for the patients of our community.

Congratulations, Doctors!

Congratulations to the physicians listed in last month’s CNY Magazine as “best doctors.” I want to acknowledge and congratulate all who practice at Community General Hospital, starting with our Medical Staff President, David Halleran, MD (photo, at left) of Colon Rectal Surgeons of Central New York, along with his partner John Nicholson, MD.

Others from the list include our intensivists Russell Acevedo, MD and Daniel Polacek, both of Critical Care Associates; John McCabe, MD, leader of the emergency medical group that provides services at Community General; James Tifft, MD, of Associated Gastroenterologists of Central New York; and John Gullo, MD, and Anthony Scalzo, MD, both of Hematology Oncology Associates of Central New York, which operates a cancer care and hematology center on the campus of Community General.

Congratulations, as well, to Francisco Gomez, MD, (photo, at right) of CNY Neurology; Leonard Levy, MD, Chair of the Department of Pediatrics; Robert Weber, MD, Medical Director of our Physical Medicine and Rehabilitation Service; Mark Levinsohn and David Thompson, MD, of the radiology group that provides services at Community General; as well as surgeon Robert Schwartz, MD, of Vascular Care.

It is a tribute, indeed, to be recognized by your peers!

Collegiality

When David Halleran, MD, was elected president of the Community General Hospital medical staff last month, he carried a dictionary with him to the podium. He opened to the definition of “collegiality” and reminded his colleagues how important it is to maintain respect for one another and to work toward common purposes.

Dr. Halleran, who is a colon rectal surgeon, said that "collegiality" is the theme of his term of office, and he encouraged his colleagues to recall why they chose careers in medicine. He reminded them how satisfying it can be to collaborate with others on patient care. “It’s still a great profession,” he said, “when you are caring for the patient.”

The stresses and strains affecting doctors were recently the subject of a New York Times article, called “The Falling-Down Professions,” which said, among other things:

▪ About 60 percent of doctors reportedly have considered leaving the medical profession.
▪ Nearly 70 percent of doctors know a physician who has already left medicine.
▪ Applications to medical schools are down about nine percent from 1997.
▪ Physician incomes have lagged behind those of other professions.

As the Times reported, “Complaints about managed care crimping doctors’ income and authority over medical decisions are nothing new, but the problems are only getting worse…” It quoted a doctor's complaint: “What irritates me the most is the use of the term ‘provider.’ We (physicians) didn’t go to provider school.”

If physicians have become “providers,” patients have also become “consumers.” The imagery may be inexact, but the commercialization of the medical care process is clearly a factor in the changing doctor-doctor relationships, the changing doctor-patient relationships, and (as I can attest) the changing doctor-hospital relationships.

This week I again heard Dr. Halleran speak about collegiality, this time at a meeting of the Quality Committee of the Board. He said that collegiality involves more than “being cordial.” Collegiality facilitates more effective communications among physicians regarding patients and their care. It’s also facilitates physicians and nurses working effectively to improve patient safety and to assure that patients get the right care at the right time.

Professional collegiality, or the stresses and strains to which it is subject, is an issue bigger than our corner of the world. But I’m very happy to have Dr. Halleran calling us to order – and getting us to work on it.