2014 Waggoner Lecture on Ethics & Values, Wednesday, October 29 at 4 p.m.

2014 Waggoner Lecture on Ethics and Values
Click the above link to print the flyer

Sharon P. Douglas, M.D., Professor of Internal Medicine and Associate Dean for Veterans
Administration Education at the University of Mississippi Medical Center, will give the 2014 Raymond W.
Waggoner, MD, Lecture on Ethics & Values in Medicine, sponsored by the University of Michigan
Department of Psychiatry, Wednesday, October 29, 2014, at 4:00 pm in the Ford Auditorium, second
floor, at the University of Michigan Hospital.

Dr. Douglas’ talk is entitled “End of Life Discussions, What, How and When? /I End of life care has
become increasingly important and the doctor plays a leadership role in advance planning. The skillful
understanding physician and his staff and aides provide a discussion format which includes the dying
patient, the family and the doctor. Dr. Douglas will confront some of the difficult issues physicians and
other caregivers face when meeting with a dying patient and his family. She will offer tools for initiating
conversations about dying and will then provide communication techniques to use at critical points in
the conversation. The conversation that no one wants to have will become more heartfelt and helpful
through Dr. Douglas’ teachings.

Dr. Douglas has recently served and just completed her term as the Chair of the American Medical
Association (AM A) Council on Ethical and Judicial Affairs. This council essentially sets the nation’s professional ethical standards on behalf of American medicine.

The talk is free and open to the public.

For information contact:

Philip Margolis, M.D.


Sandra Glover

Administrative Assistant Senior

University of Michigan Department of Psychiatry
Phone: 734-232-0352


AMA Symposium: Resources for International Medical Graduates on Oct. 25

AMA and MSMS are hosting a free networking and educational event for medical students, ECFMG-certified individuals, residents, and physicians interested in international medical graduate issues and learning about AMA and MSMS resources on Saturday, Oct. 25, from 9-11 a.m. at the Somerset Inn in Troy. Breakfast will be provided. This event is being held in conjunction with the MSMS Annual Scientific Meeting.

Those interested in the AMA Symposium also may attend optional mock interviews at 8:00 a.m.

During the symposium program panelists will discuss topics including:

AMA and AMA-IMG Section resources
Michigan Conrad 30 Program
Successfully navigating the match

“The AMA and MSMS IMG Sections are working hard to address the difficulties IMGs endure and we are making great progress,” said Mouhanad Hammami, MD, chair of the MSMS IMG Section. “Michigan is fortunate to have the AMA present this program here, so we hope new and established IMGs will attend to learn more and network with each other.”


Interviewers for the mock interviews are needed at 8:00 a.m. at the Symposium. To volunteer, please register at the link below.

“We all owe a debt of gratitude,” Doctor Hammami said. “Serving as a mock interviewer is a great way to give back.”

A Q&A session will follow the presentations. Space is limited, register today at https://login.ama-assn.org/account/login. If you have trouble logging in, please call (800) 262-3211 and get help to reset your password or to set up an account. Non-members may also create an account to register for this meeting.

The deadline to register is Oct. 21. Go to http://ama-assn.org/go/amasymposium for more information.


Those interested in attending CME courses at the 149th Annual Scientific Meeting from Oct. 21-25 can see the full schedule and register for courses at http://www.msms.org/asm.

To reserve a room at the Somerset Inn, call (248) 643-7800 or go to http://www.msms.org/Portals/0/Documents/MSMS/Education/ASM/2014_ASM_Hotel_Reservation.pdf.

Hydrocodone Reclassification Starts October 6

A new rule from the Drug Enforcement Administration (DEA) taking effect Oct. 6 reclassifies hydrocodone combination products as Schedule II controlled substances, prohibiting refills and establishing other restrictions that will require major changes to prescribing practices.

Following are the six key points you need to know so you can take appropriate action over the next few weeks:

1. Refills aren’t allowed for prescriptions that are written beginning Oct. 6. Be prepared to issue new hard-copy or electronic prescriptions for patients. Note that eScripts can only be used if state law permits and the prescriber is certified to ePrescribe Schedule II substances. Pharmacies also must be certified to accept eScripts for controlled substances.

2. Prescriptions issued before Oct. 6 won’t necessarily qualify for refills; plan to issue new ones. Although the DEA rule allows refills of prescriptions issued before Oct. 6 until April 8, 2015, other factors could prevent patients from getting those refills.

Several states have published notices that they will treat hydrocodone combination product prescriptions issued before Oct. 6 in the same way they will handle prescriptions issued after the rule’s implementation date. In addition, any state laws that are more stringent than the DEA rule will govern refills. Meanwhile, some pharmacy quality and safety processes may not allow refills for prescriptions issued before Oct. 6, and some health insurers will not pay for those refills.

3. Prescriptions can’t be called in or faxed. Make sure to plan ahead for any patients who may need refills. The new rule prohibits pharmacies from filling prescriptions delivered over the phone or via fax, so you’ll need to issue written scripts.

The only exception to this rule is emergency treatment, which would allow physicians to call in a limited quantity of the medication to cover the emergency period only. Pharmacies are required to report prescribers to the DEA if they make such a request and do not give the pharmacy a written prescription within seven days.

4. Allied health professionals might not be able to write prescriptions for these drugs going forward. Check your state’s restrictions around Schedule II substances to confirm whether any non-physician members of your team who have prescriptive authority will be able to continue issuing prescriptions for hydrocodone combination products. You may need to modify your collaborative practice agreements accordingly.

5. Multiple prescriptions may be issued at one time under certain circumstances. The new rule does allow a patient to receive prescriptions that would total a 90-day supply, if the prescriber has determined it is appropriate to see the patient only once every 90 days. Each prescription must include written instructions that specify the earliest date it may be filled.

In addition to sound medical judgment and established medical standards, make sure to base your practice’s policy on issuing multiple prescriptions on relevant federal and state laws.

6. Patients should be notified of the new requirements and processes. Make sure your patients understand that their new prescriptions will not be refilled and are aware of the procedures they will need to follow going forward.

Remember to Register for the “All Candidates Forum” Tomorrow, Tuesday, Sept 16th

If you are interested in who is running for State House Representative for Districts 52 – 55, State Senator in District 18, or Congress in Districts 7 and 12, please join us at the “All Candidates Forum” scheduled for Tuesday, September 16, at the Ann Arbor City Club, 1830 Washtenaw Avenue. Doors open at 6 p.m. and a strolling dinner will be available. Candidates take the stage at 7 p.m. A Q & A session from the audience will take place thereafter.

If interested, please contact the Washtenaw County Medical Society office at 734-668-6241.

Scheduled to attend:
State Representative – District 52
John Hochstetler
Gretchen Driskell

State Representative – District 53

Jeff Irwin

State Representative – District 54

David Rutledge
Ed Moore

State Representative – District 55

Adam Zemke

Congress – 12th District
Terry Bowman
Debbie Dingell

State Senator – District 18

Rebekah Warren
Terry Linden

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Influenza A/H3 Diagnosed in Washtenaw Adult

On September 12, a lab-confirmed case of influenza A/H3 was reported to Washtenaw County Public Health (WCPH). The case occurred in a young woman who is a college student in Ann Arbor and had classic influenza symptoms starting September 8. She was not hospitalized and is currently recovering.

The nasal swab was PCR positive at University of Michigan Microbiology Lab for influenza A/H3 and is being forwarded to the MDCH Bureau of Laboratories for confirmation. This is the first case of influenza diagnosed in a Washtenaw resident since late May.

Influenza Testing:

Early in the flu season, it is important for clinicians to order confirmatory lab testing on suspect influenza cases, especially given the current enterovirus situation. Rapid flu tests are not reliable when low levels of influenza are circulating. Influenza PCR and culture isolates are an essential part of public health surveillance.

MDCH College Flu Vaccination Challenge toolkit: http://www.michigan.gov/mdch/0,4612,7-132-2942_4911_4914-315201–,00.html

Michigan Monitoring for Cases of Enterovirus, None Yet Confirmed

The Michigan Department of Community Health (MDCH) is receiving reports indicating an increase in severe respiratory illness in children ages 5-17 across the state. MDCH is working with local health departments and hospitals to investigate these cases. At this time, Michigan has no confirmed cases of Enterovirus D68 (EV-D68) associated with the national outbreak, but MDCH is forwarding samples to the Centers for Disease Control and Prevention (CDC) for testing.

The majority of those affected nationally had a previous medical history of asthma or prior wheezing. Symptoms of EV-D68 infection can include wheezing, difficulty breathing, fever and racing heart rate. Most people infected with enteroviruses have no symptoms or only mild symptoms, but some infections can be serious requiring hospitalization.

Young residents with asthma are encouraged to be vigilant in taking their asthma controlling medications and using general hygiene precautions. Additional information about human EV-D68 can be found in the CDC Morbidity and Mortality Weekly Report: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6038a1.htm

Hearings on Senate Bill 2 Held

The House Health Policy Committee met yesterday to accept testimony on Senate Bill 2. Testimony lasted for the full hour and a half of allotted time for the hearing. Rose Ramirez, MD, testified on behalf of Michigan State Medical Society (MSMS).

MSMS was joined by physicians from the Michigan Academy of Family Physicians, the Michigan Osteopathic Association, and the Michigan Radiological Society who also testified in opposition to Senate Bill 2. Collectively, the voice of organized medicine was clear that Senate Bill 2 is not a solution that should be pursued by the legislature.

The testimony of the advocates for advanced practice nurses focused mainly on arguments surrounding access that were not substantiated and claims that their education is sufficient to justify the passage of Senate Bill 2.

The agendas for the House Health Policy are full until after the election, so it is unlikely any formal action on Senate Bill 2 will occur prior to the end of the year.

MLive’s article on yesterday’s hearings can be found here:


Rhoda Powsner Memorial Service Scheduled for October 11, 2014

A memorial service for Rhoda Powsner will be at the Ann Arbor City Club, 1830 Washtenaw Ave., Ann Arbor, on Saturday, October 11 from 2 PM to 5 PM