While it has been linked to churches in the past, I did appreciate that ESSK has come to adopt a secular identity in a site that is not church-based. After having had less-than-positive experiences at church-based soup kitchens with obligatory prayers (regardless of one's faith background) and mission/values statements that I was uncomfortable with (e.g. homosexuality is a sin), it was nice to volunteer at a place where the hungry could come for a meal free of proselytizing.
When deciding how I could best be of use to ESSK, I adapted some of our outreach practices from previous LMU volunteering to a solo service experience. I knew that probably the last thing people wanted during their lunch hour was some know-it-all medical student lecturing on how to follow a diabetic diet or how they need to exercise more. So I let people come to me-- I fanned out patient education materials on blood pressure, diabetes, and tobacco and set up a sign at one of the far tables:
Free Blood Pressure Screening! Questions? Ask the Med Student!
Sure enough, I got quite a few takers! Here's my secret-- taking their BP was my strategy to get people engaged in a conversation about their health. Aren't I sneaky? Of course there were some who just wanted to know their numbers, but there were also several who really appreciated the opportunity to discuss strategies like how to more effectively manage their diabetes, or explore with me the barriers to adequate care that have led to poor health status.
I came across several clients with poorly controlled hypertension, often due to the fact that they hadn’t followed up with a physician in a long time or they had gone without their medication because they couldn't afford the prescription. Can you imagine having to make the choice between buying your food or your medicine? This is the unfortunate reality that many people face on a continual basis.
One man I spoke with had very high blood pressure for years and had never been on meds. Many docs are quick to call patients like this "non-compliant" but we are moving away from that term in the medical field because it seems to translate poor health behaviors into a personal flaw rather than a systemic issue much larger than the individual (remember my post on the social determinants of health?). By not "complying" with what the doc tells you, the patient often unknowingly assumes this shameful identity that may prejudice physicians against them. It creates an unhelpful distance between patient and provider when these are often the people who most need to be engaged in a positive therapeutic alliance with their doc. Rather than simply rolling our eyes at the "frequent flyers" in the ED, shouldn't we be asking what keeps bringing them back and how we can help them break this cycle?
I also had a really interesting conversation in a brief smoking cessation counseling session, in which the man said something very fatalistic, “I can make healthier choices, but what does it matter? We all die sometime.” I challenged him to think about not only the fact that yes, we all die at some point, but how do we wish to die? Does quality of life not matter? I explained to him the natural history of the progression of COPD, which usually involves a slow decline followed by a rapid decompensation and death. I tried to help him understand that his decision to continue to smoke could not only lead to an earlier death but also a poorer quality of life as his lungs lost function. Looking at it from this perspective really seemed to turn on a lightbulb in his head. While he may not drop the cigarettes right then, it definitely got him thinking and may prove to be a helpful insight as he decides whether or not to quit in the future-- maybe moving him from the "precontemplation" to "contemplation" stage (check my stages of change if you'd like a review).
Next up: Julie's nursing home escapades!
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