Week #4: Getting warmer...

Week #4 Assessment: I will not complain about it.

I will keep this entry nice, short, and precise.

This week gets a 2, since it’s one of the better weeks where I didn’t have too many problems in terms of patient care and my community project. Actually, I made a lot of progress on my case study, but my survey remained somewhat stagnant. On Tuesday and Friday, I did mostly intakes and shadowed Dr. Coun. I caught a break on Thursday afternoon when I got access to my case study patient’s charts, where I got loads of information that would greatly help me with formulating questions. In addition, I also took some time and walked around the hospital with Priya just to familiarize myself with the locations of most of the departments, which came in handy when I get approached by all sorts of patients asking me for directions.

Otherwise, I met some interesting patients, as always.

Community Project: Breakthrough, finally!

I was almost desperate for a case study when I got my break on Tuesday with one of Dr. Song’s morning patients. He seemed pretty pleasant and easy to talk to, and was chatting away about his lifestyle while I was taking his blood pressure. I was excited when he agreed to be my case study! Within a 10-minute period, I was able to elicit where and with whom does he live with, his work place, his hobbies, and how he takes care of himself. Then, I managed to observe him with Dr. Song before he politely told me that he needed to talk about something private with the doctor, so I left the room. Afterwards, I received his work number and schedule. I plan on giving him a call for a telephone interview some time next week.

On Thursday afternoon, Lulu showed me how to access his charts through MISYS, and I spent roughly 6 hours on the computer going through his medical information. My access is strictly limited to notes taken by his PCP, psychiatrist, and social worker, so it might be a disadvantage to not be able to look at his cardiologist’s notes, since he has a serious, chronic heart problem. Then again, that sort of info is leaning towards diagnosis.

Upon looking at his social work, I found almost a year’s worth of psychotherapy notes, which revealed some things that were so…opposite to what he was displaying from my first impression. He went through a lot of physical and psychological turmoil. This puts me in a difficult position when it’s time to make up interview questions, as there are so many potholes I’ll have to avoid for fear of creating an uncomfortable conversation (or a worst-case scenario: the patient pulls out of my case study).

Right now, I’m still wary of letting the patient know that I looked at what were probably his most intimate thoughts, but looking at these notes, I can almost predict the types of answers he’ll provide. Besides the information I gathered, it would be intriguing to compare his answers versus what’s really going on in his life, but I guess that is better left as a personal reflection. At least I know now what to avoid in my questions, but then again, this will just make me want to probe him with the specific problems he’s going through just to see how he’ll respond to them.

Subjective: generics and acupressure.

This week, I came across several cases dealing with drug costs (which strangely corresponded with the premiere of SiCKO today, hmm…). I was extremely busy doing intakes for Team 3 this week, so I ended up shadowing Dr. Coun again on Thursday morning. I clearly remember a 64-year-old Hispanic patient who showed Dr. Coun his box of Claritin, but was recommended to purchase generic loratidine at his drug store instead. I was so impressed by Dr. Coun, who circled the drug name on the box, and carefully explained to him that Claritin was “just another name” for its less-expensive generic version. I also remembered another patient who exclaimed how she was able to buy her $120 drug in Brazil for $10. Dr. Coun then recommended her to Gouverneur’s pharmacy, which provides any prescription for $10 and won’t charge more than $40 for any number of drugs. Plus, some essential medicines and prescriptions filed by Medicare members may even be free of cost. But as with any affordable pharmacy in the U.S., one would ominously encounter long lines at the counter, which is what I see almost every day from morning to night.

Another funny thing about this hospital is the number of people I found clustering in different sectors of the building. I found more people waiting in the financial office than the urgent care center.

I also met a Chinese patient who started boasting the wonders of acupressure during intake. Apparently, her arm was injured from transporting her husband in a wheelchair and physically supporting him constantly. She admits she had tried physical therapy, but it didn’t work. Eventually, her friend persuaded her to try acupressure, but she was reluctant about spending $28 on a session so she waited it out for 3 weeks before she could no longer withstand the pain. According to her, the acupressure treatment itself is painful, but it definitely worked (it IS painful indeed; I found bruised spots on some parts of her arm…yikes!).

I was amused when she admitted that sometimes, she discontinues some of her non-essential drugs (i.e. vitamins and hormones) because she’d try to use herbal remedies instead, even proclaiming how her liver function went up and her cholesterol lowered by 50 points after using ginseng. I simply told her that she could have just gone on a healthy diet and probably achieved the same result. Besides, I warned her about the risks of not telling her PCP about her lifestyle (i.e. possible interactions). But she just smiled smugly. Haha, that sneaky woman. It’s even funnier when I myself do the same.

Overall…

It looks like every aspect of my fieldwork is running smoothly: my case study outline is pretty solid, and my relations with hospital staff and patients definitely improved over this past week. Nevertheless, I think it’s time to step up my working pace by administering surveys all day for the next 2 weeks.