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A doctor’s vision for caring with care

October 21, 2009 • Dick Hodgetts; Columnist

36 Up the road from Madison about 25 minutes, one can find a doctor with a grand vision. He has specific views on how quality health care is developed and delivered in rural America. Meet Dr. Robert Cowles, founder of the Cowles Clinic on Linger Longer Rd. What he sees and how he crafts his vision will impact health care in the tri-county region for several decades. It will impact you and your choices. Likely it will make sophisticated medical services available to you and our next generation.

He is the third generation of physicians. His grandfather was asked by the governor of Tennessee to set up a medical practice in east Tennessee to help get rural folks vaccinated, and provide some standard medical care back in the 1920’s. grandfather Dr. Cowles did just that in Greeneville, Tn. One of the more unusual aspects of his effort was the creation of the Blue Ribbon parade, where youngsters who had all their vaccination shots, had passed a dental exam, and could produce a report card with good attendance, received a big ‘ole blue ribbon, got to march in Greeneville’s Blue Ribbon parade and won a certificate for a free ice cream cone, along with a pass to a matinee movie. High incentive in rural east Tennessee in 1920. And something so minimalist by today’s standards made a huge impact on the youngsters of that region. Life expectancy rose in east Tennessee, one of those “under-served areas” some nine decades ago.

That role model was followed by another: his father, also a highly regarded physician, taught his son to be dedicated to his patients. He took him on visits to rural east Tennessee after a full day at his office to visit folks who could not make the trip into Greeneville. Robert saw patients living in wood shacks built on stilts with newspaper as wall paper, who received the best care available from his dad and yet were unable to pay anything for the service. What you will hear from three generations of Cowles physicians is this: “it is the right thing to do.”

Today, Dr. Robert Cowles is highly regarded by scores of his peers in the medical field. He was offered the position as Department Head of Urology at MD Anderson Cancer Center. He is past President of Athens Regional, he is a past Clinical Professor of Surgery at Emory, he has taught new urological surgery techniques in 35 countries. He is founder of the Cowles Clinic. All that is fine, but how does it influence us in Morgan County?

Dr. Cowles has developed the ‘Bridge Theory’ in delivery of medical care in rural areas. Here are some of its concepts. First, bring a group of highly regarded specialists to a facility which has the very best in technology. Second, make sure each physician has an outstanding reputation in his specialty. Third, expand the specialties every year as you make pre-op, post-op, and diagnostic services convenient to a rural population. Fourth, recognize that medicine is delivered best when you have a large enough client population to allow the physicians, the techs, and the support staff to repeat procedures such that their expertise improves. Fifth, it becomes an attractive opportunity for the construction of a hospital as the doctors and clients are in place. Sixth, design a Regional Hospital such that it is a healing place and not a medical jail. What?

That means the hospital you partner with must build a facility where these concepts are built in: expose the patient to the outside and to sunlight, make the patient areas very quiet and contain the sounds and alarms of the facility in interior corridors, make the food so good that the patient and their supporting family will enjoy eating it. Make the family part of the healing process. Give them places to stay adjacent to the patient, where they too can maintain contact with the world via internet and phones. Do not isolate the family or patient from the outside supporting world. If you want an example of how this works, see how this whole community is supporting Laura Margaret Burbach and her family while she is at the Duke Medical Center. If you read her Care Pages, you can see her spirits soar from the contact of hundreds here in Morgan County.

Now, we both know none of this hospital design sounds revolutionary. Every one of us has probably thought of the same thing when exposed to today’s hospitals. But, it is a contradiction to another philosophy about delivering medical services: “Build it and they will come”. I have heard this stated in local talks about our proposed hospital.
So, where is our Doctor Cowles and his vision in all this discussion? I think you are going to be surprised. There are now 85 physician specialists associated with the Cowles Clinic. The patient count is 45,000 per year. In 2010, the plan is to develop a Women’s Health Center with a strong focus on Breast Cancer: pre-op, diagnostic, and post-op. When the plan is implemented the patient count rises to 62,000 annually, and the physician count associated with Cowles Clinic exceeds 100 doctors.

As you read this a major fund raising drive is underway and has passed the six million dollar level. St. Joseph’s Hospital is now working with the Cowles Clinic, and Internal Health Paramedics such that they will build the regional facility he has dreamed about for the last 20 years.

Do not for one minute believe that I am an impartial observer. This writer is a 16 year prostate cancer survivor. My disease was diagnosed when I was 50. It returned when I was 58. The best urological specialists in Georgia and at MD Anderson advised me on my options. At 66, the advanced disease began to become more active. There are limited options when an advanced prostate cancer patient sees the disease return. Friends in several states urged me to see Dr. Cowles who was less than half an hour away. I have just completed a series of procedures which if my response is like that of others, I have an excellent chance for two more decades of life because of inspired medical treatment from Dr. Robert Cowles and his associate: Dr. David Lowther. There are only about three places in the world this procedure is being done, one is on Linger Longer Rd. at the Cowles Clinic, in what most would classify as rural America. Lucky, lucky me, and that is a heartfelt statement.

So, as we in this community make decisions on building a replacement medical facility, we should be very much aware that in two or three years, we will have a fine regional hospitals in Athens (Athens Regional & St Mary’s), and we will have a fine regional hospital on Linger Longer Rd (St Joseph East)-each less than half an hour away. The 60,000-plus folks living in the tri-county area are going to have great options for access to the best medical care. But, “build it and they will come” seems a risky concept when compared to the vision of a doctor who has 62,000 patients and 100 specialty physicians in his clinic. If you want confirmation of this risk, visit the good folks at Dahlonga who built one and they did not come, and they are attempting to get themselves out from a difficult fiscal mess, which will hound them for years.

I have tremendous respect for the men and women in Morgan County who are dedicated to providing health care choices for us. It is important to pull back at times and question our preconceptions. Are we going to build something we cannot pay for as bigger and more sophisticated treatment centers are available to our population? I don’t know. I have met a remarkable man with a strong vision on how medical care is delivered today and in the future. I would not ignore his vision, nor, his impact on our future hospital requirements. I would seriously consider developing some form of urgent care center that patches us up and allows us to be transported east or north to a regional facility with lot of specialists, along with some type of recovery center. And to all you in this community who supported me with prayers, and thoughts and expressions of concern during the last month: thank you. And thank the good Lord that Dr. Robert Cowles has his vision, and if he has a Blue Ribbon parade, I kind-of want to be invited. And, on the day this column was written which was his day off, Dr. Cowles operated on a man in dire need of his urological surgery, who cannot pay for services rendered. Why? Three generations of: “it is the right thing to do for the patient.” A great aspect of his vision.

Printed in the October 1, 2009 edition.