Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform.
My daughter is three years old and is now into all things Disney. A princess dress is proper attire for any occasion, especially trips to the coffee shop and grocery store. On constant loop are songs from all the different animated movies. I must have never really paid attention to the lyrics growing up—or maybe because English is my second language—but I am now noticing that some of the truths expressed in the songs are rather profound.
One song that has recently struck a chord is “Colors of the Wind” from Pocahontas (I have to admit, she was my childhood princess crush). The song begins with her rebuke of John Smith’s ethnocentric condescension:
“You think I'm an ignorant savage
And you've been so many places
I guess it must be so
But still I cannot see
If the savage one is me
How can there be so much that you don't know?
You don't know...”
I wonder how many patients leave their appointments with similar thoughts about me. I have traveled high and wide through the exotic places of medical school and residency, accumulated knowledge and skills (verified by my degrees and certifications), and thus able to conclude the patient encounter with the correct diagnosis and treatment plan of how my patients can become well.
At our next appointment, my expectation is that my patients adhered to the plan without question, and if they failed to follow through, my reaction is annoyance, frustration, and judgment. These patients get the nasty label of “medically non-compliant,” which actually has its own ICD-10 code: z91.19.
With each year working in an underserved community, I am learning again and again that my patients’ “non-compliance” has less to do with a willful decision to disregard my medical advice, but much more to do with my poor understanding of the many barriers they face toward becoming healthy, and my failure to adjust my treatment plan accordingly.
I have been so fortunate to be involved in a multi-disciplinary program to promote wellness amongst one of the most vulnerable patient populations: the chronically homeless with severe mental illness, substance use disorder, and chronic disease. I have the opportunity to partner with a team of social workers, nurses, and mental health providers to provide patients not just access to physical and mental health care, but also to housing, food, and social services.
Bridging the care gap
One of my responsibilities is doing street outreach to try to engage patients who have been reluctant to connect to care. One such patient was seen initially at our clinic, having recently been released from jail and had run out of all his medications. He was only in his forties, but already had heart failure from uncontrolled hypertension and chronic alcohol abuse.
He was furious when we told him his insurance had been deactivated, thinking we were the cause. Fortunately, we were able to get him back on most of his medications through our dispensary, and the team was working to get his insurance reactivated. Still, he stormed out of our clinic, cursing out the staff. Being intoxicated did not help the situation.