For Dr. Karen Geheb and her husband, Michael
Harris, the lure of the Northwest was too
attractive to ignore. Avid fly fishers and native
Texans, they were both eager, Geheb says, for a
place with “a little more geographical relief.”
When an opening became available in a residency
program in Spokane, Wash., Geheb, armed with a
medical degree and specialty in internal medicine, happily
hooked it, and the couple was northwestward bound.
When she completed her residency, Geheb wanted to
practice in a rural setting, “more farming related because
that’s where I came from,” she said. So, from Spokane, the
couple moved south to Pullman where she is now director of
hospitalist services for Pullman Regional Hospital. Like many
of the hikes she now enjoys, Geheb took a somewhat circuitous
route to begin her life as a physician.
Hard work, resolute determination and an indefatigable
interest in caring for others are in her blood. Her Irish mother
and Texan father met and married in England, where her
father was stationed with the Air Force. Her mother trained
as a certified nursing assistant, and, when they returned to
Texas, her father became a mechanic and worked for
International Harvester. At 73, he continues to work a 40-
hour week. Her mother raised her and her siblings and used
her training to care for people before home health became a
health care staple.
The eldest of six children, Geheb remembers always
wanting to be a doctor. “I took a keen interest in my baby
sister when she came home from the hospital, and I was only
2. I’ve always been fascinated by the human body,” she said.
In high school, Geheb first settled on becoming a nurse and
volunteered at Beaumont Medical and Surgical Hospital,
where she discovered two things: Nursing wasn’t for her, and
her interest in medicine, coupled with her potential abilities,
indicated she could become a doctor. Stellar high school
grades led her to begin a semester at Stephen F. Austin State
University, but homesickness and literally counting pennies
created stress too difficult to endure.
She returned home, began work at the
hospital as a clerk and enrolled at Lamar
University. Searching to regain confidence
and feeling her way toward a career, Geheb
took a drafting class and began EMT certification.
She worked for an ambulance company
that summer, finished her degree in drafting and then
began work for Dresser Industries in research and development
for oil field equipment. But, as one of the last hired
before the oil industry collapse in the ’80s, she was one of the
first to get a pink slip. “There’s nothing worse than having
worked to begin a career—especially as a woman in a traditionally
male profession—and being laid off. I felt so disheartened.
But always in the back of my head, I could hear my
mom pushing, ‘Go back to school. Be a doctor.’”
After a semester in Lamar’s pre-nursing program, she
chose to pursue a dual degree in biology and chemistry, partly
at the urging of a chemistry professor who recognized her
potential. That fulfillment would be delayed again, however.
“I kept looking at all the classes I needed to take and thinking
how old I felt. I decided I needed to finish school,” Geheb
said. She changed her major to education, and, as she finished
her first year teaching chemistry at West Brook High School,
the scientific honor society Sigma Xi selected her as teacher of
the year. But something was missing. “At the end of my third
year of teaching, my heart was still saying, ‘There’s something
else; there’s something more.’”
She returned to Lamar and earned a master’s in biology,
deciding to apply to medical school. “This time,” she said,
“the decision was a thoughtful one, and it was with the intent
of being a researcher, not a physician.” After several interviews,
she chose the University of Texas Medical Branch in
Galveston, and, later, while preparing her thesis, took a job as
a microbiologist for Helena Laboratories. There, she met her
husband, who had worked in medical research, and focused
on choosing a residency.
Evolving career
Today, as a hospitalist—the newest outgrowth of internal medicine—
Geheb often treats patients with complex conditions, an inefficient
and expensive effort within the
typical physician’s office setting.
“When you have someone who is
elderly, who has mutiple medical
problems, with many organ
systems involved, the problem
becomes that internal medicine
doctors spend more time taking
care of the oldest and the sickest,”
she said. On a good day, a
doctor in family practice will see
many more patients than the 20 or so an internal medicine doctor
sees. To that 8-to-5 day, add on a couple of hours of paperwork to
check labs, communicate results, request refills, write orders and
complete medicare paperwork, in addition to making rounds in the
hospital before that day begins and after it ends. As a result, physicians
make a choice between committing to a clinic or to a hospital.
Out of this reality came the hospitalist focus—a way to not
only improve efficiency for the clinician, but also improve efficiency
for hospitals by decreasing wait times in the management of patient
care. “You might have a three- to four-hour wait because you have
someone waiting in the emergency department to go to a floor,”
Geheb said. “If the patient on the floor was ready to be discharged
but is waiting for the physician who is in clinic all day, and a
social worker is waiting to arrange a patient’s home health, call in
medications and explain follow up, it becomes very rushed. The
patients wind up suffering because they aren’t comfortable with
their instructions.”
When a clinic assigns a doctor to work in the hospital, that
doctor takes responsibility for the clinic’s hospital patients, ensuring
they are treated in a timely fashion, which improves flow and
continuity of care.
She loves interacting with patients most. Geheb left a successful,
but wearying, clinic practice. When on call, it was for two
hospitals and seven doctors. “I would have rather been on call twice
as often for one hospital,” she said. When Pullman Regional decided
they wanted a physician on call capable of seeing high-acuity,
intensive-care patients, Geheb accepted the position. By keeping the
patients and consolidating care, the hospital captures that billing,
and patients receive prompt, quality care.
After a year and a half, Geheb became the program’s full-time
director. “I love helping patients get better,” she said. “I love educating
patients about what medicine is, what is wrong with them, how
medication is going to work, what someone has to watch out for,
what someone can do better without having to be on a medication,
what their choices are.”
In the clinic, Geheb felt she could only affect one person at a
time, but in the hospital setting, she could influence people and programs
as she became part of the team to write policy and protocols
to ensure patient safety. She championed the 5 Million Lives
campaign the Institute for Healthcare Improvement developed,
believing there are a lot of needless accidents that can be prevented
through more attentiveness and drilled procedures. “Patients who
have heart attacks should get
aspirin. They should get oxygen.
They should get certain medications.
Unless there is a reason
not to, they should get that
because evidence shows that they
are going to have a better outcome,”
she said. “That leads to
fewer complications, which leads
to going home sooner. There’s
no reason a patient should
develop a pressure sore in your facility. There’s no reason there
should ever be a wrong-site surgery.”
Through her involvement with the Washington State Hospital
Association, she helps craft and refine initiatives for patient safety.
The movement is away from a hierarchy and toward a team
approach to patient care, encouraging communication.
When Geheb sets aside her stethoscope, she bikes and takes
ballet three days a week. And, even after three degrees, she continues
learning. She’s pursuing a master’s in medical management.
With the winding road she took, “I am most proud of the fact that
I’ve come from a very meager background and am able to now
work at the state level to try to influence these decisions. As far as
I was concerned growing up, being a physician was probably the
highest thing I could be called to do. Having accomplished that,
I feel very good,” she said. “Yeah, I love what I do.”
