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MEDSTARWASHINGTON.ORG 1

CONNECTIONSMedical & Dental Staff

Inside...2 Mini Procedure, Maximum Effect 4 Cover Story 6 Update: MedStar House Call Program 8 Collaborative Medicine

MAY/JUNE 2019 VOL. 25, NO. 3

Fast Intervention Saves Humanitarian Wife and Mom

2 CONNECTIONS | MAY/JUNE 2019

We know the advent of the electronic medical record hasmade it easier for us to provide higher quality, safer care forour patients.

• The EMR is a time-saving tool that improves our accuracy,and lets us more easily transfer information to otherspecialists and colleagues.

• It provides up-to-date information at the point of care, andenables more reliable prescribing.

• It enhances privacy and security for patient data, and helpsimprove efficiency.

Those are just a few of the advantages of having an EMR. Butas we’ve all adjusted to using it, one unexpectedconsequence has been our reliance on what’s on the screen.We’re not speaking to each other as much as we used to, andwe should reverse that situation.

Interfacing with ColleaguesWhile we should continue to write notes, concerning the planof care and treatment for our patients, our dailycommunications should also be verbal. Physicians andAdvanced Practice Providers should talk to each other, as wellas with our patients and their families. We need to know:what are we all thinking? Is there something we can changethat will improve care?

Face-to-face communication among caregivers is also a team-building exercise. We develop camaraderie, improveour interpersonal skills, understand how we can work betterwith each other. And all of us are smarter together than justone of us: everyone brings something different to thediscussion, and everyone can contribute to the plan of care.Direct, personal, bi-directional verbal communication ensuresthe intended messaged is received and acknowledged. Thismethod is far better than writing communication orders.

Many of us have been in a situation where the patient statushas suddenly changed. By verbally escalating concerns, youensure everyone is aware of a change. That doesn’tnecessarily happen by relying solely on the EMR: can youreally be certain that all members of the caregiving team haveseen your patient treatment note, and have acknowledged it?

Interfacing with PatientsWhen we talk to each other and understand the care goalsfrom day one, we are also helping to prevent a readmission.Maybe most importantly, making sure your patient

understands the plan of care each day leads to having thepatient join the care team. With good verbal communicationfrom you to your patient, the patient is more likely to be anactive participant, and compliant with the treatment plan. It all results in a higher patient satisfaction rating, as well.

Difficult EncountersWe have to acknowledge that there can be manipulativepatients, demanding patients, dependent patients, and self-destructive patients in a hospital setting. At the HospitalCenter, we have a wonderful resource to help you: ThePatient Communication Consult Service (PCCS). While thePCCS was set up to assist physicians in effective andcompassionate disclosure of medical error, the communicationtechniques taught by the PCCS can be useful for communicatingeffectively with a challenging patient or family.

For any questions about the PCCS or to request help fordisclosure communications, contact Risk Management, 202-877-6145 during weekday business hours; for evenings,weekends, or holidays, page the PCCS physician on call, at202-801-5774.

Part of our “ONE TEAM” journey is making sure that we workon enhancing all of our communications skills, which leads tothe highest quality, safest patient care.

Jeffrey S. Dubin, MD, MBA, is Sr. Vice President, Medical Affairsand Chief Medical Officer for MedStar Washington HospitalCenter. Please contact him at [email protected], or202-877-6038.

chief medical officer

Two-Way Communications: Our Way Forward As ONE TEAM“Talk to people. Everything good I’ve done has come from conversations with people.”

—American astrophysicist Dr. John C. Mather xx

Helena Pasieka, MD, Dermatology, discusses a difficult case with herteam of residents.


outcome

Kidney stones run in Michael Kirlin’sfamily. He and a brother have had them,as did their father, and recently, Kirlin’s30-year old son received his first kidneystone diagnosis.

“We joke that if we were oysters, we’d bemaking pearls,” says Kirlin, a retiredhealth care services executive. “Instead,we make kidney stones.”

Kirlin had three bouts with small kidneystones when he was younger, all ofwhich passed quickly, and with minordiscomfort. Dietary changesrecommended by his physicianappeared to solve the problem, andKirlin went on with his life.

Around his 40th birthday, however, Kirlin learned at hisannual physical that the stones were back, and bigger thanbefore. Though they posed no immediate danger, Kirlin’sphysician warned him that the stones might grow andfragment, putting him at risk for blockages, infection, andkidney damage. At that point, it seemed all Kirlin could dowas remain vigilant about his health, and be ready in casesomething happened.

It would be a long wait—30years—before a urinary tractinfection sent Kirlin to MedStarWashington Hospital Center’sEmergency Department lastJune. On the recommendationof his gastroenterologist, Kirlinsaw Daniel Marchalik, MD, theHospital Center’s director,Ambulatory Urologic Surgery.

A CT scan revealed a 2-cm lowerpole stone in Kirlin’s right kidney,and a 1.7-cm lower pole stone inthe left. Both needed to beremoved; the question was how.

Kirlin knew kidney stone treatments had come a long wayfrom the days of open surgery, but he also recalled hisfather’s painful experience with lithotripsy’s ultrasoundshock waves. A ureteroscopy was an option, but goingthrough the urethra seemed to Kirlin a rather roundaboutway to get to the kidney.

“I asked if there might be another way,” he says.

Indeed there was—a procedure called minimally invasivepercutaneous nephrolithotomy, or mini-PCNL.

Dr. Marchalik explains that the traditional PCNL procedure,in which the kidney is accessed through an incision in thepatient’s side, typically requires an overnight hospital stay,and insertion of a nephrostomy tube after the procedure.

“A mini-PCNL requires a much smaller incision, and nopost-operative tube is necessary,” he says. “It also has amuch better rate of stone clearance than other modalities,such as ureteroscopy or shock wave therapy, and usuallycan be performed on an outpatient basis. The nature of Mr.Kirlin’s stones and his overall health made him a goodcandidate for the procedure.”

Kirlin underwent a mini-PCNL on his right kidney in lateJuly, and the left kidney about a month later. In both cases,he experienced little post-operative discomfort, and wasable to resume normal activity, aside from heavy lifting, twoweeks later. Analysis of the stones and a metabolic workupmade it possible for him to get personalized advice ondietary changes that could help prevent their recurrence.

“Mini-PCNL allows us to minimize the number ofinterventions our patients receive, while also decreasingtheir discomfort,” Dr. Marchalik says. “It opens the door fora more effective and efficient treatment, especially forpatients with lower pole and larger kidney stones.”

Kirlin says he’s not at all sorry to see his days as “stone-former” end in such a convenient, comfortable way. “Icouldn’t have asked for better care,” he says. “Anyone who’sa candidate for this procedure should definitely get it done.”

A “Mini” Procedure, A Maximum Effect

Daniel Marchalik, MD

Michael Kirlin can now enjoy pool time with his grandchildren, Arthur and Lula.

Maury Mendenhall was snuggling with her two small childrenand sleeping off a headache after her long flight home fromNigeria last May. She had spent the last two weekssupporting programs for children orphaned and madevulnerable due to HIV, working with multiple partners andvisiting with HIV care providers, teachers, social workers,children, and caregivers across two countries. The work wasinspiring and exhausting, and given the circumstances, a badheadache did not seem unusual.

But when the 43-year-old awoke the next morning, herheadache went from bad to worse, and nearly took her life. “I thought I would feel better if I took a shower, but I started tovomit. My mother heard me crying and came upstairs,”Mendenhall says.

“Maury said, ‘Get help. Get big help,’” recalls LauraMendenhall, Maury’s mother, who had been staying with hergrandchildren while Mendenhall and her husband, AndrewMiller, were simultaneously traveling for work.

Within a few minutes, Laura, accompanied by Maury’s father,Charles, had loaded Mendenhall into the car. Soon after, they

arrived at MedStar Washington HospitalCenter’s Emergency Department.Because she was unable to walk,Mendenhall was helped into awheelchair. Her triage nurse immediatelyrecognized the severity of the situation,and alerted Susan O’Mara, MD, interimchair of Emergency Medicine.

“We saw her right away,” recalls Dr.O’Mara. “She was awake and talking, butcompletely confused. Her mentationwas severely altered, and she wasobviously very sick.”

After learning Mendenhall had justreturned from Africa, and with nocontributing past medical history, Dr.O’Mara immediately suspected cerebralmalaria or encephalitis.

“My resident at the time said, ‘Let’s justdoublecheck this is not a bleed,’” saysDr. O’Mara. “I agreed, and we hungantibiotics and very quickly ran her to CT scan.”

Within minutes, the images of Mendenhall’s brain wereavailable. “When I saw her CT, my initial reaction was, this iscatastrophic,” recalls Dr. O’Mara.

The CT scan confirmed Mendenhall had a large, left-sidedhemorrhage with a significant midline shift. It also revealed apartial uncal herniation, a transtenorial herniation, acompression of the brain stem that occurs when there isswelling in the brain.

Dr. O’Mara quickly called Jen Kraeuter, PA-C, a neurosurgicalphysician assistant, who saw the patient and immediatelyalerted Rocco Armonda, MD, director of NeuroendovascularSurgery for the Hospital Center and MedStar GeorgetownUniversity Hospital. Soon, the two providers were preppingMendenhall for emergency surgery.

“Dr. Armonda told me everything he would do,” LauraMendenhall recalls. “I told him that I trusted him, but heneeded to know Maury takes cares of orphans and vulnerablechildren all over the world, and that today, I needed him totake care of my child. He took my hand, and said he would.”

CONNECTIONS | MAY/JUNE 2019

cover story

4

“So Many Stars Aligned for Maury”

Dr. Armonda, Maury Mendenhall and her family, Nile, Andrew Miller, Naia; and Dr. O’Mara celebrated the one-year anniversary of Maury’s time at the Hospital Center.

Time-Sensitive Diagnosis, Fast InterventionSaves Humanitarian Wife and Mom

A World AwayDeep in the Amazon rainforest of northern Peru, AndrewMiller, Mendenhall’s husband, and advocacy director forAmazon Watch, was trekking between rural communities withtwo documentary filmmakers. He reached a clearing, anddecided to check in earlier than usual via satellite phone.

“The connection was not great,” Miller recalls, but my colleaguetold me something happened to Maury’s brain, and I neededto come home. There was not a lot of information, I didn’t evenknow if Maury was in the United States or still in Africa.”

Miller turned around immediately and began walking back. “Itwas the rainy season and very dangerous trekking,” Miller says.“It’s amazing I didn’t hurt myself trying to get out of there.”

With the help of local guides, Miller arrived safely back at thefirst community. A charter plane was under maintenance thatday and could not fly Miller out. The next day, bad weatherprecluded Miller from flying. Eventually, Miller boarded thesmall plane, the first of five flights needed to get back toWashington, D.C.

Surgical InterventionIn the endovascular suite, Dr. Armonda performed adiagnostic angiogram on Mendenhall. He saw a formidabledural AVM, or arteriovenous malformation, a congenital tangleof abnormal blood vessels connecting arteries and veins in thebrain. A rupture in the AVM was responsible for Mendenhall’sbrain hemorrhage.

Dr. Armonda then threaded a microcatheter inside the firstcatheter, and entered the cranial vault. Using Onyx®, a liquidembolic, and under fluoroscopy, Dr. Armonda carefullylocated the feeder supplying the tangle of vessels. He thendeployed the lava-like embolic, essentially plugging andcutting off the AVM’s blood supply.

Next, Dr. Armonda and his team transported Mendenhall tothe operating room, and removed a 15 x 12cm bone flap of

her temporal skull to alleviate the pressure on her brain. Aftervisualizing the hematoma, he made a small incision near thesurface, and using irrigation and suction, removed thehematoma, eventually disconnecting the AVM from thefeeding vessel with surgical clips and coagulation.

Despite the evacuation of the hematoma, Mendenhall’s brainremained edematous, the result of brain irritation due to thesubstantial brain bleed. To accommodate the swelling, Dr.Armonda left the surgical site open, creating an abdominalpocket and placing Mendenhall’s skull flap between themuscle and fat in her abdomen. A helmet was placed onMendenhall’s head, and she was transferred to the ICU.

RecoveryFour days after Mendenhall’s AVM rupture, her husbandarrived at the Hospital Center. “I cried, he cried, and he laydown with me on the bed,” Mendenhall says. “She wasspeaking, but not making any sense,” remembers Miller, “andshe called all men she saw Andrew, which was fine by me.”

Despite the severity of her brain injury, Mendenhall madegreat strides. Her bone flap was reattached less than twoweeks after it was removed, with a normal time frame beingone to three months post-op. She began speech, occupationaland physical therapy, and was eventually transferred toMedStar National Rehabilitation Hospital for additionaltreatment. She returned home one month after her horribleheadache began.

In the past year, Mendenhall has made tremendous gains inher recovery, the result of hard work and countless hoursspent relearning the alphabet, colors, and common objects.

“I thought my recovery would be very rapid. It was hardrealizing that recovery would not be rapid, and identifying allthe things I couldn’t remember how to do,” Mendenhall says.“Early on, things like toothpaste, a cellphone and pizza were amystery to me. It felt humiliating. I cried all the time.”

“I now know I will never be the same,” Mendenhall says of herongoing aphasia. “But I think having a brain injury helps mebetter understand and appreciate people who have their ownissues and struggles. I know how lucky I am.”

“So many stars aligned for Maury,” says Dr. O’Mara. “Hersituation was incredibly time-sensitive, and this was such ateam effort. Everything had to work perfectly for her to havethis outcome.”

Dr. Armonda agrees. “When we saw her initially, we wereunsure of her prognosis. But someone was clearly looking outfor her. It has been wonderful to see her recover and see howfar she has come.”

“She is the ultimate humanitarian,” Dr. Armonda continues.“And for me, being able to take care of someone who takescare of others is what makes my job so incredibly rewarding.”


Cerebral

angiogram

showing an

abnormal tangle

of blood vessels

characteristic of

an AVM.

Image used with permissionfrom the Society of NeuroInter-ventional Surgery, Fairfax, VA.


It’s been 20 years since George Taler, MD, and I founded theMedStar House Call Program, bringing home-based primarycare to frail elders, who often face multiple obstacles to good-quality health care.

What began as a three-person effort at MedStar WashingtonHospital Center has evolved into a nationally-recognizedprogram with a team of 27, consisting of physicians, nursepractitioners, social workers, and support staff. Now based atMedStar Health, the MedStar House Call Program now servesmore than 630 high-risk elders in Washington, D.C. andBaltimore, and has served a total of over 4,000 since 1999.

We had few programs to emulate in1999, but the need forsuch services was clear. Elders with advanced illness anddisability, particularly those with limited financial resources,often face barriers to visiting a physician’s office. This increasestheir vulnerability to illnesses that might otherwise be routinelymanaged or avoided altogether. This often results inunnecessary and costly 9-1-1 calls, Emergency Departmentvisits, and hospitalizations.

Providing home-based primary care and 24/7 phone accesshelps break this cycle, enabling patients to manage theirhealth at home, often with the help of family members. Wheninpatient care is necessary, we help facilitate safe transport toa MedStar hospital, and specialized care.

Serving the needs of our region’s growing population ofelders is only part of the story. From the outset, we recognizedthe importance of supporting family members, who can feelunprepared to assume responsibilities and time commitmentsinvolved with caring for a loved one. Finances and other socialissues can complicate a family’s ability to find a way forward.

Social services are integral to the success of the program. Inaddition to coordinating plans with physicians and nursepractitioners, our social workers fulfill valuable roles ofeducation, counseling, and emotional support. They helppatients and families work through difficult decisions, all whilerespecting clients’ dignity and unique circumstances.

It has been rewarding to make a difference in the lives of themore than 4,000 patients during the past 20 years. We receivemuch gratitude from the positive responses of patient andfamily satisfaction surveys. It is also gratifying to see the effortsof our skilled staff recognized on a local and national level fortheir compassionate home-based medical care of the elderly.

Since 2012, the MedStar House Call program has been part ofMedicare’s national Independence At Home (IAH)demonstration, which has proven how home care medicineleads to better care, improved patient experience, andreduced total Medicare costs. Our MedStar program has beenranked in the top three sites among the 15 national sites, interms of quality and cost reduction. This is a testament to ourteam’s commitment to excellence in every aspect of our work.

On a personal note, I will be taking a new job in July 2019,outside of MedStar. The coming months will see a transition inthe program’s leadership. The mission and success of theMedStar House Call team is bigger than any one person. Thiswill be an opportunity to make a good program even better, byexploring new ways to improve care, operate efficiently, andbring our model to new patient populations.

Those of us in the MedStar House Call Program have experiencedour share of challenges and rewards during the past 20 years.When you love your work, as we do, the opportunity to bringvaluable services to our community is a privilege.

viewpoint

MedStar House CallProgram:An Updateby Eric De Jonge, MDExecutive Medical Director, MedStar House Call Program

In the spring of 2013, Jason Chen, MD, was eager to begin hisgeneral surgery residency at MedStar Washington HospitalCenter, when Connections interviewed him about his goals andexpectations coming to Washington. Every spring, we’ve gottenan update. This year, Dr. Chen will graduate from his residency,and start a colorectal surgery fellowship at University of SouthernCalifornia in Los Angeles.

“I feel blessed to match at my first choice for fellowship,” Dr. Chensays, “and to return to my home state, California. It’s been 10years; it means a great deal to be closer to my parents and takecare of my family. Filial piety is important in Asian culture.”

In his six years at the hospital, Dr. Chen has fallen in love, gottenmarried, bought a home, and gained skills and judgment to be asurgeon. Things he believed as a 27-year-old newly mintedphysician from Vanderbilt Medical School still hold true, as a 34-year-old surgeon:

• He tells every intern and medical student about three “A” wordsfor success. Dr. Chen says, “I stress the importance of attitude,availability, and ability. I believe it is crucial to have the rightmindset of wanting to be the best, always being available tocover a case or see a consult with gratitude, and of course,`being a smooth operator.”

• He tries to model himself after his mentors. Some that he willforever remember include Jack Sava, MD; James Street, MD;and Christine Trankiem, MD, Trauma; Mark Steves, MD, SurgicalOncology; Marc Margolis, MD, Thoracic Surgery; and JohnBrebbia, MD, Bariatric Surgery.

Dr. Chen applauds the merger of surgical residency programs atthe Hospital Center and MedStar Georgetown University Hospital.“It’s a huge privilege to work at both institutions, caring for someof the sickest patients on high volume services,” he says. Heanticipates a career in academic medicine, working with residentsand treating the most complex patients.

Of leaving, he says, “I’ll miss the people. I’ll miss the chuckle of myco-chief Danielle Salazar, and the excitement of my co-chiefEugene Wang, when he shares the technical details of a complexcase. I’ll miss the scrub tech, Tuesday, and anesthesiologists Dr. Le,Dr. Phung, and Dr. Hawkins, who watched me grow. I’ll miss myfellow classmates most of all, who I half-jokingly dream of startinga practice with in the future. Luckily, we’ll have one moreadventure together, studying for the written board exam thissummer in Chicago.”

“We’ve all fallen in front of each other in some way or another, andit’s great that we can laugh about it,” he adds. The friends recentlywent skiing together, a sport Dr. Chen had never tried. “I heardyou need to keep the boots really tight to support your ankles,

and I guess I took it to the extreme. I kept thinking ‘no pain, nogain,’ but ended up finding that I had ischemic blisters, where mysocks essentially burned me.”

Dr. Chen will also miss D.C. “I love the access to world’s best food,including North African cuisine, Japanese tapas, or creativecontemporary American food. I’ve been lucky enough to seeHamilton at the Kennedy Center, and attend numerous concerts,poetry slams, storytelling events, and cultural festivals unique toD.C.” One thing he won’t miss though, he added, “is having todrive around the block three times to look for parking, only to endup paying for parking in an expensive garage.”

Dr. Chen is excited to dive into the world of colorectal surgery. His wife, Sarah Wineland, is a little squeamish about his specialty.“She says, ‘Can’t you just tell your friends you’re a generalsurgeon, instead of a colorectal surgeon?’ And I promptly say, ‘No, I’m proud to be a future proctologist!’”

update

Six Years,One Thousand Operations, and Countless Memories

Newlyweds Sarah Wineland and Jason Chen, MD



In a hospital as large and diverse as MedStar WashingtonHospital Center, collaboration among specialists is essential tothe care of a complex patient population. The Department ofMedicine has taken collaboration to a new level, establishingstructured relationships for specific diagnoses to improve care.

“We’ve put processes in place forpatients with specific conditions, whichrequire the services of more than onespecialist,” says Carmella Cole, MD,interim chair, Medicine. “When otherclinicians have an interest and experiencein an area, we automatically see patientsas a team.”

Collaborative care can drive downhospital admissions, according to Dr.Cole. In some cases, diagnoses are notstraightforward, and multiple specialists

need to evaluate the patient. In other cases, treatment needs tobe coordinated. “Few patients have conditions that involve justone organ system,” Dr. Cole says. “It’s the wave of the presentand the future to involve multiple specialties in patient care.”

Specialists and patients both benefit, Dr. Cole says. “Whendoctors have close working relationships, patients benefit fromcoordinated care. If they see patients in the same place at thesame time, patients don’t have to schedule multipleappointments, which expedites care.”

Some Areas of Collaboration

Palliative Care“At the Hospital Center, we haveestablished strong ties with severaldepartments to provide coordinatedcare,” says Hunter Groninger, MD,director, Palliative Care. “By meetingpatients as a team, our clinicians candevelop relationships over time, beforecrises occur.”

The palliative care team—physicians,social workers, chaplains, pharmacists,and nurse practitioners—work closely with

Advanced Heart Failure patients. They attend meetings, go onrounds, and have a weekly palliative care clinic with the AHF

outpatient clinic. This allows the team to deliver a sharedmessage to patients, and helps them decide on future care,which lowers patient anxiety. Palliative Care is now expandingthis model to include other heart patients with advancedillnesses.

Palliative Care also works with many patients in WashingtonCancer Institute. Physicians are embedded in the CancerInstitute, providing pain relief as needed, and helping patientspursue more aggressive treatments, or plan for end-of-life carewhen indicated. Palliative Care physicians participate in cancerclinics four days a week, and are working to trigger referrals forspecific cancer diagnoses.

The newest collaboration is with Pulmonary Medicine fellows,where a palliative care physician and social worker work withfellows, to provide personalized care to patients with advancedlung disease.

The collaborative approach has earned high marks from patientsand families. “The more seamless our care is, the more we canhelp patients face difficult futures,” Dr. Groninger says. “Decision-making can be complex, so the closer we work with clinicians,the better we can serve our patients.”

Infectious DiseasesInfectious Diseases offers consults tomany other departments within thehospital, and its physicians are workingwith several other specialties to seepatients on an outpatient basis.

“In Orthopaedic Surgery, some patientsdevelop infections in devices that needour attention,” says Glenn Wortmann, MD,director, Infectious Diseases. “Whenpatients come for follow-up appointmentswith the surgeon, we see them during the

same appointment to facilitate care, so patients don’t needmultiple visits.”

Similarly, patients with LVADs sometimes develop infections.When they return for an appointment with their cardiologist, itincludes an infectious diseases physician. “This improves care byin-person coordination between cardiologist and infectiousdiseases specialist. It also is easier for patients to see both of us inone appointment,” Dr. Wortmann says.

update

Hunter Groninger, MD

Glenn Wortmann, MD

Improving Patient Care:CollaborativeMedicine Between Departments

Carmella Cole, MD


The collaborative care model has been very successful inInfectious Diseases. For the past six years, physicians jointly seefive to 10 Orthopaedic Surgery and LVAD patients every week.“We also have been able to develop personal relationships withthese physicians, which improves care throughout the hospital,”Dr. Wortmann adds.

Rheumatology/Neurology/OphthalmologyTemporal arteritis, also called giant cellarteritis, is an autoimmune condition thatcan present in ophthalmology, neurology,and rheumatology. Vision loss is usuallythe first indication, and the patient is oftenadmitted to the hospital.

“Temporal arteritis is often hard todiagnose and is often misdiagnosed,” saysFlorina Constantinescu, MD, director,Rheumatology. “For that reason, all threespecialists see the patient, then make acollaborative decision about a diagnosis.

This has two benefits: it avoids unnecessary biopsies, and itdecreases exposure to steroids used to treat the condition.”

Dr. Constantinescu recently submitted an abstract for publicationthat demonstrates the effort’s success. Of 19 patients seen by theteam, eight were deemed low probability for the condition, thusavoiding unnecessary biopsies, and significantly lowering steroidexposure. “It really helps for us all to be on the same page. Patientslove it, too.”

DermatologyA surprise for many clinicians: there is anattending medical dermatologist availableto consult with you about any of yourinpatients.

Helena Pasieka, MD, is board certified inboth Internal Medicine and Dermatology,and as a fulltime hospital consultant, haspartnered with every service line at theHospital Center.

“We’ve become integral in diagnosingcommon and rare diagnoses,” she says.

“There is an overlap between skin and every organ system; thereare innumerable ways skin may show impaired nutrition, metabolic

derangements, autoimmune diseases, or effects from medicationsand chemotherapies. The skin is an immune system organ, sowith any derangement in the immune system, your skin manifeststhat. For the most severe skin disease, I work with the Burn Unit tooptimize the supportive care, dressings, and wraps, as well asnutrition and physical therapy.”

Adding dermatology to the mix of options available forphysicians, says Dr. Pasieka, “has prevented unnecessary patientreadmissions to the hospital and throughout the health system,and has prevented infections for patients. When we’re active inthe patient’s care, whether it’s partnering with Cardiology,Emergency Medicine, Transplant, or Cancer, the patient benefits.”

Cardio-OncologyAna Barac, MD, director of MedStar Heart& Vascular Institute’s Cardio-Oncologyprogram, says the program goals includeensuring better outcomes for patientswith cancer and cardiac issues, providingearlier detection of cardiac toxic sideeffects of cancer treatments, andeliminating cardiac disease as a barrier toeffective cancer therapy.

Established in 2012, Cardio-Oncology isnow a systemwide service throughout

MedStar Health. It includes a network of cardiologists andoncologists in different subspecialties who work together, to co-manage the specific needs of each patient.

For example, for patients diagnosed with HER2+ breast cancer,trastuzumab (Herceptin®) is given as a first drug for those withnormal heart function. But in a recently completed five-year studyat the Hospital Center and MedStar Georgetown UniversityHospital, Dr. Barac reports researchers tested the hypothesis thatit could be a safe therapy when cardiology and oncologyphysicians closely follow the patient diagnosed with both breastcancer and abnormal heart function.

“As clinicians, we all need to think of potential problems intreatment, and new ways to resolve them for our patients,” shesays. “And our patients need to understand it’s to their benefit tocome to tertiary centers, to get a correct diagnosis and the mostup-to-date available therapy, which is a true benefit fromcollaborative medicine.”

Ana Barac, MD

Florina Constantinescu, MD

Helena Pasieka, MD

CONNECTIONS | MARCH/APRIL 201910

viewpoint

Chinese philosopher Confucius noted, “Wherever you go—thereyou are.” As we build for the future, it is helpful to understandwhat’s been accomplished in MedStar Medical Group, where weare now, and what is planned.

Three years ago, MedStar Health began a journey with adestination in mind: to build a world class infrastructure around ourphysician and clinician enterprise. This vision is to harness theextraordinary clinical and operational impact of thousands ofclinicians working together in a seamless, consistent, efficientmanner. The benefits are great for our patients, but equallyimportant to the clinician community, who have a choice in whereyou choose to practice medicine and refer patients. This is not aquick journey, nor one facilely achieved. However, the mostrewarding accomplishments are often the ones most challengingto achieve. There are myriad talented partners engaged in thesuccess of this important effort.

In 2016, MedStar Medical Group began to operate in a focused,consolidated manner. Our efforts centered around what we’vereferred to as “MedStar Medical Group-B,” our internal term for thepractices and providers in the business entity known as “MedStarMedical Group,” meaning, their revenue hits the bottom line of theMMG entity. Our focus was on efficient practices, elimination ofsenseless variation, enhanced access, better workflows, improvedpatient experience, and consistency in operations and financialpractices. We launched and support 30 system-wide service line-specific clinical practice councils, which serve as dynamic forumswhere clinicians from throughout the system partner, to createefficiencies and consistency in the professional and clinical practiceof medicine.

In FY18, we began managing the practices whose revenue hits thebottom lines of the Baltimore hospitals, known internally “MMG-A,”meaning aligned with the hospitals’ finances. We connected theMedStar Medical Group executive team with the administration,service line, and practice teams, bringing to bear what we achievedin MMG-B, and benefitting from best practices in MMG-ABaltimore. We’ve seen notable improvement in efficiency, access,productivity, and consistent, aligned compensation plans.

A sidebar on the new provider compensation plans: Having acommon set of expectations and goals within service lines is ahallmark of a strong medical group. Inconsistency in comp plansleads to inconsistency in practice operations, which breeds a hostof other challenges that negatively impact clinicians and patientsalike. MMG contracts concentrate on the clinical compensation ofproviders. We know that physicians often have non-clinical time fora range of activities, such as major teaching and administrativeroles. These are critical endeavors. However, the medical group

comp plan does not focus on these areas. Rather, it’s structured sothe non-clinical salary compensation is supported by the institutionwhere physicians are doing that work, and not subsidized bypractice revenue.

We’re working with the practices affiliated with MedStarWashington Hospital Center, employing strategies that wedeployed in Baltimore, as well as new hospital- and market-specificones. While the bolus of our work focuses on our employedclinician enterprise, we recognize that non-employed providers areimportant members and strong citizens of our entities. Referrals toaffiliated loyal providers can be as important as referrals toemployed physicians. Our plan is to be as inclusive as we can. Forexample, there are non-employed provider representativescontributing important value on several of our clinical practicecouncils.

Our long-term goal is to have all system physicians/APPs on theMedStar Medical Group employment platform. This includes othersupport, such as finance, human resources, physician relations, etc.Our methods are to align and coordinate where infrastructurecurrently exists, and build up where needed.

The Current and Future Stateof MMGby Richard Goldberg, MD, president, MedStar Medical Group

Christine Trankiem, MDFellowship Director, Surgical Critical Care

We receive more than 50 applicants eachyear for our one-year fellowship. We inviteabout 30 to interview for our three positionsavailable through the Match. A surgicalcritical care fellowship is the pathway tobecoming a trauma surgeon. The MedSTARtrauma center, one of the busiest andhighest acuity in the U.S., and the Burn

Center are very attractive for perspective fellows. The patients cared forin our surgical intensive care units and MedStar Heart & VascularInstitute provide our fellows a very broad and intense clinicalexperience. Our faculty is comprised of surgical intensivists fromdifferent backgrounds: surgery, pulmonology, anesthesiology, andemergency medicine; their combined expertise and their dedication tothe fellows’ education is noteworthy.

Christian Woods, MDFellowship Director, Pulmonary/Critical Care

Our fellowship program has two tracks:internal medicine graduates complete athree-year program in pulmonarymedicine and critical care. Emergencymedicine graduates complete a two-yearprogram only in critical care medicine.We accept four applicants each year,from 500 to 700 applicants. Internal

medicine residents go through the standard ERAS/Match process;however, emergency medicine graduates do not go through thestandard match process. Instead, they interview as though theywere applying for a job. Applicants for both tracks are impressedwith the size and complexity of our ICUs and our technology—extracorporeal membrane oxygenation (ECMO) and advancedcardiac care, in particular.

Gaby Weissman, MDFellowship Director, Cardiovascular Disease

Each year, we have about 700 applicantsfor six cardiology fellowships. This is athree-year program that providescomprehensive training in cardiovasculardisease and research mentorships. Eachyear, we get a strong representation fromour internal medicine residency program,

in addition to candidates from programs nationwide. We winnowthrough the applications, and select about 70 physicians tointerview. What’s most important is to find applicants who arepassionate about medicine and cardiology, and excited about thenext stage of their training. Our program is very strong clinically,with MedStar Heart & Vascular Institute (MHVI) being a strong draw.

Bronson Delasobera, MDFellowship Director, Primary Care Sports Medicine

Each year, we have more than 50applicants for two spots in our one-yearprogram. Applicants come fromresidencies in emergency medicine,internal medicine, family medicine,pediatrics, and podiatric surgery; mostcome from emergency medicine. This

program is not hospital-based. Instead, fellows work at MedStarNational Rehabilitation Hospital (MNRH) locations, and at ouroutpatient setting, MedStar Health at Lafayette Centre. A majordraw is our affiliation with MNRH, and with many local sports teams.


graduate medical education

March Madness: Finding theBest and the BrightestThe MedStar Health Graduate Medical Education Consortium did particularly well in this year’s Main ResidencyMatch, with a 96 percent fill rate of 270 positions; MedStar Washington Hospital Center had a 100 percent fill rate.Across MedStar, 52 of the new residents are from local medical schools, and 94 are international medical students.The remainder will be joining us from other schools around the U.S.

For fellowships, the Hospital Center has 82 fellows in 22 specialties, and fellows follow much the same process asthey did when applying for residencies.“The Hospital Center does very well when competing for fellows,” says SalPindiprolu, MD, the hospital’s Associate Designated Institutional Official for Graduate Medical Education (GME)programs. “We placed strong candidates in all programs.”

Program directors agree that the hospital’s reputation is well known, as is its high volume of complex patients inmany specialty areas. The location in the nation’s capital, with cultural and educational amenities, proximity to oceanand mountains, and easy access to transportation, adds to the draw.

Four different fellowship directors discussed their specific programs:


Upcoming CPE Conferences Lifelong LearningMEDSTAR CONFERENCE HIGHLIGHT

MedStar Georgetown Transplant Institute Symposium September 14 | Washington Marriott Georgetown | Washington, D.C.Course Directors: Thomas M. Fishbein, MD | Matthew Cooper, MDAlexander J. Gilbert, MD | Basit Javaid, MD, MS | Stuart S. Kaufman, MDRohit S. Satoskar, MD

MedStar Georgetown Transplant Institute is proud to be hosting the 2nd Annual MedStar Georgetown Transplant Institute Symposium (MGTI 2019). The educational program will consist of three parallel tracks navigating the diagnosis and treatment options for kidney, pancreas, liver, and intestinal disorders including those requiring a transplant. These tracks include: Advances in Liver Diseases and Transplantation, Current Issues in Kidney and Pancreas Transplantation and Dialysis, and Update on Liver and GI Diseases and Transplants for Children.

The Advances in Liver Diseases and Transplantation track will address the gap between best and current practices in order to provide the best care to patients, reduce morbidity and mortality, and reduce the burden of liver disease in the Mid-Atlantic region. Up-to-date information on liver disease and transplant topics relevant to community practitioners will be highlighted. We will focus special attention on multidisciplinary management of tumors of the hepatobiliary tract as well. Through the Current Issues in Kidney and Pancreas Transplantation and Dialysis track the content will examine kidney and pancreas transplantation with a special emphasis on the multidisciplinary approach in pre and post-transplant care of patients with renal dysfunction and diabetes and following transplantation. The third track, Update on Liver and GI Diseases and Transplants for Children, will focus on topics that will be of interest to pediatric gastroenterology, primary care and allied health providers in the course of their interactions with infants and children with small bowel disease, parenteral nutrition, and chronic liver diseases including those likely to lead to transplantation.

For more information and to register, visit CE.MedStarHealth.org/MGTI

UPCOMING CPE EVENTS

Gastric and Soft Tissue NeoplasmsSeptember 21 | Park Hyatt Washington | Washingon, D.C.Course Directors: Waddah B. Al-Refaie, MD, FACS | Nadim G. Haddad, MD | Dennis A. Priebat, MD, FACP

Adult Congenital Heart DiseaseOctober 4-5 | Bethesda Marriott | Bethesda, Md.Course Directors: Anitha S. John, MD, PhD | Melissa H. Fries, MD

Autoimmune Disorders of the Brain: Beyond PANDAS/PANSOctober 5 | Washington Marriott Georgetown | Washingon, D.C.Course Directors: Waddah B. Al-Refaie, MD, FACS | Heidi J. Appel, MD | M. Elizabeth Latimer, MD

Gastroenterology for the Primary Care Provider 2019October 12 | Ritz-Carlton | Washingon, D.C.Course Directors: James H. Lewis, MD | Caren S. Palese, MDCourse Co-Directors: Nadim G. Haddad, MD | James C. Welsh, MD, MBA, MPH

For more information regarding MedStar Health conferences, please visit CE.MedStarHealth.org

WEEKLY ACTIVITIESNumerous continuing professional education opportunities, including Regularly Scheduled Series, take place each week at MedStar Washington Hospital Center. For a complete list of CPE activities, please visit: MedStar.Cloud-CME.com

CE Transcripts are Available Online: You can download, print or e-mail your CE transcript. Visit CE.MedStarHealth.org and click on “MY CE” for complete instructions.


Center of Excellence DesignationObstetric Anesthesiology at MedStar Washington Hospital.Center is one of the first 39 institutions in the country toreceive a Center of Excellence designation, from the Societyfor Obstetric Anesthesia and Perinatology (SOAP).

Hassan Adeniji-Adele, MD, was recognized for leading thephysician team in high quality care and best Anesthesiologypractices in:

• Personnel and staffing

• Equipment, protocols, and policies

• Cesarean delivery management

• Labor analgesia management

• Recommendations and guideline implementation

• Quality assurance

The SOAP Center of Excellence designation is for four years.

News &NotesFor the fifth year, MedStar presented the HeRO Awards,celebrating “Good Catches” and highreliability behavior forassociates and providers. The Provider of the Year was DavidJohnson, MD, Orthopaedic Surgery, pictured below withStephen R.T. Evans, MD, executive vice president, MedicalAffairs & Chief Medical Officer, MedStar Health:

The Provider HeRO of theYear Award honors aclinical associate whomodels high reliability. This year’s Provider HeROof the Year was cited forembracing the HROprinciples ofPreoccupation with Failureand Reluctance to Simplify,to ensure his patient’ssafety. Dr. Evans read thenomination:

“Our honoree, an Orthopaedic surgeon at MedStarWashington Hospital Center, received a patient complainingof neck pain and headaches, which had started a fewmonths prior. The patient also cited other symptoms ofconcern. She had already been evaluated by a neurologist,as well as a neurosurgeon, who ordered a CT scan of thecervical spine and an MRI scan. The impression of thestudies was an Arnold-Chiari malformation, a structuraldefect in the cerebellum of the brain, normally a congenitalcondition. A week before seeing the Orthopaedic physician,she had also been evaluated by an otolaryngologist.

Upon careful review of the radiology images, our honoreedecided to send the patient for an immediate Magnetic

Resonance Angiography, a scan that looks inside bloodvessels of the head and neck. There was something in thissituation that didn't seem right to our physician, leading him to worry the patient was being misdiagnosed. After the scan was completed and the patient was preparing toleave, the radiologist called the patient back for additionalviews. At that time, the patient was found to have a subdural hematoma, and was escorted to the EmergencyDepartment; she later had emergency surgery.

Our honoree utilized Preoccupation with Failure andReluctance to Simplify by looking for potential errors in thesituation, and questioning a previous diagnosis. If our HeROhad not carefully reviewed the prior studies and sent thepatient for additional testing, our patient could haveexperienced a potentially fatal outcome.”

Also recognized at the Awards for their “Good Catch”during 2018 were Janeen Constantine, MS, ACNP, ANP,and Preetham Kumar, MD, Cardiology. Their recognition of the severity of illness for a patient with a history of heartfailure, a pacemaker, and blood clots kept their patient safe.

MedStar HeRO Awards: Congratulations to Dr. David Johnson

Representing the Obstetric Anesthesiology team are (standing) Eric Skolnick, MD; Karen Robertson-Sanchez, CRNA; Eileen Begin, MD, and (seated) Ariam Yitbarek, MS, RN; Hassan Adeniji-Adele, MD,and Fay Horng, MD.

Janeen Constantine, MS, ACNP, ANP Preetham Kumar, MD

Kristen Midgley, MD Ophthalmology


chief resident profile

When Kirsten Midgley, MD was still in college in Springfield,Ohio, she took a pre-med elective that matched students with adoctor in the community, offering them the opportunity toshadow a practitioner. By chance, she was paired with a localophthalmologist group.

“They took me under their wing,” she recalls of the experience.“I got to see patients, clinics, the operating room—I even spenttime with the office manager, learning how a private practiceruns.”

Now chief resident of Ophthalmology for MedStar WashingtonHospital Center, Dr. Midgley says that, when it was time toenroll in Georgetown University School of Medicine, she wasadmittedly biased toward her specialty.

“I liked a lot of my rotations, but felt that ophthalmology wasthe most interesting,” she says. “The physiology of the eye hasalways interested me, in the way you can diagnose issues in thewhole body with an eye exam.”

Dr. Midgley also says that she appreciates the flexibility andvariety of balancing clinics with surgery. “I love that I can followa patient in clinic, but if that patient ever needed a surgicalintervention, I can do that, as well.”

She says there’s nothing quite like the experience of a patientopening their eyes for the first time after a cataract surgery. Dr. Midgley calls it their “wow moment.” “I’ve had patients whilestill in the operating room who say, ‘Oh my gosh! I can readstuff across the room!’”

Dr. Midgley calls it an honor, liaising between co-residents andthe Ophthalmology leadership. “All of our attendings are reallysupportive. If we express interest in a research area, they eitherfoster that, or put us in touch with someone who has a researchproject going on in that area.”

For Dr. Midgley, that area of interest is the cornea. She believesshe was fortunate that many of her mentors at the HospitalCenter are corneal specialists, and Dr. Midgley credits thoseopportunities to observe and engage in this sub-specialty withher next career steps. Later this summer, she’ll begin a corneafellowship at Wake Forest School of Medicine. She’ll focus oncataract surgeries and more specialty surgeries, like cornealtransplants, building on the foundations she’s gained in herresidency. Ultimately, she hopes to pursue private practice,while still maintaining a relationship with an academicinstitution.

But moving on from such a great team will also present somesadness. “The highlight for me was being lucky enough to havesuch great co-residents,” says Dr. Midgley. “I really like comingto work every day, just because of who I get to work with, and Ifeel very fortunate for that.”

And what about that ophthalmologist practice in Springfield,Ohio, that was responsible for giving her a start—do they knowthe role they played in her career?

Dr. Midgley says that she told them about her acceptance tomedical school, but not her ultimate chosen specialty. “I’ll haveto follow up, and let them know!”

Kenneth L. Fan, MDPlastic & Reconstructive SurgeryFor Kenneth Fan, MD, the transformative power of plasticsurgery can be personified through a single patient. While astudent at the University of Miami Miller School of Medicine inFlorida, Dr. Fan joined a group of doctors and medical studentson a service trip to Haiti with Smile Train. There, he met a 35-year-old surgical candidate with a cleft lip. The patient hadearned a reputation as a recluse who avoided mirrors, and triedto disguise his deformity with a beard. The surgery was routine,but the change for the patient, Dr. Fan recalls, was startling.

The next time Dr. Fan returned to the Haitian village, the manwas unrecognizable, far beyond his jawline. In the interveningtwo years, the man had gone to college and had become anEnglish translator. He’d married, and now spent timevolunteering for the charity. “The way he carried himself wascompletely different,” Dr. Fan recalls. “He’d become anoutstanding member of society.”

“It embodies why I pursue medicine,” Dr. Fan says. “Throughsurgical technique, you’re making someone whole again.You’re the person who is able to restore not just the body, butthe sense of self.”

Dr. Fan comes from a family of doctors, and he jokes that hetried to stave off the inevitable pursuit of medicine, spendingyears before medical school engrossed in computer scienceand building computers. But as he pushed himself tounderstand a computer’s wiring and programming, he realizedwhy medicine was inescapable.

“I was always active with my hands, thinking about problems.That’s how I knew I wanted to be a surgeon.” After his trip toHaiti, Dr. Fan realized that his passion for problem-solving withhis hands had found the perfect specialty.

“Plastic surgery is built on a fine understanding of humananatomy,” Dr. Fan says. “It’s unique, in that we don’t takeownership of any one part of the body. Instead, we use a set ofideas related to reconstruction, to really meet the patient’sneeds and achieve optimal outcomes.”

Dr. Fan loves that, inherent in this field of ideas, there is aconstant orientation toward innovation and improvement. “Ibelieve research is such a strong component of staying on thecutting edge, and continually improving delivery andimplementation for patient care.”

One area of research passion involves pain managementfollowing breast reconstruction. For years, patients opted forprosthetic-based reconstruction, using implants, rather than amicrosurgical tissue transplant, largely because of the differencein recovery. Implant recovery was less painful, avoided narcotics,and involved a shorter hospital stay. This reality frustrated Dr. Fan,since the field’s best studies showed that the tissue transferoffered better long-term results in most cases.

“Pain was the main barrier,” Dr. Fan says. “Although not allpatients are candidates, some are unwilling to undergoautologous reconstruction, due to concern of recovery.”

Dr. Fan’s team started problem-solving. They began anEnhanced Recovery After Anesthesia protocol to tackle painmanagement after surgery in reconstruction patients. Theresults have been staggering: One year after implementation,patients are leaving the hospital in three days, compared toseven. In most cases, they’ve eliminated the use of morphineand narcotics.

Dr. Fan is excited to turn that problem-solving approach towardanother patient population ripe for support: those who sufferfrom lymphedema. “Previously, these patients haven’t hadsurgical options, it’s been almost an ignored disease leftexclusively in the realm of physical therapy,” he says. “But now,we have surgical options.”

Those surgical options draw on the experiences Dr. Fan gainedthrough a one-year microsurgical fellowship, and involves amicrosurgery technique to transplant healthy lymph nodesfrom the back, groin, or belly, and supermicrosurgicaltechnique to reroute lymphatics less than 0.8mm in size.Currently, the MedStar team is the only group in the regionwho can perform this type of surgery, which can improvelymphedema by as much as 80 percent.

But 80 percent isn’t 100 percent, so there’s still plenty of room,Dr. Fan believes, to try new procedures to help patients.


spotlight

Radiation Oncology is a mainstay of cancertreatment, and we are proud to offer ourcommunity an expert staff of professionalsand state-of-the-art technology in a patient-friendly environment.

Treatment planning is the first step toassuring the best results. We work closelywith our medical physicist and dosimetristto devise optimal treatment strategies.Patient history and preference also arecentral to our treatment. Once the teamdecides on the best treatment, we offeradvanced computerized treatmentplanning, fusing CT, MRI and PET images,and then verifying findings.

Our sophisticated radiation oncologyequipment includes the Varian Edge™, a radiosurgery device that deliversstereotactic body radiation therapy (SBRT),which precisely targets solitary nodules inthe lung, brain, pancreas, and liver. It takesone to five sessions to complete treatment,which greatly reduces side effects, andimproves our efficiency, allowing us to treatmore patients.

Another innovation is our approach tobreast cancer treatment. For patients withearly-stage, node-negative tumors, weoffer highly-effective, single-doseintraoperative radiation.

Depending on the patient’s diagnosis,internal beam high-dose rate and low-

MEDSTARWASINGTON.ORG

Non-Profit OrganizationU.S. Postage

PAIDMedStar WashingtonHospital Center

110 Irving Street, NWWashington, DC 20010

CONNECTIONSMEDSTAR WASHINGTON HOSPITAL CENTER

MedStar Washington Hospital Center Connections is managed andpublished by Communications & Public Affairs for the Medical &Dental Staff of MedStar Washington Hospital Center. It is an informativebi-monthly publication for all the members of the Hospital Center Medical andDental Staff. It is a forum to report news of interest to the medical staff, intro-duce new providers and profile current ones, exchange ideas and opinionsabout subjects of interest and controversy, and recognize the professional andpersonal accomplishments of our practitioners. Its overall goal is to help fosterand celebrate a sense of community among the broad diversity of the HospitalCenter physician membership. The newsletter is managed and published byCommunications and Public Affairs, for the Department of Medical Affairs.MISSION—MedStar Washington Hospital Center is dedicated to delivering exceptional patient first health care. We provide the region with the highestquality and latest medical advances through excellence in patient care, education 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

Jeffrey S. Dubin, MDSr. Vice President, MedicalAffairs/Chief Medical Officer

Arthur N. West,MDPresidentMedical & Dental Staff

Robert L. ScarolaVice PresidentCommunications & Public Affairs

Gregory J. Argyros, MD, President,MedStar Washington Hospital CenterN. William Jarvis, Chair, MedStar Washington Hospital CenterBoard of DirectorsKenneth A. Samet, FACHE, President and CEO, MedStar Health

Editorial Board MembersRavi Agarwal, DDSSamantha L. Baker, JDKurtis Bertram, DPMSelena Briggs, MD, PhD, MBA, FACSRafael Convit, MDZayd Eldadah, MD, PhDDerek Masden, MDKristen Nelson, ACNP, MBAAdedamola Omogbehin, MDMira Pandya, DPMLoral Patchen, PhD, CNMStephen Peterson, MDSailaja Pindiprolu, MDMaria Elena Ruiz, MDMarc Schlosberg, MDOliver Tannous, MDChristine Trankiem, 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]

Physician’s Perspective

dose rate brachytherapy, plus externalbeam radiation therapy, including 3Dconformal, intensity modulated radiationtherapy (IMRT), and image-guidedradiation therapy (IGRT) can beconsidered. We are the only center in theregion to offer total skin electronirradiation (TSEI).

Radiation therapy requires a team approach.Our team includes two radiation oncologists,supported by radiation therapists, nurses,physicists, and dosimetrist. We treat 40 to 50patients each day, Monday through Friday.We are very proud of our customer service,working closely with referring physicians,and making every effort to accommodatepatients’ needs. Our high patient satisfactionscores are a testament to our effort.

Education and research are also amainstay of our department. We attendmajor national meetings to stay up to date,and share a residency program withMedStar Georgetown University Hospital,training the next generation of radiationoncologists. We participate in majornational research programs, so we canoffer our patients a full range of treatmentoptions.

We are currently undergoing a facilityupgrade, to better serve our patients. Foradditional information, or to refer apatient, please call 202-877-3925.

From the Desk of…Pamela Randolph-Jackson, MDChair, Radiation Oncology

medicoal & denntal staffnections€¦ · a more effective and efficient treatment, especially...

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