Fall 1999 - Volume 3 Number 3

Clinical Contributions

Exercise-Induced Asthma
Robert Lawrence, MD; Ken Ettinger, MD; Michael Barrett, MD; Kuo Chang, MD; Fred Gill, MD; Jean Carney, MD

This common and poorly understood condition is manifested by bronchospasm occurring 5-10 minutes into sustained activity or several minutes after activity ends. Diagnosis is reached by conducting therapeutic trial of appropriate pharmacological agents or by ventilatory measurements during exercise. This article discusses management, with the objective of enabling the afflicted patient to maintain the desired healthy lifestyle.
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Practitioner Prescribing Habits for Pharyngitis: Implications for Evaluation and Management.
Harry S. Miller, MD; William A. Gardiner; Aracelis D. Fernandez, MD

Assuming that increasing development of bacterial resistance to antibiotics reflects, in part, inappropriate prescription of these drugs, the authors studied prescribing patterns of physicians who were awaiting throat culture results. Contrary to the recommendations of several national groups, more than half were treated pending culture reports, and physicians were less likely to treat than Nurse Practitioners or Physician Assistants. Factors influencing noncompliance and methods of improving compliance with recommendations are discussed.
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Prostate Cancer Screening: Exploring the Debate.
Howard Backer, MD, MPH

The author presents the controversial subject of the current role of screening for prostate cancer largely in the context of conflict between the perspectives of public health authorities and of individual practitioners. The article reviews much of the relevant data. Sections discuss the public as informed consumers, ethical issues, medical quality, and health care policy.
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Esthesioneuroblastoma: What Family Practitioners Should Know.
Asdghig D. Daderian, MD, FAAP; M. Roy Thomas, MD, FACP; Loucine M. Huckabay, PhD

This brief report is a case presentation and discussion of a rare nasal cavity tumor, curable if diagnosed early. Emphasis is placed on the need for constant vigilance by primary care providers, especially when common symptoms persist after treatment.
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Bedside Ultrasonography Done in Emergency Department Expedites Diagnosis of Abdominal Aortic Aneurysms: Three Case Studies.
Jeff Miller, MD, FACEP; Janna Chao, MD; Peter Grimes, MD

Using three cases of ruptured abdominal aneurysm diagnosed within an eight-month period as examples, the authors recommend routine use of physician-performed ultrasound examination in older patients with abdominal pain. The authors state that diagnostic accuracy and appropriate management of this surgical emergency are enhanced by this procedure.
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A Word from the Medical Directors

A Word on Service from the Medical Directors
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Health Systems

A Physician's Call to Action: Delivering a Superior Care Experience
Jill M. Steinbruegge, MD; Robert H. Sachs, PhD; Douglas Bonacum, MBA; Martin N. Gilbert, MD; Lisa B. Koltun, MS, HSA

This review of the impact of service quality on the overall value of the health care experience will be of interest to all Medical Groups seeking to enhance the service that they provide. The article puts to rest any doubt that patient satisfaction does significantly influence health outcomes, overall organizational costs, and clinician satisfaction.
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Using Information from Linkage Research Studies to Improve Organizational Performance.
Sherilyn M. Kam, PhD; Fran Sincere, MSIR

This is a follow-up article to the preliminary research published last year in The Permanente Journal. The authors describe in this article how the leaders of Kaiser Permanente will use the information that links the customers' opinion with employees' opinion.
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Will Drop-In Group Medical Appointments (DIGMAs) Work In Practice?
Edward B. Noffsinger, PhD

This innovative program has been received with excitement throughout the country. It is a classic "work smarter" approach in that it challenges the traditional mindset that the only product to offer patients is one-on-one interaction with physicians in an exam room. Dr. Noffsinger's Drop-in Group Medical Appointments address the care experience from a quality, service, and efficiency viewpoint with a model that can potentially work with any physician practice.
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The Easy Access Program: A Way to Reduce Patient No-Show Rate, Decrease Add-Ons to Primary Care Schedules, and Improve Patient Satisfaction.
Phillip J. Tuso, MD, FACP; Ken Murtishaw, RN, MA, DHE; Wadie Tadros, MD

An innovation is presented that underscores the fact that service excellence can be achieved only if demand-capacity is well understood and is supported by a sound scheduling system. Although this may be one of several methods of dealing with scheduling changes to improve access, the principles of the article probably apply to all such initiatives.
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Improving the Quality of Service: The KPNW Experiment.
Wendy Ray, MPH

Here is a very interesting article describing how the Northwest region is using a "Customer Service Collaborative" to create a service-oriented culture. The program is based on the Institute of Healhtcare Improvements 1998 National Collaborative "Improving Service in Health Care."
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Getting the Most out of the Clinical Encounter: The Four Habits Model
Richard M. Frankel, PhD; Terry Stein, MD

How could this edition focus on service without addressing the crucial component of the care experience--the clinician's interaction with the patient? Building on the Four Habits Model that these authors have made famous, this article presents stimulating ideas to assist physicians and other care providers as they seek to refine their patient communication skills.
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Editors' Comments

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Abstracts

Abstracts of articles authored or coauthored by Permanente clinicians
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External Affairs

How Graduate Medical Education Creates Community Service.
Jimmy H. Hara, MD, FAAFP

Graduate Medical Education is a direct community service investment benefit which is funded by our Community Service budget. In his article, Dr. Hara of SCPMG reviews the history of graduate medical education and community service. He then describes a program with which he has been involved in Southern California, where medical residents are brought to the community to enhance their training and to benefit the community at large.
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Serving Legislators Serves Permanente: The Permanente Journal on Capitol Hill.
Donald W. Parsons, MD

Don Parsons' article speaks to the value of The Permanente Journal for his activities representing us in Washington, DC to affect public policy in the best interest of our organization.
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Kaiser Permanente Baldwin Park Medical Center: Pioneer in Labor Management Partnership.
Teri G. Muse, BA

On October 7, 1998, Kaiser Permanente of Southern California opened a new state-of-the-art hospital in Baldwin Park. One of the factors in opening the Medical Center was the help of a labor management partnership. This may be the first time a US hospital has been opened in this way.
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Letters to the Editor

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Book Reviews

"The Neurologic Exam"
Martin A. Samuels, MD
Review by Vincent J. Felitti, MD, Associate Editor
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"Business @ the Speed of Thought: Using a Digital Nervous System"
Bill Gates
Review by Vincent J. Felitti, MD, Associate Editor
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"Dragon NaturallySpeaking, Medical Suite"
Dragon Systems
Review by Eric P. Daniels, MD, and Robert Hogan, MD
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Soul of the Healer

"My Kitchen" and "A Sad Winter" 
Nooshin Farr, MD, FACP
Art
Art

Sarah
Chuck Clemons, MD
pdf

Dylan and Winter and Innocence and A Child's Last Leaf
Victor David, MD
pdf, pdf, pdf

Circulation

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Subscriptions

The Permanente Journal (ISSN 1552-5767) is published quarterly by The Permanente Press. The Permanente Journal is available online (ISSN 1552-5775) at www.thepermanentejournal.org.

Letters

Articles, editorials, letters to the editor, and other material represent the opinion of the authors. Send your comments to permanente.journal@kp.org.


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