Clinical Excellence Undergirds Our Mission

Over the last few weeks I have focused on Internal Medicine’s contributions to research and education and how those efforts contribute to our reputation nationally, relative to other academic medical centers. However, it is important not to lose sight of the fact that the majority of our faculty’s effort is in the realm of clinical care. For every assay performed, every grant application submitted and every trainee given feedback, dozens of patients are receiving the highest-quality care from providers in our wards and in our clinics. As much as we are focused on our mission of preparing the future health care workforce and advancing on many fronts in research and innovation, we never lose focus on those with immediate need for healing, comfort, and hope. It goes without saying that delivering that care takes more than just physicians and nurses, but many other support staff working behind the scenes. Our department sees you all, and though you do not hear it enough, you have our gratitude for the work you do in providing compassionate clinical care to thousands of people every day.

Despite the seemingly never-ending stream of appointments, our clinical faculty’s imagination for improvements and efficiencies is impressive. Take, for example, Rhonda Fruhling, ARNP, and member of our Diabetes Clinic. She has helped manage the implementation of new technological innovations in the last year that have transformed the lives of many people with diabetes. More than 70 individuals in her clinic have begun to use new insulin pumps that deliver basal insulin automatically based on sensors measuring a person’s glucose levels and recent insulin use. Users of this pump have seen a reduction in glycemic variability, improvements in overall A1C values, and more time spent in their target range. Although one person using the pump said, “I almost forget that I have diabetes,” individuals still require meticulous self-care skills including nutritional management. Ms. Fruhling has also overseen an increase in the use of continuous glucose monitoring systems (CGMS). CGMS has utility beyond insulin pump users, by providing real-time data about glucose levels, which can be essential before engaging in activities such as driving or exercise. Recent innovations also enable patients to alert family members or friends if dramatic changes in glucose levels occur.

Let me share another recent innovation. There are many reasons why a person might need total parenteral nutrition. Recently, our Division of Gastroenterology and Hepatology initiated the Advanced Nutrition Service (ANS) in October 2016. Developed and directed by Dr. Caryn Berkowitz, the ANS is a multidisciplinary consultation service that includes a dietitian, Amber Frederick, RD, and Nanette Brokaw, ARNP. The ANS works with patients in medical, surgical, and intensive care units managing complex problems related to nutritional support of individuals who are unable to maintain their nutritional needs, which many of us take for granted. In addition to the inpatient service, Dr. Berkowitz and her colleagues have expanded to outpatient service for patients receiving home parenteral nutrition and other patients with complex nutritional problems. Recently the ANS was also critical in helping UIHC weather the national amino acid shortage caused when Hurricane Maria struck Puerto Rico last summer.

There are a number of other noteworthy activities taking place on the clinical front.

• Dr. Brittany Bettendorf in the Division of Immunology is developing a transition clinic for children with rheumatologic diseases. This will allow a longer-term continuity of care from pediatrics to adult medicine and will strengthen the ties between adult and pediatric rheumatologists at UIHC.
• Our Heart and Vascular Center recently performed the 500th transcatheter aortic valve replacement at UIHC. This far less invasive remedy to aortic stenosis is increasing in use but still requires a talented team of cardiologists, surgeons, and nurses to safely perform these procedures.
• Dr. Lama Noureddine is building a registry of individuals with polycystic kidney disease (PKD) as she expands our services to people with PKD. Her efforts will contribute importantly to the management of this complex condition.

These are only a few of the examples of the diverse activities taking place within Internal Medicine each day. As we celebrate research advances, I hope that you all know that your day-to-day service, which may sometimes feel routine or mundane, is noticed and deeply appreciated.

As this piece is going to press I am pleased to introduce our newest class of Internal Medicine Residents. We have had an outstanding match, recruiting an exceptionally talented pool of trainees from across the country. Join me in welcoming our new colleagues, whose achievements I will detail further in a follow-up post.