25 Most Influential: Helane S. Fronek, MD, FACP, FACPh

Helane S. Fronek, MD, FACP, FACPh

A colleague had this to say: “Helane is a wonderful educator and teacher - she has spread her enthusiasm for the field through countless hours and dedication to the ACP and affiliated projects.”

Where do you see the specialty of phlebology in 5 years? 10 years?

I believe that in the next 5 years, phlebology will become a specialty practiced most typically as a team of individuals - physicians, PA/NPs, nurses, and sonographers, who all contribute to the comprehensive care of the patient. The appropriate evaluation and treatment of patients with chronic venous insufficiency will become more commonly incorporated into post-graduate training programs and educational symposia. There will be more research in the field, leading to greater consensus on issues of patient management and pathophysiology. It is possible that in 10 years phlebology will become a fully accepted medical specialty, although I believe that it will take longer for that to occur.

A decade ago, few would have foreseen the crossover in types of vein treatments being offered at other specialty practices. Where do you think the next big movement is going to be and how will it affect vein practice?

I believe that reimbursement for vein procedures will be decreased, leading some individual practitioners to abandon the field and causing patients to be treated in higher volume-practices that utilize physician extenders more effectively.

Is there a particular case that stands out in your mind?

My most memorable case involves a patient who had pelvic congestion syndrome, who underwent embolization and sclerotherapy of her ovarian and iliac veins, leaving her with a 60% reduction in leg pain. She had sciatic vein insufficiency, an entity that was at the time unknown to me. Immediately after one injection of foamed sotradecol, she was unable to dorsiflex her foot, due to the inflammation resulting from the injection that affected her sciatic nerve, mostly involving the peroneal nerve distribution. Fortunately, she recovered her motor function and the pain in her leg resolved with fibrosis of the insufficient veins. The case was memorable because it underscores the unpredictability of medical treatment - there may be something that we do not understand about a given patient that will negatively affect the treatment result. Due to the rapport we had established with the patient before the procedure and the consistent care that we provided after the complication, not only did she not initiate a lawsuit, but we received thank you notes and gifts. I believe that this demonstrates the need to include care of both the initial problem as well as any complications that might result in the overall approach to any patient.

What aspects of community service are you involved in, both within and outside medical service?

My daughter and I are members of the National Charity league, through which we provide many hours of volunteer help for a variety of local philanthropies. Our family has also been involved in feeding the homeless with other members of our synagogue on Sunday mornings. Two years ago, I was able to join Nick and Terri Morrison, Steve Zimmet, Diana Neuhardt and Joe Zygmunt and help in the evaluation and treatment of hundreds of patients in Ecuador, an experience that I thoroughly enjoyed and will always cherish.

What made you decide to work in phlebology and what do you wish you had known before you did?

My decision to enter the field of phlebology was completely serendipitous and un-researched - I was looking for something interesting to do while I decided whether I would train in cardiology or pulmonary. However, some time after I entered the field it exploded, offering new and exciting avenues for both more accurate diagnosis and more effective treatment. I enjoyed the luxury of spending time with patients as I saw my other medical colleagues having to rush through patient visits. There is actually nothing that I wish I had known before I began my career in phlebology

If you could do anything else for a living, what would it be? Why?

Actually, I am leaving the field of phlebology, which I find to be increasingly technical, and will begin a training program to become a hospice chaplain next year. I realized that while I enjoyed helping my patients to rid themselves of abnormal veins and was gratified at the results and the impact on their lives, what I most enjoyed was actually spending time with my patients and helping them with other issues in their lives. I have always been interested in the period of the end of a person's life and find it to be unique and rich, and I am looking forward to helping both patients and their families cope with the many issues and find a meaningful and satisfying transition at this time.