This year will mark the 30th year since Eugene Oddone, MD, MHS began his residency at Duke. In this week’s faculty spotlight, he talks about how internal medicine has changed over the past three decades, overseeing more than 100 research projects at the COIN at the Durham VAMC, and his loves of Habitat for Humanity, mysteries, and downhill skiing.
What do you see as the biggest change in how internal medicine is performed at Duke since you arrived here? What aspects have remained the same?
Clearly the biggest change, particularly in the hospital setting, is an explosion in the availability and use of advanced diagnostic tests. In 1985 we had daily radiology rounds where we discussed shadows on plain films, occasionally CT scans; we had daily lab results, and that was about it. We were forced to talk more to our patients, and they stayed in the hospital longer, so we got to know them better. Today, when I round at the VA, we spend about half our time ordering, chasing down, and interpreting diagnostic test information, a good percentage of which is conflicting.
Another change is the evolution of Duke Health System into as a true system. In 1985, there was the hospital and the Medical Outpatient Clinic (now the Duke Outpatient Clinic). Leadership at Duke understood the importance of building a stronger primary care base. They tried a few different models over the years: first purchasing practices, then forming an HMO, and then fostering an alliance of physicians in a PPO. Now, Duke Primary Care has emerged as an essential component of Duke Health. I think the aspects that have remained the same is our strong dedication to patients and intellectual curiosity. I first saw this on rounds when I was a fourth-year medical student, hoping that Grace and I would match here.
What are your responsibilities within the division? What does a typical day for you look like?
My work week averages about four hours a day in meetings. Some of those are for my own research team and projects, some for the COIN, and other miscellaneous things. My favorite meetings are mentoring ones, and Karen Goldstein, one of my mentees, just won her VA CDA award so I will have another five years of mentoring meetings that will keep me relevant! I have my own (small!) panel of patients at the VA, and one-half day a week of clinic there (which takes about 30-45 min per day to manage outside of clinic). I say that because when you multiple my small clinical load by that of a full-time general internist…well, you do the math. I’m going to add a half-day per week in the VA PRIME clinic this coming year.
For the past few months, I’ve also been helping Ebony Boulware with promotions and tenure for the division. It can be a daunting task for faculty to put all the documents together, but it is important, and it is something that makes it unique to have a career at Duke. I’m also going to help Ebony with an annual faculty review program.
We are extremely fortunate to have Dr. Boulware as our chief. She has worked hard to understand the division, across all of its missions, and is now working to make the division a true home to over 300 faculty. Part of that is her dedication to communication as witnessed by this newsletter. But it is a big (I think the biggest) division in the Department of Medicine, so she needs help.
You’re also the director of the Center for Health Services Research in Primary Care (COIN) at the Durham VA. Can you talk a bit more about this work? What are the COIN’s most important projects for 2015-2016?
Directing the COIN is the most important thing I do. We are one of 19 nationally funded centers. Of those, we are the top in terms of winning VA HSR&D research funding. Our mission is to conduct high-quality research on strategies that enhance the delivery, access, quality, and cost-effectiveness of primary care for Veterans and the VA healthcare system. We have 31 faculty: 12 physicians and 19 PhDs. Twenty-one of those faculty have academic appointments in GIM.
We have more than 100 active research projects. Some prominent ones include Courtney Van Houtven’s national evaluation of the VA Caregiver’s Program which has provided almost $500M to caregivers of sick and injured veterans. Will Yancy’s diet study testing a novel group visit approach to dieting for veterans with out-of-control veterans diabetes. George Jackson’s evaluation of patient outcomes as a function of primary care provider training: nurse practitioner, physician assistant, and physician.
One of your areas of expertise is evaluating how effective of primary care is in treating chronic disease. Can you tell me more about this research? What are the biggest challenges and opportunities in this field right now?
The most important work I’ve done has been with Hayden Bosworth, testing his ideas about improving patient’s adherence to lifestyle (diet and exercise) as well as prescribed medical therapy for patients with hypertension. We did this mostly through a series of intervention studies, and mostly using telephone coaching by nurses. The principles underlying those studies also apply to patients with diabetes, and Hayden and other colleagues have also tested them in patients with chronic kidney disease.
One of the larger challenges relates to health systems. In the VA, there are strong incentives to manage patients outside the clinic visit (i.e., with tele-health), so these interventions are congruent with the health system. That isn’t the case in a fee-for-service system where visits form the currency for reimbursement.
What passions or hobbies do you have outside of the division?
I love to cook, and eat, meaning that I have to exercise A LOT to maintain some semblance of balance. For 30 years I ran, and I loved it. But the injuries mounted and I lost some passion for it. Now I go to a personal trainer at Empower twice a week, and Grace and I go to a spin class at Ride Cycle Studio twice a week. Once a week or so, I put on running clothes and find a trail to see if I can restart the pilot light, but not so far.
Grace and I are also active in Durham Habitat for Humanity. We help lead a group of friends and neighbors who sponsor, and work on one house a year. We’re on our 7th house. When Telisha and her family move in this July, there will be a total of 23 children (and obviously their families) who have stable, safe housing because of the Pay-it-Forward group. Durham Habitat is even more amazing—over 330 houses to date, and more than 1,000 children!
Have you recently read any books, articles, blog posts or other material that would be of interest to the division? I read all the time. Mosty, I love mysteries, particularly P. D. James and Ruth Rendell (who died last week), but also Henrik Mankell for the Wallendar series, and Jo Nesbo. My new favorite is Tana French, a young Irish mystery writer. She’s only written five books, but I loved them all.
I also love quirky history and investigative reporting—Jon Krakaur and Erik Larsen (just finished his recount of the Lusitania sinking which was excellent), and humor–I’ve read all of Bill Bryson’s books although I’m not allowed to read them in bed anymore because I laugh too much and repeat passages out loud which, apparently, is annoying when the other person is trying to get to sleep.
 |
| Eugene Oddone (right), on a recent ski trip to Crested Butte Colorado, with his wife, Grace, their three daughters, Cameron, Ania and Helen, son-in-law Sam, and Cameron’s long-time boyfriend, Steve. |