Primary Care

Two weeks. For two weeks this month I worked in the local primary care clinic, seeing the daily parade of patients and problems: the good, the bad, the ugly.

The clinic was short-handed with some staff out for spring break, and I was able to help out at the front desk. I went through training last year to be a super-user for the clinic’s electronic record, and it helps me to stay current to go in and work in the live setting when I have opportunity. And it’s good to catch up with staff I used to see on a daily basis when I worked full-time in the admin department. Plus, the clinic is in Ketchikan, so I got to be in my own home while I fulfilled this commitment. So all good.

I’ve blogged about this before. Most of my work in the world of healthcare has been on the administrative side. I came into healthcare through the back door of grant writing and office work. I’ve expanded to policy writing, recruiting, project coordination…all tasks that are familiar and comfortable. But patients…now that’s different.

Patients are the reality check to all the work I do.

I usually work in quiet offices, with much of my day consumed with writing, or researching, or interacting with other staff: problem solving, planning, coordinating efforts, meetings, interviews. All valuable, and part of the mechanism that keeps staff in house and programs operating.

But in that world I’m shielded from the nitty, and the gritty. Two weeks of primary care changes that focus.

The other staff I worked with are great: patient, helpful, appreciative of the support I offer, even when it’s imperfectly delivered. In a busy clinic, you need all hands to juggle clinic hours (the clinic offers extended hours; some days the schedule begins at 7:00 AM, and others it ends at 7:00 PM), patient demands, and keep up with the minute-to-minute of busy days. Navigating the electronic system for patient registration,  scheduling appointments, fielding a million questions a day…ok, maybe a thousand, but it seems like more…well, I’m reminded again: I’m grateful to be healthy; humbled to recognize that my complaints of life are “first world” in nature; and I alternate between admiration of people who are cheerful and upbeat in the face of difficulty, and amazement at patients who abuse the very staff who are trying to help them.

Patients are thoughtful, kind, appreciative, attentive. Some are dainty little old ladies, or stately elderly men, in for blood pressure checks and routine appointments that make them regulars. The staff know them by heart. They’re the ones that give you a sense of purpose and satisfaction.

Others are also known, but not for their good traits. They’re rude, demanding, careless, dysfunctional. They’re the ones with an attitude and a knack for saying the wrong thing. They no-show for appointments, then complain when they can’t be worked in; they “lose” prescriptions; they’re quick to criticize and expect more. You see one of those names on the schedule for the day and you hope you don’t have to encounter them. They make you glad with their absence. And yet, even as you put on the smile and ignore the attitude that’s so inappropriate, you wonder: what happened to this person to turn them into a (take your pick) bitter/manipulative/ungrateful/difficult human being?

Work in a clinic setting, and it’s inevitable: you begin to have better understanding of the issues. The headlines about healthcare and insurance and regulations have a real-life meaning that you see through forms, and requirements, and layers of bureaucracy created to manage patients, and the business of paying for care.

The patients make it real too. Some of them can barely walk. Some of them smell. Some of them are dying, slowly but surely. Some of them are living, but miserably. I see the way the staff work with the needs, the challenges, the drama. I’m impressed that these people make a life of touching, healing, processing, listening, advocating, arranging, soothing. The list could go on, and does: the work is never-ending, and the reward is more of the same.

Sometimes it’s funny. When people become patients, you can expect the unexpected, and just when you think you’ve seen it all, it’s another day, and you’ve haven’t seen anything yet.

Sometimes it’s heartbreaking. Patients die, and every week there are two or three sympathy cards laid out on a back shelf, ready to mail “to the family of…”

I say it often: working in healthcare is not a job for the faint of heart.

The job of professionals is to make hard work look easy, and the team I just worked with does that on a regular basis. They find the grace to rise to the challenge every day.

I never had any aspiration to become a nurse, or a physician, or a hands-on healer of any sort. And I’ll admit I’m more than a little relieved that now I’ll go back to my role as a sometimes-recruiter, sometimes-project coordinator, juggling many balls and enjoying the variety of my world. But I have to acknowledge, a little time in the hot seat, interacting with patients is a good thing. It reminds me that there are people at the heart of the work I do from my safe and sanitized desk.

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This is a problem money can solve

Tonight we came home from work, and I discovered an unpleasant surprise: the load of laundry I had left going this morning had been washed with a tube of lipstick, and several things were ruined…or at best will only be salvaged with a lot of effort on my part. I think there are a few things that will be total losses. Since we’re in an apartment (for this work stint) that is somewhat sparsely supplied, there were no stain treatments with the laundry supplies. I drove back to the small grocery to see what options were available. I bought four different products, hoping that something would help.

After an hour of rubbing, scrubbing, soaking and working, I had made some progress. Enough to let the things soak while we ate dinner. While we were eating, we talked about our day, Rob in the back of the clinic seeing patients, me in the front, dealing with forms, schedules…the admin side. As I’ve said, I don’t do blood.

The other staff members are great; some of them have worked here a long time. They know everyone, and everyone’s story. I hear bits and pieces, put a few names and faces together. The last time we were here, I got a little taste of clinic life, the up close and personal view you get of patients when you sit at the front desk. But when I was here before, I was primarily training staff. I had limited exposure to the patients coming and going. Not so this trip. I’m working at the front desk, filling in until the new hire starts. It was a convenient opportunity. Rob was already scheduled to work, and it was nice that I could come along, and be paid to be here.

The view is different from the front. For the past five years, I’ve worked in healthcare administrative offices, hospital settings that put me in the healthcare arena every day. But in my role, I’ve primarily been involved with the business of healthcare. I’ve had almost no patient connection. The past few months, working with document management, and now sitting in the front office seat, I am seeing the patient population for the first time.

Of course I’ve known they were out there, real people with real illnesses. I’ve witnessed the healthcare system in a limited way for myself and my family. But we’ve been fortunate, and healthy, by and large.

Now I’m seeing, from a perspective I haven’t had before. Patients come in for everything from colds to cancer, broken bones to pregnancy. They come in all ages, shapes, sizes. This is a primary care clinic. Some patients’ stories are poignant reminders that life is fragile. Some are working the system…what can they get for pain? What diagnosis will get them a trip to a specialist in Seattle, conveniently paid by Medicaid? It is unbelievable, the parade that passes on a daily basis.

There are happy patients, women in for prenatal visits, or young parents with little ones for routine checks. There are older folks who come to be monitored for some condition, but who are generally well.

And there are the others…the ones with serious issues that usually can’t be fixed, or cured, or healed. They have too many complications, too many barriers, and many people are their own worst enemies. I often see references to behaviors that are creating the reasons patients come to be seen. But regardless of cause, self-inflicted or just an act of nature, it is a sad thing to look at people who are broken.

This afternoon I saw a man who is obese, can only walk with a walker, who looked hopeless, almost lifeless. He has a heart condition, but I don’t know what brought him in today. Regardless, he’s in bad shape. Then I saw his wife, who had come to pick him up. She is a cancer patient who had part of her jaw removed. It is unsettling to look at her. I found myself looking away, uncomfortable to see someone who has been literally defaced by her disease.

I sat tonight, eating dinner, frustrated at my own innatention to detail that allowed me to wash a tube of lipstick with the laundry. If I had only checked my pockets! And of course, several things I had recently bought were in that load.

But as we ate and talked, perspective grew. My thoughts cleared, and I realized, in the words of a friend, “this is a problem money can solve.” Worst case, I spend a little money to replace what I can’t salvage. The truth is, I’m as irritated at myself for causing the mishap as I am over the ruined clothes. I get impatient when I do foolish things.

Well, there are enough bumps in life to keep me appreciative of days that run smoothly. But no ruined laundry, fender bender, burned dinner…name your pet peeve…can compete with the sadness of serious illness, life-threatning disease, chronic pain. And so far, I’m blessed to be free of any of those conditions. So with that perspective, a little ruined laundry doesn’t seem too bad. Hey, it’s all replaceable or fixable, and non-essential. I mean no disrespect toward the value of money…I know money, or the lack of it, creates hardship too. But that’s another post. And still, in the big picture, things are just things.

I wish I could say I won’t need to be reminded of this again. But that isn’t true. I’ll be frustrated at some other slice of life in a few days, or a week or a month from now. And I’ll have to remind myself what’s important. Who’s important. And that if money can solve the problem, it isn’t really a problem after all.