4 New Heart Failure Drug 6 Cover Story MEDSTAR ......2016/05/07 · MARCH/APRIL 2016 VOL. 22, NO. 2...

JULY/AUGUST 2015 | PHYSICIAN | MEDSTAR WASHINGTON HOS-

MARCH/APRIL 2016 VOL. 22, NO. 2

MedStar Health Research Institute:Academics & Real World Medicine

PhysicianNews for Medical &Dental Staff, Residents,Fellows and Alumni

M E D S TA R W A S H I N GTO N H O S P I TA L C E N T E R

Inside... 4 New Heart Failure Drug 6 Cover Story10 “My Younger Self”12 Baby-Friendly

Rachel Scott, MD, MPH; Dawn Fishbein, MD and Amie Hsia, MD,care for patients and conduct world-class research

Finish strong.That’s our goal for this fiscal year. Through meetings, emails andphone conversations, you’ve given us suggestions forimprovements that would enhance your practice at MedStarWashington Hospital Center. With only a few months left in FY16, it’s important to take a step back, and acknowledge all thatwe’ve accomplished together this year.

More Face-to-Face Communicationn We now meet with every service line on a regular basis in ourmini-town hall series, to discuss what’s working and whatneeds re-tuning. We also set up Advanced Practice Cliniciansfor their own mini-town halls, and hold separate meetings forresidents and fellows in all clinical areas.

n We now include section directors at the monthly clinicalchairs meeting, to ensure that more information gets toproviders in every patient care area.

n We added Graduate Medical Education program directors toour regular Graduate Medical Education Committeemeetings, to create a “Super GMEC” for an even better flowand exchange of information.

n Medical & Dental Staff President Arthur West, MD, and I areholding quarterly after-work meetings. These meetings areopen to all providers who may have questions about policiesand procedures, suggestions on how to improve processes,and who want to get together to discuss commoncelebrations and concerns.

More Input from You for Solutionsn The Medical Director/Nursing Director dyads are workingtogether in all inpatient care units and outpatient areas. Eachmedical director can now confer with the nursing director, toimmediately address and resolve any situation that providersfind is a potential barrier to quality, safe patient care.

n Providers in all areas have the opportunity to address theirparticular service line needs for the Cerner AmbulatoryElectronic Health Record and MedConnect III, which arescheduled to go into operation in the next fiscal year.

n We have representation on all the committees and councilsthat are formulating the structure for MedStar Medical Group,the employed provider entity for clinicians throughoutMedStar Health.

n Your access to Medical Affairs has increased, with the additionof Dr. Karen Jerome for Quality, Safety and Risk Management;Dr. Ira Rabin for Medical Operations; Dr. George Sample, forClinical Documentation Improvement; Kassie Savoy, QualityProject Manager and our front-line office staff of AllisonAgnew, Danielle Coates and Pam Donais. Our open doorpolicy ensures they are all available to help you with yourpractice needs and concerns.

More Provider Recognition n We began publicly honoring all providers who are nominatedby their peers for going “above and beyond,” with the ChiefMedical Officer’s Coin Award. The Award recognizes theprovider’s personal dedication to the mission, vision andvalues of the hospital. Physicians, APCs, residents and fellowsare all candidates for this Award. Anyone wanting tonominate a colleague can contact Marge Kumaki, director,Physician Communications and Engagement, for thenomination criteria.

n Our Medical Affairs PI project is focusing on physician on-boarding, to provide success for providers at the start of their tenures at the Hospital Center. We acknowledge the questions and concerns of all new practitioners duringtheir orientation.

Your continuing work on behalf of your colleagues is greatlyappreciated. But we need to continue to hear from you. In May, providers will be asked to take a short, 12 to 15 questionelectronic survey, via Survey Monkey®. It’s been two years sinceour last physician engagement survey, and we want to take this“pulse check” to find out where we’ve been successful andwhere we need to refocus our efforts. Please take the time to letus know how we’re doing. n

Gregory J. Argyros, MD, MACP, FCCP is senior vice president,Medical Affairs & Chief Medical Officer. He can be reached at202-877-7072 or [email protected].

Quarter 4 of Fiscal Year 16:

Refresh, Renew and Reinvigorate

2 PHYSICIAN | MARCH/APRIL 20162

Coming together is a beginning; keeping together isprogress; working together is success.

—Henry Ford

CHIEF MEDICAL OFFICER

Among themany recent changes in the health careenvironment, shifts in reimbursement and a greater emphasison health care ratings create an urgent need for exceptionallystrong collaboration among all clinicians.

This is particularly true in acute care hospitals, includingMedStar Washington Hospital Center, where extremely illpatients with multiple diagnoses mean providers with highintellectual ability are needed, to coordinate information andto collaborate with other professions. While physiciansestablish the plan of care, multiple players, includingPharmacy, Nutrition Services, Social Work and a variety oftherapists are critical to the execution of that plan. At thecenter, the nursing workforce has to be able to integrate andmanage all facets of a patient’s care.

Fortunately, the Department of Nursing has created asubstantial foundation of expertise. We exceeded our goals ofensuring a BSN prepared workforce, reaching 86 percentsaturation well in advance of the Institute of Medicine’ssuggested 2020 deadline. We are spending significant timeand resources to increase the number of nursing certificationsand training, and we are providing robust education andinvestment in opportunities such as simulation, to elevate ourpractice in all areas.

In addition, the past year has seen significant collaborativeimprovements, thanks to the efforts of our medicaldirector/nursing director dyads. These teams are critical tosetting a tone that encourages the effective communicationand coordination, which allows the unit to flourish. Root causeanalyses of serious safety events often find a breakdown innurse/physician communication. Efforts to improve length ofstay and patient satisfaction, including bedside report, involvemembers of both the medical and nursing staff. This is why

Chief Medical Officer Greg Argyros and I invest significantleadership time and effort in our dyads, so the partnershipswill grow and flourish.

Effective physician/nurse communication and collaboration iseven more important today, as nursing departments aroundthe nation struggle with a long-predicted and rapidly-accelerating nursing shortage. In the past year, the number ofnurse applications to all hospitals in our area has decreased.At the Hospital Center, it is down more than 50 percent. Nurseturnover is up throughout the D.C. region. Nurse staffingagencies are having difficulty filling contracts for temporarynurses; for example, our Cath Lab had an unfilled nurse orderfor more than 15 months.

All of this is rapidly changing the nursing landscape. Localhospitals are offering incentives that have not been seen formore than two decades, including sign-on bonuses for oneand two-year commitments, and higher hourly rates for part-time work. We have hired 45 nurses in our float pool injust one month this year; last year, our entire float pool had145 nurses.

We are all aware that health care today is an extremelydynamic and demanding environment. The acceleration ofchange, particularly for nursing, is extraordinary. In theDepartment of Nursing, we have worked hard to plan for andestablish a solid foundation, to provide some stability andensure our ability to provide expert nursing, as the demandand supply ratios are stressed.

Nursing cannot manage this change alone, however.Providers play an important role in setting the clinical tone,making certain there is clear and effective communication and in engaging nurses as partners in the provision of care.Ideally, every time providers have an interaction at thebedside, they have the nurse at their side. At a minimum,providers who come to a unit will automatically check in withthe nurses managing the patient’s care.

As we evolve our partnership and increase our interactions,our patients will thrive. We will continue to improve in thosecore measures that now determine our reimbursements andour reputation. We will retain our nurses, despite the shifts inthe nursing landscape.

Clinicians at the Hospital Center are adept and flexible, andhave always shown remarkable skill at managing change. We look forward to even more collaboration, as we movethrough these changes together. n

33

VIEWPOINT

Let’s Talk?by Susan Eckert, MSN, RN, NEA-BC, CENPSr. Vice President & Chief Nursing Executive

MEDSTARWASHINGTON.ORG

Nimesh Shah, MD, medical director, and Linda Conley, RN, nursing directorfor the CVRR, are a successful dyad team.

New HOPEfor Treating Heart Failure

Selma Mohammed, MD, PhD;Samer Najjar, MD and DavidMajure, MD, are part of the Advanced Heat Failure team.

5MEDSTARWASHINGTON.ORG 5

Samer Najiar, MD, begins his presentations on heartfailure with a graph showing the growth in heart failure in the U.S.The graph shoots upwards, the sort of skyward trajectory youwant to see in the stock market, but not in a disease rate chart.

The numbers are stunning: an estimated six million patients, upfrom 5.1 million just ten years ago. The American HeartAssociation projects that in 15 years, thanks to the rapidexpansion of the older-than-65 population and the improvedsurvival of patients who have heart attacks, the number ofpeople with heart failure will pass 8 million. Heart failureaccounts for several million doctor visits and more than amillion hospitalizations annually. It is the single largestexpenditure for Medicare, costing more than $38 billion a year.

So it is little wonder that Dr. Najjar and other advanced heartfailure specialists are excited about the release of two newmedications, to treat one of the most common forms of heartfailure.

“We look at this as a seismic change,” says Dr. Najjar, medicaldirector of Advanced Heart Failure for MedStar Heart &Vascular Institute at MedStar Washington Hospital Center, “asthis is the first time in more than a decade that newmedications have been approved by the FDA for treating heartfailure.”

Standard therapy for these patients currently relies on a fewmedications that have been shown to improve survival forpatients with heart failure, and which have been used for thepast several decades, including:n Angiotensin-converting enzyme (ACE) inhibitors, which havebeen the cornerstone of our medical therapy for thiscondition for a quarter century. They work by having directeffects on the heart, and by blocking one of the hormonesthat causes blood vessels to contract, making it easier for theheart to pump.

n Angiotensin II receptor blockers (ARBs), which are cousins ofACE-inhibitors and achieve similar effects by a slightlydifferent mechanism.

n Beta blockers, which slow the heart and probably help itconserve energy, by blocking the action of the hormoneepinephrine.

The first new drug, ivabradine, is sold as Corlanor® and, likebeta blockers, slows the heart rate but does not have any otherknown effect on the heart. Ivabradine was shown to lower therate of hospital readmissions for patients with heart failure. It wasapproved in April 2015 and became available late in the fall.The second drug, LCZ696 (marketed as Entresto™), takes anexisting ARB (valsartan) and enhances it, by combining it with asecond medication, sacubitril. There is more excitement overEntresto, says Dr. Najjar, because in a clinical trial with 8,400

participants published in The New England Journal of Medicinein 2014, “it was shown to reduce the risk of death andhospitalizations by 20 percent compared to an ACE-inhibitor.Its benefit was so strong that the clinical trial had to be stoppedearly. Entresto outperformed the ACE-inhibitor in almost all theclinical endpoints that were examined. You look at thosestatistics, and just say ‘Wow.”Entresto is only effective for a specific heart failure diagnosisknown as reduced ejection fraction, yet this includes about halfof the heart failure population. While patients have not yetbegun asking for the new drug, Heart Failure specialist DavidMajure, MD, says, “I plan on transitioning most heart failurepatients with reduced ejection fraction from the standard ACE-inhibitors and ARBs.”

One of the biggest barriers to these new drugs, says Dr. Najjar,is cost. “ACE inhibitors, ARBs and beta blockers are cheap,” hesays. “These new drugs are not.” Medicare and privateinsurance companies are currently actively working on sortingout their coverage plans. As with all new drugs, there are also unanswered questions,notes Selma Mohammed, MD, PhD, an MHVI heart failurespecialist and researcher. “We want to better define the patient population that would benefit the most from thesemedications, and better understand the long-term safety andside-effect profile,” she says. “There is also the possibility oflooking at expanded indications for use of these medicationsto other patient populations.”For example, she says, in the PARAGON-HF trial, a major multi-center trial looking at the new medication, “Entresto is beingtested for treatment of heart failure with preserved ejectionfraction, for which no specific therapy now exists. If positive,this would represent the first effective therapy to treat heartfailure with preserved ejection fraction.”n

“We want to better define the patient population thatwould benefit the most fromthese medications, and betterunderstand the long-termsafety and side-effect profile.”

MedStar Health Research Institute (MHRI) wasfounded in 1963, to be the engine behind MedStarWashington hospital Center’s ability to do research to advancepatient care. Fast forward to 2016, and it has become muchmore: it now represents the MedStar Health system’s ability toadvance patient care throughout the community, in hospitals,physicians’ offices and other modes of health care delivery.

“At MHRI, we areleveraging thecapability and reachof MedStar Healthto advance healththrough researchthroughout thecommunity,” saysNeil Weissman, MD,president, MHRI.“This is thecrossroads betweenacademics and realworld medicine,where we advancemedical knowledge,and also in a verypractical sense, helppeople get better.”

By contrast, auniversity hospitalconducts importantbench-to-bedsideresearch, but thevast majority ofpatients at the

hospital do not benefit directly. “This is the classic three-leggedstool of teaching, research and education,” Dr. Weissmanexplains. Over time, economics and social pressures havechanged, requiring a greater need to take care of patients.Academic medical centers—Cleveland Clinic, Mayo Clinic,MedStar Washington Hospital Center, for example—rebalancedto become more like a tricycle, with the largest wheel beingclinical care.

Today, MedStar Health has become a truly distributed healthcare delivery network, embedding research into thecommunity. “Now we have a project milieu to spread out andtouch people,” Dr. Weissman says. “We are now part of thecommunity fabric, by becoming not just a bunch of academicmedical hospitals, but a true academic medical system.”

Treating Patients with the Hepatitis C VirusHepatitis C viral infection (HCV) used to be a possible deathsentence, given the chronicity and silence of the infection,along with manifestions of end-stage liver disease. With newand exciting therapeutics, the disease can be cured with eightto 24 weeks of antiviral therapy, although the response isgreatest when identified early in the disease process, beforepatients are symptomatic. Therein lies the conundrum.

Working with the MedStar Health Research Institute (MHRI),Dawn Fishbein, MD, Infectious Diseases, is bringing academicsto real world care to help solve this problem. She isdetermined to identify patients with HCV across the spectrum of disease.

“This is a chronic disease, but one of the few—if any—that iscurable,” she notes. “In the current era, new therapeutics arehighly efficacious and very tolerable. In our lifetime, we caneliminate HCV.”

Some 50 to 75 percent of those with HCV do not know they areinfected with the virus. The Centers for Disease Control (CDC)recommends HCV testing for everyone born between 1945and 1965, even if they have no risk factors for the disease.Working with MHRI, Dr. Fishbein has been awarded severalgrants since 2012 that address gaps throughout the cascade ofcare for HCV.

One grant funded the testing of patients born within 1945-1965 and seen in the primary care clinic at MedStarWashington Hospital Center. Within the clinic, 7.5 percenttested positive, more than double the estimated nationalestimate of 3.2 percent. Broken down further, 13 percent ofmen and 5.5 percent of women who were tested were positive.The next step, which has been initiated, is to conduct the studythroughout MedStar Health.

Identification is the first step. “We then linked patients to carewith knowledgeable specialists,” Dr. Fishbein notes. “We canpotentially cure HCV, and treat people before they developend-stage liver disease and liver cancer.”

In another study, Dr. Fishbein is working with the FOCUSpartnership, sponsored by Gilead Sciences. Her studyidentifies patients who had previously tested positive for HCVwho have fallen out of care, likely for a multitude of reasons.The intent is to get them back into care, and potentially curethem with the new antiviral therapies.

Dr. Fishbein co-authored an article published in May 2015 inThe New England Journal of Medicine, on the results of a new


COVER STORY

MHRI—The Crossroads Between Academics and Real World Medicine

Neil Weissman, MD

77

treatment regimen for patients infected with both HIV andHCV. The regimen resulted in significantly increased efficacy,or HCV cure, without interfering with HIV anti-retroviraltherapy and control.

Working with MHRI, Dr. Fishbein is medical director of theClinical Research Unit, and module director for a newRecruitment Participant Research Unit (RPRU), for theGeorgetown-Howard Universities Center for Clinical andTranslational Science (GHUCCTS). This multi-center NIH-funded grant aims to promote and fund clinical andtranslational research, and ultimately empower MHRI toestablish more expedited research processes and effectiverecruitment centers.

Stroke Research Benefits PatientsSince 2003, MedStar Health and the National Institutes ofHealth (NIH) have had a partnership that both createsknowledge through research, and improves stroke care for thecommunity served at MedStar Washington Hospital Center.The result is a highly productive clinical research program thattakes place within the environment of the Washington region’sfirst Joint Commission-certified Comprehensive Stroke Center,where approximately 1,000 patients are treated each year.

As a part of this collaboration, medical director Amie Hsia, MD,leads the operations of this innovative stroke program thatcombines patient care with NIH research, to improve outcomesand advance the field of stroke care. An acute stroke team,consisting of vascular neurologists and nurse responders, worktogether with NIH vascular neurology fellows and faculty 24/7,to identify patients with acute stroke, implement timelytreatment and recruit and enroll patients in research studies.

The team is supported by multiple disciplines, includingEmergency Medicine, Neurosurgery, Neuroradiology,NeuroCritical Care, NeuroRehabilitation, Nursing, Laboratoryand Pharmacy. A dedicated 3.0 Tesla MRI serves as thetechnological cornerstone of the program.

“The NIH stroke research program focuses on the use of MRI todevelop new treatments, and expand treatments for acutestroke,” Dr. Hsia says. “When we understand more, we can domore to improve clinical outcomes. The Hospital Center is abusy clinical environment, but we have also been able tosuccessfully incorporate a productive clinical research programinto this environment.”

Key to optimal outcomes is timely diagnosis andimplementation of appropriate treatment, Dr. Hsia says. TheMedStar Health program specifies that all patients withsuspected stroke go immediately to the MRI to confirm thediagnosis. This ensures that those patients who meet the 4.5-hour window for administration of intravenous tPA receivetreatment as quickly and safely as possible.

Dr. Hsia and her colleagues recently published the results of aQuality Improvement project in the journal Neurology. Itdemonstrated successful and consistent reduction in this “door-to-needle” time to less than 60 minutes, from when thepatient presents to the Emergency Department. To improvetime to treatment, a multidisciplinary team examined each stepof the process, to eliminate any areas of wasted effort. “Wehope that other hospitals can take this information to their ownstroke committees to improve patient outcomes,” Dr. Hsia says.

“We are one of the few centers around the world using MRI as afirst-line diagnostic tool," she continues. Most hospitals screen a


MedStar Washington Hospital Center clinicians and MedStar Health Research Institute investigators are Amie Hsia, MD;Dawn Fishbein, MD and Rachel Scott, MD, MPH

stroke patient with CT, and if there is no bleed and the patientmeets other set criteria, tPA is administered, followed by an MRIoften 24 to 48 hours later. The NIH stroke program at theHospital Center is collecting data including pre- and post-MRIafter tPA administration and other acute stroke interventions,for patients who provide consent.

An illustration of how this data has contributed to advancingthe field of stroke is the multi-center, NIH-funded MR WITNESStrial, which is testing the safety of tPA in patients whose time ofsymptom onset is unknown.

“Based on analyses of our NIH Stroke Program’s large databaseof MRI scans for patients with known onset time,” Dr. Hsiaexplains, “we are able to see an MRI with a specific appearance,and provide a ‘tissue’ estimate of how long ago the strokeactually occurred. For patients at the Hospital Center whoseMRI appears to be within the 4.5- hour timeframe of onset, weare able to offer them the opportunity for tPA treatment withinthis clinical trial.” The Hospital Center, as part of the NIH StrokeProgram, is currently the highest enrolling site in this trial.

The HospitalCenter andMedStar Health arenow also part of thenew stroke clinicaltrials network,consisting of 25major academicstroke centers, toconduct NIH-funded Phase 3trials. The HospitalCenter andMedStar NationalRehabilitationNetwork, MedStarGeorgetownUniversity Hospitaland several otherhospitals in theDistrict haveformed SCANR,(Stroke CapitalArea Network forResearch). Dr. Hsiais Co-PI with

Alexander Dromerick, MD, vice president for Research atMedStar National Rehabilitation Hospital. “Through SCANR, wehave further developed the infrastructure to participate in theselarger, later phase trials,” Dr. Hsia says.

Dr. Hsia also is developing a telestroke program that enablesemergency physicians at other MedStar hospitals to consult avascular neurologist at the Hospital Center or MedStarGeorgetown University Hospital, via a direct video link toconfirm a stroke diagnosis and implement timely treatment.“This brings our care out into the community,” she notes, “andimproves our ability to manage patients for the bestoutcomes.”

Improving Care for Pregnant Women Who Live with HIVIn Washington, D.C., 1.9 percent of women of reproductive ageare HIV positive, far higher than the national average. Thispresents both a challenge for patient care, and an opportunityfor research that can improve care for women living with HIV inthe District and throughout the United States.

Rachel Scott, MD, MPH, is the scientific director of women’shealth research at MHRI, and is an obstetrician/gynecologist atthe Hospital Center who specializes in Ob/Gyn care for womenliving with HIV. Dr. Scott provides full-scope Ob/Gyn care forthis patient population, and manages the majority of the HIVpositive pregnancies in the District.

Dr. Scott’s clinical interest in women’s health and HIV informand inspire her research with MedStar Health ResearchInstitute. Her research goal is to improve care for HIV positivewomen is a prime example of academics meeting real worldclinical care.

“Much of the care we provide to these women in pregnancyhas been based on assumptions, rather than evidence basedmedicine,” Dr. Scott says. “We are currently collecting data onpregnancy outcomes in women living with HIV, to better informthe prenatal care we provide for these women in pregnancy.My research comes out of my clinical practice—much of itfocused on HIV in pregnancy, and the gaps in knowledge andclinical care.”

She is currently doing a retrospective cohort study of maternaland neonatal outcomes for HIV positive pregnancies, withgrant support from the NIH-funded D.C. Center for AIDSResearch and the Latham Foundation. “Pregnancy in womenliving with HIV hasn’t been closely looked at in the developedworld,” Dr. Scott notes. “The information we collect will betterinform our clinical care.”

Dr. Scott also is working with the National Institutes of Health todetermine the optimal time to deliver babies in women whoare HIV positive. “We want to see if there is a difference intransmission of the virus from mother to child, depending onestimated gestational age in mothers who are virallysuppressed,” she explains. “Current practice guidelines are,again, not based upon any hard data.”

In a related area, she is applying for a grant to investigate therelationship of antiretroviral adherence to genital tractimmunity, and possible transmissibility during pregnancy.

In another study with one of her chief residents, Katie Friday,MD, she is exploring condom use and negotiation skills amongwomen. “We know that, in addition to antiretroviral therapy, thebest way to prevent HIV transmission is by using a condomduring intercourse. We are looking at our patients’ condomknowledge, and their ability to negotiate condom use with theirpartners,” Dr. Scott says.

“It’s wonderful to be able to care for these patients,” sheconcludes. “We haven’t had a mother-to-baby virustransmission in the last three years. It’s so exciting to work onresearch that directly improves patients’ care.”n


COVER STORY continued

Alexander Dromerick, MD

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OUTCOME


The patient was a 45-year-old woman with a long historyof Crohn’s disease, who presented at her gastroenterologist’soffice with increased obstructive symptoms, including rightlower quadrant pain and abdominal distention after eating,with the recent onset of intermittent fevers. She wassubsequently referred by her gastroenterologist for surgical

evaluation.

She had been initiallydiagnosed with Crohn’sdisease in 2007, followingbouts of diarrhea andmouth ulcers. A CT scanrevealed a thickenedterminal ileum andprobable ileosigmoidfistula, explains ThomasStahl, MD, MedStarWashington HospitalCenter Interim SurgeryChair and MedStarRegional ColorectalSurgery Program Director.

“At the time of theconsultation, the patientwas on PENTASA® andprednisone,” states Dr.Stahl. “She had tried

several medical therapies that were not tolerated, or hadfailed, including REMICADE®, 6-MP and Imuran®. HUMIRA®was considered, but the patient decided against initiating thistherapy.”

The patient’s past medical history included Protein Sdeficiency and deep vein thrombosis, and her past surgicalhistory included an umbilical hernia repair. On physicalexamination, Dr. Stahl noted RLQ tenderness with palpablefullness. A small bowel MRI was ordered, and identified along, 50 cm. segment of Crohn’s disease of the terminalileum, with severe luminal narrowing. A previous colonoscopywas suspicious for an ileosigmoid fistula.

“Her diagnosis was increasingly symptomatic terminal ilealCrohn’s disease, with a fistula to the sigmoid colon,demonstrated by MR enterography,” explains Dr. Stahl. “Wediscussed surgery, which can be a frightening prospect forpatients with Crohn’s disease. But having the ability to utilizeminimally invasive surgical techniques in our inflammatorybowel disease program reduces both the pain and thepatient’s fear of surgery, and is very gratifying.”

The patient agreed to surgery, and underwent a laparoscopic-assisted ileocecectomy and repair of the ileosigmoid fistula, achallenging procedure Dr. Stahl describes as “long anddifficult.” The amount of small bowel resected wasapproximately 50 cm, and the remaining small bowel wasnormal.

The patient was discharged on post-operative day 4 and hadan uncomplicated recovery, with complete resolution of herobstructive symptoms. The patient was referred back to hergastroenterologist to resume medical management. Onemonth later, her weight was stable, and she was tolerating anormal diet. A repeat colonoscopy three months later foundno evidence of Crohn’s disease.

“Minimally invasive surgery is an option for improving qualityof life when medical management is unsuccessful,” says Dr.Stahl. “This surgery allows the patient to benefit from ashortened hospital stay, less post-operative pain, smallerincisional scarring and a reduced risk of an incisional hernia.” n

For more information, call the MedStar Colorectal SurgeryProgram, 202-877-8484, or go tohttp://www.medstarwashington.org/colorectal.

For personal referral assistance, please call Donna Sloper, RN,MSN, 202-444-0748 or 202-713-8778.

Minimally Invasive Surgical Techniques:

Successful, Safe Option for Crohn’s Disease Patients

Thomas Stahl, MD

PHYSICIAN | MARCH/APRIL 20161010

Physicians Speak Out:

“What I Would Tell My Younger Self”

FEATURE

What’s the best advice you got as a resident?

What if you could go back in time, and give that advice to yourself?

That time travel scenario was proposed to several physicians, who thought about whatthey would say to themselves, now that they have years of experience under their belts.Their advice follows:

Arthur St. Andre, MDSurgical Critical Care, Practicing since 1980

“My advice to younger clinicians is to listen carefully to patients,since an accurate history is the best guide to diagnostic endeavors. Trustin your clinical acumen, while being your own personal devil’s advocate.Reexamine your assumptions and knowledge. Trust your reasoning, buttemper it with healthy skepticism.

Also, you should continue to inspect and reinvent your own clinicaltraditions and practice as a clinician and educator. How we do thingsand how we interact with others is as important as what we do and whatwe know, when helping others.

Hold yourself accountable. As part of any health care endeavor, holdone another accountable. Focus on the benefits of managing patientsthrough a team approach. Share your thoughts, even when it isuncomfortable to do so, as no one person is perfect all the time.

As part of examining how you do things, practice with the thought ofdoing what is necessary, not simply what is effective. Today, there aremany avenues we can pursue in caring for patients. Some areduplicative and unnecessary. Often the better path is doing less thanmore.

Be a good listener, especially when emotions run high. Always look forthe hidden message, and always maintain equanimity.

You contribute much in the care of individual patients, but even morewhile influencing others as an educator, and improving our programs ofcare. By holding ourselves to high standards, we hold others to highexpectations. Serve as an example to others throughout your career.”

1111


“I’d tellmy younger self to ‘Relax, take it easy, you’re still young.’ Take time to smell the roses. Sleep is important!

Be very careful. If you have two choices and one is personally inconvenient,almost invariably that is the correct choice. At 3 a.m. when you haven’t sleptfor days, it’s tempting to cut corners. But you have to remember how thingswill look in the light of day.

Also, don’t be afraid to say you’re sorry, even if you don’t know what you’resorry for. Sometimes you are sorry that you have upset the other person. It’sokay to say ‘sorry.’ You have to have humility. It can be a very fine line—youhave to be confident, but you also have to know when to call for help.

Work hard. Always do the right thing. Always. Your reputation and ethics areyour most precious assets. Take good care of them, and do the right thing.”

Jennifer Ellis, MDCardiac Surgery, Practicing since 1999

Joelle Borhart, MDEmergency Medicine, Practicing since 2010

Alvin Bannerjee, MDPodiatric Surgery, Practicing since 2014

“There’s a huge jump from residency to private practice. I wish I haddone a lot more networking, and I wish I knew a lot more about billing andcoding.

Life does get a little bit better after residency. I’d advise residents to behealthier, exercise more and rest more. Take more time for yourself duringyour residency.

Residency always seems hard. You have different obstacles, differentattendings, different surgeries. It seems like the end of the world, the worstthing you’ll ever face. But it makes you stronger; you’ll always see somethingbigger, and it will be okay.

I’d advise my younger self to keep calm, and work through problems. It willall be all right. You have to believe in yourself.”

“I’d tellmy younger self to ask more questions! Residents often spend alot of energy covering up what they don’t know. Now I feel much morecomfortable asking colleagues and consultants questions.

Also, enjoy the process more; embrace the learning process. As a resident,you always feel you have something to prove. I’d give myself permission toNOT know something.

I also wish I had taken more time to make an emotional connection withpatients. I was so worried about missing the diagnosis, that I didn’tappreciate them for the people they are. Now it’s easier to take a few moreminutes with patients. It’s key to sustaining you long term. My goal is tomake at least one true connection each day.

It’s also important to find something to look forward to every day. There’s a lotof quick turnaround. It’s my goal to always find something to be excited about,something new to see.

Now I have a role in residency leadership, which is so rewarding. I loveseeing patients, but it’s important to have a balanced career. For me, thatincludes teaching and public speaking. I’d advise new physicians to findsomething else about the job they love and pursue that, too.”


For Loral Patchen, PhD, CNM, the inspiration to helpMedStar Washington Hospital Center implement the Baby-Friendly Hospital Initiative (BFHI) came down to some prettysimple facts.

“I got tired of walking into rooms and seeing crying mothers,”Patchen remembers. “They wanted to breastfeed their newborns,and we weren’t providing them with what they needed.”

Dr. Patchen was well aware of the advantages exclusivebreastfeeding provides for both mother and child: n Breast milk is more easily digested by newborns, and provides them with better immunological support.

n Babies who breastfeed have lower rates of ear infections and obesity.

n Mothers who nurse are less prone to breast and ovariancancer later in life.

As for any obstacles to increase breastfeeding rates, she wasn’tconcerned. “This is going to work,” Dr. Patchen remembersthinking, “because mothers want to breastfeed, and whencaregivers help patients achieve their goals, especially goals soclosely aligned with evidence, our own sense of reward in thework we do improves as well.”

The World Health Organization and UNICEF launched the BFHIin 1991, to promote exclusive breastfeeding. In order to achieveBFHI certification, a hospital must meet ten benchmarks. Thefirst step in the process is known as Discovery, performing anassessment of the hospital’s current practices.

In 2013, Lindsey Ellis, NP, IBCLC (International Board CertifiedLactation Consultant®), was studying to become a nursepractitioner. She had an interest in working with women, andapproached Dr. Patchen about getting involved in a project, andwas given the Discovery process.

She spent several months combing through records, developingsurveys and interviewing providers and patients. Of the tenbenchmarks required for BFHI, “we were pretty close to thestandard on rooming-in, the practice of having a baby stay in thesame room as the mother, to facilitate nursing. On the othernine, we needed a lot of work,” Ellis remembers.

Education is KeyMuch of the work that followed centered on education. BFHIemphasizes education for all new mothers, and all careproviders—nurses, midwives, physicians—needed to undergotraining themselves. Ariam Yitbarek, RN, senior nursing director,Women’s and Infants’ and Ambulatory Services, recalls what“training” meant in practical terms for nurses.

UPDATE

Leaders of the “Baby-Friendly” team gatheredin Labor & Delivery: Loral Patchen, PhD, CNM;Renuka Darolia, MD; Lindsey Ellis, NP, IBCLC and Ariam Yitbarek, RN.

Baby-FriendlyProviding Support For Moms and Newborns

Prior to BFHI, post-partum nurses had received six hours oftraining related to breastfeeding. Now they receive 20 hours,and this training was designed for post-partum nurses and forLabor & Delivery and NICU nurses. Yitbarek explains, “We tripledthe number of nurses who received training, and tripled theamount of training each nurse got.”

Physicians had to buy into new practices as well. Renuka Darolia,MD, Ob/Gyn, remembers a time when “skin to skin,” the practiceof placing a newborn on the mother’s chest soon after delivery,was almost never implemented after surgical deliveries. PursuingBFHI certification caused providers to consider that “we didn’tneed to do things the way they had always been done.” It alsocaused all caregivers to review their practices, to better supportbreastfeeding mothers.

BFHI requires that all patients be educated about the benefits ofbreastfeeding exclusively, but Yitbarek and Ellis both observedthat the biggest change in attitude has come from the careproviders. Ellis says residents used to consider breastfeedingsupport a secondary item, but it is now a point of emphasis.

Even some of the office staff in Dr. Darolia’s WashingtonWomen’s Wellness Center attended the BFHI-related classes.“Having everyone buy-in, from physicians to nurses andmidwives to office staff, makes it a lot easier, “says Darolia. Two and a half years after Ellis began her survey, the results are tangible.

Two Moms & Their BabiesWhen pregnant with her first child, Lydia Watts came to MedStarWashington Hospital Center, because she wanted a strongmidwifery practice that would provide excellent pre-natalsupport. Though Watts was generally aware of the benefits ofbreastfeeding, she learned new things as she journeyed throughpre-natal counseling.

“I may have the science wrong on this,” she says, “but if the babyis getting sick, there are some kind of receptors on the nipplesthat allow the breast milk to adjust, to help protect the baby. Think of that. My body is designed to do such miraculous thingsfor my child.”

She had planned on having a natural birth, but after many hours oflabor, concerns for the baby’s health led Watts and her caregiversto opt for a C-section. Despite the surgery, Watts’ newborn wasplaced on her chest within minutes of delivery. The nurses all madesure that her son was latching on and nursing properly.

Dr. Darolia notes that when moms prepare for natural childbirthand then must have a surgical procedure, “they can feel as iftheir goals are out the window.” But with the support systems inplace with BFHI, “we can give them the experience they want."

Premature births also pose particular problems for momswishing to breastfeed.

In her 25th week, Mandy Keithan had to curtail normal activities.For Keithan, who teaches trapeze and acrobat skills, that meantno more flying through the air or performing handstands.Keithan had known from the outset that she wanted tobreastfeed, but when her daughter was born at 32 weeks, shewas too small to nurse normally. Keithan had to pump milk fivetimes a day.

“The hardest thing about having a premie is leaving her in thehospital when you go home. The second hardest thing isbreastfeeding,” Keithan says. Every time she would return to thehospital, even if she only had been able to pump a small amountof milk, the nurses and lactation consultants would offer greatencouragement.

Four months later, with a healthy 12-pound baby girl in tow, thebreastfeeding is going smoothly and Keithan is getting back into her routine. “I think my daughter is going to be a youngtrapeze artist.”

Both Watts and Keithan point out that breastfeeding support andeducation from the hospital staff does not end with delivery.Watts notes that after leaving the hospital, her caregivers were“very encouraging about maintaining relationships. I never felton my own.”

Efforts for New MomsFor Nurse Practitioner Ellis, maintaining relationships is one ofthe most important aspects of the move toward BFHIaccreditation. Making sure new mothers have access to breastpumps and to easily-accessible classes remains a challenge, andthe best of intentions at times can’t stand up to the realities ofgoing back to work.

But such frustrations tend to disappear when Ellis recalls a daylast December. “Every one of the patients who came in that daywas still exclusively breast-feeding. It really made my day.”

Dr. Patchen is hopeful that the BFHI final review will take placethis spring, less than three years after the launch of the program.She is convinced the effort and expense will have been worth it.Recalling the crying mothers she used to see, Dr. Patchen says,“when you do something for your patient that she really needs,there is no better day at work.” n


Lydia Watts Mandy Keithan with her husband and baby.

Of themany crucial decisions an Emergency Medicinephysician has to make, one of the most important is whether apatient should be admitted or sent home, with follow-uptreatment on an outpatient basis.

For many routine conditions, going home is best for thepatient, in terms of both convenience and affordability. Butthere are often a host of variables that must be consideredbefore issuing a prescription and signing the discharge form. Atreatment that works for Patient A may not be best for Patient B,even if their presentations are remarkably similar.

One example is deep veinthrombosis (DVT), a conditionthat, depending on its severityand proximity to the heart,may be easily treated withmedication, or which mayrequire vascular surgery.Arranging a follow-upschedule is also important tomonitor the DVT, and ensurethe patient is taking themedication as prescribed.

Jeffrey Dubin, MD, MBA,MedStar Washington HospitalCenter’s chairman, EmergencyMedicine, says that of thehandful of DVT cases hisdepartment sees every month,

most usually end up being discharged.

While traditional outpatient treatment is a combination of dailyinjectable blood thinners, with periodic samples for testing,

“not everyone can or wants togive themselves shots,” Dr.Dubin explains. He adds thatwhile there are many newanticoagulants in pill form thatare easier to take, “they’re notsuitable for every patient, norare all covered by insuranceplans.”

Uzma Vaince, MD, director forthe Hospitalist program, addsthat physicians may see thesame case quite differently.

“What I do may be differentfrom what one of my

Collaboration Creates a

Pathway for

Optimal Outpatient Care

NEWS

Jeffrey Dubin, MD

Uzma Vaince, MD


colleagues does,” Dr. Vaince says. “As a result, patients mightwell be receiving different levels of care.”

What the Emergency Department needed, Dr. Dubin says, wasa protocol—called a pathway—that could guide physicians in theassessment and treatment of DVT patients. But unlike pathwaysthat have been developed for other conditions, this one woulddraw on the input and perspectives of many disciplines.

“We involved representativesfrom Internal Medicine,Hematology, Vascular Surgery,Emergency Medicine,Radiology, Cardiology andother resources,” he says. “Thatgave us the advantage ofhearing different perspectivesand, frequently, hearing aboutand discussing issues thatweren’t always considered.”

Those differing perspectivesare due in large part to therecent expansion ofanticoagulant medications andtheir side effects, explainsHospital Center HematologistKelly Fitzpatrick, MD.

“An ED physician may not know all the drugs that are out there,or what their side effects may be,” she says. “It’s critical that we

pick the right anticoagulant,and make sure the patient andphysician know how to use it.”

The DVT pathway also specifiesconditions that may require avascular consultation, such asthe presence of clots in majoriliac and femoral veins.

“Some DVTs require proactivetreatment beyondamticoagulants, to preventmore serious conditions thatmay arise five to ten yearsdown the road,” says VascularSurgeon Rajesh Malik, MD.“Because the pathway can getthe vascular surgeon involved

early, we can lay out what can be done usually within two weeksof the diagnosis, to reduce the risk of long-term complications—for example, leg swelling, discoloration, pain and ulceration.”

During the course of five months, the team examined whattypes of conditions may preclude the use of certainanticoagulant medications, such as abnormal liver and renalfunctions, cancer, breastfeeding and weight extremes.Regimens for specific drugs were also assessed, based on thepatient’s condition, safety and cost.

Implemented last summer, the pathway appears to be workingwell for DVT patients, from the moment they arrive at thehospital’s Emergency Department.

“Now, we have uniform guidance for what to treat in the ED,what drugs to prescribe if there are no insurance barriers, andhow and when to follow up,” Dr. Vaince says, adding that thepathway also resolves any uncertainty as to when a vascularconsultation is needed.

“This will lead to better and, more timely patient care,” she adds.

Dr. Dubin notes that the success of the DVT pathway is a goodmodel for developing treatment protocols for other conditions.

“With so many people collaborating, there’s less chance of aphysician doing something unilaterally that might causeproblems,” he says. “But the biggest difference is for ourpatients, because they’re getting exactly the treatment theyneed.” n


Kelly Fitzpatrick, MD

Rajesh Malik, MD

“We involved representatives from Internal Medicine,

Hematology, Vascular Surgery, Emergency Medicine, Radiology,

Cardiology and other resources. That gave us the advantage of

hearing different perspectives and, frequently, hearing about

and discussing issues that weren’t always considered.”

Upcoming CME Conferences Lifelong LearningFrontline Cardiology: 365 Days of ProgressMay 7, 2016 | College Park Marriott Hotel & Conference Center | Hyattsville, MarylandCourse Directors: Sriram Padmanabhan, MD; Allen J. Taylor, MD; Carolina I. Valdiviezo, MDThis course aims to shorten the translation between evidence and practice on a wide variety of cardiovascular issues including preventive cardiology, new innovative therapeutic procedures, and diagnostic methods. This meeting will bring together diverse members of the interdisciplinary practice team, towards creating a common knowledge base so important to effectiveness of the care team in today’s practice environment. For more information please visit: cme.medstarwashington.org/FRONTLINE

12th International Conference on Clinical Ethics ConsultationMarch 18, 2016 | Omni Shoreham Hotel | Washington, D.C.Course Director: Nneka O. Sederstrom, PhD, MPHThis annual conference is focused on the multidisciplinary approach to caring for the ethically complicated patient in order to positively impact the global healthcare community. For more information, please visit iccec2016.org

HIV/AIDS Continuing Education for Healthcare ProfessionalsMay 20, 2016 | True Auditorium | MedStar Washington Hospital CenterCourse Director: Glenn Wortmann, MDThis half-day program is designed to provide instruction on the impact of HIV in populations of different ages (particularly the senior population) and on persons of different racial and ethnic backgrounds. In addition, the program will educate attendees on the general risk to all individuals of HIV infection, provide guidance as to how to inform all patients about HIV/AIDS and how to appropriately monitor all patients for potential exposure to HIV. This program is designed to fulfill the requirements for licensure of healthcare professionals in the Washington, DC.For more information and to register, please visit: cme.medstarwashington.org/HIVAIDS

10th International Congress on Peritoneal Surface MalignanciesNovember 17-19 | Omni Shoreham Hotel | Washington, DCCourse Director: Paul H. Sugarbaker, MDThe mission of the 10th International Congress on Peritoneal Surface Malignancies (PSOGI 2016) is to provide clinical and scientific information on peritoneal surface malignancies and to create awareness regarding innovative treatments that will improve the quality of life for patients. This two and a half day conference will feature key note lectures, didactic sessions, debates, meet the professor breakfast sessions. Additionally, the program will include two satellite programs on Saturday focusing on peritoneal metastases imaging and pharmacology of chemotherapy treatments. Visit psogi2016.org for more information.me.medstarwashington.org/HIVAIDS

SAVE THE DATE FOR THESE ADDITIONAL FALL CME EVENTS:September 16, 2016: Controversies in Cardiac ArrhythmiasSeptember 23, 2016: Adult Congenital Heart DiseaseSeptember 24, 2016: The 3rd Annual MedStar Georgetown Symposium on Gastrointestinal Stromal TumorsOctober 1, 2016: Current Issues in the Care of Dialysis and Transplant PatientsOctober 15, 2016: PANDAS/PANS Meeting

WEEKLY ACTIVITIES

Numerous continuing medical education opportunities, including Regularly Scheduled Series, take place each week at MedStar Washington Hospital Center. For a complete list of CME activities, please visit: CME.MedStarWashington.org

CME Transcipts are Available Online You can download, print or e-mail your CME transcript. Visit http://cme.medstarwashington.org and click on “View Your CME Transcript” for complete instructions.



The Emergency Department (ED) at MedStarWashington Hospital Center has a long history of being wayahead of the curve for electronic documentation. Its physicianswere the brains behind Azyxii, the homegrown electronicsystem that captured data on emergency room patients.Microsoft® bought the program and renamed it the Amalga™Unified Intelligence System, and then sold it to other hospitalsfor their use.

The ED is now on its waytoward a fully robustelectronic health record (EHR)and will complete theprocess with MedConnect III(MC3).

“MC3 adds completeelectronic documentation byphysicians and physicianassistants,” says GregMarchand, MD, director ofclinical informatics forMedStar EmergencyPhysicians. “We are veryprepared for this transition.”

“Our Emergency Departmentis well on its way toward afully integrated EHR,” saysPeter Hill, MD, chief medicalinformatics officer for theHospital Center. “Thedepartment is embracing thenew technology.”

Currently, the ED uses severaldifferent ways to capturepatient information. InVisionis used to record patientregistration information. Atdischarge, patient records aretransmitted to or scannedinto the Medical Records

Document Imaging (MRDI) system, which generates a PDFsummary of all past care a patient has received.

Between admission and discharge, MedConnect is thecornerstone of the integrated EHR. In the ED, FirstNet is theMedConnect application that builds on PowerChart, tocustomize information for ED patients. With MedConnect II,

FirstNet was introduced for physician order entry and nursingdocumentation. With MC3, physicians’ notes will become partof the electronic chart.

Today, about 60 percent of the hospital’s ED physicians useAmadeus, the Amalga application for physicians’ notes. Theremaining physicians create handwritten documentation.

MC3 represents a big step forward to a truly robust EMR, Dr. Marchand notes. “It uses macro-based note building, whichis similar to Amadeus. Through Dynamic Documentation™,physicians and physician assistants (PAs) in the EmergencyDepartment will be able to create their own macros that willaid in documentation.”

Even better, clinicians will have the choice of enteringinformation through keystrokes or dictation. The Dragon©application allows them to dictate the relevant information.Each physician and PA creates his or her own Dragon profile,which learns to understand their voice patterns and correctlyinterprets what they say. “Dragon gets better with time,” Dr.Marchand adds. “It learns to correct itself after repeated use.”

The chart captures the story of why the patient came to the ED.“It allows the doctor or PA to note why the patient is there, whatthe history is, what tests are ordered, what your thoughtprocess is, how you interpret the tests and what is your plan forpatient care,” Dr. Marchand explains.

The benefits are obvious: more complete documentation withfewer errors caused by hard-to-interpret handwriting. Therewill be a learning curve, but the hope is that efficiency will beincreased over time.

The hospital’s ED physicians are working to create a way totrack patients in the ED. Called LaunchPoint, the applicationcreates a snapshot of each patient plus an overview of allpatients a physician is managing.

“We can see more information about each patient in the mostmeaningful way, without multiple clicks to get a full picture,” Dr. Marchand explains. “It provides cleaner, simpler, moreefficient visualization, which physicians need to take better careof our patients.” LaunchPoint also provides an overview of allpatients a physician is currently managing, allowing thephysician to better note critical alerts, which remind him or herto pay added attention or take special action.

“Our ED has always been innovative,” Dr. Marchand concludes.“We welcome anything that allows us to better care for ourpatients.” n

MedConnect IIIED Phases into Total EMR

UPDATE

Peter Hill, MD

Greg Marchand, MD

“We can see more information about each patient in the most meaningful way,without multiple clicks to get a full picture.”

Katie Friday, MDOb/Gyn


CHIEF RESIDENT PROFILE

As Chief Resident Katie Friday, MD, has spent much ofher chief residency year learning her specialty from bothsides of the examination room: as a doctor and a patient. Aschief resident of Obstetrics & Gynecology at MedStarWashington Hospital Center, she conducted checkups andmade plans to deliver her patients’ babies, as well aspreparing to deliver her own baby.

Dr. Friday welcomed her first child, Virginia Harrison Friday, atthe Hospital Center on January 31.

Her pregnancy offered her the opportunity to be in lockstepwith her patients. Dr. Friday believes that spending the first halfof her chief year as an expectant mother and the latter half as anew mom made her a better, more empathetic doctor.

“The pregnancy definitely helped me connect to patients,” Dr. Friday says.

While the demands of a chief residency and pregnancy mightfeel like a lot to handle, Dr. Friday had two points in her favor.“First, it was an easy pregnancy, and second, I love residency,”she states. “Residency is more of a lifestyle than a job. I enjoycoming to work, and when you enjoy something, you don’tthink of it as a task.”

That simple lesson—that meaningful work should feelenjoyable—helped Dr. Friday choose her future specialty whilestill a medical student at the Medical University of South Carolina.

“I was so excited to be at work that I never looked at the clock,”she recalls of her rotation in Obstetrics & Gynecology. It was thefirst job she’d had where she didn’t count how many hours shehad left, before she could leave work to go home.

Before entering medical school, Dr. Friday spent time workingin a more bureaucratic setting, but she didn’t find the worksatisfying. She’d wanted to take some time after college to becertain that medicine was her calling, and the answer seemeda clear “yes.”

“I wanted to work one-on-one with patients, to have moreintimate connections with people and help address theirproblems,” Dr. Friday says, adding with a laugh. “Andphysicians in Obstetrics and Gynecology are definitely in themost intimate field there is!”

As a chief resident, Dr. Friday says that she strives to lead by example. “I try and embody what I ask of my residents,”she says. That means coming to work and enjoying what she’s doing, but also doing any difficult work right alongsideher residents.

“There is such a wealth of knowledge at the Hospital Centerand through MedStar Health. We have such a strong caliberof residents and attendings across specialties,” Dr. Fridaymaintains. “I’m just truly thankful for completing my traininghere. I feel 100 percent ready to go practice on my own.”

Dr. Friday’s husband—whom she met in medical school—is aflight surgeon in the Army, stationed at Fort Campbell, on theTennessee/Kentucky border. He traveled back and forth onweekends the month before the due date, so that he couldplan to be there for the birth. The couple will remain longdistance until the end of Dr. Friday’s residency, when shehopes to find a position in academic medicine in Nashville.

Until then, Dr. Friday’s daughter, Ginny, will experience twogenerations of mothering under one roof. Her mother, whoretired in December, arrived in the District in January to helpwith child care.

“We had downsized to a one bedroom, one bathroomapartment before the pregnancy,” says Dr. Friday. “So she washanging out with a baby, a dog and a cat. It was a tightsqueeze, but that’s what families are for!” n


Arash Radfar, MD, PhDDermatopathology

Arash Radfar, MD, PhD almost didn’t become apathologist. The Pathology rotation was the last of his medicalschool career before the winter holidays at Tufts Medical School.In fact, when Dr. Radfar stepped foot into that final rotation, hehad already completed residency applications for his plannedspecialty: Radiation Oncology.

Dr. Radfar wasn’t expecting to fall in love, but that’s just whathappened.

“It’s funny, because that rotation changed my entire trajectory,” hesays of that final month of clinical rotations. “I fell in love withPathology and Dermatopathology.”

It was such a whirlwind romance, in fact, that Dr. Radfar had toscramble to complete a residency application before thedeadline, hand-delivering his application to MassachusettsGeneral Hospital to ensure he made the cutoff date.

“You have to be very visual to love Pathology,” Dr. Radfar says. Hefound he enjoyed looking at slides through a microscope, andrecognizing patterns. “It fit my overall learning philosophy.”

Dr. Radfar came to the United States to attend college afterspending his high school years in France. He knew he wanted toattend a university with a strong pre-med program. His uncleworked at West Chester University of Pennsylvania, andrecommended their program. His mother liked that he’d be closeto family.

He loved his experience as an undergraduate, but was wistfulabout not being in a more metropolitan area. The opportunity forhis dream of bigger city life came when he was accepted to TuftsUniversity School of Medicine. Dr. Radfar stayed in Boston forresidency and back-to-back fellowships, and still refers to Bostonas his “hometown.”

“Living in Boston was a great experience,” Dr. Radfar states. “A lotof people don’t like it because of the cold weather, but theculture is great and the educational opportunities arephenomenal. There’s always something to do. You don’t getbored in that town.”

Given how Dr. Radfar waxes on about Beantown, you canimagine it would take a pretty compelling offer to drag him away.But it was just such an offer that MedStar presented to him twoyears ago.

“This was a unique job opportunity,” he believes. “It gives me thechance to grow a vibrant dermatopathology practice, in ageographic area that has a huge potential for academic progressin that specialty. If there’s one area of the country in which to dothat, it’s here.”

Dr. Radfar says that the MedStar peer community has been anadded bonus. “The folks here have been very, very supportive.

We now have three dermatopathologists and our department ofDermatology is growing. We also have a robust collaborationwith the Georgetown University’s Lombardi ComprehensiveCancer Center, which opens up a whole opportunity to doresearch. There is huge potential in the MedStar system.”

“There’s a lot to be done,” he says. “We can do great science.”

Dr. Radfar lives with his wife in Potomac, Md. Still a city lover atheart, he’s learned that marriage, like any great love, is aboutcompromise. “If it was up to me, I’d be living in downtown D.C.,”Dr. Radfar grins. “But my wife likes the quiet life.”n

SPOTLIGHT

AtMedStar Heart & Vascular Institute, weare privileged to provide advanced carefor patients entrusted to us.

Cardiac Electrophysiology is a rapidlygrowing cardiology sub-specialty,offering:• Diagnosis with implantable or wearablecardiac monitors

• Cardiac rhythm management withpacemakers, defibrillators, andbiventricular devices

• Device extraction• Management of syncope syndromes• Treatment of atrial flutter and fibrillation,supraventricular and ventriculartachycardia, and palpitations due toother causes

• Epicardial ablation• Management of cardiogeneticdisorders

• Specialized treatment of pediatric &adult congenital heart conditions andpost-cardiac surgery arrhythmia care

MHVI’s Section of CardiacElectrophysiology includes nine board-certified, highly experienced physiciansub-specialists who are joined by uniquelytalented, specialized nurse practitioners,nurses, technologists and support staff,whose depth and breadth of experiencein cardiac electrophysiology is second-to-none. Our overarching mission is tocontinue to grow as a global destinationcenter for cardiac electrophysiology care.

20 MEDSTARWASINGTON.ORG

Non-Profit OrganizationU.S. Postage

PAIDMedStar WashingtonHospital Center

110 Irving Street, NWWashington, DC 20010

PhysicianMEDSTAR WASHINGTON HOSPITAL

MedStar Washington Hospital Center Physician isan informative bi-monthly publication for all the members of the HospitalCenter Medical and Dental Staff. It is a forum to report news of interest to themedical staff, introduce new providers and profile current ones, exchangeideas and opinions about subjects of interest and controversy, and recognizethe professional and personal accomplishments of our practitioners. Its over-all goal is to help foster and celebrate a sense of community among thebroad diversity of the Hospital Center physician membership. The newsletteris published by the editorial services division of Public Affairs and Marketing,for the Department of Medical Affairs.MISSION—MedStar Washington Hospital Center is dedicated to delivering ex-ceptional patient first health care. We provide the region with the highestquality and latest medical advances through excellence in patient care, edu-cation and research.MedStar Washington Hospital Center, a private, not-for-profit hospital, doesnot discriminate on grounds of race, religion, color, gender, gender identity,physical handicap, national origin or sexual preference. Visit the hospital’sWeb page at www.medstarwashington.org.

James Jelinek,MD, FACREditor

Cheryl Iglesia,MD, FACOGAssociate Editor

Mark Smith,MD, FACEPEditor Emeritus

Marge KumakiManaging Editor

Marlo RussellGraphic Design

Gregory J. Argyros,MD, MACP, FCCPSr. Vice President, MedicalAffairs/Chief Medical Officer

Arthur N. West,MDPresidentMedical & Dental Staff

Donna ArbogastVice President, Public Affairs & Marketing

John Sullivan, President,MedStar Washington Hospital CenterTheresa Dupart, Chair, MedStar Washington Hospital Center Boardof DirectorsKenneth A. Samet, FACHE, President and CEO, MedStar Health

Editorial Board MembersEvan Argintar, MD Jeffrey Dubin, MDZayd Eldadah, MD, PhD Peter Fitzgibbons, MD Tanya Ghatan, MD Karen Johnson, MDDerek Masden, MDMeghan Shaver, JDKristen Nelson, NPAdedamola Omogbehin, MDLoral Patchen, PhD, CNMStephen Peterson, MDMicheal Pistole, MDMarc Schlosberg, MDJames Street III, MDMarianne Wallis, MDLindsey White, MD

C O N T A C T I N F O R M A T I O N

James S. Jelinek, MD, FACREditor • 202-877-6088

[email protected]

Cheryl Iglesia, MD, FACOGAssociate Editor • [email protected]

Marge KumakiManaging Editor • [email protected]

Physicians’ Perspective

Cardiac Electrophysiology is highlytechnology-driven, and MHVI has builtextraordinary, state-of-the-art procedureas well as pre- and post-procedurefacilities throughout the Baltimore-Washington region, offering patientsworld-class care close to home. In additionto locations in the District, we provide localMaryland service in Frederick, Wheaton,southern Prince George’s County, andthroughout metropolitan Baltimore andbeyond, and in Virginia, in Alexandria,Arlington, Fairfax, Reston, Prince William,and other sites.

Patients needing complex arrhythmia carecan be treated at MedStar facilities—withMedStar Washington Hospital Center andMedStar Georgetown University Hospitalserving as our regional flagship centers—or at peripheral hospitals.

Our fundamental philosophy is to supportall referring providers with first-classcardiac electrophysiology care for theirpatients, and to return these patients tothem better than when they were firstentrusted to us. We are energized bydeep collaborative relationships withphysician colleagues throughout theregion, and by a mission to treat allpatients as members of our own families.

To discuss arrhythmia care or to facilitatereferrals 24/7/365, please call the MHVISection of Cardiac Electrophysiology at202-877-7685.n

From the Desk of…

Zayd Eldadah,MD, PhDCardiac Electrophysiology

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