50 Years of Patient Care: Patients’ Interests Above All Else
Patient Remains Priority as Health Care Changes
By Salwa Choucair
At the heart of any successful medical school lies the patient. The patient, who is the ultimate reason for hours of study, years of research and countless days spent practicing intricate techniques. From the founding faculty members and early graduates to today’s robust clinical practices and community outreach, the Joe R. and Teresa Lozano Long School of Medicine has placed patient care above all else, and by doing so, its 50th birthday is a time to celebrate that care and showcase its future.
The school’s commitment to patient care begins with educating and developing students with the number one lesson taught above all others—to always place the patient’s interests above everything else. A lesson heard loud and clear in 1981 when Ronald M. Stewart, M.D., professor and chair of the Department of Surgery, was a student here.
“The real power of the institution is the focus on patients, students and science,” said Dr. Stewart, Class of 1985. “The patient is at the center of it all, and the patient’s interests comes before my own; I received that message loud and clear as a student and as a resident. The world is not focused on me; the world is focused on the patient.”
Today, that lesson is still being taught and practiced while the school embarks on expanding its clinical practice in the San Antonio area and South Texas with UT Health Physicians, which features more than 800 physicians and other health care providers. An expansion that not only further impacts patient care but is financially sound and helps the school generate revenue that may then be invested in its other missions of education, research and community service.
“Health care is a business, and we are blessed that our business is taking care of people,” explained Carlos A. Rosende, M.D., FACS, executive vice dean for clinical affairs and executive director of UT Health Physicians. “Our patients come first. We are providing phenomenal care, and we are doing it through the creation of a coordinated-integrated health system with advantages for our patients.”
In order to understand where the school is going, however, it’s important to see from where it came.
History of breakthroughs
At 50, the Long School of Medicine is relatively young, therefore, the list of breakthroughs and inventions that have been discovered inside its walls is inspiring and extraordinary, and each impacts patient care. These discoveries have made a difference in the lives of millions of patients and continue to do so today.
One of the greatest inventions in cardiovascular disease treatment, the stent, was discovered in the 1980s by Julio Palmaz, M.D., and his collaborators in the Department of Radiology at UT Health San Antonio. It is estimated that the Palmaz™ Stent improves the lives of almost 2 million patients a year.
While conducting research at the school in the 1970s, William McGuire, M.D., a professor of medicine at UT Health, discovered estrogen receptors in breast cancer, revolutionizing the treatment of the disease. Dr. McGuire, who passed away in 1992, was a leader in breast cancer research, respected worldwide and, with Charles A. Coltman, Jr., M.D., then director of the Cancer Therapy & Research Center, launched a breast cancer symposium in San Antonio which will celebrate its 41st year in December.
Thousands of children all over the world with severe scoliosis and chest anomalies are living happy, productive lives today because of Dr. Robert M. Campbell Jr.’s invention, the Vertical Expandable Prosthetic Titanium Rib. Dr. Campbell was a professor of orthopaedics at UT Health. The work began in 1987 when Melvin D. Smith, M.D., professor of pediatric general surgery, went to Dr. Campbell with X-rays of an infant born without a chest wall. They decided the only option to save the child was to create an artificial chest wall. Two years later, Dr. Campbell finished developing the titanium rib, and the surgeons implanted it into the 2-year-old boy. The surgery was a success. The rib was approved by the U.S. Food and Drug Administration in 2004 after a 14-year national clinical trial. Dr. Campbell passed away earlier this year at age 67.
One of the school’s founding faculty members, Charles Rockwood, Jr., M.D., a world-renowned orthopaedic surgeon, was instrumental in developing several landmark breakthroughs in patient care including the creation of a shoulder prosthesis, a post-operative home-based exercise rehabilitation program for the shoulder, and textbooks for orthopaedic students on fractures and shoulder injuries. Dr. Rockwood, who served as a colonel in the U.S. Air Force Reserve, established the orthopaedics residency program along with a fellowship in shoulder fractures.
Drs. Rockwood, Robert Schnitzler and Jack Williamson were the founding physicians of the City of San Antonio’s Emergency Medical Services (EMS) and were the original authors, along with their faculty colleague Arthur S. McFee, M.D., of one of the first Emergency Medical Technician (EMT) textbooks under the direction of the American Academy of Orthopaedic Surgeons. They worked with local and state physicians to provide medical direction to help the San Antonio Fire Department develop the EMS program. Dr. Rockwood served as the medical director for the EMS/paramedic program for the City of San Antonio and Bexar County for 15 years.
At 89, Dr. Rockwood, professor and chair emeritus of orthopaedics, advises current students and physicians to continue their work with the patient in mind.
“Keep learning. Keep researching,” Dr. Rockwood said, “and always keep your eyes wide open for what could be.” He added, “Don’t be afraid to look for new solutions.”
This pioneering spirit is exactly what has propelled the advancements in patient care over the past 50 years.
“Patient care transformation is a result of scientific and technological advances,” Dr. Stewart said. “Revolutionary advances have given health care providers the tools needed to improve patient care.”
A few of the most important advances include the development of modern diagnostic imaging, minimally or noninvasive approaches to treating disease, combined with the development of quality improvement and systems-based approaches to care.
In the early days of the medical school, medical facilities—mainly hospitals—worked more or less separately from each other, without a common language or common standards of care. Today, standards of organized care, computerized networks, and timely cooperation among health care providers and facilities have transformed patient care.
“Without the people aspect, without the organizational aspects of it, you really can’t reach the full potential of those technological advances,” said Dr. Stewart, recalling a 1966 report published by the National Academy of Sciences titled “Accidental Death and Disability: The Neglected Disease of Modern Society,” which pointed out deficiencies in emergency care, stressing the importance of increased education and training of emergency providers.
This report resulted in many of the developments that are taken for granted today, such as EMS, which included paramedic training for firefighters, and the creation of trauma centers.
“It became apparent that hospitals have to work with EMS, and EMS has to work with hospitals, and furthermore, these hospitals have to work with each other,” Dr. Stewart explained. “They have to cooperate and communicate with each other and share timely information about the patient. This became the driving force behind the development of trauma centers and improved quality patient care. This communication and cooperation is the natural extension of that original EMS system led by the School of Medicine’s original faculty. This has led to key partnerships with University Health System, Brooke Army Medical Center/San Antonio Military Medical Center, and collaboration with all health care systems in our region. As a result, I believe San Antonio is now viewed as a national model for EMS and trauma systems and also a model for military-civilian partnerships.”
The simple version of the trauma center’s fundamental goal remains the same as it was in the beginning of the American Trauma Society’s 1968 mission: “to prevent injury and trauma; and when trauma does occur, to ensure that the injured victim is cared for by the ‘right people, in the right place, at the right time.’ ”
“Also, getting the right information to the right person in the right amount of time makes the difference in quality patient care. If you do this, you can have logical, effective, well-coordinated response and care,” Dr. Stewart continued. “Those general principles have flourished in San Antonio. They have literally grown here and, in some cases, grown here disproportionately compared to other places. This is primarily due to the relationship the medical school has with University Hospital, our Department of Defense partners, and the community.”
San Antonio and the medical school’s faculty have taken those principles and applied them to disaster response using their well-honed EMS and trauma system to help residents during Hurricane Harvey and victims of the Sutherland Springs shooting, both in 2017.
While patient care during the first four decades of the medical school centered around the school’s partnerships with University Health System and the South Texas Veterans Health Care System (STVHCS)—the school’s two primary teaching locations where residents and students conduct clinical training—the last decade has given rise to a new way of looking at patient care, and for the medical school, a more self-supporting one.
Dr. Rosende joined UT Health as the inaugural director of the eye clinic for the Texas Diabetes Institute in 1999. As chair of ophthalmology, he designed the eye clinic at the Medical Arts & Research Center (MARC). He was asked in 2010 to manage clinical affairs for the entire medical school.
When the medical school was founded, it received financial support from the state and was financially dependent on contracts with Bexar County and the VA. The school did not have a financial need to seek private patients, therefore its clinical practice existed primarily for the purpose of caring for patients and teaching medical students and residents. As state support decreased over the years, it became apparent that these contracts alone could not financially sustain the school so other avenues for revenue were required.
The first major change came with the creation of an integrated clinical practice which would make the medical school’s practice a destination of choice for the community, and in 2009 the MARC opened as a home for this new integrated clinical practice. With more than 800 physicians representing more than 100 specialties and subspecialties, UT Health Physicians is the largest group of specialists in Central and South Texas.
“We still partner with University Health System and the VA because we are able to provide outstanding patient care to our nation’s veterans and area residents while our students receive invaluable experience,” said Dr. Rosende, a retired Navy captain, “but we cannot be dependent on them for our financial sustainability. The practice does not make a margin on contract revenue because the contracts can only cover costs and without a margin there is no money to invest in our other missions.
“It is only by seeing private patients that the practice is able to generate a margin that allows us to invest in education and research to help improve the health and well-being of our patients and community.”
The school has worked to ensure its future in the changing health care landscape by managing its finances more efficiently and following its clinical strategic plan which includes four major components—expanding primary care, increasing access, expanding its geographic footprint, and creating centers of excellence.
“Population health and value-based care are the future of health care,” Dr. Rosende said, “and we intend to be a leader in improving the health of the residents of San Antonio and its surrounding communities. Population health management places an emphasis on primary care and aims to improve the patient experience of care while improving health outcomes and reducing cost.
“UT Health Physicians is proud that our primary care has been a NCQA-recognized Patient-Centered Medical Home since 2016. Patient care is our first priority, and we are stepping up when it comes to providing quality care and improving access to care when it is in short supply and high demand. We will continue to advance the knowledge and practice of medicine so people can be healthier.”
As it adapts to the 21st century and prepares for the next 50 years, the Long School of Medicine will continue to emphasize the most important factor in the equation—the patient, just as Albert E. Sanders, M.D., retired orthopaedic surgeon and founding faculty member, advises.
“Take the best care of every patient who comes through your door,” said Dr. Sanders, 85, who taught anatomy for 30 years and taught the management of scoliosis. “Everything else will fall into place.”