Issue 3 - Fall - Providence Washington - Providence Health & Services

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:30:15:30:00:15:45For the medical residents, every day is filledwith the experience of a lifetime. Although nosingle day is ever typical in the life of a doctor,here’s a sample day in the life of two residents:6:30 a.m.Jonathon Anderson, MD, arrivesat the Intensive Care Unit (ICU) atSacred Heart to meet with the overnightmedical team. The doctors andstaff review patients’ conditions andtreatment plans. Dr. Anderson willbe caring for four patients today.7:00 a.m.Dr. Anderson begins rounds, personallyassessing each patient’s condition,checking diagnostic reportsand making adjustments in thetreatment plan. His first patient is a74-year-old man admitted initiallyfor myocardial infarction (heartattack) with acute heart failure, pulmonaryedema (excess fluid in thelungs) and acute kidney injury.“My goal is to reduce the excessfluid, manage his myocardial infarctionwith medication since he is apoor candidate for surgery at thistime, and wean down his ventilatorsupport enough to see if he’s able tobreathe on his own,” says the doctor.7:15 a.m.Faculty members arrive early at theFamily Medicine Residency clinic.So does second-year resident LilyWittich, MD. In her role as chiefmedical resident, she acts as a liaisonbetween the residents and faculty,attending faculty meetings, managingthe schedule for resident doctors andhandling other administrative duties.8:30 a.m.Dr. Wittich’s day shifts to her clinicalresponsibilities. She’ll be seeingpatients within the hour, and beginsreviewing patient charts.9:00 a.m.In the ICU, Dr. Anderson meetswith a pulmonologist, who is aspecialist focused on the respiratorysystem. It’s what Dr. Andersoncalls a teaching moment—the entiremedical team discusses diagnosticsand recommended treatments fortheir critically ill patients.9:05 a.m.At the primary care clinic, Dr.Wittich sees her first patient, a34-year-old developmentally disabledman from a group home.He fears a toe may be infected.Dr. Wittich uses the visit to evaluatehis overall health. “Many of mypatients have complicated medicalproblems,” she explains. “This is animportant opportunity to check ontheir well-being, evaluate medicationsand determine if there areother health concerns.”9:45 a.m.Dr. Anderson is doing rounds on hispatients again, this time accompaniedby an intensivist, which is theattending physician who specializesin the care of critically ill patients.A 65-year-old male with an extensivehistory of heart disease is in theICU with a very serious case of congestiveheart failure. The patient’smedication was changed earlier inthe day, and Dr. Anderson is monitoringhis progress.10:30 a.m.Dr. Wittich has treated threepatients in the clinic so far thismorning and now follows up onanother matter: calling a homehealth agency to arrange for heartmedicine management for one ofher patients. “She is a 75-year-oldwoman with serious blood clottingin her legs, which has traveled toher lung,” explains Dr. Wittich.“She needs to be on warfarin,which is a blood thinner, for sixmonths to treat the thrombosisand pulmonary embolism.” Butwarfarin can be dangerous if notmonitored closely, and the doctorwants to ensure her patient getsthe help she needs.MedicalEducationby theNumbers71Number of medical residentscurrently in ProvidenceGraduate MedicalEducation programs.245Number of family medicinegraduates since the programbegan in 1972.65Percent of family medicinegraduates who remainedin the Spokane referral areato practice medicine.80Percent of family medicine“rural track” graduates whopractice in rural Northwestcommunities.22,500Number of patient visits toProvidence Family MedicineResidency-Spokane.71Percent of Internal MedicineResidency graduates whoremained in the Spokane referralarea to practice medicine.16 ● Fall 2012 Heart Beat
Lily Wittich, MDJonathon Anderson, MD12:00 p.m.Dr. Anderson attends the noonconference with all the internalmedicine residents. It is anotherteaching moment in which facultyand residents discuss patient casestudies. Today, a colleague discussesan HIV patient who also has hepatitisC. Physicians and pharmaciststhroughout the Pacific Northwestjoin the teleconference.1:15 p.m.Thursday afternoons are teachingtime in the Family MedicineResidency clinic. A lecture by apsychologist in the clinic focuses ondiagnosis and treatment of depression.A resident presents a report onbipolar disorder. A cardiologist fromProvidence Spokane Heart Institutegives a lecture on how primary caredoctors can manage atrial fibrillation(irregular heartbeat and a frequentcause of strokes).2: 30 p.m.Some of Dr. Anderson’s four ICUpatients are improving. His firstpatient of the day is being weanedoff ventilator support.3:15 p.m.Attempts to wean Dr. Anderson’ssecond patient, a 71-year-old male,off sedation have been unsuccessfulbecause the patient is severelyagitated. He came to ICU initiallyResidentHonoredwith Award“Colville is the luckiest city in America tobe getting you,” said a card to Katrina E.Gardner, MD, then a first-year medicalresident at the Family Medicine Residencyclinic in Spokane.Dr. Gardner now is in Colville, completingher third year of resident training.It comes as no surprise to herpatients that she was selected from afield of 3,200 eligible family medicineresidents to receive the esteemedBristol-Myers Squibb Award for Excellencein Graduate Medical Education.The award’s 10 recipients represent themost outstanding family medicine residentsin the country.“Dr. Gardner is profoundly connectedwith the human experience, and her clinicalabilities are second to none,” saysGary Newkirk, MD, director of Spokane’sFamily Medicine Residency program.“The award not only honors an outstandingdoctor, but is a testament to the highlevel of care available to residents ofEastern Washington.”for ventilator management after anoperation. Dr. Anderson is givinghim medication for agitation andhopes to transition him to oral painmedications.4:45 p.m.Dr. Wittich spends the next hourcalling patients, finishing patientreports and writing prescriptions.Before leaving the clinic, she’llreview each patient’s care with herfaculty advisor.5:30 p.m.Dr. Anderson hands off the care ofhis patients to the night team. All ofhis patients made remarkable progresstoday.5:306:006:157:007:308:158:309:009:159:45Fall 2012 Heart Beat ● 17
Page 1 and 2: heartbeatprovidenceQuality health c
Page 3 and 4: providenceheartbeatExecutive Editor
Page 5 and 6: {mailbag}Living LargeFormer heart t
Page 7 and 8: Medical Park Comingto Spokane Valle
Page 9 and 10: Home, Safe HomePrevent falls with a
Page 11 and 12: Experts Ready —In Case NeededAll
Page 13 and 14: Yet, patients don’t always ask it
Page 15: Shortly aftermoving to Spokane four
Page 19 and 20: From falls to infections to many th
Page 21 and 22: forgeriatrichip fracturesASAPIS KEY
Page 24 and 25: Katherine Tuttle, MD,a Providence S
Page 26 and 27: “I’m eternally grateful that he
Page 28: {Sustainable efforts}Going GreenWit
Page 31 and 32: Is your lifecontrolledby drugs oral

Issue 3 - Fall - Providence Washington - Providence Health & Services

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