Case Studies, continued...
Educating Physicians
A surgeon, Dr. Scott McDougal, and Dr. Siebens had shared in the care of mutual patients at the Massachusetts General Hospital and Spaulding Rehabilitation Hospital. But they had never spoken to each other until serving together on a State-of-the-Science conference at the National Institutes of Health in 2007. Dr. McDougal agreed to read a white paper on the SDMM.
He wrote to Dr. Siebens, “I read with much interest your white paper on the four domains to be utilized to facilitate patient care management. I think the concept is excellent. I like the layout very much and do believe it would be helpful in all generations, but particularly for the pediatric and elderly population, as they are least likely to be able to communicate effectively. Like many new innovations, the difficulty is going to be to get everyone to incorporate this into a universal medical record. Perhaps the computer will help.”
Over the next four months, Dr. Siebens reviewed Dr. McDougal’s de-identified outpatient office visit notes and shared with him how he might use the SDMM. He successfully accomplished this and shared, “The SDMM makes me a better observer of the patients and a better doctor.”
Seven years later, Dr. McDougal continued to correctly use the SDMM in his documentation.
Primary Care Physician
A seasoned primary care physician had a patient with multiple sclerosis who was losing his ability to walk. During an out-patient visit, and using the SDMM cue card, she inquired about his spirituality. She learned that he had a strong faith that helped him live day-to-day. She told me, "I had had no idea and it was remarkable. I really learned something important about how he managed. This helped me connect with him much better."
Residents in Physical Medicine and Rehabilitation – Learning Rehabilitation
An attending (supervising) physician who used the SDMM to teach physical medicine and rehabilitation residents (physicians learning about rehabilitation) shared two stories.
Getting On the Road Back to Work
The resident physician reported, "I would have normally not considered asking Mr. A. about his future employment just a week after his bilateral below-the-knee amputations. However the SDMM Cue Card prompted me to ask about his work. It required driving.
We set him up with our vocational rehabilitation services to start right after he left the hospital. From there, he was set up with a training program for drivers with amputations. Had I not started the ball rolling, there may have been some real delays in getting these services started. The patient may not have returned to work as soon as he did, leading to possible significant loss of income."
Identifying a Relationship Challenge
Another resident physician shared an example of how the SDMM helped her. Her patient, being rehabilitated in a hospital, was a wheelchair user and was about to be discharged home. He was returning to his "previous living arrangements, which was with his wife in a first floor apartment with wheelchair ramp access and no stairs." The plan seemed appropriate.
However, using the SDMM Cue Card, the physician was reminded to ask the patient about his surroundings. The patient responded that he was not on good terms with this wife. She had moved out two days earlier. She would no longer care for him nor be available to drive him around, leaving him without transportation (a social determinant of health). The physician added, "This information greatly changed his discharge plan."
Had she not inquired systematically about his living situation, the patient's new circumstances might not have been discovered as quickly. Bringing his major non-medical concern to light better informed the treatment plan for his life post-hospitalization.