Community of Care

Ask Louisville physician A. O'tayo Lalude, M.D., about his thoughts on the recent spike in juvenile diabetes and you'll receive a response that touches on the migration patterns of prehistoric humans and their genetic adaptability before ending, five minutes later, with a discussion of modern-day America's corn syrup-laden diet.

The doctor, who has operated a family medicine practice in Louisville's West End since 1985, has become something of an expert on diabetes in recent years, partly because so many of his patients experience complications from high blood sugar.

His enthusiastic desire to share that knowledge makes for an engaging experience. And it is something that the ebullient Lalude clearly enjoys, for he regards himself as much a teacher as a doctor.

"I believe in my heart of hearts what I was told when I was a medical student 33 years ago: The word 'doctor' means 'teacher.' So when a patient comes to me and says he has a headache, what he is saying is, 'Dr. Lalude, can you teach me more about headaches?'

"That's what I enjoy about medicine."

It also is one of the things Lalude enjoys about being a gratis faculty member for the University of Louisville's Department of Family and Geriatric Medicine. The program pairs about 200 volunteer physicians from Paducah to Pikeville with UofL medical students who complete four-week rotations working in private practices in medically underserved communities. Family Medicine residents also complete two-month rotations with gratis faculty members throughout the state.

Other clinical departments have similar programs, bringing the total number of gratis faculty in the School of Medicine to nearly 1,300 statewide.

"I really like working with the students and teaching them what I know about the practice of medicine," Lalude says. "It's a tremendous opportunity to share my enthusiasm and passion for primary care."

Lalude has about 4,000 patient encounters annually, and many of those patients are being treated for diabetes, high cholesterol and hypertension. Because he was so successful at managing the care of his diabetic patients, Lalude was asked in 2005 to join Bridges to Excellence, a national consortium of Fortune 500 companies working to improve patients' health care while also curbing runaway costs. Both goals can be met, sponsors say, by encouraging physicians to follow best medical practices when caring for their patients.

For Lalude, that means treating diabetes as aggressively as possible, including rigorous follow-ups to ensure that patients don't develop expensive and debilitating complications like stroke, heart attack and kidney failure.

"We're spending a horrendous amount of money on treating all these complications when we should be focusing on the underlying causes," says Lalude, whose participation in the program has been featured in Business Week and U.S. News & World Report.

Students who rotate through Lalude's practice get to benefit from his extensive clinical experience, but they also have the opportunity to learn more about real-world societal considerations, like the nuances of insurance reimbursement. And they learn the satisfaction of providing ongoing care in a community-based physician's office, he says.

"Some students who rotated with me over the years were planning on going into surgical specialties, but after their rotations, they decided to go into family medicine," Lalude notes. "They loved the enthusiasm and the joy of practicing medicine in a primary-care setting."

Jeniffer Gerstle, a fourth-year medical student, says Lalude's enthusiasm for primary care can be infectious.

"He has such a passion for what he's doing for the care of his patients," says Gerstle, who completed a rotation with Lalude this summer. "He spends a great deal of time with each one of his patients, and he makes sure that they receive extremely comprehensive follow-up care.

"Dr. Lalude really taught me a lot about the importance of providing thorough primary care and meeting the needs of medically underserved populations in a compassionate manner."

Rural Eastern Kentucky is an equally underserved population, which is one reason why two Pikeville-based School of Medicine alumni have been volunteering in the gratis faculty program for 21 years.

"My husband and I started teaching in the program because the Pikeville area was so terribly medically underserved 20 years ago," says Betty Coleman, M.D., who operates a family medicine practice with her husband, Larry Coleman, M.D. "It was really hard to get family medicine doctors down here."

Through the years, however, hundreds of UofL medical students have traveled to Pikeville for monthlong rotations in the Colemans' office, often staying as guests at the couple's home -- and taking the opportunity to experience backwoods four-wheeling in the Colemans' classic Willys Jeeps.
Many have elected to return upon graduation so they themselves could practice in this eastern mountain community of 6,500.

"I think having students come out and work with us made them much more likely to come back here and set up practice in Pikeville," Coleman says.

"Appalachia is different. The people are different and the language is different. Some of our patients have never been very far from home, and we still have patients who have never ridden in an elevator until they visit our local hospital.

"But students who come here get to learn a new culture and see how it affects patient care. This is a Bible-belt community, for example, so no one admits to drinking alcohol, even though we have alcoholics."

Students also get to see how two married doctors were able to balance life with a medical practice while still finding time to raise a family, Coleman says.

Partly as a result of the Colemans' efforts, Pikeville is no longer medically underserved. (The town's 200-bed hospital even supports open-heart surgery and chemotherapy treatments.)

"We're working right now with three doctors who share coverage with us on weekends who were students with us before they got their degrees," she says.

And while their original goal has been met, the Colemans continue to participate in the gratis faculty program for the simple enjoyment it provides.

"We like having medical students around," Coleman says. "They make you think about what you're doing, and they're great researchers.

"They also make some rare diagnoses every once in a while because they have the time to really dig into unusual cases."

The experience is just as rewarding for the students, says Mary Jo Ratliff, a UofL School of Medicine graduate who completed a rotation with the Colemans in 1989 and later returned to Pikeville to practice anesthesiology.

"My experience with the Colemans was just fantastic," Ratliff recalls. "They're extremely organized and conscientious physicians, and they're very caring people who are interested in taking care of the whole patient," Ratliff says.

"I think the mountain people here have an undeserved reputation, but students can see after working in Pikeville that there are good, intelligent people everywhere."

Donna Roberts, M.D., pre-doctoral director for the Department of Family and Geriatric Medicine, says the gratis faculty program has been tremendously successful, both for students and physicians, because it benefits everyone.

"The students get to see the day-to-day management of chronic and acute illnesses in a smaller setting and work one-on-one with a physician," she says.

"That's a much better family-medicine experience than what they could have on campus or doing rounds at University Hospital.

"And the faculty members all say they get a lot of satisfaction and educational stimulation from this program. The students challenge the physicians, and the physicians challenge the students.

"It's a win-win situation."