Tuesday, September 29, 2009

I received numerous copies of an editorial by Michael Cohen, President of ISMP. I like and really respect Michael. He is a smart and caring man and an advisor to PULSE of NY. But

I don’t want to respond to the individuals who are asking my opinion about this article. I don’t share the same views as other advocates. For that, I have lost many people over the years who I thought could have been long time friends. I don’t like to comment on individual stories because you can bet we will never get the whole truth – and nothing but the truth.

Michael Cohen wrote about a pharmacist who was jailed because of the death of a young child. An Injustice Has Been Done; Jail Time for an Error was written in response to the Ohio pharmacist who caused the death of a little girl. I can relate first hand to the parents anguish at having a child die BECAUSE of the medical treatment the parents trusted for their child.

I too thought of jail - or worse for the doctors when my son died because of his medical care, but in truth that wouldn’t solve anything. I would like to see those involved do community service with me, taking some of the calls I take or running a support group for people who lost a child from medical care. I would like to see this pharmacist do community education about medication errors and work with the community to teach patient safety information. I just can’t see jail time.

Even if this pharmacist was lousy at his job, had a bad attitude or was overtired, how will jail time fix that?

What should we do with someone who is driving and the sun gets in their eyes and they kill someone. How should they be treated if the family is angry and grieving but the driver stuck around to take responsibility? When someone is killed and no one takes responsibility, and doors get closed instead of offering empathy and answers, the family of the injured or deceased have every reason to be angry, and that anger will fester until the family becomes obsessed with grief, anger and revenge – and rightly so.

Unfortunately, we will never know all the details of this case but unless some good can come out of a medical professionals going to jail, I would like to see everyone make better use of their time.

Wednesday, September 23, 2009

I had the opportunity to hear a panel speak on healthcare reform. There were 4, obviously very knowledgeable people about the proposed legislation to give all Americans medical coverage. Unfortunately, I had to leave early; my lack of sleep from travel was catching up with me.

One speaker addressed the bill directly and he shared the information that made this bill work for him. He spoke for 15 minutes and told the audience of about 100 people what he wanted us to hear. Of course there was applause following his brief presentation.

I thought to myself “what is he leaving out”? Because I haven’t read the information that he read, I can’t fairly comment on the content. What about those who do have the time to read it, analyze it and understand it? How will we ever know if we support something if we don’t read it? It sounds good when we are told about it. But we can’t possibly be confident that we know the whole story.

Obviously I feel that medical coverage for everyone in America is important. Just as we count on our children’s education and the police will be keeping us safe, I want to know I can go to a doctor when I, or my family are sick.

I didn’t have a choice of teacher who would be making an impact on my children’s life in school. My children spend a year with their teacher whether I like them or not. We take our education for granted sometimes. I wonder if I would be willing to use a doctor if I had little choice who he or she was, because they are paid for by the government. Isn’t this what veterans do? Do they have a choice of doctor when they use the veteran’s services?

I worked hard to get legislation passed in NY for physician profiles. We can check our doctor’s background. But, it’s self reported and may not be accurate. But we still trust the information. I used this information to choose a doctor but have also used doctors because someone else recommended them. When we go to the emergency room everything changes; you get who you get.

How much would we be willing to give up or can we be flexible at all to allow healthcare coverage for every person in this country? Maybe we, the citizens should be thinking about writing our own healthcare reform bill and make it understandable.

Saturday, September 19, 2009

Making Meatloaf

Sharing information between medical professionals and patients and families is similar to sharing a meatloaf recipe. We can request the recipe from someone for their delicious meatloaf, but if they don’t share the recipe in detail, every detail that we need to know, we won’t get the same outcome.

If even one item or description is left out (how much bread crumbs, how large an onion or what cut of chopped meat), then the recipe will be incomplete and the outcome will be different.

The information being shared, and being heard, is filtered through 3 basic areas: Trust, Expertise, and Life Experience.

Trust is how much you can believe or count on someone. As the listener, you decide whether you can trust someone. Trust that the information is accurate. Trust that the information is complete. We even trust in ourselves that we have all the information we need without checking further.

Expertise is the knowledge that we each have about a particular subject. The listener may have expertise in an area so they do not pay close attention to the speaker. For example, an early childhood specialist may be a fine teacher but not know about childhood diseases.

Life experience focuses on your past experience. Have you been diagnosed with the flu in the past so now you may not listen carefully enough to what the doctor is saying to do for these symptoms? Or, perhaps the doctor treated a patient who has been noncompliant in the past, so now he spends less time with that patient.

By recognizing that we are filtering information constantly, we can avoid missing important information by being sure that what we say is being heard accurately. We can ask the doctor to repeat back what he heard us say. And we can repeat back what the doctor said to us.

A medical professional can easily miss a diagnosis if we forget to share all important information. The healthcare professional should repeat back the symptoms we have told them. The same goes for what we have heard them explain.

What time of day to take the medication and how many pills need to be taken at once can mean the difference between a positive outcome and one that has disastrous results.

So next time you get information from the medical professional treating you, or whether you are sharing a meatloaf recipe, be sure to repeat back what you “think” you heard so the outcome is what you want.

Tuesday, September 15, 2009

Working on my fellowship for the American Hospital Association and National Patient Safety Foundation Patient Safety Leadership program I have been given opportunities to read some of the very interesting information about patient safety I would have otherwise passed over. I am reminded about the history and the studies that have been done over the years. Patient safety is a topic so near and dear to my heart. I am one of the very few people lucky enough to turn a “hobby” into a career. Of course the pay sucks but the work is very fulfilling.

Reading articles written about making a business case for patient safety is a reminder how bad the problems really are in healthcare. If information has been studied, measured and implemented in one facility, why aren’t other medical institutions following this same process? If it works in one facility, why aren’t they all doing it?

Maybe because they haven’t read the same articles I am reading. They have to find this information out for themselves instead of some organization saying “here’s the way it should be done”.

Hopefully now with the Joint Commission’s new Center for Transforming Healthcare we will start to see how best practices can be learned and followed.

Thursday, September 10, 2009

There are 2 very important roles to being a useful and productive patient (safety) advocate. One is being objective and one is being a good communicator.

Being objective means that you allow someone to make their own decisions. Words like “you have to” or “you need to” does not make for an objective participant. Words to get the same results can be “have you thought of….” By telling someone what they “have” to do takes the power away from them. Telling someone what to do can also cause push back from the listener. The first thing I think of is “no, I don’t have to”.

As an advocate, we want the patient (or even the patient’s family) in control. We want them to make decisions but have all available resources.

As a good communicator, it may mean not talking and just listening for long periods of time. No one cares about your broken foot or gall bladder operation. It’s not about you. Practice not talking for a while. Don’t ask questions or change the subject. Just listen. Search for the feelings of the patient. Are they scared, confused or angry? Acknowledge these feelings and don’t run away from them.

Allowing patient’s to share their feelings and not bury them can help them move on and concentrate on other issues. Storing their feelings of anger for being injured, or scared about their recent diagnosis blocks them from hearing important information or from recognizing other things around them that they need to know.