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Week #5 Assessment: Not too shabby, though it could be better.

It was difficult to rate this week, since I sacrificed some patient time towards burying myself in the office working on my survey, so I didn’t do as many patient intakes as I did weeks prior. However, I did start to talk to patients a lot more whenever I’m with them. Some of them can get really chatty and personally, I really enjoy this “exhibition” of human personalities.

Since this afternoon, the finalized survey was translated, reviewed, approved, then tested on some patients, edited it (yet again) to shorten it, reviewed, reviewed again, then FINALLY…re-finalized. I was somewhat disappointed that my partner and I weren’t able to put the survey in full throttle, but work is work. This weekend will be laying out the framework (variables, coding, SPSS, Helena, etc.) so data entry would hopefully be (somewhat of) a breeze.

Now that everything seems so prospective, this week deserves a very nice 2.

Community Project: Translating and goals…

My relation with Dr. Stevens improved this week (or maybe because everyone is tired after 7PM on Thursday), and we finally had a friendly discussion on who/what/where the project should be aimed at. After making some minor changes on our draft survey, he proposed an idea that we could make posters and Plan of Action forms for cholesterol, just like what Gouverneur & NYCDOHMH did for hypertension and diabetes. I also had a neat idea to revise the current hypertension focus group program so that it includes aspects on cholesterol. A whole group on cholesterol is ideal, but I didn’t want to venture so far without knowing how these patient education programs get funded.

My goodness, how cool would it be to see an actual intervention taking place after our project? No more dusty, unused brochures stashed behind an old shelf, I hope.

For now, we are going to order nyc.gov health bulletins and tri-fold brochures to distribute to patients post-survey. Plus, we’re planning to package these pamphlets nicely (paper clip, topped with a high-quality, $0.15 ballpoint pen from Staples®) beforehand. Our idea was patient appreciation and quite possibly, interest from onlookers at the sight of “incentives” being given out around the ward.

One of the big problems we encountered when thinking about our goals was the ambiguity and complexity of the topic. Unlike diabetes, which emphasizes A1C as a crucial factor, topics such as hypertension or cholesterol tend to be repetitive in terms of variables. All 3 focus on LDL. HTN and cholesterol both involve physical activity and medication use. Maybe I can center on specific variables on a lipid panel, but the aforementioned variables are seemingly important, too.

That was why our survey ended up being too thorough and became “Jeopardy”. My current concerns are the length, the relevance of some seemingly necessary variables, and the time it takes for an intake patient to complete it without complaints (or a doctor barging in and interrupting the session). Priya’s first survey participant already complained about the length, so just as I was getting Dr. Hanley’s approval, I had to immediately run back to shorten it and salvage only the obviously important questions. In the process, I was able to remove several questions which I realized were repetitive. So after being re-finalized (for the final time), surveying will officially being on Monday morning: I decided to take my off-day to administer them.

If it’s something I learned from this week, it’s how to be nice when approaching patients (a lot of practice done during intakes), and how to modify language settings on my home computer so I that can type Chinese characters using pinyin without copying and pasting from an online dictionary. It was a pain to translate by doing the latter at Gouverneur, where I was not allowed to access most websites or tweak administrative options.

Professionally, I shouldn’t leave a mess in the office whenever I go out to lunch, or leave Lulu’s locker wide open after I’m done storing my possessions. Keep those in mind, Salina!

Subjective: Connections and a surprise.

After talking to a number of patients, reading journal articles, seeing stacks of prescriptions for hypertension, diabetes, and cholesterol medication always coming out of the printer one after another, and seeing virtually no distinct “line” that separates guidelines for each disease; I’ve concluded that most patients had to go through the torture of managing pills and foreign lifestyle changes because they fail to fully understand that they’re all connected: having one disease increase one’s risk for another, and vice versa. Besides explaining to patients what this triple threat is, physicians and educators absolutely need to acknowledge this interrelationship.

Personally, I feel that those Plans of Action should be given out separately and as a conglomerate, if necessary. Patients need to know that even though they’re in the clear for blood pressure, 150 mg/dL of LDL in their bloodstreams is still not good news.

Now, here is the story of the week:

Several weeks ago, Dr. Song gave me a copy of an old Chinese pamphlet about cholesterol that she claimed to give out to patients occasionally. The information is very friendly (with an anthropomorphic “healthy heart” mascot waving his hands on the cover), focused and concise, but the Xeroxed format didn’t give it a favorable impression. This is not the worst part.

You see, Xerox machines are remarkable tools, because some of the most primitive pranks and practical jokes relied on them. Who knows how many times that pamphlet had been duplicated, but lo and behold, too subtle to be noticed by the unsuspecting patient, were 2 middle fingers drawn on the mascot’s hands and blackened teeth, making the mascot look less healthy than he was supposed to portray. I figured that someone must have drawn them on the original and they were consequently passed on. I had forgotten about notifying Dr. Song until on Thursday, when I had to use it to look up some Chinese terminology.

I decided that I’ll show it to Clara, the head nurse. On my way to her office, I bumped into Dr. Hanley and a medical student. Their reaction was classic: mouth wide open, and stifled hysteria. By then, we were all trying not to burst out laughing.

Dr. Song’s response was a disappointed one. “A malicious, malicious prank,” she sighed.

When one nurse found out, she proceeded to rant about all types of problems she encountered in the hospital, especially those dealing with race. She went into the clashes between Latino and Chinese groups, where both staff and patients were involved. Currently, most doctors are being relocated to different locations on the floor based primarily on their language proficiency, so both Spanish- and Chinese-speaking patients can be better served by staff who speaks their native tongue. The nurse wholeheartedly supports this, reasoning that this was done based on necessity. Unfortunately, many people still use this as an excuse for being discriminatory, especially since one Team booth out of the entire floor had been renovated while the rest are furnished with decade-old furniture and are wearing down with age. Some are jealous, accusing this move biased and preferential.

I am so impressed that she speaks out not just at me, but publicly throughout the hospital. Of course, she has gotten criticized and judged based on her race, but this does not let her down one bit. She told me that she is willing to do this until she retires.

I plan on letting my passion for medicine run its course. I always felt like that is the only thing that cannot be readily destroyed. After hearing her stories, I start worrying not what my true interest really is, but how I’m going to survive in the workplace under all this pressure. Actually, any workplace.