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Long-term care

When patients and health care practitioners create a relationship that spans years, care improves

When patients and health care practitioners create a relationship that spans years, care improves

June 14, 2002|by KEVIN CLAPP

kevinc@herald-mail.com

Little Lisa Jenkins, glasses perched upon her nose, clamors for a hug from Karen Barb, who has just finished writing a prescription for new allergy treatment.

The certified pediatric nurse practitioner at Antietam Pediatric and Adolescent Care, bends her very pregnant frame and happily obliges as Lisa's mom, Lisa, looks on.

In 10 years, Barb has treated each of the family's eight girls.

How much a part of the Jenkins' lives has Barb become? Enough that 10-year-old Lisa Elaine Jenkins shares her middle name.

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"She's just been so much support to me and my husband and family, from a cold to kidney transplant," Lisa Jenkins says. "I've never actually been able to talk to a doctor like I have with Karen."

More than diagnosing coughs and prescribing medication, health care practitioners can become extended family, particularly to young families whose children they treat on a regular basis.

Like many close relationships, the longer it lasts the stronger it becomes. When Barb joined three others in 1998 to form Antietam Pediatrics, the Jenkins' family was close behind.

The continuity of care eases Lisa Jenkins' mind, but it also makes Barb's job easier.

"You get to know everything about the patient and family dynamics," Barb says. "That's the ultimate goal, to develop a rapport with a family and treat children from birth through their life stages."

When it comes to the physician-patient dynamic, a lasting union instills a confidence that can last years, as with the Jenkins', or decades, which has been the case with Paula Browning.

Dr. Albert Strauss had treated Browning, 34, 30 years ago when she was diagnosed with a form of anemia called diamond black fan.

When Sarah Browning, now 6, was born and showed signs of the same disease, there was no question where the new mother would turn.

"I was very comfortable with Dr. Strauss and just felt secure with the way he had taken care of me. I know his office, I know the nurses. There was just no question in my mind," she says. "If there's anything I need I know I can call him. You build a relationship and there's a trust and confidence there."

The paradox is that people may not go to doctors because of mistrust, while trust cannot be built without regular physician visits.

"Patients try these so-called homeopathic measures and it's very important for doctors to educate themselves on them so they can talk to patients. And I think patients respect that," Strauss says.

"If you're a primary care physician like I am, you have to have honed your communication skills to a very fine edge. Twenty years ago, if somebody came in and said 'I'm taking X, Y, Z herb,' I think they would have been discounted out of hand by the majority of physicians, myself included."

Each of the partners at Antietam Pediatrics has a core of long-term patients. Then there are those patients who drift in and out for a variety of reasons. But Barb doesn't think long-term physician-patient relationships are growing fewer and farther between.

Since she's been a nurse for 22 years, there are former patients who still keep in touch. She expects that to be the case with the Jenkins family, and Lisa Jenkins likens their relationship as sisterly rather than professional.

"It makes you feel good that you have had some impact on somebody's life enough that they stay in contact," Barb says. "In order to build trust, they have to have faith in you but you have to be open and honest with them too."

The key is communication. Sometimes doctors click with patients and families right away, though it's just as likely to evolve over time. Taking time to make patients feel comfortable, talk to them and answer their questions all helps to create a lasting bond.

"I think the real advantage and wonderful thing about a long-term relationship is the patient gets to know the doctor and the doctor gets to know the patient and their family really well," Strauss says.

"Since so much of medicine is an art as well as a science, having as much information as you possibly can about a patient and family and family dynamics helps to relate, I think, and you become, over a long period of time, friends."

And it's a double-edged sword. For every happy story Strauss shares with patients, there is tragedy and the friendly bonds create burdens he has to bear.

Not that he would trade the relationships in. Like Barb, he has patients who would rather stay with him when they have outgrown pediatric care.

"I think it must be hard to do what the emergency room doctors do, which is have so little continuity of care," he says. "I would not like that. I think that would be very hard."

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