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Not just a ‘Band-Aid approach’ at Student Health Center

Starkville — Imagine being able to see a doctor without a long wait, at no cost, as often as you need.

Sound too good to be true? Actually, it gets even better. At Mississippi State University (MSU), students pay a health fee each semester that allows them to see a physician or nurse practitioner free at the John C. Longest Student Health Center. And instead of just getting treatment for the immediate medical issues, students are also going to be dispensed a generous dollop of advice about wellness and preventive health.

For example, if a student goes in to be treated for bronchitis, the doctor or nurse is also going to talk to him about smoking cigarettes. It could make a difference for the student to be told that smoking is the number one cause of preventable death in the world. And that if he doesn’t kick the habit by the end of college, there is only a 10% chance he will quit later on.

“The thrust of the difference between us and a private health clinic is we approach things at the student health center from a preventive standpoint,” said Dr. Robert K. “Bob” Collins, physician and director of the John C. Longest Student Health Center. “Health education is a major, major component of what we do. We have a health educator with five graduate students delivering information about health education. We are looking at ways to fight the obesity epidemic that is all over Mississippi, and at Mississippi State, as well. Medicine doesn’t have a real good answer to obesity. The only good answer is exercise and dietary restraint.”

The health center provides counseling to people on eating disorders. There is also a focus on alcohol and drug education. The number one killer of college students is accidents, and many of those accidents — particularly those involving traffic accidents — involve alcohol consumption.

Forget that ‘infirmary’ image

The MSU Student Health Center is a long way removed from the old “infirmary” model that some readers may remember from college. For starters, the clinic is very well equipped and staffed. There are 17 exam rooms. Staff includes five doctors, three nurse practitioners, a physical therapist, two medical technologists, two pharmacists, a certified athletic trainer and eight to 10 registered nurses. The center is one of only two student health centers in the state to have certification from the Accreditation Association for Ambulatory Health Care.

Collins originally started working at the student health center in 1977, intending it to be a temporary job while his wife was finishing her Ph.D. But he found working with students so rewarding that, 27 years later, he is still working at the center.

“I got hooked on working with young people,” Collins said. “They are fun to work with. A lot of patients gain secondary rewards by not being healthy. For example, adults with a low back injury can say, ‘Now I can get paid for a back injury and not go to work.’ They will pump that back injury for all it’s worth. Students are not like that. They want to be well. They have that positive aspect to them. Eighteen- to 25-year-olds are a fun group to work with. They are forever asking questions that cause you to think about things in a different way.”

He also has learned it can be a critical time to have influence on a person’s life. The last time most people are susceptible to major lifestyle changes is somewhere around 18 to 22.

“After that, people are pretty well set in their ways,” Collins said. “They are not so likely to change. So if we can instill in these young people a healthy lifestyle at age 22, they will carry it with them into the future.”

For issues like smoking and eating disorders, the health center works on behavior modification as opposed to giving them a pill. Collins said while they are committed to taking care of immediate health problems, helping students commit to healthy behaviors and values is the driving function of the health center.

Practicing medicine at a student health clinic varies from what a family physician would see. For example, Collins sees more knee sprains in a month than most family physicians see in years. College students are more physically active, so injuries are common. The clinic also sees a lot of cases of mononucleosis, the “kissing disease.” The illness is spread by saliva contact from kissing, sharing drink containers, etc.

A family physician might tell a student with mono to go to bed to rest for two weeks. But Collins said bed rest has no better outcome than if the student is given medication to protect the spleen, and then sent back to class. Two weeks out of school can cost a student a semester of credit, delaying graduation and possibly costing more for the education.

Since family physicians don’t see an illness like mono very often, they might overreact to it. But at the student health clinic, doctors are familiar with illnesses like mono.

Setting expectations

Collins has another goal at the student health center — to establish high quality of care so students will expect that when they leave college.

“If they don’t get quality care, they won’t know to search for physicians who give that quality of care,” Collins said.

Doctors who work at student health clinics aren’t on that track because it makes the most money.

“If you are in it for the money, student health isn’t the place to be,” Collins said. “Not everybody is driven by money. Some of us have a bit more of a service mentality about us. Going back to original things that cause us to be physicians, if you want to make a lot of money, you would rather be a stockbroker than a physician considering the amount of hours invested to be a physician, especially a family physician.”

The MSU student clinic is a hub of activity. In the past year, there were about 48,000 patient visits. And, unlike most student clinics, this one also sees non-students such as university faculty and staff.

Bill Broyles, assistant to the vice president of student affairs, administrator of the student health center, said about 75% of the patients are students and 25% university employees. For students, there are no fees to see a doctor or nurse. Broyles said people rarely have to wait to see a doctor. Appointments are required, but it is usually easy to get an appointment the same day you call. Students also get discounted prices on lab work and prescriptions from the pharmacy.

“We’re trying to remove any barriers for students to come here,” Broyles said. “The last thing we want is for a student to get sick, get sicker, miss classes and miss exams. We would rather the student come when he or she is first feeling bad so we can get them back to the reason they came to Mississippi State to begin with: to get an education. Our function is to take care of student’s illnesses and get them back in the classroom as quickly as we can.”

Broyles, who has worked in the health center for 15 years, said one measure of the success of the clinic is that while only 25% of freshmen report they use the clinic, by the time students are seniors, 100% of seniors report using the clinic.

Years ago there was some concern that the university clinic competed with local private medical providers. But Broyles said that issue has been resolved. Bob Collins is the ex-chief of staff with Oktibbeha County Hospital.

“We have a great working relationship with Oktibbeha County Hospital,” Broyles said. “Our doctors are on staff there.”

Student health centers like the one at MSU aren’t socialized medicine, Broyles said. Students pay for the services by paying a fee once per semester. But the health center model was a precursor to Health Maintenance Organizations (HMOs) where savings are achieved by using the same providers to give health care to a group of people.

“When HMOs first came out, there was a lot of concern about how well they would serve the patient,” Broyles said. “But if you look at the student health service model, they were HMOs before HMOs were invented. You can come in and see doctors as many times as needed at no charge. With resources of students behind you, you can provide a high quality product. Students are often very informed consumers. They have high expectations. So we have to stay on top of our game to provide the high quality care they expect.”

Getting them back to class

However, in the “real world” of medical care, students might have a hard time finding a healthcare provider who is on time for appointments. At MSU, a lot of care is given to keeping on schedule so students can see the doctor, and make it to their next class on time.

“We don’t put people off,” Broyles said. “We do operate by appointment here. But what you will find if you call today for an appointment, you are seen today. If you have an appointment at 9 o’clock, generally you are in to see the doctor at 9 o’clock. We’re trying to work around students’ classes, so it’s important to stay on schedule.”

He also sees it as positive that the same services are provided to faculty and staff.

“We frankly think it is a good thing when a student comes in and sees the professor is here, too,” Broyles said. “It validates we are a real medical clinic. Sometimes students might have a perception this is a Band-Aid station. But this is a family medical clinic. I have always come here since I have lived in Starkville, and my family has always come here.”

One of the initiatives the clinic is working on now is Health Interventions That Matter (HIT’M). A nurse is assigned to go around to departments on campus and provide basic health screenings.

“We’re trying to educate employees about healthy lifestyle choices,” Broyles said. “We go out to campus and hit people who might not have a family doctor. For example, recently we were doing blood glucose tests, and found an employee with high blood glucose who had no idea she was a diabetic. She was referred to a doctor, got treatment, and is now beginning to manage her diabetes.

“High blood pressure is known as the silent killer because people often don’t have any obvious symptoms and they don’t know they are putting themselves at risk for cardiac disease and stroke.

“Our hope is that by going out into the university community and finding those people with problems like high blood pressure, we can make interventions that really will matter to their well being. From the university perspective, having healthy employees is better for productivity and obviously reduces health care costs later in life.”

Contact MBJ contributing writer Becky Gillette at bgillette@bellsouth.net.


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