The Doctor is Out (Seeing Patients)
Geriatrician FranklinWatkins, 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 andGeriatric 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."
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
"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."
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
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."