A S F S U / U C S F S T U D E N T – L E D P R O J E C T Clinic Logistics in 90 minutes

A S F S U / U C S F S T U D E N T – L E D P R O J E C T

Clinic Logistics in 90 minutes

Clínica Martín Baró: Goals

Free, quality patient care Two-way mentorship between SFSU

and UCSF studentsHealth Empowerment

– For individuals through health promotion– For the community through involvement in

community organizing

Clinical & cultural learning opportunity

Logistics

Clínica sees patients from around 9am-2pm every Saturday

4 MS1s per Saturday Sign-up is handled through a yahoo group calendar The CMB med student wiki has all the information

you need to know, forms to download, etc: http://cmb-admin.wikidot.com/med-student-duties

We will e-mail you links to these resources once we open the calendar to sign-ups!

La La ClínicaMission Neighborhood

Center 3031 24th street

Bathroom

Kitchen

24th street

Balm

y street

Bathroom

Storage

Storage Exam Room 3

Exam Room 2

Exam Room 1

Reception

Pharm

acy

HealthPromotion

Lab

Consult Room

ReceptionReception

24th street

Balm

y street

Reception

24th street

Balm

y street

Reception

IntakeIntake

Exam Room 3

Exam Room 2

Exam Room 1

24th street

Balm

y street

Reception

Health PromotionHealth Promotion

HealthPromotion

Exam Room 3

Exam Room 2

Exam Room 1

24th street

Balm

y street

Reception

History History & Physical& Physical

HealthPromotion

MonitorMed Student

1. Get a chart from the monitor

Exam Room 3

Exam Room 2

Exam Room 1

24th street

Balm

y street

Reception

HealthPromotion

1. Get a chart from the monitor2. Bring the patient to the exam room

3. Gather History & conduct physical exam


Exam Room 3

Exam Room 2

Exam Room 1

24th street

Balm

y street

Reception

Exam Room 1

Exam Room 2

Exam Room 3

Confer with Confer with PreceptorPreceptor

HealthPromotion

Consult Room

Med Student Preceptor

1. Present history & physical, and any ideas you have about assessment and plan

24th street

Balm

y street

Reception


HealthPromotion

Consult Room


2. Visit patient again with preceptor

Exam Room 3

Exam Room 2

Exam Room 1

24th street

Balm

y street

Reception


HealthPromotion

Consult Room




2. Create a plan with the preceptor

Exam Room 3

Exam Room 2

Exam Room 1

24th street

Balm

y street

Storage

Reception

Exam Room 3

Exam Room 2

Exam Room 1

Implement Plan Implement Plan

#1: #1: Prescriptions Prescriptions

HealthPromotion

Consult Room

Pharm

acy

24th street

Balm

y street

Reception

Exam Room 3

Exam Room 2

Exam Room 1


#2: Labs #2: Labs

HealthPromotion

Consult Room

Pharm

acy

Lab

1. Fill out form with lab volunteer

2. Get tubes and draw blood with preceptor’s help

3. Give tubes to lab volunteer

24th street

Balm

y street

Reception

Exam Room 3

Exam Room 2

Exam Room 1


#3: Referrals #3: Referrals

HealthPromotion

Consult Room

Pharm

acy

Lab

1. If outside services are needed, consult referrals volunteer

2. For mental health, refer to Felix Kury

24th street

Balm

y street

Reception

Exam Room 3

Exam Room 2

Exam Room 1

Implement Plan: Implement Plan:

#4: Discharge #4: Discharge

HealthPromotion

Consult Room

Pharm

acy

Lab

1. Make sure prescriptions, lab, and referral procedures are complete

2. Consult the monitor

Monitor

3. Ensure the patient understands diagnosis and plan

24th street

Balm

y street

Reception

Exam Room 3

Exam Room 2

Exam Room 1

Complete Chart Complete Chart

HealthPromotion

Consult Room

Pharm

acy

Lab

1. Update med & condition list

2. Write H&P or SOAP note

3. Fill out Follow-Up form

4. Get preceptor’s signature

Medical Student VolunteersMedical Student Volunteers Arrive at 3031 Mission Street at 7:30AM to help set Arrive at 3031 Mission Street at 7:30AM to help set

up Clinicup Clinic Dress professionallyDress professionally BringBring

– StethoscopeStethoscope– pen lightpen light– UCSF identification cardUCSF identification card– white coatwhite coat– Lunch or $5 to buy lunchLunch or $5 to buy lunch– any reference cards for history taking, exam or any reference cards for history taking, exam or

charting you feel you may needcharting you feel you may need Med Student Coordinator with give you a tour and Med Student Coordinator with give you a tour and

establish patient care teamsestablish patient care teams Tell the monitor if you are fluent in Spanish or would Tell the monitor if you are fluent in Spanish or would

like an interpreterlike an interpreter Participate in Pre-Clinic meeting at 8:30 AM, and then Participate in Pre-Clinic meeting at 8:30 AM, and then

monitor will give you a chart for your first patientmonitor will give you a chart for your first patient

ReceptionReception

24th street

Balm

y street

Reception

Reception

Estela Fuentes– 46 y.o. female– First time at Clínica– Worried about her blood pressure

24th street

Balm

y street

Reception

Exam Room 3

Exam Room 2

Exam Room 1

IntakeIntake

24th street

Balm

y street

Reception

Exam Room 3

Exam Room 2

Exam Room 1

Health PromotionHealth Promotion

HealthPromotion

24th street

Balm

y street

Reception

Exam Room 3

Exam Room 2

Exam Room 1


HealthPromotion

MonitorMed Student

1. Get a chart from the monitor

Chart from Monitor

9/20/2010 Fuentes, Estela N60

46 4/3/1964 F 84 1.60

37 C 146/94 60 12 0 23

Katie Concerned about high blood pressure

Consult with preceptor about what to focus on in History & Physical…

24th street

Balm

y street

Reception

Exam Room 3

Exam Room 2

Exam Room 1

HealthPromotion

1. Get a chart from the monitor2. Bring the patient to the exam room

3. Gather History & conduct physical exam


History Identification (ID) Chief Complaint (CC) History of Present Illness (HPI) Past Medical History (PMH) Medications Allergies Family History (FH) Social History (SH) Health Related Behaviors (HRB) ***Health Maintenance***

24th street

Balm

y street

Reception

Exam Room 3

Exam Room 2

Exam Room 1


HealthPromotion

Consult Room



24th street

Balm

y street

Reception

Exam Room 3

Exam Room 2

Exam Room 1


HealthPromotion

Consult Room



Physical Exam

Repeat any essential vital signs– Blood Pressure

Focused physical exam– Listen to 4 heart valves– Listen to the lungs– Feel for peripheral pulse and check for

swelling

Patient Education

Ask-tell-askRealistic behavior change plan

24th street

Balm

y street

Reception

Exam Room 3

Exam Room 2

Exam Room 1


HealthPromotion

Consult Room




2. Create a plan with the preceptor

Plan

Patient education about hypertension Behavior change: less salt, exercise Prescription: Hydrochlorothiazide 25 mg

once per day Labs: cholesterol for health

maintenance Referrals: none required Follow-up: in one month for

hypertension follow-up and yearly pap

24th street

Balm

y street

Storage

Reception

Exam Room 3

Exam Room 2

Exam Room 1


#1: #1: Prescriptions Prescriptions

HealthPromotion

Consult Room

Pharm

acy

Estela Robles 4/3/1964

9/20/10

Hydrochlorothiazide 25mg

30 1 1 tablet once per day HTN

24th street

Balm

y street

Reception

Exam Room 3

Exam Room 2

Exam Room 1


#2: Labs #2: Labs

HealthPromotion

Consult Room

Pharm

acy

Lab


Labs

COMPLETED LAB FORM

X

24th street

Balm

y street

Reception

Exam Room 3

Exam Room 2

Exam Room 1


#2: Labs #2: Labs

HealthPromotion

Consult Room

Pharm

acy

Lab



Drawing Blood We will train you how to do this at an

evening training session in October

Two poke rule, send to Quest if a difficult draw

We also do urine tests and pap tests

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

24th street

Balm

y street

Reception

Exam Room 3

Exam Room 2

Exam Room 1


#2: Labs #2: Labs

HealthPromotion

Consult Room

Pharm

acy

Lab



3. Give tubes to lab volunteer

24th street

Balm

y street

Reception

Exam Room 3

Exam Room 2

Exam Room 1


#3: Referrals #3: Referrals

HealthPromotion

Consult Room

Pharm

acy

Lab

1. If outside services are needed, consult referrals volunteer

2. For mental health, refer to Felix Kury

Professor of Raza Studies at SFSUFaculty advisor to ClínicaLicensed therapist

Felix Kury

24th street

Balm

y street

Reception

Exam Room 3

Exam Room 2

Exam Room 1

Implement Plan: Implement Plan:

#4: Discharge #4: Discharge

HealthPromotion

Consult Room

Pharm

acy

Lab

1. Make sure prescriptions, lab, and referral procedures are complete

2. Consult the monitor

Monitor

3. Ensure the patient understands diagnosis and plan

24th street

Balm

y street

Reception

Exam Room 3

Exam Room 2

Exam Room 1


HealthPromotion

Consult Room

Pharm

acy

Lab

1. Update meds & problem list

Medication, Allergies and Problem lists

Only include long term medications and chronic problems:– Medications:

Hydrochlorothiazide 25 mg once a day NOT: ibuprofen as needed for ankle pain

– Problems: Hypertension NOT: strained left ankle

The idea is for it to be a one stop shop for the next provider to see current meds, allergies, and conditions

24th street

Balm

y street

Reception

Exam Room 1

Exam Room 2

Exam Room 3


HealthPromotion

Consult Room

Pharm

acy

Lab

1. Update med & problem list


9/20/2010 Fuentes, Estela N60

46 4/3/1964 F 74 1.60

37 C 146/94 60 12 0 23

Katie Concerned about high blood pressure Charlie

Dr. Johnson 9/20/2010 SUBJECTIVEID/CC: Mrs. Fuentes is a 46 yo female concerned about high blood

pressure

HPI: Patient has had hypertension for 8 years and was on medications in El Salvador, but has stopped taking them. She has not seen

a doctor in 2 years. She has been feeling well, and denies headache, chest pain, or fatigue.

PMH: 8 year history of hypertension. No diabetes or high cholesterol.

Meds: No prescription medications, takes aloe for heartburn occasionally.

Allergies: No known food or drug allergies

FH: Father has 15 year history of diabetes, mother has a 20 year history of hypertension and recently suffered a stroke.

SH: She is originally from El Salvador and came San Francisco two years ago. She lives with her husband and 13 year-old son in Daly City and works at

a hotel cleaning rooms and making beds.

HRB: Patient smoked for 10 years but quit 3 years ago. Drinks casually, a few beers on the weekends. She is sexually active only with her husband.

They do not use condoms, but she has an IUD.

OBJECTIVE46 year old woman in no acute distress. Repeat blood pressure was 152/94

in right arm. Heart sounds normal S1 S2 with no extra murmurs,rubs, or gallops noted. Peripheral pulses are strong in all four extremities and no peripheral edema was noted.

ASSESSMENT1. Primary hypertension, stage one2. Due for health maintenance lipid panel and pap test

PLAN1. Decrease salt intake, exercise by walking briskly for 30 minutes 3 times

per week. Begin Hydrochlorothiazide 25 mg daily. Follow up in one month.2. Draw blood for lipid panel today and follow up in 1 month for pap test.

24th street

Balm

y street

Reception

Exam Room 1

Exam Room 2

Exam Room 3


HealthPromotion

Consult Room

Pharm

acy

Lab



3. Fill out Follow-up Form

9/20/2010Estela Robles 4/3/1964608-658-2491

Hypertension follow upPap testReview results of lipid panel

10/20/2010

Charlie Cassidy

00000000

24th street

Balm

y street

Reception

Exam Room 1

Exam Room 2

Exam Room 3


HealthPromotion

Consult Room

Pharm

acy

Lab



3. Fill out Follow-up Form

4. Get preceptor’s signature

RememberRemember We are here in the best interest of the We are here in the best interest of the

patients and to provide quality medical care.patients and to provide quality medical care. Always be PROFESSIONAL and RESPECTFUL Always be PROFESSIONAL and RESPECTFUL

to the patients, their families, CMB staff and to the patients, their families, CMB staff and colleagues, and volunteer preceptorscolleagues, and volunteer preceptors

If you need help, just ask!If you need help, just ask! Mentorship is an equal exchange and always Mentorship is an equal exchange and always

appreciated!appreciated! HAVE FUN! Learning, sharing and giving are HAVE FUN! Learning, sharing and giving are

some of the greatest rewards!!some of the greatest rewards!!

A S F S U / U C S F S T U D E N T – L E D P R O J E C T

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A S F S U / U C S F S T U D E N T – L E D P R O J E C T Clinic Logistics in 90 minutes