Caring for Children: Longest Practicing Community Pediatrician Shares How ‘Caring for Generations’ Has Changed

Edward Cahill, M.D., came from a family of architects and engineers – he didn’t set out to become a doctor. But an aptitude test and a high school counselor led him to try medicine and eventually focus on pediatrics.

Dr. Cahill – the early years

After graduating from medical school in 1970, he entered the Air Force and practiced pediatrics for two years. “Serving in the Air Force was great training,” he says. “In medical school, patients would not return for their follow-up appointments, and there was no ability to track them down or get them to come back. The Air Force gave me the experience of follow-up care, reinforcing the concept of continuity of care, something that I would need in private practice.”

Following his service, Cahill completed a fellowship in child psychiatry at The Johns Hopkins Hospital where he was introduced to his first partner, Allan Leffler, M.D., a Howard County pediatrician. “Dr. Leffler was incredibly bright; he was a member of the medical honor society and had done research,” says Dr. Cahill. “But, he decided he didn’t want to be a bench scientist. He wanted to be a family pediatrician, just like the old-time docs.” While completing his fellowship, Dr. Cahill began working weekends with Dr. Leffler’s practice, operating out of the basement of Dr. Leffler’s home. They entered into a full-time partnership and moved to new offices on Route 40 in Ellicott City. The practice expanded, added new physicians and moved to Chevrolet Drive in Ellicott City. Dr. Leffler died tragically in an accident in 2007, but Dr. Cahill still practices, carrying on the legacy of superior pediatric care that the duo started years before.

Just as the offices and the county have changed during the past 40 years, so has the practice of pediatric medicine. Dr. Cahill recalls several significant changes, such as when the hospital hired hospital-based physicians. Neonatologists began providing 24-hour coverage in 1990 in the Labor and Delivery Unit and Special Care Nursery (the predecessor to the Lundy Family Neonatal Intensive Care Unit). Pediatric coverage for emergency and in-patient care began when the HCGH Children’s Center opened in 1997. Prior to this, pediatricians were on call around the clock, and often traveled to distant hospitals to care for their patients—not easy for physicians trying to run a practice. These changes also raised the level of care. “Before, regular [adult] emergency physicians weren’t ideal for treating children, and community-based physicians could be rusty in acute emergency care,” Dr. Cahill says. Now, with specially trained pediatricians in the hospital emergency department, pediatricians in private practice can concentrate mostly on office-based care, although many still visit the hospital to perform initial physicals on healthy newborns.

When managed care emerged, it brought major change to pediatricians who previously had operated on a fee-for-service basis. At the time, most patient insurance only covered hospitalizations.

Dr. Cahill believes that broader preventive coverage offered through managed care plans brought mostly positive changes. “The good news was that patients could afford immunizations and physicals,” Dr. Cahill states. “Physicians didn’t have to worry that patients couldn’t afford the treatment they needed. It improved follow-up care because the price tag wasn’t too bad for the patient. The downside to managed care was that it rained patients down on us, which made us busy and things like hospital rounds and extra training or education fell by the wayside.”

Dr. Cahill also notes changes in medicine, including the vaccine for bacterial meningitis. “Before the vaccine, we would have to catch this dangerous condition early, diagnose it correctly and administer immediate treatment to preserve the patient’s intelligence and life,” he recalls. “Now we see very little bacterial meningitis because of the vaccine.”

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Today, Dr. Cahill’s practice, Ellicott City Pediatric Associates, has four full-time and two part-time physicians, allowing him to finally slow down. “I don’t have to work weekends and evenings anymore, but I’m not ready to retire; retirement is oversold.” In his newly found spare time, Dr. Cahill enjoys riding his bike. As a member of the Baltimore Cycling Club, he has participated in tours through the Rockies, and last year, at age 70, he racked up more than 7,500 miles.

Drs. Leffler and Cahill’s practice, Ellicott City Pediatric Associates, has cared for generations of families. Joan Jeffries started bringing her children to the practice in 1972. Now her children bring their children. “As a parent, I had so much respect for them as doctors,” says Jeffries. “They kept open lines of communication, and they had great insight into whole families. They built up trust that lasted for generations.”

Dear Well & Wise,

You’ve tried to sell us on the health benefits of gardening and poetry and even love stories, but what’s with all the math and science classes in your Friday’s events listings?

Sincerely,

Skeptical Reader

Dear SR (who is in no way imaginary),

One lesson many of us have learned from working on the blog is that there are a surprising number of things that can benefit your health if done right (the flipside, of course, being that even things that are supposed to be healthy, like exercise and sunshine, can hurt you if done wrong). But it is almost as if humans, at our basic core, are meant to engage in activities that are ultimately beneficial: little slakes thirst better than water; as kids we like to run and be active; most people do crave companionship and time spent in nature, etc.

That’s not to say many people are chomping at the bit to solve quadratic equations or bust out some quantum physics theories. Although, we have seen an increase in the interest in S.T.E.M. (Science, Technology, Engineering, and Mathematics), especially since the White House’s call to Educate to Innovate, through everything from Howard County Public School System’s increased focus on it to events such as the STEMtech Conference. And, of course, we’d be remiss if we didn’t mention HiTech, HCLS’ STEM Digital Media Lab for teens and classes.

So yes, this new focus on S.T.E.M. is good for us as a nation, but what about as individuals. Well, we know that doctors and nurses depend very strongly on math and science for their jobs, which benefits us, and that innovations in S.T.E.M. have lead to everything from new medicines, to ergonomically designed tools and furniture, to robots that can do some of our more dangerous jobs for us, and many more life-saving and life-enhancing contributions. BUT that’s not all. There is evidence of  links between good mental health and academic excellence (of which math and science play an important part). And many feel that studying math and science can improve critical/analytical-thinking skills and can also improve confidence, literacy, and overall levels of achievement. So S.T.E.M. studies are good for us; that’s our story, and we’re sticking with it.

Sincerely,

Well & Wise

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National Nurses Week 2013

The art and science of nursing:  then and now

When Judy Siegelman started working at HCGH in 1979, the field of nursing was very different from what it is today. “Back then, you could easily move to a different hospital, even in a different state, and orientation was not an issue. Now we have to learn a whole new system of technology,” remarked Siegelman. While new practices make nursing more complicated and require a much higher learning curve, in the end, the art of nursing is still about caring for patients, being their advocates and looking out for their safety.

Admiration for her mother, who was also a nurse, convinced Siegelman to go into the same profession. She received her diploma from Albany Medical Center School of Nursing in 1966 and began her career there as a pediatric nurse. After that, she worked in several different states in both community and teaching hospitals as well as in public health. “When I came to HCGH in 1979, I found the best of all worlds. The nursing care and doctors here were on the leading edge and HCGH was a very progressive community hospital – right in my own backyard. I thought I’d died and gone to heaven.”

Siegelman was assigned to work at “Unit A” in Lorien Nursing Home where HCGH rented space for Medical/Surgical and Psychiatric units. “At that time, the units were not self-contained, so patients could go from one unit to the other. Things could get pretty interesting,” she noted. After several moves and renovations, in 1997 the unit moved to 4 South, which is Medical/Surgical and Oncology.

Originally, there were 30 beds on the unit with a ratio of one nurse and assistant for every 15 patients. “It was manageable then,” said Siegelman. “Patients were not as acutely ill as they are today; they stayed longer to convalesce.”  In 1985, Siegelman became nurse manager of the unit and Jon Minford, M.D., brought his oncology practice to Columbia and started admitting patients for chemotherapy.   “Back then, patients were almost always sick after treatment.” Chemotherapy today is vastly different because of wonderful advances in preventing and managing side effects, and newer drugs are better tolerated. This allows most chemotherapy to be outpatient.

Asked if certain patients stand out in memory, Siegelman mentioned a 36-year-old man who was getting chemo for colon cancer. “He pulled all the stops to get what he wanted, but he was funny, unique and had a great attitude. He asked for me as his nurse every time he was admitted. He had very aggressive disease and did not do well, but we never talked about death.  One day near the end, he asked me if I would please come to his funeral.  Of course, I did. He died at 37. I learned a valuable lesson about crucial conversations from him.”

In 2003 Siegelman experienced the other side of patient care at HCGH when she needed a hemicolectomy for colon cancer. “Dr. Parikh saved my life,” she said. “I was here for a week and everyone took excellent care of me and looked out for my privacy.” In 2012, she needed a knee replacement after an injury during “Snowmagaeddon.” “I’d heard horror stories about knee replacements and tried to put it off, but it was the right thing to do. The JAS staff was wonderful, and I highly recommend the care at HCGH. I could be the poster child for knee replacements!” she added.

Judy Siegelman, today.

In closing, Siegelman said, “There is both art and science in the practice of nursing. The science is what you bring out of nursing school; the art is what you develop through experience. Now we have to add technology as a critical element for nursing. The monitors, IV pumps – even the beds— are all computerized.”   Siegelman noted that, years ago, only one or two types of nursing were considered specialties, but now all types of nursing are specialties. “I am happy to see Medical/Surgical now recognized as such, because these nurses deserve that recognition.”

While nursing technology, theories and practices continue to evolve and change, the essential care that nurses provide does not. They are still truly the care givers.

(photo of Judy from 83-84 Annual Report and photo of her now as nurse manager in her office)

Happy National Nurses Day, everyone—in fact, happy National Nurses Week. Why everyone? I’m not a nurse, you are thinking. Well, frankly, most of us should be celebrating nurses because at some point or another our lives have probably been touched (quite literally) by a nurse. In fact, there are approximately 3.1 million licensed registered nurses (RNs) in the United States, of whom 2.6 million are actively employed in nursing. So that’s a lot of people we need to be thanking.

According to the American Nurses Association (ANA), National Nurses Week, founded in 1954, is celebrated annually from May 6, birthday of Florence Nightingale, through May 12. The theme for National Nurses Week 2013 is Delivering Quality and Innovation in Patient Care. The theme is meant to call attention to “RNs and their contributions to the healthcare system–as expert clinicians in diverse care settings and as leaders who influence quality of care and overall performance of the system into the future.” The ANA wants to emphasize that:

…RNs are positioned to assume leadership roles in healthcare, provide primary care services to meet increased demand, implement strategies to improve the quality of care, and play a key role in innovative, patient-centered care delivery models. The nursing profession plays an essential role in improving patient outcomes, increasing access, coordinating care, and reducing healthcare costs. That is why both the Affordable Care Act and the Institute of Medicine’s (IOM) Future of Nursing report place nurses at the center of healthcare transformation in the United States.

The public wants leaders they can trust, and in 2012, Americans voted nurses the most trusted professionals in America for the 13th time in 14 years in the annual Gallup poll that ranks professions for their honesty and ethical standards. So overall, we have a good feeling about nurses, and we depend on them to lead us into what seems an often-frightening future of healthcare. Although there are concerns that as the demand for nurses grows, there will be a gap between supply and demand. As the ANA states, “Despite growth in the proportion of younger nurses for the first time since 1980, the nursing workforce still features a disproportionate number of nurses nearing retirement age.”

The ANA also gives a dynamite historical overview of National Nurses Week, if you want a true sense of how deeply felt our need and admiration of nurses goes. The ANA put it best when they said, “The public’s high regard for the profession, coupled with nurses’ education and skills, makes them well positioned to help transform the healthcare system into one that places more emphasis on prevention, wellness, and coordination of care.” And really, isn’t that the direction we all want to see healthcare go?

Check these out if you want …

…to learn more about the real-life experiences of nurses—Call the Nurse: True Stories of a Country Nurse on a Scottish Isle

I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse

…to teach your little one about nurses—Nurses

Nurses Help Us

…to learn more about a career in nursing—Mosby’s Comprehensive Review of Nursing for the NCLEX-RN Examination

Nursing

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Volunteering at Howard County General Hospital

This week we celebrate National Healthcare Volunteer Week in recognition of the support that volunteers and auxilians provide to hospital staff, their patients, family members, and within the community.   Volunteers and Auxilians practically predate the hospital, itself as they were some of the biggest supporters for building a hospital in rapidly developing Howard County.  Volunteers serve in many sections of the hospital, whether with patients or in supporting administrative roles, their work is essential to what we do. From Junior volunteers and summer interns to Senior volunteers they’ve been with us every step of the way.  In addition to the direct patient services they’ve provided over the years, they’ve founded Centers like the Claudia Mayer Cancer Resource Center, established hospital consignment shops and raised funds for our capital campaigns.

Mrs. Dorothy Brooker, a Howard County General volunteer for  26 years talks about her role and what it has meant to her.

Q. How long have you been a volunteer?

A. 26 years

Q. Where have you volunteered?

A. I volunteered with the auxiliary beginning in the 1980’s holding various positions such has treasurer, program chair, etc. I now volunteer once a week in the hospitals gift shop.

Q. What made you want to become a volunteer?

A. I lived in Buffalo, New York where I raised my 4 children and eventually worked in the school education system before retiring and moving to Columbia in 1986. The winters were getting too cold and bitter in New York, and I was ready to move closer to my children including my daughter who resides in Columbia. I went to the hospital for an exercise class I was interested in, and noticed the volunteer office. I inquired, and they said they needed volunteers with the auxiliary.

Q. Tell me about what it used to be like when you started volunteering in the 1980’s?

A. It was great fun; I really enjoyed the people. I enjoyed meeting so many new people, and making new friends. I found volunteering to be interesting and it kept me very busy.

Q. Tell me what it is like now?

A. I don’t feel it has changed too drastically. The hospital has expanded, and the gift shop location has moved about 5 times since I started. We are busier, but it has continued to be great fun for me. I still really enjoy greeting customers and meeting new people.

Q. Do you have a favorite volunteer story?

A. I won the Betty Stant Award for best volunteer, which included a fancy dinner where I had a great time.  Also, when I’m not volunteering at the hospital, I will run into people who I’ve met while working in the gift shop and they recognize me and I remember them. We have customers who are no longer patients or staying at the hospital, but will come in to browse the gift shop because they really like the items we sell.

Q. How has volunteering made you feel personally?

A. It makes me feel like I’m doing something worthwhile. I enjoy being with people, and I feel like I am helping the hospital, helping people, and it keeps me very busy. I look forward every week to working in the gift shop. I even plan my vacations and appointments around Wednesdays, so I can be sure I’ll be there each week.

Q. How would you relate volunteering to your health?

A. I am blessed to be healthy, and with volunteering it helps me to stay active and busy, while also interacting with people and meeting new people.

Thank you, Mrs. Brooker- and all of the volunteers who have served the hospital so well over the last 40 years!  Happy National Healthcare Volunteer Week!

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By Kate Schultz

Tax season has arrived and a lot of us are looking forward to getting filing out of the way and maybe receiving some extra cash in April. I think we can agree that we feel better about our taxes when we know they are filed accurately by a certified professional.

For many low-income Howard County residents, professional tax prep can be costly and is not always easily accessible, especially for those with limited mobility. And trying to do our taxes ourselves may result in errors, and ultimately not receiving the highest refund possible.

That’s why 2-1-1 Maryland at United Way of Central Maryland (UWCM) works with the Maryland CASH Campaign and other programs to help low- to moderate-income residents in the Baltimore area, including Howard County, find resources for free tax preparation.

Low to moderate-income individuals and families are eligible to sign up for the service. There are many tax prep sites throughout Howard County, including sites located in senior centers, making the service more accessible to seniors and persons with disabilities.

Henrietta is just one central Maryland resident who benefitted from the program.

Henrietta called 2-1-1 Maryland at UWCM and a call specialist helped her find free tax prep in her area and prepared her for her appointment. In a follow-up call, Henrietta said she was very pleased. She said they were prompt, everything went very well, and she even referred a friend to the program. Henrietta received a small refund in the bank in two weeks and used it to help buy food.  She also commented that she volunteers her time in the community, saying “I try to give back.”

2-1-1 Maryland at UWCM is pleased to be able to offer this important service, helping families and individuals save hundreds of dollars and work toward reaching their financial goals.

To find out if you qualify for free tax preparation services, dial 2-1-1.

For more information about 2-1-1 Maryland at UWCM, visit www.uwcm.org/about211.

Author, Kate Schultz of 2-1-1 Maryland at United Way of Central Maryland is an information and referral specialist.