Richard Altmann could easily be a very sick man right now.
Richard Altmann, Stratford, Wisconsin, is able to control diabetes, high blood pressure and high cholesterol by working with his Marshfield Clinic health care team.
He’s been diagnosed with diabetes, high blood pressure and high cholesterol, any one of which can cause life-altering or fatal complications.
Richard Altmann, Stratford, Wisconsin, is able to control diabetes, high blood pressure and high cholesterol by working with his Marshfield Clinic health care team. The fact that he is healthy and active in his late 70s speaks volumes about the care he receives from Kori Krueger, M.D., an internal medicine and pediatrics physician at Marshfield Clinic Stratford Center.
Altmann, of Stratford, found out at age 66 that he had type 2 diabetes, for which he takes oral medications but does not need insulin.
His high blood pressure has settled down with pills, to the point he doesn’t need to take them.
He continues to check his blood pressure every day. Likewise, his cholesterol levels were high but are now under control with medication.
“I take my medicines every day, and apparently they have worked,” said Altmann, a semi-retired courier driver.
Sees doctor regularly
“I see Dr. Krueger regularly, usually every three to six months. I have a lot of respect for him because he takes the time to talk to you and asks the right questions. He always wants to know if anything new is bothering you.”
Dr. Krueger, who serves on the Clinic’s Quality Improvement and Care Management Team, believes strongly in developing such a relationship with patients.
That requires investing time at the beginning to inform and educate the patient about what is being done and why.
“Diabetes is a good example. When patients are first diagnosed, I sit down with them and go over thoroughly what does this mean, why is it important to you, and I explain in very explicit terms what a hemoglobin A1c is,” he said.
“It takes a little time, but this is a lifelong diagnosis and if they understand it, that will ultimately save a lot of time, and they are so much more satisfied.”
It’s also a key reason that Marshfield Clinic did so well on the demonstration project conducted by the Centers for Medicare & Medicaid Services.
Altmann has had other health conditions. At about age 70, prostate cancer was detected at an early stage and removed without the need for radiation or chemotherapy.
After that he had carpal tunnel surgery on both wrists. He has had ongoing osteoarthritis, which has slowed his enthusiasm for polka dancing, although he and wife, Dorothy, still enjoy the music.
These kinds of health developments are all part of patient care, and the physician has to be flexible.
“It’s like a dance between the patient and doctor, with the music continually changing, and the patient is leading that dance,” Dr. Krueger explained.
“The key is being in tune with where the patient is. If I come in to the room and I’m focused on the patient’s cholesterol but he is focused on his spouse dying three weeks ago, I’m not going to get very far. Cholesterol may not be the most important thing we address that day, but if I can address their needs and wind in my concerns, they do appreciate it.”
Dr. Krueger’s interest in quality improvement and care management stems from his interest in the “big picture.” If a provider cares for 100 patients with high blood pressure and brings an extra 20 patients under control over and above their current rate of control, that's great.
Multiply that by the many thousands of patients in the Clinic system, and hundreds or even thousands of major events like heart attacks could be prevented.
“We’ll never know if Mr. Altmann might have been one of those types of statistics,” Dr. Krueger noted, “if his chronic conditions were not so well controlled.”
The quality improvement initiative focuses on how Marshfield Clinic provides care to patients.
“We’re talking about how we can make things better for Marshfield Clinic patients,” Dr. Krueger said. “If we can improve their health and their understanding of their health and do it more cost effectively, that will reduce costs. Our focus is on the patient and how we can make the health care experience better in a global way.”