This is an interview with Erinn, a Family Nurse Practitioner (FNP) who works at a non-profit clinic in Los Angeles caring for underserved and uninsured patients of a mostly Spanish-speaking population. In it, Nastassja Carusetta discusses what Erinn’s work looks like, the importance of educating patients, and how Osmosis can play a role in patient education in the near future.
What do you do?
I’m educated as an FNP, and I work in primary care and internal medicine offices, managing any problem that walks into the clinic. In my clinic, we have doctors and nurse practitioners, and everyone has their own panel of patients. So, what I do is what any other Primary Care Physician (PCP) or family doctor would do. In California, we have a supervising MD who can supervise up to four Nurse Practitioners (NPs). Practically speaking, when I have a patient who is complicated or presenting with something I haven’t seen before, or I have questions about management, I’m able to consult with them. For my patients, I am the PCP, and their experience with me is the same as if they were seeing any other PCP. I see simple things such as upper respiratory infections and urinary tract infections, more complicated management of heart failure, cirrhosis, and diabetes complications, and everything in between.
I see simple things such as upper respiratory infections and urinary tract infections, more complicated management of heart failure, cirrhosis and diabetes complications, and everything in between.
Why did you choose primary care?
I chose primary care because I like to understand how to manage all the different diseases my patients can have, and I like procedures and being a generalist. I like having the ability to manage anything my patients come in with, and I love to help my patients and see how they can improve their health over time. I enjoy having a rapport with my patients, and it brings me a lot of happiness to see the positive impact I can have on their health and how they can improve their outcomes.
What patient population do you work with?
I work with adults from diverse backgrounds; a lot of my patients are underserved and in poverty, complicating their health. They haven’t had access to medical care in the past and struggle with poor health literacy.
Why did you choose to work with the patient population you serve?
Working in an underserved area, I’ve seen how much help this group needs, and they don’t always get the best care. It’s a population that needs a lot of support and typically has reduced access to good healthcare. I speak Spanish, which allows me to give better care and have more of an impact on my Spanish-speaking-only patients. My career goal is to do something positive for other people every day at work. Even when it’s a challenge to care for my patients, I am motivated to have a positive impact and to do something good every day.
When my patients have someone who they know cares about them, and they can communicate with me comfortably, they are confident in my advice and are more likely to follow through. By taking the time to build rapport, understand where my patients are coming from, and educate them about their health, I can have a bigger impact on them and their health. I’ve seen some of my patients, for example, go from an A1C of 14% to 6% because I took the time to understand where they were coming from and work with them on their health—focusing on their goals such as to not needing to take multiple medications by making more lifestyle changes.
What challenges does this patient population present with?
A lot of my patients need help understanding what a disease means and its implications in their lives; otherwise, they don’t understand why it is important to take a medication. Often, the barrier is a lack of education, health literacy, and the ability to afford medications. A lot have barriers to being compliant with their medications because they have the belief that medications are bad and cause health problems, and they don’t understand that their disease process is worse in comparison based on its outcomes and complications.
How do you educate your patients?
As a nurse, I was trained to spend a lot of time educating my patients and have carried that over into my role as a PCP, which I’ve seen have a big impact on how patients receive my advice and the changes they implement. The most important thing I do when someone comes in is to help them understand what happens if their disease remains uncontrolled. I explain to them ways to manage their disease. When they understand their disease process and we talk about their choices, they can take ownership of their health and decide if they want to stay unhealthy and have an increased risk for complications or if they want to reduce those risks.
By educating them, my patients can choose where they want to go with their health, and they have a stake in those decisions. For example, a lot of people don’t want to be on medication, so we often start with medication, and I educate them on their options to change their lifestyle to be able to go down on their dose and potentially get off that medication. I think it’s very important for patients to have a stake in their outcomes because it helps them make decisions about their health and—ultimately—make changes and improve their health.
What are the top diseases you educate your patients about?
Diabetes, hypertension (HTN), hyperlipidemia, and kidney disease. The next things would be heart failure, liver failure, peripheral vascular disease, and musculoskeletal concerns.
Let’s watch the Osmosis video on hypertension together. What are your thoughts about how patients could benefit from these videos?
I thought the video gave good information to explain the different levels of blood pressure, risk factors, and explaining the damage that it causes. It’s a great place to start for someone who is trying to learn more about their HTN diagnosis. What I would like to see to make this a complete resource for my patients is a “part two” of those videos going into the management of their diagnosis and focusing more on education about lifestyle factors and medications. If that video could go into the “here’s what you need to do” and talk about specific changes they could make to improve their lifestyle—for example, lowering their sodium intake, eating a DASH diet, and getting 150 minutes of cardiovascular exercise per week—I could see this being a very valuable resource for patient and caregiver education.
How could you see these videos being used in practice?
There’s a lot of waiting time in the clinic, in both the waiting room and the patient room. These videos could be playing on the TV in the waiting room. Some offices also have tablets that allow patients to select information or videos on health conditions that they want to learn more about, and I could see these videos being beneficial to patients to watch while they’re waiting to see their PCP. A lot of organizations also provide patient portals, and these videos could be incorporated into those via learning links.
About the Author
Natassja Carusetta is a medical student at the University of Illinois College of Medicine.
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