P u b l i s h e d
P e n n s y l v a n i a ’s
F i r s t
M e d i c a l
S o c i e t y
The Art of Chester County
Visionary World of
HUMPHRY MARSHALL BY MIAN A. JAN, MD
What is a Quality Colonoscopy? Not all colonoscopies are alike! Studies show a marked difference in colorectal cancer (CRC) risk reduction between facilities and physicians What are the most important factors for a high quality colonoscopy? *ASGE guidelines Cecal intubation rate with photo documentation, i.e. How often do we make it to the end? o Benchmark: >90% o West Chester Gastrointestinal Group (WCGG): 99% Proper use of recommended intervals between colonoscopies performed for average-‐risk patients and for colon polyp surveillance. o WCGG has a robust, blinded, quarterly evaluation of representative pathology for each physician to ensure proper surveillance. Our CMS QualityNet Data shows compliance in excess of 98%. Adenoma Detection Rate or ADR, the most important measure of a quality colonoscopy (i.e. how often do we detect a pre-‐cancerous polyp in the colon and remove it?) o Benchmark by ASGE/AGA: ADR target of 30% is recommended for men and 20% for women. Source: GIQuIC, a CMS approved Qualified Clinical Data Registry (QCDR)
For every 1% increase in ADR, there was a 3% reduction in CRC incidence and 5% reduction in cancer mortality. Higher ADRs were associated with lower risk of cancer in both men and women. Corley, D et al, Adenoma Detection Rate and Risk of Colorectal Cancer and Death, NEJM, 2014; 370:1298-‐306.
WEST CHESTER ● EXTON ● KENNETT SQUARE ● WEST GROVE www.westchestergi.com (610) 431-‐3122
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2013-2016 CCMS OFFICERS President Mian A. Jan, MD
8 DRAINING THE
President-Elect Bruce A. Colley, DO
Vice President David E. Bobman, MD
Secretary Liza P. Jodry, MD
Past President Winslow Murdoch, MD
10 The Threats Inherent in
Mahmoud K. Effat, MD Heidar K. Jahromi, MD
Raw Milk and Related Products
John P. Maher, MD Charles P. McClure, MD David A. McKeighan Executive Director Rosemary McNeal Administrative Assistant CCMS Headquarters (610) 827-1543 email@example.com
In Every Issue 6 President’s Message 14 The Art of Chester County
Features Chester County Medicine is a publication of the Chester County Medical Society (CCMS). The Chester County Medical Society’s mission has evolved to represent and serve all physicians of Chester County and their patients in order to preserve the doctor-patient relationship, maintain safe and quality care, advance the practice of medicine and enhance the role of medicine and health care within the community, Chester County and Pennsylvania. The opinions expressed in these pages are those of the individual authors and not necessarily those of the Chester County Medical Society. The ad material is for the information and consideration of the reader. It does not necessarily represent an endorsement or recommendation by the Chester County Medical Society. Chester County Medicine is published by Hoffmann Publishing Group, Inc., Reading PA 19608 HoffmannPublishing.com For advertising information, contact Karen Zach 610.685.0914 firstname.lastname@example.org
12 18 19 20 23 24 27 28
Visionary World of
GMS Health Services HUMPHRY MARSHALL PA Teen Health Week Consider Membership in The Chester County Medical Society Preventing eFraud Volunteers Needed Grief and Loss Through the Holidays Dr. Jan Out and About: Beau Biden Memorial Goodbye to an Old Friend: Joe Pitts
Letters to the Editor: If you would like to respond to an item you read in Chester County Medicine, or suggest additional content, please submit a message to email@example.com with “Letter to the Editor” as the subject. Your message will be read and considered by the editor, and may appear in a future issue of the magazine. Cover: Adrian Martinez painting in his studio. Chester County Medicine is published by Hoffmann Publishing Group, Inc. Reading, PA I HoffmannPublishing.com I 610.685.0914 I for advertising information: firstname.lastname@example.org
A Sacred Bond BY DR. MIAN ARSHAD JAN, PRESIDENT OF CHESTER COUNTY MEDICAL SOCIETY
DR. MIAN ARSHAD JAN
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s I enter the twilight of my career and look back at almost thirty years of my practice in Chester County, (the place I call my home and only place where I have worked) and I reflect what made me the happiest it was always when I was taking care of patients, it was never about money or the perks of a good life and it was definitely not Obamacare, our EMR, insurance companies or the other red tape associated with our work. The loving touch of a patient, grateful hug of a family member, a life saved or even a thanks from a patient visited in hospice care for whom I could do nothing but he was still grateful for my visit. There is something about the water in Chester County that breeds better people. I know I am going to embarrass him but when a patient and a friend (Wayne Ligato) without any solicitation from me wrote a huge check for charity of my choice which has enabled me the seed money to start a scholarship at West Chester University. I can go on and on about the kindness and love I have received from my patients. Being a first generation immigrant I do not have a lot of family here but I consider my patients to be my family. To me taking care of patients has never been a burden but always an honor and a blessing, a calling God has been kind enough to bestow upon me. I am often told if I retire or worse, nothing will change, life will go on and it is very true, but for that eighty-five-year old that I have taken care of after her heart attack for the last thirty years and who depends on me, I am her safety blanket, it matters. I cannot tell you how many times my elderly patients have pleaded with me not to retire until they are no more. But this is a symbiotic relationship; I get as much from this relationship as they do.
The patient-doctor relationship is most sacred. I would put it at the same level as husband and wife and parent and child relationship and it has been the foundation of health care in this country for centuries. Unfortunately, this most vital bond is being threatened by the changes occurring in health care. We are moving towards economy based care, where health is based on what it costs. I am all for transparency and quality of care but when patients are directed toward the cheapest care, not the best care … I have a problem with that. We are moving towards assembly line care, where the patient does not know the doctor and doctor does not know the patient. The encounter occurs because it has the lowest cost for the payer. Our elderly patients after paying large deductibles, co-pays and quagmire of filling forms will be directed towards a physician of payer’s choice and not his or her choice. We have been fortunate in Chester County because we have legislatures who are our partners and have helped us maintain a
safe and healthy environment, both for patients and doctors. They have helped us to maintain sanctity of patient-doctor relationship. My hope is with the help and support of our patients and legislatures we can continue this trend which has kept Chester County the healthiest of sixty-seven counties in the Commonwealth. Thank you Mian Arshad Jan Mian A. Jan, M.D., is a practicing Cardiologist and President of Chester County Medical Society. Contact Dr. Jan at 610-692-4382 ext 242.
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draining the healthcare swamp BY WINSLOW W. MURDOCH, MD
ith ambiguity comes opportunity, and healthcare is certainly an ambiguous environment! Physician led opportunity is knocking at our door. Our patients, communities, small businesses, the physician community, and yesâ€Ś maybe even the Federal Government itself are begging us to open it. Can we collaborate, imagineer, and lead partners with expertise in operations and implementation to create a better future for our patients and our profession? Will we leave it to the legacy big health businesses to capitalize and exploit the uncertainty that change brings? Who should we best partner to counter the progressively unsustainable professional state that many now find ourselves, and threatens our national economy? PAMED is having a crucial vote at this yearâ€™s House of Delegates that will largely answer this question for all physicians in Pennsylvania. The result of this vote and potential to change the existing balance of power in State and potentially national delivery of healthcare services, for all stakeholders, is enormous. It does require from us an open mind, and yes, a little more delayed gratification. The change vehicle comes in forming a physician led, Integrated Practice Network (CIN) of private and employed physicians, from solo to large groups, which strive to provide Value Based service. Now wait, before you start screaming that MACRA & MIPS (PQRS and MU on government steroids) is the end of private practice, hear me out. PAMED has the potential resources to deploy, and they are ready, if approved by the delegates, to invest $15 million over the next few years in healthcare and practice innovation. The funds were generated from a large endowment made possible from the sale of PMSLIC, KEPRO, and their building in Harrisburg (none of which were acquired or developed through physician society
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dues), and strategic partners, to form a statewide CIN. For those interested in the alphabet soup details of how this would look, here it is; It can offer ala carte Management Services (MSO) to get independent and employed physicians, regardless of practice size, who are at least attempting to use a certified EMR, into a CIN, at a low price point. By third quarter, 2017, this could offer support to PA physicians to initially gather data, prepare reports, and not receive steep Federal penalties on Medicare/Aid services, via The Merit-Based Incentive Payment System (MIPS) program slated in 2019, based on practice data reporting from 2017 & 2018. Commercial insurers are also following similar value payment reforms. If CIN is adopted, within a year or two, these same practices could be ready and eligible to enter into regional or state wide Alternative Payment Models (APM), where they would self-define their own quality metrics moving forward. Yes, that means that practicing PA doctors can decide if E&M coding, MIPS and other third party metrics have merit or can be repealed and replaced by their own physician led CIN. This could be the base that creates true reform, a complete game changer. In time, it would allow loosely integrated, but data linked physicians to enter into direct contracting with patient groups, and create cost transparent arrangements with the entire spectrum of care; surgical centers, urgent care, labs, PT, hospitals, pharmaceutical companies, etc. It would make the illogical and inefficient process of prior authorization and precertification for the vast majority of routine care a thing of the past. It would incentivize many of our current strategic hurdles (you know who you are) to become strategic partners. It would enable group purchasing discounts for each practice. Most importantly, it could create a less expensive, sustainable patient centered care model that
most physicians would find professionally satisfying. There are several new models of healthcare that are evolving nationally, and in pilot projects in PA. These are market driven by small businesses, union groups, and patient groups, led by smaller networks of data sharing dedicated local doctors. Currently in PA, 80% of working insured persons are from small businesses with 50 or less employees. 60% of those with employment sponsored health insurance receive it through a companyâ€™s self-funded program that has a very high deductible catastrophic insurance policy. They use a third party commercial insurer to administer benefits (TPA). As the cost of commercial coverage and the exchanges has skyrocketed, and the service and administrative hassles from many TPAs have increased, smaller companies, with as few as 10 employees, are looking at selfinsurance. Existing self-insured companies are also asking for more efficient TPAs and direct contracting arrangements to better service their workers. This grass roots, free market, physician led alliance will be a collaboration between self-insured employers, individual patients of the participating physician practices, as well the medical office staffs and their families. As with the more advanced CIN model, these data enabled health care alliances to create direct contractual relationships for patients with a panel of independent, dedicated Healthcare Providers. It also allows direct pay discounts
for: Radiology, Lab, Pharmaceuticals, Urgent Care Centers, and eventually, Surgical Centers and Hospitals in specific geographic areas. Direct Primary Care membership fee models (Concierge Light for the average worker) are beginning to emerge that will grow, while the practices continue participation in other care networks/ contracts. By allowing ample resources to this growing direct pay base, primary care offices will have and make time to collaborate with specialists and extended service providers to form the core of the entity. OK, I have said, every year, for the last 27 years that dramatic change in this unsustainable industry is imminent. President of healthcare, Tony Soprano, and Kramer from Seinfeld as COO are short timers. I hope we as physicians can share a new vision, and open our minds to partnering with new leadership. Sorry Tony and Cosmo. Winslow W. Murdoch, MD, practices family medicine in West Chester. He is past president of the Chester County Medical Society.
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The Threats Inherent in
Raw Milk and Related Products BY JOHN P. MAHER, MD, MPH
very physician is aware that raw or undercooked shell eggs carry a risk of enteric diseases such as Salmonella. Perhaps less well known (or, more likely, less often thought of in the differential diagnosis) is that the same kind of risks exist with any raw, undercooked or improperly handled milk or dairy products. There is little doubt that milk is one of Mother Nature’s most nearly perfect foods. Most milk and milk products sold commercially in the US contain pasteurized milk or cream, or the products have been produced in a manner which kills any harmful bacteria which might have been present. According to US Regulation (21 CFR, Sect. 1240.61), “No person shall cause to be delivered into interstate commerce or shall sell, otherwise distribute, or hold for sale or other distribution after shipment in interstate commerce, any milk or milk product in final package form for direct human consumption unless the product has been pasteurized.” Such products must meet the standards of the US Pasteurized Milk Ordinance.1 The US Centers for Disease Control and Prevention (CDC) collects data on foodborne outbreaks voluntarily reported by state, local, territorial, and tribal governments which conduct most outbreak investigations. Between 1998 and 2011, 79% of those investigations, which included the status of the milk, were due to raw milk or raw milk products. These included over 2300 illnesses, 284 hospitalizations, and 2 deaths. The CDC also reports that unpasteurized milk is 150 times more likely to cause foodborne illness, and results in 13 times more hospitalizations, than illnesses involving pasteurized products. This warning does not apply only to cow’s milk. In this context, “raw milk” includes milk and milk products from cows, sheep, and goats which has not been pasteurized. Nevertheless, given American politics, consumer preferences and beliefs, and issues of “freedom of choice,” it is also a fact that various kinds of “raw milk” (unpasteurized) products are not uncommonly produced, marketed and sold in the US, despite
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the fact that public health agencies have long warned that such dairy products may be harmful to the consumer’s health. So, while the feds have banned interstate raw milk commerce, the laws governing intra-state sales are set by each state, and those regulations vary all the way from complete bans, to permitting sales from farms or retail outlets.2 Thus, as of April 19, 2016, the sale of raw milk in stores is legal in 13 states; 17 states only permit raw milk sales on farms; 8 of the states which prohibit sales still allow acquisition of raw milk only through “cow-share” agreements (apparently based upon the concept that a “cow-share owner” is part owner of the animal and has a right to consume his/her own food products without interference). In 20 other states all sales of raw milk are prohibited.1 Mandatory pasteurization and sanitation procedures have made milk one of the safest foods available. Still, several states continue to allow the sale of raw milk, usually labelled “certified” raw milk. Back in the 19th century and the beginning of the 20th century, there was a need for safer milk. Pasteurization processes had not yet been developed and milk-borne disease was widespread. Thus, beginning in 1902 with the NYC Health Department’s inspections of dairy farms, distribution systems, and retail milk vendors, certification of milk was instituted to provide a safer product for infants, the elderly, and those persons in poor health. Consequently, dairy farmers generally instituted improved hygienic practices during milking. Still, the CDC notes, the dairy farm environment is a reservoir for illness-causing germs. So, at that time, and prior to the initiation of pasteurization, certification was an improvement and was beneficial to the public health.3 Nevertheless, current evidence shows that the “certified” trademark is no longer indicative of a safer product. Outbreaks of raw-milk-related Salmonellosis and Campylobacteriosis in various states in the 1970s made it apparent that raw milk can still be a vehicle for disease transmission even though it has very low coliform and total aerobic bacteria populations (plate counts).
Public Health officials note that, no matter how good the producers’ sanitation efforts, it is now ironic that the “certified” label which was developed to improve public health, is now increasing health risks for those segments of the population it was designed to protect, namely: young children, pregnant women, the elderly, and those with weakened immune systems. For true raw milk devotees, their beliefs about the benefits of raw milk may be strongly emotional as well as based on a simpler “back to nature” philosophy, childhood nostalgia, the desire for truly “organic” foods, and/or the belief that food processing and food additives are more dangerous than the alternative. The CDC’s educational materials try to combat the myths associated with raw milk. They make the points that: (a) most of the nutritional benefits of raw milk are also available from pasteurized milk without the risks of disease associated with raw milk; (b) raw milk made into other products like soft cheese (queso fresco), cream, ice cream and yogurt, can and still does cause dangerous infections; (c) there is no protection from infection in milk labeled “organic” unless it has also been pasteurized; (d) even dairy farms with very good safety practices can harbor pathogens in their environment, their equipment, or the employees’ clothing.4 Table I: Common Pathogens Potentially Found in Raw Milk/Dairy Products 2, 4 • Campylobacter • Shigella • Giardia • Salmonella • Yersinia • Norovirus • E. coli (e.g., O157-H7) • M. bovis • Listeria • Brucella Table II: How Does Milk Get Contaminated? 5 • Cow/animal feces coming into direct contact with the milk • Infection of the cow’s or animal’s udder (mastitis) • Cow/zoonotic diseases (e.g., bovine tuberculosis) • Bacteria which live on the animal’s skin • Environmental contamination (feces, dirt, processing equipment) • Insects, rodents, and other animal vectors • Humans (e.g., cross-contamination from soiled clothing, boots, hands)
Other considerations for the physician, as well as the patients and their families, include the potential sequellae of such vehicle-borne infections. There are perhaps several such complications which should always be foremost in the clinician’s mind when thinking of these diagnostic possibilities: 1. The dangers of Listeria and pregnancy: not only can the mother-to-be become seriously ill, but the organism can cause fetal death, miscarriage, or death of a newborn infant. 2. Different species of E. coli can cause serious G.I. bleeding, renal failure, hemolytic uremic syndrome, even death. 3. Campylobacter jejuni can result in Guillain Barre’ Syndrome. 4. The frequent need for hospitalization, intensive care, life support therapy, organ transplant. 5. Many other kinds of difficulties beyond the scope of this article, such as M. bovis peritonitis, Brucella bone lesions, post-Salmonella arthritis, etc. Physicians who may run into these patients should be prepared for the arguments which will necessarily ensue. Educational materials and handouts are available from the CDC and FDA websites. One of the most useful of these, perhaps, is one from the California Department of Public Health. In that state, which does allow the legal sale of such raw products, all such products are required to include the CDPH’s warning6 on their labels: WARNING: Raw (unpasteurized) milk and raw milk dairy products may contain disease-causing microorganisms. Persons at highest risk of disease from these organisms include newborns and infants, the elderly, pregnant women, those taking corticosteroids, antibiotics or antacids, and those having chronic illnesses or other conditions that weaken their immunity. A CDPH two-page informational pamphlet labeled Raw Milk and Raw Milk Dairy Products — Risk and Recommendations is available as well. Dr. Maher is a retired physician who was the County Health Director for many years, and has been a longterm member of the CCMS Board. References: 1. http://milk.procon.org/ 2. Mengai, et al.: Emerging Infectious Diseases. Vol. 21 (1), January, 2015 3. Rosen, George: A History of Public Health. MD Publications, New York, 1958 4. http://www.cdc.gov/foodsafety/raw-milk/rawmilk/raw-milk-index.html 5. http://www.cdc.gov/Features/RawMilk/index.html 6. email@example.com
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GMS HEALTH SERVICES BY ENRIQUE JOSEPHS AND JOHN A. KOYTO, MD
he Glen Mills Schools (GMS) is a residential facility for troubled youth, devoted to providing quality services for students. The mission of the Glen Mills Schools is to change antisocial behavior to pro-social behavior and provide the necessary life skills to sustain change. The philosophy surrounding the Glen Mills Schools creates a strong school culture where students are treated with dignity and respect in an environment without imprisonment behind bars. Founded in 1826, GMS is the oldest continuously operating school of its kind in the United States. Located in Delaware County, Pennsylvania, the school sits on an 800-acre open campus with educational programs tailored to the unique needs of each student and designed to unlock the potential for personal growth. One of the main goals of GMS is to educate the whole child. To this end, the school offers an array of innovative programs and services in youth behavioral and educational development as well as a comprehensive healthcare delivery system for the 1,141 students that attend the school each year. Each student has access to high quality healthcare services including behavioral health, a Health Center, optical, dental and, even, co-occurring substance abuse treatment. Because GMS provides high-quality health care services, students are better able to focus on their studies and personal development. Some of the services the school provides are as follows:
Health Center The Health Center at GMS provides comprehensive services to meet physical and medical needs of students and staff. The Health Center is staffed with three full-time nurses and four physicians who work on site Monday through Friday. The nursing staff also provide on call coverage for health-related issues that arise after hours and on the weekends. It is important that the medical needs of each student are addressed fully. Upon entry into the school, every student is assessed by medical staff and given a full physical with lab work, PPD skin test, and vision and hearing exams. Many students find that they are in need of glasses after the vision exams. A fully functioning optical lab (that doubles as a career and technical educational training program) provides glasses and sports goggles to students. Physicals and exams are required to maintain regulatory compliance, but the Health Center goes beyond that. Students are treated for many medical issues including acne, allergies, asthma, alopecia, fungal infections, hypertension, obesity, skin disorders, sexually transmitted diseases, migraines, lacerations, wound care, suture placement/removal, staple removal, warts, sprains, knee and shoulder repairs, cardiac repairs, ingrown toenails, dandruff and more. If a student is in need of care, the medical staff at the Health Center provides that care. GMS also administers missing vaccines to students (as required by state
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law) and those recommended by the American Academy of Family Physicians. Recently, the school began giving the flu vaccine to the entire student body. Since implementation, the number of flu cases on campuses has been significantly reduced. The Health Center houses key pieces of equipment that helps provide care to students including liquid nitrogen for cryosurgery, an ophthalmoscope for eye related issues, an ear flush system to clean out impacted cerumen and a urinalysis machine. In addition, the medical staff is dedicated to teaching students how to care for themselves in regards to the administration of medicine and prevention. The staff teaches students how to use Epipens, complete blood sugar checks and administer injectable medications, eye drops, ear drops, inhalers and creams. The medical staff teaches students about a multitude of disorders and help to teach proper personal hygiene practices. GMS has an active sports program on campus and the Health Center works closely with the athletic training department to provide sports-related care. The physicians work together with trainers to evaluate student injuries and provide care and treatment for each injury. The Health Center also serves as the location for the administration of behavior modification medications for students as prescribed by a psychiatrist. Most importantly, students, and staff as well, have access to the Health Center.
Students have the opportunity to visit with medical staff Monday through Friday to discuss any medical needs that they want addressed.
Dental Center For many students, dental care is not available to them due to lack of availability or coverage by medical insurance. For over 30 years, GMS has provided dental care services to students and staff in a state-ofthe-art 3,000 square foot dental office. The office can address all dental needs using its six fully equipped operatories. On average the Dental Center provides treatment to 350 patients each month with on-call care available 24/7 for students. The Dental Center staff includes a fulltime dentist, full-time hygienist, three parttime dentists and two part-time hygienists. A full range of services are provided including prophylaxis, composite fillings, periodontal scaling and root planning, and crown and bridge work. Two endodontists provide root canal treatments and an oral surgeon comes in as needed for extractions. Each and every student who comes to Glen Mills is treated at the Dental Center with an initial exam, treatment plans and followup care. The Dental Center also houses the Dental Assisting program, which is offered as one of the schoolâ€™s 25 Career and Technical Education (CTE) programs. Within the program, students work alongside dentists and specialists to learn the field. Students learn the sterilization process, how to use the biosonic cleaner and both the autoclaves and statims. Students in the dental assistant program are prepared for a career in the dental field if they choose to pursue that career path.
Optical Lab Like the Dental Center, the Optical Lab doubles as a medical center and teaching facility. In operation for over 35 years, the Optical Lab provides glasses, created on site, to students, staff and the general public. Students in the CTE Optician program are taught hands-on skills including production through surfacing, finishing
and retail operations. They learn the skills needed to work in industry-level optical stores. Students have gained employment in the optical field in locations such as Wills Eye Hospital, LensCrafters, Pearl Vision and other community-based companies across the United States.
Wellness & Nutrition GMS participates in the National School Lunch Program (NSLP) and has a wellness policy in compliance with Pennsylvania Law. The school also has a Wellness Committee, which is comprised of members from GMS departments and student representatives. The monthly meetings focus on health and physical education curriculum, drug and alcohol classes, food and nutrition, outside community service and the Big Dawgs Club, an individualized program for students with a BMI over 35. Co-occurring Substance Abuse Program, GMS currently partners with Onward Behavioral Health (OBH) to provide mental health and substance abuse counseling (co-occurring) to its youth population. The OBH program is a Commission on Accreditation of Rehabilitation Facilities (CARF) accredited program, offering comprehensive care in a format teens can understand and trust. The different levels of care available include intensive outpatient group sessions, general outpatient group sessions, individual sessions and family sessions. Family sessions are designed to develop effective and appropriate communication, boundary setting and create a plan for a structured environment for the student to return to upon completion of their time at GMS. Fourteen students are currently enrolled in the OBH program. Group session topics have included prevention, anger management, positive communication, disease model of addiction, negative consequences of substance use, goal setting, positive coping skills and impulse control.
Diagnostic Evaluation Center The Diagnostic Evaluation Center is responsible for providing mental health services at GMS. A board certified
licensed child psychiatrist, two licensed psychologists, a licensed clinical social worker and a full time grief and loss counselor are available to students. The psychiatrist monitors students on behavioral health medications and is available to all GMS students as needed. The psychologists screen all new students to determine if mental health services such as individualized therapy sessions or grief and loss counseling are needed. Therapy and counseling services are provided by the psychologists, clinical social worker and grief and loss counselor. During the 2016 fiscal year 996 individual counseling sessions and 209 family counseling sessions were conducted for GMS students.
Athletic Trainers The main GMS athletic training room, team film room, and locker rooms are located at the Field House. The facility is staffed by three nationally certified, state licensed athletic trainers (ATC). The athletic trainers work in conjunction with the GMS Health Center under the direction of the attending physicians. Athletic trainers specialize in the prevention, management, evaluation and rehabilitation of athletic injuries. The athletic training room has an array of equipment essential in providing student athletes with quality health care services including therapeutic modalities, therapeutic rehab equipment and strengthening equipment. Treatments are designed to avoid conflicting with class schedules. Approximately 3,500 treatment sessions are conducted annually. In addition to the above services, GMS also has close working relationships with several local hospital systems, such as Crozer, Main Line Health, the Childrenâ€™s Hospital of Philadelphia, and A.I. DuPont. For over 190 years, GMS has provided quality health care services to its students. Today, the school continues to be committed to focusing on the overall well-being of its students and provides the finest of healthcare services. When students are healthy they are free to focus on their education, their personal development and, most importantly, plans for a successful future.
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The Art of Chester County
Visionary World of
HUMPHRY MARSHALL BY MIAN A. JAN, MD
do not remember the exact year, but it has been many years, since my wife Amber and I were invited to a dinner by Skip and Glenda Brion. I was stunned when I walked into the dining room and saw the famous painting, Arnolfini Portrait, by Jan Van Eyck (1390-1441, Bruges) who is one of my favorite painters. I thought for sure it was a photograph of an original which hangs in the National Gallery in London but Skip told me it is an original painting by a local artist; this was my introduction to Adrian Martinez. Skip had other paintings of his, each more vibrant than the last. Soon afterwards I visited with Adrian at his home in Downingtown and met his wonderful wife Leah. Adrian was born in the Preston Retreat Home for indigent mothers. When he was five years old his family moved to the Washington, DC area. Adrian describes his childhood growing up in the slums of DC, “I have early memories as a raggedy child standing in front of the White House looking through the bars of the beautiful wrought iron fence and wondering what life could be like inside, while ten blocks away, my home was a crumbling plaster of walls, cockroaches and rats. Social workers were disdainful but there were other people and organizations whose kindness I can never forget. People I did not know donated money to support community centers like the Hull House and free summer camps like Plato’s Place. Volunteers fearlessly drove into the dangerous neighborhood bringing food, clothes and other amenities.” Continued on page 16
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The Art of Chester County Continued from page 15
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Adrian and his family through personal drive, perseverance and strength of character not only survived but thrived. Adrian studied painting and printmaking and received degrees from the Maryland Institute of Art in Baltimore, Maryland, St. Martin School of Art in London, and Purdue University in Indiana. Through his hard work and perseverance the same wrought iron bars through which he looked as a child are now open to him as his paintings now hang on the walls of our White House (including a 10’ x 20’ mural), as well as, many other prestigious institutions and museums. President and Laura Bush call him a friend and his is a journey that anyone would be proud of. Adrian and his wife Leah live with their son Sebastian in Downingtown, a place they love and call their home. Over the years we have become good friends, we have talked about art and he has sought my opinion on health issues. Robert Shimshak said, “Good art is timeless. It assumes a new relevance to each generation and to yourself as you grow. It will connect to the past and feed the future. It is a simple and rigorous beauty that commands your gaze and thoughts whenever you look at it. The best work will break your heart. As a collector you would know when you see it and you will not be convinced by anyone to acquire it, it would be something you simply must have.” Adrian Martinez’s art epitomizes what I just described. Recently the Chester County Historical Society, where I sit on the board of trustees, decided to celebrate Humphry Marshall’s life and selected Adrian to visually recreate events in Mr. Marshall’s life. This was a great symbiotic task between a great man from the past and a great artist from the present. Humphry Marshall was born in West Bradford Township, Chester County, Pennsylvania on October 10, 1722. In the days of his childhood, education facilities were scanty and limited and Humphry would often state that he never went to school after the age of twelve. Being robust and strong he was employed as an agriculture laborer until he was old enough to be an apprentice to a stone mason. One can actually see his work still stands in the Village of Marshallton. In 1772 he first purchased 30 acres of land in what is now the Village of Marshallton. In his leisure hours he devoted himself to scientific studies of astronomy and natural history. In 1773 he commenced his ‘Botanic Garden’ at Marshallton. The noble magnolias can still be seen there during the summer. In 1785 he published on account of forest trees and shrubs of this country under the title of Arbustum Americanum, the American Grove which is believed to be the first truly indigenous botanical essay published in the western hemisphere.
In addition to his scientific work he was also County Treasurer and Trustee of the Provincial Loan Office. In 1786 he was elected member of the American Philosophical Society and a genus of American plant was dedicated to him and was named Marshallia. There’s also a square named after him in West Chester on North Franklin Street. The great man died at the age of 79 on the fifth of November in 1801, but he left a legacy which stands tall even today. When I saw the fruits of Adrian’s work I was stunned; each oil work was so lifelike that it brought Humphry Marshall, his friends and people of that era to life. Adrian’s artistic greatness communicates with his audience. It is in these paintings that he has produced masterpieces which many generations can cherish and treasure. It takes a visionary artist from the present to put on canvas the life of a legend like Humphry Marshall from the past.
“Meeting at Martins Tavern”
P L E A S E V I S I T T H E E X H I B I T: Visionary World of Humphry Marshall at the Chester County Historical Society, 225 N. High St, West Chester, PA on November 4, 2016 6:30 pm to 9:30 pm. The exhibit will be on display through December 2017 Martinez family, Sebastian, Leah & Adrian Mian A. Jan M.D. who is a practicing Cardiologist, President of Chester County Medical Society, and on the Board of Trustees of the Chester County Historical Society.
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PA TEEN HEALTH WEEK BY LAURA OFFUTT, M.D.
his past January, Gov. Wolf has proclaimed Jan. 25-29 as the first ever Pennsylvania Teen Health Week, a week focused specifically on the important topic of holistic health in teenagers. Pennsylvania is the first and only state to have such a state-wide proclamation and observance. Based on a successful First Pennsylvania Teen Health Week in 2016, plans are already underway for the 2nd Annual Pennsylvania Teen Health Week, which is scheduled for January 9-13, 2017. Pennsylvania Teen Health Week has been developed by Real Talk with Dr. Offutt, LLC and in collaboration with the College of Physicians of Philadelphia and the Pennsylvania Department of Health. The Delaware County Medical Society and the Pennsylvania Medical Society have been strong supporters of this initiative since its inception. The establishment of a Teen Health Week calls upon adults and health care and educational institutions to focus on the health needs of this special population.
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Many wrongly assume that teen health is synonymous with sexual health. However, teen health encompasses far more. Health behaviors resulting in illness later in life, that start or are reinforced in the teen years include substance abuse, diet and exercise habits, violence, and mental illness. Specifically,
worldwide, suicide is the 3rd leading cause of death amongst adolescents, and as many as half of mental health disorders start by the age of 14; many are left untreated. Sexual development occurs during these years, and it is critical to teach youth means to reduce unwanted pregnancy and communicable diseases such as HIV and other sexually transmitted diseases. Health behavior patterns established during adolescence both affect the individualâ€™s current and future health, and have the potential to lay the foundation, either positively or negatively, for adult health. Thus it stands to reason that promoting healthy behavior in teens promotes a healthy population in general. In Pennsylvania, more than a quarter of youth are overweight or obese and fewer than half of high school students report getting the recommended amount of daily physical activity. Teens account for nearly half of the cases of chlamydia and gonorrhea in Pennsylvania. Nearly half of students in 6th-12th grades report having had alcohol. A fifth of 12th graders report using marijuana in the past
month. Depression symptoms and suicidal thoughts are increasing, with 15 percent of our teens reporting seriously considering a suicide attempt. It is often described that the adolescent brain develops reward pathways faster than it develops pathways responsible for planning and emotional control, but often what is less discussed is the remarkable capacity for the adolescent brain to adapt. Thus it is recognized that exploring and experimentation are normal activities during teen years; but one should also consider that questioning, learning, and engaging with accurate health information will help adolescents develop the necessary skills to advocate for their own health. Since adolescents often are agents of change, including them in discussions and really listening to what they have to say about improving adolescent health behaviors is critical. Pennsylvania Teen Health Week is intended to inspire adults and teens in our communities to work together to protect and improve the health of Pennsylvania teens.
Individuals, schools and other organizations that wish to become involved can do so easily. Each day has a specific broad health focus to serve as a suggestion or guide around which to focus activities: Healthy Diet and Exercise; Violence Prevention; Mental Health; Sexual Development and Health; Substance Use and Abuse. Involvement can be as simple as hanging a flyer announcing the week in the office or wearing lime green, the official color of Teen Health Week. A comprehensive toolkit has been developed which includes a timeline that can start at any point in the fall, through the week itself. The toolkit includes youth activities and lesson ideas, many of which can be used to meet highlighted Pennsylvania Academic Standards with which schools must comply. Activities, sample social media posts, and a variety of resources are grouped around the broad themes covered in the week. Student clubs, youth groups, school teachers and administrators, medical practices, local businesses and other community organizations are all invited
and encouraged to participate in the week. The week will kick off with a formal presentation of Governor Wolf’s Proclamation by the Pennsylvania Department of Health under the Capitol Rotunda in Harrisburg at the State Capitol Building. The week will close out with a Good Teen Health Depends on More than Good Luck celebration in Philadelphia on Friday the 13th. Teens and adults alike are both invited to participate in these 2 events, which will be free and open to the public.
Laura Offuttt, M.D., is Founder of Real Talk with Dr. Offutt, an interactive, web-based health resource for teens.
CONSIDER MEMBERSHIP in The Chester County Medical Society
Established in 1828, the Chester County Medical Society, founded by Dr. William Darlington, M.D., is thought to be the oldest county medical society in the State. The Medical Society is involved in all aspects of healthcare policy, practice, and education and serves to advance the health of the community and to protect and expand the healthcare resources available to its citizens. T he Chester County Medical Society works collaboratively with the Pennsylvania Medical Society, but our focus is on our local community. The Society’s role in Chester County is to support, protect, and advocate for our physicians and our patients. We look forward to growing an important healthcare service for our community that will benefit us all, and we look forward to hearing from you.
Help Patients Find You! CCMS Members are listed in the Pennsylvania Medical Society’s “Find a Physician” program. Legislative Support Representation with local legislators Contact your local legislator by getting their contact information provided on our Legislator page. General Membership Meeting General Membership Meeting — an annual meeting which provides members the opportunity to impact their Society’s activities and goals. Legislative Dinner Legislative Dinner — a.k.a. “The Clam Bake” — an annual meeting for members to meet with local legislators in an informal setting for cocktails and dinner to discuss healthcare issues. Chester County Medicine Chester County Medicine has been the CCMS’s official publication for several decades. CCMS members will receive a complimentary subscription to Chester County Medicine magazine, the Society’s new twist on its longtime quarterly publication. DocBookMD — an exclusive HIPAA-secure messaging application for smart phone and tablet devices.
To learn more, join or renew, visit https://www.pamedsoc.org/about-pamed/Membership FA L L 2 0 1 6 | C H E S T E R C O U N T Y M E D I C I N E 19
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PREVENTING eFRAUD BY LEIGH BALCOM, FRAUD RISK MANAGER, ENTERPRISE SECURITY DEPARTMENT, M&T BANK
Comptroller at a mid-sized company got an email that appeared to be from the CEO, instructing him to wire $400,000 to an attorney the CEO was working with to acquire an overseas company. After several email exchanges, the Comptroller initiated the wire transfer. A few days later, the CEO noticed the transfer and asked the Comptroller about it. The CEO never authorized the transfer. Instead, the CEO’s email account had been hacked by a fraud ring, who engaged in a crime known as “Executive Impersonation” fraud. The money was never recovered. In another incident, an Office Manager for a medical practice thought she needed to get a $125,000 wire processed as soon as possible. One of the doctors told her in an email it was an urgent request and they needed to move quickly if they were going to be able to purchase the equipment at a great price. So, you could probably see the color leave her face the next day when she told the doctor the funds were sent and his puzzled look told her he had no idea what she was talking about. They immediately called the bank to recall the wire, but the funds had moved to a foreign country and the receiving bank said the fraudster had already withdrawn the money. These examples are just a small portion of numerous companies who have fallen victim to an Executive Impersonation scam. There are a few different iterations of how the fraud is perpetrated but all entail the scheme of duping a company employee into sending money via wire, ACH or even check to a fraudulent account because they think an executive at their company wanted it sent. The FBI estimates that Business Email Compromise, in which a criminal hacks into a legitimate business email account in order to conduct unauthorized transfers of funds, has cost individuals nearly $3.1 billion in the two and a half years from October 2013 to May 2016. The fraudster will simply take advantage of an employee’s desire to do what their manager requests. There are different ways this can be done. In a simple Executive Impersonation scam, the bad guys will simply change a letter or two from the manager’s email address to make it look like the email matches the company’s email domain. If an email is firstname.lastname@example.org, a simple camouflaged address could be telliott@abcI23.com. They look similar but the ‘1’ has been changed to a capital ‘i.’ The employee thinks the email is the same and responds to the bad guy, thinking they are conversing with the manager. How does the fraudster know who’s who in the company? That might be the easiest part of the whole scheme…social media or a simple Internet search. It’s easy
Continued on page 22
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PREVENTING eFRAUD Continued from page 21
to look up a company on the Internet or on social media and get names or e-mail addresses. Another form of this crime is known as Business Email Compromise. This is a more sophisticated scam where the company’s email account has already been compromised via a virus or other form of malware. The fraudster is remotely monitoring conversations between company employees. They know who authorizes payments and who processes the wires. They’re well aware that the CFO goes by “Tom” and not Thomas or Tommy. They know when someone is out of the office or on vacation. All this information is gathered by reading the emails of the company employees. The bad guy can then craft a message to the person sending payments that will make sense to the receiver of that email. If the fraudster has seen a reference to Tom being out of the office, he can send an email to the sender of payments and refer to their absence: “I’m out of the office and can’t talk right now but I need money sent to xyz.” The bad guy has already set up a fraudulent account at another bank in order to make the movement of money quick and simple. Another version is known as “Vendor Impersonation.” In this variation, the fraudster will hack into a company’s email and look for customers. They then send emails to these nonsuspecting customers and tell them an invoice is due but the payment information has changed. They’ll then give ACH or wire instructions to their own fraudulent account. In these cases, the fraud takes longer to detect because the paying customer thinks they’ve paid a bill and might not find out it hasn’t been paid for 30, 60 or even 90 days. By then, the money has been moved and is long gone. It’s not all hopeless. Executive Impersonation events can be prevented. The FBI encourages anyone sending a wire to use the following steps to prevent this type of fraud:
• Confirm all requests for money transfers in person. If confirming over the phone, make sure the confirmation is completed via known phone numbers between parties. • Verify changes in vendor payments. Call your contacts and make sure any changes are legitimate. • Keep business and personal information safe. It’s best to start with good, basic computer security like changing your passwords regularly; don’t open email attachments from unknown senders; keeping virus software up to date; and being very careful about posting personal and business information on social media. • Educate yourself and your employees. Create a payments policy and follow it. Keeping your employees educated about the latest fraud trends is a key to preventing fraud or recognizing it quickly to reduce potential losses. • Choose a financial partner who can help. Partnering with a financial institution that keeps you informed on fraud developments and is invested in helping to protect your organization from fraud is also key. As a partner in fraud prevention, your financial professional should: • Possibly help retrieve the money if a fraud occurs and the money is still available. • Keep you informed on relevant fraud industry data • Provide help on identifying fraudulent activities early to reduce organization losses. • Advise you on fraud prevention best practices. • Offer necessary fraud protection products and procedures, such as the dual authorization and the separation of duties, to reduce your risk of becoming a fraud victim. • Help you to reconcile account activity daily. • Encourage out of channel verification of any payment.
Leigh Balcom is a Fraud Risk Manager in the Enterprise Security department of M&T Bank. He has been with M&T for more than eight years. Previously he was with The Buffalo News and Rich products.
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VOLUNTEERS NEEDED For more information, please contact Marie Frey at email@example.com or 610.836.5990 x106 Community Volunteers in Medicine (CVIM) provides compassionate primary medical and dental care and health education to people who live or work in Chester County who lack access to insurance, in order to support their goals to lead productive, healthy, and hopeful lives. As a non-profit, supported 100% through philanthropy, we are committed to remaining the safety net provider for medical and dental care in our community. Volunteers are the heart and soul of CVIM. Our volunteer licensed healthcare professionals and support volunteers embody a “Culture of Caring” that is shared with our patients through the provision of compassionate, culturally competent and dignified care. These doctors, nurses, dental hygienists, pharmacists, interpreters and more come from all over to volunteer over 53,000 hours a year of service work in the pursuit of better health for the community.
Public Health Dental Hygiene Practitioner (for outreach/ education)
Dieticians for General Nutrition
Physician or Nurse Practitioner (Monday &
Registered Dieticians or Nurses with Diabetes Management Skills
Spanish Speaking Counselors/ Therapists
Social Services (completing applications for public benefits)
Front Office (bilingual preferred,
Bilingual Dental/Medical Interpreters
Corporate Partners for “Days of Caring”
Third Party Fundraisers
but not necessary. Must be computer literate)
300 B Lawrence Drive, West Chester, PA 19380 Phone: 610.836.5990 • www.cvim.org 8.24.16
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Grief and Loss
Through the Holidays BY TERRI ERBACHER, PHD PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
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he fall weather is here and Thanksgiving is right around the corner. It is a time to be thankful and express gratitude for the people and the love in our lives. But, what if you have recently lost a loved one? The holiday season can feel gutwrenching and bereaved individuals may find themselves feeling depressed, exhausted, and forlorn. It is important to note that the majority of bereaved individuals cope with their grief relatively well, are able to function as effectively as before their loss, and are able to feel joy and happiness despite intense sadness (Bonanno, 2009). However, the grief process is quite individualized (Erbacher, Singer & Poland, 2015), and may vary greatly depending upon life experiences, faith, and previous losses. The first holiday without a loved one can send a grieving person spiraling back into the depths of sorrow, yet many bereaved people say that the second year can actually feel worse. During that first year, friends and loved ones often gather around to ensure those grieving are kept busy. But, many bereaved individuals report finding themselves more alone during the second holiday without their loved one. Humphrey and Zimpfer (1996; cited in Regehr & Sussman, 2004) suggest that the grieving process can easily last up to two years. And, those experiencing prolonged grief, especially after a traumatic loss such as a suicide, may experience grief for years on end, if not forever (Bonanno, 2009). The question is two-fold: How do we recognize prolonged grief in ourselves or in loved ones? And, what can we do to ease the grief we experience, particularly over the holiday season? What are signs that you or a loved one are still in the midst of grieving? • You feel tired more often or have trouble sleeping well. • You may have trouble concentrating as you find your thoughts constantly return to how much you miss your loved one.
It is important during this season that we each nourish our soul, engage in self-discovery regarding what we truly need, and find ways to express gratitude and cherish simple joys during this difficult time. It is important to give ourselves permission to grieve. The trajectory for grief is different for each of us, so we cannot compare our experiences to that of others. We must be patient with ourselves and do what feels right to us in the moment. Most importantly, there are often hidden gifts in our grief. Perhaps we can each find new meaning this holiday season.
A few suggestions for healing over the holidays: • Allow yourself to feel. Accept feelings of sadness and be open to again experiencing joy. • Create new traditions. Perhaps have dinner at a new place or plan a night before Thanksgiving movie and pajama party for kids. • Communicate what you need and be with those who you feel supported by and who will accept you as you are. • Take care of yourself and honor your own needs, even if that means saying ‘no.’ • Establish rituals to honor your loved one; light a candle or read a remembrance poem before dinner. • Plan ahead as knowing what to expect can alleviate stress. Maybe shopping online will provide relief from hectic malls. • Don’t allow the elephant in the room; mention your loved one and share memories to keep their love alive. • Practice mindfulness; enjoy the taste of that pie, inhale deeply to smell the tree, truly hear the laughter of others, feel the heat from the menorah, or watch the snowflakes fall….and really see each of them.
• You may find yourself consumed with thoughts of blame – perhaps blaming yourself, blaming your loved one for Are you concerned about a friend, colleague or loved one? The not taking care of themselves, or blaming doctors for not best thing you can do is to simply be available (Erbacher, Singer being able to save your loved one. & Poland, 2015). Be sure to ask your friend or loved one if they want to talk, ask direct questions, and listen without judgement. • Activities you used to enjoy no longer seem worth Sometimes people are afraid that you do not want to hear their the effort. ‘sob story,’ so make it clear you care and want to be there. Help • You may find yourself questioning how your God could your loved one get through the season by initiating contact, re do this to you. establishing routines, and asking how you can ease their burden • You find yourself being more irritable and easily angered. of holiday shopping, cooking, etc. Try not to take irritability • You are more sensitive to sad events or things like gloomy personally as your loved one is making sense of their pain. Finally, share your own feelings and concerns honestly. And, if you think movies. that your loved one might benefit from therapeutic support, help your loved one seek additional resources.
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Grief and Loss Through the Holidays Continued from page 25
Need information about teen suicide, read Suicide in Schools, by Terri A. Erbacher, Ph.D.
Here are some signs to look for that your friend or loved one may need additional support: • A friend is questioning if life is worth living without his/her loved one. • You notice a colleague has withdrawn from all social interactions. • A friend is having trouble getting out of bed for anything, even fun events. • A loved one is having trouble functioning effectively at work.
Terri A. Erbacher, Ph.D., is a School Psychologist and Clinical Associate Professor of Psychology at Philadelphia College of Osteopathic Medicine.
• A friend mentions that he/she feels like a burden to loved ones. • You see a friend or loved one engaging in extremely risky behaviors (such as drug use), without a care in the world about potential consequences. • A friend, loved one, or colleague cannot stop crying throughout the day. • A colleague is terrified to leave the house for fear that something bad might happen.
• A loved one is talking about a wish to die or is making a suicide plan.
Bonanno, G.A. (2009). Why we’re wrong about grief. Thriving in the Face of Trauma [Blog]. Psychology Today. Retrieved from https://www. psychologytoday.com/blog/thriving-in-the-face-trauma/200910/griefdoesnt-come-in-stages-and-its-not-the-same-every
• A friend is talking about seeking access to suicide means, such as a gun. If you have a friend or loved one experiencing grief, try to remember them during the holidays even if their loss was long ago. Notice if your loved one is feeling depressed or suicidal and ASK them how they are doing. The single best thing you can do is just be there and offer to spend time together, even if you simply enjoy a quiet cup of coffee together. If someone you love is in crisis, they can call 9-1-1 or the 24-hour National Suicide Prevention Lifeline at 1-800-273-TALK (8255). An online chat feature is also available at http://suicidepreventionlifeline.org.
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Erbacher, T.A., Singer, J.B., & Poland, S. (2015). Suicide in schools: A practitioner’s guide to multi-level prevention, assessment, intervention and postvention. New York, NY: Routledge. ISBN-13: 978-0415857031. Regehr, C. & Sussman, T. (2004).Intersections between grief and trauma: Toward an empirically based model for treating traumatic grief. Brief Treatment and Crisis Intervention, 4(3), 289-310.
Dr. Jan Out and About:
Beau Biden Memorial Wilmington Country Club
Mian A. Jan, MD, President of the Chester County Medical Society, with Vice President Joseph Biden and US Senator Chris Coon
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to an Old Friend BY DR. MIAN ARSHAD JAN
“It’s a great mistake to think of being great without goodness. There never was a truly great man that was not at the same time truly virtuous.” — BENJAMIN FRANKLIN
C Congressman Pitt as a member of the Air Force and as a young legislature.
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Congressman Joe Pitts is one such man. He epitomizes these qualities of virtue, decency, honesty, and humility. After serving five and half years in the United States Air Force which included three tours of duty in Vietnam, completing 116 combat missions and earning five oak leaf clusters he and Ginny, his wife of more than fifty years settled in Kennett Square. Three years later he started his 24 years of distinguished tenure as a Pennsylvania State Representative. He established a great reputation as an honest and effective legislator who championed cause for farmers, traditional values and fiscal restraint. In 1997 Joe was sworn into the US Congress and lead many important initiatives. He has served on and chaired many important committees and subcommittees including the powerful Energy and Commerce Committee and the Health Subcommittee. He also served on the House Armed Services Committee, the Budget Committee, International Relations Committee and many more. Over the years he has championed causes of patients and physicians. He has led bipartisan efforts in congress to improve health of citizens and to make the environment less stressful for doctors.
Congressman Pitt with Mian A. Jan M.D. at Chester County Hospital PA.
Congressman Pitt with the mobile dispensary that he donated in Pakistan.
When I heard recently that he was retiring from congress I was saddened, for not only was he a champion of patients he was also a true friend of physicians. Over the years he had become a friend and I had visited him and Ginny at their home and they had visited me at mine and Amberâ€™s home. During the visits they always inquired about the welfare of our children. When I think back about Joe, he has always lived a modest life, only caring for his constituents and others in need. I remember when, on his own dime and time, he took wheelchairs and ambulances to Pakistan to help the sick and the needy. Most people donâ€™t know that he is a wonderful artist and also he paints historic figures. One of these days I might just steal one of those stunning paintings from him. I know citizens of Chester County are going to miss him for he is a great champion of their causes but in some ways I am glad he can spend more time with his beloved Ginny and the rest of his family. Perhaps, he will spend time teaching which is also one of his great loves. Joe is leaving on his own terms and choosing, we know he would have been re-elected without any difficulty in the November election. As I thank Joe for his service to the citizens of Chester County I also want to thank Ginny for sharing her husband with us and for always being there for him, allowing him to better serve his constituents. As a physician and citizen of Chester County I will always have a place in my heart for him. I pray for a long and healthy future for Joe and Ginny, full of joy, happiness, and peace. Mian A. Jan M.D. who is a practicing Cardiologist, President of Chester County Medical Society, and on the Board of Trustees of the Chester County Historical Society.
Congressman Pitt with Mian A. Jan, Gibran Jan and Kouresch Jan at Pitt residence.
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Chester County Medicine is a publication of the Chester County Medical Society (CCMS). The Chester County Medical Society’s mission has evol...