Access to healthcare is an incredibly important factor in changing health outcomes. Last week, at the Robert Wood Johnson 40th Anniversary Connections Conference, I was reminded that data and numbers aren’t always successful at effectively conveying messages to patients.
During one lecture, Richard Besser, MD, ABC News’ Chief Health and Medical Editor and pediatrician at Children’s Aid Society in New York City, said that if the American public is going to understand how important healthcare is to every U.S. resident, we need tell stories.
I first met C.R., a 12-year-old patient, when he came in for a well-child visit with his mother and two younger brothers. Even before reviewing C.R.’s growth chart I knew he was obese.
Although C.R.’s record indicated he had been overweight for years, he had experienced rapid weight gain during the past 6 months. When I asked if there were any differences in lifestyle that might account for the weight gain, C.R.’s mother reported that his grandmother had moved into a home right behind them and had been looking after the children while she and her husband worked.
The grandmother had been providing unlimited – and unhealthy – food for the kids, in a phenomenon that I like to call “loving to death.” Food is a culturally sensitive topic and being able to provide favorite foods to your family is, for many, one of the most meaningful expressions love. C.R. is not the first child I’ve seen who has experienced rapid weight gain during the summer months when a grandmother is providing care.
In addition to C.R.’s weight gain, I noticed that his blood pressure was consistently in the 95th to 99th percentile during each visit during the past 18 months. This was a serious concern.
C.R. was a smart young man, and when questioned about healthy foods and exercise he knew the right answers. So I did something different. Instead of counseling C.R.’s mother, I spoke directly to him. I challenged C.R. to take responsibility for his health and asked him if he wanted to do this. When he responded that he did, we role played some ways that he could politely interact with his grandmother regarding healthy food choices.
I advised C.R. to return for a follow-up visit in 3 weeks to obtain results from a fasting lipid panel and possibly begin antihypertensive medication. Not surprisingly, the tests revealed elevated total cholesterol and triglycerides.
After our first visit, I was unsure of whether C.R. would return for follow-up. So you can imagine my surprise when he came into the office 6 lbs. lighter, with his BP down below the 95th percentile. C.R. reported that he had increased the number of times he could ride his bike around the block, making it a nightly habit, and that he had asked his family, including grandmother, to help make changes to his diet. I praised the whole family, but I was especially proud of C.R. for taking action and taking care of himself.
This is just a beginning of C.R.’s journey towards improved health and not yet a long term success story. But even this beginning would not be possible, if C.R. did not have access to care at the federally funded community health center where I work – a service that I believe everyone deserves.
Julee B. Waldrop, DNP, FNP, PNP, is the Director of the MSN-DNP Program and an associate professor at the University of Central Florida. She provides health care to children at a local community health center.