Establishing a good relationship with your primary care provider is just as important as following up with them. Dr. Crystal Garza from WellMed Corpus Christi Hospitalists explains the benefits of staying in touch with your PCP.
May 29, 2024
Docs in a Pod focuses on health issues affecting adults. Providers and partners discuss stories, topics and tips to help you live healthier with hosts Ron Aaron, Dr. Audrey Baria and Dr. Tamika Perry.
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Show transcript
Podcast transcript
INTRO
Welcome to Docs in a Pod presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts nurse practitioner Olivia Rahma and award-winning veteran broadcaster, Ron Aaron, will share information to improve your health and well-being. And now here are Ron Aaron and Olivia Rahma.
RON AARON
Thank you so much for joining us today on Docs in a Pod, the award-winning Docs in a Pod podcast, available wherever you get your podcast. We're also on the radio in several markets in Texas and Florida as well. We are so pleased to have you with us. Olivia Rahma is our co-host today. She works at the WellMed at 9th Avenue Clinic in St. Petersburg. She's a nurse practitioner, earned her nursing degree from Florida State University in Tallahassee. Also earned her master's degree with honors in nursing at the University of South Florida in Tampa. Olivia is board certified in family practice, and among the things Olivia loves doing, she is a singer. She was a show singer, a competitive show choir singer as a kid, still sings, and she hugs her yellow lab and golden retriever. Olivia, thanks for being with us again as co-host.
OLIVIA RAHMA, NP
Oh, anytime, Ron. Good to be here.
RON AARON
We've got a neat topic today, talking about the importance of following up with your PCP. And I'm sure you try to drive that into the brains of all of your patients.
OLIVIA RAHMA, NP
Sure do. I have so many patients say, why do I have to come if I'm healthy? So, glad to talk about this today.
RON AARON
We're going to welcome Dr. Crystal Garza. She's a physician and CVO, we'll explain that, at WellMed Medical Management in Corpus Christi. Earned her medical degree from the University of Texas Medical Branch and a Bachelor of Science in Biology and Biological Sciences from the University of Texas Pan-American. Her mission is to improve the health and well-being of her patients. She grew up in the Rio Grande Valley in the Edinburgh area and we're delighted to have her with us. She also has two little kids and when she is not doing doctor stuff as a hospitalist and what have you, she spent a lot of time with her boys. Thanks for being with us, Crystal.
DR. CRYSTAL GARZA
Happy to be here. Thank you for having me.
RON AARON
Talk to us a little bit about something I just discovered. I didn't know that WellMed had had a position called CVO, which turns out to be someone who has up caring values for patients.
DR. CRYSTAL GARZA
CVO stands for care value optimization, and that is sort of what we do here with WellMed as a value-based care model. It's about population health management. We're looking at the care that our patients are receiving in any entity. So, let's say the hospital setting, the skilled nursing facility setting, with our specialists in the outpatient setting. So, we look at the care that they receive in those forms, and we look at the value that they bring to our patient care. We try to partner with facilities with a specialist that provide that care and value for our patients. And so, it's all about looking at where the outcomes are best and really trying to work with our outpatient teams to find those resources and utilize those resources to implement and provide that care and value to our patients
RON AARON
And for those who wonder you also have worked as a hospitalist. What do they do?
DR. CRYSTAL GARZA
I am currently the medical director for our hospitalist team here in Corpus Christi. What we do is receive patients from the emergency room, sometimes directly from the outpatient setting, and we take care of our most vulnerable patients. When they have an illness that requires hospitalization, we take care of them during their hospital stay. We coordinate care with the consultants if there needs to be a consult in the hospital, we coordinate care with the outpatient teams and we coordinate the care during that transition from hospital to home. So, a WellMed hospitalist is sort of a navigator, a captain of the ship if you will, when it comes to taking care of our patients when they're requiring hospital level of care.
RON AARON
One of the advantages, and I've heard this happening a lot. Patient X goes into the hospital, they spend a couple days there, they come out, they have a whole shelf full of new prescriptions. Nobody knows if they conflict with the prescriptions they've had. The patient doesn't really know if they should keep taking the new ones, the old ones, or all of them. The seamless connection back to their PCP, their primary care provider, through the WellMed hospitalist has to be a real plus.
DR. CRYSTAL GARZA
You hit the nail on the head there, Ron. That is exactly what happens. Just picture it. You're in the hospital. It's a confusing time. You're not feeling well. You get a whole list of medications to start or stop. And the importance of following up with your doctor is paramount at that moment in time. A WellMed hospitalist ensures that our patients have that required follow-up because we don't want our patients to leave the hospital not knowing what to start, stop or continue. That is a lot of the time what can cause a hospital readmission. If you go home and you start taking what you already had, you don't follow the right instructions because it's a confusing time. But the other advantage is that the WellMed hospitalist will help coordinate what needs to be continued, stopped, or started with the outpatient doctor. So, there's that communication piece that happens that really helps try to smooth out any type of confusion that is happening.
RON AARON
We're going to pick this up in just a moment, but I want to let folks know who may have just joined us, you're listening to Docs in a Pod, the award-winning podcast and radio show brought to you by WellMed, I'm Ron Aaron. Delighted to have with us our special guest today who is in Corpus Christi, Dr. Crystal Garza and our co-host today nurse practitioner Olivia Rahma. Olivia, tell me how it works from the PCP point of view. One of your patients goes into the hospital and they come out. What's that connection like for the patient, for you, and for the hospital?
OLIVIA RAHMA, NP
Sure. In a perfect world we know when patients are getting discharged from the hospital. So, and this is something we're able to know because we do have those relationships with the hospitalists in the hospital. We usually get a heads up, we know what's going on with them while they're there , so we can anticipate when they're getting discharged and get them set up for a follow-up appointment as soon as possible. The goal is that they get a call the day after they get home and maybe get into the office within the next three days. Which, as we were saying, is extremely important because a lot of the times patients get home and they forgot what they were told to do or they were really confused or now at home with them as a family member who maybe wasn't at the hospital so now they have questions. Another situation is they need follow ups with specialists, they need repeat lab testing, they need repeat imaging, whatever it may be. So, it's really important to make that follow up with your primary as soon as possible, even if you really don't feel like you need it. It's great to have that connection and have everything tied up in a nice bow. We know what's going on, we know what to do with you now. So, when your PCP calls you to make that follow up, don't hesitate.
RON AARON
Now, Crystal, we know that not every patient is a WellMed connected patient. What happens to others who don't have a hospitalist associated with their clinic in the hospital?
DR. CRYSTAL GARZA
That's a good question and, as a hospitalist, we see a lot of patients that aren't completely connected with WellMed clinics. The goal should be the same. We try to educate our patients on the inpatient setting, but again, a lot of it can be new information that's not entirely absorbed. It is important to internally know that you have to follow up with your primary care doctor who is going to pick up the pieces and tie it up like Olivia said in a nice bow for the patient to have the most successful discharge and outcome after a recent hospitalization. Really, it is just calling your doctor. If they're not aware of the fact that you were in the hospital, calling them, letting them know, hey, I was in the hospital, I might have some questions. It's important for our patients to also communicate with their family members that they might need some help and maybe have their family members reach out to their primary care doctors to help facilitate that follow up appointment. The three-day mark is ideal. Like Olivia was saying, in a perfect world, you're going to see your primary care doctor after hospitalization within three days. Let's say you were prescribed an antibiotic. You don't want to miss a day of that new blood pressure medication or that new blood thinner medication that was given to you by the heart doctor in the hospital. So, those are important reasons to follow up with your doctor in that interim period so that nothing gets missed and you're able to continue the best outcome possible after a recent hospital stay.
RON AARON
There's one thing I need to ask you, having been in the hospital on occasion, knock wood, nothing terribly, terribly serious. But that moment when you're about to be discharged, and the nurse says, I've got to go over some papers with you, and they cover everything you really should know to which you pay no attention because all you want to do is get out of there and get home, right?
DR. CRYSTAL GARZA
That's right. But that information is your golden ticket of staying out of the hospital, right? A lot of patients are in a hurry to get home, there's no place like home, no place like your own bed. But, at the same time, in order to stay out of the hospital and not go back, you need all of that paperwork. It is the golden ticket. There will generally be a list of medications and instructions on how to take them. Which medications to stop. That is also information that your primary care doctor picks up, looks through, reviews. It might have your primary diagnosis while you were in the hospital. So, yes, you might have a lot of other what we call comorbidities, right? Other diagnosis, like high blood pressure or diabetes, but you might have been in for a primary cause like, let's just pick heart failure. It's going to give you instructions on how to potentially make some dietary changes, take care of the way you consume fluids, those kinds of things. So, it's kind of providing you a contingency plan to stay out of the hospital. That information is gold if we want to be able to live happy, independent lives in the home setting and outside of the hospital.
RON AARON
In the best of all possible worlds, Dr. Garza and Olivia Rahma, the hospital would communicate with your PCP, send all those documents to them, all the discharge documents, all the diagnoses, all the lab tests, so that your PCP and clinic have all that information. That's the dream. Does it happen?
DR. CRYSTAL GARZA
That is the dream. It happens in a perfect world, but we all know it's not a perfect world. So, we all have to do our part, right? The hospitalist will try to communicate but let's say it was one of those days where we just didn't get to that end of the day phone call. I will say with the WellMed hospitalist team, we have a secure messaging app. It's very real time where we can send a message to the outpatient doctor that also has that secure messaging app, but like you said earlier, Ron, not everybody is as plugged in with those apps. So, it is important to take the information gathered from the hospital at time of discharge and take it to your primary care doctor who might not have all of those plugins. It's a big team. There's also care management nurses that are trying to accomplish the same goal of communicating what happened in the hospital with our outpatient teams. So, there is a whole group of people trying to facilitate a safe discharge, but we try to plug in the holes, but sometimes there are holes that happen.
RON AARON
Now hold that thought, we're going to come back to you and Olivia Rahma. I want to talk to you about how important it might be to have an advocate with you in the hospital who pays attention to all those discharge papers and what have you, because the patient really doesn't focus in many cases. If you've just joined us, or if you've been riding along with us, you're listening to Docs in a Pod, the award-winning podcast and radio show, I'm Ron Aaron. Delighted to have Dr. Crystal Garza with us. She's based in Corpus Christi, medical director for Caring Values and Hospitalists in Corpus. And Olivia Rahma, nurse practitioner, is with us as well, and you find her in St. Petersburg, Florida. You're listening to Docs in a Pod.
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RON AARON
We are so pleased you're sticking with us right here on the award-winning Docs in a Pod. I'm Ron Aaron, along with our very special guest, Dr. Crystal Garza. You find her in Corpus Christi, Texas, and our co-host today is Olivia Rahma. She's at the WellMed at 9th Avenue Clinic in St. Petersburg, Florida, and we're talking about the importance of following up with your PCP, your primary care physician. That's true whether you've been in the hospital or not. I want to come back to something Crystal was talking to me about off the air and Crystal, that is patients don't always recognize the importance of that communication between the hospital and your PCP.
DR. CRYSTAL GARZA
That's right. There are things that need to happen once we get out of the hospital to ensure that we're safe, that our loved ones are safe when they discharge from the hospital. There are things that just need to happen, and it is your primary care doctor who will help facilitate those things. And what I'm talking about is going through your medication list, making sure that you're safe at home, making sure you have all the equipment that you may need. You may have gone into the hospital walking, but you're leaving the hospital weaker or a little bit debilitated. Or maybe you went in for a fall and you need to make sure you have that walker in the outpatient setting so that you don't fall again. It is our doctors who help look through all of that are outpatient teams. But, like you said, it's important for everyone to follow up with their doctors even if you weren't in the hospital. Let's say you have just regular high blood pressure, but maybe you have a history of breast cancer last year. It was treated and taken care of, but your doctor still wants to see you. It's not just because they want to check on how your day-to-day was, they're truly interested in your medical conditions. If there were any changes, if there was any recent falls. My dad is very frail right now and he falls every now and then. He doesn't think to tell his doctor when he goes and follows-up. Those are important things to make sure that we're communicating back to the people who can really intervene.
RON AARON
We've done a lot of shows on falls and falling. And as you know, as a physician and as a daughter, if you fall, odds are you'll fall again.
DR. CRYSTAL GARZA
Exactly. So, it's important to communicate these changes to your outpatient doctor, your outpatient team, your outpatient nurse practitioner. You need to communicate these things because they are the people that can help intervene, help you prevent that future fall. And if there is a future fall, get equipment that you might need to stay safe. The goal is always to stay safe in your home setting. That is part of the reason that it's important to follow up with your doctor in a timely fashion. You don't want to let things go to the point where we can't intervene.
RON AARON
So, Olivia Rahma, I already asked the question, is it helpful to have an advocate with you in the hospital during that procedure and process as well as the discharge time as well as at your clinic visits. What do you think, Olivia?
OLIVIA RAHMA, NP
Sure, that's what I was going to say. It's not just a hospital thing. I think even with your regular follow ups with your primary, with any specialists, it can be extremely helpful to have someone with you. For instance, let's continue the hospital example. Like we've already said, first of all, as a patient in the hospital, you want to go home, you really do. You're anxious to get out of there, maybe you have a lot of questions. When the nurse or the physician, whoever's checking you out, is giving you that information at the end, you're thinking of home, you might be thinking of a question that you want to ask. And when we're doing that, sometimes we're not fully absorbing what they're telling us. You might hear one thing, and your advocate for you is hearing another thing and then you can go home and kind of say, okay, what else did he say? What did she say about that? And it's the same thing in your office visits. If you can't understand something that somebody said and maybe you're shy and you don't want to ask, but maybe your daughter, your son, your wife, your sister will ask for you. They'll remember to encourage you to follow up on something, encourage you to go for that imaging test that they ordered. It's really just like a second set of eyes, essentially.
RON AARON
I want to also jump on something that Crystal mentioned because it's so important. It's not only following up at the hospital, but it's seeing your PCP on a regular basis. When I was a kid growing up, you went to the dentist every six months, whether you thought you needed to or not. You saw your doctor at least every year. With our youngsters, the pediatrician has them locked in year after year after year, but once we turn 25, 30, 50, 60, 70, we say what I heard Olivia say to me earlier, hey, I'm feeling great, I don't need to go to the doctor.
DR. CRYSTAL GARZA
You're right. Why do we go to the dentist every six months? It's preventative. You're getting your cleaning, you're getting everything sorted out. Hopefully you don't need fillings or anything but the more consistently you go, the better your dental health is going to be. It's the same thing with your regular primary. You might not be on any medications. You might not have any medical history. But how do you know that you still don't need medication? How do you know that your labs are still just as good as they were five years ago when you last came in? You could be due for screenings that you need orders for. Women most of the time know you need a mammogram annually, but do we know about our bone density scans? Do people know when you start your colon cancer screenings? Those are things you need to be going to your PCP for. And it's important to stay established with your primary as well so when you get sick, you have somebody to call, somebody to go to, if God forbid you end up in the hospital, you do have somebody to follow up with.
RON AARON
So, Dr. Garza, what do you recommend in terms of regular sessions with your PCP?
DR. CRYSTAL GARZA
I think that your PCP is going to help guide how often you have to go. There are some patients that will need to go a little bit more frequently. Like Olivia said, it's all in the name of preventing a catastrophic event that will land you in the hospital or worse. If your doctor says, I need to see you every 30 days, then I would heed that advice and follow that advice. If your doctor says, I need to touch base with you every week, you have something active happening and I need to keep tabs on it, it's because they want to prevent something from worsening. If they say, I can see you every three months, that's awesome. That's great. Come every three months. Maybe there's a lab they're following. If they say six months, okay, let's do it. Let's get our labs evaluated, whatever it needs to be. But I think that the primary provider is going to guide our patients. Not everyone is the same kind of healthy or the same kind of sick. So, I think just following their instructions is important.
RON AARON
Now, before we run out of time, I want to come back to something we were talking about early on, Crystal, and that is your responsibilities heading up the caring values initiative. The measures you were talking about that determine how well a hospital, a clinic, a doctor's doing, all relate to keeping people alive and well, do they not?
DR. CRYSTAL GARZA
Absolutely. That is exactly right. The outcomes, keeping people alive, well, independent, without infection, low infection rates. All of those things are measures that are looked at and applied in the way we practice. So, those things are definitely important. We're constantly looking at the specialists in our communities who have the best outcomes and what is the best outcome? ItÂ’s keeping us alive and healthy and out of the hospital.
RON AARON
So, you raised a very good point. Some specialists do better than others. Why? Why is this cardiologist better than the other cardiologists in terms of wellness measures?
DR. CRYSTAL GARZA
That is a very good question. There are things that we measure. When you go to see a specialist, you want to have that trusting relationship with them. That they're going to perform with looking at the big picture and knowing what to order at the right time, at the right place, for the right reasons. And not that there are doctors out there ordering things without good reason, but we want to make sure that it's absolutely 100 percent necessary. I don't like to say that there are good and bad doctors, but there are ways to measure low-value care.
RON AARON
Some have better results?
DR. CRYSTAL GARZA
Right. Or may order things that aren't necessarily going to change the outcome or make an impact on patient care.
RON AARON
We are out of time. I hate to do that, but we got to stop you right there. So pleased to have you on, Dr. Crystal Garza, you find her in Corpus Christi, heads up the hospitalist program there, as well as the caring values program. And our co-host today, we really thank you, Olivia Rahma, nurse practitioner. I'm Ron Aaron, thanks for joining us on the award-winning Docs in a Pod.
OUTRO
Executive Producers for Docs in a Pod are Dan Calderon and Lia Medrano, Associate Producers Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. We welcome your emails with suggestions and comments on this program at radio@wellmed.net. Be sure to listen next week to Docs in a Pod presented by WellMed.
DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.
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