Saturday, November 7, 2015

Patient Safety: An Endless Journey, sponsored by King Faisal Specialist Hospital &Research Centre, Saudi Arabia

My Trip to Saudi Arabia

It was a long, but uneventful trip traveling over 6,000 miles each way to Saudi Arabia.  I was invited to speak at the first International Quality & Patient Safety
Conference held in Jeddah.  Titled   Patient Safety: An Endless Journey which was sponsored by King Faisal Specialist Hospital &Research Centre.  The planning for this trip took months.

The planned attendance was about 350 but the crowds at registration on the first morning meant that they were unprepared for the last minute request for entry.  This was a medical community hungry for knowledge and information about keeping patients safe. 

The speakers, over 30 in all were from the US as well as the Middle East.  Topics included the role of the pharmacist, medical student education, employee engagement and the accreditation process.  My role was to include the patient and family in patient safety.

I was not only there to educate, but felt I learned a tremendous amount.  After my presentation I was flocked by women who wanted to know more and were willing to share with me their stories and their culture.  I was able to learn what are some of the things we, in America might take for granted and not understand.

I was sure to explain to my hosts that some of my content might not be what they, in their culture support or believe.  I was not there to give my opinion or try to change theirs.  But the work we do at PULSE with young, unmarried mothers, or the transgender community are ways to learn about communication and honesty.  Were their patients afraid to disclose information, they may not get accurate information from their patients.  

I had another chance to share why I do patient safety work and share my journey.  This seemed to touch the women.  One woman stood up after my presentation and said “This was the best presentation I have EVER heard in my life”.  Her, and a group of women came over after and asked me to pose for photos.  (Far from my area of comfort) They took out their cameras and started doing “selfies” with me.

In this culture, it is expected that children will take care of their elderly family.  They won’t be put into nursing homes.  This opens an important role in advocacy and communication.  Men must sign the consent for a wife to have a hysterectomy a c-section or any fertility treatment.  It is also not unusual for family to receive medical diagnosis before the patient does so they can break the news to their loved one.  Although this was just some of what was shared with me, I understand that there is clarity needed in these examples.  It’s not all that simple. 

In the American “culture” men can’t have 4 wives and women can drive for themselves and wear what they want.  In the Saudi culture woman can get married young and family arranges the marriage.  People may not agree with the way others live but that is an important part of respecting each other.  This is important in health care and treating patients.  It’s another step in the conversation.  I feel honored to have been a part of this first step and introducing the work of PULSE to this new community. 

Saturday, October 31, 2015

Medical Care and the LGBT Community - L.G.B...............T.

Medical Care and the LGBT Community

Hospitals and medical staff are beginning to understand the importance of certain special concerns in treating the LGBT community. This group has special needs and sensitivity issues that may need to be addressed.

In fact, I believe that it is a serious mistake to group together the lesbian, gay and bisexual community with the transgender community – specifically transsexual. No, I am not transgender and I don’t even have family who are (not that I am aware of) but I study this topic, talk to people who are, and have been at the bedside as a patient safety advocate for people who are transgender.

The medical needs of the transgender community, in my non-medical opinion, are very different from those of the LGB community. Who you love — as in being L, G or B — is different from who you are. Just as important, is how transgender people see themselves. A lesbian may be very accepting of her body and may not cringe at the thought of exposing it. 

A transgender person, on the other hand, may have been ashamed their entire life of their body parts. Taking testosterone or hormones may have changed a transgender person’s body dramatically but without surgery; this can be surprising and confusing to healthcare workers who have not been taught about transsexuals and the stages in their transitions.

A woman who needs a prostate exam, or a pregnant man, should not be cause for alarm or even curiosity. This is not part of the lesbian and gay society. Many transgender people started off as gay or lesbian and some have become gay or lesbian. But that’s not always the case: as one friend explained to me, he is just a straight man now – almost.

Ilene Corina is the President of PULSE of NY, a community based patient safety organization and a patient safety consultant. She received a scholarship with the NPSF / AHA Patient Safety Leadership training where she studies patient safety in diverse populations on Long Island. One group she has worked with is the transgender community.

Monday, September 21, 2015

Disruptive Behavior

Disruptive Behavior Can Change Outcomes
“Disruptive behavior” in healthcare is a fairly new term to explain medical professionals who may otherwise be called rude, arrogant and not easy to get along with. An article in USAToday describes disruptive doctors as a patient safety risk.  For many reasons they are a patient safety risk including that others won’t stand up to someone who is intimidating and probably bringing in money for the hospital or practice.
Arrogance, bullying and disruptive behavior is not only in the operating room.  It can be seen in meetings and in the board room. 
A few years ago, I was at a meeting with a number of high level medical professionals.  All who seemed to get a long and respect one another.  When one physician told a story of her caring for a patient and how the outcome affected her and can be important for others to learn from, another well respected physician, who didn’t agree that that experience should be counted as a “measurement” began to raise his voice and become argumentative and explain that she was wrong.  This physician was louder and much more aggressive to get his point across.  His comfort with his own behavior made me realize that this is not new.  I intervened and shared my displeasure.  When it was all over, the physician chairing the committee announced to the group of about 30 people, including the newcomers that it is wonderful that we can all share our thoughts and ideas in a conversation and still get along and be respectful.
I followed up in a letter to the leadership of this group, some who are deeply involved in “disruptive behavior” that this behavior was not respectful nor a conversation.  The physician who was telling her story was “attacked” (she admitted that to me).  Her colleague was rude, aggressive and being “disruptive”.  My letter was taken seriously and acted upon.
It is important that we, as patients are not afraid to speak up.  We MUST acknowledge that there are improvements being worked on in patient safety and improving the patient experience but it may never leave the c-suite.  If the information doesn’t get to the bedside, it is up to us, the patients and advocates working in patient safety to make sure patients and families feel supported when speaking up. 
If you feel disrespected by a sales person, auto mechanic or customer service representative, you have a choice to not return and give them your business.  The same holds true for medical professionals.  We can't live in a world thinking that we must tolerate behavior that makes us uncomfortable.  If they treat us, the patient that way, its probably affecting their work and their relationship with their team.

Friday, August 28, 2015

Rating Doctors

North Shore-LIJ Health System Raises the Bar Once Again

North Shore-LIJ Health System is now posting ratings from patients on-line to help choose a physician. 

Now patients who use doctors affiliated with North Shore LIJ Health System can expect that their concerns - and compliments will be used as a tool to hold physicians accountable for patient relations.   How many times have you felt that your physician didn’t spend enough time with you to explain a new medication, a procedure or a diagnosis? This dialogue and communication between patient and physician is crucial to help in getting the best care possible and better outcomes.

The site is simple enough to use.  Go to the system website, type in doctor search and you can start narrowing down your search.  In one instance I went from 374 choices and by choosing my insurance narrowed it down further to 236 and then by hospital – if you have a favorite hospital, narrowed it down to 79 physicians practicing in the field I searched.

Although in the time I spent searching, I couldn’t find any negative comments.  That leaves me to wonder where they are.  Are people just leaving a practice and moving on without filling out the survey?  This is a great opportunity for patients to help patients by getting the information out and for holding the physician responsible for their “patient relations”.

I would like to see it go one step further and let us know how the office staff treated us.  So often we have more interaction with the staff managing the practice.  That should be encouraged in comments.  Although this is not a guarantee for positive outcomes – there is never a guarantee, it is yet another tool for patients to be part of the team in making choices.   

Here is something else family and friends can do to help a loved one recently diagnosed or searching for a doctor.  Do the search. 
Watch a video explaining Rating Doctors