Saturday, October 30, 2010

Making Meatloaf

The Meatloaf Recipe

What does making meatloaf have to do with patient’s safety? Let me explain.

If you make a wonderful meatloaf dinner and a friend asks for the recipe, they may wonder why theirs doesn’t come out the same.

When you share your recipe, you are telling the listener about meatloaf as you know it. If the listener uses your recipe, your information about how to make a meatloaf, it will, in fact, give them the same outcome. But what if the listener’s meatloaf doesn’t taste the same as yours?

Well...when you gave the listener your meatloaf recipe, the information was filtered through three basic areas of learning and perception: life experience, trust and expertise.

The listener heard what you said, but may have processed the information differently than you intended. For example, you said to use a pound of ground beef, an egg and a cup of bread crumbs. The listener heard you but processed the recipe as flavored breadcrumbs, ground sirloin and a large egg. If you suggested a packet of onion soup mix, the listener might have processed it as Lipton Onion Soup Mix. You may use another brand. The listener was processing the recipe through her or his life experience with ingredients or other meatloaf recipes.

Let’s say that the listener is your friend and wanted your recipe and trusted you, so they did not question your recipe. But they went by their own life experience. For example. the listener’s expertise may be to use flavored bread crumbs instead of plain and sirloin, not chuck, even without you telling them to do so.

By filtering information, the listener changes the information using these three areas of processing.
When a patient hears information from a doctor, the information is coming in from different people sharing the same information, in many different ways. Each time a patient hears about their diagnosis, how to treat a wound, or how to take their medication, they are being given different “recipes,” but everyone is expecting the same outcome. Each time the patient processes the information, he or she may perceive it differently and may not get the full “recipe” the way the healthcare professional expects and hopes.

To avoid this kind of miscommunication, following a conversation between doctor and patient, there needs to be a teach- back method used.

Asking the patient to repeat back what they heard is crucial for knowing if they understand what they heard, if they processed it the way it was intended, and if something may have been left out (like hearing flavored bread crumbs instead of plain bread crumbs).

The value of repeating back is helpful not only so the provider can be sure the patient heard correctly, but also it is a check that the provider may have left something out which he or she will catch in the teach-back.

Another way to be sure there is nothing missed is to have someone write information down while the patient and provider are in conversation. The writer, friend or advocate can make sure that there are no holes in directions. “Take your pill 2 times a day” is different than saying “take 2 pills a day”.

A patient who takes 2 pills at the same time, instead of in the morning and at night will not get the same response from the treatment but may in fact interpret taking the pills by filtering the information.

Next time you are given instructions and the results do not come out as you expected, think of “Making Meatloaf”.

Thursday, October 14, 2010

Why You Shouldn't Be a Patient's Advocate?

Who Shouldn't be a Patient's Advocate

Not everyone is meant to be a patient’s advocate. Sometimes it can take a whole community or a few different people, with different skills to help. You will often read about what an advocate should do. But there are some things they should not do. Although there is usually a place for everyone to help, there are some very specific things the patient’s advocate should not do.

Here is my list of the top 10 reasons you should not be the patient’s advocate.
You should NOT be a patient’s advocate if:

1) You are “self appointed”. The patient needs to have a say who they want with them when they are sick or injured. Just because you want to do it, doesn’t mean the patient wants you there. A spouse may be the best comfort for the patient but also may make the patient nervous when addressing medical professionals. A spouse, parent or friend who is too aggressive may just upset the situation. Have the conversation about being an advocate before it is needed; similar to discussing being a healthcare proxy.

2) You play “can you top this?" A patient’s advocate should not be talking about their own problems, aches or pains. He / she should not say things like “When I had that surgery…” or “When I used that medication”. If a patient wants your opinion, they will ask, otherwise bite your tongue. Keep your stories to yourself. It’s not about you.

3) You can’t “just” listen. Don’t interrupt, let the patient share a full thought and idea. Even if they stop to think and it takes what seems like a long time to finish a thought, don’t finish their sentences for them.

4) You are set in your ideas and opinion. If you don’t think the patient should have that surgery or needs the procedure, unless the patient asks for your opinion, you shouldn’t give it. You may want to instead encourage the patient to get a second opinion, help with research or learn why a patient wants the surgery or procedure being recommended. If it’s because the doctor said so, explore how you can help seek additional recommendations from medical professionals.

5) You want to tell the patient “you should…”. To help someone who is sick or injured is not to tell them what they should do, but instead, offer to help them do it. Instead of saying “You should get another opinion” say something like “do you want me to help you find another doctor we can trust for another opinion” or “Do you want me to do some research on that disease?”

6) You can’t read or write. The patient will be given many things to read. You will have to be prepared to help which may mean reading for the patient. Consent forms, instructions, or even the patient’s rights are all things that you, as an advocate should be prepared to help with. Writing instructions, the patient’s questions to prepare for the doctor’s visit means you, the advocate needs to know how to write clearly.

7) You are too emotionally invested in the patient. A parent or spouse may be the best person to comfort a patient, but may not be the best advocate. The patient’s family should be encouraged to call in someone from the outside who is less attached. Especially when there may be problems arising. Thinking clearly may mean stepping away from the situation for a moment. A parent who has not had enough sleep or a spouse fearful of their future may not be seeing things clearly.

8) You are afraid to speak up or get intimidated easily. Although this can be overcome with practice, if you are not going to speak up to the doctor if the patient has a concern or you see something that concerns you, do the shopping or bake a cake for the family instead.

9) You don’t have a plan. Just showing up at the hospital isn’t enough to be an advocate. You need to know why you are there. Did the patient ask you to do something specific? Take notes, organize medication lists, read consent forms? Know what you can do for the patient and then do it.

10) If you are using nursing or medical skills. If you are a nurse, and are providing nursing care, that is not the same as a patient’s advocate. Nursing care is a very specific skill and should not be confused with a patient advocate. A patient’s advocate should be building the relationship between the medical community and the patient (and patient’s family) not replacing that relationship.

You can register Here for patient advocacy training.

Thursday, October 7, 2010

National Conference of Caring Clinicians

National Summit of Clinicians for Healthcare Justice

I recently spoke at the National Summit of Clinicians for Healthcare Justice Conference in Washington DC. The Conference was sponsored by The Association of Clinicians for the Underserved. I shared my work with the transgender community and their treatment when receiving medical care.

In most cases, they are treated respectfully but unfortunately, without knowing appropriate terms or being made aware of words that may be hurtful, it is easy to offend someone who has spent their life in seclusion of who they are. Also, there are still, at times where people who work in healthcare, not always in medicine who do bring their ignorance to work each day.

I had an opportunity to not only share my work through PULSE of NY but also the work of The Joint Commission and how TJC is helping Hospitals include patients’ and families in patient safety. The Joint Commission has heard the people and now narrowing it down to the LGBT (Lesbian, Gay, Bisexual and Transgender community). Because of my work with this community as an advocate, and as a Commissioner with The Joint Commission, I was invited to speak and participate.

I was first mostly impressed with this organizations mission “to improve the health of America's underserved populations and to enhance the development and support of the health care clinicians serving these populations”. This is an organization supporting medical professionals who not only spend their adult life helping people heal, but then go out of their way to find out how to help them not only physically but to support their individual needs as a human being.

I brought with me William (name has been changed) who shared his own life experience not only as a transgender man, but working in the medical field in a major suburban hospital. William started his presentation with how he has been labeled; a paramedic, emergency room technician, student, friend and up until a few years ago, a lesbian. He has struggled in his own profession to help people understand that he is still the same person on the inside but throughout his transition, did not receive compassion from all who he worked with in the medical field. Part of the challenge to anyone who has compassion is how do you help others who do not share it as passionately understand the importance.

After speaking to a group of about 30 clinicians, I was touched by a medical student who was compassionate and caring and came up to me following the presentation to talk about how much he appreciated us coming to speak to them. I asked him, “How would you react now to a colleague or superior who does not have the same compassion as you?” He had no answer. We still have a long way to go...................

Friday, October 1, 2010

The "Best" Advocate is not Always the Closest Person to the Patient

Is the "Best" Advocate Always a Close Friend or Family?

I counted over 20 times I was an advocate for a patient in the last three years since I have been doing bedside advocacy work. That’s just going to the hospital with the patient for surgery or a procedure or meeting the family at a hospital to help them navigate the medical "system". The same system that people who work in patient safety say is what fails the patient. “It’s not people, it’s the system”.

Much of my work can, or is done over the phone just helping people speak to the doctor, get answers they need and /or speak up for their safety or the safety of someone they love.

I don’t presently charge for my services because I consider it always a learning experience for me too. It’s how I get to see what is happening and how patients and their families act, and re-act to the care they need and receive.

I am confident. I know my job. I know my limits. I’m respectful but assertive. If I am planning ahead, I can prepare early and work with the patient and the family and friends long before the hospitalization. Sometimes over the phone, sometimes over lunch.

When a dear friend and confident was recently planning surgery, I, of course was going to be the one to take him, to another state and be at his side day and night.

Another friend reminded me, “Aren’t you the one who always says family or good friends may be too close to be a good advocate?” I laughed at the thought that a close friendship, close enough to be like family, would distract me from my “job” as advocate. It’s true, I teach advocacy often enough to know that if I couldn’t do it, I would ask someone else to step up. But I was confident that I wasn’t that close that I wouldn’t be able to concentrate and pay attention to the work I know so well.

Driving up to the hospital I parked the car. My friend about to enter the hospital and have his surgery gently reminded me, “Now I need you to put on your business cap for me”.

I looked him straight in the eye and said, “I didn’t even bring a pen”.