Thursday, October 23, 2014

Another Set of Ears

Speaking in Plain Language

When I went to see this young man I arrived at his mother’s hospital floor before him.  We connected through a mutual friend who thought I might be of some comfort or helpful.   It was almost 10:00 AM and I was running late.  Respectfully, I waited outside his mother’s room until he arrived.  I have learned to stand in one spot, barely moving when I am visiting someone in the hospital.  Being respectful and aware are the two most important things to me.  My phone vibrated and he was calling from the lobby.  Visiting hours start at 11:00 AM.  I looked at the hospitals website before my visit.  He said he was downstairs waiting for 11:00.
“Visiting hours” I told him, “are for other people.  It’s not for you.  Hold your head up high and walk past the sign.  Act like you are a man in charge.”  Minutes later the elevator door opened and a tall handsome young man walked out already in a sad place and now feeling even more vulnerable.  My job was to help him feel empowered while not taking any more of his power away.
He introduced me to his mother who was unresponsive and at the end stages of cancer.  The mask on her face, when removed to offer her sips of a drink, caused her saturations to drop frighteningly low.  He did not want his mother to have the discomfort of this mask on her but the other masks weren’t working.   We immediately started writing down the things he wanted to talk to the doctor about.  The mask, her diet, her medications.  As he thought out loud, I wrote his thoughts and questions in a notebook I brought for him to keep.    He pulled out a notebook and started writing too.
When the doctors came, along with the young students in tow, the conversation turned to hospice and palliative care.  It was 10:30 in the morning and before visiting hours.  I now realized why the family never had a conversation with the doctors in charge of her care.  By 11:00, they would be long past this room and on to other patients.
The attending physician told us that the palliative care team would be in to talk to him about his mother’s care sometime today.  I asked the overwhelmed son if I may ask a question. “Sure” he said.   “Does this mean he cannot use the bathroom, have lunch or leave the room because he may miss the team?”  I asked pointing at the young man standing over me?  “He has been waiting 5 days already.”    The doctor went into his jacket pocket, pulled out a phone and called for the team to come up.  Minutes later the doctor came with the students again following.
The kind and gentle physician who oversaw this department explained that to make her comfortable they would give her medication so she can rest comfortably and take the mask off.  The conversation lasted less than 10 minutes.  The physician asked what the son wanted to do and we requested the doctor’s contact information so he can decide.  I asked if I can ask a question and when the son said “yes”, I asked the doctor so the patient’s son could hear clearly, “Are you saying that if you removed the oxygen and gave her medication to rest comfortably, she will die?”  The doctor looked at me, at the son and back at me again and said.  “Yes”.
Now, he can make an informed decision.  Family was called, arrangements were made and she passed peacefully the next day.  Her children hopefully, can live with no regrets.  Rest in Peace

Monday, October 13, 2014

Ebola is Worse?

Lessons from Ebola

People come into this country with Ebola and we see professionals wearing hazmat suits to treat patients because Ebola is contagious and deadly.  90,000 people die from hospital acquired infections each year in this country and we are still asking medical professionals to wash their hands.

Tuesday, September 30, 2014

Take Control of Your Care

Be in Control
At a recent program, a woman said her doctor is making her take medications that she doesn’t want to take.  Another patient said that she was kept in the hospital but she didn’t want to stay. 
Too often patients think they are being forced to do things by some implanted learning that they are not in control.
“If you don’t want to take your medications” I told her “don’t” but there may be consequences; from getting sicker, to losing your beloved doctor who also may say he doesn’t want to care for you if you won’t follow instructions.

After an hour long presentation, I would hope that participants understand that they are in control of their medical care.  Mistakes happen, clinicians may be wrong.  They need to know what’s on your mind.  Why won’t you take your medication?  Why do you want to leave the hospital against medical advice (AMA)?  These are things you should be able to talk to your health care team about.  If you can’t, you need to change who your team is.
One person said she couldn’t imagine going to see the hospital leadership with her complaints.  I asked her why she thought they were so untouchable.  “If you were unhappy at a hair salon or at a restaurant, if you would speak to the manager or owner, it should be no different”.  Complaining or constructive feedback are two different things.  Hospitals want your business.  They want you to tell all your friends how wonderful your surgery went.  If you are not happy, speak up.  If you’re in danger, move up….the ladder to the people in charge.

Thursday, September 25, 2014

World Pharmacist Day

World Pharmacist Day - September 25

According to the International Pharmaceutical Federation (FIP), September 25 is World Pharmacists Day.  What a great opportunity  to remember that the pharmacist is your expert on medications - more than the physician, more than your friends and neighbors, it's the pharmacist who is there to answer your questions about medication mixtures, potential side effects and appropriate and proper measurement.

Here are some tips:

·         Use only one pharmacists so they know all your medications
·        Don't change the dose or stop medication without consulting with your clinician and even your pharmacist

·        You are encouraged to read all labels and inserts but, if you start coming down with new ailments such as an upset stomach, achy joints, headaches or irritability, before seeing a new doctor check with your pharmacist about potential side effects
·        After your clinician tells you about your medication, ask your pharmacist.  The pharmacist is more up to date on warnings and new medications
·        Your pharmacist can help you with a discussion with your clinician.  If a medication doesn’t seem to be working for you, ask your pharmacist what he / she recommends so you can talk to your doctor about it
·        Be sure your pharmacist has in your record all your allergies and any adverse reactions to medications
·        Don’t ever be embarrassed to ask questions about your medication.  Whether you are a waitress, hairstylist, postal worker or auto mechanic, we all have our knowledge and skills.  Not understanding when or how to take medication is not something to be ashamed of.  ASK!
·       Consider choosing someone you trust to be your DMM, Designated Medication Manager

Don’t forget to visit for more information. The Institute for Safe Medication Practice (ISMP) is the nation's only nonprofit organization devoted entirely to medication error prevention and safe medication use. 



Tuesday, September 23, 2014

Running a Hospital

Running a Hospital
I met with leadership in a large hospital and we talked about the work I am doing with vulnerable populations who use the healthcare system, many his hospital.  When I told him that there are stories of medical professionals being less than sympathetic and kind to people with disabilities, transgender patients or young, unwed mothers he seemed surprised.  “Not all the stories are from your hospital”, I explained to him not wanting him to become defensive.  But I knew some of them were.
He told me that all of his staff are sensitive and caring to the patients that go to this hospital.
“All of them?” I questioned with my best startled voice without wanting to sound sarcastic.  He paused and said that maybe some physicians were tired after many surgeries but they were all caring. (I wasn’t even talking about physicians).

I then asked him if he visits patients at the bedside and he said he does.  This conversation wasn’t going to work.  It would become a back and forth with him defending his facility and the staff who works for him.  This is, to me, one of the biggest problems in healthcare.  Where medical errors can happen, where there can easily be a breakdown in communication, how readmissions can occur and patients and their families may not be satisfied but not sharing this information because it falls on deaf ears.

If it were my hospital I would be begging for details.  Tell me what you heard, I would be asking, or where can we improve? I would want to know.  Instead our short conversation was about how wonderful this hospital was.  It felt similar to a parent defending their child that everyone else knows is a bully.  I was not saying that this hospital wasn’t wonderful in many ways.  I started out our visit complimenting what I saw and things I have heard.  I understand that he wanted me to know how well they are doing in many areas.  But, I also know that I would have become a bigger fan the next time I got a complaint or call about someone’s safety if I knew that the leadership was ready to listen.