ROUNDTABLE: Considering the Future of Medicine On the East End

In the wake of the COVID-19 pandemic — which is still very much alive and well — health care has emerged as a leading topic of conversation, with staunch supporters and critics alike exploring where it succeeds, how it’s improving and questioning the vast work left to be done.

To add to the dialogue, The Express News Group posed a number of questions to six leaders in East End health care, asking them to reflect on the past two years and consider the future of medicine — from mental health and preventative care to medical advances, vaccinations and the pandemic itself — as well as the issues plaguing the East End and beyond, including the affordable housing crisis and its effect on innovation, shortages of primary care physicians, and more.

The participants included Robert Chaloner, chief administrative officer at Stony Brook Southampton Hospital; Amy Loeb, executive director of Peconic Bay Medical Center; Dr. Adam Stracher, chief medical officer and director of the Primary Care Division of the Weill Cornell Medicine Physician Organization; Mary Crosby, president and chief executive officer of East End Hospice; Paul Connor, chief administrative officer of Stony Brook Eastern Long Island Hospital; and Andrew Rubin, senior vice president for clinical affairs and ambulatory care at NYU Langone Health.

And this is what they had to say.

Robert Chaloner: I think we’ve learned a lot of things, but probably the three that come to mind first for me, number one, is rapid responsiveness — that the situation, when it occurred, we didn’t really know what to expect. We just had to be adaptable and respond immediately. Health care’s pretty good with that — we know how to deal with crises and emergencies — but I think we’ve even honed our skills and learned that we needed to have that flexibility and be able to respond on the spot.

Along with that, one of the lessons is preparedness planning. We do a lot of drills and preparation, but sometimes it’s the things you don’t anticipate, like early on, access to certain basic supply items and the supply chain challenges we had. People remembered hearing stories about getting access to the plastic gowns that people needed for isolation, just being prepared and having sufficient stores and trying to anticipate where those things are that could go wrong. I don’t know that, prior to COVID, we thought much about supply chain, but now we certainly do.

Finally, communication is another one. Especially in a crisis such as this, the information that flows out there, good and bad, is critical to your ability to address the crisis, and ensuring that we communicate regularly with the public, with ourselves, with our other provider colleagues, and that we work in ways to ensure that that communication stays fresh and topical — and also avoiding bad information. As we look at what’s happened with some of the stuff that’s been out there on vaccinations and things like that, ways to ensure that there’s a constant stream of good and accurate and research-based information flowing across the board. Perfecting those communication skills is something that we did well, but I think we do even better as a result of COVID.

Amy Loeb: We learned about the resilience of our team. Their response was incredible despite the unknown. They showed up day after day to care for the community. We also learned how to be more agile. We set up COVID testing tents and monoclonal antibody infusions centers overnight. As the pandemic took on new forms, we adjusted.

Adam Stracher: Ultimately, I think New York hospitals rose to the challenge and fared quite well, but were strained to near breaking. I believe we all learned that there is not enough redundancy in the system with bed capacity and staffing. These are difficult challenges to fix, but we have learned a lot about our ability to work together and overcome many barriers. Nonetheless, staffing and other resources remain challenging if we are to face another major surge.

Mary Crosby: First, I believe we all came to realize, more than ever, how important our nurses are. They are the backbone of our health care system and how ensuring they have everything they need to provide safe and effective care is essential to preventing catastrophic breakdowns in the system. Second, the pandemic taught us about the importance of treating people, not diseases. When people were separated from their families in nursing homes and hospitals, which was completely necessary for infection control, the health effects were devastating for everyone. People need to be around their loved ones when they are sick as part of the healing process. Much of what we are seeing at our bereavement center is with complicated grief who are traumatized by the loss of a loved one during the pandemic. Many have loved ones who died from other causes, but because of restrictions in visitation limited their ability to say goodbye.

Paul Connor: The pandemic caused hospitals to rethink their “hazard vulnerability assessment” process, as very few hospitals had a pandemic as a top threat. Also caused hospitals to look closely at supply chain, on-hand supplies to insure adequate resources in face of another pandemic. Hospitals also have ready made pandemic bed/floor reconfiguration. Finally, staffing and how to be prepared with a limited workforce.

Chaloner: Well, we are not sanguine that it’s going away, certainly. We are anticipating that there’ll be new variants, that they become more prevalent and it’s not entirely predictable what may end up happening. We feel our most effective weapon is the new bivalent vaccine and it may not absolutely prevent the disease, but it definitely has been shown to reduce the severity of disease, and preparing to try to get as much of our population vaccinated as possible. So we’re doing a lot of outreach ourselves to try and ensure that the vaccine is out there in our community.

Loeb: We are expecting a difficult winter not only because of COVID, but other viruses including the flu. Like most respiratory illnesses, COVID-19 tends to increase as people remain indoors during the cooler times of the year. In Europe, there has been an increase in COVID-19 numbers. This trend is expected to occur in the U.S., as well.

Stracher: Obviously no one has a crystal ball, but we are likely to see an increase in COVID cases, as well as flu and other respiratory viruses. It will likely not be nearly as bad as the original peak, but how significant remains to be seen.

Connor: With the rise of RSV and the flu being more prevalent, some are predicting the combination of RSV, flu, and COVID creating a pandemic-like environment.

Chaloner: It does. I think there’s a little bit of vaccine fatigue in the population, a little bit of countering some of that bad information. I think it’s just gotta be a constant press for people to get vaccinated. There’s a big difference now with the population vaccinated and the severity of illness compared to what it was when the population was not vaccinated and people were getting much, much sicker. So we’re gonna continue to recommend and press and also continue to staff pods all across our community, to make sure people can get access to the vaccine. We really feel that’s the best protection. It’s just gotta be a constant information stream getting out to people to get the vaccine.

Loeb: Data suggest that COVID immunity wanes with time and varies with the viral variants that we are infected with. With that in mind, it is important to consider booster vaccinations. With omicron and its subvariants, vaccine effectiveness is reduced. However, vaccinations reduce the chance of severe COVID disease.

Stracher: This booster likely provides critical additional protection against current and future variants, and while it’s impossible to know how well it will protect us, there is limited to virtually no downside and a significant potential upside in reduction in serious disease, hospitalization and death. These vaccines are safe and effective, and everyone eligible should get their booster.

Connor: I would always recommend that you speak with your primary care provider about the booster, as well as a flu shot.

Chaloner: I think the area that most of us in health care and certainly the doctors that I would speak to would say that cancer care is the area of the most rapid advances evolving very, very quickly and certain new treatments — for example, targeted biological agents and there’s something called chimeric antigen receptor, or CAR, T-cell therapy, which is evolving very rapidly, and it’s a way to stimulate the body’s own immune system to fight cancer. Locally, with a team of researchers at Stony Brook, they’re working on CAR T-cell immunotherapy and it shows tremendous progress. We’re very excited about that and I think across the board in cancer, we’re seeing some of those improvements.

Loeb: This is hard to say because so many wonderful things have happened in medicine in the last five years. There is more that we can do for stroke than ever before — including not only dissolving the blood clot from the brain blood vessel, but also, for selected types of stroke, the ability to physically take the blood clot out of the brain utilizing a minimally invasive strategy.

Cancer care has also made enormous strides with innovative approaches, including targeted therapies, immunotherapies and more robust screening tools. We also now have a Northwell Health Cancer Institute right here in Riverhead that opened in December 2020.

At PBMC, we have added a lot of new services in the last five years. In 2020 right at the start of the pandemic, we completed the construction of the Corey Critical Care Tower and the Kanas Regional Heart Center that houses our interventional cardiology services, which started back in 2017. It offers a comprehensive range of capabilities and services including an advanced cardiac rehab program and leading-edge cardiac care technology. We are also closing in on a $400,000 expansion to our breast imaging services within our women’s health program. PBMC is about to embark on a $15 million dollar expansion to our emergency department. This is just to name a few, and there are so many more advances to come. We are truly blessed to have both the support of our community and the backing of New York’s largest health care system to make great things like these happen.

Stracher: The good news is that we continue to make major strides in many areas of medical treatment, including improving survival rates for many types of cancers, reduction in death from heart attack and stroke, improved minimally invasive interventions for coronary artery and valve disease, and enhanced preventive care. One of the biggest advances is in the delivery of health care using telemedicine, which has already improved access to care for millions, including during the pandemic, but this will have lasting and far-reaching effects for all facets of care.

Chaloner: In addition to some of the immunotherapies that are being developed, the other thing that’s very interesting now across the board — and also particularly in cancer care — is minimally invasive surgery using robotic assisted surgery and laparoscopic techniques where we’re actually able to go in and do surgical resections of lungs and esophagectomies using minimally invasive techniques. In the years gone past, the surgeries were pretty major, massive surgeries, very painful, much longer recovery, and to the extent we can reduce the invasion into the body and reduce the incision and really reduce the cutting — down to the point where only the cancer is — has a tremendous benefit for the patients, in terms of their outcomes, their pain, recovery times. When you think about it, it’s being much more precise in the attack on the cancer. Rather than use a machine gun against the cancer, you’re using a sniper approach to it. That’s one of the areas that’s evolving really rapidly and to me, anyway, is fascinating how they’re about to do so much with tiny, tiny, little incisions.

Loeb: Our ability to promote and understand not only “sick care” but also “well care” and “healthspan.” Lifespan, or how long someone lives, may not be as impactful for some as “healthspan,” or one’s ability to live without illnesses or mitigate those ailments’ ability to impact one’s ability to enjoy life. We are understanding more about how to keep people well and the partnership needed with patients to ensure they can live their best life.

Stracher: The promise of precision medicine through genetic analysis is beginning to take shape and will likely transform how we screen and treat patients in the near future. Additionally, while the use of electronic health records has come with some challenges, the ability to collect data and better understand health care disparities between different populations is an important innovation that will allow us to provide better, more equitable care to everyone.

Andrew Rubin: Levering telehealth capabilities is going to be critical for us to continue to take care of our patients. Our continued use of technology allows more efficient use of our physician and staff time to ensure patients receive the best health care.

Chaloner: One, and we’re seeing it here and at Stony Brook Medicine, is being able to translate the basic research that’s happening around cancer cells and the progression of cancer into treatment. There are rapid advances happening there. The other thing, biomedical informatics and the statistical data that’s available now, as we’ve automated clinical records over the years, and being able to take this vast amount of data and crunch it and identify what treatments are effective, what populations might be at risk, and that’s truly fascinating work that’s going on. As we grow our health care databases, I think new treatments will come out of it because it’s just more information that researchers are able to utilize.

Loeb: There are quite a few new modalities that more efficiently and effectively target cancer cells and leave noncancer cells alone — this decreases the severity of side effects. This past August, in partnership with the William Ris Gallery in Jamesport, the Peconic Bay Medical Center Foundation held a fundraising event, with proceeds going toward the purchase of an introspective breast specimen imaging system for tissue. In line with our mission to enhance and improve access to women’s health care in eastern Suffolk County, this system will revolutionize breast surgery at our hospital.

Chaloner: Those are definitely my favorite projects that we have going on out here right now. The East Hampton emergency room will be a real transformational project for East Hampton health care. We know that people are not accessing health care as quickly as they should in emergency situations in East Hampton because the trip can be so daunting — and it used to be just during the summers, but now when we look at the traffic patterns, it can be an hour and a half on a mid-week fall day. People are just hesitant before they’re willing to go get an issue taken care of, so having that facility close to home will open up access dramatically, we feel. It will also help the ambulance professionals who are spending a lot of time stuck in that traffic both ways at this point – and those are volunteers. It’ll ease the burden on them.

It also will have the full array of radiological and laboratory diagnostic equipment out there, that people can get their imaging done, read by the specialist at Stony Brook and not have to travel here. Health care problems rarely just go away and often get worse. The sooner you nip things in the bud, the better. We’re hoping that it’ll just be a big, big plus for people.

Where I see the new hospital improving things, it’s really a couple of categories. One is the obvious patient comfort and even our ability to deal with infectious diseases, where in the old days, in our current hospital, people were put into rooms together. A facility that’s all private rooms will be a major, major advantage for folks. It will give us a much greater expansion and flexible emergency room and ambulatory treatment spaces so that we can continue to evolve as new technologies are happening; imaging is a good example. And a facility that’s wired for the new information technologies I think will be a major boom for us, as well.

Crosby: New facilities in Southampton and East Hampton will help tremendously with getting access to high quality care, where and when people need it. The East Hampton facility will ease the burden on the Southampton emergency department, particularly in the summer, and cut down on travel times.

Chaloner: That’s a big one for us. We, like all the businesses out here, are feeling the difficulties of recruiting staff. We’re very proud of the fact that people love to work at our hospital, but they would love it even more — and it would certainly be easier to recruit new staff — if they didn’t have to travel the distances that they’re traveling. And our employees, almost 80 percent of them are commuting from west of the Shinnecock Canal, and the traffic just from Hampton Bays can be an hour and a half some mornings. People are spending all that time in traffic, they’re putting in an eight- or 12-hour shift, it’s exhausting health care, and then they have to spend the hour and a half going back. It’s difficult on multiple levels. It’s tiring for the staff, it’s stress-provoking, they’re trying to get home to their families, and it’s a real challenge. Certainly, if we had more affordable housing closer, we could shorten people’s commute times and it would make a huge difference. We’re major, major advocates of anything communities can do to improve the housing situation.

We are doing many innovations. We’re trying to create flexible shifts for our staff, we’re trying to use technology and telehealth opportunities for those staff members who don’t necessarily need to get in the car, but a nurse can’t take care of a patient remotely, so overwhelmingly, our clinicians need to be here. So that’s a particular challenge.

Loeb: The cost of living on Long Island is always a factor for recruitment and retention. While there may be challenges, we’re innovating to overcome these challenges. And that’s why we’re focused on investing in the people who already live and work here in our community to spread the word about the great opportunities for careers right here. Our work with local high schools through career fairs, lectures by our subject matter experts and leaders are proving to be great ways to build a pipeline of potential new hires. Giving back to our community through community benefits like this are a top priority of Northwell Health and Peconic Bay Medical Center. Our medical center alone has generated more than 2,400 jobs for the region and provides more than $32 million in community benefits and investments. We’re proud to not only employ our community directly, but also through the secondary jobs created.

We’re also energized by the revitalization of our hometown of Riverhead and the plans for additional housing and downtown revitalization that is currently being planned.

With all of that said, residents should not feel obligated to compromise access to medical care just so they can maintain their suburban way of life. That’s why we’re also expanding our reach and opening facilities in Center Moriches and Shirley, so that residents can have specialized and primary care nearby and won’t have to travel long distances. PBMC is a community hospital, and it is our mission to serve the community — on their terms and meet them where they are — so they have access to the best, most advanced medical care available.

Crosby: The lack of affordable housing on the East End affects almost every level of the health care system. Consider our hospice nurses, social workers and aides: They drive all over the East End, both forks, caring for terminally ill patients in their homes. We care for more than 750 patients a year across 450 square miles. Because so few of them can afford to live out here, they drive to the area, in the trade parade, and then spend their day sitting in terrible traffic as they travel from home to home. They can be delayed in delivering important medications, supplies and equipment because of the traffic on the South Fork, particularly in the summer.

Connor: Affordable housing is critically important to our hospital, as well as other health care facilities and local business. We see more and more that the local population cannot provide the workforce to support our needs and thus our recruitment ranges farther from the hospital. Many of our employees would love to live closer to the hospital, but property values are prohibitive. Often our employees have to make a choice between convenience and commuting. This is especially difficult with workforce shortages and the geographical location of our hospital.

Chaloner: Probably the biggest asset that we have is, about 10 years ago, we started our medical residency program, so we have residencies in surgery, internal medicine, family practice and, from a primary care perspective, those programs have been a godsend to us because the young doctors come out here after medical school, they train here and a certain number of them every year like it out here and put down roots and they meet each other, they become friends and colleagues, spouses even, of each other, and want to stay. So that has been our greatest recruitment tool, training our own doctors.

We’re also expanding training with some of the specialty areas. Stony Brook is now rotating specialists in urology, pathology, radiology, obstetrics, to give exposure in the community, as well, and that will be another way to feed the pipeline of candidates we consider. It’s not easy, there’s definitely a long recruitment cycle in terms of these specialists, but with some of the training programs we’re putting in place, that’s where I see the greatest progress. It hasn’t solved the problem yet, but it’s gone a long way toward helping us.

Loeb: Northwell Health is continuing to grow our network and recruit primary care physicians who are the foundation of our community’s care. Today, we have practices from Greenport to Shoreham on the North Fork down to Shirley on the south shore out to Hampton Bays, and in many locations in between. Our goal is to continue to grow this network of providers to provide better access to primary and preventative care for our community.

Stracher: The focus of health systems on the East End community has helped improve the situation, but there continues to be a shortage of primary care physicians and advanced practice providers not only on the South Fork, but nationwide.

Crosby: There seems to be a great migration of health care systems out to the East End — most recently NYU and Weil Cornell. I know for quite some time, our physician-to-patient ratio on the East End was one of the worse in the state. I’m not sure if that has changed recently.

Chaloner: Even what we’re going to be doing in East Hampton is going to be very important to us with something like heart attack and stroke. It won’t necessarily be preventative, but the sooner you start to treat, the better, and creating treatment facilities closer to people where they live, you don’t want somebody in a stroke having to spend a half an hour, 45 minutes traveling, the sooner you can diagnose and start treatment. Having a facility like the East Hampton emergency department will be a major asset for us.

Similarly, putting doctor’s offices and building a primary care network, which we’ve been doing, and putting doctors in all the various communities makes health care as accessible as possible so that people get their regular preventative physical exams — if they see something they’re worried about, get it taken care of sooner rather than later. I think having a good, well-distributed health care network will help.

We believe, and we’ve been supported by the Davis family, that wellness services and integrative health care are major benefits. Diet, relaxation therapy, cardiac rehab, even things like yoga and mindfulness are, really, very, very helpful. There’s good science now showing that stress and poor diet and all the lifestyle issues, that if we can intercede early on with wellness techniques helps. And part of that is pitching the information to the public. In addition to our wellness center, we’ve been working on a lot of community outreach programs through the libraries, senior citizens, churches and health fairs. Good information counters poor health and that’s one of the things that we feel very strongly about.

Loeb: There are multiple strategies deployed by primary care providers to prevent catastrophic outcomes, such as cancer, heart attack, stroke and many other ailments. It’s imperative that we all see our primary care providers not just when we’re sick, but to prevent us from becoming sick.

PBMC works every day to provide the range, depth and quality of medical capabilities to fulfill our promise as the regional medical center for Eastern Suffolk County. We will be opening our new cardiac CT scan, which will allow us to scan for heart disease in a noninvasive way with advanced technology. We are also very proud of our interventional cardiac catheterization center, which is staffed by the region’s leading cardiologists.

We also are active in our community educating our neighbors about signs and symptoms of stroke. Our New York State-designated stroke center has been recognized for excellence with the American Heart Association’s Gold Plus Quality Achievement Award.

Chaloner: Not all interactions with doctors, but it is in many cases. There are times when if it’s a routine check-up, the doctor just needs to review your blood test results and everything’s normal and they want to just give you the pat on the back and encouragement to keep going. Some mental health visits and consults and some of that initial evaluation and follow-up work, it definitely can be a big advantage. I think where it’s helpful is to the extent we make it easier for people, the more likely they are to follow up with their doctor if they don’t have to travel an hour and a half to go get care, if they can just schedule a telehealth visit for 15 minutes from their office, makes a big difference and people are more likely to do that follow-up.

Loeb: We offer a wide variety of telehealth services in areas ranging from primary care to specialty care, as well as wellness and acute services. It can allow specialists that are not readily available to cover a large area and be present immediately with their special knowledge to assist emergency room physicians, for example. We have telehealth capabilities in our ICU and our local team is supported by the backing of Northwell Health’s Tele-Intensive Care Unit. This development allows us to provide 24/7 coverage by critical care providers, nurses and support associates. Since its launch in 2014, it has expanded to include multiple highly specialized programs, as well as social workers and psychiatrists.

Stracher: Not for all situations, but telehealth has the potential to improve access and reduce cost for many diseases, both acute and chronic diseases.

Connor: Telehealth/telemedicine has proven its versatility and value during the pandemic, allowing patients to maintain access to medical services. Stony Brook has a commitment to telemedicine providing telepsychiatry, neurology, endocrinology (diabetes, etc.), palliative care to begin with. We also provide addiction counseling via telemedicine. I believe, once the payors catch up with the technology, telemedicine will be more widely used, especially in less populated rural areas.

Chaloner: There’s always the obvious things like weight control, diet, exercise. More and more research is talking about getting up and moving, that being sedentary can be as destructive to your health as smoking two packs of cigarettes a day. So getting up and moving and managing diet are clearly important factors. We believe that taking preventative steps, like vaccination, are vital. Yeah, it’s a pinprick that hurts for a second, but it’s a definitely strong tool to prevent later illness, and also teaching people how to monitor their own health and know when to get help. Years and years ago, doctors weren’t necessarily as focused on those lifestyle issues, but now, doctors understand it — I know my own doctor will keep counseling me to keep the weight down and keep exercising — and that those are incredibly powerful. They always sound simple, but it really makes the biggest difference in the world.

Loeb: Regular exercise, maintaining a healthy weight and eating a balanced diet high in fruits and vegetables is critical, in addition to limiting alcohol intake. Smoking also has an incredibly negative impact on health, as well. Smoking can cause cancer, heart disease, stroke and COPD. Managing one’s mental health is also critical. Scheduling a yearly physical with your physician and talking to them about the necessary screenings you may need is critical to your overall health.

Stracher: One of the key roles for all physicians, but especially primary care physicians, is in helping our patients understand the value that healthy life choices can have in both the quality and quantity of their lives. It’s not a cliché to say that smoking cessation, adequate exercise and maintaining a healthy weight are the cheapest, safest, most effective interventions our patients can make to improve their longevity.

Connor: This is a conversation you should have with your physician, as there are a number of remedies available to address lifestyle and health.

Chaloner: I’m gonna sort of plead the fifth and say I don’t know. I wish they had made it a priority 15, 20 years ago, honestly, because I think it’s an overwhelming issue and it’s probably the greatest area that we are underserved, from a health care perspective. Mental health just turns into so many issues, it’s not just what people think. It’s what it does to their health generally, to their lives, to the community around them and their families, and we don’t devote sufficient resources as a country, I believe, to mental health. And I think it’s something that everyone in the field feels similarly about. We need to continue advocating for it. I think there’s a tremendous need out there. I wish I could say, “Oh, I think it’ll be better in five years or 10 years.” I can’t. I just don’t know what that time frame would be. At this point, I’m a little doubtful that anything’s gonna happen right away. I’m hopeful, but I’m not confident.

Locally and with our system generally, there’s a couple of things that we’re working on and partnering with some other community organizations. One of the things we’re very proud of, that we launched a number of years ago, is the South Fork Mental Health Coalition, where we come together on an annual basis with a number of other providers, social service agencies and we’ve even been working with the schools and other mental health providers and our local elected officials to get some grant money and open up access particularly for adolescents, so that we can fast-track them into mental health when there’s a crisis — and that’s been underway for a couple of years. That’s something we feel like we’ve made some tremendous inroads with and we’re collaborating with the schools to get them a fast track into mental health resources.

We’ve launched a major effort around understanding the needs of LBGTQ people and just completed a major survey of adults. Not surprisingly, but now we have good quantitative information showing that mental health is the highest priority with that population, and we’re currently in the process of working with Stony Brook. We’ve added a social worker, we just got a grant to add a case worker in the Edie Windsor Healthcare Center, and opening up greater mental health resources for that population.

Meeting House Lane, our physician group, has hired a mental health nurse practitioner, mental health psychiatric social worker, and a number of other resources. We also, in our palliative care program, for people who are suffering from either chronic and long-term disease or end of life, have expanded the counseling services because there’s often tremendous anxiety and depression associated with that.

The other thing, because there just aren’t enough mental health providers out here, is opening up telemedicine to the providers that are up the island. Stony Brook has a comprehensive psychiatric emergency program, or CPEP, the only one in the county, and we now have links to that, so that we can do evaluation and referral on an emergency basis back to Stony Brook. So if somebody comes into our ER, they can be evaluated, even if we don’t have a mental health provider on site, and that’s proving very, very useful to us, and we’ll continue to develop our service.

Addiction is certainly a real issue and, particularly in light of the opioid crisis that’s been plaguing the country and Suffolk County, the need for addiction services is tremendous, but you’re absolutely right, it’s a broad spectrum of services, whether it’s identity issues, isolation issues now — for youth, particularly, during this COVID period — depression and anxiety associated with aging and illness with the older population, just the pressures of modern life. I’ve never heard the term “anxiety” used more than over the last five years, the amount of anxiety that seems to be plaguing our population, particularly young people. The full spectrum of mental health resources needs to be made available.

Loeb: One out of five young people today suffers from mental health issues, and suicide is the second-leading cause of death for adolescents and children as young as age 10. It’s so important to start the care of mental health issues starting with children so they can grow into happy, healthy and productive adults. This is why Northwell Health is focused on bringing resources to children and their families closer to home, and we hope to welcome these resources soon to the East End. Recently, the system opened its third behavioral health urgent care center for children and adolescents since 2020. This is done in collaboration with participating school districts and is part of a major initiative to address the increase in mental and emotional distress experienced by that age group — a trend exacerbated by the pandemic for sure.

As the largest health care provider in New York, Northwell will have the ability and the responsibility to influence our country to follow suit in raising the priority of mental health, especially for our youngest citizens. It is also important to look at mental health beyond addiction because there is so much more to it than that. And that’s how we and our partners across Northwell view it.

Crosby: The need for high-quality, affordable mental health services on the East End is immense. Our Zinberg Family Bereavement Center is inundated with calls from people looking for individual and group therapy. They have all lost a loved one, but many of them have a complicated mental health history and require more than just grief therapy. Most clinics that accept insurance have long waiting lists or are not taking new patients.

Connor: Mental health is in crisis in this country. There are many problems in accessing mental health services, including but not limited to insurance coverage, shortage of community-based mental health providers, shortage of child and young adult mental health providers. Accessing mental health services are stigmatized and basic understanding of mental health and those conditions that come with being affected by mental health are not well understood. SBELIH has opened an outpatient addiction program in Riverhead, Quannacut. We treat individuals with duel diagnosis of addiction and mental health, and will be applying for an Office of Mental Health license to treat individuals with a mental health diagnosis alone. Also, Quannacut will be providing education in local schools, as well as treating adolescents. SBELIH also has adult inpatient psychiatry, detox and alcohol and drug rehabilitation.

Rubin: Mental health is a priority for all health systems across New York State and the country, and everyone working together to address these issues is critically important.

Chaloner: Health care has gotten a lot better about dealing with the issues around anxiety and stress for its staff and its patients. It used to be the notion of, “Oh, we’ll just deal with pain, tough it out.” We recognize that, no, we need to acknowledge that there is a tremendous amount of anxiety and stress, and COVID has brought that to the fore. There are techniques that we can use in health care.

One of the things we utilize is something called Code Lavender for our workers. There are horrific situations — an automobile accident where an entire family is wiped out and brought into the emergency room and despite their valiant efforts, the family members die or a child dies — and that takes a tremendous toll psychologically and lingers with the workers that are involved with that, doctors and nurses. So we’ve implemented Code Lavender, where when that happens, the staff can call and we can bring our own mental health resources — our social workers, therapists — just bring the group together to talk it out and deal with the feelings that are associated with that. And I think the most important part of it is the staff realize they don’t have to deal with that stress in isolation, or that anxiety in isolation, that it’s not unique to them. And sometimes just being with the therapist, being with the co-workers and being able to talk about it can create a tremendous resource.

We have an employee wellness program where anyone can access, for whatever reason, whether it’s job-related stress, home-related stress, financial stress and make counselors available. And also, insuring that we all are looking for the signs of burn-out and stress. It’s been a tough period for health care and we have a long way to go, in terms of supporting each other, but we as an industry are doing much better with that.

Personally, I just have to turn off email — I don’t care what it is, I just have to get away from email periodically. Email 24 hours a day is incredibly stressful. I try to exercise three or four times a week. I’m not always successful, but turn off the screens, turn off the TV and get to bed at an early hour is important, and I think that we get back to lifestyle issues is vitally important. And friends is another one. I’m a big believer in that we’re social creatures and isolation’s not good for us, so friendship is really important. So I try to make time for my friends.

Loeb: Personally, I manage stress by disconnecting and doing things I enjoy, such as hiking and listing to music. I find if I listen to music instead of the news on my way to work, I walk in feeling refreshed and happy. Also taking time to connect with friends and do some laughing is also a great mental health boost.

On a personal note, I just recently completed my first Ironman marathon competition. I bring it up because stress and anxiety is often a result of focusing on the end results. Training for the competition was grueling and physically exhausting, but I found comfort and enjoyment in the process. It was the only way I was able to make it. Enjoying the process is a mantra that I often speak about with patients and families of patients and students who are working toward gaining a career in the medical industry, which can be grueling unto itself. Enjoy the process.

Crosby: Hospice is a wholistic philosophy of care. Our patients are offered a variety of anxiety reducing services and treatments. Every patient and family is assigned a social worker who assists with emotional support and connects families to pastoral care, if they are interested. We also offer healing touch, music therapy, pet therapy and massage, all free of charge. For the families, we offer equine therapy in addition to Tibetan sound therapy and so much more. Reducing anxiety and stress for patients and families is paramount to what we do.

For our staff, including myself, we have an employee wellness program that includes on-site massages during staff meetings, yoga and meditation at lunchtime, and our Sunflower Sessions for debriefing difficult cases and providing self-care to our staff.

Connor: This is a question of personal preference. I go to the gym most mornings and find that I get a “positive mental attitude” benefit for the activity.

Rubin: Taking care of yourself physically and eating properly is very important in balancing stress, but I also recognize there are people who can’t do those things and they do have a lot of stress in their lives. Managing stress is important for good health.

Chaloner: Our population is definitely aging and one of the things that we certainly need to be focused on is early detection issues — that sometimes the health care issues associated with aging, a bright red light doesn’t just suddenly come on and say, “Bing, this is a problem.” Subtly, the symptoms start to occur and making sure that people start to identify those and seek help early on before an issue becomes a major problem. Particularly, in the older population, routine checkups are critical. That’s why we’re always talking about, see your doctor timely, get the colon screenings, get the mammographies, do the routine bloodwork, because often the problem is occurring before you start to notice it. That’s why we feel building a primary care network is vital for the population out here, so that people can access that care early on.

Cardiac services become more important as we get older. Having the cardiac cath lab that we have, that we can offer cardiac interventions and also link into the major surgery program over at Stony Brook, having a cardiac rehab program and education around heart health is important. And, also, it’s a reason why we’ve built out the cancer services here because cancer certainly becomes more prevalent in the older population.

Loeb: Peconic Bay Medical Center has officially been recognized by the Institute for Healthcare Improvement as an Age-Friendly System Participant as of late 2021. This recognition makes Peconic Bay Medical Center the only certified Age-Friendly System Participant on the North Fork. Thousands of Eastern Long Island residents can now benefit from the implementation of evidence-based interventions specifically designed to improve care for older adults.

Stracher: Frankly not very well prepared. We have a dearth of primary care physicians and geriatricians who are well-versed in care of the elderly, and we do not have adequate homecare workers and high-quality nursing homes and assisted living facilities, especially those that are affordable.

Crosby: Many people don’t know that New York State ranks last for hospice utilization. We use hospice less than any other state in the nation. If we want to be prepared for our rapidly aging population, we need thorough and widespread education around advanced directives, palliative care and end of life care so people can age in place with the resources they need to do so safely and comfortably.

Connor: The North Fork is a retirement destination and has been for some time. The demographics skew toward an older population, as about 26 percent of the population is 65 or older versus about 15 to 18 percent for Suffolk County. SBELIH has good experience with this older population, but with workforce shortages, especially in homecare workers, nurses and nursing aids, we will be challenged in meeting the needs of this growing population. One way to address the needs of the elderly is through technology. Stony Brook has established a research project that places sensors and cameras in the homes of consenting elderly individuals to provide a warning when no movement is detected. These types of research and the use of technology to better monitor the health and safety of our older population will become more mainstream in the future.

Rubin: Access to good primary care in all of the various communities we serve is the best way to treat an elderly population. Eastern Long Island for a long time has not had the number of high-quality physicians that would need to treat this increasingly large segment of this population. NYU Langone provides the highest level of care to patients at our Bridgehampton, Riverhead and Patchogue locations, as well as a new Westhampton location that will open in the future, so we’re doing everything we can to address this issue.

Chaloner: The best thing about tick-borne diseases is that most of them, a very simple antibiotic is very, very effective against them — doxycycline, which is inexpensive and readily available. The goal is obviously to get screened and, like everything, if you’ve been bitten by a tick and you’re infected with a tick-borne disease, intervene earlier and an overwhelming percentage of the time, doxycycline, which is a very simple antibiotic, will eliminate the disease. There’s a few cases, some diseases aren’t necessarily receptive to doxycycline, but there are other antibiotics that work effectively as long as we intervene early. The longer it’s allowed to linger, the more complex the disease becomes and the harder it is to deal with it, and we hear about other issues.

The other thing that we’ve learned that’s important is people used to think they get tested for Lyme disease, they don’t have Lyme disease, they’re okay but they still don’t feel great, we’ve learned that the ticks out here often carry multiple diseases and you could be infected with multiple issues.

Loeb: Unfortunately, Lyme disease is widespread on Long Island, especially on the East End. It can cause several clinical syndromes, such as arthritis, carditis, encephalitis, meningitis, and facial nerve paralysis (Bell’s Palsy). What’s most important, though, is that it’s caught early. It’s usually identified as a rash around the bite that resembles a bull’s eye target — technically, erythema migrans.

However, Lyme disease is fairly easy to treat with antibiotics. A Lyme disease vaccine is also being developed in Europe and the United States. Speak to your doctor if you feel as though you’ve been bitten by a tick. You can qualify for prophylactic antibiotics to prevent serious infections.

For all tick-borne illnesses, it is best to use personal protective measures — avoiding areas, DEET/ permethrin, checking for ticks. In addition, it’s recommended to reduce ticks in the environment by reducing rodents and deer, using pest and landscape management.

How is the medical community handling chronic Lyme disease cases — appreciating not everyone believes chronic Lyme is a medical condition?

Chaloner: Since we opened up our tick center quite a few years ago, there was some debate. There’s more and more recognition that what people often refer to as chronic Lyme, there is a long-term impact of the disease. The disease is caused by a bacterium, Borrelia burgdorferi, and that bacterium is very, very susceptible to oral antibiotics, so taking the antibiotics will clear the bacteria from your system. And, overwhelmingly, after people take the antibiotics they’re fine. A very small subset of patients may continue to feel certain symptoms, like fatigue, joint and muscle aches, brain fog, et cetera. We now call that post-treatment Lyme disease syndrome, or PTLDS. There is not a lot of debate about the validity of this phenomenon, that most clinicians actually do agree that this does and can occur. I’ve heard some of the clinicians speculate that it’s the damage to the nervous system that can be long term and different people react different ways, similar to what we’re seeing with COVID. Some people bounce back immediately, some people are reporting long-term COVID. We don’t totally understand why some people get it and some don’t, but there’s something going on with people and this needs to be recognized and treated appropriately.

There’s a lot of confusion about it and there’s a lot of research being done. Today, the medical community recognizes this is an issue. It’s not what people in the public often think it is, but there are long-term effects of these diseases that we need to take care of.

Loeb: Lyme disease is a very serious condition and one that could lead to serious medical complications if left untreated. And, make no mistake, chronic Lyme is a medical condition many people suffer from.

Most specifically, post-Lyme syndrome can occur in some patients treated for Lyme disease. While the bacterial infection causing Lyme disease may not persist, there may be residual neurological and physical effects of the disease. In these cases, antibiotics are generally not recommended as a course of treatment, but that does not take away from the pain many patients feel. Some people have a persisting inflammatory response, similar to patients with COVID. Over time, the symptoms can get better. At PBMC, we focus on patient care and treating the whole patient, which is why we deploy cross-divisional treatment. For example, some patients may benefit from seeing a neurologist for chronic fatigue or a rheumatologist for chronic joint inflammation.

Chaloner: It’s interesting when you say “relatively new” — actually, the South Fork is one of the areas where this has really been identified and we’re very lucky because one of the leading experts in the field is out here, Dr. Erin McGintee of ENT and Allergy Associates in Southampton. She’s an allergist and actually part of our medical advisory panel. She was one of the early folks who started noticing this coincidence of people being bitten by a lone star tick and then several hours later having a reaction after they eat mammalian meat. The allergy develops in response to a carbohydrate allergen, which is different from many other food allergies, which are usually result of a protein. It’s also different from many food allergies because typically if someone is allergic to shrimp, they’ll have almost immediate reaction to it. This one, you ingest mammalian meat and anywhere from three to six hours, suddenly you start to develop these allergic reactions, which is why people didn’t necessarily associate what they were eating with the reaction originally. It can be life-threatening.

The heart of the research is down in the Universities of Virginia and North Carolina, where they first discovered the connection of the lone star tick to this particular allergic reaction. A lot of research is doing on, it’s really important to note that everyone who is bitten by a lone star tick — and those are the more prevalent ticks we’re seeing out here now — is not developing this allergy. It’s still a relatively rare thing, but certainly it’s something for people to be aware of and is a real phenomenon.

The good news is, there’s now a test that an allergist, just like they can test you for allergies to other things, can test to see if you’ve got this allergy. The other thing I’ve heard the doctors talk about, which is good news, unlike some other allergies, this one tends to wane in people after one or two years, assuming they’re not exposed to additional bites. It’s something where there’s a lot of research going on.

Loeb: Alpha-gal syndrome is when a person suddenly develops an allergy to red meat, gelatins, meat gravies and other animal products after being bitten by a particular type of tick, the lone star tick. It’s an incredibly technical antibody reaction to a specific carbohydrate within the meat. Patients may experience hives, swelling of the mouth/ tongue, or anaphylaxis. Some people may have gastrointestinal symptoms, as well. As always, early detection is critical. Should you suspect a tick has bitten you, I strongly recommend contacting your doctor. There currently is no specific treatment for this development, but medical professionals are learning more every day.