[Green Cohort] Module 5

[Leslie Kao]

Please submit your SOAPs below:

[Catherine Czesnowski]

This week’s discussion and articles about patient adherence brought to light many different ways we can improve our patients quality of care. From my own experience, simply taking a daily multivitamin is a daunting task and like most patients with chronic disease, there is no symptomology when the medication is missed. Understanding how adherence to acute vs. chronic illness is drastically different is worthwhile to think about as the presence of symptoms and improvement thereof affects how our patients respond to treatment plans. I consistently strive to communicate effectively and pleasantly inform the patients of what my understanding of their problem is, the effect of their disease on the body, and how the treatment plan can improve their disease state as studies demonstrate having a long term trusting and open rapport between patient and physician is paramount to promoting long term health goals. Furthermore, telling patients the plan, what is to be expected, and asking them to self-monitor the effects of changes made to their treatment for the next visit allows them to feel a part of the decision-making process and more eager to participate in their own healthcare.

As discussed, there is always more we as healthcare providers can do to improve our patient’s adherence. I believe the most beneficial thing I need to address for patients under my care is the level of detail in understanding and discussing in depth the patients lifestyle, how and when they take their medications, and barriers they have to the treatment plan as this can alter their management to improve outcomes.

[Yeohan Song]

Ms. I walked into the room for another routine visit, with her usual spirited laugh and smile. She proudly shared that she had made an effort to decrease her weight herself, saying that she was the only person in her apartment complex who regularly walked up and down the apartment stairs to incorporate more daily exercise into her life. I congratulated her on her efforts, and though there was not much changed in her weight from her prior visit, reminded her that the road to a healthier self is life-long and would take time and continued dedication. If she stayed committed, she would one day see the fruits of her labors.

As I asked how she was faring otherwise, Ms. I mentioned in passing that she was continuing to regular see her mental health provider every 2 weeks. Previously, she had mentioned she had a condition for which she was seeing a mental health provider, but did not say much more than that. Asking to see if she was open to sharing more at this visit, I was somewhat surprised to hear her saying that she had schizophrenia. More than that, she shared that she was diagnosed after hearing voices of strangers and seeing the images of ghosts around her. A shadow was momentarily cast over her face, but quickly lifted as she regained her cheery laugh and explained that she did not like talking about the ghosts.

The Caring with Compassion module this week focused on the Biopsychosocial construct used to approach patient care, and this encounter with Ms. I reminded me again that there is very much indeed more to a person than just the conditions that are typically stratified by organ systems in the medical setting. Without knowing about the ghosts of Ms. I’s life and how they impact her perception of self and others, and how they might affect her motivation to adhere to the medical management plan discussed in her clinic visits, the most well-planned interventions may not reach their desired outcomes, and her overall health and functionality would suffer. I look forward to incorporating a more complete view of patient health as I help Ms. I and my other patients reach their overall life goals.

[Adi]

the 5 domains of the psychosocial model of care are, Social support, Resources, Behavioral and substance use disorders, Psychiatric disorders, and Biomedical conditions and medications. Yesterday, a new elderly patient came into my office and I asked him a few questions as part of the assessment of his psychosocial factors: where do you live? Do friends or family help and support you? How many days a week do you drink five or more alcoholic drinks and do you do other drugs? Have you ever been diagnosed with a mental health disorder? Are you able to take care of yourself or do you require others’ aid?

The most revealing answer was to my question whether he has friends or family that help him out. He replied that he lives with his family (wife and niece) but doesn’t trust them and claims that even though they coerce him to go to the doctor’s office, he feels that they’re not doing it to his benefit.

[Yuliya Sharakova]

The five domains of the psychosocial model are social support, resources, behavioral and substance use disorders, psychiatric disorders, and biomedical conditions and medications. Unfortunately, in our daily practice we often face these problems that affects patients’ priorities in treatment.
Ms.W is a 56 yo female, who came to the clinic to establish care and to get some referrals. During out encounter I found out, that patient was found to have breast mass about 3 months ago on mammography, and features of the mass were suspicious of malignancy. She also was complaining of chronic lower back pain, for which she did not want to do physical therapy or take any other medications, but Norco and Fentanyl patch given to her by her previous pain clinic. Recently her dose was cut down, and patient decided to change provider in order to get what she wanted. Patient requested referral to the new pain clinic. Long discussion about other treatment options did not give any results: patient was still insisting on getting pain clinic referral. Patient was also provided referral for biopsy of the breast mass with explanation of importance of this procedure.
Patient missed next scheduled appointment in 5 weeks, and came back to the clinic 10 weeks later. She managed to make Pain clinic appointment, but never made it to the breast mass biopsy. She explained to me, that Pain clinic appointment seemed more important for her, but breast mass did not bother her, and even she knew it could be a cancer, she prioritized getting pain medications over the test.

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