General Medicine at Grady

The Division of General Internal Medicine and Geriatrics (GIMG) at Grady is comprised of 49 physicians who are primarily based full-time at Grady Memorial Hospital.  The Division provides patient care in multiple settings.  Patients requiring hospitalization for non-surgical medical problems are cared for by GIMG physicians on the inpatient wards and night float attending service. Patients requiring outpatient ambulatory care for chronic or episodic illness or preventive care are seen by our physicians in the Primary Care Center (PCC), Geriatrics Center, the Liver Clinic, and other specialty clinics. GIMG physicians manage patients in these settings throughout the course of the year. 

Services Offered:

Primary Care Center

Leadership

Description of services              

The Primary Care Center (PCC) is the largest ambulatory clinic in the Grady Health System. The total number of outpatient encounters for patients seen in the PCC by Emory faculty is approximately 43,000 per year. The primary objective of the PCC is to deliver high quality comprehensive, longitudinal primary and preventive care, and to include an efficient same-day appointment system. The clinic is staffed with a talented faculty of board certified specialists in General Internal Medicine who devote the majority of their clinical time to patient care and teaching on site at Grady. The PCC is staffed at a ratio of 3-4 residents: 1 faculty. The Accreditation Council for Graduate Medical Education (ACGME) mandates that this ratio does not exceed 4 to 1. In addition, 1.0 faculty FTE is dedicated to direct patient care by the Emory Faculty.

In addition to chronic disease management and primary care, we offer a variety of preventive services including immunizations, cancer screening, tuberculosis (TB) screening, osteoporosis screening, blood pressure, cholesterol, and diabetes screening, as well as counseling for a healthy lifestyle.  Additionally, our patients have access to social, nutrition, and pharmacy education services with the consultation and supervision of our Emory providers. 

The Primary Care Center (PCC) of Grady Memorial Hospital serves a primarily older, female, African American, and lower socioeconomic status population. The majority of the patients are Self-Pay (42%), with Medicare (32%) and Medicaid (21%), representing the primary insurance for those covered. Prior research (Williams M et al, JAMA 1995) has also demonstrated low literacy among Grady’s PCC population with more than 80% of patients over 60 year old having inadequate functional health literacy.  Our patients also have many chronic conditions.  Approximately 78% have hypertension, 45% are obese, 38% have high cholesterol, 26% have diabetes, 23% are smokers, and 39% have a sedentary lifestyle.   Though our patients may have more comorbid conditions and more likely to have challenging social circumstances, our data suggest that we are still able to meet or exceed national trends in diabetes and blood pressure control.

The Hepatitis C (Liver) Clinic

Leadership

Lesley Miller, M.D.

Description

The Grady Hepatitis-C Clinic, founded in 2002, provides comprehensive care and treatment for urban, medically underserved patients with chronic hepatitis C. The Hep-C Clinic has between 800-1,000 patient visits annually (about 10-12 patients per clinic session), and there is currently a 4-month wait for a follow-up appointment.  The clinic is staffed by three Internal Medicine attendings from the Emory University’s Division of General Medicine (one attending per clinic session), a Grady clinical pharmacist (during Tuesday sessions), and a volunteer physician from the CDC. The clinic is the primary site for hepatitis C training at GMH, and provides training for 2-3 Internal Medicine residents per month, as well as gastroenterology and infectious disease fellows (1-2 per month). The Hep-C Clinic utilizes one nurse, PAR and tech, who concurrently staff usual Orange Pod activities during the Hep-C Clinic sessions.  It is the sole site at GMH providing hepatitis C treatment. To date, over 220 patients have been treated with antiviral therapy for hepatitis C. Antiviral therapy is crucial in decreasing morbidity and mortality from hepatitis C-related chronic liver disease, a growing and costly epidemic that is not expected to peak until 2030. The Grady Hep-C Clinic has developed both a regional and national reputation as a model of excellence for providing hepatitis C services to a disproportionately affected, medically underserved population.

Grady Lipid Clinic

Leadership

Terry Jacobson M.D.

Description

Many patients with high cholesterol are unable to take cholesterol lowering medications because of medication side effects. These patients may be taking medications incorrectly or may be candidates for alternate therapy with medications that many primary care physicians are not familiar with. Patients referred to the lipid clinic have 30 minute appointment times where they receive extensive teaching from a clinical pharmacist, Internal medicine resident and a faculty member board certified in clinical Lipidology. 

Joint Injection and Procedure Clinic

Leadership

Danielle Jones M.D.

Description

The mission of the Injection clinic is to provide specialized services to relieve disabling musculoskeletal and soft tissue conditions for Grady PCC patients. Musculoskeletal disorders account for approximately 8-20% of all physician visits in the United States. During primary care visits, however, patients often have multiple uncontrolled and potentially life-threatening conditions which push even disabling musculoskeletal complaints into the background.  Research has shown that corticosteroid injections performed regularly are beneficial in the management of many arthritic conditions, but physicians report low rates of procedure performance. The injection clinic was developed to help close the gap between our patients’ needs for improved mobility as well as decreased pain via access to intra-articular and soft tissue injections and our ability to provide them in a busy primary care clinic. On average, injections for osteoarthritis are repeated every 3 months, so to ensure regular access to patients, the clinic is held each week. The majority of patients receive more than one injection (e.g., bilateral knees) at each visit. 

The Women's Clinic

Leadership

Stacy Higgins M.D.

Description

The clinic provides routine office gynecologic services to patients who receive their primary care in the PCC. Services include routine pap smears, breast and pelvic exams, STD screening, menopause counseling, contraceptive counseling, and osteoporosis screening. Each clinic session has between 2-3 residents and is staffed by one faculty member. 26 patients are scheduled for each clinic session, with a show rate of ~50%. The clinic ensures that a high risk population receives regular screening in a clinical setting that they are familiar with, their medical home. It also serves as a chance for residents to complete and hone their experiential skills in procedures required by the American Board of Internal Medicine (ABIM).

Grady Employee Clinic

Leadership

Director, Stacie Schmidt M.D.

Description

Because the PCC is staffed by Emory Faculty with outstanding reputations in the medical community, Grady Employees have expressed a desire to have access to these physicians for their personal healthcare needs.  The Grady Employee clinic was formed in order to meet this need and provide a convenient method for Grady Employees to get their healthcare on site. This practice maintains a primary care, longitudinal relationship with many of Grady’s employees and their families.

Primary Care Behavioral Health Clinic

Leadership

Tamara Haynes, M.D.

Description

This clinic allows a physician who is board certified in both internal medicine and psychiatry to provide mental health services for patients in their primary care setting.  This practice performs integrated, collaborative treatment of medical and mental and behavioral health issues including anxiety/depression/substance use in patients with chronic medical illness, offers supportive counseling services, and provides linkage to other mental/behavioral health care within Grady Health System and Georgia when needed.

Healthy Lifestyle Group Class

Leadership

Stacy Schmidt, M.D.

Description of Program

The Healthy Lifestyle Group Class is a multidisciplinary group education class that engages several patients in one outpatient setting while allowing more time for patient education and counseling than a standard clinical encounter.  This session delivers patient-centered information in a manner that promotes autonomous decision-making and enhances patient self-efficacy regarding healthy diet and exercise choices.  After the educational session, physicians meet individually with each patient to discuss goal-setting and develop action plans for weight loss.  Patients leave with a task each week to work on at home, in order to reach their goal(s).  They also benefit from the ability to interact with other patients who are working to achieve, or have already achieved, their target weights.  These counseling sessions are billable by CMS and provide an important resource for our patients.