Official Publication of The Lehigh County Medical Society
EMBRACING THE JOURNEY WITH LOCAL PEDIATRIC CANCER FAMILIES PLUS LEAD PAINT AND CHILDREN JOURNEY OF A FIRST GEN STUDENT
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LEHIGH COUNTY MEDICAL SOCIETY P.O. Box 8, East Texas, PA 18046
610-437-2288 | lcmedsoc.org
2022 LCMS BOARD OF DIRECTORS Rajender S. Totlani, MD President Oscar A. Morffi, MD Treasurer Charles J. Scagliotti, MD, FACS Secretary William Tuffiash Immediate Past President *effective February 1, 2022
CENSORS Howard E. Hudson, Jr., MD Edward F. Guarino, MD
TRUSTEES Wayne E. Dubov, MD Kenneth J. Toff, DO
David Griffiths Executive Officer
The opinions expressed in this publication are for general information only and are not intended to provide specific legal, medical or other advice or recommendations for any individuals. The placement of editorial opinions and paid advertising does not imply endorsement by the Lehigh County Medical Society. All rights reserved. No portion of this publication may be reproduced electronically or in print without the expressed written consent of the publisher or editor.
5 IN THIS ISSUE ON THE COVER 6 PCFLV
Embracing the Journey with Local Pediatric Cancer Families
FEATURES 8 L EAD PAINT AND CHILDREN
14 THE MEDICAL ESTABLISHMENT Past Reflections and Hope for the Future
By Dr. Chaminie Wheeler
18 JOURNEY OF A FIRST GEN STUDENT By Sayed Arian
20 TOP TEN BOOKS TO READ
If There’s A Physician In Your Family
By David Hersh
11 THE EXPERIENCES OF A PHYSICIAN ADVOCATE IN THE POLITICAL WORLD
By Angelic Rodgers, PhD
22 THE IMPORTANCE OF TELLING A STORY By Joseph Habig Ii, MD
By Larry L. Light
23 LCMS NEWS Lehigh County Health & Medicine is published by Hoffmann Publishing Group, Inc. Sinking Spring, PA | HoffmannPublishing.com | (610) 685.0914
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IN THIS ISSUE
elcome to the summer edition of Lehigh County Health & Medicine. Time is really flying! We hope you find the contents of this issue interesting and informative; we have articles, opinion pieces and book reviews!
Articles include a focus on lead, which has been used for centuries, including as an additive for paint. If you live in a structure that was built prior to 1978, consider checking out the article “Lead Paint and Children: Effects, Statistics, & Prevention.” Another article focuses on the Pediatric Cancer Foundation of the Lehigh Valley, one of the many Lehigh Valley organizations assisting individuals and families with their health care needs.
In this issue, we also include book reviews. As you are probably aware, this magazine is for our member physicians as well as the community, so we offer reviews of books that physicians and their families may find of interest. We are also pleased to include a piece shared by the Spring/Summer edition of Physician Family/Alliance in Motion Magazine, “Top Ten Books to Read if There’s a Physician in Your Family.” We offer a book review by a fellow physician some of you may know. In “The experiences of a Physician Advocate in the Political World,” Larry Light, a Pennsylvania Medical Society (PAMED) professional lobbyist, reviews Dr. Lopatin’s book Rheum for Improvement. Finally, we offer an interesting piece: “The Medical Establishments.” Here you will find the authors’ opinions in a look back through the pandemic and comparing what has occurred in medicine and science in history. We hope you enjoy this and past issues as we add to the conversation about how medicine and wellness can help us form strong communities in Lehigh County. If you are interested in back issues, or just want to read Lehigh County Health & Medicine online, please visit our website at https://lcmedsoc. org/our-publication. If you have thoughts on this edition, or suggestions for upcoming issues, please let us know. Thank you for reading!
SUMMER 2022 | Lehigh County Health & Medicine 5
Embracing the Journey with Local Pediatric Cancer Families
he Pediatric Cancer Foundation of the Lehigh Valley (PCFLV) is a local non-profit providing free and unique programming and services to local kids with cancer and their families. Established in 2003 by a local cancer Mom, PCFLV’s mission is to embrace the pediatric cancer journey alongside children and their families, moving forward as a community with love, hope and smiles. PCFLV supports at diagnosis, encourages during treatment, empowers in survivorship, and, in the event that a child passes away, they comfort throughout bereavement. Run by a small staff of three full-time employees
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and one part-time employee, PCFLV serves any family who lives within a 50-mile radius of the PCFLV office. About 50 percent of those families are treated at Lehigh Valley Reilly Children’s Hospital, while the other 50 percent receive treatment at Children’s Hospital of Philadelphia and St. Christopher’s Hospital in Philadelphia. “We help any family in our geographical radius, regardless of where they receive treatment,” explains Michelle Zenie, the Executive Director of PCFLV and also a cancer mom. Zenie’s son was diagnosed with leukemia at age 3. “PCFLV’s mission is to provide assistance and opportunities for local pediatric cancer families. We help with the here and now needs of these families.” PCFLV programs include: a college/trade school scholarship program that provides cancer warriors with a one-time, $3,000 scholarship; a bill-paying fund through Lehigh Valley Reilly Children’s Hospital to assist with mortgage/rent payments or any other major bill; a Birthday Club, where each warrior and their siblings receive a birthday card and gift card each year until they reach the age of 18; Camp Smile, a one-week free day-camp for warriors and their siblings that includes art, theater, sports, swimming and more; a one-time house cleaning service for when an immune-compromised child comes home from the hospital; various events for kids, teens, moms and dads to allow the families to have some respite and also get to know other local families; twice-monthly Chemo Circus, where a PCFLV staffer visits the local oncology clinic and makes crafts with the kids, hands out toys, and provides lunch; monthly support groups for caregivers and bereaved parents; tickets to
various sporting and entertainment events September is Pediatric Cancer Awareness within the Lehigh Valley; a gift card program Month, and each September PCFLV hosts a that distributes thousands of dollars’ worth campaign called 30 Days, 30 Stories®. This of gas, grocery store, EZ Pass and hospital campaign introduces supporters each day cafeteria gift cards each year; an Adopt-A- to a local warrior. These are kids who are in Family Holiday Program that distributes gift treatment or in survivorship, and also highcards for Holiday gifts; monthly Caregiver lights kids who have passed away. A photo Coffee, where a PCFLV staffer takes coffee accompanies each story, which is written and goodies to the local oncology clinic for either by the child, a parent or sometimes staff and parents; a $1,000 end-of-life stipend a grandparent. These heart-warming and when a child passes away; End of Treatment impactful stories give just a glimpse into the gifts for warriors when they complete their life of a pediatric cancer warrior and family. treatment; and much more. This series can be found on the PCFLV website (pcflv.org) and also on PCFLV’s These programs are designed to help social media platforms (Facebook, Twitter, local pediatric cancer families financially, Instagram, LinkedIn). socially and emotionally. To create a support community and network is a big part of the There are numerous ways for individuals mission of PCFLV. and companies to get involved with PCFLV. They can make a monetary donation, they can “We love that we are able to connect our sponsor an event, they can volunteer as an families and we love to see when they form individual or group at a fundraising event, or bonds with each other,” said Zenie. “No they can even host their own fundraising event. one but another pediatric parent or warrior really knows what this journey is all about. “We have so many opportunities for the Having someone who is walking your same community to jump in and get involved in path to lean on is monumentally helpful.” our mission,” explained Tracy Stauffer, the Marketing, Community Relations and DePCFLV is able to fund these amazing velopment Coordinator for PCFLV. Stauffer programs due to individual and corporate is also a cancer mom. Her daughter was donations and also fundraising events. PCFLV diagnosed at age 1 with brain and spinal hosts three main fundraising events each year: cancer. “If anyone is interested in learning the Luau On The Links Golf Outing, the specifics on how to make a difference in the Ready, Set, GOLD 8k Run/5k Walk, and the lives of our local warriors, they can call the Hearts of Gold Gala. The Hearts of Gold PCFLV office at 484-221-9294.” Gala and Luau On The Links take place in the spring, and the Ready, Set, GOLD Run/ Walk is a September event. Registration for the 8k run/5k walk and the kid’s fun run is currently open for the Sept. 10th event. You can go to pcflv.org to find the registration link.
For more information about PCFLV, please visit their website at pcflv.org or call the office at 484-221-9294.
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of a ph ysi ci an a dvocate I N T H E P O L I T I C A L WO R L D BY LARRY L. LIGHT EDITORIAL OPINION
ull disclosure, I know Mark Lopatin, MD, the author of Rheum for Improvement, pretty well and, in fact, have known him for many years. We’ve played golf together, and on that basis alone I consider him a friend. But beyond our friendship on the links, as a Pennsylvania Medical Society (PAMED) professional lobbyist I worked with Dr. Lopatin and numerous other physicians on the numerous and meaningful advocacy issues covered in his book. MOC, scope of practice, tort reform, prior authorization, etc.….all of them and more. As a PAMED lobbyist what I did not have, and as a physician he did, was the benefit of thousands of physician encounters. This book is about those physician encounters, the related advocacy issues and his engagement as a health care and patient advocate. Continued on page 12
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Knowing “ML” well meant that I was already very aware of his passionate engagement as a health care advocate. So I knew upfront the direction this book was going to take. It did not disappoint me. Though I did notice an unforeseen consequence that quickly became apparent. From the first page, the words I read came back to me in his voice. At first that was a bit of a distraction. But as a I read his descriptions of patient experiences, at least in my mind, it gave his perspective and contention for physician advocacy engagement view a more meaningful quality. In its entirety, Rheum for Improvement validates a long-standing tradition that was unwritten but still a core element of PAMED advocacy, established before and maintained throughout my tenure. When we went to the state capitol to give testimony before a legislative committee, something that happened several times a year, PAMED was always represented by a physician leader. It was never the PAMED Executive Vice President and never a lobbyist.My recollection is that the American Medical Association (AMA) operates under similar guidelines. Many other professional associations in Harrisburg did not follow that rule. Their lobbyists were appearing regularly at public hearings. Their thinking being that having a familiar lobbyist carrying the message would work to their advantage and also save time for their busy member leadership. Our thinking was that a physician presenter guaranteed that the clinical aspects of the health care issue and the value of the patient-physician relationship would become part of the dialogue. I’ve always embraced that viewpoint.
IN H E A LT H C A R E A D V O C A C Y, G R A S S R O OT S PHYSICIAN ENGAGEMENT i s always va lu ed . more clearly, we didn’t have the clinical training to present as an expert on the subject. There was no doubt, a physician was the only option and that was always the right choice. The depth of concern for his patients’ wellbeing related by ML validates that theory and becomes the de facto most persuasive argument in his book.
Rheum for Improvement takes the reader on the author’s journey through his private practice of medicine and allows him to relate his genuine concern for patient care in the context of the numerous health care policy challenges that physicians have unhappily navigated in their struggles to provide quality care. His frustrations with those policy issues, he later discovers, often run parallel with the issues high on The series of patient case studies or expe- the policy agenda of groups like the AMA riences related by ML strongly supported and PAMED. For any practicing physician, the PAMED physician-only policy. Quite outside of tort reform, those issues are prisimply the physician leader or another marily restrictions to physician autonomy physician from the relevant specialty had either in statutory law or insurance rules. the benefit of clinical knowledge. As As described by ML in the plainest terms, lobbyists we could not come close to those frustrations are always palpable matching the depth of the patient-physician and clearly become an ongoing source of relationships that would be impacted by professional frustration that also impacts the policy change being debated. Even his personal life. For ML, ceding control 12 Lehigh County Health & Medicine | SUMMER 2022
over clinical decisions in patient care was obviously not an acceptable outcome. And for the reader, given an inside view of his patients’ clinical circumstances, that is a welcome consequence. For his own professional satisfaction, personal peace of mind and most importantly for the benefit of his patients the logical course of action was engagement as a health-care advocate. He embraced the goal of having physicians’ “skills and clinical judgement be the driving force for health care decisions rather than bureaucratic mandates.” Given the state of health care in the United States and the power of insurers, trial lawyers and others, he quickly had a lot of issues on his plate. I would suggest that ML expand his application of “grassroots advocacy.” His perspective in Chapter 11 is that grassroots advocacy is engagement outside of the organizational advocacy campaigns undertaken by professional membership organizations less structured than PAMED and the AMA. He relates grassroots advocacy only to his own later involvement in a wide variety of more aggressive and focused groups such as PAPA and PPA. In reality, he was engaged in grassroots advocacy from his first letter to the editor, if not before! In healthcare advocacy, grassroots physician engagement is always valued. Like all advocacy, if done with respect for the policy maker and with a message of asking for help rather than directing an action, an effective level of aggressive reasoning can impact policy decisions. Because of their clinical foundation in the patient-physician relationship, physicians have that capacity. The value of advocacy also emerges from ML’s initial exposure to election politics. He walked the walk by sharing his views and seeking support from the larger physician community. And he learned that political choices are often not simple. The caution is to realize that across the broad spectrum of political issues such as taxes, the environment, tort reform, the many aspects of health care and numerous other important policy problems it is unlikely that the candidate and the physician political
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campaign supporter will find unform agreement. That is unless the physician steps up to become the candidate. Policy makers at all levels, the news media, political candidates and the public in general all respond positively to the advocate wearing a white coat. It’s a strategy embraced by those non-physician providers who wear them to lobby at the capitol. They fill the capitol rotunda with white coats, just as physicians did to lobby for tort reform, because they want a piece of the patient-physician relationship. They want to help their patients and provide care at the highest level of their clinical training. Fortunately, it would be nearly impossible to find a physician who did not embrace those same values while bringing significantly more education and training to the examination room. My perspective is that ML gives appropriate attention to the value of personal involvement, relationships and local connections in the political universe, all important elements of grassroots advocacy. But I believe he misses the point that individuals engaging on behalf of themselves, the basic feature of grassroots advocacy, and also for their professional associations can produce the same high return from their local and personal connection with the advocacy target. He’s correct, it is the “core of politics” and the most important component of any effort to achieve “meaningful change.” After I purchased Rheum for Improvement and accepted the challenge of this review there was one ironic point that I knew was obviously going to be my closing thought, even before I started reading the book. A PAMED President I worked closely with, John Lawrence, MD, in 1999 proposed that medical schools include a course on politics and the politics of health care in their curriculum. Having developed personal relationships with a group of legislators and government officials, he knew the benefits would follow. As it happens, Dr. Lawrence was also a rheumatologist. I was anxious to connect those dots and, quite happily, I discovered that they were connected for me when ML includes a short paragraph with the same recommendation (p. 179). I feel confident that Rheum for Improvement would be at the top of Dr. Lawrence’s syllabus for those courses. It also should be there for any physician advocate seeking to make a difference.
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MEN T THE MED ICAL EST ABL ISH THE FUTURE PAST REFLEC TIONS AND HOPE FOR BY DR. CHAMINIE WHEELER EDITORIAL OPINION
ur world has watched the unfolding of the trauma and lives lost in the last 2 years not only due to COVID19 but also due to the policies that were set in place to mange COVID19. Our nation has lost close to a million lives from or with COVID19. According to the National Alliance on Mental Health, 21% of U.S. adults experienced mental illness in 2020 (52.9 million people) and “suicide is the 2nd leading cause of death among people aged 10-34.” 1 All kinds of mandates that have crippled
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the liberties of individuals have resulted in a movement by big tech, media and government agencies to coin a new word, “misinformation,” that has now become standard vocabulary among Americans. How have ideas that are challenged be coined as “misinformation?” Has censorship muzzled freedoms in our great nation at an unprecedented level? Can we rebuild trust in medicine? According to the Oxford dictionary, science is “the intellectual and practical activity encompassing the systematic study of the structure and behavior of the physical and natural world through observation and experiment.” Discord is “strife and tension that arises when two sides disagree.” Thus, the gold standard for the advancement of science is this scientific discord process. Challenging accepted or what is deemed good propels the scientific process to its purity because those ideas must be proved and defended. Has the desire by some to censor and silence thoughts that go against accepted “standards” severed the discord process? Let us reflect on two such examples in history where scientific discord was shunned and silenced.
identical with the exception that students were taught in the first and midwives in the second.4 As a scientist, Dr. Semmelweis developed a hypothesis that could possibly explain his observation of the difference in mortality rate. He hypothesized “that perhaps the students carried something to the patients they examined during labour.”4 Following the scientific process, he gathered data that led to the conclusion, “that students who came directly from the dissecting room to the maternity ward carried the infection from mothers who had died of the disease to healthy mothers.”4 In putting his findings to practice, Dr. Semmelweis “ordered the students to wash their hands in a solution of chlorinated lime before each examination.”4 This simple practice resulted in “the mortality rates in the first division dropped from 18.27 to 1.27 percent, and in March and August of 1848 no woman died in childbirth in his division.”4
Please note that the majority of physicians thought what Dr. Semmelweis was doing was heresy. He addressed several open letters to Mid 1800s was a time when the medical professors of medicine in other countries, but establishment rejected Dr. Ignaz Semmelweis’s to little effect. At a conference of German revolutionary ideas of “hand-washing.” During physicians and natural scientists, most of the this time, the mortality rate from childbirth speakers, including the pathologist Rudolf was 25-30% if you delivered at the hospital Virchow, rejected his doctrine.4 Europe’s and only 0.5% if the deliveries were performed leading medical practitioners believed that by midwives or at home.2 The accepted rea- childbed fever was a disease of the bowel soning for this variation in mortality rate by and that purging was the best medicine for the medical establishment was “overcrowding, it.4 The scientific discord process between Dr. poor ventilation, the onset of lactation, or Semmelweis and the medical establishment miasma.” 3 Dr. Semmelweis chose to question was severed. this narrative and “proceeded to investigate its cause over the strong objections of his chief, Years of rejection by his colleagues in who, like other conventional physicians, had medicine took a toll on him and his family. reconciled himself to the idea that this disease Semmelweis colleagues tricked him into was “unpreventable” meaning that 25-30% visiting a mental asylum to “help a patient.” mortality during childbirth was unavoidable.”3 When he arrived, he was forcibly restrained, injured and put in a strait jacket. Dr. SemSemmelweis observed that, among women melweis’s injuries became infected, and he in the first division of the clinic, the death died from infection only two weeks later rate from childbed fever was two or three in 1865. It was a lonely funeral in Vienna times as high as among those in the second where only a few people attended because division, although the two divisions were the medical community did not want to be
associated with someone promoting medical care that was against the accepted standard by those in power. He was buried in Vienna. Only 2 years later in 1867, a Scottish surgeon named Joseph Lister, who had apparently never heard of Semmelweis, introduced carbonic acid to wash hands before surgery to prevent infection. It was nearly 30 years after Semmelweis’s death that his life legacy that promoted hand-washing was recognized by the medical community leading to a statue being erected in his honor in Budapest.4 Another example of the medical establishment rejecting thought that deviates from the mainstream medicine happened to Dr. Andrew Taylor Still, the founder of Osteopathic Medicine. Dr. Still was trained as an MD following his father’s footsteps. In 1858, Dr. Still and his brother donated 640 acres of land to build the first four-year university in Kansas named Baker University.5 He was an active abolitionist and enlisted in the Union Army as a physician. While treating the wounded, he started to recognize the shortcomings of conventional medical practices, and he started to wonder what could be changed to improve patient outcomes. These shortcomings were further magnified in Dr. Still’s life when in 1864, three of his children died from meningitis and his youngest daughter died from pneumonia.5 The cumulation of his medical experiences during wartime and the death of his children propelled Dr. Still to conclude that the orthodox medical practices that included drugs like arsenic, opium, mercury and castor oil were frequently ineffective and sometimes even harmful.5 Dr. Still acknowledged that common medical practices such as “purging, vomiting, blistering and bleeding often left patients in weakened condition or led to their deaths.”5 Thus, Dr. Still begin studying nontoxic, bioregulatory medical practices such as nutrition, hydrotherapy, magnetic healing and bone setting. He believed that movement of the “humors” of the body would allow the body to realign itself to health.5 Continued on page 16
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“He invented the word “osteopathy” by blending two Greek roots: osteon- for bone and - pathos for suffering in order to communicate his theory that disease and physiologic dysfunction were etiologically grounded in a disordered musculoskeletal system. Thus, by diagnosing and treating the musculoskeletal system, he believed that physicians could treat a variety of diseases and spare patients the negative side effects of drugs. Dr. Still held a view common to early 19th-century proponents of natural healing and homeopathy supporting the idea that the body’s natural state tends toward health and inherently contains the capacity to self-heal. This view was opposed to that of the orthodox practitioner, which held that intervention by the physician was necessary to restore health to the patient.”5 Even though Dr. Still’s patient outcomes were far better than that of the orthodox practitioner, he was socially and professionally ostracized as well as financially ruined. In 1874, Dr. Still was publicly “read out” and formally removed from the Methodist Church for they believed that by “laying on of hands” on his patients to move the musculoskeletal system, he was trying to emulate Jesus.5 He was condemned for practicing voodoo by his colleagues, abandoned by his brothers for pursuing crazy ideas. When Dr. Still wanted to present his ideas to Baker University that he helped found, they refused.5 Again, there was “no room” for the scientific discord process at Baker University with Dr. Still. Against all odds, Dr. Still continued to pursue this new holistic natural healing medicine. With time, because of superior patient outcomes, Dr. Still had more patients than he could take care of himself. He trained his own children and others to help him take care of the high volume of patients. This new medicine was not officially recognized until 1885, which was 21 years after the death of his children that had propelled Dr. Still to see what he could do to improve patient outcomes. In 1892, he opened the first Osteopathic Medical School in Kirksville, Missouri where both women and African-Americans were able to enroll unlike the traditional allopathic medical schools of that time.5
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AS WE CONTINUE TO EXPLORE HOW TO REBUILD TRUST IN MEDICINE, LET US TURN TO HOW FINANCIAL TRANSPARENCY WOULD ADD TO SUCH AN ENDEAVOR. Is what happened to Dr. Semmelweis investigation by the agency into his medical and Dr. Still similar to what is happening practices.6 What has allowed a culture where in medicine globally in the last two years? a physician can be both honored and invesPhysicians that have challenged the COVID tigated by the same state for the exact same “standard” have suffered much consequences. work in the same month? What do these These physicians have lost their jobs, their physicians in history and today have to gain medical licenses have been threatened and by challenging the medical establishment? pharmacists have refused to follow physician The answer is simple; they have nothing to orders to fill prescriptions for FDA approved gain but everything to lose including their drugs for off-label use, a practice that is as old professional standing and livelihood just like as medicine itself. Here is one such example Dr. Semmelweis and Dr. Still. What compels from March 2022: these physicians today to swim against the current of all in authority reciting the exact “Dr. Paul Marik, founder of the Front same script? Again, the answer is simple; Line COVID-19 Critical Care Alliance these physicians believe in the evidence of (FLCCC), was recognized on March 11 after individual patients they have treated and the state’s House of Delegates unanimously want to do what they believe is in the best approved a resolution for what lawmakers interest of their patients. Is is possible that called “his courageous treatment of critically we have not learned from history? ill COVID-19 patients.” “Instead of playing it safe and going along with so-called conWe must reflect and learn from our past. ventional wisdom, Dr. Marik dared to take a It took time, but the medical establishment truly scientific approach by questioning and of those days chose to look at the evidence innovating in an environment where both of birth mortality approaching 1% with were not only frowned upon, but for which hand washing and that mainstream medical he was persecuted,” said Del. Dave LaRock, treatments using arsenic, opium, mercury a Republican and the resolution’s primary and blood letting caused more harm than sponsor. Just a few days later, Marik received good. Hindsight is always 20:20 but these a letter dated March 15 from the Virginia physicians that initially rejected Dr. SemmelDepartment of Health Professions informing weis and Dr. Still’s ideas later created space him he had until March 29 to respond to an for the scientific discord process. It was this
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scientific method in its purity coupled with the deductibles?8 It is because of consumer humility that allowed conventional medicine unawareness and the lack of transparency that to embrace Dr. Semmelweis and Dr. Still’s this cost can be hidden. Such undisclosed work. Modeling the examples of physicians costs produce that 92.5% revenue for the that have gone before us, the only way forward Goliath healthcare system. We as physicians to ignite the rebuilding of the broken trust in need to unite to unveil that 92.5% of the medicine today is to allow for the scientific “money pie” and work towards a financial discord process to flourish. transparency in medicine. Such an endeavor would mean consumer awareness and would Could we create an environment of being naturally translate into another step towards quick to pause and listen and slow to criticize rebuilding trust in medicine. treatment options that are outside the “mainstream” medicine? If our colleague’s council In addition to limiting scientific discord deviates from the “standard,” does it mean process and hindering financial transparthat thought is wrong? It is the very essence ency, another reason for the broken trust in of scientific advancement that questioning medicine is the lack of physician autonomy. is encouraged. The bedrock of ideas and For example, medical decisions being made evidence on all sides should be analyzed and based on what an insurance company deems discussed so that true scientific advancement is needed or not or if a drug is covered or for handling the COVID19 pandemic and not have left both physicians and patients future pandemics can result. No matter what frustrated. We know that medicine is first side of this “standard” we as physicians stand, and foremost a moral enterprise, grounded we must be respectful enough to listen and in the physician-patient covenant of trust. analyze the evidence of the other side. One By definition, this is the cornerstone of the must always remember that the truth never individualized relationship between the phyminds being questioned, but a lie does not sician and the patient. We know that it is the want to be challenged. If the evidence says that responsibility of the physician to give good we are wrong, we must be humble enough counsel and guidance, but it is the choice of to admit our mistakes. Because history has the patient to choose to follow that advice. shown that truth can not be silenced or Patients in general follow the guidance of their hidden, we must unite as physicians and physician because they trust their physician. rebuild trust in medicine. Is it because of this broken trust as a result of the lack of physician autonomy that our As we continue to explore how to rebuild patients are hesitant about the council we trust in medicine, let us turn to how financial give? Regaining physician autonomy would transparency would add to such an endeavor. be another step towards rebuilding the Even though every healthcare dollar in the US covenant of trust. healthcare system’s “money pie” is generated by a physician service or a physician order, Therefore, let us unite and rebuild trust according to HCP Live, did you know that in medicine. Let us work towards creating a less than 7.5% of that revenue goes towards culture where scientific discord is encouraged, physician income?7 Where is the account- where financial transparency is central, and ability for the other 92.5% of the revenue where authenticity of the physician-patient that is part of the Goliath system outside covenant of trust is the cornerstone. Our of the physician-patient covenant of trust? healthcare system would be transformed and Given that every healthcare dollar is paid grounded in trust… our hope for the future by the patient to the system’s “money pie,” of medicine! our patients deserve transparency where the money actually goes. Did you know that in Pennsylvania, an out-of-pocket chest x-ray cost is $60, but if you have insurance, the cost can range anywhere from $100-$338 because that cost with insurance is applied towards
REFERENCES: 1. https://www.nami.org/mhstats 2. https://www.pbs.org/newshour/ health/ignaz-semmelweis-doctor-prescribed-hand-washing 3. https://www.npr.org/sections/ health-shots/2015/01/12/375663920/ the-doctor-whochampioned-hand-washingand-saved-women-s-lives 4. https://www.historylearningsite.co.uk/a-history-of-medicine/ ignaz-semmelweis/ 5. https://www.biologicalmedicineinstitute. com/andrew-taylor-still 6. https://www.theepochtimes.com/ doctor-honored-and-investigated-by-samestate-for-samework_4360566.html? utm_source=Morningbrief&utm_campaign=mb-2022-03-27&utm_medium=email&est=DhkbLbCVjNUWWjI5 U%2Be6r9ndkoSoVgvN6Eb0piyE3d6qDoxU05jXrQkaOdg%3D 7. https://www.hcplive.com/view/ physician-pay-makes-up-about-8-percent-oftotal-healthcare-costs 8. https://affordablescan.com/x-ray/cost/ pennsylvania.
SUMMER 2022 | Lehigh County Health & Medicine 17
Journey of a First Gen Student BY SAYED ARIAN, MS3
r. Hashemi was writing a math problem on the chalkboard. The students began scribbling in their notebooks when suddenly the classroom door burst open. Several armed troops walked in and started grabbing students one at a time and dragging them outside. This was the typical situation in war-torn Afghanistan during the Soviet-Afghan war. Teenage boys were drafted into the chaos and had a couple of hours to gather their belongings and report for duty. One of these students was my father. After years of studying and hard work to remain at the top of his class, everything turned upside down. Within weeks of enrollment, he seized the opportunity to escape the war and seek refuge in the United States. With no understanding of English, and literally nothing but the clothes on his back, he decided his only option was to start working and begin making a living. My mother, also a war refugee, was the backbone of the family. With the restrictions on female education in Afghanistan, she also understood its value. My parents met in Queens, NY through a local mosque. That was where they started a family and also where their American Dream was born.
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Fast-forward a decade and a half later. I found myself behind a desk, watching the teacher write a question on the chalkboard. Little did I know that I also faced a threat. Not in the form of armed men crashing through the door or winding up in a foreign country with no friends or family. The problems that I would come to face were not life threatening, however they also weren’t ones I could escape from. They manifested in the form of that science project that I could not ask for help on. That backpack that was fine to use for yet another year. The snacks at the end of the lunch line that I didn’t have $0.65 for. My two older sisters probably had it worse than I did since keeping up with the latest fashion trends required frequent trips to the mall (a place we often went for sight-seeing). They were additionally targeted for the hijabs they wore. A piece of cloth intended for protection became the crosshairs for people’s insults. Although we faced these economic, intellectual, social, and religious barriers, there was one thing keeping us on track. The discipline that my parents had developed over years. After losing his father to illness as a toddler, it was this discipline that kept my father first rank among his peers. This discipline, that got him through 16-hour overnight shifts at the bus garage he practically lived in. This discipline, that allowed my mother to stretch resources thin even though it meant saying “no” to every toy we wanted to buy and trip we wanted to go on. We embodied this trait and strove to out-work the weaker hand we were dealt. We would not let our past determine our future, and our parents made sure of that. Islam emphasizes the importance of abstaining from sexual relations until after marriage. Thus, it is tradition for Muslims to marry at a younger age, as to avoid unlawful courtship. My older sisters were proposed to immediately after finishing high school. As painful as it was, my father left the decision up to them and they chose to get married. Due to the long processing times for US Visas and the piles of paperwork that need to be completed, their progress, academically, had come to a halt. This is a common reason that women
in the Middle East, such as my mother, less commonly pursue higher education and instead end up as homemakers. Even I began to search for suitable partners in high school and got married between my junior and senior year in 2012. Was this it? Did all his efforts lead to three married children and a few high school diplomas?
Airport, Survey Technology Resources, and Olympus America are a few of the places I worked at while pursuing my bachelor’s degree. Dr Robert Blumenstein, the dean of undergraduate studies and premed advisor for the college, played a large role in my preparation for medical school. He held monthly progress meetings, introduced me to med school admissions directors, and even Medicine was a career reserved for the got together a committee for mock interviews. Crème de la crème in Afghanistan. The top I recall sitting across from his desk, discussing performers in each class are offered the oppor- my average MCAT results and strategies to tunity to attend medical school and become improve my score and reapply to medical physicians. It is followed by engineering and school. Mentors like him make the American law. The stereotypical doctor, engineer or Dream possible. lawyer career aspirations in immigrant households come from this competitiveness back After graduating with my B.S. in Biochem home. It is a sign of elite status and increases and Molecular Cell Biology, I worked for two the prestige of the respective families. I was years at Sharp Packaging in Allentown, PA exposed to medicine as early as high school as a Quality Assurance inspector. This was a when I shadowed an anesthesiologist. I fell financial relief within the house since there in love with the hospital, the scrubs, and the was finally more than one person working tension in the OR. The regard my parents a full-time job. It was also an opportunity had for the field made it even more special, to save for medical school, should I get however it seemed too far out of reach. What accepted. Who knew affording school was were the chances I would be honored with a as hard as getting in? My father was offered stethoscope? My father would have been one a position as a translator for the Department of the select few, given different circumstances. of Defense in Afghanistan which took a lot This desire was the driving force behind much of the burden off our shoulders. My oldest of his efforts and may remain unfulfilled. I sister, Besma, just started dental school in could see to this day, the new expression that Florida, while my second sister, Arefa, and had settled on his face when he gave up on younger brother, Adil, both finished nursing this dream. His unrealized potential would school and work at LVHN in Allentown. Just never come to fruition through his children 30 years ago, it was war that had ended his as he had hoped. Were these the lasting hopes of becoming a doctor. Ironically, it was impacts of being an immigrant family in war that allowed me to move to Philadelphia America? Was it even possible to break the and secure a seat at the Philadelphia College cycle through pure will? of Osteopathic Medicine. Our daughter Tara was born the last day of orientation week, I will be the answer. That was the internal marking the beginning of a new journey. I promise I made. My parents had not left me now work my way through my clinical years with any excuses to make. Sure, we struggled as a rising M4 with aspirations to become a with certain aspects of life, but they never surgeon. I attribute my current achievements failed to meet our needs. In return, I owed first to God’s grace, then to my parents who them my absolute best. This new mentality directed me on this path, then to my mentors made way for the progress to come. I went who transferred to me their knowledge, and on to excel in college at DeSales University in finally to my wife and kids who keep me going. Center Valley, PA. My wife and I decided to This story is not over. I am waiting to don start a family and introduced Sajid, our son, my long white coat and maybe then make to the world in 2014. It was a blessing and the American Dream come true. came with an added responsibility. Panera Bread, Chickie’s and Pete’s, the Lehigh Valley SUMMER 2022 | Lehigh County Health & Medicine 19
Top Ten Books to Read i f There’s a Ph ys ic ian in Yo u r Fam il y BY ANGELIC RODGERS, PHD There are many books out there for physicians, but not nearly as many which are inclusive of physician families as well. Here are ten the author recommends.
Real-Life Physician Family: Secrets to Surviving, Even Thriving During Medical School, Residency, and Beyond.
At Least You’ll Be Married to a Doctor: Managing Your Intimate Relationship Through Medical School. Hagar, Jordyn
Dunn, Stacy & Joel. (2019).
The White Coat Investor Series. Dahle, James M. (2021, 2019, 2014). Available in paperback and eBook. www.whitecoatinvestor.com/the-book
In addition to hosting the popular podcast The White Coat Investor, Dr. Dahle is a practicing board-certified emergency physician. His three-book series offers tips for physicians at all stages of training, including planning for medical school admittance to planning for post-practice financial health.
Stacy and her husband Joel share tips and insights specific to military medical families, but much of what is here will resonate with civilian families, as well. As with many medical family memoirs, this one takes the reader through the Dunn’s early years in their journey, through the application process, medical school, residency, and the beginning of their post-training life as a family.
Hagar, a clinical social worker, makes use of her personal experiences as a medical spouse and her professional expertise to help others navigate medical relationships, which she describes as a three-way relationship, unique from traditional marriages. The book begins with Love in the Time of Medical School: Build a Happy, Healthy the pre-admission stage and leads readers through the years of medical Relationship with a Medical school and discusses the need for Student. Epstein, Sarah. (2017). sustained self-care, even after training. www.sarah-epstein.com The themes of balance and choices Epstein covers the beginning dominate; Hagar continually emstages of the journey of medicine phasizes how being a medical spouse by discussing the application is a choice (every day and at every process and takes readers through stage). Instead of feeling medicine to match day. Along the way, she is ruining our relationships, we provides helpful tips and strategies can move forward, making choices for couples to help them commu- that help us balance our emotional nicate better and strengthen their investment and expectations as we relationships. Epstein is a licensed support our doctor spouse. marriage and family therapist and contributor to Psychology Today. We’ve been fortunate to have her write for our blog and magazine, too. Be sure to check out her blog for great “medical relationship” entries like “Medicine is Not Destroying Your Marriage.”
(This article was originally published in the Spring/Summer 2022 issue of Physician Family/Alliance in Motion Magazine.) 20 Lehigh County Health & Medicine | SUMMER 2022
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5 Is Mommy a Doctor or Superhero? Ho, Amy Faith. (2020).
Memoirs of a Surgeon’s Wife: I’m Throwing Your Damn Pager into the Ocean. Sharma, Megan. (2018).
In this delightfully illustrated children’s book, Dr. Amy Faith Ho helps kids under- www.megansharma.com stand the important work their physician Megan Sharma’s humorous approach blends moms do. I had the good fortune to interview memoir and helpful tips in four sections: “Let’s Dr. Ho on the book, her goals for the work, Make Small Talk,” “Our Love Story,” “Life in and her plans for future work. the Trenches: Residency,” and “Life Beyond Residency.” Along the way, we read about Megan and Arun’s love story, and we also find various “survival” tips and guides. Megan also breaks down some of the economics of training, as well as burnout. Megan shared some tips about dealing with match day on our blog in 2017 with “Does Match Day Dictate Your Destiny? A Surgeon’s Wife Weighs In.”
The Thriving Physician: How to Avoid Burnout by Choosing Resilience Throughout Your Medical Career.
Studer Group. Simonds, Gary & Wayne Sotile. (2018). neuroscience.vt.edu/people/core-faculty/simonds-gr. html and https://www.sotile.com/
As “The Medical Family Resilience Challenge” by the Sotile family indicates in our Winter 2018 issue of Physician Family, the idea of a thriving physician is not a stand-alone. The thriving physician needs a strong, resilient family behind them! One of the things I loved about this book was that it expanded on the earlier Medical Marriage and covers the changing demographics of medical students and “newer” family structures that arose because of those changes. This book is part narrative and part workbook, providing an interactive experience allowing the reader to apply the concepts to their work and relationships.
Rhythms of Relationship: A Guide for Creating Purposeful Patterns to Strengthen Your Marriage. Short, Jessica. (2021).
Jessica Short’s first book grew from her blog where she writes about strengthening relationships and her life as the spouse of a medical student.
Medical Marriage: Sustaining Healthy The Relationships for Physicians and Their Families, Revised Edition. The American Medical Association. Sotile, Wayne M. & Mary O. (2000). www.sotile.com
This classic, originally published in 1996, was the first book to consider medical marriage as a truly unique situation. In this work, the Sotiles address three major areas: “Stress, Personality, and Marriage,” “The Basics of Love and Romance: Now and Forever,” and “Medicine, Marriage, and Stress.” Each of the 15 chapters ends with a references list, and most include “further reading” suggestions.
Prognosis: Poor: One Doctor’s Personal Account of the Beauty and the Perils of Modern Medical Training. Southwick, Frances. (2015).
Frances Southwick’s memoir takes the reader from the application stage, through medical school and residency. For partners and loved ones of physicians, the book is incredibly helpful in terms of truly hearing the voice of a person in training. Included in the book is an appendix that lists tips for keeping a relationship alive through training. In addition to serving as Physician Family Magazine’s Associate Editor, Angelic Rodgers, PhD, is a writer and freelance consultant. She and her wife, Dr. Dani Cothern, live in Camden, Arkansas, where Dani is an OB/GYN with Ouachita Regional Medical Center. Angelic can be reached through her website at www.angelicrodgers.com.
SUMMER 2022 | Lehigh County Health & Medicine 21
THE IMPORTANCE OF TELLING A STORY Coding has become the language of storytelling storytell ing in medicine BY JOSEPH HABIG II, MD, MEDICAL DIRECTOR, VALLEY PREFERRED
rowing up, I had an Uncle Francis. medical conditions for which we are treating DON’T DROP THE DROPPED CODES. Every year He was from North Carolina, and he our patients. chronic medical conditions that persist for a could tell a story like no one I have patient need to be refreshed and the HCC codes, ever known. When our families got How we report to contracted payers the re-coded. If not, it appears to the payers that together – myself, my sisters, and many of our severity of the illness of the patients we care for, these conditions have gone away. The classic cousins – we would sit on the floor, gathered determines the expected costs incurred in caring example here is a patient who suffered a limb around him. With his southern drawl, and his for these patients. As you know, this reporting is amputation. It is important to document this way of telling a story, he kept us entranced. He done through Hierarchical Condition Categories condition every year in their record. Otherwise, could weave words and phrases that would keep (HCC) codes, encompassed in The International it will appear that that problem no longer exists us mesmerized. We would laugh and cry and Classification of Disease, Tenth Edition (ICD- when it obviously does and is a significant hang on every word. 10), created by the World Health Organization co-morbidity for the patient. (WHO), the current book of codes utilized Every patient has a story. When they seek us across the vast world of health care. CONDUCT ANNUAL WELLNESS VISTS. Doing an out as their physician, they have a story to tell. annual well visit with your patients provides the It may be an urgent problem, or an ongoing We all work very hard, as we have been trained, best opportunity not only to code accurately, but single problem or series of problems for which to provide the best care for our patients; what to capture “dropped codes,” and help close any they seek our guidance. Either way, they look follows are four key guidelines on HCCs and Care Gaps that the patient may have. If you to us to help them with improvement or cure. how to accurately and completely tell the story are a primary care physician, annual well visits of the patients we treat. are also the best way to maintain attribution of We have all been trained to listen to our your patient. This means that according to the patients’ stories and ask them proper questions. BE AS ACCURATE AND SPECIFIC AS POSSIBLE. payer, you are that patient’s physician. To paraphrase Sir William Osler, one of the four The more specific we are in our coding, the founding professors of Johns Hopkins Hospital, more accurately we represent to the payer(s) the If you are using an EMR, there may be “If you ask your patients the right questions, they true illness and condition of the patients we see. software included that can assist in selecting the will tell you what is wrong with them.” most accurate or precise code for your patient For example, a patient with a diagnosis of encounters. If you are still using paper charts, We are also trained to know the value in “Type 2 Diabetes, uncomplicated,” is fine if moving onto an integrated EMR, such as the keeping records. Long gone are the 3 x 5 index there are no complications. However, if the universally used EPIC system, would not only cards that made up our predecessors’ medical patient has co-existing nephropathy, neuropathy, assist with proper and accurate coding, but records. For example, such a record may have or another condition related to diabetes, it is enhance vital data collection that is needed in read: “sore throat,” “PCN x 10 days.” important to use the HCC code that includes the current value-based practice of medicine. that co-morbidity. Now we muddle through – and some say Physicians and other health care providers “suffer” – with elaborate electronic technology REPORT ALL DIAGNOSES THAT YOU ADDRESS. have been recording encounters with patients to record extensive information on our patients. Coding diagnoses that may be secondary or are and interpreting them through coding for Perhaps at times it seems to be too much complications related to the primary reason for decades. So, while filling out diagnostic codes information. However, in this day and age, the encounter are very important to mention may not seem like it, it is in fact an updated the insurance companies that pay our bills and and include. If you see a patient for a particular and efficient way of telling an important story. cover the cost of the patient’s care demand it. problem, even if an acute problem, but you Using HCC codes may not be amusing or also address an existing chronic problem, it is entertaining, but it is important, and allows us So, in this time of electronic medical appropriate to document it and list that existing to do a better job at taking care of the patients records and value-based health care, we are diagnosis in your note. who entrust their care to us as their physicians. required to as accurately and as specifically as we can, record the severity of illness and 22 Lehigh County Health & Medicine | SUMMER 2022
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Hiwot Adamu Ayele, MD Cesar Augusto Barros de Sousa, MD,Resident - General Surgery Jarod Anders Berggren, MD, Resident - Emergency Medicine Leah Bonaparte Dotta, MD, Ophthalmology Tara H. Budinetz, DO, Obstetrics & Gynecology Natalie Chlus, DO, Resident Tiffany Chow, MD, Resident - Emergency Medicine Mark Clayton, MD - Developmental-Behavioral Pediatrics (Pediatrics) Yuri Magaly Cruz Carreno, MD, Resident - Obstetrics & Gynecology Cody Day, MD, Resident - Emergency Medicine Abdelsalam Sirelkhatim Omer Elshaikh, MD - Internal Medicine Anita W. Fei, MD, Resident - Hematology & Medical Oncology (Internal Medicine) Sarah Fish, DO, Medical Student Andrew Helman, DO, Resident - Emergency Medicine Elizabeth Huycke, DO, Resident - Emergency Medicine Alyssa Imperatore, DO Resident - General Surgery Shirley Jiang, Medical Student Jacqueline Renee Laundre, MD, Anesthesiology Hammad Bin Liaquat, MD, Resident - Gastroenterology (Internal Medicine) Hariharasudan Mani, MD, Resident - Hematology & Medical Oncology (Internal Medicine) Suresh G. Nair, MD, Hematology & Medical Oncology (Internal Medicine) Kutaiba Nazif, DO, Resident - Cardiovascular Disease (Internal Medicine) Danielle Ashlyn Nesbit, DO, Resident - Emergency Medicine Armando Manuel Orta, MD, Resident - Emergency Medicine Pratik Mayank Parikh, DO, Emergency Medicine Prarak Patel, DO, Resident - Internal Medicine C. Gerard Petersen, MD - Pulmonary & Critical Care Medicine Bharani Pusukur, Medical Student Sarah Rand, DO, Resident – Pediatrics Erafat Rehim, MD, Resident – Neurology Alejo Cleo Zarina Reyes, MD, Resident - Neurology Luke W. Riddell, DO, Resident - Emergency Medicine Sam Skariah, MD, Resident - Hematology & Medical Oncology (Internal Medicine) Amanda Rose Stashin, DO, Resident - Emergency Medicine Danielle Sultan, DO, Resident - Emergency Medicine Sarah P. Towne, DO, Family Medicine
Chaminie Amarasinghe Wheeler, DO, Pediatric Emergency Medicine Gregory Patrick Wheeler, DO, Emergency Medicine Yuchen Yang, DO, Resident - Emergency Medicine Sayyeda Ann Uz Zahra, MD, Resident - Neurology
Yahira Francheska Acevedo Santiago, MD, Physical Medicine and Rehabilitation Waqas Adeel, MD, Hospitalist Jacob R. Albers, Medical Student Jillian Lee Allen, DO, Resident - Emergency Medicine Stacey Blannett, DO, Resident - Dermatology Steven Joseph Capece, MD, Resident - General Surgery James J. Daley, MD, Physical Medicine and Rehabilitation Jeffrey Phillip Gordon, MD, Clinical Cardiac Electrophysiology (Internal Medicine) Vivek Gorijala - Medical Student Margaret L. Hoffman-Terry, MD, Infectious Disease (Internal Medicine) Chase L. Jones, DO, Resident - Medical Toxicology (Emergency Medicine) Tatyana Kemarskaya, MD, Geriatric Medicine (Internal Medicine) Kyle C. Klitsch, DO, Physical Medicine and Rehabilitation Alexander Michael Kowal, MD, Pediatric Radiology Kimberly S. Kuchinski, MD, Pediatrics/Physical Medicine and Rehabilitation Sean Robert Lacey, MD - Gastroenterology (Internal Medicine) Dao Le, Medical Student Kristina Maureen Lim, DO, Resident – Dermatology Karen Sarena Morris-Priester, MD – Anesthesiology John David Nuschke, Jr., MD, FACP, Internal Medicine Niketu M. Patel, MD, FACS - Head And Neck Surgery Zeel J. Patel, DO, Resident - Internal Medicine Katharine Elizabeth Pula, DO, Resident - Emergency Medicine Migdalia Resto, MD, Neonatal-Perinatal Medicine Michael Maher Sidhom, MD, Occupational Medicine Mary Catherine Stock Keister, MD - Family Medicine Alex T. Thomas, MD – Psychiatry Joseph L. Yozviak, DO, Internal Medicine
SUMMER 2022 | Lehigh County Health & Medicine 23
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