Posts Tagged ‘Bob Sallis MD’

You don’t have to be a gym star to preserve your good health

posted on March 4, 2013
Kaiser Permanente Every Body Walk! campaign graphic: Anatomy of Walking

By Lincoln Cushing, Heritage writer

In January 2011, Kaiser Permanente launched the “Every Body Walk!” public awareness campaign.  Chairman and CEO George Halvorson kicked off the initiative in his weekly celebration letter to all employees and physicians on January 14, 2011:

“It is time to celebrate walking. There are very few things that we can do that have a more positive impact on our health and our lives than walking. . . Kaiser Permanente is on a new path, so to speak, to encourage everyone in America who can safely walk, to walk. The theme is — Every Body Walk!”

Walking a prescription for health

Bob Sallis, MD, family physician at Kaiser Permanente Fontana (Calif.) Medical Center and the national spokesperson for the campaign, described the goals for Every Body Walk:

“The aim of the campaign is to inform Americans about the tremendous health benefits of walking. Walking is an excellent form of exercise for everyone. For those with conditions like diabetes, asthma, heart disease and depression, a regular walking regimen has the added benefit of helping to manage these diseases.

Bob Sallis, MD, Kaiser Permanente’s national walking advocate, talks with U.S. Surgeon General Regina Benjamin MD, during a 2012 national walking movement conference.

“I’m a strong believer in the power of walking and that’s why I literally prescribe it to my patients as front-line medicine — often in place of medications.”

From a public health point of view, the campaign is important because it addresses the many people that don’t get what is commonly thought of as “regular exercise” – going to a gym, playing tennis, or riding a bicycle.

Every Body Walk! encourages a modest amount of activity, thus opening up a new path to healthy behavior for millions of people. The campaign provides news and resources on walking, health information, walking maps, help in finding walking groups, as well as a place to share stories about individual experiences with walking.

 

Research validates value of walking

Medical research shows that walking 30 minutes a day, five days a week, can prevent the onset of chronic diseases, or help manage them. The roots of this prescription can be found in a 1996 report by the U.S. Department of Health and Human Services, Physical activity and health: A report of the Surgeon General.[i]

The research supports the common-sense and empowering notion that some exercise is better than none, and any approach to encourage activity will have positive health benefits:

“Emphasizing the amount rather than the intensity of physical activity offers more options for people to incorporate physical activity into their daily lives. Thus, a moderate amount of activity can be obtained in a 30-minute brisk walk, 30 minutes of lawn mowing or raking leaves, a 15-minute run, or 45 minutes of playing volleyball, and these activities can be varied from day to day . . . Through a modest increase in daily activity, most Americans can improve their health and quality of life.”

Recent studies confirm concept

Subsequent medical research amplified the benefits. A 2002 study by the Centers for Disease Control and Prevention found that patients who ate a healthy diet and engaged in moderate physical activity for 30 minutes a day, five days a week, reduced their risk of getting Type 2 diabetes by 58 percent.[ii]

A 2010 prostate cancer study found: “A modest amount of vigorous activity such as biking, tennis, jogging, or swimming for less than three hours a week may substantially improve prostate cancer-specific survival.”[iii]

Sidney Garfield, MD, Permanente founding physician, walking in Mojave Desert near the site of Contractors General Hospital, 1980

Recent research at Oregon State University’s College of Public Health and Human Sciences suggests the health benefits of small amounts of activity – even one- and two-minute increments that add up to 30 minutes per day – can be just as beneficial as longer bouts of physical exercise achieved by a trip to the gym.

The study, which involved a broad demographic of more than 6,000 American adults, shows that an active lifestyle approach, as opposed to structured exercise, may be just as effective in improving health, including the prevention of metabolic syndrome, high blood pressure, and high cholesterol. Lead author of the study, Paul Loprinzi, explains:

“We encourage people to seek out opportunities to be active when the choice is available. For example, rather than sitting while talking on the phone, use this opportunity to get in some activity by pacing around while talking.”[iv]

Garfield walks, jogs in desert

At Kaiser Permanente, innovation is usually framed in the context of deep previous experience. In the mid-1930s, founding physician Sidney R. Garfield, MD, was running a clinic in the Mojave Desert for the workers on the Colorado River Aqueduct project. Guess how the clinic staff stayed fit?

“When we were at the hospital (walking) is what the staff did all the time for keeping fit (and for) exercise, except we’d jog – yeah, we would run, but we’d wait until the sun went down, go out and jog and then would walk along. And about that time the rattlesnakes would come out, and then we’d really jog.”[v]

History is repeating itself, and we’re all the better for it.

 

See “Gift of Walking,” a short video featuring Kaiser Permanente Chairman and CEO George Halvorson.

Short URL for this story: http://bit.ly/WHcZbv


[i]U.S. Department of Health and Human Services. Physical activity and health: A report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, 1996. < http://www.cdc.gov/nccdphp/sgr/pdf/execsumm.pdf[ii]CDC Statement on Results of Diabetes Prevention Program
Reducing the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine has published a new article by Knowler WC, Barrett-Connor E, Fowler SE, et al entitled “Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.” N Engl J Med 2002 Feb 7;346(6):393–403.
[iii] “Physical Activity and Survival After Prostate Cancer Diagnosis in the Health Professionals Follow-Up Study,” American Society of Clinical Oncology, November 9, 2010
[iv]“Association Between Biologic Outcomes and Objectively Measured Physical Activity Accumulated in [greater than or equal to] 10-Minute Bouts and [less than] 10-Minute Bouts,” Paul D. Loprinzi, PhD; Bradley J. Cardinal, PhD. American Journal of Health Promotion, Jan/Feb 2013. http://ajhpcontents.org/doi/pdf/10.4278/ajhp.110916-QUAN-348
 [v] Unedited transcript of Dan Scannell (Kaiser Permanente Audio-Visual Department) interview with Sidney R. Garfield, 2/27/1980. Filmed near the site of the original Contractors General Hospital (1933-1938) at Desert Center, California, between Palm Springs and the Colorado River. TPMG P1357

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Southern California Kaiser Permanente doctors nurture academic culture

posted on February 13, 2013

By M. Rudolph Brody MD and Sam Sapin MD Kaiser Permanente Southern California

Rudy Brody, MD, second from left, takes residents on rounds at Los Angeles Medical Center.

First of Two Parts 

Permanente’s pioneering physicians started out in the 1940s with the idea of developing an academic environment in which to practice medicine. Accustomed to the university-based hospitals in which they got their training, these not-so-traditional doctors relished the idea of keeping their strong connection to academia. Group practice, which allowed for convenient consultation with colleagues, was the perfect vehicle.

In the late 1940s, Southern California Permanente Medical Group physicians presented interesting and challenging cases for their peers twice per week at the medical centers. More in-depth discussions took place at half-day departmental educational activities that included organized rounds at various hospitals, teaching and research.  Often the medical group hosted visiting professors who presented and led discussions.

Rudy Brody, MD, is the retired director of the Center for Medical Education at the KP Los Angeles Medical Center.

In Northern California, The Permanente Medical Group physicians were taking a similar route. Doctors were given a half day a week to pursue academic opportunities, including teaching, learning and research. By 1969, San Francisco and Oakland medical centers had graduate medical education programs, and each facility had a chief of staff for education.

Beginning in 1955, SCPMG invited medical experts renown in their fields to lead specialty symposia and share new clinical information. Research, mainly on clinical topics, flourished. Without knowing it, SCPMG physicians were practicing in an environment that met the definition of an academic medical center.

Cross-pollinating medicine and academia

What is an academic medical center? Let us take you back one hundred years in American medicine to explain:

In 1910 the Carnegie Foundation asked educator Abraham Flexner to review the quality of the 155 medical schools then operating in the United States and Canada. Flexner visited each one of the schools and prepared a voluminous report that would result in all but five of the schools being declared deficient and forced to close.

Sam Sapin, MD, in 1979. Sapin was SCPMG’s first director of Education and Research, taking on that position in 1972. In this capacity, he oversaw the development of residency and other educational programs.

The Flexner Report spurred a revolution in medical education, and the academic standards set at the time of its release are still pertinent today. In his investigations, Flexner identified Johns Hopkins University School of Medicine as the model for all institutions qualified to train new physicians.

The Johns Hopkins model set down three must-haves for an institution qualified as an academic medical center: 1) a clinical setting where new physicians can gain experience treating patients, 2) high quality teaching and 3) a research program.

Academic bent attracted like-minded colleagues

Starting out a few decades after the Flexner Report’s release, Kaiser Permanente pioneers understood the value of high-quality physician education.  Our early physician leaders created educational opportunities at the medical centers and encouraged all doctors to participate. Many physicians taught at local medical schools. With this academic mindset, SCPMG attracted many new physicians who had recently finished their post-graduate residency and/or fellowship training.

With a large clinical practice and excellent continuity of care, Kaiser Permanente medical centers also began to attract medical students looking for a clinical rotation. Next, residents from local university residency programs came to Kaiser Permanente for an elective experience. This led to residents affiliated with medical schools rotating through the Fontana and Los Angeles Kaiser Permanente medical centers.

In the mid-1950s, SCPMG physicians began to ask themselves: Why not develop our own independent residency programs? The three assets that Johns Hopkins University saw as vital to an academic medical center – opportunities for clinical experience, education, and research – all existed within Kaiser Permanente Southern California.

First SCPMG residency program launched

Led by OB-GYN physicians T. Hart Baker and Jack Halett, the first independent residency program was begun in 1955 at Kaiser Permanente Los Angeles. Dr. Baker, who later became the Southern California regional medical director, had a strong academic background and proven administrative abilities. He teamed up beautifully with Dr. Halett, who had an upbeat personality and a passion for research.

During the early years, a number of the graduates of our OB/GYN Residency Program stayed on after their residencies and devoted their professional careers to SCPMG. These included Ruth Nicoloff, MD, Fred Miyazaki, MD, Harry Richards, MD, and Doug Taguchi, MD.

T. Hart Baker, MD, retired OB-GYN physician, was instrumental in launching the KP Southern California OB-GYN residency program in 1955.

Started in 1971, the pediatrics program initially had one resident, Richard Mittleman, MD, then added Daisy Dolorfino, MD, Jim Heywood, MD, Mary Ellen Friedman, MD, and Phil Mattson, MD. All but one of these pioneer pediatric residents continued their careers at what later became the Baldwin Park Medical Center. Dr. Mattson continued his career at SCPMG in San Diego.

Graduate physician education expands

In the ensuing years, residency programs were started in several other KP medical centers: family medicine at Fontana; internal medicine, general surgery, pathology, urology and pediatrics at Los Angeles; internal medicine at West Los Angeles; and family medicine programs in Orange County, Riverside and Woodland Hills.

Vince Roger, MD, was key to the development of the Family Medicine Residency in Fontana. Dr. Roger also oversaw the launch of the Sports Medicine Fellowship in Fontana, which Aaron Rubin, MD, and Bob Sallis, MD, have directed since 1990.  Our sports medicine program was among the first 20 that were accredited in the United States in 1993.

Today, SCPMG trains more than 300 residents and fellows in 27 independent residency and fellowship programs in six of Kaiser Permanente’s Southern California medical centers.  About 150 residents at various GME programs in Southern California, including UCLA, University of Southern California, UC Irvine and Loma Linda Universities, rotate through our medical centers for a portion of their training. We can afford to be highly selective because we receive more than 7,500 applications each year for 100 available positions.

Bob Sallis, MD, a champion of KP’s “Every Body Walk!” campaign, and Aaron Rubin, MD, co-direct the Southern California Permanente Medical Group’s Sports Medicine residency program, launched in 1990.

Many people have contributed over the decades to the success of our residency programs. Our list includes our longtime Los Angeles residency program directors:  Jack Braunwald, MD, Steve Woods, MD, Ted O’Connell, MD, Thomas Tom, MD, Jimmy Hara, MD, Aroor Rao, MD, Craig Collins, MD, and Scott Rasgon, MD.

Also deserving recognition are: Tim Munzing, MD, program director, Orange County; Walter Morgan, MD, program director, Riverside; Dennis Kim, MD, physician director of the Center for Medical Education; and A. Robert Kagan, MD, an internationally known radiation oncologist.

The growth and prestige of our educational programs result from the work and support of many professionals. We have mentioned some of them in this article, but we realize that many more deserve credit and praise for their contributions.

Next time: Southern California Kaiser Permanente residents take their care to the community.

M. Rudolph Brody, MD, is the retired director of the Center for Medical Education at the KP Los Angeles Medical Center. A pediatrician, he helped create and develop SCPMG’s Pediatric Residency Program and was the first pediatric residency program director (1970-1990). He was the regional coordinator for all the Southern California Residency Programs from 1983-1992.

Sam Sapin, MD, a retired pediatric cardiologist, was SCPMG’s associate medical director for Clinical Services from 1982 to 1990 and consultant for Clinical Services until 1994. Sapin was SCPMG’s first director of Education and Research, taking on that position in 1972. Sapin was also a major influence in the development of quality assurance methods.

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