Each Thursday, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit: http://www.umassmed.edu/news/articles/2011/personal_stories.aspx.
Erika Almquist, a nurse practitioner resident at Family Health Center of Worcester, writes about the discoveries of mixed up pill bottles and the power of connecting with other family members to help her as she cares for her patient at home. –Hugh Silk, MD
Today, with accompaniment from one of our care coordination nurses, I visited MB at her lovely home in Rochdale, Mass. She lives in a two-story, Cape Cod-style house with a two-car garage and a large front and back yard. I have to say, when I drove up, I questioned if we came to the right house, as I expected a small house cramped into an overcrowded neighborhood. Yet, sure enough, when we rang the doorbell, MB opened the door accompanied by her small poodle. Once we got inside, we also met her daughter, her daughter-in-law, her grandson and, a little later, another daughter, all of whom live with MB. The last time I saw MB had been in December, which was actually my first visit with her, in which I discovered that she was incorrectly taking her medications for her chronic medical conditions—specifically diabetes, hypertension and hyperlipidemia. Subsequently, her HgA1c had gone up from 7.7 to 8.6 and her blood pressure was 150/100. As MB was clueless as to what medications she was taking at this visit, I had her return the next day with all of her medication bottles so we could review them with her and fill them into pill boxes. After this visit, MB had two to three follow-up visits with our care coordination nurse, in which they reviewed diet, checked blood sugar and tried to review her meds. Unfortunately, she only brought her pill box in once and this was without the bottles, so it was hard to check to make sure she was taking her medications as directed.
In visiting MB today, one of my major goals was to help her find a way to set up her medications so she would take them correctly. After chatting with MB for a while about her family and work, we started talking about how she was doing with following a low carbohydrate and low-salt diet and finally got to reviewing her meds. MB took her pill box out of her purse and opened all of the covers. There were different pills in each box, random ones were empty, and MB had no idea which pills were for what. Although I knew we went over this two months prior, I decided to try again, but this time with her daughter present.
I would definitely say being able to review MB’s meds with both her and her daughter was a success. In the past, I have asked MB if she could come in with one of her daughters, but her response would be that they couldn’t come because of work. In talking with MB’s daughter, I got the impression that she was very committed to helping her mother. She had just never been asked to help in the past. Having made this home contact, I believe that I can now continue to be in contact with MB’s daughter despite her inability to come in with MB for her appointments, which I think will help in increasing MB’s medication compliance. In making this home visit, I also realized how involved MB’s children are in her life and that for her health care to be successful in the future, I need to give education toward the whole family instead of just to her as an individual.