Today started as an icy morning on the Plains.
After our breakfast of oatmeal, fruit, toast and coffee in room 34 here at the Lakota Ranch motel, we “mounted up” for the journey to Wanblee.
The roads were slick. The freezing rain which started as we were getting back to the ranch last night left a layer of ice. Our cultural speaker Dakota High Hawk had slipped off the road on his way to meet us last night, rolling their car on the slippery roads. Fortunately, he and his “Auntie” were ok, just a bit shaken. We tentatively set out.
Less than a mile down the road, I received a call and recognized the number – Gundersen switchboard. Typically this is a bit of a dreaded number as a clinician, it typically means that whatever comes next is going to require a bit of work. “Ah, they found me!” I thought.
It turned out to be one of the Docs at the Wanblee clinic trying to get through to our team to warn us that the roads to Wanblee were in poor shape and that due to the weather, the opening of clinic for the day was delayed a couple hours! Medlink to the rescue! Horray!
We later arrived safe and sound for a somewhat abbreviated day in Wanblee.
Our Podiatry crew was able to meet and compare practice notes with the locum Podiatrist currently “stationed” in Kyle and Wanblee. Our Behavioral Health team got to work with the depression screening project.
I settled into my role providing Internal Medicine (Adult Primary Care) care.
I was able to see several patients through the course of the day. Most of the issues were “Acute care” focused, or filling meds for chronic problems. Not altogether different from my typical day in La Crosse. I’ve been surprised by the high level of care the patients I’ve met have been receiving. My impression was that their opportunities for seeking care were lacking, when in reality there are dedicated people providing great care here. I’d also been under the impression that patients would not have a good understanding of their care needs and issues, when in fact I’ve been surprised by the “health literacy” of the patients I’ve met. This is no doubt a result of lots of hard work done by these dedicated people.
I’ve greatly enjoyed the “commonality” of the patient experience. People are people- whether they’re the “worried well” professional upper-middle class in midwest suburbia, the deep coulee farmers who come in once a decade, the Amish, or the Lakota. Being able to use my training and years of practice to help determine a problem and work together to find a way to figure out a care plan is such a privilege.
It was just as “interesting” to experience the “same old issues” that are now a constant factor in health care. Struggling to adjust to a new EMR while trying to stay efficient and not create more work for myself and the staff around me. Trying to keep the patient relevant in the visit while navigating medication reconciliation, health care maintenance, deciphering previous notes, finding elusive data, updating problem lists and ensuring accurate and timely documentation – all while “actively listening”- proves to be a challenge in any setting. The issues of noncompliance and lack of engagement in ones care can be frustrating barriers in all cultures it seems.
But despite these frustrations, there is a feeling of tremendous hope. The staff are there because they want to be,need to be. The patients we see are grateful for the care they receive, even when there’s not an easy answer. The “commiseration” sessions with colleagues consistently turns to hopeful discussions of what could be done to improve our care delivery or the patient experience.
At our evening “debrief” tonight we shared insight on our practices, the barriers we see here and at home, and came up with some thoughts and plans for tomorrow to not just get through the day’s appointments, but try to make a meaningful impact for the patients we see.
An interesting discussion also started comparing the cultural significance of the traditional sweat lodge and the traditional sauna. More to come on that one…