For Matthew Ellman, MD, known for the high level of care he provides, and his patients, a new, vital era has arrived. Dr. Ellman, director of Yale Internal Medicine Associates,points out that the new health care reform law will provide full coverage for a wellness exam for people who qualify for Medicare. “It’s wonderful that we can now help people who have not been able to access primary care because of the expense,” he said.

The components of the exam are progressive and include screening for cognitive and functional impairment, as well as a screening and test schedule. Discussion of advance care planning, while not required, is an option [see Annual Medicare Wellness Visit on right]. “This will help patients and physicians stay on top of preventive and maintenance care, as well as normalize the conversation about end-of-life care planning,” which, according to Dr. Ellman, will be a significant improvement.

Dr. Ellman, who has been a practicing internist since 1993 and a faculty member practicing with Yale Medical Group since 1999, has a vested interest in patients understanding their continuum of care, including end-of-life health care. In addition to his extensive clinical work, he has also designed an end-of-life and palliative care curriculum for Yale medical students. He believes that students in every specialty need training in end-of-life assessment of and communication with patients.

Providing palliative care is just one aspect of Dr. Ellman’s practice. Yale Internal Medicine fields 200 to 300 calls per day and sees about 9,000 patients per year. Theresa Harris, who has worked with Dr. Ellman for 11 years and answers hundreds of phone calls daily, said, “Primary care is unique. There is a different expectation from the patient; it is almost a parental relationship.” The team of doctors, nurses and medical assistants at Yale Internal Medicine Associates (YIMA), according to Dr. Ellman, “are in this together as a staff and have the same goals to meet patient needs and to provide a reassuring and compassionate environment.”

“Every doctor in the practice is personally involved with the patients, and any concern is handled right away,” said Hillary Marino, practice manager for YIMA. Kate McKenzie, MD, who has worked at YIMA for 15 years, considers Dr. Ellman “a wonderful mentor.” Dr. McKenzie, who just received this year’s

Faculty Achievement in Clinical Care Award given by the Department of Internal Medicine, added, “Dr. Ellman is a clinician whom I hold in the highest esteem, and as director of the practice, he is always helpful in determining what is best for the patient.”

Dr. Ellman has been caring for many of his patients for as long as10 years. As we discuss his patient care practice he mentions Angela*, whom he has treated for years, to illustrate the relationships his practice fosters. Angela came into the practice one morning crying; she was upset because she hadn’t been sleeping, her blood pressure was high and she was having panic attacks. Angela is a heavyset woman in her early 50s who has diabetes, and she has not always been able to manage her illness. Dr. Ellman has treated Angela’s father and sister as well and is familiar with her family history.

At the time of Angela’s visit, Dr. Ellman was aware that Angela’s father had recently died. In fact, Dr. Ellman had visited him in the hospital just before he died and knew that Angela was experiencing acute bereavement as well as exhaustion from helping to care for her father. In his treatment of Angela, Dr. Ellman has taken a holistic approach to her care, recognizing both the medical and emotional realities of her situation. On the day Angela came to see Dr. Ellman, he talked to her about her father and mentioned some of the funny conversations they had had, as well as some of the things he admired about her father. “I was able to help her through some of her acute grief, evaluate her diabetes, treat her anxiety and sleeplessness and help her decompress her stress.” Dr. Ellman mentions that Angela visited the next week and was feeling much better as a result of receiving compassionate medical care and emotional reassurance during her previous visit. “For me it’s a gift to be able to be part of people’s lives in this way.”

As Angela’s story unfolds, it is apparent that Dr. Ellman was aware of her father’s care because he had followed his primary care patient throughout his treatment by specialists and his hospitalization. This attentiveness is a key part of Dr. Ellman’s approach: “Patient care is not simply a matter of the technology of medicine; a practice will be more successful if you open yourself to other people’s lives.”

In order to be highly successful and responsive, Dr. Ellman and his colleagues believe “that every physician has to have a strong daily clinical presence.” In addition to Dr. McKenzie, Lydia Dugdale, MD, and Peter Ellis, MD, work in the practice. Each doctor balances teaching and administrative responsibilities with their clinical work. Dr. Ellman said that all the physicians at YIMA are dedicated to “being responsive and providing the highest level of care.”

The staff at YIMA know that it is critical to keep patient flow organized and moving so that care is comprehensive and all appointments are kept. “Our support staff is critical,” said Dr. Ellman. “Theresa Harris, our senior administrative assistant, knows all the patients, and fields their questions and requests for appointments with consideration and efficiency. Our medical assistants, Blossom Linton and Jackie Givens, and LPN Christine McDowell help provide the best medical care in a comforting and reassuring way.” Linton, well-known for her soothing presence, said, “The patients are the reason I am here. They are my extended family.”

Kristy Magulak, the new APRN at the practice, is integral to coordinating care with the four YIMA physicians. “I shadow the doctors to learn from them. They are really good listeners. ” YIMA doctors also depend on their ability to have current information when treating patients. Dr. Ellman relies on Yvonne Augur. “She can retrieve medical records so efficiently—it is unbelievable when you consider the 5,000 active records she keeps track of.”

In addition to evaluating patients, requesting tests and communicating with patients and staff, YIMA would be buried without proper systems in place, which Yale Medical Group provides. Dr. Ellman moved to the Yale Physicians Building from the Dana Building  in 2010. “Our move was handled beautifully, and we faced many transitional needs that Yale Medical Group addressed.” Dr. Ellman noted that his practice will be one of the first to implement the Epic health records system. “Primary internal medicine care at Yale will enter a new era with the introduction of an electronic health record coupled with a renewed national recognition of the critical importance of preventive care.”

*The patient’s name and certain details have been changed to protect confidentiality.