2/24/2017 A CLINICAL PEARL IS • A distillation of clinical knowledge that is useful for solving every day medical problems • It may be a tip, a way to remember something, a framing CLINICAL PEARLS of a problem FACULTY AND AUDIENCE • May be evidence-based or experience-based TEACH-BACK FOR EVERYONE YOU-TUBE IN YOUR OFFICE • Patients remember less than • Great for teaching yourself new techniques but also for patients 50% of what their doctors tell • Use of inhalers, discus them • Exercises • Literacy depends on content • Epley maneuver and context • SVT reverse maneuver at home • Assessing for understanding improves recall • Teach-Back 1
2/24/2017 COMPASSION SATISFACTION & “THE GOOD LIFE” INSULIN AND HOMELESSNESS: KNOW YOUR OPTIONS • Pleasure that comes from • Common misconception: Insulin must be kept in refrigerator • What is meaningful in what helping others • Truth! Insulin can be kept at room you do? • Increases connection temperature for up to one month. Can be carried with belongings, taken to shelters, etc. • What are you grateful for in • Protects against burn-out • Common misconception: Pens require a PA your work? and are hard to obtain • The “ Good Life” full of • What core values are • Truth! Pens are increasingly covered as first- line treatment, are more portable and less meaning, aimed at greater expressed through your work? likely to be stolen than bottles and syringes, good rather than ease. and have auditory clues for the visually impaired MOST POWERFUL THING WE DO TO DECREASE DIRECT ORAL ANTICOAGULANTS AND ATRIAL FIBRILLATION MORTALITY & MORBIDITY? SMOKING CESSATION • Switching appropriate patients off • One evidence-based step toward cessation? Warfarin and onto DOACs can benefit patients who are low literacy and/or • Smoke-free homes –voluntary no smoking at home have inconsistent Vitamin K intake due • Associated with: to food insecurity � Reduced secondhand smoke exposure � Decreased consumption • But make sure NO huge co-pay…. � Increased cessation � Reduced relapse to smoking 2
2/24/2017 THEY TOLD ME EVERYTHING WAS OKAY… ADHERENCE AIDS FOR LOW LITERACY PATIENTS • I buy pill boxes of all shapes and sizes and fill them with patients at their • Patients, particularly with low health literacy or limited English appointment. proficiency, have little understanding of what we might be looking • 2 For patients who can't read or are for, what we might find from different diagnostic tests confused by all their pills, I tape one of each pill to a piece of paper with a picture • When ordering labs and other let patients know what you are of breakfast on it for am, another page with a bed for bedtime, etc. ordering and why…… Elizabeth Rogers • Miriam Maher MD WHAT’S THAT RASH? IT’S FLU SEASON: REMEMBER • Healthy folk, no treatment if >48 hr sx • Remember to ask about • An homage to my father-in-law • High risk treatment even if more than 48 public health dermatologist.. hrs sx: PG, young, old, DM, lung disease, work, who is in the family immunosuppressed, pregnant, sickle cell, • "All unexplained rashes are syphillis etc. for all patients with ESRD, ESLD, Native ethnicity, nursing home until proven otherwise.” and flu–HR need post- • CAD :Getting the flu risk for MI exposure prophylaxis and • Obesity predisposes severe disease • Lisa or Mo vaccination • VACCINATE 3
2/24/2017 COMPASSION SATISFACTION & “THE GOOD LIFE” ASSESSING NUTRITIONAL STATUS • ASK • Pleasure that comes from • How far is it to travel get to a store? • What is meaningful in what helping others • What type of store, i.e. Convenience(7-11), Fruit stand, you do? • Increases connection Small Grocery, Large Supermarket • What are you grateful for in • Think about food deserts, urban • Protects against burn-out your work? and rur al • The “ Good Life” full of • What core values are meaning, aimed at greater expressed through your work? • good rather than ease. Don Hernandez THE TEETH: MOST POWERFUL THING WE DO TO DECREASE REMEMBER TO SMILE! � MORTALITY & MORBIDITY? SMOKING CESSATION • One evidence-based step toward cessation? • I always ask my patients (of all ages) how many times a day they brush their • Smoke-free homes –voluntary no smoking at home teeth and for how long. I've been so surprised to hear how uncommon brushing twice daily for 2 minutes is! Flossing is a whole other story …. • Associated with: � Reduced secondhand smoke exposure • Best, � Decreased consumption • Sandeep Lehil, FNP-C � Increased cessation � Reduced relapse to smoking 4
2/24/2017 AUDIENCE: SHARE YOUR CLINICAL MORE ORAL CARE PEARLS • Remind your obese patients that changes made in the diet for • Email to Margaret.Wheeler@ucsf.edu weight loss improve their dental health • We will collate them on to slides for presentation tomorrow! • TOP TEN will win a copy of Medical Care of Vulnerable and Underserved Population s • Susan Fisher-Owens 5
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