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Working through Major Depression and Agoraphobia 

This month’s patient story comes from EHN Ambulatory Care Manager Jen Riley. EHN offers Care Management to members with chronic and difficult conditions. Jen tells us about a patient she recently reached out to, after receiving permission from their Primary Care Provider.

Jen began working with a patient in his mid-30s with a history of significant depression and anxiety. During initial intake, the young man acknowledged depression and anxiety leading to crippling agoraphobia, which resulted in unemployment, marital strain, and poor self-image. He attributed his depression and anxiety to a traumatic childhood and resultant strained family relationships. He reported that during the previous year he had disengaged from his previous therapist due to a poor fit and stopped taking his prescribed medications
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On a scale from zero to 10, the man rated his current operating capacity at a one, but he expressed a strong desire and commitment to improving his mental and physical health.


He made initial goals to develop a strong relationship with a mental health provider and resume riding his bike which he had previously found therapeutic. At the time of this initial phone call the patient explained that he had not left his home, for any reason, for nearly six months. On a scale from zero to 10, the man rated his current operating capacity at a one, but he expressed a strong desire and commitment to improving his mental and physical health. He made initial goals to develop a strong relationship with a mental health provider and resume riding his bike which he had previously found. The patient was successful in engaging with a mental health provider using the app Talkspace and set up a weekly virtual therapy appointment.

Jen and the patient continued weekly phone calls where they explored strategies to increase his coping with the effects of his anxiety, depression, and agoraphobia. He recognized that he realized a benefit from physical activity and expressed a desire to return to biking at a level he previously enjoyed. Initially, he set small goals like performing basic maintenance of his bike to make it road-worthy once again.

After six weeks the patient left his house for the first time and was able to ride his bike a mile. This was an enormous accomplishment for him and spurred him to make an appointment with his Primary Care Physician to discuss his health. Within three months the patient was riding his bike on a regular basis and continuin
g to add distance to his rides … up to 15 miles. He reported that his marriage was improving, he was making small steps towards setting boundaries, mending relationships with his family, and actively seeking employment.

Four months after the patient enrolled with Care Management, he had secured a part-time job at a local restaurant, had a strong relationship with his mental health provider, was regularly riding his bike for up to 20 miles, and described his health as operating at 80% capacity. He felt confident that he was ready to graduate from Care Management and expressed gratitude for the assistance in accomplishing his goals.

 

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Embracing Provider Wellness

The field of medicine has become increasingly aware of the need for addressing the health of its employees. Thankfully, we are moving away from the past model that saw providers as super humans who didn’t need sleep and could work infinite hours into a model that recognizes providers need to take care of themselves and prevent burnout for their own health but also because providers with wellbeing provider better patient care (Shanafelt, 2021). 

Experts in provider wellness recommend we embrace vulnerability and self-compassion, recognizing mistakes will happen and knowing that no one is perfect (Shanafelt). Providers have strengths but they also have weaknesses, and we need each other and our teams to build on our strengths and compensate for our weaknesses.

It's hard enough to embrace such shifts during normal times. It’s even harder in the midst of crisis. But we have to think about these issues because so many providers are at or beyond the point of burnout. At Eastside Health Network (EHN), we are dedicated to helping with provider wellness, and our efforts are led by our medical director, John Nelson.

We are continuing our provider small group support meetings, in which providers meet once a month for a series of six months, to discuss issues related to wellness. Early in 2022, we will begin our third round of these sessions. Providers who have participated in these meetings find them helpful for a variety of reasons. Here is a testimonial from past participant Darshana Shanbhag, MD, Internal Medicine, Overlake:

“Meeting in small groups has let me meet colleagues from different specialties and clinics in a very different setting, letting me know them more as individuals. In these stressful times in health care, it helps to foster a sense of community and connection. It has also expanded my perspective in the issues faced by others and has made me appreciate much more of the special support my clinic provides. Above all, it has been a lot of fun, with happy memories, and funny anecdotes.”

If you are interested in participating in our next sessions or even want to find out more information, please email Katie Olney at N-Kolney@eastsidehealthnetwork.com.

We would also love to hear from you. If your clinic has instituted a successful program to help with provider wellness, let us know, and we will share with the other clinics in our network. Or if you have ideas you’d like to try but haven’t had the time or resources, please reach out, and we’ll help in any way we can.

Shanafelt, T.D. (2021). Physician well-being 2.0: Where are we and where are we going? Mayo Clinic Proceedings. 96(10), 2682-2693.