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A 48 Hour Span of PCBH

Over the past 48 hours, there have been a number of Moments of PCBH that my mind has held onto, allowing the experience to exist well beyond the tangible moment. It started yesterday morning during our family medicine resident interviews where our program allows our BH faculty to give a 15-minute introduction to our behavioral health integration within the residency program. As I tell the eager applicants, there is fierce debates of what gets highlighted during these resident interview days, as there is a finite amount of time for the program to sell who we are. And, the fact that we dedicate a significant portion to solely discussing the role of our BHCs and our robust curriculum is a subtle reminder that, “hey, we do this shit differently here.” We talk about what it means to provide compassionate, contextual, and person-centered care, as well as efforts to improve their competence, comfort, and confidence in working with any behavior seen in primary care (from setting a SMART goal for behavioral activation for depression, to helping someone take a medication, to compassionately discussing improving diet and exercise). We talk about how at CHCW, BH integration isn’t about mental health and substance use, it is about fortifying primary care and ensuring that our health system and wherever our trainees go after graduating are equipped to see patients and communities within their context in hopes of helping them live value congruent lives. While the 15 minutes seem to last only 5 seconds (always leave these conversations wanting to say more), there is engagement from the other side of the Zoom interview where the applicants are eager, hungry, and motivated to realize what High-Primary Care could truly look like in the context of integrated teams striving to serve patients, families, and communities.

After the interviews, I ran over to join our BHC trainees in our Experiential Learning or Group Supervision that occurs every Wednesday afternoon. My mind is always amazed about the conversations that occur during this sacred space. We discuss philosophies, relational frames, what it means to be human, we sit with each other often acknowledging the incredible work we get to do. During the four-hour block yesterday, we specifically went over modules on Relational Frame Theory from (check it out), as well as had one of our pediatricians come in to discuss how BHCs could be involved in well-child visits. While the conversations throughout the four-hour span left me invigorated and excited about the work, without question, the beginning of the group supervision was the most inspiring. Each EL we start off by sharing wins and kudos and as we progressed through our weekly ritual, multiple interns/fellows commented on a recent Thursday that resulted in numerous 4:50 PM+ handoffs. Impressively, while there were multiple handoffs given at the end of the day, ALL OF THEM were completed, even one of our trainees getting one at 5:15 PM after completing another late handoff. As they discussed and shared their gratitude for each other, they also commented how “good” it felt to get these handoffs and making sure no one left our clinic without seeing a BHC. It was obvious that they embraced the often-quoted CHCW mantra of “WHO or die”.

Then, two interesting dynamics occurred. Without prompting, all of them said, “it would only work if we saw the Core BHCs doing this and that everyone was in this together.” One of the trainees said, “yeah, if it was just me every time taking the late handoffs, then that wouldn’t be okay. And, that doesn’t happen here, because EVERYONE takes late handoffs.” They also commented that while it can be tiring at times, taking those warm-handoffs wasn’t burning them out or causing them to feel disengaged with their work. There was a moment my mind was struck about the incredible conversation that was happening. Not only the idea of PCBH being realized, the importance of striving towards a value, etc., but more of the reflection of the supervisors and Cores setting the example that this is the work that we do and we are in this together.

At the end of EL, which wrapped up around 4:45 PM, I walked back to my office and I found four of our trainees still in the PCBH office space talking and brain storming ideas of how to reach more patients, how to support the PCPs. Even though my mind was tired and wanting to get to a work-dinner, it couldn’t help itself to not jump into the conversation. Forty-five minutes later, and after we had solved all of the world’s problems, the trainees and I looked at each other, each acknowledging the shared moment, and expressed gratitude for the work and us all being willing to stay late to just talk and debrief about the work PCBH provides us all.

As I shared this experience with our supervisor group and our C-Suite via an email this morning, our CEO responded back, “This is yet another example of the BHC team’s laser focus on making sure every patient achieves their best health. Your willingness (and eagerness) to accept such late WHOs is a testament to your dedication and compassion. And the resolve of the entire team to do so makes it even that much more commendable. Kudos to you all!! The culture in the BHC program is one we strive for across CHCW.”

While these experiences have filled the spirit and fortified the fire of PCBH, it was this morning’s clinic that solidified the incredible 48 hour stretch of PCBH. Eight visits, two of which were handoffs and another that was prescheduled with a PCP, occurred during the morning clinic. Three patient experiences stood out the most, one where a patient that has been dealing with a difficult decision of terminating a pregnancy and has dealt with numerous ACEs and hardships stated, “I really don’t know where I would be if it wasn’t for this clinic and the BHCs. Regularly throughout my day, my mind thinks, “what would Bauman tell me to do right now?”

Then, a handoff for a new patient to the clinic that had unfortunately been exposed to some of the most difficult life experiences humans have to deal with. Amazingly, the older adolescent was still upbeat, hopeful, and wanting to make their life one of value. At the end of our visit, I informed them, “hey, I think you are doing incredible all things considered. What do you think about following up in a month to check back in?” They responded, “well, things can change pretty quick.” Which caused my mind to grow in excitement as I conveyed, “you know what, you are right. And, what is really cool about our philosophy is that even if we scheduled something for four weeks, if something changes tomorrow or next week, you can come in and we will see you that day.” A look with curiosity crossed their face, as they responded, “really? The (traditional CMHC) told me I couldn’t see a psychologist until Feb. That is really cool and (seeing a BHP when you need to) is the way healthcare should be.”

And then, as I ran to the last handoff request that was a teen I had seen a few months ago that was okay waiting 15 minutes for me to get out of a visit, my mind began to become emotional recognizing the incredible touches and moments the morning was producing with other humans. As I opened the exam room door to the handoff, my mind remembered what I journaled about in the morning regarding how I wanted to be during the day, “be present with every human you meet.” My mind quickly centered on the teen who was so excited to show me pictures of their shop class and the work they had completed. As we made our way through the previous visit’s goals, I asked the patient about some of the self-compassion exercises I had given, which my mind, even while recommending them, predicted there was probably little to no chance the teen was going to complete them. “Oh, yeah, I did look them up. One was really helpful, I am using it before bed.” As I tried to hide back tears of amazement, the patient’s mom who was in the room said, “really glad you were able to see (the patient today), (they) said when they got home after last visit how much they really liked meeting with you.”

What a forty-eight hour span of working in primary care, of working in training programs dedicated to PCBH and realizing what High Quality Primary Care could be. Forty-eight hours of running from exam room to exam room, from talking about wins and kudos, to talking about relational frames and how we can strive to train the future providers of primary care. Forty-eight hours of primary care… what moments, what connection, what love, what compassion… what a forty-eight hour stretch of PCBH… My unrelenting gratitude for you all that do this work and being apart of a community that encourages and allows for Stories and Moments of PCBH to be shared…

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