Vital Signs: Finding a medical home

CATHY WURZER: Hey, we're starting a new monthly segment on Minnesota Now called Vital Signs. Each month, we'll be talking about topics that are important to your health and take a deep dive into medical news or what's on top of mind at the doctor's office. Joining us will be a familiar voice to longtime MPR listeners, Dr. Jon Hallberg. Dr. Hallberg is a family medicine physician at Mill City Clinic in Minneapolis and a professor at the University of Minnesota Medical School. I can't tell you how excited I am to have you back in studio.

JON HALLBERG: Oh, Cathy. This is so fun for me to be back. We were just talking. I haven't been here in about four years, and it seems like such a long time. And yet, it seems very familiar. Thank you so much for the opportunity to do that.

CATHY WURZER: Oh, I'm so happy that you're here, and there's a lot to talk about. But first, I want to introduce you to listeners. Just those who, of course, hear your voice, and they're like, yes, oh my gosh, he's back. For those who don't know you, you're a family practice physician, family medicine physician.

JON HALLBERG: That's right.

CATHY WURZER: And that means what?

JON HALLBERG: So family physicians, we are trained-- going back to residency, you graduate from medical school, you go into family medicine. Though it's very general by definition, it is a specialty. Back in the day in the 1960s, people would do a year of internship, a one year, and then they'd be ready to practice, and those were general practitioners.

But starting in the late 1960s, family medicine became its own specialty, and we specialize in the human condition and everything from preconception to the end of life. So truly, cradle to grave. My practice, I have focused. I'm just an outpatient doctor, so I'm just in clinic.

But many of my colleagues, especially those in outstate greater Minnesota, do everything and do everything that they were trained to do including delivering babies. They might do an ER shift. They'll probably round at the nursing home. I mean, really, we can do everything.

CATHY WURZER: I'm wondering here, because we've been following the closure of two rural Minnesota clinics, ending labor and delivery services. Ones in Fosston, which is in Northwestern Minnesota. The other one's in New Prague, South of the Twin Cities. As a family practice physician, does that worry you?

JON HALLBERG: Oh, I think as a citizen it worries me, being in Minnesota. I mean, this is happening-- I saw a statistic that Minnesota led the country in the number of rural hospitals that stopped providing OB services. And in fact, I think that people are going to be really surprised to know that many if not most of those deliveries that you're hearing about in these small hospitals? Family physicians are doing those deliveries.

CATHY WURZER: What?

JON HALLBERG: Yeah. That's part of our training. I mean, there just aren't-- it's going to be hard for an OB-GYN to want to be in a small town with little backup, call coverage. I mean, I think that gone are the days where you've got physicians who are willing to just do it all themselves, just be there, be on call 365 except for the few times they're away on vacation. That just doesn't happen.

Rural hospitals, just like urban and suburban hospitals, need experience. They need depth. They need coverage. And this is getting harder and harder, I think, to be on call and get enough-- if you deliver babies, you want to do a lot of that. This is not an episodic thing. You don't want to do it every so often.

And so if the numbers are dwindling, fewer people are pregnant in rural areas, fewer deliveries, you're not getting as much experience. The malpractice rates may go up. If there is a complication, it can be not good for all kinds of reasons. Yeah. It's a multifactorial problem, and it is it's a sad thing.

I mean, suddenly you're 30, 45, 60 minutes away from the next closest hospital. And if you're a pregnant woman and you're going into labor and things are progressing quickly and it's snowing? You're going to end up in the local ER and delivering there, and that's not ideal. Yeah. It's very complicated.

CATHY WURZER: Say, as a physician, and I recall you talking in the past about this concept-- maybe we can dive into that right now. You talk about everyone should have a medical home.

JON HALLBERG: Absolutely.

CATHY WURZER: What does that mean?

JON HALLBERG: So I think that every one of us needs a landing place, needs a home. I love the idea of a home. In the best of all possible worlds, everyone has a clinic that they love, that they have a primary care clinician who they love. I know that's hard.

And let's say you're a young person. You've got a super high deductible. You're healthy. Why would you think about trying to establish care with somebody? What do I need that for? If I get sick, I'm just going to try and do something online, or I'll go to--

CATHY WURZER: Urgent care.

JON HALLBERG: Yeah, urgent care. Emergency center, emergency room, even, for that matter. Although, co-pays are high there. It's just the absolute wrong place to go for an earache, for example. And the longer I'm in this business-- and now this is my 28th year after residency of practicing-- the more I realize that people need a place to land.

They need someone they can trust. Scary things happen. Scary things, frightening things happen when we least expect it. And what do you do when something like you've been given a diagnosis, or you're not getting better? And you did go to the ER. You did go to the urgent care center. How do you follow that up?

And I've just found that the wisdom, the context, the reassurance, the care that we can provide is essential, so I think that everybody needs to think about this and establish care with someone that you can have a conversation with, that you can trust. I can't emphasize enough how important that is.

CATHY WURZER: If you find a medical home-- and I understand the concept, what you're talking about-- how could that could that result in better communication between you as provider and other specialists, better coordination, that kind of thing? Does that help keep down costs, perhaps?

JON HALLBERG: Oh, absolutely. And I will say this. I mean, this seems like maybe an odd thing to bring into this, but most of the health systems in Minnesota are part of EPIC, which is Electronic Medical Record. The sort of interoperability of it is amazing. So if I have someone who, over the weekend, they went to an Essentia clinic, and then now they're following up with me,

I can see all the labs. I can see the X-ray report. I can see what the thoughts were of the person that they saw there. Mayo, a number of years ago, went to Epic, and oh, my gosh. I mean, I've got a lot of patients that go to Mayo for various reasons. And they can see my notes. I can see their notes. I mean, that sort of shared information is just incredible.

I mean, it wasn't that many years ago, charts were manila folders with pieces of paper inside. We'd have shopping carts that we'd take charts from clinic to clinic at the university. Where's the chart? And who knew? Oh, my gosh. I mean, isn't that amazing? That was the early 2000s.

CATHY WURZER: Not that long ago.

JON HALLBERG: And now, it's just it's a game changer. So that part's important. But yes, I mean, I think that having-- my specialty colleagues are great. My ER colleagues are wonderful. But patients are often very confused by the information that's been shared, or they're overwhelmed.

We kind of joke that many of my patients don't need my blessing on things. And it's not a blessing, it's a contextualizing of things. They trust me, and they really want to get me to weigh in on it. And there are times it's like, guys, you have cancer. I'm not going to be able to weigh in on the different kinds of chemotherapy that are being proposed.

But sometimes, they just need to hear that, too. You're seeing a great oncologist. Please trust what they're saying. It's really important that you just follow through. And I'm going to be here for you if you need me, but for right now, you've got a care coordinator.

You're getting this care. I'm going to step back, but I'm here for you when you're on the other side of this, and you're doing well, and we need to monitor things. So it's just dozens and dozens of reasons why it's important to have that landing home, that landing place.

CATHY WURZER: I wonder if COVID has underscored, then, the need for a medical home.

JON HALLBERG: I think it has. And I think that when we were in kind of those early days-- I mean, my little clinic, we're seeing about 100 new people a month that are establishing care with my colleagues. And that picked up in that summer of 2020 into 2021. I think people realized, holy cow. I don't have anyone.

If I get COVID, who am I going to talk to? Where am I going to go? And I think that underscores the importance of that. It has. And now that we're seeing more RSV and we've had influenza, and there, too-- if people want to be on, for COVID, they want to be in Paxlovid. Yes, there's a state way.

You can go through an MDH, Minnesota Department of Health Website to get treatment. But still, we know your medications. We've got the list right in front of us. We can see if there's any contraindications or something, a med you hold while you're on it. So again, one more underscoring of how important it is and why it's so important to have a health care home or a medical home.

CATHY WURZER: Speaking of COVID, you mentioned RSV, the flu, I see they're all trending downward in Minnesota according to the Department of Health. Viruses, I understand, don't do as well in warmer weather. So is this weirdly warm weather that we're having and are forecasted to have into this coming week-- is that doing anything maybe to tamp down the cold and flu season?

JON HALLBERG: It's really hard to say. Just to be clear, I think that it's not that the temperature itself does anything with the viruses, it's people. It's us.

And so I think what the hypothesis is that when it is really cold-- and when it's cold in Minnesota, the air is really dry, and then our mucous membranes are in turn kind of dry and fragile and crusty, it's just so much easier for a virus to land whether it's in the back of our nose or in the back of our throat.

Then, it's nice and warm and humid and dark and just perfect culture medium to make millions, billions, trillions of copies of yourself. So it's really not like the temp, per se. It's more probably what it's doing to us.

And also, human behavior. The winter, we're all indoors with one another. We're not outside playing. And so I think that's why there's a seasonality to it, to some extent. At least, that's what we think. So who knows? I mean, it could just be that it's just this weird little blip. Maybe it's going to peak again. I think this is hard to predict right now what's happening.

CATHY WURZER: Is it still too late to get vaccinated against all those diseases?

JON HALLBERG: No and never.

CATHY WURZER: We'll have you back next month. Next month. Is that OK?

JON HALLBERG: Oh, it sounds great. I would love that.

CATHY WURZER: OK. Dr. Jon Hallberg, Family Medicine Physician at Mill City Clinic and a professor at the University of Minnesota Medical School.

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