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Primary Care Updates
With the pandemic, there have been many patients who have become past due on getting their health prevention measures completed. Carla Rafferty MD offers primary care updates, prevention concerns and how most Carle locations are certified patient centered medical homes with a whole of team of people helping to take care of our patients.
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Learn more about Carla Rafferty, MD
Carla Rafferty, MD
Carla Rafferty, MD is an Associate Medical Director of Carle Windsor Campus and practicing Family Medicine physician.Learn more about Carla Rafferty, MD
Transcription:
Expert Insights is an ongoing medical education podcast. The Carle Division of continuing education designates that each episode of this enduring material is worth a maximum of 0.25 AMA PRA category 1 credit. To collect credit, please click on the link and complete the episode's post-test.
This podcast forum is brought to you to share expertise and insights within our integrated delivery system to help us improve the health of the people we serve and achieve world-class accessible care. This is Expert Insights.
David Hill, MD: So during the height of the COVID Pandemic, a lot of people were avoiding going into public places or places where other people were including their own doctor's office. But as a result, a lot of people got behind on important preventive care.
Now, it's time to get caught up on that care, and I'm excited to talk with Dr. Rafferty about what we can do in order to do that.
This is Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill. Today, we're going to be talking with Dr. Carla Rafferty, Associate Medical Director of Carle Windsor campus and practicing family medicine physician. Dr. Rafferty, welcome.
Dr. Carla Rafferty: Thank you. Glad to be here.
David Hill, MD: Happy to have you here. So, we want to talk a little bit about recovering from the pandemic and specifically at the height of the pandemic, a lot of people were really frightened to come into the hospital to come to their doctor's office. And as a result of that fear, a lot of people got behind on primary care, on preventive care that they needed and they may need to catch up. So, I'd love to hear from you, as a family medicine physician, what parts of that care you're most concerned about? What do people need to come in and catch up on exactly?
Dr. Carla Rafferty: Yeah, we did recommend that people stay away during the height of the pandemic for any non-emergent medical needs. And a lot of that encompassed preventative care. And so, we're seeing now that we are really needing to catch people up on those prevention measures to help keep them healthy and keep them away from some not so good medical problems in the future.
So, some of the things that we really focus on in primary care are screening for certain cancers like breast cancer. October was Breast Cancer Awareness Month. And so, making sure that people that are in need of a mammogram get their mammograms at the recommended intervals. Generally, that starts at age 40 and occurs once a year.
Colon cancer screening is another screening method that we want to make sure people don't fall behind on. Colon cancer screening has made some strides in the last several years. For starters, the previous recommendation was to start screening at 50. And over the last 12 to 18 months, that recommendation has dropped to 45. So, we joke that 45 is the new 50 when it comes to colon cancer screening. And how we screen for colon cancer for people that are of average risk is much simpler than what we had been doing previously. So, it used to be that everyone was to get a colonoscopy, which was a semi-invasive procedure, where we would put a camera inside the colon and look for any abnormalities. But for folks that don't have a high risk of colon cancer, and that would be people without a personal history or family history of colon cancer, or a person that has not had previous polyps that were precancerous found on a colonoscopy, they could do a stool test.
There are two options. One is called Cologuard that's done at home and it's done through the mail. You do that test every three years as long as it's normal. And the other is a FIT test that's also generally done in the comfort of your home with a stool sample. And that test gets run in the lab and is good every year as long as it remains normal, so much simpler tests than what we used to have for colon cancer screening.
David Hill, MD: Well, full disclosure, I am 54 years old and I am really happy to get that news. That is a real relief.
Dr. Carla Rafferty: Yes, a lot of my patients are as well.
David Hill, MD: Now, I have, for obvious reasons, never had cervical cancer screening, but who needs that now?
Dr. Carla Rafferty: Yeah. So, cervical cancer screening generally starts between the ages of 21 and 25. And depending on your age and what the results are, generally people will get that done, women will do that between every three years and every five years. And it's really important because it's something that we can catch changes very early and do very minor procedures to remove any abnormalities if need be before they even turn into a cervical cancer.
David Hill, MD: And are there new ways to screen for cervical cancer screening? I know when I was practicing internal medicine, it always involved a fairly invasive exam. Is that still the case?
Dr. Carla Rafferty: The pap smear is still something that we perform and that's where we take a sample of the cervix. But we now also routinely test for the virus called the human papilloma virus or HPV. And that's the virus that causes the majority of cervical cancers. And so, if we can get a sample and check for HPV, that gives us a much better understanding of what your risk is of getting cervical cancer. And that's why we've been able to go from annual screening, which we did when I was in training even, to going to every three to five years.
David Hill, MD: It's got to be a relief for people who were not looking forward to that exam. Let's go to the other end of the age spectrum. What about bone densitometry? Can we talk about that?
Dr. Carla Rafferty: Yeah. We want to make sure that as people get older, that they make sure that they maintain good bone health because we really do not want people to fall and break a bone. When an elderly person falls and breaks a bone, whether or not they can recover from that specific fracture, it really causes the patient for their health to take a turn for the worse. They may lose some independence. They may be dealing with chronic pain, mobility differences, and it can really affect their day-to-day life. And so, screening for osteoporosis with a bone density, usually starting at the age of 65, sometimes younger, if we have certain risk factors, is really important in making sure that we have adequate amounts of calcium in our diet and vitamin D and good weight-bearing exercises to keep our bones strong and healthy.
David Hill, MD: That is great advice. When I hear vaccines, I often think about children. But there are some vaccines that grownups need as well. What should those be?
Dr. Carla Rafferty: So, there are several vaccines that we do in adults. Probably most people are familiar with the booster for tetanus and pertussis. That's one that we get every 10 years. And pertussis is a condition that can cause whooping cough that we see a lot in children. And then, we get grandparents visiting those cute grandkids and then they develop whooping cough as well, which can really be uncomfortable and cause difficulty breathing.
Other vaccines that are important are the pneumococcal vaccine. There's Pneumovax 20 and Prevnar 15. These are two different kinds of vaccines that protect against a particular bacteria called Streptococcus pneumoniae. And everyone is advised to get those vaccines at the age of 65. And if you have certain risk factors like diabetes, are a smoker, have COPD or asthma, have certain heart, liver, or kidney diseases or certain cancers, it's recommended that you get that between the ages of 18 and 64 as well. And then of course, everyone will get it again at 65.
Shingles is another vaccine that's really important. Shingles is a very painful rash that occurs after people have had chicken pox when they were kids. And for people who are older than 50, it is recommended that you get this two-dose series. You only need the series once. If you got the old shingles vaccine called Zostavax, the CDC recommends that you get the updated vaccine called Shingrix because it is 90% effective at preventing shingles and the complications that occur from shingles, which is a much better percentage improvement from the previous vaccine that we had available.
David Hill, MD: Wow. And shingles is so nasty. So if people are uncertain what vaccine they got before, I suppose it's time for them to check in with their doctor and figure it out.
Dr. Carla Rafferty: Absolutely. And these are vaccines that you can also get at your pharmacies. Just make sure that you update your doctor's office if you do get one of these vaccines at the pharmacy, so we keep all your records straight.
Flu season is upon us right now too. And so, I do recommend that folks get their flu shots. It is recommended that you get this every year. And if you're over 65, it's recommended that you get the high dose version of the flu vaccine. The flu vaccines that you get in shot form are all killed vaccines. There's nothing live in the vaccine. So, when we get a vaccine, sometimes we might feel a little tired or achy or run a low-grade fever, and patients may think that they got the flu from the shot or they got sick from the shot, but it's really the shot is causing your body to practice it's immune reaction to a portion of the virus or bacteria that we're vaccinating you against. And the muscle aches and fatigue and fever are all just normal processes that your body goes through in its attempt to fight off that agent.
David Hill, MD: So, I want to clarify this again. There's absolutely no way that the flu shot can give you the flu.
Dr. Carla Rafferty: That's correct.
David Hill, MD: All right. I think that's a misconception that I hear from time to time. It's so important that people know that. You know, we started this conversation talking about the effect of the Covid pandemic on healthcare, and there is news regarding COVID vaccines. Can you bring us up to date?
Dr. Carla Rafferty: There is a new bivalent COVID vaccine that's available for people who are now five years of age and older. The vaccine should be given at least two months after your last COVID vaccine. And what's interesting about this vaccine is it is the first vaccine that offers protection against two different strands. So, the original wild-type COVID strand that was the same strand that was in all your other covid vaccines, but this new one also offers protection against the Omicron strand, which has been the dominant strand for the past 12 to 18 months. And so, it's providing some additional protection against these newer strands.
David Hill, MD: Now, that sounds like a big improvement and I hope people will go out and get that extra protection. We talked about people being worried or anxious about coming into the doctor's office when people are sick. And even in the middle of flu season, some people may be still a little bit anxious. Do we have different ways for people to get their healthcare or at least talk to their provider?
Dr. Carla Rafferty: Absolutely. One positive that came out of the pandemic among all of the problems and challenges that came was virtual health. So, the government, Medicare and all the commercial insurance companies do provide coverage for virtual health. This could be a video-enabled visit where there's video and audio component to the visit. And you can have appointments with your primary care doctor with the nurse practitioner or physician's assistant on that team. You could see counselors or psychologists with virtual health, and it really opens up the door to accessing your provider, particularly for things in which we don't need to physically do a physical exam, where we don't need to look at a body part or listen to a particular area of the body. These can be great types of visits.
As of right now, the many organizations, including Carle, also have online portals with which you can communicate with your doctor's office. The portal is a great option if you have questions following up after a visit or you didn't quite understand something that perhaps came out of a visit. If you have a new concern or a new question unrelated to a previous visit, these virtual visits are really helpful at helping get you in a very quick and easy manner so that you don't have to take a day off of work. You don't have to travel to the doctor's office. But do understand that if there are things with which a physical exam where we actually need to lay eyes or hands or ears on a body part to fully examine something, we may ask you to come in for an in-person visit, but that may not be the case for every kind of visit. So, virtual visits have been very helpful.
David Hill, MD: It's great to have that variety of ways to access your healthcare provider. And then, I guess if they say they need to see you, then you can come on in, right? I want to talk about something else that Carle offers, that is, you know, the case in some places, but hardly universal, and that is the patient-centered medical home that sounds really cozy, but it has a very specific meaning. Can you talk about what this patient-centered medical home entails?
Dr. Carla Rafferty: This is great. It's a certification that Carle has received for many of its clinics and there are surveyors that ask for certain documentation and certain processes that we do. So, it's a whole process for Carle's clinics to be designated a patient-centered medical home. And that designation comes with a lot of help for your physician in order to better care for you. It gives each patient a whole team of people engaged in their care to help with some of these simple issues or complex issues. So, most doctors are paired with an advanced practice provider, which is that nurse practitioner or physician's assistant. And sometimes you may see the doctor or sometimes you may see one of these advanced practice providers when you come in for visits. When you call in to speak with the nurse, the nurse is part of our care team, and they may provide you with some education. They may ask you questions about some of the concerns that you're having in order to determine what is the next best step, whether it's that virtual visit, whether it's coming in to see the nurse practitioner or whether or not you need to see the physician.
There are care coordinators as well that help patients navigate the healthcare system and provide some extra education for those patients that have more complex medical conditions. And we have certified medical assistants. Those are the folks that generally take your vitals, your blood pressure and your heart rate and stuff when you come in to the doctor's office. But they're helping call patients ahead of appointments to make sure that they get all the information they need, so that the visit can run more smoothly.
There's social workers that are embedded in our clinics that can help with you affording your medications or helping with transportation needs or helping you get extra help at home if you need that. Some of our clinics will have a pharmacist on staff that can help address questions about medications and drug interactions and help with ramping up a dose or ramping down a dose on a medication.
We have integrative behavioral health specialists. These are generally social workers or clinical psychologists that are integrated in your primary care doctor's office, and they can help with some short-term counseling needs like helping with stress or grief after the loss of a loved one, or they may help you get motivated in order to do the things that you need to do to take care of your diabetes and take your medications the way that you're supposed to.
And then, another example I'll give is advanced care planning facilitators. So, every person should have a discussion with their family members or friends about what they might want done should they not be able to voice those wishes themselves. This is called a healthcare power of attorney. And we have facilitators embedded in our clinics that can help answer questions that patients may have on how to choose the right person to delegate these tasks to, and what kinds of decisions that a patient may need to make in these kinds of scenarios. And so, it's a free service that really helps you address what are your long-term goals of care and who in your circle of people do you want to help your medical team know what your wishes are should you not be able to voice those yourself?
David Hill, MD: Wow. So that's really integrated wraparound care. I think I understand why it's called a home now. Dr. Rafferty, do you have any final takeaways that you want to leave our listeners with today?
Dr. Carla Rafferty: We want to make sure that everyone is up-to-date on their prevention measures, because we all know that prevention is the best medicine. And so, if there's things that you've put off or things that you've delayed because life got busy or you didn't want to venture out because of the pandemic or whatever the case is. Now's the time to get those things done and not delay any further. And we're here, ready, willing, able, and wanting to help you take control of your health and making sure that you get all of these items completed. And sometimes when you come in, we might find something else that we think is important to look at or investigate. And anything that's caught early is always better when it comes to medicine. So, please come in and don't delay some of these preventative health topics any further because we want to make sure that we stay healthy and that we're here for you when you need us.
David Hill, MD: Dr. Carla Rafferty, thank you so much for talking with us today.
Dr. Carla Rafferty: Thank you for having me. I appreciate it.
David Hill, MD: For more information and to get connected with one of our providers, please visit carl.org or for a listing of Carle providers and to view Carle-sponsored educational activities, head on over to our website at carleconnect.com. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I am Dr. David Hill.
Expert Insights is an ongoing medical education podcast. The Carle Division of continuing education designates that each episode of this enduring material is worth a maximum of 0.25 AMA PRA category 1 credit. To collect credit, please click on the link and complete the episode's post-test.
This podcast forum is brought to you to share expertise and insights within our integrated delivery system to help us improve the health of the people we serve and achieve world-class accessible care. This is Expert Insights.
David Hill, MD: So during the height of the COVID Pandemic, a lot of people were avoiding going into public places or places where other people were including their own doctor's office. But as a result, a lot of people got behind on important preventive care.
Now, it's time to get caught up on that care, and I'm excited to talk with Dr. Rafferty about what we can do in order to do that.
This is Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill. Today, we're going to be talking with Dr. Carla Rafferty, Associate Medical Director of Carle Windsor campus and practicing family medicine physician. Dr. Rafferty, welcome.
Dr. Carla Rafferty: Thank you. Glad to be here.
David Hill, MD: Happy to have you here. So, we want to talk a little bit about recovering from the pandemic and specifically at the height of the pandemic, a lot of people were really frightened to come into the hospital to come to their doctor's office. And as a result of that fear, a lot of people got behind on primary care, on preventive care that they needed and they may need to catch up. So, I'd love to hear from you, as a family medicine physician, what parts of that care you're most concerned about? What do people need to come in and catch up on exactly?
Dr. Carla Rafferty: Yeah, we did recommend that people stay away during the height of the pandemic for any non-emergent medical needs. And a lot of that encompassed preventative care. And so, we're seeing now that we are really needing to catch people up on those prevention measures to help keep them healthy and keep them away from some not so good medical problems in the future.
So, some of the things that we really focus on in primary care are screening for certain cancers like breast cancer. October was Breast Cancer Awareness Month. And so, making sure that people that are in need of a mammogram get their mammograms at the recommended intervals. Generally, that starts at age 40 and occurs once a year.
Colon cancer screening is another screening method that we want to make sure people don't fall behind on. Colon cancer screening has made some strides in the last several years. For starters, the previous recommendation was to start screening at 50. And over the last 12 to 18 months, that recommendation has dropped to 45. So, we joke that 45 is the new 50 when it comes to colon cancer screening. And how we screen for colon cancer for people that are of average risk is much simpler than what we had been doing previously. So, it used to be that everyone was to get a colonoscopy, which was a semi-invasive procedure, where we would put a camera inside the colon and look for any abnormalities. But for folks that don't have a high risk of colon cancer, and that would be people without a personal history or family history of colon cancer, or a person that has not had previous polyps that were precancerous found on a colonoscopy, they could do a stool test.
There are two options. One is called Cologuard that's done at home and it's done through the mail. You do that test every three years as long as it's normal. And the other is a FIT test that's also generally done in the comfort of your home with a stool sample. And that test gets run in the lab and is good every year as long as it remains normal, so much simpler tests than what we used to have for colon cancer screening.
David Hill, MD: Well, full disclosure, I am 54 years old and I am really happy to get that news. That is a real relief.
Dr. Carla Rafferty: Yes, a lot of my patients are as well.
David Hill, MD: Now, I have, for obvious reasons, never had cervical cancer screening, but who needs that now?
Dr. Carla Rafferty: Yeah. So, cervical cancer screening generally starts between the ages of 21 and 25. And depending on your age and what the results are, generally people will get that done, women will do that between every three years and every five years. And it's really important because it's something that we can catch changes very early and do very minor procedures to remove any abnormalities if need be before they even turn into a cervical cancer.
David Hill, MD: And are there new ways to screen for cervical cancer screening? I know when I was practicing internal medicine, it always involved a fairly invasive exam. Is that still the case?
Dr. Carla Rafferty: The pap smear is still something that we perform and that's where we take a sample of the cervix. But we now also routinely test for the virus called the human papilloma virus or HPV. And that's the virus that causes the majority of cervical cancers. And so, if we can get a sample and check for HPV, that gives us a much better understanding of what your risk is of getting cervical cancer. And that's why we've been able to go from annual screening, which we did when I was in training even, to going to every three to five years.
David Hill, MD: It's got to be a relief for people who were not looking forward to that exam. Let's go to the other end of the age spectrum. What about bone densitometry? Can we talk about that?
Dr. Carla Rafferty: Yeah. We want to make sure that as people get older, that they make sure that they maintain good bone health because we really do not want people to fall and break a bone. When an elderly person falls and breaks a bone, whether or not they can recover from that specific fracture, it really causes the patient for their health to take a turn for the worse. They may lose some independence. They may be dealing with chronic pain, mobility differences, and it can really affect their day-to-day life. And so, screening for osteoporosis with a bone density, usually starting at the age of 65, sometimes younger, if we have certain risk factors, is really important in making sure that we have adequate amounts of calcium in our diet and vitamin D and good weight-bearing exercises to keep our bones strong and healthy.
David Hill, MD: That is great advice. When I hear vaccines, I often think about children. But there are some vaccines that grownups need as well. What should those be?
Dr. Carla Rafferty: So, there are several vaccines that we do in adults. Probably most people are familiar with the booster for tetanus and pertussis. That's one that we get every 10 years. And pertussis is a condition that can cause whooping cough that we see a lot in children. And then, we get grandparents visiting those cute grandkids and then they develop whooping cough as well, which can really be uncomfortable and cause difficulty breathing.
Other vaccines that are important are the pneumococcal vaccine. There's Pneumovax 20 and Prevnar 15. These are two different kinds of vaccines that protect against a particular bacteria called Streptococcus pneumoniae. And everyone is advised to get those vaccines at the age of 65. And if you have certain risk factors like diabetes, are a smoker, have COPD or asthma, have certain heart, liver, or kidney diseases or certain cancers, it's recommended that you get that between the ages of 18 and 64 as well. And then of course, everyone will get it again at 65.
Shingles is another vaccine that's really important. Shingles is a very painful rash that occurs after people have had chicken pox when they were kids. And for people who are older than 50, it is recommended that you get this two-dose series. You only need the series once. If you got the old shingles vaccine called Zostavax, the CDC recommends that you get the updated vaccine called Shingrix because it is 90% effective at preventing shingles and the complications that occur from shingles, which is a much better percentage improvement from the previous vaccine that we had available.
David Hill, MD: Wow. And shingles is so nasty. So if people are uncertain what vaccine they got before, I suppose it's time for them to check in with their doctor and figure it out.
Dr. Carla Rafferty: Absolutely. And these are vaccines that you can also get at your pharmacies. Just make sure that you update your doctor's office if you do get one of these vaccines at the pharmacy, so we keep all your records straight.
Flu season is upon us right now too. And so, I do recommend that folks get their flu shots. It is recommended that you get this every year. And if you're over 65, it's recommended that you get the high dose version of the flu vaccine. The flu vaccines that you get in shot form are all killed vaccines. There's nothing live in the vaccine. So, when we get a vaccine, sometimes we might feel a little tired or achy or run a low-grade fever, and patients may think that they got the flu from the shot or they got sick from the shot, but it's really the shot is causing your body to practice it's immune reaction to a portion of the virus or bacteria that we're vaccinating you against. And the muscle aches and fatigue and fever are all just normal processes that your body goes through in its attempt to fight off that agent.
David Hill, MD: So, I want to clarify this again. There's absolutely no way that the flu shot can give you the flu.
Dr. Carla Rafferty: That's correct.
David Hill, MD: All right. I think that's a misconception that I hear from time to time. It's so important that people know that. You know, we started this conversation talking about the effect of the Covid pandemic on healthcare, and there is news regarding COVID vaccines. Can you bring us up to date?
Dr. Carla Rafferty: There is a new bivalent COVID vaccine that's available for people who are now five years of age and older. The vaccine should be given at least two months after your last COVID vaccine. And what's interesting about this vaccine is it is the first vaccine that offers protection against two different strands. So, the original wild-type COVID strand that was the same strand that was in all your other covid vaccines, but this new one also offers protection against the Omicron strand, which has been the dominant strand for the past 12 to 18 months. And so, it's providing some additional protection against these newer strands.
David Hill, MD: Now, that sounds like a big improvement and I hope people will go out and get that extra protection. We talked about people being worried or anxious about coming into the doctor's office when people are sick. And even in the middle of flu season, some people may be still a little bit anxious. Do we have different ways for people to get their healthcare or at least talk to their provider?
Dr. Carla Rafferty: Absolutely. One positive that came out of the pandemic among all of the problems and challenges that came was virtual health. So, the government, Medicare and all the commercial insurance companies do provide coverage for virtual health. This could be a video-enabled visit where there's video and audio component to the visit. And you can have appointments with your primary care doctor with the nurse practitioner or physician's assistant on that team. You could see counselors or psychologists with virtual health, and it really opens up the door to accessing your provider, particularly for things in which we don't need to physically do a physical exam, where we don't need to look at a body part or listen to a particular area of the body. These can be great types of visits.
As of right now, the many organizations, including Carle, also have online portals with which you can communicate with your doctor's office. The portal is a great option if you have questions following up after a visit or you didn't quite understand something that perhaps came out of a visit. If you have a new concern or a new question unrelated to a previous visit, these virtual visits are really helpful at helping get you in a very quick and easy manner so that you don't have to take a day off of work. You don't have to travel to the doctor's office. But do understand that if there are things with which a physical exam where we actually need to lay eyes or hands or ears on a body part to fully examine something, we may ask you to come in for an in-person visit, but that may not be the case for every kind of visit. So, virtual visits have been very helpful.
David Hill, MD: It's great to have that variety of ways to access your healthcare provider. And then, I guess if they say they need to see you, then you can come on in, right? I want to talk about something else that Carle offers, that is, you know, the case in some places, but hardly universal, and that is the patient-centered medical home that sounds really cozy, but it has a very specific meaning. Can you talk about what this patient-centered medical home entails?
Dr. Carla Rafferty: This is great. It's a certification that Carle has received for many of its clinics and there are surveyors that ask for certain documentation and certain processes that we do. So, it's a whole process for Carle's clinics to be designated a patient-centered medical home. And that designation comes with a lot of help for your physician in order to better care for you. It gives each patient a whole team of people engaged in their care to help with some of these simple issues or complex issues. So, most doctors are paired with an advanced practice provider, which is that nurse practitioner or physician's assistant. And sometimes you may see the doctor or sometimes you may see one of these advanced practice providers when you come in for visits. When you call in to speak with the nurse, the nurse is part of our care team, and they may provide you with some education. They may ask you questions about some of the concerns that you're having in order to determine what is the next best step, whether it's that virtual visit, whether it's coming in to see the nurse practitioner or whether or not you need to see the physician.
There are care coordinators as well that help patients navigate the healthcare system and provide some extra education for those patients that have more complex medical conditions. And we have certified medical assistants. Those are the folks that generally take your vitals, your blood pressure and your heart rate and stuff when you come in to the doctor's office. But they're helping call patients ahead of appointments to make sure that they get all the information they need, so that the visit can run more smoothly.
There's social workers that are embedded in our clinics that can help with you affording your medications or helping with transportation needs or helping you get extra help at home if you need that. Some of our clinics will have a pharmacist on staff that can help address questions about medications and drug interactions and help with ramping up a dose or ramping down a dose on a medication.
We have integrative behavioral health specialists. These are generally social workers or clinical psychologists that are integrated in your primary care doctor's office, and they can help with some short-term counseling needs like helping with stress or grief after the loss of a loved one, or they may help you get motivated in order to do the things that you need to do to take care of your diabetes and take your medications the way that you're supposed to.
And then, another example I'll give is advanced care planning facilitators. So, every person should have a discussion with their family members or friends about what they might want done should they not be able to voice those wishes themselves. This is called a healthcare power of attorney. And we have facilitators embedded in our clinics that can help answer questions that patients may have on how to choose the right person to delegate these tasks to, and what kinds of decisions that a patient may need to make in these kinds of scenarios. And so, it's a free service that really helps you address what are your long-term goals of care and who in your circle of people do you want to help your medical team know what your wishes are should you not be able to voice those yourself?
David Hill, MD: Wow. So that's really integrated wraparound care. I think I understand why it's called a home now. Dr. Rafferty, do you have any final takeaways that you want to leave our listeners with today?
Dr. Carla Rafferty: We want to make sure that everyone is up-to-date on their prevention measures, because we all know that prevention is the best medicine. And so, if there's things that you've put off or things that you've delayed because life got busy or you didn't want to venture out because of the pandemic or whatever the case is. Now's the time to get those things done and not delay any further. And we're here, ready, willing, able, and wanting to help you take control of your health and making sure that you get all of these items completed. And sometimes when you come in, we might find something else that we think is important to look at or investigate. And anything that's caught early is always better when it comes to medicine. So, please come in and don't delay some of these preventative health topics any further because we want to make sure that we stay healthy and that we're here for you when you need us.
David Hill, MD: Dr. Carla Rafferty, thank you so much for talking with us today.
Dr. Carla Rafferty: Thank you for having me. I appreciate it.
David Hill, MD: For more information and to get connected with one of our providers, please visit carl.org or for a listing of Carle providers and to view Carle-sponsored educational activities, head on over to our website at carleconnect.com. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I am Dr. David Hill.