Making a Difference: When Work Becomes Community

This article was published in our 2015 Annual Report.

Drs. Lou DiNicola and Christina DiNicola

Drs. Lou DiNicola and Christina DiNicola

In 1976 Pediatrician Lou DiNicola came to Randolph for an interview shortly after completing his residency. The first provider he met wore jeans and a flannel shirt, and he knew right then he was at an unusual organization.

“I spent the night at the CEO’s house—it really was a community hospital!” he said. “I wanted to work in Vermont, and I wanted to care for kids, not just see them and send them on to a larger medical center. I took the position.”

Forty years later, DiNicola is still practicing in Randolph (he also saw families in the Rochester clinic until 1992), and he has become a passionate and respected advocate for children’s health, helping to shape state legislation on a range of issues.

The organization has grown (there are now six community health centers), and you see fewer flannel shirts, but the feel of a “real community hospital” remains. The local Rotary Club holds morning meetings in the cafeteria, where at lunch the staff mingles with neighbors who come for great locally-sourced food; there are no reserved spaces for VIPs in the parking lot; and the computerized staff email directory is still arranged alphabetically by an employee’s first name.

In a small community everyone’s lives are intertwined. We care for people who repair our cars, teach our children, attend our church, or manage the store where we buy groceries. The lines that separate hospital from community, caregiver from patient, and even family from co-worker are less distinct.

“Everything that happens in the community —a town fire, school events, Hurricane Irene—comes into our office as well. I have patients now who are the grandchildren of patients I saw years ago,” said Dr. Lou DiNicola. “I live less than three miles from work; clearly this is my home.”

For Dr. Lou DiNicola the connection goes even deeper: Pediatrician Dr. Christina DiNicola spent a summer jobshadowing him before heading off to Stanford University in fall of 1994. Today her former mentor is both a colleague and her father-in-law.

“I wanted to live in the same community I worked in, to have the same accountability to community as to family,” said Christina, who came from a larger practice in Philadelphia last spring. “People care about each other, and about life outside work. There’s a special kind of familiarity this way. The people I see in the office I also see in my community—just in different roles.”

Both Dr. DiNicolas say this blurred line between their work and community roles brings relevance to their work, and shapes the way they deliver care. When something they do has a positive impact, they can see how lives are changed.

“In previous positions I was part of a team of rotating doctors,” said Christina. “My work in the clinic here is especially satisfying to me because I can follow up directly with patients and build ongoing relationships with families.”

Dr. Lou DiNicola says the opportunity for connection and community still attracts new providers. Another draw also endures, something he recognized when he visited years ago, and that is Gifford’s focus on quality. This ensures that the technology and expertise needed for direct patient care is available locally—most patients aren’t sent elsewhere after diagnosis. We do everything we can to treat our patients in the community setting.

“Today medical students are most often trained to be specialists at larger medical centers. Those who want to do more personalized care, and to see a wide range of cases, come to rural medicine,” he said. “I value my ongoing relationships with people in the community, but I also take satisfaction in being there for people who have come a long way for care. People from all over choose to have their babies at Gifford and helping them with the birthing process, whether routine or complicated, has also always been a rewarding experience. We have the best of both worlds at Gifford!”

Gifford Welcomes Certified Nurse-Midwife Julia Cook

Certified nurse-midwife Julia Cook

RANDOLPH – Certified nurse-midwife Julia Cook has joined Gifford’s team of midwives, and is now seeing patients in our Randolph and Berlin clinics.

Cook received a Master of Science in Nursing from Frontier Nursing University in Hyden, KY. Her clinical interests include adolescent care, patient education, and helping women to be active participants in their ob/gyn care.

Born in rural Louisiana, she moved to a suburb of Atlanta while in High School, and went on to get an associate of Science in Nursing from Georgia Perimeter College. She was first attracted to ob/gyn care after the birth of her first child 16 years ago.

“The midwives who cared for me were amazing—they empowered me as a woman and as a new mother,” she said. “I was intrigued by what they did, and asked them what I needed to do to start on that career path.”

When Cook finished her training she began to look for work in a smaller community, and was drawn by the story of Gifford’s Birthing Center and its pioneering efforts in family centered birth. She also appreciates that her work will include opportunities for well-women and adolescent care.

“I feel that education is so important when it comes to women’s health,” she said. “I especially enjoy working with adolescents because they are at a time in life when information about how to be healthy is taken with them as they transition into adulthood.”

Cook says her husband and four children are also excited about moving to New England, and the family looks forward to living in a smaller community and exploring all the new things Vermont offers.

To schedule an appointment, or to learn more about Gifford’s Birthing Center, please call 802-728-2401.

The Transformative Power of a Small Gesture

This article was published in our 2015 Annual Report.

Dr. Lou DiNicola, Development Director Ashley Lincoln and Lincoln Clark

Dr. Lou DiNicola, Development Director Ashley Lincoln and Lincoln Clark

Gifford’s Vision for the Future began in 2008, with 31 acres in Randolph Center and a list of long-term facility and community needs. After years of community input and careful strategic planning, this year we watched the “vision” become real: the New Menig Nursing Home opened in May and 25 new private inpatient rooms opened in December. A new and modernized Birthing Center will open this coming spring.

For us, one of the most gratifying aspects of this past year has been seeing people experience firsthand the impact that their gift has on our community. Our Menig residents are enjoying a new home, filled with light and beautiful views of the surrounding mountains and meadows, and anyone visiting the hospital can see how new private rooms have improved the healing environment for patients.

The highlight of our year came in November, when the Gifford Auxiliary made a million dollar contribution to the campaign—the largest gift in Gifford’s history! This gift is especially impressive as the funds were raised primarily through small-dollar sales of “re-purposed” items at the Thrift Shop.

Who could imagine that the ripple created by a donated box of unused household clutter could extend so far?

It is humbling what dedication, persistence, and belief in a unified vision can do. The investment of the Auxiliary and so many other generous donors represents a powerful affirmation of what we do every day at Gifford. Each gift has contributed to an outpouring of support that will help us continue to provide quality local care for generations to come.

Your generosity, and your faith in Gifford’s mission, makes transformation possible. We can never say it enough: thank you!

Gifford Auxiliary

Ashley Lincoln
Development & Public Relations Director

Lincoln Clark & Dr. Lou DiNicola
Vision for the Future co-chairs

A New Model for Primary Care

This article was published in our 2015 Annual Report.

Dr. Milt Fowler and physician assistant Leslie Osterman

Dr. Milt Fowler and physician assistant Leslie Osterman

For Dr. Milt Fowler and physician assistant Leslie Osterman, teamwork is the key to continuity of care.

Dr. Milt Fowler had just completed his residency when he arrived at Gifford in 1976.

He and his wife were eager to leave the city and wanted to be part of a small community.

He’s still practicing at Gifford forty years later, and now he faces another major life transition: easing into retirement.

“I’m having a hard time cutting back. I’ve known some of my patients for 35 or 40 years,” he said. “There’s a deep richness and joy in practicing primary care in a small community. Once you’ve shut the door on the chaos and paperwork and sit to connect with a patient, the office is like a sacred space.”

Providers at Gifford often say that an ongoing patient relationship is the most satisfying part of their work. For family physicians, the bonds can grow especially strong: it is not unusual for long-time primary care physicians to have treated several generations in a single family.

“I see my role as being a positive influence, someone a patient can come to for help—not just with medicine, but with other issues as well,” said Dr. Ken Borie, who has been practicing family medicine at Gifford since 1980. “Family doctors can build trust in ways a specialist can’t. That’s what’s valuable about being a primary care physician—it’s one of the intangibles that you can’t put a price on.”

Across the country a shortage of primary care physicians is forcing rural community hospitals like Gifford to look for alternatives to this traditional model. As a generation of long-time physicians starts to retire, fewer new providers choose a career in primary care.

Many factors have contributed to this shortage: primary care pays less than other fields and many medical students, burdened with student debt, specialize in other areas. Those who do practice primary care are in demand, and are much more mobile than the providers who settled in Randolph years ago. Rural communities are especially hard hit, since salaries are much higher in urban areas.

To respond to this primary care recruitment challenge, Gifford has implemented a team model, often pairing a physician with a physician assistant or nurse practitioner. These healthcare professionals have been specially trained to diagnose and treat a variety of conditions, prescribe medication, order and interpret tests, counsel, and manage patient care.

Fowler works closely with Physician Assistant-Certified, Leslie Osterman. The arrangement shortens a patient’s waiting time for appointments, but also helps to make sure that patients have quality time with a provider during visits.

“There are not enough MD/DO’s to care for everybody—we have to find new models,” said Fowler. “Leslie and I work really well together. She’s taken over much of the acute care and the preventive and health maintenance visits like annual physicals and cancer screenings. I tend to manage care for patients with more complicated needs.”

Osterman previously worked as a respiratory therapist but found she wanted to be more involved in patient care. She saw that the physician assistants she worked with could focus on preventative medicine, and shared knowledge and decision-making as a team. She returned to school, received a Masters of Physician Assistant studies from Franklin Pierce University (she completed three of her nine rotations at Gifford), and came to practice at Gifford in 2015.

“Milt introduces me to his long-time patients and they see us working together. If their next appointment is with me, I won’t be some random person they haven’t seen before,” said Osterman. “Continuity of care is really important to people.”

The new team model increases patient access to primary care professionals while preserving a quality provider/patient relationship. Like the long-term providers they work with, physician assistants and nurse practitioners say they specifically chose their roles because they wanted to build ongoing connections with patients.

“I trained as a physician assistant because I had seen that many doctors weren’t able to spend extra time with patients discussing concerns or preventive care,” said Osterman. “Sometimes patients need extra time for education or explanations, and I wanted to help fill this need.”

Quality Improvement Initiatives

This article was published in our Cancer Program 2014 Annual Report.

Rebecca O'BerryBy Rebecca O’Berry, vice president of surgery and operations

In 2014 the Cancer Program has focused on improving our screening efforts for colorectal cancer, the one cancer that can be prevented. Our two quality improvement goals for 2014 were to improve the tracking process we use for hemoccult cards given to patients and to increase the number of people screened for colorectal cancer.

Historically, less than half of the hemoccult cards given to patients are returned to the physician’s office for testing. We implemented a follow-up plan to increase our return rate and modified the system we use to track these cards. Our efforts were successful, and we were encouraged to explore bringing in a different test that is easier for patients to perform at home. This new laboratory test will be part of our quality initiative for 2015.

Throughout the organization we worked to increase the number of patients who receive some kind of colorectal screening. In the target age group of 50-75, our screening numbers increased from 59 percent (in 2013) to 90 percent (in 2014). This is a significant improvement, and shows how effective a targeted educational effort on the benefits of some form of colorectal screening can be! Unfortunately a large number of our patients still refuse to undergo colorectal screening. In 2015 we will work to improve patient access to screening by increasing the variety of our testing methods.

In 2014 we also increased our social services support for patients undergoing cancer treatment. To ensure that everyone has the help they need while moving through treatment, our patients now have easy access to a social worker and our Blueprint team. We also created a binder to collect all the information needed by someone undergoing cancer treatment.

The MagView program implemented at the end of 2013 has helped our radiology department track screening mammography in a more systematic way. This program keeps all a patient’s information in one location, and allows a much faster turnaround time for notification of results. The time a patient must wait to receive a mammography result notification letter is now less than two days!

Our providers are excellent communicators and have put a lot of time and energy into community education about prevention, early detection, and treatment of cancer. We work closely with our local senior centers to provide education sessions that are open to the public. Topics covered in these community outreach efforts include: skin cancer screenings and education (in several locations); discussions on breast cancer, bladder and prostate cancer, and colorectal cancer. We will continue to provide this education in the upcoming year.

In 2014, 53 new cancer cases were identified, with breast cancer continuing to be the most prominent followed by lung, colon, and prostate. A total of 41 of those 53 cases were discussed at Tumor Board meetings.

2014 Gifford cancer statistics

Click here to read our full Cancer Program 2014 Annual Report.

Finding Patient-Friendly Colorectal Cancer Screening Options

This article was published in our Cancer Program 2014 Annual Report.

Gifford cancer program

One of our program goals for 2014 was to screen more people for colon cancer to help decrease the number of later-staged colon cancers found in our patients. Providers and nursing staff talk with patients during office visits about cancer screening services available at Gifford, and the benefits of detecting cancer early—especially with colon cancer, the “preventable cancer.”

A typical colorectal cancer starts as a slow-growing polyp in the lining of the colon or the rectum. These precancerous polyps and early cancers can be detected (and removed) during a colonoscopy, which is the preferred colon cancer screening test. But many patients delay or refuse colonoscopy screening, and we still want to encourage those people to at least have a fecal blood cancer detection test with their annual physical.

The hemoccult cards traditionally used for this screening required a patient to collect multiple samples at home and bring them back to their provider’s office. Even with an improved follow-up system to remind people to return their cards, less than half of the tests made it back to Gifford. Many patients reported that the dietary restrictions, multiple sample collecting, and the embarrassment of having to carry the card back to their provider caused them not to complete the test.

Cancer program staff explored other screening options and found a test that detects blood in the stool more accurately, is easier for patients to use and, more importantly, can be discretely mailed back to the lab for analysis. The FIT (Fecal Immunochemical Testing) cancer detection test is now offered as part of annual physicals at Gifford.

Click here to read our full Cancer Program 2014 Annual Report.

Expertise, Personalized Care, and Comprehensive Support Close to Home

This article was published in our Cancer Program 2014 Annual Report.

Brenda CaswellWhen someone is given a cancer diagnosis, their world is turned upside down. Suddenly there is a lot of information to absorb, many tests to take, and hard decisions that have to be made quickly—all when people are feeling most vulnerable.

Travelling to receive treatment and follow-up cancer care can be expensive, exhausting, and complicated to organize. At Gifford patients with cancer have treatment options that can relieve these stresses.

Most cancers—especially breast, colon, prostate, and bladder cancers—can be treated here in our community hospital with caregivers that patients know and trust, close to the family and friends who will support them during treatment.

“Our goal is to make sure people know that they can receive the same quality of care offered at larger hospitals close to home, with a support network they know,” said Rebecca O’Berry, vice-president of Surgery and Operations at Gifford. “Battling a cancer diagnosis is hard enough—I’m thankful that we can provide quality cancer care locally and decrease our patient’s travel time during treatment.”

First accredited by the American College of Surgeons Commission on Cancer in 1965 (we received our most recent 3-year accreditation in December of 2014), our cancer program has been delivering quality cancer care to our community for nearly fifty years. Our oncology services include cancer care from an experienced oncologist, hospital specialists and surgeons, and specially certified oncology nurses; lab and diagnostic services; advanced diagnostic services, including stereotactic breast imaging; outpatient chemotherapy; preventive cancer screenings; and a strong palliative care program. Our multidisciplinary approach to each patient’s care includes identifying social service needs as well as appropriate medical expertise.

Experience, expertise, and compassionate care close to home

“With cancer, making the right diagnosis and getting the right treatment is key,” says Dr. Richard Graham, a Gifford urologist who treats prostate, bladder, and renal cancers. “Experience with specific cancers is also important. We have the expertise and technology to diagnose a lot of rare cancers, but we are small enough to see patients as individuals: You are not a number here.”

Graham notes that he saw an increase in patients whose small cancers were treated with cryosurgery and laparoscopic surgery in 2014.

Personalized support for the cancer care each patient chooses

When a patient chooses cancer treatment that is not offered here, our providers make referrals and collaborate with outside oncologists so things go smoothly. Patients have the option to receive post-operative care and chemo treatments close to home.

Brenda Caswell, a Randolph mother of five, regularly comes to Gifford for medical care and annual mammogram screenings. She missed three years of annual visits because of her pregnancy and the birth of her youngest child, and when she resumed her check-in’s her provider insisted that she get a mammogram.

“My provider didn’t let me out of the office without scheduling a mammogram,” Caswell says. “She knew me, knew that my mom had had breast cancer, and knew that regular screening was especially important for me.”

A small tumor was detected, and after a biopsy and two consultations with Dr. Ciccarelli, she decided to have mastectomy and reconstructive breast surgery through a program offered at a larger hospital. Dr. Ciccarelli’s team made referrals and helped her arrange treatment. When her cancer was found to be more invasive than originally thought, she had to plan for chemotherapy after surgery. Then, when post-operative complications required a week of inpatient care right before the holidays, she knew she wanted to be close to home and with her family.

“I was able to be at Gifford, just down the street from my home,” Caswell said. “The doctors were wonderful—they collaborated with the oncologists who were treating me, sharing blood counts and test results. It was a very smooth process.”

Click here to read our full Cancer Program 2014 Annual Report.

Customized Support for Patients Receiving Cancer Treatment

This article was published in our Cancer Program 2014 Annual Report.

patient information bindersCancer treatment can be a complicated and lengthy process. It takes time to absorb and process information, and most patients find it helpful to return to reports, schedules, and resource listings at home, so they can bring back questions they didn’t ask when meeting with their provider.

Since cancer patients often see multiple specialists, a lot of paperwork is accumulated along the way. Patients who feel informed and involved in their treatment are less stressed, but things can quickly feel overwhelming.

This year Gifford’s Cancer Program initiated new efforts to improve communication, personalize support services, and simplify processes so patients will have the help they need at a time when life can feel out of control.

Patient Information Binder: Each patient starting cancer treatment at Gifford is given an 11 x 13 inch zippered binder with five multicolored section dividers to organize care team contact information, treatment plans, information on care at home, support services available at Gifford, and general cancer information and community resources. Other folders and pockets can store reports, medication lists, appointment schedules, and important treatment information.

“It helps keep life-with-cancer organized,” said Jessica Spencer, an oncology nurse who helped design the binder. “It also has lots of information and resource listings, so patients have a place to turn to when they are not at the hospital.”

Our oncology nurses have also found that using the binder with patients can help identify support services a patient may need earlier in their treatment process.

New Psychosocial Screening Tool: There are aspects of cancer care that go beyond actual medical treatment and oncology nurses, who establish ongoing relationships with patients as they take blood tests, administer medication or chemotherapy, and monitor treatment, are often the first to learn about patients who need extra support.

A new psychosocial screening discussion with patients at their initial treatment session now helps nurses identify and track these needs more effectively. The completed forms are reviewed and referred to a social worker for further follow up if needed. Patients have received assistance with insurance issues, finances, transportation or housing needs, or emotionally adjusting to their illness.

Click here to read our full Cancer Program 2014 Annual Report.

New Tool Brings Hope for Those with Chronic Bone and Muscle Pain

This article was published in our Fall 2015 Update.

Ginger PotwinAnyone who has suffered chronic muscle and bone pain knows that it can be difficult to find a treatment that relieves the discomfort. Sometime these injuries can significantly impair mobility, or your ability to enjoy daily activities.

“We’re always looking for new ways to treat these conditions because one person’s response can differ from that of someone else who has the same condition,” said Sharon Health Center Sports Medicine Specialist Dr. Peter Loescher.

Loescher suffers from chronic tendonitis of the knee himself, so he was especially open to trying out a new technology that might help similar conditions. He recently tested the EPAT (extracorporeal pulse activation technology) tool, a hand held device that looks like a small hairdryer, which uses pressure waves to increase blood flow to regenerate damaged tissue and promote healing. He liked that the tool offered a non-invasive treatment option to traditional cortisone injections or plasma replacement needle therapy.

“EPAT is especially good with repetitive injuries—carpenters elbow, tennis elbow, and some knee conditions,” Loescher said. “The body has long since given up trying to heal these daily repetitive injuries, and EPAT can help restart the body’s own healing process.”

After successfully using the technology on himself and other staff members at the Sharon Health Center, Loescher began a 3-month trial with patients who had not found a successful treatment plan and were willing to try something new.

Chronic shoulder pain interfered with work, limited daily routines
Randolph Personal Fitness Trainer Ginger Potwin came to see Dr. Loescher when the exercises and anti-inflammatory medication prescribed by an orthopedist failed to ease increasing pain in her shoulders. Over the course of a year, her daily activities caused flare-ups, and each time her symptoms worsened. She worried that she would be unable to continue working as a trainer.

“The flare-ups in both shoulders prevented me from doing outside activities like raking the lawn, shoveling, and gardening. Also, doing household chores such as mopping and folding laundry proved challenging,” she said. “I was unable to demonstrate exercises to clients.”

Initially Loescher used a needle to break up significant calcium deposits in both of Potwin’s shoulders. He mentioned that EPAT therapy might help her condition, and Potwin decided to try it.

I felt immediate results,” said Potwin, who has had four EPAT treatment sessions. “Following each session I noticed increased range of motion in my shoulders and the pain significantly subsided—including the flare-ups with regular activities.”

Potwin says that the EPAT session lasted about seven minutes (her needle therapy sessions were about 40 minutes), with a post-treatment recovery time of a few days compared to the two weeks she had previously experienced. When she first began EPAT she had about 20 percent use of her shoulders—this increased to about 70 percent after the first treatment. Very quickly she was once again able to demonstrate exercises to her clients, which is critical for her work.

“I am back to my normal routines: I am able to rake my yard, garden, and fold clothes without pain or potential flare ups,” says Potwin. “I am also training for a thirteen mile obstacle race (Spartan Beast Race) in Killington this fall. I would have not been able to participate in this race if my shoulders were in the condition they were in prior to the EPAT treatment!”

To learn more about EPAT therapy, call the Sharon Health Center at
(802) 763-8000.

Expanded Behavioral Health Team Enhances Primary Care Services

This article was published in our Fall 2015 Update.

Gifford's behavioral health clinic hoursWith the unique ongoing relationship primary care providers establish with patients and families, they may be among the first to recognize that someone is struggling with depression, anxiety, or even substance abuse.

This year Gifford expanded the Behavioral Health team (it now includes a psychiatrist, a master’s level psychotherapist, a licensed drug and alcohol counselor, and a psychiatric nurse practitioner) to help primary care providers identify ongoing issues and help patients get the support and care they need.

“There are people in our community who are struggling with sadness, depression, are grieving a loss, or are overwhelmed by money issues. We want them to know that they can get help,” said Gifford’s Chief Medical Officer Dr. Martin Johns.

He notes that the new Behavioral Health team will complement the work of the Clara Martin Center, which handles more long term psychotherapy needs, and offers a depth of expertise that is unusual in a small rural hospital.

“Having behavioral health expertise onsite to assist in the emergency room if needed, or to consult on inpatient and outpatient care, will allow our primary care provider to help more patients manage mental illness issues,” he said.

Behavioral Health Director Dr. Peter Thomashow says his team looks closely at how biological, psychological, and social factors influence health. They offer individual, couples, and family psychotherapy and education and also collaborate with primary care providers to help them manage depression in patients.

“We are especially interested in helping individuals having difficulty coping with chronic medical illness,” said Thomashow. “Behavioral health needs to be integrated into a primary care plan, especially when treating chronic illness.”

The Behavioral Health clinic services include comprehensive evaluation and treatment for a wide range of psychiatric disorders for adults (age 18 and older) including:

  • Depression
  • Anxiety
  • Stress
  • Insomnia
  • Post-traumatic stress disorder (PTSD)
  • Bipolar disorder
  • Dementia
  • Substance abuse

BELOW IS OUR BEHAVIORAL HEALTH TEAM:

Peter Thomashow

James Tautfest

Cory Gould

Morgan Dion