Unplugging Adolescents from Social Media,
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Medical record
A Quarterly Publication
To provide news and opinion to support professional growth and personal connections within the Berks County Medical Society community.
Berks County Medical Society MEDICAL RECORD
D. Michael Baxter, MD, Editor
Editorial Board
D. Michael Baxter, MD
Lucy J. Cairns, MD
Daniel Forman, DO
Shannon Foster, MD
Steph Lee, MD, MPH
William Santoro, MD, FASAM, DABAM
Raymond Truex, MD, FACS, FAANS
T.j. Huckleberry, MPA
Berks County Medical Society Officers
William Santoro, MD, FASAM, DABAM President
Ankit Shah, MD
President Elect
Daniel Forman, DO Treasurer
Jillian Ventuzelo, DO Immediate Past President
T. J. Huckleberry, MPA Executive Director
Berks County Medical Society
2669 Shillington Rd,, Suite 501 Sinking Spring, PA 19608 (610) 375-6555 (610) 375-6535 (FAX) 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.
POSTMASTER: Please send address changes to the Berks County Medical Record, 2669 Shillington Rd, Sinking Spring, PA 19608, Ste 501.
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!
MD
FASAM, DABAM Chief, Section of Addiction Medicine, Reading Hospital/ Tower Health President
Dear BCMS Member,
My father often presented me with a figurative coin, describing each side as having positive traits and possibly some not-so-obvious negative traits. He then would ask which side of the figurative coin I preferred. When doing this he taught me to always consider my options very carefully because the obverse of the “coin” might seem enticing until I truly considered, and understood, the reverse of the “coin.” There were times I still couldn’t decide until he explained the differences. Let me give you some examples.
He once asked me, “Would you rather be talented or motivated?” Talented sounded good. We all know talented musicians, artists, and surgeons. But motivated also sounded good. I admit I was still leaning toward talented when he gave me his definition of the two options. He said, “The talented person does because they can. The motivated person does because they want to.” That’s when I started to understand where he was going with the options and why waiting for the second option, and the understanding, always made sense. He went on to explain, “The talented person might get bored, not so with the motivated person. The talented person can take for granted their talent, and success will often be assumed by others because of the talent. The motivated person stays focused and others are often amazed at what the motivated person can accomplish.”
“Would you rather know what is real or what is possible?” By this point I knew to wait and to really think about the options. I correctly pointed out that reality was limited; possibility was endless. I decided I wanted to take a chance on possibility. He pointed out that only knowing reality can have a person’s imagination stifled by facts. Reality was limited to what had already been discovered. Possibility is limited only by what we can imagine. He also, however, pointed out that while looking for the possibilities keeps innovation alive, there are some pitfalls. While it is advantageous to always keep an open mind, it should not be so open that one’s brain falls out.
But what about when he offered these choices? “Would you rather be smart or intelligent?” When presented with these two options, I immediately asked, “What’s the difference?” That was exactly what he wanted me to question. He went on to explain, “The smart person knows the answers. The intelligent person knows where to find the answers.” I remember him telling me that he loved sitting in the Manhattan branch of the New York City Library because he believed that the answer to any question he had was somewhere in that building (remember the Internet did not exist back then). Being smart may be nice, but it limits us to what we already know. Being intelligent opens us to learning so much more.
As for intellect, or the lack of it, he told me that knowing how to deal with what I didn’t know was so much more valuable than anything I did know. He told me that I can always learn something new, but being able to deal with something that I didn’t know… that was true intelligence.
In medicine, as in life, we will make mistakes. Mistakes are a natural and normal outcome of learning and growing. After making a mistake, most of us have asked ourselves, “What was I thinking?” My father told me that a better question was, “What was I learning?”
We should not be afraid to make mistakes because nobody has ever succeeded at anything ensuring against failure. Keep trying and keep learning.
William Santoro,
T.J. Huckleberry, MPA Executive Director
I Took a Selfie with an Old Colleague
Before I begin, allow me to express how wonderful our 1824 events have gone so far this year. We just had a very successful and educational event at the Berks Historical Center. Our members had the opportunity to learn more about our Society’s rich history, but perhaps more importantly, it was another opportunity to meet new members and catch up with old colleagues.
For instance, as I turned the corner to enter the hall where our event was held, I practically ran into Dr. Isaac Hiester. I met Dr. Hiester on my very first day as Executive Director. In fact, he was literally in our office every day until we went virtual. He didn’t say much; just always hanging around.
If you are currently thumbing through our directory or googling his name, Dr. Heister has not practiced medicine in Berks County for some time. This is totally understandable considering that the guy passed away nearly 150 years ago.
At this point, I think I need to clarify. No, I do not talk to dead people, and no, I have not gone crazy. I admit I never met the actual Dr. Hiester, but I grew very close to his portrait, which hung directly in front of the entrance to our office.
Our portraits, which were gifted to Albright College several years ago, were on display for our event and Dr. Hiester was the main attraction. I have to say, the old guy brought back a lot of memories. His eyes seemed to always follow me in the office. So, from time to time, I would ask him a question like, “what would you do here, Ike?,” or “catch the game last night, Dr. H.?” The same subtle smirk in his portrait always seemed to answer my questions. It’s also worth pointing out, on those few and far between days where I would be late to the office, he was always there to reprimand me. I could always picture him saying, “T.J., I did not found this Society for our Executive Director to be ten minutes late!”
Anyway, it was great seeing the guy and to hash over all the hijinks he and I would get into in the old office. So, after another awkward pause to our one-sided conversation, I asked him if we could do a selfie for old time’s sake.
… I assume he agreed.
Now, for those who would like to see actual colleagues or meet new members, our 1824 Club is a great opportunity. One of the great values the Berks County Medical Society provides is the connections and friendships you make with those who share the same struggles and triumphs.
If you are interested in hosting an 1824 Club event or joining our Society, please contact me at tj.huckleberry@gmail.com.
by D. Michael Baxter, MD, FAAFP
This is certainly an historic year for the Berks County Medical Society as we celebrate our 200th Anniversary. A bit of searching of the historical records indicates that the BCMS is probably the fifth oldest Medical Society in the United States following Massachusetts, Boston, New York and Philadelphia. For a rather remote area such as Berks County in 1824 to be in such intellectual company is truly astounding. The more I learn about Dr. Isaac Hiester and others of that era, I am truly inspired by their collegial desire to gather and share the latest on disease spread and new therapeutics at a time when science-based knowledge and abilities to share information were of course quite limited.
Sharing such timely information among colleagues is of course what the Medical Record is all about. Our feature story in this Summer edition highlights what has been described as our current epidemic of mental health disorders among children and adolescents including anxiety, depression and excessive loneliness. As Dr. Steph Lee so aptly describes, this systemic pathology finds its roots uniquely in the technology of our modern age—smart phones and the social media that is ubiquitous in the lives of these kids. She offers some readily available, easily affordable and proven antidotes to these challenges that can help parents and health care providers address this social epidemic. Dr. Doug Berne, one of our true local
For most of us, summer is a time of vacations, relaxation and perhaps reflection as we hopefully have a chance to “catch our breath” in our busy lives. It is not always easy but it is necessary and healthy to make such efforts. However, for those involved in medical education, it is also one of the busiest and most critical times as residents and fellows complete their intense years of training and new trainees join our teams. In addition, medical students who only a few years ago began this incredible journey with a certain amount of trepidation, now begin their own residencies ready to apply the wealth of knowledge they have accumulated while a new class excitedly prepares for the hard work and excitement ahead. From Dr. Hiester to the present, the cycle of medical learning, sharing knowledge and skills and enjoying that special bond that exists among medical professionals continues. We wish all our graduates the very best of success and welcome the newcomers as they join us on this amazing journey of science, technology and compassionate care that is the medical profession.
experts on childhood mental health disorders, offers his insights and additional advice in his “Guest Editorial.”
Celebrating
YEARS OF EXCELLENCE
200th Anniversary Activities (1824-2024)
1824 Journal Club
1900—1970 August 15th 6:00-8:00 PM B2 Bistro, West Reading
• Marie Curie and the Development of Radiation Therapy
• The Flexner Report’s Impact on Medical Education
• Alexander Fleming: The Discovery of Penicillin and Antibiotics
• Banting and Best: Insulin as a life-changing Rx for Diabetes M
• Jonas Salk: The Development of the Polio Vaccine
• The Framingham Heart Study, Origins and Implications
Other
Activities
200th Anniversary Celebration (To Be Announced) Electoral Candidates Breakfast (Date pending)
1971—2000 November 14th 6:00-8:00 PM The Peanut Bar, 332 Penn Street, Reading
• Advancements in Cardiovascular Disease Therapies
• The Human Genome Project
• The Transformative Implications of Transplant Medicine
• Advancements in Diagnostic and Interventional Radiology
• The Impact of Public Health on Illness and Wellness
• Ethical Challenges for the “New Age” of Medicine
Please RSVP for the 1824 Club and Journal Club events. To register and for additional information email: www. berkscms.org or contact T.J. Huckleberry @ (610) 375-6555. To plan or contribute toward 1824 Anniversary events, contact T.J. Huckleberry.
1824 Fund
The 1824 Fund has been established by the Berks County Medical Society to support our 200th Anniversary activities. Anyone who would like to contribute to this fund may do so by sending a contribution directly to: The Berks County Medical Society 2669 Shillington Rd., Sinking Spring, PA 19608 Or by contacting our Executive Director, T.J. Huckleberry, at: info@berkscms.org.
Unplugging Adolescents from Social Media, Naturally
by Steph Lee, MD, MPH,
Summer is upon us and it’s the perfect season to incorporate nature time for kids of all ages. Being outdoors is a great way to get fresh air and connect with the environment, which has lots of mental, physical, and emotional benefits for kids.
In the last few years, children and adolescents have experienced increasing rates of depression, anxiety, and feelings of loneliness. In 2019, a longitudinal cohort study of teenagers (12 to 15 years old) found that regardless of baseline mental health status, teenagers who spent more than three hours per day on social media had double the increased relative risk of internalizing problems, exhibiting symptoms of depression and anxiety.[1] Another study found that among 14-year-olds, greater social media use was a predictor for poor sleep, online bullying, poor body image, low self-esteem, and higher symptoms of depression, with girls being affected more than boys.[2] Most recently in 2022, 95% of teenagers (13 to 17 years old) reported using social media, with more than half stating it would be hard to give it up.[3] In 2023, Surgeon General Dr. Vivek Murthy published a Surgeon General’s Advisory on the importance of social connection and the significant consequences when social connection is lacking. [4] Recently, Dr. Murthy has called for
“warning labels” on social media like what has been done for such high-risk products as tobacco and alcohol.
Jonathan Haidt, a social psychologist and Professor of Ethical Leadership at the New York University Stern School of Business, recently published a book called The Anxious Generation: How the Great Rewiring of Childhood Is Causing an Epidemic of Mental Illness (Penguin Random House). In his book, he cites statistics showing a significant rise in anxiety, depression, and suicide rates among US adolescents and young adults between 2010 and 2022. While isolation during the pandemic certainly exacerbated these trends, he notes that a significant factor prior to the pandemic was the absence of smartphones and ever-present social media. As these entities have become ubiquitous in the lives of young Americans, so has the rise of psychopathology amidst this demographic. While he advocates for restrictions on smart phones and social medial access by schools and parents, especially for younger teens, there are also other readily available remedies to this national dilemma.
Nature can help play a role in enhancing social connections and bolstering mental health resilience in the face of the increasing role social media plays in children’s lives.
continued on next page >
FAAP
Unplugging Adolescents from Social Media, Naturally
continued from page 11
preservation or progress
Research regarding nature during the pandemic solidified what we’ve known about the benefits of nature as a positive tool for mental health. One study surveyed adolescents (10 to 18 years old) between April and June of 2020, during the initial wave of the pandemic. They found that connection to nature acted as a mediating factor and fueled greater mental well-being in those that participated in outdoor activities.[5] Park access has also been shown to help mental health among children and parents, with parents also benefiting by getting in more physical activity.[6]
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Being outdoors has been shown to help children with sleep, attention, and mood, and the more in nature, the better. One study has found that green natural settings, versus built outdoor and indoor environments, can reduce ADHD symptoms in children (5 to 18 years old) regardless of age, gender, and income groups.[7] Increased accessibility and increased exposure to nature were both associated with improvement in ADHD symptoms, while actually interacting with nature reduced stress.[8] Even among toddlers and preschoolers (age less than 5 years), physical activity and the great outdoors were associated positively with better sleep outcomes including less evening screen time.[9]
This is all to say that being outdoors and in nature can bolster children’s mental health tremendously and what better time to do that than in summer? Even as little as ten minutes of sitting or walking outdoors can make a positive impact on well-being, as seen with college-age students.[10]
Parents can explore the outdoors together with their children, so that families can bond and unplug from technology and enjoy being in the moment.
Physicians can also play a role in promoting mental health resilience and a healthy connection to nature by providing prescriptions for outdoor activities. There are programs like Prescribe Outside (https://prescribeoutside.org/), Philadelphia’s nature prescription program and a partnership between Children’s Hospital of Philadelphia (CHOP), Awbury Arboretum, Let’s Go Outdoors, the USDA Forest Service, and Temple University Center for Sustainable Communities. Research shows these social prescriptions promote connection to nature, strengthens social structures, and improves health on all levels.[11]
When children engage in outdoor play, it fosters a love of nature and the environment which is key for helping children understand the environmental impact we have on our communities and allows adults to raise a healthier, happier generation.
[1] Riehm KE, Feder KA, Tormohlen KN, Crum RM, Young AS, Green KM, Pacek LR, La Flair LN, Mojtabai R. Associations Between Time Spent Using Social Media and Internalizing and Externalizing Problems Among US Youth. JAMA Psychiatry. 2019 Dec 1;76(12):1266-1273. doi: 10.1001/jamapsychiatry.2019.2325.
[2] Kelly Y, Zilanawala A, Booker C, Sacker A. Social Media Use and Adolescent Mental Health: Findings From the UK Millennium Cohort Study. EClinicalMedicine. 2019 Jan 4;6:59-68. doi: 10.1016/j.eclinm.2018.12.005.
[3] Vogels E, Gelles-Watnick R, Massarat N. Teens, Social Media and Technology 2022. Pew Research Center.
[4] Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community. Available at: https://www.hhs.gov/sites/default/ files/surgeon-general-social-connection-advisory.pdf (Accessed 15 June 2024).
[5] Jackson SB, Stevenson KT, Larson LR, Peterson MN, Seekamp E. Connection to Nature Boosts Adolescents’ Mental Well-Being during the COVID-19 Pandemic. Sustainability. 2021; 13(21):12297. https://doi.org/10.3390/ su132112297
[6] Hazlehurst, M.F., Muqueeth, S., Wolf, K.L. et al. Park access and mental health among parents and children during the COVID-19 pandemic. BMC Public Health 22, 800 (2022). https://doi. org/10.1186/s12889-022-13148-2
[7] Kuo FE, Taylor AF. A potential natural treatment for attention-deficit/hyperactivity disorder: evidence from a national study. Am J Public Health. 2004 Sep;94(9):1580-6. doi: 10.2105/ajph.94.9.1580.
[8] Tillmann S, Tobin D, Avison W, Gilliland J. Mental health benefits of interactions with nature in children and teenagers: a systematic review. J Epidemiol Community Health. 2018 Oct;72(10):958-966. doi: 10.1136/jech-2018210436. Epub 2018 Jun 27.
[9] Janssen X, Martin A, Hughes AR, Hill CM, Kotronoulas G, Hesketh KR. Associations of screen time, sedentary time and physical activity with sleep in under 5s: A systematic review and metaanalysis. Sleep Med Rev. 2020 Feb;49:101226. doi: 10.1016/j.smrv.2019.101226. Epub 2019 Nov 1.
[10] Meredith GR, Rakow DA, Eldermire ERB, Madsen CG, Shelley SP, Sachs NA. Minimum Time Dose in Nature to Positively Impact the Mental Health of College-Aged Students, and
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How to Measure It: A Scoping Review. Front Psychol. 2020 Jan 14;10:2942. doi: 10.3389/ fpsyg.2019.02942.
[11] Leavell MA, Leiferman JA, Gascon M, Braddick F, Gonzalez JC, Litt JS. Nature-Based Social Prescribing in Urban Settings to Improve Social Connectedness and Mental Well-being: a Review. Curr Environ Health Rep. 2019 Dec;6(4):297-308. doi: 10.1007/s40572-019-00251-7.
Steph Lee, MD, MPH, FAAP, has been a Pediatrician and Public Health physician at Penn State St. Joseph Health Center. She and her family are returning to their home in California this summer. She will be greatly missed by her patients, friends, and colleagues. We wish her and her family the very best.
Offices in Wyomissing, Pottsville, Pottstown, Lebanon and Blandon
Nature: An Antidote for the Negative Effects of Social Media on Adolescents and Families
by Douglas Berne, MD, Child and Adolescent Psychiatry, Reading Hospital/Tower Health
In the new Pixar movie “Inside Out 2,” 13-year-old Riley enters puberty, and with it, encounters some new emotions. Most notably, Anxiety takes over control and changes her selfperception. This reflects how anxiety in general becomes a much more important emotion in adolescents, with or without the impact of social media. However, social media is well-documented to have significant negative effects on mood and self-worth in both adults and adolescents. Apps such as TikTok and Instagram provide a never-ending stream of idealized versions of people’s lives that create anxiety in most people, especially in teenage brains that are even less equipped to counter such unfiltered information.
more anxiety and distress. Most adolescents mindlessly consume social media by passively scrolling or allowing the algorithms to continue pushing videos, creating an echo chamber that worsens moods and fosters feelings of isolation and anxiety. It becomes increasingly difficult to put the device down and walk away, with a selfdefeating cycle underway.
Social media can have potential benefits, for example, helping LGBTQ teens feel connected to a community, especially if they live in a more conservative or isolated area, or helping individuals who live in more isolated areas to feel more connected to others. The ways in which social media is used by teenagers generally creates
Dr. Steph Lee’s article (see page 10) summarizes nicely both the negative impact that social media can have on adolescents and a potential solution in the form of unplugging from devices and going into nature. In addition to having their teens put away the phone, parents would be well-advised to recognize that they are role models. The mother or father staring at a phone on the playground while sending a child out to play is not modeling active engagement.
Here in Berks County, we are fortunate to have several resources for spending time in nature. Blue Marsh and Nolde Forest have
well known trails and woods. Grings Mill and the Union Canal offer walking trails along Wyomissing Creek and often have outdoor events. We have parts of the Appalachian trail, Hawk Mountain, and Neversink Mountain trails as well. There is a Rails-to-Trails along the Schuylkill River going from Frackville all the way into Philadelphia. French Creek State Park is one of the many state parks in PA. A lot of our townships have walking trails and municipal parks as well. Many venues often have family-friendly events.
In addition, spending time “unplugged” allows for both children and adults to spend time feeling more connected to the world around them rather than the virtual world, and to feel a stronger sense of control of themselves. By going for walks with their children and adolescents, parents can help guide their children to pay attention to the world around them and to facilitate bonding within the family.
As health care providers in our community, we can help families connect to one another as well as to nature by exploring the resources most readily available to them and opportune times to take advantage of our natural environment. This might be as simple as recommending a regular time for the family to walk to one of their local parks or to explore some of our great resources within the county. If parents can prioritize a little family time each week doing this, they will not only help improve connections by spending time together, but also reap benefits of reduced anxiety and harmful behaviors on the part of their children (and themselves).
Thomas K. Williams CFP®, CPA
Michael J. Dinan CFP®
THE BERKS COUNTY MEDICAL SOCIETY “BAKING CLASS”
This entertaining event was held on April 21st at the Wyomissing Restaurant and Bakery.
Under the direction of accomplished bakers (and BCMS members) Bill Santoro, MD, and Vinti Shah, MD, attendees were schooled in the art of baking with a focus on “sticky buns” and “Brazilian carrot cake.” While the baking lessons were received “warmly,” all agreed the highlight of the event was the ultimate test—sampling the outcome of our work—Delicious!
Thank you to Bill and Vinti, and especially to the Wyomissing Restaurant and Bakery staff.
1824 CLUB CELEBRATES A NIGHT OF HISTORY
The 1824 Club celebrated the Berks County Medical Society’s 200th Anniversary on June 6th at the Berks History Center.
Attendees enjoyed reviewing museum medical artifacts and socializing with friends.
In addition, Dr. Dan Kimball presented on the life of Berks County native and Revolutionary War surgeon, Dr. Bodo Otto. Dr. Eve Kimball spoke about the history of the BCMS, and Dr. Mike Baxter described the life and practice of a Berks County physician in 1824.
These presentations contributed to a grand historical perspective for the evening while recognizing the many contributions made by our medical forebears to health care in Berks County and beyond.
See You on the Pickleball Court!
by Daniel Forman, DO
The name might conjure images of relish and forgotten jars, but this rapidly growing sport is anything but sour. If you can get past the ridiculous name, I would highly encourage you to get out to the court and give it a try. You will join the ranks of the nearly nine million active players in the United States, which is up from 4.8 million just two years ago.
If you really don’t know, here are the basics: Pickleball is a doubles team sport played on a miniature tennis-type court using a wiffle-type ball and oversized ping-pong paddles. The main reason for the sport’s popularity is the shallow learning curve. One can be a reasonable beginner-level doubles partner after two hours of instruction. This is vastly different from other sports where it can take months to reach a level of self-confidence. I also find the popping sound and velocity of the ball after it contacts a well-placed paddle to be profoundly addicting.
pickleball is an age Equalizer. There is usually an age difference of 50 years or more when I go to the court, but it doesn’t matter because people gravitate to their level of play. The older players tend to move less but engage in a more
So, what’s the downside? Injuries. It was hard for me to find objective data, but on a personal level, it is a rare day when I or one of my fellow players doesn’t report some minor soft tissue injury. In my review of the literature and talking with local physicians, serious injuries including orthopedic fracture and Achilles tendon rupture are not rare. The last person I introduced to the sport, David Sacks, MD, was a prime example of pickleball excitement and injury. Dave fell while playing on his first day. When I called him the next day, he shared with me that he had a great time. He was thinking about converting his tennis court to a pickleball court, but he fractured his wrist!
Many agree that what keeps them coming back is the camaraderie. Whenever I show up at the YMCA or West Reading Courts, I simply put my paddle in a rack for “next” and find most players to be inviting and engaging. The escalating physical intensity of the game coupled with the mindfulness needed to predict the opponent’s next shot are wonderful ways to detach from the stressors of life and feed my need to continue to play. A nice plus is that many public courts allow one to play at their level or close to it. You rarely feel like you’re holding someone back or not challenged. Lastly,
I received some great advice from orthopedic surgeon Stephen Longenecker, MD, about preventing injury while playing. Of course, stretching and warming up prior to playing is always appropriate, but for casual players like me, he mentioned, not to take the game too seriously. “Since things can escalate quickly, it’s better to miss a return than a month of work.” Steve also mentioned that more serious players should participate in a formal conditioning program.
Hope to see you on the court!
DRUG Take-Back 2024
The Berks County Medical Society’s “Drug Take-back” was held on Saturday, April 27th, at First Energy Stadium, home of the Reading “Fightin’ Phils.”
This event is held annually with our partners, the District Attorney Office of Berks County, the Council on Chemical Abuse (COCA), and the Fightin’ Phils.
Over 250 pounds of medications were collected, including 24 pounds of controlled substances!
This is a great project to get these unwanted drugs out of homes and potentially off the streets. In addition, hundreds of free tickets to the “Fightin’ Phil’s” August 1st game were distributed.
Thank you to our dedicated volunteers and our partners for a great community service and an important job “well done”!
Berks County Medical Society 1824 Journal Club Review
Our second 1824 Journal Club was held at the Highlands of Wyomissing on May 2nd with a focus on medical literature and historical events from 1830-1899.
Discussions included:
Dr. Ignaz Semmelweis and the etiology of childhood fever with Dr. Mick Eager
Albrecht von Graefe and his contributions to ophthalmology with Dr. Lucy Cairns
Medical and surgical care during the American Civil War, 1861-1865 with Dr. Dan Kimball
Orthopedic practice in the late 1800s with Dr. Jim Morrissey
Invention of the slit lamp and direct ophthalmoscope with Dr. Tom Souders
Development of the “Germ Theory” by Pasteur et al with Dr. Deb Powell
Roentgen, the discovery of X-rays and the impact on medicine with Dr. Mike Baxter
In addition to a fascinating discussion, the group enjoyed a delightful dinner and social time greeting old friends/colleagues. Additional “1824 Journal Clubs” will be held in August and November covering the years 1900-1960 and 1961-2000 respectively. We invite all members and guests to join us for these most enjoyable events.
Resident Rounds: Change in Residency
by Ashni Nadgauda, MD, PGY4, Department of Obstetrics and Gynecology, Reading Hospital/Tower Health
On July 1st, a significant milestone unfolds for newly minted medical graduates: the commencement of their residency. As I embark on my fourth and final year in this intensive training, I find myself reflecting on the myriad lessons learned since my days as a wide-eyed intern.
Initially, I confess, I not only wanted to become a good physician, but I also harbored a strong desire to be well-regarded by my attendings and fellow residents. However, as my journey progressed through residency, my priorities shifted. By the end of my third year, the approval of others mattered less to me than advocating fiercely for myself, my peers, and, most importantly, our patients. Through traversing conflicts and adversities, I discovered a new facet of myself- a willingness to stand firm on my convictions, even at the risk of dissent from supervisors.
While my personal life has remained relatively stable, I have seen my co-residents encounter new roles and take upon transformative identify shifts as they navigate breakups, the birth of their children, the start of a marriage, and additional defining life changes during their time in residency. Change, it seems, is inevitable for us all. Looking back, I scarcely recognize the intern I once was. To those embarking on this journey, my advice would be to cherish your values and be mindful of your priorities, for residency is not solely about mastering medical knowledge. It is also an odyssey that will shape you irrevocably into the healer and person you aspire to become as you carry the imprint of countless experiences that have molded you into a new, evolved version of yourself.
Welcome New Member Rebecca Wu, MD
The Berks County Medical Society is pleased to announce that Dr. Rebecca Wu recently joined Nabil Muallem, MD, PC, to provide OB-GYN care to our community, and has chosen to support the BCMS with her membership.
Rebecca Wu completed her undergraduate education at Dartmouth College, graduating Cum Laude with a BA in Neuroscience. She obtained her medical degree from the University of Pittsburgh School of Medicine. She then completed her OB-GYN residency at Reading Hospital, where she was awarded the Department of OB-GYN Academic Excellence Award in 2022 and 2023, and Research Award in 2022.
Dr. Wu stayed in Berks County after graduation because of the warmth and genuineness of the community. She has a special interest in global health, and has traveled overseas to provide free OB-GYN surgical services in underprivileged areas. She is grateful for the privilege of participating in patients’ significant moments in life, whether in obstetric deliveries or gynecologic surgeries. Outside of medicine her interests include racquet sports and spending quality time with family and friends.
We are fortunate that Dr. Wu has made Berks County her home, and welcome her to the Berks County Medical Society.
by Daniel Kimball, MD, MACP
Ihad an opportunity to review Dr. Robert Reilly’s paper at a recent Journal Club meeting and Dr. Baxter invited me to write about the medical and surgical advances associated with our Civil War.
Over 600,000 deaths occurred on both sides, making it the bloodiest war in our history, with more deaths occurring in that war than all our other wars combined. Reilly suggests that the actual number may even be higher given the poor record recovery and documentation for the confederate forces after fires in Richmond destroyed many records at the end of the war.
It is estimated that for every immediate death related to combat injury in the Civil War there were three deaths related to disease, with dysentery, typhoid, measles, smallpox, scurvy, and malaria being major culprits. Added to those diseases was the absence of understanding the importance of antisepsis and knowledge about germ theory, which did not occur until several years after the Civil War. It would not be until World War II that battle injuries would exceed disease as a cause of death. It would be at least 50 years until our medical education system was improved after the Flexner report, so new physicians were poorly prepared for their professional duties and the union medical department was woefully unprepared for war.
With personnel losses due to physicians leaving service to serve the confederacy forces, there were only 98 medical officers serving union forces at the start of the conflict. Poor camp sanitation and over crowdedness, poor food quality and preparedness, and inadequate pre-enlistment screening were contributing factors to diseases-related mortality. There were Army regulations that proscribed the screening criteria for enlistment, but they were poorly adhered to since physicians were paid according to how many recruits were successfully signed up. Candidates were to be examined stripped, but the fact that over 100 women were enlisted shows that was not universally followed. Reilly says if you could walk, carry a gun, have front teeth and a trigger finger, you could enlist. He notes that the term 4F originated in the Civil War (missing four front teeth).
Combat-related deaths were related to inexperienced surgeons, the absence of an effective and efficient evacuation system, and wound infections. Care improved with time as field experience proved to be a great teacher and the medical department did a better job of assessing physician candidates and performance. Reilly highlights medical advances to include the use of quinine for prevention of malaria, the development of a functional evacuation
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Medical and Surgical Advances with our Civil War
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system, and the creation of field hospitals and large general hospitals. He highlights the surgical advances as the safe use of anesthetics, the performance of rudimentary neurosurgery and plastic surgery, and the developments of techniques for arterial ligation. Amputations were clearly the most common surgical procedure and ultimately led to the development of effective and functional prosthetics.
In the mid-1800s there were few useful medications. In 1860 Oliver Wendell Holmes stated at the annual meeting of the Massachusetts Medical Society, “I firmly believe that if the whole materia medica, as now used, could be sunk to the bottom of the sea, it would be all the better for mankind, --- and all the worse for the fishes.” But quinine was one of the exceptions. The role of the mosquito in transmitting malarial illness had yet to be recognized, but the importance of establishing camps distant from stagnant water was recognized in reducing the risk of malarial illness. Quinine was known to prevent and treat malaria but apparently the confederate forces faced greater challenges in keeping adequate supplies due to effective naval blockades. The role and importance of quarantining soldiers with symptoms of infectious disease, such as smallpox, typhoid fever, dysentery, and measles, to protect healthy soldiers, was recognized.
At the beginning of the Civil War there was no established military medical evacuation system. At the Battle of Bull Run, ambulances were driven by civilians and many of them fled when the first shots were fired. Litter bearers were drawn from the bands of the regiments and ambulances were the responsibility of the
Quartermaster, not the medical department. It was not until August of 1862 that John Letterman would be responsible for organizing an ambulance system under the responsibility of the medical department and developing a staged system of care that provided life-saving care on the battlefield, evacuation to a field hospital several miles from the battle lines, and eventual movement to larger general hospitals in remote larger cities. Before Letterman’s system, soldiers might lie on the battlefield for days prior to recovery. The evacuation system would use trains and boats to move patients to the general and specialty hospitals. That concept of triage and staged movement developed in the Civil War largely remains in use today in our military medical departments with helicopters instead of trains and boats.
The popular press of the day pictured a wounded soldier being forcibly held down, biting a bullet, or being forced to drink whiskey to tolerate his surgery during the war, but that concept of Civil War surgery was far from accurate given the recent development and understanding of the use of anesthetics. Ether was first used in 1846 by Morton and was in common use. Chloroform was the preferred anesthetic and since a smaller quantity was needed, it demonstrated a rapid onset of action, and it was not flammable like ether, allowing the use of candlelight for lighting. The National Museum of Civil War Medicine notes that anesthesia was used in 95% of Civil War surgeries. The widespread use of anesthetics allowed other surgical advances such as rudimentary neurosurgery (treatment of depressed skull fractures by elevating the bone fragments to their normal
position), early attempts at facial reconstructive surgery, and new techniques of arterial ligation to control hemorrhage and blood loss. The Civil War saw the emergence of professional nursing with figures like Clara Barton and Dorothea Dix playing major roles in providing care to wounded soldiers.
When the Civil War broke out, many Berks County physicians, as they had in the Revolutionary War, served both in the fighting armies and the medical services. These included Dr. Israel Cleaver, Assistant Surgeon of a Marine Brigade, Dr. Murray Weidman, an Assistant Surgeon of the 11th Pennsylvania Cavalry, Dr. Reuben Rhoads, in charge of a Brigade Hospital, and Dr. Peter Bertolet, who served as a Surgeon in the provost marshal’s office in Reading. Several others served, including a Dr. Trexler who marched with General William Tecumseh Sherman. In addition, one of the first recognizable Civil War hospitals was established in Reading in the main exhibition building of the Agricultural Society on Penn’s Common (now City Park). That hospital was under the charge of Drs. Martin Luther and John Brooks, commissioned military Surgeons and members of the Medical Society.
In summary, the medical and surgical advances during the Civil War had a major impact on the practice of medicine. The importance of an efficient and timely evacuation system and standardized treatment protocols laid the foundation for modern military medicine and civilian healthcare systems.
Do you have patients with:
• Chronic Headaches
• Tinnitus
• Jaw Pain
• Insomnia
• Ear Pain without signs of infection
• Dizziness
• Clicking, popping, or grating in the jaw joint
• Limited jaw opening or locking
• Swallowing difficulty
• Snoring
• Pain when chewing
• Sleep issues
• Tongue Tie
• Trigger Points in Head / Neck
• Facial pain
• Neck pain or stiffness
• CPAP Intolerance
References Used:
If so, they may be suffering from TMJ Dysfunction and/or Sleep Disordered Breathing, such as snoring and obstructive sleep apnea. We offer comprehensive diagnosis and treatment. Our many years of experience have resulted in a high rate of successful outcomes. Our philosophy involves a conservative, non-surgical, non-pharmaceutical approach to management with an emphasis on multidisciplinary care.
1. “Medical and Surgical Care During the American Civil War, 18611865”. Reilly RF. Proc(Baylor Univ Med Cent) pp. 138-142, 2016.
2. “Six Ways the Civil War Changed Medicine”. Thompson H.; Smithsonian Magazine, pp. 6-15, 17 June 2015.
3. “Military Medicine During the Civil War. A Brief History of Challenges and Innovations”. https://medicalmuseum.health.mil/. Accessed June 2024.
4. “The Berks County Medical Society: 175 Years of Medical Professionalism”; Kane, Michael B; The Historical Review of Berks County, Vol. 64, No. 4, Fall 1999.
Daniel B. Kimball, Jr., MD, is a graduate of the University of Virginia Medical School and served in the United States Army, including as Chief of Medicine at Walter Reed National Military Medical Center and Commander of the Landstuhl Regional Medical Center in Germany. He subsequently served fifteen years as the Chair of the Department of Internal Medicine at Reading Hospital. Dr. Kimball is retired and lives with wife, Eve Kimball, MD, and remains active in the Berks County Medical Society and other Berks community organizations.
Tammy Balatgek, DDS, MS, D.ABDSM, FAACP
Stephen Sulzbach, DMD, D.ABCDSM, D.ABDSM, FAACP, LVIF
Advocacy PAMED Legislative Priorities
PAMED Supports Call to Action with PCCJR
PAMED joined the Pennsylvania Coalition for Civil Justice Reform in urging legislators to establish an Interbranch Commission on Venue. This commission is needed to resolve the problems associated with the recession of the medical liability venue rule. PAMED is a founding member of the PCCJR and continues to lead the way on venue rule review. Want to learn more about Venue? Visit www.pamedsoc.org/venuerule.
PAMED Opposes House Bill 2037
PAMED has come out to oppose House Bill 2037, which amends the Pharmacy Act to allow pharmacists and pharmacy techs to administer all injectable medications, biologicals, and immunizations to patients 3 years of age and older. This bill passed the House Children and Youth Committee this week. PAMED will continue to monitor its movement and oppose HB 2037.
Additional Legislation
Moving out of committee is Senate Bill 739, legislation that will require health insurers to cover telemedicine services, and House Bill 1754, which would mandate that health insurers cover the costs associated with diagnostic testing to determine patients’ biomarkers on specific health issues. PAMED is hoping both these issues will be taken up by the full House this summer.
PAMED opposes SB 25 which would Expand the Scope of Practice for Certified Nurse Practitioners by eliminating their current requirement for a collaborative agreement with a physician.
PAMED Meets with Pennsylvania Stakeholders to Address ED Overcrowding
PAMED leaders Kristen Sandel, MD, and Andrew Lutzkanin, III, MD, along with PAMED CEO, Martin Raniowski, were thrilled to participate in a solution-focused stakeholder meeting addressing ED Overcrowding hosted by the Pennsylvania Department of Health. This meeting comes after PAMED’s Task Force on ED Overcrowding sought support from Governor Josh Shapiro for governmental assistance in tackling this enormous challenge within the healthcare community.
Pennsylvania’s Acting Secretary of Health, Dr. Debra Bogen, said, “Overcrowding in emergency departments impacts quality of care, patient safety, and patient and family satisfaction as well as staff burnout. At this first meeting, we heard different perspectives on the reasons for overcrowding, how it impacts or is impacted by other areas of the healthcare system, and some innovative potential solutions. I truly appreciated the eagerness I heard from all involved to work together toward solutions.”
For additional information members can go to www.knowledgecenter@pamedsociety.org to log in.
Student Vital Signs
by John LeMoine, MS, III Drexel University College of Medicine/Tower Health Campus
Upon completion of each year of clinical education in the hospital, trainees gain more insight into the complexities of the clinical machine and acquire more responsibility for patients. For example, a patient comes to the hospital with chest pain and difficulty breathing. A medical student early in training may recognize the pattern of symptoms and offer ideas about the etiology of disease and a plan for treatment. However, it is typically the more experienced resident/physician who acts on the plan and manages obstacles that prohibit the patient from leaving the hospital. When initial treatment fails, or when a family has tough questions about the patient’s prognosis, or when access to housing or prescription medications becomes unreliable, it is experience that serves as the most useful asset on the healthcare team.
active role in their treatment. The opportunities that come from working in an AI allow students to learn more of the complex skills that make one a physician, beyond the memorization needed for a standardized test.
In early June, I completed Step 2, the second of three board examinations that every physician in the U.S. must pass between the start of medical school and the second year of residency. Like most other medical exams, Step 2 is a controlled scenario: a series of contrivances of patient stories that probe a student’s knowledge of fundamental medicine. This is an important and practical effort, but in stark contrast to genuine clinical practice. Many students at our level of training have grown disinclined to broad memorization, but rather are eager to learn the intricacies of their specialty of choice. In all specialties, real patient encounters have nuances and uncertainties that require honed skills and experience to navigate.
The completion of Step 2 is a special milestone for two main reasons. It inspires accomplishment, as it concludes the third year and commences the fourth and final year of medical school. It also evokes increased responsibility and authority even as fourth-year students are still learning from and guided by more experienced physicians. However, unlike third-year students who learn the essentials of each core specialty, fourth-year students engage in acting internships (AIs) in their specialty of choice, the one in which they will pursue for residency in the years following graduation. In an AI, students are expected to work at the level of a first-year resident (intern), assuming accountability for more patients with a more
I have selected emergency medicine, and related electives, for my AIs in fourth year and for residency after graduation. In the final year of school, students are encouraged to complete away rotations in hospitals or regions that they are considering for residency. Being from North Carolina and attending UNC Chapel Hill as an undergraduate, I will be completing away rotations at UNC Chapel Hill and Wake Forest Hospitals to work with familiar physicians and to see if these environments are a potential fit for me in residency. To explore my passion for international medicine and improve my medical Spanish, I also plan on rotating at a hospital and clinic in Trujillo, Peru. In between the away rotations, I will complete core electives at Reading Hospital, one of Drexel’s home sites.
The time constraints of fourth year and the preparation for residency will leave me with little time for extracurricular activities, and thus, this will be my final entry as a part of Student Vital Signs in the Medical Record. This time is bittersweet for all the Drexel medical students at the West Reading campus.
Berks County is the first “second home” I have ever had. I feel an attachment to the area and its people. My co-students and I are now family, and I hope our connections remain strong as we soon prepare to disperse across the country in different specialties. The educational staff at Drexel and the healthcare personnel at Reading Hospital have prepared us well. We have trained hard, we are dedicated to patient welfare, and we are passionate about equitable health. We are nearly ready to be resident physicians.
As John completes his tenure as our “Student Vital Signs” author, the editorial staff expresses our deep appreciation for his outstanding, thoughtful contributions and wish him the very best as he advances through the challenging and fascinating world of medicine.
A Healthy Movement Since 2013 Celebrating 11 years of the Guts and Glory Digestive and Wellness Expo
Saturday, September 28th
Wellness Expo
10AM - 3PM
Saturday, September 28th
10AM - 3PM
Title Sponsors:
This family-friendly event is designed to educate the health curious, elevate the understanding of the health conscious, and raise community awareness of the importance of health and overall wellness through the exchange of information and resources.
Over a Decade of Healthy Vibes
Title Sponsors:
our 10th anniversary event that was canceled due to You DO NOT want to miss this year’s very special event.
due to event.
10am - 3pm @
WBerks - Perkins Plaza Event Lawn Broadcasting Rd, Reading, PA 19610
Scan for more info!
e will celebrate the postponed 10th anniversary of Guts and Glory Digestive and Wellness Expo in our 11th year on Saturday, September 28th, from 10 a.m. until 3 p.m. at Penn State Berks campus, 1801 Broadcasting Road, Reading, PA 19610. The Expo was originally created in 2013 and hosted by non-profit My Gut Instinct, Inc., with title sponsor Penn State Health St. Joseph Medical Center.
“We aim to provide people with health knowledge and empower them to take action to live healthier lives and become beautiful from the inside out, because we believe beauty starts on the inside,” said founder Aparna Mele, M.D. “We also want to show the community that eating and living healthy is not only easy to do, but it can also be fun and delicious too!”
Scan for more info!
Aparna Mele, M.D., is a board-certified gastroenterologist with U.S. Digestive Health. She came to the field of medicine with extensive experience in international relief work overseas and is actively involved in local philanthropic work directed towards patient education and promotion of societal health.
Our FREE, ALL AGES, PET-FRIENDLY community event features:
lectures on nutrition, tness & healthy living
PET-FRIENDLY community event features:
Makers’ Market
• Holistic experts & stress relief tips
• MEGA-colon gut-health exhibit
Kid targeted zones on healthy eating & exercise
Holistic experts & stress relief tips
MEGA-colon gut-health exhibit
screenings and non-alcoholic drinks for sale
Alternative therapies
demos (participation encouraged!)
Community partners
Nonpro t organizations
First Responders
nd us on Facebook for updates.
Guts and Glory Digestive and Wellness Expo is a free community-wide celebration of health for all ages that showcases a farmers’ market, educational booths, fresh locally sourced food, fitness zones, yoga, massage, and wellness experts, to name a few features. Over 100 vendors in attendance span all dimensions of health and well-being to engage the attendees (Wellness Warriors) with interactive demonstrations. This year we are excited to have a 20' MEGA Colon exhibit, which provides visitors with an interactive, educational experience of stepping through a largescale model of the human colon that highlights common disease conditions. We celebrate the spirit of health and wellness at our event and encourage our visitors to find inspiration at Guts and Glory to take an active role in their own well-being all year long. Special commemorative 10th anniversary t-shirts will be for sale!
• Kid targeted zones on healthy eating & exercise
• Alternative therapies
• Community partners
• Nonpro t organizations
• First Responders
us at MyGutInstinct.org and nd us on Facebook for updates.
Guts and Glory Digestive and Wellness Expo is a far-reaching, educationally inspiring, community-giving, and feel-good event held annually to promote all aspects of health and fruitful living. The event has enjoyed extensive media coverage and public accolades for their health movement in the community. Numerous community sponsors and volunteers make the event possible. Event-day volunteers and participant registration for sponsors, nonprofits, and food vendors is open and details regarding sponsorship types and on-line registration can be found on the website.
For more information about My Gut Instinct and the Guts and Glory event, visit www.mygutinstinct.org. Stay up-to-date with volunteer, sponsor, and vendor opportunities, as well as enjoy healthy recipes and inspirational motivation, on Facebook and Instagram @mygutinstinct and @gutsyandmini.
We’re making up for our 10th anniversary event that was canceled due to inclement weather. You DO NOT want to miss this year’s very special event.
Saturday, September 28th
10AM - 3PM
Title Sponsors:
10am - 3pm @
Penn State Berks - Perkins Plaza Event Lawn 1801 Broadcasting Rd, Reading, PA 19610
Our FREE, ALL AGES, PET-FRIENDLY community event features:
• Expert lectures on nutrition, tness & healthy living
• Massage
• Farmer’s & Makers’ Market
• Live DJ music
• FREE health screenings
• Healthy food and non-alcoholic drinks for sale
• Live active demos (participation encouraged!)
• Kid targeted zones on healthy eating & exercise
• Holistic experts & stress relief tips
• MEGA-colon gut-health exhibit
• Alternative therapies
• Community partners
• Nonpro t organizations
• First Responders
Member Forum
Creating Awareness of “Microaggressions”:
Unintended Insults to Marginalized Groups
by Priyanka Raju, MD, PGY 3 Resident, OB/GYN Residency, Reading Hospital/Tower Health
“Your English is so good. Where are you from?” asked my patient recently as I quietly waited for her blood pressure monitor to release. For a brief moment, I paused. “Virginia,” I hesitated. She glanced up at me. “No, where are you really from?” she persisted.
The question, “Where are you really from?” is a familiar one for many first-generation immigrants like me. While on the surface, it is a question of simple curiosity, underneath it exposes questions of identity, belonging, and the persistent feeling of being perceived as “an outsider.” Some social scientists consider the question a “microaggression.” As a physician practicing within a healthcare system which serves a largely underserved and minority population, I have witnessed firsthand how such microaggressions can permeate into professional and personal life and shape the experiences of both physicians and patients. In this Member’s Forum, we explore this seemingly harmless question and how it can impact patient care and perpetuate systemic inequalities within the healthcare system.
The Question of Belonging
Microaggressions, coined by psychiatrist Dr. Chester M. Pierce in the 1970s, refer to subtle, often unintentional, verbal or nonverbal slights and insults that convey derogatory messages to marginalized groups. These seemingly minor interactions may not cause obvious harm but accumulate over time, contributing to feelings of otherness, invalidation, and psychological distress. The question “where are you really from?” epitomizes a common microaggression faced by individuals of diverse cultural backgrounds, particularly those who do not fit the mold of a perceived “typical” American.
For many first-generation immigrants, this question strikes at the core of our identity. Raised in the United States, I proudly identify as both a product of my cultural heritage and an active participant in the American experience. Yet, when confronted with this inquiry, I am reminded of the perpetual balancing act between assimilation and preservation, the tension between embracing my roots and asserting my belonging in a society that often questions it.
On one hand, the question reflects a genuine curiosity about my cultural background, a desire to understand the unique nuances that shape my worldview and experiences. Yet, beneath the surface lies a more subtle implication – the suggestion that my American identity is somehow different or incomplete, overshadowed by the indisputable marker of my brown skin. It reinforces the narrative of foreignness, assigning individuals to the status of “outsiders.”
The Patient Experience: Implications for Access and Quality of Care
The impact of such microaggressions, particularly on those from marginalized communities who may already face barriers to access and quality care, extend beyond mere personal injuries, shaping the dynamics of patient-physician interactions and influencing the delivery of healthcare. When patients are met with skepticism or disdain based on their ethnicity or cultural background, it erodes trust in the healthcare system and dissuades them from seeking medical attention.
Members of the Berks County Medical Society are encouraged to submit topics of concern regarding health issues to the “Members Forum” column. Submissions should be approximately 750-1000 words and follow proper etiquette. All printed materials are subject to editing with author consultation by the Medical Record staff.
Research from the American Heart Association has shown that these experiences contribute to increased stress levels for patients, exacerbating chronic conditions such as hypertension, diabetes, and mental health disorders. Moreover, when patients perceive their healthcare providers as dismissive or insensitive to their cultural identities, they are less likely to adhere to treatment plans and seek preventive care, leading to poor health outcomes in the long term. Consider, for example, a black patient seeking treatment for chronic pain. If their physician dismisses their concerns or attributes their symptoms to cultural factors rather than conducting a thorough evaluation, the patient may be denied or hindered the care and support they ultimately need, leading to delays in diagnosis and inadequate pain management. Microaggressions toward patients can manifest in various other subtle ways within healthcare settings. For instance, a clinician may inadvertently make assumptions about a patient’s background or abilities based on their race, gender, or socioeconomic status. This can include speaking in a condescending tone, dismissing the patient’s concerns without thorough examination, making assumptions about dietary habits and adherence to treatment plans, misinterpreting pain tolerance based on cultural stereotypes, or making assumptions about their lifestyle choices. Additionally, microaggressions can occur through subtle nonverbal cues, such as avoiding eye contact or displaying discomfort when treating patients from marginalized groups. These seemingly minor actions can have a significant impact on the patient’s trust in the healthcare system and contribute to broader disparities in healthcare delivery and perpetuate cycles of inequality.
The Toll on Physicians: Navigating Otherness
Microaggressions that physicians face, whether subtle or overt, can have profound effects on physician well-being and job satisfaction. For instance, physicians from minority backgrounds may experience microaggressions in the form of being questioned about their qualifications and competence or be subjected to stereotypes about their abilities. The constant need to prove oneself and establish worth takes a toll on mental health, leaving physicians feeling isolated, undervalued, and unseen. It’s a battle both against
external forces and against the internal dialogues of inferiority and inadequacy. Such experiences of isolation and imposter syndrome among affected physicians contribute to burnout and attrition and ultimately compromise their ability to provide quality care to patients.
Strategies for Change: Fostering Inclusion and Equity in Healthcare
The impact of microaggressions extends beyond individual physicians or patients and shapes the broader culture of healthcare institutions. Addressing the impact of microaggressions on patient care requires a multifaceted approach that acknowledges the intersectionality of identity and healthcare. Medical education should incorporate training on cultural competency, social determinants of health, and implicit bias recognition, equipping future physicians with the skills needed to navigate diverse patient populations sensitively and effectively. Healthcare providers must undergo training to recognize and address their own biases and prejudices. Perhaps the most important aspect of this approach is systemic change to dismantle the structural barriers that perpetuate disparities. This includes prioritizing equity in resource allocation and policy decisions, increasing access to culturally competent care, promoting diversity in the healthcare workforce, and implementing measures to mitigate the impact of implicit bias on patient outcomes. By recognizing and addressing microaggressions and the root cause of health inequities at both the individual and institutional levels, we can create a healthcare system that serves the needs of all patients, regardless of their race, ethnicity, or cultural background.
Microaggressions like the question “where are you really from?” are more than just casual inquiries; they reflect biases and stereotypes that permeate every facet of society, including the healthcare system. For first-generation Americans like me, these microaggressions serve as constant reminders of the delicate balance between identity and belonging, shaping the way we navigate the world and interact with others. By addressing these issues head-on and fostering a culture of inclusion and equity within healthcare, we can create a system that honors the individuality of all patients and provides equitable and just care regardless of their background or identity.
COMMUNITY ANCHORS: * Co-County Wellness
by Rebecca J Doubek, CCWS Communications Coordinator
Who We Are
Co-County Wellness Services (CCWS) is a public health organization in Reading, Pennsylvania, serving Berks and Schuylkill County. We provide a comprehensive HIV/STD program through prevention, screening/testing, education, and care services, reaching more than 9,000 people a year.
How it All Began
It started with a phone call from a loving mother, trying to find resources for her son who had been diagnosed with AIDS. He was coming home to Schuylkill County to die. It was the mid-1980s and AIDS was quickly becoming an epidemic that was moving out of the larger cities and into more rural communities like Schuylkill and Berks County.
That phone call started a chain of events that would eventually become a network of volunteers in the community coming together to connect people living with AIDS to local services. The volunteers led to a small paid staff as the need grew – and several years later, to a full-time staff as an AIDS services independent agency called Berks AIDS Network (BAN). In the early 2000s, BAN was renamed Co-County Wellness Services, as the agency had evolved to expand
services to include sexually transmitted disease testing and treatment and education.
Who We Serve
After establishing offices and services in Berks County, we expanded to Schuylkill County with Schuylkill Wellness Services in Pottsville, providing services for people infected and affected by HIV, as well as prevention services, just as in our Berks location. Eventually, HIV Counseling and Testing Services were also identified as a need, so both Reading and Schuylkill offices added these services, made possible through private funding. Secured contracts with the Pennsylvania Department of Health [PA DOH] meant we could provide free, confidential, and anonymous HIV testing at both of our service sites.
Today there are three clinical staff, including two AIDS-Certified RNs. In 2023, Care Services reached 216 clients, including 32 new this year. We served 173 clients for a total of 3,370 hours of clientcentered HIV case management service and an additional 25 clients with 272 hours of Medication Adherence Education. The STD clinic saw over 1,080 patients in both Berks and Schuylkill clinics during the last fiscal year.
Education and Awareness
A key component of the work at CCWS has always been community education. When HIV+ numbers in the county surpassed 1000, the importance of educating youth about HIV and prevention became critical. A grant from the Red Cross allowed for the prevention and education program expansion. By the close of 1995, 18 Berks County school districts were reached through this program. In 1996, we became a member agency of the United Way of Berks County. Through United Way funding, the agency continued school-based prevention education programs throughout the county.
Where We Stand
The work at Co-County Wellness and Schuylkill Wellness Services continues to evolve and change, just as the needs of the community change. About 78% of our clients live below the poverty level with 71% insured by Medical Assistance and/ or Medicare. While the specific needs of the clients may change, the need, nonetheless, remains. People living with HIV account for 74% of those we serve in Berks and Schuylkill County. The remaining 26% have an AIDS diagnosis.
Expanding Our Reach
In 2014, CCWS became aware of the alarmingly high teen birth rate in Berks County, three times greater than that of the national
average. With the help of supporting agencies and community partners, we identified strategies and implemented the Berks Teens Matter initiative as a means to reduce teen pregnancy. In 2022, we announced that we had made our initial goal of reducing teen births by 40%. Now called Berks Teens, the initiative focuses on teen pregnancy reduction with the larger lens of comprehensive sexuality education and utilizes awareness and community education.
In June of 2020, the County of Berks tapped CCWS to be the lead agency to provide contact tracing and case investigation services for COVID-19. We provided critical services to over 50,000 residents in the community.
For employees of CCWS and SWS, the mission is clear: To serve the underserved, to provide services and education where it is inaccessible, and to create a positive impact in the community with our work. “CCWS has always taken a leading public health role in our community with challenging issues that are often emotionally charged – like HIV, sexually transmitted infections, teen pregnancy prevention and COVD-19,” says CCWS executive director Carolyn Bazik. “We’ve built the infrastructure and awareness and with the support of our community partners have been able to provide free information, programs, and services that have improved our community’s public health.”
Today, the agency employees 17 full- and part-time staff and continues to offer HIV testing, prevention, patient care, and education as well as our STD clinic screening, testing, and treatment services in both the Berks and Schuylkill locations.
*Community Anchors are organizations contributing to the improvement of health and wellness in our Berks County area.
In Memoriam Michael Sachenik, MD
(December 9, 1962—April 6, 2024)
by Richard Gregor, MD, Chair, Department of Radiology, Reading Hospital/Tower Health
Dr. Michael Sachenik had a definite presence at Reading Hospital and particularly in the Radiology Department. He was a colleague, mentor, teacher, and friend to all of us in the department.
Mike received his BS in biochemistry from Cornell University in 1985. He subsequently entered the University of Rochester where he received his MD in 1989. Mike interned in Newport News, VA, and then entered his radiology residency at Reading Hospital. Mike completed his residency in 1994 and returned to the University of Rochester for a body imaging fellowship.
vacations to the national parks, and enjoyed time at their cottage in Ocean City, New Jersey.
Mike was a lifelong suffering Buffalo Bills fan. When he was not watching his Bills, he enjoyed music and was a novice guitar player. He also was fond of photography, woodworking, gardening, and cooking. The family cats, Jazzy, Pepper, Newton, and Friday, held a special place in Mike’s heart.
Everyone who had the privilege of knowing Mike will deeply miss him. The entire Radiology family extends our most sincere condolences to Pam and the Sachenik family.
Returning to Pennsylvania to begin his practice in diagnostic radiology, Mike’s career culminated at Reading Hospital where he served the community and medical staff for the past twenty years. He had a special passion for diagnostic ultrasound and was the Section Head of Ultrasound for many years, as well as the Medical Director for the Diagnostic Medical Sonography Program at the School of Health Sciences. Mike enjoyed the opportunities to provide direct patient care and to pass his knowledge to the students, sonographers, and residents rotating through the department. His society memberships included the RSNA, ACR, ARRS, AIUM, SRU, PRS, PMS, and the BCMS.
A dedicated husband to Pam Sachenik and a loving father of Mathew, Daniel, and John Sachenik, Mike had a special fondness for his family, took many summer
Dr. Sachenik drew this diagram during one of his lectures to educate the sonographers and students four years ago. It remains in the ultrasound reading room to this day.
William Henry Reifsnyder, III, MD
(October 12, 1926 – April 15, 2024)
by Daniel B. Kimball, Jr., MD, MACP
William H. Reifsnyder, III, MD, age 97, died peacefully on Monday, April 15, 2024, at the Highlands at Wyomissing. He was predeceased by the love of his life, Peggy Ann (Von Dohren) Reifsnyder, on April 26, 2022, after 69 years of marriage. When I became the Director of the Department of Medicine at the Reading Hospital and Medical Center in 1989, Bill was serving as the Section Chief of our Internal Medicine Section, the largest of our sections, comprised of the primary care Internal Medicine physicians at our hospital. Bill was known as a superb primary care physician, loved by his patients, and admired by his colleagues.
Bill was a 1944 graduate of Boyertown High School and played on the Berks County Championship tennis team. Bill graduated from Princeton University in 1948, followed by graduation from Jefferson Medical College in 1951, where he was elected to membership in Alpha Omega Alpha Medical Honor Society. He would go on to complete a medical internship at the Reading Hospital where he would meet and marry his wife, Peggy Ann. They relocated to Rochester, MN, where he completed a three-year residency in internal medicine at the Mayo Clinic from 1953 to 1956. Bill then served as a Captain in
the US Air Force, as Chief of Medicine at Hunter Air Force Base Hospital in Savannah, GA from 1956 to 1958. He returned to Berks County in 1958 where he would practice internal medicine until his retirement from Berks Internal Medicine in 1996. He served as Medical Director of the Highlands at Wyomissing from its opening in 1987 until his complete retirement in 2006.
Bill was a life-long member and supporter of many medical organizations, including our Berks County Medical Society. Bill held many leadership positions in our community including serving as President of the Reading Hospital medical staff and service on the church council of his Atonement Lutheran Church.
To his patients and his colleagues, Bill was the consummate physician. His knowledge and skill were only matched by his deep sense of compassion and his warm demeanor. He represented the model of the ideal physician for generations of residents and colleagues. His legacy lives on in the lives of those many he cared for, taught, and shared in his professional life.
Our condolences to his family. Rest in Peace, Bill. Well done, true and faithful servant.
We are happy to make time for your patients
Eye Emergencies Cataracts
Glaucoma
Diabetic Eye Exams
Macular Degeneration
Macular Degeneration
Yes, we can see your patients same day for emergencies and often same week for consults.
Yes, we can see your patients same day for emergencies and often same week for consults.
At BERKS EYE PHYSICIANS AND SURGEONS, we are happy to offer state-of-the-art and efficient care. Our doctors provide appropriate diagnosis and treatment, and fast feedback to you. Whether
At BERKS EYE PHYSICIANS AND SURGEONS, we are happy to offer state-of-the-art and efficient care. Our doctors provide appropriate diagnosis and treatment, and fast feedback to you. Whether your patient has a sudden change in vision, cataracts, diabetes impacting vision, or even has a family history of glaucoma or macular degeneration, we would be honored to monitor and react to issues related to your patient’s eye health.
Left to Right:
Domenic C. Izzo, Jr., MD, Benjamin Nicholas, MD, Francisco L. Tellez, MD, FACS, Michael C. Izzo, MD, Peter D. Calder, MD, Kasey L. Pierson, MD, Guri Bronner, MD