Category Archives: The Practice of Medicine

Challenges, successes shared with UNC faculty

Fall has most assuredly arrived in Chapel Hill. The leaves are especially colorful this year, the morning air has been crisp more than once, and, as dean of the UNC School of Medicine I had the honor of delivering my fall address to the faculty.

This year provided ample reason for reflection. We have faced many challenges, many of them stemming from the financial crisis that was felt by individuals and institutions around the world. But I was also able to cite a long list of accomplishments for which the faculty deserve much of the credit. Among those I mentioned:

¢ We graduated and matched a wonderful class of medical students, and we filled all of our own residency positions with outstanding doctors

¢ We again ranked second overall for primary care on the U.S. News & World Report Best Medical Schools list; and we were twentieth overall and sixth among public schools of medicine for research

¢ UNC Hospitals was included among the U.S. News & World Report Best Hospitals, and ranked among the top 5 percent in H-CAPS scores

¢ We received the third highest score among all hospitals for patient satisfaction with nursing

¢ We opened two world-class facilities: the Genetic Medicine Building, the most sophisticated science building ever constructed at UNC, and the long-awaited North Carolina Cancer Hospital, which welcomed its first patients in August

¢ UNC faculty received more than $350 million in research grants in 2009; our funding from the NIH has increased 15 percent since 2007

¢ As of October, the medical faculty have received 150 awards totaling almost $50 million from the American Reinvestment and Recovery Act (the Stimulus bill)

However, the loss of jobs across the state has had a significant impact on UNC Health Care because of the growth in uninsured North Carolinians. Unemployment across the country weighs heavily as citizens and members of Congress consider health reform. The economy and health care reform were on the minds of many of the faculty at this meeting.

As I have stated in this blog many times before, health reform is an economic issue as well as a health issue. We feel that very acutely at UNC. I repeated to the faculty my belief that every American ought to be insured, and we, as a nation, need to change the way we provide health care to focus on keeping people well.

Fortunately, UNC faculty are also leading the way in creating and expanding new ways to organize and deliver quality health care services in a more efficient manner. We want UNC to be a national leader in this area.

The faculty asked questions about the challenges of our growth, including the scarcity of space. In some respects this is a good problem to have, but it is surely hard to solve, especially quickly. We also talked about our proposed new hospital in Hillsborough.

Because of the economy we have tightened our belt, but the Imaging Research Building is under construction, and we hope to open the Hillsborough hospital, if we get CON approval, in 2014.

Many of our challenges are not unique to UNC. They're faced by practically every academic medical center in the country. However, the level of excellence and the spirit of collaboration and collegiality among UNC faculty sets us apart. It is through their efforts that we answer challenges creatively, and will continue to find innovative ways to conduct research, provide patient care and educate.

Caring for patients in the N.C. Jaycee Burn Center

Our hearts go out to the patients and families of the horrific incident at the ConAgra plant in Garner.

Several hospitals in our area received patients from this tragedy, including our own Rex Healthcare. But those with the most critical injuries came to UNC, where the N.C. Jaycee Burn Center is the largest in the region. Some of these patients will surely require months spent in our burn center, and possibly years of follow-up care.

The families of our patients, like those from other tragedies and traumas, will have a difficult fight, also. Even in the best of times these injuries would be life-altering; in the financial straits in which the country and our state finds itself, they are sure to be doubly so.

UNC has experienced these tragedies numerous times the Kinston explosion in 2003, the crash at Pope Air Force Base in 1994 and the Hamlet chicken processing plant fire in 1991. It is in crises like this one that people are made aware of the burn center, but it is important to know that, according to national data, the average survivor with burns on 50 percent of his body stays in a burn unit almost 58 days, with a mean cost of around $447,000.

The center has 21 ICU beds, making it one of the largest in the country, and there is never a lack of patients to fill each bed.

Dr. Bruce Cairns, director of the burn center and associate professor in the Department of Surgery, very aptly says there is no such thing as a minor burn. Even relatively small burns require special acute care, and lengthy follow up.

Dr. Cairns, the resident physicians, nurses, social workers, therapists and myriad other staff members of our burn center continually perform with at the highest level of professionalism, and I thank them for it. They take very seriously the NC Jaycee Burn Center's mission to support the entire state, and the region, and they show that time and again not only with the excellent inpatient and clinical care they provide, but also with educational outreach programs throughout the state, and they make all of us at UNC proud to work here.

We wish our patients and their families well, and we pledge, as we do for everyone we care for, our commitment to providing them the best care possible.

You can receive updates by following the UNC Health Care News Twitter feed, and this video is an update of the patients and an explanation of burn care by Dr. Cairns and nurse manager Grace Schmits.

CDC manages swine flu

As a new strain of swine flu appears in the United States, the U.S. Centers for Disease Control and Prevention once again takes the lead.

The CDC, based in Atlanta, is uniquely qualified to deal with potential public health crises whether infectious diseases or other challenges. Its epidemiologists and laboratory scientists work in close partnership with colleagues around the world, as they are now, in Mexico, where this H1N1 flu strain first emerged.

Fortunately, we have not had any reported cases of swine flu in North Carolina. But at UNC we are taking the matter very seriously. We are taking extensive precautionary measures to ensure we are prepared to care for patients who might arrive at our doors, and to protect our staff who care for our patients.

The White House and the CDC reported today in a news briefing that each of the 20 people in the United States who contracted the flu has recovered without medical treatment. Basic hygiene practices, such as hand washing, covering your mouth when you sneeze and staying home when you are not feeling well go a long way to controlling the spread of even the most worrisome flu.

I applaud my former colleagues at the CDC, which I directed in the early 1990s, and I wish them the best of luck. They are consummate professionals who work tirelessly to keep the American public safe from threats to their health.

A community discussion on health reform

I have just returned from a large town hall meeting today in Greensboro, on the campus of NC A&T State University.

It was hosted by Governor Bev Perdue and my friend, Nancy-Ann DeParle, the head of the White House Office for Health Reform, and counselor to President Barack Obama. This regional health reform forum was attended by several hundred people, and was well covered by the news media.

I think it served a very useful purpose to tell in compelling fashion what the problems are with our too flawed health care system in America.

A number of real citizens told their stories of the challenges they have had to find and keep health insurance, and their difficulties in navigating our much too complex system.

Nancy-Ann called on me, and I was able to tell the other side of this story what it looks like to try to run a large safety net institution when unemployment is surging and uninsurance is causing a tidal wave of indigent patients to come our way. I cited the figures from a recent NC-IOM study that showed that with each one percent rise in NC's unemployment rate, we lose $14.4 million dollars. Since the rate has gone from the 4+ range to the 10+ range the impact on us is nearly $100 million!

I also said that it is my belief that we have plenty of money in America's health care system we just are not spending it very wisely. And I went on to say that we each will have to be willing to make changes and make sacrifices for the common good.

Finally, I said that I am more hopeful than I have been in many years that we are about to do major health reform and I urged us all to work together to make that happen.

Afterward several of us were able to have a small group meeting with Nancy-Ann DeParle and to talk in more detail with her. I urged her to be bold and to press ahead with this most important effort. I told her that unless each of us are a bit uncomfortable they are not pushing us hard enough.

All in all a very encouraging day. Read more about the event from WRAL-TV, Raleigh here and WUNC radio, Chapel Hill here.

View more of my comments here.

Joe DeSimone — Tar Heel of the Year

Congratulations to my colleague and friend, Joe DeSimone.

A couple of days ago the Raleigh News and Observer named him their Tar Heel of the Year for 2008.

Joe’s innovative work, for which he has gained international recognition, is being put to work in ways that promise to benefit tens of thousands of people with cancer.

We are grateful to the General Assembly and the people of North Carolina for the University Cancer Research Fund. Money from the UCRF is supporting Joe’s amazing work.

Here’s more details about him from the N&O.

What I’m thankful for at the end of 2008…

As the year 2008 comes to an end, I think many of us are glad to be done with it — it has been a year of huge economic challenges, major financial losses, and great frustrations. None of us planned to spend the past several months dealing with these issues. But we have to play the hand we are dealt, and whether we are talking about the world economy, the American financial or health care systems, or UNC Health Care — we simply have to do our best, and work hard every day.

But I am thankful for many things, here at the end of 2008 —

1. The opportunity to work in an institution that does important, consequential things — leading the way with path-breaking research, teaching the next generation of health professionals, and caring for North Carolinians and others from all walks of life.

2. The blessing of getting to spend my days with bright, energetic, committed people — who care deeply about what they do, and what we do together.

3. The privilege of being a part of the finest team of leaders in any academic health center.

4. The honor of working in a state that puts such a premium on public investment and broad collaboration to accomplish great things for its citizens.

5. The ability of UNC Health Care to provide excellent care to so many North Carolinians.

So … I count my blessings most every day. We have much to be grateful for now, and much to look forward to in 2009 and beyond.

Thanks. Bill

Congratulations to UNC’s Dr. David J. Weber

I wanted to take some time to congratulate UNC's own Dr. David Weber, this year's recipient of the H. Fleming Fuller Award, an honor given annually in memory of the Kinston, N.C. physician and founding member of the UNC Hospitals' board who died in 1986. The award recognizes doctors who demonstrate exemplary patient care, as well as excellence in teaching and community service.

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Semiannual Medical Staff Meeting

I had the great privilege of giving an address to our medical staff at their semiannual meeting last Wednesday, and wanted to post my remarks here to share them even more broadly.

Several hundred UNC Health Care doctors and medical staff attended the meeting. It was a pleasure to meet many of them to discuss what was on their minds and how we can continue to improve the patient experience at our hospitals and clinics.

Click on the “More” below to read my speech in its entirety.

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UNC in U.S. News & World Report Hospital Rankings

As I have written before, here at UNC our goal is to become the nation's leading public academic medical institution that means providing the best possible care with the latest evidence and the most compassion possible. I think we are moving toward achieving that goal and programs like the ones we instituted this year as part of the 100,000 Lives campaign exemplify the difference we make in the care we provide.

We have just received some external validation for UNC Health Care's service that I'll share with you. In the July 17 issue of U.S. News & World Report, just out this week on newsstands, hospitals across the country are ranked for the specialty care that they provide. This year, seven of our departments received top-50 rankings in the issue:

¢ Cancer, 41
¢ Digestive Disorders, 26
¢ Ear, Nose & Throat, 18
¢ Gynecology, 16
¢ Kidney Disease, 29
¢ Urology, 32
¢ Psychiatry, 22

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