DAY ONE
The first day of my Magellan, June 5th 2017, I met with Dr. Abigail Schlesinger at a Park N Ride in Harmony Pennslyvania. Dr. Schlesinger, who is a child psychiatrist and the major brains behind the TiPs program centered here in Wexford, was meeting me to drive to Erie Pa. That day we would be driving up through Erie and trying to visit as many family pediatric offices as possible. These visits were quick stops and Dr. Schlesinger joked that these visits felt a little like a drug representative's job, but it was an necessary evil to get as many offices signed up through the TiPs program as possible. The most effective way to get these offices involved was by introducing the TiPs program in person. Dr. Schlesinger makes several driving trips like this one to Erie every year, but to other counties that the TiPs program covers. She would also have to go and visit the offices that had already signed up for the program once per year as was mandated by law since it was a state founded program. By Dr. Schlesinger coming in and visiting these offices in person, she was letting these small practices put a face with the TiPs program. This also shows that the people running TiPs are really invested in the project and were not going to sign up these practices and leave them to sink once they got in deep water, or say, a patient with a difficult presentation of behavioral health symptoms.
For the offices that failed to react pleasantly to the idea of the TiPs program or felt they had no need for such a program, Dr. Schlesinger started them on a level of active thinking by personal handing out information and giving her business cards to be a direct contact. A large part of the struggle to get family pediatric offices signed up for the TiPs program is their belief that there is no need for such a program, that children do not need anxiety and anti-depression medication or that they are just being kids. Dr. Schlesinger was very sophisticated in her manner of dealing with such offices. She never appeared affronted or discouraged, she simply kept pushing the TiPs program and kept fighting for the kids in that area to get the mental and behavioral help they may need. She worked hard to turn still minds, closed to the idea of outside help, to begin thinking actively about improving their office's stance on the behavioral and mental front.
DAY TWO
On the second day of my Magellan I began what would become my regular schedule for my project. I came into the offices in Wexford which has doctors, licensed clinical social workers (LCSW), social workers (LSW), care coordinators, and secretaries in both the Children's office and the TiPS' back offices.I saw several interesting patients with Dr. Schlesinger and the therapists located at Pine Center. I cannot provide specific details of sessions, as that would be a violation of a patients privacy. Each patient did give permission for me to sit in on the session with them. Each patient was aware that I was a student. Providing each patient with clear information about who I am and what my role is is an important component of respecting patient autonomy.
Today I had the chance to sit in on an appointment with both Colleen Gianneski and Dr. Schlesinger. They were viewing a patient who had been referred to the TiPs program by the family's pediatrician, which is one of the ways that the ways TIPS program receives in person consultations. Some of the disorders that I was able to observe this day were listed on the autism spectrum. Colleen's normal routine to set of the patient for Dr. Shlesinger would be to meet with the patient and their accompanying adult first and ran through all the back ground information they needed to gather in order to give an opinion on the medication change. Colleen asked about school life, grades, activities the patient was involved in, how many friends the patient had, how home life is, and if the patient had any self harming thoughts and did he/she want to act on them. Colleen had to gather all medical and physical history of both the patient and the patient's family in order to rule out a genetic component. It was also important to collect as much back ground information for a TiPS patient because this consultation was a singularly meeting, Colleen had never met with this patient before and after the appointment would not see them again. A key aspect of the TIPS program is to keep the patient with the PCP so Colleen will most likely never see any of the patients she visited with this day again.
Once Colleen was finished, we went back to the TiPs offices and met with Dr. Schlesinger and reviewed the information and the direction Colleen was leaning towards after meeting with the patient. With Colleen's collected information in mind, Dr. Schlesinger and I went and met with the patient again. Dr. Schlesinger met with the patients by themselves and then just with their accompanying adults to see if there would be any extra information told or if a difference in responses would happen when the patient's legal guardian wasn't in the room. Dr. Schlesinger asked more about the medical history of the family because she would be the one recommending or discouraging a medication change. In the end of each session, because it was a referral through the TiPs program, the most Dr. Schlesinger could do was write back to the patient's family pediatrician with her recommendation of care. The patient's pediatrician would review Dr. Schlesinger's notes and then decide whether or not to prescribe the treatment Dr. Schlesinger had recommended. Some times the best treatment they would advise would not be medication but therapy sessions like cognitive behavioral therapy. This therapy would advance the benefits that the medication was giving the patient. Through this therapy, the patient would learn techniques to stay calm, deal with tense and new situations, and participant more in school. The goal of this therapy is to help the patient interpret the symptoms the body is sending them due to whatever stressor they were currently feeling and learn to interpret and react better.
After Dr. Schlesinger finished with her patient's appointment, we went back to her office and she worked out loud so I could follow along with her thinking process. She worked through some questions about patients that other doctors had emailed her. This was still part of the TiPS program, these emails held patient's medical information making Dr. Schlesinger one of the patient's doctors allowing her to write on their medical charts. A lot of the cases that the TIPS program got were from PCP but sometimes the cases come from other psychiatrists looking for another opinion on a tricky case. A tricky case could be a patient who had been suffering from pseudo-seizures and had been hospitalized and medicated. The problem with this treatment is that pseudo-seizures are not caused the same way as a epileptic seizure is caused and treated. Pseudo seizures are labeled as a conversion disorder which is a disorder involving neurological connections in the brain, the patient shows psychological stress in psychical ways. Since pseudo seizures are caused by something neurological and emotional in the patient, a statement of treatment for this disorder would be bio feedback.
The final part of my day was following Dr. Schlesinger and Colleen along to a presentation on eating disorders in children and adolescents: Recognition and Referral. The main eating disorders discussed were anorexia and bulimia, anorexia being the most prevalent eating disorder for this age cohort. When reviewing a patient who presents as having an eating disorder there are certain exams that the doctor should take to check. These test are a comprehensive exam, a medical exam, and an interpretational exam. From this point, the presenter recommended ways to talk to a patient with a eating disorder to respect the patient's disorder. These ways included never commenting on their appearance because no matter what, they will hear that they are fat. It is recommended to never talk about yourself either because then a comparison begins to form between doctor and patient. Lastly the presenter encouraged the people in attendance to view these eating disorders as one of our own personal fears, like heights or snakes. That way you can better understand that when you tell a person with an eating disorder to just eat a hamburger or to not throw up after eating, it is like someone telling you to walk around the ledge of a tall building or to play with a bucket of snakes. The best chance for patients with eating disorders is early intervention and treatment with full support from everyone in their family to the give the patient the best chances.
It is great that lots of other employees of the Children's offices were in attendance for this presentation because eating disorders is a disorder that is easily ignored and the patients left to suffer when there is help possible. Or, because lots of family pediatricians are not trained with the nuisances of the disorder as was discussed above, they fail to accommodate the patient as appropriately as a TiPs member would recommend. This presentation and its audience is a great example of medical professionals learning as much as they can when new information comes out or refreshing what they know in order to improve their abilities in their offices.
The first day of my Magellan, June 5th 2017, I met with Dr. Abigail Schlesinger at a Park N Ride in Harmony Pennslyvania. Dr. Schlesinger, who is a child psychiatrist and the major brains behind the TiPs program centered here in Wexford, was meeting me to drive to Erie Pa. That day we would be driving up through Erie and trying to visit as many family pediatric offices as possible. These visits were quick stops and Dr. Schlesinger joked that these visits felt a little like a drug representative's job, but it was an necessary evil to get as many offices signed up through the TiPs program as possible. The most effective way to get these offices involved was by introducing the TiPs program in person. Dr. Schlesinger makes several driving trips like this one to Erie every year, but to other counties that the TiPs program covers. She would also have to go and visit the offices that had already signed up for the program once per year as was mandated by law since it was a state founded program. By Dr. Schlesinger coming in and visiting these offices in person, she was letting these small practices put a face with the TiPs program. This also shows that the people running TiPs are really invested in the project and were not going to sign up these practices and leave them to sink once they got in deep water, or say, a patient with a difficult presentation of behavioral health symptoms.
For the offices that failed to react pleasantly to the idea of the TiPs program or felt they had no need for such a program, Dr. Schlesinger started them on a level of active thinking by personal handing out information and giving her business cards to be a direct contact. A large part of the struggle to get family pediatric offices signed up for the TiPs program is their belief that there is no need for such a program, that children do not need anxiety and anti-depression medication or that they are just being kids. Dr. Schlesinger was very sophisticated in her manner of dealing with such offices. She never appeared affronted or discouraged, she simply kept pushing the TiPs program and kept fighting for the kids in that area to get the mental and behavioral help they may need. She worked hard to turn still minds, closed to the idea of outside help, to begin thinking actively about improving their office's stance on the behavioral and mental front.
DAY TWO
On the second day of my Magellan I began what would become my regular schedule for my project. I came into the offices in Wexford which has doctors, licensed clinical social workers (LCSW), social workers (LSW), care coordinators, and secretaries in both the Children's office and the TiPS' back offices.I saw several interesting patients with Dr. Schlesinger and the therapists located at Pine Center. I cannot provide specific details of sessions, as that would be a violation of a patients privacy. Each patient did give permission for me to sit in on the session with them. Each patient was aware that I was a student. Providing each patient with clear information about who I am and what my role is is an important component of respecting patient autonomy.
Dr. Schlesinger sees children and adolescents from a very young age to 25 years of age in Pine Center. The youngest patient I saw was 10 years of age and the oldest was 21. In order to protect patient privacy I am going to provide a summary of what I learned each day.
Today I had the chance to sit in on an appointment with both Colleen Gianneski and Dr. Schlesinger. They were viewing a patient who had been referred to the TiPs program by the family's pediatrician, which is one of the ways that the ways TIPS program receives in person consultations. Some of the disorders that I was able to observe this day were listed on the autism spectrum. Colleen's normal routine to set of the patient for Dr. Shlesinger would be to meet with the patient and their accompanying adult first and ran through all the back ground information they needed to gather in order to give an opinion on the medication change. Colleen asked about school life, grades, activities the patient was involved in, how many friends the patient had, how home life is, and if the patient had any self harming thoughts and did he/she want to act on them. Colleen had to gather all medical and physical history of both the patient and the patient's family in order to rule out a genetic component. It was also important to collect as much back ground information for a TiPS patient because this consultation was a singularly meeting, Colleen had never met with this patient before and after the appointment would not see them again. A key aspect of the TIPS program is to keep the patient with the PCP so Colleen will most likely never see any of the patients she visited with this day again.
Once Colleen was finished, we went back to the TiPs offices and met with Dr. Schlesinger and reviewed the information and the direction Colleen was leaning towards after meeting with the patient. With Colleen's collected information in mind, Dr. Schlesinger and I went and met with the patient again. Dr. Schlesinger met with the patients by themselves and then just with their accompanying adults to see if there would be any extra information told or if a difference in responses would happen when the patient's legal guardian wasn't in the room. Dr. Schlesinger asked more about the medical history of the family because she would be the one recommending or discouraging a medication change. In the end of each session, because it was a referral through the TiPs program, the most Dr. Schlesinger could do was write back to the patient's family pediatrician with her recommendation of care. The patient's pediatrician would review Dr. Schlesinger's notes and then decide whether or not to prescribe the treatment Dr. Schlesinger had recommended. Some times the best treatment they would advise would not be medication but therapy sessions like cognitive behavioral therapy. This therapy would advance the benefits that the medication was giving the patient. Through this therapy, the patient would learn techniques to stay calm, deal with tense and new situations, and participant more in school. The goal of this therapy is to help the patient interpret the symptoms the body is sending them due to whatever stressor they were currently feeling and learn to interpret and react better.
After Dr. Schlesinger finished with her patient's appointment, we went back to her office and she worked out loud so I could follow along with her thinking process. She worked through some questions about patients that other doctors had emailed her. This was still part of the TiPS program, these emails held patient's medical information making Dr. Schlesinger one of the patient's doctors allowing her to write on their medical charts. A lot of the cases that the TIPS program got were from PCP but sometimes the cases come from other psychiatrists looking for another opinion on a tricky case. A tricky case could be a patient who had been suffering from pseudo-seizures and had been hospitalized and medicated. The problem with this treatment is that pseudo-seizures are not caused the same way as a epileptic seizure is caused and treated. Pseudo seizures are labeled as a conversion disorder which is a disorder involving neurological connections in the brain, the patient shows psychological stress in psychical ways. Since pseudo seizures are caused by something neurological and emotional in the patient, a statement of treatment for this disorder would be bio feedback.
The final part of my day was following Dr. Schlesinger and Colleen along to a presentation on eating disorders in children and adolescents: Recognition and Referral. The main eating disorders discussed were anorexia and bulimia, anorexia being the most prevalent eating disorder for this age cohort. When reviewing a patient who presents as having an eating disorder there are certain exams that the doctor should take to check. These test are a comprehensive exam, a medical exam, and an interpretational exam. From this point, the presenter recommended ways to talk to a patient with a eating disorder to respect the patient's disorder. These ways included never commenting on their appearance because no matter what, they will hear that they are fat. It is recommended to never talk about yourself either because then a comparison begins to form between doctor and patient. Lastly the presenter encouraged the people in attendance to view these eating disorders as one of our own personal fears, like heights or snakes. That way you can better understand that when you tell a person with an eating disorder to just eat a hamburger or to not throw up after eating, it is like someone telling you to walk around the ledge of a tall building or to play with a bucket of snakes. The best chance for patients with eating disorders is early intervention and treatment with full support from everyone in their family to the give the patient the best chances.
It is great that lots of other employees of the Children's offices were in attendance for this presentation because eating disorders is a disorder that is easily ignored and the patients left to suffer when there is help possible. Or, because lots of family pediatricians are not trained with the nuisances of the disorder as was discussed above, they fail to accommodate the patient as appropriately as a TiPs member would recommend. This presentation and its audience is a great example of medical professionals learning as much as they can when new information comes out or refreshing what they know in order to improve their abilities in their offices.
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