Dr. Louis Bartoletti Returns to Sheridan to Provide Family Healthcare

Ever since he was a child, Louis Bartoletti knew he wanted to be a small-town family doctor in Sheridan, Montana. His academic career, medical training, and professional experience have been focused on his goal of practicing medicine in the Ruby Valley and enhancing the scope of healthcare for his hometown community. The foundation of Dr. Bartoletti's professional objective has been his family's deep dedication to serving the community, both locally and internationally.

As a third grader at Sheridan School, Louis Bartoletti gave a show-and-tell for his classmates on the bones of the body and took the first steps on his trek to becoming a rural family doctor. "Even when I was ten years old, I said, I'm going to come back and be a doctor in this town, in Sheridan," said Bartoletti. He followed his dream into high school and spent Thursday afternoons trailing his mentor, Dr. Sarah Googe, around her family clinic as she cared for her patients. Dr. Googe was a primary resource for family health care in Sheridan for decades, caring for generations of families in the Ruby Valley. "She was my introduction to family medicine and being a small-town doc," said Bartoletti.

Following high school, Bartoletti attended Carroll College in Helena, majoring in Biology and Spanish. At Carroll, Bartoletti met his wife-to-be, Jade Johnstone and together they created the Carroll Outreach Teams (COT) with the objective of bringing together students, faculty, alumni, and other friends of Carroll College to provide direct service and aid to people in need. Locally, Louis, Jade, and Carroll volunteers supported the God's Love homeless shelter in Helena through a variety of direct service projects. Internationally, COT raised money and trained volunteers for the Montana Dental Outreach Team for expeditions to Haiti and Honduras where dental healthcare was provided to underserved communities. "The fire that brought us together was these kinds of outreach and equitable healthcare service projects," explained Bartoletti regarding his courtship with Jade and their COT efforts. In 2004, Louis Bartoletti's father, Dr. Tom Bartoletti, DMD, started the Montana Dental Outreach Team which has sent teams of dentists, dental assistants, and students to Eastern Europe, Central and South America, the Caribbean, and Africa. Louis began participating in these expeditions while in high school. In recognition of his efforts in co-organizing COT, Louis was honored with Carroll's Michael Murphy Award which is, "presented to the graduating senior who, through personal achievement, generosity, and leadership, has excelled in promoting the true spirit and ideals of Carroll College." Louis and Jade were married the year following his graduation and then pursued their post-grad education in healthcare.

Louis attended the University of Washington's School of Medicine WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) TRUST (Targeted Rural and Underserved) program which allows students to complete a portion of their studies at a university in their home state, a six-month rotation in a rural or underserved urban community, and at the busy urban trauma clinics in the Seattle area. The University of Washington School of Medicine is rated #1 in the United States for primary care. As part of UW's TRUST program, Louis spent five months of his medical training caring for patients at Barrett Hospital Clinic and the Community Health Center in Dillon, working in the ER, inpatient, and clinic and first assisting with outpatient surgeries, deliveries, C-sections, vasectomies, and endoscopies.

While Louis was completing medical school rotations, Jade was enrolled at the University of Washington's Doctorate Nurse Practitioner program. She also held down part-time jobs working at Harborview Medical Center at the Women's and Children's Health Clinic as well as the Pediatric Trauma and Burn Unit. When she started clinical rotations, she too pursued opportunities to train in rural settings in order to understand the challenges and play a larger role on those teams.

Louis completed his residency in Boise at Family Medicine Residency of Idaho which focuses on rural or underserved healthcare services. While he received training in a broad range of specialties, his special interests were inpatient healthcare, emergency medicine, sports medicine, endoscopy, vasectomy, and ultrasound applications.

"As I went further into medical school and residency, I was always asking, what could you do in Sheridan? What could be done to expand our capacity there."

At this time, Jade worked at the Saint Alphonsus Regional Medical Center on the hospitalist team. Louis and Jade's two children were born during their years in Boise.

Relocating to Alaska was the next piece of Bartoletti's plan to broaden their medical experience. Louis had spent his college summers working in a salmon cannery in Naknek, Alaska. Jade joined him in Naknek for his last summer at the cannery and worked as a nurse in the local clinic. The couple enjoyed the experience and were eager to work and explore Alaska. In Soldotna, Louis worked in the clinic, and at the hospital, and covered ER shifts in Seward and Homer. Jade worked in the ER in Soldotna, broadening the scope of her practice and tackling the challenges of acute care.

Although the Bartolettis enjoyed Alaska's beauty and wilderness, they knew they wanted to return to Sheridan, Montana. "That's always, always been the dream," Louis said regarding their intention to return to Sheridan. Toward the end of their stay in Soldotna, the Bartoletti's contacted the CEO at the Ruby Valley Medical Center to inquire about positions in family practice medicine and it was agreed that they would begin working in Sheridan (Louis) and Twin Bridges (Jade) in August 2023.

Before returning to Montana, the Bartolettis decided to take a side trip to work in New Zealand for a year. "We had heard about New Zealand through Burke Hansen while I trained with him at Barrett Hospital in Dillon," Louis said. He explained that there are few barriers in New Zealand for M.D.s with U.S. training. "They welcome GPs with open arms." The Bartolettis wanted to experience life in New Zealand before settling down with their children in Sheridan. Louis found practicing medicine in rural New Zealand to be "pretty wild." "For on-call overnight, they give you a car and a bag for trauma, a bag for OB, a bag of medicines, a defibrillator, and an EKG machine in the back of the car and a pager. In an emergency, you go to a patient's house, carry in all these bags, and do your assessment. If it was needed, I called the ambulance or helicopter from the big city. After hours at the clinic, the doctor is a one-person show, checking in the patient, billing, and doing their own assistance, in addition to providing medical care." Comparing rural New Zealand to what is available in rural areas like Sheridan, where there is overnight staff, an on-site lab, and radiology with a CT scanner, Louis remarked, "We have an incredible amount of power in this country, especially in our rural communities when compared to other developed nations."

In New Zealand, Louis also received extensive training in treating dermatological problems. Due to the hole in the ozone over the South Pole, the tropical climate, and the previously limited use of sunscreen, skin cancers are a prominent medical issue. "I learned a ton about skin cancer and advanced surgical techniques for removal of larger lesions."

Dr. Bartoletti has spent much of his training and career in the application of endoscopic medicine. Endoscopy is the broad term for examining the gastrointestinal tract with a scope fitted with a camera the size of a little finger. At one end, an endoscopic examination involves screening the colon to look for cancer or sources of abdominal pain, rectal bleeding, and weight loss. At the other end, the examination involves an EGD (esophagogastroduodenoscopy) examining the esophagus, stomach (gastro), and proximal duodenum through the mouth. Although endoscopy involves sedation, it does not require an anesthesiologist. Bartoletti is excited about offering this procedure as part of rural healthcare because it can be done in smaller, procedural settings. It's a healthcare service that can be provided close to home and can produce answers to questions about pain with eating, swallowing, defecating, bleeding, or trouble with indigestion. Although endoscopy isn't currently available at Ruby Valley Medical Center, it will be offered in the near future.

Dr. Bartoletti is also excited about integrating point-of-care ultrasound into rural healthcare as clinicians can use it to immediately answer patient questions and concerns. "It's a really powerful tool to look into the body without radiation, sedation, or putting people in a big tube," said Bartoletti. Currently, Dr. Bartoletti uses the Butterfly IQ, a handheld ultrasound device that hooks into an iPhone or iPad. He has also trained on a variety of other ultrasound equipment and continues to train as new ultrasound technology is available.

"Point-of-care ultrasound is particularly useful in the ER setting for getting difficult IV access. That is how we deliver medicines to people that can't swallow anything, are unconscious, and need resuscitation." Bartoletti explained that POC ultrasounds are also very useful for answering binary questions such as whether is there bleeding in the lungs or abdomen, or does the heart appear to be functioning normally. He also works with probes that look at the musculoskeletal areas of the body such as hands, elbows, shoulders, knees, and ankles. "Do we see anything big, bad, scary, or obvious that is going to help us make decisions for patients? This is what endoscopy and POC ultrasound help us do effectively and safely in the local healthcare setting," said Bartoletti.

Increased dermatological care is another area where rural healthcare can support patients without going to a big medical center. "I think we may be able to expand the scope of dermatology, providing a full analysis and biopsies at the clinic in Sheridan," said Bartoletti.

Dr. Bartoletti is also looking forward to providing Spanish-language healthcare, as needed, to the Ruby Valley community. He began his language fluency as a high school student during a year abroad in Spain and continued his studies while in college. He has applied his Spanish skills in healthcare settings throughout his career.

Dr. Bartoletti's overall objective is to be approachable and provide really "good communication with patients about what they are going through, what the uncertainties are, and what medicine can and can't figure out." He wants his patients to know that they are being heard and what their options are. He also wants to support the Ruby Valley Medical Center's ongoing pursuit of safely and effectively enhancing quality healthcare services close to home so that patients don't feel that they always need to drive to Dillon, Butte, or Bozeman for care. "Approachable, affordable, quality care – those are the main tenets."

Dr. Bartoletti, MD, will begin seeing patients at the Ruby Valley Medical Center in Sheridan on August 14, 2023. Dr. Jade Bartoletti, DNP, FNP-C, will begin seeing patients at the Twin Bridges Clinic on August 14, 2023. Please call the Ruby Valley Medical Center at (406) 842-5453 for an appointment.