Tuesday, December 3, 2013

COACH: a window into the home

This part of the curriculum, though short really stood out in my mind as a truly great learning experience. I had started the night before doing a review of my assigned patient’s medications and their discharge summary from their recent hospitalization. The medication list was easy enough to review and jot down, though like many geriatric patients the medication list, including vitamin supplements was extensive. The next portion was the review of the discharge summary. Much like when we saw patients who had been recently admitted the nursing facility the review of the discharge summary allowed us to see what we would want in a summary by evaluating one from the other side. This certainly provided insight into to how to improve my summaries so that they contain everything I would want.

When we got to the apartment complex it was easy to see that the patient, like many of the patients we see regularly in the hospital, was not wealthy. Furthermore, he was housing several other family members in his small apartment complex, which was an added social stressor. My patient, however, despite having multiple health problems, despite having visual impairment, despite having social stressors, had managed to find a means to succeed. His medication list was near identical to the one provided by the hospital, with the few differences being conscious decisions due to identified side effects from his medications. He showed us how he organized his medications and how he managed to remember his upcoming appointments. He was fortunate enough to have a daughter who is a pharmacy technician who appears to be highly medically literate. The patient himself was also quite sharp, which was certainly beneficial. I can imagine without his daughter’s help he would have a much harder time keeping track of his medications, and would likely not be doing as well clinically. The same would likely be true if his cognition was not as good as it was.

Because he was doing so well clinically we were able to pare down on some of his medications, for which he was very grateful. Despite this he still had a toolbox full of pill bottles to take on a daily basis. We were fortunate in seeing a highly motivated patient who despite having a tough home situation was able to overcome his adversities. However this one patient might be more of an exception than a rule. How many patients keep coming back to the hospital because they can’t understand how to manage 20+ medications? Or lack the social support structure needed to take care of themselves.  Ultimately, what made this visit memorable was not just the visit itself, but the multiple permutations of possible visits and the multiple challenges each possible permutation might present. 

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