Sunday, June 25, 2017
The Big Circle of Addiction and Dependency
A friend who works in healthcare recently shared an experience of a patient screaming that the patient was in pain and needed pain medication. My friend knows the history of the patient. The patient is often called a “drug seeker”. Someone who is addicted and wants “drugs”.
People in healthcare, my friend explained, rarely have sympathy for drug seekers especially when they are disruptive and loud as this patient was. The people who were working needed to tend to other patients and the other patients needed peace and quiet – not a screaming drug addict.
I listened and understood what I was hearing, yet I don’t like it.
We can’t force someone to feel bad for others. Although we can expect people to treat people with dignity. I assume this happened. Let me share my point of view.
In many case (of course not all) people become addicted or dependent following an injury, surgery or other medical reason. I have been with patients at discharge when they were handed a prescription for pain pills with no discussion about the potential dangers of becoming addicted. The patient is taking the medication and becomes addicted. Now they are back in the hospital looking for more. It’s a big circle of blame the patient.
When I hear about high school education teaching young people about becoming addicted to drugs, I am confident that no one thinks it can happen to them. (I know I don’t believe I would become addicted even though I was addicted to cigarettes and swore I could quit for years before I was able to).
What we can be teaching young people, as I have been doing, is about medication “errors” - mistakes in medication such as look-alike sound alike drugs – nail glue vs eye drops, Clearasil looks like teeth whitener, and generic vs. name brand and yes, pain pills available that you may not need.
In the news I hear over and over someone mention that they started on the road to addiction after root canal, surgery or a broken bone. It’s never discussed further. Education must start BEFORE the prescription is written. Or yes, they will be back.
It looks like I have some new material for the Family Centered Patient Advocacy Training coming in October.
Monday, June 5, 2017
Imagine having terrible pain in your leg and going to the doctor who tells you to take some medication and get some rest. When that doesn’t work you go to physical therapy and then a new medication and more rest. You follow these instructions and feel worse in the months that follow. Finally, you wait for another appointment with a doctor a friend recommends who recommends another doctor who sends you to a specialist.
It takes a few months to get that appointment, work through insurance and finally, a full 18 months following the original misdiagnosis, you get the correct diagnosis that the cancer in your leg has spread throughout your body. You begin months of treatment concentrating only on saving yourself but it’s too late. Eight months after the correct diagnosis you find that the treatment, as well as the original diagnosis has been all wrong. Now, three years after the incorrect diagnosis, you succumb to the cancer leaving your three children under ten years old with no mother.
Your grieving family doesn’t want to sue but they want answers. No one answers their questions. The doctors or medical practice. Not even the hospital who cared for you at the very end. No one responds to phone calls or to letters requesting a meeting. Now, you need to search for a lawyer and can’t find one. Read why here:
Have a comment? Want to get involved? Send your messages to firstname.lastname@example.org
Wednesday, May 24, 2017
Punish or Fix America’s Healthcare Facilities
A nurse who is involved in patient safety commented on Facebook that a local hospital is “closing their OB/GYN services. They are a remote town, downeast just over the border.”
She went on to explain “This closure puts pregnant women in danger. I hope the people downeast fight this one tooth and nail.”
I felt the need to comment on that post and ask: Isn’t this what people who lose loved ones from a medical error want? If they were injured because of the care they received, don’t they want to see regulatory agencies close the doors? Could it be that a wrong medication, an infection, or a baby born with disabilities was the start of that facility closing the doors to the thousands of patients they serve?
I get it. When my son died I wanted the doctors fired, the hospitals closed and the investigation (if there ever was one) made public. Now, many years later, I want clinicians, hospitals, nursing homes and rehabs to do better, not close down. I don’t want to see jobs lost and people die from no available care.
The agencies that review patients’ charts, investigate complaints and inspect facilities are not the reason for the problems. The problems come from the people who are overworked and making mistakes. Still, are they to blame? Isn’t it the system (run by people) really to blame?
I know many people want the oversight agencies that inspect, review and fine facilities to make their records public. I could understand a government-run agency such as our state Department of Health doing that. After all, it is government-run and I want to know what my government is doing for me. As for other agencies that may be involved in fixing the problem, why do we need to know the details of the problems when — I hope — we just want them fixed? If there are fewer infections at one hospital, does that mean another, best-graded hospital has no infections? I can’t believe that the public thinks that if a hospital was found to be spotless, a nurse can’t injure a patient with the wrong medication. What about a nursing home that shows no bedsores and reports of low infection rates; does that mean there aren’t patient falls each year with broken bones?
Why is there such insistence that organizations that inspect, survey or grade hospitals report their findings? Why aren’t hospitals and nursing homes themselves required to report to the public directly? •Three days since our last injury from a fall! •Two days since our last surgical site infection! •Only three wrong site surgeries this year! •Just two deaths from medication errors this year!
Imagine if the hospital, nursing home other healthcare facilities started to share their data with those of us who pay for their service? Who would really come out on top?
Ilene Corina is the President of Pulse Center for Patient Safety Education & Advocacy a community based patient safety organization located in New York.
Contact Ilene Corina: email@example.com or (516) 579-4711
Saturday, April 15, 2017
If you are wondering whether I have an opinion about the recent release of safety report cards on Long Island hospitals, I do.
Hospitals may do better or worse on such evaluations, (and many LI hospitals didn’t fare very well) but in the end it’s mostly down to individuals.
Another tool for rating your hospital is welcome, but what can we actually do with this information? We can’t really do much to change the hospitals, so for the past 20 years I have been swimming upstream to change us — the patients and our families who support us. Patient safety is a lonely commitment. It’s not warm and fuzzy like toys for kids or snuggling with pets. It’s not helping those already struggling with a disease that is no one’s “fault.” Patient safety is about preventing harm when simply using the healthcare system. It’s not unlike wearing a seatbelt even though it won’t be your fault if a car hits you. It’s about protecting yourself from the other driver who might fall asleep at the wheel – not illegal, just an accident.
Let’s think about measurement of hospital safety. Does this mean you won’t be injured at one of the best hospitals? Maybe not. Hopefully you won’t be injured at any of them, but there are never any guarantees. No matter how good a hospital’s patient safety culture may be, there will always be a risk from individuals who are casual in their adherence to the hospital’s error-prevention practices.
Think about the patients at these hospitals: some are at greater risk of adverse outcomes than others. Are the hospitals with the best “report cards” serving a high percentage of immigrants who don’t speak English and maybe have not seen a doctor in five, ten or 20 years? Are they serving a person who weighs 400 pounds, is an alcoholic and doesn’t see a doctor for his high blood pressure? Are the patients at these hospitals young girls giving birth with no prenatal care? Maybe, maybe not . . . . but patients’ backgrounds and histories affect their outcomes.
Are the hospitals with lower ratings seeing the gunshot victims, dealing with angry and unruly families, or patients with no health insurance? Again, it’s a possible factor.
We don’t want to blame the hospital, if it has a culture of safety. I have had a number of experiences suggesting that even in such hospitals there are individuals at the bedside who just don’t get it. Where is this reported?
When a surgeon was asked, “Can you please wash your hands before examining the surgery site?” the surgeon responded dismissively, “I did wash and I showered today too”. I know that this facility takes hand washing very seriously. Yet an individual employee had no problem not supporting the patient’s right to safe care.
I asked a nursing assistant and nurse to please be sure a patient’s tray table was close by, so she wouldn’t fall trying to get it. Whenever I visited, it was again out of reach. The family noticed that she was not eating: that was the reason.
A doctor came in through the swinging doors leading from outside with his coat still on and a stethoscope around his neck, walked over to the (bleeding) patient I was with, and attempted to examine him. I stopped him and asked the patient to refuse care until the doctor washed. When the doctor refused I went to the desk in the emergency room and asked for a different doctor. The staff knew of this doctor’s attitude and accommodated us. This could have happened even at the hospitals receiving top safety grades.
When I asked a nurse to state whom a medication was for before putting it in a patient’s IV, the nurse’s reply was “It’s for her. Did you think it was for you?” Then the nurse called the same patient by the wrong name. It could happen in nearly any hospital.
Hospital report cards are one way of knowing more about the inner workings of what happens on a larger scale. There are also the NY State Department of Health and the Joint Commission keeping watch on safety for us – but if each one of us took responsibility for the patient’s safety — our own, our families’ and our friends’ — maybe we could help Long Island’s three million residents get the best care possible.
Tuesday, January 31, 2017
What does today’s politics have to do with being a patient advocate?
In our Family Centered Patient Advocacy Training which is based on being a Patient Safety Advocate for friends, family or becoming a professional, we stress the importance of being a good listener and being objective. This past election year and the past weeks have become a great test for these skills.
As I listen to the news, I hear opposing comments and ideas. Depending on what channel I watch there can be very strong opinions one way or another. One reporter or speaker won’t make me change my mind, won’t make me feel differently, but it gives me the skills to try to understand that what is being said is important to the people saying it and the people supporting them.
I am glad that there are people speaking out on their beliefs. That is important to our country. It has never been OK to call names and poke fun of people’s looks or behavior when that is not the focus of the issues. It loses credibility when I hear about the way a person dresses, walks or laughs and that becomes part of the discussion.
Being a patient’s advocate means being able to focus on facts and what really matters to the patient. Being objective which may mean putting your own feelings aside to listen and then allow a patient to make their own decisions, even if it’s not what you would want for yourself - or them.
If you are a friend or family member acting as an advocate for a loved one who wants to have surgery but you don't think its a good idea, it means listening carefully and trying to understand what they want and why they want it that way. If you can’t get past your own needs then you may not be the best advocate. Find an advocate that can be objective and right for the whole family.
As I watch what looks like a civil war starting on our own soil, I want to get some good out of this. It may be to just practice my listening.