Archive for the 'Magazines' Category

Doctors and Patients: It’s All About POV

Point of view — I was struck as I read through the various essays written by Dr. Scott Haig, and published through Time and CNN during the past several weeks, how much point-of-view changes how we look at the world. More importantly, I have a better understanding about how communications improve when we see OUR world through someone else’s point of view.

Here are the essays I’ve found so far:

When the Patient is a Celebrity

When the Patient is a Googler

My Patients are Not Customers (which I’ve blogged about previously — see this post)

I’ll state up front that I think Dr. Haig does a pretty good job at seeing the medical world from a patient’s point of view. I disagree on a few observations but on the whole, in a conversation, we would respectfully get beyond those fine points and pat each other on the back for ‘getting it.’

Here’s what I mean: Dr. Haig (like my guru Jerome Groopman, MD) uses point of view to help his patients understand what to expect from him and his treatment advice. And, even more important, he is able to elicit from his patients what they expect from him, from themselves, and from their treatment decisions. He helps them see his point of view.

I believe that doctor-patient communications, and (I’ll even go so far as to say) patient outcomes, are rooted in that premise: that it’s important for both sides to see the other’s point of view. It’s a skill — and Dr. Haig seems to have mastered it.

In the one article about the patient who googles too much (She was so mired in her own point of view, that she was having a problem working with any doctor who could help her. ) The real point to the essay is that Dr. Haig was able to analyze his patient’s point of view, realized he would not work well with her, and then decided to send her away. [[ Note: -- I'm not sure it was her googling, but rather her attitude, that made him decide to send her away. I think that patients who learn about their symptoms and diagnoses are empowered to have a respectful conversation with their doctors, and that's what I encourage. ]]

Another article talks about a football player who became Dr. Haig’s patient. They had a good relationship because Dr. Haig managed his the patient’s expectations based on what he knew about the patient — he was respectful of the man’s sports career, even though he really had no idea who the player was. And later, when the player returned for still more treatment related to his new career — pharm sales — Dr. Haig was able to take point of view into consideration to work with the patient.

Here’s the problem. There just aren’t enough doctors OR patients who work with each other in this fashion.

And I realize that it’s what I’m trying to do as I work on behalf of patients — helping them understand how the medical world has changed — giving them a sense of their practitioners and providers point of view — to help them get better care.

AND — I try to do the same in reverse. For those doctors and other providers who just don’t “get it” — it’s because they either refuse, or are incapable, of seeing their patient’s world through a patient’s point of view.

Here’s your assignment for today: Pick someone you disagree with — a politician, a co-worker, a neighbor — and see if you can figure out his/her point of view. How do they see the world differently? What is their background for seeing it that way? And how do they see what you say and do through their own point of view?

It doesn’t mean you have to like them any better. But once you can see their point of view, it will certainly help you understand why they say what they say and act like they do. And you’ll be able to communicate more effectively if you’re ever in a position to need that skill.

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More Evidence for the Positives of Apologies

Those of us who work in patient empowerment couldn’t help but notice the results of a Harvard Medical School study released this week about what happens to a relationship between doctor and patient when the physician makes an error. The story was reported in US News and World Report the New York Times and other outlets.

Originally published in the New England Journal of Medicine (NEJM), the commentary called Guilty, Afraid and Alone: Struggling with Medical Error basically says that when a doctor commits an error against a patient, trust is eroded and doctors feel guilty. (Did anyone question this?)

Turns out that in many cases, the patient’s family members feel guilty, too, for not protecting their loved one. Even nurses who lost family members to medical errors reported feeling isolated, and fearing their loved one was going to receive substandard care due to the guilt of those who had imposed the errors. The words “fear” and “rude” and “mistreatment” polka dot the report.

What’s the bottom line? Once again we hear the benefits of apologies by those who have violated trust. Nothing new here at all. Groups like Sorry Works have been talking about this for years. Thirty-four states have enacted legislation to grease the skids. Those doctors who understand the dynamics, even for their wallets, are beginning to get the picture.

Test it here yourself. Another story published within days in Miami, about a 3-year old who died at the hands of medical test administrators — even though the family questioned the procedure. So very sad. And a good illustration of how we feel on the other end of the tragedy when responsibility is taken by the guilty party. Apologies are plentiful, restitution is being made. By the end of the story, you’ll feel bad for the offenders, too — although not nearly so sympathetic as you do for the family, of course.

Doctors and providers — please pay attention. Your patients truly need you to understand the guilt aspects of errors, and then step up to the plate. Your careers, and our health, depend on it.

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Newsweek’s My Turn: What About the Patient?

Last week, Newsweek’s My Turn featured an essay by Dr. Richard Karl. Newsweek called it “Good Doctors Spot Mistakes, Save Lives”… a lousy headline for a well-meaning essay, even if the essay needs a postscript.

(I’ve provided that postscript below.)

Dr. Karl, a surgeon, describes the frustration of trying to track down a sponge which he fears he has left inside his patient. He uses this example to cite one of the many ways physicians, and the medical system in general, harm patients — 15 million of them per year, by count of the Institute of Heathcare Improvement.

He then provides the reasons he thinks this phenomenon has gotten so out of control, from too much innovation to development of too many new drugs and treatment techniques to patients demanding to be a part of their own care decisions.

He’s right. The world has changed.

But the real measure of this man is in his bottom line, where he states, “Most everybody I know in medicine is bright, hardworking and altruistic. Many, though, have been beaten down by hundreds of urgent pages, middle-of-the-night phone calls, decreasing reimbursement, more paperwork and less grateful patients. These doctors have become less careful, and their patients suffer as a result.

It is time for my colleagues and me to reclaim our profession. It is time for doctors and nurses to work together, time for electronic records to actually work in providing the right information to the right person, time for pharmacists and nurses and social workers and doctors to see patients together.”

I hear you Dr. Karl, and I can see that you are trying to shift your thought process from being a blamer to being a fixer. I appreciate that.

But here’s the postscript: in your description of who needs to work together on the “healing together” team, you’ve missed the one person who is, arguably, the most important participant of all: The patient!

Patients: you’ll understand the need to take responsibility by understanding the constraints your providers operate under (as described by Dr. Karl) — it only makes sense for you to be an active participant in your care decisions.

Doctors: if you embrace the empowered, informed patient as a part of the healing team, you’ll find that everyone will benefit. And that, after all, is why you became a doctor.

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Doctors are Blamers or Fixers, too

A week ago, I posted about Blamers and Fixers.

Blamers are those people who have been hurt by our healthcare system in some way, and can’t get beyond the hurt. They are stuck in the anger, frustration and pain. It’s understandable, certainly, especially in cases where some permanent horror has come from it. From the loss of a loved one, to the loss of a body function or limb, it’s understandable, but not particularly helpful, that these folks are stuck in the blaming.

Fixers are about moving on. They, too, have suffered at the hands of the system, many of them in similarly devastating ways, but they have taken their anger, frustration and pain to create something positive for someone else. I listed the people I know who have done such. In some cases, they have lost their children to medical horrors, or they have suffered in some way that would just make your heart break. But they have taken that experience to a platform that creates a better situation for others. It’s cathartic and it’s useful.

I consider myself a Fixer.

Turns out that there are doctors who are Blamers and Fixers, too! I probably shouldn’t have been surprised by that, but I was. Just this week, two articles were shared with me that prove the point.

The first article comes from the Portsmouth Herald — actually published last March — about Dr. Terry Bennett, considered to be a “controversial and opinionated” gentleman titled, Doctor: Greed subverts health care. In the article he takes no prisoners, blasting doctors, facilities and HMOs in particular, then Medicare and Medicaid — in other words — just what you’ve heard me say many times before: American healthcare is not about health or care; it’s about sickness and money.

But the bottom line from the article is this: Dr. Bennett is just a Blamer. Period. He even states that he’s waiting for a “general consumer/voter uprising” to fix the system.

Um. Doctor Bennett…. just what are you doing to help? You are in a good position to be a Fixer. What are you waiting for?

Well — perhaps he is waiting for Dr. Rich Fogoros who has, in fact, analyzed how American healthcare has become so dysfunctional, and has offered his solution. And you know what? It makes a lot of sense!

Just a bit of a disclaimer here — I’ve read Dr. Rich’s book entitled, “Fixing American Healthcare — Wonkonians, Gekkonians, and the Grand Unification Theory of Healthcare“. Dr. Rich and I have corresponded on several occasions. I’ve even provided a testimonial for his book. And you can guess why — because he is a Fixer!

The article forwarded to me is a review of the book from Smart Money magazine. It describes Dr. Rich’s theory about the “covert rationing” of healthcare in America — the point that only some people get the care they need and describing the destruction of the doctor-patient relationship. He truly tells it like it is, as ugly as it is. It’s eye opening at the very least.

But the important part is this: Dr. Rich also offers his Grand Unification Theory which describes how to fix it. Yes FIX it. In a fair and acceptable way for all players. Just imagine that!

[If you are one who is interested in the big picture of the healthcare system, if you are curious about how all the disparate pieces of healthcare can come together in a positive way, then you'll want to read Dr. Rich's book. A hint: The letter U in his book has nothing to do with Universal and everything to do with Unification.]

Blamers and Fixers…. If a patient is a blamer, OK — it’s understandable. When you have been directly harmed by the system, and absolutely unable to do anything to help make it better, then I can certainly understand why you might be a blamer — at least for awhile. Been there. Done that. And even if you get past the blaming part and just move on, without becoming a fixer — well, I guess I understand that, too.

But I have real trouble digesting doctor-as-blamer and never moving to the fixer position. Just making a lot of noise. Stirring the pot. I don’t see how a doctor has helped one single patient by doing nothing but publicly complaining. Whine whine whine.

It’s like voting. It drives me nuts to hear people complain about this politician or that one, or this issue or that one — when the complainer doesn’t even get off his duff to vote. Whine whine whine.

So Dr. Bennett — please stop whining and step up to the plate. Read Dr. Rich Fogoros’ book. See what you think. Then step up to become a Fixer.

That’s my guantlet. I’m throwing it down.

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By the way: John Stossel is taking on the challenge of suggesting a fix to the system tonite on 20/20 on ABC-TV. I’ll blog about that in the next few days. [I'm looking for some creative ideas, John!]

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Drs Abr Can Mk U Sckr

An article in US News and World Report quantifies the number of deaths and injuries that result from doctors’ handwriting and the abbreviations they use on prescriptions.

Reassuringly, those errors cause only a small percentage of the 7,000 American deaths attributed to medication errors each year. It turns out that there are thousands of those kinds of errors, but most get caught by a nurse, pharmacist or someone else. (Maybe even a patient!)

I also found it interesting to learn that the Joint Commission has a list of prescription abbreviations they think doctors should avoid. Here’s a link.

Two thoughts come to mind. First, that this is exactly what I was talking about when I wrote this column, published a few weeks ago:

Your Prescriptions: Cracking the Code

And second, that these kinds of errors are 100% preventable — and WE, the patients, can prevent them by double checking everything on the prescription handed to us. Ask the prescribing doctor to provide you with verbal instructions to double check the written prescription. AND, ask the pharmacist to provide you with verbal instructions, double check them against what the doctor told you and wrote for you, AND double check them against the written instructions provided to you when you pick up the prescription.

It’s one error that can be easily checked and stopped by patients. So, let’s do it!

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Study the Studies: Too Good to Be True?

My mom turned 80 years old on Wednesday.  She lives 1500 miles away in an Alzheimer’s Memory Center.  We did the usual things;  sent a card, flowers, phone calls…. and she sounded good on the phone, although she couldn’t have told you it was her birthday, or who we were on the other end of the phone.  I love to hear her sounding happy.  It breaks my heart that she is so disconnected. I love that my dad keeps her so busy and as happy as she can be under the circumstances.

My mother is the second person in our family to have contracted Alzheimer’s disease.  Her mother, my grandmother, had it, too — although we didn’t call it such in those days.  Gramma had “hardening of the arteries.”  Same thing, different generation.  Did previous ancestors have it too?  We don’t know.

That explains to you, though, why my sisters and I are highly attentive to any news that comes down the pike regarding Alzheimer’s disease.  There must be genetic tendencies.  We figure there’s a good chance we’re next in line.  You can imagine how we peruse the headlines — we’re looking for any and every helpful tidbit, or any hopeful research results.  No silver bullets have come along.  But we do get promising news on occasion.

Unlike my sisters, I also pay very close attention to any of the news regarding hormone replacement therapy (HRT), and how it relates to anything at all.  In 1993, I had a total hysterectomy and immediately began taking estrogen-only HRT.  In these 15 years, if one was to create a chart of the good news, bad news about HRT, it would look like shark’s teeth — up and down, pointed lines – to HRT or not to HRT?  And if I had only ever read the headlines — worse yet — if I had actually believed the headlines by themselves were always accurate, then I would have been on and off that HRT a dozen times in the interim.

And that brings us to the reason for today’s blog post — an article in Time Magazine called “Study:  Estrogen May Fight Dementia.”  Reading the headline, my heart skipped a beat!  I take estrogen!  Maybe it has turned out to be my silver bullet!  Maybe I won’t get Alzheimers!

But therein lies the problem.  It’s so easy to quickly read a headline like that, then jump to all kinds of conclusions.  And that happens to all of us every day.  No matter what your health concern, past present or future — a quick headline can arouse curiosity or — worse — can satisfy by itself.

Over the years, I’ve had that heart-skipping experience (both good and bad) a dozen times.  I’ve watched the news — and I’ve learned to read not just the article from which the headlines derive, but I’ve then looked behind those headlines, sometimes reading the actual studies that created the news.

The big deal about this particular study is that one of the groups studied was comprised of women just like me.  I actually fit the profile:  age, total hysterectomy, estrogen-only HRT, dosage — almost exactly…..

But then, as happens so often….  once I read the article, I came back down to earth.  It turns out that I may have been taking HRT for too many years.  Or maybe not.  Or it may be better news for women who kept their ovaries and didn’t have surgery at all — natural estrogen.  Or maybe not. 

… and the bottom line?  As often happens, further studies are needed.

Here’s today’s advice:  don’t ever be satisfied by reading a headline.  The whole point behind a headline is to suck you in…. not give you answers.  As a result, it’s very easy to get exactly the wrong impression of the underlying story and frankly, that can be dangerous at times.

If a health headline grabs your attention, look further.  Were the people studied the same as you?  Gender, age, family history, health challenge, treatments, even geographic location — they can all affect outcomes, and the relevance of the headline and study to you. 

If you do decide the headline and story fit you, and if the results are of interest, then trace back to find the study which sparked the article.  The article will tell you what journal reported the findings, or what scientist or doctor conducted the study.  Just google the clues to trace back to the original, then read the original  to make sure the people in the study truly represent you.

And if they do, and if you think the findings will change anything about your treatment or diagnosis, then make copies and take them to your doctor for review.  Most often, your doctor will be aware of the new findings;  but if not, you’ll be helping not just yourself, but other patients who fit your profile, too.

……. UPDATE !!……..

Some homework for you — get some practice reading behind the headlines ….  submitted by Dr. Rich Fogoros, About.com’s resident heart guru, and healthcare system fixer, too …..

This headline came in this week, too, about statin drugs and their relationship to Alzheimer’s.  Statin drugs are those that help lower your cholesterol.  Give this one a look-see — and see if it applies to you: 

 Statin Drugs May Decrease Risk of Alzheimer’s Disease

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Monster, Marshalls, Others Prove No Privacy

Your no-brainer quiz for today:  What do Monster.com, Visa, Marshalls and TJMax, Oklahoma Law Enforcement, Spotsylvania County, PA, and at least 500 other entities have in common?

They have lost electronic information to hackers, scammers and phishers in the past three years.

And there’s a good chance some of YOUR personal information was among the records they lost.

Think about it:  your credit card numbers, your social security number, your bank account information….  somebody else has it now because these entities couldn’t keep track of it.

So why do I write about this today?

News in many newspapers and across the internet tells about the latest big loss — Monster.com which acknowledged losses earlier this month.  Read about it in Forbes.

And it brings to mind an email conversation with my new internet privacy guru, Bob Hedin, who warns in a very pointed way that there is no such thing as secure information. Period.

And how is this important to patients? 

Because every large internet entity out there is trying to get YOU to manage your health at its website.  They want you to keep EMRs, Electronic Medical Records.  The idea is that you and your doctor (eventually) will be able to keep your health records online.  Everything from your family history, to your doctor visits, medical test results, x-rays and CT scans, shot records, the drugs you take — everything.  How convenient it will be to have access to them from anywhere in the world!

Even the New York Times weighs in.

Sounds great, right?  Easy access?

Not so fast!  There are HUGE privacy and security problems here… because despite anything they may claim about keeping your information private, it just plain cannot be done.  Period.

Who are these large internet players?  Here’s a starting list.  It will grow, I’m sure:

  • MSN
  • Google
  • WebMD
  • Revolution Health
  • …. to name a few.

Why do you think they are interested?  Out of the kindness of their hearts?  Not a chance.  When you realize that in order to provide this service to you it will cost them out of their pockets for the storage space and administration….  they aren’t going to provide it for free.  Nor do they want to.

Nope.  Instead, they will use it for advertising!  So when you pull up your records, and recorded there is the fact that you have arthritis, which ads will you see in your “free’ medical record?  Drugs for arthritis, of course!  And how do THEY know you have arthritis?  Yes.  Because their ‘bots have “read” your records.  And if their ‘bots can do it, so can anyone else.

And who’s to say they won’t sell your information, too?  Pharmacies do it — every day they sell lists of the people who buy their drugs to the manufacturers and others who want the information.  So why shouldn’t internet companies do the same?

Honestly.  Some people just won’t care how private their records are.  Well, that is, until they get turned down for something important to them — like a new job, or life insurance, or even health insurance — eventually a home loan because they were diagnosed with breast cancer a few years ago, or even a car loan because they were treated after someone else hit THEM last year. And the only way to get much of that info is to gain access to health records that have been kept online. 

Sounds kind of Big Brotherish, doesn’t it?  Not to mention a motherlode for MSN, Google, and the others?

Now — I’ve blogged before about the importance of keeping one’s records.  And I even think there is a great halfway point.  Keep track of your own records electronically on a travel drive (thumb drive, jump drive — one of the little ones you can attach to your keychain.)  Then, at least, you can keep them with you wherever — and even if you lose it, it will be backed up on your hard drive on your computer at home (which, of course, you have security software installed).  And if someone finds the travel drive, what will they do with it anyway? 

OK.  It’s not a perfect system — but it’s better than putting all your information out there with one of the internet giants to be sold to the highest bidder.

Want to read more?  Here are a few previous posts:

Pay Cash for your Healthcare

Medical Family History: Get it Down Before They’re Gone

Steve Case’s Revolution Raises Privacy Questions

And as for Monster.com?  I’d be sweating bullets right now if my boss didn’t know I had my resume online, looking for a new job. 

Hate it when those security breaches happen.

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Lower Your Risk of Death? Impossible!

OK — here’s a pet peeve — thought I’d share it with you on a late summer Friday …

Here’s what sparked it this morning:

Time Magazine Headline “Risk of Death”

And joining Time Magazine is MSNBC:

riskdeath31.jpg

Or one more from MedicineNet – one of my favorite online health references:

riskdeath21.jpg

So can you tell what bugs me?  Here it is:  Somehow the media is obsessed with telling us how we can lower, increase, or even “pinpoint” our risk of death, when in fact we have no way of influencing our risk of death at all! 

No matter what you eat, or don’t eat, drink or don’t drink, participate in, or don’t participate in, you cannot affect your risk of death.  You can’t increase it or decrease it because (like taxes, as they say) — your risk of death is always 100%. 

Yup!  100%   There’s not a thing we can do to influence that one way or the other.  Truth is — there’s no risk involved at all!

Am I being picky?  Probably.  But in the spirit of accurate reporting, it seems like there might be better ways to phrase it. 

What should they use instead?  How about being more purposeful, such as “the ability to postpone death.”  Another way, “postpone the onset of death.”  Or if they are just dying to use the word “risk” (so to speak), they could use “the risk of earlier death.”

As I said — it’s just a pet peeve.  BUT, I also think it ties in to our mentality and our attitudes.  If what we are trying to do is stay healthier and we continually try to lower our “risk of death”, then truly, we may die earlier as a result of beating our heads against impossible odds.  Even the bookies won’t touch that one.

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Patient as Customer?

Part of my work is what I call health or medical “consumerism” — recognizing, talking about, and creating guidelines for patients as they regard cost of their healthcare.  From nuances in purchasing health insurance, to understanding how those dollars get allocated, to ideas for saving money and even appealing health insurance payment rejections — that’s what I call health or medical consumerism.  I’ve defined it in a previous blog post.

So I was interested in this week’s

Find the rest of this post at its new location:

http://www.trishatorrey.com/2007/07/27/patient-as-customer

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MRSA Report Cites Irresponsibility Everywhere

My colleague Betsy McCaughey, chair of the Committee to Reduce Infection Deaths, publishes in July’s Best Hospitals 2007 of US News and World Report that hospitals must begin to take responsibility for their infection rates, and begin to take the necessary steps to clean themselves up.

She cites a study that shows that “65 percent of physicians and other medical professionals admitted they hadn’t washed their lab coat in at least a week, even though they knew it was dirty. Nearly 16 percent said they hadn’t put on a clean lab coat in at least a month. Lab coats become covered in bacteria when doctors lean over the bedsides of patients who carry the organisms. Days later the bacteria are still alive, repeatedly contaminating doctors’ hands and being carried to other patients.”

MRSA and other infectious agents are everywhere in hospitals.  McCaughey talks about measurements infectious agents on stethoscopes, blood pressure cuffs, EKG wires, plus the patient’s bedside TV remotes, telephones and the like.

And why is all this important?  Because HAIs, hospital acquired infections, (those are infections that patients pick up while they are in the hospital, in addition to whatever problems they had when they were admitted) account for tens of thousands of deaths each year in the US alone. 

Imagine going into the hospital for a routine surgery, only to die from an infection you got while you were there?

The problem is — all the important players are playing ostrich.  The CDC does not require testing.  JCAHO, the organization that accredits hospitals doesn’t even check into infection rates.  According to the article, Joint Commission standards don’t specify how rooms should be cleaned or what bacterial levels are unacceptable. Asked whether bacterial levels should be measured, Robert Wise, JCAHO’s vice president for standards and survey methods answers: “You can only ask hospitals to do so much.”

I guess it’s too much to ask the CDC, the Centers for Disease Control, to take responsibility for rules on measuring the infection rates.

I guess it’s too much to ask JCAHO to create a standard for hospitals and expect them to rise to it.

I guess it’s too much to ask Congress members to begin looking into this mess.

I guess it’s too much to ask hospitals to keep their patients safe — and alive.

I will ask you to read the article – and then to link to Dr. McCaughey’s website to learn how to protect yourself.  Clearly no one else cares — so you need to do it for yourself.

……………..  Read more about MRSA and steps to take yourself here…………

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