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Doctors Health Nutrition

RX for Your Health with Dr. Adam Vella and Dr. Brenna Farmer

NewYork-Presbyterian Lower Manhattan Hospital is an essential part of the Downtown community. We talked with Dr. Adam Vella and Dr. Brenna Framer about the specializations of a pediatric doctor, the responsibilities at the hospital, the impact of toxicology and more.

Dr. Vella is the Director of Pediatric Emergency Medicine at NewYork-Presbyterian Lower Manhattan Hospital, Director of Quality Assurance for the Division of Pediatric Emergency Medicine at NewYork-Presbyterian/Weill Cornell Medical Center and NewYork-Presbyterian Lower Manhattan Hospital, and Assistant Professor of Clinical Emergency Medicine (interim) at Weill Cornell Medicine. What an impressive lineup of titles.

Brooklyn-born Dr. Vella was initially inclined to becoming a doctor of veterinary medicine because in high school he read a series of books by James Herriot about a veterinarian with a large animal practice, and this piqued his interest. Once he realized that veterinarians in New York focused on more cats and dogs than horses and cows, he started looking for other ways to explore the medical field, and he applied to be a premedical student. While he was studying the basic premedical sciences, he realized that he always enjoyed working with children and decided to rethink his plan.

Downtown: What makes pediatric emergency medicine different from pediatric internists and why did you choose this path?

Adam Vella: Great question. I am the type of person that is happiest when solving a problem. In this country, general pediatrics tends to focus more on well-child care meaning anticipatory guidance about health and vaccinations, and although I do practice a lot of what would be considered primary care while seeing patients in the emergency department, I enjoy working under the pressure of an emergency situation. For this reason, I decided to do an additional three-year fellowship to specialize in pediatric emergency medicine, which was one of the best decisions I have made thus far. I love the energy of emergency medicine and the challenges of establishing relationships with patients and families when they are most in need.

DT: What are your responsibilities as director of pediatric emergency medicine at NewYork-Presbyterian Lower Manhattan Hospital?

AV: As director of the pediatric emergency department at NYP Lower Manhattan Hospital I am responsible for the care of children in emergencies. Whether the care goes well or not as expected I am ultimately responsible. I recently started in this role in January of 2019 after directing the pediatric emergency department at Mount Sinai for the past 10 years and am happy to report that I have a fantastic team of physicians and nurses along with amazing support staff. NYP Lower Manhattan Hospital is a unique place as it truly is a community hospital functioning within the context of the largest health care system in New York City. There is a small town feel to the place where we all know each other well and work closely together but still have access to the best specialists in New York. I think it is the best of both worlds.

DT: What does it mean to be the director of quality assurance for your department?

AV: As I have matured as a practitioner I have been increasingly interested in health care improvement. I served as editor-in-chief for a publication titled Pediatric Emergency Medicine Practice for five years and this really opened my eyes to the importance of practicing evidence-based medicine and keeping abreast of the most recent literature related to any given health care condition. When I decided to leave Mount Sinai for NYP Lower Manhattan Hospital and Weill Cornell Medicine, I wanted to craft a position that would include this interest. Directing quality for my department means that I am in the role of scrutinizing our practice to assure that we are offering the highest quality evidence-based medical care to our patients. This involves tracking measures of quality, which I have implemented, as well as liaising with the quality leadership of NewYork-Presbyterian. I review cases to make sure we have systems in place to protect our patients from errors in practice. In this way, I am able to influence the care of all of the patients seen rather than just those I have seen personally. In fact, I have already implemented changes that will change the practice across the entire health care system, which I think is an amazing opportunity.

DT: How is it different to work in the pediatric department of a large hospital than to work in a children’s hospital?

AV: Another great question, and yes, it is different, I agree. Really it is all about advocacy for our patients. At times within the context of a large hospital, the pediatric-friendly focus can be lost in the system. At NewYork-Presbyterian, we are constantly advocating for our youngest patients within this large, complex hospital system. As pediatricians, we need to lead the way in advocating for their interests so that they are not lost in the shuffle. I trained at Children’s Hospital Los Angeles in my fellowship and was able to experience a hospital dedicated entirely to pediatric care. I strive to deliver that same level of service to our patients here within the largest health care system in New York.

DT: What have you discovered about the city in your work move from Uptown to Downtown?

AV: Well, to be honest, I work both uptown and downtown. I direct quality in pediatric emergency medicine for NewYork-Presbyterian and Weill Cornell Medicine on the Upper East Side, as well as at NYP Lower Manhattan Hospital, and working clinically at both sites. The downtown site is different in that is serves a very diverse population, including providing health care to a large Chinese population, as we are the closest hospital to Chinatown. In addition, I am seeing many tourists who are traveling from around the world to visit historic sites such as One World Trade, the 9/11 memorial and museum, Wall Street, the New York Stock Exchange, the South Street Seaport and the Brooklyn Bridge. I have truly enjoyed providing health care to this group and showing them how nice New Yorkers can be! I am also amazed by the growing community of young families moving into the financial district as it develops along with amazing new schools which have moved into our neighborhood.

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Following our interview with Dr. Adam Vella, we also had the opportunity to ask Dr. Brenna Farmer a few questions about her medical career and what she is currently accomplishing through her knowledge of toxicology.

Dr. Farmer is the assistant professor of clinical emergency medicine at Weill Cornell Medicine and Site Director of the Emergency Department at NewYork-Presbyterian Lower Manhattan Hospital. She has a natural inclination towards science and enjoyed every medical field when she was training but found that her true calling was emergency medicine because she wanted a specialty that allowed her to see and help patients of all ages with a variety of different problems that require different procedures. Now in her line of work, she is able to care for patients with urgent care problems (lacerations, joint sprains, upper respiratory tract infections, etc.) as well as emergency conditions (heart attacks, bloodstream infections, strokes, or trauma) while still providing treatment for many pediatric, obstetrical, gynecologic and surgical conditions.

Downtown: How did studying toxicology help you in this path?

Brenna Farmer: My Emergency Medicine training gives me an outstanding understanding of the pathophysiology of many disease processes, allowing me to treat critically ill or injured patients. Medical toxicology builds on my understanding of pathophysiology, by giving me more knowledge on rare or adverse drug side effects, expert training in the care of overdoses, envenomations, and other poisons.

DT: What are your responsibilities as director of the emergency department at NewYork-Presbyterian Lower Manhattan Hospital?

BF: I oversee the day-to-day operations of the Emergency Department (ED), ensuring our physicians can continue to provide care to anyone in need, no matter what time of day or night. I work closely with nursing and other healthcare specialists, including primary care physicians, surgeons and gynecologists, to ensure patients get the definitive care that they need for whatever problem they have.

DT: How did you get so involved with patient safety?

BF: Patient safety and quality is a passion of mine as a physician. My dad suffered tremendously after a medical error led to a long hospitalization, followed by physical rehabilitation with multiple physical and occupational therapy sessions. I realized that someone has to advocate for patients when they themselves can’t, and medical processes need to be evaluated to find areas for improvement. As necessary, new processes need to be developed to make certain care is provided equitably, efficiently, and follows evidenced-based, scientific practice.

DT: What things do you make sure your department does in terms of patient safety?

BF: Every day, we huddle as a team to discuss any challenges of the day related to improvement processes, staffing, new processes or resources. We also include a message about how to best provide patients with a first-class experience. In addition, care teams are formed to maintain continuity of care for all patients. In many instances, these teams consist of a nurse, physician, patient care tech, and sometimes physician assistants. This structure allows us to continuously communicate a patient’s plan of care, treatments we are implementing, and if there are any concerns. Teams also spend time training and preparing for how to handle rare emergencies should they occur. Clinicians in the ED also routinely participate in educational sessions across all disciplines (nursing, physicians, and technicians). This form of continuing education helps staff perform procedures safely, with the correct equipment, at the appropriate time and during the proper situation. Another priority for our team is to know that when they raise a concern, that it will always be heard and addressed.

DT: How is NYP Lower Manhattan Hospital promoting patient safety, quality improvement, and medication safety?

BF: This is accomplished by continually working to improve processes with focuses on safety, quality, and evidence-based care, and by also working in teams across the healthcare continuum, to ensure patients are kept front and center. In addition, teams review cases to assess for any concerns to help provide the best possible care to patients. Our NewYork-Presbyterian Department of Quality and Department of Pharmacy are always seeking ways to improve and continue to offer patients the best care possible.

DT: What can people do at home to practice medication safety?

BF: Everyone needs to know what medications they take and why they take them. Keep a list or set of pictures of medication bottles in your phone that can be shown to any provider. The information on the bottles (name of prescription, dose and instructions) is extremely helpful to all healthcare providers because it helps clinicians keep patient health records current. I also recommend storing medications out of reach of children, preferably locked away, so that unintentional exposures do not happen. When grandparents come to visit, store their medications out of reach from children and locked away. Do not keep medications in your purse or pocket, they should always be out of reach of those not prescribed to take the medication. Everyone needs to know Poison Control’s phone number: 1-800-222-1222. Do not keep left-over narcotic medications in your home. Take them to pharmacies, hospitals, clinics, or even police stations, with disposal bins. This helps reduce illegal and uncontrolled access to medications that could potentially harm others. 

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Doctors Featured Health Nutrition

Rx for Your Health with Internist Dr. Judy Tung

NewYork-Presbyterian Lower Manhattan Hospital (NYPLMH) is an integral part of the Downtown community. We talked with Dr. Judy Tung about diversity in medicine, how she found her way back to New York, and advice she has for women’s health.

Dr. Judy Tung is an academic general internist committed to providing high quality, comprehensive primary care. Her philosophy of practice prioritizes communication and continuity. Her clinical interests are in women’s health and preventive medicine. She is also a core faculty member in the medical college, serving as the Associate Program Director for the residency training program.

Dr. Judy Tung is a graduate of Wesleyan University and received her M.D. from Albert Einstein College of Medicine of Yeshiva University in 1997. She completed her Internal Medicine Residency program at University of California, San Francisco in 2000. Prior to joining Weill Cornell Internal Medicine Associates practice in 2001, Dr. Tung served one year as a Chief Resident in Primary Care Internal Medicine at New York University.

Downtown: What are some changes you’ve seen with diversity in medicine?

Judy Tung, M.D.: Greater awareness that health disparities exist and that to address it requires advancements in science (at how disease conditions might manifest differently and therefore need to be treated differently in specific populations), better partnerships with our community and strategic recruitment, and development of a health care workforce that reflects this diversity.

Downtown: What are some changes you would like to see?

JT: I would like to see institutional initiatives that address the above. For example, researchers at Weill Cornell Medicine and Cornell’s Ithaca campus recently established a new center to better understand why health outcomes vary among demographic groups. Through partnerships with communities in New York City and central New York, the Cornell Center for Health Equity will generate new evidence on how to eliminate such differences with the goal of achieving health equity for people locally, regionally, and nationally. Additionally, the Dean of Weill Cornell Medicine has made mentoring, particularly for women faculty and underrepresented minorities, a strategic priority for the next few years.

Downtown: How did you choose the field of medicine?

JT: I chose the field of medicine because I am fascinated by the human body and the human spirit; because illness is a universal equalizer, everyone is vulnerable to sickness, and because I enjoy empowering people to be their best selves and live their fullest life.

Downtown: Working with women, what are the most common issues among your patients?

JT: Women are often the keepers for the health of the family – they bring family members to the doctor’s, they prepare meals, and keep households still in the majority of American families. Educating women on how to take care of their physical and mental health has an impact on all members of the household.

Downtown: As an educator, are you noticing any significant changes in the next generation of medical professionals?

JT: Yes, the next generation of physicians are technologically savvy, innovative in their approaches to patient care, empowered to speak their minds, and advocate for their positions, making them an exciting group to work with.

Downtown: As someone who specializes in both women’s health and preventative medicine, what are some everyday things you feel that most women should be doing but aren’t? 

JT: I feel that many women (and men) underestimate the value of physical activity. It is easy to lead a sedentary lifestyle. But it’s important to remind everyone that the simple acts of walking or stretching can prevent injury, unintended weight gain, and cardiovascular deconditioning. 

Downtown: What do you like about working at NYP/LMH?

JT: LMH has a rich history and tradition of service, which was founded by Dr. Elizabeth Blackwell, the first woman physician in the United States. LMH has a lot of heart, and because of this, it has also become a haven for New Yorkers, especially during several tragedies, including 9/11. I think people who choose to work in this community hospital have a strong sense of mission and a true dedication to the patients and the community in which the hospital serves. Providers and staff are willing to stretch their comfort zone and go out of their way to help each other and help patients.

Downtown: Why did you choose New York City for your practice after completing your residency in California?

JT: New York City is my home. I always knew I would come back after my training in San Francisco because the city is in my blood. I enjoy the pace, the culture, the diversity and the no nonsense straight forward way of communicating.

Downtown: If you could choose one what’s your favorite thing about New York City?

JT: My favorite thing about New York City is the food. You can get any cuisine at any time in multiple locations, and sometimes the food is better than if it were cooked in the native country.

Downtown: Battery Park City, better known as the diaper district, hosts plenty of new moms – what advice can you give a new mom who cannot find time for herself?

JT: My advice to new moms (I have two girls now 11 and 14, but the toddler years are still fresh in my memory) is to remember that our children learn from our verbal and explicit lessons, but they also learn by watching our actions. If we want them to grow up eating well, exercising, connecting with friends and family, self-reflecting, and re-charging, then we have to role model it for them. Plus, sleep gives you patience!

Downtown: Where do you go for an escape from the hustle and bustle of downtown?

JT: I am a homebody and love curling up on my couch with a good book or a Korean drama on TV when I need an escape. Other ways for me to unplug is with a jog around the reservoir in Central Park, a trip to my mother’s home in Midwood, Brooklyn, or a large family cruise.

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Health Living Nutrition

RX for Your Health- Choosing the Right Medical Services for Your Child

Photo: Courtesy of NYP/Lower Manhattan Hospital
Photo: Courtesy of NYP/Lower Manhattan Hospital

RX for Your Health is back! With help from our friends over at NewYork-Presbyterian/Lower Manhattan Hospital, we will be bringing you different tips/advice from health experts right in your backyard! This week, we spoke to David Listman, MD, the Director of Pediatric Emergency Services, about finding the right care and services for your child; ranging from immunizations to choosing the right pediatrician. Check out his responses to our questions below:

David Listman, Director of Emergency Pediatric Services. Photo: Courtesy of NYP/Lower Manhattan hospital
David Listman, Director of Emergency Pediatric Services. Photo: Courtesy of NYP/Lower Manhattan hospital

Where is the best source of advice for medications for my child?

Despite the myriad of sources available on the Internet, it is important to discuss any new medications with your child’s pediatrician.  There are medications that are crucial to your child’s health and others that might simply relieve some symptoms.  Some medications can be taken just as needed for symptoms, while others need to be taken regularly even if symptoms are not present.  Your pediatrician can help you decide what is in your child’s best interest.  It is also important to talk to your child’s pediatrician if you are using any complementary supplements to make sure that they are safe and will not interact with other treatments.

What are the best guidelines for child immunizations?

Parents should follow the recommendations of the American Academy of Pediatrics.  These vaccines begin at 2 months and continue through childhood and adolescence.  Vaccines are safe and effective against many childhood and lifelong infectious diseases.  Many people are worried about the side effects of vaccines, but the concern that vaccines are linked to Autistic Spectrum Disorder is without any scientific basis and indeed studies have ruled out any such link.

We are lucky to no longer see diseases such as polio, measles, rubella and tetanus, as well as haemophilus influenzae type b and much less disease from streptococcus pneumonia (pneumococcus).  When there are outbreaks of measles in unvaccinated populations, there are often terrible outcomes, including death, from these preventable illnesses.  Please speak to your pediatrician about the recommended vaccine schedule and any questions that you have about vaccinations.

Where can I go for early intervention advice on childhood disabilities?

​Your pediatrician screens your child regularly for normal development in the areas of fine motor, gross motor, language and social skills.  If you or your pediatrician have concerns about whether your child is achieving these developmental milestones appropriately, further evaluation can be done by a number of professionals including a pediatrician who specializes in Developmental and Behavioral Pediatrics, a psychologist or psychiatrist specializing in the field.  Your child’s school can also refer you to a professional to do further testing if there are any concerns.  You can also formally request (in writing) an evaluation by the public school system and they are required to respond and address your concerns.

What are the best tips for picking a pediatrician?

You should choose a pediatrician who can provide high quality healthcare and meshes well with your personality and your overall approach to health.  Ask your friends and neighbors about their pediatricians.  If you are expecting your first child, call and ask if the pediatrician will do a pre-natal visit so you can meet them before your child is born and make sure it is a good match.  Ask about their attitudes and support for breast-feeding, or any other issues that are important to you.

All pediatricians should vaccinate on the same schedule.  If you are interested in complementary and alternative medical practices, ask about their approach to these issues.  Inquire about both routine office hours and sick visit hours and how the office handles after hours calls about illnesses and injuries.

Most practices are affiliated with a hospital system.  Find out if you have a preference about where they would refer your child should they need emergency or sub-specialty care, although there is no requirement to go to the hospital that your pediatrician is affiliated with.

Tell us about the NYP/LMH Pediatric ER and why it’s important to the neighborhood.

NewYork-Presbyterian/Lower Manhattan Hospital opened a unique and separate area in the Emergency Department that specializes in pediatric care.  There are specialists in pediatrics and pediatric emergency medicine who staff this area 24 hours a day, 7 days a week.  This area provides all types of comprehensive emergency care to infants, children and adolescents.

The approach to care provided by pediatric specialists differs greatly from that provided by general (adult) emergency doctors in urgent care or other non-pediatric specific settings.  The Pediatric Emergency Department at NewYork-Presbyterian/Lower Manhattan is backed up by the full spectrum of pediatric specialists at the Komansky Center for Children’s Health at NewYork-Presbyterian/Weill Cornell Medical Center, should the need arise. The Pediatric Emergency Department is an important asset to the residents of lower Manhattan, as well as the many visitors to the area to have this resource right in the neighborhood.

 

–by Jackie Hart