Berks County Medical Record Spring 2022 by Hoffmann Publishing Group

Your Community Resource for What’s Happening in Healthcare

SPRING 2022

Medical record BERKS COUNTY MEDICAL SOCIETY

A BCMS Conversation with

Kristen Sandel, MD OUR NEW VICE PRESIDENT OF PAMED

PHYSICIAN (CANNOT) HEAL THYSELF

COVID UPDATES

SCAN TO READ ONLINE

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Medical record

Contents

BERKS COUNTY MEDICAL SOCIETY

A Quarterly Publication

Berks County Medical Society MEDICAL RECORD

Raymond C. Truex, Jr., MD, FACS, FAANS, Co-Editor Lucy J. Cairns, MD, Co-Editor

Editorial Board

D. Michael Baxter, MD Shannon Marie Foster, MD, FACS Jillian Ventuzelo, DO T. J. Huckleberry, MPA William Santoro, MD, FASAM, DABAM Raymond C. Truex Jr., MD, FAANS, FACS

Features

A BCMS Conversation with Kristen Sandel, MD

12 Dr. Kristen Sandel’s Speech to the House of Delegates 14 Berks Counseling Center presents Mental Health First Aid Training

Berks County Medical Society Officers Jillian Ventuzelo, DO President William Santoro, MD President Elect Kristen Sandel, MD Chair, Executive Council Ankit Shah, MD Treasurer Jin Xu, MD Secretary Michael L. Haas, MD Immediate Past President T. J. Huckleberry, MPA Executive Director

Berks County Medical Society Phone: 610.375.6555 | Fax: 610.375.6535 Email: info@berkscms.org www.berkscms.org

The opinions expressed in these pages are those of the individual authors and not necessarily those of the Berks County Medical Society. The ad material is for the information and consideration of the reader. It does not necessarily represent an endorsement or recommendation by the Berks County Medical Society. Manuscripts offered for publication and other correspondence should be sent to 2669 Shillington Rd, Sinking Spring, PA 19608, Ste 501. The editorial board reserves the right to reject and/or alter submitted material before publication. The Berks County Medical Record (ISSN #0736-7333) is published four times a year by the Berks County Medical Society, 2669 Shillington Rd, Sinking Spring, PA 19608, Ste 501. Subscription $50.00 per year. Periodicals postage paid at Reading, PA, and at additional mailing offices.

SPRING 2022

16 Go For Broke by Richard A. Close, MD, FACS, FAANS 18 The Other Health Crisis We’re Not Talking About: A National Blood Shortage: - Miller-Keystone Blood Center - Tower Health - Penn State Health St. Joseph 22 COVID-19 Update: New Developments, New Opportunities and Challenges in 2022 Berks County Medical Society BECOME A MEMBER TODAY! Go to our website at www.berkscms.org and click on “Join Now”

24 Charles F. Barbera, MD, Named Reading Hospital President and CEO 26 Riding the Wave of Burnout 29 Government vs. Medicine It Could Be a Slippery Slope 30 Welcome New Member Jeffrey T. Cope, MD 31 Member in the News Debra Powell, MD, Receives PAMED Doctors’ Day Recognition Award 32 Welcome New Member Steven M. Presciutti, MD, FAAOS 34 Onions, Then Diamonds, What’s Next?

To provide news and opinion to support professional growth and personal connections within the Berks County Medical Society community.

In Every Issue 4 6

A Message from the Berks County Medical Society Compass Points

Content Submission: Medical Record magazine welcomes recommendations for editorial content focusing on medical practice and management issues, and health and wellness topics that impact our community. However, we only accept articles from members of the Berks County Medical Society. Submissions can be photo(s), opinion piece or article. Typed manuscripts should be submitted as Word documents (8.5 x 11) and photos should be high resolution (300dpi at 100% size used in publication). Email your submission to info@berkscms.org for review by the Editorial Board. Thank YOU!

POSTMASTER: Please send address changes to the Berks County Medical Record, 2669 Shillington Rd, Sinking Spring, PA 19608, Ste 501.

Hoffmann Publishing Group, Inc., 2669 Shillington Road, #438, Sinking Spring, PA 19608

w w w. H o f f p u b s . co m

For Advertising Information & Opportunities Contact:

Alicia Lee 610-685-0914 x210 Alicia@Hoffpubs.com Sherry Bolinger 610-685-0914 x202 Sherry@Hoffpubs.com

Guest Editor’s Comments

PHYSICIAN (CANNOT) HEAL THYSELF

LANDMARK LEGISLATION PROVIDES PLATFORM FOR MENTAL HEALTH AWARENESS AND CARE by Guest Editor: Shannon Marie Foster, MD, FACS

ll physicians, regardless of specialty, are under constant scrutiny and stress. When one of us makes a mistake, a life is at risk. When we err, we fail, as there is always negative impact. How each of us responds to this exhausting level of pressure is very personalized. Often, we are trained and conditioned to compartmentalize. Maybe we have an excellent support system. Well-chosen activities and families may provide balance and distraction. Better yet, some of us evaluate, debrief, and develop daily habits and methods of self-care.

At these moments of greatest weakness and vulnerability – where do we turn? The stigma and fear of admitting a need for help, of asking for opportunities to rest and repair, of admitting mental health needs is harsh and has never been on the side of physicians. Even trusted colleagues may judge us as weak and no longer worthy. Gaps in work time, extended leave, and any medical health issues/ diagnoses will follow each of us from state licensing boards to hospital credentialing committees and will remain a blemish on one’s records ad infinitum. THIS MUST CHANGE.

For each of us, there are, have been, and will be times when we are overwhelmed, uncertain, and find ourselves mired in self-doubt. Whether true, fair or not, our own harsh evaluation will inevitably lead to overpressure – further missteps, failures and confounding dissatisfaction – and can create a vicious circle of fatigue, overextension, and resentment where we become incapable of a high level of performance. This is burnout; a major reason that people leave our profession.

On Friday, March 18, President Biden signed the Dr. Lorna Breen Health Care Provider Protection Act into law. The law aims to reduce and prevent suicide, burnout, and mental and behavioral health conditions among healthcare professionals.

But for some, the cycle becomes ever more vicious, with despondency and no path of escape visible. More than 400 physicians die by suicide each year. Most without any precedent mental health issues or diagnoses. The only common risk factor amongst them; they were physicians.

4 | www.berkscms.org

Who was Dr. Lorna Breen? She was a well-regarded and successful Emergency Department Director at Allen Hospital in Manhattan who was truly on the front lines of COVID. She treated confirmed COVID patients, contracted COVID herself, and cared for an overwhelming number of sick patients with limited supplies. Surrounded by the dying, without a break or a cure in sight, Dr. Breen became overworked and despondent. She shared with her family and friends these mounting feelings but was afraid to seek or ask for official help. She did not want to lose her job or her license and was afraid of judgment and stigma. Lorna Breen died by suicide on April 26, 2020.

Using her story as a spearhead to raise the issues of awareness of mental health and physician suicide, a bipartisan, bicameral bill was introduced and is now Public Law No: 117-105: The Dr. Lorna Breen Health Care Provider Protection Act. This bill establishes grants and requires other activities to improve mental and behavioral health among health care providers. Specifically, the Department of Health and Human Services (HHS) must award grants to hospitals, medical professional associations, and other health care entities for programs to promote mental health and resiliency among health care providers. In addition, HHS may award grants for relevant mental and behavioral health training for health care students, residents, or professionals. Additionally, HHS must conduct a campaign to (1) encourage health care providers to seek support and treatment for mental and behavioral health concerns, and (2) disseminate best practices to prevent suicide and improve mental health and resiliency among health care providers. HHS must also study and develop policy recommendations on improving mental and behavioral health among health care providers, removing barriers to accessing care and treatment, and identifying strategies to promote resiliency. Furthermore, the Government Accountability Office must report on the extent to which relevant federal grant programs address the prevalence and severity of mental health conditions and substance use disorders among health care providers. What does this mean for all physicians? What can it mean for me? For you? Change the stigma and open the conversation. Support the process of raising and evaluating awareness of mental health on your team, in your community and at your institution. By acknowledging that we all are vulnerable

Great care for your patient starts with a strong team.

Adam J. Altman, MD Angela Au Barbera, MD Helga S. Barrett, OD Jennifer H. Cho, OD, FAAO Christine Gieringer, OD David S. Goldberg, MD, FAAP Marion J. Haligowski III, OD Dawn Hornberger, OD, MS Y. Katherine Hu, MD, MS Lucinda A. Kauffman, OD Christina M. Lippe, MD Barry C. Malloy, MD Michael A. Malstrom, MD Mehul H. Nagarsheth, MD Abhishek K. Nemani, MD Tapan P. Patel, MD, PhD Jonathan D. Primack, MD Kevin J. Shah, MD Michael Smith, MD Anastasia Traband, MD Monica Wang, OD Denis Wenders, OD Linda A. Whitaker, OD, MS

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SPRING 2022 | 5

C o m pa s s P o i n t s

Members –

T.J. Huckleberry, MPA Executive Director

WE NEED YOUR FEEDBACK.

s we inch toward 2024 and our 200-year anniversary and regather ourselves from our society’s “quarantined condition,” it is clear that we, as a

County Medical Society, must once again re-evaluate the value we provide to you and our community, as well as identify our current strengths and weaknesses. Our first step is providing the enclosed 7 questions for your consideration. This extremely brief survey will serve as the building block on how we move forward as an organization, and your feedback is essential. Please utilize the below QR code to complete the survey or keep an eye out for our upcoming e-mail blasts which will also provide the link to our survey.

6 | www.berkscms.org

Our Continued Commitment to Providing Leading-Edge Care As the first physician to serve as Reading Hospital’s President and CEO in its long and proud 150-plus year history, I write to our community with great optimism for the future of local healthcare. Without question, the last two years have been almost unfathomably difficult and the toll of the pandemic immense, but we are emerging from these challenging times with a bright future because we stand on a bedrock of excellence. Our resilience and commitment to providing the very best care to those we serve is unquestioned. When you visit Reading Hospital, our outpatient facilities, and our physician offices, you see and experience the difference our people make in their commitment to providing excellent and compassionate care. From the time Reading Hospital’s doors first opened in Berks County in 1867, and especially through the last two years of the pandemic, we have been here for you, providing superior care. You may not be aware that in February of this year Reading Hospital was named one of America’s 50 Best Hospitals. While this award places us among the top one percent of nearly 4,500 hospitals nationwide, in my view it is more important as an acknowledgment of the strength and quality of our people. The doctors, nurses, and other caregivers and team members who support what we do are truly some of the most talented and dedicated healthcare professionals in the nation. From their focus on you – our patients and community – to their commitment to providing leading-edge care, the people of Reading Hospital are the true heart of your local hospital. From the sophistication of the Reading Hospital HealthPlex to our Level I Trauma Center, to the region’s only Level III Neonatal Intensive Care Unit, to our advanced services in surgery, heart, cancer, neurology, and other specialty care, we know how important it is for you that we are here when you need us. And we will be, today, tomorrow, and in the decades ahead. When I moved my family to West Reading and began practicing in Reading Hospital’s Emergency Department more than 25 years ago, I knew I was home. It was the people who immediately made an impact on me, and it continues to be the people of Reading Hospital who make an impact today. I am humbled to be taking on the role of President and CEO at Reading Hospital, leading our excellent clinical, administrative, and support teams as we continue delivering the highest-quality healthcare in the region. Whatever your healthcare needs, you can take comfort in knowing that we are ready to serve you.

Charles F. Barbera, MD, MBA, MPH, FACEP President and CEO, Reading Hospital

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M e d i c a l R e c o r d F e at u r e

A BCMS Conversation with

Kristen Sandel, MD

First, congratulations on your recent election as Vice President of the Pennsylvania Medical Society for 2022. According to PAMED By-Laws, you will become President-elect next year and then President of PAMED in 2024. That is quite an honor and recognizes your many contributions to both PAMED and the Berks County Medical Society (BCMS).

Q: What led you to get involved and why do you feel it is important to contribute your time and energy to these groups especially now when so many of your colleagues are already feeling overstretched and even overwhelmed by the demands of clinical care? A: It is quite an honor to be elected by my colleagues throughout the Commonwealth to be Vice President of the Pennsylvania Medical Society. As just the sixth woman to be elected, I am looking forward to contributing new and fresh ideas to the society and to cultivate diversity in leadership within the organization. As we enter into a most critical time in medicine, it is important for physicians to be involved in the decisions that are being made for both patients and the future of health care. It is imperative that we as physicians recognize the responsibility that we have outside of the clinical arena if we are to ensure that we are practicing safe, state of the art, sound medicine for all patients in Pennsylvania. continued on page 10

8 | www.berkscms.org

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A BCMS Conversation with Kristen Sandel, MD continued from page 9

Q: What do you feel you can contribute as a leader in PAMED? Specifically, what would you like to see happen at the state level in the next three years that would have a positive impact for doctors and patients? A: Along with bringing increased diversity into the leadership in Pennsylvania, I am hoping that we can look ahead and be more proactive than reactive with our policies and our initiatives over the next three years. There are many areas that we can improve in medicine in the Commonwealth and I am anticipating that we will have a wealth of ideas brought forth by new, young, and diverse members. I would like to ensure that the board and leadership is held accountable for their decisions, including financial decisions, made outside of the House of Delegates.

Q: What would you suggest to your colleagues about the value of supporting and becoming actively involved in our state and local medical societies? A: As more and more physicians are becoming employed by large groups and health systems, it is vital that we have participation by physicians to protect the profession and art of medicine. Just as the Pennsylvania Medical Society is the only society that advocates for all physicians in the Commonwealth, the Berks County Medical Society advocates for all physicians as well as the patients in the area. These societies concentrate their efforts on specific, time sensitive issues facing physicians and patients they serve.

Let us now turn to some more general questions. Q: When and why did you first become interested in medicine as a career? Where did you go to undergraduate and then medical school? How did you choose your discipline of Emergency Medicine and why? A: I graduated with a Bachelor of Science in Chemistry degree from Bucknell University. Initially, I was interested in being a chemist, but as I progressed in my research at Bucknell, I realized that one of my strengths was working with people so I decided to apply to medical school. After graduating from the University

10 | www.berkscms.org

of Pittsburgh School of Medicine, I completed my Emergency Medicine residency at MCP-Hahnemann/Drexel University.

Q: What do you particularly find enjoyable and engaging about your work as an Emergency Department (ED) Physician? Are there any particular “downsides” to this work? A: I had difficulty choosing a field of medicine during my fourth year of medical school, however, as I rotated in the Emergency Department (ED), I was drawn to the field for many reasons. I enjoyed seeing a variety of patients, medical complaints, and acuity of conditions on a daily basis. I also really thrived in the ED, as it reminded me of the team atmosphere I relished during my years of playing sports, including softball at Bucknell. Emergency Medicine brings new challenges every shift and with every patient encounter.

Q: The past two years during the Covid-19 pandemic have been difficult for everyone in health care but certainly ED physicians have been on the true front lines. What has this experience been like for you and your colleagues? What are your thoughts as we head into our third year of this pandemic facing another resurgence of SARSCoV-2 with the delta and omicron variants setting records for new infections? A: The pandemic brought new and unanticipated challenges to medicine as a whole, but these challenges were particularly felt in Emergency Medicine. At the start of the pandemic, many front-line workers made the decision to isolate from their families and friends in order to protect them from this deadly virus. This isolation took a toll on most if not all of the front-line staff mentally, physically, and emotionally. One of the most difficult issues with the pandemic is that there is no known end date, and we struggle to balance our life in and outside of medicine. A positive that was felt by the staff in our ED was the outpouring of support from our colleagues and the community as we battled this virus daily.

Q: How do you manage to keep any life balance given the demands of an ED physician especially in this time of Covid-19? Do you have any advice for

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colleagues regarding how to recognize and manage high levels of stress and fatigue-major precipitators of “burn-out”? A: Sadly, due to Covid-19, many excellent physicians and front-line workers have made the difficult decision to leave clinical medicine. Burn-out has definitely been felt by almost everyone involved, and it is not surprising that some of our colleagues have decided to use their talents in other areas of medicine or completely different opportunities. The last few years have been mentally draining on the health care community.

Q: You are an educator of residents and students. What advice would you give to those just beginning their medical careers especially at this time? Can we create a better environment for them and possibly for patients in the future world of health care?

A: Medicine is a challenging field for physicians to work in in general, much less to initiate a career during a pandemic. I believe that it is important for medical students and residents to learn about the history of medicine, including the history of organized medicine and how it shaped health care. There is a wealth of opportunity for young and early career physicians to assist in molding a new future of medicine as well as create a multitude of opportunities for physicians to grow and thrive. Being a part of organized medicine outside of clinical practice allows physicians to utilize talents they have cultivated over the years to better the health of their communities along with their individual patients.

SPRING 2022 | 11

M e d i c a l R e c o r d F e at u r e

Dr. Kristen Sandel’s Speech to the House of Delegates On October 30th, 2021, Dr. Sandel was elected Vice President of the Pennsylvania Medical Society and will assume the Presidency of the organization in two years (2024). This will be the first time a Berks County physician has served as PAMED president in almost 40 years.

ello. It is an honor to address the members of the house of delegates. As a delegate for many years and a former member of the Board of Trustees, I know how valuable your time is and I thank you for participating in organized medicine to lead the Pennsylvania Medical Society (PaMed) into the future. Our society will need to be proactive, not reactive and continue to evolve quickly to meet the needs of physicians and patients. Healthcare is a difficult field to be involved in during normal times, not to mention the last few years with the unprecedented pandemic as well as the changes being forced upon physicians and other medical professionals daily. It is times like these that organized medicine plays a major and powerful role to ensure that we protect the physicians in Pennsylvania as well as the patients we care for daily. Our PaMed is one of the only advocates for every physician in the Commonwealth and continues to provide resources to ensure we return to the art of medicine. As a former administrator in the ED, chair of the Berks County Medical Society, and a current clinically practicing Emergency Medicine physician, I feel that I have experience as a known leader in both administrative matters as well as the credibility of being a front-line worker, especially during the Covid-19 pandemic. Medicine is an ever-changing field. We need to be nimble, have a pulse on the current state of medicine, and be in touch with the front-line physicians as healthcare evolves. As a future officer of PaMed I would like to ensure that members are informed of decisions in a timely fashion and updated on programs as well as finances spent between annual meetings. As a former member of the Board of Trustees and the Young Physician Section Trustee, I was able to learn a great deal from our former and current leaders as well as staff about the organization, governance styles, and

12 | www.berkscms.org

some of the difficult choices that need to be made by both the board and members of leadership. There have been issues identified concerning a perceived lack of transparency with decisions that are made outside of the annual HOD. We will be able to improve our communication with general membership between meetings and guarantee all voices are heard. There are many important roles that the society can play in the future. I have been a member of multiple task forces that addressed critical needs of our society as identified by the members of the HOD as well as a current member of the bylaws committee. Also, as the former chair of the employed physician workgroup, we created an Employed Physician Bill of Rights. We worked with the Hospital and Health System Association of PA to agree on certain principals to address concerns of employed physicians. As you know, the number of physicians employed by large contract groups as well as health systems is exponentially increasing. We need to ensure we represent and advocate for this important and large group of physicians along with our strong independent practice physicians. We need medical students and residents to stay in the Commonwealth and use their talents to improve the health of Pennsylvania. As a former residency director and medical student clerkship director, I cannot speak enough about the importance of the medical students, residents, and early career physicians in organized medicine and healthcare in general. The enthusiasm, new ideas, and alternative perspectives of these groups serve to move our society forward. I look forward to working with these sections to advance medicine in PA. As I reviewed the resolutions for this year, there were many wonderful ideas put forth by these groups and I believe there will be many vibrant discussions.

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You truly are the future of PaMed and we need to foster your ideas and thirst for medicine. Counties will always play a critical role in the future of our state society. As the current chair of the Berks County Medical Society, I have been a leader in various initiatives to improve the health of our patients and advocate for our physicians. We have been seen as leaders in combating the opioid epidemic, improving access to mental health, providing PPE to various practices and local organizations, as well as engaging early career physicians into leadership roles. We have also had success in recruiting members and have had a very great percentage of our physicians in the county participate at the county and state society levels. Berks County has been a leader in Pennsylvania for many years thanks to our former leaders, current leaders, and our executive staff. Lastly, as a woman, I am looking forward to expanding the diversity of leadership both on the board and the section level. The creation of the Women’s section was a big step forward in this expansion and there are many people of color and other underrepresented groups that have so much to give to our organization. Additional representation will continue to bring new and alternative thoughts and ideas that help to lead physicians in the Commonwealth which in turn will improve the care of the patients of PA. Thank you again for inviting me to speak with you. I believe I have the skill set that is necessary for this role and I would be happy to answer any questions that you may have by contacting me. Take care and stay safe.

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M e d i c a l R e c o r d F e at u r e Berks Counseling Center

presents

Mental Health First Aid Training

WHEN: Friday, April 22, May 6, or May 27, 2022

FORMAT: Virtual Training including 2 hours of pre-work completed prior to training TIME: 9:00 am – 4:00 pm WHEN: Friday,Email April 22, 6, or May 27, 2022 REGISTRATION: to:May KHaggerty-Kase@berkscc.org

FORMAT: Virtual Training including 2 hours of nd training must register by March 25th April 22 pre-work completed prior to training

must register by April 1st May 6th training TIME: 9:00 am – 4:00 pm REGISTRATION: to: KHaggerty-Kase@berkscc.org must register by than April 22nd MayEmail 27th training April 22nd training must register by March 25th

CLASS SIZES ARE LIMITED TO 20 INDIVIDUALS PER TRAINING. Be sure to May 6th training must register by April 1st include your name, phone number and email address. If registering more than Mayorganization, 27th training must register April 22nd one person from your please list allbynames, phone numbers and email addresses. CLASS SIZES ARE LIMITED TO 20 INDIVIDUALS PER TRAINING. TRAINING of pre-work must Be sure toPRE-WORK: include your name,TWO phoneHOURS number and email address. If be registering more person fromYou yourwill organization, please list all completed prior to than day one of training. not be admitted to the phone and email addresses. virtualnames, training if numbers the pre-work is not completed. Once registered, TRAINING PRE-WORK: TWO HOURS of pre-work must be completed you will be sent a link to Mental Health First Aid Connect, the prior to day of training. You will not be admitted to the virtual training if software platform you will use Once for the training. the pre-work is not completed. registered, you will be sent a link to MentalThis Health First Aid Connect, the platform you will use for training is sponsored bysoftware the Berks County Mental the training. Health/Developmental Disabilities Program This training is sponsored by the Berks County Mental Health/ Developmental Disabilities Program

14 | www.berkscms.org

MENTAL HEALTH FIRST AID WHY MENTAL HEALTH FIRST AID? Mental Health First Aid (MHFA) teaches you how to identify, understand and respond to signs of mental health and substance use challenges among adults.

On average,

From 1999 to 2019,

• Employers.

Nearly

130

841,000 people died from drug overdoses.

in the U.S. lives with a mental illness.

Source: American Foundation for Suicide Prevention

Source: Centers for Disease Control and Prevention

Source: National Institute of Mental Health

people die by suicide every day.

WHAT IT COVERS • Common signs and symptoms of mental health challenges.

WHO NEEDS TO KNOW MENTAL HEALTH FIRST AID

1 IN 5

• Police officers. • Hospital staff. • First responders. • Caring individuals.

Learn how to respond with the Mental Health First Aid Action Plan (ALGEE):

• Common signs and symptoms of substance use challenges.

A ssess for risk of suicide or harm.

• How to interact with a person in crisis.

L isten nonjudgmentally.

• How to connect a person with help.

G ive reassurance and information.

• Expanded content on trauma, substance use and self-care.

E ncourage appropriate professional help. E ncourage self-help and other support strategies.

THREE WAYS TO LEARN • In-person – Learners will receive their training as an 8-hour, Instructor-led, in-person course. • Blended – Learners complete a 2-hour, self-paced online course, and participate in a 4.5- to 5.5-hour, Instructor-led training. This Instructor-led Training can be: » A video conference. » An in-person class.

Sources American Foundation for Suicide Prevention. (n.d.). Suicide statistics. https://afsp.org/suicide-statistics/ Centers for Disease Control and Prevention. (n.d.) Drug overdose deaths. https://www.cdc.gov/drugoverdose/deaths/index.html National Institute of Mental Health (NIMH). (n.d.). Mental illness. https://www.nimh.nih.gov/health/statistics/mental-illness

To find a course or contact a Mental Health First Aid Instructor in your area, visit MHFA.org or email Hello@MentalHealthFirstAid.org.

M e d i c a l R e c o r d F e at u r e

Go for Broke by Richard A. Close, MD, FACS, FAANS A Book Review by Raymond C. Truex, Jr., MD

n a letter to Robert Hooke written in 1675, Sir Isaac Newton wrote a phrase which is often referred to in scientific discussion, which is “If I have seen further, it is by standing on the shoulders of Giants,” meaning that each scientific advance is based on the discoveries of those that preceded it. I doubt that many of the young physicians in Berks County have had the time or interest to discover the “Giants” of their own area of specialization, who came before them locally, given that most physicians beginning their practice of medicine tend to look to the future and act in the immediate present. However, with the benefit of advancing age, older physicians tend to look back on the road that they have travelled with thoughtfulness and an eye towards the forces that shaped their careers. Paraphrasing the philosopher Soren Kierkegaard, “Life must be lived going forwards, but it can only be understood looking backward.” My partner in the practice of Neurosurgery for almost 30 years, Dr. Dick Close, recently retired from the Reading Hospital after 42 years of service in Berks County, making him the longestserving Neurosurgeon in Berks County history, and possibly the most senior surgeon of any specialty in Reading Hospital. With the help of Berks County historian George Meiser IX and Dr. Eric Hudgins, he took it upon himself to compile a history of the Neurosurgical service at Reading Hospital, the history of which is intimately related to the evolution of Reading Hospital into the powerhouse which it is today.

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In Go for Broke, Dr. Close documents the history of the Neurosurgical service, which began in 1952 with the arrival of Dr. Herbert Johnson to Berks County. Johnson had been the #2 Neurosurgeon at Johns Hopkins, where he served as the primary clinical backup for his famous mentor and chairman, Dr. A. Earl Walker. When Herbert Johnson announced his intention to relocate to Reading Hospital — which at the time was devoid of neurosurgical coverage — Dr. Walker told him that he would starve in Reading. Nevertheless, Dr. Johnson decided to “go for broke” and brought his expertise to Berks County. Through personality, skill and amazingly hard work, Dr. Johnson went on to build a referral service that extended throughout Berks, Schuylkill, Lebanon, and parts of Lancaster and Montgomery counties. Patients that formerly would have to travel to Philadelphia were now able to find excellent care in their own city. Dr. Johnson went on to become Chief of Surgery at Reading Hospital, and he was responsible for recruiting other specialists who modernized and transformed the quality of medical care. Thus, it could be asserted that Reading Hospital would not have achieved its current status if it were not for the vision of Dr. Herbert Johnson, who would die of a cardiac arrest in 1990. Dr. Close carries the history through the intervening years in a well-written personal narrative, accompanied by many photographs. Picking up the “Go for Broke” theme established early in the book, Dr. Close ends by applying this theme by drawing parallels to the current financial problems experienced by Tower Health. Although the concept of building a larger population base along the Route 422 corridor was well founded, its implementation was not successful because of the inexperience of the Tower Health administration in supervising such an extended endeavor, and the COVID-19 pandemic was the final straw which forced the extended cancellation of elective surgeries. Despite the failed implementation of Tower Health’s modernized “Go for Broke” strategy, Dr. Close finishes by expressing optimism for the future if the Tower Health system can recapture the high standards of patient care established long ago under Dr. Herbert Johnson’s leadership. I encourage the younger Berks physicians to read this book, which will lead them to better appreciate the pioneers of medicine in our area, and to understand the challenges of our profession a century ago. The older physician may be inspired to similarly compile a history of his own specialty locally, out of respect for the giants on whose shoulders he stands. Paperback copies of Dr. Dick Close’s Go for Broke (Masthof Press) may be obtained through the Berks County Medical Society or from Tower Health Neurosurgery Group.

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M e d i c a l R e c o r d F e at u r e

The Other Health Crisis We’re Not Talking About:

A National Blood Shortage by Holly Yacynych, Marketing Manager Miller-Keystone Blood Center

hile nearly everyone has been focused on the ongoing pandemic and resulting variants of the virus; another health crisis has already become a national emergency; the blood shortage. With schools and businesses shuttering their doors and opting for remote or hybrid options, the ability to host on-site mobile blood drives abruptly ended with the start of the pandemic. Fears of donating, even today and over two-years into the pandemic, have minimized donor engagement and recruitment, and resulted in a dramatic loss in necessary and life-saving blood products. Social distancing guidelines for the safety of phlebotomists and blood donors remains a constant challenge limiting the number of individuals allowed within any blood donation facility. The rapid decline in blood collections was and continues to be felt far and wide. Blood centers across the nation have gathered often to share their struggles and provide blood products to one another during one of the darkest periods of time. With no blood to spare or share, each faces the same mission-defeating crisis: how do we replenish and supply our hospitals and communities with necessary life-saving blood products? Even when hospitals temporarily paused elective surgeries due to the lack of supply of blood, which would presumably allow for more blood to be collected, another challenge arose. Traditionally, blood centers are often faced with a dwindling supply of blood during the summer vacation months and winter months. There is still no respite, and the crisis of the blood shortage is an on-going health situation with little attention or discussion. With no organic or manufactured substitute for blood, volunteer blood donors hold the key to ending the other health crisis our nation and local communities are facing. Blood products such as platelets, plasma and red blood cells are vital in the

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A Na tional Blood Shor tage

treatment for trauma victims, cancer patients for daily transfusions, surgical patients, premature babies and several more. Blood donors are the unsung heroes for patients, and blood centers are desperate to pull them back.

Creating Hope And Answering The Call Responding to and finding alternative solutions to collect blood for 29 regional hospitals throughout our communities in eastern Pennsylvania and western New Jersey has been the focus, the challenge, and the steady success of Miller-Keystone Blood Center (MKBC). Headquartered in Bethlehem, PA, and recently opening its seventh donor center for a total of 17 collection sites, MKBC continues to find solutions to collect blood products needed daily by some of the largest healthcare networks in the commonwealth of Pennsylvania. During the height of the pandemic, MKBC was one of the first blood centers who joined together with other blood centers across the nation and at the request of the FDA, with oversight by the Mayo Clinic, to collect Convalescent Plasma while still encouraging donors to donate blood. MKBC collected and distributed 5,000 doses of Convalescent Plasma to regional hospitals, military bases and other hospitals calling for the FDA authorized therapy for COVID-19. MKBC created hope, helped save lives through the generosity of donors and answered the call.

Finding Solutions Through Community MKBC not only opened a new donor center in the heart of the city of Allentown, but also welcomed a new approach to offer donors the convenience of donating blood through a unique program. The Adopt-A-Day program allows businesses and schools to host a blood drive at any of the core donor centers located in Allentown, Bethlehem, Easton, Pittston, and Reading, PA, and Ewing, NJ. While MKBC still hosted over 2,000 mobile blood drives, the blood center touted 66,105 donors resulting in

121,000 blood products and components collected, processed, and distributed to support the blood center’s hospital partners in the last year. Yet, MKBC refrigerator shelves have a steady ebb and flow of a nearly full supply and depletion. The pandemic halted and continues to hinder the flow of over 20% of MKBC’s blood supply procured through high schools, colleges, and universities in the counties the blood center serves. To recruit a younger generation and hope they, like their generational counterparts, understand and respond to the need to donate lifesaving blood paved the way for a new MKBC program. The High School Scholarship Program allows students to find alternate ways to host blood drives while it encourages and rewards students to donate blood. Area businesses joined in their own efforts to donate blood through MKBC’s Local Leader program. Sixteen local businesses and groups each collected over 200 units of blood, with the highest collecting 794 units of blood, in 2021.

The Heroes Of A Blood Shortage MKBC has a daily need to collect and process 450 units of blood to fulfill the rising demand to care for patients of 29 hospitals. The shortage of blood is constant. The demand is always high. The challenges to adapt to a changing lifestyle across the globe and maintain the safety of staff, donors and others is always at the forefront of MKBC’s mission. The focus is to save lives and that can only be achieved by the heroes of our community – dedicated blood donors. If everyone donated blood just three times in 12 months, there would not be a blood shortage – and yet only 5% donate blood regularly. Can you spare one pint of blood to save a life? You never know if the life you’re saving today through that one donated pint of blood will save a beloved family member, friend, or neighbor. The blood you donate here with MKBC, stays here to support your community. To schedule your blood donation and for a collection site nearest you, please call Miller-Keystone Blood Center at 800-B-A-DONOR (800-223-6667) or visit GIVEaPINT.org.

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M e d i c a l R e c o r d F e at u r e

Blood Donation Critical to the Health of Our Community by Thomas A. Geng, Jr., DO, MBA, FACS Trauma Program Medical Director Division Chief, Trauma, Acute Care Surgery and Surgical Critical Care

s blood centers across the US continue to face critical shortage of blood donations, Tower Health hospitals are also currently experiencing lower than normal blood inventory. Over the last several months we’ve been working with our colleagues from Miller-Keystone Blood Center to educate the community on the shortages and how regular donations can help those with a traumatic injury, cancer, sickle cell anemia, or babies in the NICU in their healing and recovery. The health system is committed to providing the care when, and where, our community needs it. Encouraging the community to donate blood to their local blood banks is critical to our promise of “advancing health and transforming lives.” The most common need for blood transfusions includes cancer patients who may need one to two units per week, sickle cell anemia patients could receive six or more units per month, and trauma patients may need 12 to 60 units of blood because of their injuries. The health system also supports NICU babies with transfusions of O negative red blood cells whose donors must meet special criteria. Blood products are a precious resource that are used to treat and save the lives of many individuals in our community. Far too often as a trauma surgeon I see the importance of having an adequate

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blood supply on hand. We never know when we will experience a mass casualty incident or when an accident victim will come to the Trauma Center. For trauma centers across the country, a tragic and unfortunate side effect of the pandemic has been a seeming increase in interpersonal violence, often including penetrating trauma, which can require significant amounts of blood product, to treat the patient. I’m grateful Tower Health has been reminding individuals of the importance of blood donation. In response to the shortage Reading Hospital team members should be commended. In November, the hospital partnered with Miller-Keystone Blood Center to host an emergency blood drive and hospital team members registered for all 43 appointments in less than three hours. I’ve shared information on my personal and social media profiles with links to the Miller-Keystone Blood donation website, encouraging friends and family to go donate. I hope you, my physician colleagues, will consider doing the same. Individuals interested in donating locally in Berks can schedule appointments at Miller-Keystone Blood Center of the American Red Cross.

Penn State Health St. Joseph Weighs in on National Blood Shortage by Karen L. Chandler

anuary 2022 ushered in the worst blood shortage experienced by the American Red Cross in over ten years, and with it the potential risk to patients across the country.

Nationally, doctors are forced to choose which patient will receive a blood transfusion and which patient will wait until supplies have caught up with the demands. Throughout the United States, The Red Cross is experiencing a ten-percent reduction in willing blood donors since the beginning of the pandemic and continues to battle with the cancellation of blood drives, staffing limitations, and donor concerns of infection. While all blood types are needed, types O positive and O negative, as well as platelets are in urgent demand. Locally, the Blood Bank of Penn State Health St. Joseph has been struggling with the availability of blood units for transfusions and notes that platelet availability is also at a minimum. Every request for a transfusion is reviewed by a medical director and the blood shortage caused some of those requests to be reduced from a whole unit of blood to only a half unit. Although non-emergent surgeries were not postponed at Penn State Health, some physicians may have chosen to delay those

surgeries due to the national emergent situation with no blood availability. The Blood Bank staff operates under established policies according to national guidelines and standards, but as situations worsened, those polices were temporarily revised as needed and suggested. While any situations falling outside the standard polices are being closely monitored, Penn State Health St. Joseph reports the Blood Bank is mostly back to normal operations. Unknown to many in the community, the Blood Bank explains that most blood units are only good for 42 days, with platelets lasting a scant five days, creating an unending process of the need for blood donations. The staff of the Blood Bank at Penn State Health St. Joseph understands that potential donors may be afraid of the unknown and many people do not like needles. They hope to stress to the community that donors will not get sick from donating and will be watched over by a friendly and encouraging donation staff who will talk to all donors throughout the donation process to keep them at ease.

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A Na tional Blood Shor tage

M e d i c a l R e c o r d F e at u r e

COVID-19 Update:

New Developments, New Opportunities and Challenges in 2022 by Debra Powell, MD Chief, Division of Infectious Diseases Medical Director, Infection Prevention Tower Health WHERE ARE WE NOW? We have now passed the second anniversary of the start of the COVID-19 pandemic. The SARS-CoV-2 virus has affected us all. Many have been infected, suffered the loss of family members, incurred financial hardships, and were not able to participate in significant in-person life events. The good news is that the community case numbers have greatly improved from the peak of the Omicron variant in mid-January 2022 and the requirements for mask use have decreased or been eliminated. Our community is very relieved to be getting back to normal interactions.

WHAT HAVE WE LEARNED AND WHAT TREATMENTS ARE AVAILABLE? We have learned a great deal about treating and preventing this infection and are very fortunate that we have effective oral and intravenous medications for treating COVID-19 infection plus highly effective vaccines to prevent severe infection requiring hospitalization and contributing to decreasing deaths. Our antiviral medications include two oral medications: ritonavir-boosted nirmatrelvir (Paxlovid) and molnupiravir; plus, IV remdesivir. Both ritonavir-boosted nirmatrelvir and molnupiravir medications received Emergency Use Authorization (EUA) by the FDA for treating COVID-19 in an outpatient setting for those with mild-to-moderate disease who are at high risk of progressing to severe disease and/or hospitalization. Both medications have significant precautions that must be considered prior to prescribing. Remdesivir is being used for high-risk hospitalized patients. All antiviral medications are most effective when used in the first 5- 7 days of the disease course. Ritonavir-booster nirmatrelvir, due to the ritonavir component, has severe drug-drug interactions with many medications that must be cross referenced prior to prescribing. The dose must be adjusted for renal insufficiency and cannot be prescribed for patients with severe renal or liver dysfunction.

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Molnupirivir induces errors in the virus genetic code that prevents the virus from further replicating. Molnupirivir is not recommend for use during pregnancy due to embryo-fetal toxicity and is not authorized for patients less than 18 years of age due to bone and cartilage toxicity. Females of childbearing potential should use a reliable method of contraception correctly and consistently for the duration of treatment and for 4 days after the last dose of molnupiravir. Males of reproductive potential who are sexually active with females of childbearing potential should use a reliable method of contraception correctly and consistently during treatment and for at least 3 months after the last dose. In their clinical trials, hospitalization and death in those patients at highest risk were reduced by 88% for ritonavir-boosted nirmatrelvir compared to 30% for molnupiravir. For high-risk patients we also have monoclonal antibody intravenous treatments that have shown to decrease progression to severe disease requiring hospitalization and death. Due to the changing circulating variants, we have shifted the preferred product based on the variant for better efficacy. Our current preferred monoclonal antibody is sotrovimab which is effective against the initial Omicron variant. We also have a small supply of bebtelovimab which will provide an additional monoclonal antibody option for when the Omicron BA.2 variant becomes predominant. The FDA issued an EUA for tixagevimab with cilgavimab (Evusheld), a monoclonal antibody intramuscular injection, for preexposure prophylaxis for patients ages 12 years old and up who have moderate to severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments and may not mount an adequate immune response to COVID-19 vaccination. Our local area has received a very small supply of this medication and Reading Hospital is contacting patients that qualify, prioritized based on a lottery process, as the supply permits.

HAVE WE ENTERED INTO THE ENDEMIC STAGE? I think that the world is still in the pandemic stage transitioning to the endemic stage. A pandemic is when the world experiences widespread, exponentially increasing spread of infection. This is still occurring. Endemic viruses remain constantly present and have a fairly predictable spread, such as influenza and rhinovirus.

The US is seeing lower spread of Omicron due to the rapid uptick in cases during December and January that infected a significant proportion of our population including those with prior vaccination and prior infection. Those with prior immunity had less severe disease and those patients that received a booster had additional protection. We are seeing increasing spread of the BA.2 Omicron subvariant in Europe and the US case counts of BA.2 are doubling every 1 – 2 weeks. I expect that we will see additional COVID-19 cases in Berks County and an increase in hospitalizations in the next month.

HAVE WE REACHED HERD IMMUNITY AND SHOULD HERD IMMUNITY BE OUR GOAL? Our initial plan when the global COVID-19 pandemic began in 2020 was to reach herd immunity. Then, the reproductive number (Ro) was between 2 and 3, meaning that for one infected person, they infected 2-3 additional people. The reproductive number has continued to climb as subsequent variants became more infectious; approximately 7 for Delta, 8.2 for Omicron BA.1 and now 12 for BA.2. Comparing this to other viruses, Chickenpox Ro is 10, Mumps is 12 and Measles is 18. Due to this very high number, our goal is to protect as many patients as possible from severe disease requiring hospitalization and death through vaccination and tolerate mild break through infections.

WHAT SHOULD WE BE FOCUSED ON TO PREVENT RESURGENT CASES? As a global society, we need to focus our vaccination efforts on those communities across the world that have not had access to vaccination. New variants will emerge from these communities and these variants will cause the future surges across the globe. Also, we should continue to promote vaccination and boosters for those who qualify. Fourth doses are recommended for immunocompromised patients and the FDA has issued an EUA for a fourth dose for patients over 65 years of age. Also, pharmaceutical companies are continuing the clinical trials to obtain EUA for a vaccine for children under 5 years of age. Vaccinating this age group is key to obtaining sufficient immunity in the community to decrease spread to highrisk patients.

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Charles F. Barbera, MD, Named Reading Hospital President and CEO by Richard Wells, Richard.wells@towerhealth.org, 610-955-9636

est Reading, PA., March 31, 2022 - The Tower Health Board of Directors today announced the appointment of Charles F. Barbera, MD, MBA, MPH, FACEP, as president and CEO of Reading Hospital, effective April 4, 2022. Dr. Barbera brings deep experience to the position, having served in a variety of senior clinical and executive roles during his more than 25-year tenure with the health system.

than 20 years. Dr. Barbera was key in the creation and accreditation of Reading Hospital’s Trauma Center, developed a successful Emergency Medicine Residency Program, and was instrumental in the development of Reading Hospital’s Pediatric Emergency Department and Psychiatric Emergency Department. He was also the clinical leader in the health system’s expansive telemedicine efforts in response to the COVID-19 pandemic.

As president and CEO of Reading Hospital, one of the top 50 hospitals in the country, Dr. Barbera will be responsible for the hospital’s operations, clinical outcomes, employee and physician engagement, and service to the community.

An active member of the Reading community, Dr. Barbera is regularly recognized for his dedication to patients and the region. In 2019, he received the Berks County Medical Society William J. Alexander Award for Contributions to Medicine and Community Service. He is the past President of the Pennsylvania College of Emergency Physicians and the Berks County Medical Society. He also received the Berks County American Red Cross Medical HERO Award and recognition from Becker’s Hospital Review on their list of 100 Physician Leaders to Know.

“With Reading Hospital’s well-earned reputation as one of the top hospitals in the country, we had strong interest from many excellent candidates,” said C. Thomas Work, chair of Tower Health’s Board of Directors. “As we conducted the search, it became readily apparent to the Board that the best leader to move our mission forward was within our own ranks. As a highly respected clinician with strong leadership and business skills, Dr. Barbera brings a unique and impressive background to the position, including unsurpassed commitment to and knowledge about Reading Hospital and the communities it serves. We are thrilled to have someone of Dr. Barbera’s caliber and experience leading the hospital into the future.” “I am honored to serve as president and CEO of Reading Hospital, a bedrock of our community and unmatched leader in clinical excellence since 1867,” said Dr. Barbera. “As one of the finest healthcare centers in the nation, the hospital is a local treasure. I am deeply committed to working closely with our physicians, nurses, and support staff to bring about an enhanced era of collaboration – putting people first in everything we do. The team at Reading Hospital are my colleagues and friends, and I cannot wait to get to work supporting and empowering the incredible care they deliver.” Dr. Barbera joined Reading Hospital in 1996 and became the Chair of Emergency Medicine in 1999, a position he held for more

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“Dr. Barbera embodies the values and culture that make Reading Hospital such a special place. He brings a powerful combination of clinical and business acumen, but what really sets him apart is his infectious energy and dedication to service and giving back to the community,” said P. Sue Perrotty, CEO of Tower Health. “As we move forward and build a new future for Tower Health, Dr. Barbera will be a collaborative and unifying influence that will advance Reading Hospital’s legacy of clinical and operational excellence.” Dr. Barbera received his medical degree from Temple University School of Medicine, and completed his residency at Thomas Jefferson University Hospital. He holds a Bachelor of Arts degree in Communication Arts from LaSalle University, a Master’s in Business Administration from Alvernia University, and a Master’s in Public Health from The George Washington. He previously served as the president of Pennsylvania College of Emergency Physicians and The Berks County Medical Society and on the boards of Autism Society of Berks County, the American Heart Association, and the Children’s Home of Reading. Dr. Barbera currently serves as Chairman of the Pennsylvania Trauma Systems Foundation Board.

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Waves of Burnout by Karen L. Chandler

s the COVID-19 epidemic ebbs and flows, burnout among medical professionals is on the rise.

conflicts in family or other close relationships and can even affect those interactions that are more distant.

In the second edition of her book, Burnout and Self-Care in Social Work, author SaraKay Smullens, a certified family life educator, group psychotherapist, and social worker basing her private and pro-bono clinical practice in Philadelphia, updates the text’s content with a further enhanced exploration and understanding of burnout.

Physical burnout is based in the body’s physiological response to stress and can be evidenced in a multitude of illnesses that may range from sleep disturbances to the common cold, to cardiovascular disease, however, Smullens confirms that no physical symptom should be assumed caused by burnout without the indicated medical evaluations.

The wife of Dr. Stanton Smullens, a retired surgeon and New to the second edition of her book is Smullens’ fifth former chair of the Pennsylvania Patient Safety Authority, dimension of concern, societal burnout, a state she describes Smullens realizes the effects stressors have on physicians, as being “overwhelmed, overburdened, and overloaded by a especially during the onslaught of COVID-19, and ac- ‘perfect storm’ of grave, threatening, and unaddressed societal knowledges how any discussion of burnout in doctors has problems,” much like the crisis realized by many physicians been mainly limited to their professional lives. working through the COVID-19 pandemic. “It is essential that burnout warning signs are clearly Smullens notes that the Medscape Physical Burnout marked and communicated before lives are destroyed! and Depression Report in 2022: Stress, Anxiety, and Wherever burnout originates – personally, professionally, Anger showed a five-percentage point increase in overall relationally, physically, or societally (or a combination) physician burnout, from 42 percent in 2020 to 47 percent – it impacts interactively bringing grave danger. When in 2021, and an increase in emergency room physician overwhelmed, overloaded, and overburdened by external burnout from 43 to 60 percent last year. The report added pressures, when anxiety and exhaustion seem everywhere, that most doctors felt that burnout intruded upon most the destruction of self-confidence, self-respect, and an aspects of their lives, with 54 percent feeling its effects to inability to connect with others are in the wings.” (Burnout be strong to severe, including in their relationships. The and Self-Care in Social Work, 2nd edition) Maslach Burnout Inventory is a source recommended by While professional burnout remains a topic of concern, Smullens for anyone looking for help in evaluating their Smullens discusses the other aspects of burnout that impact own experience with burnout. each other and should be examined and recognized: “personal (our inner world capacity to deal with stress); relational (unresolved conflicts in families and in close relationships), societal (the impact of unresolved conflicts played out 24/7 through technology), and physical (our bodies speak to us, offering clues.)”

Smullens describes personal burnout as an upheaval in the cognitive, intellectual, psychological, emotional, or spiritual life, or a lacking in one’s inner world to deal with stress, while relational burnout is based in unresolved

Gathering over thirty years of clinical experience, Smullens sides with other experts who believe that burnout is a condition separate from depression and while there can be an overlap between the two diagnoses, Smullens explains that many people who believe they are suffering from depression are actually burned out. The World Health Organization officially describes burnout as a syndrome, rather than a psychiatric illness, such as depression, that could carry a stigma. Burnout is evidenced by a combination of reduced continued on next page

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Riding the waves of burnout continued from page 27 exhaustion, and depersonalization, and can all be brought on by chronic occupational stress.

recognize fulfilling options before our very eyes in love, friendship, and work.” – SaraKay Smullens

“Depression caused by loss, rejection, betrayal, connivance can be experienced as a fierce body punch. One may feel blindsided and bewildered as if slats in the floor of an emotional home have disappeared. With burnout the body speaks to us differently: ‘My shoulders, my arms, my being can no longer carry what is asked and expected. My brain feels fried.’” (Burnout and Self-Care in Social Work, 2nd edition)

Self-care in a multi-pronged approach is the way health care professionals can fight back from the grasp of burnout, a condition that has claimed lives as evidenced by rising suicide rates in physicians.

Smullens writes that researchers have used four attendant syndromes or “wake-up calls” to better explore the tumultuous waters of burnout, and while the complex faces of burnout may overlap, each of the attendant syndromes provides valuable insights into the experience of burnout. Compassion fatigue is the attendant syndrome that results when medical professionals give until they have nothing left and it highlights the emotional and physical fatigue that many caregivers experience. Compassion fatigue always plays a factor in the other syndromes and indicates a need to take a break for self-care. Originally defined by Freud, the second attendant syndrome, countertransference, results as a patient’s influence gives rise to a practitioner’s positive or negative subconscious feelings about a significant person from his or her own previous experiences. Smullens advises physicians encountering this syndrome to continually face how they feel about each patient and be aware of how patients trigger past or current emotions. Vicarious trauma and secondary trauma, considered the third attendant syndrome, results from a medical professional’s direct and frequent exposure to victims of trauma. Smullens notes that caring for patients who became ill or died after a COVID-19 infection may echo a physician’s own personal trauma of watching a loved one in a similar situation, and that processing the resulting emotions with a colleague or other professional can be helpful.

Personal, physical, relational, and societal self-care can work together to create better quality of life for physicians. Smullens confirms the importance of finding a program of strategies and attitudes that speak to each person in a way that is both enjoyable and can become an integral part of daily life, whether it is journaling, learning a new skill, or making a date night with a partner. Smullens believes that doctors may often forget the power of their own creativity and encourages a renewed focus on making time to devote to a dream, and when one dream does not become fulfilling to seek another. On the professional front, Smullens notes that some health care institutions are putting together wellness programs for staff to use including such features as recharge rooms and counseling services, and she hopes medical schools will follow suit and teach self-care strategies for students to reduce the risk of burnout. “All health care leaders in organizations, institutions, and government and industry must prioritize major improvements in settings… Recharge Rooms are a wonderful example. A culture of trust is essential in all healthy settings — someone to go to and process with if overwhelmed. My research shows that anxiety is alleviated when one can speak honestly to one reported to — a sign of a healthy functional setting. In dysfunctional settings, anxiety is imposed from the top, as a control mechanism. People are pitted against each other; one does not know whom to trust.” – SaraKay Smullens

In her book, Smullens tells of the tragic suicide of 49-year-old The fourth attendant syndrome is considered by Smullens to be Lorna Breen, MD, a Manhattan moral distress and injury, an experience felt by medical professionals emergency room physician supervisor unable to provide the highest quality of care and healing, a factor in at a hospital devoted, but ill-supplied, burnout exacerbated by the COVID-19 crisis. to serve the underprivileged during Smullens explains that a key to smoothing the turbulence of burn- the COVID-19 pandemic. Breen’s out is for physicians to move from compassion fatigue to compassion father, Dr. Philip C. Breen, said after satisfaction, an effort that lessens the grasp of the attendant syndromes his daughter’s death, “she tried to do her job and it killed her.” and is further helped by employing self-care strategies.

Smullens’ personal message to “The goal is to go from compassion fatigue to compassion satishealth care professionals is both faction. Key to this is the ability to have boundaries with patients, encouraging and cautionary. Yes, physicians care — but empathy is the goal. Empathy connotes boundaries, while sympathy connotes union. Energy and inner She said, “evidence-based self-care strategies, behaviors, and attitudes, resources must be protected for personal lives. Also, those in the if integrated into your life, will prevent, address, and alleviate burnout. medical profession often see themselves as SuperMen and Women, Your body and what I think of as an “InnerSelf Voice” that each of us and often extend themselves beyond reason. It is important to has, but often ignore, as we push ourselves, will signal when burnout be able to protect oneself, to say No and to understand that if we is a threat. Listen!” cannot say No, we cannot say Yes, and further, we will be unable to

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Government vs. Medicine It Could Be a Slippery Slope by Karen L. Chandler

ecent political moves will have governments weighing in on what treatments physicians can choose for their patients.

And while there are legislators who are licensed physicians, the majority are not. To counteract misinformation believed to be spread by some physicians and exacerbated by the media, the Tennessee State Board of Medical Examiners adopted a policy to penalize physicians who speak out with false information about COVID-19 vaccines and treatments. These doctors could face a potential loss of their licenses to practice. Despite the support of the policy by the American Board of Internal Medicine, the Federation of State Medical Boards, and others, the state of Tennessee took a different stance. Only months after the September 2021 policy to tighten the reins on physicians was put in place, Tennessee legislators voted to stop the licensing board from punishing licensed physicians in regard to their choices of COVID-19 treatments and required the policy to be removed. Following Tennessee’s lead, North Dakota passed a similar law and 24 more states on both sides of the aisle are considering the same path. And Pennsylvania is included in the mix. Dr. Humayun Chaudhry, CEO of the Federation of State Medical Boards (FSMB), called the decisions and considerations an “unwelcome trend.” He added, “at the end of the day, if a physician who is licensed engages in activity that causes harm, the state medical boards are the ones that historically have been set up to look into the situation and make a judgement about what happened or didn’t happen.” In December 2021, the FSMB reported findings from its 2021 annual survey of state medical boards, with the survey’s focus identifying how the boards are impacted by

and dealing with health care professionals who spread false or misleading details about COVID-19. The survey revealed 67% of boards experienced an increase in complaints about licensed physicians disseminating false or misleading information. 26% have provided statements regarding the dissemination of the misinformation, while 21% have actually taken disciplinary action against a licensee who actually spread COVID-19 misinformation. The Tennessean reports that Dr. Melanie Blake, Tennessee Medical Board president, spoke out about the legislation in September 2021.

of COVID-19 just like any other illnesses they treat on a regular basis. We’ve never seen restrictions on physicians like we have in the last 18 months.” The Tennessean also reports that Dr. Stephen Loyd of the Board of Medical Examiners reviewed Todd’s bill and expressed that as written it would not have a great impact on the board whose goal is only to fight the spread of provably false information. But Loyd did agree that the bill may create a path for physicians to argue that their false claims were actually opinions and thereby protected by the new law.

In Pennsylvania, a similar bill that would She said, “You don’t get to use your Tennes- allow physicians to veer from the guidelines see state medical license in order to promote a was put in place by the Centers for Disease platform just spewing medical misinformation Control and Prevention for their COVID-19 to your patients. I think we have an ethical treatments. obligation to investigate it and stop it and I State Representative Dawn Keefer (R-York), think the citizens of our state expect nothing the bill’s author and secretary of the House less.” Health Committee, said, “I am advocating Called the “Tennessee COVID-19 Treat- for treatment, period, for patients’ right to ment Freedom Act,” the bill prevents the try, these patients who are being told in the Tennessee Board of Medical Examiners from hospital there’s nothing else we can do for disciplining doctors for anything “solely related them. Why not a Hail Mary?” to the physician’s prescription, recommendaFurther complicating an already complex tion, use, or opinion relative to a treatment situation was revealed in Politico with an for COVID-19,” to include treatments that explanation by Chaudry. have not been approved by the state’s health “Legal structures developed for the 20th department or the FDA. century are, in many states, not suited to The bill’s author, State Representative discipline doctors who broadcast misinformaChris Todd, defends his position to MedPage tion on social media because the physicians Today by saying “doctors in this state have are not directly treating patients,” Chaudry been handed an unconstitutional ultimatum said. “So, some boards – and other regulators from a board that has repeatedly exceeded that license providers and the non-profits that its legal authority. As representatives of the certify physicians for their expertise – feel people, we must do everything in our power uncertain about disciplining such doctors, to rein in this abuse and restore the liberties even though they might be contributing to and freedoms our physicians are guaranteed lagging vaccination rates.” under our constitution.” Chaudry remains concerned by legislators’ Todd added, “my bill does that, but it also attempts to halt oversight of medical profesguarantees the ability for doctors to practice sionals. “And if you start to chip away at that, as they are licensed and trained for treatment it becomes a slippery slope.” SPRING 2022 | 29

Welcome New Member

Welcome New Member Jeffrey T. Cope, MD

r. Jeffrey T. Cope is a cardiothoracic surgeon with Penn State Health St. Joseph Medical Center, where his focus is on adult cardiac surgery. He was born in Lancaster, PA and graduated from Franklin and Marshall College before attending the Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center. He spent the next decade at the University of Virginia Health Sciences Center, during which time he completed an internship and residency in surgery, served as surgical Chief Resident, and devoted several years to research fellowships. Before joining Penn State Health in 2020 he was with Penn Medicine/Lancaster General Health, where he held the position of Chief of the Division of Cardiothoracic Surgery. Dr. Cope is a veteran of the United States Air Force and an active member of the Knights of Columbus. The Berks County Medical Society welcomes Dr. Cope and thanks him for his support. To get to know him a little better, we asked him to respond to a few questions:

Describe the focus of your practice and any areas of special interest/ expertise. I am a cardiothoracic (CT) surgeon with a special focus on adult cardiac surgery. I am experienced in the full gamut of adult cardiac surgical procedures, including coronary artery bypass grafting (ie CABG), heart valve repair and replacement (including minimally invasive approaches and TAVR), thoracic aortic surgery (including stent grafts, or TEVAR), surgery for atrial fibrillation, and implantation of mechanical cardiac assist devices (including ECMO and ventricular assist devices). 30 | www.berkscms.org

Why did you decide to practice medicine in Berks County? I have 20 years of clinical experience, mostly in the community sector. Previously, I worked for Penn Medicine/Lancaster General Health as a CT surgeon and Chief of the Division of Cardiothoracic Surgery. Since July 2020 I have been with Penn State Health, and hold clinical staff privileges at Hershey Medical Center, Holy Spirit Medical Center, and St. Joseph Medical Center. In May 2021 I answered the call to fill an urgent need for an experienced lead surgeon CT surgeon at Penn State St. Joseph Medical Center in Reading. St. Joe’s is now my focus and is where I am pleased to spend 95% of my clinical time. As I am a native of neighboring Lancaster County, community practice in Berks County is a natural fit for me.

What do you like best about practicing medicine? What I like best about practicing medicine is the ability to use my God-given talents to serve others. Also, it is very satisfying to see the progression of healing with some very sick patients. Many of my patients present with imminently life-threatening conditions, subsequently undergo cardiac surgery with all of its attendant risks of morbidity and mortality, and the overwhelming majority gradually recover to live vibrant and quality lives. I always get a lift when I see a patient back in my office who had surgery a month prior, who is now well down the road to recovery and their activity and lifestyle are no longer limited by their heart disease.

Member

in the

News

Debra Powell, MD, Receives PAMED Doctors’ Day Recognition Award

n Doctors’ Day, March 30th, Debra Powell, MD, was presented the Doctor’s Recognition Award by Katie Jordan of the PAMED staff at a ceremony at the Reading Hospital.

With family members, colleagues, and hospital administrators in attendance, Dr Powell, Chief of Infectious Diseases, Medical Director of Infection Prevention, and the Vice Chair of the Department of Medicine at Tower Health, received the award for her selfless service to patients, colleagues, and the Berks County Community, particularly in her leadership role through the COVID-19 Pandemic.

Dr. Powell has consistently made herself available to answer questions, explain new developments in the course of the pandemic, and offer advice regarding the latest treatment options and vaccines. She thanked PAMED for the recognition but said she was accepting on behalf of her many colleagues who have worked so diligently to provide excellent patient care, support one another and see us all through this pandemic. Many of those present spoke in tribute to Dr. Powell attesting to her leadership in treating infectious diseases and modeling the very best attributes of the medical profession.

Jeffrey T. Cope, MD (continued)

If you could change one thing about the current practice environment, what would it be?

Are you involved in any nonprofit/community groups at this time?

Please tell us a little about your family and the activities you enjoy outside of work.

If I could change one thing about the current practice environment, it would be to undo the emotional trauma and burnout inflicted on so many healthcare workers due to the COVID pandemic. This global pandemic has in some way adversely affected the practice – and personal well-being – of probably every clinician of every specialty involved in medical care. It is alarming and sad.

I am an active member of the Knights of Columbus. I recently made a substantial monetary contribution to the Knights of Columbus Ukraine Solidarity Fund, which provides temporary shelter, food, clothing, and medical and religious supplies to Ukrainian refugees displaced by the recent Russian military incursion into their country. I also make numerous monthly contributions to support a variety of Catholic ministries and charities.

I am the proud father of 4 terrific kids – 3 boys (ages 18-36) and 1 daughter (age 21) – and 1 precious granddaughter (age 7). My favorite pastimes – aside from heart surgery (!) – include marathon running, playing the drums, cooking, tending to my jungle of houseplants, watching Philly sports teams, listening to the Grateful Dead, and reading the Bible.

SPRING 2022 | 31

Welcome New Member

Welcome New Member Steven M. Presciutti, MD, FAAOS

r. Steven Presciutti is a board-certified, fellowship-trained orthopaedic spine surgeon. He attended Lafayette College where he received his undergraduate degree in biochemistry. He then received his medical degree from Jefferson Medical College in Philadelphia in 2009. Dr. Presciutti then completed his residency in orthopaedic surgery at the University of Connecticut prior to completing his spine surgery fellowship in 2015 at Rush University Medical Center in Chicago, IL, one of the top spine fellowships in the country. During his fellowship, he received specialized training in performing minimally invasive spine surgery techniques. Dr. Presciutti is also an accomplished researcher. He maintained his own research laboratory at Emory University in Atlanta, GA for six years prior to joining Keystone Spine in August of 2021. While at Emory, he received multiple federally funded research grants pertaining to studies of the spine. Dr. Presciutti has published more than three dozen peer-reviewed articles, as well as more than a dozen book chapters. He has been invited to present his research at multiple national and international conferences and has also won multiple awards from the Orthopaedic Research Society (ORS), the Cervical Spine Research Society (CSRS), and the International Society for the Study of the Lumbar Spine (ISSLS). He has also been accepted as a Fellow of the American Academy of Orthopaedic Surgeons (FAAOS). Dr. Presciutti specializes in minimally invasive spine surgery techniques, which typically allows patients to enjoy less pain and a quicker recovery compared to more traditional, open surgical

32 | www.berkscms.org

techniques. He maintains active surgical privileges at The Surgical Institute of Reading and Penn State/St. Joseph’s. Dr. Presciutti has been in practice since 2015. He was born and raised in Northeastern Pennsylvania and decided in 2021 to move back to Pennsylvania to be closer to his family. The Berks County Medical Society is proud to count Dr. Presciutti among its members and thanks him for supporting the important work the society does. Our community is fortunate to have access to the expert care he provides. To get to know Dr. Presciutti a little better, we asked him to respond to a few questions:

Describe the focus of your practice and any areas of special interest/ expertise. I focus on adult spinal degenerative conditions with a special focus on minimally invasive techniques. Tubular retractors allow access to the spine while sparing surrounding tissues, tendons, ligaments, and muscles that would otherwise be disrupted with traditional surgery. This type of minimally invasive approach therefore maintains spinal stability after surgery, and in some certain circumstances, can also save a patient from needing a fusion in the first place. The main benefits of minimally invasive spine surgery include reduced tissue and muscle damage, as well as less blood loss. Compared to traditional open surgery, the benefits of minimally invasive spine surgery include: reduced risk of infection, less post-operative pain, less rehabilitation requirements, faster recovery, reduced reliance on pain medication, and significantly shorter hospital

stays. Although minimally invasive spine surgery has many advantages for patients, there are some back and neck conditions that cannot yet be treated through this approach. Working closely with my patients, we find the best solution to treat their spinal problem.

Why did you decide to practice medicine in Berks County? After practicing at Emory University in Atlanta, Georgia for 6 years, my wife and I wanted to move back closer to our families, as we were both born in Northeastern Pennsylvania.

What do you like best about practicing medicine? I particularly enjoy getting to know my patients and the reward of seeing them get back to life after suffering from a painful spinal problem. I view every patient as an individual and I aim to get to know them so that I can understand their story. That helps me tailor a custom treatment plan to meet the patient’s specific goals and lifestyle.

Please tell us a little about your family and the activities you enjoy outside of work. When I’m not working, I am an avid outdoorsman – skiing, mountain biking, hiking, and paddle boarding to name a few. I am also an adventurous cook who enjoys experimenting with new recipes, grilling, and smoking. Most importantly, I am blessed with a great and supportive family – my wife, Maura, and three amazing kids.

SPRING 2022 | 33

M edical R ecord F eature

Onions, Then Diamonds, What’s Next? Introducing a new arts and literary journal at Tower Health

By Olapeju Simoyan, MD, MPH (Executive Director of Research, Caron Treatment Centers) Tower Health Medical Humanities Committee Editor, Tower Health Humanities Journal

s a fourth-year medical student at Penn State College of Medicine, I served as editor of Wild Onions, an arts and literary journal. Each issue included a statement describing the wild onion as a plant that springs up in unexpected places and blossoms into a purple flower, symbolizing the surprising beauty that surrounds us all the time.

Building on my experience with Wild Onions, I led a similar initiative as a faculty member at what was then a brand-new medical school, The Commonwealth Medical College, now known as Geisinger Commonwealth School of Medicine. The students chose the name “Black Diamonds” as a reference to Northeastern Pennsylvania’s rich coal mining history. Coal, once the foundation for the region’s economy, had vanished but the area was witnessing the formation of a new resource – a medical school created in response to the need for more physicians. The ability to make connections between nature, history and the arts in general can have an impact far beyond the naming of a journal. The Association of American Medical Colleges has recognized that by integrating the arts and humanities throughout medical education, we can train better clinicians. Active engagement in the arts and humanities can also help us create balance in our own lives, reducing the risk of burnout. With this in mind, the Medical Humanities initiative was launched

34 | www.berkscms.org

at Reading Hospital/Tower Health in September 2021. Steven Rosenzweig, MD, professor of Emergency Medicine and Director of the Office of Community Engagement at Drexel University, gave the keynote address, which focused on the role of the humanities in medical practice. Educational sessions on medical ethics were held in March 2022 and additional sessions covering various topics including the history of medicine, diversity and equity, and spirituality in medicine are already scheduled. In addition to the formal curriculum, the medical humanities initiative will include enrichment activities such as museum visits and story slams. Our medical humanities journal will provide an avenue for publication of narrative essays and other forms of artistic expression. Members of the Tower Health medical community are invited to submit poetry, artwork, photography and narrative essays to be included in this inaugural edition. Narrative essays of 500-1000 words focusing on emotions created in interactive health care experiences are desired. Tower Health trainees will have the opportunity to participate in a naming contest. (Hint: no onions or diamonds!) Please send your entries to Dr. Peter Schwartz at schwartzpa@hotmail.com

Peter specializes in customer service. Whether listing or selling residential or commercial real estate, Peter is dedicated to helping his clients. His personal attention to every aspect of the business has garnered him more than 200 five-out-of-five Gold Star independent reviews. “I have personally known Pete for close to two decades, and he is one of most conscientious, caring and outgoing people I know. He truly cares about his clients, and works harder than any other realtor I know. I highly recommend that you work with Pete.” – Dave R

Peter K. Heim, CRS, GRI

“Pete is attentive to every detail. He made a hard journey of selling my mom’s house easier not just because he is a skilled realtor but in how much he cares about the story and people behind the sale.” – Cathleen P.

Christopher Heim

“Always a great experience working with Pete and now his son Chris as well.” – Michael S.

Family is foundational, and having a perfect home for your family means everything. Having Peter Heim by your side to help you navigate through the multiple steps of buying or selling is key. Born and raised in Berks county, Peter is an award-winning Real Estate Broker with more than 35 years of experience. A family man, Peter has been married to his wife Michele for more than 30 years. They have seven children and two grandchildren. Pete and his family are involved with many Berks County organizations. This seasoned professional brings his hardworking yet fun personality to every interaction. Now Peter is proud to welcome his son Christopher onto his real estate team. Chris brings his unbridled enthusiasm, on-line savvy, and banking experience to the team. Let the Heim Team do the best job for you!

Peter K. Heim, CRS, GRI Associate-Broker

office: 610-898-1441 cell: 610-745-3378 email: pheim@kw.com www.peterheimrealtor.com

“Now more than ever HOME is important!”

YES, we can...

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Specializing in Diseases & Surgery of the Retina and Vitreous

610-372-0712 | berkseye.com | 1802 Paper Mill Road, Wyomissing, PA 19610 |

Berks County Medical Record Spring 2022

Articles inside

Welcome New Member Steven M. Presciutti, MD, FAAOS

Member in the News Debra Powell, MD, Receives PAMED Doctors’ Day Recognition Award

Charles F. Barbera, MD Named Reading Hospital President and CEO

Dr. Kristen Sandel’s Speech to the House of Delegates

COVID-19 Update New Developments, New Opportunities and Challenges in 2022

The Other Health Crisis We’re Not Talking About: A National Blood Shortage: - Miller-Keystone Blood Center - Tower Health - Penn State Health St. Joseph

Go For Broke by Richard A Close, MD, FACS, FAANS

Riding the Wave of Burnout

Welcome New Member Jeffrey T. Cope, MD

Government vs. Medicine It Could Be a Slippery Slope