Title: Grand Junction Tales From A Simple Nascar Loving Doctor, aka Lil Q
1Grand JunctionTales From A Simple Nascar Loving
Doctor, aka Lil Q
- James Quackenbush, M.D.
- Primary Care Partners
2Family Practice in Grand Junction
- The city
- The practice
- The preceptor
- Patient population/Chief complaints
- Patient presentation
3The City
4The City
- Located in the Grand Valley of western Colorado
(aka Wine Country), Grand Junction is the
largest city between Denver and Salt Lake City.
5The City
6The City
- Located at the confluence of the Gunnison River
and the Colorado River, hence Grand Junction.
7The City
8The City
- Population 48,141
- Including outlying towns 126,445
- Elevation 4586 feet
9The City
10The Practice
- Primary Care Partners- A large institution
comprised of merged pediatric and family
practices from around town. - In house pharmacy, lab, diagnostics,
- physical therapy, social work, wellness
clinic, diabetes educator, after hours clinic
11The Practice
- After hours clinic DOCS on Call
- Clinic in same building open from 5-10pm
weeknights and both weekend days until 10pm. - Staffed by two full time physicians
- (See attached article)
12The Preceptor
- Dr. James Quackenbush (Lil Q)
- Dr. Q is CU Medical School alumni, and also
played football as an undergrad at CU Boulder.
He is a large person, both physically and in
personality. Who else takes his students home
everyday for lunch carefully and lovingly
prepared by his wife? Who else makes house calls
these days? His patients LOVE him! (Oh, and he
loves NASCAR)
13Patient Population
- Majority Caucasian women aged 19-64
- Chief Complaints mostly routine health
maintenance exams, also frequent URIs, HTN
checks, DM checks, prenatal care, depression,
anxiety, other mood disorders - Procedures skin lesion excisions/biopsies,
joint injections, vasectomies
14Chronic Disease Management Patient presentation
- CC I have been taking pictures of my genitals
and showing them to random people and having
phone sex with strangers.
15Patient Presentation
- HPI This is a 35 year old woman who is married
and has one daughter. For the last 2-3 weeks she
has been feeling out of control sexually and
engaging in very risky sexual behavior.
16Patient Presentation
- She has not actually physically engaged in sexual
activity with anyone but her husband, however she
has phone sex regularly and shows strangers
pictures of her genitalia. - Her behavior quite concerning, and she is
normally very shy, quiet, and church-going.
17Patient Presentation
- She states that her husband is concerned because
she wants to have intercourse 1-2 times per day
whereas in the past it has only been once a week.
She also is extremely uninhibited during sex,
which is also new for her. - (Yes, even though her husband likes aspects of
this, he is concerned!)
18Patient Presentation
- She has also been shopping much more frequently,
especially online, and has been quite irritable
lately. (Not as interesting as the sexual
behavior, is it?)
19Patient Presentation
- PMH The patient has a long history of
depression and has been treated in the past with
Zoloft and Prozac with moderate success. Since
becoming pregnant 5 years ago, she stopped all
antidepressants and has not used them since.
20Patient Presentation
- About 5 weeks ago, the patient had a visit with
Dr. Quackenbush because she was feeling depressed
again. Due to her history of depression and
previous use of antidepressants, Dr. Q
appropriately started her on Zoloft again.
21Patient Presentation
- However, this time we induced MANIA in this
bipolar patient! (Oops!)
22Patient Presentation
- In retrospect, the patient recalled a time about
ten years ago when she felt like this and also
demonstrated risky sexual behavior. At the time,
however, she attributed this to being young and
wild.
23Patient Presentation
- Plan Dr. Q immediately called his favorite
psychiatric colleague who suggested starting
Zyprexa and Lamictal and tapering the Zoloft. We
took his advice and scheduled to see the patient
back in 3 days.
24Patient PresentationChronic Care Model
- Self Management
- This patient was already demonstrating self
management by coming in for help. She also read
about bipolar disorder because she suspected she
may have itI wonder what tipped her off
25Patient PresentationChronic Care Model
- Decision Support
- As Dr. Q does not manage a large number of
bipolar patients, we did not have an in-office
protocol of research supported guidelines.
Being the resourceful physician that he is,
however, Dr. Q acted quickly and called a
psychiatrist.
26Patient PresentationChronic Care Model
- Delivery System Design
- We carefully explained to the patient how to
change her medications and wrote it out for her
as well. - We also told her that shed be referred to a
psychiatrist, but wed also continue to follow
her during this acute stage. - Dr. Q and this particular psychiatrist have a
great working relationship and share several
patients.
27Patient PresentationChronic Care Model
- Clinical Information System
- PCP uses a great electronic medical records
system that also very efficiently communicates
with physicians outside of PCP. Dr. Q can also
send himself reminders about patients via the
system that pop up on a certain date. (i.e. a
reminder to check in with patient after appt.
with psychiatrist)
28Patient PresentationChronic Care Model
- Organization of Health Care
- PCP itself is an amazing organization that very
efficiently takes care of patients with chronic
illnesses.
29Patient PresentationChronic Care Model
- Community
- PCP has strong alliances with many specialists
in town, and Dr. Q himself is very involved with
church groups, the public schools (he gives the
puberty talk), and other various groups around
town.
30Patient PresentationChronic Care Model
- Back to the patient
- She returned in 3 days and felt a little more
sedated, but still had phone sex that day. - She returned again 1 week after the first visit
and felt about the same.
31Patient PresentationChronic Care Model
- She returned 2 weeks after first visit and
stated that she felt better but had had phone
sex the day before. She was starting to feel
guilty about the things she was doing and
wondered if she should tell her husband.
32Patient PresentationChronic Care Model
- She will continue to follow up with Dr. Q and
her psychiatrist but also has other resources - support groups
- church groups
- family
33Pop Quiz
- What is the population of Grand Junction?
34Pop Quiz
- What is Dr. Qs favorite hobby outside work?
35Pop Quiz
- What were some things we did for our patient that
may have improved her outcome?
36Pop Quiz
- What is one way in which PCP is effectively
managing patients with chronic diseases?