July 09, 2013
By David Martin
|KU School of Medicine student Alicia Rose and Fred Gilhousen, M.D.|
The student and the physician are considering the case of the patient with brown urine.
The patient, a 30-year-old male, had described an isolated incidence of brown urine to a University of Kansas School of Medicine student minutes earlier during his exam at the JayDoc Free Clinic, a student-run clinic that provides health care to uninsured and underinsured residents in greater Kansas CIty. The student leaves the exam room to discuss the patient's case with Fred Gilhousen, M.D.
"Painless," the student says. "No fevers, no chills, no pelvic pain. He said his diet hadn't changed."
"And it never happened before?" Gihousen asks. "Just the one episode? But he must have been worried about it, or he wouldn't have come in. Or somebody made him come in."
The student says the patient has been using methadone to stay off heroin. Gilhousen prompts the student to think about a possible link between drug use and the discolored urine.
"Why would he have brown urine if he had some systemic problem?" he asks. "What would be the most common cause of that?"
The student ponders.
"The same thing that may turn his eyeballs yellow…" Gilhousen says.
Bingo. Gilhousen briefly describes the increased risk of hepatitis that heroin users face as a result of reuse of syringes and injection paraphernalia. "One of the early symptoms of hepatitis sometimes is brown urine — even before yellow sclera," he continues. "They get that because their bilirubin is not being properly metabolized."
Gilhousen asks the student if the patients' eyeballs looked yellow.
"So he had a single episode," Gilhousen says. "It may never happen again. But while he's here tonight, we ought to get a urinalysis. Let's see if there is any bilirubin in the urine. We'll check to be safe."
‘Something I wanted to do'
Now its 10th year, the JayDoc Free Clinic operates three evenings a week in the offices of Southwest Family Boulevard Health Care, a few blocks from KU Medical Center. The clinic is an all-volunteer effort, from the Spanish-language interpreters to the attending physicians, like Gilhousen, who coach the students in seeing and treating patients.
Gilhousen started volunteering at the clinic in the spring of 2012. He usually works two or three nights a month, though it's been as many as five or six. "I made the mistake of saying I could be there at a moment's notice," he jokes.
A 1966 graduate of the School of Medicine, Gilhousen was drafted into the military while he was an intern. He served as a medical officer at Eglin Air Force Base, Florida, where he was assigned to the orthopedic clinic. When he completed his service, he completed an orthopedic surgery residency at the University of Oklahoma. He worked as an orthopedic surgeon in Kansas City, Kan., before retiring in 2011, at age 71.
Gilhousen learned about the opportunity to volunteer at the JayDoc Free Clinic from the KU Medical Alumni Association. He liked the idea of spending some of his newfound free time with medical students. "It struck a nerve with me that it was something I wanted to do," he says.
Sarah Dickes, a medical student who was in charge of physician relations at the time, showed Gilhousen around the clinic and described the types of cases — yeast infections, early pregnancies, spider bites — he was likely to see. JayDoc is a primary care clinic, but the students who run it don't turn away physicians with more specialized skills, like Gilhousen's. "Mostly, we want docs who can and want to teach," Dickes says.
On a typical night, patients arrive at the clinic at 5 p.m. A triage process identifies the patients who would benefit the most from the clinic. (The students do not treat broken bones or mental illnesses.) The clinic serves between 12 and 18 patients on the general clinic nights. On Tuesdays, the clinic provides specialized care — diabetes, physical therapy — on a rotating basis.
Students are meeting with patients in the exam rooms at 6 p.m., when Gilhousen typically arrives on nights he volunteers. He often brings piece of antique medical equipment from his personal collection. On a recent Wednesday, as he waited for a student to bring him a case, he modeled an instrument that resembled a corkscrew. "Every Civil War surgeon had one of these," he explained.
A student correctly guessed that the device, a trephine, was used by field surgeons to bore into wounded soldiers' skulls.
Some of the students who volunteer at the clinic are in the first year of their medical education. Gilhousen is mindful of their inexperience. When they present cases to him, he wants them to understand that there is no such thing as a dumb question. "We don't want to short-circuit the learning process," he says.
Gilhousen has vivid memories of his days as a student at the KU School of Medicine — and feeling incompetent. He says he once tried to listen to a patient's breathing with the physician end of the stethoscope still wrapped around his neck.
"I remember feeling awfully inadequate as a young medical student and wanting to disappear into a corner somewhere," he says.
‘It just leaks out of you'
After the student and attending physician have met outside the exam room, they see the patient. Gilhousen says the right way to approach a patient has not changed since he was a student: Make eye contact, extend a hand, get down to patient's level, establish rapport.
Gilhousen talks to the students about the importance of being conscientious and concerned. But mostly, they learn by watching him. "It just leaks out of you when you enter the room," he says.
Bedside manner is not the only thing students can pick up from Gilhousen. His upbeat attitude signals to the students they are embarking on a rewarding career. "I hope that we impart that medicine can be sort of fun, too," he says. "You can't lose that glow, or you're going to be miserable."
Gilhousen's good cheer contributed to his being named the JayDoc Free Clinic's volunteer physician of the year. Dickes says students are more likely to sign up for shifts at the clinic if they know they will be working with caring mentors. "We're lucky to have Dr. Gilhousen," she says.
Phillip Olsen, M.D., who practiced internal medicine in El Dorado, Kan., is also a mostly retired alumnus who puts in regular hours at the clinic. He is able to volunteer after moving to the Kansas City area to be closer to his daughter and her family. "It sounded like a good opportunity to help the students and help the patients," he says.
Willing and able volunteer physicians allow the students to focus on care giving. Last fall, Dickes attended the annual meeting of the Society of Student-Run Free Clinics. She listened as students at other schools talked about their struggle to find volunteers and solve other administrative problems. "We didn't realize how well supported we were by the community," she says.
As for Gilhousen, he says he is delighted that students — especially the first- and second-year students — have such a rich opportunity to further their medical education. He says he and the other physician volunteers are the least important members of the team, but Dickes reminds him that there would be no JayDoc Free Clinic without them.
After Gilhousen and the student worked through the case of the brown urine, a fourth-year student asked him to consult with her about a woman complaining of a sore throat.
"All right, fire away," he said.