A healthcare insider’s look at the healthcare debate from a social point of view.

5 reasons we will never actually pass a national healthcare plan.

Reason #1.
You, the patient, are offered three medical treatment choices:
Option #1 costs $10,000 and works very well with very few side effects.
Option #2 costs $1000 and will also work very well but will have a few more side effects.
Option #3 costs $300 but only works some of the time with lots of side effects.
Which will you choose?

Most people will say, “I don’t want a chance for more side effects or one that only works some of the time, I want the best, Option #1.” Or people might say, “Well it is okay for someone else to choose the 2nd or 3rd option, but I have a right to good healthcare.” And what they mean by “good” healthcare is really great healthcare. For national healthcare to work, we need people to be willing to accept and to choose the second best choice sometimes which may come with a few more side effects. The system can’t afford the best all of the time. To make this happen, we have to adjust the rules doctors live by which brings me to reason number two.

Reason #2.
Doctors must give informed consent which means people have to be given enough meaningful information so they can make a good decision regarding what treatment to choose. This information would include being told about the first, second and third best options. Who is going to say, “No, doctor, really it is fine with me. Give me second best option.” We are starting to see this problem for certain hospitals that statistically provide second rate care and therefore may eventually need to disclose to patients, “You may be better off going somewhere else.” So if doctors need to tell the whole truth, the system will break down. Informed consent will have to be limited to those treatments allowed under the national health plan.

Reason #3.
The other problem doctors will have is that they will still be held legally liable for providing good healthcare. If you don’t get better or you get extra side effects, you will sue the doctor. Why is this doctor’s fault when the system says he has to give you option #2 or #3? Our malpractice system will have to change to protect doctors who are only following the rules set up by the national healthcare system.

Reason #4.
National healthcare will mean a more equal distribution of medical resources. What that really means is that many of us will have to accept a little less for everyone else to receive a little more. Now, you may say you want this but how many people really act in an unselfish way? I know lots of people who say they care about the poor and underprivileged, but I don’t see them sending a poor family half of their paycheck. We want the government to take care of everyone while we still get everything we want. But we can’t get everything we want with national healthcare. It just isn’t possible. But, everyone could get reasonably good care.

So, we are part of the problem. We are selfish. Our selfishness is a deeply imbedded societal belief about what our obligations are to others. This country was built on individualism and watching out for your own best interest. We are not a country which cares more about others above ourselves. And those of you who just said in your mind, “Well I care.” Then do something significant to prove me wrong.

Reason #5.
The last reason things won’t change is that our politicians are not interested in voting for national healthcare. Right now they are receiving a substantial amount of money from insurance companies and pharmaceutical companies. Why would they want to stop getting all this money? They don’t. And you wouldn’t either if you were in their place. Politicians talk a good story but when it comes to action, nothing gets done. How many politicians said they are for national healthcare during their campaigns? Most, but still nothing will happen. It is about money.

But we, as individuals have power. If the politician gets voted out of office they will lose their financial kickbacks. So, we have to tell them that if they want to stay in office, they have to give us national healthcare. And if they don’t vote it in this time, we must vote them out of office. We are not helpless. If we truly care, and I hope we do, we need to speak up, speak out and vote responsibly. Contact all of your local and national politicians to vote for national healthcare. And contact them over and over again. They won’t take us seriously unless we get serious about caring for all Americans.

For a look at the money issues in the healthcare debate, go to http://kindethics.com/2009/09/an-healthcare-insiders-look-at-the-healtcare-debate-from-a-money-point-of-view/

Have a kind and respectful day.

Improving Bedside Manner While Managing Your Time

Your bedside manner will affect the medical outcome of the patient. Here are some easy tips you can do in your office. The first thing you want to do is to briefly review the chart before you walk in the room. Usually physicians will start looking at the chart once they’ve entered the room and will be so busy reading the chart, that they missed the opportunity for a warm greeting and good eye contact. So while you’re in the hallway, before you open the door, do two things. Review the chart quickly and check in with yourself. You want to check in with yourself that you’re ready to go in and be present with this particular patient. Even if your mind has been thinking about other patients in the office or the hospital, or if you’re thinking about your kid’s soccer game, stop and redirect your focus. Then when you walk in the room, the patient will feel like you are there for them and that you are paying attention. As you walk, greet the patient warmly and use culturally appropriate nonverbal skills. Don’t assume that the patient hasn’t minded waiting for you, they do mind. Apologize if you are late.

Please don’t sit behind a desk. The desk can be cold and distancing. The patient will feel more comfortable if you sit with them in the exam room. If you can, please talk to patients with their clothes on as patients can be very uncomfortable sitting in a small gown or with just a drape covering them up. If you’re using electronic medical records and are just now getting used to doing the patient interview in front of a computer screen, please remember to look up from the screen and to make sure you stay connected to the patient. I know the new technology takes some getting used to, but you can’t afford to have the patient feel like you don’t care. You also want to make sure that you don’t make the patient a third-party patient. This is when you talk to their caregiver and ignore the patient. Even if the patient doesn’t have full capacity, keep them included in the conversation.

Remember that the conversation should be a dialogue, not a monologue. Leave plenty of time for listening, especially at the beginning of the conversation. If you do want to connect with the patient on a personal level, don’t make the mistake that many doctors do. Doctors will begin to tell the patient about their own hobbies or interests. Don’t tell the patient more about you, instead you want to listen more to discover things about them. You also want to look for moments of caring where you can reach out and give the patient and family the needed reassurance. Don’t just focus on the symptoms the patient is reporting. Make sure you ask the important questions about how their lifestyle or culture may be contributing to their illness.

These are just a few tips I teach doctors when we talk about bedside manners and how to improve medical outcomes.

Have a kind and respectful day.

Sign up for free, “Kindness Reminders” – Remember to connect with your loved ones.

The “Kindness Reminder” is a brief weekly email to remind you to connect with your aging parent or other loved ones. The reminder is full of touching and fun ways to reach out and connect.

A colleague said to me, “I love my grandmother but I keep forgetting to call her.  Can you send me an email once a week to remind me to call her and can you include some ideas of things I can do for her?”  When he asked me to create these reminders for him, I realized I have been doing this type of thing all my life. I used to call my brothers and remind them to call our dad. It wasn’t that they didn’t care; it was just that like all of us, we get caught up in our own lives.

People think I am amazing because I remember to call on birthdays or to call in once a week to check on my elders. I am not amazing, I am organized. I pre-book recurring appointments in my calendar so I it sends me reminders to call, write or show I care. Otherwise, it would slip my mind and weeks would go by before I would make the effort.

These email reminders will give you a number of ways to show that you care. I will also give you ideas on how to thank those who are taking care of your loved one when you are either far away or unable to be there. The more you show appreciation for those who take care of your loved one, the better care they will get.

Just sign up in the box in the upper right section of my blog at KindEthics.com. Thanks for helping me make the world a kinder place. Please let others know about this free service.

Have a kind and respectful day.

Are you interested in becoming a legal nurse? Patricia Coonan will tell you what you need to know to transition into this rewarding profession. August 10, 2pm pacific on blogtalkradio.com/kindethics

Are you no longer able to be a nurse due to latex allergies, a back injury or are you just looking for something with more flexibility.  You may want to consider becoming a legal nurse consultant and putting all of your knowledge and compassion into helping others in a new way.  Patricia Coonan will be answering your questions regarding how to transition into the rewarding career of legal nurse consulting. Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

Patricia been a RN for 24 years and Legal Nurse since 1997. She works for the Beasley Firm as an In-House Consultant and Legal Assistant. If you are being sued, she is the person that would go through the medical records to see what happened and if you have deviated from the Standards, Protocols and Industry Practices and if you may be negligent.

Patricia has also created a training program for those nurses interested in going into the legal field. If you are interested, you can find her products on eBay under Prrn12 or at www.legalnurseprrn12.com or at pc-rn@comcast.net.

You can follow her on Twitter: pcRN or reach her at pc-rn@comcast.net.

For legal help, The Beasley Firm website is http://www.beasleyfirm.com and their offices are as follows:
The Beasley Building
1125 Walnut Street
Philadelphia, PA 19107
Phone (215) 592-1000
Fax (215) 592-8360
3000 Atrium Way
Suite 258
Mount Laurel, NJ 08054
Phone (856) 273-6966
Fax (856) 273-6913
Have a kind and respectful day.

“Saving you Money on your Prescription Medications.” Interview with MrMedsaver, Jacob Milbradt, PharmD on July 23rd, 10AM pacific.

Call in to listen live at (347) 945-5152 or listen online at blogtalkradio.com/kindethics.

If you’re struggling to afford your medication, MrMedSaver.com can help. On average, we’re able to show our clients how to save about 70% on their prescriptions. Here’s what R. Michael Dowden from Farmersville, OH, a recent MrMedSaver.com client, said about his Rx Savings Report:
“I can see already, the biggest benefit is putting information into the hands of the consumer. On some of these, I thought I already had the answers to what was the lowest cost and still effective medicine. Now I have alternatives that I can discuss with my doctor(s).”
Imagine if your mechanic selected which car you would purchase. Not having a firm grasp of fluctuating automobile prices, imagine if he chose your new vehicle without even taking cost into consideration. Instead, what if he based his decision solely on performance, looks, and amenities, and chose a brand new Mercedes? Would you stand for this? Of course not . . . that would be preposterous. Yet this scenario is the norm for the pharmaceutical industry.
Usually, the person who selects your medications (your doctor) has no idea what you’ll have to pay for them. The pharmaceutical industry changes at such a rapid pace that doctors simply can’t keep track of drug prices or developments like new generic availability. In fact, one of the key sources of drug information for doctors is drug company sales reps. These salesmen are highly trained at pushing doctors away from cost-effective generic medications, and toward the expensive brand-name drugs they are promoting. The design of the entire pharmaceutical industry is flawed, forcing you to pay much more than needed for your medications . . . and there’s no one to look out for you.
Now, with the help of Mr. MedSaver, that’s all about to change. Our company specializes in providing an independent assessment of your medication costs, ending with a report demonstrating numerous tactics you can employ to drastically reduce the amount you spend on prescription drugs. Think of us as the Kelley Blue Book for the pharmaceutical industry.
Mr. MedSaver was founded by Jacob Milbradt, PharmD, a pharmacist from Kansas who grew sick and tired of seeing his patients pay too much for their prescriptions. After daily encounters with people who couldn’t afford their prescriptions or who had to make difficult decisions, such as groceries vs. medication, Dr. Milbradt knew he had to do something that would make a real difference. After a large amount of research, he developed Prescription Cost Management—a revolutionary series of techniques that can be used to cut prescription drug costs to a mere fraction of what most people pay.
Now, these techniques have been taken to the next level—Personalized Prescription Cost Management. At Mr. MedSaver, we don’t have inflexible computer programs with “one-size-fits-all” recommendations. Instead we’ll provide you with a detailed analysis of your medications that is personally completed by a pharmacist and is 100% customized to exactly fit your unique needs.
We know how difficult it can be to afford your medications. We also realize how it often seems that there’s no one available to offer any real help. Well, not anymore. At Mr. MedSaver.com, we offer real results. Guaranteed. And remember, you can trust Mr. MedSaver for completely unbiased advice:
• We aren’t an internet pharmacy: The sole motivation of internet pharmacies is to make as much money as possible by profiting off your prescriptions. Because of this, saving you money isn’t a high priority for these companies.
• We don’t offer prescription “discount” cards: Prescription “discount” cards seldom actually offer much of a discount. In fact, most companies actually turn around and sell the data they collect whenever you fill your prescriptions!
• We will NEVER charge you to enroll in a FREE assistance program: Most websites that offer to enroll you in patient assistance programs won’t tell you that these programs are ENTIRELY FREE. Furthermore, these companies aren’t truly interested in saving you as much money as possible. Instead, they focus on continually milking your wallet every month with enrollment fees.
• We aren’t employed by your pharmacy: We don’t work for your pharmacy, and as a result our first allegiance is to you—NOT the company that sells you prescriptions.
• We are 100% independent: The big drug companies hate us, but you’re going to love us. That’s because we tell it exactly how it is. We have no financial ties to any pharmaceutical manufacturers. Also, we’ll never try to steer you toward pharmacies that have paid us to do this.

Have a kind and respectful day.

Are you a victim of the 20 second problem? Does your doctor listen to your whole story or does she interrupt you before you are done?

When the doctor says, “What brought you here today?” Does the doctor listen or does she interrupt as you begin to tell your story? If the doctor interrupts you, you are the victim of the 20 second problem. This is a common problem that has been researched over the years. Now, the doctor isn’t being rude, she is only asking clarifying questions such as: what kind of pain and how much pain and how long have you had this pain? These are important questions, but asking them too soon gets in the way of the doctor hearing the whole story. Once the doctor begins asking her questions, she may forget to come back and listen to the rest of your concerns. Without hearing the whole story, she may misdiagnose or may start heading down the wrong path because she has missed some important details.

Doctors don’t realize that this behavior will lead to the thing they hate that patients do. That is when the patient says the, “Oh by the way” question or the “One more thing doctor” question. This is the last question you ask before the doctor walks out the door. This drives the doctor crazy because they’ve already spent their time with you and are ready to move onto the next patient. But many times, the reason you have the “One more thing doctor” question is, because you weren’t allowed to ask everything at the beginning of the appointment.

So what can you do? Tell the doctor that you won’t ask one more question at the end of the appointment if she’ll take the time to listen to your whole story at the beginning of the appointment. Let her know that it will only take a minute or so for you to explain why you’ve come to the doctor’s office that day. Research has shown that all it takes is one to two minutes for the patient to get their whole story out. Now this may feel like an eternity to the doctor, but it really works to decrease medical errors, improve medical outcomes and to increase patient satisfaction.

I also recommend that you bring in a prioritized list of questions so the doctor will know what you’re there to talk about. Make sure you mention the most important items first. The doctor doesn’t have forever with you so make it easier for the doctor to help you by being prepared and getting right to the point. You can also print out the sister blog piece under the healthcare professionals category to take to your doctor’s office. It is titled, “Overcoming the 20 second problem or How I learned to save time.”

Have a kind and respectful day.

Overcoming the 20 second problem or How I learned to save time and improve the PT/MD relationship.”

Recently, I gave a lecture in Las Vegas and a few weeks later I heard back from a physician, who did one simple thing I taught her and changed her entire practice. She overcame the 20 second problem. What is the 20 second problem? Research has shown that when you sit down to talk to a patient and ask, “What brought you here today?” you will interrupt within 20 seconds of them beginning to tell you their story. Now, you’re not interrupting to be rude, you’re interrupting to ask clarifying questions. How much pain? What kind of pain? How long have you had this pain? But unfortunately, once you begin asking questions, you may not allow the patient to get back to telling you the rest of their story. Without hearing the whole story, you may misdiagnose or may start heading down the wrong path because you have missed some important details. This wrong direction will waste your valuable time.

The other thing that happens is that the patient will then say as they’re walking out the door the, “Oh by the way” question or the “One more thing doctor” question. I know this drives you crazy because you have already spent your time with this patient and are ready to move onto the next person. But the reason you have the “One more thing doctor” question is because you didn’t listen to everything at the beginning of the appointment.

So what can you do? Sit quietly and listen for one to two minutes. Research has shown that all it takes is one to two minutes for the patient to get their whole story out. Now this may feel like an eternity to you but if you can do it, you will decrease medical errors, improve medical outcomes and increase patient satisfaction. The time will be well spent. You will actually become more efficient and effective when you allow the patient to be heard at the beginning of the appointment. This may seem counterintuitive, but it really works. The doctor in Las Vegas discovered how much this communication technique worked for her.

I also recommend that you have the patients write out a prioritized list of questions so you will know what they’re there to talk about. Tell them to mention the most important items first. Explain to the patient that it will make it easier for you to help them by being prepared and getting right to the point. Patients can be taught to be better patients and to help us to help them.

Have a kind and respectful day.

The day my dad was shot in the dementia unit.

Let me reassure you before the story begins that everything turned out all right. My dad fluctuated from mild to moderate dementia. When he became confused, his delusions would frequently return him to World War 2. He lived in an Alzheimer’s/dementia unit, but he was quite high functioning. One day I got a call from my dad and he tells me that he’s been shot by a small caliber pistol. He sounded alright and in no pain on the phone, so I began to ask questions. “Where were you shot dad?” He replied, “I have been shot in the stomach but it is probably not too bad because they were bullets from a small caliber pistol.” (Well, I didn’t know what size bullets come from a small caliber pistol but since he wasn’t too concerned, then neither was I.) I asked him if the people who shot him were still in the building. “I think they’re in the hallway” he said with a very frightened voice. I asked him if it was okay if I got the nurse to come and check on his wounds. He said it was okay but that she should be careful. I called the nurses station and explained the situation. I said that I thought that my dad was okay but perhaps his description of being shot in his stomach meant that he was having stomach problems and just couldn’t report symptoms accurately. She said she would go right down and then call me after she checked on him. I got a call a few minutes later and she said that he seemed to be just fine but he had again mentioned that he had been shot by a small caliber pistol. I asked, “Could you do me a favor and take out the bullets?” There was silence on the other end of the phone. I explained that he wouldn’t rest comfortably if he still thought the bullets were in him and maybe she could just push on his belly and tell him that the bullets had popped out. She thought it was a great idea and went in and to remove the bullets. She came back to the phone and let me know the bullets were out and he was feeling better. At this point neither of us thought it was funny. Even the nurse was serious about taking out imaginary bullets and helping my dad. (Now I knew it was funny but at the same time, my dad was so afraid of the people lurking in the hallways, I wasn’t in a laughing mood.)

How did the story end? After the nurse left, he said he felt much better but he was still very frightened because the shooters were still in the building. I told him that I would send in the special forces and they would clear building of the enemy. I told him that the special forces were so stealth that he wouldn’t see them or hear them in the hallways. It would just be done. (I don’t know much about the military so I had to think fast and try to figure out something that sounded realistic for him.) I called back later to see if my dad was doing better and he was relaxed and comfortable. He felt better and was able to get a good night’s sleep because I had protected him as he had protected me throughout the years. Each time my dad would come out of his delusional state, which fortunately only lasted for a few hours at a time, he would say to me, “I think I was confused right?” And I would respond, “Yes you were, but you’re okay now.” I realized at that time that it was better to choose to comfort someone with dementia rather than to argue with them and make them wrong. I’m not saying we shouldn’t strive to get people more engaged in reality, but when they reach out and tell us they are suffering, we should do our best to support and reassure them. I love telling this story because it makes me think of my dad.  My dad was a wonderful person. He died five years ago this month and I would give anything to hear one of his crazy stories again.

Have a kind and respectful day.

TV Series and Website Seeking Stories on How We Die

I am posting an extra blog this week because this important and urgent.

I am helping with the How We Die Project and I think this might be something you might be interested in doing as well. They need stories about the good, the bad and the ethically complicated cases we have seen. This is an amazing opportunities for the public to understand the complexities of dying in hospitals, homes, nursing homes, etc. Please forward this to your nurses, physicians, social workers, chaplains, respiratory therapists, bioethics committee members, public and private guardians and the patients and families you serve. This is a national project so please forward this to anyone who might be interested across America. See below for more information. Thanks, Viki

TV Series and Website Seeking Stories on How We Die*:

A new website and TV series is looking for first-person stories from
patients, their families, loved ones, and health care professionals about
how personal experiences have shaped what we believe about death and dying.
Stories are about the decisions we make for ourselves, for loved ones, or
for patients at the end of life.
The series, tentatively titled “Stories,” is being developed by Marc N.
Weiss, creator of the long-running PBS series P.O.V. and Tom Yellin, a
veteran network news and public affairs producer.

Our pilot episode will explore experiences that tested or challenged
people’s values and beliefs about who decides when and how we die, and what
role, if any, government and healthcare institutions should play in those
decisions.

Please visit the site and submit your story! www.how-we-die.org

Have a kind and respectful day.

“Cutural Communication Strategies”, “Communicating with Dying” and “Insiders Guide to filling out your Advance Directive” Newsletters are Available.

If you missed the last newsletters, “Cultural Communication Strategies”, “Communicating with the Dying” or the “Insider’s Guide to Filling Out Your Advance Directive”, you can still get them if you sign up under the receive newsletters section on the lower right side of the blog. When you sign up you will get the bonus office visit toolkit as well as the back issues of the newsletters. I usually send out one newsletter every month so you won’t be inundated with emails. And of course I respect your privacy and won’t release your information to anyone else.

Have a kind and respectful day.

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