Tuesday, I had clinical at the
Cherokee Indian Hospital. I was able to learn more about their healthcare
system. The healthcare system is run by the Tribal Council. They make all the decisions
about how health care is implanted and what services can be offered by the hospital.
The hospital team in the primary care setting are called Pod’s which consist of
12 teams, within 6 Pod’s. In these Pod’s that included a physician, physician assistance,
APN, nurse care manager including RN’s, LPN, CNA’s, CMS, CMT, pharmacist, and a
behavioral health. The CNA’s and LPN actually work as assistants the doctor and
nurse case manager. This team works interchangeably with the patient to provide
care.
At one point during the day the
nurse told to always respect and treat my support personnel with respect and gratitude.
She stated she would not be able to do her job without her CMS. I appreciated
her statement and acknowledgement that support personnel are critical to make a
unit. I loved sitting back and watching them all work together. It felt like
they wanted to be there and they loved their jobs. In my experience on the hospital
floor it always feels rushed and the small gestures or gratitude is not always
seen. There is an urgency in the hospital
but there is usually an underlying tension or high stress feel from all working
on the floor.
When I was working in the Pod
the case manager received a call that a patient walked in without an
appointment. She met with him and he advised a new medication was not working.
She put in an order for the doctor to sign requesting to change his medication.
She said those types of situations happen frequently. The flexibility shown by
the staff to accommodate the patients was impressive. I do not feel in my experience
that my provider every tries to immediately resolve my issues or concerns. I am
usually told I need to make an appointment or I will go ask the doctor and call
you back later. At the Cherokee Indian Hospital
the nurse can submit the order for the medication change to the provider. He is
literally sitting right behind her so she can even ask him a question and get
an immediate response.
I was also at the Immediate Care
Center (ICC) where I was able to observe the triage nurse. This environment was
different the hospital but I noticed the same things. There were multiple
levels of health care professionals working together in a supportive environment
putting the patient first and meeting or exceeding their needs. The patients
were seen quickly, labs such as strep tests were processed and medications were
dispensed. It was a very well run facility
that has volumes of 60 to 80 patients a day. Many patients use the urgent care
center as a primary doctor rather than going to the hospital. The nurse remarked
that it was because “they want to get in and out and not deal with the
preventative screenings and vaccines offered at the hospital.” So there is still
some resistance to the holistic approach for patients but the ICC team doesn’t
look at this as a problem they just try to address what they can when the
patient comes in and they ‘track them down’ as needed. She mentioned it was a
small community so at times she would stop at their house to get them into the
clinic.
The other aspect to the
Cherokee culture is the use of commentary or alternative medications. I asked
the triage nurse at ICC about the use of not prescribed medications. She stated
there are still many Cherokee that use herbal or natural remedies for their aliments
along with prescription medications. I asked if the alternative practices were
shared with the physician and she said “no, it’s only discussed within the
tribe not with outsiders. “ When we went to the Cherokee Indian Village they
talked about the medicine man using plants and herbs to heal the people. Their
belief is that any sickness can be cured with something from the Earth. Our
guide talked about using yellow root for a sore throat. He said if you suck on it
or drink it in a tea it will go away faster. The biggest impression I have
gotten from this experience is they are trying to do everything possible to hold
on to their culture and traditions so it won’t die with the elders.
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