Friday, August 8, 2014

The Patient

Are Patients a Burden?
By Ilene Corina
August 2014

The patient was at least 450 lbs. He was very uncomfortable in his bed and due to his medical condition he kept soiling himself. I had to clean him up and change his bedding a number of times. This was the start of a conversation I had with a hospital worker (I will call Pat) about Pat’s day at work.
Pat described how co-workers would pass by this patient without attending to his needs, obviously considering him someone who would take extra time and need extra work, and could even pose the risk of a back injury. Disappointed at the lack of concern from co-workers, Pat treated this patient alone, with the dignity he deserved. “Doing it alone,” Pat explained, “there is more of a chance for me to be injured.” 
Because Pat was working alone, overtime was approved. “I knew there was a good possibility I could be injured,” Pat said. “But that didn’t seem to be a concern for anyone in charge.”
Morale is down in that hospital department and this lack of concern may be part of the reason. It was apparent that the traditional desire of medical staff to care for the weakest and most vulnerable was no longer present.
Pat wondered, “If I were the patient, would I be a too much of a bother for this staff?”
Medical injuries such as falls, infections and medication errors happen at the bedside. This is where patient safety training needs to happen. Medical injury does not happen in the C-Suite although that’s ultimately where staff morale is determined.
Because this patient was not in a private room, this lack of care was not only experienced by Pat, and the patient, but by the neighboring patients and their families. Other staff knew what was happening as did leadership (remember, they told Pat to stay and handle the patient alone). How can this be handled? Should Pat “complain?” Although that is a harsh word, that’s how it will be seen: as complaining. Should Pat report a “near miss?”  “I almost got hurt, or could have,” Pat could write in a report. Who should Pat tell about this experience? The same people who told Pat to stay?  Can’t you just hear middle level management saying, “What do you want me to do about it?”
So here we have it: a patient is sick or injured and vulnerable.  Add to that the other possibilities — disabled, unable to read, homeless, unkempt, drug-dependent, transgender, mentally ill, teen, unwed mother or any other category of “different” — and the sensitivity training is just not there.
It reminds me of the time I visited a woman who was disabled and in the hospital. I was called in by a local agency to check on her safety. They feared for her safety and at each visit the patient told me the staff struggled to lift her, wouldn’t listen to the patient when the patient tried to explain the best way to lift her, and a few times almost dropped her. But the patient feared retaliation if I were to go to management and try to work out a best plan for everyone involved.  Not long after my last visit I received a call from the agency. While hospitalized this patient was dropped, hit her head, and never woke up.

Monday, June 30, 2014

Bedside Story

Are There Any Real Changes?

I walk down hospital hallways narrowed by the clutter of computers on wheels, food and linen carts and staff standing in clusters talking amongst themselves. A loud machine waxes the floors as a man pushes it down the hallway and people barely move out of his way.
I’m visiting a patient who has been diagnosed with cancer, and his family. The prognosis is not good. I was there when he received the diagnosis from a physician eager to start chemotherapy that another physician later said surely would have killed him. Information is constantly being thrown at the patient’s loved ones, who are scared and lost in a cloud of emotions arising from fear, confusion and lack of sleep. Words are often unheard, instructions are a blur.

I remember the doctor telling this recently-married man the bad news — stage four cancer with “nothing” to do but palliative care — and recommending treatment. I asked the doctor, “What do you think he heard after you said he has stage four cancer?” The doctor continued to tell the patient what the treatment options were even though he had strict orders not to share this devastating news without the patient’s wife present. “I need you to sign a consent form,” the doctor told him.

Now the patient is in a third hospital and being treated for breathing difficulties. The medical staff kept telling the patient and family there is nothing that can be done for his cancer. Exhausted from lack of sleep, his wife constantly reminds staff that he is not there for cancer treatment. They had a plan. He is there to be treated for his difficulty breathing.

On each of my visits I notice the standard of care he receives. The only sink is in a bathroom near the window, yet no one ever walks past me to wash their hands. The gloves, closer to the door, were easier for staff to reach. They didn’t wash before grabbing them.

I suggest the family goes for dinner when I arrive. I do not need to be entertained. They go to dinner and I notice that the compression stockings are not connected. One of the visitors who stayed behind with me said that if they needed to be connected, they would be. I knew better. When asked, the nurse says someone “forgot” to hook them up. In the times that I visit, no one ever shifts him. He gets bedsores that the family explains, “can’t be helped.”

The patient is critical and might die soon, but for now, he wants to live. Still, in the 2½ hours I was there one evening, no one washed their hands, no one shifted him, a hose from his breathing treatment dropped on the floor and before I could stop the nurse she reconnected it.

I saw that the antibacterial gel container was taped over. I asked the patient’s family why. “Because he had c-diff,” his wife explained, and the antibacterial gel won’t work on c-diff. I asked if anyone ever washed their hands and the family said “sometimes.” Never while I was there. But I wasn’t there the 24 hours a day that his wife was there. Maybe they just didn’t wash while I was there.

Maybe everyone gets infections in the hospital. Maybe all hospitals “forget” to plug in the compression stockings. Maybe all hospital staff don’t wash. Maybe in all hospitals bedsores are acceptable. Maybe in all hospitals the patient doesn’t need an oximeter on their finger, or staff don’t shift the patient? Maybe all hospitals have cockroaches and the nurses argue over who will be the one to kill it late at night, like this one did. The list is so long.

But the family was happy because the nurses were “nice.” Families of sick patients don’t know what to look for. Hand washing becomes trivial. Families have no idea that the policies and requirements are not being followed: the patient and the family are happy if everyone is nice.
The family probably knows that the patient would have died anyway. I will always wonder what he died from. 

Rest in Peace. 

Thursday, June 26, 2014

Deciding on a DNR is Very Personal

If I had a disease and it would costly to my family, and the people who work in the healthcare system say it’s hopeless today, I might say let me go.  No acts of heroism to pump my body up with chemicals just to “get another few months”.
But as a watch someone who is dying, my thoughts change drastically.  Fight this thing his loved ones are thinking and sharing amongst themselves.  Even though the patient knows how serious his health is, he wants to live.  He wants to be with his new wife.  He wants o play his music.  Giving up means never again.  Shouldn’t we be permitted to put up that fight without others judging?
It’s such a personal time.  A DNR (order that means do not resuscitate) can be changed over and over.  It will be honored.  It’s not for outsiders to judge.  Not for the advocate to have an opinion.  It’s not for the nurses to decide or doctors to decide.  It’s hard enough to want to fight – who knows if there are miracles. Sometimes thats all we have to hope for.
Information about the DNR:

Saturday, June 14, 2014

I Didn't Know, What I Didn't Know Until Prudential Came Along

I Don’t Know, What I Don’t Know

No, really, I don’t know, what I don’t know.  I have no idea, what I don’t know.  How could I? 
I sat in a Prudential Insurance seminar recently.  There was a free dinner and speakers to talk about different types of insurance.  I was invited by an insurance salesperson, because we were going to meet in a week or so to go over my policy.  This friendly young man suggested I go to the seminar first.  I took my 22 year old son and we went not knowing what to expect but at least we would have dinner together.
As the lecture went on, a man sitting near us yelled out “so what does variable life mean?”  The presenter stopped and explained it.  Then another question and another.  I thought I knew many of these answers.  It never even occurred to me that I didn’t know.  I had thought I knew, but this was an eye opening event.  Not just about insurance but because if we don’t ask questions, because we feel inferior, scared, embarrassed, vulnerable or rushed for time, we lose out on not only not knowing, but making wrong decisions.
I have lots of questions when I buy an air conditioner or stove, or any large or small appliance.  I know what I want when I buy a car but still have lots of questions.  If, at any time we weren’t encouraged to ask questions when purchasing an item, we can leave and go someplace else. 
When it comes to insurance, or a visit with your medical care team, it’s often so intimidating and we just don’t know what to ask.
Patient support groups are crucial for the opportunity to share information and feel safe asking question.  Talking to friends and family might help.  Learn what you don’t know, before you go to your next appointment wherever that might be.
Yes, Prudential got my business.

Saturday, May 17, 2014

Questionable Doctor Report

Doctor Information

I am pleased with the recently released report  Questionable Doctors because I am confident that our healthcare system needs serious work  when it comes to patient’s safety.    I just think that the decision makers need a push in the right direction.
On the train, on my way to the NY State Department of Health patient safety committee the day after this report came out, I opened up the local newspaper, Long Island Newsday, and read an article about the wife of Dr. Anand Persaud, a Baldwin physician who improperly issued thousands of prescriptions for oxycodone and other drugs in exchange for cash payments in 2011 and 2012.   Now his wife is charged with criminal tax fraud and offering a false instrument for filing in the first degree.
Prosecutors said Dr. Persaud, an internist, wrote the prescriptions for powerful painkillers during at least 5,800 patient visit and sold prescriptions for oxycodone to undercover agents posing as patients without examining or questioning them.
A July 2013 Newsday article reports New York Attorney General Eric Schneiderman, whose Medicaid fraud unit conducted the 13-month investigation, said Persaud is one of the state's top prescribers of pain pills.  An August 2, 2013 report on News 12 Long Island reported Dr. Persaud is out on $500,000.00 bail.   Then, for almost a year, nothing until I read about his wife yesterday.
Looking at Dr. Persaud’s information on the NY State’ Physician Profile website, Anand Persaud is presently practicing (or could be) with no questionable actions (other than 3 settled medical malpractice cases) The state doesn’t add “under investigation” to their comments.
So one may say, if he is innocent until proven guilty Google your doc to get up to date information – if you even want to know.