Holy Motivational Interviewing!

Posted by Christine Rabah at Monday, October 17, 2011

So rotation #3 is almost over, but this is the first chance I had to finally blog about it!

Currently I am on my Ambulatory Care rotation at the Brighton Health Center with Dr. Trisha Wells. I can't tell you how excited I was for this rotation ever since I had realized my love for Am Care during P1 year while shadowing Dr. Choe for a project.

So, what do we do in Am Care?

Diabetes, hypertension, and cholesterol - oh my! (<-- yes, I know that was super dorky :P)

Typically, I check Dr. Wells' schedule the night before rotation, and work up our patients. Important things to check are their hemoglobin A1c, blood pressure readings, LDL-cholesterol, and of course- their medications. It is very important to note when these readings were done because they must be frequently monitored in these patients, especially if they are not within goal. Dr. Wells has a collaborative practice agreement with the physicians in this office so that she can adjust their diabetes, HTN, and hyperlipidemia medications as she sees fit. Awesome, right?? Each day, we will either have phone conversations (these are scheduled just like office visits, so that patients know to be available when we call), or we will see patients in clinic, the same way they would come see their PCP.

I've noticed that Dr. Wells' patients are very receptive to seeing a pharmacist to manage their medications. A few of them are doing so well, they don't need to be followed anymore but they refuse to stop seeing her! One patient even told her "Every time I want to eat something sweet, I see your face so I don't eat it!" This is definitely an area where pharmacists can have a major impact on patients and their well being.

Another thing I've noticed is that pharmacists actually use motivational interviewing! Who woulda thought that would come in handy? :P As silly as we felt asking mock questions in class such as "On a scale of 1 to 10 with 10 being the worst, how bad is the pain in your knees?" and "What do you think is a good goal for you to work on for our next visit?" it actually happens in practice. Patients seem to be receptive to this type of dialogue, because it makes them feel as if they are making decisions with the healthcare provider, instead of the provider telling them what to do.

During this rotation, I have done topic discussions in diabetes, diet/exercise, hypertension, and hyperlipidemia. Also, all of the students doing an Am Care rotation this month recently had a group journal club discussion where we each had to analyze a journal article relating to Am Care practice.

We only have 4 days left in this rotation, and I definitely don't want it to end.