Ep. 46 | Thomas Hobby, DO, Internal Medicine & Medical Director of Hospice of South Georgia

Transcript

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- Welcome to another episode of What Brings You in Today? I'm Erika Bennett. And I'm Kara Hope Rockwell. And we wanna thank everyone for tuning in. If you haven't already, please like and subscribe to the podcast so you can stay abreast of all of our new episodes. And if there

- Are any guests you'd like us to have on, or any topics you want us to cover, you can let us know sgmc.org/podcast.

- All right, so today we are here with Tommy Hobby, DO Internal Medicine at our SGMC Valdosta Medical Clinic.

- Thanks for having me.

- Yeah. So Dr. Hobby, what brings you in today?

- Hopefully talk about primary care and hospice and palliative care.

- All right. Well tell us a little bit about your background, kind of your journey to where you are today. So,

- I'm originally from Valdosta and so I went to Lowndes High School and Booo. And so, you know, grew up in the, sort of in the medical home. My father's a retired interventional radiologist, so I enjoyed going to the hospital with him and watching him, you know, come up at the hospital and take care of patients. And so, just had an interest in doing medicine and when I went to medical school, really liked primary care. I enjoyed taking care of, you know, primary care patients and specifically enjoyed taking care of older patients. And that's what sort of led me into internal medicine.

- Okay. Did you always know you wanted to be a doctor growing up?

- You know, I had it just living in the house with my, watching my dad. You know, I always kind of said I was gonna be a doctor and so, and just kept at it and went through college and got into medical school and everything worked out that way.

- Alright. And so work, how long have you been practicing now?

- I've been back in Valdosta for 25 years.

- Okay. So

- Went, went away as, went to Valdosta State, went away for medical school and did my training up in Chattanooga, Tennessee. And then came back in 2000 and been here ever since.

- Alright, well tell us a little bit about just your bread and butter, your primary care physician patients. Why should somebody have a primary care physician?

- Well, the majority of patients that I see are 18 and older and the majority of those are pretty much 65 and older. I see diabetes, heart disease, high cholesterol, a lot of arthritis. You know, typically I hear a lot of arthritis complaints and recently a lot more memory and dementia patients, you know, our patient population, the medical field's doing a great job of keeping people alive, older. And so the older patients get the more we see a little bit more of dementia. So seeing a lot more of that recently.

- That's interesting. 'cause we were just recording an episode with our new orthopedic surgeons and they were talking about the arthritis issues leading to hip replacements and knee replacements and that being a bigger issue. So

- Yeah, as patients are getting older, we do a, in the medical field, we do a great job. We've got a lot of advances in heart disease. I mean, we're doing valve aortic valve fixing them patients that we've never done in 90 year olds. And, and so these patients we're keeping them alive a lot longer. But unfortunately when it comes to dementia, you know, there's not a lot of prevention type, you know, tools that we have. So as these patients get older, you see more dementia, see more arthritis.

- I was just talking to my mother last night on the phone and both of her parents, one has Alzheimer's and the other has dementia. So it's interesting that you say that, but we are definitely seeing more

- And a lot of,

- Of that

- New advances in dementia and through our neurologist of doing different types of scans, doing screening, you know, trying to find out if you have the gene for dementia. So a lot better treatment options recently. So a a a lot of new things in the dementia field.

- Yeah, I was in a neurology meeting yesterday and they were talking about like infusion therapy that they're also offering

- Yeah, amyloid deposition is the new buzzword and checking, doing pets, amyloid scans, PET cts, and finding those early. And I have patients that have been doing infusions and actually seeing improvement in their memory. So a lot of good stuff.

- How do you typically, typically catch that kind of thing from a primary care visit per se?

- Well, you know, I try to encourage my patients to obviously keep their appointments, regular appointments go a long way seeing these patients earlier, establishing with a primary care. I think females do a really good job with that because they're going and seeing their gynecologist, they're doing lab work. Males typically do a horrible job at that. Yeah. They only come in when they have problems. And so I try to encourage, you know, at least by 40, you know, start seeing your primary care on a regular basis. And so you screen for these things. We, we do a lot of screening when it comes to patients when they hit 65 through a lot of the, what we call annual Medicare wellness visits. We do simple tools like drawing a clock, getting them to remember three words. So we're doing a lot of dementia screening. And the other big thing is if it's in your family, so knowing your genetics and doing the screening tests early, really help out with earlier treatment and better, better outcomes.

- I'm sure there's a big family component to that too, of like, maybe you're noticing something in your aging parent or your grandparent or whatever, some behaviors that are a little bit different and encouraging them to, to go see you go to the doctor.

- Typically it's the, you know, daughters and sons that bring in their parents. Right. And say, we've noticed this, A lot of patients as they get older, they feel embarrassed about coming and talking to their doctor that they're having memory problems. And again, females do a lot better job of talking with their doctors about symptoms than the males do. And so it's good to come in early.

- It's funny you said that because my husband turned 40 this past August and I was joking with him yesterday morning. I was like, you know, I think you're getting close to that age now for a colonoscopy. So we need

- To, and they, you know, we used to start doing colonoscopies at 50, they just moved it to 45 4 4 5.

- Yep.

- And then if you've got a family history of colon cancer, we start 'em even earlier, we start 'em 10 years before that, you know, your loved one is mo, mom, dad, brother, sister have colon cancer. You start at 10 years before they had their diagnosis of cancer. So we're doing 'em a lot earlier.

- I gotta start planting the seed now because it'll take me five years to convince him to get to get into the doctor.

- Well, I love, you know, we do have some positive outcomes. So when you hear those positive outcomes of a patient that's not having symptoms come in, do a colonoscopy, they have a polyp that was sort of a pre-cancerous polyp and you know, you've basically, you know, prevented them from having colon cancer. Those are good stories you can tell patients. And

- We had that and

- Tell your husband.

- Yeah. And we had that conversation yesterday too with breast cancer screening that we knew someone that we had encouraged, you know, during October they typically, high awareness is brought to mammograms and you know, somebody found something and it's just as scary as that can be. It's a lot scarier if you had waited 10 years and absolutely. Then got that scanned right. The treatment is so much better and more productive. So

- Early detection.

- Yeah.

- In in all in all cancers. Absolutely.

- So what about, so you said primarily it seemed to me that like you had an older population of patients. How do you encourage that 18-year-old to 40 to go ahead and establish a primary care provider?

- Again, like we talked about, you know, the, when females are going through gynecology, they're doing a lot better job. We typically get those females when they have a problem like hypertension or high cholesterol and need treatment and just encouraging patients to at least come in once a year, get lab work, knowing their genetics, screening them for smoking, screening them for blood pressure issues. And, and again, starting those screenings at early, you know, it's recommended at age 40 to start doing labs. We have some patients that we start 'em at, you know, in their 2021, even 18 if they have a strong family history of heart disease. I have a strong family history of heart disease and so I do a lot of, you know, early detection labs and you know, trying to keep healthy, trying to eat. Right. Yeah. Very, one of the hardest things to do. And keeping my, you know, weight in a good status. I think a lot of patients that I deal with on a every day is, you know, Dr. Hobby, how can I lose weight? You know, I'm having a hard time is, it's a lot easier to get fit at an earlier age. Right. Until you start at age 60, it's hard. And again, females have a lot harder time with doing that, you know, after menopause. So earlier you start the better you'll be.

- What do you think about like the 23 and me and genetic testing and do you ever have patients come in and say, Hey, this, this test shows that I have an increased risk of X, Y, ZI

- Think a lot of that, I, I mean everything helps. So if you're, you know, if you're going and doing the, you know, genetic testing and you're finding that you're at risk for this, so it puts awareness to this and it it, it makes patients come in earlier, start doing testing. A lot of that is reassurance. You know, hey, just because you've tested positive through this 23 and me doesn't mean you're gonna definitely get, you know, this disease, you're at risk and let's do some screening tests to prevent those in early detection.

- I find that stuff so fascinating. Yeah. You may find out you have a

- Relative you didn't know about though, right. That's kind of the thing that everybody's figuring out these days with that.

- That's right. And, and with today's Google doc, we get a lot of that of patients coming in, Hey, I, I googled, you know, I've got stomach pains and I've go Googled that I have pancreatic cancer.

- Yeah. And so

- A lot of that, and then when you get them in, then you can start doing these screening tests and preventative tests and, and reassuring them that they don't have pancreatic cancer.

- Right. Yes. So I had an idea while you were talking and thinking specifically for the male population that does not go to the doctor. I think it's probably gonna be the mothers that need to keep that doctor visit going after they turn 18. So the moms need be like, all right, you need to go ahead and get a primary care. And that's

- Probably helicopter moms.

- No it's not helicopter. But you gotta start that ha habit, that healthy ha. Yeah. You know, and if you do it every year, it's not like as weird, you know, it's not such a

- Whatever works,

- You're more comfortable with it. Yeah. So I think the moms, we can, we can put that one on the moms to try to get their sons. I think my to,

- I think my son listens to his mom a little bit. My 17-year-old son listened to his mom a lot more than he listens to me. So see,

- Okay. That's gonna be my next push. I'll, I'll work on that. I, so you also specialize in hospice and palliative care and there's a lot of misconceptions in that realm. Absolutely. So just give us a brief overview to start us off on hospice and palliative care. Yeah. What the differences are.

- So 2009 the position for medical director came available through Hospice South Georgia and Landale Hospice House. And I took that role. One of the best decisions I made, I really enjoy taking care of hospice patients. They built the Langdale Hospice House sometime around 2007. And it's, our hospice organization has grown tremendously. We're, we service about an average of about 140 patients a day at the outpatient setting. So in their home or in a nursing care facility. We cover eight counties, you know, around Lowndes County. And then we also have the Langdale Hospice House and we have 15 beds that provide a different levels of care of inpatient and respite care and, and residential. So yeah, I've been the medical director of that. In 2012, Tana Serra and I got together and decided to create an inpatient palliative care program started out. And we were only allowed to see patients, you know, in the intensive care unit at that time. Now we have, we go over to Smith, we see patients down in the emergency room and our service is grown. We have two nurse practitioners now and a nursing director that manages patients. So definitely grown the outpatient palliative care services run by Emily de Caesar. She started out having maybe four or five patients. She has a census of around 40 patients that she sees. Y'all had a, a, a meeting with Eli and he does all our outpatient hospice and the inpatient part of the hospice house. So huge organizations grown.

- And remind me again, because it is confusing if you don't live that world every day, what is the difference between hospice and palliative care?

- Yeah, we, I get this question all the time. I think the misconception that palliative care is hospice and hospice is palliative care. Both of 'em, you know, basically deal with the care of a patient with serious illness and, and help improve quality of life. The difference of it depends on their eligibility and their, their the care that they're gonna receive. So with palliative care, it's the care of a patient that has a serious illness but is receiving curative care. The difference with hospice would mean that patient that is receiving care with a serious illness, but technically has less than six months to live. A lot of overlap. So when, I'll give an example. So if you have a patient that is diagnosed with cancer, immediately that patient is a palliative care patient. So if palliative care is consulted, they help out and work along their oncologist, they continue to receive a curative treatment and we help out with emotional support, we help out with advanced care planning. And then when the, that patient, if they have a uncurable cancer and they get to the point where there's no curative treatment and they don't wanna come back to the hospital or go to the emergency room, then that's the perfect hospice patient. Then we come in provide services, whether it's emotional support, spiritual support, we do a lot of family teaching on caregiving. So if you've got a, a patient or loved one that you're, or a friend that you're dealing with, everybody's new and how to take care of this patient. So we sit down from social, working from nursing, from pastoral care, we provide AIDS in the house that can do bathing and, and then medical needs. So medical equipment. So I think the misconception is when patients are, when you hear the word hospice, it means you're giving up. But when we admit these patients in the hospice, we sit down as a team with them, the intake nurses meet with them, meet with the families, and offer so much services and then sort of guide them on how their care is. And it just ends up being a good thing.

- Yeah. It's just additional support. Absolutely. To deal with the process at hand. I was able to attend the Alliance South Georgia Alliance, health Alliance board meeting this past week, which includes the Hospice of South Georgia and Langdale Hospice House and our Langdale place. But the entire room was in tears. By the time Amanda, who's the director over there, absolutely got done with her report. 'cause it is just such impactful work that happens over there. And it was emotional, but it was a good emotional because it was what they were offering for those families and what they were doing. It was,

- Yeah,

- Just so impressive. And

- I, I think the misconception also with palliative, I mean with hospice is, alright, you're gonna go home, you're gonna die and we, we get this, Hey, you're gonna stop all our medicines or if we have an infection, you're not gonna treat that. So one of the first things that we do is sit down and talk with patients about trying to reduce the amount of medication. So if they're, if they have an abnormal heart rate and we don't take 'em off of their blood pressure medicines, we don't take 'em off of their diabetes medicines. So we continue all those medicines and those medicines typically go, come under the hospice benefits. So we start covering these medications. Obviously primary prevention medicines, like if a patient has high cholesterol, will typically stop cholesterol medicines for long-term use. But if they're on thyroid medicines, we continue those things. The other misconception is, hey, they're gonna go home, they're gonna get morphine and they're gonna die. And so one of the things that we do is get pain under control, get symptoms under control. So again, going through their medications, simplifying medications and seeing sometimes even improvement. Some of the best patients that we have is patients that we used to just kind of all see just cancer patients. But now we see heart failure patients. We see, again, we talked about dementia. The dementia patients that we have have increased over the last 10 years. Just, just since I've been doing it. You know, we, the majority of patients were all cancer now we see again, dementia, heart failure and so, you know, chronic illnesses that are admitted and now, you know, our cancer patients are probably only about, you know, 25 to 30% of our patients that we take care of. Yeah.

- And maybe that's just through increased awareness too of what the service is and absolutely how it works. And then we also launched recently a dementia or Alzheimer's support group, caregiver support group maybe. So if you do know someone that, a family member that is experiencing that and you're a caregiver, that is another resource that you can, it's a free support group that,

- Yeah. Any of those support groups, I think people are initially scared about going to 'em and then they find out that they get answers 'cause they see people that are going through the exact same things. Yeah, right. That they're going through. And it's always a good thing.

- And it's more common than you think. Yeah. You know, oftentimes when you get those diagnoses or you know, something just dramatic in your life, you're think it's only you're, yeah. So being connected with people that are in

- Similar situations, ly families that we go in and try to, you know, give support to like we, like I said, they're new to this and then when you start teaching them how to care, they, they do better. You know, the, the patients do better, the families do better and they start managing the patients at home. And, and I would say never do I hear any of the families saying, you know, I wish that we had never called in hospice. It's constant, we get the same sort of comments back from the families. We should have done hospice a long time ago.

- Yeah. It doesn't hurt to ever go ahead and get more information request education about it. And

- They always have the option if we go in, meet with the family and they hear our intake nurses talked about the service, they can always say, no, let's, and, and you know, if something changes, if their symptoms start getting better, we do have that come into hospice and then graduate from hospice. So

- Yeah,

- They were receiving treatment and sometimes the treatment is, you know, worse than the, than the disease. And so we, they cut back and, or you know, stop that curative treatment, they start improving. We, they graduate from hospice and then we're available if they need us, you know, in the future. So we, we do see that. I would say we, we do have a lot of patients that we see that maybe go to a tertiary center so they're, you know, have cancer or at the end stage of their treatment. You know, it's always have you wanna have a second opinion. There's no such thing as a bad second opinion. They'll end up going and getting a second opinion at a tertiary center at, you know, where Indiana Anderson or Moffitt. And then we'll bring them back home. They'll be able to go into their home where they can be around family and friends. And that is some of the, the best work we do.

- Absolutely. Three of my grandparents have been on hospice and so definitely has a special place in, in my family's heart.

- Yeah. And we see if we have a, you know, a spouse that's on hospice and typically what we'll see is their, if their wife died, you know, three years ago, then we'll see the husband, you know, at a later date. And that's always sort of that we know that we're doing a great job when the, you know, choose to utilize the cancer. Absolutely.

- Dr. Hobby, you've been serving here in Valdosta in our community for a while. What would you say is the biggest change in healthcare that you've noticed in any kind of trends or technology or what's been the most impact? Technology

- Would be the biggest thing. You know, when I started in 2000, you know, we were using paper charts as, as, as the senior. Dr. Brady and I are the senior doctors in our group now. And sometimes we

- Call that seasoned. That's not

- Seniors season doctors in, that's what I say. We, I sometimes, I wish I could go back to a paper chart. Electronic health records have definitely changed the way we practice medicine. Sometimes I feel like I'm just kind of staring at a computer, sometimes pressing buttons and the patient's kind of looking at me. And so I, I typically try to have that face-to-face time and then go to my computer. So I would say that's the biggest changes. But you know, what is a positive, what comes with that? Reminding me about certain types of preventative tests that be done. I have a, a, you know, a little column over there that tells me, Hey, don't forget about the flu shot. So definitely improving the practice of medicine and it's done good from that.

- Do you think that patients are more active in their healthcare

- Now? Internet has changed the way, I mean you can go on and chat GPT and tell 'em, hey I've got this, I've got that. The majority of the time they typically will give you a diagnosis when it's not the older patients, it's the younger patients. They'll come in and let you know what's wrong with 'em. Yeah. Ahead of time. And so, and it helps out and then, and sometimes it can

- Definitely lead you astray.

- Lead you astray. So you just kind of have to, you know, stick with your instinct and your knowledge that you have. Yeah. But I would say that was the biggest change is the Google.

- We had Dr. Google but now we have Dr. Ai. Right.

- Just ask techs tell another element, which I was on a call with our Epic team recently and they were talking about a new feature that will be released soon will be within the MyChart and your Epic platform. You'll be able to utilize the AI for the diagnose or you know, for an overview. 'cause most people just copy it out of their MyChart into like a chat GBT.

- Correct.

- So they'll be able to do it within the MyChart one to keep it secure and to have a more medically sound.

- Yeah, I mean I know that the, the current system that we have, you know, I can walk in the room, I really don't have to press anything. It'll listen to what I'm saying. That scares me a little bit. Just being an older guy.

- Documentation. Yeah.

- Right. And so I think the, I'm gonna leave that to the younger guys in the group to test that out. But, 'cause I typically, I mean mine's a a lot, I think a lot of my visit is a social visit. I enjoy talking with patients and I tend to get a little sidetracked and, and so, but I think AI is gonna be a positive

- Thing. Yeah, well you're probably really good at it. I mean you're probably so skilled now at documentation. You know,

- It's gotten easy for me.

- Yeah, it is interesting to see how all that

- Has. Absolutely.

- And now you can get your lab results and everything like in the blink of an eye immediately

- Before I get 'em patients, you get 'em and call me and say, Hey, what's wrong with my monocytes? And

- Yeah.

- And so a lot

- Of start looking that up.

- A lot of clarification.

- Yeah. Yeah, for sure. I think that's the biggest one is the lab results and if it's just a little bit outside of that normal range, everybody goes crazy. But there is some room for it to be outside of. That is what I found out from my doctor. Absolutely. When I've done the same thing.

- Well I think that's about all I have. You got anything else

- You wanna share with us today?

- I appreciate y'all having me and bringing awareness to hospice and palliative care. One of the best things I do in the day.

- Well thank you for your dedication to healthcare and our community. Thank you. And to the service to our patients, so we appreciate you.

- Absolutely. Thank you. Enjoy it.