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Patient-Responsiveness, Innovation, and Collaboration

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LEXINGTON From rheumatic fever as a child through his graduation first in his medical school class, Dr. William O. Witt’s plan had always been to be a pediatric cardiac surgeon. When chronic pain following a skiing accident in 1978 nearly ended his then planned career, little did he know that it was creating a new one as a pain specialist. “It was a surprise ‘gift’ for which I never would have thought to ask,” says Witt.

Accordingly, Witt’s creation of the Cardinal Hill Pain Institute (CHPI) in 2009 was the culmination of several decades of experience both as patient and as physician, and a strong commitment to improving it. Witt has benefitted from the convergence of three forces: Cardinal Hill Rehabilitation Hospital’s vision for patient-centered treatment and their consequent facilities expansion; his own continued innovation and collaboration; and his enduring commitment to “help my patients have better pain relief and better function as well as to feel better about the process.”

For Witt, who is board certified in anesthesiology, critical care medicine, and pain management, the attention to patient experience is a pillar of his practice. This attracted him to Cardinal Hill with its impeccable reputation in the region and its patient-specific, optimistic culture. From the region’s only super-heated therapy pool to the abundant natural lighting, Cardinal Hill has the amenities consistent with those Witt has documented to benefit patient attitudes and perceptions. Cardinal Hill also has facilities for balance training, gait training, strengthening, and ready access to many other outstanding professionals. “The entire culture at Cardinal Hill is how we focus on our patients’ remaining abilities rather than their disabilities,” he says. When the hospital’s expansion allowed him to design his own facility in 2011, “It resulted in the perfect facility for this kind of practice.”

The Optimal Space for Patient Comfort

There is much about Witt’s facility and approach that maximizes a patient’s sense of convenience, comfort, and overall well-being, such as its reserved CHPI parking, its drive-up entrances, and its beautiful three-story glass atrium.

Once in the facility, the positive patient experience continues. His waiting room has hardwood floors, overstuffed seating, high-fidelity spa music instead of television blather, a soothing waterfall, and flat screens that scroll inspirational and educational messages. Family members often accompany patients, and they are given wireless pagers so they can be free to stroll through the sunny glass atrium, view the donated art gallery, or to just move around and still be available when the patient is done.

“My staff is the face and the soul of the practice,” says Witt. Each patient is greeted, treated, and followed by highly skilled, professionally uniformed, and always friendly individuals who have a personal stake in and a commitment to the culture of the practice.

Witt is particularly proud of his procedure and examination rooms. The main procedure room contains the best equipment of its kind available, including optimum sterility, an OEC 9900 cardiac fluoroscope, a six-axis Morgan table, and modern ultrasound imaging. His examination rooms have windows to allow relaxing natural light in, with the comfort of privacy glass. “Whenever I go to any kind of medical facility, I make a mental list of what I like and what I don’t like, and after most of my 68 years, this makes for a very long list that I have fully incorporated into the practice,” he says.

Serving Patients Thoughtfully and Thoroughly

Witt serves patients from all over Kentucky, numerous other states, and from abroad. Some out-of-state patients travel to CHPI, and his proximity to Bluegrass Field is appreciated. While he uses many approaches to alleviate pain, all patients benefit from his holistic philosophy that eschews opioids and promotes nicotine cessation, sleep hygiene, weight loss, behavioral counseling as needed, and favors long-term healing as well as management of pain. Witt says that, “Even if you cannot relieve all the pain for every patient, you can improve every patient’s function and outlook. The word ‘doctor’ from its Latin root means ‘to teach,’ and most patients are eager to learn not just what we can do, but what they can do to get better; part of my job is to teach them.”

Witt also works with other physicians who do not need a comprehensive consultation but only a specific procedure as part of their diagnostic or therapeutic plan. Accordingly, he provides time-sensitive accommodation, within a couple of days, to “any physicians who want to refer patients for procedures only, such as kyphoplasty, radiofrequency lesioning of spinal metastases, or the injection or lesioning of particular structures.”

CHPI offers a large menu of services, concisely summarized by Witt as handling “pain from virtually any structure in the spine or musculoskeletal system, by injection, augmentation, ablation, or neuromodulation with surgically implanted pain control devices.”

Innovation and Connection

Witt stays at the forefront of pain management innovation with CHPI’s most recent acquisition of the STAR® system for tumor ablation and the Radiofrequency StabiliT® vertebral augmentation system.

The Star system allows for an outpatient procedure that does not interrupt chemotherapy or radiation, is performed under local anesthesia with light sedation, and can provide permanent pain relief within two hours. This single steerable probe eradicates vertebral tumors with heat, then, allows for the injection of cement through the same cannula to fill the cavity created by the vaporization of the tumor. CHPI is the only facility in the region with this system.

The StabiliT system is also a single steerable probe for the treatment of vertebral compression fractures that allows Witt to finely manipulate the point of cement injection. As a result, all cavities and fracture lines are filled while vertebral height is restored. Earlier systems for treating compression fractures cannot be targeted in this fashion.

CHPI has always fully embraced EMR technology, and Witt continues to tout its value and tweak its uses. Beginning in 2009, he worked with Addison Healthcare Systems to develop an EMR that would be optimal for his practice (March 2012, MD-UPDATE). The laborious startup process was validated, and today he has over 8,500 patient records going back over a decade in a fully secure, encrypted system, accessible from anywhere with internet access, even on his iPhone! Patients can input their medical history online prior to an appointment or with simple check boxes on an iPad when they arrive. For Witt, developing a comprehensive and customized EMR system removed tedious, time-wasting work from his practice. Most importantly, it allows him and his staff to stay focused on their patients. He highly recommends adopting an EMR system, stating, “You will find that whatever time you spend in the practice of medicine, you will spend it with patients, not alone in your office digging through a bunch of papers and dictating charts.”

Witt is now a consultant with Addison. He brings the clinical perspective that allows the software developers to update the product to work most effectively and efficiently.

Witt highly values the many professional relationships he has cultivated over his 38 years as a physician, including a number of peers in Kentucky with whom he collaborates. He also works on national and international consensus panels regarding neuromodulation therapies. One of these panels of particular interest is on preventing surgical infection during the implantation process, drawing on his degree in microbiology, his previous experience as a reference bacteriologist with the Minnesota State Health Department, and his implantation of well over a thousand such devices and many thousands of related intra-spinal procedures.

A Forward-Moving Field Demands a Forward-Thinking Practice

Witt finds this to be an exciting time in pain management. He cites neuromodulation as one of the more rapidly developing aspects of the field, noting that Boston Scientific Corporation was just awarded a 2014 Popular Mechanics “Breakthrough Award” for its unprecedented neurostimulation technology, made all the more significant in that these awards are not just for medical technology, but for all fields of technology. “This has brought tremendous attention to our field from experts in all areas of science and technology,” he says.

Witt is poised to lead and inspire regarding non-narcotic pain management, and CHPI has garnered interest from several outside groups who have come to study his model. He also lectures around the country about his approach and its success. Although his success is timely, he is quick to say that he did not originate this approach. It began with his pain management training in 1978–79, when using opioids for chronic nonmalignant pain was anathema, and excellent results were obtained with an inpatient rehabilitative model in many ways similar to what he now does on an outpatient basis.

With virtually no published data to support the efficacy of opioids for chronic nonmalignant pain and a large amount of published data showing deleterious effects and the actual production of pain through opioid-induced hyperalgesia, he smiles while reading a recent article from the American Academy of Neurology entitled: “Potential Dangers Overshadow Advantages of Opioids for Chronic Non-cancer Pain.” Witt comments on the article: “If you practice medicine long enough, not that much is really new when it comes to how the body works!”

Through his patient-responsive setting and practices, his innovation, his local and international collaboration, and his congruence with Cardinal Hill, Dr. William O. Witt has crafted CHPI into a highly successful practice. It has kept him innovating to drive his field and practice forward. In sum, these attributes are what assure that his patients not only get better, but feel better during the process as well.