Archive for the 'New Ideas in Medicine' Category



Quick Drugstore Clinics Revisited

Do you have a quick health clinic in a drug or big box store near you?  They are called Quick Clinics, Redi-Clinics, Minute Clinics or other names, and you can drop in at any time for basic needs such as a bad cough, a sprained ankle, or whatever other “simple” ailments you or your children might have.

They are reviewed in today’s NY Times.  Are they a good idea?

I blogged about them a few months ago…. and yes…. for the most part I think they ARE a good idea — but with a few cautions.

But my cautions aren’t those of the NY Times, nor are they the cautions of the American Academy of Family Physicians, or the various State Regulators or the pediatrican groups. 

What are the differences?

My cautions are about the patient’s health, and theirs are about money.

I know, I know — if you read this article, or any of a dozen others written on the subject (cited in my previous blog post), the spokespeople for these various organizations will tell you just how concerned they are about the health of the person who gets treated there. 

But if you read between the lines?  Yeah.  They’re worried about money.  These clinics cut into their income, pure and simple.  A patient has a choice between walking-in (no appointment necessary), waiting 15-20 minutes (instead of who-knows-how-long), being handed his/her prescription on the spot (instead of having to travel to the pharmacy), and paying an average of $18 less than a visit to a traditional doctor’s office.  And $18 is $18.

The AMA calls it “sacrificing quality.”  Pediatricians cite the need to understand a child’s history.  And state authorities are concerned about licensing.  But they are really worried about money.  Because in the case of these quick clinics, patients are bypassing those died-in-the-wool establishments that justify charging way too much money for way too little service.

All that said — there are some real cautions for patients that have to do with their health — so if you are tempted to use one of these quick clinics, please take note:

  • Remember that these clinics (and therefore the doctor or nurse practitioner who sees you) do not have your records or your history.  If you are someone who has had challenges, allergies, or reactions to treatments or symptoms in the past, you’ll want to continue seeing your primary care physician.  The clinic provider can’t know what your past history is and could recommend something that makes you even sicker.
  • Remember that these clinics are just as interested in selling you the drugs they have on their shelves as they are making sure you get the right medicine.  Your physician will prescribe based on what s/he knows is right.  The clinics will prescribe based on the deals they’ve made with pharmaceutical distributors.  That may not matter — it might still be the right drug — but it might not.
  • Drug interactions and contra-indications are a real concern.  With a pharmacist right there, you should be OK, but make sure you take a master list of everything — EVERYTHING — you take on a regular basis, long or short term, and share it with the practitioner you see.  Prescription drugs, yes, but also any pain relievers, vitamins, herbals, etc. 
  • Some quick clinics do not accept Medicare or Medicaid, and not all insurance companies will work with them, so ask that question before you see the quick clinic doctor.
  • If, in fact, you are really sicker or hurt beyond what you realize, you don’t want one of these quick clinics recommending the next steps — you want that to come from your primary care doctor — or — your specialist.  If you question your situation at all, don’t fool with these quick clinics.  You could end up sicker.

A cautionary tale?  Yes, but no less enthusiasm for a good idea whose time has come.

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The Concept of “Patientude”

I’ve only lived in this health and medical environment for not-quite-three years, and I am always in search of opportunities to learn more.  I attend workshops, interview doctors and other providers, network with others who do advocacy work, talk to other patients, read, read, read, and mostly just listen.  As each day passes by, I learn more.  And the more I learn, the more I realize I don’t know.  Life’s like that.

With each new person I meet (including the air conditioning guy who had to fix our A/C today — thank heavens for the A/C guy!),  I am asked, “Every Patient’s Advocate, huh?  what does that mean?  What do you do?”

Then I have to explain that I’m not a patient’s advocate in the traditional sense.  I don’t really help individual patients with their care.  I have no formal health or medical training.  I hate the sight of blood and I barely passed high school biology. 

So what DO I do?

I write. I speak. I write some more.  I record my radio show.  I give workshops.  I write some more.  All of which could be activities totally unrelated to healthcare. 

I’m a teacher, an author, a webmaster, a speaker, a columnist, a radio talk show host…. all aimed at helping patients help themselves.

Which often begs the question — “If you aren’t a doctor or a nurse or trained in healthcare then how DO you help patients?”  Which then leads me to explain why I do the work I do, and what I hope to accomplish…..

Then, finally, the light bulb went off.  Just last night, I hit on a word — a new word which I now lay claim to.  A word I am inventing, right here and right now… 

I am a teacher and trainer of “Patientude” !  Yes — that’s it!  I help patients develop the ATTITUDE and the skills they need to get the healthcare they deserve. 

It’s not enough to learn how to get ahold of medical records, or how to look up med-speak, or how to decipher a written prescription.  It’s about developing a take-charge attitude, sticking up for oneself, communicating respectfully with providers — and expecting the same in return.  It’s about taking responsibility for one’s own healthcare decisions and then sharing that attitude with other patients so they can develop their OWN patient-tude!

Are you with me?  Do you like that word?  Do you buy the concept?  What do you think?

Patientude.  A word for our times.

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Microchipping for Better Human Health?

The AP issued an article this week (picked up in many pubs, I’m sure — here’s a link) about injecting microchips into humans, in part to improve their healthcare.

The idea is that there are a number of problems we human beings could solve if we just had a microchip implanted in our arms.  For example it could identify us if we needed to enter a nuclear power plant, or it could replace a credit card so we could make purchases, just by walking by a cash register that could read the chip in our arms.  Healthcare-related applications include:  it could figure out who we are if we have Alzheimers or another dementia and can’t find our way home.  Or if we have a life-threatening illness and passed out or could not talk, it would identify the condition we had, such as diabetes or heart problems.  Or it might contain all our health insurance information, or even the list of drugs and doses we take in case someone needed to help us with those things.

The chips are called RFID:  Radio Frequency Identification.  They are the size of a large splinter, and they get injected under your skin. Whatever information is included in the chip can be read by RFID scanners. 

These RFIDs are already used in a variety of non-human applications.  For example, you can get your pet implanted with one and if your pet gets lost, the vet has the scanner that can tell who your pet belongs to.  Or if you keep cattle… well…. I don’t think a major portion of my readers are cattle farmers.  Some maybe, but not too many.

Anyway — call me old fashioned — but let me humbly share my opinion on these human applications for RFIDs.

NO WAY !!  NO FRIGGIN’ WAY !!

Just in case there is anyone who questions how I think about them — I think they are a lousy idea for humans.  There are way too many ways such an identifier could be misused, and almost nothing positive it can do that can’t be handled in some other way.

If I ever want to visit a nuclear power plant, I’ll figure out another way.  If I get Alzheimer’s and my family is worried I will wander away, or if I develop diabetes or heart problems, then I”ll just wear one of those medical ID bracelets.  And if I need to make a credit card purchase, I’ll happily pull the card from my wallet.

Nope.  This slope is just way too slippery.  Don’t even think about it…. well….. unless you want to get your dog back.

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Stepping on Patient Empowerment’s Toes

Very interesting conversation yesterday with a gentleman named Anthony Cirillo….

Anthony and I are kindred spirits in a couple of different ways.  We both hail from marketing backgrounds with probably 50+ years of experience between the two of us.  And we’ve both identified a passion within healthcare — me with my Every Patient’s Advocate work, and Anthony with his Anthony’s Song work which takes him to senior centers and conferences across the country.

And we both believe in patient empowerment — big time — realizing that the more patients advocate for themselves, the better their outcomes, and therefore quality of life, will be.

How did we find each other?  Anthony lives near Charlotte, North Carolina, although he’s originally from the Philadelphia area (hey Ant-knee!)  I’m in Central New York State near the Finger Lakes, and the foothills of the Adirondack Mountains.  We are quite divided geographically!   

So we found each other because our passions — our patient empowerment work — turned up in news alerts delivered to email…. and voila…. now we’re discussing ways to collaborate in our work.

So all this leads me to the title of today’s blog post…. certainly neither Anthony nor I are stepping on patient empowerment toes! So what do I mean?

If you find my blog of interest, you’ll be quite interested in Anthony’s TWO blogs.  He’s expanding on the evidence found in Sicko through a new blog he’s just started — Sickoh.  And he blogs about elder-related healthcare and health non-care in his other blog, called AnthonysSong, too.

Both his blogs seem focused on those abuses of the concept of patient empowerment.  Of real interest to me is his post on the lawsuits filed by various healthcare entities against bloggers who speak out against them.  And whereas I try to turn my blog entries into lessons and tips for patient empowerment, he turns his into advice for those healthcare administrators who have begun floundering now that patients have found a public venue for their opinions and horrible experiences — cyberspace.

Patients will benefit from it all — because cyberspace has begun to level the playing field in many ways.  And because cyberspace provides a networking platform for people like Anthony and me to meet, and compare notes, and collaborate. 

I hope you, too, use this marvelous tool to help you in your quest to be a sharp patient… and if you’re a crusader like Anthony or me, I hope you’ll contact us so we can collaborate with you, too!

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Errors Acknowledgement Creates a Hero

Ilene Corina of PULSE has been speaking and teaching patients about their role in patient safety for more than ten years.  She issues a bi-monthly report which contains interesting tidbits and sometimes something remarkable.

The following excerpt comes from her most recent newsletter which can be viewed in at least two ways:  a testament to Mr. Aviles who has taken a leap of faith, and as a gauntlet thrown down in front of hospital administrators and others in a position to begin public acknowledgement of patient safety travesties. 

We don’t often see the terms “hero” and “transparency” in the same paragraph.  See what you think:

How Heroes Are Made
By Ilene Corina

…. There are many leaders in healthcare who acknowledge there is a problem with medication errors, infections and bad outcomes. They often talk amongst each other and lecture to rooms full of other medical professionals. But, it’s the public who must be aware of the problems associated with the care they receive so they can play a role in improving outcomes. Were there no leaders who would do this?

On June 6, 2007 I was invited to speak at the New York City Health and Hospital Corporation Community Advisory Board Annual Meeting. Each facility associated with NY City HHC has a Community Advisory Board or CAB. The CAB is made up of community leaders who work together for the improvement of the hospital for the community.

On this date, I was going to speak to the CAB members about patient safety. I’ve done this hundreds of times before, but never with the full support of a hospital or healthcare system’s leadership. On this particular evening, after everyone was well fed, I was going to tell them that people die in hospitals from medical errors, infections and other complications that shouldn’t happen. I was going to tell them that it could be them or someone they love next and I was going to tell them that the hospital leadership knows this. I would tell them true stories about people who have died in hospitals, how it could have been avoided and what they should do to participate in their own care. And, I hoped even to be able to make them laugh at some of my stories, experiences and audio-visuals.

As the early part of the evening wore on, I sat next to Mr. Alan Aviles, HHC President and CEO. I asked him if he was ready. “There will be no turning back,” I told him almost feeling sorry for him. He made a comment about full transparency and shook my hand. “Full transparency” I thought. You can’t get any more transparent than this. Mr. Aviles was introduced to his community and he was supposed to speak for five minutes. The five minutes turned into much longer. As I listened, heart pounding and palms sweating, the Chief Executive of one of the nation’s largest healthcare systems stood in front of his community members, customers of his services and told them exactly what I would have said. “Medical errors kill as many as 98,000 people a year in hospitals nationwide.” He told them the truth.

He told them about errors, infections, deaths and injuries. As my heart beat with anticipation, I watched the audience staring in awe, some with their mouths wide open, some with their faces all twisted, all listening intently. I sat at the edge of my seat waiting, waiting to see what else he would say. He continued to tell the truth.

I wasn’t sure the rest of the audience knew how courageous Mr. Aviles was that day. I am sure his staff knew. He didn’t sugar coat the problem and he spoke directly to those who use his healthcare system. This bravery to me has never been matched. Now when I go to speak with his staff or work with the patients of NY Health and Hospital Corporation, I will do so with the same respect he showed everyone that day. His patients deserve the best and he wants them to have the best. Shouldn’t we all be there to help him along? To fix a problem, we have to acknowledge a problem.

And that’s how heroes are made.

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Well put, Ilene.  Thanks for sharing this hero’s story.

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Sicko Follow-Up: Misguided Notions

I’ve had conversations with dozens of people about Sicko in the two weeks since I’ve seen it. 

Here’s what I’ve learned in my informal poll:

One thing which is less about Sicko and more about a human frailty:  that the biggest critics of any movie are the very people who have not viewed it.  So with the wave of my typing fingers (or perhaps my delete key), I’m dismissing their opinions.  Haven’t seen the movie?   Sorry.  I’m not interested in your opinion about it….

So for the purposes of this post, I learned:

1.  That many are like me, moving their opinion bar gradually to embracing the possibility of universal health.

2.  That those who don’t think universal health care is an idea that’s time has come have never had a difficult health challenge, have some form of health insurance, and they think it’s adequate.  Little do they know…. although they are reconsidering now that they’ve seen the movie.

Snippets of conversations include:

“I never have a problem with seeing my doctor.  And my appointment lasts for almost an hour sometimes.”   (Then I ask — are you spending that much time with your doctor?  or with your doctor’s staff?)  “I spend time with all of them.”  (Then I ask — have you ever had a real health challenge?  Something beyond a basic, easily treatable or short-lived medical problem?)  The answer was “no” each time.

(When I asked a teacher how much her health insurance premium is..)  “I only pay $80 a paycheck.”  (Do you have any idea how much your employer/school district is paying for it?)  “No idea.”  (What if I told you there is a good chance your $80 premium is being supplemented by a $300 or $500 payment by your district?)  “Are you kidding me?  I had no idea.”

“Why are Americans entitled to a free education, and entitled to free books through libraries, and entitled to any number of services, but they aren’t entitled to health care?  What sense does that make?  They can’t be educated or read books if they are sick.”

“Universal Healthcare isn’t really free health care.  Nothing is free.  We would need a way to pay for it somehow.”  (yes, I expect money would still be deducted from paychecks but that money wouldn’t go to private insurers, it would go to whatever the universal healthcare entity is.)  “I wonder what would happen if I lost my job or got laid off and didn’t pay those premiums anymore?”  (I expect, just like you could draw unemployment, you would continue to get your healthcare, too, because you would have paid into the system already.)

“I have a friend who lives in Canada and doesn’t like their system.  He told me he hopes the US doesn’t move to a universal approach because he comes to the US for the care he can’t get in Canada.”  (Hmmm…. I would hate to think those Americans who can’t afford health insurance now would have to forego the possibility of care just so the Canadians with enough money can cross the border for care.)

“I don’t want the government telling me what kind of care I can get.  I didn’t send my kids to public schools either.  I want more control over their education and I want control over my healthcare choices.”  (Well then, I suppose there would still be private healthcare just like their are private schools.  One thing Americans have always had is a system of choices.  I don’t see that changing at all.)

So there you go — snippets only, but certainly representative.  I don’t see the conversation slowing down at all and I hope the ’08 presidential candidates will take note.

And for those who have never had a diagnosis that provides that punch in the stomach that a very scary diagnosis provides — try to put yourself in the shoes of the 40+ million Americans who have no insurance and figure out how you would manage a horrible disease or a chronic disorder… it’s not pretty.

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Find more of my commentary about Sicko here.

Read what other bloggers have said about it here:

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Maybe Hospitals Need Continuitionsists, Too

Wednesday’s Wall Street Journal provided an article by Laura Landro about the use of “proceduralists” in hospitals.  This is an idea whose time has come… and we almost have to wonder what on earth took them so long?

Landro defines a proceduralist as a medical specialist who is highly skilled in one or two skill-specific procedures, such as spinal taps or paracentesis or specific catheterizations.  Their work is focused not on a specific patient; rather on repeating those procedures all day long on any patient that needs them.  Because they are so skilled, and because other doctors aren’t, the chances for botched procedures and — of course — malpractice suits are reduced.

Genius, really.  And its implications are numerous.

Hospitals have wisely segmented work for years now, but rarely in the doctoring arena.  Nurses no longer change the sheets on the beds — now the housekeeping staff does that.  Nurses no longer deliver food — the cafeteria/food workers do that.  Instead, nurses are tasked with their better and educated skills;  direct care for patients.

Outside of body system specialties, like cardiologists or pulmonologists, or disease specialties, like oncologists, the only doctor-related segmentation I’ve been aware before now of is the use of hospitalists.  They are doctors who work directly for the hospital and only see patients in that hospital.  They replace the physicians that send their patients there to begin with.  I’ve podcast about hospitalists previously.  You can listen here.

So let’s consider a few other segments now, too…..

I hear complaints all the time about how lousy doctors are at communicating.  So what if we had medical communicationists?  Or maybe they could be bedside-mannerists?

And what about the doctors who have lousy handwriting?  Bring in the calligraphists!  (Can’t call them calligraPHERS because it doesn’t sound medical enough.)

Yes, of course, I’m just jerking a few chains here.  I actually think the idea of proceduralists is an excellent idea, because I do believe they can improve the safety and percentage of successful outcomes due to their skills.

My only concern is that we once again lose that big picture person.  If portions of care are too segmented, then who is looking out for the whole patient?  Who recognizes that the patient needs someone to explain things, to calm him, to INFORM him, and to make sure that the right procedures are actually being conducted at the right times?

Some segmentation is very pro-patient — safety and better outcomes result from capitalizing on doctor skills.  But too much segmentation decreases the chances for continuity of care.  And that leads to medical errors and reduction in patient safety. 

So — maybe hospitals need care continuitionists, too.

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