Cost-Conscious Care

Editor’s Note: One of the features of completing a clinical rotation at Siloam is learning about “poverty medicine” – delivering cost-conscious care. Andrew Wu, a 4th year Vanderbilt medical and master of public health student recently rotated at Siloam.  Andrew writes of his experience…

Wu, Andrew - VMS-IV - with Dr. Snader 10-2014

Dr. Brent Snader serves as a preceptor to 4th-yr Vanderbilt University School of Medicine student Andrew Wu.

One of my first learning experiences was an opportunity to learn how to practice in a cost-effective manner. A patient needed to be screened for colon cancer, which is normally done with a colonoscopy. However, due to financial constraints for this patient population, the alternative strategy of a fecal occult test was used in lieu of colonoscopy at this clinic. I found it interesting that these “alternative” methods were actually the standard for this particular patient population. In nearly all of my training, I was used to having almost unlimited resources at my fingertips. I could order labs and procedures without thinking much about the cost since they were either allowed for educational purposes or simply because the hospital could afford it. However, practicing at Siloam has allowed me to taste a bit of the reality of the cost behind the medical practice and how to appropriately adjust for it.

No magic solution…

The Siloam Institute offers clinical rotations to nearly 40 health professional trainees annually. Their rotation at Siloam helps them to deepen their understanding of how to engage persons living in poverty, work cross-culturally, and learn how to integrate behavioral health and spiritual care into their practice of medicine.

Click the video below to watch Samaiya Mushtaq reflect on a particular patient encounter stating, “I did not offer them a magic solution to their health problems, but I think they felt a little more healed after that visit.” Samaiya is a fourth-year Vanderbilt medical student who plans to pursue a residency in psychiatry.

2014 Community Service Award – The Siloam Institute

The Siloam Institute was recently recognized by the Tennessee Medical Association for its work training the next generation of health care practitioners in whole-person care.  Dr. Morgan Wills and Mark McCaw attended an awards ceremony where the video below was shown.

 

Dr. Morgan Wills, President and CEO of Siloam Family Health Center and Mark McCaw, Siloam Institute Director receive the 2014 Community Service Award given by the Tennessee Medical Association.

Dr. Morgan Wills, President and CEO of Siloam Family Health Center and Mark McCaw, Siloam Institute Director receive the 2014 Community Service Award given by the Tennessee Medical Association.

 

Whole-person care…is GRRREAT !

Tony the Tiger recently sought care at Siloam.  Listed as “Tony Tiger” in our electronic health record, Vanderbilt Medical Student Enoch Sizto was given a patient’s perspective on the entire clinic process.  Preparing for his new patient appointment, Enoch remembered to bring his identification (see accompanying photo). Tony Tiger - Enoch Shizto 2-2014

We want our trainees to see that in our attempt to provide whole-person care we need a team committed to making that experience possible.  The best practice examples of whole-person care extend beyond what goes on in the exam room between the patient and the practitioner.  Every staff member plays a role in caring for the whole person…from taking a patient phone call, to check-in, to triage, to the lab, and eventually to check-out…how staff address and care for patients is critically important.

This is not merely a “good customer service” technique, although I certainly do not knock the need for customer service training.  Whole-person care starts with the heart of the individual providing the service.  They must know themselves to be deeply loved creations of God…and, be encouraged by team members and leadership…and, supported by organizational policies and procedures.

Some ways we carry this out at Siloam is hiring staff that understand deeply our mission and can abide by our core values.  It follows with daily moments of renewal of spirit in prayer huddles to seek God’s blessing upon the shift ahead of us.  It is supported by a weekly staff meeting that allows us to form community (team-building) and reflect upon our purpose and study the scriptures.

Making whole-person care “Grrreat!” is not a destination but a process.  We continue to learn as we go.  What systems, processes or people have you experienced that make whole-person care possible in your life?

Optimized for caring

Feussner, Derek - VUMC PGY-II 9-2013 - with Mark McCaw

Mark McCaw, Associate Director for the Siloam Institute, explains the primary care preceptorship program to Dr. Derek Feussner.

Editor’s note: This blog is written by Vanderbilt internal medicine resident Dr. Derek Feussner who recently completed four weeks of training at Siloam.  He writes about his experience…

So often, in large urban medical centers, patients come and go with little focus given to their spiritual, emotional and cultural well-being. As residents at Vanderbilt, we strive to do a phenomenal job taking care of acute medical problems, diagnosing and treating complicated illnesses and performing research to advance medical knowledge. What we often overlook, however, is a patient’s spiritual health.

During my time at Siloam, I was able to see firsthand the direct relationship between spiritual, mental and physical health as it relates to a patient’s entire care. I remember taking care of one such patient who presented for a routine follow-up visit. Based on my chart review of her chronic medical conditions, her normal recent lab work and the appropriateness of her medication regimen, it figured to be a straightforward patient-physician interaction. However, when I entered the room and began speaking with her via an interpreter, it became clear there was much turmoil in her life. She had recently lost her husband and was attempting to care for her young daughter with limited resources and limited social support. Her entire family still resided in her middle-eastern homeland and her contact with them was limited.  Using the skills I had learned through my daily interaction with Siloam’s wonderful medical team I was able to obtain a social work and pastoral consult in one single visit. She met and prayed with our pastor and was set up with resources to obtain medications and care for her daughter. There was nothing specifically wrong with her body’s physiology, but her health was certainly suffering and she was spiritually ill.

Throughout “generic” medical training, residents are taught about religion and how it relates to medicine; about poverty and how it affects patients access to adequate health care – but what we never learn is how to truly care for someone in their entirety. The majority of patients have strong spiritual belief systems and these intertwine entirely with how they perceive illness, medical intervention and prevention of health problems, but as residents we rarely inquire as to patients spiritual needs. Being able to work in an environment where taking a spiritual history is “normal” has opened my eyes to the need for a more holistic approach to patient care. I look forward to carrying this knowledge into my future practice.

Dessert & Conversation with Mary Poplin

Note from the Director–

“The Siloam Institute exists to bridge the gap between academic medicine, the faith community, and the medically underserved.  As trainees at Siloam over the years are well aware, the worldviews of the clinician and patient alike have significant, practical implications for the work of healing.

In addition to training future health professionals to engage at this level (as recounted in stories on this blog), we periodically sponsor lectures or events that foster deeper dialogue around these issues.  With that in mind, we are delighted to co-sponsor an upcoming evening event on Oct. 23rd at Vanderbilt Medical School featuring Mary Poplin, professor at Claremont College and author of Finding Calcutta and Is Reality Secular? 

Whatever your own faith background, we hope you will consider joining us for dessert and provocative discussion about how to integrate personal conviction and professional practice.”

Oct-23 Lecture Flyer