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Patient-Centered Medical Home

At Vera, we talk a lot about the Patient-Centered Medical Home. This can be a confusing term to understand. This month we sat down with our Medical Director, Sarat Raman, MD, to talk about what it all means. Dr. Raman unpacks what the term truly means, why it’s important to Vera, and why it’s a game-changer for patients. We hope you enjoy the conversation.

Q: We’ve heard the term, but what really is a Patient-Centered Medical Home?

In my mind, it’s a reflection of the need for a change in how we practice medicine. If you go back 50 years, medical needs were very different than they are now, but we haven’t changed much about the way we approach patients or healthcare in the last 50 years, and we need to. People are living much longer, often with chronic diseases.

The idea of a patient-centered medical home is to provide patients with a centralized place where they can get their healthcare, where a team of doctors and nurses knows and understands each patient’s healthcare needs within the context of their broader life and then applies that in a way that thinks about what’s best for that particular patient.

Q: Why does Vera call themselves a medical home? How does using Vera in this way benefit patients?

In calling ourselves a medical home, Vera is shifting our approach so that we can focus on outcomes with the individual patient in mind, meeting the patient where they are. This isn’t just physically, but also applies to what they are able to and willing to change around their health care.

Medical homes are first and foremost patient-centered, which means that they are individually tailored to the patient. This contrasts with what normally happens in medicine. In other environments, a patient may go to the doctor, be told to take a pill, and they walk out the door and never do it. The next time they come in, we say you really ought to take that pill, and then kick them out the door again. In a patient-centered approach, we focus on the whys of the situation. You didn’t take the pill. Ok, did you know why we wanted you to take the pill? Did you try it? Maybe there are barriers in your life. Was it too expensive, did you have to take it too many times a day, were there side effects? There are any number of real options that affect people’s lives. So we can focus a bit more on tailoring their treatment, knowing that the patient has a real life that influences the way that we should approach their medicine.

Beyond that we work on increased coordination between us as the medical home and what we call the medical neighborhood. This could include any outside resources that we are referring people to, whether they are specialists or programs. We are really trying to view the patient in a comprehensive way. You’re not just the leg that’s bothering you, or the diabetes you have, you’re a full person that happens to have issues that now impact other parts of your life. We want to view all of that in context, figure out what the patient’s goals are, and try to help them achieve them.

Q: Is this unique to Vera?

The model isn’t unique to Vera, but we do bring a lot of what makes us unique to the table. We make a commitment to spend extended time with our patients. In most other clinics, providers are stuck in a 15-20 minute visit. At Vera, visits are 30 minutes and we have the opportunity for hour-long visits if we need them as well. We also build in time for providers to coordinate pieces of the patient’s care plan without taking away from direct patient care time. So from the provider perspective, it really gives us a lot of opportunity to be deeply involved in our patients healthcare in a way that we couldn’t do it before.

We also really focus on empathetic listening, recognizing that the kinds of things that we ask our patients to do are not simple things to do. And then we help marshal other resources outside of our clinic on our patients behalf. Those are the two biggest pieces that are really unique. We give our providers time to reach deeper with patients. And we also expand our medical home team to include resources for the patient to really help them achieve the plans we create with them.

Q: Why does it matter to patients?

If we’re doing this right, it shouldn’t matter to patients and they should simply get the care that they’ve always been hoping for. This is about changing the system to provide the kind of care that all of us providers went into medicine to practice, and that patients have always wanted to receive. I don’t hear much feedback about a ‘medical home’ per se. I hear feedback about providers calling patients at home to follow up about tests, or to see how their treatment plan is working or not working and then amending and adjusting based on that.

There is one piece I feel is often missed and I would love for people to get to know better. The core piece of the medical home is the team that is caring for the patient, and the most important role on that team is the patient themself. They are the center of the team. We don’t have a purpose without them. It should be exceptionally empowering and vitally important for patients to recognize their role. We are not there to do to good healthcare. We are there to help them engage in an highly involved role in their health and wellness – they are in charge.

Q: Do you have any examples of what this might mean in real life?

I was working at one of our clinics, and a patient came in who had diabetes and foot wounds that weren’t healing well because his diabetes wasn’t under control. He had been to the emergency room several times in the last couple of months, and he told me that he wasn’t able to take his antibiotics on a regular basis. He was supposed to take them 2-3 times a day, but the company policy was that if you were found with drugs on campus, you would be fired. Now I believe that policy was probably intended to cover illicit drugs, or even prescribed narcotics or opioids, and probably not something like an antibiotic, but he was firm. We were unable to contact his manager in the moment, but I encouraged him to have that conversation. I also wrote him a letter to give his manager and then on my way out I was able to connect with a company executive and talk openly about how the company policy was impacting one of their employees to the extent that they were unable to get healthier.

That was a moment – and there are many more – where we were able to engage the client on many levels. And because of our work to step outside of the clinic walls, so to speak, the patient is healing and is much better today. This patient is having a better outcome, and hopefully Vera is impacting that.

Understanding & Managing Stress

By Cathy Moore, Health Coach

In our culture, it seems like everyone is stressed. With our clients and in Vera clinics, it’s one of the key topics we talk about. The majority of our coaching clients deal with stress at some level. There are a variety of causes: a new job, change in environment, a spiraling to do list, or a full season of life.

Because stress is so prevalent, it’s essential that we find a way to notice stress triggers and symptoms, and develop plans to address them.

Distress vs. Eustress

Stress can become either toxic or motivational. For example, a deadline can be perceived as a negative stressor, or it could be seen as a positive; something that helps us get an accomplishment achieved. The difference is in how we choose to handle the stress and the story we are creating around the stress.

There are two types of stress: distress and eustress. Distress is negative stress. It occurs when the challenge is greater than the available level of confidence, capacity and/or energy. Eustress is the opposite. It’s a wonderful stress that motivates us to action. This occurs when the stretch requires growth, but does not overwhelm.

Our goal in managing stress is to convert areas of distress into eustress.

Notice Your Triggers and Symptoms

People are constantly saying, “I’m so stressed, I’m so overwhelmed.” It’s pervasive. Strangely, we aren’t taught to recognize our own unique triggers and symptoms of stress. As a result, we can’t address it in a healthy way.

I work with my coaching patients on non-judgmental noticing: the process of identifying what causes stress without making a judgement. For one person it might be the in-laws coming to visit. For another it might be that they have a work project that is huge and they don’t know how to get it done. Once you’ve practiced noticing for a while, you’ll be able to identify what to watch out for.

A key to noticing what triggers stress is learning to identify your unique symptoms of stress. Many symptoms are physical: tight shoulders, holding your breath, shallow breathing. It could be a tension headache, some people talk about their chest feeling constricted. Once you begin building your unique self-awareness library of stress triggers and their associated symptoms, you can begin to build a stress resiliency and management strategy that’s tailored just for you.

Resiliency and Stress Management

Self-awareness is the first step towards being stress empowered. The next step involves creative experimentation. I have my coaching patients explore three questions:

  • What might I do before stress ever hits, so that its effects are minimized?
  • What might I do in the midst of being stressed out to manage the stressor?
  • How can I recover my resiliency later?

Once they’ve explored these questions, they can start trying out their ideas. They’ll quickly discover the most viable tools for their unique person. These tools and strategies will be the keys to turning something that’s been toxic into an empowered place.

Give Stress Management A Chance

There’s a great acronym to help you practice stress management – it’s related to the word KNOW.

K – Ok. I accept the situation for what it is. I’m no longer resisting it, I’m letting it flow around me. This frees the energy used to resist, so that it can be used to manage the situation.

N – Noticing. What’s the story going on around me? What are the facts and what are the assumptions or interpretations I am making, that I’d want to check out? Noticing what is forming our experience of the moment helps shift what we are experiencing.

O – Owning it. What part of this is mine? If I have a story going on, and I’m interpreting a bunch of stuff and assuming things, then I need to own that I’m making assumptions. Or if I’ve made a mistake, I need to clean it up. Rather than fighting it, or avoiding it – you lean in. You also recognize that you don’t own it all. And you leave behind what’s the responsibility of other people for them to own.

W – What do I need right now? In the stress moment, what is your first step to managing it? Learn to first recognize what do I need, not what should I do, or what must I do. Do I need to step out of the room and take a deep breath? Do I need a nap? Do I need to take a vacation? First taking care of what your mind, body, and spirit is asking for will prepare you for the the next step. Which might be: What do I need to be doing in my lifestyle to deal with this?

This is where Vera coaching is a wonderful asset for people. Our coaching clients say they value the way their personal confidence, capacity and energy grows through the coaching process. It’s about having a sacred space where it’s safe for you to authentically explore, think things through and try things out. If you’re not ready for coaching, the KNOW acronym gives you something you can start with on your own.

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