An increased patient load and decisions that can make a difference in people’s lives awaits Dr. John Vandruff as he makes the 12-minute drive from his house in Round Valley to his office on East Main Street.
By 5 p.m. on this Thursday, he will have diagnosed and treated 29 patients of all ages, visited three others at the hospital, poured over stacks of medical charts and chaired a meeting as president of the medical staff at Payson Regional Medical Center.
But as demanding as his schedule is, he knew when he graduated from Baylor University medical school many years ago that he wanted to become a family practitioner.
That’s because he enjoys the challenges of working in a small town as an old-fashioned family doctor, who serves as the linchpin of health care by providing patients compassionate and comprehensive care — sometimes from cradle to grave.
The medical care he provides is not just diagnosing and treating acute and chronic illnesses. It also includes empowering patients with health education so they can make lifestyle changes to prevent illnesses before they develop.
“We can do more with prevention than with cure,” he says.
Also driving Dr. Vandruff is the research showing that patients who have an ongoing relationship with a primary care physician have better overall health outcomes, lower death rates by age and lower total costs of care.
“Those relationships involve communication,” he says. “Communication is huge in family medical care.”
Among the illnesses and injuries Dr. Vandruff will treat today are back pain, sprained ankles, industrial injury, hypertension, infections, arthritis, diabetes and stomach pains. He also performs two “Welcome to Medicare” physical exams.
He explains to his first patient, a 65-year-old man, that Medicare does not usually pay for physical exams. But in the last two years, the federally funded program to provide health care to seniors decided to allow one-time exams for those about to go on Medicare.
The exam includes an EKG to check on the heart, lab tests, the compiling of a medical history and the physical exam.
Next, Dr. Vandruff sees a patient suffering what he calls a “wound infection,” incurred after surgery at a Valley hospital to remove an ostomy pouch and close a stoma.
“With infections, we always have MERSA (methicillin resistant staphylococcus aureus) in the back of our mind,” he tells the patient. “It’s a strain of staph that’s resistant to antibiotics.”
Tests show the infection isn’t MERSA, so Dr. Vandruff drains the wound, packs it with a quarter-inch iodafoam gauze and prescribes antibiotics.
He explains to the patient, “the antibiotics will fight (the infection) internally, and the gauze helps fight it outside.”
Although family doctors are sometimes reluctant to treat open wound infections, Dr. Vandruff says he’s perfectly comfortable treating them because he served a surgery internship.
Next, Dr. Vandruff sees two patients suffering from diabetes.
The doctor explains that diabetes can be managed by diet and meal planning, physical activity and, if needed, medications.
One of his diabetic patients complains that a shoe that was once loose fitting no longer fits. Diabetes can cause infections, gangrene and nerve deadening.
Seeing the foot is swollen, Dr. Vandruff does a visual examination and notices red spots on both the top and the bottom of the patient’s foot, which looks infected.
A closer exam reveals a toothpick protruding from near the ball of the patient’s foot.
After diagnosing the problem, Dr. Vandruff admits her to the hospital in hopes intensive treatment will cure the infection without forcing doctors to amputate her foot.
“Diabetes causes numbness, and she has no sensation in her foot,” Dr. Vandruff says. “She stepped on the toothpick a week ago, but never knew it was stuck in her foot.”
The foot, he explains, is especially affected by diabetes because it damages the nerves.
“Injuries can occur and not be detected.”
One of the physician’s final patients of the day hopes to quit smoking and wants Dr. Vandruff’s help and advice.
After a lengthy consultation, the doctor prescribes anti-smoking medicine and makes it clear to the patient that if he is successful in quitting, his health will be better and he will live longer.
At the end of the demanding day, Dr. Vandruff pauses, takes a deep breath and gathers himself before answering a reporter’s question.
“Are there any medical issues in your profession that are difficult to deal with?” the reporter asks.
“Cancer is always tragic,” Dr. Vandruff answers, “but child neglect can really get to you.”
As heartbreaking as such issues can be for the family physician, Vandruff returns home after a long day to tend his garden, which helps him refresh and reload for another workday.
And, he suspects, an even larger patient load.