RESUMO
My Life My Story (MLMS) is a national Veterans Health Administration (VA) life story interview program that aims to provide more humanistic care for veterans by focusing on the patient as a person. Our project took place at the Pittsburgh VA Healthcare System and had 3 main goals: (1) describe themes that emerge in MLMS interviews from the prompting question, what do you want your healthcare provider to know about you?; (2) identify topics of importance to veterans and suggest ways for healthcare providers to explore them; and (3) foster a culture at the Pittsburgh VA that places not only the health but also the personal triumphs, hardships, and aspirations of veterans at the center. Veterans provided verbal consent to have their previously recorded stories used in this study. Stories were coded and then analyzed for patterns and themes. A total of 17 veterans participated in our study. Themes that emerged from the stories include (1) Early Hardships; (2) Economic Disadvantage; (3) Polaroid Snapshots; (4) Around the World; (5) Haunted by Combat; (6) Life-altering Moments; (7) Homecoming; (8) Romantic Beginnings & Obstacles; (9) Inequity across Gender & Race; and (10) Facing Mortality. This study's findings underscore the need to address the traumas associated with military service, as well as the challenges faced with re-integration into civilian life, when working with veterans. The MLMS interviews explored in this study can help clinicians identify topics of importance to veterans, strengthen their relationships with their patients, and improve the care that veterans receive.
RESUMO
Background: Patients needing large-volume paracenteses (LVPs) can occupy inpatient hospital beds and unnecessarily use inpatient resources. Methods: We describe an outpatient paracentesis clinic that was part of a quality assurance initiative at the Veterans Affairs Pittsburgh Healthcare System in Pennsylvania. A retrospective review was conducted that included patient age, sex, etiology of ascites, amount of ascites removed, time of the procedure, complications, and results of ascites cell count and cultures abstracted from the electronic health record. Results: Over 74 months, 506 paracenteses were performed on 82 patients. The mean volume removed was 7.9 L, and the mean time of the procedure was 33.3 minutes. There were 5 episodes of postprocedure hypotension that required admission for 3 patients. One episode of abdominal wall hematoma occurred that required admission. Two patients developed incarceration of an umbilical hernia after the paracentesis; both required surgical repair. Without the clinic, almost all the 506 outpatient LVPs we performed would have resulted in a hospital admission. Conclusion: An outpatient paracentesis clinic run by academic hospitalists can safely and quickly remove large volumes of ascites and minimize hospitalizations.
RESUMO
The author of this medical humanities article is a clinician-educator who finds himself relying more and more on poetry to make sense of the complexity, frustration, and wonder that attend the work of doctoring. Here, he posits that poems, in all their forms, are attempts at establishing order and meaning through meter, language, and sound, and that they may be particularly valuable for medical students and residents as they develop professional identities, habits of mind, and coping strategies. The author recalls that for Edward Hirsch, poetry is "a way of connecting-through the medium of language-more deeply with yourself even as you connect more deeply with others." It is this purpose-to connect learners with themselves, their patients, and one another-that compels the author to read poems to teams of residents and medical students in lieu of traditional afternoon teaching rounds. In this article, the author artfully illustrates one such "Post-Call Poetry" session, quoting some of the poems he shares with learners. At the end of each 2-week rotation on the wards, few of the learners remark on the attending's lessons on pathophysiology; however, nearly all of them, regardless of their background or career path, express appreciation for the poetry.