Tuesday, May 4, 2010

From Jess: Community Health Centers

While we spent most of our time with the Geriatrics residents, Dr. Medrano thought that it would be a worthwhile experience for us to be exposed to the Family Medicine Residency Program so we spent a morning learning about their Community Health Centers. We visited a Health Center in a community in Santiago called Korea.

I thought that by far the most interesting part was the second year experience: essentially each second year Family Medicine resident is assigned a small community in Santiago or the surrounding area and is responsible for the health of that community. The resident sees their patients both in the hospital and in their homes; what better way to really understand your patients? Each resident makes a map of his or her community and denotes with push pins the medical problems that each member of the community has – for instance every one with HTN gets a red pin, everyone with DM gets a green pin, etc. The maps make for a unique representation of the health of each resident’s community. Based on the diseases prevalent in their community, the residents (with assistance from their community health workers) develop educational sessions to improve health literacy and the general health of their community. I loved the maps – here are two of my favorites with close ups of the legends.

I wonder how much better I could care for my outpatients if I visited each of them once in their own homes? I think in addition to demonstrating to the patient that you truly care about them as an individual, you get a sense of whether they have a system for taking their medications, what type of food they have in their fridge, if they have shaggy carpet and exposed wires contributing to their fall risk, the list goes on... I know that we have VNS that can go out into the community and ascertain some of this information for us, but I feel like seeing firsthand how your patients live is pretty powerful. Time constraints of residency make it impossible to see all of our patients in their own homes but when I got back from the DR I was inspired to contact one of our attending who makes home visits to the homebound elderly to set up a few home visits so I can learn more about some of my geriatric patients that I am most concerned about.

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