The team at my clinical setting has a collaborative model of care. They have a combined practice among the physician, behavioral health psychologist, obstetrician, physician assistants, medical assistants, and front staffs. The power is manifested from the very top, which is the medical director. In my opinion and based on my observation, the team is working well together. One example that I can cite is that we had a patient in the clinic that verbalized in Spanish that he was depressed and has little interest or pleasure in doing things to the medical assistant. The medical assistant then reported patient’s verbalization of little interest to usual activities of life to the primary physician. Using the information given by the medical assistant, the primary physician further assessed the patient for depression. The PHQ-9 tool was used and he scored 12, which deemed to have moderate depression. In this case, the primary physician referred the patient to the behavioral health department of the clinic. The report was given to the psychologist about the assessment of the physician upon health history taking and patient’s behavior during the interview. The psychologist then addressed the depression and provided some counseling to address patient’s problem before it got worse. The given scenario is a good example of collaboration within the clinic for a more effective primary care. Regardless of wherever one role is in the team, each person in the team is important for an effective interprofessional collaboration. Collaboration in the practice setting encourages efficient health maintenance, disease prevention, and counseling in a timely manner.
Last week, I was given a chance to meet an 82-year old female patient who was accompanied by her husband, and was in the clinic for a narcotic medication refill. She said she has been suffering from moderate to severe pain on her dislocated right shoulder and needing medication refill to manage the pain. The doctor and I found out that she came back to the clinic a few weeks earlier than usual for the narcotic medication refill, which means she has finished her narcotic medications too soon. When interviewed in the clinic, the patient is calm while the husband is disheveled, aggressive and too demanding in asking the doctor for the narcotic medication refill. The policy in the clinic is that once a patient is on narcotic medication and needing regular refills of it, the patient should be referred to a pain management doctor to help in the medication dose management and especially for the pain management. All these information were explained to the patient and the husband but the husband continued to be pushy in getting more than one month of medication supply and wanting more than 30 pills per bottle refills on the narcotic medication. While on the other hand, the patient is calm about the doctor’s statement and was agreeing with the doctor’s recommendation. As a clinician, I assessed that the patient is in sound mind and body, able to comprehend and decide for her own. Though there were some contradictions on the part of the husband not wanting the referral to be done, the patient agreed to be seen by the pain specialist and understood the policy about the narcotic prescription. In this scenario, the doctor and I observed patient autonomy by going forward in sending the referral for pain management consultation to be able to further address patient’s pain issue, regardless of patient’s husband’s disagreement to it.
I was able to meet a female, 41-year old Hispanic patient in the clinic last week who was diagnosed with hypothyroidism, borderline diabetes, obesity, and hypertriglyceridemia. In this discussion post, I want to focus on her triglycerides level. On June 24, 2015, she had a laboratory test to check her lipid panel. The result was 888 mg/dl triglycerides. This made the doctor give her all the education about having high triglycerides including its risks as well as medications to manage the triglycerides. She was asked to come back to the clinic in 3 to 4 months to re-check her lipid panel. In October of the same year, her triglycerides went down within normal level of 137 mg/dl. She did her lipid panel again in February 2016 and her triglycerides level was 149 mg/dl. I will incorporate this patient’s situation to the transtheoretical model of behavior change. This theoretical framework assesses an individual’s readiness to act on a new healthier behavior. It provides strategies or processes of change to guide the individual through the stages of change to action and maintenance. The stages include precontemplation, contemplation, preparation, action, maintenance, and termination (Prochaska & Velicer, 1997). Obviously, she is not in the precontemplation anymore. It is because precontemplation is the stage wherein a person is not aware of the problematic behavior. Before her lipid panel was checked in June, she was not aware that her lifestyle was not helping her overall healthy state. The next stage is contemplation. This stage was when she started a healthier behavior. Her doctor took the advantage of this phase of her behavior change by making the patient aware of all the pros of changing to a healthier lifestyle. The treatment plan that her doctor has made for her revolved around focusing on the positive aspect of changing the behavior while disregarding the negatives. She successfully passed this stage as evidenced by a normal level of triglyceride on October 2015 and February 2016. The next stage is the preparation phase. After all the education and information about the dangers of having a high triglycerides level, the patient is ready to start taking action. She took small steps such as doing regular exercise and eating healthy balanced diet. Her doctor’s treatment plan in this stage was based on the fact that the patient is willing to make the steps to a healthier being. The treatment plan focused on getting support from patient’s family and friends because this stage is about the more support the patient gets, the more likely she is going to keep progressing. I believe that the next stage is where Mrs. T. N. is at the moment. It is the action phase of behavior change. Action stage is where a person has changed his or her behavior and is working hard to keep moving ahead. On her last clinic visit, she verbalized that she was getting used to the routine of living a healthier lifestyle. She is working hard to reach the goal of a normal triglycerides level for the next lipid panel blood test. What is important at this phase is to consistently give the patient praises of continuing to be in the path of a healthier behavior. As the patient continues to progress in this stage, she will then go to the next phase which is maintenance in which an individual finally exhibits the new behavior consistently for over six months. And when the patient continues to adapt the healthy behavior, she will then go to the last phase and that is termination. From this phase, the patient is evidenced to be incorporating the healthy behavior for the rest of her life. If she fails to do it, she will then go back to the first stage of the theoretical framework and go over the same phases all over again. Conclusively, transtheoretical model of behavior change indeed helps assess where on the spectrum a person falls and helps guide treatment efforts accordingly.
Prochaska, J., & Velicer, W. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38-48. doi:http://www.ncbi.nlm.nih.gov/pubmed/10170434