In late April, Michelle Kalina, a yoga instructor and wellness coach, experienced neck pain at a class.
She called Dr. Sarah Crane, her primary care physician and a leader in community health medicine at Mayo, and asked for a prescription to visit a physical therapist.
She thought pain relievers then a massage would alleviate the pain. But it gradually worsened.
"By the weekend, I didn’t want to leave the house, my head hurt so bad," Kalina said.
She made an appointment to see Crane, as the Kalinas had a flight planned to pick up their daughter from college that Friday.
Crane, Kalina’s doctor for years, knew something was wrong when she saw her patient hunched over, braced against the pain. Neither woman wanted Kalina to get on the plane without learning what was happening.
The problem didn’t seem to be muscular, or related to yoga. But Crane couldn’t tell what else it could be.
"I said, ‘It’s not outside. It’s something inside,’" Kalina said. "She said, ‘I’m going to call the neurologist.’"
That means scheduling another appointment, maybe weeks later, right? Not this time.
A specialist network
Inside the Baldwin Building, a few floors away from the exam rooms, lies a network of physicians and nurses called the Integrated Community Specialist Clinic.
Experts in psychiatry, pediatrics, cardiology, and nine other areas split time there between normal patient visits and consulting with doctors.
The program began five or six years ago, by placing psychiatrists in five buildings with primary care physicians, and has expanded to include a wide range of specialists, all ready to respond when and where they’re needed. Just last week, physical therapy was added to the list of Baldwin Building specialties.
The specialists block out times in their days to take calls from physicians, answer questions by email, and occasionally visit other floors to meet briefly with patients.
The integrated community care model was created "with the express goal of rapid access," Crane said.
And in Kalina’s case, the rapid access might have prevented a much more serious health issue — a stroke — from emerging.
Dial ‘N’ for ‘Neurology’
One of the fastest ways to reach a specialist, Crane said, is the "curbside phone number."
"It’s like 1-800-Neurologist," she said.
For Kalina, Crane called Dr. Nathan Young, the chairman of the community division of neurology, took him through the case, and told him it "didn’t seem right."
His key question: "Is it the same on both sides?"
He agreed that imaging seemed like a good step — but instead of a CT scan, which Crane would have suggested first, he recommended an MRI and and MRA, which would provide a picture of the blood vessels in the head.
"He said she would fit the profile of someone with a bilateral vertebral artery dissection," Crane said. "I said, ‘OK, that’s something we don’t want to go undiagnosed."
When a tear forms in one of the arteries leading to the brain, blood can enter the tear and clot, impeding blood flow, causing pain, and possibly — if the clot detaches and makes its way to the brain — causing a stroke.
At 6 the next morning, Kalina went in for imaging tests. Her husband, a neuro-radiologist, was supposed to work with the patients that morning, until he saw Kalina’s name come up.
He texted Crane as a colleague ran the tests.
"The first text I got from him was, ‘I think that looks like a dissection,’" Crane said.
Crane paged Young again for help.
He got Kalina in to see a neurologist that same morning.
The risk of stroke meant Kalina was rushed into treatment immediately.
"It’s all kind of a blur, but … I got in and got all the necessary medications," Kalina said.
"...And didn’t get on the plane," Crane added.
Faster diagnosis, fewer visits
The integrated model of care has a few major benefits, Crane said.
First is speed. If a patient can get multiple opinions in one visit, their treatment — especially for serious issues — should be vastly accelerated.
"We’re very lucky to have a medical Ferrari in the backyard," Crane said.
The second — and most obvious — benefit is the range of expertise available. The specialists direct patients to testing, treatment options, and other appointments, and are able to help more people in a day, Crane said, than they would by scheduling appointments normally.
Young can run "short-notice" visits in the Baldwin Building, answer calls and pages for information, and fit in email questions between his usual patient visits.
"As specialists, we see our role as … trying to do out best to get the patient the right care in the right place — at the right times," he said. "Practicing this way allows one person to take care of many more patients."
Vertebral artery dissection is also unusual for primary care physicians to see. "It’s not something that will be top-of-mind for any of us," Crane said.
The third benefit is cost. If Crane had ordered a CT scan for Kalina first, it would have taken more time and multiple tests to correctly diagnose her problem.
"We are encouraging people to call whenever they are considering using a specialist, so it’s happening a lot," she said.
If Crane hadn’t been able to check in with a neurologist, she said, she might have asked Kalina to make an appointment with the Mayo Headache Clinic — which would have taken weeks to pan out.
Dr. Brown, Kalina’s neurologist, has monitored her for months. About a month ago, she experienced the issue again — but after taking pain meds and blood thinners, she’s back in classes — and doing handstands, she said.
"I’m just amazed and grateful," she said. "And it was so fast."