Author: kennett.10

Health Care Access

by

Systems-Based Practice

I have been fortunate to have a few experiences working in the health care system. This ranges from LP being in a medical oncology office, to working often at the Columbus Free Clinic, to working as a scribe in the emergency department. These experiences have shown me three very different systems of health care from an outpatient office as part of a large academic hospital to an emergency department at a small community hospital to a free clinic. These different practices have very different systems in place to help them function and provide the best quality care to their patients they can offer.

One of the biggest differences between the different systems I have seen is the equitable access to care for each person. In the free clinic setting, it is very difficult for patients to get the optimal care. This is due to the limited resources available to them. Once the patient is diagnosed, the options for treatment are limited. The prescription drugs they can get are limited to what is in stock in the in-house pharmacy. They also have a very limited amount of specialty care available to them if they need to be referred somewhere else for further advanced care. This process is extremely difficult and often not successful for the patient. In the emergency department in the small community, there were people who may have had the financial capacity to be referred to specialties, but the specialties were in a hospital an hour away from this community hospital. This meant that all patients who had to be admitted for care more specialized than an internist could provide, they had to be transferred down to that hospital. This made it difficult for them and their family. The family would need to travel down to the new hospital as well as arrange transportation for them to be able to get back since they would be taken to that hospital in an ambulance. This also made things difficult for time sensitive emergencies to get the proper care for the patients such as tPA for stroke patients or balloon stents for a STEMI patient since they needed to be transported down to the tertiary hospital for more definitive care. These two systems are contrasted with the care that can be provided by the outpatient here at a large academic hospital. If there is a need for any further care, the patient has easy access to the services. Even in the outpatient setting, if the patient has worrying signs for metastasis, they can often get even a CT that same day in the same building. If their chemo is causing anemia, they are able to blood transfusions that same day with just a phone call by the physician. These are services that the free clinic would need to fight hard to get for their patients. Even the emergency department that I worked at had a hard time getting blood products, and it would be a lengthy process for them to get the transfusion.

These inequalities in the availability of services for different people have also been seen before I had any clinical experiences. Growing up in a small town and seeing the impact that it had on families to need to travel so far to get quality care is difficult. My brother when he was young needed to go to a hospital nearly two hours away to get care for a kidney condition he had. Even now, people in my Dad’s neighborhood get their primary care services from doctors an hour and a half away as they do not feel they will get quality care near my hometown.

I am glad I have been able to experience these inequalities in the healthcare system. These inequalities have led me to want to work in underserved areas so that I can hep with these inequalities. Being able to practice in one of these underserved areas would allow me to help reduce these inequalities I have seen in my clinical experiences as well as see in my life while growing up. I want to be able to provide high quality service to people who might not otherwise be able to have access to those services. This also has affected how I look at residency programs. I make sure that every program I interview with has an ability to work in smaller communities without much specialty care. Therefor I have set a goal for myself that by the end of residency, I will have experienced and feel comfortable practicing as an independent provider who can practice without other specialist around.

Losing Fertility and a Husband

by

Interpersonal & Communication Skills

The patient was in tears after the news was delivered. While seeing a patient in the OB/GYN clinic, I was intensely saddened by how distraught a patient was when we told her we believe she is going through menopause and likely has premature ovarian insufficiency. She was instantly in tears over the news. I was slightly surprised by her reaction to the news as she already has children ages 16 and 18 years old. I had foolishly thought she would have had the children she already wanted since she had also had two terminated pregnancies since the live birth of her two children. My not understanding of the patient’s concerns led me to ask if there was anything else bothering her about this news. That is when she told me that she had recently married a new husband who does not have any children of his own. Because she would not be able to provide him with any children, according to her Nigerian culture, she would have to divorce her husband. This was further complicated as her current husband is the reason why she was able to come over to the United States from Nigeria. By delivering this news, we made her future incredibly uncertain. She would have to divorce her current husband and her status in the US would be questionable. This put her in a tailspin. Fortunately, my resident was there when we delivered the news, and she was able to somewhat calm some of her fears. We answered some of her questions, and tried to give words of comfort. We stated that we would bring the patient back in a week after a few more blood test to confirm her diagnosis and to discuss any further questions. The way the resident was able to provide support and comfort to the patient was inspiring. But the bigger lesson was why it is so important to understand where the patient is coming from. From first glance, it may seem like this patient would have been done with children and finding out she was going through menopause and would not be able to have any more children would not be completely devastating news. But by getting to know this patient and understanding her fears, we understood the depth and agony she was going through when this news was delivered.

This situation has given me a chance to take some time and think about what I could have done better to help provide more emotional support for the patient earlier. I think one important aspect would have been while I was initially interviewing the patient on my own, I could see that the patient was very distressed about the situation as she had been worked up by her PCP and came to us for further evaluation. That would have been a good time to discuss with the patient her thoughts and feelings about the situation and what concerns she had. This would have allowed me and the resident to be better prepared to react to the situation when the resident and I went back in and discussed our thoughts on the situation that the patient was going through menopause early. This would have led to better patient comfort with the situation.