Defining Success

 
 
Dr. Singer uses his personal experience as a surgeon to define success--and failure. Your circumstances do not dictate your success. Successful people bring success to everything they do. Success comes to people who are too busy to be looking for it.

Raymond L. Singer is a cardiothoracic surgeon on the medical staff at Lehigh Valley Health Network (LVHN) since 1992 and is currently the Physician in Chief for the LVHN Institute for Special Surgery. He is the former Chief of the Division of Cardiothoracic Surgery and Vice Chair of Quality and Patient Safety for the Department of Surgery.

Dr. Singer has served as the Chair of the Department of Surgery Quality Committee and the Surgical Director for the Charles Chrin Regional Heart and Vascular Center. Dr. Singer currently serves on the Executive Council of the Air Products Center for Connected Care and Innovation and the LVHN Board of Trustees Development Committee. He is a Clinical Professor of Surgery at the University of South Florida College of Medicine. Beyond his professional affiliations, Dr. Singer takes and active role in th Lehigh Valley community.

Dr. Singer is a member of the Board of Directors for Health Network Laboratories, in Allentown, Pennsylvania. He is a Past-President of the Pennsylvania Association for Thoracic Surgery and Past-President of the Lehigh County Medical Society. Dr. Singer is a member of the Muhlenberg College, President’s Advisory Council, and has served on the College’s Board of Trustees, as well as the Board of Trustees of Congregation Keneseth Israel in Allentown, Pennsylvania.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx

February 22nd: National Heart Valve Disease Awareness Day

 National Heart Valve Disease Awareness Day

Heart valve disease (HVD) involves damage to one or more of the heart’s valves, which disrupts blood flow by not opening and closing properly.  While some types are not serious, others can lead to major complications—including death.  HVD becomes more common with age, and one in eight people age 75 and older are estimated to have moderate to severe HVD.

Heart valve disease awareness in the United States is shockingly low, despite the more than 5 million Americans affected by the disease. A recent survey of more than 2,000 adults found that 3 out of 4 Americans know little to nothing about HVD, and only one in four know somewhat or a great deal about the disease.  The seriousness of the disease combined with the fact that symptoms are often difficult to detect or dismissed as a normal part of aging, make this lack of awareness dangerous.

National Heart Valve Disease Awareness Day on February 22^nd—during American Heart Month—is an annual day dedicated to increasing recognition of the specific risks and symptoms of heart valve disease, improve detection and treatment, and ultimately save lives. With education and advocacy, we can reduce the number of people who lose their independence and their ability to fully participate in their lives; experience heart attacks, arrhythmias, congestive heart failure, and other heart disease; suffer from strokes; and even die from the disease.

If you or a loved one suffers from HVD, there is hope and help out there. Check out this site for more information on living with valve disease. 

To learn more about the campaign, how you can get involved, and the importance of Listening to Your Heart, visit www.ValveDiseaseDay.org.

Reflections on 7,000 Operations and 25 Years as a Surgeon

The following essay appeared in The Morning Call Website Opinion Page on Sunday, November 19, 2017

It’s hard to believe that so much time has passed. After 4 years at Muhlenberg College, 4 more years of medical school at the University of Pennsylvania, and 8 years of residency at the Thomas Jefferson University Hospital, I’ve now hit the milestone of 25 years in surgical practice and 7,000 operations at Lehigh Valley Health Network. It feels like yesterday that I was the new guy in town. And now today, the new recruits look to me for advice –the kind of sage advice that only experience and perseverance can provide.

My reflections are naturally bittersweet. Like most, I tend to dwell more on my mistakes and the things I wished I could have done differently. I think about the missed opportunities and the times that I was too cautious or too bold. The road has been long and demanding, full of speed bumps and challenges. There were many times that I wondered if I would make it through. And though I’ve persevered, my heart still knows little rest. In the quiet of night, I often think about the patients I could not save. Their memories remain with me, along with the emptiness of knowing that my best just wasn’t good enough.

One such patient is Trina Green from Ashland, Schuylkill County; her picture remains on my desk. I met Trina shortly after her 40th birthday. Just one year prior, Trina was diagnosed with breast cancer. She had undergone what was believed to be curative surgery, but sadly, the cancer returned, having spread to her lungs. Unfortunately, there was little I could do surgically. Trina was an avid Phillies fan, like me. Prior to her passing, Trina enjoyed one last Phillies game, sitting in my seats at Citizens Bank Park. The photograph on my desk was taken at that game, showing Trina so happy, as if she had not a care in the world. Her effervescent blue eyes sparkled with joy, as she cheered on her Phillies for the last time. Her memory and those beautiful eyes still haunt me.

Trina Green, holding the Phillies #1 sign, enjoying one last Phillies game with her sister-in-law and best friend, Linda Duell.
Trina passed away on March 13, 2006, at the age of 42.

Yet, there is also great satisfaction and accomplishment upon reflection. Over the years, I’ve touched many lives, more than I take the time to sometimes realize. One is Mischel Satunas of Bethlehem. At 49-years old, Mischel underwent a life-saving third-time, triple-valve open heart surgery, a procedure rarely performed. Prior to meeting me, she was turned down multiple times for surgery, saying that she was too high risk and that her symptoms were all in her head. She recently celebrated her 6-year anniversary from that successful surgery and has become a spokesperson and champion for women with heart disease in our community.

Dr. Raymond L. Singer hugs Mischel Satunas of Bethlehem at the Lehigh Valley Heart and Stroke Walk at Northampton Community College, Bethlehem Township, in 2015, four years after he performed a third-time, triple-valve open heart surgery on her.

Mischel would say that a smile, a touch of the hand, a kind, but confident word to let someone know that they’re going be fine makes all the difference. Patients cherish those personal moments the most, knowing that their doctor cares for them with respect and empathy. The lesson here is simple. Treat every patient as if they were your own family.

I’ve often said that I was lucky because I came from a family of patients, not doctors. My father had three cancers before he passed away. My amazing 94-year old mother is twice a cancer survivor and had heart surgery herself many years ago, and yet she continues to fight on. I’ve sat in many doctors’ waiting rooms.

I’ve witnessed the physical impact of cancer and chemotherapy. I’ve felt the pain that comes from surgery and I’ve endured the sadness of saying goodbye to someone I love.

Treating patients as if they were your own family is the key to enjoying a long career in medicine. In many ways, it’s all that really matters. Doctors can go to the best schools and learn every new procedure, but they will never truly succeed unless they learn to treat the patient, not just the disease.

This advice of “treating the patient, not the disease” is hardly new, nor mine, but goes back thousands of years ago to the teachings of Hippocrates and Maimonides. It’s as old as the Golden Rule, “Treat others as you would wish to be treated.”

Yes, I’ve been blessed to have enjoyed a rewarding career at a magnificent hospital, living in a wonderful community, raising two beautiful daughters with my wife. I’ve worked with the same staff, the same nurses, and the same dedicated colleagues for all 25 years. I’ve said many times that the reason I’ve never left is because I know in my heart, whatever success I enjoy, it’s because of the team that surrounds me.

I hope to keep the flame burning for years to come. When you love what you do, it’s not work, so retirement is not on my to-do list for now. Besides, I rather be in the operating room with these young, talented professionals, than chasing golf balls in the woods.

But no matter what the future holds for me, today I am filled with gratitude for my patients and their families, my colleagues and staff, and most of all, my family, for always being there for me. To all, I say with deep appreciation and love, thank you.

Link to The Morning Call Website Opinion Page Publication

Off-Pump (Beating Heart) versus On-Pump Coronary Artery Bypass Surgery

Below is a discussion of a follow-up article published in the New England Journal of Medicine by Dr. Grover and colleagues, showing favorable results for conventional coronary artery bypass over off-pump beating heart coronary bypass surgery. The same Veterans Affairs 2009 study showed similar results at one year.

No doubt, there are select times when the beating heart approach is preferred, for example, when the aorta is calcified. Most surgeons' experience, including mine, is that the conventional coronary artery bypass approach allows for more precise sewing and better protection of the heart. This would explain why the technique of beating heart coronary bypass surgery continues to drop in the U.S. to fewer than 20% of cases. I suspect it will now be used fewer than 10% of cases.

This article may have other implications. Some surgeons tout off-pump as "better" or "safer," usually under the umbrella of "less-invasive." Understandably, patients desire safer, less-invasive procedures, with quicker recoveries. In many areas of heart surgery, techniques have been developed to yield these desired results, such as trans-catheter valve procedures and aortic stents. But for patients who require multi-vessel coronary artery bypass surgery, this long-term study suggests that the beating heart technique may not be better than the conventional approach.

The most important thing for patients is to discuss all options with their surgeons. There are surgeons who have mastered a particular technique that may yield better outcomes than reported in research studies. Many excellent surgeons continue to develop better ways to improve the safety and outcomes for our patients. Ask your surgeon for his/her experience and results, no matter the technique. Patients should also research public report cards on surgeons and seek a second opinion whenever possible.

I'm grateful to our academic leaders such as Dr. Fred Grover and I'm proud to be part of the Society of Thoracic Surgeons, for their hard to improve the health and safety of our patients.

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Newer method of open-heart surgery carries more risks, study finds

The older method of doing open-heart surgery, in which the heart is stopped and a pump circulates blood through the body, leads to higher survival rates than a newer method of operating while the heart is beating, which doesn't require use of the pump, according to a new study. Why it matters: Coronary-artery bypass surgery is…

Team Matters

Thanks to the miracle of modern technology, I'm posting this blog from 35,000 feet up over this beautiful country of ours. I'm traveling to attend a course on minimally invasive mitral valve repair in California.

One of my favorite movies is "Up in the Air" with George Clooney. In the film, he loves being in flight, traveling across the country for his job. There is a certain serenity, a time to reflect. I agree. I find it very relaxing, one of the few times I am completely alone with my thoughts, while enjoying the view of God's work below.

Tonight, my thoughts are with my team. At the center of that team are four special women who I have had the privilege of working with for as long as I can remember --Mindy Snyder, Carol Shannon, RN, Pam Olivieri, and Lisa Garloff.

Mindy is our practice manager. Mindy is the heart and soul of our practice. Carol is one of the most experienced and talented cardiothoracic surgery nurse in the country with 35 years of experience! Pam is our office scheduler who manages thousands of patient appointments every year, somehow keeping up with emergencies and constant changes. Lisa is our O.R. scheduler, who ensures that every patient that goes to the operating room is ready and safe to proceed.

Together, they are the core of our practice. They work so hard and rarely get the recognition that they deserve.  I know that whatever success I may have enjoyed over these past 25 years, it is largely due to my team --the entire team-- exemplified by these four amazing professionals. To me, it's more than just a team, it feels like family.

Indeed, what separates our cardiothoracic team at Lehigh Valley Health Network is that we are a family. All of our surgeons, physician assistants, nurses, and staff are truly special. Patients sense this when they come to our office and when they are cared for in our operating rooms and our intensive care units.

Yes, I've been fortunate to travel far and wide for my career, as I am doing tonight. And in all my travels, I know, I'm the luckiest surgeon in the world to have the finest team at home.

"The way a team plays as a whole determines its success. You may have the greatest bunch of individual stars in the world, but if they don't play together, the club won't be worth a dime." --Babe Ruth

Patients Need to Do Their Research

Be like Barry...

Barry Kanick Showing His Research on Heart Surgeons

I make it a point to tell all of my patients to get a second opinion. I often wonder why we will visit 4 or 5 car dealerships when when looking for a new car, but we often take on face value the first recommendation we receive when looking for a new doctor?

Of course, there are some important differences.  It doesn't cost you anything to visit car dealerships, whereas it often costs a lot of money to visit various doctors, especially specialists.  Moreover, when you need a specialist, you often don't have the luxury of time.  Specifically, if you need heart surgery, you may not be in an "elective" situation --you may have to make a quick decision based on limited information.  Lastly, your health insurance may not give you many choices.

That last point is an important one.  Your insurance and/or your health network may govern your choices. For example, chances are today that your doctor is employed by a health network.  Recently, many of the best health networks are merging with each other, forming larger, hopefully even better health networks. Many will even offer their own insurance product. The big buzz word in health care today is "Accountable Care Organization" or ACO, which combines the efforts of many physicians and hospitals to share in the care and cost of caring for a population of patients.

Hopefully in the long run, all of these changes will be good for our community, especially if these larger health networks provide more "value" to their patient populations. Most large, high quality programs such as Lehigh Valley Health Network define value as providing higher quality health care at a lower cost.  Therefore, patients should do their research and make sure they are aligned with a health care organization that is focused on providing value for their family's health, not just services.

The problem is... we haven't gotten there yet.  What I mean is that despite a tremendous effort to improve health care by many stakeholders --doctors, hospitals, insurance companies, and the government-- the care we provide in the U.S. remains inconsistent.  Dr. David Nash, Dean of the School of Population Health at Thomas Jefferson University refers to this phenomenon as "unexplained clinical variation."  Simply put, for any given diagnosis or surgical procedure, different doctors or surgeons may approach the exact same problem in significantly different ways, often resulting in significantly different outcome.

So what can you do if you need to find a doctor?  First, when you sign up for your health insurance or align yourself with a hospital network, you need to read the policy carefully and determine what is allowed with regards to obtaining a second opinion or seeking a specialist out of the network.

In many instances, you may have more choices than you think.  No doubt, if you need a specialist, your physician will likely select someone who they trust within their network. And that's fine. We do the same thing at Lehigh Valley Health Network.  The fact is, at LVHN we have very high standards of excellence and a long history of quality outcomes, so it would only follow that our doctors would recommend the colleagues that they trust.

And yet, even if you are at a fine hospital, with trusted, experienced physicians, it is important to do your research and ask important questions.  Moreover, if you are at an institution that doesn't have the volume of experience or the latest technologies, or the recognition for quality that you desire for your family, all the more reason to seek a second opinion.

The Internet has become a great source of information.  There are many very good educational sites, such as Adam Pick's website: www.heart-valve-surgery.com or my own: www.heartlungdoc.com.  Also, you can find a lot of important information from state and national public report cards, such as the Pennsylvania Health Care Cost Containment Council (PHC4): www.phc4.org, or the Center for Medicare and Medicaid Services (CMS) website: www.medicare.gov/physiciancompare/search.html.

Of course, the Internet is not perfect and although you can acquire a ton of information, some may be misleading or incorrect.  That's why whenever possible you should try to get a second opinion in person. You should write down a list of questions for your doctor.  For example, if you are meeting a surgeon to discuss having an operation, some things you may wish to ask include:

1. How many years have you been doing this procedure?

2. How many of these procedures have you performed in the past two years?

3. What is your success rate?  Your complication rate?  Your mortality rate?

4. Will you be taking care of me after the surgery?

5. What are the alternatives to this surgery?

6. What are the long-term expectations?  For example, will I need another operation down the road?

Two final thoughts.  It's important to "ask around."  When you find out that you need a doctor, you will be surprised to learn how many of your friends already have experience or knowledge that may help guide your decision.  And, here's a little inside tip... in addition to asking friends who may have been patients, ask friends who are doctors and nurses.  Often the best advice will come from them.

Barry Kanick was one of the most informed patients that I have ever met.  The picture above was taken the day he was discharged from Lehigh Valley Hospital after his heart valve surgery. He gave me permission to post it on my website.  Barry first came to my attention after he emailed me from my website.  He had read Adam Pick's book and had scoured the Internet but requested to see me for a second opinion.  I called him on the phone after he emailed me and we talked for quite some time.  Then we met in my office and we continued to email each other back and forth.

To be honest, I don't think Barry decided to have me do his surgery because he necessarily thought my skills were any better than the fine surgeons on his list, but rather that I was the most responsive and transparent with my experience and results.  How a doctor communicates does matter, as does bedside manners and trust.  After literally months of research, Barry felt most comfortable with me.

His surgery went very well and he was ready for discharge to go home after only a few days.  He had little to no pain and was of course the ideal patient, very motivated to get better.  He was walking the halls on the first day!

He didn't bring out his "scorecard" on surgeons until the day he went home. I had not seen it before that day. I must admit, I almost fell over when I saw his chart.  The names on that list are among the most well known heart surgeons in the country.  I was truly honored to see my name on the same page as Dr. Joseph Bavaria, Dr. Marc Gillinov, and Dr. David Adams, to name a few.  No doubt, Barry would have done just as well if he had his surgery with any of these great colleagues.

In the end, Barry had narrowed his research to a very good short list of options. True, because his condition was stable, he had the luxury of taking his time in order to make the best decision for him.  But there still is an important lesson to learn.  That is, whenever there is a question about your health, please do as much research as you can before selecting a physician.  And, even if your insurance policy or health network governs your choices, it is still equally important to do your research and ask important questions.

Be like Barry...

Beyond the Billboards: Medical Marketing Can Help Patients Decide

 

 



 

It has certainly been an interesting year for me.  It started out with a phone call from my sister.  I thought something was terribly wrong because she was crying.  Instead she was calling to say how proud she was of me, having just passed a billboard featuring our heart surgery program at LVHN.

Fast forward a year later and my billboards are coming down as the hospital continues to highlight other physicians and topics.  Alas, my time on the side of the road, the mall, and the movies will soon fade.  But what to make of all of this marketing stuff?  Sure, it is nice to see your name and hospital proudly displayed, but what does it mean for patients in our community?

 

The fact is medical marketing is playing an increasingly important role in the decision making process for patients and their families.  As just one example, due to the ongoing healthcare reforms more and more patients are being faced with high-deductible health plans.  A concern is that this may lead to some patients delaying necessary care which in turn can adversely impact their health.  On the other hand, hopefully these patients will choose instead to simply do more research and be more selective of the care they need to receive.  Put differently, patients need to become more careful consumers.

Puman Anand Keller, a professor at the Tuck School of Business at Dartmouth, published an article in Forbes in 2014 called “What marketing can do for hospitals.” Keller pointed out that hospitals are now facing the same world of transparency and competition that hotels and other service businesses have faced for years.  Just as a consumer may go to TripAdvisor to review a hotel, patients are scrutinizing hospital ads, going to their web sites, and searching doctors’ results in Consumer Reports, US News, Healthgrades, and a growing list of other sources.

Sam Kennedy of The Morning Call published a related article on July 16, “New websites rate surgeons.” What struck me about the Call article was that it was in the “Your Money” section of the newspaper. And yet, that is exactly the point. As Kennedy states, choosing a surgeon is one of the biggest decisions you can make and often patients (consumers) are not very well informed.  Websites such as surgeonratings.org look at Medicare data to determine mortality rates, complications, length of stay, readmissions, and costs. We should expect more of these websites to appear in the future.

No doubt all of this can still be very confusing for patients.  Most hospitals tout that they are “tops” in their field for certain procedures, based upon the many different report cards available to assess doctors and hospitals.  If a hospital gets an “A” grade on a particular report card, you can be sure you will see it in an ad. As a consumer you need to look beyond the billboards and do your own research to learn more about that rating and that hospital.

Way back in 1999, I saw some of this coming.  I was sitting across a retired couple, providing a second opinion for heart surgery. After an hour of what I thought was a very complete discussion, the gentleman asked me if I had a website!  Keep in mind 1999 is ancient for the Web.  Google only started in 1998, Facebook not until 2004 and Twitter in 2006.

I decided to take night classes at Penn State on web design and started my own website www.heartlungdoc.com.  It is a personal site that mixes everything from my training, surgical experience, types of operations, and most of all, my outcomes and my personal philosophy on patient care.  Sixteen years later my website gets many hits daily from all over the world and almost every new patient has found my personal website on the Internet.

 

Of course, when it is all said and done, the best advice is to stay healthy.  But if you do need guidance, think of yourself as an informed consumer, not only as a patient.  Do not rely on just one doctor’s recommendation or one source on the Internet.  Ask questions.  If able, ask for a second opinion.  Know your doctor’s results and what other patients think of that doctor’s bedside manners, responsiveness, and empathy.  You do have choices.  When it comes to your health and your healthcare, make good ones.