Senior Center-Yay!

    Primary Care Physicians need to learn psychopharmacology; they also need to learn how to help people enhance their lives through behavioral change. This is the old saw: nature and nurture. The medications address the nature, the environmental change targets the nurture; both are important, at every stage of life. Consequently, I have taken a new route to training Family Medicine Residents to guide patients towards healthier, happier lifestyles. A physician recommendation is powerful. A friend or family member may suggest to their loved one to pursue a community resource, yet when this same suggestion comes from their doctor, there is often more impact.  Further, when a physician has seen the resource themselves, they are more likely to explain the benefits in a way which is compelling. So, Monday mornings are now consumed with what I jokingly refer to as “field trips,” but more seriously refer to as “community medicine”. The Culver City Senior Center was our focus. My residents and I were overwhelmed by the scope and accessibility of all that they had to offer. There were computer classes, trips to museums (they were going to the Getty Villa that day), Tai Chi, and a knitting group. Lunch is offered, requiring a voluntary donation of a nominal amount. The physical, mental and social stimulation available was really exciting. My group bemoaned the fact that we did not make their age cut-off. If one patient a month follows through on the recommendation to expand their world by joining the Culver City Senior Center ($10.00/year), then I have done my job, both in terms of helping residents understand community resources to improve mental health, and in terms of helping patients improve their physical and mental well-being. My “field trips” are win-win-win. I “win” because I expand my world of social services. The residents “win” because they are shown experiences which can’t really be described, they have to be seen. The patients “win” because they are given recommendations which can potentially improve the quality and the duration of their lives. A triple gain-not bad! Sometimes nurture is underrated.

 

See also….http://shirahvollmermd.wordpress.com/2010/04/07/growing-old/

‘I Trained You’

“I trained you,” my seventy-year old patient, Eleanor says, referring to the fact that I saw her in my training and we have “grown up together” as she continues to say. “I trained a few others, but I stuck with you,” she reports, referring to the fact  that she had seen many trainees, but she followed me into my private practice, allowing us to have a long relationship. “You seem rather proud of that. I agree that you were certainly there in my formative years as a professional.” I say, joining her in her assessment that her role as a patient was pivotal to my growth as a psychiatrist. “I am proud. You were just a young thing when we started, and now you seem more sure of yourself,”  Eleanor says, continuing in her role as my teacher, almost as if she is my mentor. “That is interesting that you see change in me and that you comment on that,” I say, highlighting that she is both observant and direct. “I think I did a good job,” she says, enjoying our repartee. “I am glad you think so,” I say, proud that I give her satisfaction, but also  noticing the upside-down quality to our conversation. For a few moments, the doctor-patient relationship has flipped. We are going to return, but this was an interesting interlude.

Diagnosis Dilemma