Published on March 1st, 2014
The Art of the Family Physician
Personal Medicine in the 21st Century
Family practice physicians are the bedrock of health care. They are the ones we depend on
to keep us well, make us better when we’re sick and teach us how to care for our spouses, parents and children when they are faced with health problems of their own. In fact, of all the more than 120 medical specialties that have been identified, family physicians are the ones we are most likely to trust and confide in. These are the doctors who know us best.
St. Luke’s Warren Campus family practice physicians — also known as primary care physicians (PCPs) or general practitioners (GPs) — care for more than 40,000 residents throughout our community. Since these physicians are trained in so many different areas, their skills are diverse, and, since they treat such a wide variety of ages and conditions, their impact is profound. However, if your mental image of a family doctor looks like Marcus Welby, MD — the beloved physician of 1970s TV — we invite you to take a look at what it means to be a family doctor in 2013.
Communication is Key
Family doctors are the physician’s we call when we have colds that won’t go away or fevers or rashes or persistent headaches. Diagnosing, prescribing and referring to specialists when necessary are all part of the daily routine, but most family doctors echo the sentiments of Dr. Laura Kropf of Village Medical Center in Lopatcong.
Dr. Kropf, a Doctor of Osteopathic Medicine, or DO, feels strongly that her most important job is to be someone her patients can talk to. “I want to be their health care partner,” she said, “not their captain. I want to do everything I can to help my patients understand all their treatment options, but in the end, they need to make the decisions. These are very personal choices, and the patients are the ones who must live with the consequences.”
James Goodwin, MD, her colleague at Warren Hills Family Practice in Washington, agrees but takes a long view of patient relationships. The origins of his practice go back to just after World War II, and many of the patients he’s been seeing since the early 1980s now have adult grandchildren. “We have deep roots,” he said, pointing to the antique framed glass negatives of early 20th Century Washington that adorn the hallways. “It’s not unusual for patients to recognize their great grandfathers in these photos! That history means a lot for me as a physician. When I know that Molly’s grandmother developed diabetes in her 40s, I’m going to keep a much closer eye out for symptoms than I would otherwise.”
Wellness is a Priority
As much as we depend on them to help us when we’re sick, these days, family doctors take an increasingly proactive role in keeping us healthy.
In our community, the most common chronic conditions are hypertension (high blood pressure), Type 2 Diabetes, high cholesterol, cardiac problems and even depression. At Village Medical Center in Lopatcong, a care coordinator does pre-visit planning, contacting those who are due for lab work or vaccines in advance of their appointments. Doctors and nurses huddle each morning to go over their list of patients for the day. “We all come in early,” said Frank Lombardi, DO, “so everyone on the team will be somewhat familiar with all the patients being seen that day.”
Family doctors are still all about hands-on relationships with their patients. In fact, many of them don’t routinely wear their white coats in the office. “It’s a deliberate choice,” said Eugene Decker, DO, of Coventry Family Practice in Phillipsburg. “My patients have to feel like they can trust me and talk to me about absolutely anything. For a family medicine physician, communication is the most important diagnostic tool. I find patients are more inclined to be frank when I’m not looking too official.”
Indeed, the personal touch is prevalent in every one of the five family practices affiliated with St. Luke’s Warren Campus. At Kaleidoscope Medical, the newest practice to join the St. Luke’s Physician Group, Ana Gomes, DO, doesn’t hesitate to mention that she still makes house calls to patients who are homebound
or terminally ill. “Sometimes,” said Dr. Gomes, “it’s about respect for my patients and their personal dignity.”
In fact, Kaleidoscope treats patients in English, Spanish, French, Italian and Portuguese, with a smattering of German for good measure. Dr. Gomes and her husband and partner, internist Thaddeus Aversa, DO, see hundreds of patients a week and describe their homey offices as “a timeless place.”
“If our patients need attention, we can’t always stay on schedule,” said Dr. Gomes, “but they understand because they know that when they need us, we’ll be there for them too.”
And High Tech
These days you are more likely to see your family physician toting a laptop than a prescription pad. Coventry, Village and Warren Hills were early adaptors of the switch to digital record keeping. These family practice offices have been using electronic medical records (EMRs) for more than 10 years. Kaleidoscope is the new kid on the block from a technology standpoint — they’ve been using EMRs for about three years. At Village Medical Center, even the nurses are armed with iPads so height, weight and blood pressure are already in a patient’s records when the doctor comes in the door.
“It’s so helpful to have your patient’s entire medical history in front of you as you meet,” said Oksana Yevdokimova, MD (known as Dr. Oksana to her patients). “And entering notes immediately after a patient visit saves time and ensures fresh data.”
Asked about their biggest frustrations, the answers came down to technology (it’s wonderful when it works and really frustrating when it doesn’t.) Another problem is finding medical specialists for people without insurance. Mary Siciliano, DO, a physician-teacher at Coventry, said, “We do many simple procedures for our patients here, rather than send them to a specialist, which can be expensive. We also have specialists visit us — we offer our patients a clinic for expectant mothers, an ophthalmology clinic for eye problems and an orthopaedic clinic for spine and joint problems.”
Teaching and Learning
Coventry Family Practice in Phillipsburg is home to the St. Luke’s Warren Hospital Family Medicine Residency program, a three-year, 10,000-hour curriculum for doctors fresh out of medical school. The physicians of Coventry are also instructors and the patients benefit from their increased focus. “Family physicians are trained in all areas of medicine and have the ability to diagnose and treat a wide variety of symptoms and problems,” said Dr. Decker. “That takes time. It’s very gratifying to see these young doctors become seasoned and more knowledgeable during their three
years with us.”
In fact, quite a few of the residents fall in love with their patients and with the rolling green hills of western New Jersey and settle down here. Dr. Siciliano of Coventry is a graduate of the program, as are Dr. Oksana of Warren Hills, Dr. Lombardi and Dr. Kropf of Village, and Dr. Gomes of Kaleidoscope.
Clearly, the modern family physician is on the front lines of a rapidly changing health care environment, responding to the needs of both patients and community. And yet, the tradition of compassion and personal relationship remains very much the motivating force for these dedicated doctors. Marcus Welby would be proud.
The Patient-Centered Medical Home
All family practices are, by definition, patient-centered, but the Patient-Centered Medical Home is an official designation bestowed by the National Committee for Quality Assurance (NCQA) only to family practices that meet their standards.
Dr. Gerard Delmonico is a family practitioner who, in addition to practicing medicine at Village Medical Center in Lopatcong, acts as Regional Medical Director for the physicians and practices of St. Luke’s Warren Hospital. Almost 10 years ago, he began the process of reorganizing our practices to meet the criteria of Patient-Centered Medical Homes (PCMH).
To qualify, a practice must prove that it takes a comprehensive approach to meet the needs of its patients’ physical and mental health care needs, including prevention and wellness and acute and chronic care. Special attention must be paid to respecting each patient’s unique needs, culture, values and preferences. A PCMH must be easily accessible and responsive to patients. It must also show itself to be skilled in using evidence-based medicine and advanced quality tools to ensure patient safety.
Dr. Delmonico, who is himself a graduate of the St. Luke’s Warren Hospital Family Medicine Residency Program, was somewhat of a visionary. “Ten years ago the shift towards value based payment methodologies and accountable care models was much more speculative,” he says, “But our patient-centric transformation should give us and our patients an advantage as we jointly navigate the transition in the way health care is financed under the Affordable Care Act.”
We are very proud,” he continued, “that three of our St. Luke’s Warren Campus family practices have received this prestigious designation. Coventry Family Practice, Village Medical Center and Warren Hills Family Practice are all Patient-Centered Medical Homes.”