For over 40 years, Preston P. Nunnelley, MD, has been in private OB/GYN practice, a leader in Kentucky medicine and in hospital administration. Dr. Nunnelley is retiring in February, 2015 from his position at Baptist Health Lexington. To gather some of his wisdom, MD-UPDATE publisher Gil Dunn had an extended conversation with Dr. Nunnelley which will run in two parts. This is Part 1.
MD Update: Preston, tell us about your personal and professional background and influences.
Nunnelley: My grandfather was a civil engineer and I would spend summers with him. Because of his influence, I started college at UK majoring in civil engineering in 1960. During that time I made friends with George Prewitt, a hospital administrator, and Jack Lewis, a family practice physician. I’d go to the hospital with them and see what they were doing. Through this association I developed an interest in medicine and switched my major to pre-med. After my first year of college at UK, I met and married my wife Lucille and transferred to Eastern. While I was attending Eastern, I worked nights as an orderly at Pattie A. Clay Hospital doing whatever needed to be done. The more I was around healthcare the more I wanted to be a physician. I’ve been blessed in my career, because somehow I made the right decisions. When I look back, there is very little that I’d change.
How did you decide to specialize in OB/GYN?
After medical school I was interested in a residency in surgery. I also loved OB. One day, the doctor in charge of rotating internships and the residencies program said he “had to know today, are you going to go into OB/GYN or not?” For some reason I said, “I am.” It was the right thing to do at the right time, and I never looked back.
OB/GYN gave me the opportunity to do both surgery and OB. Obstetrics is stressful, but rewarding. Sometimes when I’m out in public someone comes up to me and says, “Dr. Nunnelley look who you delivered seven years ago, 20 years ago.” That really makes you feel good.
What was the name of your first practice?
Initially, it was Ellis, Jenkins and Nunnelley. Dr. Ellis, my senior partner, was always interested in how many babies he delivered. He would number his birth certificates. When he gave up OB, he was just short of 10,000 deliveries. You don’t get anywhere close to that now.
How many babies did you deliver?
You practiced OB/GYN for over 30 years. How has it changed?
There have been many changes in both obstetrics and gynecology. The major change in obstetrics is the ability to make an early diagnosis of fetal abnormalities and other complications. We now have ultrasound, particularly 3D ultrasound, and amniotic fluid analysis which provide us with a lot of diagnostic information on the status of the baby. We have evolved to the point of a specialty practice including maternal-fetal medicine and neonatology. And now we have telemedicine. If you’re in a rural area and you’re delivering babies, you can have a specialist look at the ultrasound or even up to the point of labor.
Talk about changes in gynecology.
It’s a totally different world. When I did a hysterectomy, it would take four-to-five days before the patient went home. Now, with the da Vinci robot and laparoscopic surgery, the patient is discharged the same day or after a 24-hour stay. We have more non-invasive management techniques to reduce hospital stays and decrease complications. The patients are more satisfied; they have less postoperative pain. The easier you make the surgery, the easier to get satisfaction.
What’s next in the advancement of OB or GYN?
In obstetrics, it’s advances in infertility treatment. In my mind, there’s nothing worse than a couple that wants to start a family but can’t conceive. The treatments for endometriosis and our monitoring techniques are getting better, so we’ll have more healthy babies. Unfortunately, there are just certain things that happen in pregnancy that can’t be resolved, but perinatologists and neonatologists give us better options. It is a real team approach.
From a GYN standpoint, there’s more medical management as newer drugs are developed. There will be refinements in robotic surgery. Probably the most significant improvement will be the treatment of GYN cancers like ovarian, uterine, and cervical cancer with newer medications and surgical techniques.
What are the challenges for Kentucky OB/GYN doctors?
The biggest challenges are the lifestyles of our population. Weight, obesity, smoking, diabetes, heart disease – all of those affect pregnancy and GYN because they are risk factors in surgery. We have a very high population of smokers and patients with pulmonary disease. Kentucky has to do more in preventative healthcare because the future of medicine is prevention. We need patient population and disease management.
We are a proud people in Kentucky, and patients don’t like to admit that they can’t afford their medicine. Many of our patients, because of travel cost and other issues, don’t get good prenatal care. It is not because it isn’t available; it’s because they don’t have the money. When you get them in for prenatal care, you can talk about preventative care. It takes time and resources to deal with issues of diet management, smoking, and more. We need a lot more resources.
The biggest thing we are dealing with in prenatal care is prescriptive drug abuse. That is huge. When you see the number of babies that are influenced by that, it is heartbreaking. Now, we are getting a handle on prescriptive drug abuse, but we are trading that off for heroin. We don’t have enough resources to treat addiction. You have to treat the addiction. You can stop one drug, but they will find something else until you cure the problem. We need more sites for addiction treatment.
Who is “we”?
Public health. It hurts me to have to use the word, but that means government. That’s where the funding has to happen and that’s a big challenge for medicine in Kentucky.
What do you consider your legacy, your proudest accomplishments?
The simple word would be that I care, I cared about my patients. I made every effort to treat them as individuals and made sure that they had the best quality of care that I could provide.
As you prepare to retire, any unfinished business?
No, I really don’t think so. The unfinished business is to finish out the positions that I am in now. I started about two years ago getting into that. I think that after I retire, there will be opportunities that I don’t recognize today. There will be things that I will get involved in that will be different than what I have done in the last 41 years. I’m excited about that. I want to further my education, maybe be a Donovan Scholar, take some classes. I think it is extremely important to keep your mind working. You can be productive as long as you’re doing that. I worry about retirement and not having the challenges that I have on a daily basis here, which stimulates you and keep you going.
For more on Nunnelley’s work in organized medicine and his role at Baptist Health Lexington, check out Part 2 of this Q&A in the next issue of MD-UPDATE.