Teresa L. McConaughy, MD
Medical Director, Riverside House Calls
Paul E. Evans, III, MD
Medical Director, Riverside Program of All-Inclusive Care for the Elderly
Dr. Teresa McConaughy and Dr. Paul Evans have a lot in common. They’re both Board certified in Family Medicine; they’re both Assistant Clinical Professors of Family Practice at Virginia Commonwealth University. They’ve both dedicated their careers to caring for the at-risk older population.
They also happen to be husband and wife – and while they both did their residencies at Riverside Regional Medical Center, they’re quick to note that Dr. McConaughy went to medical school in the South (Medical University of South Carolina College of Medicine) while Dr. Evans earned his MD in the North (at the University of Connecticut School of Medicine).
The two physicians met while they were both on the faculty of Riverside Family Practice, in the residency program. “At that time, geriatrics wasn’t really a fully established specialty,” Dr. Evans says. “There were people doing geriatrics for many years, but there wasn’t formal special training.” When the fellowship in geriatrics was introduced, Dr. Evans became its first director.
Dr. Evans and Dr. McConaughy both enjoyed the residency program and genuinely liked teaching, but ultimately decided to leave the faculty and go into practice. They joined the Commonwealth Family Practice in Newport News, where they treated men, women and children. “There were a lot of geriatric patients,” Dr. Evans says, “and eventually, Riverside asked us to start a new practice in Grafton, Patriot Primary Care, in 2006. We stayed there until 2013.”
He also began doing geriatric consultative work at the Center for Excellence in Aging in Williamsburg (now the Center for Excellence in Aging and Lifelong Health, or CEALH), working with patients with early geriatric syndromes. Through the Center’s research arm, Dr. Evans and his colleagues were working with new medicine and other innovative treatments for Alzheimer’s disease. He serves as principal investigator for clinical studies at CEALH.
“And then, PACE had just opened in Hampton,” Dr. Evans continues. “Dr. Petitjean, who had served on the residency faculty with us, was the primary physician at the program, which had quickly grown to 70 or 80 participants. Dr. Petitjean was still doing some teaching at the residency program, so they asked if I would be willing to help out. I began splitting my time between Patriot Primary Care and PACE. That transitioned to full time at PACE, which in turn transitioned to my being named Medical Director at PACE.”
When Dr. Evans left Patriot Primary Care, Dr. McConaughy says he bequeathed her many of his patients, adding to her already large practice. “I had been thinking about leaving the office practice, and looking for ways to do geriatrics differently,” she remembers. “I love family practice; I was enjoying taking care of babies and adolescents and all other ages that came along with family practice, but I was evolving as a physician.
“With older patients,” she says, “I loved listening to them, I liked hearing their life stories, and getting to know them and their families. And I wanted to be able to provide care that would better help them transition to wherever they were going.”
When Dr. Kyle Allen came to Riverside in 2011, he brought a number of innovative ideas with him, one of which was establishing a house calls practice. “It wasn’t a novel idea,” Dr. McConaughy says, “as they’re in existence all across the country, mostly in the midwest. But it was definitely a novel idea for Riverside.” It was an idea that touched her personally, as she had seen her own mother’s health decline in the final years of her life, and understood immediately how a program of regular home visits could benefit such patients.
Today, as Medical Director of Riverside House Calls, Dr. McConaughy cares for more than 130 patients, seeing each one about once every four weeks. “In a busy practice, I might have 15 minutes with a patient in an exam room,” she explains. “Now I can manage my time to accommodate a half hour to 45 minutes in their home, whatever time it takes. And I can spend the time I need to spend to do a better job taking care of these incredibly amazing people.”
Part of taking care of these patients can involve conversations about sensitive topics like advanced care planning and end-of-life decision making. “Both Paul and I look at it as part of our responsibility to initiate the conversation and help people articulate their wishes,” Dr. McConaughy says. “It’s one of those things that too often gets shoved under the rug, and unless we bring it up, patients won’t bring it up. So we have to do it in a way that expresses our commitment to respect their wishes and needs, so that they know we’re guiding their care based on what they want.”
The physicians’ paths don’t often cross these days, they say, although they sometimes have the opportunity to send each other patients. “Typically, I might wave to her on I-64 if I see her car going by,” Dr. Evans says, “and she’ll wave if she sees mine.”
They acknowledge some of the same stresses inherent in caring for older, frail patients with complex medical conditions. “We share stories of our patients,” Dr. Evans says. “We ask what the other would do in a particular situation. We share the joys and some of the hardships – and we always learn from each other.”