Patient care: Provide patient-centered care that is compassionate, appropriate and effective for the treatment of health problems and the promotion of health
- 1.7 Counsel and educate patients and their families to empower them to participate in their care and enable shared decision making
- 1.9 Provide healthcare services to patients, families and communities aimed at preventing health problems or maintaining health
As an aspiring pediatrician, one of the most important skill sets I have built over the past four years has been my ability to care for and examine patients comfortably, efficiently, and compassionately. The knowledge needed to provide excellent, patient-centered care is not available from books or lectures, and it’s something I’ve instead been gradually learning through clinical experiences.
My first opportunity to interact with patients was as a sophomore in college. At that point, I was confident that I wanted to go into medicine, and I was eager for more hands-on experience than shadowing alone. That summer, I trained as a nursing assistant at a long-term care facility near where I grew up. The day after I completed my training, I was assigned to the advanced Alzheimer’s dementia unit with two other aides where we struggled to cover the basic care needs for all 43 patients on the floor. Many patients were non-ambulatory, so even a task as seemingly simple as transporting patients to meals often required operating a mechanical lift. For the most part, patients were complex and highly dependent on assistance for even the simplest daily care needs.
My training in patient care as a nurse aide was trial by fire: I struggled to be compassionate and provide care that was patient-centered on busy nights when we lacked enough aids to keep up with the care of 40+ patients. Over time, I learned how to show compassion in small ways, even on busy nights such as by asking patients about their day or their family while transporting them to dinner, for example.
I continued to work at this long-term care facility for three consecutive summers, during which time I gained skills in patient care. I developed a profound appreciation for the nurses and other aides who treated patients with compassion even on busy days, and I tried to learn from them. Over the course of my time as a nurse aid, I became better at quickly building rapport with new patients, caring for patients thoroughly and efficiently, and demonstrating humanism and compassion in what was a times a physically and emotionally challenging job.
My last summer working as a nurse aid overlapped with my first year of medical school, during which I began translating some of the knowledge I had gained in patient care as a nurse aid to my new role as a student. This role brought additional challenges and nuances, especially with my work at La Clínica Latina—a student-run free clinic that serves the Columbus Latinx population.
In this role, I saw patients independently and reported back to attending physicians, who helped me finalize assessments, plans, and prescriptions for each patient. Adjusting to these new responsibilities in patient care was its own challenge, but another layer of learning came as I navigated the learning barrier between myself and most of my patients. Few of the patients spoke English, and I conducted most visits in Spanish. It was challenging to build rapport with patients in a second language.
Over time, I became better at practicing patient-centered are in a second language. It helped that I was gaining more medical vocabulary over time, but I also became better at working around challenges in communication. I found that the principles of patient-centered care were the same even in Spanish, and the conversations involved in a patient-centered approach didn’t necessarily require complex vocabulary. I worked on identifying and exploring patients’ feelings regarding their care plan—for example, asking about patients’ confidence in a new medication. I also tried to prioritize asking patients what was important to them to cover at each visit. And, I always tried to learn something new about my patients and keep up to date on what was new in their home lives or at work.
Another aspect of caring for patients at La Clínica Latina that I had to adapt to was bridging social and cultural barriers. Patients arrived at the clinic from dozens of culturally distinct regions of Central and South America, bringing with them a vast range of educational and health literacy backgrounds. One evening, for example, I saw two patients who both had hypertension. However, one of the patients had been a doctor in Venezuela, and the other patient was a farmer from rural Guatemala who had never completed grade school. Adapting discussions about pathophysiology and treatment of hypertension to these two very different levels of health literacy was challenging, especially in a second language. However, having healthcare discussions with patients from different backgrounds helped me appreciate how important it is to confirm patients’ understanding of their health plan with methods such as teach back and by using a wide variety of resources to convey health information.
Especially for patients who were unable to read, careful attention to their comprehension of medical conversations was critical, and creative resources such as videos were helpful resources to augment homegoing instructions or telehealth visits. In fact, I helped with a project led by other students in the clinic, which developed YouTube videos in Spanish that conveyed important information about diabetes and hypertension. We worked with an endocrinologist to write videos that conveyed health facts about these chronic diseases as well as practical information for basic treatments ranging from lifestyle changes to insulin use (such as the video below).
Another unique opportunity to develop my skills in patient care was “Proyecto Alma.” This was a community outreach program that I led with a group of student volunteers. It was aimed at providing diabetes and hypertension screenings as well as nutrition education for the Columbus Latinx community through mobile health fairs at local churches. I coordinated a volunteer team, planned health fairs, and visited sites throughout the city. I also applied for and received grant funding. Through this project, I gained valuable skills in grant writing, community outreach, coordination of care, and culturally competent medical care.
One of the most unique and interesting aspects of this project was the opportunity to proactively address several significant barriers to healthcare access that our patient population faced. First, we worked to address barriers to transportation by partnering with local churches to meet patients in their own communities. Secondly, we worked to address barriers to cost by coordinating visits to the free clinic on-site for those who needed follow-up for a positive screening or who were looking to establish a medical home.
We were able to interact with hundreds of patients, and many new patients began arriving at our clinic as referrals from the health fair. It was exciting to see what a powerful tool the partnership of local organizations could be in reaching out to new members of our patient community. Just a few weeks ago, I saw a 35-year-old patient for follow-up of her diabetes–her chart noted that her initial diagnosis had been made at one of the health fairs hosted by Proyecto Alma. She has since started metformin as well as initiating changes to her diet and exercise habits, and her disease markers have gradually been improving.
As I transition into the next stage of training, I aim to continue developing my abilities to deliver patient-centered care in several ways. First, I plan to always begin non-emergent visits with a patient with an assessment of their priorities for the visit and make every effort to address those needs. Secondly, I want to try and learn at least one thing about my patient as an individual–whether that is learning something about a patient’s hobbies, family, or work life. Third, I am committed to continuing how to become a more culturally competent physician by learning directly from the diverse needs of my patients and by enriching my education with a focused curriculum of books, essays, and lectures. Finally, I hope to continue to learn about different barriers to healthcare access that patients face and practice addressing them, whether by collaborating with a social worker in the hospital or by reaching out to other organizations in the community.
I am proud of the progress I have made in the last several years with regard to patient care– I feel that I am gradually coming closer to my goal of becoming a compassionate, patient-centered caregiver. I know that this is a goal that will require continuous effort throughout my career, but encouragement from patients, attendings, and classmates has helped reassure me that I am off to a good start.