Berks County Medical Society Medical Record Winter 2024 by Hoffmann Publishing Group

Your Community Resource for What’s Happening in Healthcare W I N T E R 2 0 2 4

Medical record BERKS COUNTY MEDICAL SOCIETY

g n i t a r Celeb YEARS OF EXCELLENCE

Morning Rounds by Terry Redlin

INSIDE:

Celebrating the History of the Berks County Medical Society – 200 Years and Counting Clinical Questions for our Medical Experts – Status of Influenza, COVID-19, and RSV

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Contents

Medical record BERKS COUNTY MEDICAL SOCIETY

A Quarterly Publication

Features

Berks County Medical Society MEDICAL RECORD

8Celebrating the History of the

D. Michael Baxter, MD, Editor

Editorial Board

D. Michael Baxter, MD

Berks County Medical Society

Lucy J. Cairns, MD

2 0 0 Ye a r s a n d C o u n t i n g

Daniel Forman, DO Shannon Foster, MD Steph Lee, MD, MPH William Santoro, MD, FASAM, DABAM Raymond Truex, MD, FACS, FAANS T.j. Huckleberry, MPA

200th Anniversary Activities

26 The Joy of Model Railroading

16 Berks County Medical Society “1824 Club”

28 Report of the Proceedings of the 174th Annual Meeting of the Pennsylvania Medical Society Hybrid House of Delegates, Hershey Motor Lodge

19 Welcome New Member: Brian H. McGreen, DO 20 Addiction and the Family 22 Clinical Questions for our Medical Experts

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

WINTER 2024

25 Summer 2024 Berks County Medical Society’s Pat Sharma President’s Scholarship

30 In Memoriam: Donald S. Faust, MD

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

In Every Issue

Berks County Medical Society BECOME A MEMBER TODAY! Go to our website at www.berkscms.org and click on “Join Now”

President’s Message

Compass Points

Editor’s Notes

17 Resident Rounds 18 Student Vital Signs 24 Member Forum

COVER: Morning Rounds by Terry Redlin

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.

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.

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President’s Message

Dear BCMS Member, William Santoro, MD FASAM, DABAM Chief, Section of Addiction Medicine, Reading Hospital/ Tower Health President

s we enter 2024 there is a lot of talk about the 1824 start of the Berks County Medical Society. It has made me wonder what it was like to practice medicine in that time and how things have changed over the course of 200 years.

Two things that stand out to me as major milestones in the 1800s are the acceptance of germ theory of disease and the use of anesthesia during surgery. These two major advances, along with the study of the human body and the development of specialized surgical tools, led to major changes in the way we think of illness, methods of treatment, and hygienic practices. Medical practice back then was carried out in private homes and only occasionally in a private doctor’s office. Hospitals, which only existed in large cities, had a reputation for being dirty. Many people contracted diseases from staying in the hospital because doctors did not know how diseases spread. Therefore, those that could afford it called a doctor to their homes. Doctors making house calls were expected to treat everything from toothaches to stomach aches, fevers, and even sick livestock. Although I never treated livestock, I remember making house calls when I first went into practice. When making house calls – then and now – the tools available were and are limited to what could be carried. I still have my old medical bag. I at least had gloves in the bag. Surgical gloves did not exist in 1824. Like today, back then doctors usually charged their patients per procedure, although they knew nothing of RVUs. One major difference from doctors of today is that 19th century doctors were not often paid with cash, but rather “in kind” with whatever produce, services, or goods were available to the patient. This was especially true for rural doctors, but I fondly recall accepting homemade cookies for payment from a patient I made a house call on who did not have health insurance. In 1824, the medical field was male-dominated and not all doctors were professionally trained. Many doctors in rural areas went through apprenticeships instead of attending medical school. Physicians in cities more often attended medical school, but in 1824 the training offered at medical schools could be completed solely by reading books, without participating in clinics or practicums. Very few women publicly practiced medicine. Women took care of sick family members within the home and called for the local doctor if needed, but there were very few aspects of public medicine which women practiced in 1824. One of the few female-dominated medical fields in 1824 was midwifery. While the female dominance in this field remains, what has really changed is the rest of medicine. Today, while there are still medical specialties that are male-dominated, more than 50 percent of first-year medical students are female. Yes, the practice of medicine has changed drastically over the past 200 years. But there is one aspect that I hope has remained today as strong as it was 200 years ago. Back then becoming a physician was considered a “calling.” A physician was something one became, not something one did. Talking to my colleagues, I am comforted knowing that most of us still feel we were called to become physicians.

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C o mpa s s P o i n t s

Working together for 200 Years... T.J. Huckleberry, MPA Executive Director

The Berks County Medical Society congratulates the incoming Board of Commissioners. Thank you for making the health of every citizen the #1 priority in the coming term. We’re honored to be your partners for a healthier Berks County.

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https://www.youtube.com/ watch?v=sPKp2QRQWjs

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For 200 years, Berks County Medical Society has been the voice for physicians and their patients in our community. We’ve advocated for a standard of care that’s kept patients in charge of their health care decisions and fostered a culture of homegrown innovation that’s second to none. Tha That’s why we wholeheartedly embraced the four recommendations contained in the Berks County Commissioners’ Study of the Delivery of Health and Public Health Services in Berks County. It’s a smart, commonsense plan to protect public health and keeps an eye on the taxpayer’s wallet. Let’s work together to get it done!

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WINTER 2024 | 5

Editor’s Notes

1824-2024: Connections Past and Present by D. Michael Baxter, MD

Morning Rounds by Terry Redlin 2024 will be a momentous year. We have the challenges of a national election ahead, the excitement of a Summer Olympics (Paris), and for the Berks County Medical Society, a 200th Anniversary to celebrate. As one of the oldest Medical Societies in the country, we do have much of which to be proud. As our lead article in this issue of the Medical Record on the history of the BCMS by Drs. Dan and Eve Kimball illustrates, our medical forebears have provided a legacy of which to not only be proud but also certainly to emulate. From the very earliest days of our founding, Dr. Isaac Hiester and others struggled with many of the same issues we face today represented in our Compass Points logo: Advocacy—convincing a skeptical community of the value of immunizations (smallpox), Professionalism—upholding the highest standards of medical training at a time when the necessity of such formal instruction was called into question, Education—promoting an awareness (and necessity) for the latest scientific information available, and Collegiality—embracing the value of companionship among physician peers at a time when the logistics of distance and limited communication made contact a very real challenge. And yet, on all fronts they persevered and provided lessons that our profession can embrace today. 6 | www.berkscms.org

So, celebrate we should, and we shall! The cover of this edition of the Medical Record is an image which is very special to me. The painting “Morning Rounds” by Terry Redlin is one of a four-painting series he created called “The Country Doctor” which additionally includes the images “Office Hours,” “Wednesday Afternoon” and “House Call.” While Mr. Redlin is deceased, his legacy and paintings are preserved by the Terry Redlin Art Center in Watertown S. Dakota. They have graciously permitted us to reprint this image. A complete catalog of his work can be found at the website: www.redlinart.com. This painting hung for many years in the Oncology Unit in E Building of the Reading Hospital. As I was making my own “morning rounds” on many an occasion there, this painting always reminded me of both the joy and challenges of medical practice and the tributes we owe to those who preceded us in this uniquely special profession. Clearly, we stand on the shoulders of those who laid the foundation for the scientific medical care that we provide. With much less of a therapeutic armamentarium to offer their patients in 1824, these physicians offered what they could, most of all their devotion and care to the patients they served. While we have many more therapeutic options to offer today, let us be mindful of the lessons they can still teach us.

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

g n i t a r b e l Ce YEARS OF EXCELLENCE

200th Anniversary Activities (1824-2024)

1824 Club

Watch for notification of various social and educational events during the year. BCMS members and guests are invited to participate.

1824 Journal Club A series of four Journal Clubs will be held during 2024 reviewing the best of the scientific/medical literature of the past 200 years. Join colleagues for these interesting reviews and social time. All gatherings start at 6:00PM. Thursday, February 8th—Literature Review 1800-1820s (The Peanut Bar) Thursday, May 2th—Literature Review mid to late 19th Century (The Highlands) Thursday, August 15th—Literature Review 20th Century (The Peanut Bar) Thursday, November 14th—Literature Review 21st Century (The Peanut Bar)

200th Anniversary Formal Celebration (Fall 2024) An evening of memories, good food and fun with special guests. Full details pending.

Additional events to be announced

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. WINTER 2024 | 7

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

Celebrating the History of the Berks County Medical Society

2 0 0 Ye a r s a n d C o u n t i n g by C. Eve Kimball, MD, FAAP, and Dan Kimball Jr., MD, MACP

pon arriving in Reading in 1989 to start our “second careers” after Dan’s retirement from the army, we quickly became attached to the Berks County Medical Society. The BCMS modern building “Medical Hall” at the corner of Walnut and Madison Streets was a busy hub in the city with CME activities and social events attended by active and retired county physicians. Prior to arriving in Berks County, we helped to found Zacchaeus Free Medical Clinic in Washington, DC, but had not been active in “organized medicine.” The activities at Medical Hall attracted our attention. As we participated more and more in the BCMS, the Free Clinic at Opportunity House in Reading, the PA Medical Society, and the American Medical Association, in addition to the PA Board of Medicine and the Reading School Board, our lives were enriched in ways that we could not have imagined. We would like to share some of what we have learned about the history of our local medical society and its central place in our community.

Dr. Isaac Hiester, elected the first President of the Berks County Medical Society at the inaugural meeting August 7, 1824. He was born in Bern Township in 1785 and studied medicine at the University of Pennsylvania.

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A brief historical journey of medicine in Berks County is of interest. The land area of Berks County of the 1700s was formed from parts of Philadelphia, Chester, and Lancaster counties, and the upper boundaries extended to the New York state line – a huge area for doctors to travel. The first European settlers were Swedish immigrants who arrived along the Schuylkill River in Molatton, now Douglassville, in the 1700s, followed by Germans who came from Germantown to Oley, near Lobachsville and Friedensburg. Their healthcare needs were filled by the women of the community, including midwives. One wonders if they learned from the Indians who inhabited the area although there is no mention in any of the medical historical articles of such interactions between them. When physicians arrived, their routine was to make one visit to the home, give instructions, and ride off on their horse with a saddlebag (“scwerick sock”) filled with “medicinal tools” on to the next patient in need. The first two doctors in the county were of French Huguenot descent whose families left persecution in France because of the revoking of the Edict of Nantes (from 1598) by Louis XIV in 1685. The first of these, Dr. Jacques De La Planck, was educated in

ng i t a r b e l e C YEARS OF EXCELLENCE Switzerland. Legend says that he was riding through the Oley Valley around 1720 and a gentleman requested his services to treat his sick wife. She was healed and the itinerant doctor was asked to settle in the Oley Valley and became a part of the community. Dr. George De Benneville arrived in 1742-43. In addition to his medical skills, he is better known as the founder of Universalism in America. In 1745, Jonathan Potts was born in Colebrookdale to a wealthy family, educated in Ephrata, and accompanied Benjamin Rush to Edinburgh to study medicine. He returned to Philadelphia after a year and graduated as valedictorian of the first class of the Medical Institute of Philadelphia. In 1771, as the third physician in Berks County, he wrote a treatise on the “Utility of Vaccination” that was considered an outstanding article advocating vaccination for smallpox at a time when opposition to the smallpox vaccine was fierce.

members became reticent to come into the city, the Medical Hall building was sold to the Berks AIDS Network (now the Co-County Wellness Center). The society moved to the 13th and Rockland Professional Building, then to the Berks VNA (long ago we rented space to them!), then to a smaller office in Wyomissing off Berkshire Blvd., and now to its current virtual location in Sinking Spring. Some of the amazing historical portraits and memorabilia are now located in the new Albright College Library Rare Collections addition, while some of the periodicals and historical documents remain in the custody of the society.

Dr. Bodo Otto (born in 1709 in Hanover, Germany) came to the US in 1755 to Germantown. He arrived in Reading in 17721773 and took over “Dr. Kuhn’s Apothecary.” Drs. Kuhn, Bodo Otto (age 68-72), and John A. Otto (son of Bodo) volunteered as Senior Surgeons with General George Washington at Valley Forge from 1777-1781. Otto’s other son, Bodo Jr., was a Colonel of the New Jersey troops and died of consumption contracted during his army service. Dr. Bodo Otto, Sr. returned to Philadelphia briefly after the war and then returned to Reading from 1785 until his death in 1787. His grave is marked with a distinctive marker at Trinity Lutheran Church, Reading. Dr. John A. Otto continued to practice in Reading and was active in forming both the Berks County and Pennsylvania state medical societies.

Advocacy

Organizing the society was a large focus from 1824-1893. The Medical Faculty of Berks County received its formal charter with Articles of Incorporation on July 14, 1824, the second oldest medical society in Pennsylvania. It was renamed the Berks County Medical Society in April 1866, Medical Society of the County of Berks on November 22, 1870, and finally Berks County Medical Society on May 9, 1893. Various meeting sites including doctors’ offices, the library, various halls, and a mansion were used in the city of Reading until Medical Hall was built in 1955 for $120,000. As

The BCMS Compass Points – Advocacy, Collegiality, Education, and Professionalism – provide an important window into the evolution of our society and medicine in Berks County. On Saturday evening, August 7th, 1824, a group of Berks County physicians met at the State House at the corner of Fifth and Penn Streets in Reading to form the Medical Faculty of Berks County, a far-reaching concept as medical practice at the time was an isolated independent endeavor. Dr. Isaac Hiester was elected the first president and served from 1824-1848. He was the grandson of a former Pennsylvania Governor, Joseph Hiester, elected in 1820. Dr. Hiester was very well respected across the state and eventually became president of the PA Medical Society in 1852. The society adopted a resolution in the spirit of Dr. Jonathan Potts stating its “undiminished confidence in vaccination.” Despite these advocacy efforts, smallpox ravaged the county in 1893. Several interesting resolutions were passed in the early days of the society that reflected the times in which those physicians practiced: • 1824 - resolutions supporting smallpox vaccination in addition to one supporting disease and death reporting from their neighborhoods. • April 11, 1849 - resolutions advocating universal vaccination for smallpox throughout the state and to secure by legislation the continued on next page >

WINTER 2024 | 9

Celebrating the History of the Berks County Medical Society – 200 Years and Counting continued from page 9 registration of births, marriages, and deaths. • 1872 - opposing the practice of copyrighting common pharmaceutical preparations by registering them with trademarks. • 1882-1886 - endorsed the establishment of a national medical library and surgical museum in Washington, DC and to create a state Board of Health for Pennsylvania. • 1884 - a committee of three was appointed to “examine into the law governing the sale of poisons” and to meet with the Druggists’ Association of Reading “to prevent or restrict the indiscriminate sale of same.” • August 11, 1896 - supporting asphalt paving as preferable to brick because it was easier to keep clean and “noiseless in the passing of vehicles and other traffic.” • May 1917 - a resolution was sent to the President and Congress in support of a bill “...prohibiting the manufacture and sale of alcoholic drinks during the time the United States is at war in order that the grains may be used for life-giving products and the efficiency of the nation may be increased.” • 1925 - a resolution in support of an AMA resolution on contraception was proposed and an energetic discussion held among the 35 members present. No action was taken. • 1930-1940 - the Society opposed the “Voluntary Insurance Medical Service Plan” proposed by the PA Medical Society and threatened to secede as a component member of the state society if it should pay any monies to the insurance plan. At least 10 of the Medical Society members served in the Civil War. The Reading Hospital (NOT the antecedent of the Reading Dispensary/Reading Hospital and Medical Center) was formed by Drs. Martin Luther and John Brooke from 1861-1863. It was in the main exhibition building of the Agricultural Society on Penn’s Commons (City Park) with 130 beds for war casualties. In 1867, members founded the Reading Dispensary, which opened in downtown Reading on January 27, 1868, to serve outpatients. The president of BCMS was one of its founders and along with other physicians at times personally paid the rent. An expanded facility was opened at the site of the current Northwest Middle School in Reading in 1886 as The Reading Hospital. As it grew, the hospital moved to the present 36-acre site in West Reading 10 | www.berkscms.org

in 1926, incorporating multiple specialties within its walls as The Reading Hospital Medical Center, now part of Tower Health. St. Joseph Hospital opened its doors on August 22, 1873, responding to the emerging need for inpatient care to receive “...all classes of patients, rich or poor, of whatever sex, nationality, or faith.” It was staffed by three Sisters of St. Francis of Philadelphia with beds for 12 men and 12 women and was severely taxed by the 1893 smallpox epidemic. By 1884, a new cross-shaped hospital with 135 beds, elevators, dumb waiters, and East and South facing porches accommodating 130 patients was built on 13th Street in Reading. It acquired the Community General Hospital (formerly the Homeopathic Hospital) at 6th and Walnut St. in Reading in 1997. In 2002 it moved to its current new facility in Bern Township and in 2020 it was acquired by Penn State Community Health Group. The Adventist Hospital was purchased in the 1990s by Health South Rehabilitation Hospital and is now owned by the Encompass Rehabilitation Hospital System. The 1918 “Spanish Flu” epidemic required herculean efforts on the part of physicians to care for the myriad of ill and dying citizens. During WWII, at least 50% of the medical community (doctors and nurses) served in the armed forces overseas. A burst of activities in the 1960s included Immunization, Glaucoma and Diabetes Detection Clinics, Athletic Injury Symposia, Ambulance & Emergency Vehicle Driver Training, Seminars on Cardiac Rehabilitation (with the Berks Heart Association), Safety seat belt campaigns with the “Junior Chamber of Commerce,” a Homemaker Service for in-home assistance, two monetary awards at the Reading-Berks Science Fair which continue to today, and a Speaker’s Bureau. During Phase One of Operation Oral Polio Vaccination in the late 1950-60s, a total of 164,225 people were immunized. (The cost of 10 cents for preschool children and 25 cents for all others was waived if the person was unable to pay.) The profits were used to form an endowment fund that was increased by collecting money that was loaned to students to attend medical school and the sale of the Medical Hall building. All the outstanding loans were paid back, some with double the amount of the loan! In the 1990s, the Berks County Provider Organization was incorporated by the Society, led by Dr. William West, to be a vehicle for health insurance for the community, but as Managed Care Organizations and statewide Physician Health Organizations took continued on page 12 >

M edical R ecord F eature Celebrating the History of the Berks County Medical Society – 200 Years and Counting continued from page 10

NEW MEDICAL HALL (dedicated October 30, 1957). This building replaced the former “Medical Hall” at 429 Walnut Street. It served as the headquarters of the Berks County Medical Society for 35 years. It was purchased by the Berks AIDS Network, now Co-County Wellness Services, in 1992.

hold, there was no longer need for it. In 1993-94, Pennsylvania physicians were faced with a major crisis when the state confiscated millions of dollars from the Professional Liability Catastrophic Loss “CAT” Fund. This act as well as other medical liability threats caused a “firestorm” among physicians. PAMED, as well as the BCMS, very capably led at the time by President Peg Atwell, united physicians and halted these efforts that would have created great harm to the practice of medicine in PA. In 2020, our community, and indeed the world, was challenged with the most serious pandemic since the “Spanish Flu” outbreak of 1918-19. All aspects of our community, including its medical resources, faced immense challenges. However, our physicians, nurses, hospital administrators, and support staff responded heroically, often placing themselves at risk to protect and save patients from the SARS-CoV2 virus during the COVID-19 pandemic. Physicians served on health advisory boards, staffed community vaccine clinics, and worked extra-long hours on hospital duty, as well as in their offices, to provide care to the thousands of Berks County citizens infected. While our most difficult time, it may have been one of our finest hours as well.

Collegiality Dr. Isaac Hiester’s Inaugural Address to the Medical Faculty of Berks County, August 7, 1824 Physicians were “Carefully to observe diseases, diligently to watch their immense variety of symptoms, and faithfully to charge the memory with the effects of remedies, as guides in future practice. These are duties indispensable to every practitioner who aims at individual excellence...Dispersed, however, as we are, in different parts of the county and confined to our respective circles of practice by a pursuit at once ardent and painful, we have little leisure and perhaps less inclination, to commit to paper for the inspection of others, the results of our individual experience and observation. Without the advantages of free 12 | www.berkscms.org

exchange and comparison of knowledge with our brethren in practice, we are inclined to listen to the suggestion of vanity, and imagine ourselves standards of perfection, while we glide in to a dull routine of practice, exclusively founded on our own limited experience...[the physician] has been taught a science and a language not intelligible to anyone out of his profession... [formation of the medical society was critical] to counteract such tendency by creating a spirit of generous emulation, to elevate the profession by exciting a thirst for general knowledge, and to cultivate a taste for observation and inquiry by combining efforts and skills of physicians in various parts of the [county].” The members came from Reading, Kutztown, Birdsboro, Womelsdorf, Douglassville, Rehersburg, Lenhartsville, and Orwigsburg (then in Berks, now part of Schuylkill County) and met in many different locations after their long office hours ended. The Pennsylvania Medical Society was founded in 1848 at a meeting in Lancaster with Berks County physicians including Drs. John Hiester, William Moore, and J. Horace Seltzer in attendance. Subsequently, Dr. John Hiester was elected President of the PA Medical Society in 1853 and Dr. Edward Wallace, also from Berks County, was elected President in 1861. In 1891, the PA Medical Society met in Reading for a gala two-day event which included rides on the Neversink Mountain Railroad, banquets, a concert by the Ringgold Orchestra, and tours of both Reading and St. Joseph Hospitals. Between 1866 and 1912, the society met at the N. Fourth Street offices of Dr. J.B. Brooke for ten years, Library Hall (5th & Franklin), Board of Trade Rooms (522 Penn St.), the Dispensary club rooms (30 South 5th St.), Reading City Common Council Chambers at 5th and Franklin for ten years, and the second floor of Raser’s Drug Store at 6th & Walnut Street (owned by Dr. John B. Raser) where rent was free. A permanent home for the society was established in 1912 when a committee of 25 people led by Dr. Ira

G. Shoemaker purchased the Grisson/ Horst Mansion at 429 Walnut Street, with free rent for the first three years. Eventually parts were leased to the Berks Visiting Nurse Association ($5/month) and the Berks County Dental Society. Apartments were also rented out to the County Commissioners for clinics and other organizations and individuals. The building was named Medical Hall and was the home for the society for more than 40 years. The Society’s 100th year anniversary in 1924 was led by Dr. H.H. Muhlenberg, President, and Drs. H.U. Miller and D.S. Grim, Vice-Presidents. In celebration, the PA Medical Society held its meeting at the Rajah Temple from October 6-9, 1924, with 883 in attendance. Drs. Ira G. Shoemaker and Frank G. Runyeon were elected President and Vice-President of the state society. Dr. Benjamin F. Souders, chair of the Building Committee, presented a resolution in 1955 to authorize architect and builder fees not to exceed $120,000 for building of the new Medical Hall of the Berks County Medical Society that was dedicated on October 30, 1957, at Madison and Walnut Streets in Reading. Sherwood C. Young was the first Executive Director of the Society from 1961-1986, followed from 1986-2014 by Bruce R. Weidman. T.J. Huckleberry has been our Executive Director since 2015.

Education During the early years of the society from 1824-1880, local physicians shared their knowledge of illness occurring in their regions of Berks County at their meetings annually, quarterly, and monthly. In 1880, Dr. Israel Cleaver presented education on “Physical Culture” promoting calisthenics for children and adults in the city “...to improve the health of the youth of our city by offering them a mode of exercise which is at once light, healthful, and absolutely free from danger...” From 1896 until 1910, Drs. Henry Landis, Samuel L. Kurtz, and Israel Cleaver began publication of an annual pamphlet containing the scientific transactions (papers and discussions of them) of the Society during each calendar year. It became a publication containing

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80-100 pages per issue with advertisements! The monthly publication of The Bulletin began in 1911 announcing meetings and activities and containing articles of medical interest. The secretary of the society was responsible for its editorship. The name was changed to the Medical Record in 1955 when the society moved into Medical Hall. One of its long-term editors in the 1990s was Dr. S. Leroy Maiorana. Medical Record continues as a trusted publication for our

community and many of us have contributed to it. Volunteer editors have worked hard to recruit articles and assure quality of the publication. The addition of Hoffmann Publishing to cover printing and distribution costs using advertisements resulted in no cost to the society for the publication and the ability to distribute it to the public! The volunteer physician editors put in a great deal of time and effort with a resultant excellent publication. Dr. Lucy Cairns was the first continued on next page > WINTER 2024 | 13

Celebrating the History of the Berks County Medical Society – 200 Years and Counting continued from page 13 woman editor of the publication. Continuing education sessions as well as social events were held in the large meeting room of Medical Hall, and later when the society rented space from Berks VNA (yes, a reversal of roles!), we were allowed to use their large meeting room. In addition to Resident Poster presentations and lectures, candidate nights were held prior to local and state elections as well as regular “give and take” sessions with elected officials. In more recent years, most of the educational sessions have been provided through the medical staffs of our local hospitals. The Medical Society Auxiliary has also held many useful and respected educational events for the community and schools.

Professionalism The Charter and Articles of Incorporation for the Medical Faculty of Berks County were granted by the State of Pennsylvania on July 14, 1824. Since the beginning, our Medical Society has stood for the highest standards of medical practice and care by physicians. In addition to the many educational programs provided by the society for many years, it offered a service to the community in which concerns about a physician were confidentially evaluated and almost always resolved in a fair and amicable manner. In addition, Berks County physicians have served in leadership positions on the PA State Board of Medicine and at the PA Medical Society. In more recent years Dr. William Alexander, a true giant in Berks County Medicine who led by example, served as President of the PA Medical Society in 1986. In recognition of his many contributions, the BCMS Community Service award is presented to deserving members of our community in his name. In the long history of the society, no women were president until 1985 when Dr. M. Fay Weaver, M.D., became the first of nine women presidents of the Society during the ensuing 38 years. And most fittingly, Dr. Kristen Sandel, a past President and Board Chairperson of the BCMS, will be installed as President of the PA Medical Society January of 2024, our 200th Anniversary year. Epilogue - Our Journey in Berks County In the past 30-plus years since we have been members, the society has changed in many ways. When we arrived in Reading, there were only 12 women physicians. Drs. Deborah Consoli, Fredericka Heller, and Susan Probst were the first women OB residents at Reading Hospital. Nancy Schuman trained in Internal Medicine there. Marcia McCrae was practicing as a developmental pediatrician and very active with Pro Kids and the Easter Seal Society. Annual Residents’ Day presentations of posters were popular and combined with an endowed lecture. Health Talk was begun by Dan in 2004 on WEEU radio every Wednesday evening from 6-7 p.m. It has been a trusted source of medical information for Berks County Residents and continues with Drs. Michael Baxter, Andrew Waxler, Greg Wilson, and others as hosts. While membership has declined in many medical professional societies in recent years, and this has been true for BCMS as well, our medical society has weathered these stormy seas better than most and

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remains one of the leading county medical societies in PA. We have actively supported efforts to reduce opioid and other substance abuse in our community, hosting the PA Surgeon General, pediatrician Dr. Rachel Levine, for a very successful medical forum on the topic. We continue our annual “Drug Take Back Event” in conjunction with local law enforcement officials, an activity that has become highly successful serving hundreds of local residents. We continue to host “Residents’ Day” poster presentations, and most recently have reached out to provide a warm welcome and host events for Drexel University School of Medicine students who have become a large part of our medical community. Their enthusiasm reminds us of our early career days, and we look forward to the opportunities ahead to mentor their development and share their excitement. Also, BCMS has recently taken the lead for the creation of a Berks County Health Department as we work with local officials to resolve health disparities and improve public health in our community. Much has changed in the way we live and certainly in the way medical care is practiced, organized, and funded over these past 200 years. However, fundamentals remain the same as exemplified in our Compass Points: Advocacy, Collegiality, Education and Professionalism. In conclusion, words from the small Essays volume written in 1940 are appropriate here: “History becomes doubly valuable as we carefully record its events. Meetings may appear unimportant and devoid of data or special significance, but a decade or half century hence places the subject at a different angle. A full and complete record of present events gives to posterity an index of the past. Let us endeavor in both deed and record to emulate those whose successors we have become that it may be said of us 100 years hence: “They had lived their lives by precept and example. They had taught us how to live.” Efforts to ensure quality care for patients, preserve the integrity of the physician role, advance science-based knowledge, and promote professional camaraderie within our profession will remain essential to the mission of the Berks County Medical Society as we continually strive to build a healthier community. In retirement we remain strong advocates for our medical societies and our specialty societies. Happy 200th Anniversary Berks County Medical Society! It has been quite a journey. We are confident that together we can meet the challenges which lie ahead. We acknowledge the resources provided by the following: • “The Berks County Medical Society: 175 Years of Medical Professionalism” article by Michael Kane, Historical Review of Berks County, Vol. 64, No. 4, Fall 1999. • “Essays Concerning the History of the Berks County Medical Society” compiled by the Historical Data Committee in 1940. • History of the Reading Hospital, 1867-1942, published by the Reading Eagle Press for the Board of Managers on occasion of the 75th anniversary of the Reading Hospital, December 9, 1942.

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

Berks County Medical Society

“1824 Club”

Doctors Eve and Dan Kimball invited retired physicians and their significant others living at the Highlands to join them for a Berks County Medical Society “1824 Club” event to watch the traditional Army-Navy football game. Twentyeight people attended the event including our Medical Society President, Bill Santoro. Everyone enjoyed cheering favorite teams, consuming some light food and beverages, and sharing stories about their lives. A great time was had by all. And our favorite team, Army, earned an ugly win. Go Army; Beat Navy!

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M edical R ecord F eature

Resident Rounds by Ashni Nadgauda, MD, PGY3, Dept. of Obstetrics and Gynecology, Reading Hospital/Tower Health

hat fosters a sense of community? Most people would say time and shared experiences, but active effort also plays a significant role. As we celebrate Berks County Medical Society’s 200th anniversary, it’s an opportune moment to reflect on the importance of investing in our communities. The dynamics of our society have undergone a profound shift over the past few years, especially in the wake of COVID-19. For example, due to the effects of COVID 19, many have considered if remote work is superior to having to see co-workers all day. However, in this context, the celebration of the Berks County Medical Society’s milestone serves as a reminder to consider the broader implications of connecting and building community. My recent visit to India for a family wedding offered a different cultural perspective on community and family values. In Indian society, multiple

generations often coexist under one roof. For example, my grandparents, aunt and uncle, and their children all lived under one roof in a 3-bedroom flat for many years, up until my grandparents passed away. Now, my aunt and uncle live just four stories below their children in a multi-story building. In direct contrast to this, I see my family just a handful of times a year. For many people, the American experience can involve infrequent visits with family members, dependent on busy schedules and geographic distances. In the pursuit of career aspirations, romantic relationships, or the sheer desire to explore new horizons, we often find ourselves uprooted from the communities we were born into. However, amid these new adventures, humans will always be social creatures, and we will sooner or later need or crave a supportive community in which to thrive.

how we can actively contribute to and integrate ourselves into the communities that surround us while also staying connected with our families and the communities we come from. Technology has made it easier than ever to bridge the physical gaps, allowing us to maintain strong ties with our roots. In addition, it may be worth investing free time into engaging in local events, clubs and organizations, or volunteer initiatives to provide a sense of belonging and open avenues for meaningful connections. As we navigate the changing landscape of our lives, let’s recognize the importance of weaving a tapestry of community, one that enriches our experiences and contributes to the collective well-being of those around us. In doing so, we not only celebrate the legacy of the Berks County Medical Society but also nurture the essential fabric of human connection that binds us all.

As the holidays and new year approach, it’s worth contemplating

WINTER 2024 | 17

M edical R ecord F eature

Student Vital Signs by John LeMoine,, MS lll

he arrival of the winter holidays marks the end of another semester for medical students. Halfway through third year (the clinical rotations year), we have now completed 5/8ths of our medical school training before beginning as residents in our selected field. It is an awesome realization that in a year and a half, my medical student cohorts and I will be physicians. As students, my classmates and I sometimes feel like we are always in a state of prospection, always thinking, “What’s next?” — a valid question, and there is much to anticipate in the next couple of years. However, the winter holidays and the new year are nothing if not a time for reflection and recognition of “auld acquaintances.” July 2021, one week before the first day of medical school classes, marked the first time I set foot in Pennsylvania. Knowing the arduous potential of a medical school curriculum, I was eager and excited to develop a social support system in this new environment. Quite fortunately, two of the first people I met have become my roommates and closest friends. Luke and Evan are compassionate, bright, trustworthy, and quick to laugh, a reliable formula for any friendship. The three of us have become an inseparable trio navigating the fluctuating highs and lows of school. Our relationship has been an invaluable anchor against the demanding schedules, rigorous coursework and exams, and the challenges experienced in the hospital life. More than ever, our synergistic support of one another during the third year of school has been imperative to processing the realities of patient care. Whether it be reflecting on a patient’s death or celebrating new life, we create a solid outlet for each other at home. Over the years, Luke, Evan, and I have expanded upon our similarities to create clubs and events for the other medical students. We founded the Mexican and Hispanic Cuisine (MHC) club in

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our first year to encourage students to venture weekly into the city of Reading to try different Latinx restaurants and share stories and experiences. Similarly, in our second year, we created the Nature Therapy Club to organize events in which students can escape from the books and participate in outdoor adventures in and around Berks County. At the end of every semester, the three of us take a picture in the same pose to remember each milestone along the journey. These are just a few of the many mementos that we have created to remember the founding years of a lifelong friendship. We likely have different paths in front of us: Luke is bound for anesthesiology or critical care medicine, Evan plans on pursuing interventional cardiology, and I am leaning towards emergency medicine. However, no matter where we end up after medical school, I am certain that we will stay connected and continue to share stories and laughs for years to come.

M edical R ecord F eature

Welcome New Member

Brian H. McGreen, DO

he Berks County Medical Society is pleased to welcome new member Dr. Brian McGreen, who joined the Center for Urologic Care of Berks County in August of 2023. Dr. McGreen was inducted into the Phi Beta Kappa honor society as an undergraduate at Fairfield University in Fairfield, CT, graduating Summa Cum Laude. He earned his medical degree from the Philadelphia College of Osteopathic Medicine in Philadelphia and completed an internship in General Surgery at Hahnemann University Hospital before training in Urologic Surgery within the Main Line Health System at Lankenau Medical Center and Bryn Mawr Hospital in Wynnewood, PA. Dr. McGreen’s residency experience included additional training in pediatric urology at Nemours Alfred I. DuPont Hospital for Children in Wilmington, DE, and in urologic oncology at Roswell Park Comprehensive Cancer Center in Buffalo, NY. Following residency, Dr. McGreen undertook fellowship training at the Medical University of South Carolina in Charleston, SC. During this time, he focused on the surgical treatment of urologic cancers using minimally invasive approaches.

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To get to know Dr. McGreen 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 see and treat all patients with a wide variety of urologic conditions and have a particular interest in treating urologic cancers. What has brought you to Berks County? Family.

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What do you find most rewarding about being a physician? Improving patients’ quality of life and providing them with treatment options that suit them best. Please tell us a little about your family and the activities you enjoy outside of work. My wife and I like to spend time outdoors with our children and dog when not working. WINTER 2024 | 19

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Addiction and THe Family by William Santoro, MD

hen people think of a medical illness, most often the first thought goes to what the illness can potentially do to the body or the patient. Pneumonia. What is that going to do to me or my loved one’s lungs? Hypertension. How will that affect me or my loved one’s heart? Myocardial infarction or stroke. How will that affect me or my loved one’s ability to do activities of daily living? Cancer. How will that affect my lifespan or my loved one’s lifespan?

But what about addiction? Addiction affects the family unit as much as it affects an individual. Addiction affects relationships as much as it affects any individual body part or organ. Addiction causes or worsens a vast array of problems including medical, psychological, psychiatric, social, family, spiritual, academic, occupational, legal, and financial. Addiction is associated with a decreased life span and a worsening of multiple medical and psychiatric problems such as mood, anxiety, and psychotic disorders. Patients with addiction and psychiatric illness are less likely to comply with treatment, which results in increased morbidity and mortality. 20 | www.berkscms.org

I believe the most devastating effect of addiction is how the disease affects family systems and individual members of the family, especially children. Children with a parent dealing with addiction are at increased risk for academic, behavioral, and psychiatric problems. Furthermore, a child raised by a parent with a substance use disorder has an increased risk for substance use problems themselves. Many family members who die because of their addiction are adolescents or young adults. Many of these young adults have young children of their own. I don’t know how I can convey in writing the pain and negative impact that addiction has on a family or the individual members. Maybe it would be best if I give an example. Black Balloon Day is March 6. All across the United States, families and loved ones remember and celebrate the lives lost to drug overdose. Black Balloon Day was started by Diane and Lauren Hurley, who lost their family member – Greg Tremblay, aged 38 – to a drug overdose on March 6, 2015.

Drug overdose and addiction touch the lives of everyone without discrimination. Substance use disorder and drug overdose is blind to ethnic, religious, and socioeconomic divides.

Black Balloon Day has become both a national and international event, bringing awareness to overdose deaths in every population sub-group. In a recent family program conducted by a local treatment program on Black Balloon Day 2023 for children of parents with substance use disorder, art was used to help the children share their experiences and express their feelings related to their parent’s addiction. When talking about her drawing, one young girl stated, “Mom hit me, she punched me, she slapped me. But the very worst thing she did was she died.”

medications used for other substance use disorders such as cocaine and methamphetamines. Treatment can also be in the form of psychosocial counseling utilizing different techniques including, but not limited to, CBT (Cognitive Behavioral Therapy), DBT (Dialectical Behavior Therapy), and EMDR (Eye-Movement Desensitization and Reprocessing). I believe the best chance for success in treating addiction is by combining medication, psychosocial treatment, peer support (such as 12-step meetings), and an increase in working with a patient’s spiritual beliefs.

We can talk extensively about theories and what happens to family members and family systems of patients with addiction; however, this young girl expressed in one simple statement one of the worst outcomes of addiction—early death.

I often get questioned about the success of different treatments for addiction. During one conference I presented statistics showing that a certain treatment increased the likelihood that a patient with addiction would be able to extend recovery six months longer than a person without the treatment. An audience member questioned me as to whether an additional six months of recovery over placebo was worth the cost of the treatment and the effort needed to deliver the treatment. My first thought was to wonder whether such a question would come up if we were discussing treatment for cancer. My response was that a parent with an extra six months of recovery has the opportunity to engage with a child. That parent in recovery for an extra six months could possibly go to a baseball game or celebrate a birthday with that child and a family. The only way to truly know if six months of extra

Addiction is one of the few medical conditions that is 100% preventable, and when not prevented, causes more pain and suffering among the family members of the patient suffering the illness. When comparing the risk of children suffering from a disease that a parent has, addiction has a higher risk of being passed on to a child than diabetes has being passed on to a child of a parent with diabetes. And even if a child does not go on to have a substance use disorder, addiction causes more pain and suffering to a child of a parent with addiction than diabetes does to a child of a parent with diabetes. Society is affected in so many negative ways by addiction. Problems such as motor vehicle accidents, poverty, criminal behaviors, homelessness, and higher rates of transmission of infectious diseases are all worsened by addiction. Society is burdened in many ways as a result. For example, the economic cost of addiction in the United States is estimated to be hundreds of billions of dollars—for medical and social services, lost income, cost of treatment, and many other indirect costs of addiction. But in my opinion the cost and effect on the family unit is far greater than all other costs of addiction. Those who work in the field of addiction medicine function in a broad range of medical, mental health, social service, criminal justice, educational, private practice, and other community settings. Problems due to addiction are likely to be encountered in all these settings. Our goal should be to increase our knowledge of prevention, intervention, treatment, and referral strategies for addiction problems regardless of the practice setting.

A diagnosis of addiction does not have to be a death sentence. Treatment is available. Treatment can be in the form of medication for substance use disorders such as alcohol, opiates, and tobacco. The standard of care for treating opiate use disorder is now medication such as naltrexone, buprenorphine, and methadone. The standard of care for treating alcohol use disorder now includes naltrexone and possibly other FDA-approved medications. There are also off-label

recovery is worth the treatment cost and effort would be to ask a child such as the young girl who I described above. Ask that young girl how much six months of additional time in recovery for her mother would have been worth to her. I hope I have been able to show the many negative ways in which addiction affects individuals, society, and families. What I hope to convey is that there is a broad array of evidence-based interventions for prevention, screening and brief intervention, and treatment of addiction. I believe there is a great need for interdisciplinary collaboration and practice. I believe that if this collaboration is done properly, each of us can make a difference. Effective treatments include psychosocial, medication, and combined treatments. Each of us are in a position to make a difference in the lives of patients and families who are affected by an addiction. Thank you for your interest in this topic. WINTER 2024 | 21

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Clinical Questions for our Medical Experts What is the status of Influenza, COVID-19, and RSV (Respiratory Syncytial Virus) as we head into winter and who, in particular, needs a vaccine update or new one (RSV)? by Debra Powell, MD, MS, FIDSA, Chair, Department of Medicine, Chief, Division of Infectious Diseases, Medical Director for Infection Prevention, Reading Hospital/Tower Health

Where are we now? I am answering this question on the week between Christmas and New Year’s Day. We all had a lovely holiday seeing family members and friends. I love these social encounters and missed these events during the height of the pandemic. I am so thankful that we are able to resume these activities. The downside is, that similar to prior years due to these increased exposures, we are seeing an increase in respiratory virus infections with more admissions for COVID-19, RSV, and influenza infections. Recently, Reading Hospital/Tower Health, like many other hospitals, is in surge capacity and has opened additional patient beds. Thankfully we have staffing for this amount of patient need.

How does this compare? Prior to the Christmas holiday, we had approximately 6% of hospital beds with COVID-19 positive patients. This has increased to 13% of hospital beds with COVID-19 patients the week between Christmas and New Year’s Day. This COVID-19 census is considerably better compared to 40% in January of 2021, 30% in January of 2022, and similar to 10% in Jan 2023. Thankfully due to evolution of the virus, most of our inpatients have mild disease, with

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approximately 20% of those admitted with COVID-19 receiving Remdesivir, and very few patients in the ICU on a ventilator. Nationally and locally, we are also seeing more admissions for influenza and RSV. The CDC estimates that nationally from October 1 through December 16, 2023 there have been between 5 – 10 million flu illnesses, with 50,000 to 100,000 hospitalizations, and between 3000 – 9500 deaths.1 Per the CDC Health Alert from December 14, 2023, hospitalizations have increased among all age groups by 200% for influenza, 51% for COVID-19 and 60% for RSV.2

What is the prediction for January and February? I expect that the number of influenza and COVID-19 cases will continue to increase over the next few weeks. Below is the comparison from the last seven seasons. The 2023-2024 year, marked in red, tracks the number of cases of influenza and RSV compared to prior years starting from October 1, 2023.3 This year’s season is occurring a few weeks later than the 2022-2023 season (which began unusually early for both flu and RSV last year), and a few weeks earlier than the traditional pattern.

What can we do to prevent severe illness? I would highly recommend that everyone who is eligible be up to date with the COVID-19 vaccine by receiving the Omicron targeted vaccine that was released in September 2023. This vaccine will provide the highest amount of protection against the currently circulating strains. I would also highly recommend that everyone who is eligible receive the influenza vaccine every year. This includes everyone over the age of 6 months. The composition of the flu vaccine includes 2 influenza A strains and 2 influenza B strains that are selected based on the predicted strains that will be circulating this season. This vaccine is expected to be a good match for the circulating strains. A new study published in The Journal of Infectious Diseases estimates that flu vaccination reduced the risk of flu-related emergency department and urgent care (ED/UC) visits by almost half and hospitalizations by more than a third among U.S. adults during the 2022-2023 season.4 Be aware that the current flu vaccination rate is lower than prior years. On Dec 14, 2023, the CDC is reporting vaccination rates that range from 33% (for pregnant people) to 58% (in those over 65 years of age).5 I would encourage all physicians to recommend the flu vaccine to our patients to provide protection against severe disease. Regarding Respiratory syncytial virus, the CDC recommends adults 60 years of age and older have the option to receive a single dose of RSV vaccine, based on shared decision-making between the patient and their health care provider. I would recommend RSV vaccination to adults at highest risk for severe RSV disease including older adults, adults with chronic medical conditions such as heart or lung disease, weakened immune systems, or who live in long-term care facilities.

There are two options for protection of infants against RSV. CDC recommends a single dose of RSV vaccine for the prevention of severe RSV disease in infants under 6 months of age. This vaccine is recommended to be given from September through January for most of the United States. Alternatively, RSV antibodies can be administered to babies at high risk, including those who were born prematurely, who have chronic lung or heart disease, or a weakened immune system.6 Please note that the RSV antibodies are in short supply this season. The message to our patients is that COVID-19, influenza, and RSV can cause severe viral infections and there are steps that we can do to protect ourselves, our family members, and our community. We should recommend that patients keep up to date on immunizations, stay home when they are sick, contact their PCP for further instruction on when they need to seek additional treatment, and use home COVID-19 tests to help diagnose the infection. They should also perform hand hygiene regularly and consider wearing masks if they are at high risk of severe infection or concerned about being exposed or spreading infection. 1

https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm

https://emergency.cdc.gov/han/2023/han00503.asp

https://www.health.pa.gov/topics/disease/Flu/Pages/2023-24-Flu.aspx

https://www.cdc.gov/flu/spotlights/2023-2024/study-prevent-medical-visits.htm

https://emergency.cdc.gov/han/2023/han00503.asp

https://www.health.pa.gov/topics/disease/Flu/Pages/2023-24-Flu.aspx

WINTER 2024 | 23

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

Member Forum* by Ankit Shah, MD, Emergency Department Physician, Reading Hospital/Tower Health

mergency department (ED) overcrowding was a vague notion that had historically been foreign to non-emergency medicine workers. Since the public health emergency (PHE) in 2020, lengths of stay (LOS) in the ED have dramatically increased, leading to many challenges and frustrations within the healthcare system, both for staff and patients. This is a nationwide problem and not unique to Berks County. There are several factors that are concerning in this big picture: there are numerous causes of increased LOS, the effects of the prolonged LOS can be devastating, and the solutions are not easy to implement. Some of the contributing factors to wait times are: the Emergency Medical Treatment and Labor Act (EMTALA) of 1986, selfreferrals, throughput challenges, output challenges, and seasonal variations.

could make it such that ED is the only reasonable path. • Patient progression through the ED and inpatient locations are intertwined and dependent on many independent factors. So even if there are concerns or limitations in a department outside of the ED (equipment malfunction, medication supply shortage, staffing shortage), LOS may increase. • Not all patients that are admitted get moved to in-patient status promptly. Just as the ED is dependent on ancillary services, the ED is also dependent on floor beds being open and available for patients. Beds and rooms on inpatient units need to be cleaned and have staff available to take care of a patient coming from the ED to the floor.

• Patients sometimes self-refer to the ED for multiple reasons. Sometimes, they are unsure of whether the symptoms they are feeling are life-threatening. Other times, they have acute symptoms, but their provider is unable to see them that same day.

Above are just a few examples of contributing factors to ED wait times which ultimately lead to ED overcrowding. The subsequent effects of ED overcrowding have far-ranging impacts on patients and staff as well. Patients that must wait in the waiting room become displeased and frustrated with the prolonged wait. The frustration is understandable from their lens. Sometimes they understand the wait and at other times they channel that negativity towards staff. Feeling sick is hard and feeling sick while you’re waiting helplessly must be even harder. As an ED provider it is also hard to see the ED nurses and other colleagues be recipients of that frustration and feel morally defeated. Compassion fatigue and burnout is real. Unfortunately, there is now a nationwide shortage of healthcare workers, with many leaving the profession altogether.

• There are times when providers see patients and attempt their best to rule out acute issues on the ambulatory side but testing scheduling limitations

Solutions are not easy and will require a collaboration between the medical world and our elected officials as ED overcrowding is not a hospital problem, it is a community

• EMTALA is the federal mandate that requires ED to provide every patient with medical screening upon presentation to ED. The goal and hope was to ensure equity in healthcare and preclude hospitals from turning away patients for financial reasons. As a result, regardless of the acuity, every patient presenting to the ED must get seen and get appropriately worked up by an ED provider.

problem. As the medical and political realms collaborate, they will need to cast a wide net and take a multifaceted approach. There is a shortage of PCPs as is. While ED is the gatekeeper to the hospital, the Primary Care Providers (PCPs) are the gatekeepers to most health issues. Many are overbooked and work tirelessly to address inbox messages, do paperwork, support patients, do refills, etc. We need to not just increase access to primary care, we also need to make their lives sustainable. We will need to leverage creative methods to reach patients who otherwise cannot access healthcare. Telehealth is a great option (with the understanding that this isn’t meant to encroach on someone’s already busy schedule). Floor staff works closely to expedite discharges and we need to ensure that health systems continue to value the collaboration between providers, nursing, social work, PT/OT, speech, EVS, and other supportive services so that concerns and needs are addressed as rapidly as possible and discharge plans are made in tandem with care being provided. The goal is to get the patient discharged (safely and expeditiously) and get that room turned over as soon as possible. Some hospitals have created discharge lounges where discharged patients may wait for their rides. The causes of ED overcrowding and boarding are complex and involve more than just the ED. Conversely, the effects of ED overcrowding cannot be overstated for the impact on patients and staff. The solutions will be difficult to implement and expand far beyond the scope of this discussion; however, they’re not outside the realm of possibilities, which is hopeful. With that said, it is a privilege to be an ED physician and work with people who serve our community tirelessly and with so much grace.

*Member Forum is a new column in the Medical Record in which members are encouraged to write and express their concern about a significant health issue for patients, physicians and/or our community. Submissions should be approximately 750-1000 words and should follow proper etiquette. All printed submissions subject to editing with author consultation by the MR staff.

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

Summer 2024 Berks County Medical Society’s Pat Sharma President’s Scholarship

pplications are being accepted now for this paid summer internship. The program is designed to allow college students to explore careers in healthcare through mentorship and clinical observing experiences with practicing physicians and leaders in local government and nonprofit organizations working to advance healthcare in our community. Time commitment: 6 weeks full-time, Monday through Friday. Start date anticipated: June 3 Stipend: $2000 Eligibility: Students who will have completed at least 2 years of college at the end of the current semester and who have demonstrated an interest in a career in medicine or other field in the realm of health care, public health, or health policy. Priority will be given to students who are from the Berks County area or who are attending college in Berks County. Primary activity: Research and write an article on a clinical topic or public policy issue in the healthcare field. The topic will be chosen in consultation with the scholarship program committee, and close supervision and mentorship will be provided by Berks County Medical Society (BCMS) physicians and community experts in the chosen topic. The article will be published in the quarterly magazine of BCMS, Medical Record. Articles written by past scholarship recipients can be found on the BCMS website, berkscms.org, and in the Fall editions of the Medical Record. Additional activities will be determined by the intern’s interests and could include: • Observing clinical practice, including surgery. • Assisting the Executive Director of the BCMS for a few hours a week to learn about the operation of this nonprofit organization and the many ways it serves our members and our community. • Shadowing members of the Pennsylvania Medical Society Governmental Affairs Office.

• Participating in panel discussions with practicing physicians and with medical students, to gain insight into the process of becoming a physician and the variety of career paths available. • Attending didactic sessions at Reading Hospital offered in the Student Summer Internship program. Application materials: 1) Resume (please include home address) 2) Personal statement of no more than about 500 words describing your career interests and how this experience would further those interests 3) An example of written scholarly activity (an essay or research paper authored solely by yourself ) 4) Letters of recommendation are not required but will be considered 5) Please indicate whether you are related to a Berks County Medical Society member and let us know how you learned of this internship. Deadline to submit applications: Monday, March 4, 2024 (Notification will be by March 22.) Forward applications to Mr. T. J. Huckleberry, Executive Director, Berks County Medical Society at: Email: tjhuckleberry@berkscms.org Fax: (610) 375-6536

The BCMS thanks Dr. Pat Sharma and Dr. Ray Truex for their support of this program through gifts to the BCMS Educational Trust. WINTER 2024 | 25

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

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The Joy of

Model Railroading n 1992, Ed Hein, MD, left his position as Chief of Allergy and Immunology at St. Christopher’s Hospital in Philadelphia and moved to Reading to join a private allergy practice. After 25 years of serving the patients of Berks County and teaching residents and his colleagues about the intricacies of his discipline, Ed retired in 2017.

of tracks and scenes of town and country life. Although he has scaled down a bit, Ed continues to enjoy his trains and to share his collection with his family and friends.

In addition to traveling and sharing time with family, Ed and his wife, Lois, serve as volunteers for Atonement Lutheran Church visiting homebound and hospitalized members.

Thanks, Ed, for your years of service as a dedicated physician and trusted colleague. Enjoy those trains!

Ed strongly recommends pursuing a hobby as a relaxing balance to the pressure of a medical career and as a fulfilling focus as one transitions to retirement life.

Another interest of Ed’s is his passion for model railroading. At one time, Ed had 60 train engines as well as an extensive layout

WINTER 2024 | 27

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

Report of the Proceedings of the 174th Annual Meeting of the Pennsylvania Medical Society Hybrid House of Delegates, Hershey Motor Lodge October 28, 2023 Resolutions of interest include: 1.

Creation of an Independent Practice Physician Section to preserve independent practice.

Establishment of a Senior Section of PAMED was referred for study.

Support for the National Board of Physicians and Surgeons as an alternative to Board Recertification.

Adoption of initiatives that address food insecurity and promote access to healthy foods.

Support for clean water initiatives and infrastructure.

Expand Medical School curricula in PA to address knowledge gaps concerning patients with disabilities.

Promote inclusion in PA Medical School curricula a wide range of sexual orientation and gender identity-related health issues.

The Berks County Medical Society sent a full

delegation to the 174th Meeting of the PAMED

Support research into the use of short-acting opioid agonist therapy to treat patients with active substance use disorder.

Promote teaching about the diverse range of skin tones in medical school dermatology curriculum.

House of Delegates in Hershey, PA this past October. The delegation was led by BCMS

10. Utilize social workers and hospital-based interventions to prevent gun violence.

President William Santoro, MD. As usual a

11. Advocate for increased access to mental health services for PA school-aged children.

large amount of business including the passage

12. Update PAMED policy on Women’s Preventative Services Initiative.

of resolutions and the election of officers and

13. Encourage physicians to engage patients in Advance Directive conversations.

other official positions was held.

14. Support for continued advocacy and educate for environment and climatechange health concerns.

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15. Require pharmacies that give childhood vaccines to reconcile records in PA-SIIS system. 16. Seek for the AMA to adopt a neutral stance on “Single Payer” health reform and evaluate all such proposals based on AMA health reform policy. 17. Request update on AMA information regarding Maintenance of Certification changes. 18. Educate physicians and require monitoring by PA DOH of Direct Contracting Entities. 19. Promote state subsidized lead paint abatement. 20. Require medical schools to cover the cost of USMLE and COMLEX licensing exams. 21. Protect access to Gender-Affirming care. 22. Require that physicians must give consent for every nurse practitioner assigned to them. 23. Support for Extreme Risk Protection Orders for the prevention of gun violence. 24. Promote a uniform state system of certified State Medical Examiners in PA. 25. Establish Medical Staff authority regarding the supervision of Certified Registered Nurse Anesthetists who administer anesthesia. 26. Support for equitable and optimal mammographic services to reduce racial disparities. 27. Designate attorneys as mandated child abuse reporters. 28. Promote use of and third-party payment for continuous blood sugar monitoring and diabetic educator access for new onset Type II Diabetes Mellitus. 29. Support for Psilocybin Research in PA. 30. Remove barriers in the OR for wearing a Hijab. 31. Promote broad health literacy. 32. Advocate in PA and the AMA for adequate compensation for residents and fellows. 33. Support for evidence-based algorithms of care as opposed to race-based algorithms. 34. Request for the AMA to support the creation of doctors’ unions. 35. Return the PAMED HOD to its pre-COVID 3-day meeting format.

Election of Officers serving 1/2024: President, Kristen Sandel, MD Berks County (previously elected) Vice President, Arvind Cavale, MD Bucks County Speaker, HOD, Todd Hertzberg, MD Allegheny County Vice Speaker, HOD, Andrew Lutzkanin III, MD Dauphin County Additional resolution information and results of elections for Trustees, members of the Judicial Council and Delegates to the AMA are available at www.pamedsoc.org/HOD.

WINTER 2024 | 29

M edical R ecord F eature

In Memoriam Donald S. Faust, MD November 24, 1931—November 19, 2023 by D. Michael Baxter, MD

onald S. Faust, MD, who served as a Radiation Oncologist at Reading Hospital, passed away at the age of 91 on November 19th, 2023. He was a graduate of Gettysburg College and then served in the US Air Force prior to entering

Hahnemann Medical College. Dr. Faust served at Polyclinic Hospital in Harrisburg and then at Hahnemann University Hospital before arriving at Reading Hospital in 1973 to establish a state-of-the-art Radiation Oncology Unit. He spent twenty years in that role as an active member of the Reading Hospital staff prior to retiring in 1993. Dr. Faust was pre-deceased by his wife of 67 years, Jannell. He is survived by three daughters, a son, six grandchildren, and eleven great-grandchildren. In addition to medicine, he enjoyed nature photography, sports, and travel. He was especially committed to his Church where he served as a deacon, Bible teacher, and member of the Mission Board. While I did not know Dr. Faust well, I always viewed him as a skilled colleague and highly valued his medical opinion regarding the treatment provided on behalf of my patients. One mutual colleague of Dr. Faust described him as “old school.” To me that means an expert in his discipline, fully committed to the best care of patients, attentive to the well-being of his family and with a strong sense of his role and purpose. What more could anyone ask of their physician, colleague, husband, and father? We share our condolences with his family. We were honored to have him as a trusted colleague.

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