When communication between medical professionals works like a well-oiled machine, patients' diagnosis is faster.
by BJ Towe on Monday, July 13, 2015
Your Local Health | Written by BJ Towe
When communication between medical professionals works like a well-oiled machine, patients' diagnosis is faster. Getting in to see the right specialists is faster. And getting on the road to recovery is, well, faster. Trisha Joseph's story is a perfect example.
When Trisha Joseph, 35, of West Des Moines arrived at The Iowa Clinic Urgent Care last April, she knew the pain in her stomach wasn't normal. What she didn't know was that – less than 12 hours later – she would have had several diagnostic tests, had surgery to remove her appendix, and be back home. Here's roughly how the day went – and how having doctors who communicate seamlessly with one another enabled everything to happen so quickly.
April 14, 2015 8:00 A.M.
“I hadn't been feeling well for a couple of days,” says Joseph. Within 10 minutes of arriving at The Iowa Clinic Urgent Care in West Des Moines, Joseph was talking with Joe Yankey, D.O., one of The Iowa Clinic's Urgent Care physicians.
“But it doesn't give a doctor much to go on when you say you just don't feel good. I hurt to my stomach, got hot and cold, but had no fever. I honestly thought it was a muscle or something,” says Joseph, who had been training to run in the London Marathon two weeks later.
Dr. Yankey says, “She really didn't want this to be something serious. She came in with some abdominal pain on the right side and was a little tired.”
Yankey suspected appendicitis right away, but it's not always that clear-cut, especially in women of childbearing age. For example, an ovarian cyst produces similar symptoms.
To help diagnose the cause of Joseph's pain, Yankey ordered an X-ray, blood work, and a urinalysis. “Everything came back looking pretty normal. Usually from the lab work, you see a bump in the white blood cell count with appendicitis,” he says. But he kept digging.
Ordinarily, the next step would be a CT (computed tomography) scan. But due to a prior and not-so-good experience elsewhere with a CT scan, Joseph was reluctant. Yankey instead ordered an ultrasound.
Joseph walked the short distance down the hall to The Iowa Clinic Medical Imaging Department, where she met Radiologist Joshua Rosebrook, M.D.
The ultrasound showed no ovarian cyst but the visible portion of the appendix was dilated, which probably meant appendicitis. Still, the final verdict wasn't in. A CT scan was needed.
Dr. Rosebrook took time to reassure Joseph about the procedure and what it involved. “A CT scan is the best way to accurately diagnose appendicitis. My job as a physician was to talk her through that and help her feel comfortable with it,” he says.
“No one goes into surgery lightly. We want to be 100 percent sure that's the diagnosis. CT is a very sensitive and specific exam and the best choice,” says Rosebrook. In fact, CT scans are 93 to 98 percent accurate in the diagnosis of acute appendicitis – far better than any other diagnostic method.
The CT scan showed that Joseph's appendix was plump and inflamed. She needed surgery to prevent the appendix from rupturing, which it certainly would have in another three or four days. A ruptured appendix is life-threatening.
Yankey and Joseph discussed next steps. Moments later, Yankey was on the phone with Daniel Kollmorgen, M.D., a General Surgeon with The Iowa Clinic. “He said he'd be ready for her at Iowa Methodist's outpatient surgery center downtown,” Yankey says. “I was scheduled for surgery as soon as I could get there,” Joseph says.
Upon her arrival, Joseph was immediately prepped for surgery and talked with Dr. Kollmorgen about the procedure. And around 5:00 p.m., she was out of surgery and in the recovery room. “It kind of surprised me how quickly things came together,” Joseph says. “I drove myself to Urgent Care. It took four or five hours to figure it out, but they took me seriously and kept doing the tests. They dug into it to try to figure it out.”
Dr. Kollmorgen says, “One of the nice things about Urgent Care is that it is not an emergency room. Patients don't have to sit and wait a long time and the care is more detailoriented than ERs sometimes allow. The credit for all of this coming together so quickly has to go to the people before the operation. The right studies got ordered and analyzed by doctors who are accurate and timely.”
Making this possible, Kollmorgen says, “The Iowa Clinic has a phone app that lists all of physicians who are on-call at any point in time. I can call any of them and immediately be in direct discussions with them. I never have to wait on hold.”
Joseph was home.
Rosebrook says it rarely happens that a patient with appendicitis goes from doctor's visit to diagnosis to surgery to home in such a short timeframe.
“We work hard at being as efficient and effective as possible in getting patients where they need to go. It's great when Dr. Yankey can come down the hall to see me in Medical Imaging, hop on the phone and get Dr. Kollmorgen, and get the surgery done within just a few hours,” Rosebrook says.
“That's what all of us at The Iowa Clinic strive to do – be better at coordinating and delivering care for the benefit of our patients,” he adds.
“I've told everyone that, if you don't have a life threatening situation, don't go to the E.R. Go to Urgent Care instead. They'll get you in faster and figure it out sooner. Plus, it's cheaper.”
– Trisha Joseph, 35