BCMS Script Winter 2026

BCMSScript.

Newsletter of the Bucks County Medical Society

OUR MISSION The Bucks County Medical Society strives to advance the professional and personal development of its physician members by providing educational and practice related resources as well as legislative advocacy.

Moreover, the Bucks County Medical Society seeks to promote optimal outcomes for our patients as well as the public health of the Bucks County community.

EDITORIAL BOARD Marilyn Heine, MD, Editor-in-Chief J. Matthew Bohning, MD Hannah Do, MD John Gallagher, MD John Pagan, MD, MBA

Winter 2026

President’s Message President’s Message Like most years in medicine, 2025 has been eventful for doctors and patients. Our PAMED and Bucks County Medical Society (CMS) physician leaders continue to advocate for common sense in prior authorizations, non-compete agreements, and fair reimbursement for medical services.

We inform legislators and the public on the implications of rapidly advancing AI in medicine and potential downsides of increasing private equity ownership of physician groups.

Physician-led, team-based care remains a cornerstone of our profession along with a healthy environment to provide care be it in private The more thingssetting. change . . . practice or an employed

Following a lengthy budget stalemate, some legislative highlights of the year Our Bucks County Medical Society annual meeting and brunc include proposals to strengthen the current requirements for certificate of merit and medical experts of (SB medical 340 and HB 2088) and a to constitutional amendment on with decades service our Bucks community and medical liability venues (SB 125); definitive action by the General Assembly is new and old friends.

Theequity livelyin discussions aroundbythe pending.

Potential pitfalls of private medicine were emphasized our room a PAMED President, Dr. Lucas-Fehm MD JD, in her presentation at our Annual Bucks challenges we mutually face in patient care remind us how ou CMS Brunch and legislative testimony resulting in the introduction of a private equity in medicine (HBdifferences.

1460). Relationships to advance these initiatives were stronger thanbillour fostered at our Bucks CMS legislative reception in Doylestown in October.

IBucks amCMS honored joinpart theofesteemed line of remains ato vibrant PAMED in leadership andpresidents in our House of this gr of Delegates. Bucks CMS collaborated with our neighboring county medical roots tracing back to 1848—the same year our Pennsylvania M societies in District II and other delegations. We worked to assure that the voice of independent practice remains inchallenges policy decisions,facing to discussour healthcare worker and t Some of the numerous profession safety, and advance policy to strengthen the physician workforce, and enhance our navigate returned over theperspectives past 25 years when I first start public health have infrastructure.

Although medical may vary, our common interests across geographies and specialties far outweigh any differences. We are in Sellersville. I’ve dedicated my career to amplifying our colle certainly stronger together. The 100% PAMPAC membership of our Bucks CMS delegation atadvocating the House of Delegates echoes that unity. We thankand all from Society, for both our profession ourBucks patients in CMS who are PAMPAC members.

Pennsylvania Medical Society, proudly advancing our shared c

As a new year begins, Bucks CMS extends warmest wishes for health, happiness, and prosperity to you and your family, staff, and patients. Your commitment to Medicine and my career have changed a lot in that time, but c your profession and patients is not only admirable, but essential to our profession.

solutions persist. Fair valuation and payment for physician se John J. Pagan, MD, MBA, FACS of lesser trained medical professions, the corporatization of m President, Bucks County Medical Society medical legal challenges we face in caring for patients are issu our careers to varying degrees. While our combined multipron substantial tort reforms decades ago, liability venue shopping

Savvy Snoozing: Topics in SleepHot Medicine SavvyHot Snoozing: Topics in Sleep Medicine

7 hours for adults (age >18) and between 8-10 hours for children (age <18). We do know that sleep requirements differ based on whether we as and ”short sleepers” or ”longphysician sleepers” in Doy Dr. Tran-Gast is a pulmonary,self-describe critical care, sleep medicine with some individuals requiring more sleep than others. It is important to rule out any underlying sleep disordered breathing in patients with hypertension, coronary artery disease, or other cardiac risk factors for stroke. There is still much to Sleep medicine is broadly encompassing be learned regarding predisposing factors towards Sleepmedicine medicine broadly encompassing Sleep is a is very dynamic specialty that dementia or underlying cognitive disorders. encompasses an array of sleep conditions which overlap with fields such as pulmonary, neurology, link between sleep quality heart health which Sleep medicine is a very dynamic specialty thatA encompasses an array ofand sleep conditions psychiatry, cardiology and pediatrics. The wide In general, maintainingand a regular sleep schedule with fields such as pulmonary, neurology, psychiatry, cardiology pediatrics.

The wide range range of sleep syndromes may include sleepis important for our overall physical and mental related breathing as obstructive syndromes maydisorders includesuch sleep-related breathing disorders such aspre-existing obstructive sleep apnea; but w health.

In patients with heart disease, sleep apnea; but will also include complex coronary artery disease, or heart failure it include complex sleep-behavioral disorders such as insomnias, parasomnias, ordisorders, narcolepsy.

Each sleep-behavioral disorders such as insomnias, is important to rule out sleep disordered breathing syndrome may be managed differently depending on type and may incorporate multidiscip parasomnias, or narcolepsy.

Eachvery clinical as these heart conditions and sleep disorders syndrome may be managed very differently subspecialties including clinical psychology, dentistry and/or otolaryngology. may overlap significantly.

Studies have shown a depending on type and may incorporate significant link between sleep apnea and increased multidisciplinary subspecialties including clinical cardiovascular risk, including hypertension, heart psychology, dentistry and/or Latest advancements in otolaryngology. sleep medicine failure, and atrial fibrillation; with some studies showing up to a 45% increased risk for heart events.

Latest advancements in sleep medicine Kathy Tran-Gast, DO, is a pulmonary, critical care, and sleep medicine physician in Doylestown.

By Kathy Tran-Gast, D.O.

In recent years, the majority of sleep studies are obtained at home which has facilitated diagnos

In recent years, the majority of sleep studies Another hot topic in sleep medicine patient comfort.

The studies are highly accurate with the added benefit of being remote. Surgic are obtained at home which has facilitated One subject in which does not receive as much diagnoses and patient comfort. Thefor studies are advancements in treatments obstructive sleep suchisas the Inspire device, focusapnea, is how sleep impacted in women of have increa highly accurate with the added benefit of being child-bearing age or older.

Historically sleep interestSurgical in sleep technology.inMedical treatments for insomnia and narcolepsy have improved sle remote. advancements treatments disorders are underdiagnosed and not well for obstructive sleep apnea, the quality and quality of lifesuch for as patients with these disorders. recognized in women compared to men. Women Inspire device, have increased interest in sleep are not screened as often for underlying sleep technology. Medical treatments for insomnia disordered breathing, partly due to lack of Sleep duration and brain health and narcolepsy have improved sleep quality and recognition but also likely due to fewer complaints quality of life for patients with these disorders. by women compared to men. Women have increased riskthere of insomnia other behavioral While there is interest in sleep duration and brain health are noand specific American Academ Sleep duration and brain health sleep disorders particularly through stages of Sleep Medicine guidelines. The general consensus recommendation has been to obtain greater While there is interest in sleep duration and brain hormone fluctuations such as pregnancy and/ hours there for adults >18) and between hours for children (age <18).

We do know health are no (age specific American Academy 8-10 of or menopause.

Recognition of this is crucial to that slee Sleep Medicine guidelines.

The general consensus improve understanding, diagnosis,or and care sleepers” in requirements differ based on whether we self-describe as ”short sleepers” ”long w recommendation has been to obtain greater than women’s health.

individuals requiring more sleep than others. It is important to rule out any underlying sleep dis breathing in patients with hypertension, coronary artery disease, or other cardiac risk factors fo There is still much to be learned regarding predisposing factors towards dementia or underlying cognitive disorders.

A link between sleep quality and heart health

BCMS Script.

In general, maintaining a regular sleep schedule is important for our overall physical and mental

2 In patients with pre-existing heart disease, coronary artery disease, heart failure disorders, it is important to rule out sleep disordered breathing as these heart conditions and sleep disorders m

Strengthening Healthcare the Focus on Precision Healthcare an AI Twist Precision with an AIwith Twist Marilyn Heine, MD,Heine, FACEP, FACP, is such as stress, aging, microbiome, inflammation, and

By Marilyn MD,FCPP, FACEP, FACP, FCPP an Emergency Physician and Hematologist gene expression.

Oncologist in Bucks County.

Dr. Heine is an emergency physician and Unique hematologist in Bucks County.

Patient’s Factors inoncologist Precision Healthcare

Precision healthcare: The aim is to get “the

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Genetic: DNA analysis that impacts risk of disease and response to treatment (e.g. BRCA mutations in breast or ovarian cancer)

•

Psychosocial: Mental health, social support,

Precision healthcare aimsperson to get at “the right personlifestyle, at theand right time.” right treatment to the right theright righttreatment to the socioeconomics, environment time.” Statement attributed to former Healthand and Human Services Secretary Michael O. Leavitt.

Statement attributed to former Health • Phenotypic: Clinical and physical presentation

Human Services Secretary Michael Leavitt. Goals are to improve effectiveness, target treatment to Blood tests and imaging to define Benefits and components of precision healthcare • Biomarkers: specific conditions and individuals, understand disease characteristics and treatment response individual characteristics to lessen potential risks (e.g., hemoglobin A1c and tumor markers) or side effects and enhance patient safety, ensure Goals of precision healthcare are to improve effectiveness, target treatment to specific conditions and better outcomes, and improve quality of life. It Now let’s consider the role of biomarkers in a individuals; enhance patient safety, understand individual characteristics to lessen potential risks or side emphasizes that healthcare is not one-size-fits-all. patient whom we will call “AB” who has been effects; ensure better outcomes, and improve quality of life. with It emphasizes that healthcare diagnosed colon cancer.

“AB”’s CEA level,is not one4 Ps of Precision Healthcare a diagnostic biomarker, was high prior to surgery size-fits-all. and decreased with resection of the tumor. The side • Predictive: Data to predict disease presence of of “AB”’s colon cancer has prognostic significance. progression, allow earlyhealthcare interventioncan be grouped Components of precision into 4 Ps: “AB”’s tumor mutations are predictive as they • Prevention: Steps to reduce disease risk, correlate with risk of cancer recurrence. Since wellness, target interventions 5-FU is to beand partprogression of “AB”’s cancer • promote Predictive – use data and analytics to predict disease andchemotherapy, allow early a gene test for a pharmacogenomic biomarker is • Personalized: Tailor treatment, intervention such as lung address cancer social screening; performed to assess if the usual dose can be safely Precision Healthcare with an AI Twist drivers of health • Prevention – take steps to reduce disease risk, promote overall wellness, and given.

“AB”

By Marilyn Heine, MD, FACEP, FACP, will FCPP have monitoring of circulating tumor • Participatory: Engage patients their target interventions, as inindiabetes, heart disease, and cancer; cells tophysician assess the clinical course.

Dr. Heine is an emergency and hematologist oncologist in Bucks County. healthcare with wearables and self-monitoring

Personalized – tailor treatment, address lifestyle and environmental interventions, such as with 5 Categories of Biomarkers The aim is to get “the right treatmentcancer to the right person at the rightand time.” familial hypercholesterolemia Precision andhealthcare: mutation-targeted care; Statement attributed to former Health and Human Services Secretary Michael Leavitt. Goals are to Transformative impact of genome improve effectiveness, target treatment•to specific conditions and individuals, understand individual Diagnostic: Confirms a disease or decisions condition, using • Participatory – patients empowered in their own healthcare characteristics lessen potential risks or side effects and enhance patient safety, ensure better sequencing: Over the last 70 years,are theengaged study oftoand andthatidentifies persons with a disease subtype outcomes, and improve quality of life. It emphasizes healthcare is not one-size-fits-all. a person’s DNA has evolved dramatically from the wearables and self-monitoring. (e.g., hemoglobin S in sickle cell disease) 4 Ps of Precision Healthcare •

• Predictive: Data to predict disease presence of progression, allow early intervention first chromosomal analysis to the development • Prevention: Steps to reduce disease risk, promote wellness, target interventions • Prognostic: Identifies likelihood of disease, of vast genetic databanks and sophisticated• DNA Personalized: Tailor treatment, address social drivers of health Precision healthcare recognizes a patient’s unique Genetic aspects include DNA that Engage factors. patients in theirrecurrence, healthcare with wearables self-monitoring • Participatory: orandprogression (e.g., PSA analysis in sequencing of the whole genome or targeted gene Transformative impact of genome sequencing: OverBRCA the last 70 years, the studymutations of a person’s DNA has prostate cancer) impacttorisk of disease toevolved medication, such as gene that increase risk of panels identify genes and that response cause or increase risk dramatically from the first chromosomal analysis to the development of vast genetic databanks and sophisticated DNA sequencing of the whole genome or targeted gene panels to identify genes that for disease; diagnosis, andPsychosocial guide treatment. breast and aid ovarian cancer. mental health, social support, causefactors or increase risk forcan disease; involve aid diagnosis, and guide treatment. Identifies • Predictive: the most effective

treatment for a patient socioeconomics, lifestyle, and environment such as residing in an older home(e.g., withpresence lead of an

DNA does not equal destiny: The abnormal BCR-ABL fusion gene of chronic paint. Phenotypic traitsgenome are the to patient’s clinical and physical presentation.

Biomarkers such as blood transition from a patient’s their myelogenous leukemia) phenotype – the medical tests and imaging help history, define physical disease characteristics and treatment response; examples are hemoglobin • Pharmacogenomic: Predicts a drug’s efficacy or examination findings, disease severity, and A1c and tumor markers. toxicity based on genetic makeup response to treatment – is influenced by (e.g., G6PD deficiency) what epidemiologists call the “exposome.”

Genome sequencing: The study of an organism's entire or complete setsigns of DNA has evolved The exposome is where personal factors • genome Monitoring: Detects early of disease such as exercise, substance use, diet, sleep, analysis 70 yearsprogression or recurrence (e.g, BNPgenetic in dramatically from the first chromosomal ago, to development of vast congestive heart failure or circulating tumor income, education, work, and access to databanks, and sophisticated DNA analysis essential in cancer care and other conditions. Sequencing of in certain types of cancer) healthcare; combine with external factors DNA does not equal destiny: The transition fromcells a patient’s genome to their phenotype – the medical the whole genome targeted gene panels genes that cause or increase risk for disease; helps history, examination findings, disease severity, and response to treatment – is influenced by including exposure to or pollution, high traffic andphysicalidentifies diagnose rare,space; unexplained, atypicalresponses diseases; and guides treatment. noise, or green leading toor biological

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BCMSScript.

Psychosocial and phenotype: DNA does not equal destiny. A patient’s genome is their entire DNA. It is

Since January 2025, Pennsylvania state law mandates that state-regulated health plans, including Medicaid, cover biomarker testing when used for diagnosis, treatment, management, or monitoring of a disease, aligning with clinical guidelines and evidence.

5 Clinical Capabilities of Healthcare AI

AI drives precision healthcare

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Identification: Detecting patterns within data, often images (e.g., an early lung mass)

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Prediction: Forecasting events based on data and patterns (e.g., early recognition of sepsis)

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Summarization: Reviewing a large volume of records and efficiently summarizing key information necessary for clinical care

With this abundance of data, there is a role for AI. AI is preferably called “augmented intelligence” that • Translation: Translating data into a another highlights the importance of having a “human in the 5 Clinical Capabilities of Healthcare AI language or format to enhance communication loop.” Clinicians rely heavily on pattern recognition.

• Identification: Detecting AI augments the human ability to analyze and patterns within data, often images (e.g., an early lung mass) 5 Clinical Capabili • Suggestion: Providing recommendations, interpret vast, complex and identify patterns.

• data, Prediction: Forecasting events based on dataguidance, and patterns (e.g., early recognition of sepsis) Identifica or advice forfor action (e.g., based on•called With this abundance of data, there is a role AI. AI is preferably “augm In precision healthcare, genetic, • individual Summarization: Reviewing a large volume ofcontinuous records andglucose efficiently summarizing key monitoring patterns) • rely Predictio highlights the importance of having a “human in the loop.”

Clinicians heavi psychosocial, phenotypic, and biomarker factors can care information necessary for clinical • Summari AI augments the human ability to analyze and interpret vast, complex data, and be synthesized using•AI to efficientlyTranslating tailor disease Translation: data into a another or format to enhance communication informati A wordlanguage of caution precision healthcare, individual genetic, psychosocial, phenotypic, and biomark prevention, diagnosis, and prognosis.

• treatment, Suggestion: Providing recommendations, guidance, or advice for action (e.g., based on • Translatio synthesized using efficiently tailor disease prevention, treatmen ThereAIistoenthusiasm around the potentialdiagnosis, for continuous glucose monitoring patterns) • Suggestio ChatGPT and other large language models to Precision Healthcare: Tailor To The Patient continuou decrease the administrative burden of generating A word of caution office notes. Chatbots have potential to respond Prevention A word of caution to patient Which of these are Genetic potential for ChatGPT andinquiries. other large language models to among decrease the DThere is enthusiasm around theDiagnosis current limitations of using ChatGPTtoor other large Chatbots have potential to respond patient Psychosocial Aadministrative burden of generating office notes. language model tools in a clinical setting orThere for is enthusiasm AI Which of these are among current limitations of using ChatGPT or other large language inquiries. model administrative bur Ttools in a clinical setting or for direct patient care? direct patient care?

Phenotypic inquiries. Which of Treatment A A. Risk of incorrect and falsified responses Prognosis Biomarkers tools in a clinical se A. Risk of incorrect and falsified responses B. Risk of bias, discrimination, promoting stereotypes, inequities B. Risk of bias, discrimination,@marilynheinemd promoting stereotypes, inequities A. Risk of incorrec C. Risk of flawed training data C. Risk of flawed training data B. Risk of bias, dis D. Impacts on data privacy D. Impacts on data privacy C. Risk of flawed t E. Liability A survey by the American Medical Association E. Liability F. Absence of current regulation D. Impacts on dat (AMA) underscores that physicians’ priorities for AI F. Absence of current regulation G. All of the above E. Liability adoption are to know if it will work, will it work in G. All of the above F. Absence of cur “my practice for my patients,” will insurance cover AMA policy is that “As the number of Augmented G. All of the abov its use, and who is accountable if something A goes survey by the American Medical Association (AMA) underscores Intelligence (AI)-enabled health care tools andthat physicia wrong. In addition to its potential to assist onadoption the aresystems to know ifcontinue it will work, it work in “my practice for my patients, towill grow, these technologies AMA policy is that “As the number of Augmented Intelligence (AI)-enabled health care tools and systems administrative side of a practice, current clinical use, and whomust is accountable if something goes wrong.

In addition in to its potentia be designed, deployed continue to grow, these technologies must be designed, developed, developed, and deployedand in a manner thatpolicy is AMA is abilit that use cases of AI include its ability to identify high administrative side of a practice, current clinical use cases of AI include its a manner that is ethical, equitable, responsible, ethical, equitable, responsible, and transparent.” continue to grow, risk cardiology patients, recognize melanoma, cardiology patients, recognize melanoma, assess blood pressure patterns on re and transparent.” ethical, equitable, assess blood pressure patterns on remote patient detect stroke risk, improve detection of fetal abnormalities, analyze for diabetic Precision healthcare, drivendetection

by AI, has of the potential to improve effectiveness of patient care, enhance monitoring, detect stroke risk, improve Precision healthcare, driven AI, has the auto-triage imagin review of pathology specimens, detect criticalbyillness earlier, patient safety, and optimize patient outcomes.

Central to patient-centered care are the patient’s values, Precision fetal abnormalities, analyze for diabetic retinopathy, potential to improve effectiveness of patient care, healthcar Please see here. personal goals, and level of function and support. patient safety, and enhance review of pathology specimens, enhance patient safety, and optimize patient goals, and detect critical illness earlier, auto-triage outcomes. Central to patient-centered carepersonal are To watch a video of Dr. Heine’s related keynote for the Wilcoxon Innovation in Health Sciences Summit, imaging exams, and more. Please see here. the patient’s values, personal goals, and level of please see here.

To watch a video o function and support. please see here.

To watch a video of Dr. Heine’s related keynote for the Wilcoxon Innovation in Health Sciences Summit, please see here.

To learn more, please see here.

Correct answer: G To learn more, please see here.

Correct answer: G

BCMSScript.

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Here are a couple of the many photos from the Bucks CMS Legislative Reception.

If you think these will work, great; if not, I can send others. Between this and the n all of the legislators are included. A simple caption could be: Bucks CMS members and state legislators enjoyed an evening of conversation to In the Winter 2025 issue, there were montages of photos. Is that preferable? discuss issues important to physicians and patients.

If space is limited, it may be preferable to include the scholarship donation request rather than the BCHIP engagement image.

Bucks CMS delegation at the PAMED House of Delegates

With Rep. Prokopiak and Rep. Hogan, at the Bucks CMS legislative reception

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    

With Senator Farry, at the Bucks CMS legislative reception

The Physicians’ Voice in Politics

Bucks County Medical Society celebrates unity with our community partners.

Pennsylvania Medical Political Action Committee

JOIN PAMPAC HERE: www.PAMPAC.org

Thank you to the Bucks County Medical Society Members who were PAMPAC Members in 2025 Commonwealth Club Marion Mass, MD | John Pagan, MD, FACS, MBA Capitol Club Judith Gallagher-Braun, MD | Marilyn Heine, MD, FACEP, FACP Richard Leshner, DO | Mark Pappadakis, DO Keystone Club Robert Mirsky, MD | Rachael Sampson, MD Mary Toporcer, MD

Bucks County Medical Society is proud to be a founding member of the Bucks County Health Improvement Partnership.

Sustainer Level Arvind Cavale, MD, FACE, FCPP | Daniel Latta, MD Steven Orland, MD Other Contributors John Gallagher, MD | Daniel Haimowitz, MD, CMP, FACP Karl Helmond, MD, FACS | Bindukumar Kansupada, MD, MBA David Levin, DO | David Pao, MD | Peter Schwartz, MD Ann Showan, MD | Kathy Tran-Gast, DO | Joseph Werner, MD

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BCMSScript.

This Patient is Confused: Are TheyHaving Having a Stroke?

“I’m Confused:” Is This Patient a Stroke?

So while true ischemic stroke may not make up a large bulk of patients with AMS, it’s a diagnosis that needs to be respected. It’s also a diagnosis not to be made lightly, as deciding that Dr. Pappadakis is an emergency physician from Bucks County. a patient is having an ischemic event and giving thrombolytics can potentially cause harm. With Emergency Medicine (EM) is Tenecteplase specifically, 20% of patients develop often likened to “walking a asymptomatic intracranial hemorrhage (ICH), minefield in clown shoes.” with data showing anywhere from 1% to 6% of Undifferentiated patients with vague complaints patientsadeveloping ICH4. Undifferentiated present a high risk for misdiagnosis, a challenge Emergency Medicine (EM) is often likened to “walking minefield symptomatic in clown shoes.”

Mark Pappadakis, DO, is an emergency physician from Bucks County.

By Mark Pappadakis, DO

amplified with when vague metricscomplaints threaten to supersede These highlight the immense cognitive patients present a high risk forcases misdiagnosis, a challenge amplified when me clinical judgment. This is starkly evident is the pressure on the EM physician. Anchoring, threaten toaltered supersede clinical judgment.

This is starkly evident is the patient with altered mental st patient with mental status (AMS), forcing stereotyping, and confirmation biases loom the immediate Is this a stroke?

(AMS), forcingquestion: the immediate question: Is this a before stroke? the patient is even fully examined. With

metric-driven pressures mounting, the decision to Consider two scenarios based on real cases. A treat can have lasting ramifications. The solution, nursing home who based presented to thecases. A nursing Consider twopatient, scenarios on real home patient, who presented to the emerge however, is deceptively simple: step back and reemergency department (ED) with AMS, dysarthria, department (ED) with AMS, dysarthria, and ataxia, was last knownwithout to be “normal” examine the patient the noise. within the 4-hou and ataxia, was last known to be “normal” within window thrombolytics.

The non-contrast CT On is negative, vital signs1are andanthey are not the 4-hourfor window for thrombolytics.

The nonexamination, Patient has normal, jaundice and contrast CT is negative, are normal, and anticoagulants.

Withvital the signs door-to-needle clock ticking, do fluid you shift. pushThrombolytics Tenecteplase? abdominal are held. Labs they are not on anticoagulants. With the door-tosoon reveal coagulopathy and elevated ammonia — needle clock ticking, do you push Tenecteplase? hepatic encephalopathy, not a stroke. In contrast, A second patient, found by EMS in their apartment lobby, is reported “intoxicated.” arrival in Patient 2 is found to haveas left-sided paralysis.On A high A second patient, found by EMS in their apartment ED, they appearas to“intoxicated.” speak only Mandarin, interpreter reports their CT speech is incomprehensib for stroke prompts perfusion imaging, lobby, is reported On arrival but ansuspicion revealingto a large vessel in the ED, appear to speak Mandarin, Given thethey initial report, is heonly simply placed in a hallway sober up?occlusion. After successful clot retrieval, his first words—in perfect English— but an interpreter reports their speech is were, “What happened?” incomprehensible. Given the initial report, is he

In 2002, it was roughly occurred due to AMS . The number has increa simply placed in aestimated hallway to sober up?10% of all ER visits These cases are potent reminders that cognitive and the cause can be challenging to diagnose rapidly. include trauma, hypoxia, biases Etiologies remain a significant risk to both patient infection, In 2002, it was estimated roughly 10% of all ER and has physician. instinct shouldn’t be on the reg encephalopathy, nutritional deficiencies; variedClinical presentations.

Depending has psychosis visits occurred due to AMS1. The number These casesbyare potent and reminders that cognitive biases remain a sig replaced metrics protocols, and patients 2 increased, the cause can be challenging the brain,and stroke can account for 25% of patientsnever presenting with AMS. A key driver of that diagnos physician.

Clinical instinct shouldn’t be replaced by metrics and pro read the textbooks. to diagnose rapidly. Etiologies include trauma, 3 lateralizing signs on neurologic exam .

Patients who present with non-lateralizing signs were found textbooks. hypoxia, infection, viral encephalopathy, nutritional have strokepsychosis mimics,has including 23% vestibular dysfunction, 13% toxic/metabolic, 13% seizure, 9% deficiencies; varied presentations.

References: 3 References: Depending on the region of the brain, stroke can functional disorder, and 7% complex migraine . 11 22 33 44 account for 25% of patients presenting with AMS.2 A key driver of that diagnosis is lateralizing signs on 3 So while true may not neurologic examischemic . Patients stroke who present with make non- up a large bulk of patients with AMS, it’s a diagnosis th lateralizing signs were found to also have astroke mimics, needs to be respected.

It’s diagnosis not to be made lightly, as deciding that a patient is havin including 23% vestibular dysfunction, 13% toxic/ ischemic event and giving thrombolytics can potentially cause harm. With Tenecteplase specifically metabolic, 13% seizure, 9% functional disorder, and of develop3. asymptomatic intracranial hemorrhage (ICH), with data showing anywhere from 7%patients complex migraine 1

to 6% of patients developing symptomatic ICH4.

These cases highlight the immense cognitive pressure on the EM physician. Anchoring, stereotyping confirmation biases loom before the patient is even fully examined. With metric-driven pressures mounting, the decision to treat can have lasting ramifications. The solution, however, is deceptively simple: BCMSstep back and re-examine the patient without the noise.

Script.

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On examination, Patient 1 has jaundice and an abdominal fluid shift. Thrombolytics are held. Labs s

CHIP).

Please address the “widows” as you BCHIP: The Power of Collaboration see best (Q1 and response 4) BCMS Script sat down with Kimberly information and support. This was a partnership M. Permar, BS, MA, Executive Director of The Bucks County Health Improvement Partnership (BCHIP).

with Bucks County, local health systems, and community organizations.

Image change.

Should be same size as original image, headshot.

BCHIP’s greatest success has been expanding access to immunizations. We complement the Bucks County Department of Health by offering mobile vaccination services for homebound residents. We partner with local pharmacies to bring vaccines to vulnerable populations, including senior living facilities, shelters, senior centers, and school districts with high rates of unimmunized children. These services are provided at no cost; private funding is used to support underinsured and uninsured individuals.

BCMS Script: What is the mission of BCHIP? Our mission at BCHIP is to provide leadership in Bucks County through collaboration, address gaps in health services, and improve the health of the community. When determining which programs to offer, we consider Board direction, partnership opportunities, available resources, and—most importantly—unmet needs within Bucks County.

BCMS Script: What are BCHIP’s priority endeavors for the near future?

Looking ahead, our priorities include sustaining existing services and identifying opportunities to address emerging healthcare gaps such as mental health advocacy. We support the Bucks-Mont Collaborative Advocacy Network to help address mental health and substance use disorder. BCHIP is committed to helping healthcare systems implement best practices in collaborative care and strengthening connections with community partners.

BCMS Script: Bucks CMS is a founding member of BCHIP and a representative continues to serve on the BCHIP board. Who are the other BCHIP Board members?

Dr. David Damsker, Director of the Bucks County Department of Health, serves as chair of our Board. Our Board also includes the CEOs of all six Bucks County hospitals, along with leaders from the Bucks County Intermediate Unit, Bucks County Community College, Christ’s Home, Woods Services, Lenape Valley, and community members such as Vail Garvin and Charles Field. Their collective experience and guidance are essential to BCHIP’s work.

BCHIP has convened key stakeholders to address violence in healthcare settings. In partnership with the Bucks County District Attorney’s Office, local police departments, and hospital leaders, we are identifying resources and solutions to minimize violence to providers.

BCMS Script: What are some of BCHIP’s most successful initiatives?

BCHIP provides several no-cost resources to support Bucks CMS members and their patients, including programs for Advance Care Planning, smoking cessation, and vaccinations. We continue to seek opportunities to collaborate with physician practices and connect patients to needed services.

Over the past 30 years, BCHIP has implemented numerous successful programs. Health and dental services program in Lower Bucks County met a significant need, but served only a small portion of the county, and changes in the healthcare environment ultimately led the Board to transition the program to St. Mary Medical Center.

The entire community benefits when healthcare organizations across the county work together. To learn more, please see: https://www.bchip.org/.

In BCHIP’s countywide domestic violence awareness campaign, educational signage and resource cards were placed in restrooms across Bucks County, providing discreet access to

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400 Winding Creek Blvd.

Upcoming Events!

Mechanicsburg, PA 17050-1885

• The Bucks County Medical Society Board meets bimonthly. Bucks CMS members are welcome to attend Board meetings.

For details, please contact buckscms@ pamedsoc.org • SAVE THE DATE April 19, 2026 Annual Membership Meeting Location TBD

We thank you for your membership and welcome you to contact us anytime at buckscms@pamedsoc.org

PRSRT STD U.S. POSTAGE PAID HARRISBURG, PA PERMIT NO. 922