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Making the Case for Care Continuity

Nancy Morris, MD, serves patients in Laurel County with CHI Saint Joseph Health Medical Group Primary Care Associates of London.

LONDON When primary care physician Nancy Morris, MD, recently met her new colleague, vascular surgeon Sherisa Warren, DO, she was both stunned and delighted to realize that, as a high school student, Warren had shadowed her for a month. Morris says, “It was one of the coolest things to see a student that I’d worked with who had actually been successful and pursued her dream and become a physician.”

Morris, herself, became a physician after graduating from the University of Kentucky College of Medicine where she also completed her residency in internal medicine. However, her dream of becoming a doctor reaches back to her preteen years. She says, “I had really good insights in seventh grade. That’s when I thought, ‘This is the path I need to pursue.’ We had a really close family friend who was a physician. So, early on, I saw medicine as a path where I could really serve.”

Since 1998, Morris has been serving in Laurel County as a primary care internal medicine physician and joined the CHI Saint Joseph Medical Group – Primary Care of London in 2013. She sees adult patients 18 and up with a wide range of complaints. Though diabetes, high blood pressure, high cholesterol, and heart disease are the most prevalent presentations, cancers, autoimmune disorders, and other rarer diseases. She also enjoys skin lesion removal of benign, precancerous, and cancerous lesions. Morris states, “In internal medicine, you see the gamut. You see all of it. So, you have to stay sharp on even some of the rare things, because every now and then you’ll diagnose something that’s not quite as common and need to know where to send the patient to get it taken care of.”

Along with the variety of care, Morris relishes the continuity of care she can provide through internal medicine in both the inpatient and outpatient settings. “Continuity of care has been a big focus in my career. Developing that relationship with a patient in the outpatient setting and then being there for them when they’re really sick in the hospital. I have seen their eyes light up when I come in the room, and they say ‘I’m so glad you’re here.’ They feel comfortable knowing their regular doctor is there in the hospital taking care of them,” Morris states. “You have the advantage of seeing them when they’re really sick in the hospital, but also in an outpatient setting, following through with them after they’ve been in the hospital. You have the advantage of developing a relationship with them in the outpatient setting, so you’re taking care of all their preventative care needs.”

Ten Hours Is a Short Day

Making rounds at the hospital is how Morris typically starts her morning at work. Next, she heads to the clinic where she sees an average of 24 patients a day. In the midst, she must fulfill her duties as Medical Director of the Hospice Program and as attending physician for her nursing home patients. Add to that paperwork, charting, meetings, and mentoring, and you have one packed schedule. Morris says, “It’s a ten-hour day most days. Sometimes I do wear too many hats, but there is such a need in our community. There are just not enough doctors here. We need more physicians that will come and serve.”

Morris is concerned that the trend in internal medicine is to lean away from continuity of care in favor of specialization, with very few internal medicine programs teaching inpatient and outpatient care in tandem. According to Morris, “In my specialty, on the horizon, you’re not going to see physicians like me very much. You’re not going to see doctors who do inpatient and outpatient and manage nursing home patients. Most internal medicine physicians now focus on one or the other; they don’t do both. I’m still old school. And I think there is so much value in that continuity of care. “

Doctor as Patient Advocate

Along with continuity of care, Morris puts the greatest emphasis on patient advocacy and prevention. Morris says, “Being a patient advocate is something they don’t really teach you in training, but you have to learn once you’re in practice for a little bit. You have to learn to fight for your patient. If there’s a test they need, if there’s a medicine they need and their insurance company is not giving you the option, how do you go about fighting for your patient and being that patient’s advocate? No one else is going to do it for the patient.”

The other chief component in her philosophy of care is prevention: “Prevention is one of my number one focuses in my day-to-day discussions with patients and patient interactions. I ask, ‘What can we do to keep you from developing diabetes? What can we do to prevent you from having a heart attack? If you’ve had a heart attack, what can we do to keep you from having another one? What can we do to keep your bones strong to keep you from falling and breaking your hip?’”

In her practice, as part of prevention, obesity management is crucial because of its link to already pervasive problems such as diabetes, high blood pressure, and heart disease. However, promoting testing, including mammograms, bone density, and colonoscopies, is also key. She also encourages patients to get vaccinated for the flu, pneumonia, and, of course, now COVID-19.

Morris states, “I’ve been very pleased with how proactive my patients have been with get ting the COVID vaccine. It just showed me they are really in tune to try and stay healthy and stay well. It reinforced to me that even though I’m in a rural community, patients really do want to get better and do listen.”

In closing, Morris elaborates on that misconception about her patients. She says, “When people think rural, people think that because the socioeconomic status is not quite as high, [patients] are not going to do what we tell them and are not going to be compliant. I don’t see that. Ninety percent of patients really want to be well and healthy and they just need someone to take the time to teach them, and educate them, and help them get on the right track.”