Terry Gao, Philly Shares
SDOH Health Impact Areas:
Public Health | Medical | Behavioral | Psychosocial
I have chosen to take a year between my third and fourth year of clinical medicine training to pursue a Health Design Research Fellowship. My first and second years were classroom based lectures – comprised of basic science content as well as interventions, epidemiology – intended to expose us to the wide range of pathologies we would encounter as future clinicians. “For this infection, we give X; if not X, we give Y. For this suspected disease, we diagnose with Z.” I concluded my second year feeling encyclopedic in my knowledge base of pathology specific minutia. The life lessons and empathy crash courses came in third year, in the shapes of interpersonal conflict, hospital hierarchy, and – above all else – patient interactions. My most challenging patient interactions always occurred with those whom I had developed personal connections with.
I realized that just knowing which anticoagulants to give Mrs. X in the aftermath of her heart attack, or knowing when it was time to stop Mr. Y’s Lasix, or knowing to trend Mrs. Z’s pressure during her dialysis appointments – it wasn’t enough. I realized that for every 5 minutes I had control over what to do to help my patients, there were entire lifetimes they’d spend away from me. There were patient’s whose lives depended on their ability to connect to an outpatient provider, and time and time again for factors we couldn’t seem control in the acute setting, we’d be unable to connect them to those resources at their time of discharge. It felt like we were constantly running out of time to address these problems, where maybe they could have been resolved with a little knowledge of patient context and some creative problem solving.
In the particular instance of Mrs. T, I made the decision intervene. She was the first patient I took care of during my last rotation of the year, Internal Medicine, and she was Vietnamese speaking only. She sufered from congestive heart failure, a condition that at the time of diagnosis requires careful outpatient adjustments of Lasix to find the perfect dose and regular blood tests to assure that all electrolyte levels remain within the normal ranges. Since her diagnosis in May, she had been hospitalized three additional times for the same problem. I quickly discovered that for a litany of reasons, she had been unable to acquire her medications between each hospitalization. I resolved to work diligently to do what I could to understand her particular barriers to care. My decision to do so helped me realize that true healing takes a team much larger than you’d think – it takes cooperation across the many facets of a patient’s life to truly impact healthcare outcomes.
Eventually, I was able to connect her to a team of Vietnamese speaking providers within the city and arrange transportation to the visits through her adult day care center. I helped her obtain home health aide services with the help of our social work team, and found a grocery delivery service compatible with her needs to lessen the physical burden her disease had taken on her. My decision to develop CoLab stems from the multitude of similar experiences I’ve had over the past year. CoLab, especially as a community engagement tool, challenges me to take on the concept of patient centered care at a whole other level.