Elizabeth Pedowitz: Shadowing & Surveying Visiting Doctors BACK

Published by AFAR

I am officially a few weeks into my MSTAR project. I am working with the Mount Sinai Visiting Doctors (MSVD) program that provides care to homebound, generally elderly, patients within Manhattan. I had experience with MSVD this past year as part of my Longitudinal Clinical Experience (LCE). The LCE involves following a doctor and his or her patient for two years while learning about the patient’s chronic illnesses, life, and how the two intersect. My LCE patient is in her late 80s and suffers from a complexity of issues including severe scoliosis, breast cancer, advancing dementia, and a collapsed lung. She is homebound with an oxygen tank, which leaves this very creative woman feeling extremely stifled. I loved my experiences with the MSVD and my patient and knew that MSTAR would be a perfect way to do more research in the department.

My project this summer is examining how much time the physicians in MSVD spend providing care outside of home visits. There is some known literature investigating this matter for primary care physicians, but there is a need to expand this research to the home visit population that my research mentor, Dr. DeCherrie, and I believe requires more care coordination. I am also comparing the two models of care that the MSVD uses to observe any potential differences in the amount of time the physicians from each spend on providing care outside of the home visits.

So far I have been working on creating a form that the physicians can fill out for every interaction/event they have outside of home visits that is related to their patients’ care. It’s interesting how much it has changed over the last month while it was being piloted. The form asks for the patient’s name/DOB so we can look at certain patient characteristics like dementia status, the nature of the interaction/event, whether it could go towards possible reimbursement (CPO possible), and the outcome of the interaction/event by circling best responses in a table I have created. Most of these interactions/events are not going to be CPO possible and so they are not reimbursed.

The physicians have been split into different weeks and I have been working on having them sign the consent forms. Monday, 7/9, will be the first day they use the forms. I’m really hoping everything goes well and that the forms are easy to use and not too cumbersome. I don’t like the idea of making the physicians do more work, but hopefully the findings of my research will help them in the long run. Everyone so far has been really great about helping me pilot the forms and all of the physicians (there are thirteen in the MSVD) have agreed to participate in my project.

I’ve now had two opportunities to shadow doctors. This morning I went with the Visiting Doctors to see two homebound patients. One had ALS and could not speak; he had to use an iPad program to type what he wanted to say and then a robotic voice would say it. He had fallen and needed to have two stitches taken out, which I was able to help with. The other patient was a 90-year-old woman who had fallen and was having knee pain. She can’t walk and her daughters are extremely concerned. The other day I shadowed a fellow in the Geriatrics department. That was a great experience as well because I was able to initially take in the patients and do the history (one in Spanish) and then present to the fellow before she saw them. So far I am having a great time in MSTAR and learning a ton!

Elizabeth Pedowitz
Mount Sinai School of Medicine

"Diary of an MSTAR Student" follows scholars in the 2012 Medical Student Training in Aging Research (MSTAR) Program, highlighting their summer experiences. As they continue their path of research, training and clinical practice, read their daily thoughts at www.afar.org/mstarblog. New diary entries are posted every day, so check back soon.