Outpatient US Clinical Experience in Family Medicine in San Francisco

Information about this clinical experience:

This is an outpatient US clinical experience during which you will be under the supervision of a physician who is board certified in Family Medicine. This preceptor has a deep commitment to improving healthcare in the U.S. and looks for ways to fill existing gaps in the care of vulnerable patients. As this physician is truly an innovator, rotators will have a wonderful opportunity to see how a forward-thinking doctor can change the way in which medicine is practiced.

Frail, vulnerable older adults face many barriers to healthcare access. Accessing healthcare can be difficult for older adults with disability or transportation challenges. One practice model that can be particularly effective in meeting the needs of individuals in this age group is house calls. In the olden days, physician house calls were common. After a significant falloff in the percentage of physicians making house calls, there has been some renewed interest among physicians in bringing care to patients’ homes.

There are numerous benefits to making house calls. Observing the patient in the context of their physical and social environment can be very insightful. Factors that can be difficult to assess in a traditional clinic or outpatient practice, such as social factors, nutrition, hygiene, and compliance with medication, are more readily and easily addressed in the home. Collateral information obtained from caregivers may provide crucial information for making treatment decisions. In addition, as caregiver stress is a significant problem, visiting the family in the home allows the team to offer support to not only the patient but also the caregiver.

As a rotator, you will have the opportunity to visit patients in their homes or participate in telehealth for acute care complaints, chronic disease management, and prevention and risk factor modulation. You will see how the preceptor and the team work tirelessly to meet the varied needs of their patients with a focus on keeping patients out of the hospital. There is a considerable body of evidence that shows high-quality home care can reduce hospital readmission rates, cut down on healthcare costs, and increase patient satisfaction.

You will see how the team utilizes their clinical acumen, careful observation, critical thinking, and creative decision-making to provide excellence in care. Due to the complexity of the patients’ conditions, both medically and socially, you will observe how a multidisciplinary approach is employed to deliver holistic care. One important aspect of care delivered in this practice are goals of care conversations and advance care planning. Through these conversations, the team helps patients understand their healthcare priorities and make important decisions to align future treatment with consideration of their values and preferences. When patients require palliative care, the team is equipped to perform comprehensive assessments of these patients, create care plans, and provide ongoing support to manage symptoms and tend to quality-of-life issues.

To prepare for this clinical experience, we recommend you read the following very informative and enlightening article:

House Calls

During your experience, you will learn the following U.S. medical practices under the preceptor’s supervision (please note that this experience remains within the regulations of California pertaining to the unlicensed practice of medicine):

• Taking patient histories under supervision.

• Examining patients under supervision.

• Presenting patients.

• Entering notes in EMR (Athena)

• Having opportunities to research the literature to answer clinical questions at the point of care.

• Educating the patient.

• Spending time with other healthcare professionals to understand their roles and responsibilities.