Putting Together Puzzles

The following is a reflection written by Nicole Ashley, one of this year's Little Village House Volunteers.

In college, I heard that applying to medical school was like putting together a puzzle of yourself— showing as many sides of yourself as possible and how they all fit together with the goal of becoming a physician. Grades, MCAT scores, letters of recommendation, volunteer experience, research, tutoring, employment, other activities, they each form a piece. Without any few pieces of this puzzle, one can still distinguish the images there, but the more pieces one is able to contribute, the clearer the picture ends up—and the better chance of getting into medical school. At the same time, the number of puzzle pieces is not the only important factor in revealing the picture of who you are; the pieces must be clear and the right fit with each other to construct the best puzzle. I learned that applying to medical school involves understanding many different elements of ourselves and how they interact. Not only must we challenge ourselves in a variety of ways, we must do so consistently to provide a comprehensive picture of ourselves and our motivations.

Well, now that I’m on my way to medical school this fall, I can forget about that whole puzzle analogy, right? It served its purpose.  I got where I wanted to go.

Actually, not the case. Working with health care providers, case managers, therapists and medical assistants on a daily basis at Erie Family Health Center, I have come to realize the importance of putting together multiple perspectives to reach a common goal. It is so applicable to all aspects of patient care, not just applying to medical school. I believe this is best demonstrated by how my team starts our day three mornings a week in what is called a case conference. For whichever of our over 200 HIV-positive patients with an appointment that day, we attempt to put the pieces together. The case managers often have valuable information that the patient has neglected to tell the doctor. Perhaps the patient is afraid to discuss substance abuse with the medical provider but has previously done so with the case manager. In case conference, an opportunity exists for discussion about this sensitive issue, possible resources and how to approach them. However, the patient might have mentioned missed doses of medication with their health care provider, who can approach the case manager and suggest further adherence counseling. We have had discussions that ensure the patient’s preferred name is used—we serve several transgender patients who prefer names that are different from those in their electronic medical record.  Quality medical care involves both broad scopes and deep digging; compiling each individual concern with the ability to look at each issue in depth. The puzzle is both complete and clear.

So, what’s the lesson from all this? From my time at Erie, I have begun to more clearly see the importance of each team member’s contribution to the care of our patients.  I am extremely grateful for the opportunity to interact with such a variety of professions within the health care field.  Each perspective is valuable and contributes to the medical care as a whole. And what’s next? For one, plenty more puzzles to put together, while realizing that none is ever truly complete. For many of our patients with depression, substance abuse, or housing issues, HIV is the least of their problems. Constructing each puzzle is a gradual process involving the maintenance of a relationship with the patient, and vast networks of additional relationships in the health care team.

Finishing the puzzle? Not quite. It’s only just beginning.