Friday, November 29, 2013

School-based clinic in KCK has some teeth

By MIKE SHERRY, Kansas Health Institute 

KANSAS CITY, Kan. — Past the soaring main entrance of Wyandotte High School, and through the broad hallways of the Depression-era building, sits a warren of offices that is domain of school nurse Karen Dewberry.

“Until Wednesdays,” she said, “when BullDoc takes over.”

Taking its name from the school’s bulldog mascot, BullDoc is free clinic that serves a student body of more than 1,400 kids in grades nine through 12. Now in its second year, BullDoc is a partnership between the University of Kansas Medical Center and the Kansas City, Kan., school district.

Similar to JayDoc, the student-run community clinic that KU Med has operated for a decade, officials said BullDoc is equal parts safety-net provider, learning lab, vocational training ground, and even vehicle to boost student achievement.

Open from 9 a.m. to noon, officials said the clinic might serve as many as 40 students each session.

Medical staff generally includes four or five novice medical students overseen by their physician professors. Seniors at the school, who are working on a capstone health project, help run the administrative side of the clinic.

Patient needs range from pre-participation physicals for sports, to medication management for asthmatics, and treatment, assessment and referral of mental health issues. The clinic also provides information and counseling on sexual and reproductive health.

Boosters of the clinic include Drs. Allen Greiner and Joe LeMaster, who serve as co-directors on the KU Med side, Robbie Howard, a health science teacher who administers the clinic for the high school, and Wyandotte Principal Mary Stewart.

“There is the potential for this to turn into an overall solution for medical care for a substantial portion of the population,” LeMaster said, “meaning the kids that are in schools and their families that maybe don’t have access to medical care in other ways, in other places.”

A day in the life

As the clinic opened for business last week, the medical students huddled with the student helpers. A couple of the seniors also manned the entrance to greet patients and to shoo away gawkers.

Space in the clinic is tight.

For vision exams, patients stood against a bit of wall space in one room and read an eye chart hanging in the office next door. In a big room across the hall, a few curtained metal frames provided exam space.

In one corner, first-year medical student Molly Wingfield checked the blood pressure of a wrestler. His readings have been high, so LeMaster told the student they needed to keep an eye on him.

Wingfield said it was a little nerve wracking working with patients so early in her training.

“But I feel like I’m actually helping some people, which is really nice,” she said. “And, it’s a really good service for the students.”

Medical students typically don’t start their clinical training until their third year of school, and first-year student Tequilla Manning said the early experience at BullDoc provides some “baseline information about interacting with patients.”

She also liked that she could take what she is learning in class and put it to use in a real-world setting. “I’m not just waiting until my third year to apply all that medical knowledge,” Manning said.

As for Jessica Rodriguez, 17, one of the Wyandotte students working in the clinic, she said the experience is giving her a birds-eye view of the life of a physician. She wants to be a pediatrician.

“It gives me an idea of how I’m supposed to be doing my job,” Rodriguez said.

Seeing the medical students in action, she said, also provided insight into what her schooling might be like in the not-to-distant future.

Faculty views

Stewart, the principal, said the interaction with the medical students and the doctors makes BullDoc something of a “step before going out to an internship” for the high school students.

And Howard, the health science teacher, credited the availability of the physicals with a surge in participation in school sports. Frequently, he said, families don’t have the money to pay for the required pre-participation exam.

And once students become involved in sports, Howard said, it encourages them to maintain their grades so they can remain eligible.

Greiner said BullDoc grew out of conversations between the Department of Family Medicine and local leaders on how the department could help the community. The discussions highlighted schools as one area of need, he said.

And now, LeMaster said, the KU Med School of Nursing is looking at replicating BullDoc at another district high school for its nurse practitioner students.

One plan for BullDoc, said LeMaster and Greiner, is to get it to a point where it can bill Medicaid and private insurers, if the students have such coverage. They estimated the annual cost of running the clinic is about $100,000.

“I’d like to see us almost like every semester take a little baby step forward,” Greiner said. “I think it’s the best way to be sure that we put something in place that, just like JayDoc, 10 years later, we look back and we go ‘Oh yeah, that started 10 years ago, and it’s doing just fine and meeting its mission.’”