The Doctor Will See You Now
Futuristic virtual clinics are becoming the house calls of days gone by. By Jon Anne Willow
Banking executive Molly Thiel had been seriously sick for days. Her fever was high and her asthma was flaring up. But, like many, her busy job and family duties pinched her time and pushed her health to the bottom of the priority list. As the day wore on, she felt increasingly worse, and knew that if Saturday came, she would likely end up sitting at an urgent care clinic for hours.
“I knew I had to do something,” Thiel says. She was working on multiple deadlines from home and needed to be there when her kids finished school. She didn’t have time for a trip to the doctor.
“A friend kind of pushed me to try the virtual clinic,” she says. “I went to the site and filled out the form. In about 10 minutes, I got a call from a doctor.”
Thiel loved it. “The doctor was extremely focused on my care, and I didn’t feel rushed at all. He even told me things about managing my asthma that I didn’t know. He called in a prescription that my husband picked up on his way home, and I never had to leave the house.” The doctor sent a detailed follow-up email, outlining her treatment and prognosis.
Thiel is referring to a new endeavor by Froedtert and the Medical College of Wisconsin, which recently opened the region’s first online-only, or “virtual” clinic, open 24 hours a day. Since its official launch in April, some 400 patients have received care for a variety of ailments.
“Technology helps more people have access to services like this,” says Michael Anderes, the health care system’s vice president of digital health, “and the rate of access is growing rapidly.”
In 2014, Anderes and his colleagues assembled a digital health accelerator team charged with integrating emerging technologies into real health care delivery, often seeking relationships with startup companies doing innovative work.
“We look at what’s out there on the horizon that’s ready, and that can touch lives directly,” says Anderes. “We’re focused on two main initiatives: how we can improve access in the community, and how we can improve outcomes. This one was in the sweet spot because it definitely does both.”
Froedtert’s virtual clinic is bound by the same laws as a traditional practice, so it’s only available for patients physically in Wisconsin. Visit the clinic’s website (virtualclinic.froedtert.com) and provide some basic information, then answer questions about your symptoms. You’ll either be referred to the ER for immediate care or asked to pay the $49 flat fee and choose your preferred method of contact. Telephoning is an option, but ideally, the visit is done via webcam. A picture, according to Anderes, “really is worth a thousand words in this case.” In less than 30 minutes, during which time you can lay back and relax in your own environment, the doctor will see you.
You might consult with Dr. Steven Creelman, one of the Froedtert virtual clinic doctors. Creelman practiced family medicine for about 20 years before switching gears, joining a group some 10 years ago that did house calls. Now, he says, “I do virtual house calls.” He hasn’t looked back.
“Here,” he says, “while we can’t do a full physical, we can take more time with each patient – about 20 to 30 minutes – which allows us to get a full history and to really educate a patient on how to treat their own conditions. At times, this can even lead to better care than you can get in an office.”
Dr. Mark Niedfeldt couldn’t agree more. In 2008, he left his academic sports medicine practice after a dozen years at the Medical College of Wisconsin to set out on his own.
Niedfeldt opened a private practice in which patients pay an annual membership fee that covers most routine services. The practice ensures that he doesn’t have to carry a patient load exceeding his ability to deliver the best care. Every patient has his cell number and email address, and when needed, he even makes house calls.
“The big thing that people need is time,” says Niedfeldt. “It’s amazing how often someone comes in with a routine complaint, but if you ask a few extra questions, you find out there’s more going on. In a traditional practice, you have to make that choice of whether you’re going to open the box because of time constraints.”
Being employed by a large health system has its perks, but as a practitioner, the drawbacks eventually outweighed the advantages for Niedfeldt. His approach was radically different – highly personalized versus ad hoc, on-demand care – but his motivations were similar to those that spawned telemedicine.
“When you have this pressure to see a lot of people, you have to make hard calls,” explains Niedfeldt. “I got to the point where I sometimes knew a patient needed something, but I just couldn’t take the time. And I think patients have become conditioned to that, so they hold back. I just couldn’t live with that.”
Creelman’s sentiments echo Niedfeldt’s. “I’m most effective when my patients and I can communicate thoroughly,” says Creelman, “when I can take the time to read body language, watch for signals and listen well.”
Bel Air
Does moving to the ‘burbs improve your health? Not necessarily. By Matt Hrodey.
Every year, the UW Population Health Institute conducts a nationwide survey that results in its County Health Rankings, a trove of unequaled scope that we cherry-picked to compare our local urban counties (Milwaukee and Racine) with those that are more suburban (Waukesha, Ozaukee and Washington). Which is the healthier zone to live in? It depends on how you ask the question.
Mental Health
M&R Counties: Thumbs Down
WOW Counties: Thumbs Up
People living in Milwaukee and Racine counties endure approximately one more day of “not good” mental health every 30 days (about 3.7) than those living in Waukesha, Ozaukee and Washington counties.
Binge Drinking
M&R Counties: Thumbs Up
WOW Counties: Thumbs Down
All three WOW counties are at or above the state average for binge drinking, which is defined as having four drinks (women) or five (men) during a single bender. Racine County also matches the average, but Milwaukee County comes in slightly lower.
Air Pollution
M&RCounties: Thumbs Down
WOW Counties: Thumbs Down
The closer you get to Chicagoland, the higher these numbers get, which means the WOW and M&R counties are roughly the same. “Air pollution” means the density of particulate matter in the air from power plants, automobiles and heavy industry.
Obesity
M&R Counties: Thumbs Down
WOW Counties: Thumbs Up
None of the WOW or M&R counties deviate far from the state average of 29 percent. In Racine County, the worst of the bunch, about 32 percent of residents classify as obese. Bucolic Ozaukee County is the thinnest at 25 percent.
Long, Lonely Commutes
M&R Counties: Thumbs Up
WOW Counties: Thumbs Down
Long commutes are closely associated with poor health, and some 37 percent of Washington County commuters drive more than 30 minutes every day. All of the WOW counties are a bit high, whereas Milwaukee County, at 24 percent, is the lowest.
Smoking
M&R Counties: Thumbs Down
WOW Counties: Thumbs Up
More than 20 percent of residents in Milwaukee and Racine counties are regular smokers. That drops as you head north and west – to 16 percent (Waukesha County), 14 percent (Washington County) and 12 percent (Ozaukee County).
A Day in the Life
The spine is human anatomy’s central scaffolding. Its 20-odd moving vertebrae rotate between round, fibrous discs with a gooey, gel-like center, a marvelous system. Until something goes painfully wrong. Then it’s time to see Dr. Farooque. Photos by Adam Ryan Morris.
Name Dr. Mustafa Farooque
Age 58
Specialty Spine physiatrist and medical director of Aurora Health Care’s Back and Spine Program
Hospital Aurora St. Luke’s Medical Center
Dr. Nice
Why “bedside manner” still matters in an era of high-tech medicine. By Matt Hrodey.
In the late-1990s, a group of four researchers, including a family care physician from Antigo, Wis., named Kristine Flowers, performed one of the great acts of medical eavesdropping. Curious to study how doctors extract information from patients during the early and crucial “agenda-setting” phase of the appointment, the researchers planted recording devices in the offices of 29 family care physicians in Colorado, rural Washington and elsewhere. (Of course, this only happened with the approval of both doctor and patient.) After transcribing 264 appointments, the landmark study published in 1999, and still cited by doctors today with a nervous chuckle, reached some remarkable conclusions. Foremost among them was that the doctors – many of them old hands – listened to patients’ initial complaints for only an average of 23.1 seconds before jumping in or otherwise redirecting the conversation.
This was troubling, since other research has found that primary care patients typically arrive at appointments with at least three separate concerns, and the doctors’ interruptions tended to stem the flow of information. Overtures such as “Tell me about your leg pain” forestalled any discussion of similarly bothersome back pain. The good news for busy doctors was that probing for all of a patient’s aches and ills took only an average of six seconds longer.
Bruce Campbell, a professor at the Medical College of Wisconsin who specializes in diseases of the neck, cites the 1999 study and another blockbuster from 2014 when talking about “bedside manner” – that combination of empathy and attentiveness that leaves patients with a hopeful (or at least looked-after) feeling. This latter study concluded that, when it comes to patient perceptions, a doctor’s personality is actually more important than the quality of his or her care. Further complicating the picture is research on “vicarious empathy,” one’s response to the sufferings or joys of others. It declines steadily as young doctors-to-be proceed through medical school and falls “dramatically,” he says, during the third and fourth years. “You learn to rationalize your response to other people’s suffering.”
Campbell leads some of MCW’s efforts to help medical students stay in touch with their feelings, and by extension, their bedside manner. His writing workshops for busy med students include free-writing sessions where they create impromptu essays on their experiences. The hope is that emotional reflection supports more standard instruction on interviewing patients, along with the million other techniques being thrown at them. “Medical school is kind of like drinking from a fire hose,” he says.
At Columbia St. Mary’s, doctors are asked to follow an acronym, A.I.D.E.T., which emphasizes their responsibility to explain what’s happening to a patient, how long it might take, and more: Acknowledge, Introduce, Duration, Explanation, Thank You. These points are supposed to form the backbone for a successful appointment or consult, and make it more methodical. “We tend to interrupt very early in the conversation,” says Matthew Connolly, medical director for internal medicine at Columbia St. Mary’s. Whereas, ideally, “You give the impression that you do have time to spend with the patient, even if you don’t and have other patients to attend to.” Sit down, he instructs, and don’t hide behind the laptop that so many doctors now carry around. Even in emergency situations, there are wiser and more mindful ways of barking out orders and data. “People can come away with a feeling of confidence based on how we do that,” Connolly says, “or they can be freaked out.”
