The medical decision is just part of life’s equation.

So many people ask me what they should be thinking about when making medical decisions. Whether you are making your own decisions or having to make decisions for others, there is a lot to think about.

Your doctor or your loved one’s doctor will talk to you about the medical aspects of any health-related decision. But that doesn’t mean that you are limited to thinking only about medicine. It may be important to consider the financial costs associated with the treatment plan, if the patient’s religion should play a role in the decision and whether there are cultural issues that come into play. Think about the overall picture of your loved one’s life. In The Caregiver’s Path to Compassionate Decision Making, I offer lists of questions to help you understand the whole picture.

It would be nice for the decision to be as simple as asking, “Will the treatment work and what are the side effects?” But life isn’t that simple. What if you were about to make a medical decision that allowed something to be done to the person’s body that was forbidden by the person’s culture or religion? You might have chosen a certain treatment to save her life, but because the patient received that treatment, she will no longer be able to move on to the hereafter. Yes, the medical decision was a good one, but how the decision will affect the person’s life, based on her personal belief system, was not.

If the person you are making decisions for is very religious, then it would be good to find out if there are any religious rules or values that you should consider in your decision making. I know that when I work with my hospice patients, it is important to know if there are certain rites or blessings that have to be performed before the patient’s death. I don’t have to agree with what the person wants, but if I am the caregiver, then I need to do what I can to make sure the person’s religion or culture is respected. I will need to call in the appropriate religious leader to take care of the spiritual needs of this person. If the person is not religious or spiritual, then you will need to respect this and leave religion out of the decision making process.

For most people, the financial costs of the medical treatment will need to be considered or you may be putting the person in financial danger. You may be in charge of making only the healthcare decisions, but you should make sure that you or somebody else checks with the insurance company to find out whether or not it will pay for the treatment and to get the proper authorizations. Don’t let a simple mistake like forgetting to call the insurance company to let them know that your loved one was admitted to the hospital put your loved one in financial distress. Making decisions without using the financial questions could bankrupt your loved one. Our goal of protecting the person should include protecting his or her wallet.

For a list of questions you can use when making decisions, go to the resource page and download the list from the excerpts from The Caregiver’s Path to Compassionate Decision Making – Making Choices for Those Who Can’t.

Have a kind and respectful day.

Healthy Aging Radio Show will be featuring Viki Kind on June 28, 2010 at 5pm EST

This Monday, Dr. Michael Perskin will be featuring Viki Kind on his show “Healthy Aging” on Monday, June 28, 2010 from 5-6pm EST.

Every Monday from 4 – 6 pm ET, Dr. Michael Perskin joins the Doctor Radio lineup on SIRIUS Satellite Radio to answer listener questions about aging and the care of the elderly. Dr Perskin is a specialist in geriatric medicine and works with individuals as well as family members caring for their loved ones. Sometimes the questions we have can be as simple as “why do my knees hurt?”, and sometimes they are as difficult as “my mother can’t remember who I am.” Knowing where to turn when medicine and age intersect is a prescription for less stress, better care and a healthier life.

Michael H. Perskin, MD, is the Director of the Faculty Group Practice for the Department of Medicine at NYU Langone Medical Center, as well as Clinical Assistant Professor of Medicine.

Dr. Perskin’s clinical practice is devoted to individualized patient-centered care. His focus is on prevention, comprehensive geriatric care management, and diagnosis.

Have a kind and respectful day.

Don’t go to the hospital in July – It could be dangerous to your health

I was talking to legal nurse expert, Patricia Coonan, and she was telling me that there is a definite increase in medical errors in July. I have heard this joked about in the world of medicine, but it is not a joke. Errors increase every year at this time because this is when doctors in training shift to a new level of responsibility. The newly graduated doctor becomes an intern, the intern becomes a resident and the resident becomes a fellow. With this increase in responsibilities practically overnight, the doctor needs to be ever more vigilant about asking for help when they get into an overwhelming situation. It is normal for them to need help occasionally and they need to speak up at those times. Patricia says that medical negligence is usually not because the patient has the negative side effect, but is when the doctors or nurses don’t notice and fix the problem. Medical errors are normal because humans are taking care of us. And the younger doctors are still learning.

I am not telling you this to scare you but to make sure you are educated. You should always have a patient advocate at the hospital with you. You should ask what medicine is being given to you and what dose you are getting. If it is not on your list of medicines, ask why you are getting this new drug. You should make sure people are washing their hands before they touch you. You should make sure you have all of your questions answered before you sign a consent form. If you can, ask questions and make sure you are getting a consistent message from your doctors. If you are too ill to watch out for yourself, then get a love one to protect you and ask questions.

The only way you get new doctors is to train them. And they get trained by learning on all of us. These are real doctors and they have been well trained. I have had all of these levels of doctors take care of me when I was in the hospital and I was just fine. So, I am not saying you should be afraid of interns, residents or fellows. This is just a reminder to be your own patient advocate.

Have a kind and respectful day.

PROSPECT PARK RESIDENCE TO HOST “Four Tools for Making the Difficult Life and Health Decisions” 6/30/10 6pm EST

Families, Caregivers and Healthcare Professionals Invited to Free Informative Session

Prospect Park Residence, a full-service senior living community in Brooklyn, NY, will host an informational session for families, caregivers and healthcare professionals titled, “Four Tools for Making the Difficult Life and Health Decisions”.

The event will take place on Wednesday, June 30, 6-7:30 pm.

The session will provide attendees with information and guidance on
how to make the right medical decisions for loved ones with care and
compassion while respecting what is or was important to that person.

Prospect Park Residence is located at One Prospect Park West at Grand Army Plaza, directly across the street from Prospect Park. For more information or to RSVP, visit www.prospectparkresidence.com or call (718) 622-8400.

Have a kind and respectful day.

Patient’s Rights – Where do they start and where to they end?

What are our obligations to the patient? Keep in mind that autonomy only works with people who have the capacity to make their own decisions.

Here are some of the patients’ rights that come with using autonomy:
• Patients have the right to receive all the information they need to make a good decision.
• Patients have the right to make their own decisions.
• Patients have the right to refuse treatments they do not want.
• Patients do not have the right to demand treatments that will be medically ineffective or are medically inappropriate for their condition.

It is important to realize that there are limits to a patient’s rights. A patient is limited to asking only for treatments that will benefit her. This limitation makes sense. It would be pointless, and potentially harmful, to provide a treatment or medication that would not improve the patient’s condition. So, as a physician, you are able to say no to practicing bad medicine. If what the patient or decision maker is requesting would be inappropriate or non-beneficial you can say no and protect the patient. But if it is a medically valid option, even when you disagree with what the person wants because you think they are being foolish or it isn’t the best option to choose, we have to respect that it is the patient’s body and life.

I know this can be difficult as you watch people making foolish choices. But that is autonomy. All of us, including you, are allowed to make the decisions that make sense in the context of one’s own life. (Of course, there are different boundaries in pediatrics.)

One technique I use with patients is to say, “Here is the ideal plan. Now let’s talk about your plan.” That allows the two of you to partner together to build a plan, although it might not be ideal, it is something the patient is willing to consider and to try. And then perhaps in the future, the patient will be willing to consider the other options you would like him or her to try.

Have a kind and respectful day.

Autonomy and Patient’s Rights

Autonomy means that a person makes his own decisions, so it only works with people who have the capacity to make their own decisions. If you have determined that your loved one still has capacity, then this is the correct decision making option. With Autonomy, the person gets to say what should be done to his body.

When I went to my doctor to talk about my injured back, my doctor told me what options were available to help me get better. He said I could try physical therapy, have a cortisone injection in my back, or just wait and see if it got better over time. Because I had the ability to think for myself and to make my own decisions, I was able to choose what I wanted to do. I got to think about the different options I was given and then make my own decision. I had Autonomy.

Here are some of the patients’ rights that come with using autonomy:
• Patients have the right to receive all the information they need to make a good decision.
• Patients have the right to make their own decisions.
• Patients have the right to refuse treatments they do not want.
• Patients do not have the right to demand treatments that will be medically ineffective or are medically inappropriate for their condition.

It is important to realize that there are limits to a patient’s rights. A patient is limited to asking only for treatments that will benefit her. This limitation makes sense. It would be pointless, and potentially harmful, to provide a treatment or medication that would not improve the patient’s condition.

Keep in mind that autonomy only works with people who have the capacity to make their own decisions. If you have determined that your loved one does not have decisional capacity, you will have to use different tools such as Substituted Judgment or the Best Interest Standard. (I will cover these two later this month.)

Have a kind and respectful day.

A Caregivers Journey interviews Viki Kind on 6/28/10 at 11am PST

A Caregivers Journey is a free radio show run by Susan Baida and John Mills, co-Founders of eCare Diary.com. This show will focus on issues of care providers, long-term care, advanced aging — and it will feature expert speakers on aging, long-term care, dementia and other illnesses and issues typically associated with aging in America.

eCareDiary.com is a one-stop source for all things aging. They support both the aging community AND care providers. They are sought after speakers on advanced aging and care providing, and their website is a huge source of tools and information.

Have a kind and respectful day.

Four Tools for Making Difficult Life & Health Decisions

Prospect Park Residence, a full-service senior living community in Brooklyn, NY, will host an informational session for families, caregivers and healthcare professionals titled, “Four Tools for Making the Difficult Life and Health Decisions”.

The event will take place on Wednesday, June 30, 6-7:30 pm. The discussion will be led by author Viki Kind, MA, a clinical bioethicist, medical educator and hospice volunteer.

Reservations are required.

The session will provide attendees with information and guidance on
how to make the right medical decisions for loved ones with care and
compassion while respecting what is or was important to that person.

Prospect Park Residence is located at One Prospect Park West at Grand Army Plaza, directly across the street from Prospect Park. For more information or to RSVP, visit www.prospectparkresidence.com or call (718) 622-8400.

Have a kind and respectful day.

Join Viki for a CME Lecture at Sunrise Hospital, Las Vegas on 6/23/10

Join Viki Kind, M.A. author of “The Caregiver’s Path to Compassionate Decision Making: Making Choices for Those Who Can’t” as she gives a CME Lecture on Improving Healthcare Communication at Sunrise Hospital in Las Vegas.

Sunrise has been re-certified as a primary stroke center for the next two years! The Joint Commission sent a surveyor to Sunrise in February 2010 as part of the re-certification process and the examination of our data, processes and outcomes went extremely well. Sunrise had the first certified primary stroke center in the valley and no other facility in the area offers a more comprehensive program.

When:
June 23, 2010 from 8-9am and 1:15-2:15pm

Where:
Sunrise Hospital & Medical Center
3186 S Maryland Pkway
Las Vegas, NV 89109
Telephone: (702) 731-8000

This event is free for all medical personnel.

Have a kind and respectful day.

Caregiver Yoga – Right in your home while you raise money for your school

Interview with Laura Colvin-Brown about Caregiver Yoga and raising money for your school. June 10 at 10AM pacific. www.blogtalkradio.com/kindethics

Take care of your self AND your school! Finally… a way for busy parents and educators to get in a little TLC for themselves, while helping out their favorite school…aaaahhh!

If you are like all the other parents and educators that I know, you don’t have time to visit your local yoga studio: who would watch the kids?! …..but you WISH there were a way. Well, now there is!

How about THIS…. we will send you eight new yoga classes every month… that you can watch and do right from your home computer or laptop ANYTIME… and you can do them as many times as you like! 8 all new gentle flow yoga classes will be sent right to your inbox every month when you subscribe to our service. This is like having a private yoga studio right from your screen… for only $15/ month! ….and the best part? Half of that goes directly to the school or group who sent you here.

Compare this to a yoga studio near you: some charge $15 PER CLASS! This is the easiest, most reasonable way to get your yoga in and help your school out at the same time.

Sign up today to receive 8 full video classes every single month!
www.OnlineYogaFundraiser.com
www.FlagstaffYogaFestival.com

Have a kind and respectful day.

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