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Sunday, April 21, 2013

The Veteran Clockmaker

Here we go again with more patient and Dietetic Internship adventures at the Memphis VAMC!(Previous week's blog posts can be found to the left under the navigation by date headings.)

DIETETIC INTERNSHIP: Weeks 6 & 7  (of 41)
Weeks 6 & 7 - Home-Based Primary Care
Nationwide, the VA has a great program called, Home Based Primary Care(HBPC), which sends medical practitioners to a patient’s home if travel for an appointment would prove extremely difficult.  The HBPC team includes doctors, nurse practitioners, nurses, dietitians, social workers, etc…  The frequency of specialty visits is dictated by the patient needs, but he or she is usually visited by at least one practitioner every other week.
Entry into one’s home can be a very private and privileged experience.  A person’s home is very personal and unique, and entering such a dwelling offers a glimpse of a his or her life.  This week, I entered >15 different homes (with another RD), and each presented exceptionally different experiences.  Some were in quite insalubrious neighborhoods, while others were more nourishing.

Monday, April 8, 2013

Patient tears

Here we go again with more patient and Dietetic Internship adventures at the Memphis VAMC!
(Blog post for Weeks 1, 2, 3 can be read HERE)

DIETETIC INTERNSHIP: Weeks 4 & 5 (of 41)
Week 4 - Outpatient at the hospital
Week 4 ushered in a similar, but slightly different patient: Outpatient at the hospital.  Just as if you might go to the hospital for appointments with your cardiologist, have blood drawn at the lab, etc, you would also see your Registered Dietitian.  

I am coming to (quickly!) learn: Every rotation has new challenges.  This one started with 2 enormous assignments that took about 40 hours (outside of work) to complete, teaching a food demo, co-teaching a cardiology healthy living class (cholesterol focus), and a truckload of online training courses due this week. Oh, patients, too.  Let’s not forget about them   And a presentation on Friday.  To top it off, a fun transition from an 8:00am start time to 7:00 am.  I like getting up early.  I don’t like the loss of an hour change!

Some highlights from this week:

Patient 1
On Wednesday morning, my patient was an 86 year old man that had never had a visit with an RD.  He was progressively gaining weight, particularly in the past few years he had put on significant weight, yielding uncontrolled diabetes mellitus, high blood pressure, and high cholesterol.  I started with the basic appointment questions, and quickly surmised that something was amiss.  I probed.  I gently questioned.  My empathetic connection has always been well-oiled and running, and soon this gentleman was in tears.  As was I.  He had terrible, unabashed tears.