Transitions
By William L. Bargar, M.D.
The first half of 1998 has been a time of significant change for our practice.
On January 20, 1998, Dr. Taylor stopped practicing orthopaedic surgery
due to a health problem. He hopes to return to orthopaedics someday if
his health permits. He is now devoting his time to research for a new
bearing surface that may significantly enhance the longevity of hip and
knee replacements. We wish him luck.
Dr. Thomas Blumenfeld has joined the practice as of February 20, 1998
and taken over many of Dr. Taylor’s former patients. His “Letter
of Introduction” appears below. Tom was my fellow for the years 1995-1996
and has been practicing at the MedClinic in Sacramento since completing
his fellowship. I have worked with Tom closely and trained him in hip
and knee joint reconstruction. He is an outstanding surgeon and a caring
and devoted physician. In addition to hip and knee replacements and revisions,
he will also specialize in knee arthroscopy and non-implant shoulder surgery.
These are two areas in which I was not trained and which will add to the
services the practice can provide. We welcome Dr. Blumenfeld to the practice.
I hope many of you will take advantage of his expertise.
A Letter of Introduction
By Thomas J. Blumenfeld, M.D.
“Be kind to the patient, and gentle to the tissues.”
OTTO AUFRANC, M.D.
I tried to write a short letter of introduction about myself, yet realized
two things. Introducing myself to you in the standard way (I trainer here
and there, my life goal is to be mentioned with the greats) came across
as an early obituary. I also felt that what I hope to do is more important
that what I have done. Therefore, the following is written to give you
an idea of why I am here.
In 1945 at the request of Dr. Paul Guttman, my grandfather, Charles M.
“Morrie” Blumenfeld, left academia and a research career devoted
to understanding cancer, and came to Sacramento. From 1945 to 1978 he
was a figurehead in pathology at Sutter Memorial Hospital. Over the course
of his career he brought many advancements to medicine. He foresaw the
need for rapid attainment and dissemination of medical information and
brought the first computer for medical use to Sacramento, he brought the
first electron microscope to Sutter, developed an automated chemistry
analyzer and later after training with Papincolau brought the pap smear
to Sacramento an accomplishment of which he was most proud. When not busy
in medicine he found time to invent the “Pool Sweep.”
I lived with my grandparents during a very formative time in my life,
when I was unsure as to what to do. My grandfather taught me of his deep
love and respect for medicine and for the good that the wise practice
of medicine can bring. Because of his influence, a dropout political science
major working as a union laborer went back to school at U.C. Davis, attended
Tufts for medical school, stayed for residency, then did a fellowship
with Dr. Bargar to fulfill my vow. When I left for medical school in 1986,
my grandfather said, “Tom, medicine is a stern mistress. Treat her
well and you will love the day you become a doctor; treat her poorly,
and you will rue that day.” On that same day I promised him that
I would return to Sacramento and keep the family name alive in medicine.
Despite the ravages of managed care, I believe that being a physician
is a wonderful thing. I plan on being here until they drag me out.
Other Transitions
As of July 1, 1997 Dr. Bargar discontinued his fellowship program. For
ten years he has taken an orthopaedic surgeon who has completed his residency,
to be his fellow for one year of additional training in adult reconstructive
surgery of the hip and Knee. Because of the changes brought on in part
by managed care, fewer residents are choosing to do a fellowship in this
area. Therefore, with some sadness, Dr. Bargar has terminated the fellowship
program.
For the past year Dr. Bargar has utilized physical therapist, Cheryl Heincy,
to perform some of the functions of the fellow. She was funded by a grant
from Sutter Institute for Medical Research which expires in June of this
year. Dr. Bargar plans to hire a Physician Assistant (PA) to see patients
with him in the office, assist him in surgery and with rounds in the hospital.
PAs function as “physician extenders” and will at times see
patients independently but under the close supervision of Drs. Bargar
& Blumenfeld. For example, surgical patients will be seen by Dr. Bargar
for their pre-op appointment, have their surgery and be seen at their
6-week follow up. Those patients scheduled for a 3 or 6 month follow up,
as well as an annual visit, may be seen by the PA. Obviously, if there
are problems or concerns, you will be seen by Dr. Bargar.
As a result of these transitions, there will be some changes in the front
office. We plan to consolidate the medical assistant functions for Drs.
Bargar & Blumenfeld with the Physician Assistant taking over some
of the duties of patient callbacks and scheduling for Dr. Bargar.
Attention Patients
Please remember your physician’s time and that of all our patients
are valuable. We schedule appointments according to your request. If you
are having an annual recheck we allot a specific amount of time. If you
have another joint (hip or knee) that you are concerned about, we need
to schedule another appointment or allot more time at your visit so that
your appointment does not run into another patient’s time. Be as
specific as possible at the time you call. Thank you.
Dear Doctor… Q. What are chondrotin and glucosamine sulfates and are they effective
in the management of arthritis? A. Chondrotin and glucosamine sulfates are parts of the molecular
structure of cartilage. They are available as “nutritional supplements”
and therefore are not controlled by the FDA. Various individuals and companies
are claiming that these “building blocks” of cartilage are able
to regenerate worn and arthritic cartilage. There is no scientific proof
of this. Many patients who have taken them, however, say their joints
feel better. The mechanism for this is unclear and there may be significant
“placebo effect” occurring. But it is also possible that they
provide some anti-inflammatory effect. Remember these are not regulated
or controlled substances. Therefore, they may contain other ingredients
that contribute to their effect or cause unwanted side effects. I know
of no untoward effects but patients should be cautious and skeptical of
these substances.
Q. What are Synvisc or Hyalgan Injections? A. These are trade names for hyaluronic acid, which is the major
lubricant in joints. It is now available for injections into the knee
joint. According to the companies marketing them, they are indicated for
patients with degenerative arthritis of the knee who are not yet candidates
for surgery, but who can’t take anti-inflammatory medications, or
in whom they have not been effective. They are given as a series of weekly
injections into the knee joint for three weeks (for one company) or five
weeks (for the other company).
These substances were not developed by orthopaedic surgeons and the results
of their pre-FDA trials were not published in orthopaedic literature.
Therefore, we are a little skeptical of their efficacy at this time. According
to the studies published in conjunction with rheumatologists, they are
comparable in the degree of relief to anti-inflammatories. If they work,
their effect can last up to eight months. They are also expensive. Each
injection costs about $500.00. At this time many insurance companies do
not cover them and Medicare coverage is variable.
Because of the limited indications of only moderate degree of pain relief
and high cost, we are taking a wait-and-see approach, looking for more
studies by orthopaedic surgeons.
Medicare Beneficiary Freedom to Contract: A Patient’s
Point of View
By Mrs. Robert (Jo) King of Grass Valley, California
During the last twelve months, my husband successfully underwent two total
knee replacement surgeries by Dr. Bargar. We were very fortunate to experience
success and extremely good pre- and post-operative care from the surgeon
and his support staff. At the beginning of the process, we discussed provider
compensation for these services. When we discovered the low rate of provider
payment Medicare and our supplemental insurance provided, we asked if
this covered all the costs. As many of our generation, we were concerned
that our level of care might be impacted by any reduced rate of pay. We
were told that the costs were covered, barely, but it is illegal for the
provider to accept any payment in addition to that made by Medicare and
the supplemental insurance. If the provider accepted additional payment
from the patient, the provider would be penalized for a two-year period
wherein no Medicare claims could be made. In our case there was no reduction
in the level of service and care provided. We have heard that all Medicare
patients are not as fortunate as was my husband.
Two pieces of legislation are now being considered by Congress that would
allow separate contracts between providers and patients without the two-year
penalty. The House of Representatives will vote on HR 2497 and the Senate
will vote on SB 1194. We would prefer that this proposed legislation included
provisions for patients to pay what they could afford in addition to the
Medicare payment. While these bills do not allow that, they are a step
in the right direction and we will ask our Senators and Representatives
to support them.
Will writing letters or calling make a difference? Yes, they will –
more than any protest march or demonstration will ever do. Contact with
our Congressional leaders means votes. Our elected representatives do
not read every word of our letters, but they do count the number of letters,
phone calls, faxes and e-mails they receive for or against any issue.
You can be sure that if enough of us let Congress know how we feel, they
will represent us accurately. Their future in elected office depends on
it.
Dr. Bargar’s comment (to Medicare contracting)
These bills are not very popular with legislators, but they are vital
to keeping the best doctors in the Medicare system. Without them, the
best physicians and surgeons will drop Medicare entirely when the decline
in reimbursement reaches their break-even point. The AARP thinks they
will increase the cost of medical treatment for Medicare beneficiaries.
They may be right, but this is preferable to having no treatment at all,
or treatment by the least qualified physicians. I urge you to write your
legislators and ask them to support this legislation.
Joint Parade
A Joint Parade will introduce a new fun walk in Chico on August 29th at
Bedwell Park with a shotgun start at 9:00 a.m. The Chico community is
excited to see the Arthritis Foundation getting more involved. The goal
is to raise $10,000 for chapter programs and services. Teams consist of
ten or more walkers and to honor the 59th Anniversary of the Foundation,
raising $50.00 per team. If you would like to take part in this event,
contact Tony George in the Chico area at (530) 345-8595 or Patrick Dunlap
of the local chapter in Sacramento at (916) 368-5599. JOIN US!
Golf Tournament
We are planning to take a swing at rescheduling the golf tournament previously
scheduled last October but postponed due to early rain. Money raised will
be earmarked for orthopaedic research. The specifics have not yet been
carved out but if you are interested, please contact Mr. Bob Jones after
May 10th at (530) 274-7767 or by fax at (530) 477-0305.
Free Support Groups For Patients… Arthritis – Held monthly, every third Monday, 6:30-8:30 p.m.
at Sutter Health Administration Building, 2800 L. Street in the 1st Floor
Classroom. Call 1-800-847-9031 Back Pain – Held quarterly at Sutter Center for Rehabilitation,
Thursday from 6-7:30 p.m. at 1201 Alhambra. Call 1-800-847-9031 Joint Replacement – Meets monthly every fourth Monday from
9:30-11 a.m. at 1201 Alhambra. Call 1-800-847-9031 Pre-Joint Replacement Class – Meets monthly every Tuesday
from 2-3 p.m. at SGH Conference Room A. Call 1-800-847-9031.
Transitions