Bedside Manner(s)

Snotty Nurse

We named her “Snotty Nurse”.  Not a very nice thing to call someone who works with critical care patients and sees what is probably the worst of the worst in the hospital.  But, her bedside manner just wasn’t there.  When the nurses change shifts or doctors did rounds she would say to anyone there quietly sitting at the patient’s bedside, “You have to leave” in a tone that was anything but pleasant.  No explanation.  When the patient, a 20 year old boy just opened his eyes and recognized me for the first time in over 24 hours and he squeezed my hand while scared from the ventilator breathing for him, I begged her to let me stay 2 more minutes.  “He just opened his eyes and is holding my hand tight” I told her.  “No, you have to leave” she said abruptly.  Reluctantly I gathered my things and left so the doctors could talk about him without any input from the people who know him best.

She doesn’t say hello as all the other nurses do.  There is no greeting or acknowledgement, but  she will grunt something if someone is in her way or if we greet her with a “good morning”.  She won’t explain things to the patient’s mother unless asked and when one guest tried to relay information, she gave a sarcastic reply.

I began to realize that this nurse can actually become a liability to a hospital.  Were something to go wrong, the family may feel she didn’t listen and want to hold her, as a representative to the hospital, accountable.  There was a time that the patient’s family didn’t want to “bother” her with information, that was important about the patient’s look which turned out to be relevant to this patient’s outcome. 

Some people feel that bedside manner is irrelevant but the fact is bedside manner is an important piece of communication which can help predict an outcome.  Most probably, the care will be fine and the outcome will be good.  But, if not, I for one will wonder about this nurses patient care.

Newsday Uncovers What We Need to Know

Following the News

“Doctor Busted” the headline reads in today’s Long Island Newsday on page 4.  A Long Island doctor was arrested on charges that he was illegally prescribing drugs to people who didn’t need them and were not even seen as his patient.  Dr. Telang has written over 40 articles and works for the National Institute for Health.  He has a very impressive resume.   The story also reads that his office is in Port Jefferson but looking at the NY State Physician Profile website, it says that he is practicing in Upton and Bethpage.  The state physician profile says nothing about Port Jefferson.

In the same article we are reminded that Telang is the third doctor in the past month who is part of this investigation.  Dr. Leonard Stambler was also accused of selling prescriptions for pain killers. He too is listed in the physician profile website as practicing with a clean record.  Besides one small payment from a medical malpractice case, he looks like a fine physician if we count on the states profile to help is choose a doctor.   

Newsday reminds us that Dr. Eric Jacobson pleaded not guilty of charges that he wrongfully prescribed pain killers from his Great Neck office when in fact the NY State website says he practices only in the Bronx – and he has a clean record too.  Dr. Jacobson is the doctor who prescribed thousands of pain killers to David Laffer who killed four people at a Medford pharmacy robbery.

Do you remember Dr. Sanji Francis who was led away in handcuffs 2 years ago this month?  NY State Physician Profiles has him as surrendering his license but Healthgrades, an independent organization rating doctors and hospitals  has him still practicing in Massapequa LI, NY.

Also in today’s Newsday a health aide is accused of stealing $3,000.00 from an elderly man.  So, besides all the inaccuracy’s in the records that are supposed to help us gather empowering information, don’t believe that no one in healthcare wakes up and plans to hurt someone.  For some, they not only plan it, it has become a lifestyle.

HIPAA, HIPAA, HIPAA!!

HIPAA What Does it All Mean??

I just received another conference notice.  This time, it’s about HIPAA, it will be held in Washington DC for the small registration fee of $1,195.00. But, if you are late paying, the cost goes up to a measly $1,795.00.   This 3-day conference will cover breakouts, keynote speakers and probably everything and even more than you ever wanted to know about patient privacy. 

Do I sound sarcastic?  Maybe just a bit?  What about us patients who walk into a doctor’s office or a hospital setting and sign that we received the HIPAA policy (and have no clue what it says).  Or, we are told “no” for any number of things like we want to find out about a patient, want to accompany a patient to a doctor’s office or are trying to help a patient / friend get information.  We get “HIPAA, HIPAA, HIPAA” (said in the whiny Jan Brady voice).

I wouldn’t pay $1,000.00 to go to Washington to learn about HIPAA nor would I pay $100.00 and now YOU don’t have to either!

Greg Radinsky, vice president and chief corporate compliance officer North Shore-LIJ Health System,

On February 1, 2011 NorthShore LIJ Health System is lending out their Vice President and Chief Compliance Officer Greg Radinsky to help us, the general public understand “HIPAA Everything You Want to Know About Patient Privacy but Are Afraid to Ask"  and it will be FREE to all who want to attend. 

We just ask that you bring your business cards and take notes. 

You may never get another chance like this again!

When:  February 1, 2012

Time: 1:00 – 3;00 PM

Where: South Nassau Unitarian Universalist Congregation,

228 South Ocean Ave. Freeport NY

Who should attend:  Anyone who advocates for patient’s, is a patient or may be a patient and wants to learn about HIPAA in terms you can understand.

RSVP to PULSE (516) 579-4711 or icorina@pulseofny.org

See a list of upcoming free educational programs here. http://www.pulseofny.org/series.html

This program is sponsored by the PULSE of NY Patient Safety Advisory Council

About PULSE:

PULSE is dedicated to raising awareness about patient safety and reducing medical errors through advocacy, education, and support. We work to empower the public to make informed decisions, increase effective communication and respect between healthcare providers and the public, and create community partnerships that will foster and ultimately lead to safer healthcare environments.

Hospital Readmissions

The Cost of Re-Hospitalizations

When it comes to preventing hospital readmission's, no one wants that more for the patient (or family) than PULSE, a grassroots patient safety organization.  Not only because of the cost to health insurance, Medicare and Medicaid but because of the cost to the economy and risks for the patient’s safety for a number of reasons .

Hospitals, as we already know are dangerous places.  There are high infection rates, possibility of patient mix-ups and risk of falls.  But what about the additional lost work time for the family because of a hospital readmission or what congress is calling a re-hospitalization?  There is additional time for replacement of staff, payment of sick time, and of course using Family Medical Leave when a family member has the right to be with the patient or take care of things at home.  Getting out of the hospital is important for patient safety reasons.  So how do we get the patient home and to stay home which we all know is the best place for the patient?

As a patient safety educator in the community for over 15 years, I am confident that the public wants their family home too.  Given the tools to help with patient compliance, understanding discharge instructions and safe medication use are all important areas patients and families can play a role in reducing re-hospitalizations.  This is not something we need to “work on” this is something we have done since 2006 with Family Centered Patient Advocacy Training”.  Our next training is February 7 at 6:00 PM.

Nice Works for Safety

Being Nice in the Hospital

As I walked through the hall of a hospital I needed to remind myself that it was, in fact a hospital.  Each employee smiled and held the door.  In this very busy hospital with crowded hallways, I had to remind myself that this was not a hotel.  The volunteers were friendly and courteous.  The cleaning crew smiled as they walked passed me and no matter where I was, someone always seemed to want to know if I needed help finding something.

I watched as an employee escorted a woman off the elevator and brought her to the cafeteria following a brief interaction on the elevator.

In most cases I would say that “nice” doesn’t make an organization competent.  But, in some cases, being nice in a hospital setting can relax the patients and their family, it can help patients be more honest about their illnesses and problems allowing for more accurate record keeping, and it of course, makes patients want to come back.

No, being nice is not a sign of competency but when it is across the board, being nice obviously is coming from the top.

Informed Consent

Informed Consent

Is it consent, if they aren’t informed?  A friend of mine who is a paramedic explained this to a colleague when treating a patient at his home while on a call.

Kyle has been a paramedic for many years and also works in an emergency room as an Emergency Room Technician.  His skill for treating people in an emergency go way beyond their physical needs.  He is gentle and kind and also willing to take the time to explain the options to a patient.

I like to ask him about his calls and they are usually uneventful but interesting non-the-less.  But on this evening, following his shift, he explained to me about a patient’s pain and discomfort and request to not be brought the hospital.  Kyle explained to this man what they can do for him at the hospital to relieve his pain.  Or, he can stay home and what can happen to him if he refuses care.  What made this conversation interesting to me, someone who is sensitive to health literacy or anyone’s capability to communicate with each other especially under stress, is that Kyle’s colleague questioned the man’s capability, as an adult to make an informed decision and give consent.   “When someone doesn’t understand or know their options” Kyle explained to his colleague, “Then they are not informed”.

Michael Jackson's Doctor Found Guilty

GUILTY!

Is it ever appropriate to cheer when a person is convicted of a crime?  But, that’s exactly what happened outside the courtroom of the trial of Michael Jackson’s doctor as he was found guilty today of manslaughter.  When the verdict was announced, there were cheers outside the courtroom.  Dr. Conrad Murray, the former personal physician of Michael Jackson, was found guilty of involuntary manslaughter in the 2009 death of the pop star.

There goes the idea that “no one in healthcare ever wakes up in the morning planning to hurt someone”.   It may have been his lack of knowledge, ignorance, incompetence or arrogance that caused Dr. Murray to behave in a way that caused another’s death.  We may never know, but he is now a criminal and will be in prison for a long time.

It empowers advocates like myself to continue to suggest that patients and their family keep asking questions, go with your gut and don’t “assume” that things can’t go wrong.  We may never know what really happened the night that Michael Jackson died and we won’t even ever know everything the jury knows, but I can tell you lives were tragically changed that fateful night in 2009 and again today -  and I thinks it’s sad, hardly worth cheering about.

Politics Religion and Patient's Safety

Politics Religion and Patient's Safety

You may not think that religion or politics would play a role in safe, quality healthcare, but it does every day. We just don’t always see it.

You may remember I wrote about the woman who couldn’t work for PULSE because we are a friend of the transgender community and do advocacy work helping to make sure their needs are met and they are treated safely and respectful (like anyone else). When I shared the experience with a local physician and asked about medical professionals not wanting to help patients who go against their religious beliefs, he explained that this is a common problem with abortion too.

Medical professionals who don’t want to help women who have an abortion must safely remove themselves from the situation.

Now I read about doctors in Kansas who are fighting the system that would keep women safe following an abortion.


Politics and religion have no place in healthcare. The law, is the law and needs to be followed. Talking openly about abortion and why women choose that road, or learning about people who are transgender and openly speaking about our differences will help people understand their similarities. It also will help to get laws past protecting the rights of people to not feel ashamed of who they are which will openly start a conversation and sensitivity training. If we aren’t addressing these areas, we will be allowing people with power to show their prejudice at the most inopportune times.

Health Literacy (Again)

More on Health Literacy

Health literacy is defined by the U.S. Department of Health and Human Services as “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions". Health literacy has become a medical term used by medical professionals to study, measure and learn communication skills with their patients (and their family).


I don’t consider myself a medical person but I do consider myself a patient safety advocate. And, since communication is one of the biggest problems with patient’s safety I will be addressing my own “Top Ten” list of how to improve health literacy.

#10. Stop using abbreviations –always. Don’t do it with friend, family or at work. Get out of the habit now. Don’t say the U.S. of A. Say “The United States of America”. Don’t say my GYN, say “My gynecologist”. Don’t say we are barbecuing dogs; say “we are barbecuing hot dogs”.

I was recently with a group of 9-12 graders and heard someone use the term LGBT. I stopped the speaker and asked if everyone in the group knew what that meant. One girl didn’t. We would assume a teenager knows that term but if it isn’t used by her friends or family, how could she know it? We need to speak in full sentences always so when speaking about healthcare, there are no surprises.

#9. Assume a patient can’t read. Healthcare workers handing patients forms to sign can ask “Do you need help with the forms?” This gives the patient the opportunity to say that they forgot their glasses, are too nervous to read the forms or anything else they want to say besides saying they won’t understand them. Friends or family accompanying the patient can ask too. Every time I go to the doctor I am handed forms to read and sign. I wonder what the person would say in a crowded waiting room if they can’t read.

#8. Have a private place to complete forms. Don’t make the patient feel embarrassed or self-conscious. Never react to an answer. If you learn the patient’s age or weight, go on to the next question and never bring it up again.

#7. The patient needs to repeat what the doctor said in their own words. And, the doctor needs to ask. “Take the pill 2 times a day for a week and then come back” The patient needs to now explain when they will take the pill. “I will take them at night” repeats the patient. “How many”? “I will take 2 at night with dinner so I remember” If the doctor wants one pill in the morning and one at night, is it at 7:00 AM and 7:00 PM? Make it easy. This isn’t about literacy it’s about explaining yourself so anyone can understand it.

I worked in the post office for 19 years and mailed packages all over the world. Recently I tried to figure out if it would benefit me to use the newer “flat rate” box to mail a package to my son in college or should I get boxes and mail them without the flat rate price. The clerk spent enough time with me until I understood. Is that about literacy too?

#6. Ask the doctor to come back. After an overload of information, whether in the hospital or the office, ask the doctor to give you a few minutes to think of the questions you may have. Write them down and gather your thoughts. The doctor or medical provider should suggest, “I know that was a lot of information, why don’t I see another patient and check back with you to make sure you still understand what I said”.

#5. If you don’t understand your doctor, and he has explained the same thing over and over, ask the nurse to explain it. You can tell me how to do something and what to do but if I didn’t get it the first three times you said it, you better either pick new words or get someone in who speaks in a way I understand it.

#4. People with accents aren’t deaf. People who are deaf, are not dumb. People who are elderly are not all frail, people who are young have a right to ask questions. People in wheelchairs can hear. Don’t talk to their transportation person and ignore the patient. If the patient has a disability, they probably know it. Don’t be afraid to acknowledge it and ask how you can help.

#3. If your doctor doesn’t spend the time explaining him/herself on more than one occasion, don’t be afraid to change doctors. Just because you have used this doctor for 20 years doesn’t make that doctor “good”. There are always new and competent doctors being trained. Look for a new one.

#2. Remember “making meatloaf”. You can share your meatloaf recipe with 10 people and no 2 will come out the same. If every detail isn’t shared, you may not get the outcome the doctor expects. Details, details, details!

#1. NEVER let a medical professional intimidate you! I was recently with a patient in the hospital and the doctor stood over her bed and said to the patient “What are you so worried about?” The patient, an educated woman, sick of being in the hospital started crying. I jumped in front of the doctor and said “Just answer the woman’s question”. Healthcare providers will get much further answering the patient’s questions and if not able to, tell them.  Be honest and forthright with the patient about your own limitations in communication.

If we don’t follow the care plan we are considered “noncompliant” if we don’t understand the care plan, we have low health literacy.

How about we just get everyone communicating a bit better?

The Joint Commission Survey

A Hospital Survey

I hear talk from people about the way The Joint Commission works and what exactly is their role in keeping patient’s safe.

As an example of what may happen at a typical hospital following a tragic event, let’s follow a complaint about a young woman who dies from an infection in a Joint Commission-accredited hospital. The family reports the incident to The Joint Commission (the name was changed from Joint Commission on Accreditation of Healthcare Organizations, aka JCAHO).The Joint Commission takes the report, sends an acknowledgement letter to the family that the report was received, and offers to get back to the family after action is taken about the complaint. Weeks go by and they hear nothing. Assuming nothing is being done, the family tells people The Joint Commission is not doing anything; But that is not true.

The Joint Commission accredits more than 19,000 health care organizations, including hospitals, ambulatory care services, home care and mental health services. These customers pay The Joint Commission for their survey. Joint Commission surveys are more rigorous than the surveys of other accrediting organizations. The standards are much higher and the survey is more detailed and difficult to pass.

In the case of the infection-control related death illustrated above, a “for cause” survey may be done when a complaint is brought to the attention of The Joint Commission about a Joint Commission accredited organization. A team of surveyors go to the organization with no notice to the organization and evaluates the organization to determine if the organization is doing what they are supposed to. For example, they may not be complying with The Joint Commission’s infection control standards.

There are 294 Joint Commission standards. If there is a problem that is not life threatening, the surveyor will look for a pattern. If it is simple to fix, the surveyor will tell the organization to fix the problem immediately. If the problem is more complex, the surveyor will write up an RFI, Requirement for Improvement. If the accreditation decision will be affected, a report about the problems at the organization is presented to The Joint Commission’s Accreditation Committee. The committee meets with Joint Commission staff to review the problems.

In the case of the woman who died from an infection, if there were no patterns of breakdowns in infection control practices, no action would be taken upon the hospital where the young woman died. The death is tragic, but not because the organization was not doing what it was supposed to. In other instances, it could be a series of problems that led to this one death; similar to the Swiss Cheese effect (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1298298/ ).

If there was a pattern of breakdowns in infection control practices at the organization where the woman died, the hospital would have to complete a written report and take immediate action to fix the problems.When health care organizations do not fix problems in a timely manner, Joint Commission staff may recommend that a follow-up survey be conducted, which could lead to preliminary denial of accreditation, or even denial of accreditation.

When accreditation is denied, the organization can request a hearing. The hearing is conducted by an independent panel, including a board member who is unknown to the organization, which reports their recommendations to the Accreditation Committee.

Although this process takes time, it “works” because it enables – and supports – the organization in its efforts to correct its problems so that care can continue to be provided to patients in a safe manner. I don’t think anyone really wants a hospital to close its doors. However, we should all want and expect excellence. That is best achieved if the health care facility follows the procedures and meets The Joint Commission standards.

Some people want the survey information made public. The state surveys are transparent so why shouldn't The Joint Commission survey be too?

The Joint Commission standards are much higher.  If the survey findings were open to the public, organizations may leave the Joint Commission and use the state survey system.  Since the states constant cutbacks, there may be many opportunities to cut back on surveys.  How could the state commit to offering a service if there isn’t enough staff.   I would fear the surveys may not get done at all.  When healthcare organizations pay for the service, there needs to be enough people to do the job.

And if you are concerned about your state being neutral in the process, check to see how much money is distributed in campaign funds……………..

Patient's With Special Needs

A Special Kind of Patient

Part of my work with The PULSE of NY Patient Safety Advisory Council is working with specific groups and teaching them about patient safety and learning from them, what it is about the care they receive which makes them feel unsafe or, incapable of getting safe, quality care.

One of the groups I have been working closely with is people with disabilities. People who have various disabilities are an extremely unique patient. They can’t possibly be treated the same as all patients. They are often in need of additional and very specific care. Most importantly they need to be treated, as all patients with dignity and respect.

 A patient who I recently visited in the hospital could not move her legs and had very limited use of her arms. She couldn’t turn her head and was very large, making it difficult to move her. Her mind is sharp and has a quick sense of humor but when the medical staff sees her, they want to assure her that they know what to do for her. There is no way anyone “knows” how to handle someone with disabilities unless they ask them. Some people have no feeling in their lower extremities, some do.

 When trying to move her, staff pulled on her leg that has very limited movement and pulled her tendon, leaving her in terrible pain causing an additional day in the hospital while getting x-rays.

 Another patient I have been seeing had surgery and is unable to move her legs and most of her upper body. Most patients are encouraged to get out of bed immediately following surgery. In many cases these patients can’t. They need the support of staff to help move them and it is critical that they are moved constantly. Disabled patients have special needs for their toileting and movement. They may take extra time but it can be time well spent if they ask the patient, “How can I help you”.

 While at the hospital, I saw how hospital staff left for the patient in the next bed, also disabled, her breakfast tray on a table out of reach. Her son came and found she had not eaten since she arrived the day before.

 This patient I was visiting asked me to move her leg for her. Something as simple as getting comfortable in bed is impossible when you can’t move. I helped shift her leg and watched her grimace. Fearful that I was hurting her she assured me it was ok and encouraged me to continue. She was grateful for my help. It lasted less than one minute. That afternoon she told me a nurse’s aide came in and when she asked for help moving her leg she went too fast and injured her.

 When transferred to a rehabilitation center, she was given a bed too narrow. Not able to control her body in the sitting position, she feared she would fall out. The rails, she explained were just not high enough. With a phone call I got the hospital to send over her old bed.

Patients with disabilities need to speak up and hospital staff should be taught to listen. I was told once by a hospital administrator that they tell nurses to spend more time with patients with disabilities. “Do you” I asked him, “give them less patients or just tell them to work harder?” He agreed that there was no system in place to offering them the care they need.

A Nurse or an Advocate?

Is a Nurse an Advocate?

Working with a small group of nurses who would soon become patient’s advocates was an eye opening experience. For years nurses have called themselves the patient’s advocate, but in actuality, they are the patient’s nurse.  They may offer medical care, information, comfort and advice but that’s what a nurse does.  An advocate is the person who makes sure all that happens – correctly and in a timely manner.   I learned, at this recent training session that many nurses have been taught at a very early age to be respectful of the doctor.  When in the hospital, some nurses won’t speak up to the doctor when something doesn’t seem right.  This confirms why I have heard many times over the years that nurses are the ones who tell the family when a patient died or was injured because of the care received. 

Nurses will always say that they are the patient’s advocate.  And, in many ways that’s true.  But the nurse can’t possibly stay at the patient’s bedside or pay attention to only one patient as an actual advocate will do.  Nurses are often shuffling the responsibility of more than one patient, sometimes as many as ten, and that itself is a good opportunity for an error.

If you can bring an advocate, better that they are trained, but they should have only one patient and should be an extension of your care and be able to stand up to any doctor on your behalf.

The Advocate's Training

The Advocate's Role in Communication

I just read on a website that is offering patient advocate training that the participant will learn, among other things for the fee of $795.00 to “Interpret medical jargon, diagnosis and treatment to the patient and family when appropriate”.

In the advocacy training offered by PULSE of NY we dispute the role of the advocate to ‘interpret” medical information to the patient.  If the patient or family does not understand the information being given, the advocate’s role is to make sure the patient does – by having the doctor or other medical professional repeat it, or rephrase the information.

Another area, that this advocate will be trained in for this fee is “Explain various diagnostic tests, treatments and medications”.  This too is dangerous water for an advocate to be wading in. 

A patient’s advocate should not be interpreting or translating for the healthcare provider, they should be the bridge connecting the relationship and strengthening it.  Another professional, such as an advocate willing to take over for the doctor or medical professional can become complicated and there is danger of giving or getting misinformation.  An advocate should never tell the patient “I will explain it to you”.  They should absolutely be encouraging the medical professional to help the patient understand.    In the healthcare system there are people who have roles to help the patient and family understand the appropriate services, and their rights.  The advocate’s role should be to make sure they are doing their job.  Not doing their job for them.

The pharmacist, nurse or physician can answer questions about medication, the advocate should not.  Making sure the patient is getting the proper and agreed upon medication is the role of the advocate.  The advocate should not be getting information without the patient’s approval, nor can they speak for the patient if there is not written consent.  Too often a nurse at the bedside will assume that the advocate knows the patients history.  They may not and the advocate needs to know early on what their role will be to protect themselves and the patient what their role is not.

To sign up for the PULSE Patient Safety Advocate course go to PULSE of NY Family Centered Patient Advocacy Training.

Making a Choice

Choosing a Hospital or Doctor

A common question I hear is “How do I choose the best doctor”?  It’s not an easy question to answer.  Choosing a doctor or hospital is a very personal choice.  It may be important for you to be a close distance from your doctor because travel is an issue or that you go very often to see your doctor.  Some people want someone they can talk to, feel listened to and are just generally very comfortable with.   You may want someone who specializes in certain areas or choose a surgeon who has done the procedure numerous times (but how were the outcomes?)  I will hear that the “best” doctor is actually a really nice person – since we really don’t know what makes someone the best at anything.  It is, after all a personal choice. 

By checking websites such as www.nydoctorprofile.com you can learn if the doctor has done any outstanding work in their field, where they went to school and how long they are practicing.  You can learn if the doctor has been disciplined by the state or about their malpractice settlements, if there were over three in ten years.  But there is no way of knowing if there are pending lawsuits or disciplinary charges.

I was recently asked how someone would choose between two hospitals.  The caller had a hospital he was ready to use for surgery.  He said someone questioned his choice.  I would not give my opinion since even at the “best” hospitals, things can go wrong.  A patient can get an infection, the wrong surgery can be performed or the patient may receive the wrong medication at any hospital. 

What actually needs to be addressed is what we can do, as patients and as family members, to help ensure the best outcome.

This link to a Quick Guide to Patient Advocacy explains the simplest steps family or friends of the patient can do such as listening carefully, writing down questions in advance and insisting the doctor answers so you can understand.  Don’t allow a doctor to rush you and share accurate information freely.  Be honest about lifestyle and medications, vitamins and supplements.  Understanding the policy’s and safety practices when entering the hospital, and knowing that they are being followed, is an important way to help ensure safe care.

Religion in the Way

Patient Safety and Religion??

It hit me like a ton of bricks, right out of left field. I opened an e-mail early in the morning to find that a woman who has been working for us for a few weeks quit when she learned of PULSE’s work with the transgender community. Her letter read “I must say that while I support the overall mission of PULSE of NY, as I a born again Christian, I do not support homosexuality and transgender issues. To do so now by continuing to work on various projects with the organization, would be to go against the principles of my Christian faith.”

I was curious, and asked what her Christian faith had to do with the human right to patient’s safety, which is, after all what PULSE is about. She explained in thoughtful detail “By working to push for equal rights in healthcare without taking a stand against it, I am very well giving a green light to something I don't agree with”. Her letter was kind and gentle, but still very confusing to me. In our exchange I told her I don’t agree with drug abuse and abusers but will fight for their right to safe, quality care.

 In her note she replied “I also see this as a means of supporting the alternative lifestyle in general. I will offer assistance to anyone and help them receive support and guidance who is repentant and wants to change, but I am against supporting the practice to continue on with that behavior.”

 I was sad to lose her and then felt anger that people hide their prejudice behind religion. I felt the passion for the work I (we) do in patient safety is not as important as …..the bible? This wouldn’t have become a religious discussion. I know my beliefs and wouldn’t dare discuss them with people I don’t know but this was deeper than religion. What if a nurse or doctor, resident about to do surgery or a paramedic about to save a person’s life feels this way? Would saving them or healing them, go against their “Christian faith”? Would treating a homosexual or transgender patient in the hospital be giving them the “green light” to continue “that behavior”?

 I was an advocate for a transgender man having a hysterectomy some years ago in a Catholic hospital. Though the staff at this facility obviously lacked sensitivity training and some common sense, most of the people there were kind and gentle. They may not have even been Christian workers. But what if I wasn’t there. Could it have been different? Will I always wonder now if people bring their prejudice to work?

 I expect that medical professionals are caring and take an oath to help and heal but it has put a fear in me that we cannot assume everyone thinks that way and this is another reason to be sure everyone has an advocate with them in the hospital.

Save The Company Time and Money

Family Medical Leave and Patient Safety

Betty needs to take a few days a month off from work to take her husband of 30 years to doctor’s appointments and for procedures following his stroke earlier this year.  Under the Family Medical Leave Act she is entitled to time away from work.   

Supportive of Betty, her boss gives her the time, no questions asked, but the company she works for  suffers when Betty is away.  What exactly is Betty doing for her husband when she takes him to the hospital for tests and procedures?  When I asked her, she says she drives him to the appointments and asks the doctor questions.

What Betty or her the supervisor at her job don’t realize, is that there are many things she can do to help ensure that her husband receives the best care possible and help speed up her time back to work – ultimately saving her from using sick time or losing pay and save her company money.

The Family Medical Leave Act (FMLA) entitles family members to take up to 12 weeks off from work to care for a sick family member.  But the family is not given the skills that can actually help produce better results speeding up recovery time and shorten lost work days.  Very often they are just the driver for the patient or what I call, the coat holder, doing nothing more than holding the coat for the patient, maybe ask a few questions, or write some notes.

If Betty took a brief training course in Family Centered Patient Advocacy, she would have some of the skills to make sure everyone who touched her husband washed their hands, cutting down the risk of infection.  She would learn to carry antibacterial wipes to clean door knobs and anything her husband, or others touched that may carry germs.

She would be confident to take all her husband’s medication, vitamins and herbs to the doctor or pharmacist for review to check for hidden side effects or interactions.

Betty may learn to ask about support groups for stroke patients who would help her, and him through the maze of paperwork increasing her chances to get back to work faster.

She would feel empowered to ask the doctor to repeat himself if she didn’t understand instructions avoiding a missed appointment, missed dose of medication or the improper use of equipment.

Betty would know to look for risks of falls so her husband would be safe from injury at home and in the hospital.  If he were to fall it could easily cause a delay in her return to work.  

Betty would learn to take notes when the doctor is speaking and ask the doctor to come back so they can think of more questions before they leave, possibly avoiding another day of missed work to visit the doctor or make phone calls for corrected information.

She would learn to ask for forms before she has to sign them so she can read them.

And finally, Betty would encourage a friend, family member, someone from her church, synagogue or a neighbor who doesn’t work to take the advocacy training too so Betty can go back to work and not be afraid that no one else could care for him.

Wouldn’t that be wonderful for her company?

Byron Garcia and Michael Bloomberg

Who is Byron Garcia and why is he important?

Byron Garcia is best known for his leadership of 1,500 prisoners dancing to Michael Jackson’s “Thriller”  following the death of Michael Jackson, prisoners wanted to pay tribute and practiced for many long hours stopping only when it rained, or to eat according to a CBS News report.

Garcia claims prisoners told him 'You have put my mind off revenge, foolishness, or thinking how to escape from jail, or joining a gang'," he said.

Byron Garcia, a businessman became the warden of the prison when his sister became governor and offered him the job.  With no experience with the prison system, Garcia transformed the prisoners from angry murderers, rapists and drug pushers to dancers who enjoyed entertaining and paying tribute to Michael Jackson through dance and rhythm teaching them cooperation and control.

Mayor Michael Bloomberg was a businessman until 2002 when he became New York Cities 108^th Mayor.

In September 2010, New York City claimed to be the safest large city in America

Under Bloomberg’s direction New York City is leading the nation in job growth.

So, what does this have to do with patient safety?  Imagine if patients ran the hospitals?  We may not know the business, but we may be the best at running the hospital.  Garcia knew people and he knew what they would be willing to do to.  He knew what they needed.  A tribute to Michael Jackson.

Mayor Michael Bloomberg was not a “politician” but a businessman and turned the city around.  Imagine if I were given a year to work with a hospital and improve patient care?  I know I could turn it around and make it safe.  Not because I know every detail about patient safety standards and policies but because I know people, how to make them strong and want practice safe, quality care.

I’m up for the challenge, anyone willing?

Health Information Technology

HIT

A phone call and e-mail invitation last week brought me to Philadelphia to be part of a small discussion group talking about health information technology (HIT) this week. This group was brought together by the US Department of Health and Human Services to explore the consumer’s perspective of healthcare technology.

Ironically, this has come at the same time a local RHIO or Regional Health Information Organization is focusing on learning the patient’s perspective through research trials. Over the years I have learned that Health Information Technology, opportunities to use the internet to correspond with your doctor’s office or share information between hospitals and doctor’s offices is actually potential life-saving technology.

It occurred to me that in my own son’s case so many years ago, as he was bleeding from a tonsillectomy and I brought him to 4 different doctors on 5 different occasions during that week to be examined, if they each knew I did that, they may have taken my concerns more seriously. Not knowing at that time that I went from doctor to doctor may have actually made them think they were the first visit. Not stressing that I made numerous visits with continued bleeding may have made them not aware of how much he was actually bleeding sending us home with the comforting words “don’t worry, he will be fine” each time.

Could health information technology saved my son’s life? That’s a question that will never be answered but knowing the full history of a patient is important to each doctor’s decisions of care and presently they are trusting us, the patient and family to share information appropriately and fully.

Hot Coffee

Hot Coffee; The Story of a Family's Fight Through Our Civil Justice

A young mom says to me “I could have sued my doctor, but my son turned out fine”.  I asked her why she would sue her doctor as we watched her son dancing to the music.  “Because they made so many mistakes”, she said.

I found myself explaining to her that a lawyer would probably not take the case if there was no pain and suffering, no loss of life and not even an injury.  I tried to tell her.  We don’t sue people because we don’t like them.  There isn’t a “winnings” or “jackpot” like the media likes to make it seem. That’s all for the media, it’s not real life.

I spoke with the daughter and son-in-

law of  Stella Liebeck who spilled

hotcoffee on herself and sued

McDonalds

I was telling her about “Hot Coffee” a movie that finally shares with the public the truth about the McDonalds hot coffee that spilled into the lap of the elderly woman many years ago.  Most people think she spilled her coffee and because of inconvenience, sued McDonalds for a large sum of money. 

That’s not the way it happened.  I saw the movie twice and knew the story because I followed it years ago when I started patient safety.  People make comments about lawsuits without knowing the facts. People just like to comment not thinking how hurtful or inaccurate their comments might be.

I saw the movie the first night at the premier in New York City.  I got to speak to the family of the woman who spilled the coffee.  “I’m a scientist, an educated man with a good paying job” the son-in-law told me.  “This was not about money”.  I believed him.  The next 90 minutes was a riveting movie about America’s civil justice system like you just don’t know it.   

Filming Surgery

Massachusetts bill would give patients the right to film surgery


Hospital officials say the measure would increase liability costs and present challenges to infection control. Physicians question the logistics of videographers in the OR.

http://www.ama-assn.org/amednews/2011/06/27/prsb0627.htm

I’m not sure I would support having my surgery filmed. If others want it on tape, so be it. I suppose the law is a good thing. But to have a video camera in the room, I would be afraid would be a terrible distraction. If I chose my doctor to do the surgery for all the right reasons, I’m not sure filming their behavior would be appropriate. And, for what reason? Assuming it would be for a lawsuit, the video would have to prove that there was malpractice. If they strayed away from policy and standards, was there damage done because of it? Infections surely can’t be videotaped and an item left inside doesn’t need a video. With the surgery itself be videotaped so the viewer(s) can see the accidental cut? So, now that it’s on video, does the patient heal faster? Or, will he doctor say it was because he/ she was distracted by the video?


I am in support of the legislation; I am just pretty sure I wouldn’t use it.

When they Don't Want to Hear Your Opinion

The Advocates Role

There are many different kinds of patient advocates. There are those who will keep a patient comfortable. There are those who will review medical records and help with billing, or help with placement and rides to and from appointments and there are those, like myself who are patient safety advocates and concentrate on the patient’s safety. It is often difficult to try to explain to the general public the difference.


I find much of my work is on the phone. I do go to the patient’s bedside to meet with the family on occasion, but when it’s not absolutely necessary I can just get in the way.

A family recently asked me to visit them, and their parent who was being treated at a Long Island hospital. I knew there was tension between one adult child and the attending physician. I interviewed the nurse before meeting with the family and she told me about some of the family heartache and confusion. I knew I would be working on communication issues mostly. The nurse asked me what my role was and what was I going to do.

I told her “I am going to repeat everything that you and the doctor say - but I am not representing the hospital”. In this case, the family does not want to hear how sick the patient is. They want to know what is going to be done to help the patient come home. Medical professionals often know that with a disease, infection or damage to certain parts of the body, patients won’t get better. This family wouldn’t hear any of it. As their advocate, it is important to listen to them, hear their needs and keep others opinions, including my own, out of it.