Tuesday, September 30, 2014
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.
Posted by Ilene at 7:49 AM
Thursday, September 25, 2014
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 www.ismp.org 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.
Posted by Ilene at 8:22 AM
Tuesday, September 23, 2014
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.
Posted by Ilene at 6:35 AM
Wednesday, September 10, 2014
Joan Rivers, Death of a Legend
I rarely comment on specific cases of medical injury and this won’t be different. There is usually more to the story than we will ever know and I don’t like to give energy to a situation that the professionals are already reviewing. But, it wouldn’t be fair if I didn’t comment on the death of Joan Riversjust because I am such a big fan of hers, the press surrounding her death and the fact that her death came 2 weeks before our Comedy for a Cause, Patient Safety isn’t Funny But Laughter is Still the Best Medicine fund-raiser. She could have been a headliner but patient safety is probably something her family has never even thought of.
Most people who have never lived through a tragedy such as this don’t realize that it is not the specifics of a case that matters, it’s that when someone goes in for medical treatment, they are supposed to get better or at least not worse. Sure, all procedures are risky but for those of us who have lived it, this public attention of Joan Rivers rocks some of us to the core and trust must start all over again.
Posted by Ilene at 8:27 AM
Friday, August 8, 2014
Are Patients a Burden?
By Ilene Corina
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.
Posted by Ilene at 9:38 PM