Unfilled Hunger: Seeking Relationships in Primary Care--A Perspective from the Keystone IV Conference

Miller, William L.

doi:10.3122/jabfm.2016.s1.150405

Cited by 7 publications

(6 citation statements)

References 14 publications

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“…58,59,60 We can own our larger professional responsibility to address societal inequities that cause illness and suffering. 61 We can band together in professionalism 62,63,64 rather than in narrow self-interest to work toward a system that invests in relationships, measures what matters, 37,54 and supports healing and health. 65,66…”

Section: Commentary 2 By Kurt C Stange Md Phdmentioning

confidence: 99%

How Should Clinicians Ally With Patients Whose Health Is Unlikely to Be Improved by Even Numerous Clinical Encounters?

2022

AMA Journal of Ethics

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Patients experiencing homelessness and mental illness face conditions and circumstances that deserve focused ethical and clinical attention. The first commentary on the case applies insights from qualitative research about social determinants of health to these patients' care and dignity. The second commentary describes 3 kinds of power wielded by physicians-charismatic, social, and Aesculapian-each of which is considered in terms of whether and to what extent physicians' power should be owned, aimed, or shared.Case JJ is a 27-year-old man with schizophrenia, who is brought to the clinic by staff members from a local shelter. JJ does not adhere well to his antipsychotic medication, has experienced several inpatient psychiatric civil commitments and other encounters with numerous clinicians in the region's health care system, and does not have reliable access to shelter, food, water, or hygiene. You, JJ's caregiver in the clinic right now, empathize with him, staff from the shelter, and others trying to help JJ avoid poor health outcomes for which he is at such high risk.You refilled JJ's medication and reviewed his laboratory values, but you know there is little you can do for JJ that can counter the myriad and well-known social determinants undermining the effectiveness of even the most skilled intervention any clinician could offer JJ during a clinical encounter. You wonder how to make the most of this moment you have with JJ on his life journey.

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Section: Commentary 2 By Kurt C Stange Md Phdmentioning

confidence: 99%

How Should Clinicians Ally With Patients Whose Health Is Unlikely to Be Improved by Even Numerous Clinical Encounters?

2022

AMA Journal of Ethics

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“…It begins with a comprehensive focus on the whole person in their family and community context, then uses that broad focus to provide the majority of care, selectively involving those with narrower expertise when that is likely to be helpful, and coordinating multiple sources of care (Donaldson et al, 1996; Starfield, 1998). It is based on treating health care as a relationship (Colwill et al, 2016; Green & Puffer, 2016; Miller, 2016; Rudebeck, 2019; Scott et al, 2008; Soubhi et al, 2010), not just as a commodity (Heath, 2006; Lown, 2007; Stange, 2016; Sturmberg & Cilliers, 2009)—getting to know people over time (Bazemore et al, 2018; Ford‐Gilboe et al, 2018; Olaisen et al, 2020; Team, 2017), and by being available during critical life events (Mainous et al, 2004). That knowledge of the person in context allows them to help the older person and family to prioritize the most important aspects of care, taking a life course perspective and integrating care across multiple chronic illnesses, acute concerns, preventive opportunities, mental health, and family care (Stange, 2009b).…”

Section: Case Storiesmentioning

confidence: 99%

Integrated, Personalized Care for Older People

Stange¹,

Gaglioti²,

Bindas³

2022

Journal of Elder Policy

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Medical science has made magnificent advances by dividing complex problems into their component parts. The strength of clinical trials, and the resulting evidence-based clinical guidelines, is that they isolate a particular phenomenon or therapy from its context to assess its effect without the confounding of diverse contextual factors. However, the health and health care of whole people, and particularly older people who often live with multiple chronic conditions, is context-dependent. Older people are not well served

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“…It begins with a comprehensive focus on the whole person in their family and community context, then uses that broad focus to provide the majority of care, selectively involving those with narrower expertise when that is likely to be helpful, and coordinating multiple sources of care (Donaldson et al, 1996;Starfield, 1998). It is based on treating health care as a relationship (Colwill et al, 2016;Green & Puffer, 2016;Miller, 2016;Rudebeck, 2019;Scott et al, 2008;Soubhi et al, 2010), not just as a commodity (Heath, 2006;Lown, 2007;Stange, 2016;Sturmberg & Cilliers, 2009)-getting to know people over time (Bazemore et al, 2018;Ford-Gilboe et al, 2018;Olaisen et al, 2020;Team, 2017), and by being available during critical life events . That knowledge of the person in context allows them to help the older person and family to prioritize the most important aspects of care, taking a life course perspective and integrating care across multiple chronic illnesses, acute concerns, preventive opportunities, mental health, and family care (Stange, 2009b).…”

Section: What Care Do Older People Need?mentioning

confidence: 99%

“Here it was waiting for me:” Diabetes Diagnosis Pathways and Implications for Health Policy

Chard¹,

Girling²,

Harris-Wallace³

et al. 2022

Journal of Elder Policy

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Diabetes in older adults is a growing public health concern with nearly 30% of Americans 65 and older having diabetes. This includes 2.6 million older adults with undiagnosed diabetes who are at high risk of microvascular and cardiovascular complications (Centers for Disease Control and Prevention, 2022). The majority of cases are Type-2 diabetes. The past decade has witnessed an expansion in screening recommendations in an effort to reduce rates of undiagnosed older adults. Drawing on the sociology of diagnosis, we suggest further attention to the social factors that shape the diagnosis process is needed. We examine the diabetes diagnosis process from the perspective of older adults with type 2 diabetes. The data derive from diabetes illness narrative interviews with non-Hispanic White and African American older adult men and women (age ≥50) with type 2 diabetes (N=83). Our thematic analysis reveals four pathways to diagnosis: 1. Annual wellness exam, 2. Workplace screening, 3. Community-based opportunities, and 4. Health event or alarm. Diabetes' early symptoms are often normalized within daily life, with health insurance gaps, providers' dismissal of symptoms, and nonprescription medications reinforcing efforts to address initial symptoms within the home. Wellness visits, as well as worksite and community-based screening, critically intercede in the unfolding of symptoms. In contrast, diagnosis in connection with a health event or alarm carries an additional toll on social and emotional well-being. These findings have implications for national screening policies and local diabetes control efforts.

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Unfilled Hunger: Seeking Relationships in Primary Care--A Perspective from the Keystone IV Conference

Cited by 7 publications

References 14 publications

How Should Clinicians Ally With Patients Whose Health Is Unlikely to Be Improved by Even Numerous Clinical Encounters?

How Should Clinicians Ally With Patients Whose Health Is Unlikely to Be Improved by Even Numerous Clinical Encounters?

Integrated, Personalized Care for Older People

“Here it was waiting for me:” Diabetes Diagnosis Pathways and Implications for Health Policy

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