Today, SevenPonds spoke with Mercedes Grace Laurencin, M.D. M.P.H. about the interpersonal, social and psychological aspects of providing primary care as a physician. Her retainer medical practice, based in Santa Cruz, California, places special emphasis on accessibility issues for elderly and terminally ill patients, with a focus on holistic patient-centered care.
Juniper: Your academic career began with a B.A. in Religious Studies at Brown University. What inspired you to practice medicine? Currently, what is the greatest source of inspiration for you to provide quality care?
Dr. Laurencin: My single largest inspiration for practicing medicine is my mother, who was a family practice physician for 40 years in inner city Philadelphia. I got to see first hand what medicine was like because her practice was on the first floor of the same building we lived in. My mother had a great love of learning as well as caring for her patients, and taught me that medicine is an art that must be based in science.
Religious Studies was my rebellion – I was going to be an academic. Nevertheless, I had enough of a biology concentration to do my pre-med training, and went on to be a teaching assistant for my next three years at the University of California, San Francisco. I love to teach – teaching my patients about their bodies – what we know and don’t know. Presenting information and listening: This is part of the art of medicine. I also teach staff and students and learn a lot in that process.
Juniper: In your research, you’ve studied the link between nutrition, depression and chronic illness. How has this informed your practice as a primary care physician?
Dr. Laurencin: When I finished my family practice residency, I worked for a while in a primary care practice and then got the opportunity to do a two-year research fellowship with my mentor, Dr. Larry Fisher, who is an expert in the intersection of psychology and physiology in Type 2 diabetes.
There are several social, geographic and economic factors that influence the way people eat and sleep. I’m thinking of these “food deserts” — neighborhoods where it is difficult to find stores that sell fresh, healthy food. Additionally, there are many other factors that a physician may not be aware of initially. My stepdaughter is now a second-year resident in family medicine, and we have conversations about the challenges of assessing these factors – especially in her case, where she’s working with a traditional 20-minute-per-patient mode. This is why I switched over to a retainer practice, which allows me to spend more time with patients to try to ascertain the key that might unlock a change in behavior, which is the basis for any effective treatment plan.
Juniper: You place a big emphasis on accessibility for elderly patients in your retainer practice. How did this become a major focus for you?
Dr. Laurencin: When I was a resident, one of the things we did was home visits. Sometimes, patients can’t get out to come to an appointment, and sometimes you need to see what environment they’re living in. When I started practicing, I noticed that there were a lot of patients who had trouble getting out to see a doctor and wanted — needed — that kind of at-home care. Often patients would wait until the very last moment to see a doctor and need to call an ambulance. They would receive good care in an emergency room, but not necessarily the care they needed.
And so, I really enjoy working with patients at home. It presents special challenges, like how to get some services to the location. It’s easy enough to say to an able-bodied patient, “Well, I’ll send you off for an angiogram or colonoscopy, and we’ll figure this out.” Well, that’s not necessarily possible for someone who is homebound and doesn’t have the ability or desire to do those things and yet presents symptoms that require collaborative problem-solving and decision-making. Part of my role in this situation is to organize transport to a hospital and communicate with other health care professionals and specialists, not just about what tests need to be run for a patient, but why we’re doing this, keeping the patient’s goals and needs in mind.
Juniper: Do you have any advice for people navigating the healthcare system and speaking with professionals on their own, without the benefit of a physician advocate?
Dr. Laurencin: The most important thing would be to bring someone else along who can spend four or five hours in the emergency room with you. It doesn’t have to be a close friend, just someone who is willing to sit and listen and write things down. The relationship isn’t important so much as the person’s role in that moment.
I’ve seen this throughout my years in emergency wards: When you have someone in the room writing things down, and saying things like, “Excuse me, can you say that again please?” it makes everyone slow down. It can be received by attending physicians as offensive, at times, but it works. So it’s really good if you can find someone — a neighbor, friend or relative — to keep names and proposed treatment plans straight, even if they come in shifts of an hour here, an hour there.
If you’re in the emergency room, you’re frightened about what’s going on with you (if you knew, you’d likely not be there), and it may be serious enough that you’re either in pain or having an uncontrolled symptom that needs to be addressed, so you’re not thinking clearly and can’t retain information very effectively. This relates to palliative care in the sense that it’s important to have these conversations with your support network ahead of time: Who’s going to be there? It’s important to think about these things before they hit you upside the head, especially if you’re dealing with chronic illness and/or don’t have a spouse, which is a situation a lot of older women face by virtue of living on average longer than their partners. A patient may or may not have children or other family members in the area (if at all), so having a support network that they can call upon will prevent a situation where they’re sitting in an emergency room alone and frightened.
Keep an eye out for part two of our interview with Dr. M. Grace Laurencin next week!