le cahier de kev

le cahier de kev

adventures fresh off the press

One Less Problem To Handle

After Memorial Day everyone usually gets into the spirit of summer.  It was eventful with the smell of barbecue and people enjoying the sunshine.  I've been keeping up with my exercise regimen similar to when I was training in swimming and dance.  I was sore for a few days when I started some of the intense upper body sets, but thankfully, my body recovered quickly.


I have a few food pictures of the food that I prepared for Memorial Day.  I made shrimp scampi with linguine and plated one for a picture (it didn't look too elegant on the tray! haha)


Shrimp Scampi Linguine


I also chopped up some tomatoes for bruschetta.  With all of the heavy meats and dishes, I thought that it would make a nice, light appetizer.


Mixing in the tomatoes, olive oil, herbs, and spices



Since summer's around the corner, I found a souvenir from a Disneyworld vacation a couple of years ago.



I sent the pictures to my brother and he told me, "I remember that!"  How time flies by indeed.  I cleaned it and used it as a pencil and stationery holder.  I'm sure that the water was a little bit higher when I first got it, but I'm surprised there's still a good amount today.  It really did brighten my day because it brought back so many great memories from vacations during the summer.


My brother and his best friend moved into their new apartment a few weeks ago.  They had to move everything from the old place into the new place.  I gave my brother anything additional from my old apartment that I wasn't using anymore.  He also gave me a pair of Asics as thanks and I was very grateful for it. Meanwhile sis left for the summer.  She called me from the airport and told me that they were getting ready to board.  I wished her a safe trip and told her that we would see each other again in late August/September.


Asics gift from my brother



Breast Cancer Imperative, Inc. had its launching and blessing a few weeks ago.  The Philippine Canadian Inquirer covered the event and we were so proud of everyone's hard work.  Here is the link to the article.  Please feel free to share the article.  I've been working together with Delia and the team to piece everything together for the site.  She let me know that there were video footage and pictures being developed so that I can anticipate on seeing it soon.


Coverage of the MAMMOvan

courtesy of the Philippine Canadian Inquirer



There were a lot of things I learned about global health from Breast Cancer Imperative and my ESL facilitation work at the New York Public Library.  As we are moving toward a more integrated community in the United States, it's easier to be cognizant of the health issues that are affecting communities from abroad.  The cultural lens that we use when we examine others can be different than the ones that they are relatively used to.  For example, what may be acceptable to discuss in our culture may not be the same in another culture.


Usually the first step during treatment plans would be conducting assessments.  These provide background information to help assist the patient by focusing on the condition they are presenting.  The stage is usually set with the standard, "What brings you here?" question asked by the professional.  Although assessments cover specific topics that need to be addressed, the discussion most often than not, will not be cut and dried.  Depending upon the circumstances of the visit or discussion, there may be varying emotions that could affect their willingness to respond or cooperate during the assessment.  The professional performing the assessment can either receive informative replies or dead silence.


When examining a biopsychosocial assessment, we can see how comprehensive the questions can get.  These questions create an overview of the health and lifestyle of the patient as well as examine the social and environmental factors currently influencing the patient.  When you examine the assessment, you can see how thorough and personal many of the questions can get.  As such, it's not always going to be easy to get information out of these patients.  Couple in the background of patients who come from different cultures and countries, and things become even more complicated.


Sample page of a biopsychosocial assessment

Courtesy of Indian Health Service under the U.S. Dept. of Health and Human Services

(Click page for the full assessment)



One of the questions that we discussed during a previous ESL session was "What is something that is improper to ask in your culture during a first meeting?"


The answers were varied ranging from asking about age to income.  Now bring in the professional conducting the assessment on the first visit and you can see how the cultural question above will play out.  Imagine having to give personal information to someone who you barely know (despite the fact that they are a health professional).  It can be quite daunting having to answer questions related to alcohol and drug use or sexual health issues.


When starting an assessment, it is important to recognize that a formation of trust has to be established in order for the patient to be honest and open with their answers.  If a patient is not comfortable with the evaluator or the environment, it will make things more difficult to assist the patient.  An important point is to always ensure confidentiality when beginning an assessment.  Usually this will be covered during the introduction while providing the patient with instructions.


Another case is that these professionals have to conduct several assessments (you already saw how lengthy it is!) and can easily become overwhelmed with trying to elicit information while meeting deadlines.  When there are several patients with only two or three case managers/coordinators, time can reduce patience and energy.  Dealing with an uncooperative patient can then become an obstacle to helping them receive necessary treatment.  So how can we deal with it?  It will be different for everyone, but I can share my tools for working with these populations.


1. Separate each situation and do not carry it over to the next case.

When things don't go as planned with one case doesn't mean that I should become less patient with the next case.  Instead of carrying on that stress, I take a break for a few minutes, write the case notes to just reset, and then start anew with the next case.  It wasn't easy at first.  I remembered my mentor and clinical instructors warning us of burnout and getting emotions mixed up.  This lead to more stress and bringing work issues home. 


My mentor shared something with me that still sticks with me to this day.  "We can only do what we are capable of, but at the end of the day, we just have to let some things go... and we must continue to have faith in ourselves and in others for the next day."


We all have our limits, but if we don't have faith in ourselves, how can we instill hope for the treatment and wellness of others?  Despite the strong emotions in these professions, we can only do what we can.  If a patient does not want to discuss things, it does not mean either side is incapable.  It only means that we have to restructure and reevaluate our process and find ways to help the patient to open up.  For this to happen, we have to "reset ourselves" for each case and not carry any stresses to the next person.


2. Show a personal side of you to the patient.

When I mean personal, I mean being kind and open while sharing a story.  I don't mean pouring out your heart or showing your "Facebook self" to the patient!  If you go straight to performing the assessment or not even looking them in the eyes, don't expect them to open up.  When you share personal information, you want to make sure that the person conducting the assessment shows compassion and interest.  Otherwise, why would I want to share information on family issues to a person who just sits down and takes my information like I'm data for a biology lab report?


3. Be patient and find a way to maintain a strong therapeutic relationship.

When discussing matters such as a family history of substance abuse, mental illness, or status of/death from a chronic disease, how a professional handles this information can make or break the therapeutic relationship.  There will be times when a patient will just close up.  This doesn't necessarily mean that the assessment is going poorly, it only means that there are other factors at play.  For example, a question on abuse might bring back painful memories for a patient or examining a history of cancer in the patient's family might be difficult to discuss due a close member passing way.  Reassure them that they are in a safe environment and they can take time to gather their thoughts and emotions before continuing. 


If you rush them or force them to answer due to time constraints, it will backfire.  The assessment is not a cross-examination to get answers so aggressive methods may not be suitable in this case.  When time or deadlines are a factor, be positive and honest with the patient and tell them that you want their treatment and services to be handled as soon as possible and their cooperation can help expedite the process.  Assessments are two way conversations so all parties have a chance to become involved.


4. Take into account their background (cultural, religious, etc.)

Different cultures and religions have different rules when working with healthcare and mental health professionals.  It's important to discuss any issues prior to the assessment.  If a person prefers to be assessed by someone of the same gender or if a person cannot discuss certain issues due to religion, taking these into account can show respect for their identity and beliefs.  If there is no mutual respect given to their requests, the assessment process will be at a standstill.


There might not be resources to fulfill every patient's request; however, showing cultural competence and sensitivity to the needs of these populations can help them open up during the assessment process.  By becoming flexible, they can also work with you to facilitate this process.


In the end, tackling each issue will be "one less problem" and can simplify the assessment process.


I'm really digging Ariana Grande's song "Problem" right now.  It's catchy and light-hearted which is nice to listen to.



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