Lancaster Physician Winter 2024 by Hoffmann Publishing Group

Winter 2024

H E A LT H C A R E S Y S T E MS

Working to Promote Diversity, Equity and Inclusion

plus ‘TIS THE SEASON FOR NASAL CONGESTION: WHAT CAUSES IT, HOW TO TREAT IT, & TIPS FOR PREVENTING IT BY KAREN RIZZO, MD, FACS

SUPPORTING SOMEONE THROUGH THE LOSS OF A LOVED ONE BY MARIA HAYES, DO

UNDERSTANDING THE REFUGEE EXPERIENCE TO INFORM MENTAL HEALTH MODELS OF CARE BY JEANNE MARTIN-SCZECHOWICZ

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Argires Marotti Neurosurgical Associates of Lancaster

Offers Botox Treatments to Relieve Pain from Chronic Migraine

Migraine, a neurologic disorder that often causes severe headaches, affects about 12% of people in the United States, with nearly three times as many women experiencing the condition as men, according to the American Migraine Foundation.

the U.S. Food and Drug Administration for migraine treatment.

A small percentage of people who get migraines suffer from chronic migraine, a condition characterized by the experience of headache on at least 15 days per month.

Dr. John explained that Botox works by blocking the transmission of substances related to pain that the body releases during a migraine. Blocking those substances prevents them from reaching the nerves where the pain is felt.

According to Dr. Jarod John, a neurologist with Argires Marotti Neurosurgical Associates of Lancaster, chronic migraine can be extremely debilitating and interferes significantly with daily living.

Using a tiny needle, a doctor administers Botox at 31 injection sites on the forehead, temples, back of the head, neck and upper back.

“What we do is target the affected muscles and underlying nerves,” he said. “The nerves take up Botox from the muscles, and that relaxes them and stops the pain from occurring.”

“People who have these migraines often can’t get out of bed,” Dr. John said. “They can’t care for their families or go to work. They’re extremely painful and they’re very disruptive because they occur with such frequency.”

In addition to headaches, patients often experience tightness in the jaw, stiff neck, pain in the back and shoulders and other symptoms. Botox effectively relieves that type of pain by relaxing the affected muscles.

Dr. John also noted that the number of chronic migraine patients seeking help at his practice is on the rise.

“So, it not only prevents the headaches, it helps with all those other symptoms, as well,” Dr. John said. “Most patients get very good results.”

“I probably see a chronic migraine patient every single day,” he said. While several types of medications are available to treat migraines, they aren’t effective for all patients and can cause undesirable side effects such as weight gain, fatigue, brain fog and dizziness. Fortunately, according to Dr. John, chronic migraine sufferers have another option – botulinum toxin injections. How Does Botox Treat Migraines? Botulinum toxic, most commonly known as Botox, is traditionally a wrinkle-reducing treatment used by aesthetic surgeons and dermatologists. In 2010, it was approved by

Who Can Benefit from Botox Injections for Migraines? Botox may be an option for those who suffer from chronic migraine at least 15 days per month, with headaches lasting four or more hours with each attack. The treatment must be approved by a patient’s insurance provider before doctors can administer Botox, and it can take several weeks and multiple treatments before someone experiences relief from the headaches. A treatment takes about 10 minutes, and most patients experience just mild to moderate discomfort from the injections.

Dr. Jarod John

“All my patients say the treatments are well worth any discomfort they have,” Dr. John said. “It allows them to get back to their lives without having to worry so much about another headache.” The drug wears off after about 12 weeks, meaning the treatments must be repeated. Side effects normally are minimal, Dr. John said, with the most common being drooping of an eyelid or eyebrow area. However, he noted, other possible side effects include headache or flu-like symptoms, drooling and dry or watering eye. Very rarely, Botox can spread into the body, which could cause more serious symptoms such as muscle weakness, vision problems or difficulty breathing. Dr. John recommended that patients who believe they could benefit from Botox injections speak to their primary care physicians or contact Argires Marotti Neurosurgical Associates of Lancaster for a consultation. “It’s not for everyone, but it can be a real source of relief for people with chronic migraine,” Dr. John said. Argires Marotti Neurosurgical Associates is located at 160 North Point Boulevard in Lancaster. The phone number is 717-358-0800. You can request an appointment on their

160 North Pointe Boulevard | Lancaster, PA 17601 | 717-358-0800 | ArgiresMarotti.com

contents

WINTER 2024

COVER STORY Health Care Systems: Working to Promote Diversity, Equity and Inclusion

2023/2024 BOARD OF DIRECTORS OFFICERS Stacey S. Denlinger, DO

p. 26

President

Highlands Family Practice & UPMC Wound and Hyperbaric Center

Sarah E. Eiser, MD President Elect Penn Medicine Lancaster General Health Physicians Lancaster Physicians for Women

Robin M. Hicks, DO Vice President UPMC Supportive Care & Palliative Medicine

Christopher R. Scheid, DO Secretary College Avenue Family Medicine

Stephen T. Olin, MD Treasurer Penn Medicine Lancaster General Health

Laura H. Fisher, MD Immediate Past President Lancaster Family Allergy

DIRECTORS Robert K. Aichele, Jr., DO Marco A. Cunicelli, DO | Resident Kendall R. Dempsey, MD | Resident

Best Practices 6 New Penn Medicine Lancaster General Health Program Helps Patients Avoid Hospital Stays By Providing Advanced Care At Home 8 Penn State Health Lancaster Medical Center Surgical Weight Loss Program Uses Latest Minimally Invasive Techniques And Personalized Care

10 WellSpan Uses AI to Improve Patient Safety and Reduce Nursing Burnout 12 Practice Management Insights: Motivating Your Team

David J. Gasperack, DO

In Every Issue

Anna S. Goetze, DO | Resident

5 President’s Message

30 Legislative Updates

14 Healthy Communities 22 Patient Adovcacy

33 Medical Society & Foundation Updates

25 Passion Outside of Practice

35 News & Announcements

Lena Dumasia, MD

James M. Kelly, MD Karen A. Rizzo, MD, FACS Susanne Scott, MD, MPH Danielle Rubinstein, DO

EDITORS Dawn Mentzer Beth E. Gerber Lancaster City & County Medical Society

Laura H. Fisher, MD Lancaster Family Allergy

Lancaster Physician is a publication of the Lancaster City & County Medical Society (LCCMS). The Lancaster City & County Medical Society’s mission statement: To promote and protect the practice of medicine for the physicians of Lancaster County so they may provide the highest quality of patientcentered care in an increasingly complex environment.

26 Perspectives Content Submission The Lancaster Physician 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 Lancaster City & County Medical Society. For more information or submission suggestions, please email bgerber@lancastermedicalsociety.org.

Lancaster Physician is published by Hoffmann Publishing Group, Inc. Sinking Spring, PA HoffmannPublishing.com 610.685.0914 SEE PAST ISSUES AT LP.HoffmannPublishing.com FOR ADVERTISING INFO CONTACT: Sherry Bolinger, Sherry@hoffpubs.com, 717.979.2858

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WINTER 2024

President’s Message

Happy New Year to everyone! It’s hard to believe we have passed through the holiday season already and winter is upon us. Fall was a busy time for LCCMS. Since the last issue, we have had seven of our members attend the Pennsylvania Medical Society House of Delegates in Hershey. For those of you unfamiliar with this, it is an opportunity for each county to send a delegation to debate and vote on resolutions proposed by members. These resolutions address health-related issues that impact our Commonwealth and guide policymakers to pass laws that promote health in our state. They can cover anything from food insecurity to mental health topics to education programs related to health and the body. It is not well known, but it is probably one of the most important things we do as an organization. Another important event is our annual Holiday Social & Foundation Benefit. This is when we gather to celebrate the award winners of the annual scholarship and raise money for future scholarships. The awards are given to individuals who are from Lancaster, attending medical school, and in financial need. Every summer, the LCCMS board reviews numerous applications. This year, we were able to provide four medical students with monetary gifts that will help them with the cost of their education. We hope that in the future they will come back to Lancaster to practice medicine and further enrich our community. It is always enjoyable to meet the awardees and learn more about them. We were fortunate that all our awardees had representation at the event. Check out the featured article in our Fall issue for more information about these amazing young people.

Stacey Denlinger, DO Highlands Family Practice & UPMC Wound and Hyperbaric Center Visit lancastermedicalsociety.org

The winter season is full of gatherings and giving. Whether in your own family unit or looking at the larger community, now is a good time to reflect on ways we can help those around us. Many organizations are looking for donation items, volunteers, etc. If you are able, it’s a great time to be part of something and give back to the community. I may sound like a broken record, but as a primary care physician, I can’t help but think of all the other things we also share when gathering and giving — influenza, RSV, coronavirus, adenovirus, pneumococcal disease, etc. Community members, please remember to talk with your physician about ways to protect yourself and prevent preventable diseases. While we have vaccinations against some organisms, there are multiple ways to mitigate risk. For example, hand washing and physically distancing yourself if you are ill or know someone is ill. Public health has been charged with polarizing opinions. At the end of it all, viruses and bacteria are living microscopic organisms that are spread in a variety of ways. When infected, you are potentially contagious. Not all these organisms will cause severe disease in all people. It is not a “black and white” situation, and many gray zones exist. The risk reduction strategies mentioned above have been evolving as the standard for public health practices for hundreds of years. Let us not allow decades of science-supported information to be overlooked by a series of recommendations that were delivered at a time of fear and unknown. For me, this time of year usually comes with an inherent feeling of hope and wonder. To be honest, I needed an extra dose this year. I recently saw the new Disney movie, Wish. It was what I needed— an excellent reminder of how a small amount of good spread over many can prevail against evil. Leave it to Disney! If you are also needing some magic and wonder in your life, I recommend checking it out. As always, take time and read and enjoy the articles in this issue. Thank you for the continued interest in the Lancaster City & County Medical Society. Stay well!

SD Wondering how to keep up with important LCCMS and PAMED news and updates?

Visit our website at www.lancastermedicalsociety.org

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best

pr ctices ALSO IN THIS SECTION • Penn State Health Lancaster Medical Center Surgical Weight Loss Program Uses Latest Minimally Invasive Techniques and Personalized Care • WellSpan Uses AI to Improve Patient Safety and Reduce Nursing Burnout • Practice Management Insights: Motivating Your Team

N E W P ENN MEDI CI NE LANCAST ER G ENERA L H EA LT H PROG RA M

Helps Patients Avoid Hospital Stays by Providing Advanced Care at Home

ealth care is increasingly shifting away from traditional settings, such as hospitals and doctors’ offices. Instead, more and more patients prefer to receive care in a place that offers unbeatable comfort and convenience: at home.

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Penn Medicine Lancaster General Health (LG Health) offers a growing number of programs to deliver safe, effective clinical care within patients’ homes. In addition to providing high-quality care in a familar location, the benefits of these programs include increased patient satisfaction, lower risk of complications, less stress for caregivers, and significant cost savings. A new LG Health program, Penn Medicine Advanced Home Health (PMAHH), aims to avoid hospitalizations by providing a higher level of in-home care to patients experiencing an acute change in their medical condition. Instead of resorting to an emergency room visit or hospital stay, through the program, patients have their short-term elevated needs addressed through in-home provider visits and medical management services. Penn Medicine Advanced Home Health is initially available to the approximately 400 Lancaster County patients who already receive traditional Penn Medicine Home Health services, such as nursing visits; speech, physical, or occupational therapy; or home infusion. PMAHH Medical Director Leon S. Kraybill said that in any given month, about 20% of those home health patients will experience an acute medical need that could require emergency care or hospitalization. However, many people don’t want to go to the hospital for a variety of reasons, ranging from schedule disruptions and financial concerns to the possibility of acquiring an infection. “While these patients might need quick medical attention, in many cases they don’t necessarily need to be hospitalized,” Kraybill said. “With close daily supervision by a medical provider, many of these conditions can be safely managed at home.” The PMAHH medical team’s involvement begins when a home health clinician identifies a patient with a concerning symptom, such as a low oxygen level, new fever, or weight gain.

PENN MEDICINE LANCASTER GENERAL HEALTH (LG HEALTH) OFFERS A GROWING NUMBER OF PROGRAMS TO DELIVER SAFE, EFFECTIVE CLINICAL CARE WITHIN PATIENTS’ HOMES. These symptoms could signal the patient is experiencing congestive heart failure, chronic obstructive pulmonary disease, pneumonia, or another potentially serious infection. PMAHH currently serves patients who live within 15 miles of Lancaster General Hospital. The team, which includes Kraybill and lead advanced practice provider Jessica Mendez, CRNP, temporarily assumes primary care of the patient, which includes daily home visits. On the first home visit, the team assesses the patient with a physical examination and a thorough review of medical history, medications, and acute and chronic health concerns. They establish a plan to provide necessary medical care at home, which may involve anything from lab tests and X-rays to administering intravenous medications. While PMAHH is organizationally separate from Penn Medicine Home Health, the two teams collaborate to deliver this service.

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The patient continues to receive traditional home health services, such as nurse visits and remote monitoring of vital signs, as needed. The PMAHH team also keeps in touch with the patient’s primary-care provider and other medical specialists. “There is a wide range of people involved in caring for the patient during their time of acute need,” Mendez said. “We all work together as a team to ensure that all of the patient’s needs are met, and not just those that directly involve their medical care.” In many cases, the acute concern is just one of a patient’s many health conditions. In addition to treating the immediate issue, the team looks at the patient’s entire medical picture, which could include addressing fall risks in the home or discussing advance care plans. The team also works to mitigate social factors that may be affecting the patient’s overall health, such as untreated mental health conditions, or food or housing insecurity. After the patient’s acute condition stabilizes, they return to the care of their primary care provider. The patient continues to receive traditional home health services until appropriate for discharge. For those patients who can’t be cared for safely at home, hospitalization remains an option. In some cases, it may become necessary to refer the patient to hospice care. Kraybill expects Penn Medicine Advanced Home Health will continue to grow, as the program adds more staff and expands its referral sources, admission criteria and the number of patients who can be served. “We are committed to growing this program so we can continue to provide top-notch care to more patients at home, which is where they want to be,” he said. “Our goal is to care for all of our patients whenever and wherever they need us.”

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Best Practices

P ENN STATE HEALT H LA NCAST ER M EDICA L C ENT ER

Surgical Weight Loss Program Uses Latest Minimally Invasive Techniques and Personalized Care

Dr. Allison Barrett meets with bariatric surgery patient Trina Love during Love’s one-year follow-up appointment.

Patients, most of whom leave the hospital the day after surgery, benefit from less postoperative pain and shorter healing times.

ore than 42% of U.S. adults are obese, affecting their physical and mental health and longevity and causing far-reaching societal and economic impacts.

“I’ve been using the da Vinci system for the last four or five years, and it’s been transformative to my practice,” Barrett said.

“Lancaster County Community Indicators,” a report by the Steinman Foundation, revealed that as of 2019-2021, 29% of Lancaster County adults were considered obese and 42% overweight.

Lancaster Medical Center’s surgical weight loss program is currently in the process of applying for national accreditation through the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, which sets national standards for bariatric surgery.

And while obesity, which is recognized as a chronic and progressive disease, is common, it is not easily treated. Many factors contribute to excess weight gain, and more than one approach is necessary for its treatment.

ENHANCED RECOVERY AFTER SURGERY PROGRAM Barrett also credits short patient stays to the hospital’s “enhanced recovery after surgery program,” an initiative that calls for reduced fasting times, minimal use of narcotic and opioid drugs, and an early return to activity following surgery. Patients are given liquids within a few hours of surgery, providing early access to calories and nutrition that speeds recovery. The use of narcotics and opioids is reduced by substituting a combination of acetaminophen and ketorolac, and patients receive a long-acting injected medication that provides numbness to the abdominal wall for two to three days following surgery.

One approach is surgical weight loss, available to Lancaster County residents at the new Penn State Health Lancaster Medical Center in East Hempfield Township. Dr. Allison Barrett, director of bariatric surgery at Lancaster Medical Center, along with her surgery partner Dr. Parth Sharma, perform approximately 75 procedures a year, including gastric sleeve, gastric bypass and revisional surgeries. They employ the da Vinci Surgical System to ensure a minimally invasive surgery with the greatest precision. “The robotic platform gives us excellent graphics with pristine imaging of the anatomy during the operation,” Barrett said.

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L to R: Dr. Allison Barrett, right, and surgical assistant Bri Zapata begin a sleeve gastrectomy procedure at Penn State Health Lancaster Medical Center; Dr. Allison Barrett, right, administers a long-acting nerve block medication to alleviate postoperative pain and lessen the need for narcotic and opioid drugs; Dr. Allison Barrett uses a da Vinci Surgical System to conduct a sleeve gastrectomy procedure. The system ensures a minimally invasive surgery with smaller incisions and reduced risk of complications.

Minimal narcotic use enhances patients’ ability to be active shortly after surgery, which discourages formation of blood clots, aids in digestion, and is important for mental health during recovery. Patients normally are up and walking a few hours after their operations and strongly encouraged to move as much as possible during their hospital stay and when they return home. “We’ve seen excellent results from that program,” Barrett said. “The vast majority of our patients do extremely well after surgery.” Most patients with non-physically demanding jobs are able to return to work within seven to 10 days after surgery. PERSONALIZED CARE FOR EVERY PATIENT Another feature of Lancaster Medical Center’s surgical weight loss program is the one-on-one, personalized approach to care that’s offered to every patient. “All our patients meet with their surgeon during their very first visit and get to form a relationship from the beginning of their journey,” said Taylor Ford, a nurse practitioner in the hospital’s bariatric surgery practice. “Patients often comment that they feel comfortable, safe and respected by every member of our team. We pride ourselves on that.” Prospective patients meet several times with a surgeon, a nurse practitioner, a dietitian, and a social worker to assess their needs and determine whether they are good candidates for bariatric surgery.

Team members spend significant time educating patients about every aspect of surgery so they know what to expect before, during, and after the procedure. “We want patients to be as prepared as possible, and we’ll do whatever we can to help them,” said Nicole Rhoads, a dietitian. Laurie Kelley, the practice’s bariatric nurse coordinator, assists patients with setting up appointments and coordinating their care. It normally takes between three and six months to prepare a patient for bariatric surgery. Recently, many prospective surgical weight loss patients have been leaning instead toward obesity drugs such as semaglutide, sold under the brand names Wegovy and Ozempic (a higher dose medication that was approved in 2017 to treat Type 2 diabetes). While Barrett said weight loss drugs may be effective for patients needing to lose only a modest amount of weight, surgery remains the gold standard for those with more weight to lose or who cannot afford the medications, which can be cost-prohibitive. Also, she noted, patients who discontinue use of weight loss drugs due to cost or unpleasant side effects tend to regain the weight they lost because their appetites return, often with even higher hunger levels than previously. “The decision on how to best lose weight requires an honest conversation between the doctor and the patient,” Barrett said. “Not every treatment is appropriate for every patient.”

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FROM STRUGGLE TO SUCCESS Trina Love, a Berks County resident, was suffering from hypertension, joint pain, shortness of breath and other symptoms prior to undergoing gastric sleeve surgery with Barrett in November 2022. “I was having trouble breathing,” recalled Love, who is 50. “I couldn’t even walk up the stairs in my house.” A self-described “emotional eater,” she had begun exercising and losing weight prior to her surgery, but felt she wouldn’t be able to achieve the results she was looking for without medical help. The personalized care she received before, during, and following surgery was a huge factor in increasing her comfort level and motivating her to make the necessary lifestyle changes. “I met Dr. Barrett, and I felt like she was someone who really had my best interests at heart,” Love said. “I saw the social worker two times to have my mental condition assessed and met with the dietitian and nurse practitioner to talk about the changes I’d need to make.” One year after surgery, she has lost 85 pounds and reduced her body mass index from 44 to 28. According to Barrett, Love was a model patient. “Trina Love is a great example of someone who was willing to make the lifestyle changes necessary to address the chronic disease of obesity,” Barrett said. “She was ready for real, honest change, and the surgery gave her the tools she needed to do that. She’s a great example of how we’re changing lives at Lancaster Medical Center.”

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Best Practices

The Artisight system is set up so multiple patients can be monitored at the same time.

WellSpan Uses AI to Improve Patient Safety and Reduce Nursing Burnout

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ellSpan hospitals are harnessing artificial intelligence to enhance patient safety and address nursing burnout, through a new system that allows nurses to monitor patients and perform certain routine tasks virtually. Called Artisight, the system is being rolled out across the WellSpan system with two programs that use a two-way audio/video system to virtually check on and engage with patients. Full implementation is expected by summer of 2024.

WINTER 2024

The Artisight system features a monitor in a patient’s room, for easy communication.

The programs include: • Virtual sitter, which allows a nursing assistant to use a computer module to remotely monitor patients who are at risk for falls, are forgetful, or may be impulsive about pulling out lines or tubes needed for their care. • Virtual nurse, which allows a nurse to use a computer to remotely conduct discharges, admissions, and patient education, much like a video visit with a provider works. A pilot program at WellSpan Surgery & Rehabilitation Hospital, launched in August, showed positive results, including a 39% decrease in patient falls and a 25% improvement in well-being among nurses. “The system already is making a significant impact in the quality of care we provide to our patients,” said Kasey Paulus, WellSpan senior vice president and chief nursing executive. “With the challenges our healthcare industry faces today, we are committed to augmenting our workforce, automating administrative tasks, and using technology alongside our dedicated care time to revolutionize how we deliver care.” Artisight allows WellSpan to address the staffing challenges facing health systems by allowing virtual nursing staff to support the care team at the bedside while improving care. It is part of the health system’s workforce transformation, which is redesigning how it uses people, processes, and technology to provide care to patients in the tight labor market.

It is just one example of how WellSpan is harnessing AI for better care. In other areas of the system, WellSpan radiologists are harnessing the power of Aidoc, which uses AI to quickly flag patient imaging results for abnormalities that might not be noticed by the human eye, while other providers are using a system called DAX, which uses AI and voice recognition to listen to and document a conversation between a provider and a patient, converting it into clinical notes. In the Artisight system, AI monitors patient movement, constantly learning and adapting, and can recognize when a patient moves into a position that puts the person at a higher risk of falling. Nursing assistant virtual sitters can communicate with the patient through the system, asking them not to get up and to wait for help, and alert nearby team members to quickly respond to the patient’s room, if needed. The system allows WellSpan to use team members more efficiently because a nursing assistant can monitor up to 16 patients at a time, something that would not have been possible previously due to staffing constraints. Employees feel overall that the system is improving patient safety on the unit. “Even when a caregiver isn’t in the room, the patient is never alone,” Paulus says. “Our team can quickly and effectively coordinate the care that the patient needs.” With regard to virtual nursing, WellSpan asked its own team for input on which

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workflows to target with virtual nursing. The nursing team picked admissions, discharges, and patient education. Virtual nursing provides a win-win for team members on both sides of the system. On average, having a dedicated team member virtually perform those tasks is saving other nurses two hours per shift, which frees them up for more direct patient care tasks. What’s more, nurses who are virtually doing admissions, discharges, and patient education report they feel they have more time to explain and answer questions because they don’t have other patients requiring their direct care. Virtual nursing could be used for other purposes in the future, Paulus noted, such as pain reassessment. “Once you have the hardware in place — a camera, microphone, and computer monitor — you can expand the use of it,” she said. The Artisight system also could be used for specialty consults and family care conferences. Interpreters can be invited virtually to participate as well, she noted. “While many AI solutions solve a single problem well, we are discovering that the Artisight platform may be able to solve many problems for us,” says Dr. R. Hal Baker, senior vice president and chief digital information officer at WellSpan. “We’re exploring those possibilities as we imagine what’s next with this platform.”

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Best Practices

Practice Management Insights

ADDRESSING THE ISSUES, CHALLENGES, AND OPPORTUNITIES THAT IMPACT TODAY’S MEDICAL PRACTICES

MOTIVATING YOUR TEAM

“Clean up the Matchbox cars right now if you ever want to play with them again!” I have four small kids (and one on the way!). Sometimes I nicely say (OK, yell) those words at the end of a long day. It’s a classic example of the “carrot-and-stick method” of motivation. If you do this, I will reward you, and if you don’t do this, I will punish you. For centuries this has been the go-to business method used to motivate employees with external forces, such as rewards and punishment. The problem? Research shows it doesn’t work for complicated industries such as health care. What works? Tactics that kindle internal motivation.

CHRIS MCCARTY, DO, MBA

WellSpan Family Medicine – Terre Hill

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I went to experts, WellSpan Health colleagues, to learn how they use this method.

Vice President of Medical Affairs at WellSpan Ephrata Community Hospital

“I establish clear, well-defined goals.” Megan Lecas, WellSpan Senior Vice President of Service Lines

Humans are hardwired for stories. We spend most of our time with friends and family telling and listening to stories. In our professional lives, however, we often ignore the power that stories hold to convey a message.

Creating and communicating clear goals is a pivotal initial step in motivating our teams. These goals allow each member to take ownership while giving them the autonomy to accomplish those goals. Too often we overlook the decision-making abilities of our team members by micromanaging their work. Leaders need to give clear descriptions (like a picture) of what a completed project looks like. They also need to clearly define expectations for members’ individual roles and how they function together. If you are unsure how to communicate the goals of your team, consider using the SMART framework. Goals should be specific, measurable, achievable, relevant, and time-bound. Etsy is an ecommerce company that allows small merchants to sell handmade goods via its website. In 2017, the company was on the brink of failure. More than 2 million people were using their platform and over 800 different projects were in the works to improve their revenues, but the company still was struggling financially. That is when a new CEO, Josh Silverman, stepped in to set specific goals and expectations to turn the company around. Silverman instructed his teams to focus only on projects that would have a financial benefit within 60 days. His team delivered by improving Etsy’s website search function, employing artificial intelligence to provide better recommendations, and beginning holiday promotions to return to profitability. I love his quote: “If you give a team of talented people clarity on what success looks like and what the constraints are, it’s amazing what they can do.” “Storytelling is my most powerful and motivating tool.”- Dr. Ericka Powell, WellSpan

Dr. Powell notes that stories illustrate how we are together on a shared journey. They add compassion, kindness, and thoughtfulness to our work. They give us purpose. Purpose is a powerful motivator because it shows how we are contributing to something greater than ourselves. It’s knowing the work we are doing is helping others or advancing a cause. In health care, it’s easy to know in our heads that our jobs have purpose, but we need stories for us to believe it in our hearts. Here’s an example of the power of storytelling for motivating teams from a 2007 study by Adam Grant. They studied the University of Michigan’s fundraising call center. The center was staffed with student employees who would contact alumni and ask for scholarship fund donations. They followed a strict script and were typically met with rejection. The researchers brought in previous scholarship recipients to tell the workers their stories about how the aid had helped them to achieve their goals and dreams. Now, they had a face and a story attached to what they were doing, resulting in a greater sense of purpose. Just one month later, these now highly motivated workers were bringing in almost four times as much money per week compared to before. One of the easiest ways to use storytelling in health care is to ask patients and other community members to talk about their past experiences with your health system. You want to hear from people who had both good and bad experiences. “Motivators can be and should be honored for their uniqueness.”- Ashley Zinn, WellSpan Vice President of Human Resources

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Most organizations use standardized external motivators because they seem simple, fair, and spreadsheatable (my word for things that look nice on a big, color-coded spreadsheet). Pick a few parameters to follow and dish out the cash to people who hit the goals. So, what’s wrong with that? The factors that motivate one person may demotivate another. Plus, research shows those across-the-board financial incentives almost always fall short of inspiring change. WHAT CAN LEADERS DO? Even if you have no power over changing reward structures, you can unlock internal motivation in your team members by assigning them tasks or projects that bring them joy and awaken their passions. Google has famously capitalized off this with their “20% Project.” They allow their employees to use 20% of their time to work on side projects that can benefit the company. This has resulted in innovations such as Gmail and has been a powerful motivation tool seen by the increased engagement scores. You can do something similar by giving your team members assignments or projects they personally care about. To do this, you have to know your team members. What are they passionate about? Why did they come to work at your organization? What do they do in their free time? You can try questionnaires or playing team-building games, but the way to get to know others is spending time with them. Even if your team members only spend a small amount of time each week on these projects, they will likely be more motivated in all aspects of their job. When you are looking to motivate your team, try these methods that kindle internal motivation. The problems we face in health care are only going to become more and more complicated. This will require us to do more work in teams. Kindling the internal motivation of our team members will be needed for us to face the challenges ahead.

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Healthy Communities

How Advancements in Lung Cancer Treatments May Improve the Quality of Life in Patients

LORI GERHART BSN, RN, OCN Lancaster Cancer Center

DR. HYATT P. DEGREEN III DO Lancaster Cancer Center

ung cancer is the leading cause of cancer deaths in the United States. According to the American Cancer Society, in 2023 there were 238,340 new cases of lung cancer diagnoses (117,550 in men and 120,790 in women) and approximately 127,070 deaths. Lung cancer typically has a poor prognosis with an overall survival rate of 20%. Early detection is key to better outcomes. Low dose computed tomography (LDCT scan) is recommended for adults who have no symptoms but are at an elevated risk. Earlier this year the U.S. Preventative Services Task Force (USPSTF) updated its recommended guidelines for annual screening. It recommends screening for individuals who currently smoke or have quit in the past 15 years if they are age 50 or older with a personal smoking history 20 packs per year or more (for example, one pack per day for 20 years or two packs per day for 10 years, etc.). USPSTF estimates the number of at-risk individuals who are eligible for lung cancer screening

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will almost double with these guidelines. Work is being done to help detect cancer using peripheral blood samples, which could further aid in an earlier diagnosis. Unfortunately, negative disparities in survival rates for people of color exist, specifically in individuals who are Black or Latino. Individuals in these populations are typically diagnosed at a later stage, less likely to undergo screening, and less likely to receive surgical treatment (or treatment at all). According to a BMC Cancer study, African Americans (who only comprised a small percentage of participants) were more likely to be current smokers (though with lower overall cigarette use), unmarried, to have not completed college, and have more medical comorbidities — all variables associated with poorer lung cancer outcomes. Even with the presence of these poor prognostics, low dose screening CTs resulted in the most pronounced reduction in lung cancer mortality of any racial cohort. [1] This is certainly a systemic issue that needs to be addressed in the medical community. We need to evaluate and tailor our current approaches to lung cancer screening recruitment to ensure ALL receive access to screening programs and smoking cessation counseling. It is also important to establish trust in the medical system, which could lead patients of color towards treatment paths in the event lung cancer is detected. The number one risk factor for developing lung cancer is cigarette smoking. As clinicians, it is important to identify individuals who smoke and provide ways for cessation. When individuals quit smoking at any age, they lower their risk of lung cancer. Exposure to second-hand smoke and radon can also lead to a lung cancer diagnosis. Careful assessment of these risk factors should be addressed on initial examination.

Unfortunately, most patients with lung cancer do not elicit symptoms until the disease has spread. Lung cancer symptoms may include the following: PERSISTENT COUGH CHEST PAIN SHORTNESS OF BREATH WHEEZING HEMOPTYSIS ENLARGED LYMPH NODES FATIGUE UNEXPLAINED WEIGHT LOSS There are two main types of lung cancer: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Small cell lung cancer or “oat cell lung cancer” contains cells that are smaller in size, appearing like a grain of oat under a microscope (hence the name). SCLC typically originates in the bronchi located in the middle of the chest. [2] It tends to divide rapidly and responds well to treatment modalities, such as chemotherapy and radiation. However, SCLC is more aggressive, and patients have a poorer prognosis. A vast majority of all cases of SCLC are caused by smoking cigarettes.[3] In contrast, NSCLC contains cells that are larger in size and slow growing. It affects the cells lining the surface of the lung’s airways. [4] NSCLC contains three main subtypes: adenocarcinomas, squamous cell carcinomas, and large cell carcinomas. The most common type of NSCLC is adenocarcinoma, which is typically found in the outer region of the lung and glands that secrete mucus to help one breathe. The second most common are squamous cell carcinomas, which are flat, thin cells that line the inside of our airways. Lastly, the rarest form of NSCLC are large cell carcinomas, which can be found anywhere in the lung and are typically aggressive.

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The treatment of lung cancer has changed significantly. We have therapies that can boost one’s own immune system to fight their cancer. We have molecular testing allowing us to identify mutations in the tumor’s DNA and a patient’s peripheral blood sample and administer specific targeted therapies. These therapeutic options, previously for patients in the metastatic setting, are expanding into neoadjuvant (prior to surgery) and adjuvant (after surgery) treatment. Supportive medications have improved and supportive services have evolved, both of which can improve the quality of life of patients during their care. Advances in radiation therapy too have benefited the patient population with more effective targeted approaches associated with less toxicities. Most advancements we see have been with non-small lung cancers; however, research continues in both this and small cell lung cancers. There is hope for continued therapeutic advances in the future. REFERENCES 1. Lake M, Shusted CS, Juon HS, McIntire RK, Zeigler-Johnson C, Evans NR, Kane GC, Barta JA. Black patients referred to a lung cancer screening program experience lower rates of screening and longer time to follow-up. BMC Cancer. 2020 Jun 16;20(1):561. doi: 10.1186/ s12885-020-06923-0. PMID: 32546140; PMCID: PMC7298866. 2. MedlinePlus. Lung cancer - small cell. Moffitt Cancer Center. What is the difference between small cell lung cancer & non-small cell lung cancer? https://medlineplus.gov/ency/ article/000122.htm. 3. https://moffitt.org/cancers/lung-cancer/faqs/ what-is-the-difference-between-small-cell-lung-cancernon-small-cell-lung-cancer. 4. Yale Medicine. Non-small cell lung cancer: symptoms, diagnosis, and treatment. https://www.yalemedicine.org/ conditions/non-small-cell-lung-cancer.

SOURCES American Cancer Society. Cancer Statistics Center. http:// cancerstatisticscenter.org. December 10, 2023. American Lung Association. http://www.lung.org/research/ state-of-lung-cancer/racial-and-ethnic-disparities. December 10, 2023. Association of Community Cancer Centers. http://www. accc-cancer.org. December 10, 2023. Centers For Disease Control and Prevention. https://www. cdc.gov/cancer/lung. December 10, 2023.

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Healthy Communities

’Tis the Season for Nasal Congestion WHAT CAUSES IT, HOW TO TREAT IT, & TIPS FOR PREVENTING IT KAREN RIZZO, MD, FACS

Lancaster Ear, Nose and Throat, LLC

asal congestion or rhinitis is a common symptom experienced by millions of people throughout the year. It has many causes, including infectious from viral, bacterial, or fungal contributions. Environmental stimuli such as allergic and non-allergic factors and medications can also contribute. Rhinitis involves inflammation of the mucous membranes lining the nose, eyes, and throat that contributes to sneezing, itching, and watery discharge. VIRAL RHINITIS The most common type of rhinitis is viral — or simply called, the common cold. It is usually self-limited and frequently caused by the rhinovirus. Symptoms typically last for seven to 10 days and include nasal congestion, sneezing, watery nasal discharge, postnasal drip, and sore throat. Ear infections, snoring, mouth breathing, and fatigue can be associated with viral rhinitis. If symptoms last for longer than 10 days or don’t improve, concern over an evolving bacterial infection exists and the use of antibiotics may be necessary. With viral rhinitis, decongestants are typically helpful in reducing the nasal congestion. Steroid nasal sprays may also help with nasal congestion if allergies are suspect. Antibiotics are not helpful in the treatment of acute viral rhinitis.

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ALLERGIC RHINITIS Allergic rhinitis is caused by a reaction of the body’s immune system to an environmental trigger, most commonly involving dust, mold, pollen, grass, trees, and animals. Both seasonal and year round allergies can cause allergic rhinitis. Symptoms typically include itching, sneezing, runny nose, stuffiness, watery itchy eyes, headaches, coughing, and sometimes wheezing. Treatment options include avoiding the substance that triggers the response. Nasal cortical steroid sprays can decrease nasal inflammation and are relatively safe for long term use. Antihistamines can prevent allergic reactions and its symptoms, but some are sedating. Saltwater solutions flushed through the nose via a squeeze bottle can be helpful to flush out irritants. Desensitization injections (allergy shots) contain small amounts of the substance that triggered the allergic response and help to build long-term tolerance to specific environmental triggers. Their effectiveness can take months to years to be fully appreciated. Non-allergic rhinitis is a condition where patients become congested, but the trigger is not allergy mediated. It is thought to be more of a sensitivity reaction to environmental irritants. Symptoms include sneezing , nasal congestion, coughing, and postnasal drip. Commonly, congestion increases at night when one lies down, which contributes to mouth breathing and snoring. This typically occurs because of swelling of the inferior turbinate. Intranasal anatomy consists of the nasal septum (which is cartilage and bone) and divides the right and left side of the nose. It can become deviated from birth trauma or trauma to the nose as one grows. There are three turbinates on either side of the nose that warm, clean, and humidify air as it passes to the lungs. The bottom turbinate (known as the inferior turbinate) is the largest, and it directly impacts nasal breathing. This structure swells and leads to nasal congestion from various stimuli including infectious and environmental. For some people, the act of lying down causes congestion as enhanced blood supply to the inferior turbinate causes it to swell. The person typically starts mouth breathing and eventually snores. This can be a very troublesome and annoying problem for life partners who find it difficult to sleep when loud snoring occurs. Treatment options

include steroid nasal sprays, antihistamine nasal sprays, and sometimes surgical intervention. The inferior turbinate can be reduced in size by a number of surgical techniques. Straightening of deviated septum is also helpful to optimize nasal breathing. Decongestants —such as oxymetazoline, phenylephrine, or pseudoephedrine — can be helpful. These medications are over the counter and cause blood vessels to constrict inside the lining of the nose creating reduction in congestion. Many decongestant sprays should only be used for three days because their prolonged use can result in a rebound effect in congestion. This phenomena can lead to addiction to decongestant sprays very quickly. The nasal lining can break down from chronic use of decongestant sprays leading to perforations or holes in the septum which can predispose people to nosebleeds. Rhinitis medicamentosa exists when decongestant nasal sprays used inappropriately contribute to ongoing nasal congestion. ATROPHIC RHINITIS Atrophic rhinitis is another form of rhinitis in which the mucus membranes of the nose can thin out or atrophy. This can cause hardening of the nasal passageways and a dryness effect. This typically occurs in older people. If excessive dryness occurs in the nose, bleeding can result. When patients are on blood thinners, bleeding can become problematic. These medications do not start the bleeding, dryness does. Once the bleeding starts it persists because of the patient’s decreased blood-clotting ability. Nasal dryness is the main reason for nosebleeds. Keeping the nose moist with products like saline nasal spray and Ayr nasal gel (which has aloe vera in it), and using a cool mist humidifier in the bedroom are helpful tactics. Keeping home humidity at 45% is ideal for the health of the lining of the nose and sinuses. THE RISKS OF CHRONIC RHINITIS Chronic rhinitis can lead to sinusitis. Sinusitis can be acute or chronic and involves inflammation of the lining of the sinuses. There are four sinuses on either side of the face — frontal, ethmoid, maxillary, and sphenoid. They all drain into the nose in an area called the middle meatus. The sphenoid sinus enters in a different location. Infections of the sinuses can be caused by viruses,

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bacteria, and fungus. An acute viral sinus infection is expected to improve or resolve within seven to 10 days. Typically patients are managed with supportive care. If symptoms continue to worsen then a bacterial component is likely and antibiotics are utilized. The management of acute sinus infections targets nasal congestion and watery nasal discharge. Over the counter decongestants and saline nasal spray can be very helpful. If an allergic contribution is suspect, a steroid nasal spray can be utilized. Decongestants such as Sudafed can be helpful when the eustachian tube is malfunctioning and patients are complaining of ear fullness or a change in hearing. Seventy to 80% of patients with acute sinusitis will improve on their own without antibiotics if they have a normal immune system. For those who have worsening symptoms and fail to improve within that initial seven to 10 days, antibiotics should be started. Concerns over increasing resistance to antibiotics exists and typical initial antibiotic therapy does include amoxicillin or augmentin. If there is a penicillin allergy, doxycycline is a reasonable option. When treating sinusitis, the aim is to reduce inflammation to optimize aeration and drainage of the sinuses. When sinusitis is not controlled, serious extension of infections can occur involving the brain or orbit region. At that point, hospital admission for IV antibiotics and possible surgery may be necessary. Chronic sinus infections lead to the buildup of the tissue lining the interior of the sinuses. That can lead to ongoing problems with aeration and drainage of the sinus, resulting in mucus stagnation and fueling of recurrent infection. When this occurs, a CAT scan of the sinuses will likely demonstrate tissue buildup and obstruction and the potential need for sinus surgery exists. COMMON SENSE PREVENTION TIPS It is important to remember that when sick, avoid coughing and sneezing on other people. The spreading of respiratory droplets with infectious agents can lead to the spreading of rhinitis and sinusitis. Practicing good hand washing techniques and minimizing the spraying of respiratory droplets to other people will help reduce the spread of infectious causes of both rhinitis and sinusitis.

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Healthy Communities

Understanding the Refugee Experience TO INFORM MENTAL HEALTH MODELS OF CARE JEANNE MARTIN-SCZECHOWICZ Associate Director for Integration, Church World Service – Lancaster

or over 200 years, Lancaster County has welcomed refugees and immigrants from across the globe to hope and home in our area, from Anabaptists fleeing religious persecution in Europe to Ukrainians finding peace during the current war with Russia.

neighboring country. For many, this means literally running for their lives, with no time to collect their belongings or even flee together as a family unit. As a result, many families are separated or lose contact throughout their displacement, leaving many struggling with anxiety, grief, and guilt.

Over the past 35 years, Church World Service (CWS) Lancaster has welcomed more than 7,000 new refugee neighbors from 27 different countries to our area. Unfortunately, the need for refugee resettlement continues to grow. According to the most recent United Nations High Commissioner for Refugees (UNHCR) mid-year report, 110 million people worldwide have been forcibly displaced from their homes due to persecution, conflict, violence, and human rights violations. Of those, more than 30 million are identified as refugees.

In camps or urban centers, refugees are forced to remain in a kind of limbo as they wait to understand if it will be safe to return home or what permanent solutions exist. The stability, friendships, goals, and “normalcy” that once was no longer exists, and refugees are required to navigate many new, and oftentimes complex, unknowns — whether family members have survived, if it will be safe to return, or how to regain some sense of agency with limited opportunities for employment or education.

FORCED TO FLEE Although each individual and family has a unique story of displacement, the loss of home remains the primary shared experience by refugees around the world. Forced to flee, often abruptly, under direct threat of persecution, refugees must seek immediate safety in a

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During displacement, many remain dependent on limited international aid to meet their most basic needs such as shelter, food, education, and health care. When this is not enough, families will try to identify additional resources, exposing them to additional risks such as

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gender-based violence and further persecution. Limited resources against a high demand also results in a variety of medical needs that go unmet or are not adequately addressed prior to resettlement.

and while Mariam began to heal, the complexities of her resettlement experience destabilized her well-being. Shortly after arrival, she shared with her case manager that she was having “too many thoughts” and trouble sleeping again.

THE OPPORTUNITY & GRIEF OF RESETTLEMENT While resettlement can be a life-saving and life-changing opportunity (available to less than 1% of refugees), it can also bring grief, anxiety, and additional trauma. The experiences of being forced to flee and years of displacement can be compounded by the additional stressors of integration into a new community. Navigating new financial, education, medical, and employment systems and experiencing racism and xenophobia while trying to rebuild the trust and social relationships dismantled by war can amplify mental health needs.

Referred to a CWS intensive case manager, Mariam first learned more about available resources. Interested in counseling, she received assistance connecting to a local provider. This included navigation support to arrange appointments, interpretation, and transportation. Although the agency worked with immigrants, the counselor had limited, direct experience working with refugees. Therefore, the counselor coordinated with the CWS case manager to learn more about Mariam’s initial needs and country background information. Additionally, she invited Mariam’s feedback on language support to ensure understanding and comfort. CWS staff coordinated with each other and family volunteers who were helping Mariam address basic needs as a newcomer (such as housing, ESL learning, employment) — stabilization that enabled her to engage with and continue counseling sessions.

THE IMPORTANCE OF TRAUMAINFORMED CARE Recognizing the impact of trauma on the whole person and presenting problems to steer accessible, safe, and appropriate services, can positively impact client engagement in treatment. In general, refugees often experience reduced access to care as compared to their U.S.-born peers. While individuals and families are often reluctant to seek support because of the stigma associated with mental illness, recognizing help-seeking behaviors and conditions in refugee populations can also be challenging because of differences in language and culture. Further, the cost of care, limited English proficiency, challenges navigating the U.S. health care system, and lack of transportation are other limiting factors. When care is provided, newcomers may still be struggling to assimilate to U.S. norms and expectations, making it difficult to continue with treatment independently. Yet, despite these challenges, there are numerous successes that speak to the power of collective efforts from both specialized and village supports to welcome and empower new neighbors on a pathway to heal from the traumatic events they have endured. Mariam* arrived in Lancaster after first fleeing violence in her home country. While displaced, she witnessed the murder of family members,

Benny* arrived in Lancaster with his family after his four children were born in a refugee camp. His efforts to manage household needs unraveled slowly following his first year in the U.S. as the stressors of integration compounded. Expressing he did not have friends, Benny was invited to join a men’s support group, facilitated by a CWS team member and a community volunteer (experienced in counseling). The group sessions allowed members to discuss and relate to challenges they experienced during resettlement, identify coping skills, and build additional social capital. As sessions progressed, rapport with the CWS case manager strengthened and the client expressed additional support needs. With consent, the client was also supported in connecting with a professional counselor. Both of these individuals were supported in accessing inclusive mental well-being services that included one or a combination of the following: psychoeducation, counseling, community sociotherapy and alternative wellness initiatives, mentorship, and/or crisis intervention when necessary.

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Mariam and Benny were both able to continue care thanks to coordination between CWS case managers, family members, community leaders (including former refugees), and social service providers. With this coordination, barriers that may have prevented long-term access to care — such as language, costs, and transportation — were addressed and managed. BUILDING A COMMUNITY OF CARE By strengthening the community’s understanding of the refugee experience and working together across sectors, we better position ourselves to create safe spaces that foster healing. As providers, it is essential that we approach care through a culturally humble lens and remain willing to learn alongside our clients. We must consider the communication methods we regularly utilize and incorporate additional tools when necessary. We must remember that no one size fits all, and “western-style talk therapy” may be welcomed by some but not by others, so we should continue to explore and support connections to additional engagement opportunities in the community that help restore peace and dignity. We must remember to offer support, build awareness and understanding of what mental health services can be, and recognize that this conversation may be ongoing. And we must coordinate with other formal and informal helping providers and refugee community stakeholders to ensure basic needs are met, making space for newcomers to set goals and restore trust. The internal wounds created by war, forced displacement, and loss of livelihood can take time to heal. For some, this can be a smoother journey of rebuilding, relearning, and reconnecting. For others, the resettlement journey is very much a trauma-healing phase that requires additional support. Yet, feeling safe in one’s heart and mind serves as the foundation for successful integration and the potential for all community members to thrive. *Note: pseudonyms have been used to protect the identity of the individuals in this story.

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Patient Advocacy

SUPPORTING SOMEONE

Through the Loss of a Loved One

MARIA HAYES, DO

Hospice & Community Care

rieving begins the moment a person receives a life-limiting diagnosis. Patients and family members grieve a variety of losses ranging from physical limitations to hopes and wishes for the future. After a death, individuals can be impacted in many ways — physically, emotionally, cognitively, socially, and spiritually for many months. Although it is a natural process, many may feel overwhelmed, anxious or compelled to search for a quick remedy. Those who are grieving need someone to listen who will not judge, problem-solve, or give advice. A willing ear and acceptance of whatever they are feeling is the greatest gift.

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The following are some suggestions for ways you can be helpful during this stressful time. Be there. Grieving individuals need support and presence more than they need advice. Be observant. Actively listen to what they have to say. Be aware that the bereaved person is feeling vulnerable. Their self-esteem may be very low. Be alert to verbal and nonverbal communication. Watch for physical reactions to the death (lack of appetite, sleeplessness, headaches, inability to concentrate). These are normal reactions but will affect their coping ability, energy, and recovery, especially over time. Use them as clues for what support is needed. Be patient. Remember that they need to talk about the person who died. Important questions and concerns may take a while to come out. Bereaved individuals will grieve for months to come.

Be aware of your needs, as well as your limitations. Watch your own stress level; as you are trying to help others, take care of yourself. Helping Children and Teens Cope with the Loss of a Loved One Losing a loved one is challenging for people of any age, but especially for children and teens. After a death, many children and teens feel alone and confused. They may be worried that someone else they care about will die, but they often keep their fears to themselves. Here are some ways to help children and teens cope with their feelings and the loss of their loved ones. • Understand that children’s expressions of grief are often brief and episodic. • Provide reassurance of your ability to love and care for your children despite your own grief. • Invite children to participate in rituals, either directly or indirectly. They can write about the person who died or convey their views to other presenters at the rituals.

Be honest. Honesty is important and can be gently delivered.

• Help children choose appropriate mementos that belonged to the deceased.

Be attentive. Adapt your responses to the situation. Prepare the person for what to expect in the future. Offer specific ways you want to help.

• Create an open environment for sharing and asking questions. Teens need to be able to express their thoughts and feelings about death and have those feelings validated.

Be cautious about sharing your own experiences of loss. Most grieving people need to talk about their loss, not listen to yours.

• For many teens, keeping the clothing of the deceased, or having a significant item (a watch or other jewelry, sports equipment or trophies, or tools) helps them “feel closer” to the person who died.

Be supportive and accepting, regardless of what feelings they express. Be helpful in practical matters, such as running errands, preparing meals, or offering childcare. Be hopeful. As difficult as it may appear to bear, your belief in someone’s ability to heal and grow may help them rediscover strengths and qualities they had forgotten. Be honored to be a support at this critical time in their lives.

• Young children’s regressive behavior may include stubbornness and “acting out” as well as sleeping problems and some anxiety about returning to school. • Normalize children’s concerns about returning to school and feeling “different” from their friends. • Encourage your child or teen to return to school and other activities soon after the death. They will benefit from the normalcy and a sense of security from the routine. Inform the school of the death. Explore

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supportive services available to children if they become upset while at school, collaborate with school staff, and identify a trusted school staff member who can offer support while they are in school. • Encourage the teen to draw support from their peer group and other important adults, such as teachers and relatives. Community Resource – Pathways Center for Grief & Loss The Pathways Center for Grief & Loss, a program of Hospice & Community Care, is a free resource to our community, regardless of whether your loved one was a hospice patient. The team at the Pathways Center specializes in helping people cope with serious illness or loss after death. Professionally trained master’s-level counselors are available to: •P rovide support to individuals of all ages. • E ducate people about common grief responses. • Facilitate opportunities to interact with others who have had similar experiences through support groups. • Teach effective coping skills. • Help individuals realize the choices they have on their grief journey. Please call the Pathways Center to speak with someone about how we can help. Counselors are available Monday through Friday, 8:00 a.m. to 5:00 p.m. The Center is located at 4075 Old Harrisburg Pike, Mount Joy. For more information, call (717) 391-2413 or visit www.PathwaysThroughGrief.org. Being a support to someone who is grieving is hard work. You cannot give the bereaved what they really want, which is to have their loved one back. This can leave you feeling helpless, wishing you could do more for them. Remember what is most important is that you show that you care and are there for them. You do not have to have all the answers; you just need to be willing to listen.

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Healthy Communities

Thyroid T Eye Disease

hyroid Eye Disease (TED) is an autoimmune disease caused by circulating autoantibodies that attack the thyroid and can independently attack the retro-orbital tissue. TED is commonly associated with hyperthyroidism, and it is part of the Graves’ triad, consisting of: hyperthyroidism, ocular and periocular signs and symptoms, and pretibial myxedema. In my experience, pretibial myxedema is rarely seen. TED is more common in women than in men, affecting twice as many women. While most often associated with hyperthyroidism, TED can also occur in individuals with normal thyroid function or even in hypothyroid patients. TED is worsened by smoking, as smoking suppresses T suppressor cells; this can worsen the inflammatory response. TED can occur at the outset of thyroid disease or many years after thyroid disease has been stabilized.

Causes, Symptoms, and Treatments DAVID I. SILBERT, MD, FAAP

Conestoga Eye

The patients we, as oculoplastic specialists, see in our office have often been diagnosed with TED and are sent to us due to more severe signs and symptoms. Often, they have been placed on methimazole. They will typically be treated with methimazole for 18 months or longer. In patients who do not achieve control with methimazole, next steps include thyroidectomy or radioactive iodine (RAI). There is increased risk of worsening of TED with RAI; thus patients treated with RAI are generally prescribed steroids while they undergo treatment. More commonly, patients with eye disease symptoms will have thyroidectomy instead of RAI as there is less risk of worsening the eye disease.

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The severity and combination of symptoms can vary widely among individuals with thyroid eye disease. The condition typically lasts for a number of months then stabilizes. Control of hyperthyroidism can be helpful. However, more significant findings including eye protrusion, eyelid retraction, or misalignment of the eyes will not fully improve with stabilization of the disease. Historically, treatment involves managing the underlying thyroid dysfunction, oral or IV pulsed steroids used for short periods to control inflammation, and in severe cases, orbital radiation or urgent surgical intervention, including orbital decompression in cases of optic nerve compression, and/or eyelid surgery in acute cases of corneal exposure. If possible, surgical intervention is delayed until the thyroid disease is stable because premature surgery can cause activation of TED. Once the thyroid disease is stable, surgery can be performed including orbital decompression, followed by strabismus surgery in cases of eye misalignment and finally eyelid surgery for retraction and malposition of the eyelids. If surgery is anticipated, it is best to follow this order, though many patients only require eyelid surgery and don’t need orbital decompression or strabismus surgery. Recently, teprotumumab (Tepezza) has been introduced which has significantly changed the way thyroid eye disease is treated.

Common Signs and Symptoms Proptosis: One of the most obvious signs of TED is exophthalmos, the protrusion of one or both eyes. This occurs due to inflammation of the eye muscles and tissues behind the eyes, causing proptosis of the eyes. In combination with eyelid retraction, exophthalmos can cause eye irritation, dryness of the eye, and can significantly alter the appearance of the individual. In severe cases, exposure can lead to corneal scarring, infection, and ulcers. Eye redness, tearing, and irritation: Inflammation can lead to redness, swelling, and discomfort in and around the eyes independent of proptosis or retraction of the eyelids. The eyes may become dry and irritated, which paradoxically can cause increased tearing.

Vision changes: TED can lead to changes in vision: ranging from mild blurring from surface tear film irregularity to more severe visual impairment from optic nerve compression or from dryness or scarring of the cornea. Double vision (diplopia): TED can cause misalignment of the eyes from enlargement of the extraocular muscles. Most often the medial rectus and inferior rectus are affected, but the muscles can be affected asymmetrically with one eye worse than the other. Enlargement of extraocular muscles can lead to restriction of motility, strabismus, and double vision. Often the diplopia can be worse in certain gazes. Eyelid retraction and lagophthalmos: Exophthalmos and retraction of the upper and/ or lower eyelids can impair closure of the eyes. This can cause functional issues such as dryness and exposure, but it also creates cosmetic issues impacting a patient’s self-esteem. Sensitivity to light: Increased sensitivity to light (photophobia) may occur from increased exposure of the eyes. Eye pain: Many individuals with TED experience pain or discomfort in the eyes. The pain can be surface pain or deep orbital pain with or without movement of the eyes.

Management and Treatment The treatment of thyroid eye disease depends on the severity of the disease process. The goals of treatment are to manage inflammation, relieve symptoms, and address any complications. Thyroid management: If TED is associated with hyperthyroidism (Graves’ disease), managing the thyroid dysfunction is important but generally not curative with respect to the eye issues. Treatment typically involves medications such as methimazole, radioactive iodine, or thyroidectomy. Following initial treatment, thyroid replacement is often necessary. Surgery is deferred if possible until the thyroid status is stable. Tear substitutes and lubrication: For individuals experiencing dry eyes, artificial tears or lubricating eye drops can help relieve discomfort and maintain eye moisture.

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Ointment at nighttime is also helpful as there is often nighttime lagophthalmos (incomplete closure of the eyelids). Corticosteroids: Steroids can be administered orally, topically, or intravenously as pulse therapy to reduce inflammation and alleviate symptoms. Steroids may be effective in managing acute phases of TED, however, the disease invariably re-flares once steroids are discontinued. Steroids are associated with significant side effects and are not a good long-term solution. Orbital radiation therapy: Radiation therapy can be used to reduce inflammation and prevent progression of TED. It can be considered in more severe disease, such as optic nerve compression or severe exposure. It, too, has potential side effects and is not an option in patients with other retinopathies, such as diabetic retinopathy. Surgery: In more severe cases or when there are complications, surgical interventions may be considered. Orbital decompression surgery may be performed in cases of optic nerve compression or severe proptosis leading to exposure. It can also be used to restore a more normal appearance in patients with exophthalmos once the thyroid disease is stable. Orbital decompression enlarges the size of the orbit by removing bone to allow the retro-orbital tissue to expand into the sinuses. If orbital decompression is performed, it is best performed as the initial procedure, as strabismus (misalignment) can be worsened following orbital decompression. If the patient needs additional surgery, strabismus surgery to correct eye misalignment is typically performed followed by eyelid surgery to address retraction or other eyelid malposition. Correcting strabismus and diplopia in TED patients with prism or strabismus surgery is more difficult than in typical strabismus patients as there is often fibrosis of the muscles and the strabismus can be incomitant (better or worse depending on gaze direction). Typically strabismus surgeons seek lack of diplopia in primary position and in downgaze so patients can read. It’s important to recognize that TED can reactivate at any time and results from surgery are variable. Continued on page 24

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Tepezza: Teprotumumab (Tepezza), a human insulin-like growth factor-1 receptor inhibitor, has revolutionized treatment in TED. It was approved by the FDA in 2020 for patients over 18 years old and is the only treatment approved by the FDA for TED. In 2023 the FDA updated teprotumumab’s indication to include use for the treatment of all TED patients, though private payers typically will only approve teprotumumab for patients with a clinical activity score of 5/7. Treatment consists of eight infusions every three weeks and costs in excess of $300,000 for the treatment regimen. In many cases, surgical intervention is no longer required after treatment with teprotumumab, or less surgery is required. Pricing of teprotumumab is quite controversial, especially after Horizon Therapeutics, the developer of Tepezza, was sold for $20 billion to Amgen.

Teprotumumab typically decreases inflammation with studies showing an average decrease in proptosis of 2mm — similar to what can be achieved with orbital decompression. We have seen impressive results with teprotumumab, including decrease in inflammation, reduction in proptosis, and resolution of strabismus and diplopia.

Resources

For patients with thyroid disease who have developed significant eye signs and symptoms, it is reasonable to schedule an appointment with an ophthalmologist for a baseline examination. Control of thyroid disease is important but does not prevent the possibility of developing TED. Finally, patients who smoke should be encouraged to discontinue smoking as it significantly increases the risk of developing TED.

Smith, Terry J., et al. “Teprotumumab for thyroid-associated ophthalmopathy.” New England Journal of Medicine, vol. 376, no. 18, 2017, pp. 1748–1761, https://doi.org/10.1056/ nejmoa1614949.

Douglas, Raymond S., et al. “Teprotumumab for the Treatment of Active Thyroid Eye Disease.” New England Journal of Medicine, vol. 382, no. 4, 23 Jan. 2020, pp. 341–352, https://doi.org/10.1056/nejmoa1910434. Hubschman, Sasha, et al. “Teprotumumab and Orbital Decompression for the Management of Proptosis in Patients with Thyroid Eye Disease.” Ophthalmic Plastic and Reconstructive Surgery, 16 Nov. 2023, https://doi.org/10.1097/ iop.0000000000002563.

“Thyroid Eye Disease - EyeWiki.” Eyewiki.org, eyewiki.org/ Thyroid_Eye_Disease. Ting, Michelle, et al. “A Comparison of Proptosis Reduction with Teprotumumab versus Surgical Decompression Based on Fat-To-Muscle Ratio in Thyroid Eye Disease.” Orbit, 17 Nov. 2023, pp. 1–9, https://doi.org/10.1080/01676830.2 023.2282509.

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Passion Outside of Practice

Jilian White, MD

WellSpan OB/GYN and WellSpan Vice President of Medical Affairs

It’s our pleasure to highlight a Lancaster City & County Medical Society member’s “passion outside of practice” in each issue of Lancaster Physician. Beyond their commitment to health care, LCCMS members have many other talents, skills, and interests that might surprise you. In this issue, we’re thrilled to feature Jilian White, MD, and her passion outside of practice. our careers. As his interest in the sport began to wane, my interest grew. I was training seven days — 10 plus hours — a week. My first full distance triathlon was IRONMAN Maryland in 2016. I can say that full distance IRONMAN is not my favorite race distance, but it is awesome when you cross the finish line and hear, “You are an IRONMAN”. Qualifying for and competing in the 2023 IRONMAN World Championships in Kona, Hawaii is the pinnacle of Dr. White’s athletic achievements thus far.

How long have you been participating in this activity?

I have been competing in triathlons for the last nine years.

Why is this pursuit special to you?

Triathlon has taught me more about myself than any other activity in my entire life, more than even residency. Training for long distance races is all about dealing with how to handle your mind when you are doing something monotonous, boring, and uncomfortable. But when you succeed, there is something euphoric about breaking through and hitting a personal record. I truly believe that this is the reason endurance sports are so appealing to so many physicians. It is an opportunity to see how far you can push yourself. Having finished a 750-meter swim and 12.4-mile bike race, Dr. White finishes a 3.1-mile run at IRONMAN Maryland.

Dr. White and her husband in 2014 at their first triathlon.

Competing in Triathlons Would you briefly describe your passion outside of practice for those who might be unfamiliar with it? Triathlon consists of completing three sports in succession. Many times, triathletes will joke, “Why be mediocre at one sport, when you can be mediocre at three.” Triathlon typically is completed in the sequence of swim, bike, run, but it does not always go in that order. There are varying lengths of triathlons that people compete in. Shorter courses typically consist of a 750-meter swim, 12.4-mile bike, and 3.1-mile run. The distance increases incrementally to the full

distance triathlon which is a 2.4-mile swim, 112-mile bike, and 26.2-mile run — a.k.a. IRONMAN.

How did you develop an interest in your passion outside of practice?

My passion started when my husband and I decided to try the sport in 2014. We participated in the Mount Gretna triathlon called “Got the Nerve.” We were both hooked. After the race, my husband decided he wanted to run a full distance triathlon in the next two years, so I decided to try it too. We were just two people trying to stay in shape while raising a family and building

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What else would you like readers to know about this passion?

Triathlon is one of the most rewarding activities I have ever participated in. I started competing in triathlons as a back-of-the-pack kind of athlete. I was happy just to not have to walk during the run portion of the race. Every year I got better and better. Eventually, I decided I wanted to try and qualify for an IRONMAN World Championship Event. In 2021, I qualified for and competed in the IRONMAN 70.3 World Championship in St. George, Utah. Later, I decided to return to the full distance races. I returned to IRONMAN Maryland in 2022. It was my breakthrough race. I placed top ten and qualified for IRONMAN World Championships in Kona, Hawaii. In the world of triathlon, Kona is the pinnacle. I completed the IRONMAN World Championships in October 2023. If you had told me nine years ago that I would have accomplished so much in this sport, I would have thought you were crazy. Now, I truly believe that anything is possible.

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Perspectives

H E A LT H C A R E S Y S T E M S

Working to Promote Diversity, Equity and Inclusion SUSAN SHELLY Writer

ncreasing attention is being given to issues of diversity, equity, and inclusion (DEI) across a range of businesses and industries, including health care. And as patient populations become more and more diverse, the need for awareness of and sensitivity to the needs of all cultures represented becomes increasingly urgent. Health care systems across the country — including those serving Lancaster County — are working to assure inclusion for all patients, remove barriers to care, increase diversity among employees, enhance cultural competency, and take other steps toward assuring diversity, equity, and inclusion in health care. Lancaster Physician reached out to the health care systems serving Lancaster County to learn more about their efforts in these areas. We spoke with representatives from UPMC, WellSpan Health, and Penn State Health, and received answers to questions by email from Penn Medicine Lancaster General Health.

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UPMC UPMC was early to the table regarding its efforts related to diversity, equity, and inclusion, Tina Nixon said Tina Nixon, vice president of Mission, Effectiveness and Diversity, Equity and Inclusion for UPMC in Central Pennsylvania. Nixon was hired in her role more than nine years ago and has enjoyed strong support from leadership in her efforts to enhance diversity and make UPMC’s facilities more inclusive for all patients. “DEI is a buzzword now, but it’s nothing new to us,” Nixon said. “We’ve recognized the importance of understanding our patients and their needs for a long time.” She cited a number of programs and initiatives at UPMC in Central Pa., including diversity dialogue dinners in partnership with regional YWCAs and “Lunch and Learns,” where employees are given safe space to ask questions and express concern about sensitive matters. A monthly educational series focuses on issues of cultural awareness, such as understanding different religions and cultures. The theme of January’s series is human trafficking awareness. “We are constantly looking for ways to engage and educate our staff and members of the community,” Nixon said. “The more we know about each other, the better.” Each of UPMC’s seven central PA hospitals, including UPMC Lititz, has a Diversity, Equity and Inclusion Council that is responsible for disseminating systemwide information to staff. Because language is important in efforts surrounding diversity, equity, and inclusion, staff members can apply for the Bridging the Gap Medical Interpreter training program, a nationally recognized program. Those accepted for the program must successfully complete a curriculum before being certified as a medical interpreter. “This program is advantageous because it helps our staff members who are bilingual learn to become effective translators,” Nixon said.

Employees also receive communications training about choosing non-offensive words and avoiding words that may negatively impact certain populations. “The words you use matter,” Nixon said. UPMC also provides training on issues associated with sexual and gender identity, encouraging providers to consult all patients on their preferred names and pronouns. Patients also are screened for social determinants of health to help determine their access to food, housing, clothing, transportation, affordable childcare, employment, and other conditions that can challenge access to care and impact health outcomes. When needs are identified, providers can connect patients with community services to help meet them. “We’re able to begin closing the loop on some of those social determinants of health by connecting patients to services within our community,” explained Nixon. “We’ve developed a lot of important partnerships, and we work closely with those partners to get our patients the help they need.” Looking ahead, UPMC in Central Pa. will introduce training in neurodiversity in 2024, educating employees about how people learn and work differently depending on brain function and behavioral traits. The system also is working to increase its proportion of employees with disabilities. “We’re taking a broad view and working with a goal of eliminating health disparities within our region, and we’re fortunate to have a leadership team that supports that mission,” Nixon said. “I think there’s still much more to come.” WELLSPAN HEALTH WellSpan Health is one of only three health care systems in the country, and the first in PennAnn Kunkel sylvania, to receive health equity accreditation from the National Committee for Quality Assurance. The accreditation, which recognizes WellSpan as a leader in addressing health equity, was

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awarded in August and sets the health system apart from others in its efforts around diversity, equity and inclusion, said Ann Kunkel, vice president of community health, homecare and hospice. “Health equity is in our DNA at WellSpan,” Kunkel said. “It’s in our blood and in everything we do.” Earlier in 2023, the health system was recognized for its DEI initiatives, training programs, and leadership by national and regional publications, including Newsweek and Training magazine. Kunkel, who has served in her current role since 2020, said that while WellSpan has long been cognizant of DEI-related issues, efforts to address them intensified during the pandemic when inequities in the availability and distribution of vaccines became apparent. Additional programs were initiated to raise awareness and educate staff, and structures were put into place to help assure equitable treatment for various populations. “I think that’s the essence of health care,” Kunkel said. “You can’t provide quality care without addressing the uniqueness of the people you’re serving.” DEI training is part of orientation for new employees and leadership training is provided throughout the year. More than 150 WellSpan team members have graduated since 2022 from the health system’s Inclusion Champion program, which trains employees to actively serve as allies and promoters of equity for patients and one another. Earlier this year, WellSpan introduced HeretoHelpAll.org, an online resource and referral tool aimed at connecting community members with available services. More than 5,000 referrals were made to community-based social service providers since the program launched in February 2023. “Our long-term goal is to be able to have a closed-loop connection with those agencies,” explained Kunkel. “Our patients can’t enjoy Continued on page 28

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Perspectives optimum health when they’re struggling with food or housing insecurity.” Patients also are asked to use a self-screening tool for social determinants of health when entering a provider’s office. WellSpan leadership is addressing a growing Haitian Creole population in Lancaster County by providing additional language resources and reaching out to residents requiring health services. The system is increasing the number of interpreters available and employs video interpretation as needed. “We’re working very hard on that,” Kunkel said. “Any time we get more than 1,000 people of a certain population in our area we need to start putting tools into place.” In other efforts, WellSpan is working to increase screening rates for colorectal and breast cancers while closing the disparity gap for people of color, encouraging employees in non-medical roles to train toward transitioning into medical roles or advancing in medical roles and providing vocational training in Lancaster County through a partnership with the Spanish American Civic Association. PENN STATE HEALTH Lancaster County is home to a diverse population, including significant numbers of Hispanic and Amish residents, African Lynette Chappell- Williams Americans, a growing Nepali community, and others. Penn State Health recognizes that diversity and is making every effort to understand and serve the needs of all residents, said Lynette Chappell-Williams, vice president and chief diversity officer. “As we address the unique needs of these diverse communities, we find that it lifts up the population as a whole,” she said. “The better we can understand each other, the more everyone will benefit.” The health care system established diverse patient councils that are charged with addressing the needs of patients with disabilities, members of the LGBTQ community and patients of different racial/ethnic backgrounds and cultures.

Councils include physicians, individuals from varying communities served by Penn State Health, employees who are responsible for patient satisfaction, and others. “I cannot tell you how much I’ve learned during the course of conversation between the members of those councils,” Chappell-Williams said. The new Penn State Health Lancaster Medical Center, which opened in October 2022 in East Hempfield Township, includes a parking lot that accommodates horses and buggies used by Amish patients, and the inside of the hospital features gender-neutral restrooms and accommodations for patients with disabilities. More than 200 professional artists were commissioned to create 450 pieces of art reflecting the experiences of various ethnic groups, which is displayed throughout the building. “It’s not what you’d expect in a hospital,” Chappell-Williams said. “Everything in that facility was done to encourage a feeling of safety and respect, which can go a long way toward building trust.” Efforts by Penn State Health to address DEI-related issues intensified significantly following the pandemic and killing of George Floyd. “Those events were wake-up calls for us,” Chappell-Williams said. “We knew we had to tackle the issue of racism head on, and we needed to address the problems the pandemic laid bare. We knew there have always been health disparities among different populations, but COVID really put it out there for everyone to see.” In response, town hall-style meetings were held for employees and a zero-tolerance-for-bias policy adopted. The needs of patients were scrutinized, and social determinants of health examined. “We realized that we needed to address health disparities in a much grander way,” Chappell-Williams said. “We started really looking at how underlying health concerns caused by issues like food insecurity, housing and transportation were affecting the people we serve.”

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As a result, patients are screened and connected with needed services whenever possible. Staff members are educated about social determinants of health to raise awareness and more language interpreters have been hired. Employees are given opportunities to participate in conversational Spanish classes designed to help them better communicate with patients, and the health care system works to identify and utilize bilingual faculty and staff who are qualified as medical interpreters. It also is in the process of hiring a Nepali interpreter to join the current Spanish and American Sign Language interpreters. “We know we have to keep working on breaking down language barriers,” Chappell-Williams said. She credited Penn State Health CEO Stephen Massini with advancing the health system’s push toward increasing its DEI efforts. “It was all driven by our CEO, Steve Massini, who recognized the importance of addressing issues of DEI,” she said. With so many efforts underway, team members from the Office for Diversity, Equity and Inclusion are now working to determine the health care system’s level of success in combatting bias and promoting inclusivity. “We’re looking at how to measure the way actions are being put into place and how employees are held accountable,” explained Chappell-Williams. “We’ll keep working on what we’re doing because it’s our goal to be the most trusted health care provider in the region.” PENN MEDICINE LANCASTER GENERAL HEALTH Recognizing that its mission of advancing the health and Dr. Jean David well-being of the communities it Dumornay serves can only be fulfilled when everyone has the opportunities and means to reach and maintain good health, Penn Medicine Lancaster General Health is taking actionable steps toward achieving equity and improved health outcomes for all. “For far too many people in our community, there are health disparities that can affect

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everything from their ability to access life-saving cancer screenings to the likelihood that they’ll experience a serious complication during childbirth,” Dr. Jean David Dumornay, executive director of the Department of Diversity, Equity and Inclusion, wrote in an email. To help combat disparities that are driven by issues with language, LG Health in 2010 implemented a Linguistic Employee Advancement Program (LEAP) to train bilingual employees to become skilled medical interpreters. Participants complete a rigorous training program, after which they can serve as LEAP interpreters, in addition to other interpretation services available to patients, family members and visitors with limited English proficiency or who are deaf or hard of hearing. In addition to in-person, interpreting services are available by phone or video. “We know that language barriers can present a range of negative consequences for patients who have limited English proficiencies, including lower compliance with care instructions, medication usage and follow-up care,” Dumornay wrote. “That’s why it’s so important that we offer qualified medical translation services to our patients.” LG Health has partnered with a diverse group of community members to form a community advisory board that provides recommendations on how the health system can best work toward building trust and understanding with marginalized communities.

LG Health is proud to have received the highest rating in the Human Rights Campaign Foundation’s National LGBTQ Healthcare Equality Index. Designated as an LGBTQ+ Healthcare Equity Leader, the system is recognized for its commitment to providing supportive, affirming care to LGBTQ+ patients and their families and for assuring an inclusive workplace and community outreach. “This is just one example of our continued focus on cultivating mutual respect and understanding with our colleagues and everyone we serve, regardless of background,” wrote Dumornay. Looking to the future, the Department of Diversity, Equity and Inclusion is working with human resources to implement an ASPIRE leader development program aimed at ensuring the continuation of equal opportunities for internal development and promotion for all employees, no matter their background. That effort is vital in ensuring a diverse workforce that is representative of the patients the hospital system serves, according to Dumornay. “We will continue to pay special attention to hiring, promoting, and retaining a diverse workforce that is representative of everyone in the communities we serve,” he wrote. “Our patients and community expect and deserve nothing less.”

Working alongside you to care for your patients with serious illness at home.

The group works together to address social determinants of health, including poverty, food insecurity, substance abuse, behavioral and mental health, housing, and others, according to Dumornay. In addition, he wrote, financial representatives are available to help patients apply for federal, state, or local assistance programs, including LG Health’s own financial assistance program. Within LG Health, a Diversity, Equity & Inclusion Advisory Council made up of team members representing varying positions across the health system works to inform strategic decision making, monitor progress towards goals and objectives, and champion the organization’s efforts surrounding DEI.

• Specialist-level palliative care including an extensive interdisciplinary team • Pain and symptom management related to life-limiting illness • Goals of care discussion • Patient advocacy and care coordination • Caregiver support and education

A DEI Ambassador program was developed in 2022 to train and equip leaders on how to serve all patients and colleagues with a focus on empathy, DEI, cultural humility, and trauma-informed leadership. Nearly 1,000 leaders and employees have received relevant instruction and are known as DEI Ambassadors. They attend monthly trainings, during which they learn to inform and engage their colleagues about upcoming DEI programs, resources, and events and encourage feedback from staff regarding issues related to DEI.

Quality care, quality of life. www.ChoicesHealth.org To make a referral, call (877) 898-0685 or email us at

choicesreferrals@choiceshealth.org.

“These individuals are the ears, eyes and voices of empathy and equity at a unit or department level,” Dumornay wrote.

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Legislative Updates

THE LEGISLATIVE YEAR IN REVIEW 2023 “Unpredictable” is probably the best word to describe the many changes that have taken place over the past year…both from a legislative perspective and a political one, although the two are often inextricably linked. Shortly after the 2022 House of Delegates in October that year, the General Assembly approved Senate Bill 225, prior authorization reform legislation. This proposal was the result of nearly six years of stakeholder meetings,

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physician coalition discussions, meetings with PAMED physician leaders, and grassroots physician advocacy. The new law made changes to the time-frames health insurers have to make prior auth decisions, refined the definition of medical necessity related to prior authorizations, streamlined the process of medication step therapy and enacted changes to the qualifications of peer-to-peer reviewers. Passage of Senate Bill 225 was applauded by physician organizations across the Commonwealth along with members of the legislature. Though more work needs to be done when it comes to the relationship between physicians, health insurers and patients. November 2022 also brought the election of a new Governor, Josh Shapiro, and a historic shift of power in the state House of Representatives with democrats edging out a one-seat majority. These changes, coupled with the untimely death of Anthony DeLuca, a democratic member of the House, impacted the ability of the General Assembly to “hit the ground running” in early 2023. Adding to the political complexities of a new legislative session was the resignation of several democrat house members who had been elected to other offices, including Lt. Governor Austin Davis. As a result, the “business” of the House didn’t really get started in a serious way until April. We were also happy to see the election of Arvind Venkat, MD, to the State House of Representatives, the first physician to do so since 1961. Since his swearing in, Dr. Venkat has made a positive impression with members of his caucus and has, more than once, influenced or helped shape health care legislation in Harrisburg. We anticipate that Dr. Venkat will continue to be a driving force, and trusted source of clinical knowledge, to many members of the legislature. It should be noted that PAMED’s political action committee, PAMPAC, was an early supporter of Dr. Venkat’s candidacy. Politics aside, we have seen several proposals put forth this legislative session that have PAMED very much engaged. We saw the reintroduction of Senate Bill 25, legislation that would grant CRNPs with independent practice authority and expect to see a companion bill introduced in the House before the end of the

year. Legislation was also introduced to allow pharmacists to prescribe medications. A public hearing on this measure, House Bill 1000, was held in September with future stakeholder meetings expected. Staying with the theme of scope of practice expansion, PAMED has been engaged with the PA Chapter of the American College of Obstetricians/Gynecologists in considering a legislative proposal that would no longer require nurse midwives to maintain a collaborative agreement with an OB/GYN. As of early December, consideration of these proposals is not expected in the near term. While PAMED spends considerable resources on scope of practice issues, there are a number of bills, unrelated to scope, on which we are actively engaged. These include, but are not necessarily limited, to the following in no particular order: Pennsylvania Orders for Life Sustaining Treatment (POLST)—PAMED continues to work on moving proposals in both the Senate and House to address the issue of POLST. Sen. Gene Yaw (R-Lycoming) has introduced Senate Bill 631 and Rep. Tarik Kahn (D-Philadelphia) has introduced the companion bill in the House as House Bill 1212. Committee consideration of House Bill 1212 could come in early 2024. Insurer Credentialing—PAMED has identified Sen. Ryan Aument (R-Lancaster) as a possible sponsor in the Senate for legislation to shorten the time it takes to credential providers with health insurers. PAMED is working on several fronts to gather documented information on the delays in the credentialing process. It should be noted that Rep. Steve Mentzer (R-Lancaster) has introduced a version of our credentialing bill in the House as House Bill 1510. Non-Compete Agreements—As mandated by the PAMED House of Delegates, we continue to discuss the issue of non-compete agreements in physician contracts with many legislators. Interest in this area seems to be growing as lawmakers learn more about how these contractual agreements negatively impact patient access and continuity of care. Sen. Michele Brooks (R-Venango) has re-introduced a proposal, Senate Bill 521,

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that would require a patient to be notified if their physician changes practices. Under the legislation, patients would receive the appropriate contact information for their physician should they choose to continue seeing their provider in another location. The bill would also void non-compete agreements when a physician is terminated “without cause.” The Hospital and Healthsystem Association of Pennsylvania opposes this legislation. In the House, Rep. Dan Frankel (D-Allegheny) has introduced House Bill 1633, a proposal that would outright ban the use of non-compete agreements in all physician employment contracts. PAMED will be working with Rep. Frankel, and other policy makers in the House, to move this proposal forward. While PAMED supports House Bill 1633, our support is contingent upon adding a provision that would permit the use of non-compete agreements by private physician practices. Bio-markers—Legislation introduced by Sen. Devlin Robinson (R- Allegheny), Senate Bill 1754, would mandate that health insurers cover the costs associated with diagnostic tests to determine a given patient’s biomarkers related to a specific illness. Rep. Kyle Mullins (D-Lackawanna) has joined with Rep. Bryan Cutler (R-Lancaster) in introducing House Bill 954, another bio-marker proposal as well and a companion to the Senate version. PAMED, along with a broad coalition of provider organizations and patient advocacy groups, supports both legislative initiatives. Telemedicine—PAMED is hopeful that a telemedicine bill may finally get to the Governor’s desk this legislative session. Sen. Elder Vogel (D-Beaver) has once again introduced Senate Bill 739 of which PAMED is supportive. ED Overcrowding—PAMED has asked Governor Josh Shapiro to establish a task force on the issue of ED overcrowding. While no legislative remedy to this crisis has been introduced, PAMED hopes to work handin-hand with the Shapiro administration in identifying a solution and following through with its implementation. Continued on page 32

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Legislative Updates

GREATER CARING. WE’VE EXPANDED OUR PROVIDER TEAM.

Mental Health Access—PAMED, along with the Pennsylvania Psychiatric Society (PSA), has embraced the collaborative care model between psychiatrists and primary care physicians as a way of expanding mental healthcare services to patients in need. House Bill 849, authored by Rep. Mike Schlossberg (D-Lehigh), provides funding to establish coordinated care models in primary care offices. The language also includes a model that utilizes psychologists in care models as well.

Lancaster Cancer Center is proud to announce its expansion of care with the addition of Roxana Ramos, CRNP. She joins the team of expert physicians and highly trained staff who are committed to providing the highest quality of cancer care in the county. We make new patients and second opinions a priority with appointments available within 24 hours by calling 717.291.1313.

Reproductive Health—PAMED has met with Rep. Leanne Krueger (D-Philadelphia) regarding her proposal to expand access to contraceptives. Her proposal, House Bill 1140, would remove limitations on the duration of prescriptions for patients taking medications that not only prevent pregnancies but also treat ailments such as endometriosis and Polycystic ovary syndrome. PAMED is working cooperatively with Rep. Krueger to “tighten” aspects of the bill to ensure that physicians ultimately have control of the prescription process.

703 L ampeter Rd. , L ancaster, PA 17602 L ancaster Cancer Center.com • (717) 291-1313 Suppor t | O n -site L aborator y | O n -Site Me dically Inte grate d Dispens ar y Hyatt P. (Tracy) DeGreen III, DO; Lena Dumasia, MD; and Roxana Ramos, CRNP

Constitutional Amendment on Abortion—Rep. Danielle Friel Otten (D-Chester) introduced House Bill 1888, a constitutional amendment measure that would enshrine within the state constitution an individual’s right to exercise personal reproductive liberty related to pregnancy. A constitutional requirement to hold a public hearing on the proposal was satisfied on December 12, 2023. It is anticipated that the bill will be considered by the full House of Representatives in early 2024.

THE POINT AT 101 NORTH QUEEN Downtown Lancaster

Nested atop the renovated 101 N Queen building, The Point’s modern condos provide magnificent views of the historic Lancaster skyline and offer the best of luxury living in Central PA. Currently available are two finished units plus a resale unit with two ensuite bedrooms. Four unfinished units also are available for buyer customization, including a penthouse suite. The condos feature a tax abatement program for a period of time, large outdoor terraces, two ground floor parking spaces with access to a private elevator for condo owners, a storage unit for each condo off the garage, and a community room on the condo floor. Turn your dream of luxurious city living into a reality!

Although the current legislative session has been less than robust, a breast cancer-related proposal authored by Sen. Kim Ward (R-Westmoreland) made it to the finish line in record time in May of this year. Senate Bill 8, lauded as a “first-of-its-kind” in the country to improve breast cancer screening coverage of necessary BRCA testing and screening for high-risk Pennsylvanians, had the support of PAMED and several patient advocacy groups. PAMED played an active role in helping to develop this legislation through several meetings between PAMED Board Chair and oncologist Ed Balaban, DO, and Sen. Ward’s legislative staff. The bill was signed into law by Governor Josh Shapiro as Act 1 of 2023. As we begin the 2024 legislative calendar, PAMED is looking ahead strategically on many of the issues contained in this report. We anticipate a busy legislative agenda as lawmakers will be looking ahead to the state’s April primary election and of course, the Presidential election in November of 2024. As always, PAMED members are encouraged to develop relationships with their local state representatives and state senators. These relationships will play a key role in helping PAMED to achieve our legislative goals.

For more information about any of the items mentioned above, please visit the Advocacy Section of PAMED’s web site at

Contact: Anne M. Lusk, REALTOR® 717.291.9101 | aluskhomes@gmail.com | AnneLusk.com

www.pamedsoc.org/advocacy

Each Ofﬁce Is Independently Owned And Operated.

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Medical Society / Foundation Updates

HOUSE OF DELEGATES WRAP UP

n October, the Pennsylvania Medical Society held its second hybrid House of Delegates (HOD) meeting, allowing attendees to participate both remotely and on-site at the Hershey Lodge. This meeting included networking, continuing education, entertainment, and policymaking. The hard work of your Speakers and PAMED staff, and the flexibility of our delegates, produced a successful meeting. Before business started, a moment of silence was observed for Dr. Joe Danyo, a past president who founded the American Association for Hand Surgery, and to honor Dr. Carol Rose, PAMED’s first female president, and Mrs. Joanne Bergquist, Pennsylvania Medical Society Alliance representative and the only non-physician to receive the R. William Alexander Award. In addition to robust discussion and commentary online ahead of the HOD, delegates had a lively debate on many of the issues that face health care, patient care and the practice of medicine. Here is a look at some of the resolutions that delegates either adopted or directed to PAMED’s Board for decision or further study. Keep in mind that this is not an exhaustive list. Proceedings and Actions of the 2023 HOD are available online at www. pamedsoc.org/HOD. Continued on page 34

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L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Medical Society / Foundation Updates

Board Certification – Delegates voted to Adopt the recommendation from the Board of Trustees study and report which was called on by a resolution in 2022. Delegates support policy to advocate for a model of board certification achieved by completing a training program, passing a one-time examination, and completing yearly continuing education. Food Deserts and Food Insecurity – Delegates voted to Adopt as Amended a resolution advocating for initiatives that address food insecurity and promote access to healthy food options, supporting legislative efforts that promote food is medicine interventions for patients with health conditions affected by food insecurity or diet, and encouraging the adoption of routine food insecurity screening by health care providers. Advance Directive Conversations – Delegates voted to Adopt as Amended policies encouraging physicians to engage in advance directive conversations with their patients, medical schools to incorporate lectures and standardized patient sessions related to advance directives into their preclinical curriculum, and health care settings to enhance the ability of their health care team to talk with patients about advance directives, as well as supporting efforts to increase the public’s education about advance directives and their importance. Convergence Insufficiency Testing – Delegates voted to Not Adopt supporting the addition of Near Point of Convergence (NPC) screenings to the Pennsylvania School Vision Screening Program, advocating for NPC screenings in all children who report common symptoms of convergence insufficiency during eye screenings, promoting referral to a licensed ophthalmologist if NPC screenings come back abnormal, and encouraging schools to provide resources for parents to find local ophthalmologists upon abnormal screening.

Supporting Research into the Safety and Efficacy of Kidney Transplants – Delegates voted in line with the Reference Committee’s recommendation to Adopt as Amended. This resolution resulted in asking for PAMED to support the safety of kidney donations. Improving Access to Ambulatory Blood Pressure Monitoring for Obstetrical Birthing Individuals in Pennsylvania – Delegates voted in line with the Reference Committee’s recommendation to Refer for Study. Given the concerns and existence of programs that are relevant to this resolution, further study is needed before the purchase of Blood Pressure Monitoring systems is decided upon by the Board of Trustees to aid in the improvement of access. Protecting Access to Gender-Affirming Care – Delegates voted to Adopt opposition to legislative efforts to criminalize or impose legal penalties against parents and guardians who allow minors to receive gender-affirming care, health care facilities, physicians and other health care providers, and patients seeking and receiving gender-affirming care. Physician-Nurse Practitioner Prescriptive Authority – Delegates voted to Adopt as Amended support for legislative efforts to require physicians to give direct consent prior to a nurse practitioner being assigned to them under a collaborative agreement.

Removing Barriers for Adapting Surgical Attire for Religious and Cultural Headgear in the OR; Including Donning a Hijab – Delegates voted to Adopt the recommendation from the Board of Trustees study and report which was called on by a resolution in 2022. This report supported for the removal of barriers in medical education and practice by acknowledging adaptations for surgical attire for all individuals providing for religious and cultural accommodations while ensuring patient, medical student, and physician safety reflects the contemporary medical student and physician community including permissibility to wear “religious head coverings (e.g. head scarves [hijabs], veils, turbans, bonnets) that are clean, constructed of tightly woven and low-linting material, are without adornment, and fit securely with loose ends tucked in the scrub top and may be worn to cover the hair and scalp in semi-restricted and restricted areas.” Addressing Health Literacy within Health Care Delivery Settings – Delegates voted to Adopt the recommendation from the Board of Trustees study and report from 2022 supporting state legislation that furthers health literacy and provides resources for health care delivery settings to implement health literacy strategies in patient safety and quality improvement measures in order to ensure clear communication and decrease barriers to patient-centered care.

Achieving Equitable Support for Optimal Mammographic Technology to Reduce Racial Disparities – Delegates voted no on Refer for Decision and instead voted to Adopt as Amended support for advocacy efforts for full access to optimal evidence-based mammographic technologies.

PROCEEDINGS AND ACTIONS OF THE 2023 HOD ARE AVAILABLE ONLINE AT WWW.PAMEDSOC.ORG/HOD. LANCASTER

PHYSICIAN

WINTER 2024

News & Announcements

Frontline Group Spotlight

WellSpan Surgical Specialists – Ephrata

Dr. Osvaldo Zumba

ellSpan Surgical Specialists – Ephrata stands as a preeminent medical practice serving the northeastern region of Lancaster County with the utmost distinction. Comprised of a team of three highly esteemed board-certified medical professionals, the practice is exclusively situated within the confines of WellSpan Ephrata Community Hospital, an integral component of the illustrious WellSpan network. Dr. Osvaldo Zumba, a trailblazer in the field of robotic surgery, received his training at Rutgers University, distinguishing himself as one of the pioneering graduates in the country. His practice encompasses both general and advanced robotic surgery, with a focus on minimally invasive procedures. Dr. Zumba is fluent in Spanish, enhancing accessibility and communication with a diverse patient base. Dr. Jose Luis Mejia, originally from Ecuador, achieved his medical degree at the esteemed Central University of his homeland. He furthered his surgical expertise through training at East

LANCASTER

Dr. Jose Luis Mejia

Tennessee State University. Fluent in both English and Spanish, Dr. Mejia excels in a comprehensive spectrum of general and advanced robotic surgical procedures. Complementing these medical professionals is an exceptionally trained support staff. The practice offers a comprehensive range of services, including upper and lower endoscopy, open and robotic hernia repair, colorectal procedures for both benign and malignant conditions, hiatal hernia and reflux surgery, as well as expertise in gallbladder pathology. Furthermore, they are well-equipped to address acute care issues encountered in the WellSpan Ephrata Community Hospital emergency department. New patients are welcomed, and despite the dynamic nature of the practice, the staff strives to facilitate swift scheduling for consultations and surgical interventions. The message of the practice to the community states, “Your health and well-being remain our top priorities, and we are committed to delivering exceptional care with efficiency and dedication.”

PHYSICIAN

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

News & Announcements

Member Spotlight

Where do you practice and why did you settle in your present location or community?

As we entered the third year of the COVID pandemic, my children started job hunting for me. A “We’re hiring!” sign was hung at a local ice cream shop in Lancaster County, and my then 7-year-old son suggested I apply for a job there. Smiling, I asked if this was because he hoped for free ice cream (if you know my kids, they take ice cream very seriously…). He responded: “No, mommy. Because, maybe, if you work here, you could have dinner with us sometime.”

Pamela Taffera-Deihl, DO, MBA Hospitalist, WellSpan Health and Outer Banks/ECU Health Former Medical Director, WellTrack Patient Placement & Transfer Center, WellSpan Health

LANCASTER

What a gut punch. As the world and health care were spiraling around me, I failed to notice how much my family missed me during COVID. I am honored to have traversed the COVID-19 pandemic with WellSpan Health, where our COVID response plan in March of 2020 included creation of WellTrack Patient Placement & Transfer Center under my medical directorship. I am no longer director of this centralized command center of WellSpan, but under the leadership of physicians and staffed by an outstanding group of nurses, it continues to achieve expedited and appropriate level of care for patients in the region. As we settle back into whatever this “normal” is, we are rebuilding health care, and I am rebuilding my life. I stepped off the corporate ladder and back into full-time patient care; my husband and children are thrilled to have their wife and mom back. I am currently a hospitalist at WellSpan Health hospitals in South Central Pennsylvania and the chair of medicine at Outer Banks Health in rural Eastern North Carolina. As a family medicine trained physician, I love the acuity and puzzle-solving of inpatient medicine. Even in the most challenging times of health care with scarcity of resources, villainous perception of physicians, financial crises, and burnout, providing direct patient care as a physician is still the most honorable and beautiful profession. Providing the highest quality and compassionate care to patients also helps me to be a better wife, mom, daughter, and human.

PHYSICIAN

WINTER 2024

What do you like best about practicing medicine?

I used to be one of our younger physicians, but the docs, nurses, APPs all keep getting younger, as I grow…“more experienced.” Looking back on the last 15 years of practicing medicine in Pennsylvania, I have had the honor of meeting the most amazing people! SO many amazing stories. This includes colleagues who have cared for one another through personal and professional crises, leaders who have helped me to mature, and most importantly, patients and their families in our communities. I’m particularly grateful for my friend from residency, Dr. David Gasperack. Whenever I have had a “quitting day,” David has been there to listen, uplift, and mentor me. He is a visionary leader for the future of medicine in Lancaster County! Beyond my amazing colleagues (please take care of each other out there, friends), there is no greater honor than to sit with a patient and their family, at some of the most private and intimate moments of their lives and try to make that experience better for them. Whether it is the joy of new life or peace and comfort in death, every patient story has left a mark on my heart and transformed the way I practice medicine. So, my favorite parts of medicine are the people and the stories they have to tell. Lancaster County is full of cool people! I’m so grateful for each of them.

Are you involved in any community, non-profit, or professional organizations? If so, please list the groups. What are your hobbies and interests when you’re not working?

two dogs and (begrudgingly) one cat. We rescue and rehabilitate abused or abandoned pit bulls, which adds to the chaotic fun in our home. We love the beach, salty air, and sand in our shoes. A few of my “favorite things” include the love of: Jesus, red wine, sushi, high heeled shoes (the trademark of my hospital rounds), cooking, politics, Bon Jovi, and Friends (both the sitcom and my tribe of people). I tout master’s level expertise in witty comments, and I love to read. Due to my love of wine and cooking…I exercise by necessity. I love running and ran my first half marathon when Annie was 3 months old. I hate: COVID, red beets, and social injustice. I hope to be an author when I grow up — maybe I’ll be able to share some of the amazing stories from my career in medicine.

For what reason(s) did you become a member of the Lancaster City & County Medical Society and what do you value most about your membership?

After residency, I served a term as the (youngest!) president of the Berks County Medical Society in 2013. This opportunity demonstrated the amazing value of engagement in local and state medical societies where physicians can advocate for themselves and their communities, affect healthcare policy, and redesign health care for the future. The Lancaster City & County Medical Society allows us to support each other as professionals and colleagues via the professional and fellowship opportunities provided by the medical society. I encourage everyone to become involved with their local and state medical society.

I live with my husband Steve and our children. We love to be active in our church and community. Our hobbies are usually sidetracked by the hobbies of Reed (17), Annie (9), and Joey (8), but I can’t imagine anything more fun than being these kids’ mom. We have

LANCASTER

PHYSICIAN

News & Announcements

FRONTLINE GROUPS WINTER 2024 Frontline Practice Groups have made a 100% membership commitment to LCCMS and PAMED. We thank them for their unified support of our efforts in advocating on your behalf and facilitating an environment for physicians to work collaboratively for the benefit of the profession and patients. A rgires Marotti Neurosurgical Associates of Lancaster

 Avalon Primary Care  BestFit Virtual Health + Wellness PLLC  Campus Eye Center  Carter MD Aesthetics  College Avenue Family Medicine  Community Anesthesia Associates  Community Services Group  Conestoga Eye  Dermasurgery Center PC  Dermatology Associates of Lancaster Ltd  Dermatology Physicians Inc  The ENT Center  Eye Associates of Lancaster Ltd  Eye Health Physicians of Lancaster  Family Eye Group  Family Practice Center PC – Elizabethtown  General Surgery of Lancaster  Glah Medical Group  The Heart Group of Lancaster General Health  Hospice & Community Care  Hypertension & Kidney Specialists  Iconic Medical Arts

New Members

 Lancaster Arthritis & Rheumatology Care  Lancaster Cancer Center Ltd  Lancaster Cardiology Group LLC  Lancaster Ear Nose and Throat  Lancaster Family Allergy  Lancaster Radiology Associates, Ltd.  Lancaster Skin Center PC  Manning Rommel & Thode Associates  Nemours duPont Pediatrics Lancaster  Neurology & Stroke Associates PC  Patient First – Lancaster P enn Medicine Lancaster General Health Care Connections

 Penn Medicine Lancaster General Health  Physicians Diabetes & Endocrinology  Penn Medicine Lancaster General Health  Physicians Family Medicine Lincoln  Penn Medicine Lancaster General Health  Physicians Family Medicine New Holland  Penn Medicine Lancaster General Health  Physicians Family Medicine Norlanco  Penn Medicine Lancaster General Health  Physicians Family Medicine Red Rose  Penn Medicine Lancaster General Health

reinstatements

Allison Barrett, MD Penn State Health Medical Group – Noll Drive

Albert Driver, MD Pennsylvania Department of Health

Tyrone Bristol, MD Penn Medicine Lancaster General Health Physicians Hospitalists

Jennifer Erich, MD Hospice & Community Care

Ifeoluwapo Eleyinafe, MD

Matthew Evans, DO UPMC Heart & Vascular Institute

Melanie Falgout, MD Penn State Health Medical Group – South Lancaster Katherine Hicks-Courant, MD Penn Medicine Lancaster General Health Physicians Gynecologic Oncology Mary Kate Johnson, MD Hospice & Community Care Akhil Kher, MD The Heart Group of Lancaster General Health Laura Levidy, MD Penn Medicine Lancaster General Health Family Medicine Residency

 Physicians Family Medicine Susquehanna  Penn Medicine Lancaster General Health  Physicians Lancaster Physicians for Women  Penn Medicine Lancaster General Health  Physicians Specialty Medicine  Pennsylvania Specialty Pathology  Randali Centre for Aesthetics & Wellbeing  Shady Grove Fertility – Lancaster  Surgical Specialists—UPMC  Tiedeken MD Eyecare  Union Community Care – Duke Street  Union Community Care – Hershey Avenue  Union Community Care – Kinzer-Church Street  Union Community Care – New Holland Avenue  Union Community Care – Water Street  UPMC Breast Health Associates  UPMC Heart and Vascular Institute U PMC Plastic & Aesthetic Surgical Associates  WellSpan Ephrata Cancer Center  WellSpan Family Health – Georgetown  WellSpan Surgical Specialists – Ephrata

LCCMS EVENTS 2 0 24

Kanchana Herath, MD Penn Medicine Lancaster General Health Physicians Arthritis & Rheumatology Daniel Mast, DO Union Community Care – New Holland Avenue Sabrina Milhous, MD Union Community Care – Duke Street

SAVE THE DATE LCCMS Annual Dinner Wednesday, June 26 The Inn at Leola Village

Jeffrey Mufson, MD Lancaster Behavioral Health Hospital Mahvash Sheikh, MD Community Services Group

Bethann Scarborough, MD Penn Medicine Lancaster General Health Physicians Palliative Care

Celia Tong, MD Lancaster Radiology Associates, Ltd.

Robert Shelly, MD Union Community Care – Duke Street

Osvaldo Zumba, MD WellSpan Surgical Specialists – Ephrata

LANCASTER

for more info visit www.lancastermedicalsociety.org

PHYSICIAN

33RD ANNUAL

APRIL 5-14 Reading, PA

MARCUS MILLER & JONATHAN BUTLER LEE RITENOUR & DAVE GRUSIN and KIRK WHALUM WEST COAST JAM! RICK BRAUN, RICHARD ELLIOT, PETER WHITE and the WEST COAST HORNS BRIAN CULBERTSON: THE TRILOGY TOUR CELEBRATING WOMEN IN JAZZ III featuring MELBA MOORE, NICOLE HENRY, MAYSA, PAULETTE MCWILLIAMS and more

JOEY ALEXANDER plus TUCK & PATTI

PRESENTED BY

PAT METHENY: DREAM BOX TOUR DANIELLE NICOLE ERIC DARIUS & REBECCA JADE and RHYTHM & GROOVE TOUR: BRIAN SIMPSON, MARION MEADOWS, STEVE OLIVER GREG ADAMS & EAST BAY SOUL

plus many more must-see concerts!

Tickets on sale NOW at berksjazzfest.com! PROUD SPONSOR OF BOSCOV’S BERKS JAZZ FEST

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Visit UPMC.com/WeDeliverCPA