The Doctor is Out (Seeing Patients)

Geriatrician Franklin Watkins, MD, says the highlight of his week is when he travels a few blocks from the Medical Center to the Elizabeth and Tab Williams Adult Day Center at the corner of Melrose Street and Cloverdale, where he provides an on-site clinic for participants. 

"This is the type of program and care that I wish my grandmother could have experienced," said Watkins, an assistant professor of Internal Medicine (Gerontology and Geriatric Medicine). "This is the way we should be practicing medicine. Seeing patients in this setting not only gives us better data, but we are also making the experience much better for the patient."

Personal Insight

Watkins grew up with a grandmother who developed dementia and lived with his family for six years prior to spending her last two years in a nursing home. That was during the 1980s, in the early days of dementia care. It was also in rural eastern Tennessee, where community resources were few, beyond their church family. 

"I had an early immersion in the world of dementia," Watkins said. "That gives me great appreciation for what we could have done better from the standpoint of community resources and physician understanding. It's easier to put myself in a family member's shoes and understand the stress they experience."

Going to the Patient

Based on the Medical Center's previous successful collaborations with Senior Services of Winston-Salem, which operates the Williams Center, Watkins approached the organization and started the clinic in late 2010. He schedules routine visits lasting up to an hour and a half per patient on Tuesday mornings and is available at other times for unexpected problems. 

"In geriatrics, we still do house calls," Watkins said. "During the day, the Williams Center is home to patients who have memory loss, so we go there. It's more convenient for patients and caregivers and provides information that is unavailable in an office visit. I see how patients are interacting with other participants, and the staff informs me about subtle changes they have observed. Patients with dementia often cannot vocalize their symptoms."

Continuity of Care

Continuity of care is the most important aspect of having the clinic on site, said Lynn Byrd, RN, health care coordinator at the Williams Center. She and other staff members spend so much time with participants that they become like family members, and they have built a close relationship with Watkins as well. 

"It's like having a direct line to him," Byrd said. "I always get a quick response when I call or email him." 

"I may be a young guy, but I'm an old-school physician," said Watkins. "I give patients, families and center staff my cell phone number. It's important that they have access to me."

High Satisfaction

The Williams Center offers Watkins' services as an option for new patients. While the number of families that have asked him to provide care for their loved ones still represents a small portion of the center's patient population, those who have are enthusiastic about the on-site clinic. 

"Patients with dementia often find unfamiliar settings and strangers stressful," said Kathy Long, vice president of Adult Day Services, who recently joined Senior Services after a 40-year career at the Medical Center that included serving as nurse manager for the Sticht Center on Aging's Acute Care for the Elderly (ACE)unit. "The families really appreciate getting care here, where our participants feel comfortable and know everyone." 

Byrd recalled one caregiver's comment that is typical of many others she has heard. "This helped me keep mom home longer," the caregiver told her. "It's just been a lifesaver." 

"Many families say, 'we didn't know that medicine like this still existed,''' Watkins said. "Those comments give me inspiration and confirm that we are really doing something right."

Back to the Future

A federally funded Geriatric Academic Career Award from the Health Resources and Services Administration supports Watkins' clinic. He brings Internal Medicine interns and interested medical students to shadow him, and he is encouraged by their excitement at discovering what nontraditional medicine outside the hospital walls can do for the community. 

"It's a way of opening some young eyes to a model they will likely see implemented increasingly throughout their careers," he said. "This is the Marcus Welby model, where you follow the patient wherever they need you to be, whether at the clinic, at their home or at an adult day center. This truly is where I see dementia care going. We're harkening back to an earlier era."