Delaware County Medicine & Health Summer 2016

SUMMER 2016

Music & Medicine

Meet Debra Harder, MD, PhD

The Deadly Pandemic of 1918 When Flu Hit Delaware County

Confronting a Crisis

TABLE OF CONTENTS

OFFICERS 2016 Ronald B. Anderson, M.D., President Joyann Kroser, M.D., President Elect George K. Avetian, D.O., Vice President Fredric N. Hellman, M.D., Treasurer Salvatore A. Lofaro, M.D., Secretary Richard V. Buonocore, M.D., Past President DIRECTORS Stephen N. Clay, M.D. Margaret T. Hessen, M.D. John A. Kotyo, M.D. Joseph W. Laskas, D.O. Virginia McGeorge, CCS-P, CMM Michael A. Negrey, M.D. Chike N. Okechukwu, M.D. Stephanie Tanner, M.D. Jill Venskytis, CMM, HITCM-PP DCMS STAFF David A. McKeighan, Executive Director Rosemary McNeal, Administrative Assistant

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Contents SUMMER 2016

CONTACT INFORMATION Publisher, Tracy Hoffmann Hoffmann Publishing Group, Inc. Design, Kim Lewis 2921 Windmill Road Reading, PA 19608 HoffmannPublishing.com 610.685.0914 SUMM ER 2016

ADVERTISING Karen Zach 484-924-9911 Karen@HoffPubs.com Any opinions expressed in this material are for general information only and are not intended to provide specific advice or recommendations for any individual.

All rights reserved. No portion of this publication may be reproduced electronically or in print without the express written permission of the publisher.

Delaware County Medicine & Health is published quarterly {Spring, Summer, Fall, Winter}.

Music & Medicine

er, MD, PhD

Meet Debra Hard

The Deadly Pandemic of 1918 When Flu Hit Delaware

County

Confronting a Crisis

ON THE COVER

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2 Music & Medicine 4 Healthcare and Domestic

Violence Conference 8 The Deadly Pandemic of 1918

When Flu Hit Delaware County 12 Updates from the office of

Senior Medical Advisor 16 Confronting a Crisis:An open

letter to America’s physicians

on the opioid epidemic 18 Opioids for Pain 20 Pennsylvania Delegation

Advocates to End Mandatory,

Secured Recertifying MOC Exams 21 Jill’s Timeless Tidbits

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ON THE COVER

Music & Medicine

The artistry (and science) of Debra Harder, MD, PhD

W

by Ronald B. Anderson, MD

hen one attends a classical music concert, part of the typical routine is to pick up a program as you hand in your ticket. The program will list the names of the works you will be hearing, details as to the various movements of which the work is comprised, and often includes supplemental information giving the listener further background such as the date of composition, historical context, biographical information about the composer, and sometimes more details about the structure of the work and what to listen for. This past winter I attended a piano concert given by Debra Harder at Haverford College. Rather unexpectedly, in addition to the usual program of the works to be performed, the concertgoers were given a handout at the door with diagrams of chromosomes, genes, and histones, along with a detailed family tree of the Bach family spanning the 17th and 18th centuries. She played works by members of the Bach family as well as compositions by Beethoven and Chopin; her performance was musically superb and of the highest professional caliber. But between works, she would pause to explain the basic science of genetics, and reflect on the fact that 5 generations of the Bach family produced a large number of highly talented and renowned musicians, culminating in J.S. Bach (1685-1750) and his sons. Surely there was inherited musical talent in this family. Debra noted that after Bach’s sons, however, this superlative musicality seemed to dissipate in the family’s further progeny. She posed the questions: “What happened? Why did the genetic code that found such marvelous expression for so many generations suddenly go dormant?” This led her to discuss epigenetics, the field of genetic science that studies how gene expression can be switched off and on through the influence of environmental factors

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or other unrecognized external forces. It was a fascinating speculation that brought out a different dimension of musical appreciation. Hardly the type of thing one would normally expect from attending a classical music concert.

Debra is well suited to this type of intellectual exploration owing to her background as a physician, scientist, and professional musician. I interviewed her recently to further explore this duality of scientific curiosity and musicality.

She was born in Vermont to a very musical family, so music was very much in the air in her home. Her father was a doctor for whom music was an important part of his life. She started playing piano at the age of 3 and began formal lessons when she was 6. She progressed rapidly, making her orchestral debut at the age of 12, and at age 16 performed as soloist in a recording of the Ravel G major Piano Concerto with the World Youth Symphony. But she was also very interested in science and medicine, and therefore decided to enroll in a 6-year BS-MD program at Northeastern Ohio University College of Medicine.

After graduation, she worked as an Emergency Room physician while continuing piano studies and performance and simultaneously juggling the demands of motherhood.

Then Earl Wild, a renowned virtuoso pianist, came to town as artist-in-residence at Ohio State University. She auditioned to study piano with him and was accepted. This changed the course of her life and made her realize she was more an artist at heart. She enrolled at Ohio State and received a Masters and Doctorate degree in Music.

Since then her career has been devoted to teaching and performing music, and her list of concerts and recordings (as detailed on her web site referenced below) is most impressive. Although her artistry is top-notch, there is still the scientist in her that shines through. She notes many similarities between music and medicine. She feels that both medical diagnosis and musical performance involve an “intellectual curiosity, looking at the big picture while at the same time delving deeper into the finer detail.” She feels that common to both endeavors is a central humanitarian engagement, in which the practice of medicine as well as the performance of a piece of music involves striving to “be able to put yourself into another soul.” Combining her scientific and artistic perspectives, as well as her ongoing interested in teaching, has led her to formulate programs that bridge this gap and imbue her performances with medical and scientific overtones. Last year she put together a program delving into the illnesses suffered by various composers and how this might have affected their creativity. More recently she developed the program centering around epigenetics mentioned above. (This program will be repeated on September 18, 2016, at 7:30 PM at Temple University’s Esther Boyer College of Music and Dance, Rock Hall, Philadelphia, and in November at Lankenau Hospital.)

Through her musical artistry, Debra is devoted to exploring both the larger concepts as well as the creative details in music and medicine.

Hear Debra on air, Saturday mornings starting at 7:00 AM where she hosts a classical music radio show on WRTI 90.1 FM Visit her website at www.debralewhardermusic.com or on Facebook at www.facebook.com/debralewhardermusic ------------------------------------------------------------------------------Dr. Anderson is based in Media, PA. He is currently the president of the Delaware County Medical Society. In addition to his practice of rheumatology, he has an interest in music and holds a degree from Harvard in musicology as well as his MD degree from Indiana University. This is the first in a series of articles on Music and Medicine in which he plans to explore the inter-relationships of these disciplines through biographical vignettes of performers and composers, past and contemporary.

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FEATURE

Healthcare and Domestic Violence Conference

By Blake Cohen, Medical Advocate for the Domestic Abuse Project

O

n May 17th 2016, The Domestic Abuse Project of Delaware County held its first Healthcare and Domestic Violence conference. The conference was attended by 140 healthcare providers including physicians, nurses and social workers, and provided five education hours. The day was broken up into three education sessions that ultimately provided a well-rounded, informative, and affecting day for all attendees. Two speakers were physicians, and the third a former victim of Intimate Partner Violence and current DAP volunteer. As this was the first conference of its kind, the intention was to keep the topic general and to provide a gripping personal experience

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that still maintains connection to healthcare. On display at the event were tools to aid in making Domestic Violence a real and pertinent issue to the providers. Displayed by the entrance were The Clothesline Project t-shirts made my past and current shelter residents, and the yearly binders of domestic violence articles maintained by the Medical Advocate. These were effective in communicating the prevalence of this issue, and throughout the conference providers took time to look at these true and varied accounts of IPV. In addition to the PCADV funding, this conference was co-sponsored by the Delaware County Medical Society for the CME credits for physicians, Widener University School of Nursing for the nursing CEs, and NASW for the Social Work credits.

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Jennifer McCall Hosenfeld, MD

The first speaker was Jennifer McCall Hosenfeld, MD, Associate Professor of Medicine and Public Health Services at Penn State Hershey College of Medicine, and a practicing General Internist at Penn State Hershey Medical Center. Dr. Hosenfeld directs the Penn State Center for Women’s Health Research, and sits on the Steering Committee of Futures Without Violence’s National

is not ONE overall best tool, but a combination of tools and questions best suited for normalizing this conversation with patients. The Medical Advocacy Program facilitates this type of training on site within our six hospital systems and at other facilities throughout Delaware County.

Conference on Healthcare and Domestic Violence. Dr. Hosenfeld’s presentation began with the epidemiology and health implications of DV, where the ACES study provided important correlations between violence and health care needs, and the National Intimate Partner Violence and Sexual Violence Survey of 2010, which highlighted not only the different types of violence but also the idea that the most recent study of this nature was six years ago. She highlighted the US Preventative Services Task Force’s recommendation that physicians screen women for IPV not only when they appear to show signs of victimization and went on to introduce the HARK screening tool and recommended best practices for screening, as well as barriers to screening. An important takeaway from her presentation is that there

The second part of Dr. Hosenfeld’s lecture focused on Reproductive Coercion and Birth Control Sabotage, and Traumatic Brain Injury. These are both emerging topics that are also incorporated into every Medical Advocacy Program training. Utilizing the Futures Without Violence patient safety cards (which were also on site for providers to take) is an easy way to incorporate this type of screening into provider visits. Unfortunately, as these are emerging topics, healthcare providers are not always familiar with these terms as a tactic of domestic violence. Reproductive Coercion is defined as behaviors that interfere with contraception use and/or pregnancy pressure, while Sexual Coercion is coercing someone to do something sexually without using physical force.

Traditionally, Traumatic Brain Injury is associated with sports injury, but it is important to keep in mind when working with patients who have experienced strangulation or been hit with a heavy object and/or pushed to the degree where they may have hit their head. Complications of TBI with a DV survivor result in increased risk of drug use and increased likelihood for staying in the abusive relationship.

Sadly, the patient might only present when they are seeing the effects of the brain injury, such as dizziness and memory loss. More specific studies pertaining to TBI and IPV are needed.

Denise Escher

The second speaker was Denise Escher, a seven-year domestic violence survivor and DAP volunteer. Denise was a former Medical Advocacy call when she was a patient at Crozer, stabbed 11 times by her then-husband, in front of her two young sons. The

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Medical Advocate and the Legal Advocate met Denise in the hospital and supported her, filling out the PFA paperwork with her, and ultimately Denise went through all of DAP’s programs. Years later she went through the volunteer program and became an Outreach volunteer, working with the very Medical Advocate who had assisted her in hospital. She now does tabling events at health fairs, and at the recommendation of the Medical Advocate, spoke to physician residents during their training so that they could hear her impactful story as part of a special lecture program.

Denise shared that while she was screened many times by healthcare providers, the questions they asked were focused on her physical safety.

At the time, she honestly answered her providers that she did feel safe when asked if she was physically hurt by her partner. Her then-husband had never been physically violent towards her, yet he did utilize everything on the Power and Control wheel, which details abusive tactics that a batterer will use. It was only when working with the DAP advocates who showed her this tool, however, that Denise finally recognized the true nature of what she had been experiencing.

Sharing this personal account at the conference, along with pictures of her injuries, was extremely impactful and provided a completely different experience and type of lecture than the physicians themselves could provide. Denise also shared how this violence impacted her two sons, both of whom, like her, suffer from PTSD related to the event. In addition to the physical violence and the ongoing emotional and physical effects as a direct result, Denise is enduring a third type of victimization. Her ex and his father continually try to get in contact with her to insist that she not fight his parole this year.

Even after seven years, she and her family continue with this struggle.

Continued on page 6

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FEATURE

Bryanne Robson, MD

The third speaker was Bryanne Robson, MD, a practicing Family Medicine physician in the Crozer Keystone System at Brinton Lake and Associate Program Director in the Family Medicine Residency program.

Dr. Robson identified that this topic was of personal importance to her and shared why she chose to do her Residency scholarly research project on the importance of DV education to healthcare providers. This research began with administering surveys before and after to evaluate the effectiveness of the program, and eight hours of lecture to residents and faculty in the Family Medicine residency program. The lectures were designed to educate providers on resources, hear firsthand survivor accounts of IPV, and to engage in role play screenings to increase comfort

with this topic. The results of Dr. Robson’s research showed that with this education and lecture series, responses increased significantly from pre to post test. She developed a “quick guide” resource sheet for physicians to have on hand that will also help with routine screening and resources. Ultimately her research won Best Original Research in the Crozer Keystone system that year. Following her lecture on the research, the conference attendants participated in role play screening scenarios based off of case studies from the Family Medicine practice.

The scenarios ranged in age and gender, as well as how they presented to providers. The audience had some difficulties working in the screening to a regular visit, which solidified the continued need for education and awareness on Domestic Violence

and DAP as the area resource.

The role play was very well received in the conference evaluations as people appreciated the ability to put into practice what they had learned throughout the day.

-----------------------------------------------The Medical Advocacy Program of the Domestic Abuse Project provides free education to healthcare providers in Delaware County. If you would like to set up a program for your staff, please contact Blake Cohen at 610.565.6272 ext 3118 or via email at bcohen@dapdc.org.

Blake Cohen is the Medical Advocate for the Domestic Abuse Project, and is one of Pennsylvania’s longest running Medical Advocates having been providing education and advocacy services at DAP since 2008.

Direct Outcomes from the Conference • Of those that submitted evals, 66 people rated the overall day as excellent, 37 people rated it as very good, 16 rated it as good, 1 rated it as fair, 0 answered it was poor, and 1 provided no answer.

• Of those that submitted the evals, 115 people said they learned new skills to assist them in their work, and 3 said they did not. 1 was undecided. 2 were unanswered.

• Of those that submitted the evals, 118 people said they feel better prepared to work with a client/ patient who is a victim of DV, 1 said they do not. 1 was in the middle. 1 was unanswered.

Some of the comments were: “wonderful experience, thank you!” “I loved the resources provided, even more please. I overheard a male guest nervous about being one of the only men in the room but felt safe/ comfortable (no male bashing happened).” Great presentation of all aspects of areas.” “I truly enjoyed the conference and the opportunity to network over lunch.

I commend the conference organizers including the registration people for an outstanding job. Thank you!!!”

“Please provide more breaks.” “Excellent speakers with extensive skills and knowledge…” “Adjust microphone as needed” “I understand this is your first conference.

You should be proud. I’ve attended many conferences and the interaction was well thought.” “Adding in a mental health/behavioral health perspective.”

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From this conference, the MAP is set to make great strides next year, having already been contacted for programs that until this event had been long time goals.

The Medical Advocate provides education to all of the CKHS residents in the Pediatric (8), Family Medicine (10), and OBGYN department (2). The Clinical Coordinator for the Internal Medicine department attended the DAP conference and has reached out to set up programming for the Internal Medicine residents program, which will be reaching an additional 25 physicians each year.

In direct correlation to the conference, the MA will be writing an article for the Delaware County Medicine & Health magazine that is distributed by the Delaware County Medical Society in both Delaware and Chester Counties. One of the Crozer OBGYN physicians who attended the conference has invited the MA to speak at the OBGYN Grand Rounds (25 people) in October, the MA will be facilitating 2 trauma groups at Key Recovery (a Dual Diagnosis Facility treating both adults and teens with mental health and substance abuse issues), and speaking to the OR nurses at another CKHS facility, this time Delaware County Memorial Hospital. In the month following the DAP conference, we also received an increased number of hospital based Medical Advocacy calls which could be connected to the conference.

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NIH Launches

Moms’ Mental Health Matters

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he National Institutes of Health (NIH) has launched Moms’ Mental Health Matters, a new initiative to raise awareness among pregnant and postpartum mothers, their families, and health care providers about depression and anxiety during pregnancy and after the baby is born.

The NIH has developed free health education materials in English and Spanish, including posters that describe the signs of perinatal depression and anxiety, counter the idea that all moms are happy during this time, and encourage pregnant women to know the signs of depression and anxiety before their baby’s arrival.

The program has also developed an action plan to help moms identify when to seek help. In addition, the conversation starter postcard, specifically designed for the mom’s support system, offers suggestions for communicating with a loved one about this issue.

Learn more and order free materials at www.nichd.nih.gov/MaternalMentalHealth.

New App for Pennsylvania Physicians: Download to iPhone and Android

Staying up to date on the latest news and advocacy issues impacting Pennsylvania physicians just became easier with the launch of the Pennsylvania Medical Society’s new mobile app.

Go to: www.pamedsoc.org/app to download this app to your iPhone or Android device to receive daily news updates and act on important advocacy issues.

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DELAWARE COUNTY MEDICINE & HEALTH

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HISTORY

The Deadly Pandemic of 1918 When Flu Hit Delaware County

By Harry V. Armitage, M.D. 97th President of the DCMS

Medical men wore masks to avoid the flu at U.S. Army hospital. Nov. 19, 1918.

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D

uring the fall of 1918, at a crucial stage of World War I, as American forces were moving toward German positions in the Argonne forest, a pandemic of influenza swept through the world killing many more Americans within two months than were killed in a year of the war itself. War and disease become intertwined, and the cataclysm that engulfed the world precluded accurate record keeping, but it is believed that more than 21 million people died of influenza before the pandemic came to an end.

Tahiti nearly twenty percent of the native population died after the disease borne by steamship passengers, made entry into the island paradise. It ravaged the world and terrified the populace. Primarily, it struck robust adults between twenty and fifty year of age and was frequently accompanied by fulminating pneumonia.

in america

In America nearly 200,000 died in the epidemic during the months of September, October and November, while during the entire year, by a conservative estimate, 550,000 died. More lives were lost to influenza than were killed in battle during World War I, World War II and the Korean and Vietnam wars combined. In Philadelphia, the hardest hit of any major American City, 7,600 died in fourteen days. Streetcars were packed with bodies and used as hearses.

A shortage of coffins and undertakers necessitated burial in mass graves.

it begun

Actually, the pandemic had begun in the spring of that year when deceptively mild common flue Masks and cubicles were used in American Army broke out, first at Camp Funston hospitals, where patients’ beds are reversed, so in Kansas and then at Camps breath of one will not be directed toward another.

Oglethrope, Gordon, Doniphan, Freemont, Grant, Lewis, Hancock, Shelby and others during March and April. In Europe epidemic influenza was first observed in the American Delaware County, in proximity to Philadelphia, was clearly Expeditionary Force at a camp near Bordeaux, a major at risk of epidemic spread with its active war industries, port of entry for American Troops. During the spring surging population of workers and overcrowded lodgings. and summer months the disease was prevalent in troops Here the epidemic began with unalarming mildness. On in the trenches, in camps, and on troopships spreading a front page devoted primarily to war news, a headline readily from army to army so that the British and French in The Chester Times on September 21, 1918 announced Armies were soon copiously seeded by the flue virus. The that influenza had hit Chester. The accompanying Alps and Pyrenees could not hold back the disease, and it story mentioned that there were fifty cases in the City. easily traversed lofty mountain passes leading to Italy and According to local physicians, it was not a very serious Spain. Nor did no man’s land deter spread to the enemy malady, being nothing more or less than la grippe. The and German troops on the Western Front soon fell victim story implied that “to a certain degree, the disease could to influenza, known to them as “blitzkatarrh.” Spread of be traced to the underhand work of the despicable Hun.” the disease in the German Army was of such magnitude that General Erich von Ludendorff blamed the failure of a It soon became evident, however, that the problem was major offensive on poor morale compounded by influenza. significantly more serious than it had been thought to be initially. During the next week the disease spread rapidly and by October 1, it was reported that Spanish During the summer, as the first wave seemed to be subsiding influenza was sweeping swiftly through the City and that in America, the disease strengthened its hold on Europe and physicians were working day and night treating hundreds of Old World extending to Scandinavia and the British Isles. It cases. A conference attended by physicians, City Council, was known as Spanish Flu everywhere but in Spain, where the Mayor and health officials was held to determine it was said to have blown across the Pyrenees from French methods for prevention of spread of the epidemic; it was battlefields. Then toward the end of August, with virulent suggested by H.C. Donahoo, M.D., head of the Chester backlash, an intensely contagious second wave spread rapidly Health Department, that schools, churches, hotels and throughout the world, reentering the United States through other places where people congregated be shut down. the port of Boston, surfacing at the ports of Brest, France Continued on page 10 and Freetown West Africa and extending to Iceland, New Zealand, India, the Philippines, Alaska, Cuba and Hawaii. In

Delaware county

The First Wave

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HISTORY His opinion was supported by others but was opposed by the former mayor. He said that it would be more harmful for children to be outside than inside of the schools, for the disease was in the air, and that you might as well try to stop a whirlwind as an epidemic. The issue was debated pro and con with physicians and councilmen taking both sides of the question. The next day Council passed a resolution announcing the closing of all theaters and playhouses, all dance halls, all liquor saloons, all poolrooms, all soda and soft drink fountains, all public and parochial schools, all churches and Sunday schools, and the prohibition of all club and lodge meetings, and all carnivals, parades, and open air meetings. Shortly thereafter the criminal session of the County Court in Media was adjourned until such time as the epidemic was over. The Aberfoyle Manufacturing Company closed the entire plant in order to fumigate the buildings and to give its employees a chance to rest and recover.

Continued to Spread

Despite these precautions the disease continued to spread.

The public was advised to go to bed at the earliest sign of illness, to open all the windows in the bedroom, and keep a fire burning in the house. Medicine to open the bowels freely was recommended, along with a diet of simple nourishing food. It was advised that no one be allowed to sleep in the same room with a sick person. To prevent relapse, patients were told to remain in bed until a physician said that it was safe to get up. The use of paper handkerchiefs to protect against spread to others was recommended, as was the use of gauze masks by attendants. A headline in the Boston Globe read: “Filter the Smack” and, in the news item that followed, stated that kissing was to be avoided, but those who were unable to control the desire to kiss, should kiss through a handkerchief. Hygienic precautions were generally observed, but, in addition, measures of dubious value such as wearing camphor bags around the neck and eating garlic and raw onions came into popular use.

During the next week, the number of new cases increased explosively. On October 4th, five thousand cases were believed to be in the City, and every physician had at least two hundred cases under care. On October 6th, Dr. Donahoo estimated that there were ten thousand cases in the City, and that each doctor was attending two hundred to three hundred and fifty cases. It was reported that virtually the entire corps of cadets at the Pennsylvania Military College had come down with influenza. One-hundred and twentyfive-bed emergency hospitals opened in the National Guard Armory were soon taxed to capacity and an overflow unit in the Odd Fellows Temple became necessary. A severe

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shortage of doctors and nurses was aggravated when eight nurses at the Chester Hospital contracted flu. Aid was requested from the state and federal governments and physicians from the Army and Navy were sent to the City.

The Pennsylvania Reserve Militia deployed its Sanitary Squad of fifteen men and eight doctors to Chester. State Health Department nurses were brought in from Reading, which at that time was unaffected by the epidemic; others arrived from Pittsburgh and other parts of the state. However, a dire shortage of nurses continued and private citizens volunteered as attendants of the sick in the emergency hospitals. Requests were made to employers of trained nurses to release them for care of influenza patients.

The munition plants in Eddystone and the local shipyards were almost paralyzed, as workers fell victim to disease.

Many lived in crowded boarding houses and were easy prey to infection. The Health Department found it necessary to issue an order prohibiting the ejection of lodgers who were ill, and to enforce this edict, the Fuel Administration agreed to stop the delivery of coal to violators. The Emergency Armory Hospital, utilized for treatment of war workers, remained filled to overflow. It was later estimated that of the six hundred patients treated in the Armory during the epidemic, thirty four percent died, or as Dr. Donahoo said, “went out by the back door.”

By October 8th the epidemic seemed to have crested; the number of new cases was decreasing, but the death rate continued to rise. Three days later, while fewer new cases were being reported, more deaths occurred than on any other day of the epidemic. Burial became difficult. White’s funeral parlor was used as a mortuary and contained as many as one hundred bodies at one time. There was a shortage of coffins, and pine boxes made at the Sunship Building & Drydock Company were used as crude caskets.

City Council established a Department of Disposition of the dead headed by Colonel Sweeney, a retired army officer, and those who found themselves unable to bury their dead were advised to contact this department. It was estimated that in addition to six hundred deaths in Chester, another five hundred deaths occurred in Delaware County during the epidemic. At one point three hundred and forty-five boxes of dead were stacked at the Lawn Croft Cemetery in Linwood, and finally a steam shovel was brought in to dig a common grave for mass burial.

The epidemic in Chester and Delaware County lasted about five weeks, gradually disappearing in mid October, with sporadic cases occurring during the early months of 1919. It can be assumed that, during the epidemic, the

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majority of people in the community had been exposed to the disease and as mass immunity built, the epidemic came to an end. The same sequence of events occurred in other parts of the world, but the chronologic end of the epidemic was not easy to determine, for a trail of new cases extended into 1919 and possible the early part of 1920. Thus ended one of the most virulent pandemics in recorded history.

When deaths in the tropics are estimated and added to other recorded deaths, it probably killed many more than 21 million people. The worldwide toll may well have been 30 million.

Editor’s Note This article was originally published in The Bulletin of the Delaware County Medical Society in May, 1998.

In 1918 Pfeiffer’s bacillus was considered the most likely cause of influenza. Today, it has been firmly established that the causative agent for influenza is a virus capable to singular mutability. The 1918 virus is believed to have been a swine flu mutant of ephemeral nature. In the intervening years, many strains have been studied, but the 1918 virus has not been found. Assuming that bodies buried in permafrost may be cryogenically preserved attempts have been made to retrieve the virus from corpses of flu victims. In 1951 bodies were exhumed from the Seward Peninsula in Alaska, but only bacteria were recovered; the virus could not be found. However, last year the 1918 flu genes were isolated from formaldehyde preserved lung tissue removed from an army private who had died at Fort Jackson in 1918. This year The New York Times (February 8, 1998) reported that Dr. Johan Hultin, retired pathologist, exhumed four bodies of 1918 flu victims from a mass grave in Brevig Mission, Alaska. He found that one corpse, that of an obese woman, was well preserved and that tissue samples from the lungs could be obtained. Researchers at the Armed Forces Institute of Pathology have found that these samples contained genetic material from the 1918 flu virus.

Dr. Armitage served in the US Army from 1944 – 1946 and then practiced general surgery in Chester. He was a former Chair of the Board of Directors of Pennsylvania Blue Shield and was the longtime Chief of Surgery at both Crozer Chester Medical Center and Sacred Heart Hospital in Chester.

Study of the genetic pattern of the Spanish Flu virus may help to explain its lethality and possibly be of use in preparation of a vaccine should the virus make a return. Modern knowledge of virology and the ability to develop effective vaccines have proven value in epidemic control. However, vaccination does not confer immediate immunity, and because of the astonishing contagiousness of Spanish Flu, its apparition is a reminder that it might again encompass the world in another pandemic.

REFERENCES: Crosby, Alfred W., America’s Forgotten Pandemic, Cambridge University Press, 1989.

The New York Times, February 8, 1998.

The Chester Times, September 21st through October 17, 1918.

The author is Harry V. Armitage, MD, who served as DCMS President in 1963 and the Chair of the Pennsylvania Medical Society’s Council on Medical Service in 1964. Harry grew up in Chester; his dad and his uncle were both local leaders in medicine. He attended the University of Pennsylvania and Thomas Jefferson Medical College.

Harry is undoubtedly one of the most active DCMS members of all time! In 1963 he and several other prominent DCMS members, including J. Albright Jones, M.D., Robert F. Plotkin, M.D. and William Y. Rial, M.D., organized and ran the “Victory Over Polio Campaign” in Delaware County.

Dr. Armitage also served as editor and associate editor of The Bulletin of the DCMS for close to four decades. He and the aforementioned Victory Over Polio committee members were the co-founders of the DCMS Public Health Fund and leaders in public health advocacy. In his retirement Harry worked as a volunteer physician at the PA Department of Health Center in Chester. He remained as the Director of the Tumor Board at the Crozer Chester Medical Center until he was 94.

Harry V. Armitage, M.D,. passed away on March 31, 2016. He was 99 years of age. Dr. Armitage is survived by his wife of sixty-five years, Betty, their three children and their families.

Future editions of Delaware County Medicine & Health will feature some more of Dr. Armitage’s medical history articles, including a focus on the efforts to stamp out polio and the creation of the DCMS Public Health Fund.

DCMS members and friends who would like to make a donation in Dr. Armitage’s memory are encouraged to make a tax-deductible contribution to The Foundation of the DCMS, and help support our continued work in public health.

Contributions may be sent to The Foundation of the DCMS 600 N. Jackson St., Suite 201A, Media, PA 19063-1561.

Comments welcome – please send to delcomedsoc@comcast.net.

In our next edition we will feature another medical history article

by Dr. Robert Weibel about the development of the Mumps Vaccine.

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SECOND QUARTER UPDATE

UPDATES from the office of

Senior Medical Advisor

By George K. Avetian, DO, FCPP, Senior Medical Advisor

West Nile Virus Surveillance and Control Program

Delaware County Heroin Task Force

2016 marks the seventeenth year that Delaware County is conducting a West Nile Virus Surveillance and Control Program to prevent the potential public health effects of the West Nile virus on county residents. The program, funded through a grant from the Pennsylvania Department of Environmental Protection (DEP), runs May through October, which is the high season for mosquito activity.

We are in the midst of the peak months of mosquito activity and it is wise to be vigilant of the West Nile threat.

I encourage you to educate and stress to our patients the importance of taking precautions to eliminate any potential breeding places for mosquitos such as pools of stagnant water. This is especially important this year as we are also focusing on the impending threat of the Zika Virus and its mosquito vector the Aedes genus of mosquito.

The Department of Intercommunity Health Coordination has educated Delaware County residents with informational brochures on best mosquito control measures. In addition, our Department has participated in informational programs as well placed educational posts on social media and on the Delaware County web site. Thus far in the second quarter we had no cases of West Nile Disease in Delaware County.

More information on West Nile activity can be obtained at the state website: www.westnile.state.pa.us/faq.htm.

12 DELAWARE COUNTY MEDICINE & HEALTH

The Delaware County Heroin Task Force, chaired by District Attorney Jack Whelan has met regularly over the past five years to focus on local efforts to deal with this national epidemic. If you have been following recent news reports you are aware that we have made great progress with our Task Force. Members of the Heroin Task Force, established

by District Attorney Jack Whelan, Delaware County Council and Chairman Mario Civera have met regularly over the past five years to focus on activities to deal with this growing concern. Recently Councilman David White has joined the team as well as Common Pleas Court Judge John Capuzzi.

Also joing the Task Force is Mike Raith, director of adult probation and parole in Delaware County. To expand our activities in the rehabilitation process, two trained certified recovery specialists (CRSs) are now available to respond to reports of an overdose with the end goal of connecting those overdose victims to a treatment program. At the March 9 County Council meeting, Council approved the hiring of the two CRSs who will be alerted when an overdose victim is taken to a hospital. While working within the guidelines of the Health Insurance Portability and Accountability Act (HIPPA), the hospital staff will advise the patient and their family about the CRS resource.

In addition, we have established permanent drug disposal sites at forty locations strategically placed in secure sites throughout our county. This initiative involves our local police departments and we are very pleased to have their support and participation securing the drop off sites. We are also fortunate to have the participation of our local law enforcement in the Nasal NARCANÂŽ (naloxone HCI) program. Since November 2014, when police officers in Delaware County were authorized to administer naloxone to overdose victims, over 275 lives have been saved. According to the U.S. Centers for Disease Control and Prevention (CDC), naloxone has saved 26,463 lives nationwide over the past 20 years. In October 2015, the state of Pennsylvania issued a standing order, which provides the entire state with prescription access to naloxone products at participating pharmacy locations. Co-pay costs will vary based on Medicaid

summer 2016

and insurance plans. On May 3, 2016 Councilman Dave White and District Attorney Whelan joined representatives from ACME and Adapt Pharma to announce the availability of NARCAN® Nasal Spray in all ACME pharmacies across Delaware County. Nasal Narcan is now available over the counter at many Delaware County pharmacies for purchase by family members and friends for individuals at risk. Over the past several months Councilmen White, District Attorney Whelan, Executive Director Grace and I have met with community groups promoting awareness of this epidemic while educating our partners on preventative measures and treatment resources. Inhibiting the Heroin epidemic is a challenging project and we are pleased to have numerous community groups working collaboratively with us.

Further information on activities of the Heroin Task Force are available at www.co.delaware.pa.us/heroin or can be reached via links on the Delaware County web site www.co.delaware.pa.us and on our District Attorney’s web site www.delcoda.com.

Department of Intercommunity Health Coordination Communication efforts continue as it is our Department of Intercommunity Health Coordination’s priority to inform and educate our community. I ask each of you to partner with us in the effort to educate our patients on medically relevant topics. In addition to our County website, communication modalities include Facebook(http://www.facebook.com/ DelcoCH?sk=wall), Twitter (@DrAvetian), and community forums. Recent posts on social media included pieces on West Nile virus, Zika virus, water safety for the summer months, cataracts, health literacy, signs of a stroke, new nutrition labels proposed by the FDA, sunscreen effectiveness, and rabies. I continue to provide updates on the numerous community events taking place in Delaware County.

Our Department of Intercommunity Health Coordination under the leadership of its Director Lori Devlin together with our Department of Emergency Services directed by Ed Truitt remains focused on the Delaware County Strategic National Stockpile (SNS) Program. Delaware County’s plan is based on a national initiative mandated through the federal government to ensure adequate levels of preparedness in the event of a disaster. County Council is committed to protecting the lives of all residents in the event of a catastrophic incident.

This is a collaborative venture of many County departments and much credit is to be given to our County Council and Executive Director for their strong support of this program

and for providing necessary resources which enable us to continue to demonstrate proficiency in our evaluation by the Centers for Disease Control (CDC) and the Pennsylvania Department of Health. Most recently on June 22, 2016 a table top exercise was performed with Delaware County leaders in the Government Center Building in Media and at our 911 Center.

Together with my colleagues in the Department of Intercommunity Health I attend regular meetings of the Health Advisory Board. This Board is comprised of representatives from the three Delaware County Health systems, the Delaware County Medical Society, our Delaware County Medical Examiner, and physician representatives. Topics discussed focus on issues relevant to the residents of Delaware County. Twice a year the meetings are open to the public and the most recent public meeting was held May 25, 2016. The public forum enables community members to have questions answered and concerns addressed.

www.delcomedsoc.org

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SECOND QUARTER UPDATE

Health Literacy Coalition Lori Devlin and I are working with David McKeighan, Executive Director of the Delaware County Medical Society, promoting the activities of the Health Literacy Coalition.

The focus of the Health Literacy Coalition is to improve a patient’s ability to access services, understand health-related information and follow medical instructions. Many seemingly well educated people suffer from limited health literacy and their care may be less than optimal because they simply don’t understand. Problems that may occur as a result of low health literacy include missed appointments, medication errors, patients getting misleading information from websites, and an overall lack of compliance with medical advice. Our efforts will be to enhance communication and understanding between medical personnel and patients; to promote use of diagnostic tools as well as resources and activities and to have a positive impact on the health of the community and to enhance patient outcomes.

We continue to meet quarterly with our municipal health officers and provide educational programs that are of benefit in their communities. At each meeting, together with Lori Devlin we update our health officers of the progress of The Heroin Task Force in addition to other health initiatives throughout the County. On Friday, June 3, 2016 we provided members of our Local Boards of Health with an update on vector transmitted diseases including West Nile and Zika. Ed Klein, the Volunteer Management Coordinator for the County updated our Municipal Health Officers on activities of the Delaware County Department of Emergency Services. Our educational programs with municipal health officers cover topics of discussion based on relevance to the health officers.

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George K. Avetian, DO Senior Medical Advisor Office of Intercommunity Health Government Center Contact for feedback and suggestions: (610) 891-5311 avetiang@co.delaware.pa.us

Issues to Consider When It Comes to MACRA Implementation The Quality Payment Program — which includes the Merit-based Incentive Payment System (MIPS) and advanced Alternative Payment Models (APMs) — signals a major transformation in health care. One only needs to examine the Centers for Medicare and Medicaid Services’ (CMS) own estimates to understand the magnitude the proposed rule represents.

Contributing Editor(s) Wanted No Experience Necessary DCMS Members – Physicians and Practice Administrators Encouraged to Apply

For more details go to www.delcomedsoc.org and click on Articles & Publications - then click Practice Management Articles

Help build our quarterly publication into a terrific communications tool!

Responsibilities include writing, editing and working with staff to solicit articles for publication in Delaware County Medicine & Health Please contact our staff at (610) 892-7750 or email delcomedsoc@comcast.net.

14 DELAWARE COUNTY MEDICINE & HEALTH

summer 2016

MEDICAID UPDATE

Are You Ordering, Prescribing, or Referring for MA Beneficiaries?

Don’t Forget to Revalidate in Medicaid!

T

he PA Department of Human Services (DHS) made a change to its PROMISe internet portal designed to let physicians and other providers know if they are not enrolled or revalidated in Medicaid, known as Medical Assistance (MA) in Pennsylvania.

Per a DHS Medical Assistance Bulletin issued on April 1, 2016, claims submitted to the PROMISe system with an NPI number in the field for an ordering or referring provider, who is not enrolled or revalidated in the MA program, will automatically generate a message on the claim remittance advice to alert the billing provider that the ordering, referring or prescribing provider is “not on file” and must enroll or revalidate in the MA Program.

When processing claims that include a field for an ordering or referring provider, DHS uses the National Provider Identification (NPI) number on the claim to validate the provider’s enrollment in the MA Program.

The Affordable Care Act requires that all practitioners, including those who order, refer, or prescribe items or services for MA beneficiaries, must enroll in the MA Program. This requirement applies even if those providers do not submit claims to the state Medicaid program for Medicaid-covered services rendered to Medicaid beneficiaries.

Beginning September 25, 2016, claims will be denied if the ordering, referring or prescribing provider appearing on the claim is not enrolled in the MA Program.

In cases where a provider who is not enrolled in the MA feefor-service program orders, refers, or prescribes a service for a MA fee-for-service beneficiary, the claim submitted by the rendering or billing provider will not be paid, even though the rendering or billing provider is enrolled in the MA program.

DHS says that examples of services that require a prescription, an order, or a referral are: • All medications • Medical supplies, medical equipment, orthotics, and prosthetics • Lab tests • Home health services • Radiologic imaging services • Hospital admissions • Procedures done in a hospital short procedure unit (SPU), an ambulatory surgical center, or a treatment room

s? n o i t s e Qu

Contact the DHS Program Office at 1-800-537-8862 with any questions or concerns.

PAMED members also can contact PAMED’s Knowledge Center at 855-PAMED4U (855-726 3348). Physicians and practices can find more PAMED resources on revalidation and the application process, including information on how to verify whether you are enrolled in the MA program.

www.delcomedsoc.org

DELAWARE COUNTY MEDICINE & HEALTH

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OPIOID ABUSE

Confronting a Crisis: An open letter to America’s physicians on the opioid epidemic

By Steven J. Stack, MD, Emergency physician and the 170th president of the American Medical Association

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he medical profession must play a lead role in reversing the opioid epidemic that, far too often, has started from a prescription pad.

For the past 20 years, public policies—wellintended but now known to be flawed—compelled doctors to treat pain more aggressively for the comfort of our patients. But today’s crisis plainly tells us we must be much more cautious with how we prescribe opioids.

At present, nearly 2 million Americans—people across the economic spectrum, in small towns and big cities—suffer from an opioid use disorder. As a result, tens of thousands of Americans are dying every year and more still will die because of a tragic resurgence in the use of heroin.

As a profession that places patient well-being as our highest priority, we must accept responsibility to re-examine prescribing practices. We must begin by preventing our patients from becoming addicted to opioids in the first place.

16 DELAWARE COUNTY MEDICINE & HEALTH

We must work with federal and private health insurers to enable access to multi-disciplinary treatment programs for patients with pain and expand access for medication-assisted treatment for those with opioid use disorders. We must do these things with compassion and attention to the needs of our patients despite conflicting public policies that continue to assert unreasonable expectations for pain control.

As a practicing emergency physician and AMA president, I call on all physicians to take the following steps—immediately—to reverse the nation’s opioid overdose and death epidemic: •

summer 2016

Avoid initiating opioids for new patients with chronic non-cancer pain unless the expected benefits are anticipated to outweigh the risks. Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred.

•

Limit the amount of opioids prescribed for post-operative care and acutely-injured patients.

Physicians should prescribe the lowest effective dose for the shortest possible duration for pain severe enough to require opioids, being careful not to prescribe merely for the possible convenience of prescriber or patient.

• Physician professional judgment and discretion is important in this determination.

•

Patient-Centered Care, Focused on Recovery

Register for and use your state prescription drug monitoring program (PDMP) to assist in the care of patients when considering the use of any controlled substances.

Kindred’s Transitional Care Hospitals specialize in patient-centered care.

Our patients are critically or chronically ill, requiring specialized and aggressive treatment. Care is provided through an interdisciplinary team approach which includes physicians, nurses, therapists and specialists, among many others.

Our goal is to produce the optimal clinical outcome, helping our patients recover as fully as possible.

• Reduce stigma to enable effective and compassionate care.

•

Work compassionately to reduce opioid exposure in patients who are already on chronic opioid therapy when risks exceed benefits.

• Identify and assist patients with opioid use disorder in obtaining evidence-based treatment.

To learn more, visit www.kindredhospitals.com or call 1.866.KINDRED.

• Co-prescribe naloxone to patients who are at risk for overdose.

As physicians, we are on the front lines of an opioid epidemic that is crippling communities across the country. We must accept and embrace our professional responsibility to treat our patients’ pain without worsening the current crisis. These are actions we must take as physicians individually and collectively to do our part to end this epidemic.

Kindred Hospital Philadelphia 6129 Palmetto Street Philadelphia, PA 19111

Kindred Hospital Philadelphia – Havertown 2000 Old West Chester Pike Havertown, PA 19083

Kindred Hospital South Philadelphia 1930 South Broad Street Philadelphia, PA 19145

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Together we can make a difference.

Steven J. Stack, MD, Emergency physician and the 170th president of the American Medical Association

www.delcomedsoc.org

DELAWARE COUNTY MEDICINE & HEALTH

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OPIOID ABUSE

OPIOIDS FOR PAIN Be Smart. Be Safe. Be Sure.

Prescription opioid medications serve an effective role in pain management, but growing abuse of these drugs has reached epidemic proportions in Pennsylvania. To fight back, the Pennsylvania Medical Society has created a public advocacy program called: Opioids for Pain: Be smart. Be safe. Be sure.

This program has several simple goals: • •

•

Reduce opioid abuse and overdoses Educate patients about the safe use of opioids and the warning signs of addiction Help physicians prescribe opioid drugs with more precision and less potential for abuse

Educate citizens in your district through these resources.

PAMED has created posters for you to distribute at events and ready-made stories and images to add to your newsletter, website and social media pages.

Go to PAMED website – www.pamedsoc.org to Download Lawmaker Resources For Physicians Learn five ways you can take the lead in addressing opioid abuse and misuse with your patients.

PAMED has also created printable tear-off sheets and waiting room posters for physicians to use.

Go to PAMED website – www.pamedsoc.org to Download Physician Resources

The key points of the Opioids for Pain program: 1. Be smart — Patients should know the risks of opioid use when they receive a prescription.

No one plans on becoming an addict, but many do by ignoring dosage limits and frequency.

2. Be safe — Patients should be instructed on how to use opioids for moderate to severe pain, and warned not to save extras or give them to friends or relatives.

Physicians are encouraged to write smaller prescriptions with fewer refills. The PAMED website has a link to find where to safely dispose of leftover medications.

3. Be sure — Patients should be told of the early signs of addiction or abuse and how to protect themselves from addiction, including how to avoid it and where to turn if they feel they may have developed a problem.

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For Lawmakers

For Patients Patients need to work with their physicians to be smart, safe and sure about opioid use. PAMED resources include seven questions patients should ask their physician as well as a list of where they can drop off unused medications.

Go to PAMED website – www.pamedsoc.org to Download Patient Resources

summer 2016

“I’m fortunate to have received a scholarship to participate in PAMED’s Year-Round Leadership Academy. Throughout the years of medical school, residency, and fellowship, the focus is becoming a good clinician. Our teachers guide us through complexities of assessing, diagnosing, and treating patients for many different conditions. Then, we enter into “practice” and realize how critical leadership skills are to providing the standard of care we seek to achieve. This leadership series builds the foundation necessary to navigate conversations we encounter as a routine part of practice. It provides the resources that have made me more confident to pursue leadership roles.”

Chad Walker, DO Rheumatology Professional Orthopaedic Associates Scranton, PA

2016-2017 Year-Round Leadership Academy Designed for physicians in practices, groups, hospitals, and health systems, this program provides broad, practical leadership training, networking and mentoring, and strategies to address challenges.

The 10-month program runs September 2016 through June 2017 and includes eight online courses and three day-long live sessions offering 60.5 CME and CPE credits. Facilitators are AAPL faculty and, for some online discussions, PAMED staff.

Scheduled courses include: • Physician in Management: Communication • Productive Behavior, Restoring Productivity Live Session—Oct. 14, 2016 • Meta-Leadership: Removing Barriers and Building Bridges • Physician in Management: Effective Physician Leadership • Physician in Management: Finance • Physician in Management: Quality • Physician in Management: Negotiation Live Session—April 7, 2017 • Strategic Decision-Making • Strategic Planning • Strategic Thinking • Building and Leading Effective Teams Live Session—June 23, 2017

CME and CPE Courses are accredited for CME. The courses in this program qualify for credit toward the CPE designation and for AAPL’s master’s degree programs with Carnegie Mellon University, Thomas Jefferson University, University of Massachusetts Amherst, and University of Southern California. For more information about the graduate programs, visit www.physicianleaders.org/education/ programs/masters.

Cost per person (covers educational materials, CME and CPE credits, and food at live programs): • PAMED member physician—$2,500 Physicians who enroll at the member rate agree to maintain PAMED membership for the program’s duration. There are scholarship opportunities available for PAMED members.

Learn more at www.pamedsoc.org/YRA. • Physician non-member of PAMED—$3,500 To qualify for the member rate, call 855-PAMED4U or join online at www.pamedsoc.org/join.

Register now at www.pamedsoc.org/YRA or by completing the form on the reverse side.

LEGISLATION

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PENNSYLVANIA DELEGATION Advocates to End Mandatory, Secured Recertifying MOC Exams

hough physicians are certainly committed to lifelong learning, we’ve heard from many Pennsylvania Medical Society (PAMED) members that Maintenance of Certification (MOC) is a time-consuming, burdensome disaster that is out of touch with their current practice of medicine. PAMED and its physician leaders, as well as several other state medical societies, continued their advocacy efforts on behalf of physicians at the recent annual meeting of the American Medical Association (AMA) House of Delegates in Chicago.

At this meeting, PAMED and the Pennsylvania Delegation to the AMA extended their leadership roles in our initiative to further educate their physician colleagues on matters related to the fiscal affairs of the American Board of Internal Medicine (ABIM) and the questionable value of MOC as we support AMA, state, and specialty efforts to create a continuous professional development process that works for all physicians.

“The Pennsylvania Delegation took the position we’ve been hearing from members for quite some time in opposition to MOC to the annual AMA meeting,” said PAMED President Scott Shapiro, MD. “During this meeting, PAMED continued its leadership on this issue, convening a national discussion panel to present their research findings, insights, and recommendations regarding the failures of the ABIM and the MOC process. The discussion regarding the actions, finances, and possible historical motivations for the ABIM’s actions was eye-opening and alarming.”

The AMA House of Delegates ultimately approved resolution 309 as amended, which includes language that: • Calls for the immediate end of any mandatory, secured recertifying examination by the American Board of Medical Specialties (ABMS) or other certifying organizations as part of the recertification process for all those specialties that still require a secure, high-stakes recertification examination.

• Directs the AMA to continue to work with the ABMS to encourage the development by and the sharing between specialty boards of alternative ways to assess medical knowledge other than by a secure exam.

20 DELAWARE COUNTY MEDICINE & HEALTH

• Directs the AMA to continue to support the requirement of CME and ongoing, quality assessments of physicians, where such CME is proven to be cost-effective and shown by evidence to improve quality of care for patients.

• Directs the AMA to support a recertification process based on high quality, appropriate CME material. This process will be directed by AMA-recognized specialty societies covering the physician’s practice area, in cooperation with other willing stakeholders that would be completed on a regular basis as determined by the individual medical specialty, to ensure lifelong learning.

The adoption of this resolution was viewed as a strong message from physicians across the country to have the AMA take a stronger position on the matters related to the ABIM and MOC. Resolution 309 was cosponsored by Pennsylvania, Florida, California, Georgia, Washington, New York, and Virginia.

Prior to the resolution being adopted, the stage was set by the panel discussion sponsored by PAMED and the Pennsylvania delegation featuring Charles Kroll, CPA, Bonnie Weiner, MD, Wes Fisher, MD, and PAMED President Scott Shapiro, MD, and the announcement that PAMED issued a statement of no confidence in the ABIM. One physician said that the “Pennsylvania Medical Society melted the meeting down with a blistering two-hour exposé on the abuses of the ABIM and the boards in general. With a much needed boost in morale and the data to support strong action, the full house convened on Wednesday and the delegates soundly rejected the Committee’s butchering of the resolution, extracted it to a full vote on the house floor, and restored the strong language of the first resolved.”

Dr. Shapiro added: “This was a continuation of efforts that have been ongoing for years led by physician leaders in Pennsylvania. The Pennsylvania delegation is very proud to announce that the culmination of years of our hard work resulted in the AMA passing a resolution that was co-authored by our Pennsylvania delegation that ultimately creates AMA policy calling for the immediate end of all highrisk security risk certification examinations by the ABIM, and all our specialties that still require a needless similar exam.”

summer 2016

JILL’S TIMELESS TIDBITS

MEDICAL PRACTICE MANAGEMENT

Jill’s Timeless Tidbits

C

reative ways to foster comaraderie and teambuilding with your office staff or family and friends: Use fun and wacky holidays, also referred to as Unofficial Holidays, to create small celabrations or big events. Use of these unofficial holidays is increasing in popularity in today’s culture. I have been in healthcare for 28 years and have always enjoyed incorporating these into my workplace to help boost morale, create a positive focus, and strenghten our team. I also enjoy doing this with my own family. These can be used as humorous distractions and excuses to share laughs with friends.

There are many websites offering official and unofficial holiday dates. Most of the dates referrenced in my article are from www.holidayinsights.com.

Here are some of my favorites coming up. Celebrate these dates too or some of the many others not listed here and let your imagination be your guide!

Jill Venskytis, CMM, HITCM-PP Practice Administrator Drexel Hill Pediatric Associates DCMS Board Member Vice President Delco PAHCOM Chapter

Whether at home or work our lives have become markedly dependent on computers - make sure to celebrate System Administrators Appreciation Day on July 31st.

AUGUST 16 is National Tell a Joke Day – make your coworker’s day with belly splitting laughs. Post comics and jokes on staff bulletin board; post on computer screen savers; post on time cards. If celebrating at home get creative with jokes spread about your house.

September is a great time to think about your personal and professonal growth. According to holiday insights. com September is both National Courtesy Month and Self Improvement Month. Fittingly several dates within the month have notable themes:

SEPTEMBER 10 is Swap Ideas Day SEPTEMBER 13 is Positive Thinking Day SEPTEMBER 21 is World Gratitude Day

SEPTEMBER 21 is International Peace Day SEPTEMBER 28 is National Good Neighbor Day Additionally consider SEPTEMBER 16 National Play Doh Day either ‘just for fun’ or as a ‘destress’ tactic under Self Improvement.

I would also consider SEPTEMBER 28 Ask a Stupid Question Day a challenge to practice National Courtesy.

However, I always tell my staff no question is too stupid. You never know when your question will lead to great knowledge and insight, or lead to awareness of a need for improvement. As quoted in Wikipedia: A 1970 Dear Abby column in the Milwaukee Sentinel said: “There is no such thing as a stupid question if it’s sincere.

Better to ask and risk appearing stupid than to continue on your ignorant way and make a stupid mistake.”

www.delcomedsoc.org

DELAWARE COUNTY MEDICINE & HEALTH

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DELAWARE COUNTY’S ‘TOP DOCS’ ARE WITH CROZER-KEYSTONE Thirty-five Crozer-Keystone Health System physicians were included in Philadelphia magazine’s 2016 “Top Doctors” issue published in April. The doctors were nominated in surveys of their peers conducted by Castle Connolly Medical Ltd.

CONGRATULATIONS TO THE FOLLOWING PHYSICIANS: Taro Arai, M.D. Colorectal Surgery

Karl Grunewald, M.D. Thoracic and Cardiac Surgery

Nathan Okechukwu, M.D. Nephrology

Thomas Bader, M.D. Obstetrics and Gynecology

Linwood Haith Jr., M.D. Surgery

Hemchand Ramberan, M.D. Gastroenterology

Kenneth Briskin, M.D. Otolaryngology

John Hiehle Jr., M.D. Diagnostic Radiology

Anthony Rooklin, M.D. Allergy and Immunology

Kenneth Boyd, M.D. Colorectal Surgery

Rima Himelstein, M.D. Adolescent Medicine

John Sprandio, M.D. Medical Oncology

David Broyles, D.O. Family Medicine

Jackeline Iacovella, M.D. Infectious Disease

Marc Surkin, M.D. Otolaryngology

Robert Cabry Jr., M.D. Sports Medicine

Deborah Kahn, M.D. Geriatric Medicine

Dean Trevlyn, M.D. Orthopedic Surgery

Catherine DiGregorio, M.D. Pain Medicine

Thomas Klein, M.D. Allergy and Immunology

Stephen Walker, M.D. Urology

Nicholas DiNubile, M.D. Orthopedic Surgery

Pei Ann Kong, M.D. Internal Medicine

Christopher Williams, M.D. Ophthalmology

Igor Dorokhine, M.D. Geriatric Medicine

Mark Lisberger, M.D. Cardiovascular Disease

Sean Wright, M.D. Plastic Surgery

Christine Egan, M.D. Dermatology

James McGlynn, M.D. Orthopedic Surgery

Lubna Zuberi, M.D. Endocrinology

Albert El-Roeiy, M.D. Reproductive Endocrinology

Stephen Nelson, M.D. Infectious Disease

Alan Zweben, M.D. Internal Medicine

John Feehery, M.D. Otolaryngology

Joel Noumoff, M.D. Gynecologic Oncology

crozerkeystone.org