A. John Saranko, M.D., 2008 Florida Family Physician of the Year

Florida Family Physician
Official Publication of the Florida Academy of Family Physicians Fall 2008
A. John Saranko, MD
2008 Florida Family
Physician of the Year

Florida Academy of Family Physicians
OFFICERS
President
Timothy Davlantes, MD, Jacksonville
President-Elect
Dennis Mayeaux, MD, Milton
Vice President
George A.W. Smith, MD, Pensacola
Secretary-Treasurer
Bruce Flareau, MD, Clearwater
Board Chair
Cyneetha Strong, MD, Tallahassee
Directors
TERMS EXPIRE 2009
David Feller, MD, Gainesville
John Gross, MD, St. Petersburg
Robert Raspa, MD, Jacksonville
Coy Irvin, MD, Gulf Breeze
Caroline Van Sant-Crowle, MD, Palm Harbor
TERMS EXPIRE 2010
Marvin Dewar, MD, Gainesville
Jennifer Keehbauch, MD, Orlando
Martha Price, MD, Tampa
Greg Sloan, MD, Chipley
Anne Waldron, MD, Jacksonville
TERMS EXPIRE 2011
Gregg Gutowski, MD, Plant City
Amber Isley, MD, Orange Park
Ira Pearlstine, MD, Port St. Lucie
Marc Rivo, MD, Miami Beach
Bernd Wollschlaeger, MD, Miramar
EX-OFFICIO DIRECTORS
(Family Medicine Department Chairs)
H. James Brownlee, MD, Tampa
R. Whit Curry, MD, Gainesville
E. Robert Schwartz, MD, Miami
Daniel J. Van Durme, MD, Tallahassee
RESIDENT DIRECTORS
Carrie Vey, MD, President (Daytona Beach)
Brooke Orr, MD, Vice President (Clearwater)
Terreze Gamble, MD, Secretary-Treasurer
(Tallahassee)
STUDENT DIRECTORS
Catherine Crawford (University of Miami)
Raj Mehta (University of Florida)
Coren Menendez (University of South Florida)
Kim Plumitallo (Florida State University)
DELEGATES/ALTERNATE DELEGATES
Delegates
Alma Littles, MD, Tallahassee
Dennis Saver, MD, Vero Beach
Alternate Delegates
Amber Isley, MD, Orange Beach
Donald Twiggs, MD, Callahan
Florida Family Physician
Volume 57 • Issue 1
Florida Academy of Family Physicians
6720 Atlantic Boulevard • Jacksonville, Florida 32211-8730
(904) 726-0944 • (800) 223-3237 • Fax (904) 726-0923 • www.fafp.org
FAFP Staff:
Tad P. Fisher, Executive Vice President (tad@fafp.org)
Camille Adams, Director of CME Programs and Exhibits (camille@fafp.org)
Mary Jo Griseuk, Director of Membership Development (maryjo@fafp.org)
Joyce Lowe, Comptroller & Executive Assistant to the EVP (joyce@fafp.org)
Annelle McClean, Director of Meeting Planning
& Director of Resident & Student Relations (amcclean@fafp.org)
Kathy Short, Administrative Assistant (kathy@fafp.org)
FAFP Consultants:
Ed Shahady, MD, Director of Centers of Office Practice Excellence (eshahady@att.net)
Jim Daughton, Metz, Husband & Daughton, Legislative Consultant (jim.daughton@metzlaw.com)
Christine P. Fisher, Director of Public Affairs (cpf1219@aol.com)
Amanda Fliger, Moore Consulting Group, Communications Consultants (amandaf@moore-pr.com)
Ray Lowe, EHR Now! Project Director (ray_lowe@comcast.net)
Guest Editor:
Jan Larson, MD
Florida Family Physician is printed on recycled paper with soy-based inks.
Florida Family Physician Writing Guide
The Florida Academy of Family Physicians is seeking contributors for its official quarterly journal on such
topics as practice management and physician community involvement, as well as clinical subjects.
Articles can contain up to 900 words. Photos of authors are requested but are not required. Photos should
be emailed as a JPG file scanned at 400 dpi. If you are unsure, e-mail us what you have and we will have
our publisher evaluate it. We are also seeking cover photos that may accompany a feature article or simply
an interesting photo with a two- or three-sentence description.
The editor reserves the right to edit in a reasonable manner for grammar, spelling and punctuation. If there
are any questions regarding content or if any major changes are necessary, the editor will contact the author.
If you have questions, please contact Christine Fisher, FAFP director of public affairs, cpf1219@aol.com.
2008-09 Editorial Calendar
Winter issue (December) copy due to FAFP by October 31, 2008
Spring issue (March) copy due to FAFP by January 31, 2009
Summer issue (June) copy due to FAFP by April 30, 2009
The theme of the winter issue of Florida Family Physician is “Complementary and Alternative
Medicine.” Please contact the Managing Editor, Christine P. Fisher, at cpf1219@aol.com, if you
would like to submit an article. Letters to the editor are accepted.
Published September 2008
FAFP FOUNDATION OFFICERS
President
Daniel B. Lestage, MD, Orange Park
Vice President
Dennis Saver, MD, Vero Beach
Treasurer
Bruce Flareau, MD, Clearwater
Secretary
Tad Fisher, Jacksonville
Amber Isley, MD
Communications Chair & Editor, Orange Park
Carolyn Mayeaux
Editorial Assistant
Editorial Board
Tad P. Fisher
Executive Editor, Jacksonville
Christine P. Fisher
Managing Editor, Jacksonville

Contents
Features
Meet Your New President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Meet Your 2008-2009 Officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Summer Break Away. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2008 Florida Family Physician of the Year:
A. John Saranko, MD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2008 Award Winners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
FAFP Foundation Exceptional Resident Scholar Program . . . . . . . . 22
Projectile Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Extras
To the Editor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Nominees for FAFP Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Physicians Take a Lesson from the Three Little Pigs . . . . . . . . . . . . 28
Florida SHOTS Online Survey Reveals Ease
of Access to Records – Number-One Benefit of System. . . . . . . . . . 29
Volunteers in Medicine Jacksonville
Celebrates Its Fifth Anniversary . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Departments
Calendar of Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Family Medicine in the News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Your FAFP Foundation at Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Residents’ & Students’ Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Medical Curiosities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Florida Family Physician is published by Innovative Publishing Ink.
10629 Henning Way, Suite 8 • Louisville, Kentucky 40241 • Phone 502.423.7272 • Fax 502.423.7979
Innovative Publishing Ink specializes in creating custom magazines for associations. Please direct all inquiries to Aran Jackson, ajackson@ipipublishing.com.
5

Meet Your New President
by Terri Davlantes
It is with tremendous pride that I introduce
you to my husband, Tim Davlantes. Tim
grew up in Grosse Pointe Farms, Michigan,
a suburb of Detroit, with his mother, father
and three brothers. His father worked in the
automobile industry, and his mother was a
homemaker. He is the grandson of Greek
immigrants, and much of his life revolved
around his Greek heritage. Tim learned to
speak Greek so that he could communicate
with his grandparents. He attended Greek
school to learn about the Greek culture and
language; he went to Greek church and
served as an altar boy. He has a multitude of
aunts, uncles and cousins, and their gatherings
resemble a scene out of the movie My
Big Fat Greek Wedding. There is plenty of
Greek food; plenty of Greek line dancing,
which goes on until the wee hours of the
morning; and plenty of boasting and bragging.
And woven throughout all of this is a
deep love and appreciation for the family.
The value placed on the family during his
childhood directly impacted Tim’s career
choice. During medical school at Wayne
State University, Tim most enjoyed those
times when he got to interact with the whole
family, and he appreciated the concept of
developing lasting relationships with his
patients. He also wanted to be able to practice
the wide variety of skills he had learned
in medical school. When it came time to
choose a specialty for his residency, his first
and only choice was family medicine.
Growing up in Michigan, Tim used to detest
the long gloomy winters, when the radio stations
would sponsor contests to see who
could guess the number of minutes of sunshine
that month. It was no surprise that he
applied only to residencies in the South and
on the water. When he interviewed with St.
Vincent’s Family Medicine Residency program,
he instantly knew he had found his
medical home for the next three years.
During residency and the early years of his
practice, Tim was fortunate to have been
mentored by some outstanding family
physicians, most notably Dr. Guy Selander
and the late Dr. Merrill Anderson. These
physicians knew how to communicate, to
The Davlantes family
relate, to teach and to learn. They instilled in
him a love for the practice of family medicine
and a desire to promote family medicine
through involvement with the FAFP.
In the 1980s, when managed-care plans had
begun to appear on the health care scene, Tim
became involved with them as a physician
advisor. This ultimately led to a shift in his
career path, when he accepted a position as a
medical director for Cigna of North Carolina.
During the next nine years, Tim held senior
leadership positions with several managedcare
organizations. Although these roles
allowed him to capitalize on his organizational
and management skills, he very much
missed seeing patients. Therefore, he decided
to return to the practice of medicine, joining
the Mayo Clinic as an assistant professor at
the Mayo Clinic School of Medicine. He
thoroughly enjoys working with the family
medicine residents, having an opportunity to
play a part in their personal and professional
maturation, and sharing with them his knowledge
of and love for family medicine.
Tim and I met at St. Vincent’s, when I was
working as a nurse in the CCU, home on
break from law school. We were married in
1984 and soon began to welcome our four
children into our family. Our lives for the
past 22 years have revolved around the children
and their activities. Elizabeth is 22 and
in her first year of medical school at
Washington University in St. Louis.
Stephanie, 20, is a junior at the University of
Florida majoring in graphic design. Michael
is 18 and a freshman at the University of
San Diego, where he is in the Marines
ROTC program. Christopher, 15, is a sophomore
at Bishop Kenny High School and is
hoping to one day become a chemical or
electrical engineer.
Tim has always believed that a stable home
is the foundation of a happy and successful
family. Likewise, he is convinced that a
medical home is the foundation of healthy
patients who are empowered to make wise
lifestyle choices. The patient’s family physician
is perfectly situated to serve as the
medical home. Tim is looking forward to
devoting much attention during his presidency
to promoting the concept of the medical
home in Florida.
6

CALENDAR OF EVENTS
Health Awareness Events
OCTOBER
5-11: Fire Prevention Week
(www.firepreventionweek.org)
17: National Mammography Day
(www.cancer.org)
Talk About Prescriptions Month
(www.talkaboutrx.org)
Healthy Lung Month (www.lungusa.org)
National Breast Cancer Awareness Month
(www.nbcam.org)
National Domestic Violence Awareness
Month (dvam.vawnet.org)
Halloween Safety Month
(www.preventblindness.org)
NOVEMBER
18: Prematurity Awareness Day
(www.marchofdimes.com)
20: Great American Smokeout
(www.cancer.org)
American Diabetes Month
(www.diabetes.org)
National Alzheimer’s Disease Awareness
Month (www.alz.org)
National Hospice Palliative Care Month
(www.nhpco.org)
National Family Caregiver Month
(http://www.thefamilycaregiver.org)
DECEMBER
1: World AIDS Day
(www.unaids.org/en/default.asp)
7-13: National Handwashing Awareness
Week (www.henrythehand.com)
Safe Toys and Gifts Month
(www.preventblindness.org)
FAFP Future Meetings
New England CME Cruise Getaway
October 4-11, 2008
Royal Caribbean’s Jewel of the Seas
Out of and Returning to Boston
101st Family Medicine Weekend
December 12-14, 2008
The Ritz-Carlton
Amelia Island
102nd Family Medicine Weekend
March 27-29, 2009
Bay Point Marriott Golf Resort & Spa
Panama City
2009 Summer Break Away
July 16-19, 2009
Boca Raton Resort & Club
103rd Family Medicine Weekend
November 13-15, 2009
Buena Vista Palace
Lake Buena Vista
To the Editor
My name is Pamela McDaniel. I just read an article written by Russ
Hostetler, MD, “One Last Class” in the summer 2008 issue of Florida
Family Physician. What a wonderful story! It was very moving to me.
My Aunt Esther died in 2005 from lung cancer. She went from
being a strong and independent woman to having to be bathed
and fed like an infant. It was very hard on her mentally; that
is, until her mind started slipping away from the lack of oxygen.
Watching her fight for air was — well, to be honest
with you, pure torment for me. I felt so helpless. I was her
primary caregiver, and it was by far the hardest thing I’ve
ever had to do.
All I could do was watch her struggle daily with the choice
she made when she was only 8 years old. There wasn’t anyone
talking about tobacco then. She said she started
because her brothers and cousins were doing it. I would get
so upset with her when I was a child and beg her to stop, and
her reply was, “I have to die from something.”
She was 73 when she passed. Having walked that path, I now
choose to talk, and talk a lot (and loud), so maybe I can save someone
the pain that will come from the use of tobacco. I am so thankful
to the doctors who are truly making it their mission to educate
people about the dangers of tobacco and, just maybe, save their lives.
Florida Family Physician 7

MEET YOUR 2008-2009 OF
Timothy M. Davlantes, MD, President
Dr. Davlantes grew up in Michigan and
received both his undergraduate and
medical degrees from Wayne State
University Detroit. He completed his residency
in family medicine at the
University of Florida, Jacksonville, and
practices at the Mayo Clinic in
Jacksonville, where he is an assistant professor
of family medicine. He has served
the patients of Duval County for nearly
25 years.
Dr. Davlantes was elected to the FAFP Board of Directors in 1999
and has also served two terms as secretary-treasurer. He has
served as a member of the FAFP CME Committee, Government
Relations Committee, and the FAFP Foundation Board of
Trustees. He is board certified in family medicine. His memberships
include the Duval County Medical Society and the Florida
Medical Association, and he is a past member of the Health
Planning Council of Northeast Florida Board of Directors.
Dr. Davlantes’ wife, Terri, is vice dean of the Florida Coastal
School of Law. They reside in Jacksonville and have four children:
Elizabeth, Stephanie, Michael and Christopher.
George A.W. Smith, MD, Vice President
Dr. Smith is the medical director of
Escambia Community Clinics, where
the mission is to provide compassionate
care for patients, regardless of their
ability to pay. He was the 2006 FAFP
Family Physician of the Year.
Dr. Smith attended the University of the
West Indies in Kingston, Jamaica,
where he received an MB and BS with
honors in Community Health. He
served a rotating internship and worked
in ambulatory care at the Princess Margaret Hospital in Nassau,
Bahamas, before his residency at Howard University Hospital in
Washington, D.C., where he was chief resident. Before coming to
the Escambia Community Clinic, Dr. Smith was a captain at the
88th Fighter Hospital at Holloman Air Force Base in New Mexico.
He currently serves on the Northwest Florida Area Health
Education Centers Board, of which he is a past president. He is
also an assistant clinical professor with both the University of
Florida and Florida State University.
Dr. Smith and his wife, Maxine, have four children and reside
in Pensacola.
Dennis R. Mayeaux, MD, President-Elect
Dr. Mayeaux, a native of Louisiana,
moved to Florida in the mid-1970s to
attend the University of Florida, where
he received his undergraduate degree in
chemical engineering. He then went on
to receive his MD from the University
of Miami and completed his family
medicine residency in Pensacola. He is
board certified in family medicine with
added qualifications in geriatrics and
holds a faculty appointment with the
Florida State University College of
Medicine at the Pensacola Regional Campus.
Dr. Mayeaux completed two terms on the FAFP Board of
Directors and has served on the Scope of Practice Committee, the
Government Relations Committee, the FAFP Foundation Board of
Trustees and as the FAFP vice president for two terms. He is also
a member of the Santa Rosa Medical Society and the Florida
Medical Association.
Dr. Mayeaux practices with Gulf Coast Physician Partners in
Milton, where he also resides with his wife, Janet, and their three
children. He ran the Boston Marathon twice and is a big band
clarinetist and saxophonist.
8
Bruce Flareau, MD, Secretary-Treasurer
A native of Long Island, New York, Dr.
Flareau began his tenure in Florida as
a family medicine resident at the
Bayfront Medical Center, St. Petersburg.
He received his undergraduate degree
in biology at the State University of
New York at Stony Brook and his medical
degree at the Upstate Medical
Center in Syracuse, New York. He is
currently the chief medical informatics
officer at BayCare Health System
and affiliate professor at the University
of South Florida Department of Family Medicine. He also
holds faculty appointments with Florida State University and
Duke University.
Dr. Flareau served on the FAFP Graduate Medical Committee and
the Quality Practice Management Committee and is a past chair of
the Residency Directors’ Council. He was the 2006 FAFP Full-
Time Educator of the Year Award recipient. He belongs to the
Association of Family Medicine Residency Directors and the
Society of Teachers of Family Medicine and is a certified physician
executive. In 2007, he received the Morton Plant Mease
Physician Award for Excellence in Medicine.
He and his wife, Kathleen, reside in St. Petersburg with their two
children. An avid outdoorsman, Dr. Flareau enjoys caving, scuba
diving, fishing, boating, climbing and rappelling.

FICERS
Cyneetha Strong, MD, Board Chair
Dr. Strong was born in the rural north
Florida community of Quincy. After graduating
from high school as valedictorian,
Dr. Strong attended the University of
Florida, where she earned her undergraduate
and medical degrees. She completed
her residency at the Tallahassee
Memorial Hospital Family Medicine
Residency Program. It was during this
time that she became involved in the
FAFP as a residency representative.
Dr. Strong has served on the FAFP Board of Directors as vice president,
as president-elect and as president, as well as on numerous
committees. Her memberships include the National Medical
Association, the Capital Medical Society, the Florida Medical
Association and the William J. Gunn Medical Society. She is board
certified in family medicine and holds a faculty appointment with
the Florida State University College of Medicine.
Dr. Strong received the FAFP Young Leader Award in 2000.
She practices urgent care and family medicine at Patient’s First
in Tallahassee and enjoys travel, shopping, fine dining and
Gator football.
Nominees for FAFP Office
Please Help Us Identify Academy Leaders for 2009 Elections
The Florida Academy of Family Physicians is looking for quality leaders. Leaders who have the knowledge,
time and commitment to help the Academy determine policy and services that will help the membership deal
with the present challenges and opportunities of practice.
The Board meets three times a year with meetings occurring during
Family Medicine Weekends and the Summer Break Away. Board
members usually serve as a resource to a committee and spend additional
time before meetings reading the Board packets and preparing
for the meetings.
The Nominating Committee will select a slate of officers and directors.
If you have recommendations for consideration of the
Nominating Committee, please call the FAFP office at (800) 223-
3237, or talk with Neil Oslos, MD, chair, at noslos@aol.com.
Any member may nominate an Active member in good standing,
provided he or she follows the guidelines as noted below. Those
nominations (see specific information required) are due by
February 2, 2009, and will appear on the ballot along with the
Nominating Committee’s recommendations that will be sent to
Active, Life and Supporting (FP) members in good standing.
We encourage your input. Please review the recommended guidelines
for various offices, and if you choose to make a nomination,
you must:
1. Verify nominee is an Active member and meets the leadership
guidelines provided below
2. Get a signed letter of interest and willingness to serve from
the nominee
3. Provide nominee’s curriculum vitae or other background information
4. Mail all requested information to the FAFP Office by February
2, 2009
Recommended Guidelines
President-Elect and Vice President
Three years FAFP Board of Directors experience or has served as
secretary-treasurer for three years, or any combination thereof.
Delegate and Alternate Delegate
Shall be serving or have previously served as a director or an officer
of the Florida Academy of Family Physicians.
Board of Directors
Previous FAFP, AAFP, or another state chapter experience. This
includes student or resident positions on the FAFP Board, or three
years active committee experience on any FAFP committee, or committee
chair of a FAFP committee plus a minimum of two years
committee experience.
Florida Family Physician 9

FAMILY MEDICINE IN THE
NEWS
FAFP Member to Lead National Association
The director of the Orange County Health Department is
now leading a national public health association dedicated
to being the guardians of the public’s health.
Orange County Health Department Director Kevin M.
Sherin, MD, officially became the national president of
the American Association of Public Health Physicians
(AAPHP) Saturday, June 14, 2008. The induction ceremony
was held in Chicago at the meeting of the
American Medical Association (AMA).
Dr. Sherin was nominated in 2004 as vice president of
AAPHP and then, by a membership vote, was selected as
president-elect. Dr. Sherin has been involved in AAPHP
since 1990. “It is an honor to serve this association as its
LeaP Awards FAFP Vice President
leader for the term from 2008-2010, especially since this
is a time when health once again is a major focus of dialogue
in America,” Dr. Sherin said.
The mission of the AAPHP is to promote the public’s
health and educate the nation on the role and importance
of the public health physician’s knowledge and skills in
practicing population-based medicine and fostering
communications, education and scholarship in public
health. The association played a major role in advocating
for the tobacco settlement in 1998. The association represents
physicians from all specialties who work in public
health, and who have a passion for and care about
protecting the health of all Americans.
Leadership Pensacola (LeaP) has awarded George A.W.
Smith, MD, the Red Room award, which is given for
service to those less fortunate in the Pensacola community.
Founded in 1982, LeaP is a program of the
Pensacola Area Chamber of Commerce that is committed
to developing community leaders who have a comprehensive
knowledge of the Pensacola area through a network
of leadership in the public and private sectors. Dr.
Smith was the FAFP’s 2006 Florida Family Physician of
the Year, and he was recently elected vice president of the
FAFP. Dr. Smith and his wife, Maxine, and their four
children reside in Pensacola.
FAFP Member Publishes Third Book
AnhVu Nguyen, MD, of Largo, has published his third
book on medical procedures, Medical Perceptions: Fact
or Fiction, with the general public as his target audience.
Dr. Nguyen has also authored nearly 100 articles for a
number of medical publications, including Consultant
Medical Journal, Patient Care and Core Content Review
of Family Medicine. He often lectures on preventing medical
errors and was named the FAFP Volunteer Educator
Award recipient at the June Summer Break Away.
AAFP/Bristol-Myers Squibb Award for
Excellence in Graduate Medical Education
We are proud to announce that three Florida residents in family medicine
have been named for this prestigious award. These recipients will
join an outstanding group of previous winners who represent the most
outstanding family medicine residents in the country. The Awards
Recognition Ceremony was conducted Friday, September 19, 2008, in
San Diego at the AAFP Scientific Assembly.
Congratulations to:
Chris Scuderi, MD, St. Vincent’s, Jacksonville
Peter Swain, MD, Bayfront, St. Petersburg
Carrie Vey, MD, Halifax, Daytona Beach
10

Florida Family Physician 11

SUMMER BREAK AWAY
Kudos and Thanks
2007-2008 CME Committee
Harvey Cassidy, MD, Chair, Jacksonville
Timothy Davlantes, MD, Vice-Chair,
Jacksonville
Sandra Argenio, MD, Jacksonville
Amber Isley, MD, Orange Park
Jennifer Keehbauch, MD, Orlando
Alma Littles, MD, Tallahassee
Jose Rodriguez, MD, Tallahassee
Dennis Saver, MD, Vero Beach
Cyneetha Strong, MD, Tallahassee
Caroline Van Sant-Crowle, MD, Palm Harbor
Doug Walsh, DO, Myakka City
The CME Committee is responsible for the
Florida Academy of Family Physicians’ continuing
medical education program. It has
supervision, review, approval and reporting
functions for all CME activities. It is
responsible for determining education
needs and objectives of FAFP members and
deciding the best way to meet those needs.
The Committee is also responsible for seeing
that the Academy complies with AAFP
and ACCME Essentials and Standards.
2007-2008 Exhibitors
AAFP Ask & Act
Abbott
Alpha-1 Foundation
American Cancer Society, Florida Division
American Express OPEN
Availity, LLC
Avisena, Inc.
Bankers Healthcare Group
Blue Cross and Blue Shield of Florida
Boehringer Ingelheim
Brymill Cryogenic Systems
Cornerstone Wellness.md
Dermpath Diagnostics
eClinical Works
e-MDs
Florida Council on Compulsive Gambling
Florida Drug Therapy Management
Program for Behavioral Health at USF
Florida SHOTS
Forest Pharmaceuticals
FPIC
Hazelden
Hoveround Corporation
iMedica Corporation
JSA Medical Group
Kyphon, Inc.
MAG Mutual Insurance Co.
Masley Optimal Health Center
Mayo Clinic Referring Physician Office
MedAesthetic Solutions
Medtronic (formerly Kyphon)
NCG Medical
Noteworthy Medical Systems
Novo Nordisk, Inc.
Ortho-McNeil Neurologies, Inc.
Pfizer
Pricara
Pro-Assurance
RelayHealth
Roche
sanofi pasteur
Solantic Walk-In Urgent Care
Solvay Pharmaceuticals
SpineMed
Talbott Recovery Campus
UCB Inc.
UnitedHealthcare
U.S. Army Healthcare
Visionary Medical Systems
Florida Family Physician 13

EXHIBITORS
FACES IN THE CROWD
14 14

ANNUAL BUSINESS MEETING
Cyneetha Strong, MD, outgoing president
Pam Rodriguez, AAFP Tar Wars ® program director
Tim Davlantes, MD, incoming president
CME SESSION
Jeff Levine, MD, MPH, Biggest Loser season two winner
CME Program Co-Chairs: Drs. Jennifer Keehbauch, Dennis
Saver, Caroline Van Sant-Crowle
Amber Isley, MD
Florida Family Physician 15
Florida Family Physician 15

INAUGURAL AND RECOGNITION CELEBRATION
Cyneetha Strong, MD
Installing Officer and Past President Guy Selander, MD, and the
Davlantes family
FAFP Past Presidents
Past FAFP Award Winners
FAFP Board of Directors
FAFP Staff: Annelle McClean, Mary Jo Griseuk, Tad Fisher, Camille
Adams and Joyce Lowe
Resident Directors: Terreze Gamble, MD; Carrie Vey, MD; and
Brooke Orr, MD
16
Student Directors: Coren Menendez, USF; and Kim Plumitallo, FSU
16

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magazines for businesses and
associations. Please direct all
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www.ipipublishing.com
Florida Family Physician 17

2008 Florida Family Physician of the Year
A. John Saranko, MD
The Florida Academy of Family Physicians
has selected A. John Saranko, MD, as
Florida’s 2008 Florida Family Physician of
the Year. Each year, the FAFP recognizes an
exemplary family physician who serves the
patient and the specialty above and beyond
the call of duty.
“At a time when falling reimbursement and uncertainty in the medical
profession distract many from just being able to practice, John
Saranko is focused on the patient,” said Tad Fisher, executive vice
president of the Florida Academy of Family Physicians. “Dr.
Saranko is simply a force of nature, as well as grace under fire. He
is a remarkable man whose love of family and patients leaves a legacy
for future family physicians to follow. He is truly second to none.”
Dr. Saranko’s dedication to family medicine and his efforts to
improve the health of all Floridians is evident in his many volunteer
positions. He served as a member of the Board of Trustees of St.
Joseph’s Baptist Healthcare, the Hillsborough County Medical
Association and as Healthcare Communication & Marketing
Association delegate to the Florida Medical Association. He also
served as president of the medical staff at South Florida Baptist
Hospital and on its Board of Directors.
Dr. John and Pat Saranko
Born in Tampa, Dr. Saranko lived in Lithia, a small farming community
in eastern Hillsborough County, until his graduation from
Pinecrest School. He then spent four years in the U.S. Marine Corps,
serving in Scotland, the Mediterranean and Cuba. In 1967, he married
the love of his life, Patricia Hart of South Carolina, and later
graduated from Clemson University in 1971, receiving his medical
degree from the Medical University of South Carolina in 1977. He
then settled in Plant City to begin his medical practice.
Dr. Saranko’s much-deserved honor as Florida Family Physician of
the Year is best explained by those he serves: his patients.
“These days some doctors seem more concerned about the bottom
line than the patient. In contrast, I believe that caring for the health
of families is Dr. Saranko’s calling. Our community is blessed to
have a friend and doctor like him,” one patient said.
“Choosing family practice as opposed to a more lucrative ‘specialty’
speaks to the values of Dr. John Saranko,” another patient of 16
years said. “He is a respected member of our small community and
often finds time to attend local weddings, graduations, parties,
funerals and church functions. Since he is aware of our family histories,
he has a deep insight into many problems concerning health.”
The Saranko family
From another longtime patient: “Dr. Saranko has been our family
doctor for over 20 years. He is very dedicated to his patients, and
18

Distinguished Service Award
Guy T. Selander, MD
he always has time to listen to us. He puts in long
hours of work all for us. You can tell that he really
cares about you and what is wrong with you. We
think the world of our hometown doctor. Dr.
Saranko has even taken time out of his busy day to
come make house calls on my father, who had cancer,
and my grandmother, who died last year at the
age of 100. If she were here, she would tell you
how much she loved Dr. Saranko. You don’t find
many doctors these days who take time to make
sure their patients are getting the best care at
home. I can’t thank Dr. Saranko enough for all he
has done for my family and the community. We are
very proud to have him as our doctor and friend.”
And from Neil Oslos, MD, Halifax Family
Medicine Residency Program: “John has been the
quintessential family physician since the early days
of his residency training. When we were on call at
night, even though he was a senior resident, he was
always first to arrive at the bedside of a patient having
difficulties. He loved OB and spent extra time
at our program after graduation to enhance his
obstetric skills before moving home to open his
practice in Plant City. He also learned some hard
lessons about what patients go through when he
broke his hip waterskiing during the second year
of his residency. Fortunately, this healed well after
surgery and has left him fully capable of outpacing
most of us on one of his beloved bicycles.”
Dr. Saranko was president of the FAFP in 2002-
2003. He, along with his FAFP colleagues, strives
to advance the specialty of family medicine and
promote key issues for the organization, such as
the patient-centered, primary care medical home
concept (where an ongoing relationship with
a physician is established so patients receive
comprehensive care and become active participants
in their health decisions) and the fights
to increase the number of residency slots in
Florida and ensure physicians are accurately and
fairly compensated.
John and Pat Saranko live in Plant City, where they
raised their now-adult children. Their son, Chris,
and his wife, Tammi, are the parents of Lindsy Kate
and Samuel Calhoun; and their daughter, Kim, and
her husband, Andy, are expecting the newest addition
to the Saranko extended family in September.
Drs. Tim Davlantes and Guy Selander
Dr. Tim Davlantes had the pleasure of presenting this award to his friend,
mentor and former boss, Guy Selander, MD, of Jacksonville.
Dr. Selander has served the FAFP
as a Board member, a past FAFP
president, an FAFP Family
Physician of the Year recipient, a
member of the FMA Board of
Directors, a past president of the
FMA and a delegate to the AAFP.
He is our medical statesman.
Today, he continues his service as
a practicing family physician in
Jacksonville, where he and Joan
both are giants in their community.
The following quote by Dag Hammarskjold is inscribed on his plaque:
To Exist In The Fleeting Joy Of Becoming
To Be A Channel For Life As It Passes By
Cool Water, Glittering In The Sunlight
In A World of Sloth, Anxiety And Aggression
To Exist For The Future of Others
Without Being Suffocated By The Present
Dr. Guy and Joan Selander
Thank you, Dr. Selander, for your dedication and service to family medicine,
the patients of Florida and our nation.
Florida Family Physician 19

Full-Time Educator
Walter C. Taylor III, MD
Each year, the FAFP recognizes one
exemplary educator for being a
full-time role model for tomorrow’s
family physicians. Jacksonville’s
Walter C. Taylor III, MD, has been
selected as the FAFP’s 2008 Full-
Time Educator Award recipient.
“Walt Taylor is an excellent family
physician educator at all levels —
graduate, undergraduate and continuing
medical education,” said Dr.
Sandra Argenio, former president
of the Florida Academy of Family
Physicians. “He has been and continues to be an excellent mentor
for his fellow faculty and residents.”
In addition to the Full-Time Educator Award, Dr. Taylor has received
numerous honors from colleagues and residents for his contributions
to teaching. In 1994, Dr. Taylor joined the staff of the Family
Medicine Department at the Mayo Clinic, specifically to pursue the
development of a sports medicine program and fellowship. In 2002,
Dr. Taylor’s dedication brought about the Mayo Sports Medicine
Fellowship, and he was recognized by the Mayo Clinic of
Jacksonville as Teacher of the Year. Additionally, Dr. Taylor received
the Irving Glick Award for his outstanding service to the Women’s
Tennis Association. He continues to serve as the tournament physician
for the Bausch & Lomb Tournament held annually at Amelia
Island. Dr. Taylor was recently appointed program director at the
Mayo Family Medicine Residency Program.
“Walt has been instrumental in implementing our sports medicine
curriculum for our family medicine residency,” Argenio continued.
“He has served as a team physician for local high schools and as the
sports medicine physician for a large number of community and professional
sporting activities.”
Devoted to the practice of family and sports medicine, Dr. Taylor has
been a key player in the development of both areas in the
Jacksonville area.
Part-Time Educator
George R. “Scotty” Whiddon, MD
The FAFP has recognized Scotty
Whiddon, MD, of Tallahassee, as this
year’s Part-Time Educator Award
recipient. While he is being recognized
for his part-time efforts, those of
us who know him well know Scotty
does nothing part-time, least of all
practice family medicine or mentor
students and residents.
“Dr. Whiddon is an integral part of
the community in which he practices
and frequently volunteers to assist
students and others with health fairs,
international trips, sports physicals and other activities to improve the
overall health of the community,” said Dr. Alma Littles, associate dean
of the FSU College of Medicine and former FAFP president. “He is a
favorite of our students for clinical education.”
In addition to the Part-Time Educator Award, Dr. Whiddon has
received the Florida State University Faculty Council’s Mission
Model Award and is one of the Florida Academy of Family
Physicians’ first graduates of the Diabetes Master Clinician
Program. Today, he joins Dr. Shahady as one of the teachers of the
program, which provides model care for patients with diabetes.
The DMCP’s innovative strategies include group visits and a Webbased
disease registry that produces easy-to-understand patient
and practice report cards and strives to combat the patient, physician
and system barriers usually associated with diabetes and
other chronic disease care.
“Dr. Whiddon is an outstanding teacher for medical students at
multiple schools,” said Dr. Ed Shahady, medical director, DMCP.
“Students love that his passion for evidence-based medicine is
coupled with a kind and caring attitude toward his patients.”
20

Volunteer Educator
AnhVu Nguyen, MD
The FAFP has selected AnhVu
Nguyen, MD, Largo, as this year’s
Volunteer Educator Award recipient
— one who continually strives to
improve the practice of family medicine
and the lives of his patients.
“As volunteers, each of us understands
the sacrifice that must be
made to strengthen our communities
and enrich our profession,”
said Dr. Timothy Davlantes, president
of the FAFP. “Dr. Nguyen is
an excellent example of a physician
who goes above and beyond for family medicine and the
health of all Floridians.”
For the past several years, Dr. Nguyen has distinguished himself as
an exceptional family physician, but more importantly, he continues
to give back to his community and state by volunteering to serve as
a teacher and preceptor for medical students and residents at the
University of South Florida College of Medicine and Bayfront
Family Health Center.
“Dr. Nguyen exemplifies the best qualities of an educator through
his continued improvement efforts and frequent teaching and precepting,”
said Dr. David Parrish, director of the Bayfront Family
Medicine Residency Program. “I have known Vu for years, and he is
an energetic author, speaker and teacher. His books and lectures on
medical errors are well-known. He tirelessly works for the betterment
of our specialty as well as improving quality in medicine.”
Dr. Nguyen will continue to share his insight and knowledge with
students to ensure the future is bright for family medicine. As an
organization devoted to the patients, community and betterment of
organized medicine, the FAFP takes pride in recognizing such committed
role models as Dr. Nguyen.
Young Leader Award
Christienne A. Sain, MD
The FAFP Young Leader Award was
established to recognize up-andcoming
leaders who show great
potential to serve the Academy, as
well as who strive to improve the
specialty of family medicine. This
year’s award winner is Christienne
A. Sain, MD, of Tallahassee.
Christie is a native Floridian, born
in Orlando. Prior to going to medical
school, Christie worked for
Patients First North in Tallahassee
as a medical assistant for past FAFP
president Tom Hicks, whom she still considers her role model and
mentor. Her experiences at Patients First, including two medical mission
trips — one to Haiti and one to El Salvador — motivated her to
apply to medical school. She was admitted to the first graduating
class at the FSU College of Medicine.
Christie remained in Tallahassee to do her residency at the
Tallahassee Memorial Family Medicine Residency Program, where
she served as chief resident. She has returned to practice at Patients
First, taking her career in medicine full-circle.
Christie’s commitment to family medicine and the Academy was
apparent very early in her career. She has dedicated herself to many
challenges as an advocate for patients and her medical colleagues.
She became a resident director to the FAFP Board of Directors and
was elected secretary/treasurer and president of the FAFP Residents
Association. She has served as vice president of the American
Medical Student Association and the American Medical Women’s
Association. She has also served as treasurer and vice president for
the Medical Explorers of Florida Hospital, Orlando. More recently,
Christie has taken on the position of statewide coordinator of the
Florida Tar Wars ® Program. We know she will be a great advocate
helping to prevent children from ever using tobacco products.
Christie is a front-line advocate for family medicine. She wants her
family physician colleagues to feel the same pride in the Academy
and specialty that she does. She works at it, engages in debate, listens
to colleagues, works with staff, and hears the needs of her
patients and colleagues.
Christie credits Kenny, her husband of 14 years, with being
“her rock” on her long road to achieving her dream of becoming a
family physician.
Florida Family Physician 21

FAFP Foundation
Exceptional Resident Scholar Program
The Florida Academy of Family Physicians Foundation strives
for excellence in education. Consequently, it is a high priority of
the Foundation to train exceptional family medicine residents in
Florida to provide quality care for the patients in our communities.
We, as a Foundation, believe in investing in the future of
family medicine through our future family physicians. Offering
family medicine residents training in Florida as a token of appreciation
and recognition of their efforts assists with maintaining
and continued recruitment of our best and brightest.
The FAFP Foundation Exceptional Resident Scholar Program is
based on merit and the selected residents are chosen through a
selection committee process. Third-year family medicine residents
each year are chosen and awarded $1,000 each. Residents
with high achievements in academics, political/organizational
activities, research, extra-curricular activities — sports, music
and hobbies — and occupational activities are judged. In addition,
resident award applicants must submit a personal statement
about their reasons for studying medicine and why they chose
family medicine as a specialty.
2008 is the third year of the program, which is being sponsored
through grants provided by the Blue Foundation of
Florida and the Theresa L. Fisher Memorial Fund in the
FAFP Foundation. We extend our sincere appreciation to
Dr. Dennis Saver, vice president, and Dr. Dan Lestage, president
of the FAFP Foundation, for their efforts in securing the
funding for exceptional scholar awards. In addition, we thank Dr.
Saria Carter-Saccocio for her initial leadership in organizing this
valuable program.
The 2008 recipients of the Exceptional Resident Scholar
Program are:
1) Christienne A. Sain, MD, a graduate of Tallahassee
Memorial Hospital Family Medicine Residency Program –
Donald Zorn, MD, Residency Director
2) Delicia M. Haynes, MD, Daytona Beach, a graduate of the
Halifax Medical Center Family Medicine Residency
Program – Ed Prevatte, MD, Residency Director
3) Dani Mathew, MD, MPH, Palm Harbor, a graduate of the
Morton Plant Mease Family Medicine Residency Program –
George Hutter, MD, Residency Director
Christienne A. Sain, MD
Delicia M. Haynes, MD
Dani Mathew, MD
22

FAFPʼS 101ST FAMILY
MEDICINE WEEKEND
Oustanding CME and a Fond
Farewell to FAFPʼs Executive Vice
President Tad P. Fisher
Golf Tournament Benefiting
FAFP Foundation
Look for brochures in the mail. Information and
online registration available at www.fafp.org.
Call FAFP at (800) 223-3237 with questions or
for more details. This is always a popular location.
Reserve your room early!
Want to Get Away During the Holiday Season
Want to Relax in the Midst of All the Hustle and Bustle
Gather with Family and Friends at the
Ritz-Carlton Amelia Island • December 12-14, 2008
Call (800) 241-3333 or Book Online at www.Ritz-Carlton.com Using Group Code FAFFAFA.
The Department of Community Health and Family Medicine
seeks a full-time (1.0FTE) non-tenure-track Clinical Assistant
Professor to work at the Lake City Primary Care Clinic.
Position will be responsible for delivery of direct primary health
care with teaching responsibilities of UF medical students and
Family Medicine residents assigned to clinic and participating
in departmental activities such as clinic attending. A current
Florida medical license is required. Salary will be negotiable.
Please send a letter of interest and curriculum vitae to:
Marvin Dewar, M.D.
Search Committee Chairman
c/o: Sherri Swilley
P.O. Box 100237
Gainesville, Florida 32610-0237
(352) 273-5159
(352) 273-5213 Fax
Equal Employment Opportunity Employer.

YOUR FAFP FOUNDATION AT WORK
Many Thanks to Our 2007-2008 Foundation Donors!
You can contribute online at www.fafp.org — click on “FAFP Foundation.”
Donations to National Conference
Luis Albuerne, MD
Sandra Argenio, MD
Susan Beaven, MD
Dr. H. James and Barbara
Brownlee
Patrick Cimino, MD
Ariel Cole, MD
Luckey Dunn, MD
Tad and Chris Fisher
Richard Hays, MD
Tracey Hellgren, MD
Thomas Hicks, MD
Bud Huber, MD
George Ikeler, MD
Lisa Jernigan, MD
Jennifer Keehbauch, MD
William Kepper, MD
Patricia King, MD
Bernard Kurecki, MD
Dung Nguyen Le, MD
Hao Viet Le, MD
Liat Le, MD
Nhien Le, MD
Daniel Lestage, MD
Alma Littles, MD
Suzanne Minor, MD
Neil Oslos, MD
David Parrish, MD
Robert Raspa, MD
Izabela Riffe, MD
Juan Rivera, MD
Marc Rivo, MD
Mary Robinson, MD
Kathleen Santi, MD
Dennis Saver, MD
Sidney Sewell, MD
Christine M. Shim, MD
Joseph Sprigle, MD
Donna Stephens, MD
William Stewart, MD
Curtis Stine, MD
Julie Sudduth, DO
Walter Taylor, MD
T. Byron Thames, MD
Daniel Van Durme, MD
Barbara Williams, MD
Donations to Legacy
Frank Avey, MD
William Belk, MD
Susan Betzer, MD
Tony Bien-Aime, MD
William Bosworth, DO
Dr. H. James and Barbara
Brownlee
Erin Buzzella, MD
Biliston Clarke, MD
Whit Curry, MD
Marcella Cyba
James Derby, MD
Robert Dobbs
James Drew, MD
Margaret Drucker
Dan Fulmer, MD
John Gross, MD
Mae Gutierrez, MD
Gregg Gutowski, MD
Aashiv Hari, MD
Robert Healy, MD
Agueda Hernandez, MD
Russ Hostetler, MD
Amber Isley, MD
Jerry Jacobs, DO
Stephen Kaskie, MD
Jennifer Keehbauch, MD
Kenneth Kiehl, MD
Bala Krishnan, MD
Dan Lestage, MD
Alma Littles, MD
Joyce and Ray Lowe
Gary D. Miller, MD
Cindy Mitch-Gomez, MD
Yves Morency, MD
B.D. Ogg, MD
Neil Oslos, MD
David Parrish, MD
Dana Perrin, MD
Pfizer
Jacquelyn Puglia, MD
Stephen Quintero, MD
Louis Registre, MD
Juan Rivera, MD
Marc Rivo, MD
Nancy Rockstroh, MD
Fleur Sack, MD
Kathleen Santi, MD
Dennis Saver, MD
Robert Schwartz, MD
Ed Shahady, MD
George A.W. Smith, MD
Arthur Splendoria, MD
Cyneetha Strong, MD
SunTrust
Diana Twiggs, MD
Don Twiggs, MD
Daniel Van Durme, MD
Joseph Von Thron, MD
William Wagner, MD
Anne Waldron, MD
Lydia Wallace, DO
Ira Warshaw, MD
Mark Whalen
Bernd Wollschlaeger, MD
Donations to Silent Auction
Dr. Robert and Shannon Ashley
William Belk, MD
Jerry Boland, MD
Stephenie A. Box
Kay Brown Photography
James R. Cummings, MD
Robert Curry, MD
Timothy Davlantes, MD
Victor A. Rivera Diaz, MD
Tommy Dietz
Drs. David and Joyce Feller
Lee Fischer, MD
Tad and Chris Fisher
Bruce Flareau, MD
Futch Printing & Mailing
Gainesville Health &
Fitness Center
George Gant, MD
Bill Gilmer, MD
Keilah Gonzalez-Bonilla, MD
Ann Grooms, MD
John Gross, MD
Ruth Eckerd Hall
Craig Hansen
Terry Hayes, MD
Richard Hays, MD
Roman Hendrickson, MD
Thomas Hicks, MD
Roy Hinman, MD
Robert Hoff, MD
Entertainment by J.K.S.
Productions
Jennifer Keehbauch, MD
Kenneth Kiehl, MD
Dr. Ginny and Ryan Kwong
Dr. Walt and Barb Larimore
Gary Lee, CPA
Dr. Daniel and Helen Lestage
Alma Littles, MD
Joyce and Ray Lowe
Steve Masley, MD
Dennis Mayeaux, MD
David Miller, DO
John Montgomery, MD
Karen Moore
Dr. Neil and Suzie Oslos
Martha Price, MD
Bascom Raney, MD
Marc Rivo, MD
Mary Robinson, MD
Fleur Sack, MD
Christienne A. Sain, MD
Iréne Salley Studios
Rogelio Samson, MD
Dr. John and Patricia Saranko
Drs. Dennis and Jeannie Saver
Guy Selander, MD
Sandy Selander
Ed Shahady, MD
Mary Shahady
Nichole Shields
George A.W. Smith, MD
Gary Snell, MD
Lynn and Robert Steele
Cyneetha Strong, MD
Albert Tawil, MD
Axel Ruiz Tellez, MD
T. Byron Thames, MD
David Thompson, MD
Susan Toth, DO
Dr. Don and Linda Twiggs
Dr. Daniel and Patricia
Van Durme
Caroline Van Sant-Crowle, MD
Carrie Vey, MD
Dr. Anne and Jim Waldron
Brian Webb
Mark Webster, MD
Virginia Welton
Steve Winn
Bernd Wollschlaeger, MD
24

RESIDENTS’ & STUDENTS’
Once again, the family medicine residents of Florida have been
doing amazing things. At the recent 2008 Summer Break Away, in
Naples, the residents held the Residents’ Association meeting, where
each program had a chance to update the others on all of their exciting
happenings. All of the residents reported enthusiasm at the start
of all of their new interns. The residents are already planning next
year’s recruitment, which kicked off in Kansas City at the National
Conference for Family Medicine Residents and Medical Students,
where nearly 40 Florida medical students were in attendance.
CORNER
by Carrie Vey, MD, Halifax Medical Center
Great Things Are Happening!
Many of the residents have expressed interest in the various aspects
and options that family medicine has to offer. At the recent
Residents’ Association meeting, Jay Poonkasem, MD, from Morton
Plant Mease, demonstrated acupuncture and how to incorporate it
into practice. Residents at Halifax have added Botox ® to the outpatient
procedures clinic, and residents at Jackson Memorial will be
adding circumcisions to their lists of procedures. Tallahassee
Memorial residents are still benefiting from the Mind Body
Medicine program. Many recent family medicine residents are
exploring the various options of family medicine by starting fellowships,
including three Florida Hospital graduates and one Morton
Plant Mease graduate, who have entered a geriatrics fellowship; one
Florida Hospital graduate, who has entered an OB fellowship; and
Dr. Poonkasem, who has started an administrative fellowship at
Morton Plant Mease and will begin an alternative and complementary
medicine fellowship in the coming months. In the spring and summer,
the residents have planned a few special sessions during the
Residents’ Association meeting, including a panel of various fellows
and then a panel of physicians practicing in various ways.
Coren Menendez, USF College of Medicine, practices acupuncture on Kim
Plumatillo, FSU College of Medicine.
The residents are still very active members of their respective
communities. The Jackson Memorial residents have successfully
educated the public with a healthy cookbook, incorporating
healthy living with ethnic foods. The Morton Plant Mease residents
held an inaugural Tar Wars ® presentation at a local elementary
school, while Halifax residents and Florida State University
students and residents participate in Tar Wars ® in Tallahassee.
The statewide winner for Tar Wars ® hailed from an FSU College
of Medicine student presentation! Bayfront and St. Vincent’s
participate in Reach Out and Read, and the residents heard from
Dr. Sonya Dominguez, regional Reach Out and Read coordinator
and faculty at St. Vincent’s. Reach Out and Read is expanding
internationally from St. Vincent’s, as the residents brought the
program to Haiti. Florida Hospital residents have dedicated themselves
twice to two mission trips this year to Mexico — one in
general medicine and the other in colposcopy.
Jay Poonkasem, PGY-3 from Morton Plant Mease, demonstrates acupuncture
technique to residents and students at the recent Resident Association Meeting
in Naples.
Three Florida residents have been recognized nationally with the
AAFP Graduate Medical Education Award for Excellence (the
Bristol Meyers Squibb Award), which is awarded to 20 third-year
residents in the nation. Congratulations to Chris Scuderi, from
St. Vincent’s; Peter Swain, from Bayfront; and Carrie Vey,
from Halifax.
Florida Family Physician 25

Projectile Diarrhea
And Other Musings on Being a Family Doctor
It was one of those “You gotta help me!” calls, and it came from a
young woman who frantically reported that her husband had passed
out in the bathroom, and there was “Crap everywhere!” I scribbled
down the directions to their trailer and took off. I drove the seven
miles in seven minutes. In a clearing up on a hill over the red dirt
road was the sky-blue doublewide.
by Russ Hostetler, MD
Plant City
I pushed the doorbell button. Hearing nothing,
I pushed it again. Then I resorted to
knocking. Finally, a teenaged girl jerked the
door open, looked at me with fire in her eyes,
and turned to run back into the house.
“Couldn’t chu hear me hollerin’ for ya ta
come on in” she shouted as she sprinted
through the living room and down a hallway
to the right. I followed without saying anything.
Even though I had been warned over
the phone that feces was involved, I was not
prepared for the sight that awaited me in the
bedroom and attached bath that was at the
end of the hallway.
The room was crowded by a king-sized bed.
Along the perimeter were several closets with
bi-fold doors, almost all of which were open.
On one set of closed bi-folds was a splash of
brown liquid stool that continued onto mostly
dresses tightly crowding the closet and
organized by color. Looking further around to
the right, I saw another spray of stool drenching
parts of a rack of blouses and dripping
onto the shoes that covered the floor. The aim
of whoever wielded the poop cannon could
not have been more devastating. Closer to the
floor and on the wall beyond the closets was
another splash of liquid feces dripping down
the wall like so much brown paint under the
influence of Jackson Pollock.
Walking past the bed and over a puddle of
poop, I could see a lake of brown liquid in the
sheets and hoped for a plastic mattress cover.
Just beyond the end of the bed and to the left
was the bathroom, in which there was a naked
young man lying on his side in the middle of
the manure-laden bathroom, with the angry
young woman kneeling next to him and wiping
feces off his hands with a washcloth. I
could see that he was breathing OK, and his
color was good — except for all the brown
material on him, of course. I put my bag on
the countertop next to the sink and pulled on
a pair of latex gloves before grabbing a towel
to drape over the source of the poop.
His strong, regular pulse was reassuring, and
I said so. His pulse was also a bit fast, and his
blood pressure was a bit low. Volume depleted
and post-ictal crossed my mind. I put a
thermometer in his armpit while I examined
him. His head, neck, heart and lungs were all
OK. I found out he could move all of his
extremities on command when I asked him to
lie on his back so I could examine his
abdomen. He had rushes and gurgles everywhere,
but his abdomen and groin creases
were otherwise normal. The thermometer
under his arm now read 100.3.
“Let’s get you into the bathtub,” I said to the
boy as I took one of his stinky hands in mine
and put my other hand behind his head. “Can
you sit up”
The boy nodded, and he did. The girl helped
from the other side, and soon he was sitting
on the edge of the bathtub. It was easy to lift
his legs and swing them around into the tub
because his bottom was lubricated with youknow-what.
Missy — that was her name —
turned on the hot-water tap and lowered the
drain plug.
“I don’t think you want to trap the water at
first,” I said. “Just rinse him off and let the
poop run down the drain. Once he’s all rinsed
off, then you can close the drain and bathe
him. With his fever, a warm bath should feel
really good.”
“Is it OK to let poop go down that drain” she
asked, wrinkling her nose.
“Yes, the stuff that goes down that pipe and
the stuff that goes down the toilet go into the
same pipe that goes into your septic tank.”
“Really” She was incredulous.
“Yup.”
“So, if Ah pee in the shower, Ah can save the
water it’d take to flush the toilet”
“Yup.”
“Dang, Ah wish Ah’d a’known that when
the well almost went dry. Ah coulda had
me a shower instead o’ savin’ water to flush
the toilet.”
“Well, it’s a good thing the well isn’t almost
dry now, because you have a lot of cleaning up
to do,” I said as I glanced into the bedroom.
“Ah ain’t cleanin’ it up! Ah didn’t put it there,
and Ah ain’t cleanin’ it up. As soon as Ah get
him cleaned up, Ah’m takin’ him to his
mama’s, and then Ah’m goin’ to my mama’s.”
I asked her to tell me what happened, and as
she talked, I collected some feces with a
tongue blade and put it in a red-topped blood
collection tube.
She told me she had gone to pick him up from
his work because he complained of a fever
and cramping belly pain. The foreman had
given him some aspirin just before she picked
him up, and he was shivering on the way
home, but once in the doublewide, he started
complaining of feeling hot and stripped

naked. She related that she could hear him on
the toilet “fartin’ up a storm” as she heated
some soup for him in the kitchen. When she
got back to the bedroom, he was in bed with
the covers pulled up over his head and shaking
again. Then he had leaned over the edge of the
bed like he was going to vomit, but instead of
vomiting she heard him pass diarrhea in the
bed. She screamed for him to get out of the
bed, and he tried to, but he was weak, so he
ended up on all fours. That was when he
sprayed the clothes in the closet. She
screamed some more. He tried to crawl to the
bathroom but was having projectile diarrhea
and falling over as he crawled along. He left a
puddle on the carpet about the time she
grabbed his arms and dragged him into the
bathroom. He rolled over and tried to get up,
but ended up spraying the wall there. He didn’t
talk to her anymore, but just seemed to roll
around on the floor leaking liquid stool. That’s
when she called me.
“Let me draw some blood and run some tests,”
I said. As I worked, Missy washed the boy and
we talked.
“Whadayah think’s wrong with him” She
asked with sincerity.
“Well, the fever puts us on to an infection, so
it could just be a stomach virus, but you usually
don’t see this kind of diarrhea with just a
stomach virus, so I’m going to bet on a bacterial
infection. I thought he might have had a
seizure. Has he had seizures before”
“No.”
“Since he isn’t vomiting, we should get some
Tylenol in him.”
Missy moved to the medicine cabinet by the
sink to get some Tylenol. With the needle
work completed, I pulled off the gloves and
got out my prescription pad.
She was letting the water out of the tub and
helping Joe, which was his name, to sit on the
side of the tub as she dried him.
“Here’s a prescription for amoxicillin and
another for metronidazole. Those are antibiotics
to fight intestinal infections. And here is
a prescription for Immodium that he should
take after each loose BM up to six doses a day,
but I want you to call me if he needs more than
four doses, OK”
Missy nodded. “Ah’ll tell his mama t’ call you.”
I helped get Joe dressed and then walked him
out through the stinky bedroom to the kitchen.
I wrote out a recipe for a rehydration drink;
OJ, salt, sugar and baking soda, while Missy
pulled the Firebird up to the front steps. Once
we got him loaded into the passenger’s seat, I
walked back to the steps to retrieve my doctor’s
bag. As I turned, Missy yelled, “Thanks,
Doc — just send Joe the bill,” and drove off.
I drove back to my now-empty office and
smeared out a little of Joe’s feces on a glass
slide to look at under the microscope. I used a
Wright-Giemsa stain and soon found gold colored
gull-wing shaped organisms in the midst
of a plethora of mostly lymphocytes. Vibrio
cholera flashed through my mind, but
Campylobacter was more likely. I made a
mental note to call Missy to let her know that
her well may be contaminated.
I never saw either of them again. Later, I
learned from Mary, my front desk person,
they had split up. It was clear to me in an
instant that a lot of crap had gone on
between them before I arrived on the scene.
MEDICAL
CURIOSITIES
by Marc Berger, MD
Suppository
Mold
This photograph is of an antique brass suppository mold. Molds such
as these were used in the 19th century to make medicinal suppositories.
Pharmacists would compound the suppository by mixing a
measured amount of medication into around 15 grains (1 gram) of
cocoa butter (theobroma oil), or other readily meltable fatty material,
melting the mixture and then pouring it into a chilled mold, such
as the above brass mold. Once cooled, in about two to five minutes,
the mold was then separated, and the formed suppository could be
easily extracted, wrapped in foil or other material and kept cool until
ready to be used.
This mold would be used to make three standard 15-grain cocoa
butter, bullet-shaped suppositories at a time. The United States
Pharmacopoeia in the 1800s had recipes for some common medications,
usually by making lots of 12 in one batch. One favorite medication
was morphine, where 5-20 mg or more of morphine would
be molded into cocoa butter for rapid pain relief, sparing the liver
first-pass effect. This is still with us in the form of the modern belladonna
and opium suppository, occasionally used for bladder or
prostate spasms in the postoperative period.
Florida Family Physician 27

Physicians Take a Lesson
by Jeff Cohen, Esq.
from the Three Little Pigs
In the classic kid’s tale, three little pigs try to protect themselves
from the Big Bad Wolf. The pigs each build a house, each using
a different material. Pig 1 builds his house of straw, but it is no
match for the wolf. Defeated, Pig 1 runs to Pig 2’s house. Pig 2
builds his house of sticks, and it also is no match for the wolf.
The first two pigs now run to Pig 3’s house. Pig 3, who holds
degrees in mechanical engineering and architecture from PU
(Pig University), builds his house of bricks. The wolf is thwarted.
This story is used to teach children the value of intelligence,
ingenuity and planning. But there is another way to see it — one
that provides great instruction for today’s physicians.
The wolf represented the pigs’ worst fear
(being eaten). Each pig alone could not
deter the wolf. Even two pigs together could
not succeed. It was only when they all stood
together that victory was possible. Now
that’s a powerful story!
Physicians today feel haunted, some would
say attacked, by many things — managed
care, hospital administration, the government
payers. Individually, physicians do
their best. They shave costs. They look for
new revenue sources. They hire lawyers and
consultants. They scramble to see more
patients. They earn less personal income.
They get stressed, and so do their families.
Their passion for medicine is often overshadowed
by these harsh realities. Although
physicians still love what they do and love
how it changes people’s lives, practicing
medicine isn’t as fun and energizing as it
once was.
Today, there are stresses that did not exist
years ago, and over time, physicians have
begun to tell a new story about themselves
and their profession. This story casts the
physicians as “little pigs” and hospitals and
managed-care payers as “big bad wolves.”
In archetypal terms, physicians have
become the warriors who do battle and get
beaten up in the process each day. As their
strength is drained, it affects not only them,
but also their patients and communities.
When the physicians lose their power and
their enjoyment, the quality of medical care
is threatened.
In my view, the community of physicians
has never been so fractured. Sadly, when
there is a connection, it is often to focus on
frustrations and bruises. The community has
become weak and negative-minded.
Commonality, instead of strengthening, has
become draining and disempowering. But
there is another way.
Years ago, medical staff meetings and
departmental meetings were packed.
Medical staffs completely controlled the
quality of care provided in their hospitals.
Staff members had respect for themselves
and each other. Hospital administrations
had respectful and symbiotic relationships
with their staffs, requiring communication
and cooperation.
The clear thing about the three pigs’ story
is that there was a complete shift when they
all stood together. It is not an easy task, to
be sure. Everyone differs in outlook, values
and thinking. Sometimes, it is hard for two
people to respect and value each other’s
differences. This requires a shared vision
of compassion and respect — in essence,
“spirituality.” It is easy for the pigs
because, well, they are just pigs. We don’t
hear that Pig 1 once called Pig 2 a bad
name or that Pig 2 took Pig 3’s parking
space. The pigs may have their disagreements,
but they have a shared goal: survival.
They can try to survive alone and fail
or work together despite their differences
and live. Taken a step further, they create a
common vision that is energizing and
enjoyable and where everyone wins.
28

Physicians have a challenge similar to
the pigs. In short, it comes down to
shared vision, to creating a new story
— not just personally, but also collectively.
Everyone knows the current
story — the one that doesn’t work.
What story can physicians tell instead
What inspires them This will guide the
new vision. Physicians have to come
together to start this process. In a sense,
they have to cut the strings that bind
them and create a new vision without
personal limitations.
Work on the vision first, and the particulars
will become apparent. Once the
vision becomes energized, as it once
was, you will know what to do about
managed-care payers; you will know
what to do about hospital administration.
Reacting to individual problems
here and there does not take physicians
anywhere. In fact, it leaves them digging
themselves deeper into negative
situations and problems with no apparent
way out, because no greater vision
guides their decisions toward a better,
more fulfilling and more powerful way.
Physicians have to stop looking for
quick fixes. A lawyer reviewing medical
staff bylaws, though useful, is valueless
if the medical staff members will
not work together. Physicians have to
be flexible with the modern world.
They cannot insist that medicine stay
exactly the way it was. Technology is
different. People are different. Patients
have a greater need for information,
want to play a more active role in their
care and are more open to things that
may be confusing to physicians. If
physicians are to enjoy practicing medicine
again, then it will be because they
have reestablished themselves as a
whole. It will require time, commitment,
flexibility, interaction and a good
dose of humor. In short, physicians
have to show up ... again.
Mr. Cohen worked as associate general counsel
to the Florida Medical Association from
1989 to 1993. He is a shareholder in the
Delray Beach law firm of Strawn, Monaghan &
Cohen, P.A. and is board certified by the
Florida Bar as a specialist in Health Law. He
was recently selected by Florida Trend as one
of Florida’s Legal Elite. Mr. Cohen may be
reached by calling (561) 278-9400.
© 2008, Strawn, Monaghan & Cohen, P.A. All
rights reserved. Republication with attribution
is permitted.
Florida SHOTS Online Survey
Reveals Ease of Access to Records
– Number-One Benefit of System
The Florida SHOTS registry has established itself as a user-friendly tool for health care
providers to determine the immunizations a child needs based on age and past medical
records. To refine and maximize the benefits of the Florida SHOTS system, a statewide
online survey was conducted earlier this year. The survey was designed to gain insight into
the use of the registry and determine how the features of Florida SHOTS are perceived
among immunization providers. Health care providers throughout the state participated in
the survey.
When asked to identify benefits to participation in Florida SHOTS, nearly 96 percent of the
respondents identified the immediate access to a child’s immunization status as one of the
major benefits of the system. Coming in at a close second was access to computer-generated
reports of a child’s immunization history and status accepted by schools, day cares and
camps (94 percent). Following were school access to electronically certified 680s (Blue
Form) (88 percent); toll-free assistance helpline (87 percent); and time and cost savings of
printing standardized immunization records versus pulling and registering records manually
on each shot record card (86 percent).
Moreover, respondents were asked to rate 16 Florida SHOTS features based on the respective
levels of importance to their office. The striking majority of respondents (98 percent)
identified ease of access as the most important feature, while 96 percent picked the ability
to print automated DH 680s (Blue Form). In addition, immunization status screening (95
percent); ease of entering data (93 percent); and system-certified DH 680 (Blue Form) (92
percent) round out the top five features as indicated by our respondents.
The survey also looked into how immunization providers administer the system. Results
show nurses continue to be the most common position responsible for entering information
into Florida SHOTS (41 percent). Other positions responsible for data entry are office managers
(8 percent); administrative staff members (7 percent) or a combination of nurses,
administration staff members and office managers (36 percent).
The majority of the respondents perceive Florida SHOTS features as providing practical
benefits to their everyday work, and 45 percent said they enter immunizations daily into the
registry. Another 16 percent said they enter data at least once a week, and an additional 13
percent at least once per month. Fifteen percent don’t input information in the system but
only view what is already there.
Finally, the respondents who use the registry daily or once a week were asked to list the
biggest benefits of regularly entering shots in the registry. The responses suggested an
increased efficiency in dealing with the practical aspects of carrying out immunizations,
such as: clear schedules for vaccinations and follow-ups, a faster way to complete and print
out 680 forms and the ability to access information and print Blue Forms (DH 680) without
having to call the health department.
In addition, recording information daily allows for higher accuracy, as it helps identify contraindications
in the history of new patients, avoids giving children unnecessary vaccines
and minimizes the risk of transcription errors. Moreover, entering information on a regular
basis makes data reporting easier and enables acquisition of data on new patients or patients
who arrive at their doctor’s appointment with incomplete shot histories.
Florida SHOTS is a free, statewide, centralized online immunization registry that helps
health care providers and parents keep track of immunization records. Enroll today at
www.flshots.com. If you have questions about the registry, call (877) 888-SHOT (7468)
Monday through Friday, 8 a.m. to 5 p.m. Eastern, or e-mail flshots@doh.state.fl.us.
Florida Family Physician 29

Volunteers in Medicine Jacksonville
Celebrates Its Fifth Anniversary
by Kim Keffer, Volunteer
In September, Volunteers in Medicine in
Jacksonville (VIM-Jax) celebrates five
years of providing quality medical care
for the working uninsured. The clinic provides
primary care, preventative health
education, laboratory studies and many
medications at no cost to qualified patients.
Volunteer physicians, ARNPs, RNs and lay
volunteers provide care for the clinic’s
patients. VIM-Jax relies upon donations and
grants from individuals, foundations and
community organizations to pay for medications
and fund operations, including lab and
imaging services.
In January 1992, Dr. Jack McConnell formulated
a unique plan to provide free health
care to those who couldn’t afford it. He met
with a group of retired physicians on Hilton
Head Island, and they set about the business
of creating a clinic to meet the health needs
of poor families living and working on
Hilton Head Island. The Hilton Head
Volunteers in Medicine clinic opened the
next year, providing free medical, dental,
eye care and mental health services to lowincome,
working uninsured families. By
2001, there were 20 VIM clinics in 19 states.
Dottie Dorion, a retired nurse with a passion
for providing health care to those without,
learned of the Hilton Head VIM Clinic. She
and Dr. Jim Burt, a retired urologist, visited
the Hilton Head clinic and Dr. McConnell,
returning home inspired and determined to
create a volunteer clinic in Jacksonville
modeled on the Hilton Head facility. In June
30
2001, they began discussions with the Rev.
Gene Zimmerman regarding the potential to
have a VIM-like project with the support of
downtown churches. In September 2001, Dr.
C. B. McIntosh joined the group, and in
2002, a core group of retired physicians and
community leaders was formed to lay the
foundation. Later, a working board was
established, and fundraising efforts began in
earnest, culminating in the opening of
Volunteers in Medicine Jacksonville on
September 12, 2003. A dream was born!
Today, there are 60 VIM clinics serving the
working uninsured in 24 states nationwide.
In Jacksonville, care is focused on the segment
of the population in the 150 to 250
percent range of the federal poverty guidelines
(currently $13,000 to $25,530 for an
individual, plus an additional $3,500 for
each dependent in the household). Patients
must be without private or governmentfunded
medical insurance, work at least
20 hours per week and reside or work in
Duval County.
The dream is now a reality, and as we
approach our fifth anniversary, approximately
500 patients pass through VIM-Jax
doors monthly, each one treated with care
and compassion by our volunteers and
given quality care without cost — a significant
increase since the early years, when
118 patients were the norm. Patients receive
free primary medical care, referrals for special
services, diabetic and nutrition counseling,
mental health counseling and the
medications they need to live healthy, productive
lives. In addition to primary care,
the clinic offers the following specialties:
cardiology, dermatology, gastroenterology,
gynecology, ophthalmology, orthopedics,
pediatrics and urology. Care is provided by
active and retired physicians, nurse practitioners
and lay personnel, all of whom
donate their time without compensation.
VIM-Jax collaborates with local hospitals,
including St. Vincent’s, Baptist and the
Mayo Clinic and has a collaborative agreement
with the University of North Florida.
At this time, our volunteer staff includes 30
physicians, 14 ARNPs, six pharmacists, 47
RNs, 92 lay volunteers, eight diabetes educators
and several physicians to whom we
refer patients.
Active FAFP volunteers include B. Leslie
Beadling, MD; Dawn Mussallem, MD; and
Photis Nichols, MD.
From humble beginnings, VIM-Jax has
grown into a well-recognized force in the
free health care world in Jacksonville.
The clinic and its volunteers have received
publicity, support and multiple awards
both from within the community and internationally.
The clinic is located at 41 East
Duval Street, and we invite you to call
us at (904) 399-2766 to arrange a tour. We
welcome offers to volunteer as well as
referrals of patients who would qualify for
services. You may also visit our Web site,
www.vim-jax.org.

Elected legislators make decisions about your financial survival and providing a medical home for your patients. These decisions are
made in the chambers of the Florida House and Senate, not in the exam room. Florida's FamilyMedPAC wants to elect people who are
friendly to family physicians’ needs. To accomplish this goal, your FamilyMedPAC needs your help.
FamilyMedPAC is an investment in your profession. You invest in your home, family, food, clothing and transportation. You also invest
in your education and profession merit planned investment. Make your voice strong by supporting FamilyMedPAC.
YES, count me in — I want to help family medicine speak with a
stronger voice in Tallahassee!
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