Lehigh County Health & Medicine Spring 2025

SPRING 2025

Official Publication of The Lehigh County Medical Society

PLUS

BLOOD PRESSURE SELFMONITORING PROGRAM EXPANDING HEALTH SAVINGS ACCOUNTS THE FLEXNER REPORT

CLOSING THE GAP: A Path to Greater Patient Choice and Lower Healthcare Costs

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contents

SPRING 2025

LEHIGH COUNTY MEDICAL SOCIETY P.O. Box 8, East Texas, PA 18046

610-437-2288 | lcmedsoc.org

2025 LCMS BOARD OF DIRECTORS* Chaminie Wheeler, DO President Kimberly Fugok, DO President Elect

14

Mary Stock, MD Vice President Oscar A. Morffi, MD Treasurer Charles J. Scagliotti, MD, FACS Secretary Rajender S. Totlani, MD Immediate Past President *effective February 1, 2024 - for two-year terms

CENSORS

5 IN THIS ISSUE

Howard E. Hudson, Jr., MD Gregory Wheeler, DO

FEATURES 6 BLOOD PRESSURE SELFMONITORING PROGRAM

TRUSTEES Wayne E. Dubov, MD Kenneth J. Toff, DO Alissa Romano, DO

By Tina Amato, MS, RD, LDN

OPINION ARTICLE 14 EXPANDING HEALTH SAVINGS ACCOUNTS:

EDITOR 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.

16 What Exactly is "Walking Pneumonia"?

By Jennifer Brubaker, MD, FAAP

18 When is it Time to Hit the "Reset" Button?

By Debra Ohrel

20 The Flexner Report:

A Path to Greater Patient Choice and Lower Healthcare Costs

By Chaminie Wheeler, DO

ON THE COVER 14 CLOSING THE GAP:

How PA Navigate Connects Healthcare to Whole Person Care

By Beck Moore

Lehigh County Health & Medicine is published by Hoffmann Publishing Group Sinking Spring, PA | HoffmannPublishing.com | (610) 685.0914

FOR ADVERTISING INFO CONTACT: Patricia Young, pat@hoffmannpublishing.com, 610-685-0914 x702

A Profound Prescription for Science and Accountability in Medical Education

By Dan Kimball, MD, MACP

L C M E D S O C .O R G

IN THIS ISSUE

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e made it through another winter, and things are turning green! Welcome to the Spring edition of Lehigh County Health and Medicine. Hopefully, you’ve been a regular reader of our magazine. This issue features a variety of topics—from blood pressure self-monitoring to updates on the HSA program, to an overview of the Community Action Association of Pennsylvania, and more.

Our cover article, from the Allentown Health Bureau, highlights a program for individuals diagnosed with high blood pressure. Learn more about how you might be selected to participate.

We also provide an update on potential legislation that could encourage you to reconsider a Health Savings Account (HSA). If you’re unfamiliar with HSAs, according to Healthcare. gov, they are a type of savings account that allows you to set aside money on a pre-tax basis to pay for qualified medical expenses. By using untaxed dollars in an HSA to pay for deductibles, copayments, coinsurance, and other eligible expenses, you may be able to lower your overall healthcare costs. Read “Expanding Health Savings Accounts” to learn how this legislation is designed to make HSAs more appealing to a broader audience.

Are you familiar with the Community Action Association of Pennsylvania and PA Navigate? Refer to the article “Closing the Gap,” which discusses how PA Navigate can serve as an invaluable resource for physicians and other healthcare team members. It streamlines referrals to community-based services directly from your healthcare setting.

PA Navigate helps healthcare providers and their patients make critical connections to reduce health disparities and promote a healthier, more equitable society.

We hope you enjoy this edition—as well as past ones—as we continue the conversation about how medicine and wellness can strengthen our communities in Lehigh County. If you're interested in back issues or want to read Lehigh County Health and Medicine online, please visit our website: https://lcmedsoc.org/our-publication.

If you have ideas or suggestions for upcoming issues, we’d love to hear from you! Send us an email at info@lcmedsoc.org. Thank you for reading!

SPRING 2025 | Lehigh County Health & Medicine 5

FEATURE

BLOOD PRESSURE SELFMONITORING PROGRAM TINA AMATO, MS, RD, LDN, ALLENTOWN HEALTH BUREAU

6 Lehigh County Health & Medicine | SPRING 2025

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he Allentown Health Bureau received a grant from the PA Department of Health to implement a Blood Pressure Self-Monitoring Program.

The program enrolls up to 35 participants per year who were diagnosed with high blood pressure. Participants receive a free blood pressure monitor and are followed for 4 months. Each participant meets with a coach twice a month and receives monthly nutrition seminars by a registered dietitian.

Checking blood pressure at home helps individuals feel more engaged and therefore motivated to improve their health. Poorly controlled hypertension is a serious condition that can affect many bodily systems over time including the heart, kidneys, vision and blood vessels. That’s why home monitoring may be especially helpful for people struggling with high blood pressure; and helps them promote their own chronic disease self-management.

One in three adults had high blood pressure in Pennsylvania (Chronic Disease Burden Report 2021). This is similar to Lehigh County where 31.2% of adults have hypertension (2022 St. Luke’s University Health Network Community Health Needs Assessment). Having hypertension puts individuals at risk for heart disease and stroke, which are leading causes of death in the United States.

Eating a heart-healthy diet is important for blood pressure management and to reduce the risk of heart disease. Research has shown that the DASH (Dietary Approaches to Stop Hypertension) eating plan helps to lower blood pressure. The DASH diet helps to regulate and reduce blood pressure by increasing the consumption of potassium, calcium, magnesium and fiber though the consumption of fruits, vegetables, whole grains, lean protein, and low-fat dairy products. Potassium reduces the effects of sodium to ease tension in the blood vessels while magnesium helps our blood vessels relax, both of which help to control blood pressure. Potassium is widely available in many foods including beans, lentils, starchy vegetables such as potatoes and winter squash, leafy greens, fruits such as bananas and cantaloupe, avocados, and salmon. Magnesium is found in nuts, seeds, dark leafy green vegetables, whole grains, and meats such as beef and poultry.

The Dietary Guidelines for Americans recommends those at risk for heart disease consume less than 1,500mg of sodium per day. Excess sodium intake can cause an increase in fluid retention, making it harder to control blood pressure. According to the Centers for Disease Control, Americans consume more than 3,300mg of sodium per day, the majority coming from processed foods. Following the DASH diet promotes whole foods naturally low in sodium and high in vitamins and minerals.

Through the Allentown Health Bureau’s Blood Pressure Self-Monitoring Program, individuals with known hypertension have the ability to regularly check their blood pressure at home, learn healthy lifestyle changes through coaching and education sessions, and be linked to healthcare providers if needed. By targeting those most affected by hypertension, the Allentown Health Bureau has an opportunity to provide culturally competent services and help to address disparities that may have hindered individuals from being able to control hypertension in the past.

If you are interested in joining the program, or referring someone to the Allentown Health Bureau, contact 610-437-7760 ext. 7131.

SPRING 2025 | Lehigh County Health & Medicine 7

OPINION ARTICLE

EXPANDING HEALTH SAVINGS ACCOUNTS:

A Path to Greater Patient Choice and Lower Healthcare Costs CHAMINIE WHEELER, DO PEDIATRICS, DIRECT PRIMARY CARE

8 Lehigh County Health & Medicine | SPRING 2025

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In recent years, the U.S. Congress has introduced multiple bills aimed at expanding and modernizing Health Savings Accounts (HSAs). These legislative efforts are rooted in the recognition that HSAs empower individuals to take control of their healthcare spending, foster a competitive free market, and ultimately reduce the cost of healthcare. By broadening access to HSAs and increasing their flexibility, these initiatives provide Americans with greater autonomy in managing their healthcare dollars and making informed choices about their medical needs.

ENHANCING PATIENT CHOICE AND FINANCIAL FLEXIBILITY One of the most significant advantages of HSAs is their ability to increase patient choice in healthcare. Currently, many Americans are constrained by employer-based insurance plans with limited options for providers and services. HSAs, particularly when decoupled from high-deductible health plans (HDHPs), enable individuals to allocate funds for healthcare expenses based on their specific needs. The Personalized Care Act (H.R. 5810) introduced in January 2025 seeks to achieve this by allowing individuals to contribute to HSAs regardless of their insurance plan type. This expansion ensures that more Americans can benefit from tax-advantaged healthcare savings and access a wider array of services, including direct primary care and healthcare-sharing ministries.

Additionally, the proposed HSA Modernization Act of 2023 (H.R. 5687) increases contribution limits, allowing individuals to save more tax-free dollars for medical expenses. By raising limits to $10,800 for individuals and $29,500 for families, patients have greater financial security in managing their healthcare expenses. This flexibility enables families to plan for both routine medical care and unexpected health emergencies without being overly dependent on third-party payers or government programs.

STRENGTHENING THE INDEPENDENT PHYSICIAN MOVEMENT Expanding HSAs provides a critical advantage to independent physicians by giving patients greater financial autonomy, making direct primary care (DPC) and independent practices more

accessible. When patients control their healthcare dollars, they are more likely to choose physicians who offer transparent pricing, personalized care, and innovative treatment models outside of hospital networks. Moreover, by allowing HSAs to cover direct primary care fees and specialty services, these reforms could help independent physicians to thrive without relying on insurance companies.

VERTICAL INTEGRATION OF HEALTHCARE HAS MERITS, BUT HASN’T YET YIELDED THE PROMISE OF REDUCED COSTS AND INCREASED PATIENT CHOICE. Expanding HSAs empowers patients to spend directly on care rather than navigating insurer-imposed restrictions. The Healthcare Freedom Act (H.R. 5842) proposes “Health Freedom Accounts,” which would allow tax-free withdrawals for a variety of medical expenses, including insurance premiums and direct primary care memberships. This could help patients opt out of more restrictive insurance networks and opt in to independent providers who offer more affordable and transparent pricing.

Furthermore, reducing the reliance on third-party payers encourages competitive pricing, making healthcare more affordable while fostering an environment where independent physicians and specialty care providers can thrive. By expanding HSAs to cover a broader range of healthcare services, patients will be incentivized to seek care from physicians who provide cost-effective, high-quality treatment.

CONCLUSION The expansion of HSAs through legislative efforts such as the Personalized Care Act (H.R. 5810), HSA Modernization Act (H.R. 5687), and Healthcare Freedom Act (H.R. 5842) represents a crucial step toward increasing patient autonomy, fostering a competitive healthcare market, and reducing overall healthcare costs. Additionally, these reforms provide a pathway to strengthening independent medical practices. By giving individuals the ability to manage their healthcare dollars and choose providers that best meet their needs, these initiatives pave the way for a more patient-centered and financially sustainable healthcare system.

One of the most significant advantages of HSAs is their ability to increase patient choice in healthcare. Currently, many Americans are constrained by employer-based insurance plans with limited options for providers and services.

SPRING 2025 | Lehigh County Health & Medicine 9

UNLOCKING GROWTH

How MADJ Marketing Transforms Medical Practices

10 Lehigh County Health & Medicine | SPRING 2025

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SPONSORED CONTENT

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hen MADJ Marketing MADJ didn’t stop at the digital surface. recruitment crisis. Amid a climate of first partnered with a two- They built a reputation management system widespread staffing shortages, this system physician practice, the that encouraged satisfied patients to leave needed to compete for top-tier talent challenges were familiar: glowing reviews, increasing both credibility across specialties, all while maintaining low brand awareness, a barely-there web and conversions. Meanwhile, continuous its employer brand and handling PR presence, and marketing that consisted data analysis helped refine every tactic, sensitivities. mostly of hope and word of mouth. But ensuring marketing dollars did more beneath the surface, there was potential—an with less.

MADJ Marketing stepped in not with untapped patient base, a loyal core clientele, a band-aid, but a blueprint. and a vision for something bigger.

The results? A 3x expansion in practice size. From two physicians to a full team They started by crafting a compelling MADJ began by reimagining the practice’s of four doctors, three physician assistants, employer brand—one that spoke not just digital front door: a website overhaul and fifteen support staff. Website traffic to career opportunities, but to culture, that didn’t just look better but care, and purpose. Through worked better. With clean design, tailored messaging for patient-friendly navigation, and What began as a modest office now operates nurses, physicians, and allied content optimized for search professionals, MADJ ensured as a cornerstone of community care, all thanks the health system wasn’t just engines, the practice started showing up at the top of local to MADJ’s strategic blend of art and science seen as a job, but as a mission results—right where prospective in marketing. worth joining. patients were searching.

Digital advertising took Next came paid ads—targeted, strategic, jumped from 1,500 to over 59,000 visits the message further, leveraging job boards, and tailored to the most-searched conditions annually—a staggering 4,000% increase. search engines, and geo-targeted social and procedures. Combine that with What began as a modest office now operates campaigns to put opportunities in front intelligent retargeting and social media as a cornerstone of community care, all of the right people at the right time. And engagement, and suddenly, this once- thanks to MADJ’s strategic blend of art with SEO baked into every post, listings quiet clinic became a trusted voice in the and science in marketing. rose above the noise. community. Facebook and Instagram weren’t just for posts—they became Elsewhere in the healthcare world, a In addition, MADJ streamlined storytelling platforms, where the human prominent regional health system faced the candidate experience—improving side of healthcare met high-impact branding. a different kind of challenge—one communication touchpoints, refining the that’s haunted hospitals nationwide: the application journey, and creating engaging continued on next page >

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MADJ Marketing empowers healthcare providers to grow with customized, results-driven strategies. A small physician practice tripled in size and saw a 4,000% increase in web traffic after MADJ revamped its digital presence, launched targeted ads, and improved online reputation.

A regional health system facing recruitment challenges doubled its qualified applicants, improved employer ratings, and cut hiring time by 40% through MADJ’s strategic branding, digital outreach, and crisis communication planning. What sets MADJ apart is their empathetic, data-informed approach—combining creativity with analytics to build trust, credibility, and sustainable growth. With MADJ, medical practices can truly iMADJine the possibilities.

Physician Practice

Health System

marketing SPRING 2025 | Lehigh County Health & Medicine 11

content such as video and display ads to boost interest.

This full-funnel approach kept prospects informed, excited, and ready to apply.

Results soon followed. Qualified applications doubled.

Career page visits skyrocketed by 275%. Positive employee reviews surged 50%, boosting the system’s employer rating.

And the time-to-hire was slashed by 40%, thanks to streamlined processes and better candidate engagement.

For this regional health system, MADJ wasn’t just a marketing partner—they were a strategic ally in workforce sustainability.

What connects these success stories isn’t just outcomes— it’s MADJ’s philosophy.

First, they listen. Every engagement starts with deep discovery: Who are you? Who do you serve? What do you dream of becoming? This insight becomes the bedrock of custom strategies that are never one-size-fits-all.

Second, they blend creativity with analytics. Whether it’s a heartwarming video campaign or a hyper-focused PPC ad, every creative choice is backed by data. Their ongoing optimizations ensure campaigns don’t just start strong—they get smarter over time.

Third, they stay human. Healthcare is personal. MADJ knows that behind every patient click is a person in need.

Behind every job post is a professional seeking purpose.

Their messaging, visuals, and engagement strategies never lose sight of the emotional core that drives decisions in healthcare.

Finally, they measure what matters. ROI isn’t just a buzzword—it’s baked into everything they do.

With dashboards, A/B testing, and patient feedback loops, MADJ provides transparency and continuous improvement.

The result? Marketing that doesn’t feel like marketing— but feels like meaningful connection, credibility, and growth.

If you're ready to move from surviving to thriving, maybe it’s time to ask yourself: What could you accomplish if you iMADJined the possibilities?

Visit madjmarketing.com to learn more.

12 Lehigh County Health & Medicine | SPRING 2025

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SPRING 2025 | Lehigh County Health & Medicine 13

FEATURE

Closing the Gap: How PA Navigate Connects Healthcare to Whole-Person Care

BY BECK MOORE, CEO AT COMMUNITY ACTION ASSOCIATION OF PENNSYLVANIA

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ith over 1,300 searches, “Food Pantry” was PA Navigate’s most searched-for term in the first quarter of 2024.

Physicians are on the frontlines of addressing not only their patients’ immediate health concerns but also the broader social factors that profoundly impact well-being. Food insecurity is just one of the multitude of factors that exacerbate chronic conditions, delay recovery, and often lead to preventable Emergency Room visits. For many patients, these social determinants are not just lifestyle challenges – they are significant barriers to achieving better health outcomes.

As a trusted advocate for patients’ health, doctors and physicians understand the importance of treating the whole person. Yet, identifying and addressing social determinants of health (SDOH) can be a complex and time-consuming process.

That’s where PA Navigate comes in.

This innovative, state-supported platform simplifies the connection between healthcare providers and local resources, enabling healthcare workers to efficiently refer patients to wraparound services like food pantries, housing assistance, and more.

By leveraging PA Navigate, physicians and clinics can ease the burden of care coordination while ensuring patients receive the support they need to lead healthier, more stable lives.

Unpacking the Social Determinants of Health (SDOH) When we talk about SDOH, we’re referring to the conditions in which people are born, grow, live, work, and age. These factors, such as access to nutritious food, stable housing, transportation, and employment opportunities, profoundly shape health 14 Lehigh County Health & Medicine | SPRING 2025

outcomes. Addressing them is essential to achieving true health equity.

Food insecurity, for example, is a critical social determinant but far from the only one. Imagine a patient who has diabetes but struggles to afford healthy food. Even with the best medical care, their condition will worsen without access to proper nutrition.

Similarly, a patient experiencing unstable housing may find it challenging to manage their medication regimen or attend follow-up appointments. Each of these challenges underscores the interconnectedness of social conditions and health outcomes.

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for a family struggling with food insecurity. On the other hand, a larger healthcare system can seamlessly integrate the platform into their existing workflows, streamlining processes and improving efficiency across the board.

Strengthening Connections, Lowering Barriers

Bridging the Gap with PA Navigate PA Navigate is a game-changer for simplifying referrals to community-based services directly from the healthcare setting. It’s a straightforward, user-friendly platform that helps healthcare providers connect patients with local resources in real-time.

Whether referring someone to a food pantry, a housing program, or transportation services, PA Navigate makes it easy to bridge the gap between medical care and essential social supports.

For providers, it means spending less time navigating fragmented systems and more time focusing on what truly matters: patient care. And the best part? Physicians don’t need to be caseworkers – or even have one on staff – to make it work. PA Navigate empowers all types of practices, from small clinics to large healthcare systems, to offer care that truly considers every aspect of a patient’s well-being.

Enabling Holistic, Whole-Person Care What makes PA Navigate so impactful is how it supports holistic care. Doctors often see the disconnect between what happens in the exam room and the challenges our patients face in their everyday lives. PA Navigate helps close that gap by giving us tools to address immediate medical needs while connecting patients to critical community resources.

When they integrate social determinants into their care plans, it strengthens the bond between doctor and patient. Patients notice when their provider cares about more than just their symptoms – it builds trust and shows a commitment to their overall health. And this approach doesn’t just improve individual outcomes; it helps reduce readmission rates and prevents avoidable Emergency Room visits, creating a ripple effect that benefits the entire healthcare system.

A Platform for All One of the things users love most about PA Navigate is its simplicity. Its intuitive design means that anyone can use it – no technical expertise required. Clinics and practices without case management staff are easily leveraging this tool to make meaningful connections for their patients.

Take, for example, a small primary care office. With PA Navigate, they can quickly find nearby food assistance programs

The real beauty of PA Navigate lies in how it strengthens connections – between patients and providers, healthcare settings and community organizations, and medical care and social supports. These connections are critical for tackling the root causes of health disparities and fostering a healthier, more equitable society.

For providers, using PA Navigate is a way of saying to patients, “I see you. I hear you. And I’m here to help.” For patients, it’s a powerful reminder that their doctor truly cares about their wholeperson health. This kind of trust not only improves adherence to care plans but also leads to better outcomes overall.

Moving Toward Health Equity We have a unique opportunity to influence not just the health of individual patients but the well-being of entire communities.

Addressing social determinants of health isn’t easy, but tools like PA Navigate make it possible – and manageable. It’s more than just a referral system; it’s a bridge to holistic, equitable care that recognizes the full scope of what patients need to thrive.

I’m genuinely optimistic about the future of healthcare when I see solutions like PA Navigate in action. By embracing this innovative tool, we can close the gap between medical care and social supports, ensuring no patient’s health is limited by their circumstances. Together, we can build a healthcare system that works for everyone, one referral at a time.

If you are a community-based organization, nonprofit, or work with a local organization, please help connect them to the Community Action Association of Pennsylvania’s website, www. panavigatehelp.org, to connect to a Community Engagement Manager today!

This article was originally published in the Winter 2025 edition of Philidelphia Medicine magazine. It has been updated.

Resources: PA Navigate - Pennsylvanians can find help with various needs, including access to things like food, housing, utilities, transportation, and more - right in your local community. https://www.pa.gov/agencies/ dhs/resources/for-residents/panavigate.html Video by Val Arkoosh https://youtu.be/Z5BDxfOSl7s SPRING 2025 | Lehigh County Health & Medicine 15

FEATURE

What Exactly is “Walking Pneumonia”?

Why Are We Seeing More of it This Year?

How Can You Stay Healthy This Winter?

JENNIFER BRUBAKER, MD, FAAP UNION COMMUNITY CARE

16 Lehigh County Health & Medicine | SPRING 2025

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he term “walking pneumonia” was introduced in the 1930s. At that time, there was a widespread realization in the medical community that a “milder” form of pneumonia existed, which didn’t develop the same lobar pattern of infection on x-ray or clinical exam but seemed instead to cause milder—albeit more diffuse—lung inflammation. Even though there were serious cases with this type of pneumonia, many people had less severe forms and were able to walk around and continue their daily lives, leading to the term “walking pneumonia.” The more medically correct term now used is “atypical pneumonia,” which contrasts with typical bacterial lobar pneumonia, most commonly caused by Streptococcus pneumoniae.

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It was not until the 1940s that the organism responsible for most cases of atypical pneumonia, Mycoplasma pneumonia (M. pneumoniae), was first isolated from a patient by Dr. Eaton. Its classification as a bacterium occurred even later, not until the 1960s. M. pneumoniae is an atypical bacterium because its cell volume is much smaller (less than 5%) of other bacteria, and it lacks a cell wall, making it resistant to many antibiotics, such as beta-lactams, used to treat other types of pneumonia. We now typically use azithromycin or another macrolide antibiotic to treat M. pneumoniae. This treatment was first introduced in the late 1980s. Before then, tetracyclines were primarily used.

This year, starting in June and currently ongoing, cases of atypical pneumonia from M. pneumoniae have been greatly increased across the country, reaching10-20x last year’s levels depending on the area. In Pennsylvania, the Department of Health put out a health advisory this past October warning of the increase as well as increases in other respiratory viruses, especially rhino/enteroviruses, which can cause similar symptoms. M. pneumoniae tends to have peak increases every three to seven years, and until now, has not had one since the COVID-19 pandemic. It often peaks in school-aged children, but this year preschool children (2-4 years old and even the 0-2 year-old group) are also having more infections than usual. Previously M. pneumoniae has been uncommon in the under 4 year-old age group making this change significant. It is not an officially reportable disease, so it can be hard to get accurate data, but the CDC estimates there are likely more than 2 million infections with M. pneumoniae in the United States each year and more during peak outbreaks. Anecdotally, our practice is currently seeing increased numbers of cases.

Atypical pneumonia can be hard to diagnose because it presents similarly to many viral infections, including influenza, RSV, rhino/ enteroviruses, COVID-19, and other forms of bacterial pneumonia. It often starts out like a “common cold” with nasal congestion, cough, headache, fever, and a general feeling of fatigue and malaise. In younger children it can also present with vomiting, diarrhea, and wheezing, which are less typical in older children. In contrast to other infections, M. pneumoniae tends to be more persistent, with the symptoms lasting longer than many of the

common viral respiratory infections. Testing for M. pneumoniae is more typically found in hospital and emergency department settings and is infrequently used in outpatient settings. It is often diagnosed by a respiratory swab as part of a larger panel for diagnosing all the viruses listed above. In the office setting, it is usually diagnosed clinically with history and physical exam findings and sometimes with the help of a chest x-ray.

M. pneumoniae has a long incubation, from two to three weeks, so it can spread through a family for a long period of time, even one to two months. It is transmitted by respiratory droplets when an infected person sneezes or coughs. It can be present on hands and surfaces and be transmitted when someone else touches an infected surface and then touches their mouth or nose. It has a long clinical course, and even with antibiotic treatment, symptoms (especially cough) can last one to two months, but often in a mild form.

There is no current vaccine for M. pneumoniae, so prevention includes: • Good handwashing habits • Covering mouth and nose when coughing or sneezing • Cleaning and disinfecting surfaces and toys

young children, with around 80,000 hospitalized each year. RSV causes proportionally more severe disease in infants less than 6 months of age. In the United States, RSV season typically begins in the fall and ends in the spring. This was disrupted by COVID-19 but now seems to be back to its typical seasonal pattern. People now have two options to help prevent RSV infection in their infants: a maternal vaccine (Pfizer’s Abrysvo®) given during pregnancy September through January and recommended for women who are between 32 and 36 weeks pregnant OR an RSV antibody (nirsevimab, brand name Beyfortus®) given to babies after birth. You don’t need both.

Nirsevimab was only available in limited quantities last season, but this year is more widely available in many outpatient offices.

It generally is well tolerated with mild side effects in most infants. It is a one-dose passive immunization, which means the baby receives preformed antibodies that provide protection for about five months, which should get them through an RSV season. This is in contrast to a typical vaccine with the goal of inducing the baby’s own immune response. Nirsevimab is recommended for babies under 8 months of age (whose mothers did NOT receive the Abrysvo vaccine) at the start of the RSV season (November-March) or any baby born during the RSV season, administered at birth or anytime afterward during the season.

SOURCES CITED:

• Avoiding crowded places

BMC Med Imaging. 2009 Apr 29;9:7. doi: 10.1186/1471-2342-9-7

• Maximizing immunity by eating well and getting enough sleep

Front Microbiol. 2016 Mar 22;7:364. doi: 10.3389/fmicb.2016.00364

Influenza, COVID-19, and respiratory syncytial virus (RSV) can also cause cough, congestion, fever, headache, and malaise and can be clinically confused with M. pneumoniae. Testing for them is available in many outpatient settings, and all these respiratory viruses have vaccines available this winter. The American Academy of Pediatrics and the CDC recommend that children 6 months of age and older receive influenza and COVID-19 vaccines for the 2024-2025 fall/winter season.

Front Microbiol. 2016 Mar 22;7:364. doi: 10.3389/fmicb.2016.00364 American Academy of Pediatrics: https:// publications.aap.org/redbook/resources/25379/ AAP-Recommendations-for-the-Prevention-of-RSV Center for Disease Control: www.cdc.gov National Institute of Health: https://www.ncbi.nlm. nih.gov/books/NBK430780/

This article was originally published in the Winter 2025 edition of Lancaster Physician magazine. It has been updated.

Even with the increased prevalence of M. pneumoniae this year, RSV is still the most common cause of acute respiratory infections in

SPRING 2025 | Lehigh County Health & Medicine 17

FEATURE

WHEN IS IT TIME TO HIT THE “RESET” BUTTON?

T

he past three years have been a blur in the medical field for everyone.

So many changes have occurred.

Processes, staff, regulations, and attitudes have all shifted. How do we as managers get through this and come out at the end feeling like you have done your best?

DEBRA OHREL PRACTICE MANAGER, PENN MEDICINE LANCASTER GENERAL HEALTH PHYSICIANS DIABETES AND ENDOCRINOLOGY

18 Lehigh County Health & Medicine | SPRING 2025

Within our practice, we have gone through big changes in how we work. We have managed through a pandemic, various staffing volumes, burnout, employee disengagement, and patient dissatisfaction. How do you regroup, rebound, and boost morale?

L C M E D S O C .O R G

We have chosen to do a reset. What does that mean? Go to where the work is done and take a deep dive into what is going on in the moment. Then look back to where you were, look at your current state, and determine where you want to be. The only way you can do that is to start at the beginning and go back to the basics. You may feel you do not have the time to do it, but it is important to make the time. In the end, you will gain the insight and information you need to give your team time back in their day.

We have staff members with a range of experience—from three weeks to 30 years.

You need to find out what they know, what they need to know, and where they want to be in three years. Once you know who needs to be retrained or refreshed, you can determine where to start. With the exit of staff due to COVID burnout, we found ourselves hiring new employees quickly.

We had good intentions of onboarding and providing them with the resources to do their job with success and satisfaction. However, due to high work volumes, it was challenging to provide new employees the full onboarding package. We were also creating unnecessary extra administrative work which brought frustration among the team. Experienced staff were feeling overwhelmed from training new staff, working longer hours, and feeling guilty if they took time off from work.

We eventually reached a point where we had the right volume of staff needed. Now was the perfect time to pause, reflect, and do a “reset.”

So how can you, as a manager, support your team?

Do a reset. Determine what is needed from each employee. Sit with each employee individually and then as a group. You will find employees are a great resource of information. They are doing the work, and they know where the problem lies. They want to be a part of the solution, and they want to be heard. When interviewing each of them, you will see they all have different levels of need due to their years of experience, knowledge, and ambition. Consider going through the new employee onboarding process and skill set review again. Evaluate

the new processes created in the last two years and have each employee walk you through them. Shadow the employee and highlight what they do well. No matter how simple a process may seem, take the time to review it, and revise it to meet your current needs. Frustration can occur if people are not performing tasks in a consistent way, leading to communication breakdowns.

Look for opportunities to identify your team’s strengths and weaknesses and opportunities to retrain staff. This should not be intended to be punitive or negative when you identify deficiencies. The employees need to know that your end goal is to have them become successful in their role by giving them the tools and resources they need to do their job.

It shows you are listening to their concerns, you are aware how they are feeling, and you want the best work environment for them to be successful.

Things we have done during our reset this year:

• We shared the new onboarding document developed by HR and had every employee complete it. Having everyone sign off gives the manager opportunity to reinforce standard policies. Attendance, cell phones, dress code, etc. – all things that slide by the wayside as time passes.

• Each employee completed the annual competencies and focused on areas of opportunity. We provided retraining and education where needed, and identified staff members who can be the subject matter experts.

• We created a team that helps to evaluate current practice processes. We included providers, supervisors and others that wanted to be included in process improvement. We reviewed processes and revised them to meet our current standards. All staff were updated on the new processes. Staff will be accountable to follow the standards to reduce errors, rework, and stress.

• We tasked the providers to review 20 in-basket messages and identify why they could not have one call resolution to the message. What did the provider

need from the clinical team to address the message quickly and efficiently? We shared these areas of opportunity with the team and are currently working on process improvement to reduce redundancy and waste in the in-basket.

• Our first process we addressed was refills.

This is a beast every day that creates havoc in every provider’s in-basket.

We are reviewing all the ways a refill comes into the office and where the breakdown occurs that delays the refill.

We feel positive we can make a difference, decreasing the volumes of bounce-back to the practice, increasing patient satisfaction, and reducing refills that occur in between the patient’s visits.

•W e evaluated what the clinical staff are tasked with daily. We clearly defined what their roles are and assigned tasks to meet their strengths.

•W e identified that we needed a higher level of licensure to support providers with in-basket management to reach our goal to reduce in-basket burnout and increase provider productivity.

• We were able to justify the need for additional RN/LPN support.

The above are just a few examples of how we’re working toward our reset. We have great engagement from the team, and we will continue the process over the next several months. I personally have seen positive involvement and see that the team is aware that changes are happening for the better.

Having the team onboard to help with brainstorming solutions was eye opening for me. They were excited and felt valued.

As a manager, I have always felt I needed to provide the team with the answers. Through this process, I realized we have had the answers all along within our team. We just needed to take the time to pause, reflect, and reset.

This article was originally published in the Fall 2024 edition of Lancaster Physician magazine. It has been updated.

SPRING 2025 | Lehigh County Health & Medicine 19

FEATURE

The Flexner Report:

A Profound Prescription for Science and Accountability in Medical Education

by Dan Kimball, MD, MACP

T

he 360 plus-page Flexner Report was commissioned under the auspices of the Carnegie Foundation, founded in 1905.

Their initial mission was to provide pensions for college professors, a task that would eventually become TIAA (Teachers Insurance and Annuity Association). Under the leadership of its first president, Henry Pritchett, the foundation trustees originally envisioned this proposed medical school study, as the first of many studies about the quality of professional schools, in North American and Europe.

It is notable that the American Medical Association’s Council on Medical Education, which was established in 1904, had as its primary focus when founded, “…the need for a comprehensive study of our medical schools including their curricula, facilities, and faculty” and were enthusiastic supporters and enablers of this study.

Since the founding of the AMA in 1846, it was committed to two propositions, first, that “…it is desirable that young men received as students of medicine should have acquired a suitable preliminary education …” and secondly, “…that a uniform elevated standard of requirements for the degree of MD should be adopted by all the medical schools in the United States.” It would be more than fifty years after the AMA adopted those aspirational goals before work on those goals would begin. Many would suggest it began following the release of the Flexner Report in 1910.

Abraham Flexner, who conducted the study and wrote the report for the foundation, was born in Louisville, KY in 1866 and was the sixth of nine children born to Ester and Moritz Flexner. He was the first in his family to attend college. He attended Johns Hopkins University where he earned a BA in classics after two years 20 Lehigh County Health & Medicine | SPRING 2025

of study. He also pursued graduate studies in Psychology at Harvard University and the University of Berlin, but never completed work on an advanced degree.

In 1890, after teaching for four years at Louisville High School, he founded and directed an experimental college-preparatory school.

Two years earlier, he had published a critical assessment of the state of the American secondary educational system, titled “The American College: A Criticism.” That paper would catch the attention of the Carnegie Foundation, which led them to invite Flexner to engage in his study.

Flexner opposed the then-standard model of education that focused on mental discipline and a rigid structure. His school did not give out traditional grades, it used no standard curriculum, refused to impose examinations on students, and kept no academic records of students. Instead, he promoted small learning groups, individual development, and a more hands-on approach to education. Flexner was not a physician and had never been inside a medical school before undertaking this study.

He joined the Foundation staff in 1908 and wrote this report in 1910, which is officially titled “Medical Education in the United States and Canada,” which is traditionally referred to as “the Flexner Report.” Although he is best remembered for this report, his greatest educational gift may have been his founding and leadership of the Institute for Advanced Study, a private, independent academic institution located in Princeton, New Jersey which quite notably included Albert Einstein as a resident scholar.

L C M E D S O C .O R G

The Flexner Report contains two large major sections. Part I contains multiple chapters that include a review of the history of medical education in the United States, and an assessment of the current medical education process in the late 1800s. Four chapters outline what the four years of medical school should look like, including a chapter on the finances of running a medical school, a short section on “medical sects” to include homeopathy, osteopathy, and eclectic medicine, a short chapter on suggestions about the role of state medical boards in assuring the training of physicians, a short chapter about “the Postgraduate School,” which may be labeled the first internship, and two short chapters on the medical education of women and the medical education of the Negro, which in hindsight have been labeled as sexist and racially biased.

Part II of the report is a detailed listing of the 155 medical schools visited in the United States and Canada. Sixty-nine of these schools were proprietary. There is an appendix which includes a table showing the number of faculty, enrollment numbers, tuition income and the budget of the schools.

In a previous Medical Record article, discussing the career of the 18th Century Berks County physician and Senior Physician to General George Washington at Valley Forge Dr. Bodo Otto, I noted that apprenticeship was the primary method of medical education in our country from the colonial period through the early 19th century. During that time aspiring physicians would typically learn the trade by working directly under the supervision of an established doctor, gaining hands-on experience and practical knowledge. You might call this the “see one, do one” method of learning. This apprenticeship might last anywhere between 4 to 7 years and included assisting with surgeries, maintaining medical records, ordering supplies and other duties as assigned. The apprentice could begin his own practice when they were approved to do so by their supervising physician teacher. There was no board exam or licensure process.

The earliest medical schools in the United States included the University of Pennsylvania School of Medicine (now the Perelman School of Medicine), founded in 1765; the King’s College Medical School (now Columbia University College of Physicians and Surgeons), founded in 1767; the Harvard Medical School, founded in 1782; and the Dartmouth Medical School (now the Geisel School of Medicine at Dartmouth), founded in 1797. During the American Revolution, King’s College was temporarily closed, when the British occupied New York, and later reopened as Columbia College, which would eventually become Columbia University.

Proprietary medical schools in the United States began to emerge in the early 19th century. These schools were for-profit institutions that were often established by individual physicians or small groups of physicians. These schools would play a significant role in medical education during the 19th century, offering more formalized training compared to that of the apprenticeship model. The first

proprietary medical school in the US was the College of Physicians and Surgeons, founded in 1807, and would ultimately become part of Columbia University. By 1900 there were approximately 160 proprietary medical schools operating in the United States.

These schools varied widely in their ability to screen applicants for admission, to have a standardized curriculum, to provide clinical experience, and to have appropriate equipment for teaching including laboratory facilities and libraries. Funding to pay the faculty and run the school was totally supported by tuition fees and donations. For the most part these schools were operated to make a profit for the founding faculty members.

Flexner felt strongly that two years of college with emphasis on study of the sciences should be required to enter a medical school but at the time of his report only 16 of the 155 schools had such a requirement, with six additional schools requiring one year of college. Fifty other schools required a high-school education or its equivalent, and about 80 other schools had little to no entrance requirements, other than the ability of students to pay the tuition fees.

Flexner notes in his report an exceedingly high failure rate, exceeding 50% in many of the medical schools surveyed, which he attributed to the lack of preparation by many of the accepted students. He captures some of the views of current professors at these schools with quotes from some of them, such as, “…the facilities are better than the students; …the boys are imbued with the idea of being doctors; they want to cut and prescribe; all else is theoretical; …it is difficult to get a student to want to repeat an experiment in physiology; …they have neither curiosity nor capacity; the machinery doesn’t stop the unfit; …men get in, not because the country needs doctors, but because the school needs the money.”

Flexner highlights a professor’s response to his question, “What is your honest opinion of your own enrollment process?” and the professor says, “Well, the most I would claim, is that nobody who is absolutely worthless, gets in.”

There were approximately 163 allopathic medical schools in the United States and Canada at the time of this report and Flexner visited 155 of them. He notes in his report that during the 100-year time before his report, there were over 450 different medical schools established, most of which had come and gone by the time of this study. For instance, the city of Chicago had 14 medical schools, the state of Missouri 47 schools and the state of Indiana 27 schools.

There were 8 Osteopathic medical schools in the United States in 1910 but to the best I can understand, Flexner did not visit many of them. He did include the then-newly established Philadelphia College of Osteopathic Medicine as one of the 7 Pennsylvania schools visited. There were no osteopathic medical schools in Canada in 1910. In addition to osteopathy, there were 10 eclectic medical schools that focused on herbal remedies and 22 homeopathic medical schools at the time of the report. continued on next page > SPRING 2025 | Lehigh County Health & Medicine 21

continued from previous page Today there are 156 allopathic medical schools, and 40 osteopathic medical schools in the United States. There are 5 homeopathic organizations, not medical schools, with 4 in the United States and 1 in Canada, that offer training and certification in homeopathy. To the best of my knowledge, only the State of Arizona licenses homeopathic practitioners.

The following are the (paraphrased) six major findings of the Report: 1. For 25 years there has been an enormous over-production of uneducated and ill-trained practitioners (that is a quite damning statement to start the report).

2. Over-production of ill-trained men is due in large part to the existence of a very large number of commercial (proprietary) schools.

3. Until recently the conduct of a medical school was a profitable business, because the methods of instruction were mainly through didactic lectures.

4. The existence of many of these unnecessary and inadequate schools has been defended by the argument that a poor medical school is justified in the interest of the poor boy.

5. A hospital under complete educational control of the medical school is as necessary as a laboratory of chemistry or pathology.

6. Throughout the eastern and central states, the movement under which the medical school articulates with the second year of college has already gained such impetus that it can be regarded as practically accepted.

clinical experience in hospitals and dispensaries that would be affiliated with medical schools, allowing students to apply their knowledge in real-world settings.

5. Specifically, there should be a Reduction in the number of medical schools. The Report called for the closure of the proprietary and substandard medical schools that did not meet the proposed standards.

6. About Licensing and accreditation. The report urged stricter licensing of graduates and an accreditation process to assure that medical schools met the new standards.

7. And a recommendation to focus on the quality of medical graduates as opposed to the number of medical graduates.

The Flexner Report received a mixed reception in the medical community. Those schools already affiliated with colleges and universities were largely positive, while the proprietary schools were clearly threatened. The demands of this Report would put a strain on already inadequate funding streams for medical education. It was clear that tuition fees alone would be inadequate to support the future medical school.

Some have held that the Report reflected racist and sexist views that were inappropriate, while others would say that the report reflected the segregated and gender-biased norms of the time in 1910. It did result in the closure of five of seven historically Black medical schools, many in rural areas, with only the Howard University and Meharry Medical College being left to train African/American physicians. Today, there are four historically Black medical schools in the US.

There were 7 major recommendations of the Report:

While Elizabeth Blackwell was the first female graduate from one of our medical schools (the Geneva Medical College, in Geneva, NY) in 1849, the number of female medical students in 1910 at the time of the Flexner report was very low. Dr. Blackwell had applied to many schools and was refused admission.

1. There should be greater Standardization of Medical Education. The Report recommended that medical schools should adhere to high standards of admission and education, requiring at least a high school diploma and two years of college studies including premedical courses in biology, chemistry, and physics.

Today, just under 55% of our entering medical students are female. Enrolling qualified historically underrepresented students into our medical schools continues to be a challenge. Data reflects that in recent classes of students entering our medical schools, 25% are Asian/Pacific, 11% are Latino, 8.5% are African/ American, and 0.2% are native American/Alaskan native.

2. There should be Integration of Medical Schools with Universities. The Report advocated for medical schools to be part of a larger university system to ensure oversight, resources, and academic integration.

In summation, clearly the Flexner Report has played a defining role in the establishment of medical education as we know it today. It has had a lasting impact leading to more qualified candidates for training, the establishment of standardized curricula, improved training of students, and a focus on scientific research, and led to the earliest forms of post-graduate medical education, giving rise to the many residency and fellowship programs which are essential to professional development and quality patient care.

In summation, “Our hope is that this report will make plain once and for all, that the day of the commercial medical school has passed.”

3. There should be greater emphasis on Scientific Method and Research in the teaching. The Report emphasized the importance of scientific research and the scientific method in medical education, which includes a strong foundation in laboratory sciences.

4. There should be more Clinical Experience. The Report emphasized that medical education should include practical 22 Lehigh County Health & Medicine | SPRING 2025

This article was originally published in the Fall 2024 edition of Medical Record magazine. It has been updated.

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