“Isn’t she the cutest? She’s my patient, too”: La Clinica de La Raza, Oakland, California

These were the words of Bina Patel, MD, who introduced the new baby of one of her female patients to me in an exam room. To another family physician, these words are magical, and the way that Bina smiled when she said them was an instant reminder to me of why family medicine is so special. We live to take care of whole families and their communities, and a lot of pride comes from being able to be there for all of them.

This is part 1. Part 2 will be posted tomorrow, in the interest of readability.

From La Clínica’s Web site:

La Clínica has played an important role in the East Bay by offering low-cost quality health care services for multilingual and multicultural populations at 23 locations in three counties: Alameda, Contra Costa, and Solano counties, with many of our patients served in the City of Oakland. La Clínica’s comprehensive services include: pediatrics, family medicine, women’s health care, mental health services, dental and vision care, and health education. We offer these services regardless of people’s ability to pay or insurance coverage.

To most effectively serve the diverse community of the East Bay, La Clínica hires health practitioners who fluently speak Spanish, English, Chinese, as well as Hindi, Arabic, and Amharic. We also make a concerted effort to recruit doctors, nurses, health educators and other providers who come from the same cultures as our patients.

The commitment to supporting the community with providers that reflect its own culture was very evident when I was invited for a visit. What was also evident when I entered the facility was the amount of care that was being provided – a lot. There was what I would say was a level of activity I had not encountered at Kaiser Permanente or John Muir Health – a “buzz.” It was reflected all the way into provider workspaces, which are shared.

On the day I attended, there was a bit of what I called a “cake explosion,” with the staff celebrating a colleague’s birthday. I had to include pictures here, and especially one of the slice plated on a fraction of a plate – this organization is concerned with affordability all the way down to their celebrations! Kidding aside, the way the staff celebrated each other on the day I visited was impressive.

Pictures: Click on any to see full size

The practices

I spent the morning with Steve Schiff, FNP, who has been a practitioner at La Clinica for 3 years. Steve is a fluent Spanish speaker and all of his visits except for one were conducted in Spanish. His use of the paper chart was very reminiscent of my practice prior to 2004, right down to the yellow billing slip placed on the top. He seemed as facile with paper as I was (which can be pretty facile, if you know how to use any tool). For one patient with multiple chronic conditions, he even took the time to type a true “After Visit Summary” for the patient. Because the practice is not computerized, this has to be a special effort. Regardless, he made sure to provide clear instructions regarding the regimen.

I spent the afternoon with Bina Patel, MD, who has been a practitioner at La Clinica for 2 years. She trained in a community clinic setting on the east coast and wanted to continue work in that environment when she came to California. Bina trained in an environment with an electronic health record, so she leverages the tools available here. This includes a basic computerized schedule, lab results, and medication lists, in a read-only record. Like all of the family practitioners here, she practices obstetrics, so her patients may include multiple members of the same family. I saw great examples of medication reconciliation, with patients bringing in all of their medicine bottles to be reviewed. Bina also makes sure to document each visit immediately after it occurs to support efficiency and accuracy.

Both practices included a spectrum of care, from the basic to the relatively urgent. There is no mistaking the fact that this is a busy practice. At the same time, the actual encounters did not seem rushed and the exam room, and maybe the fact that the providers are working in and represent the community they are a part of makes for a different feel.

I talked some with both providers about the potential use of electronic health records and patient centered health information technology (e.g. patient-physician e-mail). I will post information about those conversations tomorrow. Errors: https://www.tedeytan.com/wp-content/uploads/2007/12/img-0470.jpg is not accessible or supported filetype.https://www.tedeytan.com/wp-content/uploads/2007/12/img-0471.jpg is not accessible or supported filetype.https://www.tedeytan.com/wp-content/uploads/2007/12/img-0473.jpg is not accessible or supported filetype.https://www.tedeytan.com/wp-content/uploads/2007/12/img-0474.jpg is not accessible or supported filetype.https://www.tedeytan.com/wp-content/uploads/2007/12/img-0475.jpg is not accessible or supported filetype.https://www.tedeytan.com/wp-content/uploads/2007/12/img-0476.jpg is not accessible or supported filetype.https://www.tedeytan.com/wp-content/uploads/2007/12/img-0478.jpg is not accessible or supported filetype.https://www.tedeytan.com/wp-content/uploads/2007/12/img-0481.jpg is not accessible or supported filetype.https://www.tedeytan.com/wp-content/uploads/2007/12/img-0477.jpg is not accessible or supported filetype.



Interesting post. One question about the after-visit summary: Did they have any generic content (patient education) that they could wrap inside of the personalized notes?

When you report on the EHR & PCHIT conversations tomorrow, I'll be particularly interested in any special issues that they think exist with respect to the language differences and electronic access barriers that exist in their patient population.



Great question. I would answer it by saying that the practice truly does harken back to my practice pre-2004, when I used paper charts exclusively. At that time, I had a limited selection of patient education materials that I could hand to patients, and any personalized note I would provide would be handwritten, and occasionally manually typed for clarity.

At the same time, we had some form of Case Management and other ancillary services such as Nutrition, as La Clinica does, where there would be opportunities for personalized information provision.

Ted Eytan, MD