Picky eaters: case

Case/challenge

Scenario

A young man follows his child into the room and sees a pamphlet he's interested in but we only have the French version displayed. He asks if we have it in English and I pull it out from one of the many boxes I am keeping under the extra desk until we can find someplace to store them. Eventually the plan is to have an extra computer at that desk that patients and their families can use while they wait. The pamphlet is called Feeding your child ages 2-5. The man tells me his daughter is 2 years and 7 months old and a very finicky eater. I offer to see if I can find some other resources. He's nervous about staying in the room with me as he might not hear his name being called. The waiting room is quite animated this morning and a vacuum is being used nearby. I offer to find some information for him and tell him she can pick it up after his appointment.

Resolution

I find a few good resources that will supplement the pamphlet nicely:

From Eat Right Ontario: Picky eaters and serving sizes
From Kids Health: Nutrition & Fitness section
From the BC Ministry for Children and Families: Feeding your toddler with love and good food (pdf)

I print these out and place them handily on my desk for the man to pick up when he leaves. He never returns for them.

Discussion

I'm not sure what to do with the 10 pages or so that I have printed. We have not yet established a procedure for this eventuality but I am now inspired to create one. Some things to consider: a way for patients to be located when they are with me and their name is called; a way to get printed information to a patient in case they forget it (email, fax?); a place to put abandoned printed information that may be used at a later time.

Further resolution & discussion

The following week I decide to try and track down the man and see if he still wants the information. I go to the chief administrator at Herzl to ask if she can suggest how to find the man using only a first name. Medivisit, the clinic's appointment scheduling software, only allows a search using both first and last. She randomly calls one of the team coordinators, who as it happens knows the man we are looking for. I have contact information in my hands within 2 minutes. I call the man and he does still want the information. I leave it with the team coordinator for him to pick up at his next visit. I am very impressed with how well the teams seem to know their patients.

Pushing boundaries or juggling hats: challenge

Although my two positions at the hospital are intricately connected, I am paid for them separately, so I try to keep my work in each location as separate as possible in order to honour my obligations to both.

When I got the request for information at the library on pediatric MS from a Herzl resident, it had not yet been established what to do when a Herzl request comes to me when I am at the library. I had another request at the library from Herzl that same week so it seemed imperative that a decision be made regarding procedure.

It has since been decided that I will treat the request as a PFRC request, and also fill out a consult at the Herzl which can then be placed in the chart, which is what I had instinctively thought to do. This seems like a reasonable solution, although it does mean that I may be occasionally counting a single encounter twice.

The head librarian is also available to consult with patients and has said she is happy to help with Herzl requests coming to the library should I not be able to. This is where having the additional support of a library and especially of an existing patient resource centre makes having an in-house service slightly more feasible, especially when the librarian is only on site part-time.

Reinventing the wheel, changing habits & time management in the first months after implementation: challenge

Because the UK service we are basing our model on is no longer operational following the retirement of its librarian, we are in essence reinventing a structure we know exists but do not have the blueprints for. Much of the first months have been spent dealing with the practicalities of setting up the service, establishing policies and procedures, and promoting the service to health care, administrative and support staff as well as to patients.

One of the biggest challenges has been to get health care staff into the habit of referring patients to me. It is my hope that the cases presented here will help. For now I have given the following guidelines:

When to use the service:

• Anytime anything is new (i.e. treatment, diagnosis, medication etc.)
• When more information would help your patient make a decision
• When you’ve been asked for more info but don’t have time to provide it
• When info is needed in a language other than English and French
• When info is needed at an easier reading level

**** do not discount patients you suspect have low literacy****

I am only on site 7 hours per week and this is problematic because I am not always immediately present to fill prescriptions. This will necessitate that those needing my services be prepared to make appointments for a later date and/or to send me their request by phone or email. It has taken some time to establish me in the system so that patients can make appointments to see me with their team coordinators. It is only this week that this has become possible. in the meantime I had asked that referrals be left for me in my mailbox. I have received my first referrals (yellow InfoRx sheets torn from the pads I had printed) in the past two weeks. I have left messages for patients and made contact with one: my first appointment is on Oct. 1st, this coming Monday.

Since I do not yet have cases to present I will instead describe a few I have handled in the past several months at the Library's Patient and Family Resource Centre (PFRC)- see next post.