Charles Edwards, MD, on Patient Care
Closely huddled by attentive residents and students, USF physician Charles Edwards, MD, performs his daily rounds of patients inside Tampa General Hospital. Dr. Edwards is a hospitalist and as such, he and his team care for hospitalized patients until they are well enough to be discharged. Patient stays range anywhere from 12 hours to many months.
Regardless of stay length or ailment, these in-house doctors known as hospitalists lead a team of other specialists such as physical therapists, nurses and pharmacists, to best provide safe and efficient patient care.
“We see every type of patient at this hospital so it’s hard to say that there is a typical pattern and that’s one of the unique challenges for a hospitalist,” said Dr. Edwards.
The hospitalist role is fairly new in medical practice, just two decades since the position first began to appear. Its purpose was to eliminate needless transportation time for primary care doctors so they could focus more on office visits and so that the hospital can provide immediate personalized care to their patients. Currently there are 34 USF Health hospitalists working at Tampa General Hospital.
“We are here, we are here 24 hours a day. Available immediately to see patients, if needed,” said Dr. Edwards who takes pride in connecting with his patients, “though [my care] may not continue, while they’re here [I’m] going to care for them as much as their primary care doctor does.”
On a typical morning you’ll find Dr. Edwards and his team reporting on their patients’ progress with details about medication, mental status and sleep or eating patterns. They will see between 15 to 20 patients throughout the day. However, patient care involves more than bedside visits. For physicians like Dr. Edwards, responsibilities extend into his personal life and he is passionate about it. He might read more about the symptoms of a patient he’s not sure about or catch up on the latest from his favorite medical journal.
Dr. Edwards’ profession is not just about patient care, it’s an “innate curiosity about medicine,” and a balance of at least four other roles. In addition to being the director of the Division of Hospital Medicine, vice-chairman for Clinical Operations in the Department of Internal Medicine and chief of staff at TGH, he is also an associate professor at USF Health’s Morsani College of Medicine.
“Without a doubt teaching is my main inspiration,” said Dr. Edwards. “The one thing I can do and enjoy, [is to] go around with my students, residents and my team to see our patients.”
Many doctors were inspired to pursue their profession by personal reasons, or wanting to do something important in life. Dr. Edwards had these reasons, but his active role as an educator is a daily reminder of the benefits of his kind of work.
“I’m constantly around other people who are learning,” said Dr. Edwards. I constantly have to try and teach younger physicians and that’s one of the best ways to learn, is to teach. They certainly keep you on your toes.”
Aside from his patients, mentorships and dedication to keep up with medical advancements, Dr. Edwards has his mind set on the future of hospital medicine.
“We’re constantly looking for ways to make the hospital safer,” said Dr. Edwards. He’s referring to the main challenge his profession faces: The transition of patient care.
Caring for patients has a multi-level set of tasks that include bedside visits, medical charting, preventing infections, avoiding unnecessary tests, not delaying patient stays, and the continuum of patient care beyond their hospital stay.
“One of the things that you must do is make sure you understand the challenges a particular patient is going to face when they’re discharged so that you can try to best address them,” said Dr. Edwards. “But it is often a source of anxiety when patients leave the hospital.”
The final stage of Dr. Edwards’ care involves updating the patient’s records and sharing the hospitalization charts with the primary doctor. Patient medical information is private and protected by federal HIPAA laws, which limit how hospitalists and primary doctors can exchange records.
Medicine, as most professional fields, has been increasingly harnessing the powers of technology. The transition of patient care is eased by the standardization of electronic health records and USF Health’s Physicians Group patients will benefit even more with its transition to EPIC– the same EHR used at TGH, thus providing a stronger continuity of care. With a unified records system, interdisciplinary caregivers can access thorough medical data about a patient. Hospitals, clinics and physicians can share details about their patient’s outcome and will help relieve the worry that hospitalists have when treating or discharging patients. But for Dr. Edwards, the best assurance has a personal touch.
“Technology will certainly play a big role in improving the transition of care in the future, but there’s no substitute for good old-fashioned verbal communication with fellow colleagues.”
Story and multimedia by Sandra C. Roa, USF Health Office of Communications.
Harry van Loveren, MD, on Patient Care
Over and over again, Harry van Loveren, MD, walks through a surgery in his mind before actually cutting open the brain of his patient, perfecting every step and accounting for everything he will encounter, the expected and the unexpected.
Dr. van Loveren is chair of the Department of Neurosurgery and vice dean for Clinical Affairs for the USF Health Morsani College of Medicine. Along with a brilliant mind and capable hands, his visualization technique has made him an accomplished and much sought after neurosurgeon.
“To prepare for the kind of operations I do you have to mentally do the operations a number of times before you walk into the operating room,” he said. “And you have to understand it all – the anatomy, the surgical instruments, the surgical techniques – so your mental experiments are valid, that what you see in your mind is what you will see in the patient’s head. That these things you see in your mind are true and that if it works in your mind it had better work in the operating room. And if I can’t see that in my mind’s eye, I go back to the (training) lab, go back to text books, and review videos and figure it out until I can create a paradigm in my mind where I complete the surgery successfully.”
How does someone decide to become a neurosurgeon? For Dr. van Loveren, it was because it’s considered the most difficult area of medicine and requires the longest amount of training.
“To be honest, I don’t know why other people go into neurosurgery but I know why a lot of us do – because we’re so egotistical and because we want to be the best,” he said. “As we’re going through medical school we look around and ask what would be the hardest thing I could do? What would be the biggest challenge? But I don’t think we’re the only ones who do that. For instance, look at people who go into the police force and say ‘I want to be on the SWAT team’ or go into the military and say ‘I want to be a Navy SEAL.’ There’s an element of that to becoming a neurosurgeon. We’re looking for the greatest challenge.”
In fact, when he joined USF Health about 10 years ago, he set a goal for his Department to become the go-to neurosurgery department in Florida. Starting with only six neurosurgeons, he has built the Department to about 30 surgeons and nine PhDs, becoming a hub for the most complicated cases.
“My practice is a little bit unique,” he said. “It’s called complex cranial so I do the more complex side of brain operations and a lot of my practice is taking care of patients for other neurosurgeons in the state either for those things they don’t want to do or don’t feel they ought to be doing. That can be a bit of a lonely and frightening position to be in. But nobody wants to see any lack of confidence in us and we don’t really want to feel that lack of confidence.”
His other reason for choosing neurosurgery is because he saw it as the one specialty in which he would never stop learning.
“I chose it because it looked like my learning curve would go on forever,” he said. “When I looked at neurosurgery, I saw older neurosurgeons still making great contributions and the acquisition of experience is so valuable to neurosurgery. So the finish line is, wonderfully, always just beyond our reach.”
He admits, though, that the real reason he chose neurosurgery might truly be because he thinks “the brain is cool.”
“The brain is who we are, it’s what we think, it’s what we believe,” he said. “The ability to affect a person’s life by manipulating that organ is profound and extremely interesting. And we really get some insight into brain function when we’re operating on someone while they’re awake and speaking to you. And with certain stimulation you can bring back very specific old memories for the patient, you can play music, you can run videos. It’s all stored in the brain and you can recall it and make it come out for the patient.”
With a laugh, he added “It’s just a really satisfying career. You should try it sometime.”
Story by Sarah Worth, photos and video by Sandra C. Roa and Mihaela Madsen, USF Health Office of Communications.