Gostine Manages To Like GR
“But at the time, there were no good jobs in anesthesiology in Detroit,” he said.
So the young Wayne State University medical school graduate decided for the time being to pursue an area of medical curiosity a professor had implanted in his mind: Namely, that anesthesiology could be a springboard to other aspects of health care.
“I found that appealing,” Gostine said. “I’m not sure why, but I just did.” And because no Detroit job was immediately available, he enrolled in a fellowship in pain management at Kansas City’s Menorah Hospital.
It was a step that ultimately led to the establishment of Michigan Pain Consultants PC, a firm that serves hospitals and patients in Grand Rapids, Muskegon, Holland, Allegan, Greenville, Fremont, Hastings, Detroit and Kalamazoo.
Gostine and his long-time friend and colleague, Fred Davis, M.D., are the principals in that firm. They also operate a separate corporation that has management service organization contracts with pain management clinics in Michigan City, Fort Wayne and Phoenix, Ariz.
All told the two firms employ 10 physicians and nearly 90 other medical and support staffers.
By chance, the pair put down the firm’s roots at Butterworth Hospital in 1984 when Davis contacted Gostine to inform him that Butterworth needed a good anesthesiologist.
It so happened that Gostine arrived during a remarkable confluence of events. First, Gostine discovered that the hospital had a sort of unofficial one-man pain clinic in the form of Dr. Earl Visser.
“He was an anesthesiologist and he was doing some pain management procedures for patients a couple of times a week. Well, he was a very gracious, wonderful person. When I got there I was fellowship-trained and Earl had just picked it up on his own, which was the way most doctors did then.
“He essentially said, ‘Hey, you’re trained in this. I’m just going to turn it over to you.’”
What also was happening at the time was that Butterworth was leading the nation in pioneering outpatient surgery. “I’ve never been able to pin it down,” Gostine said, “but I’ve always understood Butterworth did the first outpatient surgery in the country.”
Whatever the case, he said, the health industry’s increasing use of outpatient surgery created a rapidly increasing need for pain management medicine.
“It was at that time a very small operation,” Gostine said. “The program saw 10 to 15 patients a week, and because that’s the sort of thing I wanted to do, I really threw myself into it.
“Fred joined me and we did the Butterworth Pain Management Center, and it became a full-time clinic.
“It was just the two of us for a long period of time — until the ’90s. Then we had some other doctors join us simply because we had established a good reputation for patient care in this area.”
He explained that as time went on, the group began to coalesce. “We were primarily practicing in various hospitals in West Michigan.”
Gostine explained that, in laymen’s terms, the practice of pain management tends to fall into diagnostics, therapy and what one might term coping skills.
As one example, he cited a case concerning a man in his 70s afflicted by back and hip joint arthritis and suffering intense leg pain.
“From a diagnostic point of view, this can help clarify where the pain’s coming from,” Gostine said. “So we inject and look for a differential response.
“We injected nerves in his back and we got a marginal response for a day for two.
“So then we injected the nerves of the hip. The patient felt wonderful for about four weeks. ‘Doc, I been doing things I haven’t been able to do in ages.’
“This means he’s a candidate for hip replacement.”
He said the firm’s therapeutic work often helps control pain that’s otherwise uncontrolled, like with cancer patients. “We also can implant narcotic delivery systems directly into the central nervous system that can control the pain that’s otherwise uncontrolled.”
One call for the clinic’s work frequently involves elderly patients who are admitted for, say, heart attacks. “Say that after a week, the patient’s heart is stabilized and he’s ready to go home, but his back is killing him from lying in bed for that long.”
Gostine said such patients also often are weak because they’ve been more or less inert for a week. In such cases, the pain clinic can help the patient become ambulatory again.
“Even though pain management is not widely known,” he said, “it is evolving into its own subspecialty.”
Michigan Pain Consultants moved into its own office building outside the hospital two years ago. The practice is located at 4100 Lake Drive, off East Paris Avenue.
But it still operates hospital clinics. “I can see many of our clinics ultimately being outside the hospital but some always will stay on as hospital clinics,” Gostine said.
He said hospital clinics are ideal for working with hospitalized cancer patients and trauma patients and also are useful when the occasional need arises for extra steps in treating post-operative patients.
Chronic pain, he added, often is more efficiently treated in outside clinics, where it’s easier to bring the aid of other specialists such as psychologists to bear.
“It’s ideal to have a foot in both camps,” he said. “ There is some cost pressure to move outside. It depends upon how efficient hospitals can be. Fortunately hospitals in western Michigan have traditionally been very, very efficient.”
Now the key question: After 18 years, does he miss not living in Detroit?
“I would never go back to the east side,” Gostine chuckles. “Not being able to get a job in Detroit was my biggest break.”