When the Best Medicine isn’t Medicine…

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Kristy Oman, a fourth year Belmont Pharmacy student who recently completed a four week rotation at Siloam

Three learning moments that will influence my future practice are also three lessons to carry throughout all aspects of life, not just in the practice of medicine.

1.  Health literacy does not equate with English proficient. I have encountered patients who did not have high health literacy, both before this rotation and during, who spoke perfect English. I have had the pleasure to meet several patients on this rotation who required a translator, yet were quite knowledgeable about their disease states and medications. As providers, we should be careful not to let the language of the patient influence your perception of their healthcare knowledge or health literacy level.

Lesson one: never judge a book by its cover.

2.  High quality does not have to mean high cost. The care provided here at Siloam is outstanding, and everyone I have met demonstrates compassion and a sincere desire to provide the best healthcare to each and every patient. I have spent a significant amount of time trying to source medications for patients, whether that is from patient assistance programs, Dispensary of Hope, or the $4 generic list at Wal-Mart. There are times when treatment options are limited, but this month I have witnessed first-hand how diligently providers try to access the best treatment options available.

Lesson two: Where there is a will, there is a way.

3.  Treat the whole person. I was sent on a home visit to investigate possible triggers for a patient experiencing exacerbations of asthma. Quickly upon arriving in the home, we discovered a very possible source: mold. After speaking with the patient and educating her, she was surprised and thankful to realize there were things in her environment that were likely making her asthma worse: dust, mold, air temperature changes. Was teaching the patient how to spot mold directly related to pharmacy expertise? Not really. Was it the right thing to do and best for the patient? Absolutely.

 Lesson three: sometimes the best medicine isn’t a medicine. 

Guest blog written by Kristy Oman

Muslims and Gelatin-based medications

Guest blogger, Elisa Greene, Pharm.D., is an Assistant Professor in the Belmont University College of Pharmacy.  Through a collaborative agreement with Belmont, Dr. Greene dedicates half of her time to caring for patients and precepting pharmacy students at Siloam.

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Elisa Greene, Pharm.D., counsels a patient on medication.

Anyone who has spent time at Siloam is aware of the variety of cultures, religions and languages represented in our patient population. We all desire to provide the highest quality of care. However, despite our best efforts at cultural competency and effective use of interpreters, we often overlook an important aspect of cross-cultural care: dietary restrictions.

Common dietary considerations include variations in blood sugar during Ramadan and other times of religious fasting, vitamin D deficiencies due to all over body coverings reducing sun exposure, and vitamin B deficiencies in Vegan diets that many refugees follow. An additional, less well known, restriction involves gelatin. Gelatin (stearic acid) is derived from beef or pork products and is an ingredient in almost all medications that are in capsule form. It is sometimes, although less commonly, present in tablet formulations, as well. For our Muslim patients, ingestion of pork is forbidden by their religious convictions. As you can imagine, this often results in a therapeutic challenge for clinicians!

Consider this case encountered by Dr. Kristin Martel (a staff physician at Siloam)…

“I had a Somali patient with severe hypothyroidism who returned for a follow up visit with continued complaints of the same symptoms. She admitted to not taking the thyroid medication I had prescribed. She revealed her fears that there was, in fact, gelatin, in some of the levothyroxine tablets. The patient was relieved when she heard that I could specify gelatin-free formulations of this medication. Since then, she has been more consistent with taking her medicine.”

This case illustrates the importance of considering whether dietary restrictions, and specifically the fear of products containing gelatin, are functioning as a source of non-adherence with medical therapies. Identifying this concern allows for development of alternative treatment plans. Gelatin-free products are often available, but require extra research into the inactive ingredients. In general, choosing tablet forms of medications instead of capsules for Muslim patients, when possible, can minimize gelatin exposures.Capsules

Resources are available to aid in this effort. Here is an excellent website* for identifying inactive ingredients in medications. It can be helpful for those seeking to avoid a substance such as gelatin, lactose, or red dye # 40. Also, a quick Internet search displays many commercially available gelatin-free forms of fish oil, an over the counter medication used to lower cholesterol.

Whole-person health care in general—and care offered by Christian believers in the Incarnation in particular (God among us in the life of Jesus)—should seek to meet the patient where they are.  Whether or not we agree with some of the specific convictions of our patients, we nonetheless need to acknowledge and respect them.  By creating an open, nonjudgmental atmosphere where potential barriers to care can safely emerge, the setting is optimized for healing. Assuming there is no harm to the patient from the proposed alternative, and that it doesn’t cause the clinician to violate her own integrity, we ought to seek to meet and treat patients on their own terms as much as possible.

* www.medicines.org.uk/EMC

Whole-Person Care: It’s Not Just for Patients!

Editor’s Note:  Elisa Greene, Pharm.D., professor at the Belmont School of Pharmacy, works at Siloam for 20 hours per week to provide medicine management and patient education.  She also precepts 4th year pharmacy students who are completing a clinical rotation at Siloam.  Below is an excerpt from Siloam Family Health Center’s newsletter, Healing Waters, where Debbie Barnett interviews Dr. Greene about the impact these rotations have had on her students.

Dr. Elisa Greene shares…

“The life changing experiences and worldview shifts that the students report reflect more on the collective experience of Siloam and the mission and the vision and the people here, rather than on me or the pharmacy component.  

“Initially my services and role here were immature, as I was still trying to get my feet on the ground and figure out where I fit in at Siloam.  So it certainly wasn’t me that provided many of the dramatic wow-moments they have had during their rotation.  It was a result of being at Siloam and working with the team here.  

“I think life lessons are just as important as the clinical lessons.  You can always read about the latest drug or side effects and read through counseling points.  But those skills of communicating and caring and seeing people as a whole person and not just a problem are invaluable.  Interacting with co-workers is a skill that can never be taught in the classroom.  

“A lot of students have remarked about the Wednesday clinical meetings and are stunned that people are so collegial and so respectful of one another’s skills.  There are no power-plays and no passive-aggressive comments or rudeness to one another.  I think many of them have seen that as the norm in their previous workplaces and this has really impacted them.  They have said to me, ‘These people say the love Jesus and they’re actually acting like they mean it!  And they even like each other, too!’“

“Until coming to Siloam, I hadn’t really thought about my students beyond the classroom.  I am tasked with teaching them things they need to know professionally.  But that is not the whole sum of my role in their life.  They come here and they still have personal problems and challenges – either in gaps in their learning or things that are going on outside their professional and academic lives.  They come here as a whole person and I think that the whole-person patient care that’s important to Siloam has opened my eyes to see that the students are whole people, too.”