This interview with Tasha Alexis, M.D., San Luis Valley Occupational Medicine, Alamosa, is the second in a series about best practices in workers’ compensation. Based on her performance in Pinnacol’s clinic profiling report, we posed a few questions to her about her practice style, collaboration and treatment plans.
How did you decide to practice in occupational medicine?
Dr. Alexis: For me, it happened in the last year of residency. I did a rotation at Concentra for about six weeks. I had done employee health at the Department of Veterans Affairs the year before, so it drew me in because I like having a specific population to take care of. That is what preventive medicine is about; you take care of a specific type of population, and that’s what I liked.
What are some of your biggest challenges you face in caring for injured workers in your area?
Dr. Alexis: For me, the biggest challenges would be the patients who come in with the most severe injuries, such as crush injuries. Those are difficult and have lengthy recoveries. It takes a while to get them back to normal, and they require monitoring more closely than everybody else at the beginning.
Other cases may be those with back injuries, because pain is subjective. It’s hard sometimes to figure out what’s wrong if it’s not showing up in clinical symptoms or on an image.
Are there things about your practice that are unique or different from other occupational medicine practices?
Dr. Alexis: We have great specialists we can refer patients to. Here, with everything in-house, if I question something or want another opinion on an image, I can go to the orthopedics department and the orthopedists will review it with me and advise me on the next steps. I have a team behind me. And in our office, we have Dr. Scott Timothy, who is a physiatrist, and I can discuss patients with him.
Your clinic profile report shows that your patients with hand and back injuries seem to spend less time off work than patients treated at other occupational medicine practices. What’s your approach to return-to-work and what is unique about how you treat?
Dr. Alexis: We have physical therapy next door to us, on the same floor. I talk to the therapist about my patients and they come to us. We discuss what is going on during the patient’s therapy sessions, what they are doing and what we should be doing going forward. We also have a good working relationship with Dr. Aaron Polzin, our chiropractor. This helps facilitate our treatment of back injuries along with our physiatrist, Dr. Timothy. When I compare this to previous places I’ve worked, that collaboration and feedback was definitely missing. The coordinated care is so convenient, and we have fewer missed appointments and no-shows too.
What do you think is the most important topic or what do you discuss with an injured worker during the first visit with you?
Dr. Alexis: At the first visit, I discuss what I think the injury is and the mechanism of the injury. If we are doing any tests, I explain those to them and the treatment we’re going to provide. Then, we discuss the typical course of recovery for this particular type of injury. I also add cautionary advice based on if this happened versus that and how the recovery might go depending on what is happening. I try to give them a well-rounded explanation of the recovery process and what they might expect.
What do you do when the injured worker is reluctant to go back to work or wants to return too soon?
Dr. Alexis: When a patient is afraid to go back to work because they feel they will be injured, I talk to them about the restrictions we’re going to apply. I also tell them I’m going to discuss it with their employer if there are any issues.
On the other side, for patients who want to go back to work sooner, especially ones who should not go back to work, I spend a lot of time explaining why they shouldn’t be at work and the risks or complications they may have when going back too soon.
What would you say are one or two highlights about your care? What makes occupational medicine work for you?
Dr. Alexis: I love that we can take a patient from an injured state where they are scared, worried and freaking out and we can calm them down. We show them some of the treatment methods we have as options. We can give them therapy, and medication isn’t always necessary. Our physical therapist has a long list of modality choices for treatment and our orthopedic department is excellent about educating the patient and showing them exercises they can do at home. We give them lots of options.
A lot of time physicians have a challenge getting to know the clinician community. It sounds like you have good partners in your practice and are not working alone.
Dr. Alexis: My practice partner, Dr. Susan Geiger, has been very influential since I started here a year ago. She’s been in the community for years, and she has been my mentor. We see each other twice a week and spend one day a week going over challenging cases. She helps me work through any issues and offers advice on what to do so it’s been a perfect partnership.
See the example of this designated provider's clinic profile report for comparisons to peer groups.