Brad Johnson, MD, was attracted to emergency medicine because he liked the faster pace and the critical decisions needed to save patients’ lives.
“The thing that drew me to emergency medicine is that many of the decisions you make can have a big impact later on,” he says. “And having the opportunity to see this impact is what attracted me to critical care.”
His emergency medicine residency at Henry Ford Medical Center led the Chicago native to the Critical Care fellowship at the University of Iowa’s Department of Anesthesia, where he has pursued a philosophy of “continuity of care.” Last fall, he and several other clinical providers from the Department of Anesthesia visited skilled nursing and rehabilitation facilities in the Des Moines area to get a broader perspective on the patient journey to recovery.
“It was incredibly valuable. We had the ability to receive feedback that we normally would not receive in the critical care environment,” Johnson says. “I was able to talk to a mother whose son was in a horrendous car accident, and she gave us insight about bedside manner, the family’s perspective, and how the small things can make a huge impact.”
“In the ICU, patient care is more of a marathon, with many small, seemingly benign decisions. It’s easy to lose perspective of what those smaller decisions mean down the road,” he says. “When you see a patient doing better after an ICU stay, that’s a big victory.”
It’s also the impetus behind Johnson’s ultimate goal of pursuing a pain fellowship: establishing a “continuity of care” clinic.
About half of ICU patients go on to develop chronic pain, he says. Having a clinic where providers are intimately familiar with the patient’s ICU course and progress can benefit both the patient and the providers.
“In emergency medicine and critical care, you rarely see the patient after they’ve been discharged or moved on to a different type of care, so it’s difficult to know how they do afterwards,” Johnson says. “But if you can stay with the patient through the entire recovery process, you get better at understanding the disease process and how your early decisions affect the patient and the family, and the patient can stay with one provider to continue their long term recovery.”
Johnson isn’t the only one looking at a more holistic view of the patient journey. Loma Linda Medical Center in California recently conducted a pilot project using anesthesiologists as perioperative hospitalists and found that the model decreased patients’ length of stay and reduced both complication rates and total direct patient costs after urologic surgery.
Still, Johnson acknowledges that he’s not quite in the mainstream in his subspecialty.
“Not many intensivists want to care for these patients long-term yet, but there seems to be a slow-growing movement toward that,” he says. “I’d love to see Iowa at the forefront of that movement.”