Daily Archives: July 10, 2017

SCMS Resident Update

Greg Sanders, MD, Program Director, Sea Mar Marysville Family Medicine Residency

The first medical residency in Snohomish County has started. Six pioneering family medicine residents began their 3 year tenure at the Marysville Sea Mar CHC Family Medicine Residency June 26th. Currently, they are orienting in the local community, the clinic and Providence hospital. Then they start their 4 week rotations, at the hospital or with specialists in the community.

Providence is preparing for the residents, as this is their first residency. Certainly, there is a cultural shift, as the hospital transitions to a graduate medical teaching institution. Dr. Frank Andersen gave a hospital tour to the resident’s significant others, who now know where their loved ones will be spending up to 80 hours per week for the next 3 years. In addition to the family medicine residents, Washington State Elson Floyd School of Medicine first year medical students are spending some time at Providence. They will return and spend all of their third and fourth years at this hospital.

There has been great support from Providence and the specialists in our community. Recently, the residents went through some baseline skills testing. Local family physicians Jim Fletcher, Hans Danker and Kevin Clay participated in these events. The exposure to enthusiastic, wise local physicians with heterogeneous backgrounds makes for a dynamic learning environment. The orientation sessions are loaded with a variety of events, like team building, ACLS training, skills testing, community windshield surveys, introduction to scholarly activities, quality improvement, simulations, underserved curriculum, EHR, etc.

I hope you have an opportunity to work with the residents. They are a strong cohort, and their enthusiasm for learning is infectious. Share some of your wisdom.


In Memorium: Remembering Larry Weed, M.D.

Gerald Yorioka, MD, SCMS President

Larry Weed, M.D.: 12/26/1923-6/3/2017

Few physicians may have personally met Larry Weed, but most have utilized the S.O.A.P. not format for clinical chart entries.

In the arena of continuing education, there has been a focus on setting forth clear learning objectives, but upon listening to Dr. Weed speak at the Alliance for Continuing Medical Education (ACME) national meeting, it became apparent from the effect on his audience that there was a different way to attain adult learning.  Many in the audience would be so stirred to disagree with him that they would dig in, sharpen their position, to counter his provocative statements.  Whether it was by design or not, there was effective learning brought to action.

The S.O.A.P. notes were easy in comparison to the knowledge-coupler concept he promoted in subsequent years.  It is guiding the clinical physician to optimally use the available knowledge at the point of care.  Technology in the form of On-line resources and Electronic Records is now catching up to his ideas.  From the beginning, the physician would be the one making the diagnosis, recognizing the fact that there are often valued intangible factors that enter into human decision making.  Japan has experimented with robot secretaries and news this week revealed the use of robots replacing coal miners.  I once had a patient with metastatic lung cancer who insisted on seeking six “second opinions.”  When asked why she picked the advise of one particular specialist, her response was, “I liked him better.”  I think Larry Weed would understand.

Emory University 1971 presentation by Larry Weed


Precision Medicine

Gerald Yorioka, MD, SCMS President

The FDA is planning to release guidelines to facilitate the approval of drugs targeting cancer-linked DNA mutations.  The current process of FDA approval is costly and time-consuming, and disheartening to patients with a current diagnosis of cancer.  The new proposal is titled Medical Innovation Development Plan and is in response to a February Presidential speech before Congress.  Most applications for the introduction of new drugs requires over 200,000 patients who would be affected.  Below that cutoff level, the applications would be categorized as “orphan drugs.”  The new policy is to expect an FDA response within 90 days.

The King County Medical Society offered a CME program “Are You Ready for Genomic Diagnostics?” open to Snohomish County Medical Society members on June 18.  The program was focused on diagnostic capabilities, but the ultimate goal would be to achieve therapeutic benefits.

We may be on the threshold of a new practice of medicine for the 21st Century, so this proposed move by the FDA may be welcome news that will save lives in previously hopeless situations.  In line with this a subsequent Newsmax article “Personalized Vaccines Hold Cancer at Bay” July 5, presents this to the public as “Novel class of personalized cancer vaccines.”