Each year a new team of SHM officers is elected to lend their wisdom, time, experience, and skills in a collaborative effort to help manage the business of our organization, drive new initiatives, and support the society’s mission. At this year’s annual meeting in Washington, D.C., we again witnessed that familiar changing of the guard with the following inductions:
- President Mary Jo Gorman, MD, MBA;
- President-Elect Russell Holman, MD;
- Treasurer Patrick Cawley, MD; and
- Secretary Jack Percelay, MD, MPH.
“Hospitalists are squarely in the spotlight today on key issues affecting patient care, quality of hospital care, hospital leadership, and other concerns. So it is important that we have a strong, hands-on leadership team that is committed to continuing the positive momentum SHM has generated for hospitalists,” says Larry Wellikson, MD, FACP, CEO of SHM. “I couldn’t be more thrilled with our slate of newly appointed officers. Time and again through the years Mary Jo, Rusty, Pat, and Jack have proven that they are active participants, and that they are leaders who will rise to the occasion to help us meet our objectives.”
Dr. Gorman, a charter member of SHM, has been a practicing hospitalist since 1997, when she founded the first hospitalist practice in St. Louis. In early 1999, her group merged into IPC—The Hospitalist Company and grew to become the dominant hospitalist group in the city. In 2001, Dr. Gorman was promoted to vice-president of medical affairs for IPC, responsible for the design and implementation of company-wide programs involving business development, recruitment, physician training, and operations in all of IPC’s markets. In 2003, she was named chief medical officer and today works with more than 300 physicians nationwide to develop programs and strategies that enhance clinical performance and drive the delivery system towards more efficient care and greater patient satisfaction. She also oversees IPC’s physician training, mentoring and retention programs, as well as IPC’s call center nurses, healthcare services and clinical studies.
A cum laude graduate of St. Louis University, Dr. Gorman earned a BA in Chemistry/Biology in 1981, then went on to earn her MD in 1984 from Southern Illinois University School of Medicine in Springfield. In 1996, she earned a MBA from Washington University, Olin School of Business, in St. Louis.
SHM’s new President-Elect Dr. Holman is senior vice president and national medical director for Cogent Healthcare, an organization that manages hospital medicine programs throughout the country. He is responsible for program implementation and management, quality systems reporting and auditing, physician leadership development, and data systems integration. Formerly, Dr. Holman was the medical director of Hospital Services for HealthPartners Medical Group & Clinics, part of HealthPartners, Inc. in Minnesota. There he also was the founder and director of the HPMG Fellowship Program in Hospital Medicine.
A long-time member of SHM, Dr. Holman served on the Board of Directors as treasurer from 2004-2005. He was previously chair of the Leadership Development Committee, chair of the Midwest Council, course director of the SHM Leadership Academy, and a member of the Public Policy Committee. In February 2006 he co-authored the “Update in Hospital Medicine,” which appeared in Annals of Internal Medicine. In 2002, he received the SHM Award for Outstanding Service in Hospital Medicine.
Through the years, Dr. Holman’s commitment to hospital medicine has helped produce nationally recognized standards in the areas of quality improvement activities, models of medical education, observation units, communication systems, compensation plans, case management, surgical co-management collaborations, and patient flow initiatives. Dr. Holman serves on two national editorial boards for medical publications and is currently co-authoring a comprehensive textbook and electronic decision support tool in hospital medicine.
Dr. Holman earned his MD from Washington University School of Medicine in St. Louis and trained as a resident and chief medical resident at the University of Minnesota in Minneapolis.
New Treasurer Dr. Cawley is a hospitalist at the Medical University of South Carolina in Charleston, where he currently serves as interim executive medical director of MUSC Medical Center. He previously served as the chief of the Section of Hospital Medicine, vice chairman of clinical affairs in the Department of Medicine, and associate executive medical director at MUSC Medical Center.
A charter member of SHM, Dr. Cawley has served on numerous committees and was previously secretary of the Board for the 2004-2005 term. He has worked in both academic and nonacademic hospitals and has served as a consultant to numerous hospitals in the development of hospital medicine programs.
Dr. Cawley received his Bachelor of Science in 1988 from the University of Scranton (Pa.) and his MD from Georgetown University School of Medicine in Washington, D.C. He completed an internal medicine residency at Duke University in Durham, N.C. Later this year, he will complete his MBA from the University of Massachusetts-Amherst.
SHM’s new secretary is Dr. Percelay. He is director of Virtua Inpatient Pediatrics, a large pediatric hospital medicine group in Southern New Jersey with 14 full-time hospitalists covering two hospitals. Since 1991, Dr. Percelay has worked in a variety of community-based settings including the general pediatric ward, pediatric sub-specialty units, pediatric intensive care unit (PICU), neonatal intensive care unit (NICU), and the emergency department.
A charter member of SHM and one of the nation’s first pediatric hospitalists, Dr. Percelay currently holds the Pediatric Seat on the SHM Board, in addition to serving on the Public Policy Committee and co-chairing the Pediatric Committee. He has been intimately involved in collaborative Pediatric hospital medicine projects such as the PRIS research network and the Denver 2005 and 2007 Pediatric Hospital Medicine conferences.
Dr. Percelay is also the founding chairperson and immediate past chair of the American Academy of Pediatrics Section on Hospital Medicine and co-authored the AAP policy statement on pediatric hospitalists. He completed his medical school and pediatric training at the University of California at San Francisco, along with an MPH at the University of California at Berkeley.
SHM congratulates these new officers and thanks our 2005 officers (Steve Pantilat, MD, president, William Atchley, MD, FACP, treasurer, and Lisa Kettering, MD, FACP, secretary) for their exemplary work.
Annual Meeting e-Community a Success
If the feedback from attendees at this year’s Annual Meeting was any indication, the inaugural launch of SHM’s Annual Meeting e-Community was a success.
Each year, SHM’s Annual Meeting provides an opportunity for hospital medicine professionals to network with colleagues and take advantage of more than 40 educational sessions during the course of three days.
While the location for the meeting changes regularly, there is a constant desire within the Annual Meeting planning committee (a group of volunteer members) to improve the attendee experience. The Annual Meeting e-Community (AMeC) was designed with that in mind.
The AMeC effectively extended the reach of the annual meeting both before and after the event. Since early April, attendees have been able to access the handouts for the presentations that were given at the event and network with colleagues thanks to dedicated discussion communities. There are also listings of exhibitors scheduled to be in attendance and general information about Washington, D.C., on the AMeC.
Because of the positive feedback received, the e-Community will stay online through early July, giving attendees the chance to download presentations from sessions that they didn’t attend and make contact with colleagues they met while in Washington, D.C.
Attendees appreciated the ability to access meeting materials prior to the event. “The Annual Meeting e-Community gave me a great opportunity to really plan out the sessions that I wanted to attend prior to the meeting,” says William Rifkin, MD, a hospitalist from the Yale School of Medicine.
According to Joy Wittnebert, AMeC project manager, the site was launched in response to feedback from past annual meetings. “Attendees have been consistently telling us that they want to be able to customize their experience and have more opportunities to network with colleagues before and after the event,” she says.
In the coming months, SHM staff will work with the Annual Meeting Committee to analyze additional feedback and begin making plans for the 2007 version of the site.
SHM Education Committee Launches 18-Month Strategic Plan
Helping our members and the hospital medicine community advance in professional growth and development has been on center stage as seen in the SHM Education Committee’s recent completion of an 18-month strategic plan. The plan is a framework designed to guide staff and volunteer leadership as they work to expand the society’s current slate of educational offerings. Inherent in the framework’s design is a focus on taking advantage of the myriad new channels that have come online for delivering educational content.
The plan is rooted primarily in the recently released Core Competencies in Hospital Medicine. The Core Competencies are a benchmark for the development of curricula within the hospital medicine specialty.
“One of the most exciting parts of this plan is its connection to the Core Competencies,” says Geri Barnes, SHM’s director of education and quality initiatives. “The connection means that this is one of the strongest educational plans that the society has put forward.”
A driving force in the creation of this plan was the committee’s desire to expand SHM’s educational offerings through a variety of technologic venues. “In the coming year, our educational offerings will truly become multi-dimensional,” says Scott Johnson, SHM’s director of information services. “As we expand into audio CDs, podcasts, and Web-based offerings, more hospitalists will be able to take advantage of these learning opportunities, which will have profound effects on the hospital medicine movement.”
With the education plan approved by SHM’s Board of Directors at its recent meeting, the Education Committee, chaired by Preetha Basaviah, MD, from Stanford University, will turn its attention to the first stage of implementation—a complete needs analysis. Some research has already taken place as part of SHM’s ongoing internal quality improvement processes.
“The key to the success of our plan is that we will be integrating feedback from hospitalists throughout North America as we move forward,” says Dr. Basaviah. “Ultimately, this kind of communication will ensure that we reach our primary goal: to provide tools and resources that help hospital medicine professionals improve the quality of care that they provide.”
Stay tuned to The Hospitalist for updates on the committee’s progress and an advanced look at new educational products.
Palliative Care: a Core Competency for Hospitalists
By Theresa Kristopaitis, MD, with input from Howard Epstein, MD, and the SHM Palliative Care Task Force
Palliative care is focused on the relief of suffering and support for the best quality of life for patients facing serious, life-threatening, or advanced illness, as well as their families. Palliative care is a general approach to healthcare that should be routinely integrated with disease modifying therapies. It is also a growing practice specialty for appropriately trained healthcare professionals dedicating their practice to the delivery of palliative care services.1
Optimally palliative care is delivered through an interdisciplinary team consisting of physicians, nurses, chaplains, social workers, pharmacists, as well as other disciplines as patient/family needs warrant. Models of palliative care delivery include hospital-based inpatient consultation services, inpatient palliative care units, outpatient and home-based consultation services, and ambulatory clinics. Hospitalists are ideally positioned to start inpatient palliative care services and reap the professional and institutional benefits that palliative care offers. Tools to develop a program can be obtained through the Center to Advance Palliative Care (www.capc.org).
A Core Competency
The skills gained from developing expertise in palliative care are indispensable to hospitalists—even if they don’t formally work with a palliative care team. Palliative care itself is identified as a healthcare systems core competency of hospital medicine.2 In addition, other hospital medicine competencies overlap with those key to palliative care: pain management, care of the elderly patient and vulnerable populations, communication, hospitalist as consultant, team approach and multidisciplinary care, transitions of care, and medical ethics.3 For some of the most challenging, yet common, inpatient clinical scenarios, palliative care and hospital practice can become indistinguishable.
Inpatient Scenarios: How Can Palliative Care Help?
Scenario 1: A patient on chronic long-acting opiate therapy is admitted to the hospital with complaints of pain, nausea, and vomiting.
The appropriate assessment and management of pain is a patient’s right and an institution’s responsibility, yet it is often inadequate.4 Many barriers to effective pain management have been identified, including limited physician undergraduate and graduate training.4,5 A fundamental goal of palliative care is pain relief. In turn, expertise in the pathophysiology of pain and safe prescribing of opioid, non-opioid, and adjuvant analgesics is critical for palliative care physicians. Palliative care training and resources focus on principles of analgesic pharmacology, equianalgesia, changing routes of administration, control of continuous and breakthrough pain, opioid rotation, and adverse effects of analgesics. A comprehensive introduction to the fundamentals of pain management can be obtained via Education on Palliative and End of Life Care (www.epec.net.) Pain Management Module.
Non-pain symptoms can be as troubling for patients with advanced illness as pain. The formal assessment, reassessment, and management of common symptoms, including nausea, vomiting, dyspnea, constipation, fatigue, and delirium, are a primary domain of palliative medicine. Nausea and vomiting, for example, can become a demoralizing symptom complex. Stimuli to the vomiting center can arise from the cerebral cortex, vestibular apparatus, chemoreceptor zone, and gastrointestinal tract resulting in a broad etiologic differential diagnosis.
With a solid understanding of its pathogenesis and pharmacologic and non-pharmacologic therapeutic principles, nausea and vomiting can be treated in the vast majority of patients. Multiple agents addressing multiple mechanisms may be required. Even the nausea associated with complete bowel obstruction often can be successfully palliated, without the use of nasogastric tubes or surgery.6 The End of Life/Palliative Education Resource Center (www.eperc.mcw.edu) is one of many resources with tools to improve a hospitalist’s evaluation and treatment of non-pain physical symptoms.
Scenario 2: A patient with advanced heart failure and his family are overwhelmed by differing consultant opinions on the appropriateness of implantable cardioverter defibrillator (ICD) insertion.
Effective communication with patients is a core responsibility of both hospitalists and palliative care physicians. A complementary—and at times challenging—skill is the ability to promote communication and consensus about care among multiple specialist consultants. Ripamonti and colleagues write, “Almost invariably, the act of communication is an important part of therapy: Occasionally it is the only constituent. It usually requires greater thought and planning than a drug prescription, and unfortunately it is commonly administered in subtherapeutic doses.”6
The American Academy of Hospice and Palliative Medicine UNIPAC series is a resource for physicians to hone their general communication skills, as well as those more specific to palliative care, such as sharing news (often bad) with patients and families and engaging in therapeutic dialogue.8
Palliative care begins with establishing the goals of care with a patient.9 All physicians bring great value to patient care when they are skilled at negotiating goals of care. There are numerous possible goals of care, from prevention, to cure, to prolongation of life, to achieving a good death. Ideally, goals of care should be discussed with patients and families as early as possible in the course of a serious, life-threatening illness. Establishing realistic and attainable goals of care assumes increased importance in the setting of advanced disease, where treatments intended to prolong life may become more burdensome than beneficial.9
As the reader may have experienced, too often these discussions have not taken place or are held late in the trajectory of illness, such as when patients are hospitalized for severe progressive disease or are facing imminent death.10 In the scenario of potential ICD insertion, conversations with patients to clarify device-specific goals are best accomplished before they are placed and in the context of a broader discussion of the patient’s general medical condition and overall goals for care.11 This type of discussion ultimately improves the informed consent process for ICDs and other technologies. ICD recipients should be guided to periodically revisit their goals, particularly when their health status significantly changes.11 Unlike for initial ICD placement, there are no guidelines for disabling already implanted ICDs. The opportunity to discuss this issue with a patient before a crisis or before they lose decision-making capacity is frequently lost and occurs all too often at life’s end.12
Scenario 3: An elderly debilitated woman with advanced cervical cancer has been hospitalized six times in the past two months. She is cared for at home. Her family is tired but they are doing “the best they can.” She is brought to the emergency department again with weakness.
Effective implementation of care management strategies for patients with life-threatening and advanced disease requires assessment of their physical, social, emotional, and spiritual concerns.1 Similarly, family caregivers have their own—often unvoiced—biopsychosocial stressors.13 Physicians directing patient care must appreciate the significance of these multiple issues, even if they are not comfortable or are ill-equipped to handle them on their own. The power of the interdisciplinary palliative care model is that team members evaluate the patient from different perspectives and pool their expertise in addressing the complex needs of their patients and families.8
In some multidisciplinary models, the onus may lie on the physician to recognize the patient and family needs and mobilize the appropriate resources. Coordination of care at home for patients in the later stages of chronic illness may seem daunting during hospital stays. However, by employing measures utilized by palliative care teams, such as reviewing the goals of care, introducing community resources to help patients and families manage at home, providing anticipatory grief and bereavement support, and considering hospice referral, discharge planning and transitions in care can be much more sustainable.14 With these interventions, patients, families, physicians, and hospitals all benefit.
Hospital-based palliative care programs are growing exponentially.15 Hospitalists are in a unique position to continue their development. Even if the time or circumstances are not yet right for you to become a part of a formal palliative care program, there are daily opportunities to reap rewards from the knowledge, attitudes, and skills that palliative care training offers.
- National Consensus Project for Quality Palliative Care: The development of practice guidelines 2004. Available at www.nationalconsensusproject.org. Last accessed April 28, 2006.
- Pistoria MJ, Amin AN, Dressler DD, et al. The core competencies in hospital medicine. J Hosp Med. 2006;1:2(S1).
- American Board of Hospice and Palliative Medicine. Available at www.abhpm.org. Last accessed April 28, 2006.
- Phillips DM. JCAHO pain management standards unveiled. JAMA. 2000;284:428-429.
- Sullivan AM, Lakoma MD, Block SD. The status of medical education in end-of-life care: a national report. J Gen Intern Med. 2003;18:685-695.
- Ripamonti C, De Conno F, Ventafridda V, et al. Management of bowel obstruction in advanced and terminal cancer patients. Ann Oncol. 1993 Jan;4(1):15-21.
- Buckman R. Communication in palliative care: a practical guide. In: Doyle D, Hanks GWC, MacDonald N, eds. Oxford Textbook of Palliative Medicine. New York: Oxford Community Press; 1993:47-61.
- Storey P, Knight CF. UNIPAC five—caring for the terminally ill—communication and the physician’s role in the interdisciplinary team. In: Hospice/Palliative Care Training for Physicians—A Self Study Program. New York: Mary Ann Liebert; 2003:1-147.
- Morrison RS, Meier DE. Palliative care. NEJM. 2004;350:2582-2590.
- Quill TE. Initiating end of life discussion with seriously ill patients: addressing the “elephant in the room.” JAMA. 2000;284:2502-2507.
- Berger, JT. The ethics of deactivating implanted cardioverter defibrillators. Ann Intern Med. 2005;142:631-634.
- Goldstein NE, Lampert R, Bradely E, et al. Management of implantable cardioverter defibrillators in end-of-life care. Ann Intern Med. 2004;141:835-838.
- Levine C. The loneliness of the long-term caregiver. NEJM. 1999;340:1587-1590.
- Meier D. Palliative care in hospitals. J Hosp Med. 2006;1:21-28.
- Morrison RS, et al. The growth of palliative care programs in United States hospitals. J Pall Med. 2006; 8 (6):1127-1133.
Get a Job!
SHM Launches the first-ever career Web site exclusively for hospitalists
By Jeannette Wick
Job boards—Internet sites designed to allow employers and prospective employees to find each other electronically—are among the most active Internet sites. For many job seekers Monster.com, CareerBuilder.com, and Indeed.com (among others) have become essential job search tools. Until now, however, no site has catered to healthcare professionals in general—much less to hospitalists in particular.
Thanks to the new SHM Career Center (http://hospitalmedicine.org/careercenter), though, things are about to change. The Career Center is part of a comprehensive, “cradle-to-grave” approach SHM is taking to assist hospital medicine professionals in their career development pursuits. The site offers numerous advantages over traditional job-hunting tools, such as classified advertisements, personal contacts, and randomly mailing resumes to interesting employers—advantages such as the ability to post your resume in a searchable database, a database of open positions across North America that you can search using a variety of variables and the opportunity to receive a notification when a job that matches your criteria is posted online.
The Career Center also represents an improvement over general job boards because the pool of positions offered and solicited on the site is restricted to those only for hospital medicine professionals. The site is free for all, although SHM members are able to take advantage of certain “members-only” functionality (resume posting, e-mail notification of new job postings). “Career opportunists,” or hospitalists who are gainfully employed but constantly curious about what else is available, will enjoy this site, too.
The Way it Works
SHM’s Career Center matches applicants and jobs using search features that allow applicants to tailor their search. As an applicant, you enter your job preferences as you would when searching for an article in PubMed or when looking online for a board-certified specialist in a specific geographic region when referring a patient. The boxes prompt you to provide the minimum information necessary for an acceptable search. For example, you need to provide geographical preferences, the type of position you’re looking for, and the specialty area you’re interested in to best tailor your search.
Visitors can browse all jobs by specialty or state—or view the complete list of jobs. The advanced search option augments the specialty and state fields with the ability to specify keywords (see “Hospitalists and Keywords,” p. 10), specialty, employment type (full time, moonlighting, and so on), and the announcement opening date. (The latter is important to applicants who believe older announcements raise a red flag indicating conditions that make it unattractive to candidates.)
The advanced search option also allows you to look at job summaries with the results. So instead of receiving a simple list of the job title, the location, and the announcement date, the summary includes a short description of the position. But visitor beware: You have to click a box to make this happen. Otherwise, your search will create a simple list of jobs, and clicking on any individual job will bring up the job summary. The information is accessible either way.
Most job seekers will find the site quite easy to navigate, although a few may be impeded by cookies. (For more information, see “Got Cookies,” p. 10.) The FAQ area is a site strength and will help you eliminate hurdles, from inability to navigate the site, to figuring out how to be notified electronically when new jobs are added.
Once you enter your search criteria, a list of jobs displays. Then click on a specific job to open another page describing the position in great detail. After seeing the array of positions available, SHM non-members are likely to join the society just to have access to the full functionality of the Career Center.
Your next step is to create an account; doing so allows you to apply for positions with just a click. Once you establish an account (a process that takes just a few minutes), click on “Edit My Profile.” In this area, you’ll establish your profile.
Meat and Potatoes: Post Your Resume
The Career Center’s features are state-of-the-art. You can create a resume and a cover letter. To post your resume in “My Account,” for example, select “Post My Resume,” then “Document Management,” and then “Resume.” You’ll need to open a plain text version (no bold, underlining, italics, or bullets) of your current resume on your computer, and then copy your resume to the clipboard.
Never done this before? Here again, you can open a guidance window or a printable FAQ to walk you through the process. Two minor system limitations appear here: You must click a box to make the text wrap automatically, and the site has no spell-check function. You have to spell check your cover letter and resume before you copy and paste. If you edit your text at any time while in the Career Center boxes, then be sure to proofread to ensure you haven’t introduced any errors. After you create your resume, you can open a text version (a file that ends in the suffix .txt) to see how employers will view it.
In the past, hospital medicine applicants could stand out with a well-formatted resume on quality paper. Online documents force every applicant’s information into the same mold, and this often concerns applicants. Will a skilled, tri-lingual, well-published hospitalist look like every other applicant when an employer is looking at a simple text version of your resume?
The Career Center allows you to upload up to three formatted documents that can be attached to applications. If you are unable to upload your documents, you may e-mail them to the site, which will then attach them to your account. Some applicants find it useful to have two specific types of resumes on hand: a traditional reverse chronological resume that emphasizes experience, and a less structured functional resume that describes transferable skills.
Depending on your computer savvy, the time it takes to set up your account and load your resume will vary. Hospitalists with robust skills may be able to load a resume in fewer than 30 minutes, but it may take longer for others. Regardless, the return on investment is large because the information you enter will form the foundation of your materials that a perspective employer will review. Once your resume is loaded, applying for a position only requires a few clicks.
Benefits That Make Your Search Sizzle
If you are an SHM member, the “Job Agent” functionality allows you to receive weekly updates of new jobs added that match your search criteria. (Note: You can join SHM online through the Career Center or by visiting www.joinshm.org) This function is located in your account. It allows you to specify the date you would like to stop receiving notification e-mails. Your account also tracks applications submitted.
After you log in, click “Job Applications” to display any jobs you have applied for and the date that the application was submitted. When a job posting expires (according to a pre-established date set by the employer) a strikethrough line will appear through the job application. Applications remain in your account for 90 days from the submission date. Clicking on the “Apply for this Job” icon opens a new screen, and it allows applicants to edit applications even after you’ve sent it and until the job posting closes. Once the job posting is closed, no application changes can be made.
Employers post their vacancies for 30 days at a time, and they can select packages that include print advertisements in The Hospitalist and/or the Journal of Hospital Medicine. Approximately 85% of employers who advertise in print media also advertise on the Career Center, although a few advertise only on the Career Center. To cover your bases, look in all three places.
Just as some applicants prefer anonymity, some companies choose to list their ads confidentially. In these cases, you will submit your online application, and the employer will contact you via the system with more information if you are a good match.
Employer responses will be forwarded to your e-mail account through the Career Center. Once you begin talking with a prospective employer, it is up to you to use good research and interview skills to ensure that this is indeed a good match. When you find a position, you can remove your resume from circulation. Or, you can store it in the Career Center database for future opportunities by clicking “No, do not post my resume.”
Alternatively, you can remove your information from the database permanently: Go to “My Account” and select “Delete Account.”
What the Future Holds
SHM’s information services team will keep tabs on the recently launched SHM Career Center Web site and invites user feedback—specifically any demographic information that will help them build the most practical, useful career site for hospitalists.
With the average age of a hospitalist about 37, SHM expects that visitors and users to comprise a youthful, computer savvy group. Eventually, SHM wants to expand the site so it tells you more than just what jobs are available (e.g., how to create a resume, interview techniques, and how to build desirable hospital medicine skill sets). They will also track how many employer-employee matches are made using the Career Center.
When unemployment is low, as it most certainly is for hospitalists, leverage rests with job seekers, not employers. While employers are looking for talent and availability, career opportunists crave convenience. The SHM Career Center represents the most comprehensive collection of hospitalist opportunities available on the Internet.
Users will find site navigation easy, and prompts and cues offered by the site designers clear and accurate. Traffic on the site is expected to grow quickly as it becomes what SHM hopes is the most indispensable tool for hospitalists conducting job searches.TH
Jeannette Yeznach Wick, RPh, MBA, FASCP, is a freelance medical writer based in Arlington, Va.