Endorsements and Stories

Koushik Kasanagottu, MD

“Hey doc, I’m back!” beamed my patient on our sixth follow up clinic visit. At this moment, my face lit up with a smile. This is the reason why I wanted to become a doctor: to develop those meaningful relationships with patients. Bayview primary care residency program gives me the opportunity to develop these relationships. It is common to see my patients routinely because the program provides me with a clinic schedule for the whole year so I can effortlessly schedule follow-up visits. The whole process functions seamlessly due to the support from the clinic staff, chief residents, and program leadership. Home visits are another rewarding program at Bayview Primary Care. It’s incredible the amount of information you learn about your patients by observing them interact with their home environment. Med recs are accurately completed as pill boxes lay by their bedside. Caregivers are available to discuss their concerns. Health education is more effective because we can tailor it to meet their needs more effectively. Bayview primary care program empowers me to become the physician that I hope to be.

Karla Kendrick, MD

One of my most gratifying patient experiences while in the primary care track at Bayview has been taking care of Mr. O. I met Mr. O for the first time in clinic early in my intern year. He was then a 45-year-old UPS driver, and had hypertension and tobacco use. Prior to meeting him, it took some years to come up with a good BP regimen, as he had side effects from some commonly used medications and difficulty taking pills multiple times per day. By the time I met him, he was doing well on nifedipine and chlorthalidone, and our first few visits mostly focused on tobacco sessions and other cardiovascular risk factor reduction, as well as minor aches and pains from strenuous activity. During my second MICU rotation intern year, I was shocked to come into the unit and find him intubated with Legionella pneumonia. During our last visit a few weeks prior, he had been saying he didn’t feel good but didn’t have any particular symptoms, like cough, shortness of breath, fever, etc. I instantly wondered if I missed something; if I was a bad PCP because my patient ended up in the ICU; if there was anything I could have done to prevent this. When his sedation was lightened for a spontaneous breathing trial, I told him I was sorry, and that I’d be there for him fully going forward, taking his every concern with the upmost diligence. Once he was extubated, he acknowledged that “things just happen”, to not fault of my own.

Over the next year, Mr. O gained about 40 pounds, initially starting from being out of work following his severe illness. His cholesterol rose above normal limits. His hemoglobin A1c rose to 6.5% for the first time, though he had no diabetic symptoms. His systolic blood pressure rose slightly above 130. I told him how this weight gain, high cholesterol, likely diabetes, high blood pressure, and tobacco use all made him high risk for heart attacks and strokes down the line, and we needed to do something about it now. Of course, there were medications, metformin and statins, that could help control some of these risk factors, but I knew Mr. O struggled with meds. I also knew that these risks could be controlled with some lifestyle modifications. So, we talked about diet. We went over all the foods he eats in a typical day and week. We talked about what his family eats. We talked about activity levels. We talked about ways to avoid tobacco. I referred him to see a nutritionist. The next time I saw Mr. O, about 3 months later, he had lost about 10 pounds. He had seen the nutritionist by then, and had eliminated sugary beverages from his diet. He also increased his fruit intake, and started eating salads every day for lunch. He got a gym membership. Over the next year, Mr. O lost 30 lbs. His cholesterol normalized. His Ha1c went to 5.9%. His blood pressure remained well controlled on his previous regimen. He even cut significant cut back on his tobacco use.

Mr. O has taught me a lot during my time in residency. He has taught me how to care for patients outside of the hospital and in times of critical illness. He has shown me what it means to be there for someone through the good and bad times. He has taught me how to effectively improve lifestyle habits that can lead to serious morbidity. As I am ending residency, I am sad that I will not be able to care for him much longer, but the experiences that he has helped provide have been integral for my development as a primary care physician. These types of relationships that I have been able to build while in the primary care track at Bayview have made the years in residency feel worthwhile, and fulfilling.

Linda Mobula, MD, MPH

I was a resident in the Primary Care Program at Johns Hopkins Bayview from 2008-2011. My training at Bayview allowed me to set up a primary health care program in Cite Soleil (Haiti), one of the largest and poorest slums in the Western Hemisphere. I managed a few clinics in Cite Soleil for one year, and soon realized that chronic diseases such as hypertension and diabetes were highly prevalent in this population. We therefore set up a system to allow for improved care and follow-up.
Working at the Comprehensive Care Practice provided me with unique skills to care for patients living with HIV. This later helped me as I worked for the USAID Office of HIV /AIDS, America’s flagship program for HIV, where I assisted in writing HIV program country operational plans for countries such as South Sudan, Burundi, DRC, etc. As the co-PI of the Ghana Access and Accessibility Program, I helped write a research protocol looking at outcomes for patients with diabetes and hypertension. If I had not received training in primary care, I would not have recognized the importance of treating chronic conditions in a low- and middle- income country. This program allowed several health centers to improve clinical outcomes for hypertension and diabetes, as well as improve health systems.

The Bayview Primary Care Program is such a special program, one that helped me achieve my goal of improving the health of the most vulnerable, and ensuring that the management of chronic disease is prioritized in poor countries.