On occasions when Dr. Joann Knudson needs special advice about the care or treatment of one her patients in the Yale University Health Services' obstetrics and gynecology department, she turns to colleagues at the School of Medicine. In brief telephone conversations or longer consultations, Knudson can discuss particular problems with specialists in their fields, always with full confidence that her communications will result in the best possible care for her patients.

This easy access to other physicians in her own field of expertise and in other specialties is just one of the benefits Knudson and her colleagues at the Yale Health Plan (YHP) share as part of their special relationship with the School of Medicine.

Like all of the physicians at the YHP -- which is the clinical care center for the University Health Services -- Knudson serves as a member of the clinical faculty at the School of Medicine, and is thus a part of a large University community of clinicians who share the goals of providing optimal health care for patients and training medical students.

Working partnership. "We are able to have this wonderful working partnership with the School of Medicine because of the fact that we truly are a part of the same community," says Knudson, who is chief of obstetrics and gynecology at University Health Services and assistant clinical professor at the medical school. "Because we are close colleagues, we're always comfortable picking up the phone for a quick assessment or to get advice."

YHP physicians also refer the vast majority of their patients to medical school physicians for highly specialized care not available at the University Health Services. At the School of Medicine, more than 600 full-time faculty members provide patient care in over 100 specialties, including neurology, anesthesiology, orthopaedics and rehabilitation, pathology and surgery. Within these clinical departments, there are also numerous subspecialties, such as cardiology, endocrinology, oncology, plastic surgery, infectious diseases, AIDS care and geriatrics, to name just a few. In addition, there are nearly a dozen multidisciplinary and special clinical programs, including the Comprehensive Breast Care Center, the Yale Cerebrovascular Center, the Neurooncology Program and the Yale Respiratory Failure Center.

All of the faculty members at the medical school who deliver patient care are part of a group known as the Yale Faculty Practice. The YHP maintains a contract with the School of Medicine via its Faculty Practice to provide specialty care for its more than 26,000 members, which include approximately 75 percent of Yale staff, in addition to graduate and undergraduate students.

"Through this contract, we have a highly developed team approach to clinical care," explains Dr. Paul Genecin, director of University Health Services and associate clinical professor at the School of Medicine. "While University Health Services has a comprehensive primary care staff, there are some specialties and subspecialties for which it is not practical for us to offer care. For example, while we could have a full-time staff cardiologist or a full-time surgeon, those doctors couldn't possibly cover all of the aspects and facets of care in those areas for all of our patients.

"At the School of Medicine, however, there are specialists in pediatric cardiology, cardiac nuclear medicine and cardiovascular medicine, or physicians specializing in abdominal or vascular or oncologic surgery, among other areas, and they are known for being experts in their fields. So it works better for our members if we refer them to, and then collaborate with, clinicians at the medical school, where they can get highly specialized care when needed," he says.

In many cases, medical school physicians see YHP patients at the University Health Services at 17 Hillhouse Ave. Other patients, however, are sent to clinics at the medical school, just a few blocks away. "It's such a wonderful resource for us to have the ability to send our patients down the street, essentially, for their care," notes Genecin.

"In certain respects, there's a feeling that we are all working under one roof," he adds. "Because we are all part of the University community, our communication is more seamless. We know each other well, and we share an understanding of the culture of the University environment. This ability to communicate so easily is extremely beneficial for our patients, and provides them with a more integrated type of experience than they might have gotten from some other kind of arrangement."

Likewise, because they work and teach at the University, School of Medicine physicians are "tuned in" to the needs of Yale students and staff, according to Genecin. "Our goal at University Health Services is to help the University serve its educational mission by helping keep our members -- those who work and study here -- healthy so they can do what they are here to do," he comments. "The medical school physicians to whom we refer our patients are on our Yale timetable. They are also academicians, and they understand the schedules and the needs of students and staff and are responsive to it."

Furthermore, because medical school physicians are also teachers and researchers, members of the Yale Health Plan have the additional benefit of receiving health care and services that are state-of-the-art, notes Genecin.

"Medical school doctors are among the best in the nation, and in certain specialties are considered to be the top experts in their fields," he says. "All of us who are Yale Health Plan members are extremely fortunate in knowing that if we are ill, we will be treated using the most advanced techniques available, by physicians who are involved in cutting-edge research."

Dr. David J. Leffell, medical director of the Yale Faculty Practice and professor of dermatology and surgery, says the collaborative relationship between medical school and Yale Health Plan physicians is a vital part of the mission of the school, which is committed not only to teaching and innovative research but to excellence in clinical care as well.

"Our relationship with the Yale Health Plan is a natural and obvious one," he says. "From our perspective, members of the Yale Health Plan are ideal patients: they are sophisticated and knowledgeable about health matters. The educated patient often makes the best patient. Our affiliation gives us the opportunity to put all of our resources to good use, with the shared goal of optimizing the care we give to our patients."

As physicians learn from each other and from their patients, they are also helping create knowledgeable doctors of tomorrow, notes Leffell. "Our students learn from us as we collaborate with each other," he says.

Medical school students, faculty and Yale Health Plan physicians often come together for weekly grand rounds sponsored by many clinical departments at the medical school. "Our clinicians really benefit from the education we continuously get as we attend grand rounds, listen to outside speakers who are guests at the school and hear about updates in therapies," says Knudson. "That ongoing learning we all share in is invaluable."

-- By Susan Gonzalez