How many times?

How many times must a person hear a message before taking it to heart? 

 

The classic example is quitting smoking.  Every smoker knows that he or she “should” quit smoking, and all the reasons why.  I personally would never tell a person to quit smoking.  I suggest cutting down, suggesting ways to cut down.  Quitting smoking is difficult, but smoking less has benefits too and can lead to actual quitting.   I have never been a smoker, but I know that it is one of the harder addictions to lick.

 

I have been thinking about other changes I’ve made in my life, though, and how many times I had to hear “You should…” before making a beneficial change.  In those cases, though, it was an addition of a good behavior, rather than the subtraction of a detrimental behavior- quite a different thing.

 

For instance, my physician had to gently remind me about five times that I needed to take calcium before I started taking it (almost) every day like I should.  But I have a better example.

 

At the church I used to attend, there was an announcement in the bulletin every week about an ESL (English as a Second Language) tutoring program for Spanish-speakers, which in our city are many.  I thought I would probably like to volunteer, but I had a hundred excuses: it was on the other side of town; I had too many other things to do; I was shy, and it was a one-on-one tutoring situation; I didn’t know any Spanish.

 

I probably saw this notice fifty times and went through the same list of excuses every time.

 

Then I had a surgery and ended up being off of work for more than three months.  I watched a lot of TV during that time.  Regular TV got boring and I started watching Spanish-language TV.  I was lonely and needed something to do; I couldn’t work eight hours, but I could tutor for two.  I called the head teacher and got started tutoring.

 

Think about that: I saw the notice fifty times.  The head of the program had spoken about it enthusiastically many times as well.  It took that, plus a life-altering medical issue, to get me to try it.

 

I love it; I’ve been doing it for three and a half  years, during which time I’ve started seriously studying Spanish, in the hopes of being able to better serve the Spanish-speaking patients that come to our clinic.  I’ve become more comfortable talking to people.  It has positively impacted my life in so many ways–and others’ lives as well.  But taking that first step?   That took a lot.

 

So I do understand that it is difficult to make life changes.  But I also understand that positive changes not only benefit the person who makes a good change, but people all around that person.   I keep all of these things in mind every time I interact with a patient.

Learning from every encounter

A couple of weeks ago, I went to see my auto mechanic.  The conversation that we had made me realize that every interaction with another person is a chance to learn, and often the things that I learn are applicable to my work as a nurse.  This particular trip to the mechanic was one such time.

 

I only had to wait a short time for him came out to talk to me, even though I had shown up without calling first.  He listened carefully as I described my car’s problem- I don’t know much about cars, but from what I said he figured out the most likely cause, taking a test drive to verify: sure enough.

 

As we were setting up an appointment for him to actually do the work, I casually mentioned that my husband and I are looking for a new car.  I mentioned that I wanted a hybrid.  He asked me a couple of careful questions and I realized that what I really wanted was the lowest-emission vehicle possible.  He helped me understand my real goal: reducing  the amount of pollution that I create is more important to me than saving gas (our city has enough ozone-awareness days.  The fact that urban populations are already exposed to high pollution has been well-documented; believe me, our clinic gets plenty of asthma exacerbation calls on those muggy, smoggy days). 

 

I hadn’t realized what I really wanted until he teased it out of me- knowing my and my husband’s  habits and opinions, particularly but not exclusively regarding driving,  from having been our mechanic for many years.  He told me a few other things to get me started on my search, distilling his own research on the subject into words I could understand- knowing that I know little about cars besides how to drive.

 

As I was leaving, I asked him if he could fix the malfunctioning “tweet” alarm mechanism that seemed broken: every time I got out of the car, it would tweet at me, seemingly for no reason.  “Oh,” he said simply.  “It’s not broken.  Look.”  He showed me that the transmission was allowing me to remove the key in the “accessory” position, rather than “lock,” causing the alarm to sound.  I wish I could convey here his tone of voice: I had asked him what must have been a stupid-easy question, and he answered simply in a way that did not allow me to feel stupid.  Changing my habit has indeed solved the “problem.”

 

Afterwards, I realized that this is how I would like to be in my work as a nurse: patient, knowledgeable, kind.  Every encounter with another human being can be a learning experience, regardless of whom it is with.

Truly patient-centered

“Patient-centeredness establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they require to make decisions and participate in their own care.”

Institute of Medicine

Envisioning a National Healthcare Equality Report

What is “respect?”  What does that word mean? 

 It makes me think of the twin concepts of “rights” and “responsibilities” and how they work together.  Patients always have “right of refusal,” for instance, and I honor that- but it is necessary- mandatory, I should say- that it be informed refusal.  It becomes my responsibility to inform the person of risks and benefits of possible choices, and the patient’s responsibility to make an informed choice.  At times I find myself in the role of “translator” from more technical medical language into words closer to a person’s typical vocabulary, something I enjoy greatly (as a nurse and a lover of language in all its forms).

The reasons for refusal can be surprising.  With open communication, these can be discussed openly, and new possibilities found– and that is a part of my nursing role too- to relay these to the physician, in order to find the solution most acceptable to the patient.  We’re working as a team.

 

More information about the seven core features of a patient-centered medical home can be found here.

Not really new at all

I mentioned my ”new role”  focused on the PCMH (Patient-Centered Medical Home) model of care.  It’s not truly new to me- I’ve been doing similar things for some time, albeit on a smaller scale, in between helping treat acute illnesses or exacerbation of chronic illnesses.

 

But now that is becoming my entire work focus- helping people live healthier lives, problem-solve through personal barriers, and seeing them feel better during the process.

 

I have had some success emailing patients, too, and seeing blood sugars gradually come into a healthier range- and people noting that they do, indeed, feel better-  has been most gratifying.

 

I have also had some frustrations and I would like to share some of those as well.

 

I promise I will never compromise patient confidentiality by posting identifying factors– because privacy is so important.  I hope to be inspiring, to problem-solve, and to share ideas with others who may be doing this, or thinking about doing this, at their own clinics.  I’ve always worked out problems by writing, and this seemed like the perfect forum to do so on.

PCMH Nurse

PCMH stands for “patient-centered medical home.”   It is a new concept that is actually an old concept: the idea that people each have a place where they receive person-centered care, a place that is like a “home” or home-base, if you will, where the person and his or her provider work as a team to set goals, and acheive those goals.

 

Except I missed an important piece in my definition above: nursing.

 

Allow me to explain: I got a new job yesterday.  Actually, I was chosen for a new role in my current job- with a hugely different focus than what healthcare has become in this country: people.  Individuals.  Families.  Wellness. 

Not medication, not technology: not that those things are bad.  They are useful tools.  But we have other tools: ideas.  Partnerships.  Caring.  Empathy.

 

Everything that has happened to me in my life has prepared me for this and I am ready to rock.

 

I work in Family Medicine.   Our specialty is not to specialize.  I believe in Family Medicine, and have always chosen Family Medicine physicians as my primary healthcare providers.  President Obama believes in Family Medicine too- he has just appointed a new surgeon general, Regina Benjamin, who is a primary care doctor.   Per the article- worth reading- “The administration pushes to reorient the health-care system toward prevention and primary care.”   Dr. Benjamin stated, when President Barack Obama introduced her Monday at the White House Rose Garden, “My hope, if confirmed as surgeon general, is to be America’s doctor, America’s family physician.”  Vindication!

 

So, to  anyone who may be reading this, I do apologize: the blog formatting needs work, and this first post is rather desultory.  I just wanted to celebrate by starting a new blog.

 

If you would like to know more, here is some further reading to get you started.