2016
Volume 5, Issue 2
MHP NEWS & NOTES THE SPECIALIZED CARE OF CAVA’S CARDIOLOGISTS
Cardiology and Vascular Associates (CAVA) is a multispecialty group including internal medicine, and pulmonary and sleep medicine, though as indicated by the name it is best known for its cardiology and vascular medicine.
CONTENTS The Specialized Care of CAVA’s Cardiologists . . . . . . . . . 1 Balloon Sinuplasty Brings Relief to Headache Sufferers. . . 6 MHP Diabetes Education Program Receives ADA Recognition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 MHP Physicians Honored as “Top Docs”. . . . . . . . . . . . . .8 Welcome to MHP: Erwin Feldman, Oakland Family Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Who’s Who at MHP: Jennifer Beal, Millennium Medical Group West. . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
CAVA was formed officially in 2000, though its principals had come together even before that. The group’s philosophy has always been that improved patient care, improved patient experience, and improved cost containment can best be achieved when physicians use their complementary skill sets as a team, and make wise use of innovation and new technology. CAVA joined MHP in 2014, attracted to a larger group that shared that philosophy, a philosophy that best fits the modern medical world of health care reform and Accountable Care Organizations. We’d like to take this opportunity to present an overview of the cardiology services CAVA offers, highlighting in particular those highly specialized treatments that are not routinely offered by all cardiology practices. There are several treatments CAVA provides that few other practices in Michigan offer. CAVA provides comprehensive cardiology services, with [Continued on Page 2]
2
CAVA (CONTINUED) specialists who focus on interventional cardiology, electrical physiology, and non-invasive procedures. They perform a full spectrum of diagnostic tests, including nuclear imaging, echocardiography, all vascular imaging, and other non-invasive diagnostics. The non-invasive cardiologists (Abdul Hasan, MD, FACC, Chandra S. Reddy, MD, FACC, Kathryn Pitone-Lipkin, DO, FACC, Jay Kozlowski, MD, FACC, Randall L. Reher, MD, FACC, Anjani Rao, MD) see a high volume of patients, passing them on to the electro-physiologists or interventional cardiologists as needed. The cardiac electrophysiologists (Russell Steinman, MD, FACC, Rajiv Nair, MD, FACC, Aaerf Badshah, MD) deal with electrical disorders of the heart. Their scope of practice includes, among other things, the implantation of cardiac devices such as pacemakers and defibrillators which help regulate the heartbeat, and advanced implantable cardiac devices such as cardiac resynchronization ICDs, which are used to treat patients with congestive heart failure who also have problems involving the electrical conduction in the left ventricle. CAVA’s electrophysiologists also perform invasive mapping and ablation of various types of cardiac arrhythmias,
including atrial fibrillation, supraventricular tachycardia and ventricular tachycardia. With atrial fibrillation, which is the commonest of these arrhythmias, patients are carefully selected for the ablation procedure after conservative measures, including antiarrhythmic therapy, have failed to control their symptoms. They are then brought in for the ablation procedure which is typically done under general anesthesia and can take 3-4 hours to perform. Multiple intracardiac catheters are advanced through the veins of the thigh into the right atrium, and intracardiac ultrasound is used to guide a transseptal puncture, whereby a curved needle is used to puncture the thin membrane or septum that separates the two upper chambers (atria) of the heart. Advanced three-dimensional electromagnetic mapping techniques are then used to map the atria and the pulmonary veins which connect the lungs to the left atrium, after which radiofrequency electrical energy is delivered through the tip of a flexible ablation catheter to cauterize the muscle that encircles the pulmonary veins. This is an example of a complex ablation which can greatly benefit carefully-selected patients. Many of these patients [Continued on Page 3]
3
CAVA (CONTINUED) would, in years past, be subjected to much more invasive, open-chest surgical procedure to achieve the same result. CAVA’s electrophysiologists also provide diagnostic testing for intermittent arrhythmias. They selectively utilize implantable monitors called “loop recorders” to diagnose arrhythmic conditions which occur infrequently. They monitor over 2000 patients with implantable cardiac devices, such as pacemakers and implantable defibrillators.
Some of the most innovative of CAVA’s treatments stem from its interventional cardiologists’ realization that some of the skills they had developed for interventional procedures in the heart could also be put to work in other blood vessels. The electrophysiologists of CAVA strive to provide more than just their technical expertise in these complex procedures. Their goal is to collaborate closely with referring physicians, specifically primary care providers and referring cardiologists, to help their patients in a multi–disciplinary manner. They feel that this is the most cost-effective and appropriate way to deliver cutting-edge invasive and noninvasive electro-physiology care.
devote a substantial amount of their time and resources to initiating and developing promising new techniques. This in spite of the fact that payers typically do not compensate for new treatments until after they are in widespread use. But CAVA’s physicians prefer to stay ahead of the curve, meaning they are often among the first cardiologists performing certain procedures. Some of the most innovative of CAVA’s treatments stem from its interventional cardiologists’ realization that some of the skills they had developed for interventional procedures in the heart could also be put to work in other blood vessels. For example, consider blockages in the heart. When the heart is being starved for oxygen due to a blockage in a coronary artery, there are many common symptoms that cardiologists will look for. There are a number of procedures that they can then use to intervene, often in an emergency room situation where time is of the essence, as such a blockage can quickly do permanent damage to the heart, up to and including death. They can perform an angioplasty by placing a balloon in the coronary artery and expanding it to open up the artery. They can stent the coronary artery. They can perform what’s called an atherectomy, where they use a rotating blade or laser to remove the material blocking the coronary artery.
CAVA’s interventional cardiologists (Kirit Patel, MD, FACC, Michele DeGregorio, MD, FACC, Abdul Halabi, MD, FACC) use various non-surgical procedures to treat conditions such as coronary artery disease, heart valve disease, and peripheral vascular disease.
But when patients have such a blockage in one place—say, a coronary artery—there is an increased likelihood they have or will in the future develop blockages elsewhere in the body, such as in the carotid arteries, the renal arteries, or arteries in the lower extremities.
Most of the cardiology specialists of CAVA have had an even greater amount of education and training than the very high levels required of physicians in general. Following their undergraduate, medical school, and residency education, they not only completed a cardiology fellowship, but then an additional interventional cardiology fellowship or electrophysiology fellowship.
Due to the research and groundbreaking work of forwardthinking interventional cardiologists such as those of CAVA, some of these same treatments for blockages of coronary arteries—angioplasty, stenting, atherectomy—are today used in the peripheral veins and arteries outside the heart.
CAVA physicians are involved in a significant amount of cutting-edge research, and are disproportionately represented in leadership positions in the medical community, including holding past or present directorships in many local hospitals. They have a great deal of experience in their field; multiple CAVA cardiologists have been practicing for more than 25 years. Vascular Innovations CAVA’s cardiologists would have very busy practices even if they limited themselves to only the most common, established procedures. But their approach has always been to
There are many advantages to using these new techniques compared to the traditional surgery used to treat peripheral vascular blockages in the past. One of the most dramatic differences is that there is little or no recovery time for these minimally invasive procedures. Patients no longer need to stay in the hospital or miss substantial time from their job. Complications are exceedingly rare, and outcomes are consistently very good. Valve Treatments Among the common causes of end-stage congestive heart failure are weak, malfunctioning, or leaking heart valves that significantly diminish the heart’s ability to pump blood. Valve [Continued on Page 4]
4
CAVA (CONTINUED) problems can be treated with traditional surgery, but it can be a tricky and risky procedure because the very factor that makes treatment necessary—a weak heart—also makes traditional surgery dangerous.
covered in polyester. It is inserted into the femoral vein through the use of a catheter. The surgical team uses fluoroscopy and echocardiography to help guide the device to its proper placement within the heart. The target valve is then clipped in such a way as to enable it to function more normally. If necessary, multiple clips may be used in this manner in one procedure.
The interventional cardiologists of CAVA are among the few cardiologists in Michigan performing a revolutionary alternative to traditional open-heart surgery that uses a device called a MitraClip.
Recovery time from the MitraClip procedure is far shorter [Continued on Page 5]
The MitraClip is a tiny clip made of chromium and cobalt,
New Vascular Center Provides an Alternative to the Hospital for Advanced Vascular Care CAVA’s physicians are on staff at a variety of hospitals in southeastern Michigan, so patients have many options in finding a hospital close to home. Among the hospitals where CAVA procedures are done are St. Joseph Mercy Oakland in Pontiac, Huron Valley-Sinai in Commerce Charter Township, William Beaumont in Royal Oak, McLaren
Oakland
in
Pontiac,
and
Crittenton
in
Rochester Hills. However, many diagnostic and minimally invasive procedures do not need to be done in a hospital setting. For this reason, CAVA recently opened the Vascular Center of Michigan. The Vascular Center is located in the Clarkston Medical Building, at 5701 Bow Pointe Drive, Suite 210, in Clarkston. The phone number is 248-365-6900. The Vascular Center was designed to be truly “patient-centric.” Patients can pull right up to the door, enter the building, go up an elevator, and arrive at their suite in almost no time. The overall process, including not just the procedure itself but all the necessary steps before and after, is far less inconvenient, cumbersome, and timeconsuming than is typically the case in a hospital. Patients have offered enthusiastically favorable feedback, as they appreciate the personalized care they receive, how much more comfortable they feel in the Vascular Center, and the fact that they are able to go home on the same day as the procedure rather than having to stay overnight in the hospital. Along with the increased patient satisfaction comes cost savings compared to procedures requiring hospital stays. Among the services offered at the Vascular Center are:
Arterial
Disease:
Angiogram,
Angioplasty,
Atherectomy, Stenting, Intravascular Ultrasound (IVUS), and Ultrasonic Arterial Imaging for the Carotids, Aorta, and Upper and Lower Extremities.
Venous
Disease:
Radiofrequency
Ablation,
Sclerotherapy, Ultrasonic Venous Imaging of the Lower Extremities for the Assessment of Venous Insufficiency, Microphlebectomy, Venogram, Angioplasty, Intravascular Ultrasound (IVUS) and Venous Compression, and Stenting for May-Thurner Syndrome.
5
CAVA (CONTINUED) than that of traditional open-heart surgery to repair a valve. Prior to the introduction of the MitraClip, patients for whom conventional surgery was deemed too risky had no choice but to live with their condition. Such patients who now have their problem valve clipped with the MitraClip instead typically live longer and have a higher quality of life. For a significantly narrowed heart valve, one option for some patients is to replace the valve. Trans Aortic Valve Replacement (TAVR) is another procedure performed by the interventional cardiologists of CAVA that few other cardiologists in the state are able to offer. As with the MitraClip, the device—a self-expanding valve bioprosthesis—is delivered by use of a catheter without having to open up the heart surgically. It is positioned so as to replace the aortic valve of the heart. Studies have shown TAVR to be as safe and effective as traditional open-heart surgery, with much shorter recovery time. Some patients for whom open-heart surgery was too risky now have a viable treatment option. Abdominal Aortic Aneurysm Treatment An abdominal aortic aneurysm (AAA) is an aneurysm (a blood -filled bulge in a blood vessel) in the abdominal aorta (the largest artery in the abdominal cavity). If it ruptures, it can cause significant damage, and in fact is typically fatal. Because an AAA often has no symptoms it can easily go unnoticed and undiagnosed until it’s too late. For this reason, at CAVA, when diagnostic tests are run on the heart, the ultrasound techs also check down the aorta for an aneurysm just in case. This practice has enabled them to catch many AAAs which can then be treated before a catastrophic rupture. AAA is another condition for which an improved new treatment has been developed in recent years, and is now used by cutting-edge interventional cardiologists including those at CAVA. Treating an AAA involves putting a graft on the abdominal aorta. In the past it was necessary to cut through to the aorta from the outside surgically, and to put a graft on the outside of the artery. Today it is possible to come up through the groin and put a graft on the artery from the inside. The differences are huge. Recovery time for conventional AAA surgery was weeks to months, and sometimes even a year or more. For the new procedure, recovery time is a tiny fraction of that. Patients may be kept in the hospital for up to 24 hours for observation to make sure there are no
complications, but after that they typically can return home and resume their normal life. Morbidity is drastically lower. Certainly cost is drastically lower. Inferior Vena Cava Filter Implantation The inferior vena cava (IVC) is the large vein that carries blood back to the heart from the lower body. Blood clots that develop in the leg or pelvis can sometimes break free and travel up through the IVC, eventually lodging in the heart or lung, a condition that can be fatal. In order to prevent this, a filter can be placed in the IVC to catch and dissolve or trap any such blood clot before it can do any damage. Until recently, IVC filters were only available as permanent devices. Now there are also temporary IVC filters that can be removed when the threat is past. All else being equal, removal is desirable because the longer the filter is in the body the more risk there is of complications. Implantation of IVC filters is another procedure performed by CAVA’s interventional cardiologists. Again this is a procedure that used to be done via conventional surgery with a lengthy hospital stay and prolonged recovery time, but now can be done as an outpatient procedure with minimal recovery time using catheters through the groin or jugular. Placement of the filter is guided by a fluoroscope, and is usually just below the lowest renal vein. If the blood clot has already travelled to the lung—at which point it is called a “pulmonary embolism”—and thus it is too late to use an IVC filter, the interventional cardiologists of CAVA are experts in dissolving such clots through the use of special catheters placed in the lung. These are but a few of the services performed at CAVA. To learn more about these services and everything else CAVA has to offer, you can go to their website at www.cava.cc or call their call center at 248-333-1170.
6
BALLOON SINUPLAST Y B RINGS RELIEF TO HEADACHE SUFFERERS Most people have heard of cardiac angioplasty, a procedure to open coronary arteries narrowed by plaque, in which a catheter with a tiny balloon on the end is inserted into an artery, and then the balloon is expanded to widen the artery. What is less well known is that in recent years a similar procedure, called balloon sinuplasty, has been developed to treat sinusitis and sinus headaches. We spoke with Dr. Warren Brandes of MHP practice E.N.T. Surgical Associates to learn more about this procedure. The Problem The natural openings of the sinuses in adults are one to two millimeters wide. However, there are many things that can narrow the openings to less than one millimeter, including allergies, chronic infections, or chronic sinusitis. For some patients, there are congenital issues or anatomic issues that obstruct or narrow the sinus passages. For most patients with narrow sinus openings, the most unpleasant symptom they must deal with is sinus headaches. Roughly 20% of patients who see ear, nose, and throat doctors do so for sinus headaches. Some have been suffering with these headaches for years. Other Treatments Before balloon sinuplasty is considered, patients are treated with multiple courses of medications. Antibiotics, decongestants, and nasal sprays are used. Many patients receive allergy testing and/or a CT scan. But 60%-70% of sinus headache patients move on to surgery. In some cases it’s because the medications are not working for them, and in some cases it’s because they are looking for a more permanent solution than medication that they must take for the rest of their life. E.N.T. Surgical Associates does not always start its patients with these other treatments, because many of them have already been through that stage with their primary care physician or another ear, nose, and throat specialist, and they have been referred to E.N.T. Surgical Associates specifically for surgery. In the past, surgery for this condition meant something called functional endoscopic sinus surgery (FESS). Major surgery in the vicinity of the eyes and brain always has its risks, so FESS has been reserved for particularly severe cases. Patients who didn’t respond to medication, had a normal CT scan, and didn’t have a severe enough problem for FESS were caught in a kind of no man’s land and had to learn to live with their
Dr. Warren Brandes of E.N.T. Surgical Associates
headaches. The Procedure Now those patients have an appealing option. Balloon sinuplasty is intended for just the kind of patients with mild to moderate sinus disease or sinus headaches that are not candidates for FESS. In preparation for balloon sinuplasty, the patient is asked to specify the location of his or her symptoms. This will typically reveal which sinus passage or passages need to be widened. Special scopes are then used to get a closer look at the narrowed sinus openings. The catheter with the tiny balloon that is inserted has a light at the end of it that transluminates the cheek. This allows the surgeon to verify that the catheter has been inserted into the correct sinus. One can actually see pretty clearly right through the patient’s cheek, especially the lighter complexioned the patient is. To further facilitate being able to follow what’s happening while it’s happening, often a “landmark” system is used. This is a sound wave based system like sonar, that tells where the instruments are at all times, while the surgeon looks at a monitor or looks directly through the skin. With the catheter in its intended spot, the balloon portion is inflated. This causes microfractures of the very small, eggshellthin bones that separate the sinuses. The whole procedure typically takes 30-45 minutes, but the time that the balloon is actually inflated in the sinus is more like 30-45 seconds. When the inflated balloon causes the microfractures, it is in effect reshaping the sinus opening. The sinus opening will heal wider than before the procedure, thus allowing the sinus to function more efficiently. Studies indicate that five years after the procedure, the sinus opening remains enlarged in 85%[Continued on Page 7]
7
BALLOON SINUPLAST Y (CONTINUED) 90% of patients. The procedure has no adverse cosmetic effect. The patient does not look any different from the outside. As with any surgery, there can be pain, scarring, infection, bleeding, or the need for more surgery. But the risks of balloon sinuplasty are very, very low, certainly significantly less than the risks of FESS. Conclusion Balloon sinuplasty is a procedure that has become more
common in recent years. Dr. Brandes does about 200 of the procedures each year. It is the kind of minor surgery that can be done in a doctor’s office on an outpatient basis, or in a hospital. Dr. Brandes, though, believes it is better, all things considered, to do the procedure in the hospital. Balloon sinuplasty is a relatively new technique that has been extremely beneficial to a lot of patients. It’s a revolutionary innovation for patients with mild to moderate sinus headaches and sinus disease.
The four steps of balloon sinuplasty: 1) A guide wire and balloon catheter are inserted into the inflamed sinus, 2) The balloon is inflated to expand the sinus opening, 3) Saline is sprayed into the infected sinus cavity to flush out pus and mucus, and 4) The system is removed, leaving the sinuses open.
MHP DIABETES EDUCATI ON PROGRAM RECEIVES ADA RECOGNI TION Linda Kangas reports that the diabetes education program she runs for MHP has received formal ADA Recognition from the American Diabetes Association. This is not only an honor for Ms. Kangas and her program but has significant practical benefits. Prior to a program receiving such recognition, payers require that diabetes education be billed under physician group visit codes, which necessitates a physician physically accompanying the patient(s) to where they will receive the education. For a program that has received ADA Recognition, on the other hand, diabetes education may be billed under diabetes education codes, and the physician need only send over a physician order. Ms. Kangas is a registered nurse and certified diabetes educator. Though she only came aboard recently with MHP— in 2015—many MHP physicians, mostly from Millennium Medical Group, know her and have worked with her in the past. But it’s important to emphasize that her services are now available to all MHP practices, not just Millennium or any subset of MHP. Look for a profile of Ms. Kangas in an upcoming issue of MHP
News & Notes, with information on her background and qualifications, and more detail on the diabetes education services she offers. To learn more, her office is located in Suite 30 in the TriAtria Building, and her phone number is 248-587-2345. The fax number for physician orders is 248-539-0963.
8
MHP PHYSICIANS HONORED AS “ TOP DOCS” Sorry we’re a bit late on this one, but we wanted to make our readers aware of their MHP colleagues who were selected for Hour Detroit’s latest “Top Docs” feature, published in their October 2015 issue. (This list can also be found at www.mhpdoctor.com.)
All told, 72 MHP member physicians in 32 categories made the grade, some in multiple categories. The awards are determined by popular vote. Our congratulations to all those so honored.
9
ERWIN FELDMAN, OAKLAND FAMILY PRACTICE Do you remember that scene from Schindler’s List, when Oskar Schindler is overwhelmed by the realization that with more effort and more sacrifice he could have saved even more people from the Holocaust? At a time of life you would expect him to be basking in the gratitude and appreciation he was receiving for the good he did, his obsessive focus was on the potential good he left undone. When you speak with Dr. Erwin Feldman, you get that same sense of “Never mind what I’ve done. There’s more I could do, more I could contribute.” The good he has done is never enough; as long as there could be more he will not allow himself to relax. Uphill Climb It’s never easy becoming a doctor. Pretty much everyone who achieves the status of being a doctor can tell you some horror stories of sleep deprivation, financial struggles, relationship strains, academic challenges, what have you. But even amongst doctors, Dr. Feldman’s journey stands out as having required extraordinary perseverance and sacrifice. The Feldmans were a very poor family. Certainly there were no doctors in the family. Young Erwin grew up in a housing project in Detroit.
Here was his schedule:
Desiring to make something of himself, he worked to put himself through pharmacy school. He spent two years at the University of Toledo and then returned to Detroit to finish his degree at Wayne State University.
8 AM-5 PM: Attend medical school.
He worked as a pharmacist at a clinic in Garden City, a newer clinic with mostly young doctors. He bonded with them, and they urged him to go to medical school so he too could become a doctor. He was hesitant, because for one thing by then he was married and he and his wife had just had their first child, meaning there was no way he could take a break from having a substantial income.
Day after day, year after year.
One of the physicians working at the clinic was Dr. John Baker, who was on the board of the Chicago College of Osteopathic Medicine. He talked Dr. Feldman into at least applying to the school, which he did. With his excellent grades and having Dr. Baker in his corner, getting in was no problem at all. The problem, though, was money. After much deliberation and much discussion with his wife, he decided to take the plunge and go to medical school, even though that meant he would have to work full time (he obtained a job as a pharmacist in Chicago) while doing so.
6 AM: Wake up.
5:30 PM-11 PM: Work as a pharmacist. 12 AM-3 AM: Study at home.
He was a virtual stranger to his wife and young son. Best case scenario he slept three hours a night, and often it was less. “It was a little bit hectic and a little bit tiring,” he says in a classic understatement. It’s a wonder he survived. He almost didn’t. Twice he fell asleep at the wheel and drove off the road, nearly killing himself. Things loosened up a little after that, but were still demanding. He returned to Michigan for a one-year internship at Martin Place Hospital (now St. John Oakland Hospital) in Madison Heights, but the intern pay was so low that he had to moonlight as a pharmacist on weekends in order to be able to support himself and his family. In spite of the hardships he was convinced he had made the right decision. He knew from early on that he really enjoyed the practice of medicine, even more than being a pharmacist. [Continued on Page 10]
10
FELDMAN (CONTINUED) Career Certainly the struggles were not over yet. He decided to open a family practice with another young physician he knew, Dr. Paul Grundland, though they had almost no money to start it with, and no patients. They were able to rent a small medical office eight blocks from Martin Place Hospital. To generate some money until they could build up their patient base sufficiently, they ran two hospital emergency rooms—the one at Martin Place and one in Clinton Township at what is now Henry Ford Macomb Hospital. As an added benefit of their work in the emergency rooms, they obtained a lot of new patients. Many of the emergency room patients they saw had no family doctor, so they would give them their cards (something you would never be allowed to do today). They were also doing house calls back then, at any time of the day or night. They’d scramble to cover their patient appointments as best they could, as one or the other of them rushed off to fulfill their obligations at one of the emergency rooms or to make a house call. At times the pace was almost as frantic as the medical school years. But they stuck with it and made it work. Within two years they were seeing 125 patients a day. In those days they did everything as family doctors—delivered babies, performed circumcisions, performed gynecological surgeries, took out tonsils, and much more. For about 35 years he remained partners with Dr. Grundland. Their practice outgrew their original office as other physicians came on board, and in 1976, he, Dr. Grundland, Dr. Howard Glazer, and Dr. Alan Belkin built the building that today houses Oakland Family Practice. This was highly unusual back then—a group of family doctors coming together to own and operate their own medical building. Following the retirement of Dr. Grundland and their selling of that building, Dr. Feldman practiced on his own for many years six blocks away down 12 Mile Road. Not Time to Retire Dr. Feldman loved his solo practice. He had a great staff that had been with him for years. He had great patients he had treated for years and often decades. He brought his dog to work every day, much to the delight of his patients. But just as there were major hurdles to deal with in his 20s to become a doctor, there have turned out to be major hurdles to deal with in his 70s to remain a doctor. It’s a story we’ve heard many times from many doctors, but as the health care
industry changed, it simply was no longer economically feasible to maintain a solo practice. Not to mention there was greater and greater pressure to switch to electronic medical records, which for him meant drastically changing the way he had practiced medicine since the 1960s. So why not retire? At his age, why not walk away? Having undergone four back surgeries and two knee replacements, and suffering from severe arthritis that can make even simple movements painful or impossible, why not call it a career? Because he always wonders if he has done enough as a doctor. He feels like he should keep contributing to the world in the way he is trained to do for as long as he is capable of doing so. “Family practice is different from any other form of medicine. You become attached to your patients; they become attached to you.” What if his patient needs him and he’s not there? He doesn’t want to ever be in a position to look back like Schindler and realize there was that little bit more that he could have done that he didn’t do, that could have made all the difference to a suffering human being. Besides, despite all the travails, he still genuinely enjoys practicing medicine. “It does something for me that won’t be there if I stop. It gives me a reason to get up in the morning. I just want to work. I don’t want to stop and do nothing.” Of course it was an agonizing decision to give up his practice. “It’s like selling a house you’ve been in for a long time and have become totally attached to.” But if he were to continue his career, he had no other option than to join a larger group and count on the “strength of numbers.” Joining Oakland Family Practice gave him the opportunity he sought. It meant he could stay in Madison Heights, which was key to him, as he didn’t want to geographically abandon his patients. Out of loyalty to him, probably most of them would have followed him to somewhere else in the metropolitan area, but out of loyalty to them he didn’t want to force that choice on them. “I started here; I should finish here.” Ideally he would have been able to keep his loyal staff too, but it simply wasn’t possible. (The one exception is that his longtime office manager Annette Parrinello has joined Oakland Family Practice as a staff member—“I totally rely on her.”) A new office also means, alas, that he cannot any longer bring his dog to work with him each day. He has also forced himself to accept the necessity of electronic medical records. He freely admits that he’s not a computer guy—he just recently got his first home computer—but you do what you have to do, just as he has always done since he was rushing back and forth between a [Continued on Page 12]
11
JENNIFER BEAL, MILLE NNIUM MEDICAL GROUP WEST much every rotation, and internal medicine seemed the best way of choosing “all of the above.” “Internal medicine allows me to work from A to Z on every medical issue.” So for her residency she did a three-year program at Botsford Hospital, where she was Chief Resident the third year. It was during the course of her residency that she became aware of the dearth of geriatric medicine specialists, and how thus the elderly niche of the population was being underserved. Especially with the aging of the baby boomer generation, the need is only increasing, yet still too few young doctors are choosing the field of geriatrics.
Certainly one of the themes of Dr. Jennifer Beal’s medical career thus far has been variety. A more important one is the ability and willingness to spot a population in need and commit to serving it. The Road to Geriatrics Dr. Beal has never strayed from Michigan. She grew up in Farmington Hills, did her undergraduate work at Albion College, and received her medical degree from Michigan State College of Osteopathic Medicine. The Michigan State program attracted her because she liked the manipulative medicine and the osteopathic philosophy of treating the whole patient. Also, she liked that it’s one of the few programs in the country where for much of the first two years students in the allopathic medical school and students in the osteopathic medical school train together, so you get a lot of exposure to both approaches to medicine. For her preceptorship her third and fourth years of medical school she was based at Huron Valley Hospital in Commerce Township, but with rotations at other area hospitals as well. For a time she felt that pediatrics was the field she’d most likely pursue. But once she got more exposure to the various specialties, that choice changed to internal medicine for two reasons. One, as much as she loves working with children she came to understand that dealing on a full time basis with sick children and the parents of sick children was going to be too hard for her emotionally. Two, she found there was something to like about pretty
She observed many cases of hospital admissions and readmissions that were avoidable. In some cases the elderly have very complicated medical issues to deal with and these issues aren’t getting the attention they need. In other cases even where the issues aren’t inherently very complicated, the conventional-length office visits do not provide enough time to properly explain matters to the patient and their family, and perform appropriate follow-up. For economic reasons doctors are forced to allot only a modest amount of time to each patient, and sometimes—especially in the geriatric cases that caught her attention—that just isn’t enough. She believed that addressing this need was the best use she could make of her medical talents, and that she could and should help elderly patients enjoy a better quality of life, even in cases where it wasn’t realistic to have much impact on their length of life. So she followed up her residency with a year of geriatric training at the University of Michigan in a program that is a partnership between the university and the Veterans Administration. Dr. Beal’s Practice Dr. Beal came to Millennium Medical Group West in 2013, after she completed her geriatric training at the University of Michigan. The position has worked out very well for her, as it gives her the variety she craves and the opportunity to work with the elderly population. She estimates that 15%-20% of her practice is non-geriatric internal medicine. The remainder is geriatric medicine. Every other Wednesday she has clinic hours at Botsford Commons Senior Community in Farmington Hills. (She alternates with Dr. Kenneth Gallmore, also of Millennium Medical Group West.) On Fridays she has office hours at the Livonia office of Millennium Medical Group West. [Continued on Page 12]
12
BEAL (CONTINUED) Beyond that, she’s “on the road.” She visits nursing homes, sub-acute rehabilitation facilities, and assisted living communities. She sees patients receiving hospice care. She does home care visits. At Botsford Hospital she covers as needed when their geriatrician is away, doing geriatric and palliative care consults. It’s always changing; she’s always seeing new faces and new places, which is just the way she likes it, though “it takes considerable organizational skills to keep it all straight.” Among the things she focuses on in her geriatric care is minimizing patient medications. Patients get on medications more easily than they get off. Often no one closely reviews medications to see if they should be continued; in practice continuing is the default. So elderly patients will come to her with long lists of medications, and she examines them closely to weed out duplicates or medications that even if they needed them at one time they do not now. Another thing she has found to be valuable is learning more about her patients’ social environment and lifestyle. Often this enables her to guide someone in a healthier direction. Certainly the home care visits help in this regard, as she can see how people live rather than trying to piece it together from what they tell her. She also finds it valuable to consult with family members
about an aging loved one, as they can have a great deal of positive influence on a patient. These are things that take time, but thankfully in most of the settings in which she works she can spend adequate time with a patient rather than having to rush. As she anticipated, you really need that time to be able to provide the best care to the geriatric population. She also does educational work in the community. She has multiple times been the “Doc” in Botsford Hospital’s monthly “Walk With A Doc” program at Heritage Park. She is involved in Botsford Commons’s dementia support group. She is glad to give talks for this program, as she has found that one of the populations she most enjoys treating is the dementia population, again in part because she sees a need that is not being adequately met: “A great deal of support is needed not only for the dementia patient but for the caregivers.” Dr. Beal has pieced together a very busy, and varied, work life for so early in her career, one that she thoroughly enjoys and finds fulfilling. Dr. Beal is seeing patients at: 28711 W. 8 Mile Road, Suite A Livonia, MI 48152 Phone: 248-474-2220 Fax: 248-474-5273
FELDMAN (CONTINUED) full time job and the Chicago College of Osteopathic Medicine. He notes that the staff at Oakland Family Medicine has been exceedingly helpful in his transition as a septuagenarian to 21st century technology. Dr. Feldman sees patients four days a week. He takes a lot of walk-in patients, which many family doctors won’t do. One of the joys of his life was seeing his brother (eleven years younger) and now MHP colleague, Barry Feldman of Millennium Affiliated Physicians, follow him into the medical profession. Asked if he influenced Barry’s decision to go into medicine, he responds. “I hope I did. I couldn’t be more proud of him and all that he has accomplished. He originally worked under me, and I wanted us to continue to work together, but he decided it was time for him to move on and be on his own, and in the long run that was the right decision. Even though I’m the older brother, I regularly consult with
Barry and rely on his wisdom.” But the MHP family connections don’t end there. His young nephew Dustin Feldman is now an MHP physician with Millennium Cardiology. “It makes me proud to have a nephew who is a terrific cardiologist. It gives me a good feeling every time I refer a patient to him.” Dr. Feldman is 77 years old. How much longer can he do this? He’ll retire when he no longer can contribute to the world as a doctor, no longer make a positive difference for his patients, and not a moment sooner. Dr. Feldman is seeing patients at: 1385 East 12 Mile Road Madison Heights, MI 48071 Phone: 248-399-6090 Fax: 248-399-5282
MHP News & Notes would like to hear from you. Please direct all questions, comments, suggestions, complaints, rumors, leaks, news, bouquets, brickbats, and other assorted contributions to: Craig Gabriel 248-677-0412
Cell: 248-766-7844
[email protected]
