Friday, May 1, 2015

In Which I Receive Patient-Centered Care

See how conscientiously I'm icing and resting and everything, Dr. Young Guy? 

I had an interesting conversation with Dr. Young Guy at my appointment the other day. Who, by the way, thought my Sharpie doodle on my hip contained one large dot that was surprisingly accurate.

Woo hoo!

Why was I scribbling on my person? Read this.

I must say, Dr. YG and I make a great trochanteric bursa injection team. I find the spot, he injects. Viola. This particular injection seems to be especially relief inducing; I'm not sure if this is due to my spectacular Sharpie marking skills, or the fact that I've been unusually compliant about resting and icing the injection site.

(Oh. And Dr. Young Guy? If you're reading this, my favorite rheumatology doctor EVAR? Um. I always ice and rest after the injections. Seriously. To some extent. Really.)

The conversation to which I alluded in the beginning of this post was most interesting because I realized that it was a very good example of a method of physician/patient interaction that most excellent physicians already use, but unfortunately may be somewhat of a novelty to other health care providers. This concept in delivering health care is called "Patient Centered Care" and has been the topic of much discussion in medical circles over the past several years. Read the definition from The Annals of Family Medicine in an article  entitled "The Values and Value of Patient-Centered Care" found here:
...The originators of client-centered and patient-centered health care were well aware of the moral implications of their work, which was based on deep respect for patients as unique living beings, and the obligation to care for them on their terms. Thus, patients are known as persons in context of their own social worlds, listened to, informed, respected, and involved in their care—and their wishes are honored (but not mindlessly enacted) during their health care journey. There have been concerns that patient-centered care, with its focus on individual needs, might be at odds with an evidence-based approach, which tends to focus on populations. Fortunately, that debate has been laid to rest; proponents of evidence-based medicine now accept that a good outcome must be defined in terms of what is meaningful and valuable to the individual patient. (Bolding mine) Continue reading here
"Meaningful and valuable to the individual patient." Exactly. Our conversation during my appointment was textbook patient-centered care. It went something like this:

Me: Blah blah blah blah blah (I usually like to begin my appointment with a few minutes of blabbing about various things such as the Mariners baseball team and the Trailblazers basketball team.)

Dr. Young Guy: (Short discussion during which support of Trailblazers is expressed. And preference for an  East Coast baseball team which I will not dignify with it's name is opined. Pffft.) Good to see you. So what's been going on?

Me: Three things, in order of importance: One - my bursitis is very painful right now; Two - My knee hurts like heck too; and Three - My dumb stupid lupus rash is beginning to show up again.

[Insert a physical exam of said ailments. Which is followed by a discussion detailing potential ways to address said ailments.]

Dr. Young Guy: So. Are you thinking that it's time for another bursa injection? 

I nod.

Dr. Young Guy: I recall that you've had a good response to those. How long ago did we do your last one? (Consults medical record) Ok. Let's do that today. So let's look at your knee next. [Insert discussion here about my options for dumb stupid knee treatments.] All right. I agree that your choice of a knee brace is a good place to start with that. And the lupus? 

I yank the neckline of my t-shirt down to reveal several small bright red spots on my neck and upper chest.

Dr. Young Guy: Ah. I see what you mean. It looks as though there's some lesions, but they're small and not as many as you've had before, right? [Insert conversation evaluating the risk vs benefit of decreasing my lupus rash by increasing my immunosuppressant drug and encouraging me to continuing to use sunscreen and other methods of avoidance of UV rays.]

Me: I think that I can live with this rash as long as it doesn't get worse or becomes really itchy or sore. I think your idea of staying with my current dose of cellcept makes sense.

Dr. Young Guy: Ok. Let me know if your rash or the pain in your hip or knee gets worse.

The value of feeling as though I have been expected to prioritize my health problems, discuss my treatment options, and set criteria for success is priceless.

Great medical care? Brilliant. 


Anonymous said...

Communication and trust in a doctor can make a huge difference.

Laura said...

YES. I love doctors who do this. My current doctor is awesome about having a discussion with me, informing me, giving me choices. (When there are choices. Sometimes, there really is no option except 'wait it out' that is medically viable. I have no idea what she'd do with a patient who argued that point, because I don't. Well, actually, I do, because maybe _once_ she has suggested something for the symptoms that I wasn't already doing. Usually, though, the symptom-control choices are obvious for my issues.)

Laura said...

...actually I do know, not actually I Argue that point. Argh, clarity!

Unknown said...

Cute sandals Julia :)

Unknown said...

Terrific. My PCP is like that. Don't have a rheumy. I seem to know more than they do - at least the Portland options. I think I am headed for another bursa injection too.