Cheryl Martin (Host): A look at primary care on this episode of Curating Care, a podcast brought to you by St. Clair Health, expert care from people who care. I'm Cheryl Martin and joining me is Dr. Amanda Hercules-Smith, an Internal Medicine Specialist with the St. Clair Medical Group. It's great to have you on, Doctor.

Amanda Hercules-Smith, MD: Thank you for welcoming me.

Host: First, please tell us a bit about yourself and what led you to choose internal medicine as your specialty.

Amanda Hercules-Smith, MD: So, as you said, my name is Dr. Amanda Hercules-Smith. I have been with the St. Clair Medical Group for now five and a half years. Prior to this, I practiced at Heritage Valley for eight years, in sort of different forms of internal medicine. So, I was a Hospitalist, which is primarily an inpatient doctor. I also practiced traditional medicine, doing inpatient and outpatient, as I do now. I've been out of residency for about 13 years, and, I like internal medicine. I had excellent training at Allegheny General Hospital, in a wide range of common and complex medical issues, which drew me to internal medicine.

And I read something recently which said it's similar to a pediatrician for adults. And that's what it is, focusing on adult medicine, and getting a comprehensive view of the human body. I think internists have some of the strongest work ethic in medicine. You need to be constantly learning, constantly evolving as medicine is ever changing. And I get to treat a wide array of illnesses which is what drew me to internal medicine in the first place.

Host: That's great. Now, Doctor, when it comes to primary care, there is of course, internal medicine and family medicine. Talk a little bit about the differences of each field.

Amanda Hercules-Smith, MD: Family medicine doctors have a broader scope than we do. They are able to see children and adults and are also trained in obstetrics and gynecology and some surgical procedures. Internal medicine physicians, our care is directed to adults 18 and over, and we have more training in disease processes that happen in that patient population.

Host: Now you also serve as the Director of St. Clair Urgent Care. Share briefly about urgent care and also when a person should go to urgent care or see a primary care physician or go to ER.

Amanda Hercules-Smith, MD: Urgent care cases can usually be seen in 24 to 48 hours. On the reverse, you have emergency care, which needs to be seen immediately and is often life threatening. And that's why we have the growth of urgent care facilities in the first place to lighten the burden and wait times in the emergency room.

And to ensure that everyone was getting appropriate care in a timely fashion in the appropriate setting. And when would you go to an urgent care, versus going to the ER? Well, at the urgent care, we're able to handle cold symptoms, flu symptoms, minor lacerations, sprains, fevers, simple rash, urinary tract infections, do STD checks. We test for COVID and the flu and RSV, minor burns, eye infections, ear infections, sinus infections, and migraines, and also, we're able to do some primary care things like urgent blood pressure management.

Host: When would a person say, I need to go see my primary care physician in this instance?

Amanda Hercules-Smith, MD: For your primary care provider would be able to handle some of the urgent things that I just mentioned. Urgent care facilities, unlike primary care offices have a walk in capability and so you be seen at any time and their hours are longer than at a traditional primary care care office. So it makes these urgent care facilities more accessible for patients.

On the flip side, we would advise patients to go to the emergency room with chest pain or stroke like symptoms, slurred speech, loss of vision, weakness, a severe headache, a head trauma, a seizure, loss of consciousness, gastrointestinal bleeding, suspected poisoning, difficulty breathing, a fever of greater than 102, abdominal pain. Those things, we would advise a patient to go to the emergency room. Any significant trauma, any uncontrolled bleeding, should be directed to the emergency room.

Host: Now, St. Clair Health prides itself on providing expert care from people who care. How do you establish and maintain continuity of care with your patients, especially those with chronic conditions?

Amanda Hercules-Smith, MD: It's very much a team based approach and it's an excellent question. Especially at our office, everyone is involved in the care of the patient, the nurse, the MA, the physician. We also have care coordinators, and most recently, triage nurses and RNs who are handling medication refills to ensure the best quality and safety for our patients.

And, patients with chronic illnesses, we have longer appointment times at the beginning to establish care, and then we try to see them on a regular basis, depending on need, for most patients every three to four months. We also involve home care and physical therapy in the community, and they act as a liaison to us, the primary care providers.

We stay in very close contact with our specialists, especially the ones within the system, to coordinate care as necessary for our patients.

Host: That's great. So, how important then is patient education in your practice and what are some key topics that you discuss with your patients to empower them in managing their health?

Amanda Hercules-Smith, MD: Patients need to be able to make an informed decision about their care. And they can only do that when they're educated about their disease processes. We talk about diet. We spend a lot of time discussing healthcare screening, the necessity, pros and cons for the patient, and what adds value to the patient's overall outlook on their healthcare. We talk about mood disorders, issues with anxiety and depression, sleep deprivation. We discuss in detail, especially in this current environment with new vaccinations, we discuss, what's necessary and what's not and how it prevents diseases, and we try to go into detail at annual wellness exams, the need for screening and early diagnosis, and prevention of chronic diseases and, the ability of these screening tests to save lives.

Host: Now, you touched on this a little bit, internal medicine often involves of course collaboration with specialists. Share some insights into how you coordinate care, more insights with other medical professionals just to ensure the best outcomes for your patients.

Amanda Hercules-Smith, MD: It's so important to communicate with other practitioners. I think in my practice, particularly, I stay in very close contact with cardiologists, nephrologists, and surgeons, who I am collaborating with throughout the day. I think the primary care provider has the most comprehensive view of the patient's overall health care. And it's important for specialists to be made aware. And it is my job as a primary care provider to relay what's happening with our patients to other medical teams. Just things like stopping and starting a new med based on what may be happening with the patient's blood pressure or their kidney function is crucial to maintain and help. Things like the psychiatrist may not be aware that the patient has been falling on the new medication that was prescribed for anxiety. And so we reach out a lot, especially for our elderly patients, to notify other practitioners about what is happening overall. As a primary care provider, I always say it starts and ends with us.

And we're the ones to close the loop and fill in the gap for our patients to the best of our ability.

Host: So how do you envision the future of internal medicine evolving?

Amanda Hercules-Smith, MD: It's a very interesting question, and I think everyone would have a different opinion. I think in the future, patients are going to be very much a part of the primary care team. They'll be able to make more informed decisions. Hopefully, we are able to integrate more supportive services such as physical therapy and dietary counseling and obesity clinics and pharmacists into the primary care model and it not be things that are outside.

I think we'll have comprehensive primary care practices going forward and, at least that's what I envision. I think there would be more in home care and remote monitoring for our patients, to improve access. I think we're going to have physicians trained for care directed at certain populations, more training for patients greater than 65, more training of geriatricians, more training of primary care providers in women's health, physicians trained to address obesity, LGBT community. I think the U.S. population is changing ever so often, as we see in the news and dealing with unvaccinated patients, would come with it's own challenges, diseases that we were not trained to treat. I think there would be more training towards that and care targeted towards a refugee population.

There'd be more resources placed into rural communities, increased procedural training. I was thinking, wouldn't it be great if your primary care provider can do your knee injections at home, and you do not necessarily have to come to the orthopedic clinic. And so, I think there would be more community based care for patients. Would we ever see physicians going back into the homes? Possibly. Our population age is increasing, people are living longer, and as time goes, that may be a necessity.

Host: Very informative conversation and insights. Thank you so much, Dr. Amanda Hercules-Smith for being with us today.

Amanda Hercules-Smith, MD: Thank you for having me. Have a great day.

Host: To contact Dr. Hercules-Smith, please call 412-835-4886. Again, that's 412-835-4886 or visit stclair.org. If you found this podcast helpful, please share it on your social media. You can also check out our entire podcast library for other topics of interest to you. This is Curating Care, a podcast from St. Clair Health. Thanks for listening.