It is not always easy to connect with the patients participating in my hypertension case management project. I am supposed to call with patients who have been lent home blood pressure monitors each month to follow-up on their blood pressure readings and self management goals. Surprisingly I have a found that more than a few of the nine patients participating prefer to make the extra trip into clinic and do our check-in face to face. I had been playing phone tag with one patient in particular for a few weeks. He happened to come into clinic one day for a follow up with his primary care doctor, and wandered up to my desk as he was waiting to be registered. “Are you Erin?” he asked tentatively. Recognizing his voice form our previous phone conversations I said “Why yes I am, and you must be Ron.* Its so nice to put a face to a name.” He was just as pleased to match a face to the voice that left him messages each month. I asked if he had time to check in after his appointment with the doctor, and he returned a while later ready to talk. He had a complicated medical case and was not keeping good track of his hypertension due to other worries and problems. Throughout our conversation I tried hard to pick out the things he was really concerned about that may be a good place to start. He was not really willing to pick one goal to work on, but was recognizing that there were many things that could change. I empathized with his complicated situation and encouraging him to take things one step at a time. We were able to make one goal that he would be willing to revisit when we checked in January after he’d had some testing done for his other health concerns. We had a wonderful conversation and he felt very comfortable sharing his worries with me. I knew he would respond well with a little more encouragement and could handle a little more push to make some small lifestyle changes the next time we talked. As he stood up to leave my desk, we talked about our next check in. He said “you know, I’d really prefer to come in and talk with you in person if that’s possible. It really was a pleasure meeting you.” I guess a little personal connection can go a long way.
*Name changed to protect patient confidentiality
Wednesday, July 27, 2011
November: Patient Advocacy
My identity as a patient advocate and future physician go hand in hand, but I have had some interactions with doctors in my clinic that contradict that ideal.
A patient came in needing help with Labor and Industry paperwork that required a letter from the doctor stating her treatment plan in order for her to continue getting her payments. The paperwork had been faxed to the provider a week or so previously and the patient asked the doctor about it during her visit, but she was sent to the "social worker" to have this paperwork filled out. The paperwork explicitly required information directly from the doctor, and was not information that any other clinic staff could fill out. The patient was very distressed. She was frustrated with the quality of care she was receiving as well as very concerned about being able to pay her bills.
As I worked with medical assistant to make sure the doctor wrote the letter, she explained that he often tries to have other clinic staff do this kind of work. He doesn't like to be bogged down with paperwork and simply passes it off. How frustrating that a physician who's entire job is to care for his patients would stop so short of providing complete and quality care!
I expected to be allies with providers to make sure patients had everything they needed. I did not expect to have to advocate for my patients so much within my own clinic.
A patient came in needing help with Labor and Industry paperwork that required a letter from the doctor stating her treatment plan in order for her to continue getting her payments. The paperwork had been faxed to the provider a week or so previously and the patient asked the doctor about it during her visit, but she was sent to the "social worker" to have this paperwork filled out. The paperwork explicitly required information directly from the doctor, and was not information that any other clinic staff could fill out. The patient was very distressed. She was frustrated with the quality of care she was receiving as well as very concerned about being able to pay her bills.
As I worked with medical assistant to make sure the doctor wrote the letter, she explained that he often tries to have other clinic staff do this kind of work. He doesn't like to be bogged down with paperwork and simply passes it off. How frustrating that a physician who's entire job is to care for his patients would stop so short of providing complete and quality care!
I expected to be allies with providers to make sure patients had everything they needed. I did not expect to have to advocate for my patients so much within my own clinic.
Tuesday, July 19, 2011
November - Pride: one of the few things left to hold onto
One patient who I see on a regular basis has really made Sea Mar his home. This is in part because he has been coming here so long that the clinic staff treats him more like that quirky uncle than a patient, and in part because he is homeless and really has no place else to go in South Park. I am like the gatekeeper of his home. He will walk in the door, raise a hand and shout "How's it goin, Miss Erin?" then continue forward seating himself in the chair in front of my desk and hand over one of the many tattered business cards of social support services that are the thread holding the remaining fabric of his life together.
His situation broke my heart a little further right before Thanksgiving. As temperatures dropped, he came in each day with a new layer of clothes and with a little less excitement in his greeting. His usual smile started to droop and the glimmer in eye grew dimmer and dimmer. I searched for housing downtown, but without a guarantee that he would have a place to sleep, he didn't want to make the trek to the city.
One day it was finally dropping below zero and emergency shelters in the city center were opening up. I urged him to go to City Hall, but he pushed back, not wanting to have to wait in line for hours just to be kicked out early in the morning. "But it's a warm bed" I pleaded with him. He replied "Its not a bed. Its a cot on the floor." I had no response. He was desperately trying to hang onto his last shreds of dignity. He would rather sleep with blankets under the bridge than wait in line to be packed into a dirty, smelly room with other people without homes hoping for a few hours of warmth on the City Hall floor.
There was nothing I could say to convince him to go. I can make the resources known, but protecting your pride when you have nothing else is sometimes a bigger priority.
His situation broke my heart a little further right before Thanksgiving. As temperatures dropped, he came in each day with a new layer of clothes and with a little less excitement in his greeting. His usual smile started to droop and the glimmer in eye grew dimmer and dimmer. I searched for housing downtown, but without a guarantee that he would have a place to sleep, he didn't want to make the trek to the city.
One day it was finally dropping below zero and emergency shelters in the city center were opening up. I urged him to go to City Hall, but he pushed back, not wanting to have to wait in line for hours just to be kicked out early in the morning. "But it's a warm bed" I pleaded with him. He replied "Its not a bed. Its a cot on the floor." I had no response. He was desperately trying to hang onto his last shreds of dignity. He would rather sleep with blankets under the bridge than wait in line to be packed into a dirty, smelly room with other people without homes hoping for a few hours of warmth on the City Hall floor.
There was nothing I could say to convince him to go. I can make the resources known, but protecting your pride when you have nothing else is sometimes a bigger priority.
Tuesday, July 12, 2011
October - First Presentation at the Consulate
We were full of nerves and excitement at our first presentation at the Mexican Consulate. The Health Education team nervously practiced our parts in Spanish, hoping to sound natural and fluid as we tried to get the important information we wanted to share across to the room of people anxiously waiting for their documents.
There were a few bumps in the road as other groups showed up scheduled to present, but we rolled with the punches and waited our turn. Finally it was time to go. The audience started out fairly quiet and hesitant o participate, with the exception of one woman. She sat in the front row with her husband with her eyes wide and eager to contribute to the conversation about Diabetes, Hypertension and High Blood Pressure. She was the first to volunteer when we offered free testing for those three conditions with our nurse. On the other hand, there was a man who sat in the back with a sly smile who just kept quiet, not quite buying what we were talking about. Throughout the presentation, he became a little more vocal. He asked questions, participated in a demonstration, but still did not want to get tested. As our Diabetic Educator spoke about Diabetes, our Champion poked her bright eyes around the corner of the testing room and displayed her bandaged finger for all to see, proud of getting her blood sugar checked and encouraging others to do the same.
As the discussion wound down, and we asked the last time for people interested in getting their blood sugar, blood pressure, and cholesterol checked, our quiet friend and his sly smile reluctantly shook his head and raised his hand. Empowered not only by the knowledge we imparted, but by the actions and advocacy of his peers, he checked his sugar, which was high, and was referred to out clinic for follow up - something so simple that will help him live a longer and healthier life.
There were a few bumps in the road as other groups showed up scheduled to present, but we rolled with the punches and waited our turn. Finally it was time to go. The audience started out fairly quiet and hesitant o participate, with the exception of one woman. She sat in the front row with her husband with her eyes wide and eager to contribute to the conversation about Diabetes, Hypertension and High Blood Pressure. She was the first to volunteer when we offered free testing for those three conditions with our nurse. On the other hand, there was a man who sat in the back with a sly smile who just kept quiet, not quite buying what we were talking about. Throughout the presentation, he became a little more vocal. He asked questions, participated in a demonstration, but still did not want to get tested. As our Diabetic Educator spoke about Diabetes, our Champion poked her bright eyes around the corner of the testing room and displayed her bandaged finger for all to see, proud of getting her blood sugar checked and encouraging others to do the same.
As the discussion wound down, and we asked the last time for people interested in getting their blood sugar, blood pressure, and cholesterol checked, our quiet friend and his sly smile reluctantly shook his head and raised his hand. Empowered not only by the knowledge we imparted, but by the actions and advocacy of his peers, he checked his sugar, which was high, and was referred to out clinic for follow up - something so simple that will help him live a longer and healthier life.
Tuesday, July 5, 2011
October - Hypertension Case Management
Today I enrolled my first patient in our hypertension case management pilot program.
As she sat down at my desk, wide-eyed and overwhelmed by her disease, I could see her pressure rising along with her anxiety. She recently buried her son, and has had over 5 family members die due to high blood pressure. I asked what she knew about the disease, and she said not much. She was told she had it about 6 years ago, but felt fine so didn't worry about it. I could see her putting pieces together as I gave simple explanation of what blood pressure is, and what having high blood pressure for a long time can do to your body. As she began to comprehend the risks of uncontrolled high blood pressure, she was more and more willing to take charge of her disease. With the support of her daughter she was ready to make a change. When I asked about what has inspired her to change and how I could best support her, the tears started to well up in her eyes. Still struggling with the recent death of her son, and the social isolation of living with an absent niece, she was grateful just to have someone who would walk with her through her struggle to survive this disease. With support and knowledge she was encouraged and empowered to manage her blood pressure. The silent yet heartfelt thank you spoken through tear-filled eyes reminds me why I have chosen to serve others and inspires me to continue to walk along side my patients in their struggles to lead healthy lives.
As she sat down at my desk, wide-eyed and overwhelmed by her disease, I could see her pressure rising along with her anxiety. She recently buried her son, and has had over 5 family members die due to high blood pressure. I asked what she knew about the disease, and she said not much. She was told she had it about 6 years ago, but felt fine so didn't worry about it. I could see her putting pieces together as I gave simple explanation of what blood pressure is, and what having high blood pressure for a long time can do to your body. As she began to comprehend the risks of uncontrolled high blood pressure, she was more and more willing to take charge of her disease. With the support of her daughter she was ready to make a change. When I asked about what has inspired her to change and how I could best support her, the tears started to well up in her eyes. Still struggling with the recent death of her son, and the social isolation of living with an absent niece, she was grateful just to have someone who would walk with her through her struggle to survive this disease. With support and knowledge she was encouraged and empowered to manage her blood pressure. The silent yet heartfelt thank you spoken through tear-filled eyes reminds me why I have chosen to serve others and inspires me to continue to walk along side my patients in their struggles to lead healthy lives.
Another Year Gone
My year of service with AmeriCorps/HealthCorps is almost over and I haven't written a word since orientation last September... WOOPSIES!
This year has been full of growth to say the least, and I truly do want to share my journey with you all. As I start to get everything ready for the new Patient Navigator in my last four weeks with Sea Mar Community Health Centers, I'm starting to reflect on what this year has meant to me and what I will take away from this experience.
But before I process too much, I wanted to share some of the things I've done. Throughout the year we are required to report "Great Stories" each month showing the work we've done and what we've learned. These are ultimately used as a promotional tool for our program, but as I weed through them I thought I'd post a few so people can have a better sense of the things I've done this year.
So keep your eye out - the next few posts will be a few of my "Great Stories" from this year.
Enjoy!
This year has been full of growth to say the least, and I truly do want to share my journey with you all. As I start to get everything ready for the new Patient Navigator in my last four weeks with Sea Mar Community Health Centers, I'm starting to reflect on what this year has meant to me and what I will take away from this experience.
But before I process too much, I wanted to share some of the things I've done. Throughout the year we are required to report "Great Stories" each month showing the work we've done and what we've learned. These are ultimately used as a promotional tool for our program, but as I weed through them I thought I'd post a few so people can have a better sense of the things I've done this year.
So keep your eye out - the next few posts will be a few of my "Great Stories" from this year.
Enjoy!
Wednesday, September 8, 2010
Solidarity or Self Care
So as I finally get settled in Seattle and am starting my Orientation for AmeriCorp, I find myself in a quandary.
One of the important aspects of JVC is living in the community in which you serve. All year I walked less than a mile from my home to work. I was able to limit my car usage with my human-powered transportation and lived within a few miles of where the majority of our patients lived. My roommates and I did participated in some "escapism" every now and again in the nicer neighborhoods of Portland either taking a stroll down NW 23rd street or simply admiring the adorable houses and porches in the South East neighborhoods. But solidarity - and figuring out what that really meant - was important.
One of the important aspects of JVC is living in the community in which you serve. All year I walked less than a mile from my home to work. I was able to limit my car usage with my human-powered transportation and lived within a few miles of where the majority of our patients lived. My roommates and I did participated in some "escapism" every now and again in the nicer neighborhoods of Portland either taking a stroll down NW 23rd street or simply admiring the adorable houses and porches in the South East neighborhoods. But solidarity - and figuring out what that really meant - was important.
Now I find myself living in the North end of the University District - butting right up against Ravenna and Greenlake - a pretty "Yuppie" area as my roommate Nick, a Former Jesuit Volunteer like myself, likes to point out. I've always wanted to live in this area. I love that Greenlake is less than a mile away - perfect for an after work run. I'm three blocks from my favorite vegetarian restaurant. Going for a walk around the neighborhood there are restaurants representing over 10 different ethnic groups. I brag about the area's 96% walkability score - the library, groceries, bars, restaurants, coffee shops, and shopping are all within walking distance.
But then I take my 20 minute drive on I-5 to South Park (A South Seattle neighborhood between the industrial area and boeing field) and feel guilty...
After two days of orientation I've learned how much Sea Mar community health clinics have poured into this neighborhood. It is incredibly diverse - way more so than North Seattle. It reminds me a lot of Gresham. Its where a lot of the minorities have been pushed out to because of the gentrification of other Seattle neighborhoods. But there is so much joy and community organizing going on. I feel like there is a real desire for change so many efforts to engage the community in celebrations like Fiestas Patrias, helping the local organic farm that supports the local food bank, and gatherings to save the South Park Bridge. Because the need is so visible, the opportunity for change seems more tangible.
I wanted to be happy and comfortable in my home and enjoy being close to friends. Outside of my housemates, living in Gresham was not necessarily where I wanted to spend my time. But now I wish I could really be a part of the community I'm going to serve. North Seattle is far away - physically and in philosophy/perspective.
I hope I can bring a little bit of South Park home with me this year.
Subscribe to:
Posts (Atom)