By Susan Shelly
FOR –EPILEPSY BY VENKATACHALAM MANGESHKUMAR, MD
BY LORI GERHART, BSN, RN, OCN
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Stacey S. Denlinger, DO President
UPMC 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
Kendall R. Dempsey, MD | 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
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.
Ihope this letter finds everyone celebrating a return to a more familiar holiday season. Lancaster City & County Medical Society held multiple events this fall — like the annual dinner where we celebrated individuals and organizations providing exceptional service to Lancaster County. Many of our members also enjoyed the mixer at the new Medical Heritage Museum in November and the Holiday Social & Foundation Benefit in December. I think I speak for everyone when I express what an emotional boost it has been to share stories and experiences with colleagues again face-to-face! The museum had so many interesting displays, including an interactive physical exam display. I encourage you to visit and see the collection of medical history and artifacts from Lancaster County.
As we all figure out what “normal” means for us both personally and professionally, I remember one of my favorite quotes: “Be kind for everyone you meet is fighting a battle you know nothing about.” ~ Wendy Mass
I hope we can end 2022 and begin 2023 by listening more than we talk and by practicing more empathy than judgement.
Though news about SARS-COV-2 and COVID (in all its forms) has dominated the conversation for years and will continue to be part of our community as we learn more over time, the rest of medicine continues to advance. Diseases both old and new need to be given fair attention, including the rise in RSV cases we are seeing.
Thank you to the contributors and readers of this magazine for your continued support. We want to continue to highlight topics related to medicine and the community. If you have any interest in writing or want to suggest a topic you are interested in hearing more about, please let us know. We also hope to continue to offer the small group discussions program, “Docs, Drinks, and Dialogue.” If you are interested in hosting, or co-hosting, please contact our executive director, Beth Gerber.
While many, even most, patients recover from COVID-19 without lasting effects, for others, the recovery process can be more prolonged and complex. These patients continue to experience physical, emotional, or cognitive symptoms, which can significantly impact their overall quality of life.
Tony T. Ton-That, M.D., medical director of Penn Medicine Lancaster General Health’s Post-COVID-19 Recovery and Rehabilitation Therapy Program, said many patients suffer from continuing symptoms six months or more after a COVID-19 infection. Those symptoms can range from weakness, pain, and fatigue to “brain fog,” anxiety, and depression.
“We are still learning about the possible long-term effects of COVID-19 that can affect people months or even years later,” he said. “Our recovery and rehabilitation therapy program offers multidisciplinary care to address these symptoms, so patients can once again function as active members of their communities.”
According to the CDC, it’s difficult to determine exactly how many people experience post-COVID conditions. Estimates can vary as widely as 2.5 to 30 percent, depending on a number of factors, including whether the patient was hospitalized during their original illness and whether symptoms are self-reported or recorded in medical records.
LG Health’s multidisciplinary COVID-19 recovery and rehab team includes physical, occupational, and speech therapists, as well as neuropsychologists and behavioral health counselors. Patients are referred by their primary-care provider, a specialist, or themselves.
The LG Health program, which is unique to southcentral Pennsylvania, is part of an ongoing effort across Penn Medicine to help patients who experience “long-haul” COVID symptoms. Penn Medicine’s PostCOVID Assessment and Recovery Clinic offers a similar multidisciplinary approach to care through virtual and in-person visits
throughout the region. And the Penn Neuro COVID Clinic treats patients who continue to experience symptoms related to cognition, headache, vertigo, and brain fog.
For many patients who face lingering challenges after COVID-19, that continued care and support can prove essential to finally returning to a more normal life.
At the LG Health Post-COVID-19 program, a case manager coordinates each patient’s care, ensuring timely access to the appropriate providers across various specialties. Patients receive an evaluation and personalized care plan, which takes into account medical history and any pre-existing conditions that may be exacerbated by COVID-19.
Case manager Jill Fehrman said the program sees patients of all ages and genders, who experienced varying severity of illness with COVID-19. While the length of rehabilitation therapy varies based on the patient and their progress, about six to eight weeks is typical.
Persistent poor endurance, fatigue, dizziness, and headaches are common symptoms
that can persist from the physical standpoint, she said. It is not uncommon for these symptoms to be present for several months. A physical therapist can help to rebuild strength and endurance through monitored exercise on the treadmill or other stationary equipment. Vestibular treatments and balance training can help to treat dizziness.
“We are seeing people who had COVID19 several months ago and are still easily fatigued and have poor endurance,” Fehrman said. “In some cases, that can lead to additional concerns, including weight loss.”
Cognitive impairment — or “brain fog” — can lead patients to struggle with activities of daily living long after their initial recovery from COVID-19. Occupational or speech therapy can be an integral part of returning a patient to a higher level of cognitive function. An occupational therapist, for example, might focus on strategy implementation, adaptation, and actual task engagement.
“Many of our patients sometimes have a hard time figuring out the right word for what they want to say,” Ton-That said. “Others have trouble gathering ingredients to cook a meal. It takes them a longer time to accomplish routine tasks.”
When it comes to emotional health, patients who have recovered from COVID19 might experience anxiety, depression, and even post-traumatic stress disorder. A neuropsychologist or counselor can help to address these symptoms, which may be especially prevalent in patients who had lengthy hospital stays and severe illness.
While most patients improve with rehabilitation therapy, Ton-That said some might require additional care from a pain specialist, cardiologist, or pulmonologist. The patient’s primary-care provider coordinates referrals to those follow-up services, if necessary.
“Our program takes a highly collaborative approach to treating our patients who are experiencing long-term symptoms of COVID-19,” he said. “We have seen that there continues to be a great need in our community for this type of care.”
Cognitive impairment — or “brain fog” — can lead patients to struggle with activities of daily living long after their initial recovery from COVID-19.
Julie Dionne put off getting a mammogram for about five years.
But after her cousin died from breast cancer and a friend was diagnosed with the disease last summer, she realized the dangers of ignoring the screening procedure.
“It was top of my mind,” says Julie, a 49-year-old mother of five children, who lives in Lancaster County. “I knew I needed to take care of it.”
Then her providers at WellSpan Family Health – Georgetown told her she could easily get the breast cancer screening on WellSpan’s mobile mammogram coach when it came to their office in rural, southeastern Lancaster County. So, in mid-November, Julie got a mammogram, which was negative for any issues.
“Robin (Robin Skosko, a nurse practitioner at Georgetown) talked about how I should do it,” Julie said as she waited for her appointment on the coach in its cozy, well-lit space on a rainy November day. “This seemed a little less intimidating to me, not being in a busy medical building.”
The mobile mammography coach — which looks like a giant blue and pink bus and takes advanced breast cancer screening directly to where people live and work — is just one way that WellSpan is working on reducing inequities in breast cancer screening rates among different demographic groups.
WellSpan was recently recognized for this work by being named a top finalist for the 2022 Bernard J. Tyson National Award for Excellence in Pursuit of Healthcare Equity Award. Established by The Joint Commission and Kaiser Permanente, the award recognizes health care organizations that directly deliver health care and their partners that led initiatives that achieved a measurable, sustained reduction in one or more health care disparities.
WellSpan began addressing discrepancies in breast cancer screening rates by digging into its electronic health record to examine the rates among different racial groups and designing ways to improve its outreach to underserved communities. This is part of WellSpan’s vision to be a trusted partner committed to improving access to care to all patients it serves.
What the health record revealed was that white women had a screening rate of 71 percent, as compared to 69 percent for Black women, and 70 percent for Hispanic women in November 2021. After WellSpan worked on improving rates, rates rose for all groups, increasing to 75 percent for white women, 74 percent for Black women, and 76 percent for Hispanic women by June 2022.
“One of the few things we can do to improve survivability with late-stage cancer is to diagnose it early,” said Dr. Carlos Roberts, the vice president and chief medical officer of women’s and children’s services at WellSpan, who oversaw the breast cancer screening project. “We can have a better outcome if we find the cancer sooner rather than later.”
Roberts has a grandmother, aunt, and another close relative who all died from breast cancer, and his sister also battled it. For him, this work was personal.
“Each of these patients is someone’s aunt, someone’s grandmother who, if we get this right,
has more time they can spend with their other family members,” he said. “That’s what this work means to me.”
Here are some specific things WellSpan is doing to increase mammogram rates:
Focus groups revealed that some Hispanic patients mistakenly thought that most mammograms found cancer, and so they were avoiding the screening, fearing the disease. WellSpan set up meetings with Hispanic patients, using Spanish interpreters, to demystify the test and explain that, in fact, most screenings show no cancer. However, the test is important because the main goal is to catch any disease early so it can be treated earlier and help patients live healthier lives.
WellSpan is working to more quickly identify patients who qualify for either Medicaid and Medicare and help them sign up for the insurance because the two federal insurance programs cover the entire cost of an annual screening mammogram. For patients who do not qualify for those programs nor have health insurance, WellSpan is working to connect them to financial resources to cover the cost. WellSpan also received a grant from Capital Blue Cross to help uninsured women receive screening mammograms on the mobile mammography coach. This grant allowed 50 women to get a screening in the last year.
WellSpan uses its electronic health record to identify patients who are due for a mammogram
and sends them a reminder message via MyWellSpan, the online portal for patients. The message provides a link to easily schedule the test.
In its first year, the mobile mammography coach provided mammograms to almost 600 women at 70 screenings at sites including a library, community centers, and local companies. The screenings were held in rural areas like Georgetown, where women do not always have easy access to a mammogram.
In fact, the Georgetown practice was the first WellSpan primary care office to host the coach, in October 2021. The coach returned again in April of 2022 and again in November of 2022, with about 25 patients receiving their mammograms during each visit. Some, like Julie, had not received a mammogram in quite a while but were attracted by the convenience of getting one on the coach parked right outside the practice, said Tyler Barnett, office manager. In fact, the practice has seen a nearly 50 percent increase in the number of patients who received their annual screening mammography since the coach began making visits to the practice.
The coach also has visited Delta, a town of less than 800 people in southern York County, close to the Maryland border, and an apple growers’ co-op in Peach Glen, a small community in northern Adams County. The coach also raised awareness by holding tours and sharing information about breast cancer at events that included a women’s motorcycle rally.
When the one million children living with congenital heart disease in the U.S. become, by medical definition, adults living with congenital heart disease, the graduation is often inauspicious.
In fact, the teams of caregivers, regimented appointments and constant safeguards of their youth sometimes start to slip away. Patients miss screenings, skip appointments, and stop looking for the adult equivalent of what they had as children. Reasons vary. The patients have become attached to the specialists they’ve known for 18 years, whose care they trust — and they don’t want to change. Others simply don’t know they need to keep going.
“Some patients may believe they’re completely fixed,” said Dr. Amanda Cai, a Penn State Health cardiologist specializing in adult congenital heart disease, cardio-obstetrics and general cardiology who sees patients at Penn State Health Children’s Lancaster Pediatric Center. “They’ve had surgery or intervention for their congenital heart disease and they don’t have a lot of symptoms at present, so they may feel ‘cured.’ In some instances, they may have even been told this by previous providers. But the reality is that care for congenital heart disease is usually lifelong, especially now that the majority of patients are living to old age and seeing later complications of their congenital heart disease or acquiring non-congenital heart disease such as coronary artery disease, arrhythmias and heart failure.”
Now, doctors with the Penn State Health Program for Adult Congenital Heart Disease are working with pediatric specialists in
Lancaster County to provide a supportive and seamless transition from pediatric to adult care.
Penn State Health’s adult congenital heart disease team developed an evidence-based transition plan with colleagues in pediatrics, discussing the optimal timing and approaches for young adult congenital cardiac care patients to make their transition.
The latest American Heart Association and American College of Cardiology guidelines for care of the adult congenital heart disease patient suggest that pediatric cardiologists start the transition process for pediatric patients around 12 years of age. That doesn’t mean sending adolescents to doctors for grown-ups. Rather, 12 is when doctors should start the conversation: when the patient is older, they’ll need to keep up with a new doctor. At the same time, providers should encourage their pediatric patients to start paying attention during medical appointments so they become progressively more familiar with their conditions and can advocate for themselves, Dr. Cai says.
Penn State Health Children’s Lancaster Pediatric Center, which opened in June 2022 at the intersection of Harrisburg Pike and Route 30 in Manheim Township, offers preteens and teens a familiar, comfortable environment to meet adult specialists. Connections are made; names and faces linked. And if the patients want to continue their adult care in that setting, they can. Specialists with the Penn State Health Program for Adult Congenital Heart Disease, including Cai, see adult patients at the Lancaster Pediatric Center as well as at locations in Harrisburg, Hershey, Reading, York, and State College.
In recognition of its expertise, Penn State Health’s program recently earned accreditation from the Adult Congenital Heart Association. This national organization provides education and resources exclusively for adults with congenital heart disease. Penn State Health’s program — one of only 47 nationwide to earn the accreditation — is one of the largest in Pennsylvania and among the oldest in the U.S.
“This accreditation should reassure referring providers that their patients with congenital heart disease will receive expert and specialized, evidence-based medical care for their congenital heart disease,” Dr. Cai said.
Comprehensive heart disease care for adults
Penn State Health has six adult congenital heart disease physicians and two congenital heart surgeons. The full spectrum of services for adult patients includes surgery, cardiac catheterizations and electrophysiology procedures. Complex imaging services include cardiac computerized tomography scans, magnetic resonance imaging and transesophageal echocardiograms.
The adult congenital heart disease specialists at Penn State Health welcome referrals from area physicians to Lancaster Pediatric Center and invite referring providers to discuss any questions they have about transitioning patients from pediatric to adult care. In addition to providing care for congenital heart disease, the cardiologists treat other heart conditions as well. Pregnant or post-partum women with congenital or acquired heart disease can also receive specialized care at Lancaster Pediatric Center.
Physicians whose pediatric patients need a higher level of care can take comfort knowing that the nationally recognized, specialty care of Penn State Health Children’s Hospital is now conveniently available right here in Lancaster County. The new Penn State Health Children’s Lancaster Pediatric Center offers a full spectrum of medical and surgical consultative care for children from infancy through age 18. It significantly expands access to the most advanced care in nearly every pediatric specialty and subspecialty.
Call 717-606-1170 to make a referral.
Learn more: pennstatehealth.org/lancasterpediatrics
Penn State Health Children’s Lancaster Pediatric Center 1430 Harrisburg Pike
Lancaster, PA 17601
LORI GERHART, BSN, RN, OCN Clinical Director, Lancaster Cancer Center
The demands on professionals and individuals in the health care world have always been recognized as a “given” by those very professionals and their leaders. That constant pressure inevitably leads to burnout. Burnout is a topic that has permeated the literature in medicine, general management, human resources management, and organizational development. It is considered a major cause of the deleterious impact on staff performance, productivity, and retention and even, to a degree, sub-optimal patient care.
Mindfulness is not a new management fad or trend. Ancient Buddhist literature contains detailed guidance on mindfulness. More recent research exists in numerous articles on the subject specific to health care workers. “Evidence is accumulating that mindfulness training is useful in reducing stress for health care workers and may increase the quality of their interactions with patients.” [Mindfulness 6, 744-758 (2015), Original paper published :05 June 2014, Peter Morgan, Jane Simpson & Alistair Smith.]
Mindfulness is also commonly known to many as “Care for yourself so you can care for others… an age-old adage that is easily forgotten in our jampacked personal and professional lives.” [The Role of Mindfulness in Enhancing Self-Care for Nurses by Margo Halm, RN, PhD, NES-BC, Am J Crit Care (2017) 26 (4): 344-348.]
Working definitions of mindfulness from Oxford Languages include:
1. The quality or state of being conscious or aware of something. “Their mindfulness of the wider cinematic tradition”
2. A mental state achieved by focusing one’s awareness on the present moment,while calmly acknowledging and accepting one’s feelings, thoughts, and bodily sensations, used as a therapeutic technique
According to a 2020 blog article on mindful.org, “Mindfulness is the basic human ability to be fully present, aware of where we are and what we are doing, and not overly reactive or overwhelmed...”
Mindfulness means paying full attention to something. It means slowing down to really notice what you are doing. Being mindful is the opposite of rushing or multitasking. When you are mindful, you are taking your time. You are focusing in a relaxed, effortless way.
In general, we seek to develop three key characteristics of mindfulness:
• Intention to cultivate awareness (and return to it repeatedly)
• Attention to what is occurring in the present moment (simply observing thoughts, feelings, and sensations as they arise)
• Attitude that is non-judgmental, curious, and kind
Healthcare professionals and lay staff alike have many stressors in their daily working lives, even more so since the COVID-19 pandemic. Caring for oneself became an operational imperative, exacerbated by the trifecta of COVID and its many variants, the seasonal flu, and RSV. A focus on the Lancaster Cancer Center (LCC) workforce’s total well-being was recognized as the best approach to our personal and professional challenges.
This article recognizes the powerful and current existence of pressures on healthcare workers and presents an approach to mental, emotional, and behavioral health in a medical practice setting. My experience with direct patient care, close collaboration with oncologists, and as a leader and manager of professional and lay staff members for over 32 years led me to explore methods to improve mindfulness. I recognized the need for an approach to the mental, emotional, and physical health of the physicians, nurses, and staff that would positively impact their caring for cancer patients and each other, reduce stress-related burnout symptoms, and enhance employee retention and engagement.
I began with a plan to research the subject of mindfulness and engage presenters on the subject. Taking account of the size of our practice, I tailored the plan to support our unique population of patients, physician, nurses, and staff at LCC. This program was designed as a long-term strategic investment that would serve to impact the key success factors at LCC to adhere to our stated mission of “Care Beyond Treatment” and thus improve and maintain individual and group performance.
I recognized early in my planning that operationalizing mindfulness training into the daily lives of employees would not be a once and done effort. I realized there had to be a pivot to a focus on total employee well-being. Below is the list of the processes I began to integrate to create a
mindful environment at LCC.
• Holding daily team huddles and regular staff meetings during which plans and events are discussed to inform and share expectations about mindfulness as it relates to total well-being.
• Researching and organizing team-building activities for staff with the goal of increasing employees’ engagement, thus improving productivity and elevating retention rates.
• Reviewing patient satisfaction survey results regularly and sharing them.
• Offering an Employee Assistance Program and flexible PTO policies.
• Creating avenues for staff recognition of individuals’ manifestation of our mission, “Care Beyond Treatment.” Staff members have access to index cards (Cheers for Peers!) specifically for the purpose of sharing their witnessing of a co-worker doing something special for an employee or a patient or their loved one.
• Recognizing the need to support employees for clinical or other development opportunities, including attendance at relevant professional organizations, cross training, and furthering their education. This is based in the belief that LCC’s investment will lead to increased engagement. LCC has several employees who have progressed from their initial positions to more advanced positions over time.
• Acknowledging that financial wellness has a major impact on an employee’s overall well-being. Through our company-sponsored 401(k) plan, participants have access to financial advising for retirement, and participation is encouraged using a matching mechanism.
Our program at LCC is dynamic, evolving, and focused on developing a culture of awareness, caring, and engagement. We recognize we must remain committed to developing our culture of awareness — and encouraging mindfulness to enhance workforce and patient well-being is a part of that. A robust organization culture is not about benefits, size, or material advantages — it is about how people are treated.
VENKATACHALAM
Epilepsy is simply defined as a disorder of the brain in which nerve cells do not signal properly. Seizures stem from an uncontrolled burst of electrical activity which results in clinical manifestations that may include loss of awareness or consciousness, behavioral changes, abnormal motor movements, and occasionally transient sensory changes.
There are two major subtypes of seizures: petit mal and grand mal. Petit mal seizures start in childhood and extend into adulthood. A petit mal seizure is a transient loss of awareness with eye fluttering and/or hand twitching that occurs for seconds. A grand mal seizure usually has a loss of consciousness followed by generalized convulsions of the limbs. Patients can also experience tongue biting or urinary incontinence. The patient’s head and gaze usually deviate to one side. The whole episode may last three to five minutes, and the patient will gradually wake up and regain consciousness. Patients may be confused for a short period of time before returning back to their baseline. Dacrystic seizures are seizures when a person makes a crying sound. There is another seizure called partial complex with secondary generalization. There is also another rare type of seizure, which usually starts in teenagers, called juvenile myoclonic seizure. A subset of seizures includes those classified as secondary or symptomatic. Some examples include post-traumatic brain injury (TBI); transient ischemic attack (TIA), a.k.a. stroke; or brain tumors. Notably, one to five percent of cortical strokes are complicated by a seizure disorder.
Some epileptic syndromes arise from a genetic abnormality. The International League Against Epilepsy (ILAE) classifies this subset as idiopathic generalized epilepsy (IGE). According to the ILAE, some examples of IGE include juvenile myoclonic epilepsy, juvenile absence epilepsy, and childhood absence epilepsy. Patients may require an MRI of the brain to look for structural disorders that include heterotopic brain and radial migration line disorders and tuberous sclerosis. Dravet syndrome, also known as severe myoclonic epilepsy of infancy, was found to have a genetic association with
the voltage-gated sodium channel SCN1A found on chromosome zq24. It is an epileptic syndrome associated with encephalopathy. Lennox-Gestaut syndrome (LGS) is a severe form of epilepsy that typically starts in infancy or childhood. It is usually caused by a genetic abnormality or brain injury from infection or trauma. LGS is difficult to treat and is often associated with developmental delays. The ILAE task force has classified this disorder as epileptic encephalopathy. Medications such as Onfi (clobazam), Banzel (rufinamide), and inhaled cannabinoids may help. A brain MRI to identify cortical dysplasia may also be advised.
At this time, epilepsy does not have a cure but can be well controlled through treatment with antiepileptic drugs. The mechanism of action of antiepileptic and anticonvulsant drugs to prevent seizure is variable. One mechanism involves decreasing the excitation of cortical neurons or enhancing the inhibition of cortical neurons. Another mechanism involves altering the neuronal electrical activity by affecting ion channels in the cell membrane. In general, antiepileptic medications are always continued in adults for driver’s license maintenance, but an adult should not drive after a seizure for at least six months. Along the same lines, the rule of thumb is to never stop antiepileptic drugs in juvenile myoclonic seizures or symptomatic seizures. Prolonged or back-to-back seizures may require hospitalization and acute management with intravenous medications, such as Keppra (levetiracetam) and Depakote (sodium valproate), and/or nasal sprays, including Valtoco (diazepram) and Versed (midazolam). When multiple antiepileptic
drugs fail to work, patients may need surgical intervention with a lobotomy procedure.
Some seizures result in a postictal period and can be associated with crying spells or laughing spells lasting up to a minute with grunting, mumbling, lip smacking, or fidgetiness. Some seizures present with automatism, which is characterized by hand wringing (clasping together of hands and squeezing), involuntary movements, lip smacking, or running in circles. Automatism occurs when the seizure discharge emanates from an area of the brain called the amygdala. Patients can also develop autonomic dysfunction, such as abnormal blood pressure, irregular heart rhythms, and slurring of speech, and patients may have a drop attack and syncope. Patients will need to follow a neurologist on a regular basis and may require periodic electrophysiologic testing, known as routine EEG, which is usually completed in 35 minutes but can also be a 24-hour continuous EEG. More extensive monitoring can also be done for three days duration in an epilepsy monitoring unit. At the time of a seizure, an EEG will be abnormal for the majority of the time.
Migraines may also be seen in epileptic patients. In that case, a drug will be prescribed that will help both epilepsy and the migraines. Examples include Depakene (valproic acid), Lamictal (lamotrigine), Topamax (topiramate) and Zonegran (zonisamide). In order to improve compliance, some drugs are available in an extended-release formulation. Compliance is a key factor in reducing seizure recurrence. Some patients may have recurrent seizures with prolonged unconsciousness. If a seizure lasts 30 minutes or longer, that is known as status epilepticus, which can be fatal and requires the patient to be hospitalized and potentially mechanically ventilated to maintain airway flow. Sudden death has been rarely reported in epileptic patients.
In conclusion, epilepsy is a very complex neurological disorder. We must remain informed and aware to potentially help someone who may be in need.
AT THIS TIME, EPILEPSY DOES NOT HAVE A CURE BUT CAN BE WELL CONTROLLED THROUGH TREATMENT WITH ANTIEPILEPTIC DRUGS.
SARA D. BOWEN, MD, FAAP Penn Medicine Lancaster General Health Physicians
It is that time of year again…or is it? Ask any pediatrician across the globe if they are seeing much RSV right now and the answer will be a resounding, “Yes!” The RSV season began with a roaring start. Moreover, it hit earlier than expected, after relaxation of COVID-19 measures in 2022. RSV, coupled with COVID-19 cases and skyrocketing influenza cases, made this past fall one for the record books. Outpatient offices remain flooded with calls and appointments are booked quickly each day. Local pediatric hospitalist colleagues are seeing record numbers of hospitalizations and pediatric intensive care unit bed crunches. Critically ill children are forced to board in community emergency rooms while waiting for PICU beds in tertiary hospitals. RSV, influenza, and COVID are each vying for a seat at the top of the viral illness mountain.
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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.
Healthy Weight Management & Bariatric Surgery
2150 Harrisburg Pike, Suite 300 | Lancaster
717-544-2935
Kelly, Sleeve Gastrectomy Patient Joseph McPhee, MD James Ku, MD Zachary Ichter, DO Bariatric Surgeons Non-Surgical Providers Virginia Wray, DO Lawrence Wieger, DO Andrea Girolamo, CRNPRespiratory syncytial virus, or RSV, is a member of this trio; it is a common respiratory virus that typically is present in the late fall through early spring. RSV can affect anyone, at any age, and cause symptoms ranging from mild sniffles to severe and life-threatening disease. Most commonly, severe disease occurs in young infants, particularly those under six months of age, and premature infants. Additionally, children (and adults) with compromised immune systems, chronic lung disease, congenital heart disease, or neuromuscular disorders that impair airway clearance are at risk for more serious complications. Adults and the elderly over 65 years of age are also at higher risk for severe disease, particularly if they have underlying medical problems.
Epidemiologically speaking, RSV is the most common cause of lower respiratory tract infection in children under 12 months of age. Historically, hospitalization rates were highest in young infants and children under five years; however, we have observed a larger number of older children requiring hospitalization this season. Additionally, RSV accounts for a large percentage of outpatient visits. As of early December 2022, RSV case counts are climbing higher and earlier than expected for this time of the year; this rise in cases began in early September!
RSV transmission is by direct contact with virus-containing secretions on hands or fomites. (The pesky little single-stranded RNA virus can survive for several hours on hands and surfaces, so wash those hands and stethoscopes!) It also spreads by large droplet aerosolization from coughs and sneezes; there are also reports of airborne spread. RSV typically incubates two to eight days; RSV is contagious even in the one to two days prior to symptom development. Some children shed RSV for up to four weeks after initial infection! Due to varying viral genotypes, reinfection can happen throughout the season, though subsequent infections are typically less severe. Diagnosis is typically clinical, but rapid PCR testing is available. This testing is helpful for infection control purposes but does not largely change management of the illness.
While symptoms often begin mildly, they can quickly worsen and require escalation of care. Typically, children start with upper respiratory tract symptoms of cough, congestion, sneezing, and rhinorrhea (runny nose); fever and loss of
appetite are also often present. As the illness progresses it leads to lower tract respiratory illness (LRTI) presenting with wheezing, worsening cough, and increased work of breathing. Bronchiolitis, pneumonia, and even respiratory failure are typical lower respiratory tract sequelae.
In pediatrics, RSV most commonly causes bronchiolitis, but other viruses can lead to this as well. Bronchiolitis manifests as fever, increased work of breathing, tachypnea, cough, and wheezing with crackles and rhonchi heard on lung auscultation. Babies with increased work of breathing will exhibit tachypnea (abnormally rapid breathing), nostril flaring, head bobbing, grunting, wheezing, and retractions. These symptoms follow the typical one-to-three-day upper respiratory infection prodrome. The LRTI symptoms usually peak on days three to five and gradually resolve; the cough (and even wheezing), however, can last up to a month before it finally improves.
The treatment for RSV is largely supportive. Steroids, albuterol, and antibiotics do not routinely provide benefit. In some cases, children may receive these due to other underlying medical problems. Nasal suctioning with saline is the best option for most infants, though tackling a screaming baby to provide frequent suctioning is no picnic. The best time to suction an infant is just prior to feeding and prior to sleeping. A cool mist humidifier can sometimes aid breathing. Due to severe nasal congestion, infants may have a difficult time breast- or bottle-feeding. Smaller feeds that are more frequent can be of benefit. Children over one year of age can take a spoonful of honey prior to sleep to help with cough and to soothe a sore throat.
Children with signs of dehydration, decreased urine output, refusal of foods and fluids, lethargy, and dry mucous membranes require prompt care. Additionally, children with sustained increased work of breathing, apnea, and / or hypoxia require emergent medical evaluation to monitor for respiratory failure. When admitted to the hospital, these children require IV fluid support, oxygen, high flow nasal cannula, positive pressure ventilation, and, in severe cases, intubation and mechanical ventilation. Secondary otitis media and bacterial pneumonias can develop as well, though a viral etiology is the most common cause of pneumonia in children. Infants under
two months of age are at highest risk for these sequelae, but with rising RSV case numbers, many older children are also requiring additional respiratory support!
Palivizumab (Synagis) is a monoclonal antibody given intramuscularly to infants at high risk of severe LRTI due to RSV; this injection is given monthly during RSV season. The American Academy of Pediatrics has specific guidelines for palivizumab administration based on gestational age at birth, as well as presence of chronic lung disease, congenital heart disease, and other congenital and/or genetic disorders. Palivizumab is safely given with other vaccines and thus there is no disruption to typical vaccine schedules.
RSV is a significant clinical problem, causing countless illnesses each year. Because treatment is supportive, parents and caregivers are easily frustrated. Consistent education on course, treatment, and illness duration coupled with prompt medical care for moderate to severe illness is helpful as parents navigate RSV waters.
1. Barr, Frederick E. MD, MBA and Barney S Graham, MD PhD. Respiratory Syncytial virus infection: Clinical features and Diagnosis. Edwards, Morven S, MD and Mary Torchia, MD ed. UpToDate. Waltham, MD: UpToDate Inc. www. uptodate.com. (Accessed on December 12, 2022.)
2. Jones, Andrea MD, FAAP, Section on Infectious Diseases, American Academy of Pediatrics. “RSV: When it is more than just a cold.” December 12, 2022. https://www.healthychildren.org/.
3. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. “Respiratory Syncytial Virus.” December 12, 2022. https://www.cdc.gov/rsv/clinical/index.html
4. Piedra, Pedro O MD and Ann R Stark, MD. Bronchiolitis in infants and children: Clinical features and diagnosis. Edwards, Morven S, MD and Mary Torchia, MD ed. UpToDate. Waltham, MD: UpToDate Inc. www.uptodate.com. (Accessed on December 12, 2022.)
Have you ever tried to take a vacation without planning? Ever tried to hold an event without planning all the details? Without a plan for these events, you may end up without a place to stay or enough food for your guests. Planning is important in many aspects of life, including your finances.
The definition of planning is deciding on and arranging in advance. It is never too early to begin planning for things such as a home purchase, education expenses for you or family members, retirement, long term care, or estate concerns. Financial planning provides you a detailed map for achieving your goals. It can also provide guidance on the types of investments, ways to protect assets, and the amount of risk needed to reach those goals. So how do you get started?
the beginner's guide to
The first thing is to determine your goals. Ask yourself:
• WHAT DO I WANT TO ACHIEVE?
• WHAT IS THE TIMELINE FOR EACH GOAL?
• WHAT IS THE COST?
• WHAT FUNDS DO I ALREADY HAVE AVAILABLE TO HELP ME REACH MY GOALS?
Write down the answers and be specific and realistic. Next, determine if additional funds are required to meet your goals. If so, where will those funds come from?
Then you need to decide how to invest the funds for each goal. Shorter term goals (less than five years) would be invested more conservatively, whereas longer term goals (10 years or longer) could possibly take on additional risk given the longer time frame to allow the funds to grow. Finally, evaluate your goals on a regular basis and when special circumstances arise, such as a career or family change, a financial windfall, unexpected expenses, economic events, or health issues. Reviewing your goals regularly will help you determine the amount of investment risk you should be taking as well as help you stay on track with other financial decisions.
By working with a financial advisor to create a financial road map (which is specific to your goals and risk tolerance), you will find answers to many of the following questions:
• HOW MUCH DO I NEED TO SAVE TO HAVE THE RETIREMENT LIFESTYLE I ENVISION?
• HOW WILL MY FAMILY BE PROTECTED IF SOMETHING HAPPENS TO ME?
• AM I TAKING ON TOO MUCH INVESTMENT RISK BASED ON MY GOALS?
• WH AT IS THE BEST WAY TO GENERATE RETIREMENT INCOME FROM MY INVESTMENTS?
• H OW DO I TRANSFER ASSETS MOST EFFICIENTLY?
To start creating your retirement plan, you need to estimate your retirement needs. There are several ways to do this. The most common way is
to estimate your retirement need as a percentage of your current income. The problem with this method is it doesn’t account for changes to your specific situation, such as increased travel, additional health care expenses, or hobbies you want to maintain for the remaining years of your life.
A more accurate method of calculating your expenses is to prepare an estimated budget for the future. Including costs, such as:
FOOD AND CLOTHING
HOUSING
UTILITIES
TRANSPORTATION
INSURANCES
HEALTH CARE TAXES DEBTS EDUCATION
(children or grandchildren)
GIFTS
(charitable and personal)
SAVINGS RECREATION
(travel, dining out, hobbies, leisure activities)
MISCELLANEOUS ITEMS (pets, memberships, personal grooming, etc.)
These are just a few examples of the expenses you may have; there may be others specific to your situation. You may also have some expenses that will change as you move through retirement. For instance, you may pay off a loan soon after retirement, you may have higher travel expenses in the earlier years of retirement, or your health care costs may be higher in later years of retirement. These should all be accounted for. Build in a cushion; now is not the time to be conservative with your estimates.
After you have an idea of what your retirement expenses will be, you need to consider the effect inflation will have on your plan. The Consumer Price Index (CPI-U) is data published by the Bureau of Labor Statistics, which tracks the rate of inflation. Over the last 20 years, inflation has averaged approximately 2 percent per year1. Inflation can make a significant change to your estimated expenses.
Now that you have an idea of how much money you will need each year, determine when you want to retire and estimate how long
you will be retired. Determine the year (or age) you want to retire and then estimate your life expectancy. There are numerous tools to assist in determining life expectancy, including government statistics, life insurance tables, or a life expectancy calculator. A life expectancy calculator is the most specific — it uses age, gender, race, health, lifestyle, occupation, and family history to give you an estimated life expectancy. In keeping with being conservative, it is best to assume you will live longer than expected.
Next, determine what sources of retirement income you have. There can be several places where you might receive income during retirement. A pension plan offered by either a current employer or a previous employer, 401k/403b, other employer retirement plans, IRAs, annuities, investments, income from working during retirement, and/or Social Security. You can check your estimated benefit by logging on to www.SSA.gov.
Once you have determined the difference between your retirement costs and your income sources, what do you do if there is a gap? There are several ways to reduce or eliminate the gap, such as cutting current expenses and saving more towards retirement. You could reallocate assets to investments that have the potential for higher returns, but keep in mind higher potential returns often mean a chance of greater risk of losses. You can lower your income expectations in retirement, review the list of expenses, and see if there are things you can reduce, like travel and entertainment. Other options could include working part time or consider delaying retirement for a few years.
The final step in retirement planning is to monitor and update your plan each year if you have a significant change in your life. Establishing and maintaining a financial plan is critical to achieving your goals.
1650 Crooked Oak Drive, Ste 100 • Lancaster, PA 17601 www.MeyerLePrell.com • 717-519-4193
[1] Calculated from Consumer Price Index (CPI-U) data published by the Bureau of Labor Statistics, January 2022
This is being provided solely for informational and illustrative purposes, it is not an offer to sell or a solicitation of an offer to buy any securities. The factual information given herein is taken from sources that we believe to be reliable but is not guaranteed as to accuracy or completeness. Neither Janney Montgomery Scott LLC nor its Financial Advisors give tax, legal, or accounting advice. Please consult with the appropriate professional for advice concerning your particular circumstances. For more information about Janney, please see Janney’s Relationship Summary (Form CRS) on www.janney.com/crs which details all material facts about the scope and terms of our relationship with you and any potential conflicts of interest.
Statistics released during the past year concerning nationwide health care staffing shortages are discouraging, to say the least.
The American Hospital Association in February 2022 submitted a statement to the Senate Health, Education, Labor & Pension Committee, describing the issue as “critical,” while U.S. Surgeon General Vivek Murthy, MD, issued an advisory in May that called on the country to address the growing threats of staffing shortages and health worker burnout.
Data released in June by the Association of American Medical Colleges indicated that the U.S. could face a shortage of between 37,800 and 124,000 physicians by 2034, and the U.S. Bureau of Labor Statistics projected the need for 1.1 million additional registered nurses by 2030 in order to meet demand.
There is little dispute that staffing shortages continue to plague health care systems across the country, as well as in other parts of the world, and that the situation is likely to remain a problem for the foreseeable future.
While Lancaster County health care systems are not immune to these shortages and are working aggressively to address them, representatives of some of the systems serving the county reported their situations seem to be improving, and they’re hopeful the worst may be behind them.
They spoke of workers who had left the systems and then returned to their jobs, reframing the “Great Resignation” as the “Great Regret,” and said they are working hard to assure that benefits and working conditions are in line to attract other workers.
Lancaster Physician reached out to the health systems serving Lancaster County to learn more about their current situations and what they’re doing to address shortages of staff. Penn State Health, Penn Medicine Lancaster General Health, UPMC, and WellSpan Health responded.
Penn Medicine Lancaster General Health
Pandemic-related resignations and other factors have contributed to staffing shortages in some areas within Penn Medicine Lancaster General Health, said Kay Brady, interim chief human resources officer. Staffing issues are especially affecting the areas of nursing, respiratory therapy, and surgical technology.
But on a positive note, Brady said, the rate of employee turnover appears to have leveled off since peaking last September.
“We’re not back to pre-pandemic numbers yet, but it’s getting better,” she said. “Our turnover rate has decreased in the past year.”
Like other health care systems, LG Health has had to make changes in its efforts to attract, hire, and retain employees.
Where it once employed a more generalized approach to finding people to fill open positions, it now focuses on more proactive “sourcing” of potential employees, including some who had previously left positions within LG Health.
“We spend a significant amount of time sourcing for our jobs,” noted Brady. “We’ve found we really need to get out there and identify candidates for open positions.”
Recruiting through social media has increased significantly, and “Talk to Us Tuesday” events held on-site enable potential employees for entry-level jobs to get on-the-spot-interviews at specific locations.
LG Health also uses an internal pipeline system to advance employees, offering scholarships to qualified workers who wish to continue their educations. And staff members work with area school systems to bring 16- and17-year-old students into the hospital to introduce them to health care jobs.
“We want students to be aware of the variety of opportunities available to them,” Brady said.
In addition to altering its recruitment and hiring efforts, the system has stepped up its efforts to address the health and well-being of current employees.
An on-site resilience coach counsels workers on issues related to stress and burnout, and regular surveys are conducted to determine employee well-being needs. Management continually monitors compensation rates to make sure the system remains competitive.
“It’s important to make sure we know how employees are feeling and what they’re looking for within their work environments,” Brady said. “We want them to know that they’re valued.”
While LG Health’s staffing situation has improved, there’s still work to be done.
Certified medical assistants who work in doctors’ offices are in short supply, and varying recruitment and hiring practices must be engaged to attract employees to different parts of LG Health’s coverage area.
The health care system serves patients in Lancaster City, as well as suburban and
rural areas, Brady noted, requiring different strategies to attract employees to varying types of work environments.
“We touch 300,000 people a year,” Brady said. “That’s a lot of area to cover.”
She’s hopeful that attitudes toward working in health care will improve and more people will begin to pursue careers in the field.
“I think it’s a cyclical thing, and I think the situation will improve,” Brady said. “But I’m also realistic about where we are right now and the need to keep working to make sure we have sufficient levels of staffing to care for our patients.”
With two new hospitals that opened just about a year apart in 2021 and 2022, Penn State Health remains under pressure to attract additional employees to staff the new facilities.
“We were really needing to staff up so we could continue to serve our communities and deliver what we’d promised we would,” explained Jennifer Sarff, vice president of human resources.
While there have been some challenges in getting the hospitals — the newest of which is a $375 million facility that opened in October in East Hempfield Township — sufficiently staffed, Sarff said a shortage of workers appears to have abated somewhat over the past several months.
“I would say that it (understaffing) definitely continues to be a problem, but we are seeing some improvement as the months go by,” she said.
Peak shortages occurred in April, May, and June of this past year, but Sarff said the system was able to meet its recruiting goals for the opening of Penn State Health Lancaster Medical Center.
The hospital has continued to serve its patients, supplementing with agency nurses when necessary to meet patient needs.
Hired to her current position during the height of the pandemic, Sarff said Penn State Health has had to shift its hiring focus and pivot to doing things differently.
“We’re doing things we haven’t previously done,” she noted.
Those things include careful monitoring of market reviews, making salary adjustments, and keeping a close watch on market data.
New technology is being employed for recruiting employees, and jobs fairs — which were completely virtual during the pandemic — are now a combination of virtual and in-person. Penn State Health also is moving toward a regional recruitment method and has enhanced communications with potential employees.
“We’re hoping all of these things will make it easier to identify, hire, and onboard employees,” Sarff said.
The health system also is looking internally to better understand what employees are looking for in an attempt to boost employee retention.
“We’re using internal data like we never have before,” Sarff shared.
While there are openings at nearly every job level, nursing positions remain the hardest hit by shortages. Forty percent of all
job openings across the Penn State system are within the category of nursing jobs, including bedside nurses, licensed practical nurses, and nursing educators.
There are numerous reasons why so many nursing positions remain unfilled, Sarff said, but a major contributor is a low proportion of nursing students graduating within Pennsylvania. If more people can be persuaded to pursue nursing as a career, the problem will improve.
Penn State Health officials are encouraged that some employees who gave up their jobs during the pandemic have come back, a move that is evidence of wider-spread Great Regret.
“We are definitely seeing that play out here,” she said.
While she expects it will take time for the worker shortage to resolve, Sarff said Penn State Health continues to move forward with hiring and retaining employees.
“I’m encouraged by the positive trend we’re seeing, and from what we’re hearing from our employees,” she said. “We’re really excited about the opening of our newest hospital here and we’re looking forward to serving the people of Lancaster County.”
WellSpan Health is addressing the widespread worker shortage by employing innovative incentives for hiring and retaining workers, reported Dr. Ericka Powell, vice president
of medical affairs at WellSpan Ephrata Community Hospital and an emergency department physician.
Those efforts include working to rehire employees who left their jobs during the pandemic — an endeavor that has been successful. More than 1,000 workers have returned to WellSpan during the past two years, according to Powell.
“It’s a pretty significant number,” she said. “We’re proud of that.”
Powell said WellSpan Health continually promotes a culture of excellence, an effort that resulted in the system being recognized last year by Becker’s Healthcare as a top destination for employment on its 150 Top Places to Work in Healthcare 2022 list.
Factors contributing to that designation included workforce diversity, employee benefits, and opportunities for professional growth for employees.
Powell noted that WellSpan has been reaching out to the LGBTQ community and other groups in its efforts to promote employee diversity, and it offers excellent salaries along with extensive benefits packages that are tailored to meet employee needs.
“Those distinctions and recognitions have made us stand out in the community,” she explained. “We’re just known as a great place to work.”
WellSpan partners with high schools and community colleges to introduce students to
health care jobs and offers an advancement program for employees who are looking to advance in their careers.
Its recruitment efforts are supported by employees, who receive rewards for referrals.
“Everyone at WellSpan helps to recruit,” said Powell.
To address the issue of nurses leaving the health care system for higher paying jobs with agencies, WellSpan initiated a WellStaffed™ program of floating nurses across its regional health system.
The program addresses patient care needs at each of WellSpan’s hospitals, while providing opportunities for nurses and certified nursing assistants who wish to expand their skill sets by supporting various specialties.
“We’re super excited about that program,” Powell said. “It’s done really well.”
The health system also plans to initiate a pharmacy residency program at Ephrata Community Hospital with the intent of increasing its pool of pharmacists. It currently has a pharmacy residency program at WellSpan York Hospital.
And, said Powell, the system is innovatively employing new technologies that enable providers to deliver effective care to patients in less time. With Baby Boomers retiring and staffing levels still below pre-pandemic levels, it’s important to take advantage of resources that enable better patient care.
“Ideally, we could replace every provider who leaves WellSpan,” Powell shared. “But when you can’t do that, you have to look at how you can do things differently and use technology to close the gap.”
Staffing issues are a significant problem for health care systems, Powell acknowledged, and must be addressed on state and national levels. But WellSpan is doing all it can to hire and keep employees who value the organization’s culture and recognize the advantages of working there.
“We want people to know it’s a career they’re coming to, not just a job,” she said. “And that applies to everyone, from those in housekeeping to physicians.”
UPMC
UPMC has expanded its job training and education efforts and created additional opportunities for potential employees with innovate pipeline programs that enable those interested in careers in the medical field to get first-hand experience.
The programs, intended to address worker shortages by connecting individuals with employment opportunities at UPMC, include EMT training, medical and surgical technician training, an urgent care assistant program, and others. UPMC also partners with community colleges and other schools to encourage students to consider health care careers.
“We are looking for creative ways to build pipelines and remove barriers to receiving an education,” said Amanda Paull, a recruitment manager at UPMC.
The urgent care assistant program, which began in 2022, enables someone who is at least 18 years old and has earned a high school diploma to receive training in an urgent care setting while being paid as a UPMC employee. Qualified trainees who successfully obtain required certification can then be considered for permanent hire within the UPMC system.
“It’s a great opportunity for people to come in and get the training they need for employment,” Paull said.
New to the central Pennsylvania region is the UPMC Shadyside School of Nursing at UPMC Harrisburg, which opened to its inaugural class in August. Partnering with Harrisburg University, Shadyside School of Nursing is a 16-month, cost-effective, accelerated diploma program for registered nurses. It, and other UPMC nursing schools, will offer a tuition loan forgiveness program for new enrollees beginning in the fall of 2023.
The school includes non-nursing classes, nursing classes taught by UPMC faculty, and over 900 hours of clinical rotations at regional UPMC facilities.
Shayla Thompson, UPMC’s director of human resources, said the school addresses a need for nurses across the region.
“We know that the need for nurses is expected to increase, and we’re working to help meet the growing health care needs of our region,” Thompson said.
With 127 students in the inaugural class, the school is expected to graduate thousands of nurses over the next decade.
Retention efforts also are in place to address worker shortages, which Paull said are most prevalent in the areas of nursing, respiratory therapy, and imaging.
Thompson said UPMC addresses employee retention by providing pathways for workers to advance in their careers. A care attendant, for instance, potentially can move up to a nursing assistant position, eventually qualifying to be a registered or licensed practical nurse.
“We have career ladders for several roles within our organization that provide staff the opportunity to grow and develop within their careers,” she shared.
In addition, UPMC emphasizes a culture of openness and appreciation of its staff.
While worker shortages remain a concern, Thompson noted that the system is continuing to grow and can staff additional facilities. In addition, some employees who left the health care system have returned.
“We are continuing to grow and add practices to our organization, which is exciting from our perspective,” Thompson said.
Some friends and I went to Callaloo on Christmas Eve of this past year (Wow, it’s 2023!). My one friend had previously tried it, and I had been wanting to try it for quite some time now after I had heard great things about it. They do not take reservations, but it is first come first served, and the customer service is great. They are open Wednesday to Sunday. It is located downtown on North Mulberry Street. It seemed like there might be a few parking spots available for street parking, but fortunately we could walk to it and didn’t have to drive.
Coming into the restaurant on a day when it was about 13 degrees outside was quite nice. The inside of the restaurant is relatively small and cozy. There are a few tables against the wall, but it wasn’t full. The waiter greeted us and showed us right to our table, near the door. There was a seasonal menu at the front that included specials, and there was a QR code at the table that you could scan to see the regular menu online. I like the menu because it is small and not overwhelming. We wanted to, of course, try everything! For drinks, I had the Sorrel (roselle hibiscus) drink, which was sweet and quite refreshing. One of my friends had the LLB (lemon, lime, and bitters) drink.
We all started with the must-haves. The Doubles appetizer, the most famous street food from Trinidad, featured flaky fried bread with curried chickpeas. It came with a very cool, refreshing cucumber chutney (made fresh as well). Next we had the Aloo (potato) Pepper Roti (bread). It definitely had an Indian flavor, and was shaped in triangular pieces. It was a table favorite, along with the Fried Chicken Bao Buns with their sweet and spicy glaze! The bun was thick, soft, and tasty. The restaurant even had a homemade hot sauce for dipping. Our waiter was very attentive.
For the main course, we all wanted to try each other’s dish, since the appetizers were excellent. I ordered the Curried Chicken Buss-UpShut (buss up shut buss up shut!). The flaky bread, termed “paratha,” is an Indian bread dipped in curry, just like naan bread. The curried chicken was excellent; it was tender, served with chickpeas, pumpkin, and potatoes. Everyone at the table enjoyed it and said they wanted to order it next time. My friend had the Char Siu Pork Belly. The braised pork was very nicely cooked with a tasty glaze and a hint of sweetness, served over fried rice. Her son had the Bulgogi Beef Bowl, a Korean meat dish with a barbeque glaze. The meat was braised, slow cooked, and tender but nice and crispy on the outside. It was served over rice with a nice egg on top. Lastly, my other friend had the Curried Fish and Shrimp Bowl. The fresh coconut curry broth was perfection, with both the fish and shrimp perfectly cooked. We all enjoyed all of the dishes. The average cost of the entrees was about twenty dollars each.
We didn’t think anything could top what we had so far, but we were wrong. For dessert, we ordered the Coconut Bread Pudding with dulce de leche caramel sauce and the Crème Brulee with cardamom infused custard. I have to say the crème brulee was everyone’s favorite, and a perfect end to the meal! We all wanted more, and we would definitely order that again.
Callaloo is a perfect choice for dinner, especially if you like to try unique, authentic, fresh, very tasty cuisines. I can’t wait to go there again.
Our goal is to reduce stress, enabling you to feel reassured and in control through the transitions you experience on your journey. If you have questions about investment management, your plan for retirement, or a recent change in your financial picture, we are ready to help you transition well.
www.domaniwealth.com
We are proud to welcome neurologist Dr. Michelle DePoy to our Neuroscience Institute team. Dr. DePoy is fellowship trained and specializes in the field of headache medicine.
Medical School: Virginia Commonwealth University School of Medicine
Residency: Thomas Jefferson University Hospital
Fellowship: Jefferson Headache Center, Thomas Jefferson University Hospital
Areas of Expertise:
• Cluster headache
• Hemicrania continua
• Hypnic headache
• Migraine
• Paroxysmal hemicranias
• Sudden unilateral neuralgiform headache
with conjunctival injection and tearing (SUNCT)
• Tension-type headache
• Trigeminal neuralgia
• Other primary headache disorders
Dr. DePoy is part of LG Health Physicians
Neurology and sees patients in Lancaster and Elizabethtown. To refer a patient, please call 717-396-9167.
Neuroscience Institute
EXPANDING OUR ADVANCED NEUROLOGY EXPERTISE IN LANCASTER
E. Michelle Gibson DePoy, MD
Domani Wealth, LLC (“Domani”) is an SEC registered investment adviser with its principal place of business in Lancaster, Pennsylvania. Domani and its representatives may only transact business in states where they are appropriately notice-filed and registered, respectively, or exempt from such requirements. For information pertaining to the registration status of Domani, please contact the SEC or the state securities regulators for those states in which Domani maintains a notice-filing.Angie Stephenson, CPF®, CPA/PFS angie.stephenson@domaniwealth.com 717.393.9721 Ken Eshleman, CFP® ken.eshleman@domaniwealth.com 717.393.9721
Looking back at the General Assembly’s 2021-22 legislative session, PAMED’s legislative activity was robust. We saw the final passage of a number of bills in which PAMED was actively engaged. Additionally, PAMED was instrumental in blocking the passage of other proposals that were not consistent with our policy. The past year also marked the first time PAMED had been actively engaged in the budget process as we successfully secured additional funding for the state’s Primary Care Loan Repayment Program. This program provides loan forgiveness, presently up to $80,000, for physicians who choose to practice in a rural or underserved community for two years. PAMED secured an additional $2.5M to bring the program’s total allocation to $7M. This is the first time in more than a decade that the legislature has increased this line item.
While PAMED focused our advocacy efforts on the legislative arena, the undercurrent of “politics” seemed pervasive in 2022, as many legislators turned their focus towards the electoral process. While always sensitive to the politics that drives the development of public
policy, PAMED successfully highlighted the impact that some legislative proposals would have on both physicians and the patients they treat. It will come as no surprise, especially to those who follow policy making at both the Federal and State level, that political discord has reached an all-time high. The legislative process should be about compromise. But it seems that the proverbial “middle ground” no longer exists in the traditional process of legislative compromise. Instead, both sides of the aisle are entrenched in their beliefs and reluctant to give in to the other side. Though exceptions do exist…they’ve just become harder to find.
PAMED is unique in that the breadth of our legislative interests range from legal reform to scope of practice to insurance reform, and everything in between, with each of these subjects garnering interests from different subsets of the General Assembly. As a result, our legislative priorities are often influenced by political expediency, and we often find ourselves shifting gears on issues depending on the interest and will of legislative leaders, committee chairs, and our legislative
champions. Having said that, PAMED remains steadfast in its commitment to core priorities such as prior authorization reform and scope of practice.
Prior authorization reform has been a priority issue for PAMED and our 40+ member coalition of physician organizations and patient advocacy groups for over six years. Earlier in the past session, Senator Kristin Phillips-Hill introduced Senate Bill 225, and championed the effort to achieve Senate passage before the 2022 summer recess. We were extremely pleased to see her efforts, and the efforts of many others, pay off when the Senate approved Senate Bill 225 in June.
Since the measure was referred to the House Insurance Committee, PAMED had been part of a coalition of individual organizations that met regularly with Senate staff and representatives of the insurance industry to hammer out language that could ultimately pass the House of Representatives. The meetings were contentious, as one might expect,
with the industry pushing back on nearly every provision of the original bill. PAMED remains focused on how prior auth impacts patient care.
Signed by the Governor as Act 146 of 2022
When it comes to legislation addressing scope of practice, PAMED has always viewed patient safety as our number one concern, not the potential competition from our non-physician colleagues. As a result of the COVID-19 waivers that granted pharmacists with expanded authority to provide COVID19 vaccines, pharmacists began efforts in early January 2022 to further expand their role into the realm of childhood immunizations seeking the authority to provide this service to their customers over the age of five. Working in concert with the PA Academy of Family Physicians (PAFP) and the PA Chapter of the American College of Pediatrics (PA-ACP), that effort was stopped before it became part of a legislative proposal.
Though the child vaccine issue was sidelined, PAMED along with PAFP and PAACP did agree to allow pharmacists to provide seasonal flu and COVID-19 vaccines to individuals aged five and above. This compromise should serve to keep the issue of child vaccines off the table for the foreseeable future.
Other scope of practice issues, such as the interests of CRNPs and psychologists looking to either seek independent practice authority or expand their existing scope were kept from advancing during this past legislative session. Though we expect all of the scope, issues to return in the 2023-24 legislative session.
After the Pennsylvania Supreme Court issued a statement earlier last year that the current venue rule related to medical liability cases would revert to its pre-2003 status, PAMED engaged in advocating for the passage of House Bill 2660. This proposal, a legislative resolution that would have been the first step in potentially amending Pennsylvania’s constitution to place the question of judicial “venue” in the hands of the legislature instead of the state Supreme Court,
unfortunately did not advance beyond the House Judiciary Committee. PAMED was not alone in advocating for the passage of House Bill 2660. We were joined by the Hospital and Healthsystem Association of Pennsylvania and several business groups, all of which are members of the Pennsylvania Coalition for Civil Justice Reform (PCCJR). Though the bill only won committee approval in the House of Representatives, it was successful in getting the issue before the legislature. PAMED will continue to work within the framework of PCCJR to ensure that Pennsylvania’s legal climate is improved.
The following are legislative initiatives that either made it to the Governor’s desk during 2022 or fell short of making it through the legislative process prior to the end of this legislative session.
Provides health care practitioners the authority to prescribe or personally furnish antibiotics to treat sexually transmitted infections, without having examined the individual for whom the drug is intended. This is in accordance with the Expedited Partner Therapy (EPT) in the Management of Sexually Transmitted Diseases guidance document issued by the United States Center for Disease Control (CDC).
Signed by the Governor as Act 147 of 2022
Amends the Health Care Facilities Act to allow ambulatory surgical facilities to perform certain permitted surgical procedures without seeking a waiver/exception from the Department of Health. The bill creates an updated waiver/exception process for surgical procedures not on the 2022 CMS ASC-CPL list or otherwise prohibited by state regulation.
Signed by the Governor as Act 87 of 2022
A Joint Resolution proposing five separate and distinct amendments to the PA Constitution.
1. Establishes that the PA Constitution does not grant any right to abortion or taxpayer funding for an abortion.
2. Allows the General Assembly to disapprove regulations by its own vote with no signature by the Governor required.
3. Eliminates a separate election for Lieutenant Governor. Allows the gubernatorial candidate to select his own running mate.
4. Requires all voters, whether in person or not, to present a government-issued form of identification prior to voting.
5. Requires the General Assembly to provide by statute for the auditing of elections and election results.
Current Status —Passed the General Assembly on July 8, 2022. Identical language must pass again this session and then the ballot questions can be presented to the voters at the next statewide election, possibly as early as the 2023 Primary Election. Given the outcome of the election and the uncertainty of what party will control the House of Representatives, Senate Bill 106 will likely not be considered in 2023, putting an end to a possible constitutional referendum question on the primary election ballot in 2023.
Introduced at PAMED’s request, this legislation would significantly alter the parameters by which restricted covenants could be used in physician employment contracts. The bill had been approved by the House Health Committee but did not advance any further. PAMED continues work toward finding a legislative pathway to see this bill through the process. Alternatives are also being explored to negate strong opposition from hospitals. PAMED will be seeking to have legislation addressing restricted covenants reintroduced in this current legislative session.
Continued on page 30
House Bill 1280 – Patient Test Results
Amends the Patient Test Results Information Act. Provides for certain exclusions, and definitions within the Patient Test Results Information Act.
Current Status—Failed to win approval by the Senate Health and Welfare Committee. This measure will be reintroduced in 2023.
House Bill 1393 – Fentanyl Test Strips
Amends the Controlled Substance, Drug, Device and Cosmetic Act to legalize the use of drug testing products like fentanyl test strips for personal use. PAMED supported this initiative.
Signed by the Governor as Act 111 of 2022
House Bill 1421 – Primary Care Loan
Provides additional funding for the Primary Care Loan Repayment Program. Raises funding from $4.5 million to $7 million.
Signed by the Governor as Act 54 of 2022
House Bill 1563 – PA Drug and Alcohol Abuse
Amends the Pennsylvania Drug and Alcohol Abuse Control Act (DAACA). This legislation brings DAACA into alignment with HIPAA to create a consistent and easily understandable standard and revises outdated regulations. The bill also provides consistency between statutory and regulatory language.
Signed by the Governor as Act 33 of 2022 (Note: HB 1561, now Act 32, was a companion bill that amended the Mental Health Procedures Act.)
House Bill 1630 – Pharmacy Benefits Manager
This legislation, which PAMED supported, grants power to Pennsylvania’s Auditor General to audit Pharmacy Benefits Managers (PBMs) that do business with the state, namely through the Medicaid program. While the bill doesn’t provide complete PBM transparency, it is a good first step.
Signed by the Governor as Act 98 of 2022
House Bill 2419 – Outpatient Telehealth
Allows psychiatrists and other mental health providers to provide telehealth services.
Signed by the Governor as Act 76 of 2022
House Bill 2604 – Health Care Facilities
Allows name badges to have the health system a health care provider works for on the badge. Previously name badges had to be specific to the location the provider was working, becoming an issue for providers who work in multiple locations.
Signed by the Governor as Act 79 of 2022
House Bill 2679 – Pharmacy Act
Amends the Pharmacy Act to allow pharmacists and supervised pharmacy interns to administer influenza and COVID-19 vaccines to children ages five and older.
Signed by the Governor as Act 80 of 2022
As is customary before the start of a new legislative session, lawmakers from both the Senate and House of Representatives go through the process of electing their individual caucus leaders for the upcoming session. Below are the leaders in place for the 2023-24 legislative session.
2023-2024 House Leadership Election Results
House Republican Leadership:
• Leader: Bryan Cutler (R-Lancaster)
• Whip: Tim O’Neal (R-Washington)
• Appropriations Chair: Seth Grove (R-York)
• Caucus Chair: George Dunbar (R-Westmoreland)
• Caucus Secretary: Martina White (R-Philadelphia)
• Policy Chair: Josh Kail (R-Beaver)
• Caucus Administrator: Sheryl Delozier (R-Cumberland)
House Democratic Leadership:
• Leader: Joanna McClinton (D-Philadelphia)
• Appropriations Chairman: Matt Bradford (D-Montgomery)
• Whip: Jordan Harris (D-Philadelphia)
• Caucus Chair: Dan Miller (D-Allegheny)
• Caucus Secretary: Tina Davis (D-Bucks)
• Policy Chair: Ryan Bizzarro (D-Erie)
• Caucus Administrator: Mike Schlossberg (D-Lehigh)
2023-2024 Senate Leadership Election Results
Senate Republican Leadership:
• Interim President Pro Tempore: Kim Ward (R-Westmoreland)
• Leader: Joe Pittman (R-Indiana)
• Whip: Ryan Aument (R-Lancaster)
• Appropriations Chair: Scott Martin (R-Lancaster)
• Caucus Chair: Kristin Phillips-Hill (R-York)
• Caucus Secretary: Camera Bartolotta (R-Washington)
• Policy Chair: Dan Laughlin (R-Erie)
• Caucus Administrator: Lisa Baker (R-Luzerne)
Senate Democratic Leadership:
• Leader: Jay Costa (D-Allegheny)
• Appropriations Chair: Vincent Hughes (D-Philadelphia)
• Appropriations Vice Chair: Tim Kearney (D-Delaware)
• Whip: Tina Tartaglione (D-Philadelphia)
• Caucus Chair: Wayne Fontana (D-Allegheny)
• Caucus Secretary: Maria Collett (D-Montgomery)
• Policy Chair: Katie Muth (D-Montgomery)
• Caucus Administrator: Judy Schwank (D-Berks)
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
On Saturday, Oct. 22, 2022, the Pennsylvania Medical Society held its first ever hybrid House of Delegates (HOD) meeting, allowing attendees to participate both remotely and on-site at the Hershey Lodge. This meeting was the first of its kind for PAMED. With the hard work of your Speakers and PAMED staff, and the flexibility of our delegates, the meeting was able to be held successfully.
In addition to robust discussion and commentary online ahead of the HOD meeting, delegates had a healthy and productive debate on many of the issues that face health care.
Here is a look at some of the resolutions that delegates either adopted or directed to PAMED’s Board for decision or further study. Keep in mind that this is not an exhaustive list. Proceedings and Actions of the 2022 HOD are available online at www.pamedsoc.org/HOD.
COVID Vaccine Policies – Delegates voted to Not Adopt opposition to mandatory COVID vaccination policies and continue support for rigorous informed consent with respect to COVID vaccines. Delegates believed overwhelmingly that PAMED should, as a public health organization, continue to support vaccination policies.
Removal of Vaccine Exemptions – Delegates voted to Adopt as Amended the removal of non-medical childhood vaccine exemptions to support medical-only vaccine exemptions.
Pharmacy Childhood Vaccine Reconciliation – Delegates voted to Refer for Study the requirement for pharmacies giving childhood vaccines to reconcile them in PA-SIIS. PAMED will support and work with local agencies to encourage state-wide reconciliation of vaccines to avoid med errors.
Pharmacists Scope of Practice – Delegates voted to Adopt as Amended support of legislative efforts by the Pennsylvania General Assembly specifying that pharmacists notify the prescriber if intending to refuse to fill lawful prescriptions in an effort to increase patient safety.
– Delegates voted to Adopt as Amended support of the Pennsylvania Department of Health in the prevention of the inappropriate expansion of optometry outside of scope (i.e., surgical and medical practice).
Telehealth for Psychiatric Care – Delegates voted in favor of the Reference Committee’s recommendation to Not Adopt PAMED’s support of telehealth over on-site services for the delivery of psychiatric care. Delegates and the Reference Committee believe telehealth is an important option for care but should not be the only or preferred option.
Support Single-Payer Healthcare – Delegates voted to Not Adopt the removal of opposition to a single-payer health care system. The Reference Committee's suggestion of aligning with the AMA’s stance of not favoring a specific healthcare delivery model was supported by many of the delegates that were in attendance both virtually and in person as reflected in the final vote.
Parental Leave for Medical Students and Residents – Delegates voted to Adopt as Amended the Reference Committee’s recommendation to support efforts by the American Medical Association (AMA) on the national issue of parental leave for students and residents. The AMA currently has policies that support parental leave for medical students and residents, which should be consulted and reviewed.
Hazard Pay for Residents in National Emergencies – Delegates voted to Not Adopt this resolution, which called on PAMED to support hazard pay provisions for resident physicians.
Removing Barriers in the OR for Women
Donning a Hijab – Delegates voted to Refer for Study accommodations for people donning a hijab in the operating room. The PAMED Board of Trustees will study: a) the removal of barriers in medical education and practice for hijab-wearing women as well as b) advocacy as it relates to policy changes at medical schools and hospitals in the Commonwealth of Pennsylvania to include accessibility to accommodations, including non-transparent surgical hoods that cover the head and neck and/or medical-grade low-lint,
light-colored, tightly woven, washable hijabs.
Creation of Access to Safe Quality Care Coalition – Delegates voted to Adopt as Amended the creation of a coalition of Pennsylvania Medical and Specialty Societies modeled after New Jersey’s access to care coalition, which includes a public facing website, with a mission to ensure the continued high quality of care provided by a physician led team approach to medicine.
Analyzing the Financial Components of Graduate Medical Education in Pennsylvania to Ensure that Resident and Fellow Physician Compensation Equitably Reflects Their Workforce Contributions – Delegates voted to Refer for Study the issue of graduate medical education compensation in Pennsylvania. PAMED’s Board of Trustees will study the current compensation and financial benefits provided to resident and fellow physicians and whether PAMED should embark on advocacy in that regard.
Support for Safer Supply Testing – Delegates voted to Adopt as Amended support for safer supply testing devices for substance use. PAMED supports legislation removing fentanyl test strips and other medical or scientific devices and methods which test for toxic or hazardous substances from the list of drug paraphernalia under the Controlled Substance, Drug, Device and Cosmetic Act of 1972. PAMED will forward the issue to the AMA at the next appropriate AMA meeting.
Support for Protecting the Physician-Patient Relationship Regarding Reproductive Health Care – Delegates voted to Adopt as Amended support for protecting the physician-patient relationship in matters specific to reproductive health care. PAMED will rescind the following policies: 5.998 Abortion, and 5.999 Testifying Before State Legislature. In addition, PAMED supports shared decision-making for the physician-patient relationship as it applies to all reproductive health, including abortion. PAMED opposes legislative measures that criminalize physicians for decisions with patients regarding the provision of reproductive health care as well as measures that expose patients to criminal or civil consequences due to receiving medical care.
Continued on page 32
Management
Reversible Contraception and Other Gynecological Procedures – Delegates voted to Adopt as Amended the support for training physicians on the use of local pain control techniques for office-based gynecological procedures along with the discussion of pain control options, risks, and benefits with patients of such techniques. PAMED also encourages further research into evidence-based anesthetic and anxiolytic medication options for long-acting reversible contraception procedures and other office-based gynecological procedures.
Role of Health Systems Solutions in Preventable Medical Errors – Delegates voted to Adopt as Amended the recognition that preventable medical errors are not solely due to individual responsibility but also to health systems that need to be made safer. PAMED will encourage institutions to make health systems safer by: 1) Viewing medical errors as challenges that must be overcome, 2) Fostering a culture of safety that focuses on system-based improvement, 3) Encouraging all individuals on the healthcare team to play a role in making the provision of health care safer for patients and healthcare workers, and 4) Implementing
voluntary, anonymous, or confidential error reporting systems and protecting them from legal discovery. Delegates voted to oppose the use of criminal penalties in errors of medical decision-making.
Physician
and
permitting the dispensing of multi-dose medications upon discharge from healthcare facilities as well as the use of multi-dose medications for multiple patients in accordance with safe handling and dispensing protocols.
Regarding Supervision of Non-Physicians – Delegates voted to Adopt as Amended support for physicians in contract mandate issues and safeguards as it relates to the supervision of non-physician practitioners. PAMED will support whistleblower protections for physicians who report unsafe care provided by non-physicians to the appropriate regulatory board.
OR Medical Waste and Topical Drug Waste Reduction – Delegates voted to Adopt as Amended support for medical waste reduction in the OR through a multidisciplinary task force. The task force will identify and promote best practices to minimize medical waste as well as identify and eliminate barriers in existing state laws, regulations, and healthcare organizational policies to achieve the goal of reducing medical waste related to medical procedures. PAMED will partner with AMA to craft state legislation
State Bypass of Physician Authority – On several occasions, the state legislature has raised the issue of physicians’ use of off-label medications in the treatment of COVID-19. This resolution, Adopted as Amended, will help to clarify PAMED’s position that off-label use of FDA-approved medications is appropriate provided the use is based on sound scientific evidence and for which the safety and efficacy have already been demonstrated.
Voter Registration for Patients – With the General Election less than two weeks away, delegates voted to Adopt as Amended support for non-partisan efforts that provide the necessary resources to help patients with voter registration and civic participation to those physicians who wish to engage in this activity. PAMED also supports efforts to address social and structural determinants of health by encouraging its members to engage in the electoral process.
NOW
BY KIM JOVINELLI
As its title implies, the Lancaster Medical Heritage Museum (LMHM) was founded as the Edward Hand Medical Heritage Foundation in 1982 by the Lancaster City & County Medical Society. Edward Hand was a prolific figure in Lancaster. Born in Ireland, he was a physician, soldier, and politician who served under George Washington during the Revolutionary War.
For the last 40 years, the museum has grown to include almost 14,000 medical and medical history related objects. However, until recently, these objects were held in the Burle Business Park on New Holland Avenue behind a security gate with little to no signage. The museum was a “hidden gem in Lancaster” as Board Member Dr. Nikitas Zervanos would say.
In 2019, the museum began the process of reevaluating its image. This included looking for a new space that was more accessible to the public and changing the name to the Lancaster Medical Heritage Museum. In 2021, the museum officially moved into its new location, graciously provided through Penn Medicine Lancaster General Health through the efforts of many board members and employees of the health system, and museum employees. Since then, the LMHM has created several new exhibits it never had the opportunity to showcase. This includes one of the largest ophthalmology exhibits in Pennsylvania, an exhibit on dentistry and its specialties, a 19th century pharmacy cabinet, an art wing, a nursing exhibit, and a rotating exhibit space currently featuring an exhibit called Pandemics and Prevention. On top of this, the museum houses a hands-on exhibit to showcase the skills any doctor would have to use to diagnose a patient and a wall decorated with student artwork created in collaboration with the Elizabethtown College biology and anatomy department.
Through the work of volunteers, board members, staff, and the health system, the museum was able to open its doors to the public in its new location at 410 North Lime Street, Lancaster, PA. Currently, the museum is open during its winter hours: Monday, Wednesday, Friday from 10am to 3pm. Beginning April 28th, 2023, it will change over to its summer hours of Tuesday through Saturday from 10am to 3pm. Admission is $8.00 per person. Children under three and LG Health employees (with their badge) can visit for free. Follow us on our social media or visit lancastermedicalheritagemuseum.org for all up-to-date information.
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Where are you from and where did you study medicine?
I grew up in Lancaster and graduated from Hempfield High school. I completed medical school in 2012 at Philadelphia College of Osteopathic Medicine.
Why did you want to be a physician?
My grandfather was an osteopathic physician and general practitioner “back in the days” when they did it all — clinic hours, house calls, obstetrics, coverage at hospitals and emergency departments, and more. As I was growing up, he was ending his career and closing his practice. However, he was a forever learner and the best teacher. As I was learning to read, he would break out the medical journals to challenge me. In his retirement from clinical practice, he started working with residents at the Orange Street Clinic. I sometimes went down to the clinic with him or into the old Community Hospital (you could do that back in those days!) and would see his interaction with residents, patients, and staff. He sincerely loved being a coworker, leader, teacher, and doctor — whatever the role meant in that moment. I was very young, and I didn’t know exactly what he did at the time, but I wanted to do whatever he did.
What are the biggest changes you’ve seen in medicine since you began practicing?
Since I began practicing, the biggest change has been the adoption
of “the digital age.” When I was in medical school and even at the beginning of residency, we still used paper charts in many places, printed out daily schedules, and hand wrote prescriptions. Now it’s mostly done electronically. Although we are not completely digital, often the only paper on my desk is my personal preparation notes and reminders.
What (or who) has helped you become the doctor you are today?
My grandfather clearly had the biggest influence on me, but I have been fortunate to have been trained by other physicians and nurses who are passionate about the institution of medicine and preserving what is so special about the job of caring for another person. My patients have also molded me over the years. Lastly, becoming a mother had a huge impact on who I am today. Being a parent changes your perspective. I am for sure a different doctor than I was before having my son.
If you had one piece of advice for those just starting out, what would it be?
Identify core values and don’t compromise those values, but know the path is not always straight. Anticipate the need to be flexible at times on your journey.
If you could recommend one book for today’s medical students, what would it be?
Oh, there are so many! I can’t choose just one. Anything by Brene Brown or Atul Gwande, but I use what I learned from reading “You Can Stop Humming Now” by Daniela Lamas and “Why Zebra’s Don’t Get Ulcers” by Robert Sapolsky in my practice every day.
How has LCCMS helped you in your career?
Practicing medicine in an office, outside of the hospital, I don’t get to interact with many other physicians. Being part of the medical society gives me the opportunity to interact with colleagues I would otherwise never see or even meet in person. Before residency, I was not very interested in politics, but the medical society has allowed me to realize the importance of what happens at the state and even federal levels that impacts our day-to-day work. Whether we like it or not, our best chance to make big change is to be involved with organizations that provide that type of political support.
Why should physicians become engaged in the local medical society?
It’s no secret that many physicians are burned out and not happy with the current state of our industry. As a group, we are often divided by the workload we face, without time to discuss solutions and only blips of time to complain about the problems. The medical society is a forum that amplifies physician voices and works toward solutions that we hope will improve the way we work and in turn benefit our patients, which is always at the core of our mission.
Our goal as a society is always to increase membership. We want more people to come out to events, to engage, express their challenges, and share their vision for health care in Lancaster County. I want to foster an environment that encourages discussion. Our physician community is diverse and full of kind, intelligent, and innovative people. However, it’s not without its differences and barriers. We must break down those barriers before we can move mountains!
Despite my last statement about moving mountains, I’ve never considered myself a “glass half full” kind of woman. As I’ve matured, I identify with the psychologist-reported concept from “Learnings from a Glass of Water”…either half full or empty, over time the glass becomes equally heavy to hold. If we accept that we all have a story that creates a lens that inherently limits our perspective, we can move aside preconceptions to find the common thread. I often feel stuck where we are, in medicine, as a country, a community, a society, etc. I think that’s what we need to address so that we can accomplish the positive change I know I am craving. And I don’t think I am alone.
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Westphal Orthopedics was founded in 2014 by veteran orthopedic surgeon, Dr. Thomas R. Westphal. Dr. Westphal’s vision was to build a practice centered around the patient experience, while enhancing efficiency to achieve a quadruple aim. Our mission is to provide exceptional orthopedic care to improve the quality of life of the patients we serve, to lead in the innovative treatment of orthopedic conditions, and to pass on the legacy of excellence instilled in this practice.
Too often in health care, patients leave an office feeling like a diagnosis or a statistic. Our aim was to change that; to bring back the personal touch that patients not only expect but also deserve. Our staff and providers are taught that no matter what challenges they may face, their most important job is to be an advocate, resource, and confidant to our patients. By putting our focus on our patients and their needs, we have established a practice that cherishes the patient-physician relationship.
While patient satisfaction and experience are our top priorities, we are also committed to maintaining a positive environment for our staff and physicians. It is no secret that burnout has become a dilemma in health care, and at Westphal Orthopedics we have put a strong emphasis on work-life balance. Addressing these challenges has not been easy, but we have leveraged technology and other resources to create a highly efficient workplace.
Payor relations, government regulations, COVID-19, and numerous other threats have made health care one of the most challenging industries. By focusing on the health of our patients and the quality of life of our staff and physicians, we will continue to overcome any obstacle while maintaining our mission of improving the quality of life for our patients. Our hope is to be a model for other practices and physicians and to continue to work toward the quadruple aim.
Where do you practice and why did you settle in your present location or community?
I am a dermatologist currently practicing at Dermatology Associates of Lancaster. I grew up here in the Lancaster area and love being able to serve the community that has given me so much throughout my life.
What do you like best about practicing medicine?
After 5+ years in practice, I cherish the relationships I have formed with my patients. I enjoy working with my patients to help obtain the best outcomes for their skin. I love seeing patients of all ages and treating a wide variety of dermatologic conditions from skin cancers to autoimmune conditions.
Are you involved in any community, non-profit, or professional organizations? If so, please list the groups:
I am a member of the American Academy of Dermatology, the Pennsylvania Academy of Dermatology, and the Pennsylvania Medical Society. I look forward to getting involved again with Girls on the Run and Special Olympics once our children are a little older because I love the mission of both of these organizations!
What are your hobbies and interests when you’re not working?
Most of my non-working hours are spent running after my 2- and 3-year-old girls and getting ready for a baby boy in February. As an athlete through college, I value fitness and wake up early each morning for some “me” time with Peloton before the busy day starts. Running is my passion, and I look forward to training for marathons again in the near future. As a die-hard Philadelphia Phillies and Eagles fan since birth, 2022 was a great year!
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?
As a young physician, forming relationships with other providers in the community has been invaluable in terms of professional growth. It has also helped me provide timely and comprehensive care for my patients in the Lancaster community.
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
Penn Medicine Lancaster General Health Physicians Drs Eichenlaub and May
The ENT Center
Eye Associates of Lancaster Ltd
Eye Health Physicians of Lancaster
Family Eye Group
Family Practice Center PC – East York
General Surgery of Lancaster
Glah Medical Group
The Heart Group of Lancaster General Health
Hospice & Community Care
Hypertension & Kidney Specialists
Lancaster Cancer Center Ltd
Lancaster Cardiology Group LLC
Lancaster Ear Nose and Throat
Lancaster Family Allergy
Lancaster Radiology Associates Ltd
Lancaster Skin Center PC
Manning Rommel & Thode Associates
Nemours duPont Pediatrics Lancaster
Neurology & Stroke Associates PC
Ouilikon Medical Associates PC
Patient First – Lancaster
Penn Medicine Lancaster General Health Care Connections
Penn Medicine Lancaster General Health Physicians Cardiothoracic Surgery
Penn Medicine Lancaster General Health Physicians Diabetes & Endocrinology
Penn Medicine Lancaster General Health Physicians Family Medicine Lincoln
Penn Medicine Lancaster General Health Physicians Family Medicine Manheim
Penn Medicine Lancaster General Health Physicians Family Medicine New Holland
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
Shady Grove Fertility-Lancaster
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 Lancaster Pulmonary & Sleep
UPMC Breast Health Associates
UPMC Pinnacle Manheim Pike Primary Care
UPMC Plastic & Aesthetic Surgical Associates
WellSpan Ephrata Cancer Center
WellSpan Family Health – Georgetown
WellSpan Family Medicine – Trout Run
Westphal Orthopedics
Dr. Miles D. Harriger entered heaven on October 2. Born in Johnstown, PA, he was the son of the late Clarence M. and Mary Smith Harriger. He graduated from Beaverdale High School where he played football and basketball and ran track. He was also an Eagle Scout and received a college football scholarship to Lebanon Valley College.
After graduating from college, he served as a medic in the army. He was chosen as “Who’s Who” in American Colleges and Universities and was president of his junior and senior class. He received his medical degree from Jefferson Medical School and interned at Lancaster General Hospital.
He was a family physician in East Petersburg for 43 years and served as school doctor, deputy coroner, and plant physician at Howmet Corporation (Alcoa) for many years. He was on the staff of Lancaster General Hospital and St. Joseph’s Hospital.
Miles is survived by his wife, JoAnn, and daughters Dr. Janet Harriger, Jeannie Ryan, JoAnn Cenekofsky (husband Keith), and Dr. Jennifer Harriger (husband Josh Woodward); sons Joseph Harriger (wife Julie) and David Harriger (wife Ann Marie); grandchildren - Alycia Caramanico (Jason), Michael Ryan (Carolyn), David Campbell, Megan Ryan (Traci), Miles J. Harriger (Alex), Declan Harriger, Madeline Woodward, Mackenzie Woodward, Grady Harriger, and Cavan Harriger; and nine great-grandchildren.
Rachel Angstadt, DO
PennMedicine Lancaster General Health Physicians Palliative Care
Christopher M. Baloga, DO Conestoga Eye
Nicole Chiota-McCollum, MD
Penn Medicine Lancaster General Health Physicians Neurology
Thomas C. Coyne, DO
Penn Medicine Lancaster General Health Physicians Family Medicine Twin Rose
Ellen M. Crimmel, MD
David J. Cziperle, MD
Penn Medicine Lancaster General Health Physicians Thoracic Surgery
Allan S. Davis, MD
Kendall Dempsey, MD resident, Lancaster General Hospital
Chinenye Onyekachi Emuwa, MD
UPMC Lancaster Pulmonary & Sleep
Dorothy Young Fisher, MD
Joseph M. Gibson, MD
Penn Medicine Lancaster General Health Physicians Anesthesiology
Elyse N. Goveia, MD
Penn Medicine Lancaster General Health Physicians Geriatrics
Charles F. Henderson, MD
Penn Medicine Lancaster General Health Physicians Arthritis & Rheumatology
Tara Marie Higgins, MD
UPMC Obstetrics & Gynecology Specialists – Lititz
Haneen Hussein, DO resident, Lancaster General Hospital
Nicholas P. Kelley, DO Lancaster Emergency Associates Ltd
Marianne Lutz Kelly, MD
Saima Khalid, MD
Penn Medicine Lancaster General Health Physicians Occupational Medicine
Kathryn M. MacLaughlin, MD
Rachana Murthy, MD
Penn Medicine Lancaster General Health Physicians
Diabetes & Endocrinology
Rica Patil student
Rama Peri, MD
WellSpan Ephrata Community Hospital
David Gabriel Prado, DO
TW Ponessa & Associates Counseling
Michael K. Robinson, II, MD
Penn Medicine Lancaster General Health Physicians Family Medicine Oxford and Family Medicine Red Rose
Katelyn M. Shoe, MD
Penn Medicine Lancaster General Health Physicians Family Medicine Lincoln
Trilochan Singh, MD
Penn State Health Medical Group – Lime Spring
Elizabeth A. Streeten, MD
Lara B. S. Thompson, MD Penn Medicine Lancaster General Health Physicians Family Medicine County Line
Alexandra Vaughan-Masamitsu student
Adam D. Voelckers, MD UPMC College Avenue Family Medicine
Masood Ahmad, MD
UPMC Lancaster Pulmonary & Sleep
James D. Artuso, MD Penn Medicine Lancaster General Health Physicians Anesthesiology
Carl E. Becker, MD Westphal Orthopedics
Christopher D. Brabazon, DO
Paul N. Casale, MD
Christopher R. Cowart, MD Penn State Health Anesthesiology & Perioperative Medicine
Michael Cusick, MD
Mark J. Epler, MD
Penn Medicine Lancaster General Health Physicians
Cardiothoracic Surgery
Steven M. Gottlieb, MD
Nemours duPont Pediatrics Lancaster
Fernando A. Gutierrez, MD
Penn Medicine Lancaster General Health Physicians Anesthesiology
Brittney Ann Hacken, MD Penn State Health Medical Group – Lime Spring
Muhammad A. Hameed, MD
Robert D. Hong, MD Keystone Urology Specialists
Sophia Estella Horwath, MD
Penn Medicine Lancaster General Health Physicians Geriatrics
Philip J. Jantzi, MD
Penn State Health Lancaster Medical Center
Patrick Henry Judson, MD
Lisa K. Kernic, DO
Penn Medicine Lancaster General Health Physicians Hospitalists
Phyllis Landis Leaman, MD, FAAEM, FACEP
Alison Lima, MD
WellSpan Family Medicine – Trout Run
Frank Y. Liu, MD
Penn Medicine Lancaster General Health Physicians Urgent Care
Angela M. Montalvo, DO resident, UPMC Lititz
Alexandra E. Moody, MD
Penn State Health Medical Group – Lime Spring
William M. Parrish, MD Orthopaedic Specialists of Central PA – UPMC
Nehal D. Patel, MD
UPMC Heart & Vascular Institute – Lancaster
Jennifer M. Payne, MD
Penn Medicine Lancaster General Health Physicians Sports Medicine
Cristopher B. Posadas, MD WellSpan Urgent Care – Ephrata
Stanley T. Prince, MD
Kelly A. Reese, MD
Penn Medicine Lancaster General Health Physicians Walter L. Aument Family Health Center
Daniel Alexander Russo, MD Penn Medicine Lancaster General Health Physicians Family Medicine Lititz
Carlos A. Sanchez, MD
Penn State Health Lancaster Medical Center and Health Lime Spring Outpatient Center
Ecaterina Sartina, MD Pediatrix – Lititz
Mamta Sherchan, MD
Penn State Health Exeter Outpatient Center and Lime Spring Outpatient Center
Jonathan D. Small, MD
Laura M. Smith, MD
UPMC Highlands Family Practice
Michael E. Smith, MD
Penn Medicine Lancaster General Health Physicians Wound Care & Hyperbaric Medicine Center
Charles C. Stehman, MD
Penn Medicine Lancaster General Health Physicians Anesthesiology
Brian P. Sullivan, MD
Penn Medicine Lancaster General Health Physicians Family Medicine Abbeyville
Sameera Mukaram Syed, MD
UPMC Obstetrics & Gynecology Specialists – Lititz
Joan Brumbaugh Thode, MD
Penn Medicine Lancaster General Health Physicians
Roseville Pediatrics
Louis H. Trotman, Jr., MD
Penn Medicine Lancaster General Health Physicians Urgent Care
Sriram Venigalla, MD
Penn Medicine Lancaster General Health Physicians Radiation Oncology
Michael Caranay Viray, MD
The Heart Group of Lancaster General Health
Jessica Marie Walker, MD
Penn Medicine Lancaster General Health Physicians
Family Medicine Red Rose
Jessica L. Waughtel, DO
Julie Innocent Woods, MD
Keith J. Wright, MD
WellSpan Family Health – Georgetown
Spage M. Yee, MD
Eye Care Group of Lancaster
“I want to support people in reaching whatever goals they have.”
- Lynn, MSW, LSW, Outpatient Social Worker
