About me
Emily Jones
She/hers
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Welcome to my capstone! My name is Emily and I am a fourth year student majoring in health sciences and general sciences. My degree is focused on pre-medicine, and I hope to work as both a healthcare provider and within healthcare management. For my capstone I've had the opportunity to continue my work at OSHU as a medical scribe. Through this course I have been able to expand my understanding of healthcare equity, empowering underserved populations, and problem solving unmet needs in a sustainable, community based manner.
She/hers
-
Welcome to my capstone! My name is Emily and I am a fourth year student majoring in health sciences and general sciences. My degree is focused on pre-medicine, and I hope to work as both a healthcare provider and within healthcare management. For my capstone I've had the opportunity to continue my work at OSHU as a medical scribe. Through this course I have been able to expand my understanding of healthcare equity, empowering underserved populations, and problem solving unmet needs in a sustainable, community based manner.
Social CONtext
The social context surrounding healthcare and health is incredibly important, as these determinants have some of the most influential impacts on health outcomes. Personal choice certainly plays a role, however ultimately health is limited by factors such as access to fresh fruits and vegetables, childhood experiences including exposure to violence or trauma, living situations, education, and much more.
hISTORY OF ohsuUniversity of Oregon Medical School was established in 1887 as the city was burgeoning and had its share of public health problems. Substantial steps were taken during this time to reduce the causes of contagious diseases. As the 1800's continued, several important milestones were completed, such as the creation of the Multnomah County Poor Farm erected, foundation of clean, and reliable water sources. By the early 1900s Portland had established itself as the health center of the US, and underwent a massive enlargement throughout the following 100 years. Today, OHSU places focus on patient care, research, education, and community. They carry out their goals with a focus on transparency, diversity, quality, and service excellence.
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DUTYS, RESPONSIBILITIES, and overarching goalsMy role encompasses working as a scribe for four different providers, helping them to accommodate the needs of their different patient populations. My duties throughout the day include documenting everything said/done during visits, providing forms, supplies, and other resources to patients, completing insurance/medication paperwork, and assisting with patient triaging.
My main goals within this work is to better understand the true meaning of healthcare equity and what this can look like in practice, understanding the varying methods of patient interaction and what strategies within medicine are most effective. I also hope to continue growing in my knowledge surrounding how to honor the unique and diverse range of needs seen in medicine, which partially consists of evaluation community resources and how these can be best utilized. A large part of completing these goals can be accomplished through specific tasks, as detailed under the 'aims at OSHU' section below. |
unmet needsEach year, OSHU completes a workup that explores areas of unmet needs, addressing each service area within Oregon and the major social/geographic/fiscal barriers they face . From their last report, the most prominent factors include the following:
Ability to afford care
The percentage of the local population that is above the Medicaid cutoff of 138% of Federal Poverty Level, but still too poor to afford health insurance on their own. Ambulatory Care Sensitive Conditions ACSC are preventable hospitalizations, defined as a set of inpatient discharges that may have been preventable had they been treated with timely and effective primary care. These include common conditions such as asthma, diabetes, hypertension, and pneumonia. Amount of Providers Per 1000 Patients Providers specializing in mental health services, dentistry, family medicine, and more. This is a significant measure as it plays a large role in access to care as well as clinics. Travel Time 3 criteria were considered good indicators of community access to primary care and to prevent misuse of the ER, including screening and referral for mental health and substance abuse, 24/7 access to clinical advice by telephone, and ongoing management of chronic diseases. |
UNST goals
as defined by psu
Social Responsibility: Sets the intention for students to examine values, theories and practices that inform their actions, and reflect on how personal choices and group decisions impact local and global community.
Diversity, Equity, and Social Justice: A goal to explore and analyze identity, power relationships, and social justice in historical contexts and contemporary settings from multiple perspectives.
Effective Communication: To collaborate effectively with others and to be competent in appropriate communication technologies such as verbal, non-verbal, listening, and more.
Critical Thinking: Consists of problem posing, investigating, and conceptualizing in order to become active, self motivated, and empowered learners.
My aims at Ohsu in correlation to unst goals and unmet needs
Seeing that my role serves as a supportive function within a larger system to effective change, there aren't many ways I can effect direct, sustainable change. This is furthered by the fact that many of the issue seen within healthcare are systemic and will take generations of hard work to shift towards a better future. This said, I can work as a scribe in a way that is conducive to the success of my provider and patient, who are then able to take a step towards improved health and more productive healthcare.
Patient capacity and time management- Working with a scribe allows providers at my clinic to see 15-17 patients daily within family practice versus 10-13. This greatly improves access for patients who are able to be seen in short notice, and even more importantly means that appointments are longer. This indirectly improves the unmet needs of 'providers per 1000 patients', as when more patients are being seen there is a larger threshold and institutions are able to hire more providers. With less time focused on insurance details and order authorizations, doctors are also able to focus on what really matters- the patient and their needs. This results in higher patient satisfaction as they can be truly heard by the doctor, ask questions, get patient education, and walk away feeling confident and empowered in their health. Patient interaction time is vital for genuine relationships to form, which in turn creates a level of trust and ultimately higher quality care.
Quality documentation- The scribe role also allows thorough, detailed chart notes to be created for each patient. When working alone, Doctors will typically chart using small phrases and greatly summarized concerns. This leaves much more room for error, misunderstanding, and misinterpretation through specialists and other providers. As a scribe I am able to document the specific needs of each patient, quotes and personal stories, their health priorities, and much more. Having accurate chart notes is a huge part of streamlining medical care and making sure each patient is seen through their own unique lens.
Something important that scribes do is highlight diseases which we put under the label 'HCC', which is essentially a high risk condition that needs to be addressed sooner than later. These are often issues which, if unaddressed, would result in an ACSC. Therefore, documentation plays an important role in the unmet need of ambulatory care sensitive conditions, or inpatient visits that may have been preventable. When charts are thorough and accurate, providers are able to proofread their diagnosis and plan with ease, contact patients quickly, and essentially address HCCs before they lead to something more serious.
Power and privilege- Something I aimed to take away from my work at OHSU is a better understanding of the power dynamics present within medicine as well as the concept of healthcare as a privilege within the United States instead of a basic human right. The UNST goal of diversity, equity, and social justice spoke to this directly, as most issues within healthcare can be boiled down to one of these categories. After completing my work I've come to see many of the unmet needs within the LGBTQ population, immigrant population, low income population, and more. Seeing the role of privilege in health disparities is likely the most important part of enacting change, largely because the privilege is implemented through systems that enable such situations and continue them through generations. In my work specifically, I saw this play out mainly through income inequality and how healthcare is often based on access to wealth, as well as the complexity of interconnected issues that make it difficult for minority populations to access healthcare. To give an example to what I mean, I was able to see why many of our transgender patients struggle with finding insurance- many of them have endured employment discrimination, unstable housing, lack of transportation, and other issues that greatly complicate access to care. This also speaks to the UNST goal of social responsibility, as once these systems are seen for what they are we can consider our personal role in changing them.
Quality documentation- The scribe role also allows thorough, detailed chart notes to be created for each patient. When working alone, Doctors will typically chart using small phrases and greatly summarized concerns. This leaves much more room for error, misunderstanding, and misinterpretation through specialists and other providers. As a scribe I am able to document the specific needs of each patient, quotes and personal stories, their health priorities, and much more. Having accurate chart notes is a huge part of streamlining medical care and making sure each patient is seen through their own unique lens.
Something important that scribes do is highlight diseases which we put under the label 'HCC', which is essentially a high risk condition that needs to be addressed sooner than later. These are often issues which, if unaddressed, would result in an ACSC. Therefore, documentation plays an important role in the unmet need of ambulatory care sensitive conditions, or inpatient visits that may have been preventable. When charts are thorough and accurate, providers are able to proofread their diagnosis and plan with ease, contact patients quickly, and essentially address HCCs before they lead to something more serious.
Power and privilege- Something I aimed to take away from my work at OHSU is a better understanding of the power dynamics present within medicine as well as the concept of healthcare as a privilege within the United States instead of a basic human right. The UNST goal of diversity, equity, and social justice spoke to this directly, as most issues within healthcare can be boiled down to one of these categories. After completing my work I've come to see many of the unmet needs within the LGBTQ population, immigrant population, low income population, and more. Seeing the role of privilege in health disparities is likely the most important part of enacting change, largely because the privilege is implemented through systems that enable such situations and continue them through generations. In my work specifically, I saw this play out mainly through income inequality and how healthcare is often based on access to wealth, as well as the complexity of interconnected issues that make it difficult for minority populations to access healthcare. To give an example to what I mean, I was able to see why many of our transgender patients struggle with finding insurance- many of them have endured employment discrimination, unstable housing, lack of transportation, and other issues that greatly complicate access to care. This also speaks to the UNST goal of social responsibility, as once these systems are seen for what they are we can consider our personal role in changing them.
moving forward
Moving forward, I would love to continue gaining experience within healthcare and advancing the journey towards true community health. Starting off this capstone experience I had a certain set of expectations and goals I wished to explore- these included health equity in practice, how to make the system more efficient as well as patient oriented, and how to improve access. Navigating my role at OHSU with these specific intentions made a large impact on information I picked up and what I now am even more excited to grow within. Although my passion for healthcare remains unchanged, my perspective on many of the important details certainly has. Reading through 'Walk out Walk On', holding vulnerable class discussions, and growing within my work as a medical scribe has allowed me the opportunity to grow in a way I had never expected, shifting the lens of health I had previously confined to a stereotypical box. I’m excited to continue my work at OHSU and move onwards to a career in health that is community based while also focusing on enacting change on the system as a whole.