SF General uses a weight and symptom calendar to help patients identify patterns in their behavior that cause conditions to worsen.
Collaborator (Non-Members)Larissa Thomas, Michelle Schneidermann
Our patients don’t always see the connection between their behaviors and how they feel. They also don’t want to be told to stop doing drugs or stop eating the delicious high-sodium food their mom makes. The second we start telling them to stop doing anything they stop listening to us and that hurts our ability to develop a therapeutic alliance with them.
San Francisco General is a non-profit hospital and level 1 trauma center in San Francisco, CA. It has 598 beds and serves a diverse population, the majority of whom are lower income and do not speak English as their first language. Many are also illiterate in English as well as their preferred language. The hospital also serves individuals who may not have health coverage, housing or access to food. They enroll the most difficult to engage patients who have a history of substance abuse and poor health outcomes. Their transitions program began in 2009 and is influenced by the Care Transitions Program and Project RED.
What We Tried
We gave patients a simple calendar to fill out every day. All they need to do is write down their weight and then circle either the red, yellow, or green dot based on how they feel. We review the calendar with them on their follow up calls. “What was your weight on Monday? Tuesday? And which color did you circle?” We can start to notice patterns and highlight them to patients. “It looks like you weren’t feeling well on Friday, Saturday, and Sunday. Were you doing anything differently then compared to Monday or Tuesday?” or “You started to gain weight on Wednesday, what did you do on Tuesday?” They might not tell us that they were doing drugs or eating takeout, but they’ll start to realize which behavior caused the changes.
Patients start to see patterns without us even saying anything. Maybe they were smoking crack on Friday, but we don’t have to accuse them of anything or make them feel defensive, we just highlight the pattern and let them make the connections. The calendar also helps because people are bad historians; they forget how they felt from one day to the next. The calendar helps them remember.
Patients often take these calendars with them to their follow up appointment with their primary care physician. The PCPs really appreciate this tool and are thankful that we provided it to the patients. It helps to strengthen our relationship with the outpatient providers.
Even when patients do tell us they were doing drugs or not taking their medication, we aren’t judgmental or they won’t open up to us again. Instead, we ask if they can cut back a little or maybe remember to take their beta-blocker before going to hang out with friends.