As my tenure as DCMS President ends, it’s time for reflection.
It has been quite a ride. I shook the trees, poked the bear, and raised some hackles. But that’s okay. My goal was to be a physician protecting patients.
Many changes have occurred—for the society, for medicine, and for me professionally.
The society took many steps forward with the addition of Gerard (Gerry) Egan as our administrator. He provides calm, consistent coordination—if that makes sense to anyone other than me. This is a volunteer-run society, and the “volunteers” are physicians with the usual “saving lives” thing as our number one priority. Therefore, I did not have a lot of time to be presidential. But Gerry focused the time I had to create a much better county society while smoothly handling all the administrative duties required of him. These included restarting Central Pennsylvania Medicine magazine, coordinating meetings, keeping our small nest egg safe, dramatically improving (with the help of Dr. Gunder’s family) what we offer our students through the Gunder Scholarship Endowment, updating the website, answering the phones, contacting the membership via email, paying the bills, and filing the necessary tax forms. For that, I owe him a sincere thank you.
Medicine is changing, and we are seeing more clearly the effects of the shift from
physician-run to institution- and private equity-run healthcare. Yes, I know this is not new to us, but the changes in patient care and outcomes are becoming more obvious—even to the public. As physicians, trying to adapt to what we cannot change while working to change what we can will be the challenge for the next president’s term and beyond.
As for me professionally, I’ll share what I have learned over the last two years. People do listen if you speak up for physicians and patients. There may be a price to pay if you choose to publicly expose business practices that negatively affect patient care and physician well-being. And the bridges you keep intact throughout your career can provide safe passage when being chased by giants.
If you don’t like what you see, stress the system to see if it can be changed. Use the medical society to support your efforts—that is why it exists.
I am lucky because I feel that I am a better person and physician because of my experiences over the last two years as DCMS President.
Dr. Andrew (Andy) Lutzkanin will be taking over the role of DCMS President for the next term. He is a much better leader and communicator than I am, so I only see bigger and better things ahead for our county medical society.
LOOKING Forward
By ANDREW LUTZKANIN, MD, FAAFP
Greetings! Please let me first say how humbled I am to have the opportunity to serve as the 155th President of the Dauphin County Medical Society. This society has a rich history of supporting physicians and their patients and has developed leaders in medicine for decades. Today, however, we stand at a pivotal moment in our society’s history. I want to thank my predecessor, Joe Answine, MD, not only for his tenure as president but for his years of service to this society and the community of medicine in Dauphin County. Under his leadership over the past two years, our society has undergone a major re-organization in its executive leadership. We have been fortunate to find our new chapter executive, Gerard Egan, as he has streamlined our operations, gotten creative with our relationship with the Pennsylvania Medical Society, and set us up to strategically look forward.
Let me pause here for a moment to introduce myself. I was born right here in Dauphin County at the Harrisburg Hospital and grew up in Middletown. I attended medical school at the Penn State College of Medicine here in Hershey. And after residency and fellowship I returned to my roots, taking
a faculty position in the Department of Family and Community Medicine at Penn State. I practice full spectrum family medicine including outpatient care at my clinic in Middletown, inpatient care on our residency teaching service, and obstetrics including C-sections. I teach Health Systems Science to the medical students, am part of the core residency faculty, and serve as medical director of obstetrics, women’s health services for our department. I have a lifelong commitment to our community and strive to make sure that our future colleagues are well equipped to enter their careers. This is where our county medical society can step in.
Through local networking, we as a society can support one another. We can foster mentorship relationships with those in training and new to practice to ensure a viable workforce for our community as the system continues to change and present ever-new challenges. We can collaborate to ensure that we all stay alert to those changes in medicine, both scientific and political, that will put us all on a path towards success. And we can come together as a safe space to share our frustrations, our ideas, and even kick back and have some fun when the moment is right.
So, as I look to the next two years as your president, my focus will be threefold:
1. What organized events or other activities can DCMS do to support its members?
I want to look to you, our members, to guide us in this. What do you value? What would you want to attend? Is it a CME conference? Is it a networking event at a local restaurant or sporting event? Stay tuned to your emails and this magazine for ways to connect.
2. What does the leadership of our society look like going forward? We all seem to be busier and busier, I get it. I have a busy academic practice, a young family, and my own personal activities. Our prior leadership structure of a Board of Governors with elected officer positions has served us well in the past and is what has brought me here, but clearly may not be the best structure moving forward. Let’s take a look around at other county societies and organizations of similar size and develop a leadership structure that ensures we can stay relevant and nimble and also continue to foster new generations of physician leaders.
3. How can we better leverage partner organizations, including PA Med, to lighten our load?
Why try to go it alone? We are well positioned geographically and structurally to partner with a variety of groups to ensure success, while also keeping an eye on the bottom line. Why not leverage the power of our health systems to provide quality CME? Why not join forces with other community organizations to provide advocacy and networking opportunities? How do we form these strategic partnerships in a way that enhances our mission and vision?
I aspire for the day when every physician, resident, and medical student in Dauphin County is a member of our society. While that day is not today, it can be our tomorrow.
A MESSAGE FROM THE DCMS EXECUTIVE DIRECTOR, GERARD EGAN
Happy New Year to our valued DCMS members! As we begin 2025, I want to take a moment to acknowledge the continued support from our society and community. As we step into this year, we’re excited about the new possibilities ahead, and I’m pleased to introduce our new President, Andrew Lutzkanin, MD, FAAFP.
Andrew’s leadership arrives at a pivotal time for our organization, as we focus on several key priorities during his term. In the immediate future, we plan to focus on creating and promoting events and activities that support our members, revisiting our leadership structure and exploring ways to improve for future generations, and better leveraging our partner organizations to maximize our impact. I am confident that Andrew’s approach will strengthen both the collective voice and network of medical professionals in our region. Please join me in welcoming him to this important role!
I would also like to extend a big thank you to our past President, Joe Answine, MD, FASA, whose leadership over the past two years has been instrumental in guiding DCMS through numerous challenges and opportunities. Joe’s tireless efforts, strategic vision, and commitment to our mission have helped set a strong foundation for our future endeavors. We are grateful for his dedication and will continue to build on the progress made under his leadership.
Finally, I want to highlight how important the input of our members has been in shaping the agenda and direction of DCMS. Your feedback, ideas, and contributions to improving healthcare in our community are the driving forces behind our initiatives. Please continue to share your thoughts and perspectives, as they are vital to our ongoing work as a society. As we advocate for policies that benefit both providers and patients, your voice remains critical to our collective success.
Here’s to a year filled with growth, collaboration, and meaningful change. I look forward to working with all of you as we shape the future of medicine!
PERIOPERATIVE CARE OF THE GERIATRIC PATIENT
A New Penn State Initiative
By JOSEPH F. ANSWINE, MD, FASA
With the advent of Enhanced Recovery After Surgery (ERAS) programs, care of surgical patients has advanced to be consistent with current literature. However, at all phases of the surgical process (pre, intra, post-operative), it also has become more complex. There are rigorous prehabilitation efforts, aggressive pre-operative assessments, relaxed fasting recommendations, nutrition support prior to surgery, a more detailed anesthetic plan, and aggressive early post-operative mobilization.
A major example of the complexity is the use of multimodal pain management. As we move away from opioid only peri-operative pain control, opioids have become a lesser part of multiple modalities utilized to produce tolerable surgical pain. Regional blocks, cognitive therapy, and many other medications are commonly used. The medications may include acetaminophen, non-steroidal antiinflammatory drugs, steroids, ketamine, alpha 2 agonists, anti-depressants, magnesium, and even cannabinoids after discharge.
However, is this more diverse and complicated process including the use of many more medications appropriate for all patient populations, especially the elderly?
Intrigued by this question, I presented an ERAS program to the division of Geriatric Medicine at Penn State. Those in attendance were attending physicians, NPs, and Fellows. The input was invaluable, especially their concerns with the aging physiology.
It turns out that little data exist evaluating whether significant benefit occurs with the use of the many components of ERAS in older patients.
Obviously, those over 65 in exceptional health will likely garner the benefit seen in younger adult patients, but what about those that are frail or cognitively impaired? Are all the components of ERAS even feasible in such compromised individuals?
Should the addition of a geriatric consult be included during the pre-operative process?
The geriatric physician could evaluate potential drug reactions between chronic medications and those used acutely before, during, and after surgery. An age-appropriate
frailty evaluation could be done to produce a reasonable pre-habilitation and post-operative rehabilitation plan. A baseline mental status examination can be done to determine the risk of and if post-operative cognitive decline has occurred. Obviously the geriatrician can participate in maximizing the treatment of any co-morbidities. And lastly but most importantly, they can assess whether the
Is this more diverse and complicated process including the use of many more medications appropriate for all patient populations, especially the elderly?
surgery is in line with the elderly patient’s wishes and short- and long-term plans.
The early goal of this initiative is to have inter-departmental discussions including geriatrics, anesthesiology, all surgical specialties, pharmacy, nursing, and rehabilitation in order to be consistent with current best practice when dealing with the older surgical patient.
Over time, we hope to be at the cutting edge of surgical care of the frail and elderly patient.
THE WOMAN WHO BARKED
By ERIC GREENSMITH, MD, PHD, ASSOCIATE PROFESSOR
ANESTHESIA & CRITICAL CARE
MEDICINE,
M.S.
HERSHEY
MEDICAL CENTER | THE PENNSYLVANIA STATE UNIVERSITY
She was elderly, disheveled, confused and alone. Mrs. G. was over seventy years old, and was the widow of a World War II sailor and, therefore, was entitled to care in the tertiary Naval Medical Center where I served as head of intensive care. A neighbor who became concerned after not seeing her usually gregarious friend for several days had found Mrs. G. at home. Mrs. G. was discovered sprawled out on the floor of her non-air-conditioned apartment on a hot Virginia summer day. She had soiled herself, reeked of urine and was issuing incoherent sounds that approximated a terrier’s bark. The neighbor called 911 for an ambulance and Mrs. G. was transported to the Emergency Room of our Medical Center. In the E.R. she was cleaned up, labs were sent and an intravenous line was started (with some difficulty since the patient was very dehydrated). Except for some tachycardia (heart rate of 110 beats per minute), she appeared physically undamaged with the possible exception of some bruising where she presumably fell to the floor.
The most disconcerting aspect of Mrs. G.’s presentation was her combativeness and her incessant barking. Every attempt to address her, comfort her, minister to her, or medicate her was met by growling and barking much as would be expected
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from a wounded dog guarding its turf. A review of her past medical record revealed that she had been seen by a psychiatrist at our facility and, in fact, had been on a pair of psychotropically (mind-affecting) active medications. To protect her from herself (and reassure adjacent patients) she was placed in cloth arm and leg restraints. It was the general consensus in the E.R. that heavy sedation was in order for this clearly deranged woman. There are only a few locations in any hospital where there is adequate staffing and monitoring to permit heavy sedation. The intensive care unit (ICU) is one such location. Thus, the decision was made to move her to the ICU where she could be sedated into manageability and it would be up
This white-haired benign-appearing woman snapped and snarled as hands reached out to lift her in the bed sheets to her new bed.
to the psychiatrists to sort out this apparent psychotic break. An element of secondary gain might have imputed to the Emergency physicians for this expedited transfer since this barking woman was unnerving patients and staff alike throughout the crowded E.R.
I met the patient upon arrival in the ICU. She looked small, shrunken and forlorn in the stretcher used to transfer her to our unit. When we went to lift her into the ICU bed her visage altered instantly at the perceived threat. This white-haired benign-appearing woman snapped and snarled as hands reached out to lift her in the bed sheets to her new bed. With some difficulty she was transferred to the new bed and the customary monitors of the ICU—blood pressure cuff, EKG patches and the pulse oximeter—were applied. Each of these devices is non-invasive and painless to the wearer but this woman, who clearly saw danger in each and every approach by a stranger, resisted them as though they were medieval devices of torture. There was a wild, vigilant look in her eye like a cornered animal. I felt like a veterinarian as I tried to use soothing vocal tone as much as word content to get through to this unfortunate woman the notion that we were there to help her.
Unfortunately, there is nothing soothing
about an ICU environment—even when all is going well. The noise level has been suggested as an OSHA hazard and the sights and smells of an old open-ward ICU have been known to bring on fainting spells by visitors, and even medical and nursing students. Ventilator alarms ring out a klaxon-like sound periodically, oximeters alarm if they slip off a patient's finger and the large, inflatable bed cushions (the least urgent of all ICU devices) emit a truly alarming siren sound that suggests something more urgen—say, a nuclear attack—is in the offing.
Psychiatry residents arrived to assess Mrs. G. Chief among the tools of the psychiatrist is language—as in “How are you feeling today, Mrs. G.?” or “What bothers you the most today, Mrs. G?” Most of the residents’ questions were met with a baleful stare but a few questions elicited the barking sounds that had been more prominent in the E.R. “Where were you born, Mrs. G?” “Woof - woof, woof, woof!” was the exchange.
While the psychiatry residents pondered this unique presentation of mania, my residents and I looked over the patient’s medication list. As much as medications have relieved human suffering over the centuries, these same medications have also caused untold heartache. There is not a medication in the Physicians Desk Reference that doesn’t have a list of contraindications (reasons not to use the drug) and side-effects longer than the list of reasons to use the drug. Our patient had been on Lithium for her bipolar mental disorder and benztropine (brand name Cogentin) for her Parkinsonism.
A brief discussion of pharmacology is in order here. Lithium is a naturally occurring element from the same chemical family as potassium and sodium. There is no natural biologic role for lithium in the body, but in the 1940s J.F.K. Cade discovered that guinea pigs fed lithium salts became lethargic. With little else in the way of science or safeguards, he tried the same remedy on agitated and manic psychiatric patients and reported good results in 1949. Since that time lithium has factored prominently in the field of psychiatry—particularly in the treatment of bipolar or manic-depressive disorders.
Patients with bipolar disorder can swing from states of agitation—mania and grandiose thinking patterns—to mute depressive states
in a matter of hours—an unfortunate “Jekyll and Hyde” existence that leaves patients and their loved ones exhausted, confused and wary. Lithium, with its mood-stabilizing properties, has been a Godsend to patients with bipolar disease but the drug is also fraught with problems. There is a very narrow “therapeutic window” for drug levels with lithium—that is the range within which it is useful but not toxic. Minor changes in hydration status—as in diarrhea, sweating or addition of other drugs that alter kidney function—can cause wide swings in lithium levels and rapidly take a patient from sub-therapeutic to toxic. Ironically, lithium itself can alter kidney function. Even at therapeutic levels of the drug, some patients become unresponsive to their own hormones that dictate when the kidney should conserve fluids by making less urine. As a result, these patients develop Diabetes insipidus (DI). Patients with DI can urinate several gallons per day—unless the patient can “keep up” and consume tremendous quantities of water to make up for the urinary losses, they are in danger of severe dehydration.
While the word “Diabetes” is common to both, Diabetes insipidus (“D.I.”) is distinct from Diabetes mellitus (“D.M.”), the common disorder of sugar metabolism. In both disorders there is copious production of urine—in Diabetes Mellitus this is because ultra-high sugar levels filtered from the blood will drag water out in the urine. In DI, the kidney becomes unresponsive to hormonal instructions to conserve fluid. The name DI come from the Latin for “lacking flavor” since the urine was sugar-free as opposed to Diabetes mellitus where the urine was “honeysweet.” Apparently medical practitioners were made of “sterner stuff” in former days and actually tasted their patient’s urine as part of their diagnostic regimen
Apparently, Mrs. G. had fallen, couldn’t get up, became dehydrated, and had gone into DI. Since all of this drama was unwitnessed, we’ll never know if the dehydration and D.I. preceded the fall or visa versa. A quick check of her blood showed that her lithium was very high and her kidneys, having sensed that she was dehydrated, had ceased to make urine and were in danger of irrevocable kidney failure.
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While this explained much about Mrs. G.’s presentation, it did not explain her aggressive behavior—especially the distressing barking. The second element of the patient’s problem was the benztropine. This drug was used for mild symptoms of Parkinsonism. It is swallowed in pill form, crosses into the brain and blocks some of the acetylcholine receptors to level up a chemical imbalance between dopamine and acetylcholine—two chemical transmitters in the brain. Too little Dopamine response yields the familiar “pill-rolling” tremor, shuffling gait and blank expression of Parkinsonism while too little Acetylcholine response can result in a patient who is “...red as a beet, hot as a hare, mad as a hatter and dry as a bone…”—a phrase memorized as a rite of passage by every second-year medical student to describe the effects of too much anti-cholinergic drug. Because the benztropine is eliminated from the body by the kidney, and Mrs. G’s kidneys were no longer working, it was as though she had taken an overdose of the drug. She was acting “mad as a Hatter.”
The phrase “Mad as a Hatter” is known to most folks via Lewis Carroll’s classic tale of Alice’s Adventures in Wonderland . The phrase was in common usage in 1865 at the time that the English author wrote his classic tale, but can be traced back at least an additional 30 years to the 1830s. One process of felt manufacture, used from the 16 through the 20th centuries, involved exposing beaver, rabbit and hare pelts to a solution of mercuric nitrate and then blowing the processed materials dry in the process of forming gentlemen’s hats. Exposure to the heavy metal mercury solution and the fumes from the drying process resulted in toxic brain syndrome known as Korsakoff’s psychosis. Thus, workers in the haberdashery trade were at progressive risk of becoming “mad.”
There is an antidote to “anticholinergic syndrome”—a medication called physostigmine that blocks the metabolism of the nerve transmitter acetylcholine. As this chemical builds up, it is successful in displacing some of the acetylcholine blocker drug and the result is a restoration of the chemical balance in the brain. We sent to the pharmacy for a vial of this (rarely used) medication.
Meanwhile, at Mrs. G's bedside the psychiatry residents were becoming frustrated. Earnest attempts to sooth her, speak with her and win a therapeutic relationship were going nowhere. As the physostigmine arrived from the pharmacy and we were drawing it up in a syringe, I heard an exchange with the psychiatrists.
“Where are you from Mrs. G?”
“Growl, ruff, ruff.”
In retrospect it seems almost humorous but at the time it was tragic and unnerving—to see a fellow human reduced to the behavior of a caged animal is more difficult to observe than arterial bleeding or an unreduced fracture.
With a syringe of physostigmine we approached the bedside. We administered a half-milligram intravenously and repeated the question.
“Where are you from Mrs. G.?” “Growl, ruff, ruff.”
The answer came clear, and unequivocal with a ring of irritation to it as in, “I've been trying to tell you—why do you keep asking?”
For a brief second, all sounds in the cacophony of the ICU faded to silence. We were alone at the bedside—me and Mrs. G. I was vaguely aware that there were a few psychiatry and ICU residents next to us. She looked tired but relaxed—gone was the caged animal—an elderly, frail woman replaced her. I was as happy as I’ve ever been in medicine—the terrier was gone and I had made contact with a person.
Meanwhile, at Mrs. G’s bedside the psychiatry residents were becoming frustrated. Earnest attempts to sooth her, speak with her and win a therapeutic relationship were going nowhere.
The psychiatry resident looked at me with disdain—as in “I just asked that question— what answer did you think you'd get?”
I thought I’d detected a little less vehemence in Mrs. G’s response—was she changing in response to the drug or just tiring of these young men torturing her with their incessant questions?
I gave an additional milligram of the physostigmine through her IV—now she had 1.5 mg and I left a little time for the drug to circulate throughout her body and percolate through to the brain. A change came over her visage—the light of comprehension came on in her eyes. She was still disheveled with her hair, hospital gown and sheets all askew but she somehow didn’t look so feral.
Geographic Service Area: 27 counties in central Pennsylvania: Adams, Bedford, Blair, Bradford, Centre, Clearfield, Clinton, Columbia, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon, Lycoming, Mifflin, Montour, Northumberland, Perry, Potter, Snyder, Sullivan, Tioga, Union, York
Board of Directors:
Jim Adams
Ryan Adams
David Ark
Marsha CurryNixon
Dr. Oralia Dominic
Olivia Edwards
Carol Gauker
Garry Gilliam
Allison Hess
Patricia Husic
Rebecca Lupfer
Steven Merrill
Eric Patton
Frank Pellegrino
Kris Pollick
Jessica Ritchie
Shila Ulrich
Ashley Visco
Top Funding Sources: Corporations, Individuals, Foundations
Better Access to Better Foods = Better Health
Food insecurity is commonly defined as “the lack of access to enough nutritious food for a healthy, active life.” Through partnerships, the Central Pennsylvania Food Bank’s Health Innovations Program connects our feeding network and clients with healthcare resources and support in an effort to promote health and wellness.
With the rising need of food pantry services across central Pennsylvania, there are many neighbors who face the double burden of food insecurity and chronic diseases like type 2 diabetes, heart disease, and hypertension. Poor nutrition is one of the key lifestyle risks for chronic diseases, and nutrient-rich foods are not always available or accessible for our food insecure neighbors. Food environments play a major role in influencing individuals’ food choices which can have a significant impact on their health. Food pantries can position themselves as integral players in health promotion by modeling healthy eating patterns, providing nutrition education resources, and increasing the availability of nutrient-rich food choices.
INITIATIVES & PROGRAMS
Supporting Provider-Based Food Insecurity Screenings and Referrals
We build intentional referral processes with medical providers and insurers to assist clients with SNAP application assistance.
HealthShare Boxes
We offer a large variety of nutritious food that can be used to help improve patient health. Boxes can also be used as part of a targeted intervention program that uses food as medicine to improve important clinical outcomes. We also manage a home delivery program to reach clients through strategic partnerships.
Supporting Clinically Based On-Site Pantries
By expanding access to healthy foods along with education and support, we work with our healthcare provider partners to help patients make a positive impact on their health.
Supporting Traditional Pantry Partners
We connect healthcare provider partners with our network to provide screenings and health education in trusted community settings.
“Our neighbors face tough choices right now between paying their rent, gas, and medical bills or buying food. Empower change with the Central Pennsylvania Food Bank today by partnering, volunteering, advocating, and donating.”
- Joe Arthur, CEO
UNLOCKING GROWTH
How MADJ Marketing Transforms Medical Practices
In today’s competitive healthcare landscape, standing out isn’t just an advantage—it’s a necessity. Patients are more informed, choices are abundant, and reputation can make or break a practice. That’s where MADJ Marketing comes in, a trusted partner in elevating medical practices to new heights. With a results-driven approach, MADJ Marketing has proven time and again that the right strategy can turn a small practice into a community leader.
A CASE STUDY IN SUCCESS
Consider the story of one medical practice that partnered with MADJ Marketing and saw a dramatic transformation. Specializing in orthopedic and musculoskeletal care, this practice had built a strong foundation in patient care but faced increasing competition and struggled with brand recognition. Before implementing MADJ’s tailored strategies, the practice had low online visibility, minimal patient engagement, and stagnant growth. Despite having a reputation for top-tier care, they lacked the digital presence necessary to attract new patients.
What started as a team of two physicians and six staff members grew into a thriving practice with four physicians, three physician assistants, and 15 support staff. More importantly, their improved digital presence led to increased appointment bookings, greater patient retention, and an enhanced reputation in their community.
THE MADJ MARKETING DIFFERENCE
So, what makes MADJ Marketing’s approach so effective? It’s a blend of expertise, innovation, and personalized strategy. A practice’s website is often the first impression potential patients get, and MADJ creates sleek,
integrate it with traditional marketing methods, such as community outreach and referral partnerships, to create a holistic growth plan. This combination ensures that practices not only attract new patients online but also establish long-term relationships that drive continuous growth.
iMADJine THE POSSIBILITIES
Every medical practice has the potential for growth, but realizing that potential requires the right partner. MADJ Marketing doesn’t offer one-size-fits-all solutions; they craft unique strategies tailored to each client’s strengths and goals. The success story above is just one example of how MADJ helps practices go from surviving to thriving.
What started as a team of two physicians and six staff members grew into a thriving practice with four physicians, three physician assistants, and 15 support staff.
The results speak for themselves. Annual website visits skyrocketed from a mere 1,500 to over 59,000, driving greater patient awareness and engagement. With strategic reputation management, the practice built trust and became a recognized name in patient care. A targeted social media strategy created a direct and personal connection with patients, fostering loyalty and engagement.
user-friendly websites optimized for search engines, ensuring that the right patients find the right practice. By focusing on specific conditions and procedures, MADJ ensures marketing dollars go further, reaching those who need care most. In a world where online reviews heavily influence decisions, MADJ helps practices build, maintain, and showcase their excellence. Healthcare is personal, and social media helps create meaningful patient connections, increasing trust and brand loyalty.
MADJ Marketing also understands that digital strategy alone isn’t enough; they
As the affiliate marketing partner of the Dauphin County Medical Society, MADJ Marketing specializes in helping medical practices grow by enhancing their digital presence and patient engagement. Through customized strategies, they ensure healthcare providers stand out in a competitive market.
Their expertise includes modern website design, search engine optimization, targeted advertising, and reputation management. By leveraging datadriven techniques, MADJ helps practices attract new patients, increase bookings, and establish trust within their communities.
Beyond digital marketing, MADJ fosters patient connections through social media and community outreach. Their holistic approach combines online and traditional marketing to create lasting growth.
With a comprehensive approach that blends cuttingedge digital techniques with proven marketing principles, MADJ Marketing empowers healthcare providers to take control of their brand, reach more patients, and build lasting success. Their expertise extends beyond marketing—they become strategic partners dedicated to their clients’ long-term growth.
If you’re ready to elevate your practice and build a stronger connection with your community, it’s time to take the first step. Contact MADJ Marketing today and iMADJine the possibilities.
For more information, visit madjmarketing. com or call 484-336-4341.
SCAN HERE FOR THE FULL CASE STUDY.
CAN PHYSICIANS SAVE HEALTHCARE?
By JOSEPH F. ANSWINE, MD, FASA
In January of this year, Gordon Morewood, a professor from Temple University Hospital, and I were interviewed by PennLive. The topic was who is in charge of healthcare.
Our answer, stripped of any fluff or sugarcoating, was that it is no longer physicians, as it was in the past. Today, healthcare systems and private equity groups hold the power.
The panel—consisting of a PennLive editor and representatives from the clergy and a minority organization—was clearly surprised by our perspective. The public, it seems, has
Doctors and nurses make up a very small percentage of the population, but patients make up 100%. Call legislators, departments of health, and medical societies and boards.
little awareness of how healthcare decisions are currently made. Based on the panelists’ reactions, people still believe that doctors make the life-sustaining and life-saving decisions. In reality, choices about studies, therapies, and specialist referrals are made far removed from those who interact with patients daily. And the individuals making those decisions are, more often than not, not medical professionals.
“Be the best” has been replaced by “be adequate and cut costs.” Calculating RVUs has replaced calculating lives saved or lost. Doctors and nurses are treated as interchangeable parts, regardless of skill or knowledge.
The panel wanted to know what the public can do to change this troubling trajectory. Our answer? Question, complain, and become more active participants in healthcare decisions. Ask who is providing your care. Inquire about their qualifications and experience.
Doctors and nurses make up a very small percentage of the population, but patients make up 100%. Call legislators, departments of health, and medical societies and boards.
As for physicians, do the same—question, complain, and engage more actively with healthcare systems. But question who or what? The system, the institutions, the insurers. If you’re worried about retaliation, it will likely come. But that Hippocratic Oath, though outdated in some ways, still declares that patients are our number one priority.
Remember, RVUs won’t help you much when you are the patient. 100% of doctors are patients too.
Talk to your patients. Let them know when the care you provide is less than ideal, and explain why.
And maybe—write an opinion piece. Post on social media. People read that stuff. The public will see what you say, right between recipes and cute dog videos.
By the way, our interview can be found on the PennLive website under the title:
“Pennsylvania doctors are sounding the alarm over health insurers putting profits above patient care | PennLive Editorial.”
“SHARING MEDS”
One morning in the fall of ’87, an ambulance backed up to our small inner-city hospital and delivered a 37-year-old single white female, in a bathrobe, who was both unconscious and hypotensive. We whisked her into the trauma bay and started IV fluids running wide open as we performed our examination. In the ER, treatment and diagnosis tend to proceed simultaneously. A precise diagnosis would help guide therapy, but we needed to stabilize the patient long enough to arrive at that diagnosis.
The patient’s name was not found in a review of our medical records, so we had little information to go on regarding her medical history, medications, or allergies. A
few minutes after we got the patient stabilized, the ER desk clerk came to tell me that the patient’s male companion had arrived.
I left the patient’s bedside and went out to the family waiting area to look for her boyfriend. He was the standing man in his 60s with disheveled clothes and a distressed look in his eyes. He saw me—or at least he saw my white coat—and he came over, hat in hand, to ask, “How is she, Doc?”
I explained that her blood pressure was very low, but we were doing our best to bring it up to normal levels. I told him that I needed information that might help us treat her more effectively.
“When did this start?”
“She was fine when we woke up this morning—talked to me and everything. Then I went to take a shower, and when I came out of the bathroom, she wasn’t talking. At first, I thought she had fallen back to sleep, but she looked different, and I couldn’t get her to wake up—even when I shook her. I called the ambulance right away.”
“Has anything like this happened before?”
“No, never. She’s in good health—ran almost 10 miles yesterday.”
“Does she take any medications?”
“No, just health stuff.”
“Does she have any allergies?”
“No.”
“Does she have any health problems at all?”
“No, Doc, I’m the one with the health issues.”
He unbuttoned the top of his shirt, revealing the upper edge of a median sternotomy scar—the kind of incision used for cardiac bypass surgery.
“I still wear a nitro patch, even after this here surgery.”
I excused myself to return to the patient but promised that we’d get him in to see her as soon as she was stabilized.
Despite a liter of IV fluid, the patient’s blood pressure was still in the 80/40 range, and she was tachycardic. Could this be sepsis?
(Low blood pressure and tachycardia are consistent with this, but her temperature was normal, and her WBC count was still pending.)
I added norepinephrine to raise her blood pressure as we continued to administer fluid boluses. I began a secondary survey, a comprehensive examination to look for clues to the cause of her symptoms. I started at her scalp and moved methodically downward. Her pupils were reactive, her mucous membranes looked dry, her lungs were clear, but her heart was pounding. Her skin turgor was poor for her age and athletic history. Her abdomen was quiet, with few bowel sounds. We placed a Foley catheter, but little urine was produced—what little there was went off to the lab for culture and analysis. I performed a
brief vaginal examination, primarily to check for a tampon—this was the era of toxic shock syndrome, which was tied to vaginal tampon use. I reached her feet without finding much of a clue.
Next, we rolled the patient to examine her backside. The back of her head, neck, thorax, and lumbar areas appeared normal. As I looked toward her buttocks, they seemed unremarkable—except for a clear mound stuck to the left buttock.
Whatever it was, we couldn’t leave her lying on it, as it would cause a pressure sore. I reached to remove the lump, but it stuck slightly to her skin. It felt like Saran Wrap
Despite a liter of IV fluid, the patient’s blood pressure was still in the 80/40 range, and she was tachycardic. Could this be sepsis?
with gel inside. White lettering on the clear plastic covering caught my attention, so I unfolded the crumpled mass to read it.
It was a nitroglycerin transcutaneous patch.
Nitroglycerin is used by cardiac patients to dilate the blood vessels that feed the heart, preventing or treating the pain of angina pectoris—the discomfort caused by inadequate blood flow to the heart muscle.
We removed the patch and washed the area to eliminate any residual medication. Over the next hour, the patient made a complete recovery.
I went out to relate the entire tale to the patient’s boyfriend. I asked him if he knew how a crumpled nitroglycerin patch had ended up on her left buttock.
He briefly looked confused—then a knowing look crossed his face, followed by downcast eyes and a slight blush.
He thought back to that morning and admitted that after waking up, he and his girl had had “…a roll in the hay,” as he put it.
“…And it involved a lot of rollin’, Doc!”
STUDENT VITAL SIGNS
ALooking Ahead: Medicine in the Next Decade
by Amogh Nagol MS ll, Drexel University College of Medicine West Reading Campus
s a medical student, I often reflect on the incredible changes we are witnessing in healthcare today and ponder what the next decade will bring. The journey through medical school provides a unique perspective—we see the challenges and opportunities emerging in real time, both in classrooms and in clinical settings. Looking ahead, three significant shifts stand out, shaping not only how we practice medicine but also how we prepare for it.
Technology is revolutionizing the way we learn and deliver care. Artificial intelligence (AI) is no longer just a concept; it is already assisting in diagnosing diseases and predicting patient outcomes. As students, we are introduced to tools like advanced imaging software and telemedicine platforms, which are redefining patient interactions. Telemedicine, in particular, has demonstrated its value in increasing access to care for underserved communities.
Yet, these advancements raise questions: How do we maintain empathy in a digital age? How do we ensure all patients benefit from
these innovations, regardless of socioeconomic status? Medical students and physicians alike must advocate for the ethical and equitable use of these tools, ensuring technology enhances rather than replaces the human touch in medicine.
From lectures on the impact of socioeconomic status on health, to the rising prevalence of chronic diseases like diabetes, it is clear that the next decade will demand a shift toward preventative care. As students, we see the impact of social determinants of health during clinical rotations, where patients’ environments and lifestyles profoundly influence outcomes. Addressing these issues will require more than individual action—systemic change and interdisciplinary collaboration are essential.
Physicians and future physicians must work together to champion public health initiatives. Whether advocating for vaccine access or tackling health inequities, our role extends beyond the clinic into policy and community engagement.
The changes ahead are profound, but they are not insurmountable. As medical students, we are learning not just the science of medicine but also the importance of collaboration. By working together, sharing knowledge, and advocating for our patients, we can shape a future where medicine continues to advance without losing its humanity.
Looking ahead, I am inspired by the resilience and determination of the medical community. Together, we can face the challenges of the next decade and build a healthcare system that is innovative, equitable, and compassionate.
IThe Possibilities, Probabilities, and The In-Between
by Peter Aziz MS ll, Drexel University College of Medicine West Reading Campus
am tasked with writing about “looking ahead at the next 10 years of healthcare and the relevant foreseen changes, for better or worse.” Frankly, I have no idea how to expand on this prompt, especially considering the current political and global turmoil.
As medical students, we are often taught to embrace the “unknown.” This comfort with uncertainty forms the foundation of the concept of differential diagnoses, where a list of potential diagnoses is developed, each correlating with the constellation of symptoms presented. The medical toolbox is then utilized to assess and adjust this list, moving diagnoses up or down based on findings. In essence, we are being trained to start with the unknown, generate possible explanations, and then evaluate evidence—or the lack thereof—to identify the most probable diagnosis.
I find myself applying this principle of comfort with uncertainty not only during patient encounters but also when contemplating the trajectory of my medical career. There are countless unknowns that my colleagues and I must accept: board exams, residency placements, and numerous other variables that could disrupt our plans. If it is challenging to envision a clear future for the few undifferentiated stem cells that are us medical students, then forecasting the future of the entire body that is our healthcare system is an even greater challenge. Yet, even if predicting the trajectory of healthcare is difficult, there must be possibilities, probabilities, and something in between.
In treating diseases, “empiric treatment” is based on extensive evidence of efficacy without a definitive diagnosis—just a probable one. Once again, physicians operate with an element of the unknown, using tools that the medical community has collectively deemed effective. These treatments are guided by a history of benefits outweighing risks, supported by a shared wealth of experiences. Similarly, a unified front among medical practitioners will likely drive the evolution of healthcare in the years to come, particularly when the realm of policy can potentially hinder rather than help our efforts. In the next 10 years, it is very possible, as has been the case historically, that our healthcare system may not always put the patient first. However, a unified medical community that advocates for the patient above all else can significantly counter this possibility, preventing it from becoming a high probability. At the same time, scientific advances—such as breakthrough treatments, artificial intelligence, robotic surgeries, and innovations across medical subspecialties—will help push upcoming changes for the better. One can hope for a positive trajectory for our healthcare system and that changes will lead to improvements, but uncertainty is also okay.
This article was originally published in the Winter 2025 edition of Medical Record magazine. It has been updated.
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Message from the 2024 Outgoing PAMED President Kristen Sandel, MD
As we come to the end of the year, I’d like to express what an honor it was to serve as your president. During my tenure, I’ve traveled across Pennsylvania visiting various practices, health systems, medical schools, and county medical societies, to discuss the importance of restoring the joy in practicing medicine. As a practicing emergency physician for over 20 years, I understand how the day-to-day stress and burnout of our profession can overshadow the passion that drives us to deliver the best care to our patients. But this year, we made strides to combat some of the issues that tie our hands in providing the utmost patient care in Pennsylvania.
Together we made a difference with several accomplishments this year:
• Made significant progress working with the Department of Health to address emergency department overcrowding in Pennsylvania. We are anxiously anticipating those recommendations being received by the Governor early next year.
• Successfully addressed noncompete clauses that were signed into law to limit this language in physician contracts.
• Safeguarded against scope of practice creep.
• Advanced telemedicine to ensure services are covered by insurance.
• Awarded five Innovation Grant recipients with funding for projects that are creatively addressing issues that have historically marginalized patients in Pennsylvania.
• Recognized 30 talented and innovative physicians as our Top Physicians Under 40 for their unique paths and approaches to patient care.
• Celebrated a dedicated physician rewarded for her decades of international voluntary services.
• Held a webinar with the National Board of Physicians and Surgeons promoting viable alternatives in board certification.
• Worked with the Foundation of the Pennsylvania Medical Society and other stakeholders to successfully advocate for the State Board of Medicine to modify impairment questions on license applications.
The best moments for physicians often come when we are closely engaged with our patients, facing challenges together, and supporting them on their journey to recovery.
Looking forward, I am excited about the continued collaboration within our community. Our shared commitment to advancing our practice in medicine and prioritizing patient safety will undoubtedly lead to even greater achievements. Let’s keep working together to create an environment where both physicians and patients thrive.
Thank you for your unwavering dedication and support. Here’s to a future filled with continued success, fulfillment, and joy in our noble profession.
(Dr. Kristen Sandel is of course a member and former President of the Berks County Medical Society. Dr. Sandel is one of a long line of Berks County physicians who have been President of the PA Medical Society; however, the first in 40 years.
We congratulate Kristen on her many accomplishments and appreciate her strong support for the care of patients and the well-being of her physician colleagues.)
This article was originally published in the Winter 2025 edition of Medical Record magazine. It has been updated.
PAMED
LEGISLATIVE UPDATES
Pennsylvania Medical Society Reacts to Governor Shapiro’s
Move to Allow Nurse Practitioners to Practice Independently
The Pennsylvania Medical Society (PAMED) firmly supports the belief that physicians should be the leaders of health care teams, advocating for a collaborative approach that prioritizes patient safety and high-quality care. As health care providers who undergo extensive
education, training, and clinical experience, physicians bring a depth of knowledge and expertise that is essential for effective medical decision-making.
However, the Pennsylvania Medical Society is deeply disappointed by the Governor’s
recent position on allowing nurse practitioners to practice independently, without the support or safety of physician supervision. While nurse practitioners play a crucial role in the health care system, it is critical to recognize that patient safety is compromised when they
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operate outside the scope of collaborative, physician-led care. Independent practice by nurse practitioners, without proper physician oversight, introduces significant risks to patient outcomes.
“Patient safety should always be our top priority,” said PAMED President Lynn LucasFehm, MD, JD. “Physicians are uniquely qualified to lead health care teams, as they bring years of comprehensive education and hands-on clinical experience to their decision-making. While nurse practitioners
are valuable members of the health care system, their ability to provide care is best enhanced when working alongside physicians in a collaborative, team-based approach. We strongly urge the Governor to reconsider this position and focus on ensuring that patient safety remains the central concern in healthcare policy.”
PAMED calls on our legislators to support policies that foster collaboration, ensuring that health care teams are led by physicians who have the depth of training necessary to
oversee complex medical decisions. We believe that effective health care is not about reducing the role of physicians but about strengthening the entire team to ensure that patients receive the safest, most effective care possible.
The Pennsylvania Medical Society remains committed to advocating for the health and safety of all Pennsylvanians and will continue to work toward solutions that prioritize patient-centered, physician-led care.
Stay up to date on PAMED’s legislative priorities at www.pamedsoc.org/Advocacy
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