By Stephanie Aldrin, MD
Last week, I covered the night shift for our hospital medicine service at M Health Fairview St. Joseph’s Hospital, as the family medicine resident house officer. On this service, I care not only for patients in the hospital, but also patients who regularly receive care at Bethesda Family Medicine Clinic and have medical questions needing an urgent answer.
The hard part is not usually the medical advice, but working with a patient or family member who is at home, feeling worried, scared and unsure if they should wait until the morning to come in or if they need to be seen by a physician right away.
A Reassuring Option
One call came in at 2:00 am. It was the daughter of an elderly Hmong woman living near our clinic. She was worried that her mother’s glucometer, the device that checks her blood sugar, was not working. After calling the device manufacturer, they informed her that the blood sugar level was too high for the device to read and that her mother could die from a reading that high. The daughter was rightfully frightened and needed to know what to do.
She asked, “Should I give her more insulin? Does she need to go to the hospital? Could she really die?”
We talked through the options; ultimately, I advised that it would be best to bring her mother into the hospital, so we could run additional tests. I explained the various possibilities of what could happen after she arrived, and shared my concerns that if her mother’s blood sugar level was really that high that we would need to lower it quickly, as it could cause long-term problems.
The daughter asked me where she should take her mother. When I shared that I was at St. Joseph’s Hospital and I would talk to the doctor in our emergency department (ED), she felt reassured. St. Joseph’s is just down the street from their home, and a doctor from a clinic they knew and trusted was already there and would ensure her mother was well taken care of.
Together, the ED physician and I were able to treat the patient’s blood sugar, plan for a follow up visit at Bethesda clinic the following day and send her home safely with her daughter, all without requiring inpatient hospitalization.
An Extension of Outpatient Primary Care
St. Joseph’s Hospital is an extension of the outpatient primary care we provide to our patients. We are a better healthcare community because of our ability to provide a higher level of care to our patients in the same neighborhood where they see their regular doctor.
Guiding a patient to St Joseph’s is easy; it’s located just down the street (from the clinic), has Hmong and Karen language interpreters (in person) and has been caring for Bethesda clinic patients for years.
Many of the patients we see at St. Joseph’s have challenges in accessing healthcare. They are homeless, have limited resources and frequently speak a language other than English. The catchment area for the hospital is adjacent to a federally designated underserved area, and many area residents lack a reliable source of transportation.
As a family medicine resident, this is a great place to train, because it challenges us to think broadly about our role as family medicine physicians. We see both medical and social complexity and learn to connect patients with resources and supports that enable them to be healthy.
Our patients live here—many within walking distance of the clinic and hospital. They rely on St Joseph’s Hospital for not only emergency care, but also for quality mental health and chemical dependency services.
Working within this neighborhood for 47 years, we have built trust and rapport with our patients, a critical component to providing compassionate, effective care. We have also built relationships with partners, who are committed to this community, such as Higher Ground St Paul (across the street from St Joe’s), and work together to coordinate hospital, clinic and outpatient services to improve the long-term health of our patients.
St. Joseph’s Hospital increases access and improves health equity for our patients. While the medical care the patient in my story received could have been happened at any hospital, it was THE relationships, among hospital system, physicians, patient and community, which allowed for patient-centered care and prevented a hospital admission. Working within a community-based hospital made this outcome possible.
Many Minnesota family docs have spent time at St Joseph’s Hospital or within the St Joseph’s residency over the past 47 years, as medical students, residents, or practicing physicians, and have seen the ways this hospital reaches out and supports patients in their time of need.
You may have heard or seen online discussion about St. Joseph’s Hospital in St. Paul and its future.
Consider sharing your positive St Joseph’s experiences and memories via Twitter and Facebook, using the hashtag #StJoesServesStPaul. We hope to ensure that the spirit of St Joseph’s Hospital and voices of our patients and community are present at the table.
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Post author: Stephanie Aldrin, MD, second-year resident, University of Minnesota St. Joseph’s Hospital Family Medicine Residency, @stephaniealdrin