A Hahnemann "Day In the Life"
A Resident Blog
by Rossana Lau, MD, PGY-2
It was Wednesday morning. At 8:30 am we had our weekly PCMH (Patient Medical Centered Home) meeting where MDs, nursing, administrative and support staff, behavioral health staff, and medical students participate in team-building exercises, working toward making our patients the focal point - and the center - of practice redesign.
As our patients started to come in at the end of our meeting, I dropped my "ruddle" off at the nursing station. It is a way to communicate with our nursing staff to ensure certain requests are made (i.e. stamp labsheet, take BP in both arms, shoes off for microfilament test, etc) to ensure efficiency and work flow. My first patient today came to follow up on some abnormal labwork, which unfortunately point towards a threatened abortion. She was appropriately upset, but wanted to speak with someone. I paged our behavioral health fellow Caitlin, and she came into the room to talk to my patient.
My second patient was a well child check for an infant with oculocutaneous albinism. I met her at her birth and have since become her PCP. After giving her parents a book from the "Reach Out and Read" program, I popped back into my first patient's room to check in with her. She was feeling better and we made decisions for followup and further work up.
I then went to the next room to meet my next patients, a son and his mom. The mom has dementia and her son is her primary caretaker and HCP. We addressed her needs first and went over the MOLST form today. We then shifted gears to focus on him. He is due for some labwork at our next visit and I provided him with a prestamped labsheet. My final patient this morning has a questionable lesion on his forehead that we will excise and send for pathology. We had him set up in the procedure room and performed a bunch biopsy.
Phew, what a morning.... I was also thinking about my patient who had a massive stroke several days ago while I was on vacation and was now in the ICU. I have been in communication with her husband and he was clearly distraught over, as he has been asked to decide how aggressive her care should be. After talking to him on the phone, I needed to debrief and stopped off at the office of one of our attendings. I reviewed the case with Dr. Stephanie Carter, a recent Barre graduate who is now an attending at Hahnemann. She was very supportive and gave me advice and guidance.
One of the things I love about being at a tertiary academic medical center are the specialists I have as resources. Later on, I curbsided Dr. Suzana Makowski, a palliative care doc, and she pointed me towards other tools I can use to help the team ease suffering and ensure dignity. At the end of the day, I visited my patient and set up a family meeting later on in the week with the husband and the family as well as the ICU attending.
All in a day's work as a PCP at Hahnemann.