Dr Anna Lembke, Author of “Drug Dealer MD, How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard To Stop”

Anna Lembke

This week, hosts Mark Masselli and Margaret Flinter speak with Dr. Anna Lembke, Chief of Addiction Medicine at Stanford University School of Medicine, and author of Drug Dealer MD, How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard To Stop.  She examines the dramatic rise in opioid prescriptions and overdoses and the role the health care industry is playing in this crisis.

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Dr. Keith Yamamoto, Vice Chancelor for Science Policy and Strategy at UC San Francisco

Keith YamamotoThis week, hosts Mark Masselli and Margaret Flinter speak with Dr. Keith Yamamoto, Vice Chancellor for Science Policy and Strategy and Executive Vice Dean for Research at the School of Medicine at UC San Francisco. He discusses strategies for informing the incoming Trump administration – to ensure ongoing support for the nation’s biomedical research community, the need to advance precision medicine protocols and goals, and improvements needed to advance medical training and academic research in the 21st century.

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Why am I Still Here after 10 years?

Many years ago I joined forces with Dr. Iden, who had been practicing in the small town (pop. 3000) of Berryville, Virginia. He had been practicing over 40 yeas at the age of 70.  The office was a wonderful relic of the “golden Age” of medicine. A true PCMH…..The staff knew everyone, there were no appointments except for physicals. If the waiting room was full in the morning you came back after lunch. If you were too sick to come in, we went to your house. We saw the retired judge and we saw the migrant apple pickers. The nursing home was just a few blocks away and we even did Occupational Medicine for several manufactures in the area. I once used a screw driver from under the sink to remove a screw from a workers’ finger.  Doc Iden’s  doctor-father did not retire until he crashed his car into the wall in the hospital parking lot at the age of 90. Every year, Randy and his wife, the pharmacists gave us  a whole cooked Virginia ham for the holidays. (You have to be from Virginia to know what a cured Virginia ham is all about). The other pharmacy in town was one of the last old time pharmacies in the country and when that guy retired, the new pharmacy school that opened nearby packed up the entire shop and installed it as a museum in their building.

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Half the  medical charts were still kept on index cards stapled together. The note for a visit might read “11/15/1985, Pneumonia, Erythromycin”.

Whether the patient had insurance or not, the entire family’s leger was kept on a yellow card in a file box. Charges and payments were listed for the entire family without explanation whether it was an insurance or patient payment or for whom the charge or payment was entered! After I convinced my boss we needed to modernize ( and spend a lot of money to do it) he agreed with skepticism. I took it upon myself to computerize the office so that we could submit bills electronically and stop completing the infamous HCFA 1500 forms by hand. I knew my shiny new Apple computer and the program inside out. I was the IT department.  I could walk the office through restoring a crashed system by phone. I remember pulling all-nighters to set things up, fix bugs and do updates.

My next venture was my own start up office with 6 providers and a staff of about 15. Hiring and keeping a staff seven days and 4 nights a week can be exciting.  Doing the HR stuff, providing insurance as rates are skyrocketing, doing peer review and making sure nursing and everyone else is credentialed, insured and had flu shots is…….interesting. While ‘learning the business” as you go was a fun challenge for me, it was made more so by  having to pay the bills, which meant seeing a full load of patients and more. Now in 2016, my own doctor is struggling to keep their office independent.  His latest disheartening challenge is MACRA.

Getting this far with my missive, I realize it is Thanksgiving week. I am thankful to work for CHC, Inc. that does all those things for me. My biggest worry now is the patient. I know bugs in ECW happen but IT is there  to fix it. Insurance goes up but someone else researches the best options. I may be rushed and cut corners to get though the day, but I am pushed and prodded to “check the boxes” . My family gets sick and I can call out without anxiety about rescheduling all those patients.

I also know that we are leaders…on the cutting edge of innovation in a transformed and ever-changing world of medical care. At a meeting of FQHC leaders  a while back, I went to seminar after seminar where innovative ways of providing services were presented. Over and over I found myself saying, “We do that! We do that already! We do that too!”  It made me kind of proud to represent CHC.

What I do everyday is challenging. I see patients. I am doing what I signed up to do a long time ago.  I like it.

 

By: Hartmut A. Doerwaldt, MD

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Giving Back to the Community that Opened its Arms to My Family

Paulina Miklosz, nurse practitioner at CHC of New Britain, remembers the first time she came to the clinic in 1997.  “I was eight years old,” said Miklosz, whose family had just emigrated from Poland. She remembers the receptionist who spoke to her in Polish, the nurse who also spoke Polish and the translator who helped her communicate with pediatrician Robert Dudley during the physical exam.

“It was so reassuring to hear someone speaking our language,” said Miklosz.

Miklosz was drawn to nursing while attending New Britain High School where she completed a nursing assistant certification program. She then enrolled at Boston College and completed her bachelors and master’s degrees in nursing there.  She also studied Spanish, a language she knew would come in handy as a nurse practitioner.

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“I had studied Spanish in high school, and really missed it once I got to college so I decided to minor in Hispanic Studies and study abroad in Quito, Ecuador. I fell in love with the language and culture, and I wanted to be able to provide the same reassurance to Latino patients that I received from CHC’s Polish-speaking staff. I felt called to serve the community of New Britain, and I knew Spanish was something I needed to provide truly culturally competent care here.”

Miklosz is a graduate of CHC’s nurse practitioner residency program.  “The NP residency is a great way to transition from a grad program to full-time clinical practice and really hone one’s clinical skills,” said Miklosz.  “Specialty rotations and precepted clinics are built into the program so you are still learning how to best treat patients while building your own small panel. Residency programs really help NPs become well-rounded primary care providers.”

Miklosz is also currently enrolled in the doctoral nursing program at the University of Connecticut.  “I hope to use the training in my clinical work with the homeless, which has really become a passion of mine” said Miklosz, who works within CHC’s Wherever You Are (WYA) health care for the homeless program. “The NP residency is where I was first exposed to homeless care. I really enjoyed my WYA rotation during the residency and was fortunate enough to transition to WYA after 2 years at the New Britain CHC site.” Miklosz maintains a small Polish-speaking patient panel at the New Britain site where she continues to work one day a week.

“The nurse practitioner role is rooted in the nursing model which differs a bit from the medical model. NPs usually start out as RNs, caring for patients at the bedside and often supporting patients (and their families) through trying and difficult times.  This allows nurses to see the patient in a truly holistic way and identify patients’ psychosocial needs in addition to physical needs. I believe it’s imperative to keep those nursing principals firmly in mind as NPs continue to practice and advance their nursing career.”

Miklosz looks forward to continuing her work at CHC and, more specifically, in New Britain. “I feel very blessed for the opportunity to give back to the community that opened its arms to my family 18 years ago.”

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Committed to Healthcare for Young People

Leah Lucarelli found her career in fifth grade, while helping her pediatrician aunt in the office during school vacations.  “She let me take height and weight measurements, and I fell in love with primary care for kids.”

As nurse practitioner for CHC’s school-based health care program, she cares for youngsters in Macdonough elementary and Keigwin middle schools. “My role is to help my patients stay healthy and stay in school.  I love teaching them about their heath and taking care of themselves.”

At first, she was on the path to becoming a pediatrician, majoring in biology and psychology, until her college health professions club showed her other possibilities.  “A career as a nurse practitioner was never on my radar, but it just seemed right. It seemed like it focused more on holistic care than on the disease process.”

After graduating from Hobart and William Smith Colleges, Lucarelli enrolled in the BSN program at SUNY Binghamton.  A year later, she started working as a pediatric nurse and joined the master’s nursing program at Quinnipiac University.  While there, she worked at a community health center and found her calling.  “It may sound like a cliché, but I really want to help people, and patients at community health centers really need the care.”

Lucarelli recently received her doctorate in nursing from Quinnipiac University.  “I wanted to learn how to apply evidence-based medicine and make healthcare more effective.”  Her research for her doctoral degree focused on ways to improve screening for adolescent depression and improving the referral system for referrals for additional care.  She is confident she can use what she has learned to improve depression screening and referrals for students in the school-based program.  “CHC provides both medical and behavioral health care, so it’s ideally suited to be helpful identifying youngsters who may be depressed and helping them get the care they need.  We provide fantastic care in a cost effective way and I’m excited to be part of continuing that work.”

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Health Policy Challenges President-Elect Trump Must Face

Robert BlendonThis week, hosts Mark Masselli and Margaret Flinter speak with Dr. Robert Blendon, Director of the Harvard Opinion Research Program at the Harvard T.H. Chan School of Public Health about health opinions that will challenge the Trump administration in establishing health policy. Dr. Blendon discusses how differing opinions regarding health care will shape the administration’s health policy agenda moving forward.

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Meet Mary Blankson, DNP, APRN, FNP-C

During her junior year as a pre-med major at Tufts University near Boston, Mary Blankson realized she didn’t really want to be a doctor.  She met with an advisor and researched other opportunities found being a Family Nurse Practitioner really stood out to her.

Upon graduation from Tufts, Mary was accepted into Yale University’s Graduate Entry Pre-Specialty Nursing Program on the Family Nurse Practitioner Track. When the time came to begin applying for nursing jobs, a classmate who was applying to a Community Health Center, Inc. suggested Mary do the same. Mary applied and received a phone call for an interview at CHC. She recalls being nervous and intimidated during the interview but she was ultimately hired as a nurse for CHC’s New London site.

After she was hired in 2005 Ingrid Fetta, the onsite medical director for New London, was very supportive and played a significant role in Mary’s success at CHC. Mary loved working in the clinical practice and felt the experience made her a well-rounded clinician.

Mary’s hard work and dedication paid off and in 2012 she became the on-site medical director for CHC’s Groton and New London sites. Mary shared that she absolutely loved being the job. She truly enjoyed advocating for not only her staff but for her patients as well.

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In 2014, while Mary was pursuing her Doctorial of Nursing Practice at Johns Hopkins University, she received a phone call from the Chief Nursing Officer who told Mary she was going to be leaving CHC and thought Mary should apply for the position.  On July 1, 2014 Mary started her positon as Chief Nursing Office here at CHC. Mary then made sure to attribute her success to all of those who helped her along the way.

During her career, Mary has served CHC in a number of ways, she is the Nurse Practitioner Residency leader and preceptor, where she provides guidance to residents during their time at CHC; she was a Microsystems team leader; she served as the VP of Medical Staff, where she was responsible for providing assistance to the Chief Medical Officer; and she spent some time as a family NP in a school-based setting at the ISAAC school, where she was able to see a different side of the services provided by CHC.

When I asked Mary what her favorite part of working at CHC was, she shared she loves working with her teams because of how meaningful they are. She loves being a mentor and supporter to anyone who crosses her path. Mary loves that there is never a day without a challenge; she appreciates having the opportunity to think and learn from different situations. Mary ended by sharing that she has a passion for teaching and helping to make others better.

CHC is lucky to have such a kind and compassionate employee encouraging our nurses and shaping their care.

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Focusing on Primary and Preventive Care

Nicole Seagriff knew in high school that she wanted to be a nurse like the one who cared for and comforted her mother during treatment for breast cancer. When she got her nursing degree from Boston College, she went to work as a nurse in the intensive care unit at Yale-New Haven Hospital, caring for critically ill patients.

“My patients were suffering from complications of high blood pressure, such as a heart attack or stroke.  They were losing limbs from uncontrolled diabetes.  Treatments were intensive and helpful but not likely to provide a cure.  It all seemed so wrong to me.  I decided I wanted to help patients before they reached the intensive care unit.” So Seagriff enrolled in Yale’s School of Nursing to obtain a master’s degree and become a family nurse practitioner, working with people on a continuing basis, promoting wellness as well as caring for their ills.

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“I wanted to get into community health to help people like my aunt who had breast cancer but didn’t seek timely treatment because she didn’t have insurance,” said Seagriff. She enrolled in CHC’s Nurse Practitioner residency program and in 2012 began practicing fulltime at CHC in Norwalk.  “I’m very grateful for the residency program,” says Seagriff, who added it gave her the support she needed to really enjoy her work and practice to the full extent of her training and education.

She enrolled in Duke University’s online nursing doctorate program to gain skills to improve her practice and patient outcomes.  She focused on improving screening for the risk of genetic breast cancer risk, which has special meaning for Seagriff since it had affected not only her aunt, but also her mother and her maternal grandmother.

“I realized that if any of my patients came to me with the same family history of breast cancer that I had, I’d encourage them to get genetic testing and that inspired me to get the testing. She discovered she had the BRCA mutation, which increases breast cancer risk, and promptly started to get screenings. Nine months later – at age 26 – she learned she had the disease.

With her risk for breast cancer, Seagriff would have started screenings at age 30. “I got a four-year jump on the disease,” said Seagriff.

As part of her research, Seagriff found a genetic counseling center less than two miles from the Norwalk and Stamford sites.  She also learned that her patients would take advantage of genetic counseling when they were made aware of their risk and when it was close to home, on a bus route, and easy to access.

“I’m a firm believer in the importance of screening based on individual risk factors,” Seagriff said. “With my training, I can help others understand the importance of risk factors and the benefits of screening tests. I can also help CHC provide care and promote preventive measures in ways that are most effective and cost efficient for our patients.”

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Extraordinary Care: Operations Manager Connects Homeless Patient with Long Lost Daughter

Today, Kai S. Perry, Operations Manager for our Meriden and Bristol sites sent the following email to our operations managers’ team explaining why she missed a meeting, and about what it really means to be an operations manager at CHC.

Hello team

I am sorry I missed our meeting today.  I had a patient who is a frequent flyer here who needed my assistance.  This man comes in and speaks to me daily.  I know his life story of being an engineer then being laid off and turning to alcohol for answers.

He was recently evicted and is now homeless.  I often heard him speak of his children when he comes  in, so I asked him today where his children were.  He broke down and cried about how he has not seen or heard from them in over 20 years.  All he knew were their names and what colleges they went to.

With the help of Facebook and google I was able to connect this man with his daughter who thought he was dead.  The light that ignited him when he heard his daughters voice is one that I will never forget.  I’m a ball of emotions right now, but this perfectly summarizes why I love working  with our patients and there are somethings that we do as operations managers that can’t be put into a job description.

He took up a good portion of my morning – over an hour to be exact, but I honestly must say that was one of the most rewarding hour I spent in a long time.

This is why I know I am where I need to be.

Enjoy your day!

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Dr. Vindell Washington, National Coordinator for Health IT at HHS

Vindel WashingtonThis week, hosts Mark Masselli and Margaret Flinter speak with Dr. Vindell Washington, National Coordinator for Health IT at the Department of Health and Human Services, which oversees the agency’s program to shift the health care industry from paper to electronic health records. Dr. Washington discusses the agency’s strategic plan for advancing those goals and for accelerating the creation of universal standards for health information exchange and the promotion of interoperability.

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