Technology the latest tool in Dr. James Gude's crusade to keep health care personal

Dr. Jim Gude was at his Sea Ranch getaway one recent weekend listening to his Bach collection, walking his dog on the beach and reading two books, all while doing rounds with his laptop at hospitals in Willits, Sebastopol and Healdsburg.

This is the Gude life -- half in the classics and half in the future of what he calls the "paradigmatic change in medicine."

Gude, who has been a big player in the Sonoma County medical community since 1971, makes his current home base at Sebastopol's Palm Drive Hospital, where he's director of the Intensive Care Unit. Most of the time his dog, a mellow Airedale named Oliver, is in the office more than his owner.

Gude is a man who moves fast and talks even faster. No surprise that it takes a robot to keep up.

He believes that a big part of the future of medicine and health care delivery is technology. Right now that's a silver-blue robot topped with an LCD screen filled with the face of a critical care physician or other specialist who could be on the other side of the globe or across town and still do a bedside consultation with a hospital patient in Sebastopol, Healdsburg or other sites.

"I can do this from my kitchen table," said Gude. "I can do this from Starbucks. Isn't that neat?"

In 2006, Gude founded OffSiteCare, a telemedicine company, with his friend and colleague, the late Dr. Lewis Solomon.

The two, who met at Yale Medical School and worked together at Sutter and Memorial hospitals, discussed their ideas over dinners at Hank's Creekside restaurant in Santa Rosa.

"We founded OffSiteCare on napkins," said Gude, who with his friend came up with a way to use robotic telemetry to deliver specialist consultations to smaller facilities.

Gude has placed telemetry robots in the ICUs of Palm Drive, Howard Memorial in Willits and Healdsburg District hospitals. By the end of year, he said, there will be robots at Ukiah Valley Medical Center, Mendocino Coast District and Sonoma Valley hospitals, linking the smaller facilities to specialists 24 hours a day.

The robot doesn't replace doctors but allows physicians to be somewhere else and communicate with a patient and hospital staff. "It's the next phase of medicine. We can bring experts from anywhere," said Gude. "With a robot I can look, I can listen. I can feel," using ultrasound.

"Jim has always been ahead of his time," said Dr. Marshall Kubota, an AIDS specialist and former director of the Sutter Family Practice Residency program. "He embraces what he sees as promising technology. I think being in the ICU a lot, Jim has seen the benefits that technology can bring."

Kubota, who was a student of Gude's when the family practice program was run by what was then called Community Hospital, said he's not surprised that Gude, at age 68, remains tireless, upbeat and optimistic.

"I've never known him otherwise," said Kubota. "He's a gentleman, incredibly intelligent and one of the hardest working physicians you'll ever find."

A nearly lifesize portrait of Gude painted by a patient dominates one wall of his Palm Drive office, portraying him at his desk on the phone. The only thing missing is Gude's signature bow tie.

His wife thought the painting was a perfect fit for his office. "She said, 'That painting is as big as your ego. I'm not having it in the house,' " Gude recalled with a hearty laugh, obviously agreeing.

Gude and his wife, Sally, a retired teacher and librarian, met in high school in Gary, Ind., but didn't get together until she wrote him a letter while he was at Yale wondering if he thought she should move to the East Coast or the West. He said East.

The literary Gude likens their happy ending to the final scene in W. Somerset Maugham's "Of Human Bondage," where the hero finds his love, "also a Sally."

Board-certified in internal medicine, pulmonary diseases and critical care, Gude came to Sonoma County after medical school at Yale, residency at Stanford University Medical Center and two years as a submarine doctor with the Navy.

In Sonoma County, he's worked at the old General Hospital as well as Memorial, Community-Sutter and Warrack. He's taught at UCSF and is still coordinator of medicine for the family practice residency program. He's director of the ICU at Healdsburg District and Howard Memorial hospitals and Sutter Medical Center.

"Jim is one of the patron fathers of medicine in this area," said Evan Rayner, Healdsburg District Hospital's chief executive officer. "He knows almost every physician in the community and has trained so many of them through the family practice program. He continues to be an educator, mentor and forceful innovator."

Rayner credits Gude for being a big part of the once-struggling Healdsburg hospital's turn-around, largely by revitalizing the ICU and bringing in his robot. Healdsburg was the first critical-care access hospital in the state to utilize the remote technology.

Gude was "a perfect fit" with the hospital's mission "to keep health care close to home, which is good medicine," said Rayner.

Lori Austin, acting CEO at Palm Drive, also sings Gude's praises, and his robot's, for bringing "a new sense of confidence" to the financially troubled hospital, where Gude does morning rounds daily. "It's as if you're in a teaching hospital," she said. "Morale is booming. We are so lucky he's here."

The robotic tool, she said, "brings specialists to the hospital who we've never had. In the past, even though we are only 12 miles from Santa Rosa, specialists wouldn't come out to consult."

Gude helped bring the growing specialty of "hospitalist" to Sutter, in which a staff physician heads a team of caregivers focused on the medical needs of a hospitalized patient rather than having the patient's primary-care doctor try to manage things.

Also at Sutter, he was the brains behind a healing garden, using herbs like Chinese ginkgo and Indian lemon grass. Were Sutter to shut its doors, Gude would move the garden over to Palm Drive.

Unlike many in his profession and the general public, Gude does not despair over the future of health care.

"The solution to the future is not the solutions of the past." And it has to be new technology, not old, he said. "The old ways of office visits don't make sense. Going to San Francisco for care doesn't make sense. Not anymore."

Robotic telemetry has given smaller hospital ICUs "some muscle," he said, which is part of being able to stay open.

"To run a hospital without an ICU is to not survive. If you have an ICU, surgeons will use your hospital. Doctors will put their patients on the wards."

He envisions a day when a patient would have a camera in his house connected with his doctor and other specialists. It takes more innovation, of course, he said. "We need a Bill Gates of medicine."

In the meantime, Gude is doing what he can. He and his son have a robot operation in Sydney at Prince of Wales hospital connected to a hospital in the Outback.

He's working with a hospital in India to hook up a robot that will consult with HIV specialists at San Francisco General Hospital. Gude also hopes to have a robot at the 2008 Summer Olympics in Beijing as a demonstration project. "I want to get the Chinese ministry of health interested."

There are skeptics, he admits. "People tell me it sounds like Don Quixote. It sounds like a dream."

But Gude, who believes the country will have national health care "in our lifetime," said the future of medicine is loaded with changes.

That doesn't make him a total geek. He still reads books the traditional way. A copy of his latest read, "The Creators" by Daniel Boorstein, is full of scribbles and underlines.

"I'd rather read a book than play with a computer," Gude said. "The computer is a servant that works well."