The Berks County Medical Society Medical Record Winter 2014 by Hoffmann Publishing Group

Medical Record WINTER 2014

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M e d i c a l

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Drs. Dan & Eve Kimball Look Back & Look Forward Governance Structure Changes Rejected...............20 24th Annual Fall Golf Outing........................................30

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MEDICAL RECORD

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2014

Medical Record

of the Berks County Medical Society

A Quarterly Publication

To provide news and opinion to support professional growth and personal connections within the Berks County Medical Society community.

The Berks County Medical Record

Lucy J. Cairns, MD, Editor Editorial Board

D. Michael Baxter, MD Emma Singh, RPh, MD Betsy Ostermiller Bruce Weidman

Berks County Medical Society Officers

Kristen Sandel, MD, President Lucy J. Cairns, MD, President-Elect

PARTNER WITH OUR TEAM

D. Michael Baxter, MD, Chair, Executive Council Michael Haas, MD, Treasurer Andrew Waxler, MD, Secretary Pamela Q. Taffera, DO, Immediate Past President Bruce R. Weidman, Executive Director

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Berks County Medical Society, 1170 Berkshire Blvd., Ste. 100, Wyomissing, PA 19610 Phone: 610.375.6555 | Fax: 610.375.6535 | Email: info@berkscms.org

The opinions expressed in these pages are those of the individual authors and not necessarily those of the Berks County Medical Society. The ad material is for the information and consideration of the reader. It does not necessarily represent an endorsement or recommendation by the Berks County Medical Society. Manuscripts offered for publication and other correspondence should be sent to 1170 Berkshire Blvd., Ste. 100, Wyomissing, PA 19610. The editorial board reserves the right to reject and/or alter submitted material before publication. All manuscripts and letters should be typed double-spaced on standard 8 1/2"x11" stationery. The Berks County Medical Record (ISSN #0736-7333) is published four times a year in March, June, September, and December by the Berks County Medical Society, 1170 Berkshire Blvd., Ste. 100, Wyomissing, PA 19610. Subscription $50.00 per year. Periodicals postage paid at Reading, PA, and at additional mailing offices. POSTMASTER: Please send address changes to the Berks County Medical Record, 1170 Berkshire Blvd., Ste. 100, Wyomissing, PA 19610.

WINTER 2014

BECOME A MEMBER TODAY! Go to our website at

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President’s Message A Message from the President

Drs. Dan & Eve Kimball Look Back & Look Forward

PAMED House of Delegates 2013 Rejects Changes to Governance Structure

The Importance of Good Digestive Health

24th Annual Fall Golf Outing

Departments: Editor’s Comments................................................................................................................................................................ 4 President’s Note.................................................................................................................................................................... 6 Foundation Update............................................................................................................................................................. 12 Alliance Update.................................................................................................................................................................. 16 House of Delegates............................................................................................................................................................. 20 BCMSA Events Calendar..................................................................................................................................................... 23 Legislative and Regulatory Updates..................................................................................................................................... 24 Annual Resident’s Social..................................................................................................................................................... 28 MEDICAL RECORD

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EDITOR’S COMMENTS

Lucy J. Cairns, MD, Editor

o you trust your doctor? The answer is almost surely “yes!” since otherwise most people would be out the proverbial door. Trust is the foundation which supports the sharing of the very private, often embarrassing information physicians need in order to make the right diagnosis. And without a high degree of trust, revealing our physical selves, with all our blemishes and imperfections, and allowing the violation of that self by needles, scalpels, and other implements with the power to permanently change us would be impossible. The question then becomes, why do you trust your doctor?

The medical profession as a whole consistently ranks near the top of trusted professions in the annual Honesty/Ethics in the Professions Gallup poll. The professions at the bottom of the list (members of Congress rank just above lobbyists and just below car salespersons) tend to be those frequently in the public spotlight for instances of dishonest and selfserving behavior. While the medical community is not immune from scandal, such instances are relatively rare, and promoting ethical behavior has long been a central focus of medical education and professional societies such as the AMA. In addition to continually expanding and updating its wide-ranging Code of Medical Ethics, the AMA maintains a Council on Ethical and Judicial Affairs, an Ethics Resource Center, and an Institute for Ethics. Trust in physicians is also based on factors such as the excellent (and well-deserved) reputation of the medical education and training system in our country and the countless examples of altruistic behavior on the part of physicians. But in the end, physicians must earn the trust of patients in the course of their personal interactions. Few patients can make an accurate assessment of their doctor’s clinical skills, but every patient can judge a doctor’s level of concern for their well-being and commitment to helping them through difficult times. As Maya Angelou famously put it, “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

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The feeling on the part of a patient that they have been really listened to by someone who genuinely cares is in itself therapeutic, and there is evidence that patient outcomes improve with higher levels of trust in their physician. Not all outcomes in medical care are as desired or as expected, however, and this is when trust may be lost. Trust is almost sure to be lost if communication breaks down, and it often does when a physician perceives a potential lawsuit in the making, since everything that is said or not said from that point on could have legal ramifications. Unfortunately, legal concerns may then prevent the doctor from expressing his or her feelings of distress, regret, and sympathy, and the patient’s distress is compounded by the impression that the doctor does not care. The so-called “Apology Law” which took effect in Pennsylvania on December 24 will alleviate to some degree the legal concerns which have made it difficult for doctors to communicate more openly with patients after errors or unanticipated outcomes. The law protects certain expressions of empathy (in strictly defined circumstances) from being used as evidence of fault in an ensuing lawsuit or other legal action. “Apology” is a misnomer when used to refer to this law, since an apology is a regretful acknowledgement of an offence or failure (per the Concise Oxford Dictionary), and the new law does NOT protect any action or statements admitting negligence or fault. The actual name of the bill is the Benevolent Gesture Medical Professional Liability Act, which is obviously too lengthy for headlines! For further analysis and advice regarding implementation of this law, see the article provided by PAMED in this issue.

After an unwanted, unanticipated outcome in medical care, honest expressions of empathy on the part of the involved physician can provide reassurance that the doctor continues to be invested in caring for the patient and may preserve trust. But patients who have suffered a potentially preventable harm want more than empathy. What they want is detailed information: how the event happened, why

it happened, who is at fault, what you are going to do for them now, and what steps will be taken to make sure such an event will not happen to someone else in the future. Not providing a patient with all pertinent information regarding their care and health status is a violation of the AMA Code of Ethics and sends a signal to the patient that a cover-up is occurring, destroying trust and increasing the likelihood that a suit will be filed. If an error or omission did occur and led to patient harm, the facts will almost surely be discovered in the course of the suit, and the attempted cover-up will be used by the plaintiff’s attorneys to inflame the sympathy of the jury. If an investigation into an unanticipated outcome does reveal that a standard of care was not met, the ethical course of action is full disclosure to the patient. Such disclosure, accompanied by an apology, an offer of compensation (when appropriate), and discussion of steps being taken to reduce the likelihood of similar events in the future, has become one model for improving the way medical liability is handled.

This approach has the potential to address the needs of the person who was harmed much more rapidly and efficiently than a lawsuit would, and provides a mechanism for identifying and acting on patient safety issues. Thus, it is not just the right thing to do, but it can provide a better resolution for the injured party or their family and improved patient safety in the future. For the University of Michigan Health System, adopting a version of this approach called the Michigan Model has reduced legal costs and number of suits filed. Pennsylvania’s “Apology Law” does not change the legal framework for dealing with medical liability in our state. The first action any physician concerned about liability should take is to consult with their insurance company or risk manager, to be clear about the potential consequences of any further action. But once that consultation has taken place, the new law makes it safer for our compassionate doctors to show a patient who is hurting that they placed their trust in a physician who continues to care.

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MEDICAL RECORD

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2014

president’s message

Kristen Sandel, MD

“

Failure is not fatal, but failure to change might be.” This quote by the late John Wooden exemplifies the state of organized medicine in recent years. With the passage of the Affordable Care Act and a multitude of other recent changes in health care, we are at a crossroads in our profession. We have been challenged as physicians to examine and reflect on ourselves, on our societies, and on the way we practice medicine. 2014 is bound to be another challenging year for us as physicians and as a medical society, but it also offers us an excellent opportunity to improve the state of health care in Berks County. As some of you may know, I was an athlete in a former life and have always been a fan of sports. Many of the lessons that are learned by participating in athletics and being part of a team can be translated into other professional careers, including and especially medicine. I would like to share anecdotes from some of the most well respected names in sports with you, as they are poignant when discussing the state of medicine today.

“Individual commitment to a group effort - that is what makes a team work, a company work, a society work, a civilization work.”

Vince Lombardi In this volatile time, we cannot abandon groups like the Berks County Medical Society, but we need to embrace and commit as individuals to them. How many associations advocate for every physician in Berks County, regardless or his specialty or employment model? There are numerous groups that are advocates for patients, for hospitals, for specialties, and for various disease processes. But how many really advocate for physicians and for their ability to deliver safe, high-quality medical care? Now is the time to come together, to join the team, and to promote the practice of medicine.

“To be an innovator, you can’t be worried about making mistakes.” Julius Erving.

The practice of medicine has undergone numerous changes over the past few years and may look very different to 6 | MEDICAL RECORD

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many of you than it was twenty and especially fifty years ago. Some of the changes we have observed over the past few decades include the increase in the number of women entering the profession, the aging physician population, the inability to retain young physicians trained in Pennsylvania, and the shift from independent to employed practice models. Some may say that the days of physician autonomy in medicine may be numbered if physicians cannot adapt to the ever-changing landscape of medicine. We need to be innovative in our approach to medicine and to organized medicine in particular. We cannot be stagnant or be afraid to change for fear of making a mistake. We need to adapt to the changes that we cannot control and ensure that we grow as a society, so that we may remain relevant to physicians and to the community in years to come.

“A person always doing his or her best becomes a natural leader, just by example.”

“The way a team plays as a whole determines its success. You may have the greatest bunch of individual stars in the world, but if they don’t play together, the club won’t be worth a dime.”

Joe DiMaggio The leadership that has been displayed by our past presidents has been exemplary. They have done their best and led by example in order to maintain the Berks County Medical Society as one of the most highly respected county organizations in Pennsylvania. Our older and more experienced physicians have been excellent mentors to our young physicians, medical students and residents. We look to them to continue this tradition, in order to ensure that we continue to encourage the physicians we are educating to practice in Berks County. It is only through leadership that we can grow the profession and ensure that the patients of Berks County receive excellent care for years to come.

Babe Ruth We have been increasingly challenged by scope of practice issues not only in Berks County and Pennsylvania, but also throughout the country. There are multitudes of heath

care professionals who would like to provide care which some may consider outside of their scope of practice or procedures which should only be performed by highlytrained physicians. We cannot be reactionary in our response to these requests, but we must be proactive. We must be willing to assume the leadership role of the health care team, but also to recognize the value of each team member and the skills that these individuals have to offer our patients. The amount of training and time that we have spent practicing our craft places us in a unique position to be the leader of a health care team designed to provide the highest quality care to patients in Berks County. However, we must remember that each team member is important and has a role in patient care. Unless we can identify ways to work together for the good of the patient, we will not succeed in providing them with the best possible care.

And so, in the immortal words of John Wooden, “Failing to Prepare is preparing to fail”. We must be prepared to face the future challenges of medicine, whatever they may hold, in 2014 and beyond. And we must be willing to work as a team to meet these challenges and rise above them, not only for our patients, but also for ourselves and for the future of our society.

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Drs. Dan & Eve Kimball Look Back & Look Forward

Members of the Berks County Medical Society were delighted to learn that the Berks Visiting Nurse Association has chosen our own Drs. Dan and Eve Kimball to receive the physician Health Care Champion Award for 2014. Over the course of their long careers, the Drs. Kimball have contributed in a wide variety of ways to improving health care in Berks County and beyond. This award is a fitting recognition of the extraordinary level of service that has marked each of their careers. The Berks Visiting Nurse Association has its own long history of serving the health care needs of Berks County residents, and currently offers a number of community health programs in addition to comprehensive home health and hospice care. The Health Care Champion Awards will be celebrated in April at the annual Health Care Champion Breakfast. Contact the BVNA for ticket information, and join in honoring the awardees. All proceeds will benefit uninsured and underinsured BVNA clients. (Lucy J. Cairns, MD)

Why medicine?

Eve: Reviewing my Mother’s journal after her death I came across the following entry: “Uncle Edwin says that since Eve has brucellosis, she will not be able to have children so I must find a career for her to substitute for a family. He suggests medicine.” She took me out of school to go to missionary society meetings at Luther Place Memorial Church in Washington, DC from the time I was seven years old through high school (gave me excuses to take to my unhappy teachers!). Albert Schweitzer, MD was my role model! Did I have a choice to NOT go into medicine?!!!! Dan: My parents’ influence and my own early exposure to the medical system due to health issues were the major factors in my choosing a career in medicine. My mother had wanted to become a doctor, but the depression put that goal out of reach. She then passed her interest in science on to me. While in high school I had the opportunity to work in a research facility and as a hospital/OR orderly, and later I had a job checking references in the old Index Medicus at the National Library of Medicine for a PhD pharmacologist who was a journal editor.

How did you meet?

We were lab partners at the University of Virginia School of Medicine, Charlottesville, VA (Thomas Jefferson’s university!) for Anatomy, Physiology, Biochemistry, and Pathology! We became engaged during our junior year and married the week after graduation.

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When did you settle in Berks County, and why?

Dan: Many of us recognize that career progression can depend on networking, and this was certainly the case in our coming to Berks County. In 1989 I decided it was time to end my career in the military and look for a civilian teaching position. Since 1985 Eve and I had been living and working in Germany, where I served as commander of the Landstuhl Army Medical Center. I had no idea where to look for a position back home, and then one day I received a call from Dr. Bob Muir asking me to consider an opportunity at the Reading Hospital. Bob had been our Chief Surgery Resident during our internships in Colorado, and we subsequently served together at Walter Reed, when he was Chief of Surgery and I was Chief of the Internal Medicine Service and Program Director. I responded to Bob’s invitation by asking, “Where is Reading, PA?” Having grown up in Washington, D.C. and northern Virginia, I knew little about Pennsylvania beyond memories of riding on a fire truck when my family visited my great grandfather in Danville when he was Fire Chief there. I accepted Bob Muir’s invitation and we found our way to Berks County.

Please describe the arc of your careers over time, and how your goals may have evolved.

Eve: When I interviewed at the University of Virginia in 1961, the Chair of the Physiology Department greeted me seated in his chair, smoking his pipe with his feet on his desk. He never got up, just motioned me to sit and asked me what my plans were after medical school. I answered, “I would like to be married, raise a family, work part time while they are growing up and then full time when they are grown.” His feet came down off the desk and he looked at me – “You are serious? How do you justify all the money we are spending to train you as a doctor?” My reply, “My life expectancy is longer than that of the 72 men in our class, so I will be working longer than they!” Indeed, our other lab partners have all died and Dan is “retired,” but I am still practicing! Four women per class was the school’s quota at that time, despite applications from other women who were better qualified than a number of the admitted male students. Notable medical school events were staying at the bedside of our OB patients through their entire labor and performing our own lab work (CBC, UA, Stool for O & P). Dan and I both worked in the chemistry lab at night, which gave us an appreciation of the constraints of accurate lab studies. Donating blood was another source of income - $25 per pint donated.

Dan and I applied for rotating internships to the US Army ($8,000 per year), Mary Hitchcock (Dartmouth)($250/ month), Christ Hospital in Cincinnati ($500/month), and Cincinnati General ($250/month). When I told the Army interviewer I wanted to do Pediatrics, the response was “that’s good because that’s the only place we can use you!” We selected internships at Fitzsimons Army Hospital

(now closed, with the property owned by the University of Colorado Medical Center!) because we could get an excellent education and not have to borrow money! Our UVa Med School Assoc. Dean told us that we were “throwing away 16 years of education by going to the military for training” – a statement that we continue to vehemently dispute! Continued on Page 10 MEDICAL RECORD

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longer resulted in a long discussion at morning report! I successfully completed my first Pediatrics residency year despite becoming pregnant, but was nonetheless forced to resign my commission with the status “honorable discharge—disability: pregnancy.” My Chief of Pediatrics, Col. Robert Scherz, MD, was very supportive but was not able to obtain an exception to the rules. Col. Scherz was largely responsible for Congress passing legislation making child car seats and medicine bottle safety caps the law of the land, and he served as Chair of the Poison Committee of the AAP for many years. He also supported six children on a military salary and qualified as a stock broker with the highest possible score on the exam! I was the first female intern in the US Army, so finding sleeping quarters for on call nights was sometimes a challenge. When Dan and I were scheduled for the same ER rotation, Dan asked the Charge nurse if a double bed could be provided for us. You can imagine the expression on her face–until she realized that he was joking!

During our time at Fitzsimons we saw much tuberculosis. Hematuria meant a need to screen for renal TB! Out of four morbidity and mortality conferences during his first month Internal Medicine rotation, Dan presented three! He felt like the “grim reaper.” During our internships we were fortunate to have Col. Edwin Overholt, MD as our Chief of Medicine. He was an incredible teacher and internist whose specialty was fevers of unknown origin. He taught us all critical thinking and emotional caring for our patients, and was a stickler for detail. If we came to morning report without the “tails” on our white coats properly buttoned, he would take scissors and cut them off! The Assistant Chief of Medicine was Col. James Bergin, MD, a hematologist. He insisted upon our reciting the coagulation cascade (Eve’s nemesis, Dan’s forte) whenever we had a patient with a bleeding disorder. We applied to stay at Fitzsimons for Pediatrics and Internal Medicine, but were assigned to Madigan Army Hospital (Tacoma, Washington) adjacent to Fort Lewis. At first we were very disappointed, but now we view it as the best thing that could have happened. Because it was a large basic training facility, Dan saw many cases of meningococcal meningitis. The standard of care was: discovery of a petechia in a patient on the ‘URI ward’ followed by spinal tap, blood culture, and antibiotic administered – all within 20 minutes. Anything taking 10 | MEDICAL RECORD

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While Dan completed his Internal Medicine residency, I worked part-time in the hospital clinic. When Dan’s career took us to Washington, D.C., I finished my last year of Pediatric residency training at what was then Children’s Hospital of D.C. (now Children’s National Medical Center). My first post-residency job was with the then-President of the American Medical Women’s Association, Dr. Carolyn Pincock. Through Dr. Pincock I had an opportunity to speak with Congresswoman Bella Abzug, who asked me what legislation I would like to see passed. As a working mother I was very aware of the costs of raising children, so I suggested a tax deduction for child care expenses. Bella implemented it!

Next came five formative years with Agnes Schweitzer, MD, who did home visits and was THE expert in Washington, D.C. on breast feeding (this was prior to the advent of lactation consultants). Then the opportunity arose to purchase (for $10,000) a small practice in Montgomery County, Maryland. There I mentored Patty Franklin, PNP (who later became president of NAPNAP!) and we worked together for five years while growing the practice. When Dan and I left for Germany, Dr. Pamela Parker purchased the practice. It is still in existence, and Pam hires many women physicians who desire to work part-time while raising their families.

When we moved to Landstuhl, Germany I obtained a position with the Exceptional Family Member Department, seeing children with special healthcare needs. This experience triggered an abiding interest in the Medical Home concept and CSHCN, and in caring for children in Foster Care, specially challenged children, and children with special abilities.

I spent my first few years in Berks County as an attending physician for the Reading Hospital Pediatric Clinic. In 1991 I left the hospital to open my own office in downtown Reading—in the old Bruno fur store on North 5th Street. As the practice grew, additional space was required, and

between 2001 and 2008 I was based at an office in West Reading while Dr. ElSheikh staffed an office on S. Fifth Street in the city. We brought the practice together again in 2008, when we renovated our current “miracle building” at 655 Walnut St. in West Reading in six hectic months. With over 16,000 sq. ft. and 28 exam rooms, I never thought we would fill this space up, but it has happened!

At All About Children Pediatric Partners, we focus on rendering quality care to children in exceptional circumstances, along with advantaged children. 80% of the practice patients have medical assistance insurance. We aim for a medical home model and have begun to include mental health services at our site. Offering dental services to round out a health home is on our radar. Independent health homes are a viable, cost-effective alternative to the “corporate” model that is being promulgated across the US. Many practices across the nation are successfully providing high quality, cost-effective care independent of large corporations by utilizing the “health home” model exemplified under federal auspices by Federally Qualified Health Centers. “Business sense” and assumption of responsibility for keeping costs down is a must for physicians to be successful with this model, but patients are very pleased and livable salaries are possible. We schedule/see three patients per clinician per hour so that we can attend to all the concerns that patients express at one visit, instead of having them return for multiple visits. The managed care environment, with capitation, makes financial planning possible. Fee-for-service incentivizes unnecessary visits that could be managed via telephone, increasing family sense of competence. Dan: My original plan was to fulfill my 3-year military obligation upon completion of my rotating internship and then return to Virginia as a Family Doctor. However, like many in medicine I was greatly influenced by a mentor during my training, and changed my plans as a result. I am referring to my Chief of Medicine at Fitzsimons, who was an outstanding educator clinician and who inspired me to follow a similar path. Therefore, I went on to an Internal Medicine residency, and my love of teaching was confirmed during a 6-month stint as Chief Resident. Another mentor who influenced my career was the staff hematologist at Madigan. In the course of my residency training, there was an epidemic of meningococcal meningitis, with its fascinating coagulopathy. I learned a lot about hematology and blood coagulation, and was inspired to pursue fellowship training in hematology/oncology at Walter Reed, and then a year-long research fellowship training program in the Coagulation Lab at the Walter Reed Army Institute of Research. At the completion of this training I had orders to relocate to the William Beaumont Army Medical Center in Ft. Bliss, Texas, but at the last

minute I was asked to remain at Walter Reed and run the Hem/Onc Fellowship Training Program. After six years in this position, I served as Director of the Internal Medicine Residency Program, Chief of the Dept. of Medicine, and Deputy Commander for Clinical Services at Walter Reed prior to becoming Commander of the Landstuhl Army Medical Center in Germany from 1985-1989. My career in Berks County began with serving as Chief of Medicine at the Reading Hospital for fifteen years. I spent the final five years of my clinical practice as the part-time Medical Director for Hospice St. John of Berks County, which is part of Diakon Lutheran Social Services Organization.

Please describe your current professional activities and interests.

Eve: I have almost completely stopped seeing patients, except for some children with special abilities. I continue working with the Office Manager, providing clinical input for the administrative side of the office. Like an old soldier, I will just “fade away”! I have thoroughly enjoyed my work with the Dentists of PA – getting doctors to look at teeth as we look into the oral cavity and improving prevention services to young children and access to dental care for 1-5 year olds. I plan to continue my work in this area. Dan: I retired from clinical practice in May of 2010. I have thoroughly enjoyed all of my career experiences. Early on in my military career, it was emphasized that a professional has a responsibility to be part of his or her professional organizations because “if one is not part of the solution, one is part of the problem.” As I have wound down my clinical activities, I have become more active in the governance and advocacy activities of organized medicine at the regional, state, and national levels. I remain involved with the Berks County Medical Society, PA Medical Society, AMA, American College of Physicians, and the National Board of Medical Examiners.

What comes next?

We plan to travel to some fascinating places, spoil our grandchildren, and complete some projects currently under way with our respective state professional societies. Eve plans to continue her work to improve access to oral health care for children from 12 months of age onward across the state of PA and in Berks County. Berks County is positioned to lead the way if we choose, with medical dental collaboration, oral health literacy, and use of dental “extenders” – public health dental hygienists, extended function dental assistants, and community dental health assistants. These are exciting times: the teeth are beginning to be recognized as important to our overall health! MEDICAL RECORD

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FOUNDATION UPDATE

Physicians’ Health Programs Welcomes New Staff Members

he Foundation of the Pennsylvania Medical Society Physicians’ Health Programs welcomed new case managers Tiffany Condran and Kendra Parry this year. The Physicians’ Health Programs (PHP) ensures physicians have the supportive resources and tools to stay healthy so they can continue providing healthcare for others. Physicians, like the rest of the population, are vulnerable to chemical dependency, physical disability or breakdowns in mental health.

the Roxbury Treatment Center in Shippensburg. Tiffany completed her coursework for her Master of Science, Applied Clinical Psychology and earned her Bachelor of Science in elementary and Kindergarten education, with a concentration in social and behavioral sciences from Penn State.

Tiffany joined the PHP staff because she was impressed with the philosophy and mission of the PHP and was interested in utilizing her clinical skills in a different professional environment while continuing to help people through the recovery process. “I enjoy having the opportunity to build relationships with our participants and having the privilege to be a part of their recovery journey,” she said.

Tiffany decided to enter the addictions field after completing a semester internship at an inpatient dual diagnosis treatment program while completing courses for her master’s degree. Her main goal in regards to the PHP is to help support individuals through their recovery process so they can continue to practice medicine and contribute to society’s health and wellness.

New case managers (l) Kendra Parry and Tiffany Condran. A physician who is having problems or who has concerns about a colleague (e.g. addiction, physical disabilities, or neuropsychiatric disorders) should reach out to the PHP. “We are thrilled to expand our PHP staff to better serve our participants,” said Foundation of the Pennsylvania Medical Society Executive Director Heather Wilson. “Tiffany and Kendra both bring a strong background in counseling and each provides a unique perspective on our core mission. Our program will continue to strengthen with their experience.” Tiffany, Pennsylvania State Board Certified Alcohol and Drug Counselor, most recently worked as a counselor at Gaudenzia Inc., in Mechanicsburg. She also worked at 12 | MEDICAL RECORD

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“I have professional experience in both mental health and addiction therapy at multiple levels of care so I believe this will help me make appropriate referrals for treatment needs, build rapport with participants and their families, and have a solid understanding of the challenges and triumphs that individuals encounter through this process,” she said. When she is not at work, Tiffany enjoys kayaking, motorsports, going for walks, spending time with her family, gardening, and going to the movies. Kendra, Pennsylvania State Board Certified Alcohol and Drug Counselor, most recently worked as a counselor at Gaudenzia Inc., in Harrisburg. She earned her Bachelor of Science degree in psychology from Messiah College, Grantham. Kendra volunteers with Keystone Human Service and the Paxton Street Home.

Kendra joined the PHP staff because she felt it was a great opportunity to help others. “I love working in human services, especially in the field of addiction. Previously, I had worked in addiction counseling, saw the chance to continue

Continued on Page 14

Social Media Policy–What Should It Say?

5. A clearly worded statement that the policy will not be applied in a way that restricts an employee’s use of social media to engage in protected activities, clearly stating that working conditions or terms of employment are not within these categories; and

6. Don’t rely on disclaimers. According to the NLRB, certain workplace rules such as “This Policy will not be construed acebook, LinkedIn, and Twitter are just a few of the or applied in a manner that improperly interferes with many social media websites that have sprung up in the employees’ rights under the National Labor Relations Act” last several years. As the use of social media grows, you do not cure otherwise unlawful provisions of a social may have concerns about how your employees’ use of social media policy because employees may not understand media may be affecting your organization. For example: from the disclaimer that protected activities are in fact permitted. An employee may be logging on to these sites frequently during the workday, depriving your company of productive working time.

Employee chats on Facebook might include negative comments about your company, a supervisor or other employees.

An employee could divulge sensitive information, such as the company’s financial performance, in a blog on his or her personal web page.

If you haven’t already done so, you may want to consider creating a social media policy for your workplace. But just how far can your organization’s social media policy reach?

Guidance from the NLRB

Presently, no federal laws restrict or prohibit employers from monitoring or using social media activities as the basis for employment related decisions, unless those decisions involve discrimination, retaliation or some other protected form of communication. A recent report issued by the National Labor Relations Board (NLRB) provides some insight for employers on how to create policies governing the use of social media that do not unlawfully interfere with employees’ rights under federal law to engage in certain protected activities, such as the right to discuss wages and working conditions with co-workers.

Social Media Policy Considerations

Keep in mind the following considerations raised by the NLRB when creating your company’s social media policy: 1. A clearly articulated need for the policy;

2. Explanation that employees are free to express their own views and opinions on social media but may be held responsible for those statements;

Social media is a present, pervasive and complex issue in the workplace that will likely only continue to be used for workplace purposes, during company time, or with company owned equipment. As employers have a legitimate interest in controlling employees’ social media use for the purposes of limiting disclosure of company information and protecting the company image, social media policies will also likely continue to be the primary tool for navigating social media. The NLRB’s guidance offers the best available tool for employers to develop social media policies, but employers should continue to remain cognizant of employee expectations for privacy and changing employment laws to ensure their policies are not overly broad, unlawfully restrictive or instrusive. As with all workplace policies, it is a good idea to review your policy with an attorney who is knowledgeable in this area of the law as well as Pennsylvania state law.

Tonya Nevling 3. Concise and detailed definition of the types of information HR Consultant an employee is not permitted to disclose (i.e. confidential Power Kunkle HR Solutions, LLC information or trade secrets); 4. Definition with specific examples of communication that will be prohibited under the company’s policy of anti- discrimination, harassment or bullying;

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to challenge myself and to expand my knowledge and skill set,” she said. “I think being able to advocate for people is the best part of working for the PHP.”

Kendra said that after a short time working as a counselor, she found that one of the best ways to help someone is just by listening. For so many people who struggle with addiction they just need to know someone is there to listen and to care about what they are saying. “I always felt one of my greatest strengths was my ability to listen and hear what others are saying so it was a natural fit. My goal for the PHP is to become a contributing member of this already great team of people. I hope to be able to help make the program better in any way that I can. My coworkers are some of the hardest working and caring people I have met,” she said. When she is not at work, Kendra likes to spend time with her family and friends. She is recently married. She loves to watch baseball and football, and goes to as many Phillies and Ravens games as she can fit in. She also enjoys reading, crocheting and cooking. The PHP has restored careers, families and confidence by helping more than 3,000 physicians seek and receive the recovery care that enables them to remain a vibrant part of the physician workforce.

Doctor's Grove Doctor's Grove was established by the Berks County Medical Society Auxiliary (now Alliance) in the late 1970's and dedicated on Doctor's Day in 1981. It was created as a way to honor or remember Berks County physicians and their families. It is located at the Berks Heritage Center at the Tulpehocken Creek Park. There are currently about 100 maple trees planted.

This year, it is the hope of the Berks County Medical Society Alliance to expand Doctor's Grove by renewing community interest in honoring or memorializing local physicians and they families, by offering the opportunity to purchase trees to enhance the beauty of this location. There will be a dedication ceremony on or around Doctor's Day 2014, March 30. If you are interested in purchasing a tree to honor a Berks County physician or practice, please fill in the form below and send along with a check in the amount of $250 to:

BCMSA 1170 Berkshire Blvd Wyomissing PA 19610

Maple trees will be selected by early Spring, please respond by Feb 15th. All contributions will be listed in the Berks County Medical Record publication.

P h o ne M onda y - T hursda y 7 : 3 0 a . m . to 5 p. m .

( 8 6 6 ) 7 4 7 - 2 2 5 5 or ( 7 1 7 ) 5 5 8 - 7 8 1 9 E-mail

php - foundation @ pamedsoc . or g A ddress

P hysicians ’ H ealth P rograms 7 7 7 E ast P ark D rive P. O . B o x 8 8 2 0

H arrisbur g , P A 1 7 1 0 5 - 8 8 2 0

14 | MEDICAL RECORD

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Your name Phone Address Email Name of physician/medical practice to be honored Person you wish to be notified of the contribution Phone Address

Donors will receive an invitation to the Doctor’s Day 2014 dedication.

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Our Fall Luncheon was hosted by Kalpa Solanki, where we were honored to have one of our own members, Dr. Aparna Mele of Digestive Diseases Ltd, speak. Dr. Mele is a board certified gastroenterologist and hepatologist and she is the only female gastroenterologist in Berks County! The audience was completely spell-bound by her informative talk about the GI system- how it works, how to keep it happy, and how to make smart dietary choices.

ALLIANCE UPDATE KATHY ROGERS B C M S A P res i d e n t

Our 2013-2014 year is in full swing and we have already had some fantastic events! Welcome new BCMSA Members

e started the year with our new member coffee hosted by Judith Kraines. It was wonderful to reconnect with members and meet physician spouses who are new to the area. We are pleased to welcome Amanda Abboud, wife of Dr. Michael Abboud, and Tiffany Schaffer, wife of Dr. James Schaffer, to our membership!

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The Importance of Good Digestive Health

s a digestive doctor, the eternal question asked of me by my patients is how to keep one’s “gut” healthy? The topic of gut health raises four important points which I emphasize, when counseling my patients. These key features have to do with what we eat, how we eat it, the weight we carry, and the preventative measures we take to reduce the risk of disease. These slogans best capture these four points:

1. “Eating is a necessity, but eating intelligently is an art” – Francois de la Rochefoucauld 2. “Hunger is governed by the body, and appetite is governed by our thoughts” – Clement G Martin 3. “Those who don’t find time for exercise, will have to find time for illness” –Edward Stanley 4. “It is more important to know what sort of person has a disease than to know what sort of disease a person has.” -Hippocrates

Before I embark on how to keep our guts healthy, it would be beneficial to first review the importance of the enteric bacteria we share our guts with! Gut flora includes a complex of microorganism species that live in our digestive tracts and is the largest reservoir of human flora. Their primary benefit to us involves gleaning energy from fermenting undigested unused carbohydrates, which produces short chain fatty acids, energy substrates that are then absorbed into the bloodstream. Intestinal bacteria also synthesize vitamins B and K and metabolize bile acids and sterols. The human body carries about 100 trillion microorganisms in the digestive tract. The metabolic activities performed by these bacteria resemble those of an organ, leading some to liken gut bacteria to a “forgotten” organ. Research suggests that the relationship between intestinal microbiota and humans is symbiotic, as these microorganisms perform many important roles in promoting normal gastrointestinal function, regulating metabolism, and comprising 75% of our immune systems. In fact it is the dysregulation of gut flora that can contribute to many diseases, including allergies, colon cancer, inflammatory bowel disease, and infection. There are many short and long term causes of dysregulation of these enteric bacteria, including medications such as nonsteroidal anti-inflammatories and antibiotics, chronic stress, prolonged illness, and diets high in refined carbohydrates, sugars and processed foods and diets low in fermentable fibers.

What We Eat

The digestive system processes and absorbs nutrients from the foods we eat. There are ten important steps to eating healthy for the gut.

Intestinal health could be defined as the optimal digestion, absorption and assimilation of food. Gut health is critical to overall health and good health starts with good digestion. The foods we eat and the way we process them are essential to the normal functioning of the rest of the body. Digestive problems often cause poor absorption of the nutrients our bodies need to maintain good health. The resulting nutritional deficiencies contribute to an increased risk of chronic disease. Resolving GI problems does not just improve your immediate quality of life by eliminating unpleasant symptoms — it also promotes long-term health.

1. First, maintaining a balanced diet is critical, which should comprise of a variety of fiber-rich foods like fruits, vegetables, oats, beans, moderately lean meats, fish, eggs, protein, and dairy. 2. Saturated fats should be avoided. 3. Third, don’t rush through a meal! Give quality time for meals, eat slowly to allow more efficient digestion, and chew thoroughly to release the important digestive enzymes that break down food. 4. Limit alcohol intake, which can inflame the mucosal lining of the digestive tract. 5. One’s diet should include prebiotics such as inulin and fructooligosaccharides, which facilitate the growth and activity of our gut flora and build immunity. Prebiotics foods include asparagus, onions, garlic, leeks, bananas, and beans. 6. Drink plenty of hydrating liquids to facilitate defecation, approximately 2L/day. 7. Don’t skip meals! Starvation creates a catabolic state, which depletes protein stores, leading to muscle loss and decreased energy. Regular meals maintain blood sugar levels, prevent sugar cravings, and control hunger and therefore weight.

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8. Eat at least 5 servings a day of fruits and vegetables which are rich in essential vitamins, minerals, and fiber 9. Consume 2-3 servings a day of dairy, an important source of calcium, vitamin A, vitamin D, and vitamin B12 10. Eat whole grains which contain natural fiber, vitamins, and antioxidants, all of which get stripped in the refining process The benefits of fiber cannot be emphasized enough. Fiber normalizes bowel movements by increasing the weight and size of stool, adding bulk and allowing for complete evacuation. It maintains bowel health as some fiber is fermented in the colon and may lower the risk of hemorrhoid development, diverticular disease, and colon cancer. Soluble fiber lowers cholesterol levels by lowering low-density lipoprotein and may have other health benefits including reducing blood pressure and inflammation. Fiber can slow the absorption of sugar, thereby helping to improve blood sugar levels. Finally, fiber helps in achieving a healthy weight, as high fiber foods generally require more chewing time, which gives your body time to register satiety, so you are less likely to overeat. Also, a high fiber diet tends to make a meal feel larger and linger longer, so you stay full for a greater amount of time. High fiber meals are also less energy dense, which means they have fewer calories for the same volume of food.

How We Eat

The health of the digestive tract is not just influenced by what we eat, but also the frequency and velocity and volume of our ingested intake. There are enormous benefits to eating smaller more frequent meals. People who eat several small meals throughout the day are less likely to overeat because they stay relatively satiated. The feeling of hunger does not develop as intensely when there are only two hours or so between meals. This prevents people from gorging because they are simply not hungry enough to overeat. Smaller meals can facilitate more efficient digestion by accelerating gut motility. This not only helps the food digest quicker, but also prevents postprandial fullness and bloating that limits daily activities. Muscle is built and maintained more quickly by a steady flow of amino acids from frequent eating. It leads to better regulation of insulin, which in turn turns food into energy and stores it for future use. Vitamins and minerals are more efficiently processed. Finally, smaller more frequent meals control hunger by keeping blood sugar levels balanced and avoiding wide fluctuations in blood sugar. After all, hunger is a dieter’s worst enemy! The Weight We Carry

According to the surgeon general, obesity today is officially an epidemic; it is arguably the most pressing public health problem we face, costing the health care system an estimated $90 billion a year. Three of every five Americans are overweight; one of every five is obese. Obesity is the

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2nd leading preventable cause of death (smoking is #1). On average, obese people live 7 years less than non-obese people. The average life expectancy in the US is expected to decline because of it. It is well understood that obesity has global and far-reaching consequences on overall health and longevity, but how is it linked to the digestive system? Excess fat intake leading to obesity can cause delayed gastric emptying with symptoms of abdominal pain, bloating, nausea, and early satiety. Obesity causes extrinsic pressure on the abdominal viscera and can lead to GERD, Barrett’s esophagus, and esophageal cancer, the fastest growing cancer in the United States. It is linked to numerous chronic functional disorders of the gut and can also directly lead to hepatobiliary and pancreatic disease. New research suggests that changing the mix of gut microbes can prevent obesity, but only if combined with a healthy diet. Researchers at Washington University School bred sterile mice with no gut microbes of their own. Then, they took gut microbes from human twins - where one twin was lean and the other obese - and transplanted them into the mice. Mice receiving the obesity-related gut microbes gained weight and fat, and developed obesity-related metabolic problems, while the mice that received the leanness-related gut microbes did not. They then paired up the mice so that the ones with microbes from the lean human twin were put in the same cages as mice with gut microbes from the obese twin. Mice naturally eat each other’s feces, so the researchers wondered if they would transfer gut microbes to each other, and if so, which set would end up dominating the gut: the leanness ones or the obesity ones? They found the answer depended on the type of diet. If the mice were on a healthy diet - one low in saturated fat and high in fruits and vegetables - then the leanness-associated microbes invaded the gut of the mice with the obesity-associated microbes, stopping them putting on weight and developing metabolic problems tied to insulin resistance. The study reveals another clue about the intimate ties between gut bacteria and diet in the development of obesity, and suggests that eating a diet high in fruits and vegetables encourages leanness-related microbes to populate the gut, leading to better weight control.

Prevention

Prevention can reduce the significant economic burden of disease in addition to improving the length and quality of people’s lives. Taking charge of what we eat, how we eat, and the weight we carry, plus eliminating other body stressors are crucial to gut health.

1. Controlling stress has an enormous impact as stress increases gut peptides that accelerate gut motility. 2. Eliminating tobacco use is also imperative, as smoking is directly linked to numerous digestive diseases, including gastroesophageal reflux disease, peptic ulcer disease, liver disease, inflammatory bowel disease, colon polyps and colon cancer, to name a few. 3. Maintain a normal bowel movement pattern with a high fiber diet.

4. Get plenty of sleep as sleep deprivation can have many negative effects on bowel functioning, appetite, and body weight. Adults need one hour of sleep for every two hours of being awake! 5. Limit alcohol intake 6. Maintain an ideal body weight and combat obesity by actively exercising! Beyond weight control, exercise has many profound benefits. It improves physical health and quality of life. Regular exercise helps reduce the risk of premature death from heart disease, high blood pressure, high cholesterol, diabetes, and colon and breast cancers and bolsters the immune system. Exercise improves psychological well-being by improving mood and reduces the likelihood of depression and anxiety. Physical activity stimulates endorphins that usually leave us feeling happier and more relaxed. You will not only feel better, but look better when you exercise regularly which, in turn, boosts confidence and self-esteem. Exercise increases energy levels, by maximizing circulation. It promotes better sleep by helping you fall asleep faster and into a more deep sleep, allowing you to be well-rested, and enhancing concentration, productivity and mood. It helps maintain and increase muscle and joint strength, improves balance, coordination, reaction time and flexibility.

Guarner, F; Malagelada, J (2003). “Gut flora in health and disease.” The Lancet 361 (9356): 512–9. O’Hara, Ann M; Shanahan, Fergus (2006). “The gut flora as a forgotten organ.” EMBO reports 7 (7): 688–93. Ridaura, VK; Faith JJ, et al. (2013). “Gut microbiota from twins discordant for obesity modulate metabolism in mice.” Science 6: 341 (6150): 1241214.

Aparna Mele, MD

Aparna Mele, MD, earned her medical degree from George Washington University School of Medicine, trained in Internal Medicine at Thomas Jefferson University Hospital, and completed a Gastroenterology Fellowship at Penn State University’s Milton S. Hershey Medical Center. She joined Digestive Disease Associates of Wyomissing in 2007 and is a member of the Berks County Medical Society.

The importance of screening exams to detect early disease cannot be emphasized enough. Waiting until alarm symptoms develop to seek medical attention may make disease prevention too late. All individuals should be encouraged to get a screening colonoscopy in a timely fashion, according to national guidelines, to detect and remove precancerous polyps before they develop into cancer. Regular heartburn sufferers in high risk demographic groups should be screened early for precancerous cellular changes that can lead to essional rtified Prof esophageal cancer. The only Ce in Berks! ist

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Cummings, J.H.; MacFarlane, G.T. (1997). “Role of intestinal bacteria in nutrient metabolism.” Clinical Nutrition 16: 3–9.

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PAMED House of Delegates 2013 Rejects Changes to Governance Structure

s a result of a close vote at this year’s PAMED HOD meeting in October in Hershey, there will be no changes to PAMED’s governance structure in 2014. After a multi-year review of the governance structure of the Pennsylvania Medical Society, the 2013 House of Delegates (HOD) voted down a report by the Committee on Bylaws that had been approved by the Board of Trustees. Approval of this report by the HOD would have initiated a series of changes to develop a new structure for PAMED. The report failed to garner the 75% approval vote needed to adopt the proposed changes. The 75% requirement relates to the management of the PAMED endowment fund, which requires approval by an affirmative vote of both the Board of Trustees and the HOD. Because governance changes were being proposed for both, the large affirmative vote was required. The proposal failed by about 7 votes out of over 200 votes cast.

The concepts for change had their genesis in 2011, when the HOD approved a Young Physicians Section resolution that proposed a study of PAMED’s governing process and structure. Following this study, delegates at the October 2012 HOD meeting directed the PAMED Board of Trustees to take action to create significant governance changes through bylaws amendments. Those changes included down-sizing the Board, enhancing mechanisms for member voices to be heard, creating a process for new trustees to be nominated using skills-based criteria, and moving policy-making for non-urgent issues to a body smaller than the HOD and to the Board on urgent issues. The 2013 report was the result of further study of these concepts by multiple physician committees, including a six-month deliberative process by the Governance Workshop chaired by Dr. Dan Kimball. Berks County was

Bruce A. MacLeod, MD and family with Governor Tom Corbett following his installation as President of the Pennsylvania Medical Society. 20 | MEDICAL RECORD

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well represented, with Dr. Kristen Sandel and Dr. Andrew Lutzkanin also serving on the workgroup. Both Dr. Sandel and Dr. Lutzkanin had served on the previous study group led by Dr. Cutler, whose report led to the 2012 HOD action directing the Board of Trustees to create a new governance plan. Whether this issue will resurface in 2014 is currently unknown. The Board of Trustees might consider implementation of some of the proposals that do not require bylaws changes. These could include consideration of a committee nominating process using skills-based criteria and enhancing mechanisms for member voices to be heard.

Benjamin Schlechter, MD

In other HOD news related to Berks County, a resolution proposed by BCMS member Richard Bell, MD was successfully adopted. This resolution was in response to the increasing use of electronic cigarettes, particularly by teenagers, and urges the state legislature to prohibit the sale of e-cigarettes to minors and otherwise regulate them no differently from tobacco cigarettes. It also advocates including education on the dangers of e-cigarettes with tobacco education programs in schools. As a result of this resolutionâ&#x20AC;&#x2122;s adoption by the HOD, newspapers across the state, including the Pittsburgh Post-Gazette, Reading Eagle, Scranton Times, and Easton Express Times, have written editorials in support of this PAMED position.

Raymond C. Truex, Jr, MD MEDICAL RECORD

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BERKS COUNTY MEDICAL SOCIETY 2014 SCHEDULE OF EVENTS

Sunday, January 19

11-2PM

Installation Brunch

Friday, February 28

7AM

Administrative Committee

Friday, January 31

7AM

Thursday, February 6 6PM Thursday, March 6 Monday, March 11 Monday, March 24 Friday, March 28

Thursday, April 3 Friday, April 4

6PM

Thursday, May 1 Friday, May 9

Friday, May 30

Thursday, June 5 Monday, June 16 Friday, June 27 Friday, July 25

Friday, August 22 Thursday, Sept. 4

Noon 7AM 6PM

10-2PM 7AM 6PM

7AM 6PM

Noon 7AM 7AM 7AM 6PM

Wednesday, Sept. 17 Friday, Sept. 26

7AM

Friday, October 31

7AM

Tuesday, October 14 Thursday, Nov. 6 Friday, Nov. 21

Thursday, Dec. 4

6PM

8-noon 6PM

7AM

Noon

Thursday, Dec. 4 Friday, Dec. 19

Executive Council

Retired Physician Luncheon

HEALTH TALK Tune in to Health Talk Live on WEEU radio to hear live community conversations about health topics with members and guests of the Berks County Medical Society! Join the discussion every Wednesday evening from 6 to 7pm when the Berks County Medical Society presents “Health Talk.” It’s your chance to call and chat with many of the region’s leading health care practitioners! Take a look at the Berks County Medical Society’s website, BerksCMS.org, for more information.

Administrative Committee Executive Council

FOr Live call in: (610) 374-8800 or 1-800-323-8800 to participate.

Residents’ Day & Memorial Lecture

Administrative Committee Executive Council

6:30-9AM Legislative Breakfast

Monday, September 8 Noon

Thursday, October 2

Executive Council

8AM-noon CPR Recertification

Friday, April 25

Administrative Committee

Berks County Medical Society’s

6PM

7AM

Hosts include: Dr. John Dethoff (pictured) Dr. Chuck Barbera Dr. Andy Waxler Dr. Pam Taffera

Administrative Committee Executive Council

Retired Physician Luncheon Administrative Committee Administrative Committee Administrative Committee Executive Council

Retired Physicians

Luncheon Golf Outing

Administrative Committee Executive Council

CPR Recertification

Administrative Committee Executive Council

Administrative Committee Retired Physicians

Luncheon Executive Council

Administrative Committee

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2014

LEGISLATIVE AND REGULATORY UPDATES From: J. Scot Chadwick, V i c e P r e s i d e n t, G o v e r n m e n t a l Aff a i r s ———————— Amy C. Green, Ass o c i a t e D i r e c t o r , G o v e r n m e n t a l Aff a i r s P e n n s y l va n i a M e d i c a l S o c i e t y

Legislation Protecting Physician Apologies Signed by Governor Thanks in large part to physician advocacy, on Oct. 25, 2013, Gov. Tom Corbett signed into law legislation preventing most physician apologies from being used against them in a medical liability lawsuit.

The Pennsylvania Medical Society (PAMED)thanks the supporters who sent more than 1,300 messages to the state legislature in support of this legislation over the course of the two-year campaign.

This legislation (now Act 79, formerly Senate Bill 379) will protect most physician apologies except for admissions of negligence, which would remain admissible. It removes a barrier to open communication between physicians and patients after a poor outcome, which is essential to maintaining the physician-patient relationship. It does not take any legal right away from injured patients or impair their ability to file a personal injury action against a health care provider should they choose to do so. It also does not limit the amount that a patient can recover in such an action.

Learn more in this educational webinar and in the newest issue of PAMED’s CME publication, Managing Risk (http;llwww.pamedsoc.org/MainMenuCategories/ Laws-Politics/News-from-Harrisburg/LegislationNews/Apology-law-education.html. Thank Pennsylvania’s legislators (https;1Iwww.votervoice.netiPAMED/ Campaigns/25414/Respond) for unanimously voting yes on this bill. 24 | MEDICAL RECORD

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In particular, PAMED appreciates the work ofthe bill’s prime sponsor, Sen. Pat Vance, and the sponsor of the House version, Rep. Keith Gillespie. Smoothing the way in both chambers were the majority leaders, Rep. Mike Turzai and Sen. Dominic Pileggi. PAMED also thanks Gov. Tom Corbett for including this as part of his Healthy PA plan (http;llwww.pamedsoc.org/healthypal announced earlier this fall and his quick action in signing the bill.

“As physicians, it is part of our job-part of our moral and ethical responsibility-to respond to patients and families when there are less than favorable outcomes,” said C. Richard Schott, MD, president of PAMED, in a statement (http://www.pamedsoc.org/FunctionaICategories/ About/Media/Apologize.html).

PAMED News and ViewsDecember 2013 Healthy PA Physician-Only Teleconference • PAMED and Todd Shamash, deputy chief of staff to Gov. Corbett, held a physician-only statewide teleconference on Dec. 16 to share information about the governor’s Healthy PA proposal. • Listen to the teleconference and view the PowerPoint slides on PAMED’s website at www.Qamedsoc.org/ healthypacaII.InthefIrst35minutes.Mr. Shamash provides an overview of what Healthy PA reforms mean for physicians. In the last 20 minutes, he answers physician questions. • Physicians will have more opportunities to give their input by participating in one of several public hearings or webinars being held by the Corbett administration. Get the details at www. pameclsoc. org/healthypafeed back.

Call to Action

• Congress adopted a .5 percent update to Medicare payments for three months, temporarily averting a 24 percent cut to physicians’ reimbursement. The short- term patches need to come to an end.

• Read more and urge Congress to permanently repeal the flawed Sustainable Growth Rate (SGR) Medicare payment formula, www.pamedsoc.org/sgrrepeal.

Resources on the ACA Health Insurance Marketplace

• PAMED is continuing to compile resources to help physicians and patients. Find them on our website at www.pamedsoc.org/healthreform.

• PAMED also is working on quick resource guides for physicians and their patients on the federal health insurance marketplace. Once tbey are finalized, they will be posted to our website. • Physicians who have questions on the ACA are encouraged to use our Ask the Expert form, www.pamedsoc.org/acaguestions. • PA Applies Band-Aid to Obama’s So-Called “Fix” for Policy Cancellations

Physician Leadership Day • On Dec. 10, PAMED physicians, residents, and medical students gathered at the state Capitol in Harrisburg for a media event with Gov. Corbett and Rep. Matt Baker (R-Tioga), and then met with their legislators to advocate for measures to help keep our health care teams strong, physician-led, and patient-centered. • Get more information, including photos and a video from the event, www.pamedsoc.org/ leadershipday. Continued on Page 26 MEDICAL RECORD

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2014

where n ote d . P 2 0 . . u n d er the photo please i n sert

B ruce A .

M ac L eo d , M D a n d f am i ly w i th G o v er n or T om

Drug Take Back Programs • As part of Gov. Corbett’s effort to help tackle prescription drug abuse, he announced on Dec. 16 that up to 250 disposal boxes are being placed in secure locations across the state. Get more information at www.pamedsoc.org/drugtakeback.

Legislative Updates

• Team-Based Care Bills Relax Physician Assistant Countersignature Requirements while Maintaining Patient Safety.

• Govemor Signs Child Abuse 1O-Bill Package; Strengthens Reporting Laws.

• Legislation Would Help Students with Life-Threatening Allergies in Emergencies.

• Bill Would Help Ensure Patient Safety when Anesthesia Is Administered. • Patient Safety Concerns Addressed ill Bill Allowing Audiologists to Practice 10M. • Check out Quick Glance for the latest updates - www. pamedsoc.org/quickgiance.

CME Reminder - 2014 is a license renewal year. PAMED can help physicians meet their CME requirements, www.pamedsoo.org/cme. Webinar Series on Opioids

• Series of six one-hour webinars designed to help educate physicians and other prescribers on the appropriate use of long-acting and extended-release opioids.

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• Archived webinars posted to PAMED’s website, www. pamedsoc.org/opioids.

• Watch the six webinar series and successfully complete the assessment to earn 6 AMA PRA Category 1 Credits™: CME is free to members; $150 for nonmembers.

2014 Year-Round Leadership Academy • Year-round education for physicians and other health care leaders in practices, groups, hospitals, and health systems. • Broad, practical leadership training; networking and mentoring opportunities.

• Six online courses, four day-long live sessions, and an optional team-based project addressing a current issue within a physician’s practice environment. • Participants will be able to earn 61.5 CME credits and 57.5 credits towards the Certified Physician Executive (CPE) certification (21 core credits and 36.5 elective credits) if they complete the full complement of courses.

• Register as soon as possible as the 2014 learning group is limited to 30 participants, www.pamedsoc.org/ academyregistration.

Practice Tools & News

• For physicians: Specialty-specific, ICD-I0 documentation training (online), CME credits available, www.pamedsoc. org/icd 1Odocumentation. • For practice coding staff: ICD-I0 regional coding workshops, www.pamedsoc.orgiicd IOworkshops. • 2014 medical record copying fees, www.pamedsoc. org/20.l 4copyingfees.

• New contract review service offering: Financial review of physician employment contracts, www.pamedsoc.org/ contracts. • How the 2014 Medicare fee schedule impacts reimbursement, www.pamedsoc.org/2014Medicarefees. • Meaningful use deadlines extended, www.pamedsoc. org/mudeadlines.

Fifth Annual Residents’ Day and Memorial Lecture

Residents’ Day and Memorial Lecture The Berks county Medical Society will hold the fifth annual “Residents’ Day and Memorial Lecture” on Friday, April 4, 2014 beginning at 10AM in the auditoriums of the Berks Visiting Nurse Association. Residents’ posters may be reviewed at that time, followed by the presentations of the winning posters. Following a buffet lunch, physicians who passed away during 2013 will be recognized. This year the Memorial Lecture, entitled Medical Professionalism: Opportunities in a Time of Rapid and Enormous Change,” is being presented by James F. Arens, MD. Dr. Arens is retired Chairman of Anesthesiology at UT Houston and UTMB at Galveston. He is constantly recognized and acclaimed as an eminent leader and educator. Among his many accomplishments, services and positions are: President of the American Board of Anesthesiology(1986-1987), President of the American Board of Medical Specialties (1996-1998), President of the American Society of Anesthesiologists (1988-1989), CEO of the University of Texas Medical Branch in Galveston, Chairman of the Department of Anesthesiology at the University of Texas MD Anderson Cancer Center in Houston (1999-2005), and the recipient of the American Society of Anesthesiologists, American Board of Anesthesiology, Texas Society of Anesthesiologists and the American Medical Association Distinguished Service Awards.

Please email info@berkscms.org or call 610-375-6555 if you are interested in attending.

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2014

ANNUAL RESIDENT’S SOCIAL

he Annual Residents’ Social was held on Tuesday, November 12th at “The Works” in Wyomissing. Approximately 35 residents and family members enjoyed the evening of socializing with fellow residents, eating pizza, and playing games. This event was sponsored through a generous donation from PMSLIC!

28 | MEDICAL RECORD

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2014

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24th Annual Fall Golf Outing

The Berks County Medical Society 24th Annual Fall Golf Outing was held at the beautiful Golden Oaks Golf Club on September 25th, 2013. We were thrilled with the participation, the venue and with the proceeds that will be used to perpetuate “Health Talk” and the educational services of the Berks County Medical Society. Berks County Medical Golf Outing Results

First Flight 1st Place

Bob Thomas Gene Shaffer Robert Early Sneed Shadduck

Timothy Stringer Mike Abbound Patrick Colarusso

2nd Place

59 Match of Cards

Second Flight 1st Place

Jeffrey Simons Mike Brown Patti Brown Dave Schaebler

Bob Ruhe Jeff Gilley Keith Rentschler

67 Match of Cards

2nd Place

Long Drive Ladies Long Drive Men Closest to the Pin Ladies Closest to the Pin Men

30 | MEDICAL RECORD

Patti Brown Jeff Bajor Carolyn Bamberger Chris Heinly

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The 2014 Fall Golf Outing will be held on wednesday, September 17, 2014. MARK YOUR CALENDAR!

MEDICAL RECORD

SPRING

2014

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All conferences are held in the Reading Hospital Conference Center, Rooms 1 & 2 at 8AM, except where noted. 1/3 Friday’s Child Pediatric Palliative Care: More Than End of Life Care or Hospice Deana Deeter and Linda Watson Penn State Hershey Children’s Hospital 1/10 Diagnosis and Treatment of Papulosquamous Disorders Louis Mancano, MD Medical Director, Ambulatory Practices Reading Hospital

1/17 Clinical Case Presentation: A Patient with Lyme Disease and Babesiosis Kathleen McElwee, MD Reading Hospital Physician Network, Infectious Diseases Jettie Hunt, MD Department of Pathology Reading Hospital 1/24 Principles of Palliative Care Vinti Shah, MD Reading Hospital Physician Network, Palliative Care

1/31 Type 2 Diabetes Mellitus: Optimizing Control with the DPP-4 inhibitor/GLP Receptor Agonists M. Joyce Buliyat, MD Assistant Professor, Department of Family and Community Medicine Penn State-Milton S. Hershey Medical Center 2/14 Cardiac Stress Testing: What Test for Which Patient? Michael Avedissian, MD Cardiologist Cardiology Associates of West Reading 2/21 Choosing the Appropriate Study: EvidenceBased Radiology Guidelines for Clinical Practice Michael Feightner, MD Radiologist West Reading Radiology Associates 2/28 Age Related Macular Degeneration Barry Malloy, MD Chief, Section of Ophthalmology, Reading Hospital Eye Consultants of Pennsylvania 32 | MEDICAL RECORD

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