Dr. Dunn's red nose campaign aims to change the culture of family medicine, one visit at a time
By Kristy Bleizeffer Apr 13, 2016
A few weeks ago, Andy Dunn, M.D., did a home visit for a man dying of cancer. His condition made it hard for him to get to the doctor, so the doctor came to him. The man told Dr. Dunn that no healthcare provider had ever come to his house before.
Dr. Dunn thinks that's a shame. As medical director of Mesa Primary Care and Sage Primary Care, he's working to create an atmosphere that is less clinical and more personal. One that brings care to patients when and where it is needed. One that makes a doctor's appointment something to be excited about. He calls it his Red Nose Campaign.
Primary care -- or family medicine as it is also called -- is at the front lines of health care. These are the doctors and mid-level providers who work with patients over their lifetimes and often care for several generations of one family. The relationships they build with patients can impact everything from diagnoses to how well patients follow their treatment plans.
Forging this type of relationship with his patients was one of the reasons Dr. Dunn transitioned from one of Wyoming Medical Center's most beloved hospitalists to family medicine. Here, he describes his vision for primary care in Casper. And, by all means, if you see him wearing a red nose during your next doctor's visit, don't be shy: Go ahead and give a little "honk."
What do you mean by "Red Nose Campaign?"
It's basically Patch Adams and Norman Rockwell rolled into one. There is a Rockwell painting (and it is hanging in Mesa's waiting room) where the doctor is listening to a young child's doll with his stethoscope. That always kind of stuck with me. Being a patient can make you feel very vulnerable at times. I feel very fortunate to be in the position to help lead people through that.
So, with the Red Nose Campaign, we are trying to create that vibe that a visit to the doctor's office can be fun. We're really trying to create a family atmosphere here- from babies to adults.
I still get a lot of compliments on that commercial. People talk about that red nose. Even before the movie with Robin Williams, I knew of Patch Adams in medical school. One of my professors was colleagues with him and he told me a lot of stories. I thought that was how medicine should be.
Did that influence your decision to go into family medicine?
I originally wanted to go into emergency medicine, but that idea of really helping people through laughter really resonated with me. One of the reasons I wear ugly sweaters and why, as a hospitalist at Wyoming Medical Center, I'd wear fake moustaches and things, is that when people laugh, it just breaks down the walls. It stays with people.
Once, when a patient was in the hospital on the Progressive Care Unit, I got a few other guys together and we all wore pink shirts and fake moustaches. And we sang as a barbershop quartet for a patient. In the clinic, one of my patients was pretty sick so I wore a hazmat suit because he came in with a cold and a cough.
Explain some of the ways you hope to remove barriers between patients and doctors at Mesa and Sage Primary Care?
We have theme days at Mesa and Sage -- ugly sweater days, Star Wars days where everyone dresses up like a Star Wars character -- that kind of thing. We want to make these clinics feel less sterile and more of a home-like atmosphere.
It's mind, body, spirit approach. It's not just about medicines any more. You have to reach out to people, make them laugh, care for them where they are. We will be doing more home visits for patients who can't make it to us. We are planning more specialized clinics for conditions like diabetes to make sure patients are getting the right care. Sage Primary Care just achieved the highest level of recognition as a Patient-Centered Medical Home and now has a walk-in clinic for its patients.
We want people to ask about the red nose if they see us wearing them, that kind of thing.
How does this affect quality of care?
When you break down barriers and when patients let their guards down, they are often more open about their health, their symptoms, and how they are really feeling. That helps the caregivers make better diagnoses and develop good treatment plans with the help of the patient.
From the perspective of the doctor, it's to help us get out of the mindset of the business side of medicine. It's not about the billing, or seeing a certain number of patients in a day, or getting to the next patient who has been waiting too long. It's nice to remember why you got into this field, and that was to help people. That's the big thing.
It's in line with the idea that when providers feel invested in the relationship, it makes them better doctors?
Without a doubt. When you have more ownership of that patient visit, when you are invested in the relationship, when you develop a rapport, you do work a little harder, I think.
We want to emphasize that this is place of healing, not just a medical clinic. We want to focus on the totality of health. I think a lot of times, it's easy for providers to get into a rhythm where you’re saying, "here's a med, here's a med, here's a med, see you later." We want to change that dynamic.
Why is it important for people to establish with a primary care provider?
It's all about continuity. Primary care providers establish a patient's baseline for health. Family doctors know who you are, visit after visit. We know your social and economic situations and some of the barriers to good health. We know your health history and your family's health history in many cases. Hopefully, we have built that trust that goes a long way when you are treating someone. We can have open and honest conversations and have the ability to spot trends in your health over time.
For example, if your primary care doctor notices that you have acid reflux every spring, they could possibly link it to allergies and get you the right treatment.
Sage and Mesa accept patients of all ages, from birth to old age. What is the advantage when providers treat a whole family?
It's what most family practice providers are all about. That's the essence of our calling. We see people of any age for any thing, and when you're treating a family, the apple doesn't fall far from the tree. If Dad has sleep apnea, and the kid develops sleeping problems, you know where to start looking.
When you establish that kind of relationship with your patients, what's it like to run into them outside of the office?
I was in the Verizon store once and a patient asked me about their rash. I've had people in the
movie theater turn around when they saw that commercial of me playing on the screen and start laughing. I love those kinds of interactions.
To be a family physician, you are at the front lines for medicine. When you are out in the community, it's neat to relate to people on a personal level. It makes it fun for me, and I think it makes it fun for them. Sometimes I will have to wear a hat, though.
It makes it worth it. One of the reasons I didn't choose emergency medicine is because you can't follow a patient through their recovery. As a family doctor, I can do that and I get to see them out in the community and I can ask how their loved ones are doing, so it's really cool.
Dr. Dunn is board certified in family medicine and is medical director of Mesa Primary Care and Sage Primary Care. He grew up in Denver and moved to Casper to complete his residency at University of Wyoming Family Practice. He was a Wyoming Medical Center hospitalist for several years.