Tools

The other day, I was at my own physician’s office (I see a Family Medicine doctor too) and talked with the nurse about my own job as she was getting my flu shot ready.  She told me that the doctor had asked her to call a certain patient every day to remind her to take her blood pressure medication.  No, it wasn’t an elderly patient, or someone with mental illness or anything like that.  It was a young woman who was working full time, and busy, and simply not taking her medication for whatever reasons. 

 

I don’t know about that.  It seems much more productive to help people find the tools to solve their own problems.  Tools already exist- things like pill boxes, calendars, post-it notes, toothbrushes (as in, keeping the pill bottle next to it…assuming that you do indeed brush your teeth at least once a day).  The nurse went on to say that she called this woman every day until she herself went on maternity leave, and then hadn’t started up again; if she had encouraged the woman to solve her own problem, the leave would not have disrupted anything (and, well, I don’t imagine that the nurse called her at home on the weekends, either).  This sounds catty.  I don’t mean it to be.  I am figuring this out for myself.  People that I have been calling and talking with have told me how nice it is that I took the time to see how they are doing and several have told me that they hadn’t been taking their meds- and started to take them after I called them.  Interestingly,  a recent study shows that when patients perceive that a caregiver does, indeed, care about them, they get better faster. 

 

So I would have asked that patient, what’s something that you do every day at around the same time, something you never forget or skip in your routine?  How could you use that as a trigger to remember to do this other thing?  Or, could you set an alarm?  What else can you come up with?

 

What else can you come up with?

Groups

I’ve done some benchmarking in the past year.  Several months ago I had set up a tour of another big urban Family Medicine clinic in our city, one whose focus is to serve the underserved (as is ours), but that seems to be more innovative in doing so.  One of the things that amazed me about the place- besides the fact that all providers are bilingual in either Spanish or Hmong- is its commitment to offering facilitated peer groups.  They offer all kinds of groups for people with all kinds of chronic conditions.  Diabetic cooking classes.  Salsa dancing for weight loss.  Asthma management groups.  The only offering that was not well-received, they told me, was a group for women with depression.

 

Another “sister” clinic offers a smoking cessation group, prenatal programs, nutrition classes, weight loss, and a diabetic group.

 

We ourselves have had a group for diabetic patients for a couple years now, and recently piloted a prenatal group- the nurse that works with the prenatal group was happy with how it worked out.  “They call each other!” she told me today.  Certainly, it did look like the pregnant ladies were having a good time- and learning- in their meetings.  I can’t help but think that peer groups are the way to go: mutually supportive people coping with similar situations, able to share their own solutions to problems. 

 

I put together a proposal for a six-week stress-management group that we could offer in January and February, the darkest and coldest and most post-holiday time of year here; we’ll see if it is deemed feasible.  It could be fun.  I certainly hope so!

Enough?

I had initially thought that our clinic was going to submit the PCMH application in December; as it turns out, we are submitting it tomorrow.  Have I done enough?  Have I reviewed enough charts?  Have I made enough care plans?  Have I called enough patients?  (Well, calling them and actually reaching them is an entirely different matter.)  Have I filled out the templates correctly in the electronic medical records?  Are there things I should be doing that I am completely unaware of?

 

I did have two meetings with patients this week that went especially well, which keeps me enthusiastic and feeling like I am somewhere near the right track.  But, sending someone off into the wide world with more information, a tool to accomplish something, or a sense of confidence is totally different than “meeting numbers for the month” or “percentage of our diabetic patients that are well-controlled.” 

 

I’m trying not to feel anxious about it.