AcuteCare Telemedicine Blog

Eagle Scout, AcuteCare CEO Dr. Matthews Gwynn Does His Best To Help Others

Being a good scout has carried Dr. Matthews W. Gwynn through life, to the post of chief executive officer of AcuteCare Telemedicine, and consistently as one of America’s Top Doctors, according to U.S. News and World Report.

An Eagle Scout’s life lessons are a solid foundation for Dr. Gwynn, now 55, as he strives, on his honor, to do his best to help others. “It teaches you to do the right thing if you take it seriously,” he says of Scouting’s influence.  “In my blood I always try to do the right thing. I believe there is something to be said for society that, if you simply follow the Scout law and motto and think like that, it sounds hokey, really hokey, but the world is a better place.”

Dr. Gwynn was born in Baltimore, Md., then moved around in his early years, to Cincinnati, Ohio, Raleigh, N.C., and Reston, Va.

With his father’s encouragement, he grew into the idea of becoming a doctor. As a chemistry major with a liberal arts education, it was his love of science and problem solving, plus his maternal grandmother, that cleared the path for Dr. Gwynn’s career. In his teenage years, he helped take care of his grandmother after she’d suffered a stroke. “I came to understand the frailties of people,” he remembers. “I realized I could make a living at it and also help people get better.”

He is a graduate of the College of William and Mary and the University of Virginia Medical School. He completed an Internal Medicine residency at the University of Alabama in Birmingham, and then returned to the University of Virginia for his Neurology residency. He is also a partner in Atlanta Neurology.

The challenges and riddles of Neurology are what eventually drew Dr. Gwynn in. “I loved the fact that it was a puzzle and the diseases were highly interesting and very challenging,” he says. “Not particularly easy and not everybody could do it. It required a very formal thought process to come to the right answer.” He says he was discouraged at first, “that there was nothing to do for people” he adds. “It was the old saying ‘diagnose and adios’ in neurology.” So he went into general medicine residency to find something to help people get better. But he changed his mind and realized he was fascinated by Neurology, just as the field was developing quickly.

Dr. Gwynn realized that telemedicine was a rising frontier in the field of Neurology. “The current economics in medicine is unfavorable for many neurologists to stay in hospitals. Almost all liability comes from there, and it is very disruptive to your primary income source, which is your private practice,” he says.  This exodus creates a real void. “Telemedicine is not a fad. It’s a demand that is growing,” the chief of Neurology at St. Joseph’s Hospital in Atlanta adds. “We are trying to use this opportunity to fill the gap.”

The CEO sees the professionals at AcuteCare Telemedicine as “competent, punctual and engaging.” He says they embody the “Three A’s of Medicine”: ability; availability; and affability. “They are competent and have a wide breadth of clinical neurology experience and knowledge and are leaders in their field,” Dr. Gwynn adds. “They are engaged. We are people-people. We provide expert advice and with patients we are able to empathize and help them really well; better than most of our colleagues.”

Dr. Gwynn is also director and founder of the Stroke Center of Northside Hospital and recent chairman of the Department of Internal Medicine. He says the ability to connect with people is crucial in telemedicine. “It’s amazing how well that works,” he says. “Within five seconds I can gain the trust of the patient as much as if I were in the room by greeting them with a smiling face and respect.

We all find commonality very quickly with our patients,” the husband of 27 years and father of two says assuringly. “A lot of people are very frightened when they have neurological symptoms, because it is so foreign to them. It’s an enigma. So we’re there to try to put them at ease and figure out how to help them.”

Dr. Gwynn has also become a national expert leader in using botulinum toxin for medical treatment of chronic migraine, movement disorders, spasticity, and other disorders, and he trains other physicians to use it in their own practices.

The doctor enjoys a round of golf in what little spare time he gets. He also likes to cycle and backpack and enjoys classical music.

The Eagle Scout in a white coat gets his inspiration within each new day. “I love that every day is different and that I am going to see interesting people,” Dr. Gwynn says. “That people are going to come to me asking for my advice and wanting me to help them and make them better. I can’t help everybody but I can listen to everybody and ameliorate their suffering.”

He is also fond of the direction AcuteCare Telemedicine is taking. “By the end of next month we’re going to be in six states and many different ERs,” Dr. Gwynn says, “and I can reach anyone from anywhere. I can even have an influence on someone’s care 2,000 miles away in Arizona. That’s very cool.”

Stroke Mimics in the Emergency Setting

The role of the neurologist in treatment of acute stroke often focuses on the decision to use clot busting medication (tissue plasminogen activator; tPA), recommending care setting (e.g. ICU vs routine admission) based on patient deficits and prognosis, and of course, patient education in the midst of this emotionally charged experience. However, an often overlooked mandate for the neurologist is the proper recognition of stroke itself. Dr. J. Stephen Huff, Associate Professor of Neurology at the University of Virginia, provides a clear and comprehensive review of what are termed stroke “mimics” – disorders which may appear to be a stroke, but are not.

Stroke, broadly defined, is any prolonged disruption of focal neurologic function due to decreased blood flow from blood clotting in a specific region of brain. If that disruption is transient or intermittent it is typically referred to as a transient ischemic attack (TIA). If brain function is disrupted by a cause other than a blood clot, treatment with tPA may not only lack benefit but expose the patient to unnecessary harm. Recognition of “stroke syndromes” that result from specific artery involvement is the bread and butter of neurology. The abrupt onset of aphasia (language deficit) and right sided weakness almost certainly indicates a patient has blocked their left middle cerebral artery. Blocking this same artery on the right results in the classic presentation of left sided weakness and “neglect,” an inability to recognize one’s own physical deficits. In either case, the immediate administration of tPA can be life-saving.

Other disorders may cause brain dysfunction unrelated to a blood clot. This is the case in approximately 13-20% of patients presenting with presumed stroke. If the duration of symptoms is unclear, this number may even be as high as 30%. The most common mimic is seizure. Excessive electrical and chemical brain activity may result in focal weakness (Todd’s paralysis) and other deficits. If the seizure was not witnessed (especially in patients with previous stroke as the cause of seizures), excluding an acute stroke can be difficult. Focal neurologic injury from brain tumor, inflammation (e.g. multiple sclerosis), or even peripheral nerve palsy may be mistaken for stroke.

Stroke can be mimicked without direct injury to the brain. The most common mimic in this category is a complex migraine in which visual disturbance, weakness, numbness and even aphasia can occur. Hypoglycemia or, less often, hyperglycemia (low and high blood sugar) can cause general symptoms of lethargy or coma, but focal brain dysfunction (particularly weakness) often occurs and can outlast normalization of blood glucose. Finally, 30% of patients presenting with psychiatric causes of physical illness (i.e. conversion disorder) exhibit neurologic deficits, typically weakness.

Determining the cause of a patient’s deficits can sometimes be accomplished in an emergency setting through the use of CT imaging and appropriate diagnostic tests. Often the results of serial examinations, detailed history and, increasingly, advances in MR imaging can eventually lead to the correct diagnosis. However, certain diagnoses, notably migraine and conversion, are diagnoses of exclusion, so repeated events and extensive negative testing may be required for confirmation.

Among patients presenting with neurologic deficits, emergency department physicians correctly identify stroke before applying diagnostic studies in about 75% of cases. This means as many as 1 in 4 cases are incorrectly diagnosed. It is the role of stroke experts, like those of AcuteCare Telemedicine, to quickly and accurately determine the likely cause of neurologic deficits, the risks and benefits of multiple treatment options and convey a plan of action simply yet fully to the patient and loved ones. It is a difficult but rewarding task.