Lancaster Physician Fall 2022

PERSPECTIVES FROM LOCAL Health Care Systems

By Susan Shelly

End ofLife Care

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KETAMINE

A VIABLE TREATMENT FOR DEPRESSION AND CHRONIC PAIN? BY DAVE SIMONS, DO

REACH OUT AND READ PREPARING OUR YOUNGEST PARTNERS IN HEALTH FOR A LIFETIME OF SUCCESS BY CONOR M. O'DAY, MHA

REFLECTIONS ON MANAGING A HEALTH CARE TEAM THROUGH THE PANDEMIC –AND BEYOND BY DIANE FLETCHER

for Your Practice

2022 contents

BOARD OF DIRECTORS

OFFICERS

Stacey S. Denlinger, DO

President

UMPC Highlands Family Practice & UPMC Wound Healing Center

Sarah E. Eiser, MD

President Elect

Penn Medicine Lancaster General Health Physicians Lancaster Physicians for Women

Robin M. Hicks, DO

Vice President

UPMC Supportive Care & Palliative Medicine

Stephen T. Olin, MD

Treasurer

Penn Medicine Lancaster General Health Walter L. Aument Family Health Center

Laura H. Fisher, MD

Immediate Past President Lancaster Family Allergy

DIRECTORS

Robert K. Aichele, Jr., DO

Marco A. Cunicelli, DO | Resident Lena Dumasia, MD

David J. Gasperack, DO Lauren M. Hammell, DO | Resident James M. Kelly, MD

Karen A. Rizzo, MD, FACS

Christopher R. Scheid, DO Susanne Scott, MD, MPH

Danielle Rubinstein, DO

EDITORS

D awn Mentzer

Bet h E. Gerber

Lancaster City & County Medical Society

Robert K. Aichele Jr., DO

Immediate Past President Penn State Medical Group - South Lancaster

LancasterPhysician is a publication of the Lancaster City & County Medical Society (LCCMS). The Lancaster City & County Medical Society’s mission statement: To promote and protect the practice of medicine for the physicians of Lancaster County so they may provide the highest quality of patient-centered care in an increasingly complex environment.

Best Practices

WellSpan to Use Shockwave to Break Up Heart Blockages

Penn Medicine Lancaster General Health Will Open Central Pennsyl vania’s Only Proton Therapy Center

In Every Issue

President’s Message

Healthy Communities

Special Financial Series

Passion Outside of Practice

Content Submission

of Life Care

Relationship-Based Care Starts from Ground Up at Penn State Health’s New Lancaster Medical Center

Practice Management Insights: Reflections on Managing a Health Care Team through the Pandemic — and Beyond

&

The Lancaster Physician magazine welcomes recommendations for editorial content focusing on medical practice and management issues, and health and wellness topics that impact our community. However, we only accept articles from members of the Lancaster City & County Medical Society. For more information or submission suggestions, please email bgerber@lancastermedicalsociety.org.

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THE LATEST UPDATES BY FOLLOWING US ON SOCIAL MEDIA

President’s Message

It seems like the last two years have flown by quickly. While COVID-19 did not allow me to see as many of you in person as I would have liked, it was with great joy that we were able to have our 178th Annual Meeting and Awards Celebration of the Lancaster City & County Medical Society in person this September. Our speaker, Denise Johnson, M.D., from the PA Department of Health, provided information on disparities and challenges in access to care for women in Pennsylvania.

It was also a pleasure to honor Dr. Michael Ripchinski with the Healthcare Leadership Award, recognizing a physician or lay person for outstanding work in the health care field. Dr. Ripchinski was instrumental in the formation of the Vaccinate Lancaster Coalition, coordinating health systems, government organizations, and our own LCCMS to achieve more than 224,000 vaccinations of area residents. I would encourage all of you going forward to put aside partisan politics and misinformation regarding public health measures, including vaccinations. As physicians and scientists, stick with facts and strive to set an example with your own vaccinations and those of your families and children. Seek to give your patients research-based, factual information.

Going forward, I would also encourage you to step up for health care advocacy. You are an important resource for an incoming PA legislative body with very little to no expertise in medical issues. Reach out to your local representatives in your districts and introduce yourself, offer to serve as a source of healthcare information. Our local Society and PAMED are happy to help with talking points. Establish relationships now. Educate yourself before elections and be well informed about the PAMPAC supported candidates. Recent actions such as a change in venue for medial malpractice cases and prior authorization for necessary patient treatments are controlled by special interest groups and require all our participation to enact more favorable change. Thank you to those who attended our recent legislative breakfast, and please look for more opportunities ahead.

I look forward to connecting further at our upcoming social and future educational opportunities. We have a membership mixer planned with the Lancaster Medical Heritage Museum, and, at our Holiday Social the first weekend in December, we will honor and award scholarships to an outstanding group of applicants who we hope will be our future colleagues.

It has been a pleasure to serve as the president of the Lancaster City & County Medical Society. Please join me in welcoming our new president, Stacey Denlinger, a compassionate, energetic, and intelligent physician who will do an excellent job.

LHF

Laura H. Fisher, MD Lancaster Family Allergy

Visit lancastermedicalsociety.org

Wondering how to keep up with important LCCMS and PAMED news and updates?

Follow us on Facebook at www.facebook.com/LCCMS

Visit our website at www.lancastermedicalsociety.org

Blockages

ellSpan cardiologists are open ing severely calcified heart blockages with a new tool: sound waves.

Called “Shockwave,” the technology is designed to treat those who have dense, diffi cult-to-open blockages in their heart’s arteries, a condition often referred to as “hardening of the arteries.”

Cardiologists using Shockwave employ a special balloon for the procedure, guiding it to the blockage of built-up plaque within the walls of the artery. There, it emits ultrasonic

frequencies that crush the blockage and safely push the pulverized pieces out of the way. Once the artery is open, cardiologists can place a stent, a tiny tube that acts like a scaffolding, to hold the artery open.

WellSpan Ephrata Community Hospital’s cardiology team began using the procedure in mid-October. It is already employed at Well Span York Hospital, WellSpan Chambersburg Hospital, and WellSpan Good Samaritan Hos pital. The procedures are done in the cardiac catheterization labs at the hospitals.

“We are looking forward to having this new technique to help our patients at Ephrata,” said Dr. Julian Esteban, an interventional cardiologist at WellSpan Ephrata Community Hospital. “We know this will provide them with excellent results so they can live their best lives.”

Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. The type of heart disease treated by Shockwave, coronary artery disease, is the most common kind of heart disease, killing almost 383,000 patients in the U.S. in 2020, according to the U.S. Centers for Disease Control. About 20 percent of those deaths occur in adults less than 65 years old.

Patients who are prone to heavily calcified, hard blockages includes people with diabetes, people with high cholesterol, and smokers. About 30 percent of patients have this type of blockage.

Also known as intravascular lithotripsy, Shockwave works on the same principles as lithotripsy used in the kidneys to break up kidney stones.

To break up blockages, cardiologists also can use a tiny drill — sometimes compared to a “Roto-Rooter” drill used to clean out pipes in homes. That tiny drill can be used in concert with Shockwave, giving cardiologists an additional tool to open up stubborn or hard blockages.

Shockwave can sometimes give new hope to patients who have been turned down for bypass surgery due to their heavily calcified arteries. It safely unblocks the artery while minimizing risks.

“This is just one tool we offer our patients to treat their cardiac issues as we offer them leading-edge care,” Esteban said.

WellSpan Ephrata Community Hospital’s team in a cardiac catheterization lab, where Shockwave technology will arrive in October.

Practices

Pamela J. Boimel, MD, PhD, explains that proton therapy uses proton energy (positively charged particles) instead of standard X-rays to destroy cancer cells. While more powerful than standard radiation treatments, it is safe for patients, due to the unique way proton beams enter the body.

PENN MEDICINE LANCASTER GENERAL HEALTH

Will Open Central Pennsylvania’s Only Proton Therapy Center

Proton therapy — a revolutionary radiation treatment that targets cancer cells with pinpoint accuracy, making it possible to safely treat tumors near critical organs or highly sensitive areas of the body — will be available to patients in Lancaster later this fall.

Only two centers in Pennsylvania will offer proton therapy: Penn Medicine’s Roberts Proton Therapy Center in Philadelphia, and now Penn Medicine Lancaster General Health. LG Health’s new Proton Therapy Center, located at the Ann B. Barshinger Cancer Institute, represents a $48 million investment in innovative and essential patient care in Lancaster County and surrounding communities.

The new Proton Therapy Center is the latest milestone in LG Health’s continuing efforts to deliver advanced cancer treatment locally. The Cancer Institute, which opened in 2013, now cares for 15,000 patients

per year, demonstrating LG Health’s nearly 130year commitment to its mission of advancing the health and well-being of the community.

Pamela J. Boimel, MD, PhD, Medical Direc tor, Radiation Oncology, and Director, Proton Therapy, at LG Health’s Ann B. Barshinger Cancer Institute, explains that proton therapy uses proton energy (positively charged particles) instead of standard X-rays to destroy cancer cells. While it’s more powerful than standard radiation treatments, it is safe, due to the unique way proton beams enter the body.

“Traditional radiation enters the body from one side and exits the other side. Healthy tissues in the path of these X-rays are exposed to radiation,” she said. “With proton therapy, we can tightly mold the proton beam to fit the shape and depth of individual tumors. We also control the path of the beam so it travels directly to the tumor and stops, without continuing through the body. This spares more healthy tissue and may result in fewer hospitalizations and lower risk of side effects or complications for some cancers.”

Proton therapy is perhaps the most advanced treatment for cancer tumors located close to critical organs and highly sensitive areas of the body, such as the brain, spinal cord, heart, lungs, head and neck. It also provides new options for patients whose cancers can’t be completely removed by surgery, or who

have previously received standard radiation in the same area.

LG Health’s new Proton Therapy Center builds on Penn Medicine’s proton therapy expertise led by the Roberts Proton Therapy Center in Phila delphia, which opened in 2010 and is the largest center in the world for both proton and standard radiation. Penn Medicine has treated more than 8,000 patients with proton therapy and provided training to more than 70 percent of the clinicians using this technology across the world.

Proton therapy is a significant addition to the comprehensive cancer treatment options offered at the Cancer Institute, including a broad array of radiation-therapy services. LG Health’s radiation department is fully integrated with the Penn Medicine team in Philadelphia.

LG Health is able to treat a multitude of cancers using proton therapy, including brain and spinal tumors; breast cancer; gynecologic cancers; gastrointestinal cancers; head and neck cancers; lung cancer; lymphoma; mesothelioma; prostate cancer; and sarcomas.

Compared to standard radiation therapy, pro ton therapy reduces radiation to healthy tissues by 50–70 percent, with fewer hospitalizations, and lower risk of side effects or complications reported for some cancers. For example, patients with head or neck cancers often experience fewer side

effects — such as loss of taste, smell, and ability to salivate — than with standard radiation ther apy, resulting in better quality-of-life outcomes.

The new Lancaster center also alleviates travel and related burdens for local patients, who pre viously had to travel to Philadelphia to receive proton therapy. Patients typically receive proton therapy treatments five days a week for several consecutive weeks.

As part of Penn Medicine, the Ann B. Barshinger Cancer Institute offers a unique combination of clinical expertise and person alized support services at every step — from diagnosis to treatment to survivorship and follow-up care — all in the comfort of a community setting. Multidisciplinary teams of oncology experts work together to ensure the highest level of patient care close to home. This includes a continually expanding list of treatment options, from the latest technologies and surgical procedures to next-generation immunotherapies and clinical trials.

LG Health recently began offering CAR T-cell (Chimeric Antigen Receptor T-cell) immuno therapy, the first FDA-approved gene therapy that trains a patient’s own immune cells to fight cancer more effectively. It was developed by work led at Penn Medicine in Philadelphia, which has been at the forefront of immunotherapy research for decades.

T-cells, a type of white blood cell, are removed from the patient and reprogrammed to find and destroy cancer cells when reinfused into the bloodstream. The treatment brings new hope to patients with certain types of aggressive blood cancers that have not responded to other therapies.

“We are committed to bringing advanced medicine to our patients in Lancaster and Central Pennsylvania,” said Randall A. Oyer, MD, the Cancer Institute’s Executive Medical Director. “For families in our community to have local access to the kind of care rarely seen outside a major academic medical center — it’s nothing short of life-changing.”

LG Health’s new Proton Therapy Center is located adjacent to the Ann B. Barshinger Cancer Institute at 2102 Harrisburg Pike, Lancaster.

Proton therapy is a revolutionary radiation treatment that targets cancer cells with pinpoint accuracy, making it possible

highly sensitive areas of the body, such as the brain, spinal cord,

neck.

Best Practices

PATIENT, FAMILY, TEAM, SELF

Relationship-Based Care Starts from Ground Up at Penn State Health’s New Lancaster Medical Center

It’s lunchtime on a Wednesday, and even though Penn State Health Lancaster Medical Center won’t start accepting patients until Oct. 3, tables in the cafeteria are full.

Men and women sit in pairs by the yawning windows that bracket the rolling central Penn sylvania countryside. They face one another. “Knee to knee and eye to eye,” instructs Ann Rollman, the nurse educator who is there to teach them.

When Rollman scrapes a mallet over the keys of a toy xylophone, one person from each pair will describe to their partner who they are in a series of “I am” statements. They’ll start with their name and what they do for a living. Then they’ll move on to other descriptors. “I am fun-loving” or “I am a world traveler.”

Cheryl Bealer, left, and Sara Grove, registered nurses at Penn State Health Lancaster Medical Center, participated in a Relationship-Based Care event.

It’s uncomfortable. Brows furrow as speakers search for the right words. When Rollman again plays her xylophone indicating time is up, a few of the speakers look relieved. But the onus the entire time was actually on the listeners, who must report back to the speaker what they heard.

The exercise is all about active listening, Rollman says, one of the cornerstones of Rela tionship-Based Care, a system every employee at Lancaster Medical Center will learn, from environmental services personnel to the chief executive officer. Relationship-Based Care focuses on patients and their families, teamwork and health care workers themselves.

“We’re establishing the foundation for care,” says Barbara Zuppa, vice president and chief nursing officer at the hospital.

FOCUSING ON PRIORITIES

The program incorporates principles of relationship-based care with other health care principles and includes sessions such as this one, led by Rollman, a nurse educator with four decades of experience. Since the 341,000-square-foot, 132-bed hospital on State Road in Lancaster opened to staff for training in July, its employees are finding out how Rela tionship-Based Care works day by day, patient by patient. A Relationship-Based Care council made up of representatives throughout the hospital is helping to coordinate their efforts.

Other hospitals have completed similar assessments of relationships between employees, themselves, and their patients, but often in

response to situations — when employee selfcare begins its inevitable lag or when increases in volume and the rush of the work pushes the patient experience down on the priority scale.

During the seminars, some of the lessons Rollman and her colleagues teach are phil osophical. For example, she draws a small circle inside a larger circle on a white board. The small circle represents everything you can control. The outer circle represents all that is outside your control. The circle you focus the most attention on always gets bigger. At the same time, the other circle becomes smaller. In other words, the more you focus on what you can do, the less problems outside that realm will matter.

In the hectic world of a hospital, keeping the focus on priorities can be a challenge. “It’s also really rewarding,” said Christina Bowers, a float nurse at Lancaster Medical Center. Bowers’ job will require her to move from department to department, and she’ll work harder to achieve the three tenets of Relationship-Based Care.

STORYTELLING

But at Lancaster Medical Center, the focus on patients and families, teamwork, and employee self-care will take center stage and guide decisions. That’s why she came here. “It’s so nurse-focused,” she said. “We have a lot of input.”

And so do many others. Cheryl Bealer, a certified wound ostomy continence nurse, said she’s been impressed at the all-inclusive nature of the training. In her session with Rollman

and throughout her time during the hospital’s planning stages, she’s been rubbing elbows with top hospital brass and upper-echelon executives.

Storytelling among participants is an important component of Relationship Based Care — and not just the eye-to-eye, knee-to-knee variety, which exemplifies the kind of laser-like focus you need to be truly patient- and family-centric. During their Relationship-Based Care training sessions, employees share stories of moments where relationship-based care worked.

LISTENING WITH INTENT

During her session, Bealer shared a story from another Penn State Health hospital — Penn State Health Milton S. Hershey Medical Center. She’d taken her 12-year-old son there for a procedure around Thanksgiving. Before the hospital was scheduled to distribute a special holiday meal, her son asked for a grilled cheese sandwich. She told him it probably wouldn’t happen because the hospital had so much to coordinate for the holiday.

His meal arrived at lunchtime. When she removed the cover, she found not the standard turkey dinner, but a grilled cheese sandwich. Her son was thrilled.

“There are many other organizations where that wouldn’t have occurred,” Bealer said. “It was very relationship-based for my child. It wasn’t just listening. It was listening with intent.”

Dee Brown, a registered nurse at Penn State Health Lancaster Medical Center, participates in an ice breaker during a Relationship-Based Care event. Ann Rollman leads the Relationship-Based Care event.

Best Practices Practice Management Insights

ADDRESSING THE ISSUES, CHALLENGES, AND OPPORTUNITIES THAT IMPACT TODAY’S MEDICAL PRACTICES

Reflections on Managing a Health Care Team through the Pandemic — and Beyond

The most recent two years in health care have taught us so many things. We have learned how to navigate a pan demic while continuing to provide quality medical care in spite of supply chain issues, vaccine discussions, teaching while learning telemedicine, and watching tents being erected in our parking lots. Those of us who have been in health care for many years recall the birth of electronic medical records, the rise and fall of HMOs, and private practices opting to align with large healthcare systems. These changes were all accepted with courage and a “can do” attitude but never prepared us for the biggest challenge of our careers, “The Great Resignation.” I do not think any of us were prepared for the vacancies in an industry that was focused on weathering the pandemic storm, from the front lines, with limited staff.

DIANE FLETCHER, Practice Manager, Penn Medicine Lancaster General Health Physicians Lancaster Physicians for Women

Our paramount concern became embracing and protecting our staff. We learned to have personal conversations, discussing barriers that would keep employees from coming to work, watching for daycare and school closures caused by COVID exposures, understanding and accepting last-minute schedule changes, and embracing employee volunteers who were willing to help out when emergencies arose. We cross-trained staff, allowing greater depth in our capabilities, while empowering our workforce with greater trust and more responsibility. Our staff signed up for extra shifts in departments that felt stronger vacancy impacts, and we “loaned” employees to those with stronger needs than our own, all for the greater good — our patients.

Our Employee Health team monitored positive COVID exposures, and staff isolated when eating lunch, knowing that taking off a mask to eat, in close proximity to co-workers, could jeopardize the health of the entire staff. In the early days of the pandemic, exposures were treated like positive results and quarantines were frequent. Plexiglas barriers were placed in all patient-facing areas, creating distance between staff and patients. Employees were afraid they would take the virus home to their family and opted to remain home, thinking it would last “a few weeks.” Parents opted to stay home with their children instead

of navigating daycare exposures and school closures. Some in our aging workforce opted for retirement, while some simply had enough.

We became keenly aware that we needed to provide some flexi bility, work-life balance, creativity, and, most of all, grace, to those employees who chose to weather the storm with us. We embraced remote work, separating into two teams, working from home every other week. This allowed for the flexibility each team needed to care for children, aging parents, and themselves. Team exposures and those with positive COVID tests could rest or continue to work from home thanks to great strides in IT and insurance reimbursement for telemedicine appointments.

Those who remained became Healthcare Heroes, the ones who weathered the storm, bending but not breaking in the wind as they waited for the rainbow to signal an end to the storm. We are so happy for those who have continued in health care despite uncertain times and cannot wait to embrace those whose heath care careers have yet to begin. We are warriors, a little bruised but prepared to take on whatever health care looks like tomorrow.

Healthy Communities

ketamine

A Viable Treatment for Depression and Chronic Pain?

DAVE SIMONS, DO Community Anesthesia Associates

Ketamine, a medication wellknown to anesthesiologists, has multiple roles in perioperative anesthetic practice including as a sedative, induction agent, and anal gesic. Ketamine is an NMDA antagonist derived from phencyclidine. It is known for its unique effects compared to other anesthetics including dissociation, cardiac stimulation, preservation of airway reflexes,

and bronchodilation.1 Sub-anesthetic doses of ketamine have been used for acute pain relief and mild sedation during painful procedures, particularly in emergency department settings. Now, new roles for ketamine are emerging. Increasingly, ketamine is being utilized in outpatient settings for its purported role in the treatment of chronic pain conditions and depression.

In multiple randomized-controlled trials dating back to the 1990s, sub-anesthetic doses of ketamine (0.2-0.5mg/kg IV) have been shown to result in a rapid anti-depres sant effect. Studies show onset of effects as early as four hours after a 40- to 60-minute ketamine infusion with a peak anti-depressive effect at 24 hours.2 However, findings are less consistent regarding duration of action with effects lasting anywhere from three to seven days and rarely lasting more than two weeks.2 Therefore, patients utilizing ketamine infusion therapy for depression may require multiple infusions for adequate treatment of depressive symptoms.

In 2019, the FDA approved esketamine, an enantiomer of ketamine, for intranasal delivery as a therapy for treatment-resistant depression and major depressive disorder.3 This medication is used as an adjunct to a conventional antidepressant. It must be administered in a clinical setting and is to be used for rapid relief from depression symp toms. Typically, it is administered at a dose of 56-84mg twice per week for up to four weeks followed by once weekly after week four.3 However, the optimal frequency of long-term maintenance therapy is unknown.

Increasingly, ketamine infusion therapy has been used for the treatment of both chronic neuropathic and non-neuropathic pain. A meta-analysis of 211 patients in seven different randomized-controlled tri als revealed a significant analgesic effect in patients undergoing IV ketamine infusions vs. placebo.4 Pain scores were reduced for between two to 14 days after an average infusion lasting five hours with a median dose of 0.35mg/kg. Ketamine was shown to have proven analgesic for neuropathic pain, non-neuropathic refractory cancer pain, and complex regional pain syndrome. Efficacy was

not shown for its role in treating fibromyalgia or phantom limb pain.

In 2018, the American Society of Regional Anesthesia and Medicine (ASRA), the Ameri can Academy of Pain Medicine (AAPM), and the American Society of Anesthesiologists (ASA) released consensus guidelines on the use of IV ketamine infusions for chronic pain.5 They list guidelines on indications, dosing range, relative contraindications, pre-infusion testing, positive response, and administering personnel. Almost all the recommendations have a low certainty of benefit with Grade B or C evidence per the U.S. Preventative Task Force grading of evidence.5 Nonetheless, the presence of guidelines aids physicians in the safe use of ketamine for depression and certain chronic pain conditions.

Articles in media outlets such at the New York Times and Forbes have only increased public awareness of ketamine treatments for various medical conditions. With the increasing off-label use of ketamine, there has been a rapid increase in the number of ketamine clinics. Many of these clin ics are cash-only and may not be staffed by a board-certified interventional pain physician. In most hospital settings, the administration of ketamine is overseen by an anesthesiologist or emergency medicine physician. Typically, patients have hemo dynamic monitoring including monitoring of blood pressure, heart rate, and pulse oximetry. With limited data on dosing strategies and lack of proper monitoring of patients undergoing ketamine infusions, there is the risk of serious harm occurring to patients. Ketamine clinics also advertise that ketamine can be used to treat PTSD, OCD, anxiety, alcohol and drug addiction, opioid withdrawal, and eating disor ders. 6 Websites for these clinics advertise miraculous responses in a relatively short amount of time utilizing what is marketed as “psychedelic medicine.” While ketamine has been shown to be useful for certain medical conditions, the best approach to both pain management and mental health treatment remains a multi-modal, multi-disciplinary approach.

There is no doubt ketamine has useful applications in both pain management and psychiatry. It has proven effects in treating certain types of pain and particular mental health disorders. There is still much data needed to evaluate duration of treatment and the long-term effects of serial ketamine infusions. Chronic pain physicians will be at the forefront of this emerging modality as more research results emerge. While ketamine has been around for over 50 years, its new uses are both exciting and promising in the future of clinical pain management.

REFERENCES

1. Culp C, Kim HK, Abdi S. Ketamine Use for Cancer and Chronic Pain Management. Front Pharmacol. 2021;11:599721. Published 2021 Feb 2. doi:10.3389/ fphar.2020.599721

2. Corriger A, Pickering G. Ketamine and depression: a narrative review. Drug Des Devel Ther. 2019;13:30513067. Published 2019 Aug 27. doi:10.2147/DDDT. S221437

3. Nijs M, Wajs E, Aluisio L, et al. Managing Esketamine Treatment Frequency Toward Successful Outcomes: Analysis of Phase 3 Data. Int J Neuropsycho pharmacol. 2020;23(7):426-433. doi:10.1093/ijnp/ pyaa027

4. Orhurhu, Vwaire MD, MPH*; Orhurhu, Mariam Salisu MD, MPH†; Bhatia, Anuj MD, FRCPC‡; Cohen, Steven P. MD§,‖ Ketamine Infusions for Chronic Pain: A Systematic Review and Meta-analysis of Randomized Controlled Trials, Anesthesia & Analgesia: July 2019 - Volume 129 - Issue 1 - p 241-254 doi: 10.1213/ANE.0000000000004185

5. Cohen SP, Bhatia A, Buvanendran A, et al. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesi ologists. Reg Anesth Pain Med. 2018;43(5):521-546. doi:10.1097/AAP.0000000000000808

6. Walsh, Z., Mollaahmetoglu, O., Rootman, J. Golsof, S., Keeler, J., Marsh, B., Morgan, C. (2022). Ketamine for the treatment of mental health and substance use dis orders: Comprehensive systematic review. BJPsych Open, 8(1), E19. Doi:10.1192/bjo.2021.1061

Reach Out and Read

Preparing Our Youngest Partners in Health for a Lifetime of Success

CONOR M. O’DAY, MHA Ambulatory Operations and Practice Manager - Primary Care, Penn Medicine Lancaster General Health Physicians

While pediatric patients have been fortunate to show rela tive viral resilience during the age of COVID-19, health care practices occasionally need to remind themselves that they remain a vulnerable population at large. These are, after all, the most formative years of our youngest patients’ lives, and both clinicians and parents alike should never take that level of neuroplasticity for granted. It may be hard to believe now, but kids may not be so receptive to our suggestions forever!

One of the ways Penn Medicine Lancaster General Health (LG Health) has sought to improve the pediatric experience, as well as clinical outcomes of preventative Well Child visits, has been expansion of its participation with the non-profit Reach Out and Read (ROR) program. Per the organization’s website, ROR is a national advocate for daily reading and other language-rich activities, aimed at helping to stimulate healthy brain development and strengthen meaningful family bonds. The integration of this priority into our network of primary care practices is an important catalyst for healthy childhood development. Through partnering with Scholastic and other approved vendors, healthcare organizations are able to acquire age-appropriate reading material for a dis counted rate to distribute to children during their routine visits to the doctor. The dread and stigma of needles can be replaced (or at least diminished) with anticipation of a new book instead.

On average, more than 80 percent of the volume of the human brain is already formed by the time children reach age 3. Neural connections related to our sensory abilities, such as language interpretation, are simul taneously being formed and reinforced. As these skills develop throughout infancy, they become the foundation for more complex cognitive function. The cascade continues: Elementary school reading level is in turn a prime indicator for the pivotal shift of

students transitioning from “learning to read” to “reading to learn.” Failure to thrive at this stage has the potential to pave the way for more serious disadvantages, asso ciated with outcomes related to graduation rate and income decline, not to mention reinforcement of a dangerous cycle. Many of the current and future battlegrounds of primary care innovation will be related to advancement of health literacy, healthcare equity for previously underserved popula tions, and the evolving role of the patient as not only a stakeholder but an active member of their care team. It is in the best interest of all parties involved to ensure the significance of reading is implemented into a patient’s care plan from practically Day One.

For many years, a handful of academic primary care locations within LG Health were actively trialing the ROR partnership. In January 2020, the decision was made to expand operations to 26 primary care sites throughout Lancaster, Lebanon, York, and Chester counties. This included the appli cation of nearly 250 physicians, advanced practice providers, and administrative site coordinators for a mandatory medical education session. We needed to assemble practice summaries for de-identified patient demographics and assign medical consul tants to assist with project rollout and staff questions. Unknown to us at the time, the global pandemic was getting underway as well. Nevertheless, the project continued to gain steam over the next six months, moving through the various stages of budgeting, enrollment, training, and IT support before a staggered launch in July of that same year.

Practices are responsible for maintaining their own inventory of individual book catalogues. A physician and administrative champion for the healthcare organization at large are assigned to assist with prac tice or site coordinator needs. A regional coordinator from ROR is also available to help with some of the higher-level challenges that new sites may encounter,

such as issues with application status or supply chain.

Book selections are broken down into several age groups with increasing com plexity, ranging from one month through five years old. The handoff can double as both an enjoyable staff interaction and also a diagnostic tool, with providers or nurses utilizing the recommended S.A.F.E.R. pathway to glean valuable clinical insight:

• Show the book early and share it with the child.

• Ask the parent about reading activities in the home and assess the response.

• Feedback: Give feedback to the parent about your observations of the child’s interaction with the book.

• Encourage the parent to read aloud daily and express the benefits of becoming a reader.

• Refer the family to a family literacy program if indicated and record intervention in the chart.

These steps can provide useful anticipa tory guidance for subjects such as bedtime routines and school preparedness. Clinicians may also utilize developmental surveillance for the parent-child relationship, assessing familiarity of the book and asking parents about general reading activities in the home.

In our first fiscal year of full site participa tion, the LG Health primary care network has distributed an extensive library of over 21,000 age-appropriate books. Many sites have seen significant year-over-year improve ments in Well Child visit attendance and Likelihood to Recommend practice scores. Longer term, research opportunities are

Healthy Communities

abundant to establish trends indicating improved preventative visit adherence, compliance with child hood vaccination schedules, and other potential clinical indicators.

It is tremendously important to take the steps now in forming the healthy habits that will help make our youngest patients their own greatest advocates in health. Get involved or learn more about activating your family medicine site as a participating location at reachoutandread.org.

SOURCES

Council on Early Childhood (2014). Literacy Promotion: An Essential Component of Primary Care Pediatric Practice. Ameri can Academy of Pediatrics Publications, 404-409. Retrieved from https://publications.aap.org/pediatrics/article/134/2/404/32944

Harvard University, Center of the Developing Child (2007). The Science of Early Childhood Development. Retrieved from https:// developingchild.harvard.edu/resources/inbrief-science-of-ecd

Reach Out and Read (2022). https://reachoutandread.org

Assurance in the

Ken Eshleman, CFP® ken.eshleman@domaniwealth.com

Angie Stephenson, CFP®, CPA/PFS angie.stephenson@domaniwealth.com

CENTRAL PA’S ONLY PROTON THERAPY CENTER

Pamela J. Boimel, MD, PhD Medical Director, Radiation Oncology Director, Proton Therapy Penn Medicine Lancaster General Health

Cancer patients have access to the most advanced proton therapy center at Penn Medicine Lancaster General Health.

A global leader in proton therapy, Penn Medicine brings this life-saving treatment to Central PA. Proton therapy uses a precise beam of powerful energy to attack only the cancer cells and avoid healthy tissue, which can result in fewer side effects and a better quality of life during treatments. From our renowned team of experts to the latest technologies and advanced treatment options, the Ann B. Barshinger Cancer Institute is unmatched at bringing comprehensive cancer care to our area. To refer a patient, visit LGHealth.org/CancerReferral or call 717-544-9417.

Ann B. Barshinger Cancer Institute

Spending, Bear Markets, and Finances for High Earners

ANGIE M. STEPHENSON, CFP®, CPA/PFS Partner and Senior Wealth Advisor, Domani Wealth

The market has not been comforting in 2022.

It’s been unnerving to see the headlines.

It can be panic-inducing to check your investment account balances, watch graphs of market movements, and compare percentages.

You probably have heard phrases such as “stay the course” and reminders that your investments and your financial plan take a long-term view.

You know it requires patience, calm, and in a sense, putting blinders on to help your finances weather through the market volatility.

For physicians entering their pre-retirement years, it can be particularly disconcerting. Checking spending and investment returns daily isn’t something most of us prioritize, and physicians have other concerns — such as patient care, lack of staffing, and operational issues — that take precedence. When we do have a moment, it can seem disappointing and overwhelming to think about an approaching retirement with the way this year has gone for financial markets.

We know we should focus on composure, and we all try our best. However, for many of us, doing something will help us focus more on the long-term as we think about our retirement years. It’s hard not to be reactive, so in a time like this, how can physicians and other professionals be proactive, so their investments are positioned better when the markets begin to improve?

Liquidating

First, a quick note on what not to do.

It can be tempting to liquidate investments during an economic downturn. One reason is because it can make you feel safer with more cash on hand should you need it. It can also be tempting to pull dollars out of the markets because you feel you don’t know what will happen in the future; you believe it will help protect your finances from negative market trends.

It is definitely hard to predict with any certainty when the markets will begin to level out and improve where you would reinvest the cash.

By moving to cash, you’re trying to time the markets – to guess correctly when a “good” time to put money back in will be. Studies have shown that pulling money out to keep it safe during market downturns produces several consequences that could be harmful to a physician’s financial state:

• Missing out on market increases, which can often restore and improve investment portfolios

• Losing out on the diversification that can help keep your financial picture balanced

• Negative tax consequences by removing money from the markets, which could trigger a capital gain

Spending and Cash Needs

Sometimes, to avoid liquidating invest ments, it’s not just a matter of stalling the knee-jerk reaction of removing funds from volatile markets, it’s also an intentional financial direction to help keep your spend ing healthy.

Even with a comfortable income, when the economy isn’t as bright as it could be, it is important to evaluate your spending and cash needs.

One clear way to think about spending is dividing expenses into nondiscretionary and discretionary spending buckets.

Nondiscretionary expenses are items such as mortgage payments, rents, utilities, insur ances, healthcare, food, etc. These are bills and purchases we all simply need to make in our daily lives.

We all have discretionary spending as well, and in times like this it is important to evaluate whether you can delay some expenses or consider if they are necessary. It’s often in less-than-confident markets

when many of us reconsider discretionary spending items.

Discretionary Spending –Options to Slim or Remove

1. Buying a new car when the one you own is working and does not require major main tenance or repairs. Cars are in short supply and the prices have increased significantly. In some cases, there are bidding wars taking place on car lots.

2. If you have a car on lease and the agree ment is about to end, it may be advisable to view the buyout provisions of the lease. The terms for purchase of the leased car would have been set in prior years before inflation was a large factor. The price may be very competitive based on current car prices — even compared to used car markets.

3. Vacations involving trips closer to home can help save funds. This one is hard as many of us have been confined due to the COVID restrictions and want to venture out for mental health reasons. It’s a delicate topic but certainly an area of discretionary spending that makes sense to consider.

4. Home improvements or updates may be another source of discretionary spend ing. Suppose you had planned to add a screened porch, inground pool, or update bathrooms and kitchens. The decision to delay these types of projects may allow you to keep your portfolio intact to recover more fully when the markets return. We also know that building materials and labor costs have escalated significantly. Finding a contractor who can do the work is another large challenge. Due to demand, the prices may be more inflated than you want to pay right now.

5. Electric and energy costs have increased significantly and, in many cases, more than the current inflation rates. Evaluate the various energy providers to find the one with the lowest prices and lock in for a period of time. Both natural gas and elec tricity empower residents to choose their own providers and select from different

price options and contract terms. Sometimes you can lock in a year or two depending on the provider.

6. Consider your entertainment budget. We all need to enjoy life and spend time with family and friends. What is your budget for this? Do you eat out several times a week with friends? Entertainment may even include cable TV. If you have not checked with your provider to ask for a concession or reduced rate, it may be worth a call to them or look at other options that may be less expensive.

7. There are many other discretionary expens es most of us have every month. Look at all your spending to decide what is discretionary and perhaps can be adjusted for a period of time until the economy and markets improve.

Many of these expenses have also been affected by the large levels of inflation that we have been experiencing.

Thinking About Spending

Running your household spending is like running a business. When the economy is healthy, revenue is increasing, and markets are growing. This means a business can make more favorable discretionary spending deci sions. This may include profit share bonus amounts paid to team members, capital improvements of provider sites, staff gather ings for entertainment and connection, etc. When the economy isn’t as rosy, businesses re-evaluate some of their spending, whether business travel to a conference that could be attended virtually, project expansion, and team entertainment and gatherings.

We all should consider looking at our household budgets in a similar manner to running a business. Spending less will allow you to take less — or none at all — from your portfolio during these volatile periods.

If you are a physician in the stage of add ing to retirement goals and accounts as you near retirement age, reducing discretionary spending may allow you to invest more funds while the stock prices are lower. In a few years, you should look back at this downturn and realize that the valuations were attractive from a buyer’s perspective, allowing you to add more to your retirement nest egg during these times.

It can be challenging to move beyond the emotions evoked by an intense economic situation. For physicians, it’s also challenging to manage day-to-day financials on top of demanding roles and responsibilities in the medical field. Considering spending, saving, and market positions during challenging economic times can help physicians move confidently into their financial future.

EXPANDING OUR

NEUROSURGICAL EXPERTISE IN LANCASTER

We are proud to welcome neurosurgeon Dr. Daniel Calnan to our Neuroscience Institute team.

Dr. Calnan is a fellowship-trained vascular neurosurgeon who has advanced training in the specialties of brain aneurysms and interventional stroke treatment.

His areas of expertise include:

• Arteriovenous malformation

• Brain aneurysms

• Brain tumors

• Carotid artery disease

• Cerebral vascular disease

• Dural arteriovenous fistula

• Head & neck tumor embolization

• Intracranial atherosclerosis

• Interventional stroke treatment

• Traumatic brain injury

• Spine conditions (herniation, radiculopathy, trauma)

Dr. Calnan practices at LG Health Physicians NeuroScience & Spine Associates. To refer a patient, please call 717-569-5331.

Neuroscience Institute

Daniel Calnan, MD, PhD

Passion Outside of Practice

Swapna Deshpande, MD

It’s our pleasure to highlight a Lancaster City & County Medical Society member’s “passion outside of practice” in each issue of Lancaster Physician. Beyond their commitment to health care, LCCMS members have many other talents, skills, and interests that might surprise you. In this issue, we’re thrilled to feature Swapna Deshpande, MD, and her passion outside of practice.

exhilarating, satisfying, and cathartic. Then, lo and behold, I kept on telling stories!

Since then, I have been part of varied platforms such as Lancaster and York Story Slams, Moth storytelling events, Lancaster Extraordinary Give Story Slam, and ACP (American College of Physicians) Story Slam. We have started a CME (continuing medical education) activity as well where providers share a five-minute true story with their colleagues in the audience. The activity has been received quite well. We have had over 30 providers tell their stories — most of them being first time storytellers!

How long have you been participating in this activity?

Three and a half years. What started locally soon ventured into participation at the annual ACP Story Slam and the Moth and KevinMD storytelling events. Some degree of success followed as I won an international “I’m proud” short video competition with ACP, got published by KevinMD during the height of the COVID pandemic, and won the Story Slam at Lancaster Extraordinary Give! I must add that for me it’s not about winning. It is about telling, potentially making a good point through spoken words, and spreading kindness.

Storytelling

Would you briefly describe your passion outside of practice for those who might be unfamiliar with it?

I’ve got two! I grow tropical plants with fragrant flowers — Jasmines and Plumerias to name a few! And I’m a storyteller (Aren’t we all?), which I’ll elaborate on here.

I tell real-life true short stories on stage in front of live audiences. During the pandemic, I presented my stories virtually.

How did you develop an interest in your passion outside of practice?

About four years ago, an interesting turn of events occurred, spiraling from one to another, as I traveled alone to Atlanta. I very much wanted to tell that story and found a local platform, Lancaster Story Slam at the Zoetropolis theatre. I was extremely afraid of ascending on that stage at the time, but by the end of it, I found the experience

Why is this pursuit special to you?

The very first time, despite being extremely nervous, I found storytelling immensely gratifying. When you speak from your heart and try to spread goodness through your stories, it is pure bliss.

What else would you like readers to know about this passion?

We all have stories to tell. In our profession and in our lives, we deal with enormous pressure. But there are multiple rewarding moments and spreading our experience with the rest of the community can be quite healing for tellers and listeners alike. I persuade you all to tell your stories!

Internist, Penn State Health Medical Group – Cocoa

End ofLife Care

BY SUSAN SHELLY Writer

Although they are still relatively new fields, the use of palliative and hospice care is expanding quickly throughout the United States.

Surveys reveal that hospital-based palliative care services have increased by more than 25 percent during the past decade, with about two-thirds of all U.S. hospitals offering the services. In hospitals with more than 300 beds, 90 percent offer palliative care and hospice services.

Starting as a means of treating cancer patients in the very late stages of illness, palliative care has been expanded to serve a wider range of patients struggling with chronic symptoms and lately it is offered in earlier stages of chronic illness. In addition to services offered at hospitals, the use of palliative care is increasing at clinics and in home-based services.

Palliative care is different from hospice care in that it can be offered in conjunction with medical treatments that are intended to change the course of a serious illness, while hospice care is for patients who are no longer receiving curative care. During hospice care, the focus of the patient’s wellbeing is comfort, with the avoidance of aggressive medical measures. Most hospice patients are expected to have a natural survival time of less than six months, while palliative care patients can live for years as they cope with an illness.

Both palliative and hospice care are intended to ease pain, help manage symptoms, and pro vide emotional and practical support to patients and their families.

Palliative care teams are interdisciplinary and can include physicians, nurse practitioners, physicians assistants, nurses, social workers, and chaplains, with supplementary services provided by counselors, pharmacists, dietitians, physical therapists, rehabilitation specialists, home health aides, and others.

All the health systems serving Lancaster County offer palliative care services and either provide or refer patients to hospice care. Lancaster Physician reached out to WellSpan Health, Penn Medicine Lancaster General Health, Penn State Health, and UPMC in Central PA to learn more about these specialties and how they operate within their hospitals.

WELLSPAN HEALTH

in primary care physicians’offices and other locations throughout the WellSpan system, and Horizon nurses offer talks and information sessions to increase awareness.

Having plans for end-of-life care in place before those decisions are needed assists physi cians and relieves the burden on family members to have to do so, Ambort noted.

“None of us ever knows what might happen,” he said. “It’s never a bad idea to be introduced to what palliative care can offer and to make these kinds of decisions early on.”

Talking about and making decisions regarding end-of-life care is much easier to accomplish before an illness or acute medical condition occurs.

“We try to be as fluid as possible when working with patients,” Ambort said. “We are very flexible within our system, and I think that flexibility is definitely a strength. Ultimately, it all comes down to the wishes and needs of the patient, and that’s the way it should be.”

PENN MEDICINE LANCASTER GENERAL HEALTH

Predictions of critical nation wide shortages of palliative care clinicians are prompting palliative care providers at Penn Medicine Lancaster General Health to advocate for standardized training for all providers across the system who work with seriously ill patients.

Dr. Bethann Scarborough

Dr. Andrew Ambort

The field of palliative care is just coming into its own, and physicians are working hard to make sure patients and other health care providers are aware of the advantages this type of care offers, said Dr. Andrew Ambort, a hospice and palliative care physician at WellSpan Palliative and Supportive Care in Ephrata.

“Compared to other specialties, palliative care is very much in its infancy,” Ambort said. “We’re all still growing and trying to see how we can best serve members of our communities.”

Helping patients become familiar with endof-life-care and directives regarding that care are goals of WellSpan Palliative & Supportive Care, which established Horizon Planning for that purpose.

Horizon Planning encourages patients to develop advanced care plans and think about the type of health care they’d want in the event of a medical crisis during which they were unable to make their own health care decisions.

Packets containing information, a living will, durable power of attorney for health care, physician orders for life sustaining treatment (POLST), and other documents are available

Ambort encourages anyone diagnosed with a serious illness such as heart failure, chronic obstructive pulmonary disease, cancer, dementia, Parkinson’s disease, kidney failure, or liver failure to talk to a palliative care specialist soon after the diagnosis has been made.

“That way patients can become aware of their options and learn about what they might expect as the disease progresses,” Ambort said. “Maybe they’ll never need palliative care services, but it can’t hurt to know what’s available.”

Balancing palliative care with other medical specialties can cause some tension, Ambort explained. Physicians typically are trained to provide all treatments possible for their patients, while a palliative care physician would help a patient understand possible side effects and consequences of treatment and let patient and family decide if they want to pursue it.

“We sometimes have differences in opinion, but I never take it personally,” shared Ambort. “And while some doctors might be resistant to the idea of palliative care, I’ve never met anyone who isn’t willing to have a conversation.”

WellSpan recognizes that its patients vary in cultural and religious backgrounds and is committed to respecting the needs and wishes of every patient. End-of-life care can occur in a hospital, outpatient clinic, a patient’s home, or other setting.

Dr. Bethann Scarborough, lead physician in Penn Medicine Lancaster General Health’s palliative care program, said Lancaster General Health currently has well-established palliative care programs in place at the hospital and the Ann B. Barshinger Cancer Institute. It is working toward implementing additional palliative care training for clinicians who work with patients diagnosed with cardiac disease, pulmonary disorders, dementia, kidney or liver failure, and other serious illnesses.

“Our goal is to offer some extra training to these individuals so that every provider is equipped to offer a level of palliative care to every patient with a serious illness,” said Scarborough, who is also an associate professor of palliative medicine within the University of Pennsylvania Health System.

Scarborough, along with palliative care providers across the country, also is advocating for government-supported palliative care and hospice education centers that could improve training for palliative care clinicians and offer training for other caregivers who could benefit from learning about palliative care.

A survey of members of the American Academy of Hospice and Palliative Medicine, the largest physician membership society for palliative care, revealed that many palliative care physicians – along with physicians across nearly every discipline – are planning to leave their jobs even as the number of patients eligible

Perspectives

for palliative care increases. Though the most common reason physicians plan to leave their jobs is retirement, access to palliative care is also impacted by other variables, including a high concentration of specialists in urban areas, with more limited access in rural or underserved areas.

By 2030, this imbalance will result in a ratio of only one palliative care physician for every 26,000 patients, nationwide.

“That is why it’s so important to increase the number of federally funded palliative care training slots and provide training to every provider,” shared Scarborough.

Although concerned about caregiver shortag es, Scarborough is positive about an increasing acceptance of palliative care among both patients and clinicians in a growing number of specialties. National societies for cardiology, pulmonary, oncology, and other specialties have become advocates for palliative care, something that had not occurred in the past.

“They’re all endorsing palliative care as some thing that should be offered earlier in the disease progression,” Scarborough said.

As patients gain understanding of the purpose and advantages of palliative care, they also are more likely to embrace the specialty than they had been in the past.

Also, Scarborough added, awareness that palliative care and hospice care are not the same is on the rise among patients and their families.

While hospice is an insurance benefit intend ed for patients who likely will live less than six months and are no longer receiving curative care, patients receiving palliative care can live for years with help managing symptoms and pain, emotional support, community resource referrals, chaplaincy care, and other services.

Scarborough praised the interdisciplinary palliative care team at Lancaster General Hos pital, which in addition to physicians includes advanced practice providers, nurses, social workers, chaplains, pharmacists, and others.

“They are critical to the provision of high-quality palliative care,” Scarborough said.

“The services these team members provide are invaluable to patients and their families.”

PENN STATE HEALTH

palliative care, realizing patients are best served when care begins at, or shortly after, diagnosis.

Dr. Kristina Newport

Penn State Health places a high value on palliative care, making inpatient and outpatient services available to every patient.

“I’m proud to say the leadership of Penn State Health realizes the importance of palliative care and fully supports our efforts,” said Dr. Kristina Newport, a palliative care physician. “We have a goal of taking care of every patient with serious illness starting at the time of their diagnosis.”

Interdisciplinary palliative care teams, including physicians, advanced practice providers, nurses, social workers, chaplains, pharmacists, and others, are in place in all Penn State Health hospitals and cancer centers, with care also available at outpatient clinics. Practitioners also provide telehealth services when appropriate.

The health care system does not offer in-home palliative care, but partners with community care providers such as Hospice & Community Care and refers patients to those services, when appropriate.

“We are in constant collaboration with our home health, home-based palliative care, and home hospice partners,” Newport said.

Newport stressed the value of community care providers, but, due to recent growth in the number of organizations offering home-based palliative care, urged patients and their families to be cognizant of the quality of care provided. Agencies should be led by board certified palliative care physicians, and patients should be able to contact staff when they need it, not just during certain hours.

“We encourage our patients and their families to ask questions and be confident about the care they’ll be receiving,” she shared.

Newport is encouraged that during the 14 years she’s worked in palliative care, it has become a far more integrated and accepted part of the overall health system. Providers in the fields of oncology, pulmonology, cardiology, surgery, nephrology, and other specialties routinely refer patients to

In some cases, Newport said, palliative care can begin even before diagnosis. She recently met with a woman who was waiting for test results that could confirm the presence of metastasized cancer.

Physically and emotionally overwhelmed when she arrived at the appointment, the woman talked with Newport and her team about how are needs will be met, relieving some of her stress and anxiety.

“It can really lift some of the weight from a very difficult situation,” Newport said.

While palliative care teams work with patients who have been diagnosed with serious illnesses, they are not only concerned with the end of life.

“Our job is not focused on death. It’s helping people to live well until they die,” Newport explained.

Having grown up in Lancaster County and spending her career here, Newport is especially excited about Penn State Health’s Lancaster Medical Center, which opened in early October in East Hempfield Township.

The new hospital, she said, provides new opportunities for patient care in the Lancaster community.

“Everybody who’s going to work there is doing so because they are committed to providing excellent care for their friends and neighbors,” Newport said. “And that’s how I feel, as well. I want to help people live as well as they can in the community where we both live.”

UPMC

Dr. Fotini Debonera

Palliative care and hospice care are vital aspects of health care, and UPMC supports these services to best serve its patients.

“UPMC is committed to serving our patients with every level of support needed at every stage of their lives,” said Dr. Fotini Debonera, who leads UPMC’s home-based primary care program in Lancaster County.

Palliative care teams work not only to control symptoms of patients diagnosed with serious illnesses, but to support those patients and their families emotionally and practically through difficult times, opening space for crucial conver sations and allowing them to reflect on goals of care, explained Debonera, who is board certified in both family and geriatric medicine.

Ideally, she said, everyone should plan for end-of-life care before a health crisis occurs by talking with loved ones and get ting advance health care directives in place. Debonera stressed, however, that patients can change their directives if they have a change of heart, perhaps tiring of living with an illness or thinking differently about quality of life as they age.

Members of UPMC’s home-based primary care team are able to discuss end-of-life care options with patients during their visits, enabling patients to express their wishes regarding topics like intubation, resuscita tion, or tube feedings. POLST (Physician Orders for Life-Sustaining Treatment) forms

are completed, updated as necessary, and normally kept in the home so they’re available in the event of an emergency.

“We make sure these discussions occur during stable times so we can ensure the level of care chosen is exactly aligned with a patient’s wishes,” Debonera said. “It’s a privilege to care for a patient in their home, and also incredibly effective and beneficial because you’re able to identify first-hand the challenges or barriers to care they’re facing. Our team can often change the course of one’s wellbeing, including health care, medication, resources, access to support, and advocacy.”

Home-based primary care programs ensure that patients, who would otherwise remain at home, invisible, receive the care they need and are attended to, she said.

Despite the fact that palliative and hos pice care substantially support patients in their journeys battling disease, Debonera acknowledged occasional hesitancy with

enrolling patients in hospice care. Patients and families need to take their time to understand the specialty, have their ques tions answered, and ultimately, make some often-difficult decisions.

“Providers should patiently engage with patients and their loved ones, make themselves available to answer all questions, and be prepared to visit the matter again if the patient or family is not yet ready for that decision,” she said.

If a patient is no longer able to make decisions, the burden to do so falls on family members, who must live with their decisions for the rest of their lives. Providers must understand the difficulty of that and be willing to work with those caregivers.

Conversations regarding end-of-life care are difficult, but crucial to assuring patients receive the type of care they want and deserve.

“Patients need to know you’re listening to them and that you’ll make sure the course of their care will abide by their wishes, and their wishes only,” Debonera said.

PENNSYLVANIA MEDICAL SOCIETY

QUARTERLY

In late August, the Pennsylvania Supreme Court adopted amendments to the Pennsylvania Rules of Civil Procedures to rescind the 2003 rule governing venue in medical professional liability actions. The change will now expand venue to additional counties beyond the county in which the alleged malpractice occurred. The Penn sylvania Medical Society condemns this as a step backwards to the days of unstable medical liability market and a mass exodus of physicians from the PA Commonwealth.

On Monday, Sept. 12, PAMED Presi dent-Elect Dr. F. Wilson Jackson, III joined other advocates to testify to the House Policy Committee against the PA Supreme Court’s rule change.

Dr. Jackson said the ruling “will cause increased physician burnout and will cause specialty physicians to stop performing high-risk procedures.”

The Civil Procedural Rules Committee will re-examine the 2022 rule amendments two years after the effective date of January 1, 2023.

Prior Authorization (Senate Bill 225)

With few session days left before the elec tion, not a lot of momentum is happening with the legislative bills PAMED keeps a close eye on. Senate Bill 225 (legislation that would reform onerous prior authorization and step therapy process) is expected to be up for a vote sometime soon though. While the situation remains fluid, we continue to push for Senate Bill 225 to be considered before the end of this legislative session.

PAMPAC and Gearing Up for the Election

The Pennsylvania Medical Political Action Committee (PAMPAC) is excited about the prospects of helping to elect Arvind Venkat, MD, who could be the first physician to the General Assembly since the 1960s. Dr.

Venkat practices emergency medicine in Pittsburgh and is running in an open seat created by the shifting of legislative districts because of reapportionment.

PAMPAC plays a critical role in helping to advance PAMED’s legislative agenda. Although PAMPAC does not engage directly

in legislative advocacy, PAMPAC’s support of legislative candidates helps to “open doors” for our members by developing positive and productive relationships with legislators and legislative candidates. Physicians are encour aged to support PAMPAC. Contributions can be made here: https://www.pamedsoc. org/laws-advocacy/PAMPAC.

For more information about any of the items mentioned above, please visit the Advocacy Section of PAMED’s web site at www.pamedsoc.org/advocacy

Review reviewed by ASHIMA VASWANI, MD UPMC Pinnacle Anesthesia Services

PLOUGH

IMAGES PROVIDED BY

WITH PERMISSION OF PLOUGH

Like a ship plowing through uncharted waters, Plough restau rant offers a cuisine that is unlike any other in Lancaster.

When I first walked into Plough, conveniently located in the heart of downtown in the Lancaster Marriott at Penn Square, I was immediately in love with the ambiance. There’s a very glamorous vibe, with just the right amount of mood lighting and subtle music playing in the background. Plough is loyal to Lancaster County, sourcing many of its ingredients from local farms, making an effort to give us a true farm-to-table experience.

When we first arrived, we were seated at the bar while we waited for a table. We did not have a reservation, so our wait time was approximately 30 minutes. I enjoyed a cocktail recommended by the bartender called “The Proposal.” It was subtly sweet with a touch of fizz, perfect to start off the night.

Once at our table, we started with a couple of appetizers. The grilled shrimp appetizer was phenomenal. It was accompanied with toast points to dip in the sauce — a “lick the plate clean” kind of sauce! The pork belly and peaches appetizer was one of my husband’s choices since I normally do not prefer the consistency of the meat. However, I must say that this was one of the better pork belly dishes I have tasted. The savory flavors complemented by the peach glaze was the perfect marriage of sweet and salty.

My main course, the spicy lamb ragu, was extraordinary. Not only was it good on the night we ordered, it was still delicious the next day when I ate the leftovers for lunch! All the flavors that came together in the sauce, paired with the ricotta cheese and spicy oil, were delectable. My husband opted for the cholula pineapple short rib entrée. This was probably the only dish I did not love. The accompaniments were very good, however, I thought the meat could’ve used a bit more seasoning, and it seemed a tad bit overcooked.

For the final course, we had the chocolate chip banana bread — I mean, how could you go wrong with this combo! It was served with miso caramel and cinnamon ice cream and all of it melted in your mouth. I highly recommend saving some room for this one!

Whether you’re out with a large group or it’s date night, Plough is an excellent choice for dinner; quality meals complemented by a picturesque venue and lively atmosphere.

PLOUGH

25 S. Queen St., Lancaster, PA 17603 717-207-4095 | ploughrestaurant.com

WEIGHT LOSS FOR A HEALTHIER LIFE

We offer non-surgical and surgical weight loss options.

For your patients that struggle with their weight and related issues such as type 2 diabetes or sleep apnea, our Healthy Weight Management & Bariatric Surgery program has a successful track record for obesity treatment. Our team is dedicated to helping patients achieve sustainable weight loss and improve their health. From an on-site exercise center just for patients to nutrition counseling and on-going follow-up and support, we have the resources to help your patients succeed.

Your patients can take the first step by signing up for our online seminar at LGHealth.org/HealthyWeight. If you would like to talk to our staff about our program, please call 717-544-2935.

Bariatric Surgeons

Non-Surgical Providers

Healthy Weight Management & Bariatric Surgery 2150 Harrisburg Pike, Suite 300 | Lancaster

Joseph McPhee, MD James Ku, MD Zachary Ichter, DO

Demetria, Sleeve Gastrectomy Patient

Virginia Wray, DOLawrence Wieger, DO

Andrea Girolamo, CRNP

David Gasperack, DO WellSpan Family Medicine – Meadowbrook Vice President and Regional Medical Director, WellSpan Medical Group

Member Spotlight News & Announcements

Where do you practice and why did you settle in your present location or community?

I practice at WellSpan Family Medicine – Meadowbrook located in Leola, PA. I was recruited right after my residency in Reading, PA. What started as an “I’ll give this a try for a couple years” decision turned into 16 years of clinical practice.

What do you like best about practicing medicine?

It may sound cliché, but what I like most about practicing medicine is helping people. As physicians, we are given the unique ability to positively affect people’s lives in a way that no one else can. It is truly and honor and a privilege.

Are you involved in any community, non-profit, or professional organizations?

I currently sit on the board of Hospice & Community Care of Lancaster County and strongly support their mission and vision. Attending the Labor Day Auction at the Solanco Fairgrounds for the first time this year was quite an experience. I’ve attended many other community events and fundraisers in the past; this event is on an entirely different level. The community support of this endeavor is remarkable.

What are your hobbies and interests when you’re not working?

I’m at that stage in life where there isn’t much free time. With five chil dren in multiple activities, my wife and I spend a lot of time just trying to stay on schedule. That being said, we are actively involved in our church community, Sacred Heart Parish located in West Reading, PA.

For what reason(s) did you become a member of the Lancaster City & County Medical Society and what do you value most about your membership?

One of the silver linings of COVID was being able to collaborate with other health systems and independent physicians to help meet the health needs of our community. LCCMS provided the platform to make that happen. After seeing the benefits of this crucial collaboration, I knew I had to get more involved. Becoming an active member of LCCMS has allowed me to see issues from different perspectives. By far one of the best things I’ve done in the past few years.

Campus Eye Center

Campus Eye Center is an ophthalmology practice founded by Dr. John Bowman and Dr. William Spitler in 1972 with the vision of building and developing a team of medical professionals focused on providing the highest quality comprehensive eye care in our community.

Our mission is to protect, preserve, and improve the vision of those we serve utilizing a patient-centered practice approach characterized by outstanding clinical, technical, and surgical expertise and service. In addition to working with patients requiring care for primary eye diseases, we work closely with local family and specialty physicians to manage and treat a variety of chronic illnesses with ophthalmologic complications, including diabetes and arthritis. Both diseases require regular eye exams and communication and collaboration between practices to ensure the healthiest outcomes for our patients.

Our physicians are board certified by the American Academy of Ophthalmology and participate regularly in continuing education. Our clinical staff members are certified ophthalmic assistants and participate in regular educational training as well. This allows our doctors and staff to provide the most up-to-date treatments for our patients.

We provide treatment to patients of all ages, from premature newborns to our growing elderly population. Dr. Lee Klombers provides treatment

for a variety of pediatric and neuro-ophthalmology conditions, while Dr. David Williams provides outstanding surgical treatment for our cataract patients, and Dr. Kerry Givens provides the most thorough treatment for glaucoma and many other ocular conditions. Our main office is located at the Suburban Outpatient Pavilion, where we have treated patients since its opening in 1995. We also see patients at the Willow Lakes Health Center.

Our scope of treatment includes routine vision exams provided by our on-staff optometrists. Our optometrists provide up-to-date prescriptions for glasses and contact lenses.

What sets us apart from other practices in Lancaster County? We have an outstanding group of employees who are dedicated to our patients and to our practice. Our administrative and management staff have all been with the practice for over 10 years, as well as many of our outstanding clinical and business staff.

Campus Eye Center’s primary goal is to continuously improve our service to patients. We have an attitude of gratitude toward our patients for allowing us to participate in their care. We strive to exceed expectations in all aspects of our care.

Back row:  David Williams, MD., Lee Klombers, MD, and Kerry Givens, MD.  Front row:  Olga Womer, OD, and Lisa Kott, OD

Nationally ranked for heart care by U.S. News & World Report.

Right here – close to home.

Kaedan was born with life-threatening heart defects and had his first open-heart surgery at just four days old. He’s had many surgeries since — all right here in Central PA from a team whose surgical outcomes are among the best in the country. Today, he’s 18 and in college studying criminal justice.

Kaeden | LANCASTER

Lancaster Medical Society Foundation Awards $14,000 in Scholarships

AR EA RESIDENTS RECEIVE ASSISTANCE TO ATTEND MEDICAL SCHOOL

This year, five area students were selected as recipients of the annual Lancaster Medical Society Foun dation scholarship awards. The competitive process, which makes selections based on good character, motivation, academic achievement, and financial need, included submissions from applicants throughout Lan caster County.

“Each year the process gets a bit more challenging,” shared Beth Gerber, Executive Director of the Lancaster City & County Med ical Society and the Lancaster Medical Society Foundation. Gerber oversees the application process and works with the selection committee charged with choosing the awardees through a blind review process.

“In addition to an examination of need and achievement, our application submissions must include a narrative from each student, sharing what has led them to a career in medicine. Their stories are touching, often remarkable and sometimes heart-breaking. It’s clear that to many future physicians, the ‘why’ is a very purposeful, heart-felt decision.”

This year’s recipients include Kevin Chao, of Lancaster; Nicole Hanselman, of Manheim; Hannah Kuntz from Elizabethtown; Launick Saint-Fort, of Ephrata; and Rhea Sullivan from Landisville.

Saint-Fort — a trauma research coordinator, graduate of Penn State Berks, and a first-year medical student at the Pennsylvania State College of Medicine — was awarded $4,500.

For Saint-Fort, whose younger years were spent as a child slave in Haiti, medical school and a potential career as a physician were beyond her wildest dreams.

“As a child, I endured an array of childhood diseases, easily preventable through vaccina tion, as quality health care was not extended to the poor, and public health information was reserved for those who could read — in a country whose literacy rate is the lowest in the western hemisphere,” Saint-Fort shared.

“These perspectives will allow me to relate to people of diverse backgrounds and recognize the cultural and psycho-social factors related to a patient’s perceptions of health, illness and the health care system,” she explained.

“It is my ultimate goal as a physician to not only provide the utmost care to my patients but to be a beacon of hope for those who aspire to triumph over adversity.”

Hanselman, an Elmira College graduate and research specialist, currently in her first year at Saint James School of Medicine in Illinois, received a $3,500 award. She explained that her passion to pursue medicine was conceived in a small orphanage in Vietnam.

“By the time I was five years old, I had lost my biological father, mother and eldest sister due to lack of basic medical care.”

Placed in an orphanage at seven, Hanselman was assigned to care for the sickest babies, but could only do so much to ease their pain and suffering. “These early childhood experiences

sparked my dream to become a medical doc tor and advocate for global access to reliable healthcare services.”

Hanselman shared, “A career in medicine is a perfect occupation for me because I get to combine my two passions in life (medi cine and service to humanity) to positively impact society.”

Kuntz, a former medical assistant with AmeriCorps and graduate of Rochester Insti tute of Technology, is a first-year student at the Pennsylvania State College of Medicine. Her passion for medicine was fostered through her volunteer experiences working with under served populations in Lancaster City and later in Rochester, New York.

“Through becoming a doctor, I want to turn my empathy into action,” said Kuntz. “Through these experiences, I have gained a deeper understanding of how a patient’s socioeconomic status impacts disease diagnosis, treatment and prognosis. Most importantly, I have learned just how important it is for every patient to feel seen, heard and respected.”

Sullivan, a fourth-year MD/PHD student at the Pennsylvania College of Medicine and a graduate of Pennsylvania State University Schreyer Honors College, shared that her decision to pursue a career in medicine came after a few “startling realizations” that she had while in college.

“The opioid epidemic didn’t feel ‘real’ to me until I was quite literally confronted with it,” shared Sullivan. Witnessing the deaths of both

a fellow college student and then a neighbor, when home on break, she realized the impact of addiction.

“These were tragic situations that shook me to my core. They framed for me, just how tight the grip of the opioid crisis had on our communities. I knew I wanted to harness my passion for science to help my community, which to this day, continues to suffer from opioid addition.”

Chao, a former medical scribe and volunteer smoking cessation counselor, is a Saint Joseph’s University (formerly University of the Sciences) graduate and second-year student at Drexel University College of Medicine.

Chao’s choice to pursue medicine grew from childhood experiences with the health care system. Born with a heart abnormality that was incredibly difficult to manage, he credits his parents, pediatrician, and cardiologist for their tireless care giving him a life that he would not otherwise have had.

“The doctors I grew up seeing regularly became my role models in life because of their compassion and kindness. I want to give others what my doctors gave me — hope that life can improve.”

Chao, Kuntz, and Sullivan were all awarded $2,000 scholarships.

Founded in 1991, the Lancaster Medical Society Foundation is a 501(c)3 nonprofit organization that was formed to grant schol arships to students from Lancaster County who are accepted at or continuing a medical degree at an accredited allopathic or osteopathic medical school.

The Scholarship Foundation is generously supported by the Lancaster County medical community, through hospitals and health systems, group practices, individual medical society members, local businesses, and Lan caster-area residents. Since its inception, more than $282,000 in scholarships have been given to deserving local students.

LAUNICK SAINT-FORT

NICOLE HANSELMAN

KEVIN CHAO

RHEA SULLIVAN

HANNAH KUNTZ

(Tracy) DeGreen

IS

THAN

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Lena Dumasia, MD

CANCER CARE IS ESSENTIAL.

DEATHS

John J. Schubert, MD

Dr. John J. Schubert, 90, went home to the Lord on July 27th, 2022. John was the husband of Eileen (Merunka) with whom he shared 61 years of marriage. He was born the 5th child of the late Frederick and Mary (Dieckhaus) Schubert in Philadelphia, PA. He is predeceased by his siblings Fred (Maria), Mary (Mike), Betty (Ed), and Rev. Gerard, OSFS. He is survived by his brother, Joe (Peggy) of Downingtown.

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John dedicated much of his life to his medical career as a nephrol ogist. He attended LaSalle College and Jefferson Medical College. During his residency, John developed a unique interest in studying the complicated physiology of the kidney. After a fellowship at Penn, John worked at Philadelphia General Hospital, opening its first dialysis unit in 1970. John was a founding member of the Greater Delaware Valley Kidney Advisory Committee, an organization that truly pioneered the establishment of dialysis units and patient dialysis training throughout the Philadelphia area.

In 1972, John chose to bring his expertise to Lancaster General Hospital, opening the first kidney dialysis unit there, as well as taking on the education of family practice residents. John was a brilliant physician who loved to learn and think creatively about the intricacies of his patients’ problems. In addition, he treated his patients as if they were family and dedicated much time and energy to the success of the Lancaster Area Kidney Foundation (LAKA). This foundation educates and supports patients with kidney disease.

In addition to medicine, John enjoyed fishing, tennis, skiing, traveling, and wood carving. He was a dedicated member of St. Mary’s Catholic Church and volunteered there as a eucharistic minister, parish council member, decorator, diocesan tribunal advocate, and as a funeral choir member. After his retirement, John also volunteered for several years as a physician with the Water Street Rescue Mission.

In addition to his wife and brother, he is survived by his children: Greg (Anne Bradbury), Steve (Mary Peterson), Liz (Steve Woratyla), Joan (Hunter Johnson), Jerry, and Kate (Matt Wallin). He is also survived by 9 grandchildren.

John’s family would like to thank the kind and vigilant staff of Wissler Run and Trout Run — at Mennonite Home Communities — who pro vided loving care during his final weeks.

LCCMS EVENTS 2022

Friday, October

Saturday,

PAMED House of

Wednesday, November

LCCMS Membership Mixer Lancaster Medical Heritage Museum 5:30 - 7:30 p.m.

Saturday, December 3 Holiday Social & Foundation Benefit Lancaster Country Club 6:30 - 10:30 p.m.

FRONTLINE GROUPS FALL 2022

Frontline Practice Groups have made a 100% membership commitment to LCCMS and PAMED. We thank them for their unified support of our efforts in advocating on your behalf and facilitating an environment for physicians to work collaboratively for the benefit of the profession and patients.

Alere Family Health LLC

Allergy & Asthma Center

Argires Marotti Neurosurgical Associates of Lancaster

Avalon Primary Care

Campus Eye Center

Carter MD Aesthetics

Community Anesthesia Associates

Community Services Group

Conestoga Eye

Covenant MD

Dermasurgery Center PC

Dermatology Associates of Lancaster Ltd

Dermatology Physicians Inc

Stephen G. Diamantoni, MD & Associates –Quarryville

Drs Eichenlaub & May

The ENT Center

Eye Associates of Lancaster Ltd

Eye Health Physicians of Lancaster

Family Eye Group

Family Practice Center PC – Elizabethtown

General Surgery of Lancaster

New Members

Jason P.D. Bailey, MD Covenant MD

Stephen Bruening, DO

Danielle Cross, MD

Penn Medicine Lancaster General Health Physicians Neurology

Willis E. Godin, MD

UPMC Heart & Vascular Institute –Lancaster

Sam W. Keller, MD

Penn Medicine Lancaster General Health Physicians Anesthesiology

Katherine J. Kereshi, MD Penn State Health Pediatrics

Janine Kiernanpractice administrator

UPMC Heart & Vascular Institute –Lancaster

Glah Medical Group

Hospice & Community Care

Hypertension & Kidney Specialists

Lancaster Cancer Center Ltd

Lancaster Cardiology Group LLC

Lancaster Ear Nose and Throat

Lancaster Family Allergy

Lancaster Plastic Surgery

Lancaster Skin Center PC

Stephanie A Mackey MD

Manning Rommel & Thode Associates

Neurology & Stroke Associates PC

Ouilikon Medical Associates PC

Patient First – Lancaster

Penn Medicine Lancaster General Health Care Connections

Penn Medicine Lancaster General Health Physicians Diabetes & Endocrinology

Penn Medicine Lancaster General Healt Physicians Family Medicine Lincoln

Penn Medicine Lancaster General Health Physicians Family Medicine Manheim

Penn Medicine Lancaster General Health Physicians Family Medicine New Holland

Courtney Moran, MD

Pittsburgh VA Medical Center

Antonio J. Vetrano, DO

UPMC Obstetrics & Gynecology Specialists – Lititz

Nicholas V. Weit, DO WellSpan Ephrata Community Hospital

Reinstated Members

Gregory D. Cox, DO

UPMC Heart & Vascular Institute –Lancaster

Diane K. Donnelly, MD

Penn State Health Medical Group –Prospect

Mandy R. Fannin, MD

WellSpan Family Medicine –Trout Run

Gordon H. Hutt, MD

UPMC Heart & Vascular Institute – Lancaster

Traci M. Kohl, MD WellSpan Internal Medicine –Ephrata

David S. Martin, DO

Penn Medicine Lancaster General Health Physicians Family Medicine Norlanco

Penn Medicine Lancaster General Health

Physicians Family Medicine Susquehanna

Penn Medicine Lancaster General Health

Physicians Lancaster Physicians for Women

Pennsylvania Specialty Pathology

Randali Centre for Aesthetics & Wellbeing

Retreat Behavioral Health

Union Community Care – Duke St

Union Community Care – Hershey Ave

Union Community Care – Kinzer – Church St

Union Community Care – New Holland Ave

Union Community Care – Water St

UPMC Express Care

UPMC Lancaster Arthritis & Rheumatology Care

UPMC Pinnacle Breast Health Associates

UPMC Pinnacle Manheim Pike Primary Care

UPMC Pinnacle Plastic & Aesthetic Surgical Associates

Jyothy Punnoose, DO

Scott T. Riebel, MD

UPMC Heart & Vascular Institute – Lancaster

Marc S. Russo, MD

Penn Medicine Lancaster General Health Family Medicine Lititz

Surender Singh, MD

UPMC Heart & Vascular Institute – Lancaster

WellSpan Good Samaritan Hospital Emergency Department

Nehal Dhirendra Patel, MD

UPMC Heart & Vascular Institute –Lancaster

Sunil P. Patel, MD

UPMC Heart & Vascular Institute –Lancaster

Lydia R. Slater, DO

Penn Medicine Lancaster General Health Physicians Internal Medicine

WHY MAGEEWOMENS for moms and babies?

Because we have more experience delivering more babies.

With more than 25,000 babies delivered each year across all UPMC Magee-Womens locations, we provide comprehensive care for mom and baby. And with many locations close to home in central Pa., expecting families have peace of mind knowing they have access to our ob-gyn experts and advanced newborn medicine, including Level III NICUs in Harrisburg and Lititz and Level II NICUs in York and Carlisle. To learn more about how we are keeping moms and babies strong, visit UPMC.com/WhyMageeCPA.