Berks County Medical Society Medical Record Spring 2024

INSIDE: The Life of an 1824 “Country Physician” Kristen Sandel, MD, Inaugurated as the 174th President of PAMED

Reflections on About 50 Years of Pulmonary and Critical Care Medicine – John Shapiro, MD

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Berks County Medical Society MEDICAL RECORD

D. Michael Baxter, MD, Editor Editorial Board

D. Michael Baxter, MD

Lucy J. Cairns, MD

Daniel Forman, DO

Shannon Foster, MD

Steph Lee, MD, MPH

William Santoro, MD, FASAM, DABAM

Raymond Truex, MD, FACS, FAANS

T.j. Huckleberry, MPA

Berks County Medical Society Officers

William Santoro, MD, FASAM, DABAM President

Ankit Shah, MD President Elect

Daniel Forman, DO Treasurer

Jillian Ventuzelo, DO Immediate Past President

T. J. Huckleberry, MPA Executive Director

Berks County Medical Society

2669 Shillington Rd,, Suite 501

Sinking Spring, PA 19608 (610) 375-6555 (610) 375-6535 (FAX)

Email: info@berkscms.org

www.berkscms.org

The

William Santoro, MD FASAM, DABAM Chief, Section of Addiction Medicine, Reading Hospital/ Tower Health President

Dear BCMS Member,

Ineed to start with a disclosure. I am often an early adapter to technology. I started using voice dictation in the 1980s long before it was accepted by the masses and used in everyday cell phones. I bought my first gasoline/electric hybrid car in 2008. I have been driving a fully electric vehicle for several years and I don’t plan on ever buying an internal combustion engine car for myself ever again. I state these milestones so that you understand that I am not opposed to new technology.

Throughout history medicine has been known to be very appropriately reluctant to embrace new technology. The medical field has always had a healthy skepticism about new technology. The skepticism is appropriate as we need to be certain that the new technology embraced truly improves outcomes for our patients. We often look down on a product or technology that only proves “noninferiority.” Our slow acceptance of new technology is appropriately based on the adages, “first do no harm” and “don’t fix something that isn’t broken.” So, in an industry known for its reluctance to embrace new technologies, why is the acceptance of artificial intelligence (AI) moving so quickly in healthcare? And just as importantly, what are the implications? Artificial intelligence is already so widely accepted that when I recently shared with a medical student a story I had written, after reading it, he asked if I created the story utilizing Chat-GPT or a chatbot.

I recall the beginning of my third year in medical school. I, along with five other medical students, gathered in a conference room at the hospital. Our attending explained that we were each assigned to a patient already admitted to the hospital, but we were to go in and do a history and physical without looking at the patient’s chart. This was my first experience creating a doctor-patient relationship. I felt that the relationship was so sacred I could not just walk in and start asking questions. I honestly valued the “relationship” much more than the “doctor” or “patient” part of the “doctor-patient relationship” so that I spent the first 15 minutes simply talking to this person in a hospital bed. I talked about who I was and asked non-medical questions concerning who he was. Forty-three years later I still remember his name, Jose Guzman Feliciano, and still remember a lot of what we would call his social history; he lived alone after his wife passed away 15 years earlier. What I don’t remember, however, is the diagnosis that brought him into the hospital. Once I felt confident that I had a person-to-person relationship with him I then began creating what I believe was my first doctor-patient relationship.

My time in medical school was in the day before computers, but sometime after stone tablets.

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From that first day of my third year in medical school through the end of my residency I carried several soft cover textbooks and a notebook in the pockets of my white coat. I referred to these textbooks and notebook as my peripheral brain. Today, the medical student’s and resident’s peripheral brain is the handheld computer. In my time, I evaluated a patient, scoured through my peripheral brain, made a plan for treatment, and hand wrote (in a paper chart) my decisions and the basis for these decisions. Very soon physicians will interview a patient and input the data into the handheld computer. At that point the computer will determine the diagnosis and treatment plan. With artificial intelligence, the computer will even document the medical note.

Artificial intelligence medical documentation comes with life-changing consequences for patients if an error occurs, so its use must be done very carefully. Medical AI programs require an extensive understanding of medical terminology, documentation standards, and natural language. Choosing a tool that isn’t vetted for high accuracy is asking for trouble. In the language of artificial intelligence, accuracy is also referred to as “hallucination rates.” Hallucinations in AI refers to the tendency of a program to create inaccurate conclusions and list them as fact. AI hallucinations can occur when the program makes assumptions based on patterns, even if the generated conclusion is factually incorrect. With significantly high stakes in medicine, AI-powered clinical documentation and solutions must have a nonexistent hallucination rate.

Yes, when I started in medicine we often talked about the doctor-patient relationship. While the electronic medical record has improved documentation and the ease of collaboration/ communication with colleagues involved in patient care, too often what we have now is a doctor-computer relationship with the patient being relegated to a data source. We must also consider where the delivery of medicine will go with the growth of artificial intelligence. I believe that artificial intelligence will permeate all aspects of our lives, including the field of medicine. I do not worry that artificial intelligence will replace me as a physician because, although I believe artificial intelligence can, and will, correctly diagnose many illnesses, correctly map out the treatment of those illnesses, I also believe that the delivery of healthcare will always require a person. We need to remember that we collect data to treat, but it is the human connection that cares.

T.J. Huckleberry, MPA Executive Director

There Are No Lines of Code for Common Sense

The focus of this edition of the Medical Record is on the advancements in Artificial Intelligence (AI), a controversial topic that stirs diverse emotions in different people. Many believe that this will be the next great step in science and industry. Others fear this technology will only further deplete the work force. Some people think that this is a gateway to unrealized innovations, while others have nightmares of science fiction robots taking over the planet. I, for one, have watched Blade Runner, Alien, and Terminator too many times to not envision that my future nursing home residence will be run by some malcontent version of Hal from 2001 Space Odyssey, thus placing me in the latter group of neotechnophobic luddites who are more than a little weary of AI.

Now, please do not get me wrong; progress in all forms is crucial to human experience. Making the world a better place should be the ideal of all mankind. If AI can truly cure cancer, or reduce emissions, or make bacon cheeseburgers cholesterol free, I am all for it. However, we should always remember that AI must be thought of as a tool to assist and not an independent decision-maker because there is no replacement for common sense, and the only code that can generate true humanity is genetic.

History has proven this time and time again. Just ask Stanislav Petrov…. You all know who Stanny P. is? The man literally saved the world and most of you thought he was the goalie for the Flyers! Here is a quick history lesson. Stanislav Petrov was a lieutenant colonel in the Soviet Air Defense Forces. Petrov was on duty September 26, 1983, when the Russian’s early-warning satellite system detected what appeared to be five U.S. nuclear-armed intercontinental ballistic missiles breaching USSR air space. Petrov

was faced with a critical choice that had to be made instantly; assess the warning as a false alarm and take no action or alert his superiors at the Kremlin, who would most likely launch a counterattack?

Thankfully for all of mankind, Petrov just drank his coffee and went with false alarm. But why? Why at the height of the Cold War and nuclear stockpiling did this man not perceive the data as a creditable threat since his computer said it was happening? Well, later he explained that if the United States really were going to start World War III, they would have fired more than just five missiles. Using common sense, he was correct. An error in Soviet satellite readings had mistaken the reflection of sun on to cloud coverage as inflight U.S. missiles. It’s important to note that Petrov was actually reprimanded and demoted for his actions that day. However, after the fall of the USSR and his story became known, he was awarded several international awards.

The point of Lt. Colonel Petrov’s story is that if we just blindly take advantage of new technologies without reminding ourselves of the value of our own human faculties and the limitations of our creations then we are setting on a dangerous course.

As a patient, I rely on my physicians to utilize all advancements at their disposal to improve my health and the health of my family, but most importantly, when my life is on the line, I rely on their talents, compassion, and common sense to save my life. Each day our physicians are faced with Petrov-like decisions. While some night I will wake up in a cold sweat because of a nightmare of a glitchy android-driven medical catastrophe, I will calmly fall back to sleep knowing that I have physicians caring for me who base their decisions on the essential element of human intelligence (HI).

Iby D. Michael Baxter, MD, FAAFP

n this Spring edition of the Medical Record, we look back and we look forward. As we celebrate the 200th Anniversary of the Berks County Medical Society, we are highlighting historical periods in the lives of our patients and physicians. In the article “The Life of an 1824 Country Doctor,” we are reminded of the intersection of medical science, technical skill, and compassionate care in the practice of medicine. It is almost incomprehensible for us to transpose ourselves to that time and place. Who can imagine practicing medicine without the availability of antibiotics, radiology, anesthesia, modern communications, and hospital services? And yet with their limited knowledge and technical skills, but high degree of compassion, they did the best that they could, which serves as an inspiration to us today.

Looking forward, our cover story emphasizes the increasing role of Artificial Intelligence in the practice of medicine. We are indeed fortunate to have an incredible array of technology, including AI, at our disposal. The potential to improve patient care and perhaps

mitigate some of the more onerous aspects of medical practice is nearly unlimited. However, as this article emphasizes, there will also be potential risks, some foreseeable and some not. Just as the opportunities afforded by the internet and specifically our amazing handheld computers, our cell phones, offer previously unimaginable access to information and communication, we are increasingly seeing the downside, such as the dissemination of disinformation and the rise of social isolation (“The Loneliness Epidemic”) and mental health concerns, especially among our children and youth.

In particular, looking back and looking forward, we are reminded that more than any other profession, the practice of medicine requires a high degree of interconnectedness between these spheres of scientific knowledge, technical proficiency, and our human compassion. The potential is great for AI to improve our medical care; however, by definition, AI will never replace our humanity as an essential element of what makes a great physician.

Celebrating

YEARS OF EXCELLENCE

200th Anniversary Activities (1824-2024)

1824 Club

“1824 Medicine” Wine & Cheese at the Berks History Center, June 6th 6:00–8:00 PM 940 Centre Ave., Reading

1824 Journal Club

1860-1899 Literature/History at the Highlands at Wyomissing

May 2nd 6:00–8:00 PM

1900-1960 Literature Review at B2 Bistro, 701 Reading Ave., August 15th 6:00–8:00 PM West Reading

Other Activities

Prescription Drug Take Back Event

April 27th 8:00-11:00 AM at First Energy (Reading Fightin’ Phils) Stadium

MOM-n-PA Dental Mission, Reading, PA

June 21st, 22nd Santander Arena, 700 Penn St., Reading

Doors open 6:00 AM (Physician assistance needed for medical screening)

Please RSVP for the 1824 Club and Journal Club events. To register and for additional information email: www. berkscms.org or contact T.J. Huckleberry @ (610) 375-6555. To plan or contribute toward 1824 Anniversary events, contact T.J. Huckleberry.

1824 Fund

The 1824 Fund has been established by the Berks County Medical Society to support our 200th Anniversary activities. Anyone who would like to contribute to this fund may do so by sending a contribution directly to:

The Berks County Medical Society 2669 Shillington Rd., Sinking Spring, PA 19608

Or by contacting our Executive Director, T.J. Huckleberry, at: info@berkscms.org.

The Life of an 1824

“CountryPhysician”

by D. Michael Baxter, MD, FAAFP

Doctor” by Luke Fildes

The life of a physician is never easy. As those of us in this profession know, each day brings a host of physical, psychological, and even spiritual challenges that can tax the best of us. However, few of us can truly imagine the challenges facing the physicians of 1824. The treatment of patients (what we formally call the “practice of medicine”) has always existed as a Venn Diagram at the intersection of scientific knowledge, technical skill, and humane care, even as the emphasis of each of those spheres has changed over time.

As we celebrate the 200th Anniversary of the Berks County Medical Society, a singular achievement for any U.S. medical organization, this is a grand opportunity to reflect on how that Venn Diagram has shifted over these two hundred years. What was the practice of medicine like as a “Country Doctor” in 1824? In our recent “1824 Journal Club,” we explored this question: “How did physicians practice medicine and what issues were physicians confronting in 1824?”

First a few demographics: The Census of 1820 recorded a total U.S. population of 9,638, 453 of which 1,538,022 were in slavery. (In 1780 Pennsylvania adopted the “Act for the Gradual Emancipation of Slavery” which became model legislation for the rest of the country, however, slavery did not fully end in PA until 1850.) The total Pennsylvania population was 1,049,458, the third

largest state behind New York and Virginia. The total population of Reading was 4,322, the sixth largest city in PA and the 46th largest in the U.S. Although there were physicians practicing in the city, there were also those living and serving patients in the larger, more rural areas of the county. Of course, both travel and methods of communication were quite limited, thus, the establishment of the Berks County Medical Society with the intention of meeting regularly to share news of disease spread and discuss treatment options was quite a step forward for the time.

Scientific knowledge as a key to the practice of medicine was limited in 1824. Much of the theory of disease and the foundation of medical care was still based on a centuries-old model known as the humorous theory; when someone was ill that was due to an imbalance of body humors—blood, yellow bile (liver), black bile (spleen), and phlegm. Illness represented an imbalance of these humors, so emphasis was placed on re-establishing balance through such acts as purging and bleeding (“leeching”). Also, there was wide use of such therapies as opium and even strychnine for an array of maladies. Proven treatment options were limited, especially in an age before the “germ theory” of infectious diseases was understood. Epidemics of cholera, typhus, diphtheria, and strep (“scarlet fever”) could ravage communities, devastating populations and mostly affecting children and the elderly.

“The

In 1824, almost all physicians were males and there was often little formal schooling in medicine. The most prestigious medical schools were found in Europe except for a few in the United States in such communities as Boston and Philadelphia. Berks County was fortunate to have physicians even in those early days who had trained at such prestigious medical schools (“Celebrating the History of the Berks County Medical Society” by Drs. Eve and Dan Kimball in the Winter 2024 edition of the Medical Record).

Women did play a prominent role, however, as midwives in childbirth care. In addition, there were few formal medical offices with physicians predominantly practicing out of their homes making “rounds” visiting patients by horse and buggy.

Interestingly, the historical record shows that physicians in the early 19th Century were challenged with convincing their patients of the value of immunization, like what we confront today, especially following the COVID-19 Pandemic. The English physician Edward Jenner demonstrated the efficacy of smallpox vaccination in 1796. By the early 19th Century, the value of this technique was recognized as the best means of combatting the scourge of smallpox which had ravaged humans for thousands of years. Many patients resisted and indeed there continued to be smallpox epidemics in Berks County with one of the largest at the end of the 19th Century.

Another similarity, though nonmedical, between 1824 and 2024 was the highly contentious presidential election. John

Quincy Adams, Andrew Jackson, and Henry Clay, among others, were contenders for the Presidency. When no candidate won a decisive victory, the 1824 outcome was decided by the US House of Representatives as John Quincy Adams was chosen the sixth President of the United States, perhaps an ominous sign for our own time.

The physicians of 1824 had limited scientific knowledge, but they did have a degree of technical skill and almost certainly a deep sense of compassion for their patients. There is a rather famous 1891 painting, “The Doctor” by Luke Fildes, reproduced on page 10, which shows distraught parents with their discerning physician at the bedside of a dying child, perhaps from an overwhelming strep infection. I have thought about that picture many times as I have similarly sat by a patient facing the end of their life. Certainly our 1824 predecessors lacked the science-based knowledge and the technical skills that we bring to our patient care today, however, I have no doubt that they utilized their limited resources to the best of their ability and offered their patients a very personal level of compassionate care. Yes, our science and our technology are far superior to theirs, and yet we are reminded by their example that it is ultimately our compassion-driven commitment to alleviate suffering and to provide comfort in time of need that remains essential to the healing role of the physician.

TArtificial Intelligence in Health Care: Promise or Peril?

by Susan Shelly

he use of artificial intelligence (AI) in health care continues to gain momentum as its value is recognized in performing tasks ranging from transcribing medical documents, assisting with drug discovery and development, remotely treating patients, and diagnosing illnesses.

At its best, AI can improve health care systems to make them smarter, faster, and more efficient, resulting in more easily accessible care for millions of people, increased safety, better patient outcomes, and reduced costs.

But as the use of AI increases, serious questions are being raised regarding the potential for risk in areas such as privacy and security, bias and social inequity, data collection and algorithm development, job displacement, and the quality of patient-provider relationships.

There also is increasing concern about potential liability for physicians if an AI program offers a diagnosis, treatment plan, or other medical advice that turns out to be incorrect.

Recognizing that AI is already employed in numerous ways by Berks County health care providers and poised to become even more widely used, Medical Record reached out to some members of the medical community to hear their thoughts.

Most of those we talked to expresssed guarded enthusiasm for the use of AI in their own health care settings and throughout the industry.

Dr. William Santoro, Chief, Section of Addiction Medicine at Tower Health and President of the Berks County Medical Society

While concurring that AI is the way of the future in health care, Dr. William Santoro urges restraint in how it’s implemented and employed.

“Traditionally, the medical field is skeptical about new technology, and I believe that’s appropriate,” Santoro said. “Let’s make sure the tools we choose are well-vetted and tested before we put them to use.”

He applauds the use of AI in applications such as automatic notification of potential drug interactions when writing prescriptions and noted that he was an early adopter of voice dictation. Also, during the pandemic he relied on telehealth for staying in touch with patients – with good results.

“It’s not that I’m opposed to technology or reluctant to use it,” Santoro said. “I just think we shouldn’t rush into AI before we fully understand its function.”

Santoro, who has been in practice for 41 years, expressed concern that extensive reliance on computers could lead to a lessened ability for problem solving and creative thought.

“Sometimes I wonder if we’re dummying down and not learning because of our dependence on computers,” he said.

While also concerned that AI could limit human interaction in some instances by having machines do the work of people, Santoro is confident that human presence in health care will continue.

“People don’t want to go to a health care system that’s driven by AI-operated machines,” he said. “People want to go to a doctor who will talk to them about how they’re feeling and show concern for them.”

Comparing the onset of AI to automobiles replacing horses and buggies, Santoro conceded that AI cannot be held back.

“It’s clear that AI is going to be the way of the future of health care,” he said. “The question is how we use it so that it fits into our humanity.”

Isaiah Adio, Chief Information Officer of Berks Community Health Center

The Berks Community Health Center is in the early stages of technological advancement, according to Isaiah Adio, Chief Information Officer, but is working to develop its infrastructure and looks forward to future implementation of AI.

“We are in the process of revamping our technology and we have a lot of work in front of us,” said Adio, who was hired by Berks Community Health Center about four months ago. “Once we get all those pieces into place, we’ll be ready to consider AI.”

He looks to AI in the future to increase engagement by enabling patients to schedule their own appointments, follow up on post-visit care instructions, and receive health-related news and educational materials.

Adio also is looking forward to translating capabilities offered by AI – something he said the health center will welcome – and said it can help to protect patient information. When implemented and used effectively, he believes AI can cut costs.

“There are many applications we’ll be looking at,” Adio said. “The way AI is going, the next five years will be very, very big.”

Addressing concerns that AI will result in job loss through automation, Adio said it’s up to leadership to assure employees that while their jobs may change, they will not disappear.

“The only people who will lose their jobs are those who refuse to walk alongside of AI,” he said. “It’s the way of the future and it’s here to stay.”

Although the health center has no current timetable for implementing AI into its operations, Adio said he is working with staff and decision makers to assure it continues to advance technologically.

“Berks Community Health Center in the future will benefit from AI,” he said. “It’s just a matter of time.”

Dr. Andrew Waxler, Cardiologist at Penn State Health St. Joseph Medical Center, Member of the Health Affairs Committee of the American College of Cardiology, and former President of the Pennsylvania Chapter of the American College of Cardiology. He is also a Past President of the Berks County Medical Society.

As a cardiologist, Dr. Andrew Waxler believes AI can help patients take greater control of their heart health.

Wearable devices that measure heart rate, blood pressure, oxygen saturation, heart rhythm, and other physiologic parameters can be extremely helpful, as can apps that enable patients to record EKGs at home to determine atrial fibrillation or other arrhythmias.

“I’ve seen patients end up in the emergency room with a stroke and then they’re diagnosed with AF,” Waxler said. “A device that alerts someone to atrial fibrillation when they’re asymptomatic is a breakthrough.”

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Artificial Intelligence in Health Care: Promise or Peril?

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He also is excited about AI-powered systems that can aid in early detection of cardiovascular disease based on factors including genetics, lifestyle, and living environment, and programs that analyze patient data to identify patterns and predict how patients would respond to various treatments.

“That could help cardiologists provide a more personalized treatment plan,” Waxler said.

While looking forward, however, Waxler is concerned that some AI applications could negatively affect patient-physician relationships.

“I don’t think patients want to interact with machines instead of people,” he said. “Patients and physicians must be able to have some sort of emotional connection.”

As a member of the Health Affairs Committee of the American College of Cardiology, Waxler is working with colleagues to study AI and its potential impact on the field of cardiology and health care in general.

“We are taking a close, hard look at AI and the potential long-term and short-term effects it could have on cardiovascular doctors, staff, and patients,” Waxler said. “We’re working to position ourselves on this topic.”

While optimistic that AI will be helpful long-term, Waxler warned against misuse.

“Like a lot of things, AI is a double-edged sword,” he said. “It needs to come with guardrails until we have a better understanding of it.”

Anish Sethi, third-year medical student at Drexel University College of Medicine at Tower Health

Believing the use of AI in medicine is in its infancy, Anish Sethi is enthusiastic about the possibilities.

“I’m excited to see the many ways it can be applied to medicine,” he said.

Combining lifelong interests in computer science and medicine, Sethi currently is working on an AI project with a colleague at the Mayo Clinic and University of Rochester.

Still in the early stages, the project aims to use machine learning models to make predictions about patients based on variables pertaining to them.

“There are so many avenues to go down with AI and medicine, but I think the main thing will be using AI as a prognostic tool,” Sethi said. “It’s really about figuring out how to predict the future.”

Sethi, who is 24, is interested in how medical data is gathered and used.

“All that data that’s been collected over the past few decades is now able to be harvested and put to use,” he noted.

Sethi credited electronic health records (EHRs) for providing patient data that can be used to identify optimal treatment options,

aid in decision making, survey population health, and develop predictive models.

Looking forward, Sethi did not rule out the possibility that some aspects of AI could be problematic.

“There’s always something that can go wrong when we try something new,” he said. “But it’s impossible to see what might happen because there are so many moving variables.”

Sethi, who plans to pursue a career in neurology, hopes to continue exploring the implications of AI, saying it is human nature to push the boundaries of knowledge and experience.

“As humans, we’re driven to keep learning and developing new ways of doing things,” he said. “I’m excited to see where we’ll be in 10 or 20 years from now.”

Dr. Kristen Sandel, Emergency Department Physician, President of the Pennsylvania Medical Society, and Past President of the Berks County Medical Society

Inaugurated as president of the Pennsylvania Medical Society in January, Dr. Kristen Sandel wants to bring joy back into the practice of medicine. She’s hopeful AI can help.

“I’m hopeful technology can be used to sustain employees by making our jobs easier and improving work-life balance,” she said.

Sandel, an ER physician and medical director of the emergency department of WellSpan Ephrata Community Hospital, applauded current uses of AI.

She cited programs that capture physician-patient dialogue and convert it into clinical notes, read CT scans of stroke patients, assist with triaging, and scan EHRs to identify patients at high risk for readmission.

While recognizing the value of AI, Sandel expressed some reservations.

Because it’s programmed by humans, some AI contains biases that could negatively affect patient care.

“The AI is only as good as the people who design it,” Sandel said.

She also worries the use of AI could decrease interaction between physicians and patients.

“AI can communicate with patients, but not all communication is spoken word,” Sandel said. “We must balance technology with that human connection.”

At the state level, the Pennsylvania Medical Society is keeping a close eye on the use of AI.

“We watch everything closely, particularly legislation and regulatory decisions,” said Sandel, former chair of the executive committee of the Berks County Medical Society. “We want to make sure the things coming out are vetted through the proper channels to assure we stay in compliance and provide safe patient care.”

Looking ahead, Sandel is hopeful that AI will continue to

improve patient care, but with keen oversight from humans.

“You always need great people in medicine and computers will never replace that human touch,” she said. “But emerging technology will enhance the care we’re able to provide, and we’re grateful for that.”

Dr. Eugene Reilly, Vice President, Chief Medical Information Officer Tower Health; Chief, Division of Trauma and Surgical Critical Care, Reading Hospital; Medical Director, Trauma Program, Reading Hospital

Dr. Eugene Reilly believes AI will fundamentally change the way health care is developed and delivered – bringing benefits and challenges.

He applauds the use of generative artificial intelligence to help document patient visits, enabling providers to focus attention on patients instead of charting, but worries about the potential for yetunexplored technical and ethical issues.

An AI program can scan vast amounts of information and return possible diagnoses of illness, he said, but cannot understand the values of patients and providers dealing with the course of treatment.

“Health care is changing, just like life in general,” Reilly said. “AI is showing up everywhere, and there’s going to be good and bad.”

Computers perform some tasks better than humans can, Reilly contended, such as analyzing and performing computations on vast stores of data to identify patterns.

Relying on machines to undertake that type of work in health care will leave providers more time and opportunity to deal with human aspects of medicine.

“That could free up humans to do what we’re supposed to be good at, like forming durable, human relationships with our patients,” Reilly said.

He expressed concern about the accuracy of information AI generates and how that information might be used. A danger, he said, is employing AI-generated information without question.

Great care for your patient starts with a strong team.

Adam J. Altman, MD

Angela Au Barbera, MD

Helga S. Barrett, OD

Jennifer H. Cho, OD, FAAO

Christine Gieringer, OD

David S. Goldberg, MD, FAAP

Marion J. Haligowski III, OD

Dawn Hornberger, OD, MS

Y. Katherine Hu, MD, MS

Lucinda A. Kauffman, OD, FAAO

Christina M. Lippe, MD

Barry C. Malloy, MD

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Mehul H. Nagarsheth, MD

Abhishek K. Nemani, MD

Tapan P. Patel, MD, PhD

Jonathan D. Primack, MD

Kevin J. Shah, MD

Michael Smith, MD

Anastasia Traband, MD

Monica Wang, OD

Denis Wenders, OD

Linda A. Whitaker, OD, MS

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“Remember that generative AI puts a premium on sounding human, not necessarily on being right,” Reilly said. “The real problem is that humans are fallible, and we expect these machines to not be.”

AI will provide many benefits for health care, but must be used wisely and with a degree of caution.

“In my mind, the key is making sure there are guardrails in place to prevent the

tail-end, dystopic risks from occurring,” Reilly said.

Dr. Brian Kane, Chief, Division of Family Practice at Tower Health

Noting that EHRs have significantly improved patient care by integrating information and making it available in real time, Dr. Brian Kane is optimistic that continued on next page >

Artificial Intelligence in Health Care: Promise or Peril?

continued from page 15

emerging AI technologies can make EHRs more user-friendly to providers and patients.

“Electronic health records have been a game changer,” Kane said. “When I started in practice it was paper charts with significant lag time with patent information. Now, I know in real time what’s going on with my patients.”

Currently, Kane is looking at an AI application that records provider-patient conversations and creates office notes, eliminating the need to enter patient information on a computer during the visit.

The program has been piloted at Tower Health and is being offered to a limited number of providers for use.

“If it works the way I understand it should, it could really change the way a doctor interacts with a patient because it would remove the computer from the equation,” Kane said.

As with any new technologies in health care, the program should be implemented slowly, he said, with attention given to how it’s received by patients.

Prior to the current war in Gaza, Kane was working with medical professionals in Israel to create an AI program designed to scan vast stores of medical literature with the goal of providing patient diagnoses.

The program returns diagnoses based on a patient’s responses to a series of prompts, while also citing reports on which the diagnoses are based.

“It provides a way to utilize medical information that no person would ever have time to sort through and process,” explained Kane.

As AI is increasingly used in health care, Kane advised it should be viewed as an aid to care, but not allowed to dictate process or replace human interactions.

“It’s up to us to use it appropriately,” he said.

Dr. Ankit Shah, Emergency Medicine Physician and Clinical Informaticist at Tower Health, and President-Elect of the Berks County Medical Society

Trained in emergency medicine, Dr. Ankit Shah recently became a board-certified clinical informaticist, a position he describes as “a bridge between all the medical data that’s out there and the clinical professionals working at the bedside.”

The volume of data generated by health care systems is huge and increasing exponentially, making it impossible for providers to keep up.

That’s where Shah comes in.

“My role is to see what’s out there that’s relevant, valuable, and applicable for providers caring for patients,” he said. “My goal is to make their lives easier.”

His role gives Shah a front-and-center seat to the emerging world of AI in health care.

“I definitely am more exposed to it than the average doctor, and that’s a good thing,” Shah explained. “Clinical physicians are busy caring for people and saving lives. They shouldn’t have to think about AI programs.”

While providers at Tower Health employ AI in various capacities, health care in general tends to lag five to 15 years behind other industries in adopting technology.

That lag, explained Shah, is due to fear that AI could negatively affect patient care.

“There is hesitance and fear associated with artificial intelligence in health care,” he said. “But I see it slowly making its way into the realm of patient care.”

Shah cited programs that can comb EHRs to generate responses to patient questions or refute denials for services from insurance companies, noting they save time and enable physicians to concentrate on their real work of caring for patients.

Shah sees the potential for AI in health care as seemingly boundless, but warned that steps must be taken to assure it is used properly.

“This (AI) is where medicine is going, and I’m excited to be at the forefront,” he said. “But it cannot be implemented without human oversight.”

Final Thoughts

While it seems clear that AI will continue to emerge as a force in many aspects of health care, ushering in innovation, opportunity, and promise, it’s also clear there are some grave misgivings associated with it.

The World Health Organization last year issued a call for caution regarding the use of AI, and numerous other organizations and U.S. health care leaders have done the same.

Whether artificial intelligence will prove to be promise or peril remains unknown, although most people would probably guess it will bring some of each.

One thing, however, is perfectly clear.

As the use of AI in health care advances, the entire health care community should commit to doing everything possible to ensure that, in keeping with the highest medical principles, it first, will do no harm.

Advocacy Update

PA Legislative priorities for PAMED and the BCMS include: (Contact your state legislators).

Senate Bill 521, House Bill 1633 to Abolish Noncompete Agreements in Physician Contracts recently was approved by the House Health Committee on a vote of 21-4. Support for this bill remains a very high priority.

SB 25 to Expand the Scope of Practice for Certified Nurse Practitioners by eliminating their current requirement for a collaborative agreement with a physician is opposed by PAMED/BCMS.

HB 747 to address the recent PA Supreme Court decision which permitted “venue shopping” by plaintiffs in medical liability cases. This bill would overturn this rule and is supported.

HB 1510 to reform and streamline the PA insurance credentialing process is supported.

“Study of the Delivery of Health and Public Health Services in Berks County”: BCMS continues to work with the Berks County Community Foundation and others to educate the public and promote implementation of the study recommendations announced in March 2023. Recent programs by BCMS members on Chanel 69 News and WEEU “Health Talk” emphasized the importance of moving forward to improve the health of everyone in Berks County.

Thomas

Michael

Kristen Sandel, MD

Inaugurated as the 174th President of PAMED

Kristen Sandel, MD, Past President, and Past Executive Council Chair of the Berks County Medical Society, was inaugurated as the 174th President of the Pennsylvania Medical Society on January 24, 2024.

It is especially fitting that Dr. Sandel is recognized with this honor on the 200th Anniversary of the Berks County Medical Society. Over the 176-year history of PAMED, several BCMS members have held this position, however, Kristen is the first in 35 years since Wiiliam Alexander, MD.

Our members are proud of Kristen’s achievements, wish her well and offer our support for her efforts on behalf of Pennsylvania’s patients and physicians. Congratulations!

The following is Dr. Sandel’s Inauguration Address.

Good evening,

One day in 2005, I was in the trauma bay and received a call from Dr. Brian Kane. He was the Young Physician Section representative from Berks County to the PaMed House of Delegates. As usual, I was immersed in chaos in the bay while he was asking me if I would consider being the young physician representative for Berks County, as he had aged out of the position. Under the pressure of patient care, I agreed and basically forgot about it, until I was contacted to begin to attend meetings at the Berks County Medical Society and the House of Delegates.

Today, that journey comes full circle, as I will be the first president of the Pennsylvania Medical Society from Berks County in over thirty-five years and one of a handful of women elected to this prestigious position.

Medicine has evolved immeasurably over the last two centuries. Last year, we celebrated the 175th anniversary of PaMed and fondly looked back on the history of medicine and advocacy not only in Pennsylvania, but also on a national level. Our past president’s, Dr. Wilson Jackson, initiative was extremely well received by the members of the society as it looked to ensure that physicians were

educated and intricately involved in decisions that affect the care of the patient, especially financial aspects of medicine. While we continue to pursue those efforts, my initiative will be somewhat different. As an Emergency Medicine Physician who has practiced in that setting for over 20 years, I have seen a dramatic change in the way medicine is delivered and the way that physicians perceive their job. I use the term job because it feels like that to many, just another clock in, clock out job, not a profession. Many of the hopes that physicians had in practicing medicine and bedside patient care have been whittled down to metrics and analytics due to a variety of factors. Regulatory pressures, insurance company demands, and critical financial decisions are seen as hurdles by frontline physicians who are trying to hold the patient-doctor relationship sacred. In the end, most physicians went to medical school to make a difference in people’s lives, and sometimes that gets lost in health care in

PAMED leadership group photo

Kristen Sandel, MD, and her parents

Dr. Sandel presenting her Inauguration Address

2024. Physicians are placed in front of computers, not in front of patients, to meet the documentation demands that are needed to keep their offices and hospitals open. Covid-19 brought an entirely new set of challenges to bedside care and the way we deliver medicine, not to mention the way we handle work/life balance. The number of physicians who struggle with burnout, substance use disorders, workplace violence, and mental health concerns has skyrocketed, especially in those physicians who work in a hospital setting and emergency care setting. How do we bring back the enjoyment in Medicine?

My initiative for this year will concentrate on revitalizing our profession and bringing the joy back to the practice of medicine. This is not an easy task or one that should be taken lightly. This is not a push for a few lectures on burnout and some meditation exercises, deep breathing, circle drumming, or yoga. This initiative is to look at the root cause of the problem. We need to start addressing the elements that are causing physicians to retire early, leave the bedside, and in some cases, take their lives. Over the next year, I will be working with our outstanding PaMed staff to start the conversations

and to bring us back to that wide-eyed first year medical student we were years ago. We need to start reconnecting with each other, in person, not over computer screens. We need to get to know our colleagues as people, not just as virtual consultants. We need to bring care and decision making back to the bedside. We need to get back to the heart of medicine and what brings us happiness.

We’ve already started to work on one of the biggest healthcare crises affecting medicine and burnout, the boarding and overcrowding of Emergency Departments throughout the commonwealth and our nation. Our taskforce has worked to bring this issue to the forefront in Harrisburg, and we have engaged in conversations with key stakeholders, including members of the governor’s office and the department of health in PA. This is only a start. Over the next year, you will see various efforts to engage with physicians across Pennsylvania, as well as opportunities for education and for physician reflection, to identify ways that PaMed can help to resolve the frustrations in medical practice and bring us back the art of medicine.

Finally, I would like to thank my family, friends, mentors, and coworkers, many who are here today for their presence, guidance, support, and their love, especially during some very difficult times over the past 20 years. Your contributions to my life are innumerable and clearly, I would not be standing here today without you. I am eternally grateful to you all and will look to you over the next year for your continued support as I work with the physicians in PA to restore the joy in medicine.

Thank you.

Berks County Medical Society 1824 Journal Club Review

The first Berks County Medical Society 1824 Journal Club was held on February 8th at the Peanut Bar. It is notable that as we celebrate our 200th Anniversary the Peanut Bar is celebrating its 100th Anniversary as a fixture in the city of Reading.

About a dozen members attended, enjoying a lively discussion of literature reviews and case studies from the New England Journal of Medicine and Surgery from 1824.

The group was welcomed by BCMS President, Bill Santoro, MD, and the following articles were reviewed:

“Some Observations on the Utility of Opium” - Lee Radosh, MD

“New Treatment for Croup” - Eve Kimball, MD

“Case of Tetanus” - Dan Kimball, MD

“On the Therapeutic Effects of Strychnine” - Ankit Shah, MD

“The History of the Smallpox Vaccine” - Deb Powell, MD

Much discussion occurred regarding the practice of medicine by our early 19th Century Berks County forebears and a great appreciation acknowledged for the many medical advances that we have at our disposal in the 21st Century.

Our next 1824 Journal Club will be at the Highlands, 2000 Cambridge Avenue in Wyomissing on May 2nd, 2024, at 6:00 PM.

All members are invited to join for the enlightening discussion and the great collegiality. We will be discussing medical literature from the late 19th Century, a time of great scientific advancement in the practice of medicine including Rontgen’s discovery of X-rays and Pasteur’s advancement of the “germ theory” of disease. Please RSVP to tjhuckleberry@berkscms.org .

Resident Rounds

by Hannah Thompson Herring, DO PGY-3 OB/GYN Resident, Reading Hospital/Tower Health

Afew weeks ago, I was scrolling through Instagram when I came across a picture of William West. West was completing his ophthalmology residency from George Washington Hospital when he died by suicide at the age of 34. Unfortunately, this tragedy is becoming too common among resident physicians and other medical professionals. According to the Accreditation Council for Graduate Medical Education (ACGME), suicide is the second overall cause of resident physician death and the first overall cause of death in male resident physicians. In 2017 alone there were 105 residents who died by suicide.

What causes the rates to be so high? Deepika Tanwar, MD, of the Harlem Hospital Center in New York City, noted that physicians who die by suicide often suffer from untreated or undertreated depression or other mental illnesses. But if only 1530% of physicians screen positive for depression, then what are the other factors that contribute to the rates of suicide among medical residents?

High levels of stress often begin early in medical school with long hours, lack of sleep, and competitiveness that only further increases by the limited number of residency positions that are available after graduation. During residency, these stressors intensify even more as residents navigate difficult patient interactions and emergency situations all while working under intense pressure for 80+ hours per week. Despite these challenges, residents are expected to persevere and cope with a “superhuman” mentality that has entrenched medical training for the longest time. Because of this, there is often hesitation to reach out for mental health services because of the fear of losing opportunities or being viewed as weak or incapable of being a good physician. It is a terrible irony that for a profession that is prone to so many stressors, there are such significant barriers to getting relief.

So, what can we do to fix this? First, we can work to destigmatize the narrative around mental health in the medical profession. It is time to

dismember the “superhuman” mentality and remember that doctors are actually human too. We must focus on our own health, because only then will we be able to truly provide the best care for our patients. Second, we can work to supply resources on suicide prevention and provide access to counseling and mental health services without fear of repercussion. Identifying individuals at risk, creating connected and protective environments, and encouraging physicians to access mental and other health care are key components of prevention programs for all people. And lastly, we can support the medical students and resident physicians that we know.

The medical education system does not fully equip us to process human suffering, trauma, or death, so we are often left navigating these difficult emotions alone. Let us strive to provide supportive environments for students and residents to train and learn, while also providing opportunities for honest and transparent conversations around physician wellness and mental health.

WELLNESS MATTERS

PREVENTING AND TREATING SPRING AND SUMMER INJURIES

by Olawale Adeyemi, MD, MPH PGY 2 Resident

Department of Family and Community Medicine

Reading Hospital/Tower Health

As we say our final goodbyes to icy roads, snowflakes, and blistering winds, and hang up our fur jackets and wool/ cotton scarves, we move into warmer temperatures and begin more outdoor activity. It is just such a time that we should also be looking at all the ways to prevent injuries while we stay active during the Spring/Summer seasons.

A few hints and tips can be useful. No matter what activity you are excited about, be it jogging, swimming, flag football, tennis, or pickleball, the thought of avoiding injuries might have crossed your mind at some point. Just as the popular slogan says, “prevention is better than cure,” when it comes to frequently encountered spring/ summer injuries, there are a few things we can do to minimize the chances of getting injured.

SUNBURNS

As spring approaches, the temperature gets warmer, and the days grow longer. As a result, we all want to spend more time doing outdoor activities. While sunlight is a great source of Vitamin D, it is important to note that spending excessive time in the sun puts us at risk of getting a sunburn.

This happens when the skin is exposed to sunlight’s ultraviolent radiation for too long and too directly. In scientific jargon, it is an inflammatory response in the skin that is triggered by direct DNA damage from ultraviolet radiation.

This can be painful and may increase the risk of skin cancer. We can protect ourselves from this happening by wearing protective clothing, using appropriate sunscreen, ensuring that we stay adequately hydrated, and taking regular sunbreaks while spending time outdoors. Sunscreens have a Sun Protective Factor (SPF) rating that is based on the ability to prevent sunburn. The higher the SPF, the lower the amount of DNA damaged directly. The American Academy of Dermatology recommends broad spectrum sunscreen protection (protecting against both UVA and UVB rays), an SPF of at least 30, and ideally water resistant if activities are planned that involve the beach, pools, or water sports. It is important to seek medical attention if sunburn is accompanied by blisters, fever, chills, or any signs of infection on the skin such as swelling or pus.

SPRAINS AND STRAINS

A sprain happens when a ligament is stretched or torn due to sudden twisting, while a strain happens when a muscle or tendon gets inflamed from repeated motion or general overuse.

Sprains result in pain and swelling and can make the affected joint difficult to move. Similarly, strains can result in pain, swelling, and weakness.

Traditionally, these injuries are both treated by PRICE, an acronym for protection, rest, ice, compression, and elevation. In addition, using anti-inflammatory drugs such as Ibuprofen could help relieve the pain and inflammation. As a more recent treatment, some practitioners use platelet rich plasma (PRP) injections which have shown promising results in speeding recovery from these injuries.

It is important to see a medical provider if a sprain or strain is accompanied by severe pain, difficulty moving the affected area, signs of a fracture, e.g., significant pain and swelling over a bone area, or a cracking or popping sound that could be indicative of a ligament tear.

HEAT EXHAUSTION/HEAT STROKE

Heatstroke is the most severe heat-related illness and in its most severe forms can be fatal. Signs and symptoms can include an elevated body temperature greater than 104.0°F, red skin, headache, dizziness, confusion, loss of consciousness, and seizures. This can be life-threatening because it can potentially cause a breakdown of multiple organs, muscle injury, and kidney injury. Heat stroke results in about 600 deaths yearly in the United States (1), hence this is something to pay close attention to in spring and summer.

Heat exhaustion is a medical emergency and is also a significant form of heat illness. It is caused by the loss of water and electrolytes through sweating. The symptoms of heat exhaustion include nausea,

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• CPAP Intolerance

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Wellness Matters

continued from page 23

vomiting, headache, tingling, dizziness, weakness, thirst, high body temperature, excessive sweating, dilation of the pupils, and a decreased output in urine.

When such a heat-related illness is identified, the following are good first aid tips to follow: move the person to a cool place, then take off any extra layers of clothing. You can cool the person by fanning them or placing a wet towel on their body. Have them lie down and put their feet up if they are dizzy. Furthermore, have them drink water or a sports drink. Remember to turn the patient on their side if they are vomiting to prevent any risk of aspiration. For any patient who appears in distress (or when in doubt) an emergency 911 call should be placed for medical assistance.

ABRASIONS AND LACERATIONS

An abrasion is a wound of partial thickness involving the skin layers. They are usually accompanied by minimal bleeding. This usually occurs when the exposed part of the skin meets a rough surface in a grinding manner such as gliding on concrete or another abrasive material and eventually results in a wound of the upper layer of the skin. Abrasions should be cleaned before taking out debris. Bacitracin ointment can be applied to the area, and then a dressing is used to cover the wound. This helps to provide moisture to the area. It is important to avoid direct sunlight to the affected area as this could cause hyperpigmentation.

On the other hand, lacerations are wounds caused by blunt trauma, or sharp objects. They may appear regular or irregular. Unlike abrasions, usually none of the skin is missing in lacerations. The treatment involves stopping the bleeding by applying pressure directly on the area, cleaning, and then dressing the wound. If the cut is deeper or bleeding does not stop with pressure, it may be necessary to seek care in an emergency department where stitches may be applied to stop the bleeding and reduce the scarring.

BIKE ACCIDENTS

Bike safety is a great public health concern. Bicycle rides make up only 1% of all trips in the United States (2). However, bicyclists account for over 2% of people who die in a crash involving a motor vehicle on our nation’s roads. As we begin to ride bikes with the more favorable weather, it is necessary to obey traffic laws, use bicycle lighting at night, and of course, wear a helmet for protection. Riding should be limited around dusk as most fatal car-bike accidents occur during that time likely due to the poorer visibility. Always ride at or below the acceptable speed limits.

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Stephen Sulzbach, DMD, D.ABCDSM, D.ABDSM, FAACP, LVIF

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while riding and to always have a first aid kit along in the event of an injury. Some of the injuries commonly seen in bike accidents and how to handle them have been described above including sprains, strains, lacerations, and abrasions. However, a major incident involving head trauma or fractures warrants immediate emergency medical attention.

NEAR-DROWNING

Near-drowning is defined as immediate survival after deprivation of oxygen that causes unconsciousness or suffocation due to submersion in water. If a person is rescued from this situation, it is important to administer quick first aid. As the rescuer, do not place yourself in danger and do not get into the water unless you are sure it is safe. You might extend a long pole or use a throw rope attached to a floatable object such as a life jacket, then toss it to the person and pull them safely to the shore. If you have training in rescuing people, do so immediately if you are certain it would not cause any harm. If the person’s breathing has stopped, begin rescue breathing as soon as possible, move them to dry land and initiate Cardiopulmonary Resuscitation (CPR) if unconscious and signs of cardiopulmonary failure. Call 911 or the local emergency number if you can’t rescue the drowning person. If you are trained and

hospital for medical evaluation.

For preventative approaches, it is advisable not to drink alcohol while swimming or boating. Pools should be fenced, and lifeguards should be on site. Never allow children to swim without supervision. Everyone should observe water safety rules and ideally, everyone should also take swim classes and /or water safety courses.

INSECT BITES

AND STINGS

A bee sting happens when the stinger of a female bee punctures the skin causing pain and a wound. When this happens, the first step is removing the stinger as soon as possible, as a delay could lead to injection of more of the bee venom. Once this is done, a cold compress should be applied to reduce swelling, while the itching can be relieved with an antihistamine and numbing cream.

continued on next page >

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Wellness Matters

continued from page 25

A small percentage of people may develop a more serious reaction to a sting known as “anaphylactic reaction.” Symptoms of this response could include an itchy rash with throat closure due to swelling that can obstruct or stop breathing, severe tongue swelling, shortness of breath, vomiting, lightheadedness, and low blood pressure. This reaction can be life threatening, hence people who are known to be highly allergic should always carry a self-injectable epinephrine pen (EpiPen) with them to be used for immediate treatment.

Similarly, tick bites are more common during the warm months, and this varies by geographical region. In the Northeast, wooded areas and bushes tend to have more ticks. People bitten by ticks can show symptoms of fever, joint pain, body aches, fatigue, and rashes. Tick bites can be prevented by limiting exposure in high-risk areas, wearing tight-fitting clothes, using insect repellants, and checking for ticks regularly. If ticks are found on the body, they should be removed as soon as possible by using a tweezer as close to the tick’s mouth as possible and pulling without rotating. It is important to confer with a medical provider after such an event to evaluate the need for an antibiotic prescription.

Snakebites are rare, and can present with symptoms such as bleeding, rapid heartbeat, allergic reaction, and breathing problems. It can be challenging determining if a bite by a specific species is life-threatening, but generally, the outcome of a snakebite depends on multiple factors: type of snake, physical condition of the person, size of the bite, area bitten, amount of venom injected, and time it takes to receive treatment. The American Medical Association and the American Red Cross recommend immediately washing the area of the bite with soap and water. Traces of venom left on the skin or bandage can be used in combination with a snake bite identification kit to identify the species. All persons who have a snakebite should be transported to an emergency room in a timely fashion as an antivenom is often still the only effective treatment for envenomation.

Scan to read online!

Overall, if the area of an insect bite, bee sting, or snakebite shows any signs of warmth, redness, swelling after evaluation, and first aid treatment, it is necessary to see a medical provider for treatment of a possible cellulitis (skin infection).

Spring and Summer are great seasons of the year to engage in healthy activities and to enjoy life. With preparation and attention to safety, we can all minimize our risks and maximize our fun.

REFERENCES

1. Gaudio FG, Grissom CK (April 2016). “Cooling Methods in Heat Stroke.” The Journal of EmergencyMedicine. 50 (4):606616. doi:10.1016/j. jemermed.2015.09.014. PMID 26525947.

2. Federal Highway Administration. 2017 National Household Travel Survey. Washington, DC: US Department of Transportation; 2017. Available at: https://nhts.ornl.gov/person-trips. Accessed on 02/15/2024. www.Hoffpubs.com

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Student Vital Signs

Tby John LeMoine, MS III Drexel University College of Medicine/Tower Health Campus

he training of a physician does not begin nor end with medical school. Medicine is a career of lifelong learning that starts at a young age and continues perhaps beyond retirement. Even if someone does not yet know that they want to be a physician, it is one’s youthful experiences, both good and bad, that first start to shape the character of a healer. A child who observes a nurturing relationship yearns to offer an empathetic ear. A teen who witnesses a family death understands loss and resilience. Medical students then step forward to study and experience what it means to take care of another human being at their most vulnerable. And then, even after passing the final board examination and earning their certification, it is the years of successes and failures of individual healers that mold them into unique and diverse physicians. This uniqueness and diversity are the essential virtues of a successful physician population, for our world is comprised of beautifully complex, diverse individuals who are best cared for by an equally unique and diverse combination of physicians.

My time spent in the third year of medical school on different rotations in the hospital has revealed how much more there is to learn about medicine beyond the textbook and how much can be gleaned by just careful observation. Reading Hospital employs attending and resident physicians from all over the country and the world, boasting several positions for international medical graduates (IMGs). Working alongside these doctors with various cultures and experiences has taught me an array of compassionate bedside strategies and demonstrated to me how a diverse patient population

benefits from a diverse team of physicians. It is not uncommon for patients of different backgrounds to feel intimidated or frustrated in unfamiliar settings, especially when facing illness in a hospital. A few words of a native language, an expression of cultural understanding, or a genuinely empathetic gesture all carry tremendous potential in patient comfort and healing.

It has been my observation that imposter syndrome—the inability to recognize one’s success as legitimate or worthy—is quite common in many fields but especially in medicine. Over the past three years of being a medical student, I have directly mentored or had casual conversations with several individuals interested in becoming a physician. Frequently in these discussions, I see evidence of imposter syndrome or hear concerns about not being “smart enough” for medicine. I try to remind them that while medical school is challenging and requires a significant amount of sacrifice and dedication, being “book smart” is not what makes a great physician. Those things can be learned. Rather, it is the unteachable skills, the unique experiences that bred the passion for healing others, that makes a wonderful physician. It is your story, your uniqueness, your history, and culture that connects you to others. In medicine—or in any field—use your story to help people.

I believe that a great deal of progress has been made in the way of physician diversity, with much more to come. I am proud to be a part of the next generation of rising physicians and excited to see the progress we can make in building better connections that bring us closer together.

Reflections on About 50 Years of Pulmonary and Critical Care Medicine

“Ripple in still water

When there is no pebble tossed Nor wind to blow”

— Grateful Dead, 1970

by John Shapiro, MD

On a brisk September 1975 morning, walking down Hamilton Walk on the first day of medical school, little did I know what a marvelous, rich life awaited. My career in medicine has provided the extraordinary privilege of working with talented, wise, dedicated, and kind people, sharing with patients and their families the happiest and at times saddest moments in their lives, and the wonderful good fortune of meeting my wife Ellen, working at that time in the Pulmonary division at HUP, welcoming me with calming WFLN music in the background.

When asked to reflect on the changes I’ve seen since that day in Philadelphia, I thought back to the state of medicine 50 years earlier (around 1925). The world had just come through WWI (“The Great War”), about 50 million people had died during the 1919 flu pandemic (about 3% of the global population, approximately 1/3 of the world population infected) and with the “Iron Lung” yet to be introduced by Drinker and Shaw (about 1928), people with polio were dying because of mechanical respiratory failure. The medical world I was entering seemed so much more sophisticated. We had “fancy” volume-controlled mechanical ventilators, effective influenza vaccines were readily available so there never would be another pandemic, the Vietnam War was ending, and we all envisioned a world at peace with “Woodstock Nation” finally taking root and

flourishing. Would the next fifty years be as momentous?

For amusement, I have paired each of the following remarkable medical advances with descriptive titles of songs from my era, but in no way do I mean to trivialize their profound significance.

“A Change is Gonna Come” (Sam Cooke, 1964) - HIV/ AIDS and COVID 19: Nothing has made a bigger difference in the practice of medicine than these two “little” viruses, which have in fact bookended my career. In the late 1970s there were no “universal precautions,” body fluids were handled routinely by house staff, and we knew very little about the role of T and B cells. Everyone diagnosed with AIDS was dying. Similarly, with the 2020 COVID-19 pandemic, we again experienced a quantum shift in the way we practiced medicine, the way we protected ourselves, and how we interacted with patients and their families. Fortunately, immunologists rapidly provided effective vaccines, developed on a timeline that saved many millions of lives.

“With a Little Help from My Friends” (Lennon/McCartney, 1967) - Multidisciplinary team rounding: ICU care is now led by an Intensivist, a position that did not exist in 1975. The development of a rounding team adding pharmacists, respiratory therapists, PT/OT, social workers, and case managers to the bedside

ICU nursing staff and Intensivist has provided a multifaceted, comprehensive, and more effective approach to the management of critically ill patients.

“Bridge Over Troubled Water” (Paul Simon, 1970) - NonInvasive Ventilation: The ability to extend ventilatory support to a system that does not require intubation has revolutionized the options of respiratory care available to individuals with both hypoventilatory and hypoxic respiratory failure.

“Lean on Me” (Bill Withers, 1972) - Palliative Care: We now have a skilled team of sensitive practitioners who help caregivers, patients, and their families navigate the difficult and often treacherous landscape of critical illness, assisting with seemingly impossible decisions. Together we are more able to create and execute plans of treatment and care that suit each individual situation. In many cases we have been able to shift our focus from merely extending life to improving the quality of living and ease of dying.

“We Shall Overcome” (Traditional/Pete Seeger, about 1963) - Management of Lung Cancer: No area of pulmonary medicine has evolved more in the last 50 years than the treatment of lung cancer. Our diagnostic tools, surgical techniques, multidisciplinary approach, and emerging oncologic treatments (immunotherapy, understanding oncogene driver mutations, etc.) have significantly improved survival statistics. The availability of low dose CT scanning has finally given us an effective tool for the early detection of potentially curable cancers by screening “at risk” individuals.

“It’s So Easy to Fall in Love” (Buddy Holly (1956)/Linda Ronstadt (1977)) - The role of Process: In 1975 we thought we were providing excellent ICU care, but we really didn’t know because we had not critically assessed our outcomes. Until the quality of care provided in the ICU was evaluated in an objective, statistically rigorous model, we were operating blind. With attention to real data, the benefits of glucose control, DVT prophylaxis, sedation vacations, stress ulcer prophylaxis, etc., have been incorporated into routine ICU management.

“I Can See Clearly Now” (Johnny Nash (1972)/Jimmy Cliff (1993)) - Advances in fiberoptic bronchoscopy: The transition from a hand-held direct vision fiber-optic bronchoscope with limited optics and sampling options, to today’s CT directed, video game type console has provided a significant expansion in the diagnostic capabilities and therapeutic options now available.

“Here Comes the Sun” (George Harrison, 1969) - Biologic/ Asthma medicines: The development and expansion by Pharma of this class of medications (Fasenra, Dupixent, Tezspire, Nucala, Zolair, etc.) has significantly broadened the scope of patients that benefit from therapy directed at controlling inflammatory pathways, with less untoward side effects than earlier treatments. This has led to marked improvement in the quality of life for individuals with severe allergic asthma.

“Operator” (Grateful Dead, 1970) - Communication/ Information technology advancement: Perhaps nothing has transformed our practice of medicine more than the advent of the cell phone and the electronic medical record. No longer is poor penmanship a barrier to collaboration and the medical record now can be accessed at any time by multiple individuals at multiple

sites. Our cell phones allow near instantaneous access to medical information/guidelines as well as immediate communication between providers and the ability to deploy and redeploy manpower in real time as needs evolve. However, as beneficial as these tools have been, one noticeable price paid is less direct physician/ patient interaction and the resultant loss of valuable non-verbal communications.

“Friend of the Devil” (Grateful Dead, 1970) - Role of business in medicine: When I entered medical school it was unusual for physicians even to advertise, and one rarely heard of practices or hospitals being bought and run by investors. When asked on rounds if I should order a specific test, my attending physician’s stock answer was . . . “if you think of it, order it.” Granted we must allocate our limited health care dollars wisely, but medicine, unlike many other businesses, needs to be held accountable to issues affecting human lives, not just the bottom line.

What the next fifty years has in store remains to be seen. I could not have wished for a more challenging and satisfying career, or to have shared it with more wonderful and diverse colleagues, patients, and families. It has been the people who have enriched my world in ways that years ago I could not have imagined. I continually marvel at . . . “what a long, strange trip it’s been.” (JG)

John A. Shapiro, MD, recently retired after nearly 50 years from his career in medicine as a Pulmonologist and Critical Care Specialist.

Dr. Shapiro was raised in Warwick, New York, and graduated from Johns Hopkins University in 1975, majoring (as he says) in Biophysics and the “Grateful Dead.” He spent the next nine years in West Philadelphia, graduating from the University of Pennsylvania Medical School and completing his Internal Medicine Residency and Pulmonary Fellowship at the Hospital of the University of Pennsylvania where he met his wife, Ellen.

In 1984, the Shapiros moved to Berks County for Dr. Shapiro to join Dr. John Shuman’s three-man Pulmonary Disease Specialists practice. With the advances and increasing demands of critical care/ ICU medicine, his group joined with Berks Schuylkill Respiratory Specialists in 2005 to form the Respiratory Specialists group which provides extensive out-patient services as well as in-patient Pulmonary and ICU care at Reading, PSU St. Joseph, and Pottstown Hospitals.

John has consistently demonstrated his “unflappable” commitment to the highest standards of our profession and personal attention to the needs of his patients. We are all better for his many years in our midst. We wish him, Ellen and their children Timothy, Rachel, and family the very best ahead as John with “A Touch of Grey” just keeps on “Truckin.”

Member Forum

The State of the U.S. Health Care System:

The Plight of the Employed Physician

by Richard A. Close, MD, FACS, FAANS

In his farewell address to the nation in January 1961, President Dwight Eisenhower warned against the military-industrial complex. What he did not say was that there was an even greater risk, and that is the healthcare-industrial complex.

With the surge of science and technology coming after World War II and reaching a crescendo which has yet to peak, expenditures in healthcare became overwhelmingly huge. Over time, healthcare became increasingly controlled by the insurance industry, both health and liability, the plaintive bar associations, and the pharmaceutical industry, all of which have a powerful influence on government decision makers.

Increasingly, near the bottom of this healthcare hierarchy stand physicians. As regulations increased, insurance costs became outrageous and worsened. As practice costs rose, it became nearly impossible to run an office, much less practice good medicine. I remember talking to my friends and acquaintances about our problem, and was told why not pass the rising costs on to the consumer as is done in every other business? The answer was simple; it was and is against the law for physicians to collectively bargain for their fees. That is to say that we were left with taking whatever the payers decided to pay (often 30% of what is billed), if and when they decided to pay, which was never within 30 days as is common business practice.

When I brought the medical liability system up to my attorney acquaintances, I was told it would not be a problem if only there were not “bad doctors” and that the only way to control this was through litigation. We all know that this is a fallacy, and it really only amounts to a money grab with a large percentage of litigation

payouts ending up in the hands of the attorneys and not their patient clients.

Facing these challenges, I eventually became employed along with my partners. We were given a contract after very little negotiation and set about continuing with our practice. Nothing initially changed as far as the care we were able to provide and in the way we were able to run the practice. As time went on, however, the first thing I noticed was that I received an email from the health system informing me that my patients were no longer my patients but were patients of the health system. This implied rather clearly that if I chose to leave the health system, I could not take my patients with me. This did not really matter, as we were practicing almost identically to how we had done when we were in private practice, however, looking back I think the seed was planted. When our office manager retired, the replacement was a middlemanagement person who didn’t work for us but worked for the health system. We quickly learned that this person’s primary loyalty was to the health system. We learned to be careful about what was said in the office and certainly to the upper management group, realizing that our contract clearly stated that we could be fired at any time without cause.

So, in essence, the system is stacked against physicians. We are dealing with extremely wealthy, powerful, and well-organized entities, each serving their own interests. Unfortunately, ethics, and especially the doctor- patient relationship, have become lesser priorities. To be clear, this is not a criticism of any one specific health care system, but rather the state of the overall health system as it exists today.

Members of the Berks County Medical Society are encouraged to submit topics of concern regarding health issues to the “Members Forum” column. Submissions should be approximately 750-1000 words and follow proper etiquette. All printed materials are subject to editing with author consultation by the Medical Record staff.

As these changes occur, health systems apply metrics supplied by the hospital association in terms of measuring performance, time off, continuing medical education and reimbursement. These values often differ significantly from those of medical societies, including our specialty societies. There is little regard made for time spent teaching medical students, allied health workers, nurses, interns, and residents, and salaries are often on the low side of fair market value. Business practices can also change in the office raising questions if those entities that run large scale enterprises, e.g. as hospitals and clinics, can operate physician practices as productively and efficiently as physicians themselves or effectively manage physician employees.

I am not saying that operators and administrators of health systems, both for-profit and not-for-profit, are bad people. On the contrary, these are hard-working, well-intentioned individuals who want to help our patients. However, due to the environment in which they function, including all the factors listed above, their endpoint must be the bottom line. And yet we physicians take a different view while recognizing that cost factors are important.

There is a difference between physicians and all of the other participants in healthcare. Physicians are the only ones who take an oath to a code of ethics as well as make a pact with each of our patients to provide excellent scientific care, to honor and respect their dignity and privacy, to do them no harm, and to essentially conduct ourselves with them as we would with a beloved family member. Such is the essence of the Hippocratic Oath which we took at graduation, and which has been guiding physicians since c400 BC and is a foundation of the doctor-patient relationship.

Given what I have presented, what are our options? I doubt that our current conditions that I have described can continue, however these realities make it impossible for physicians to return to the traditional private practice model. Rather, we will need to consider new models for physician practice. Foremost, physicians need to be able to collectively bargain for reasonable fees and reimbursement. For too long physicians have not been given this authority which is afforded to most other workers and professionals in this country and that must change. This should be done locally and not nationally as

circumstances change from one community to the other. It should be done with groups of similar practitioners. For example, surgeons, office-based practitioners, etc., should be able to sit down with the payers and bargain for reasonable fees. Then the payers will be incentivized to rein in the cost of drugs and to get much needed tort reform. The current system provides little incentive to do so because it is only the physicians who are bearing the greatest burden. Health systems can then contract with individuals or groups of physicians for certain services, such as coverage and teaching.

To make this a reality, physicians need to be as organized as the other players. The Bar Association, the Hospital Associations, and the Pharmaceutical Industry are well-oiled machines with a strong influence on public officials. Politics is local and it is essential for physicians to be involved in county and state medical societies. We must be willing as clinicians to serve on committees to provide credible oversight of the practice of medicine as it relates to guaranteeing quality of care and to do so in a constructive fashion for both patients and physicians. The purpose of such oversight should be improvement rather than punishment.

Another alternative is unionization. It is becoming more and more common for residents in training to join unions. If this trend continues, it will be seamless for graduates of residency programs to expect to belong to a union when they enter the workforce. I am not at all clear that this is the best path, but it certainly seems to be gaining strength and may well become the future of medicine. My hesitancy regards the negative impact that unionization may have on the doctor-patient relationship.

Finally, if I can presume to give some advice to my younger colleagues, it is this: get involved, learn basic business and politics, and above all, don’t trust the system to take care of you because it won’t. You are all bright enough to achieve your goals. Your careers will include great accomplishments and service to your patients. Next to these achievements, the current challenges are minimal.

Dr. Close is a retired Neurosurgeon who served the ReadingBerks Community for 42 years.

COMMUNITY ANCHORS: * Threshold, Inc.

by Edward Michalik, PsyD President/CEO, Threshold Rehabilitation Services, Inc.

Threshold Rehabilitation Services, Inc., is a not-for-profit service organization providing services to the disability community since 1965. Threshold initially began providing transitional residential services to assist adults struggling with mental illness.

Growing community needs produced development and expansion over the years and enabled the organization to evolve into a comprehensive and diversified rehabilitation program. Threshold provides values-based and normative environments, which fully support human, civil, and legal rights, and contributes to peoples’ personal outcomes. We believe that every individual is to be respected as a true person of value to society, having rights and responsibilities to influence and control decisions and choices affecting their lives.

Threshold is known for serving individuals with developmental disabilities. However, many do not know that we also provide a full array of services to people who struggle with serious mental illness. Threshold has been at the forefront of implementing services for this population which work to instill hope in recovery and management of the symptoms which often interfere with daily living.

The newest service Threshold began providing in 2020 is a Residential Treatment Facility for young adults aged eighteen through twenty-five. The two-year program provides evidencebased therapy and skill building activities to prepare young adults to live successfully in their communities. Threshold stepped to the plate to provide this service in response to a need identified by the Berks County mental health system.

The agency also provides a Partial Hospital Program (PHP) which offers intensive mental health treatment for program participants. Intensive treatment often begins with full-time participation in the program (30 hours per week). As individuals become stable and achieve treatment goals, they require less intensive service from the program, and treatment hours are reduced to as few as twelve hours per week. The PHP staff maintains continuity of care until the individual no longer requires partial hospitalization services and moves to outpatient psychiatric services.

The PHP provides treatment through traditional group therapy, psychiatric evaluation and medication prescription and consultation with the program CRNP (Certified Registered Nurse Practitioner) who is supervised by the program psychiatrist. Group therapy topics include but are not limited to the following: anger management, trauma, self-esteem, forgiveness, whole health, process and open discussion, psychiatric education, coping skills, social skills, forensic issues, and recreational groups including creative expression, music therapy and therapeutic games. The primary therapist, individual, and team review treatment plans every fifteen (15)-treatment days.

In addition, Threshold provides full-care Community Residential Rehabilitation (CRR) group homes for adults who have a primary mental health disability/diagnosis. The Transitional Residences are designed to work with adults who require training and support regarding independent living skills such as medication, nutrition, meal preparation, comparative shopping, housekeeping, home safety, budgeting, personal hygiene, physical health, community orientation, socialization, and use of leisure time. The program’s

goals are to expand an individual’s self-care skills; promote independence; and reduce the need for and frequency of inpatient psychiatric hospitalization. The CRR group homes are in high demand in the county and there is always a waiting list. The State Hospital, community hospitals, and local shelters are the primary referral sources for the service.

Supported Living Services are provided for adults with mental health challenges. Many individuals have a strong preference to be in control of their living environment and to choose where they live and with whom. Additionally, we believe that individuals could be more effectively receiving support services in their own apartments while increasing their self-esteem, integrity, and empowerment. Threshold was awarded the contract in March 2022 to increase our mental health supported living services. The goal of the program continues to be assisting individuals in finding safe and affordable housing in the community which maximizes their opportunity for integration and offers comprehensive supports as intensively as needed and desired to maintain community living. The key support elements include the use of community resources, development of daily living skills, financial planning, budgeting, service linkages and coordination, response and support related to housing and psychiatric issues and emergencies.

Since December 1998, Threshold has been providing a psychiatric rehabilitation program for adults with mental illness through Mosaic House. Mosaic House is modeled after Fountain House, the first Clubhouse that opened in New York City in 1948. The Clubhouse is designed to help members achieve social,

educational, and vocational goals. Members and staff participate in the development of activities and policies of the Clubhouse. Everyone is actively involved in the operation and decision-making procedures of the Clubhouse. The key to the Clubhouse is the Work-Ordered Day. Members are expected to participate in the work generated by the house including intake, clerical, cleaning, decorating, cooking daily lunch, assisting with members’ education, accessing services, helping new members become oriented to the house, reach-out to absentees, etc. Members and staff work sideby-side in work units doing what needs to be done to keep the Clubhouse functioning. By learning the work of the unit, members learn valuable skills, which can be used in everyday life, in school, or training, at volunteer jobs, or in a place of employment. Threshold opened a second clubhouse, Hope Springs, as part of the Healthy Transitions grant to serve transitional age youth and young adults in Berks County.

Threshold also serves patients transitioning from Wernersville State Hospital to the community through the Community Hospital Integration Project Program (CHIPP.) Services include a full array of housing supports, clinical support, and emergency respite services. CHIPP is an initiative designed to promote the discharge of persons with a long-term history of hospitalization. CHIPP funding creates a service system which supports people to live in the community while managing state hospital utilization through the establishment of diversionary services.

For additional information contact Linda Groff: lgroff@trsinc. org or (610) 777-7691.

*Community Anchors are organizations contributing to the improvement of health and wellness in our Berks County area.

In Memoriam

David B. Rees, Jr., MD (January 24, 1950-December 31, 2023)

by D. Michael Baxter, MD

Dr. David Rees had an undeniable presence, and that presence was felt at Reading Hospital and in the Berks County Community for 40 years. Dave was born in Pittsburgh to David and Ruth Rees, and he embraced the Pirates’, Penguins’, and Steelers’ black and gold proudly, even during the lean years.

Dave was a varsity baseball player and a 1971 graduate of Ohio Wesleyan University. He subsequently entered Temple University School of Medicine, graduating in 1975. Not surprisingly given his love of sports, Dave chose a career in Orthopedic Surgery, completing his residency at Temple in 1981 under the legendary John Lachman, MD. He spent the next two years as a physician and Associate Professor at Temple, while also providing care at the Shriner’s Hospital of Philadelphia.

In 1983, Dave joined other Temple Orthopedic Surgery graduates in the well-established Orthopedic Associates of Reading where he served his many patients and colleagues until his retirement from active practice in 2017. One of my favorite memories of Dave was sharing patients with him as he organized the annual Shriner’s Hospital of Philadelphia out-patient clinic in Reading, evaluating many children and teens with major orthopedic and structural skeletal problems. Without the services of this clinic, many of these kids would have struggled to find the care that they needed. The Shriner’s, with Dave’s local guidance, stepped up as they always have, to provide these kids the life-changing care they needed.

As noted, Dave was a strong presence at Reading Hospital and not just in the operating suites. He served as the Chief of Orthopedic Surgery (1995-2003), Credentials Committee Chairman (2000-2001), Vice President of the Medical Staff (2001-2003), and President of the Medical Staff (20042006). However, to imply that Dave’s only influence was in these administrative roles would be a gross injustice. Dave had an opinion on every topic, and he was not shy about sharing that opinion with anyone who would listen and even those who wouldn’t. Few physicians had the impact at Reading Hospital as Dave over those 35 years.

Dave had a special joy for his family. He was the husband of Bonnie for 50 years and the father to three children, David B. Rees III, Liz Rees Giardino, and Becca Rees. He attentively served as the “on-call” orthopedic consultant for his five active grandchildren, Jack, Molly, and Annie Rees, and Sophie and Emily Giardino. Dave is also survived by four siblings.

Besides sports, Dave enjoyed music (with an enormous music collection), gardening, trivia, golden retrievers, and trains—evident by his remarkable HO scale model railroad. He enjoyed special family time at the beach and at Aimhi Lodge in Maine. In retirement, Dave could often be found beginning his day with friends at Dosie Dough, the local coffee shop and bakery. Few patrons will fill that seat at Dosie Dough or few doctors his presence at Reading Hospital the way that Dave did. He is certainly missed by his patients and colleagues. We extend our most sincere condolences to Bonnie and the Rees family.

John J. Robertson, MD

(December 24, 1927-March 1, 2024)

by D. Michael Baxter, MD

“ The Last of the Country Doctors” may not be quite accurate, however, it is a fitting epitaph for Dr. John Robertson who served the Kutztown community for decades. Like many physicians of his generation and certainly before, John was in solo general (family) practice, working primarily out of a home office with his wife frequently serving as his receptionist/office manager. It is with a good deal of certainty that John made hundreds if not thousands of house calls, countless nursing home visits, trips to the Reading Hospital, and of course cared for an incalculable number of patients throughout rural northern Berks County. And he did it all with a jovial, skillful and trusted manner.

John J. Robertson was born in Girard Township, Erie County, Pennsylvania, to John and Margaret Robertson. He earned a Bachelor of Arts degree in Chemistry from the University of Pittsburgh in 1957 and subsequently a medical degree in 1961 from the same institution. He completed his general practice internship/residency at Reading Hospital in 1962 and began his 37-year practice in Kutztown until his retirement in January 1999. His first wife, Marjorie (Kibler) Robertson, died March 7, 1998, and his second wife, Annette (Monroe) Robertson, EdD, died February 16, 2011. He was predeceased by sons, Kenneth (1952), John (2019), and daughter, Patricia (2018). He is survived by three sons, Alan (Rita), David (Pamela), Russell (Lori), daughter-in-law, Alys, widow of son, John, and a sister, Marian R. Moynihan. He is also

survived by eight grandchildren and nine greatgrandchildren.

When I arrived in Berks County 34 years ago, I was pleasantly surprised to find so many well-established, skilled GPs (family physicians) across Berks County. From Reading to Shillington, West Lawn, Sinking Spring, Morgantown, Birdsboro, Blandon, Mohnton, Bernville, Western Berks, Hamburg, and Kutztown, each community had a small group, but usually a solo practitioner serving their communities. John was such an individual, trained locally at Reading Hospital, and then becoming an indispensable piece of his local community and a highly respected colleague among his peers.

Although John may not have been a “country doctor” in the truest sense since his office was in the borough of Kutztown, nevertheless, he practiced as a “country doctor” with those finest characteristics represented by so many of our Berks County physicians over these past 200 years. His patients were fortunate to receive his skill and his care. He was a positive presence among his peers, a wellrespected colleague who will be missed by all. We extend our condolences to his family who must have many proud memories to share.

Eye Emergencies

Cataracts

Glaucoma

Diabetic Eye Exams

We are happy to make time for your patients

At BERKS EYE PHYSICIANS AND SURGEONS, we are happy to offer state-of-the-art and efficient care. Our doctors provide appropriate diagnosis and treatment, and fast feedback to you. Whether your patients

Macular Degeneration

Macular Degeneration

Yes, we can see your patients same day for emergencies and often same week for consults.

Yes, we can see your patients same day for emergencies and often same week for consults.

At BERKS EYE PHYSICIANS AND SURGEONS, we are happy to offer state-of-the-art and efficient care. Our doctors provide appropriate diagnosis and treatment, and fast feedback to you. Whether your patient has a sudden change in vision, cataracts, diabetes impacting vision, or even has a family history of glaucoma or macular degeneration, we would be honored to monitor and react to issues related to your patient’s eye health.

Left to Right: Domenic C. Izzo, Jr., MD, Benjamin Nicholas, MD, Francisco L. Tellez, MD, FACS, Michael C. Izzo, MD, Peter D. Calder, MD, Kasey L. Pierson, MD, Guri Bronner, MD