Wednesday, August 24, 2011

the dreaded refill

the refill process in the USA seems to baffle the majority of community clinic patients (at least in this Latin American community provider's experience). Although I have educated patients in the refill process, helped them call the pharmacy, handed out copious refill instruction sheets, and scheduled visits with social workers and nurses to educate on the refill process, clarifying literacy and other obstacles to refilling much needed medication... the issue still persists. Most recently, I started a campaign with the intake staff, to ask patients if they needed a refill, and instruct them how to 1) call their pharmacy and 2) check if they have a refill available prior to requesting a clinic walk in visit for a refill request.... this seemed to help, for a while, but now the requests are back again.

Some days in health care, I feel like a parrot, repeating the same phrases over and over and over again.... maybe I need to invest in a video production studio and instead of prescribing medication, prescribe an instructional video at the end of each visit... hmmm, that's a thought.

Saturday, August 6, 2011

the wolves within

As I have stepped deeply into management/leadership this year in a department which required a great amount of change in order to offer excellent patient care and a positive work environment, I have leaned on the power of story telling. It's amazing how people come together around a common story theme, and can really connect to the meaning of the tale... this is a favorite of my staff;

An old Cherokee is teaching his grandson about life. "A fight is going on inside me," he said to the boy.

"It is a terrible fight and it is between two wolves. One is evil - he is anger, envy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority, and ego." He continued, "The other is good - he is joy, peace, love, hope, serenity, humility, kindness, benevolence, empathy, generosity, truth, compassion, and faith. The same fight is going on inside you - and inside every other person, too."

The grandson thought about it for a minute and then asked his grandfather, "Which wolf will win?"

The old Cherokee simply replied, "The one you feed

consider; the clinic/hospital/environment in which you work is also the place you are LIVING in... regardless of what you return home to, or what you enjoy after hours. Your words are powerful, in your life, your staff's lives, and your patient's reality.. use them with impeccable caution and create with them the reality you want to live in. It's that easy (and that difficult).

calling all critics

what topics/comments do people want to see covered here?

Normally, I wait until an inspiring day to recount long lost stories of community health that come to mind.

Are there topics people prefer me to write about?
Particular questions or situations I can add my experience to?

let me know :)

Onward community health peeps.... you're a rare breed, but the world would never be the same without you!

Thursday, August 4, 2011


Morado; Spanish for purple.. the concord hue beloved by many, and a lovely accent for almost any skin tone when use appropriately.... today, While admiring an elderly patient's carefully coiffed lavendar curls I was reminded of the good bad and ugly of the color purple and it's application to community health;

Gentian violet...aka "crystal violet", no, it's not a new urban form of Meth, but an inky dark fluid just this purple side of indigo.... some science geeks (myself included) may remember this lovely substance along with iodine tipping us off to the leakage of starch through a plastic cellulose "baggie" immersed in water during a freshman biology lab (osmosis anyone?)... my patients, on the other hand, apply this willie wonka fluid liberally to ANYTHING that might need curing/disinfecting/fixing/healing/younameit.

I have seen bright purple fingers, patches on limbs, cuts, and burns.. but only one purple penis. Yes, that's right, penis.

I will never ever forget the day that a kind elderly Senor stepped into my office, complaining of a problem with his "parte"... when he presented said "parte" it was stained a bright purple that only meant one of two things; extreme emergency, or case of purple violet dye. "Sir" I asked in spanish "did your penis start off as purple or did you put something on it". I breathed a sigh of relief as he described application of Gentian Violet due to an itchy rash he had experienced the prior week. Return to clinic the following week, and d/c application of lovely purple stain in the meantime revealed classic case of balanitis.... that had been covered up by all shades of glorious purple.

lost in translation

You have to appreciate the Bilingual humor that so often comes with practicing medicine in a community clinic… consider, when one decides upon the final characters for a chinese tramp stamp, before signing on the dotted line, I highly recommend bringing along a friend fluent in Chinese. This can be ever to helpful to prevent accidental life long imprinting of “idiot” or “fatty” instead of the tranquil “longevity” symbol theoretically offered. The same concept is true when purchasing brightly colored T-shirts at a local thrift shop…they may cost $1 in the bargain bin, but unless one is versed in the language imprinted on the T shirt, proceed with caution.

I have fond memories of a lovely Oaxacan patient who came to the clinic in a tight white baby T imprinted with bling bling gold and rhinestones spelling out “That’s right, I’m the bitch” across her tiny chest. This soft spoken Indian woman had NO idea what she was projecting to the world, and my kind MA took a few moments to explain this to her. Crestfallen, the sweet patient opted to leave wearing her shirt inside out. This experience was brought to memory today when I saw an older Hispanic gentleman perusing the halls of the clinic, shade of his sombrero barely obscuring the “Michigan Flip Cup Champ” T shirt he proudly sported. Something tells me this Senor has never played a game of flip cup in his life, but who knows.. maybe he’s developed new skills in a new land?