Health Sciences Report Fall 2004

Healthy Living Gets Equal Treatment at Student Health Service
By Susan Sample

Photos by Tim Kelly

Peek inside any of the eight exam rooms on the first floor of the University's Madsen Health Center and you may see the bodies of sick students. You'll definitely hear messages promoting healthy living for the entire student body.

"We provide health care as a safety net to students to help them get through school, but part of our mission is education. That's what differentiates us from a standard health-care practice," said Joan Rawlins, M.P.A., director of the Student Health Service (SHS). "We see our role as empowering students to take control of their health."

Even a clinic visit for a sore throat can be an opportunity to educate. "We're not here just for sick care; we're here for healthy living," explained Vicki Judd, M.D. "We have the luxury of being able to spend time with students. Our visits average 30 minutes. We'll ask: "How are you handling stress? Are you eating okay? Exercising? Are you sexually active? Do you have a support system?" We're mandated to make sure students are as healthy as they can be.

"It's quite wonderful," added Judd of the half-time medical directorship she took over last year. A professor of pediatrics specializing in congenital heart disease at the U School of Medicine, Judd continues to see patients at University of Utah Hospital, Primary Children's Medical Center, and clinics in Provo and Ogden. But she is unequivocal about working at the Student Health Service: "It's a provider's dream."

The doctor, who was named Physician of the Year by the Utah Medical Association last March, has found her new patients "very intelligent. They've usually researched their condition on the Internet before they come. And they're usually very sick. They know they have to be here, which is satisfying. I can discuss options with them, and they truly give informed consent."

Any U of U student is eligible to be treated at the SHS. No insurance is required. Spouses and dependent children are also welcome, which greatly broadens the patient base. "We see two-day-old babies to nontraditional students in their 60s and 70s," noted Rawlins.

"The public tends to think the U has 28,000 healthy, upper middle-class insured students. In reality, the students are very poor, and a good majority are uninsured."

About 1,200 students purchase a U student health insurance policy, according to Rawlins. She attributes the low number of enrollees to the U's status as a commuter campus: many students live at home and are covered by their parents' or their spouse's insurance policy. Under a new requirement this fall, foreign students must show proof of medical insurance or purchase the U plan.

Every student is required to pay an annual $17 student health fee, which goes to help support the SHS. No taxpayer monies are used to pay for the nearly 12,000 annual visits to the clinic. Last year, about 11,500 adults and 400 children were treated. With visits split evenly between new and returning patients, Rawlins figures that 8,000 students used the SHS during the 2003-04 school year.

Medical director Judd estimates that the fees SHS charges for its services are about "one-half of what is customary in the community. We will try to do everything we can here, because it's very cost-effective. True emergencies we send to the ER. But if a student needs stitches, an IV for the stomach flu, a cast, an abscess drained, we'll do it."

"We're really like a family medicine clinic. We do see a lot of stress, anxiety, and depression, because students are under a lot of pressure," she added. "But we can help."

In addition to Judd, the staff includes an interdisciplinary team of health-care providers who hold specialty clinics each week at the SHS, as well as teach at the health sciences center. Barry Stults, M.D., professor and chief of the Division of General Internal Medicine at the U medical school, is the consulting internist. David Petron, M.D., assistant professor of orthopaedics, specializes in sports medicine. Tek Kilgore, M.S., A.P.R.N., assistant professor at the U College of Nursing, also sees sports medicine patients, as well as offers men's health care and pediatrics.

The SHS serves as a primary practice site for College of Nursing faculty. Nurse practitioner Amy Cutting, M.S., A.P.R.N., assistant professor, focuses on women's health care, and Sue Kirby, M.S., A.P.R.N., assistant professor, who is certified in travel medicine, holds a clinic for travelers. Kathleen Stillion-Allen, M.S., A.P.R.N., associate professor, treats depression and anxiety, in addition to pediatric patients.

Unique to Utah's SHS is health educator Jason Gillman, C.H.E.S. He lectures campus groups on health issues and meets with the Student Health Advisory Committee, which organizes the annual Wellness Fair and sponsors "Head to Toe," a health and wellness column in the U student newspaper, The Daily Utah Chronicle. Along with Judd, he recently completed statewide training for HIV testing and rape crisis counseling.

Despite the breadth of services offered, the SHS manages to operate in the black. "We're all concerned about the cost of health care," said Rawlins. "We don't splurge, because it's students' money. They pay our way."

Thrift doesn't translate into second-class health care for the U student body. Rawlins is very proud that last spring the SHS was re-accredited for three years by the Joint Commission for Accreditation of Healthcare Organizations (JCAHO). It is one of only 30 college health services nationwide to receive this distinction. "It was very rigorous," she said of the comprehensive evaluation that usually is undertaken by hospitals. "We were accredited apart from the health sciences center. I take great pride in this."

Although the U of U health sciences center is its primary referral source, the SHS reports to the U vice president for student affairs. "We're a student service," noted Rawlins, "but the health sciences center is our greatest support system for knowledge, referrals, and teaching."

Judd regularly invites fellow faculty members to address topics relevant to the SHS medical and administrative staff. Last summer, Doug Gray, M.D., assistant professor of psychiatry, lectured on suicide in young people. Paul Summers, M.D., associate professor of obstetrics and gynecology, spoke on vaginitis, and Louise Eutropius, R.N., University Hospital epidemiology, on infection control.

In a reciprocal role, the SHS serves as a site for School of Medicine and College of Nursing students to learn. Judd has a medical resident work with her; each nurse practitioner has an A.P.R.N. student assigned every semester.

"It's a great training site," said Judd, who serves as secretary for the Pacific Coast College Health Association. "We do ask patients' permission before we allow students-in-training to go in the room. Most of the time, they don't mind."

Like patient privacy, "confidentiality is our highest concern," stressed Rawlins. "If students didn't trust us, they wouldn't come. Even before HIPAA [the federal Health Insurance Portability and Accountability Act that protects individuals' health information], we required students to sign consent forms before sharing their information with anyone, including their parents or coaches."

Judd and Rawlins meet with students and their parents during orientation to explain the privacy and confidentiality polices, as well as tell them about services available at the SHS. Although appointments are required, except for emergency care, most visitors can be seen the same day they call or the next day. "Students' lives are so busy. We leave space during the day, so we don't turn anyone away," said Judd. "If you're on campus, it's easier to pop in here, have a strep test, then go back go class."

"We're the best-kept secret on campus," said Rawlins.

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