Patient Centered Care: Crossing Borders

One of the distinctive events of our clinical immersion is that we have the opportunity to tour our community, on foot and bike, and meet patients in their home.  During this process, we came across a very sweet family, who had just finished bathing their elderly mother.  As we approached the home we observed flies swarming around her feet that were covered by a blanket. When we removed the blanket we noticed that her left second toe was discolored and appeared to be ready to fall off.

With  interpretation by the Thai students and professor who were with us, we worked to do a thorough evaluation of the patient. She stated that the toe was once painful but she now had limited sensation and no pain. When asked why she did not seek care for this issue, she replied that she thought it would cause more pain.  The family stated that they had taken their mother to a health care provider, but were unsatisfied with the treatment plan offered.  These feelings have continued to impact the way that the patient and family utilize health care services. 

During the home visit we, along with our Thai brothers and sisters, developed a plan that included the priorities and values of the patient and family.  We were able to work with the clinic and the community to provide transportation to this patient who had limited mobility.  Once she arrived at the clinic, we were able to not only complete the dressing change without pain to the patient, but we were also able to teach the family how to help care for the wound while at home. Our Thai sisters also used an innovative method to catch bugs as an additional method to keep the wound clean. 

As providers, our priority was not only to provide a painless dressing change, but to also develop a plan that was acceptable to the family and patient.  Regardless of culture or country, patients and family members seem to be more invested, have more trust, and are more willing to participate in their health care if providers are able to communicate and demonstrate that they value the opinions, values, and needs of the patient and caregivers.  

Upon reflection of this experience, we were able to recognize some similarities and differences with wound care in the United States.  We appreciated the fact that the process of dressing changes was different; there is a greater appreciation and conservation of dressing supplies without compromising the need of the patient.  In the US, we tend to be less thoughtful with our supplies or resources. Unfortunately, we have observed instances in the US and abroad in which people are prescribed treatment plans that do not fit in to their lives or their belief system and therefore fail.  We have witnessed fear and lack of trust in our health system act as barriers to care.  While these are very complex issues and lack a simple solution, working to be inclusive with your patient's needs, priorities, and values is an excellent start to decreasing these barriers and improving overall care and patient outcomes.